Valve In Aortic Position Research Articles

The novel balloon-expandable Myval transcatheter heart valve: systematic review of aortic, mitral, tricuspid and pulmonary indications

Introduction and objectivesMyval technology represents the first balloon-expandable alternative since the Edwards system became commercially available. Despite certain controversies, its use has rapidly expanded. We aimed to gather all the available literature regarding its indications and outcomes. MethodsA comprehensive search of articles published between December 2016 and May 2024 was conducted using BioMedCentral, Google Scholar, and PubMed to evaluate the main outcomes of Myval for native aortic stenosis (AS) (meta-analysis) and off-label uses (systematic review). ResultsA total of 151 studies were identified, and 74 were included in the analysis, covering aortic (n=51), mitral (n=9), tricuspid (n=6), and pulmonary (n=8) valve positions. A meta-analysis of studies on native AS demonstrated that Myval is safe and effective, with a 30-day mortality rate of 1.3%, good hemodynamic performance, low rates of pacemaker implantation (8.8%), and ≥ moderate paravalvular regurgitation (1.3%). Compared with other contemporary devices, Myval was competitive and associated with lower rates of pacemaker implantation. In a systematic review of off-label indications, Myval was also found to be safe and effective. In bicuspid AS, pure regurgitation, and aortic valve-in-valve procedures, success rates were 100%, 92%, and 100%, respectively, with pacemaker rates of 9.9%, 22.2%, and 3%, respectively. For mitral valve-in-valve/in-ring procedures, the success rate was 96.9%, while in tricuspid and pulmonary positions, small case series reported 100% success rates for both, with minimal procedural complications. ConclusionsMyval technology is safe and effective for the treatment of native valvular disease and dysfunctional prostheses or rings in all heart valve positions, although larger scale studies are warranted.

Risk of thromboembolic and bleeding events in patients with atrial fibrillation after valvular intervention in either aortic or mitral position

Abstract Background The optimal oral anticoagulant treatment (OAC) for patients with atrial fibrillation (AF) undergoing valvular intervention is uncertain. Mitral valve prostheses are believed to be more thrombogenic than the aortic due to lower flow velocity across the valves. The only randomized controlled trial of AF patients with biological valve prostheses included only patients receiving mitral valve prostheses (1). It is unclear if these findings could be extrapolated to patients receiving aortic valve prostheses. Purpose To describe baseline characteristics and comorbidities of patients receiving biological valve prostheses in aortic or mitral valve position and to investigate possible associations between valve position and the incidence of cardiovascular (CV) death, ischemic stroke or systemic embolism and major bleeding. Methods All patients in Sweden undergoing open heart surgery with aortic or mitral valve replacement with biological prostheses between 2010-2016 with known AF were included. The study cohort was identified in the SWEDEHEART registry. Information on comorbidities, drug exposure and occurrence of outcome events was collected from SWEDEHEART and other national registries. Association between the position of valve prosthesis (mitral and aortic) and incidence of outcome events was investigated using Cox regression analysis. Multivariable adjustments were made for comorbidities. Results In total, 2359 patients with AF underwent aortic (n=2103) or mitral (n=256) valve replacement. The median age was 75 and 73 years, respectively. Hypertension, diabetes mellitus and previous TIA were more common in the aortic valve group, whereas heart failure and previous major bleeding was more frequently observed in the mitral group. In both groups, about 50% of the patients were not on OAC treatment at time of discharge from valve intervention, despite that the mean CHA2DS-VASc score was 3.3 and 3.2, respectively. Mitral valve prostheses were associated with similar risk of CV death (hazard ratio (HR) 1.09; 95% confidence interval (CI), 0.77 – 1.56), ischemic stroke and systemic embolism (HR 1.27; 95% CI, 0.85-1.92) compared to aortic valve prostheses. In contrast, receiving mitral valve prosthesis was associated with lower risk of major bleeding compared to aortic prosthesis (HR 0.58; 95% CI 0.38 – 0.88). Conclusion(s) The study indicated similar risk of CV death, ischemic stroke and systemic embolism among patients with AF undergoing valve replacement with biological prostheses in either aortic or mitral position. Mitral valve replacement was associated with lower risk of major bleeding.

