Treatment Of Aortic Valve Disease Research Articles

An intelligent aortic valve model for complete cardiac cycle.

The aortic valve (AV) is crucial for cardiovascular (CV) hemodynamic, impacting cardiac output (CO) and left ventricular volumetric flow rate (LVQ). Its nonlinear behavior challenges standard LVQ prediction methods as well as CO one. This study presents a novel approach for modeling the AV in the CV system, offering an improved method for estimating crucial parameters like LVQ across various AV conditions, including aortic stenosis (AS). The model, based on AV channel length during the entire cardiac phase, introduces a time-varying AV resistance (TV-AVR) parameterized by the pressure ratio across the AV and LVQ, enabling the simulation of both healthy and AS-related conditions. To validate this model, in vitro measurements are compared using a hybrid mock circulatory loop device. An unconventional use of a convolutional neural network (CNN) corrects the model's estimates, eliminating the need for labeled datasets. This approach, incorporating real-time learning and transforming 1-D CV signals into 2-D tensors, significantly improves the accuracy of LVQ measurements, achieving an error rate of less than 3.41 ± 4.84% for CO in healthy conditions and 2.83 ± 1.35% in AS cases-a 33.13% enhancement over linear diode models. These results underscore the potential of this approach for enhancing the diagnosis, prediction, and treatment of AV diseases. The key contributions of the proposed method encompass nonlinear TV-AVR estimation, investigation of transient CV responses, prediction of instantaneous CO, development of a flexible framework for noninvasive measurements integration, and the introduction of an adjustable resistance model using an extended Kalman filter (EKF) and CNN combination, all without requiring labeled data.

Catheter-based and surgical treatment for aortic valve diseases

The pathophysiology of aortic valve diseases is of predominantly degenerative nature, characterized by calcific aortic valve stenosis, which is associated with areduction in prognosis. The prevalence of aortic valve insufficiency also increases with advancing age. Timely causal treatment is crucial in the management of aortic valve diseases. Following the indication for intervention, the heart team plays acentral role in evaluating the results and making therapeutic decisions that consider the patient's preferences. In the assessment of treatment options, considerations regarding the long-term perspective are particularly crucial, especially in younger patients. The most common therapeutic approach for aortic valve diseases is the introduction of anew valve prosthesis. In the majority of cases, this is now achieved through catheter-based implantation of abioprosthetic heart valve, known as transcatheter aortic valve implantation (TAVI). Open surgical aortic valve replacement (AVR) is favored in younger patients with low surgical risk or in the case that TAVI is not feasible. In AVR, both biological and the longest-lasting mechanical prosthesis types are used. Surgical repair techniques are primarily applied in cases of aortic valve regurgitation. Notably, TAVI, as well as surgical procedures for the treatment of aortic valve diseases, have undergone significant advancements in recent years, including expanded indications for TAVI and, on the surgical side, in particular the development of minimally invasive surgical techniques.

Clinical considerations and challenges in TAV-in-TAV procedures.

Transcatheter aortic valve replacement (TAVR) has emerged as a viable treatment for aortic valve disease, including low-risk patients. However, as TAVR usage increases, concerns about long-term durability and the potential for addition interventions have arisen. Transcatheter aortic valve (TAV)-in-TAV procedures have shown promise in selected patients in numerous registries, offering a less morbid alternative to TAVR explantation. In this review, the authors aimed to comprehensively review the experience surrounding TAV-in-TAV, summarize available data, discuss pre-procedural planning, highlight associated challenges, emphasize the importance of coronary obstruction assessment and provide insights into the future of this technique.

Limited Access to Aortic Valve Procedures in Socioeconomically Disadvantaged Areas.

