Tricuspid Aortic Valve Research Articles

Impact of the Tricuspid Valve Detachment Technique on Hard-to-Expose Ventricular Septal Defect Closure

Ventricular septal defect (VSD) closure is a common procedure in congenital heart surgery. The exposure of VSDs can be challenging, especially in cases involving the tricuspid septal or anterior leaflets, chordae, or subvalvular apparatus. Although tricuspid valve detachment has been suggested to improve surgical visibility, its long-term effects remain unclear. Herein, we investigated the outcomes of VSD closure with or without tricuspid valve detachment and assessed the impact of this technique on postoperative tricuspid valve function and atrioventricular conduction. In total, 175 patients who underwent isolated VSD closure through the right atrium were retrospectively enrolled and divided into 2 groups: the tricuspid valve detachment group (n = 17, 9.7%) and the nontricuspid valve detachment group (n = 158, 90.3%). Patient characteristics were comparable between the two groups, and medical records and echocardiography reports were reviewed for each patient. The primary outcomes were mortality and reoperation, whereas the secondary outcomes included residual VSD, tricuspid valve regurgitation, advanced atrioventricular block, and aortic valve regurgitation. Clinical variables were compared between the two groups. Overall, tricuspid valve detachment did not increase perioperative complications or affect long-term tricuspid valve function. There were no cases of mortality or reoperation in either group. Although the tricuspid valve detachment group had longer bypass and cross-clamp times, this did not significantly affect ventilation or intensive care unit stay duration. Follow-up echocardiography revealed no significant intergroup differences in tricuspid regurgitation, residual shunt, or aortic valve regurgitation. In conclusion, tricuspid valve detachment is a safe and reliable technique for the complete closure of hard-to-expose VSDs without compromising tricuspid valve function. Moreover, it does not increase the risk of adverse events, and its outcomes remain favorable during short- and long-term follow-ups.

Insights From the Histopathologic Analysis of Acquired and Genetic Thoracic Aortic Aneurysms and Dissections.

The purpose of this study was to apply contemporary consensus criteria developed by the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology to the evaluation of aortic pathology, with the expectation that the additional pathologic information may enhance the understanding and management of aortic diseases. A scoring system was applied to ascending aortic specimens from 42 patients with heritable thoracic aortic disease and known genetic variations and from 86 patients from a single year, including patients with known genetic variations (n = 12) and patients with sporadic disease (n = 74). The various types of lesions of medial degeneration and the overall severity of medial degeneration overlapped considerably between those patients with heritable disease and those with sporadic disease; however, patients with heritable thoracic aortic disease had significantly more overall medial degeneration (P = .004) and higher levels of elastic fiber fragmentation (P = .03) and mucoid extracellular matrix accumulation (P = .04) than patients with sporadic thoracic aortic disease. Heritable thoracic aortic disease with known genetic variation was more prevalent in women than in men (27.2% vs 9.8%; P = .04), and women had more severe medial degeneration than men (P = .04). Medial degeneration scores were significantly lower for patients with bicuspid aortic valves than for patients with tricuspid aortic valves (P = .03). The study's findings indicate considerable overlap in the pattern, extent, and severity of medial degeneration between sporadic and hereditary types of thoracic aortic disease. This finding suggests that histopathologic medial degeneration represents the final common outcome of diverse pathogenetic factors and mechanisms.

Specific Multiomic Profiling in Aortic Stenosis in Bicuspid Aortic Valve Disease.

Bicuspid aortic valve (BAV) disease is associated with faster aortic valve degeneration and a high incidence of aortic stenosis (AS). In this study, we aimed to identify differences in the pathophysiology of AS between BAV and tricuspid aortic valve (TAV) patients in a multiomics study integrating metabolomics and transcriptomics as well as clinical data. Eighteen patients underwent aortic valve replacement due to severe aortic stenosis: 8 of them had a TAV, while 10 of them had a BAV. RNA sequencing (RNA-seq) and proton nuclear magnetic resonance spectroscopy (1H-NMR) were performed on these tissue samples to obtain the RNA profile and lipid and low-molecular-weight metabolites. These results combined with clinical data were posteriorly compared, and a multiomic profile specific to AS in BAV disease was obtained. H-NMR results showed that BAV patients with AS had different metabolic profiles than TAV patients. RNA-seq also showed differential RNA expression between the groups. Functional analysis helped connect this RNA pattern to mitochondrial dysfunction. Integration of RNA-seq, 1H-NMR and clinical data helped create a multiomic profile that suggested that mitochondrial dysfunction and oxidative stress are key players in the pathophysiology of AS in BAV disease. The pathophysiology of AS in BAV disease differs from patients with a TAV and has a specific RNA and metabolic profile. This profile was associated with mitochondrial dysfunction and increased oxidative stress.