DLFFNet: A new dynamical local feature fusion network for automatic aortic valve calcification recognition using echocardiography

Background and ObjectiveAortic valve calcification (AVC) is a strong predictor of adverse cardiovascular events and is correlated with the degree of coronary artery stenosis. Generally, AVC is identified by echocardiography using visual “eyeballing”, which results in huge differences between observers and requires a long time to learn. Therefore, accurately identifying AVC from echocardiographic images is a challenging task due to the interference of various factors. MethodIn this paper, we built a dynamical local feature fusion net capable of processing echocardiography to recognize AVC automatically. We proposed high-echo area which were segmented by a U-Net. Meanwhile, we fine-tuned the segmentation results by adding brightness in the mask tuning module in order to dynamically adjust the selection of local features. To better fuse multi-level and multi-scale information, we designed a pyramid-based two-branch feature fusion module in classification, which enables the network to better integrate global and local semantic representations. In addition, for the echocardiographic data collected by different devices and doctors, inconsistent aortic valve position with a small occupied area, a unified preprocessing algorithm was designed. ResultsTo highlight the effectiveness of the proposed approach, we compared several state-of-the-art methods on the same ultrasound dataset. The 231 patients with short-axis views of the aortic valve images were collected and labeled (masked) by experienced ultrasound doctors from The First Hospital of China Medical University. The accuracy, precision, sensitivity, specificity, and F1 score, micro-AUC, and macro-AUC of the model for the test dataset were, 82.40%, 82.50%, 82.50%, 91.23%, 82.47%, 92.39%, and 92.25%, respectively. ConclusionsThe results showed the possibility of using echocardiography to examine AVC automatically and verified by visualization methods that the Region of Interest of the model is consistent with the observed region of the experts.

Heyde-like syndrome occurring for the first time following aortic valve replacement with a bioprosthesis: a case report

BackgroundHeyde’s syndrome is known as a combination of gastrointestinal (GI) bleeding and aortic valve stenosis. However, there are no reports of an association between GI bleeding and bioprosthetic valve stenosis initially occurred after aortic valve replacement (AVR), even though there are several reports that GI bleeding due to native aortic valve stenosis disappeared after AVR, and GI bleeding recurred due to bioprosthetic valve stenosis or patient-prosthesis mismatch.Case presentationAn 80-year-old woman who was on hemodialysis for 13 years had undergone AVR with a bioprosthetic valve for aortic regurgitation 3 years prior. She was admitted with acute heart failure and anemia that required repeated blood transfusions. Capsule endoscopy revealed multiple active hemorrhages of the small intestine due to angiodysplasia. Echocardiography showed severe bioprosthetic valve stenosis in the aortic valve position as a result of structural valve deterioration (SVD). Because Heyde’s syndrome was strongly suspected even though gel electrophoresis analysis of von Willebrand factor multimers, the gold standard examination for the definitive diagnosis of Heyde’s syndrome, was not performed, a redo AVR with a new bioprosthetic valve was performed. After the second AVR, both the heart failure and anemia due to GI bleeding promptly improved.ConclusionsBioprosthetic valve stenosis due to SVD can bring GI bleeding just as in native aortic valve stenosis. Redo AVR is a promising treatment if the combination of GI bleeding and valve stenosis in the aortic valve position appears even after AVR.

Long-term valve performance of St Jude Medical Epic porcine bioprosthesis in aortic position.

The aim of this study was to review long-term clinical outcomes and valve performance after Epic Supra valve implantation in aortic position. From 2011 to 2022, 44 patients (mean age 75 ± 8years) underwent surgical aortic valve replacement (SAVR) with an Epic Supra valve at our hospital. Survival, incidence of late complications, and echocardiographic date were retrospectively analyzed. During a mean follow-up period of 6.2 ± 3.5years, the overall survival rate was 91 ± 4% at 2 and 88 ± 5% at 5years, while rates of freedom from major adverse cardiovascular and cerebrovascular events (MACCE) were 86 ± 5% and 83 ± 6%, respectively. There was one case of reoperation for prosthetic valve endocarditis at 6years after the initial surgery. Echocardiographic examinations showed 5-year rates of freedom from severe structural valve deterioration (SVD) and moderate SVD of 100 and 92%, respectively. There was no significant increase in mean pressure gradient or decrease in left ventricular ejection fraction from 1week after surgery to the late follow-up period. Long-term clinical results and durability of the Epic Supra valve in aortic position were satisfactory.