To explore how differences in local socioeconomic deprivation impact access to aortic valve procedures and the treatment of aortic valve disease, in comparison to other open and minimally invasive surgical procedures. Procedure volume data were obtained from the Healthcare Cost and Utilization Project from 18 states from 2016 to 2019 and merged with area deprivation index data, an index of zip code-level socioeconomic distress. We estimate the relationship between local deprivation ranking and differences in volumes of aortic valve replacement, which include transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR), versus coronary artery bypass graft surgery and laparoscopic colectomy (LC). All regressions control for state and year fixed effects and an array of zip code-level characteristics. TAVR procedures have increased over time across all zip codes. The rate of increase is negatively correlated with deprivation ranking, regardless of the higher share of hospitalizations per population in high deprivation areas. Distributional analysis further supports these findings, showing that lower area deprivation index areas account for a disproportionately large share of SAVR, TAVR, and LC procedures in our sample relative to their share of all hospitalizations in our sample. By comparison, the cumulative distribution of coronary artery bypass graft procedures was nearly identical to that of total hospitalizations, suggesting that this procedure is equitably distributed. Regressions show high area deprivation index areas have lower prevalence of SAVR (β=-15.1%, [95% CI, -26.8 to -3.5]), TAVR (β=-9.1%, [95% CI, -18.0 to -0.2]), and LC (β=-19.9%, [95% CI, -35.4 to -4.4]), with no statistical difference in the prevalence of coronary artery bypass graft (β=-2.5%, [95% CI, -12.7 to 7.6]), a widespread and commonly performed procedure. In the population aged ≥80 years, results show high area deprivation index areas have a lower prevalence of TAVR (β=-11.9%, [95% CI, -18.7 to -5.2]) but not SAVR (β=-0.8%, [95% CI, 8.1 to 6.3]), LC (β=-3.5%, [95% CI, -13.4 to -6.4]), or coronary artery bypass graft (β=5.2%, [95% CI, -1.1 to 1.1]). People living in high deprivation areas have less access to life-saving technologies, such as SAVR, and even moreso to device-intensive minimally invasive procedures such as TAVR and LC.

Patient Characteristics and Outcomes Associated with Sentinel Protection Device Use in Patients with Aortic Valve Disease Undergoing TAVR in a "Real-World" Setting.

Transcatheter aortic valve replacement (TAVR) has become the dominant treatment for aortic valve disease. While TAVR safety has improved over time, concern remains over the occurrence of cerebrovascular accidents (CVA) secondary to device placement, which is associated with increased morbidity and mortality. The Sentinel Cerebral Protection System (CPS) was developed to reduce the risk of embolic strokes associated with debris produced during TAVR. Studies evaluating Sentinel CPS efficacy have produced conflicting results, and there is little understanding of which patients are selected for device placement in "real-world" settings. With no existing guidelines on device use, the purpose of this study was to describe and compare the characteristics of patients who receive CPS with those who do not in a "real-world" setting of consecutive TAVR patients and evaluate its impact on postoperative complications, namely stroke. This was a single-center, retrospective study of all patients undergoing TAVR between July 1, 2019, and December 31, 2020. Patient demographics, baseline, and perioperative characteristics were collected prospectively using the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry and our institution's TAVR database for analysis. Postoperative outcomes were assessed using primary endpoints of in-hospital/30-day stroke and the composite of death, stroke, and bleeding/vascular events at one-year. To adjust for baseline differences, a propensity score was developed including all factors that were different between groups, and Multivariate Cox Regression analysis was used to control for these differences. Patient follow-up was 97% complete at 12 months with 100% echocardiographic follow-up. A total of 242 consecutive patients (57.9% male) were analyzed, with a mean age of 79.9 9 years. Of these patients, 134 (55.4%) received the Sentinel CPS and 108 (44.6%) did not. Sentinel CPS patients were more likely to be male, not on dialysis, without prior CVA or pacemaker, had less severe chronic lung disease, and were lower operative risk compared to concurrent non-CPS patients. CPS patients were also found to have higher hemoglobin and albumin levels, lower creatinine, and were less likely to be on immunosuppressant therapy. The incidence of in-hospital/30-day stroke after TAVR did not differ between CPS and non-CPS patients (0.0% vs. 1.9%; p = 0.198). Unadjusted analyses at one-year showed a lower occurrence of the composite endpoint in CPS patients compared non-CPS patients (8.3% vs. 17.0%; p = 0.034). After adjustment, the hazard ratio (Adj HR) for the CPS group was no longer significantly associated with a lower composite endpoint (Adj HR = 0.609, 95% CI 0.244-1.523; p = 0.289). Both unadjusted (p = 0.233) and adjusted (p = 0.132) analyses showed no difference in the incidence of stroke at one-year. Our study demonstrates that in a "real-world" setting, the Sentinel CPS device is more likely to be used in healthier and less complex patients. In analyses adjusted for illness severity and patient complexity, CPS use did not have a significant effect on the incidence of in-hospital/30-day stroke or the composite endpoint of death, stroke, and bleeding/vascular events at one-year.