Aortic root rotation: morphological analysis of the aortic root with three-dimensional computed tomography.

The aortic root (AoR) rotation and its spatial morphology at the base of the heart were postulated but not described in every detail. AoR rotation modalities may play an important role in decision-making during AoR surgery and its outcome. The aim was to provide a detailed spatial anatomy of the AoR rotation and its relation to the vital surrounding structure. The AoR rotation and its relation to the surrounding structure were assessed in 104 patients with tricuspid aortic valve. The interatrial septum was chosen as a reference to describe AoR rotation that marked the midline of the heart base as a landmark for the AoR rotation direction. Intermediate, clockwise and counterclockwise AoR rotations were defined based on the mentioned reference structures. The AoR rotation was successfully assessed in 104 patients undergoing ascending aorta and or AoR intervention by multidetector row computed tomography. AoR was positioned normally in 53.8% of cases (n = 56) and rotated counterclockwise in 5.8% (n = 6) and clockwise in 40.4% (n = 42) of cases. In clockwise AoR rotation, the right coronary sinus was positioned in proximity to the right atrium and of the tricuspid valve, whereas in a counterclockwise rotation, the noncoronary sinus was placed over the tricuspid valve just over the membranous septum. The AoR's rotation can be diagnosed using multidetector row computed tomography. Understanding the anatomy of the aortic valve related to rotational position helps guide surgical decision-making in performing AoR reconstruction.

Systematic adjustment of root dimensions to cusp size in aortic valve repair: a computer simulation.

Aortic valve repair requires the creation of a normal geometry of cusps and aortic root. Of the different dimensions, geometric cusp height is the most difficult to change while annular and sinotubular dimensions can be easily modified. The objective of this study was to investigate, by computer simulation, ideal combinations of annular and sinotubular junction size for a given geometric height. Based on a literature review of anatomical data, a computational biomechanics model was generated for a tricuspid aortic valve. We aimed to determine the ideal relationships for the root dimensions, keeping geometric height constant and creating different combinations of the annular and sinotubular junction dimensions. Using this model, 125 virtual anatomies were created, with 25 different combinations of annulus and sinotubular junction. Effective height, coaptation height and mechanical cusp stress were calculated with the valves in closed configuration. Generally, within the analysed range of geometric heights, changes to the annular diameter yielded a stronger impact than sinotubular junction diameter changes for optimal valve configuration. The best results were obtained with the sinotubular junction being 2-4 mm larger than the annulus, leading to higher effective height, normal coaptation height and lower stress. Within the range tested, stenosis did not occur due to annular reduction. In tricuspid aortic valves, the geometric height can be used to predict ideal post-repair annular and sinotubular junction dimensions for optimal valve configuration. Such an ideal configuration is associated with reduced cusp stress.

Transcatheter aortic valve replacement in the treatment of bicuspid aortic stenosis with "down-size" interventional valves: procedural and mid-term follow-up.