Hemodynamic impact of different aortic valve prosthesis in the aortic valve position

Hemodynamic impact of different aortic valve prosthesis in the aortic valve position

A challenging triple valve surgery for long-standing pulmonary hypertension in rheumatic heart disease: a case report

Background Pulmonary hypertension is an increase in the mean pulmonary arterial pressure, greater than 25mmHg at rest, or greater than 30mmHg while exercising. In valvular heart disease its presence indicates a decompensated state of the disease. Surgical interventions are the ultimate treatment for the correction of valvular heart disease. Case Report A 38-year-old female was admitted to the Emergency Department (ER) with complaints of shortness of breath, chest pain, palpitations, and history of fainting. The patient was initially scheduled for aortic and mitral valve replacement and tricuspid valve repair at the end of year 2020. However, due to covid-19 pandemic, the patient was re-scheduled for surgery. On the 15th of June 2022, the patient was admitted to the ER of Zainoel Abidin General Hospital, and was consulted to the CTVS division. On the 17th of June 2022, the patient underwent a successful mitral valve replacement using mechanical St. Jude 29 mm valve, mechanical St. Jude 17 mm for aortic valve position, and tricuspid valve repair commissurotomy and using MC3 Edward ring annuloplasty. The patient was hospitalized for seven days and underwent successful first phase cardiac rehabilitation before discharge. The patient has since made remarkable improvements, establishing better quality of life. Conclusion Reduced pulmonary pressures postoperatively are often modest, and persistent pulmonary hypertension (PH) is known to be common and an indicator of poor prognosis. For patients with long-standing pulmonary hypertension due to rheumatic heart disease, valve replacement surgery effectively reduces pulmonary hypertension caused by damage to the left heart valve.

First 12-month follow-up of bioresorbable synthetic heart valves implanted in the aortic position in sheep

Abstract Background Replacement of diseased heart valves with the currently available valve prostheses has serious drawbacks. The use of bioresorbable synthetic “in situ tissue engineered” heart valve prostheses has been proposed to overcome the limitations of traditional heart valve prostheses. Such bioresorbable synthetic heart valve prostheses have been successfully tested as pulmonary valve replacements in preclinical studies, but data on aortic valve replacement is lacking. Here, we present the first in-vivo study on the long-term functionality of bioresorbable synthetic heart valves in the high-pressure circulation. Methods Approval for the animal studies was obtained by the Amsterdam University Medical Centres Animal Care Ethics Committee (AVD1180020197705) and are in agreement with the current Dutch law on animal experiments (WOD). We surgically implanted bioresorbable synthetic aortic valve prostheses in 20 female Swifter sheep in orthotopic position. The scheduled follow-up times were 1, 3, 6, 9 and 12 months. Results Fifteen sheep (75%) recovered well from the surgical valve implantation procedure and were included in this analysis. No sheep died due to valve failure. All valves remained free from active infectious endocarditis, thrombotic complications, and pathological calcification. A total of 10 valves (67%) were intact, thin and pliable and remained free from leaflet thickening, retraction and degradation up to 12 months after implantation. In most valves (67%), the scaffold remained sparsely- or unpopulated by cells during 12 months follow up. In some valves (33%), colonization of the valve scaffold was observed, however this was most often associated with partial degradation of the leaflet and leaflet thickening. In general, the degradation of the scaffold fibres was limited throughout the follow-up period. Conclusion We are the first to evaluate in vivo bioresorbable synthetic heart valves in aortic position. While valves remained functional, the study also serves as a starting point to further optimize scaffold and neotissue development for heart valve replacement in the high-pressure environment. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): 1. Cardiovasculair Onderzoek Nederland (grant number CVON2012-01)2. Netherlands Organization for Scientific Research (024.003.013)

Analysis of Mechanical Prostheses Excised from the Aortic Valve Position

Described herein are certain clinical and morphologic findings in 33 patients who had their dysfunctioning native aortic valves replaced with a mechanical prosthesis and 4 to 302 months (mean 127) later had the mechanical prosthesis explanted because of developing prosthetic stenosis or regurgitation because of thrombus forming on a metallic disc, pannus on the cloth ring with overhanging the prosthetic orifice, or because of parabasilar regurgitation. Of the 33 patients, 25 were not infected and 8 were infected. At follow-up at least 23 of the 25 patients without infection and 7 of the 8 patients with prosthetic infection survived >1 year after the prosthetic valve explantation.