Anticoagulatory treatment and clinical outcomes after transcatheter aortic valve implantation: results from 45,598 patients of the German Aortic Valve Registry (GARY)

Abstract Background Transcatheter aortic valve implantation (TAVI) has developed to the therapy of choice for patients with symptomatic severe aortic stenosis who are inoperable or at high or intermediate operative risk for surgical aortic valve replacement. However, the optimal anticoagulant therapy post-TAVI still remains a matter of debate and individual patient characteristics and comorbidities lead to the prescription of different regimens in clinical practice. Purpose This study investigates current anticoagulant treatment patterns and clinical outcomes in patients after TAVI in a real-world population. Methods The German Aortic Valve Registry (GARY) is a prospective, multicenter all-comers registry enrolling patients undergoing invasive treatment for aortic valve disease. From January 2011 to December 2019, 141,790 patients from 92 hospitals performing TAVI procedures in Germany were enrolled. Different anticoagulant treatment regimens were assessed at hospital discharge for patients after TAVI procedures. All-cause mortality and the combined endpoint "cardiac and cerebrovascular events" containing myocardial infarction (MI), stroke, transient ischaemic attack (TIA), aortic prosthesis re-intervention and all-cause mortality in the first year after TAVI were examined by treatment regimen. Results The study population comprised 45,598 patients with TAVI between 2011 and 2019: 46.5 % received dual antiplatelet therapy (DAPT), 25.7 % oral anticoagulation (OAC) plus antiplatelet therapy, 15.0 % single antiplatelet therapy (SAPT), 6.8 % OAC monotherapy, 4.7 % triple therapy and 1.3 % did not receive any anticoagulant medication. The majority of patients with oral anticoagulation were prescribed VKA (66.8 %) compared to DOAC (33.2 %). After adjustment for baseline confounders, cardiac and cerebrovascular event free survival did not differ significantly between patients with SAPT and DAPT (HR 0.94, 95% CI 0.89-1.00, p = 0.07), albeit the risk of all-cause mortality was slightly increased in SAPT (HR 1.24, 95% CI 1.12-1.37, p <0.001) and all regimens containing oral anticoagulation (OAC mono: HR 1.24, 95% CI 1.08-1.42, p = 0.002, OAC duo: HR 1.23, 95% CI 1.13-1.35, p < 0.001, OAC triple: HR 1.25, 95% CI 1.08-1.45, p = 0.003) compared to dual antiplatelet regime. In patients with OAC, the risk of all-cause mortality (HR 0.99, 95% CI 0.89-1.10, p = 0.81) and cardiac and cerebrovascular event free survival (HR 1.07, 95% CI 0.97-1.18, p = 0.17) was not significantly different in patients with DOAC-containing regimens when compared to VKA-containing regimens. Conclusions In an analysis from one of the world’s largest national registries of patients undergoing TAVI, we found comparative effectiveness of SAPT vs. DAPT and DOACs vs. VKA after TAVI with respect to cardiac and cerebrovascular events. The increased risk of all-cause mortality in patients with antiplatelet monotherapy might be confounded by unmeasured morbidity but requires further attention.Multivariate: Reference group DAPTMultivariate: Reference group VKA