Due to the influence of anatomical structure, replacing the bicuspid valve using transcatheter aortic valve replacement (TAVR) would increase the risk of perivalvular leakage and conduction block, affecting the hemodynamic effect of the interventional valve. In this study, for bicuspid and tricuspid valves, we implemented different valve selection strategies to explore the safety and effectiveness of TAVR in the treatment of bicuspid aortic stenosis with "down-size" interventional valves using the VenusA-valve system. The operation was performed with the VenusA-valve via transfemoral approach. The selected valves were appropriately sized based on the results of transthoracic echocardiography (TTE), contrast-enhanced computed tomography (CT), and the morphology of intraoperative pre-dilation balloons. For tricuspid valve cases, the VenusA valve is usually larger than the annulus diameter, whereas the "down-size" approach was adopted for bicuspid aortic valve (BAV) cases. The shape of the pre-dilation balloon allowed further sizing of the annulus diameter by the degree of lumbar constriction of the balloon, aiding in intervention valve size selection, particularly in cases of BAVs. A total of 65 patients underwent TAVR for aortic stenosis with VenusA-valve systems. Of these, 29 cases had a BAV and 36 cases had a tricuspid aortic valve (TAV). The distribution of VenusA-valve sizes differed between TAV and BAV cases (P=0.007). Furthermore, there was a significant decrease in the average mean gradient in TAV patients from 54.7 to 12.2 mmHg (P<0.001), and in BAV patients from 61.6 to 14.3 mmHg (P<0.001). The percentage of paravalvular leakage greater than mild was 6.90% in the BAVs and 5.56% in the TAVs at procedural outcomes (P=0.955). The mean follow-up period was 22.23 months (range, 12 to 39 months). The proportion of New York Heart Association (NYHA) class III/IV decreased from 78.5% preoperatively to 11.3% at the last follow-up (P<0.001). A total of 27 patients with TAV and 19 patients with BAV underwent TTE at 1-year follow-up after operation. There was no significant contrast in the average pressure difference between TAVs and BAVs at 1-year follow-up (11.9 vs. 14.3 mmHg, P=0.18). The VenusA-valve for TAVR produced positive clinical outcomes and valve functionality in both BAVs and TAVs. In the case of BAVs, selecting a smaller interventional valve size was deemed viable.

Aortic Valve Repair with External Annuloplasty in Bicuspid versus Tricuspid Aortic Valve Patients.

Surgical repair for regurgitant bicuspid aortic valve (BAV) is promising but underutilized due to perceived complexities and lack of long-term data. This study evaluated the efficacy of valve-sparing root remodeling (VSRR) or isolated valve repair combined with calibrated external ring annuloplasty in BAV versus tricuspid aortic valve (TAV) patients. All patients operated on for aortic regurgitation and/or aneurysm at our institution between 2014 and 2022 were included and entered into the Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR). Patients with successful repair at index surgery (100% in the BAV group, 93% in the TAV group, p = 0.044) were included in a systemic follow-up with echocardiography at regular intervals. Among 132 patients, 58 were in the BAV (44%) and 74 in the TAV group (56%). There were no inter-group differences in preoperative patient characteristics, except BAV patients being significantly younger (47 ± 18 y vs. 60 ± 14 y, p < 0.001) and having narrower aortic roots at the level of sinuses (41 ± 6 mm vs. 46 ± 13 mm, p < 0.001) and sinotubular junctions (39 ± 10 mm vs. 42 ± 11, p = 0.032). No perioperative deaths were recorded. At four years, there was no significant difference in terms of overall survival (96.3% BAV vs. 97.2% TAV, p = 0.373), freedom from valve reintervention (85.2% BAV vs. 93.4% TAV, p = 0.905), and freedom from severe aortic regurgitation (94.1% BAV vs. 82.9% TAV, p = 0.222). Surgical repair of BAV combined with extra-aortic annuloplasty can be performed with low perioperative morbidity and mortality and excellent mid-term results which are comparable to TAV repair.

Ascending Aortic Progression After Isolated Aortic Valve Replacement Among Patients with Bicuspid and Tricuspid Aortic Valves.

The aims of the present study were to compare the long-term outcomes for ascending aortic dilatation and adverse aortic events after isolated aortic valve replacement between patients with bicuspid aortic valve (BAV) and tricuspid aortic valve ( TAV). This retrospective study included 310 patients who had undergone isolated aortic valve replacement with an ascending aorta diameter ≤ 45 mm between January 2010 and September 2021. The patients were divided into BAV group (n=90) and TAV group (n=220). The differences in the dilation rate of the ascending aorta and long-term outcomes were analyzed. Overall survival was 89 ± 4% in the BAV group vs. 75 ± 6% in the TAV group at 10 years postoperatively (P=0.007), yet this difference disappeared after adjusting exclusively for age (P=0.343). The mean annual growth rate of the ascending aorta was similar between the two groups during follow-up (0.5 ± 0.6 mm/year vs. 0.4 ± 0.5 mm/year; P=0.498). Ten-year freedom from adverse aortic events was 98.1% in the BAV group vs. 95.0% in the TAV group (P=0.636). Multivariable analysis revealed preoperative ascending aorta diameter to be a significant predictor of adverse aortic events (hazard ratio: 1.76; 95% confidence interval: 1.33 to 2.38; P<0.001). Our study revealed that the long-term survival and the risks of adverse aortic events between BAV and TAV patients were similar after isolated aortic valve replacement. BAV was not a risk factor of adverse aortic events.