Long-Term Clinical and Echocardiographic Outcomes Following the Ross Procedure

The Ross procedure as treatment for adults with aortic valve disease (AVD) has been the subject of renewed interest. To evaluate the long-term clinical and echocardiographic outcomes following the Ross procedure for the treatment of adults with AVD. This post hoc analysis of a randomized clinical trial included adult patients (age <69 years) who underwent a Ross procedure for the treatment of AVD, including those with active endocarditis, rheumatic AVD, decreased ejection fraction, and previous cardiac surgery. The trial, conducted from September 1, 1994, to May 31, 2001, compared homograft root replacement with the Ross procedure at a single center. Data after 2010 were collected retrospectively in November and December 2022. Ross procedure. The primary end point was long-term survival among patients who underwent the Ross procedure compared with that in the age-, country of origin- and sex-matched general population. Secondary end points were freedom from any reintervention, autograft reintervention, or homograft reintervention and time-related valve function, autograft diameter, and functional status. This study included 108 adults (92 [85%] male) with a median age of 38 years (range, 19-66 years). Median duration of clinical follow-up was 24.1 years (IQR, 22.6-26.1 years; 2488 patient-years), with 98% follow-up completeness. Of these patients, 9 (8%) had active endocarditis and 45 (42%) underwent reoperations. The main hemodynamic lesion was stenosis in 30 (28%) and regurgitation in 49 (45%). There was 1 perioperative death (0.9%). Twenty-five year survival was 83.0% (95% CI, 75.5%-91.2%), representing a relative survival of 99.1% (95% CI, 91.8%-100%) compared with the general population (83.7%). At 25 years, freedom from any reintervention was 71.1% (95% CI, 61.6%-82.0%); from autograft reintervention, 80.3% (95% CI, 71.9%-89.6%); and from homograft reintervention, 86.3% (95% CI, 79.0%-94.3%). Thirty-day mortality after the first Ross-related reintervention was 0% and after all Ross-related reinterventions was 3.8% (n = 1); 10-year survival after reoperation was 96.2% (95% CI, 89.0%-100%). This study found that the Ross procedure provided excellent survival into the third decade postoperatively that was comparable to that in the general population. Long-term freedom from reintervention demonstrated that the Ross procedure may be a durable substitute into late adulthood, showing a delayed but progressive functional decline. isrctn.org Identifier: ISRCTN03530985.

A midterm follow-up study of the application of a confluent aortic valve neocuspidization technique with pericardium in children.

The treatment of aortic valve diseases in children remains a great challenge. We aim to report outcomes and midterm follow-up data of our confluent neocuspidization technique with pericardium for aortic valve replacement (AVR) in children. A retrospective analysis was performed on all 20 children who underwent the confluent neocuspidization technique with pericardium at Children's Hospital of Fudan University from March 2017 to May 2022. Outcome measures included echocardiographic measurements, surgical intervention, and mortality. A total of 20 patients (17 males vs. 3 females), with a median age of 7.5 years [min-max, 0.3-12 years; interquartile range (IQR), 4.4-9.7 years], a median body weight of 24.0 kg (min-max, 6.0-52.3 kg; IQR, 15.6-31.0 kg), and median aortic valve annulus size before surgery of 19.0 mm (min-max, 11.0-25.0 mm; IQR, 17.1-21.5 mm), underwent the neocuspidization technique with pericardium (17 autologous pericardia and 3 bovine patch). With 50% of bicuspid aortic valve and 50% of tricuspid, they were respectively diagnosed as aortic stenosis (AS) (7/20, 35%), aortic regurgitation (AR) (8/20, 40%) and mixed AS and AR (AS & AR) (5/20, 25%). The median postoperative follow-up time was 19 months (min-max, 5-61 months; IQR, 16.3-35 months). The peak pressure gradient across the aortic valve decreased from 81.0±37.0 mmHg in AS group and AS & AR group before surgery to 25.9±15.8 mmHg within 24 hours after surgery (P<0.001) and was mostly around 25 mmHg during follow-up. All patients presented mild or less than mild regurgitation within 24 hours after surgery. There were no hospital mortalities. Three patients needed reintervention during follow-up. There was one late death related to mitral valve stenosis. Though the confluent neocuspidization technique with pericardium provided immediate relief of significant AS or regurgitation, the midterm outcome was suboptimal. More research is needed to find the optimal material for AVR.