Filamin A heart valve disease as a genetic cause of inherited bicuspid and tricuspid aortic valve disease

ObjectiveVariants in the FLNA gene have been associated with mitral valve dystrophy (MVD), and even polyvalvular disease has been reported. This study aimed to analyse the aortic valve and root...

Midterm outcomes of the Ozaki procedure in patients with a bicuspid aortic valve: retrospective single-center, non-randomized, parallel-group study

BACKGROUND: An alternative to plastic surgery on the bicuspid aortic valve (BAV) can be replacement of the leaflets with autopericardium using the Ozaki technique. The procedure is characterized by excellent hemodynamic results in the short and long term in patients with tricuspid aortic valve (TAV). However, the question remains about the long-term results of the procedure and the frequency of reoperations in patients with BAV.&#x0D; OBJECTIVE: To analyze the midterm outcomes of the Ozaki procedure in patients with BAV.&#x0D; MATERIALS AND METHODS: Retrospective single-center, non-randomized, parallel-group study was conducted. Since January 2015 to October 1, 2023, the clinic performed 809 Ozaki procedures. The work included 540 patients with studied midterm and long-term outcomes for up to 5 years. Both isolated aortic valve replacement and combined operations with coronary artery bypass grafting and (or) correction of mitral and tricuspid valve defects were performed.&#x0D; RESULTS: Midterm mortality was 5.7% (n=3) in the group with BAV and 7.3% (n=36) in the group with TAV. Reoperation for aortic regurgitation was required in 16 patients (2.9%): 1 patient (1.9%) in BAV group and 15 (3.3%) in TAV group. Freedom from reoperations in patients with BAV after the Ozaki procedure for up to 5 years was 95.4%, in the group with TAV — 92.6%. The peak gradient on the aortic valve in the group with BAV was 16±7.3, in TAV group— 16.4±10.9. 5 years after surgery, the mean gradient on the aortic valve does not exceed 10 mm Hg.&#x0D; CONCLUSION: The Ozaki operation in patients with BAV is an effective and safe procedure in the midterm follow-up period.

Characteristics and prognosis of isolated aortic valve infective endocarditis in patients with bicuspid aortic valves: a propensity matched study.

Bicuspid aortic valve (BAV) is the most common congenital heart disease with an increased risk of infective endocarditis (IE). Few data are available on isolated native BAV-IE. The aim of this study was to compare patients with tricuspid aortic valve (TAV) IE and BAV-IE in terms of characteristics, management and prognosis. We included 728 consecutive patients with IE on isolated native aortic valve in 3 centres: Amiens and Marseille Hospitals in France and Salerno Hospital in Italy. We studied in hospital and long-term mortality before and after matching for age, sex and comorbidity index. Median follow-up was 67.2 [IQR: 19-120] months. Of the 728 patients, 123 (16.9%) had BAV. Compared with patients with TAV-IE, patients with BAV-IE were younger, had fewer co-morbidities and were more likely to be male. They presented more major neurological events and perivalvular complications (both p < 0.05). Early surgery (<30 days) was performed in 52% of BAV-IE cases vs. 42.8% for TAV-IE (p = 0.061). The 10-year survival rate was 74 ± 5% in BAV-IE patients compared with 66 ± 2% in TAV-IE patients (p = 0.047). After propensity score matching (for age, gender and comorbidities), there was no difference in mortality between the two groups, with an estimated 10-year survival of 73 ± 5% vs. 76 ± 4% respectively (p = 0.91). BAV is a frequent finding in patients with isolated aortic valve IE and is associated with more perivalvular complications and neurological events. The differences in survival with TAV-IE are probably related to the age and comorbidity differences between these two populations.