Aortic valve replacement with single strip autologous pericardium.

Aortic valve replacement with mechanical valves is the standard treatment for aortic valve disease in Indonesia. Its usage is associated with high cost, risk of endocarditis and thromboembolic event, and lifetime consumption of anticoagulants. We perform a novel replacement technique of the aortic valve using an autologous pericardium and evaluate short-term outcomes. From April 2017 to April 2020, 16 patients underwent aortic valve replacement with a single-strip autologous pericardium. Outcomes of left ventricle reverse remodeling (LVRR), six minutes walking test (6MWT), and soluble suppression of tumorigenicity-2 (sST-2) were measured at 6 months post-operation. A total of 16 surgeries were performed using aortic valve replacement with single strip pericardium without conversion to mechanical valve replacement. The patients included 8 males and 8 females, and the mean age was 49.63 + 12.54 years old. The most common diagnosis was mixed aortic valve stenosis and regurgitation (9 cases). The mean aortic cross-clamp time was 139.88 + 23.21 min and cardiopulmonary bypass time was 174.37 + 33.53 min. At 6 months post operation, there were an increase of 6MWT (p = 0,006) and a decrease of sST-2 level (p = 0,098). Echocardiographic showed 2 patients had LVRR. Survival and freedom from reoperation are 100% at one-year follow-up. Aortic valve replacement with single strip pericardium is a good alternative to aortic valve replacement with a mechanical valve. Short-term evaluation at 6 months post-operation showed improvement in clinical status and echocardiographic parameters compared to baseline.

Aortic Valve Replacement with Single-Strip Autologous Pericardium.

Aortic valve replacement with mechanical valves is the standard treatment for aortic valve disease in Indonesia. Its usage is associated with high cost, risk of endocarditis and thromboembolic event, and lifetime consumption of anticoagulants. We performed a novel replacement technique of the aortic valve using an autologous pericardium and evaluated the short-term outcomes. From April 2017 to April 2020, 16 patients underwent aortic valve replacement with a single-strip autologous pericardium. Outcomes of the left ventricular reverse remodeling (LVRR), 6-minute walk test (6MWT), and soluble suppression of tumorigenicity-2 (sST-2) were measured at 6 months postoperation. A total of 16 surgeries were performed using aortic valve replacement with single-strip pericardium without conversion to mechanical valve replacement. The patients included eight males and eight females, and the mean age was 49.63 ± 12.54 years. The most common diagnosis was mixed aortic valve stenosis and regurgitation (9 cases). Five patients underwent a concomitant coronary artery bypass graft (CABG) procedure and 12 patients underwent either mitral or tricuspid valve repair. The mean aortic cross-clamp time was 139.88 ± 23.21 minutes and cardiopulmonary bypass time was 174.37 ± 33.53 minutes. At 6 months postoperation, there was an increase in the distance walked at the 6MWT (p = 0.006) and a decrease of the sST-2 level (p = 0.098). Echocardiogram showed two patients had LVRR. Survival and freedom from reoperation are 100% at 1 year of follow-up. Aortic valve replacement with a single strip of pericardium is a good alternative to aortic valve replacement with a mechanical valve. Short-term evaluation at 6 months postoperation showed improvement in clinical status and echocardiographic parameters compared to baseline.

Direct oral anticoagulants versus vitamin K antagonist after transcatheter aortic valve implantation

ObjectiveAfter transcatheter aortic valve implantation (TAVI), the optimal regimen of anticoagulant therapy in patients with an additional indication for oral anticoagulation remains a matter of debate. This study investigates the...

Bicuspid aortic valve: one of the last remaining challenges for the percutaneous treatment of aortic valve disease

Bicuspid aortic valve: one of the last remaining challenges for the percutaneous treatment of aortic valve disease

The Accelerated Transcatheter Heart Valve Testing Environment: Loading, Motion, and Fluid Dynamics.

Transcatheter aortic valve replacements (TAVRs) are an increasingly common treatment for aortic valve disease due to their minimally invasive delivery. As TAVR designs require thinner leaflets to facilitate catheter-based delivery, they experience greater leaflet operational stresses and potentially greater durability issues than conventional surgical valves. Yet, our understanding of TAVR durability remains largely unexplored. Currently, preclinical TAVR durability is evaluated within an ISO:5840 compliant accelerated wear tester (AWT) up to a required 200 × 106 cycles, corresponding to approximately five years in vivo. While AWTs use high cycle frequencies (10-20 Hz) to achieve realistic timeframes, the resulting valve loading behaviors and fluid dynamics are not representative of the in vivo environment and thus may not accurately predict failure mechanisms. Despite the importance of fatigue and failure predictions for replacement heart valves, surprisingly, little quantitative information exists on the dynamic AWT environment. To better understand this environment, we examined frequency and diastolic period effects for the first time using high-speed enface imaging and particle image velocimetry to quantify valve motion and flow, respectively, using a Durapulse™ AWT at frequencies of 10, 15, and 20 Hz. Regardless of operating condition, no waveform achieved a physiologically relevant transvalvular loading pressure, despite having an ISO compliant geometric orifice area (GOA) and waveform. General fluid mechanics were consistent with in vivo but the AWT geometry developed secondary flow structures, which could impact mechanical loading. Therefore, the nonphysiologic loading and variability induced by changes in operating condition must be carefully regulated to ensure physiologically relevant fatigue.

Population Study of Sex-Based Outcomes After Surgical Aortic Valve Replacement

BackgroundSurgical aortic valve replacement (SAVR) is a key strategy for the treatment of aortic valve disease. However, studies have involved primarily male patients, and whether the benefits of this approach can be extrapolated to female patients is unclear. MethodsClinical and administrative datasets for 12,207 patients undergoing isolated SAVR in Ontario from 2008 to 2019 were linked. Male and female patients were balanced using inverse probability treatment weighting. Mortality, endocarditis, and major hemorrhagic and thrombotic events, as well as 2 composite outcomes—major adverse cerebral and cardiovascular events (MACCE) and patient-derived adverse cardiovascular and noncardiovascular events (PACE)—and their component events, were compared in the weighted groups with a stratified log-rank test. ResultsA total of 7485 male patients and 4722 female patients were included in the study. Median follow-up was 5.2 years in both sexes. All-cause mortality did not differ between sexes (hazard ratio [HR] 0.949 [95% confidence interval {CI} 0.851-1.059]). Male sex was associated with an increased risk of new-onset dialysis (HR 0.689 [95% CI 0.488-0.974]). Female sex was associated with a significantly increased risk of both new-onset heart failure (HR 1.211 [95% CI 1.051-1.394], P = 0.0081) and heart failure hospitalization (HR 1.200 [95% CI 1.036-1.390], P = 0.015). No statistically significant differences were seen in any of the other secondary outcomes between sexes. ConclusionsThis population health study demonstrated that survival did not differ between male and female patients undergoing SAVR. Significant sex-related differences were found in the risk of heart failure and new-onset dialysis, but these findings should be considered exploratory and require further study.