Five-Year Outcomes After Bicuspid Aortic Valve Replacement With a Novel Tissue Bioprosthesis

BackgroundThis study investigated the safety and effectiveness of surgical aortic valve replacement with RESILIA tissue (Edwards Lifesciences) through 5 years in patients with native bicuspid aortic valves. Outcomes were compared with those for patients with tricuspid aortic valves. MethodsOf 689 patients from the COMMENCE (ProspeCtive, nOn-randoMized, MulticENter) trial who received the study valve, 645 had documented native valve morphology and core laboratory-evaluable echocardiograms from any postoperative visit, which were used to model hemodynamic outcomes over 5 years. Linear mixed-effects models were used to estimate longitudinal changes in mean gradient and effective orifice area. ResultsPatients with native bicuspid aortic valves (n = 214) were more than a decade younger than those with tricuspid aortic valves (n = 458; 59.8 ± 12.4 years vs 70.2 ± 9.5 years; P < .001). The bicuspid aortic valve cohort exhibited no structural valve deterioration over 5 years, and rates of paravalvular leak and transvalvular regurgitation were low (0.7% and 2.9%, respectively [all mild] at 5 years). These outcomes mirrored those in patients with native tricuspid aortic valves. The model-estimated postoperative mean gradient and effective orifice area, as well as the rate of change of these outcomes, adjusted for age, body surface area, and bioprosthesis size, did not differ between the 2 cohorts. ConclusionsAmong patients with bicuspid aortic valves, RESILIA tissue valves demonstrated excellent outcomes to 5 years, including no structural valve deterioration and very low rates of paravalvular and transvalvular regurgitation. These results are encouraging for RESILIA tissue durability in young patients.

The Prevalence of Coronary Artery Disease in Bicuspid Aortic Valve Patients: An Overview of the Literature.

The prevalence of coronary artery disease (CAD) in bicuspid aortic valve (BAV) patients is a debatable topic. Several studies have indicated that BAV patients have a lower prevalence of CAD compared with patients with a tricuspid aortic valve (TAV), but the effects of age and gender have not always been considered. This systematic review provides an overview of articles which report on CAD in BAV and TAV patients. Searches were executed in April 2021 and January 2022 according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines in three online databases: Medline, Embase, and Scopus. Screening and data extraction was done by two investigators separately. Primary and secondary outcomes were compared between BAV and TAV patients; a fixed effects model was used for correcting on confounders. Literature search yielded 1,529 articles with 44 being eligible for inclusion. BAV patients were younger (56.4 ± 8.3 years) than TAV patients (64 ± 10.3 years, p < 0.001). All CAD risk factors and CAD were more prevalent in TAV patients. No significant difference remained after correcting for age and gender as confounders. BAV patients have a lower prevalence of CAD and CAD risk factors compared with TAV patients. However, when the age differences between both groups are considered in the analyses, a similar prevalence of both CAD and CAD risk factors is found.

Enhanced expression of iNOS is associated with aortic valve stenosis in patients with bicuspid aortic valve

Abstract Background A congenital bicuspid aortic valve (BAV) is one of the most common congenital cardiac abnormalities, with a prevalence estimated between 0.5% and 2%. Aortic valve stenosis (AS) is the most common complication in patients with BAV. The mechanisms responsible for the rapid progression of AS in patients with BAV relative to those with a tricuspid aortic valve (TAV) are unknown. A previous study showed that the pathogenesis of AS in patients with BAV is associated with a more aggressive inflammatory process, with increased macrophage infiltration and neo-vascularization when compared with that seen in patients with TAV. A considerable number of human diseases have an inflammatory component, and a key mediator of immune activation and inflammation is inducible nitric oxide synthase (iNOS). Overexpressed iNOS has been implicated in the pathogenesis of numerous conditions, including coronary plaque destabilization. To elucidate the role of iNOS in the aortic valve of patients with AS, we carried out an immunohistochemical study of the presence of iNOS in aortic valve specimens from patients with AS with either TAV or BAV. Methods Frozen aortic valve samples were obtained surgically from patients with AS with TAV (n=34) or BAV (n=34), and stained with antibodies against macrophages, microvessels, iNOS and 4-hydroxy-2-nonenal (4-HNE), an index of lipid peroxidation. The immunoreactivity of macrophages, microvessels, iNOS and 4-HNE was quantified using computer-aided polarimetry. Double immunostaining was also performed to identify cell types that stained positive for iNOS. Results Quantitative analysis demonstrated that macrophage-, iNOS-, and 4-HNE-positive areas, as well as the number of microvessels, were significantly higher in patients with AS with BAV than with TAV (macrophages, P&amp;lt;0.001; microvessels, P&amp;lt;0.05; 4-HNE, P&amp;lt;0.05; iNOS, P&amp;lt;0.001). The iNOS-positive area was positively correlated with the 4-HNE-positive area (R=0.43, P&amp;lt;0.0001). Double immunostaining for both iNOS and macrophages identified iNOS-positive cells as macrophages. Conclusions These findings suggest that accumulation of iNOS in macrophages may increase oxidative stress and contribute to the rapid progression of AS in patients with BAV.