Reconstruction of Motion Images from Single Two-Dimensional Motion-Blurred Computed Tomographic Image of Aortic Valves Using In Silico Deep Learning: Proof of Concept

The visualization of motion is important in the diagnosis and treatment of aortic valve disease. It is difficult to perform using computed tomography (CT) because of motion blur. Existing research focuses on suppressing or removing motion blur. The purpose of this study is to prove the feasibility of inferring motion images using motion information from a motion-blurred CT image. An in silico learning method is proposed, to infer 60 motion images from a two-dimensional (2D) motion-blurred CT image, to verify the concept. A dataset of motion-blurred CT images and motion images was generated using motion and CT simulators to train a deep neural network. The trained model was evaluated using two image similarity evaluation metrics, a structural similarity index measure (0.97 ± 0.01), and a peak signal-to-noise ratio (36.0 ± 1.3 dB), as well as three motion feature evaluation metrics, maximum opening distance error between endpoints (0.7 ± 0.6 mm), maximum-swept area velocity error between adjacent images (393.3 ± 423.3 mm2/s), and opening time error (5.5 ± 5.5 ms). According to the results, the trained model can successfully infer 60 motion images from a motion-blurred CT image. This study demonstrates the feasibility of inferring motion images from a motion-blurred CT image under simulated conditions.

Changes in treatment of aortic valve diseases for acute and elective indications during the COVID-19 pandemic: A retrospective single-center analysis from 2019 to 2020.

Coronavirus disease 2019 (COVID-19) pandemic had an impact on the quality of healthcare services and led to many changes in the treatment of cardiac pathologies. To assess the differences in the clinical manifestations, management and outcomes of patients with aortic valve diseases (AVDs) treated invasively before and during the pandemic. This retrospective single-center study involved patients with AVDs treated by means of balloon aortic valvuloplasty (BAV), transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) in 2019 and 2020. They were divided into groups with respect to the year of intervention (2019 compared to 2020) and the priority of admission (urgent compared to elective). Preoperative characteristics, early outcomes and probability of annual survival were compared between the groups. The number of patients admitted urgently increased from 37 in 2019 to 54 in 2020, with a higher prevalence of men in 2020 (83.3% compared to 56.8%, respectively). Elective cases, on the other hand, declined from 279 in 2019 to 256 in 2020. Among the latter, more subjects had manifestations of heart failure (p < 0.001), coronary artery disease (CAD; p = 0.002), hypertension (p = 0.006), as well as had a history of a stroke (p = 0.002). In the meantime, more TAVI and fewer SAVR procedures were performed in 2020 (86 compared to 127 and 192 compared to 125, respectively; p < 0.001). In 2020, TAVI individuals had risk of death (according to the EuroSCORE scale) than in 2019 (p < 0.001). The probability of annual survival was comparable (p = 0.769) among AVD patients treated before and during the coronavirus pandemic (91.3% compared to 88.3%, respectively). Although during the COVID-19 pandemic more nonelective and higher-risk AVD individuals received interventional treatment, the outcomes were comparable to the pre-pandemic era (2019). Our findings support highly valuable, less invasive therapeutic methods for treating aortic pathologies during the pandemic.

Functional performance of 8 small surgical aortic valve bioprostheses: an in vitro study.