Aortic stenosis progression among patients with bicuspid aortic valve

Abstract Background Bicuspid aortic valve (BAV) is associated with an increased risk of aortic stenosis (AS). The role of AS progression rate, its determinants, and prognostic implications need to be better understood in patients with BAV-AS. Aim This study aims to compare AS progression rate between patients with BAV and tricuspid aortic valve (TAV), its determinants, and its impact on clinical outcomes. Methods We retrospectively included patients who had undergone &amp;gt; 1 transthoracic echocardiogram (TTE) documenting AS and preserved left ventricular ejection fraction (LVEF). Moderate to severe aortic valve regurgitation and aortic prosthetic valves were excluded. Patients with suspected BAV in TTE and a confirmatory CT scan were identified. A greedy matching was used to match patients with BAV and patients with TAV on age and sex in a ratio 1:1. Aortic peak velocity (APV) was modeled as a function of time using a mixed-effects nonlinear model to capture possible biphasic progression. A core model parameter reflecting AS rate of progression was calculated and compared between patients with BAV-AS and TAV-AS. Multivariate linear regression was used to explore possible predictors of AS progression. All-cause death was compared between patients with BAV and TAV. Results We matched 80 patient-pairs from within our study cohort by age and sex (age 54 ± 11 years, 40 % female). Follow-up time was higher for patients with tricuspid aortic valves (TAV) (5.9±2.6 years vs. 4.6±2.8 years, p&amp;lt;0.01). Patients with TAV-AS had a higher prevalence of cardiovascular risk factors (arterial hypertension [81 % vs. 41 %, p&amp;lt;0.001], diabetes mellitus [39% vs. 8%, p&amp;lt;0.001], and dyslipidemia [71 % vs. 26 %, p&amp;lt;0.001]). Baseline APV was similar between patients with TAV-AS and BAV-AS (2.9±0.9 m/s vs. 2.7±1.0 m/s, p=0.05), but AS progression rate was higher among patients with TAV-AS (logistic growth rate: 0.11±0.04/year vs. 0.02±0.04/year, p&amp;lt;0.001). No interaction was seen between aortic valve morphology and comorbidities with respect to AS progression rate. TAV-AS was associated with increased rate of all-cause death (p=0.02) but failed to remain a significant predictor of mortality after multivariate adjustment for baseline comorbidities and AS rate of progression. Conclusion In our matched cohort, the BAV-AS progression rate was lower than TAV-AS. BAV-AS was associated with lower mortality despite similar baseline AS severity, possibly reflecting a slower AS progression and a decreased burden of cardiovascular risk factors in this population.

Hemodynamics and plasma biomarkers in individuals with mild-to-moderate ascending aortic dilatation and tricuspid aortic valves

Abstract Background Ascending aortic (AA) dilatation is a silent disease that requires frequent follow-up measurements of the AA diameter. Unfortunately, the AA diameter is an insufficient predictor of future growth and complications. Hemodynamic and circulating biomarkers represent promising ways of improving the risk stratification in AA dilatation. Most patients with AA dilatation have tricuspid aortic valves (TAV). However, previous studies have mainly focused on AA dilation in individuals with bicuspid aortic valves (BAV) using either hemodynamic or circulating biomarkers separately. Purpose To assess the relationship between hemodynamics in the AA and circulating biomarkers in individuals with mild-to-moderate AA dilatation and age-and-sex matched controls with TAV. Methods The study cohort of individuals with mild-to-moderate AA dilatation were identified based on AA diameter on coronary CT angiography in the population-based Swedish CardioPulmonary BioImage Study (SCAPIS) in Linköping. 54 cases with AA diameter &amp;gt;= 40 mm and 50 controls with AA diameter &amp;lt;40 mm (mean age 59, 19% female) underwent 4D Flow cardiovascular magnetic resonance imaging (CMR). The 4D Flow CMR images were processed to compute mean and maximum velocities, wall shear stress (WSS), flow displacement (FD) at peak systole, and oscillatory shear index (OSI) in the AA. Markers of collagen synthesis and degradation; type I collagen α1 chain (COL1α1), matrix metalloproteinase (MMP)-1,-2,-3,-9,-12) and their inhibitors (TIMP-1,-2,-3,-4), were quantified in plasma (n=104). High sensitivity C-reactive protein and interleukin(IL)-6 were used to assess systemic inflammation. Results FD at the location of maximum dilatation, mean FD and mean OSI were higher in cases compared to controls. Mean velocity, mean WSS and maximum WSS were lower in cases compared to controls. None of the circulating biomarkers differed significantly between cases and controls. Interestingly, several circulating biomarkers correlated with hemodynamics markers in the whole cohort. COL1α1, MMP-2 and TIMP-2 correlated inversely with max OSI (r=-0.342, p=0.001; r=-0.277, p=0.006; r=-0.238, p=0.018, respectively) while MMP-3 correlated positively with mean velocity (r=0.274, p=0.006), mean WSS (r=0.270, p=0.007), max WSS (r=0.220, p=0.029), and inversely with FD at the location of maximum dilatation (r=-0.218, p=0.031). TIMP-4 correlated with mean OSI (r=-0.284, p=0.005). Conclusions Several hemodynamic markers obtained with 4D Flow CMR were altered in mild-to-moderate AA dilatation with TAV, while circulating biomarkers did not differ from controls. However, significant correlations were identified between several biomarkers and hemodynamic markers. We therefore speculate that the levels of circulating biomarkers may be altered as the disease progresses. Future studies should examine the implications of these novel findings along the trajectory of AA dilation and its association with complication risk.Methods figureHemodynamics markers table

Evidence of early bioprosthetic valve dysfunction after TAVR in aortic valve stenosis during one-year follow-up according to VARC-3

Abstract Objectives Transcatheter aortic valve replacement (TAVR) has become a frequent treatment method for severe aortic stenosis and has increased significantly in younger patients and at lower surgical risk. Therefore, long-time considerations and the performance of TAVR devices are highly interesting. The Valve Academic Research Consortium 3 endpoint definitions (VARC-3) were released recently, offering updated and clear classifications of bioprosthetic valve dysfunction (BVD). In this retrospective multicenter study, we aimed to assess the prevalence of BVD during one-year follow-up and potential differences between self-expandable (SEV) and balloon-expandable valves (BEV). Methods Underlying conditions were evaluated by univariate analysis. Normality was tested using the Shapiro-Wilk normality test. The primary clinical endpoint was defined as immediate failure in device success, secondary endpoints were defined as prevalence of BVD during one year FU and composite endpoints according to VARC-3. Results The final study cohort consisted of 1478 patients from three tertiary care centers that underwent TAVR between 01/2015 and 12/2018. Mean Follow-up (FU) was 361 ± 26 days. During this time span overall BVD was documented in one-fourth of all patients (-BVD[-]: n=1090 (73.7%); BVD[+]: n=388; 26.3%). Further discrimination into the four main categories of BVD presented following results: Structural valve deterioration (SVD) n=142 (9.6%), Non-Structural valve deterioration (NSVD) n=235 (15.9%), hypo-attenuated leaflet thickening n=18 (1.2 %), and endocarditis n=31 (2.1%). Two-thirds of all events were identified within 30-days post implantation, accounting for new-onset of BVD during time course in one-third of all documented BVD. Device success was significantly lower in the +BVD cohort (80.6% vs. 70.1%, p&amp;lt;0.01*). When comparing SEV and BEV, there were significant differences in overall BVD at 30-days post implantation (13.8% vs 18.5%, p&amp;lt;0.01*), as well as in device success (74.1% vs. 81.5%, p&amp;lt;0.01*), early safety (63.8% vs. 69.8%, p=0.014) and clinical efficacy (94.1% vs. 89.9%, p&amp;lt;0.01*). Again, discrimination into the four main categories of BVD showed differences in NSVD at 30-days post implantation (9.8% vs. 14.3%, p&amp;lt;0.01*) as well as at 1-year FU (7.6% vs 14.8%, p&amp;lt;0.01*). Conclusion In this large retrospective multicenter study, we could observe that NSVD was the BVD category most frequently detected after TAVR in tricuspid aortic valves during 1-year FU. NSVD occurred mainly within 30 days post-implantation in patients with balloon-expandable valves, being one factor that significantly diminished device success, early safety, and clinical efficacy.