Selection of a surgical aortic valve (SAV) bioprosthesis model for the treatment of aortic valve disease remains controversial. The aim of this study was to characterize the functional performance of 8 SAV models in a standardized in vitro setting. The hydrodynamic performance of 8 SAVs with labelled size 21 mm (Avalus™, Hancock® II, Mosaic® Ultra™, Perimount®, Perimount® Magna Ease, Epic™ Supra, Trifecta™ GT; Freestyle®), was investigated in a pulse duplicator. Transvalvular pressure gradients and effective orifice area (EOA) were recorded. The geometrical orifice area and physical dimensions of the valves were determined, and new functional dimensions were introduced. Mean pressure gradient (MPG) and EOA differed significantly between the analysed SAVs. The Epic presented with the lowest EOA and highest MPG, while the Trifecta showed the highest EOA and the lowest MPG. We introduce a useful way to determine the minimal internal diameter and a new measure termed 'relative orifice area' to characterize a valve's performance. SAVs showed significant differences in their hydrodynamic performance despite the same label size. This finding was related to the construction of the valves. We introduce a new measure that characterizes the functional performance of a valve model and size for the treatment of an aortic annulus of a specific size. Our data emphasize that SAV selection should carefully be done using an individual patient approach and that future research is necessary to improve the current generation of SAVs.

Aortic valve neocuspidization: Frequently asked technical questions.

Since the first description by Professor Ozaki in 2011, more than 5500 aortic valve neocuspidization procedures have been performed worldwide, with promising short- and mid-term outcomes. We here report the nuances required to master this highly reproducible, standardized technique for the treatment of aortic valve disease.

Hemodynamic study of the effect of the geometric height of leaflets on the performance of the aortic valve under aortic valve reconstruction

BackgroundAlthough aortic valve reconstruction has become an alternative treatment for aortic valve disease, the design of the geometric parameters of the reconstructed leaflet still mainly depends on the experience of doctors. The present study investigates the effects of the height of the leaflets on the performance and biomechanical states of the reconstructed aortic valve.MethodsThis numerical study was carried out using the finite element approach and the lattice Boltzmann method. The dynamic and biomechanical characteristics of the leaflets were evaluated by using the finite element approach, while the blood flow in the aortic sinus was evaluated by applying the lattice Boltzmann method. Three types of leaflets with different heights were designed. Then the dynamic characteristics, stress distribution, and effective orifice area (EOA) of the aortic valve and flow pattern were calculated as the indicators.ResultsThe results demonstrated that the height of the leaflets could indeed regulate the performance and the biomechanical states of the aortic valve. The rapid valve opening times of the 3 types of leaflets gradually reduced along with the decrease of the height ratio (HR_0.8: 120 ms vs. HR_1.0: 68 ms vs. HR_1.2: 31 ms), while the rapid valve closing times (RVCTs) of the 3 types of leaflets were similar to each other (approximately 75 ms). Moreover, the radial displacement of the leaflet at the fully open time increased along with the decrease of the HR of the leaflets (HR_0.8: 8 mm vs. HR_1.0: 6 mm vs. HR_1.2: 4 mm). In addition, the stress level of the leaflets also increased with the increase of the height of the leaflets (max stress, HR_0.8: 0.5 MPa, vs. HR_1.0: 1.1 MPa, vs. HR_1.2: 1.8 MPa). Similarly, the low velocity region near the ascending aortic wall and the wall shear stress (WSS) level on the ventricular side of the leaflets also increased along with the increase of the HR of the leaflets.ConclusionsIn short, the height of the leaflets mainly affects the opening performance of the reconstructed aortic leaflets. The HR of the reconstructed leaflets for adults should be less than 1.0 to balance the opening and closing performance of aortic leaflets.

30-Day Outcomes With the Portico™ Transcatheter Heart Valve: Insights From a Multi-Centre Australian Observational Study

Transcatheter aortic valve replacement (TAVR) is an established therapy for the treatment of aortic valve disease in appropriately selected patients. Previous studies using the self-expanding Portico™ transcatheter heart valve (THV [Abbott Structural Heart, St Paul, MN, USA]) have demonstrated the technical feasibility of this system albeit in the hands of relatively inexperienced Portico users. The objective of this study was to assess the real-world safety and efficacy of the Portico THV (with and without the FlexNav™ delivery system) at the 30-day timepoint in an Australian cohort.