Analysis of Prevalence and Clinical Features of Aortic Stenosis in Patients with and without Bicuspid Aortic Valve Using Machine Learning Methods.

Aortic stenosis (AS) is the most commonly diagnosed valvular heart disease, and its prevalence increases with the aging of the general population. However, AS is often diagnosed at a severe stage, necessitating surgical treatment, due to its long asymptomatic period. The objective of this study was to analyze the frequency of AS in a population of cardiovascular patients using echocardiography (ECHO) and to identify clinical factors and features associated with these patient groups. We utilized machine learning methods to analyze 84,851 echocardiograms performed between 2010 and 2018 at the National Medical Research Center named after V.A. Almazov. The primary indications for ECHO were coronary artery disease (CAD) and hypertension (HP), accounting for 33.5% and 14.2% of the cases, respectively. The frequency of AS was found to be 13.26% among the patients (n = 11,252). Within our study, 1544 patients had a bicuspid aortic valve (BAV), while 83,316 patients had a tricuspid aortic valve (TAV). BAV patients were observed to be younger compared to TAV patients. AS was more prevalent in the BAV group (59%) compared to the TAV group (12%), with a p-value of <0.0001. By employing a machine learning algorithm, we randomly identified significant features present in AS patients, including age, hypertension (HP), aortic regurgitation (AR), ascending aortic dilatation (AscAD), and BAV. These findings could serve as additional indications for earlier observation and more frequent ECHO in specific patient groups for the earlier detection of developing AS.

Discussion to: Outcomes of aortic root replacement with tricuspid aortic valve reimplantation in patients with residual aortic regurgitation

Discussion to: Outcomes of aortic root replacement with tricuspid aortic valve reimplantation in patients with residual aortic regurgitation

Assessing turbulent effects in ascending aorta in presence of bicuspid aortic valve

Aortic valves with bicuspids have two rather than three leaflets, which is a congenital heart condition. About 0.5–2% of people have a bicuspid aortic valve. Blood flow through the aorta is commonly believed to be laminar, although aortic valve disorders can cause turbulent transitions. Understanding the impact of turbulence is crucial for foreseeing how the disease will progress. The study’s objective was use large eddy simulation to provide a thorough analysis of the turbulence in bicuspid aortic valve dysfunction. Using a large eddy simulation, the blood flow patterns of the bicuspid and tricuspid aortic valves were compared, and significant discrepancies were found. The velocity field in flow in bicuspid configurations was asymmetrically distributed toward the ascending aorta. In tricuspid aortic valve (TAV) the flow, on the other hand, was symmetrical within the same aortic segment. Moreover, we looked into standard deviation, Q-criterion, viscosity ratio and wall shear stresses for each cases to understand transition to turbulence. Our findings indicate that in the bicuspid aortic valve (BAV) case, the fluid-dynamic abnormalities increase. The global turbulent kinetic energy and time-averaged wall shear stress for the TAV and BAV scenarios were also examined. We discovered that the global turbulent kinetic energy was higher in the BAV case compared to TAV, in addition to the increased wall shear stress induced by the BAV in the ascending aorta.