Infective Endocarditis Involving a Bioprosthesis in the Aortic Valve Position with Operative Excision

Described herein are findings in 15 infected bioprostheses that had been in place from 5 to 120 months (mean 42). The major purpose was to show multiple photographs of the operatively-excised bioprostheses to illustrate the variable causes prompting excision of the bioprostheses. Eleven patients survived ≥ 30 days following the bioprosthetic excision and 9 patients lived longer than 1 year postoperatively. The techniques to explant the infected bioprosthesis appears to vary a bit among the operating surgeons.

Impact of mitral versus aortic bioprosthetic valve position on thromboembolism and bleeding risk in patients with atrial fibrillation

BackgroundThe impact of valve position on thromboembolic and bleeding events in patients with atrial fibrillation (AF) and bioprosthetic valves is uncertain. MethodsWe analyzed 159 patients with AF after surgical single-valve replacement from the BPV-AF registry (Retro) (UMIN000034198), which was a multicenter, retrospective, observational registry that enrolled 214 patients with AF and bioprosthetic valves to assess differences in bioprosthetic valve position. Baseline characteristics and clinical outcomes were compared on the basis of the position of aortic or mitral bioprosthetic valves. The primary efficacy endpoint was stroke or systemic embolism, and the primary safety endpoint was major bleeding. ResultsThere were 85 patients (53.5%) in the aortic valve (AV) group and 74 patients (46.5%) in the mitral valve (MV) group. The MV group had a lower body weight and a higher prevalence of prior major bleeding compared with the AV group. Thromboembolic and bleeding risk scores and the administration of antithrombotic agents were not significantly different between the groups. The primary efficacy endpoint was not significantly different [AV group: 8.2%; 2.25/100 person-years (PY); MV group: 4.1%; 1.01/100 PY] (log-rank, p = 0.23). The primary safety endpoint was significantly higher in the MV group (17.6%; 4.54/100 PY) compared with the AV group (5.9%; 1.59/100 PY) (log-rank, p = 0.049). The adjusted hazard ratio of the primary safety endpoint in the MV group relative to the AV group was 2.71 (95% confidence interval 0.86–8.54, p = 0.09). ConclusionsIn Japanese patients with AF and bioprosthetic valves, thromboembolic risk does not differ on the basis of valve position. Bleeding risk is higher in patients with MV bioprostheses, although valve position itself might not be an independent predictor for bleeding.

Establishment of a resazurin-based aortic valve tissue viability assay for dynamic culture in a microphysiological system.

Tissue pathogenesis of aortic valve (AV) stenosis is research focus in cardiac surgery. Model limitations of conventional 2D culture of human or porcine valvular interstitial/endothelial cells (VIC/VECs) isolated from aortic valve tissues but also limited ability of (small) animal models to reflect human (patho)physiological situation in AV position raise the need to establish an in vitro setup using AV tissues. Resulting aim is to approximate (patho)physiological conditions in a dynamic pulsatile Microphysiological System (MPS) to culture human and porcine AV tissue with preservation of tissue viability but also defined ECM composition. A tissue incubation chamber (TIC) was designed to implement human or porcine tissues (3×5 mm2) in a dynamic pulsatile culture in conventional cell culture ambience in a MPS. Cell viability assays based on lactate dehydrogenase (LDH)-release or resazurin-conversion were tested for applicability in the system and applied for a culture period of 14 days with interval evaluation of tissue viability on every other day. Resazurin-assay setup was compared in static vs. dynamic culture using varying substance saturation settings (50-300μM), incubation times and tissue masses and was consequently adapted. Sterile dynamic culture of human and porcine AV tissue segments was established at a pulsatile flow rate range of 0.9-13.4μl/s. Implementation of tissues was realized by stitching the material in a thermoplastic polyurethane (TPU)-ring and insertion in the TIC-MPS-system. Culture volume of 2 ml caused LDH dilution not detectable in standard membrane integrity assay setup. Therefore, detection of resazurin-conversion of viable tissue was investigated. Optimal incubation time for viability conversion was determined at two hours at a saturated concentration of 300μM resazurin. Measurement in static conditions was shown to offer comparable results as dynamic condition but allowing optimal handling and TIC sterilization protocols for long term culture. Preliminary results revealed favourable porcine AV tissue viability over a 14 day period confirmed via resazurin-assay comparing statically cultured tissue counterparts. Human and porcine AV tissue can be dynamically cultured in a TIC-MPS with monitoring of tissue viability using an adapted resazurin-assay setup. Preliminary results reveal advantageous viability of porcine AV tissues after dynamic TIC-MPS culture compared to static control.

Experience with the Freestyle Valve: A Versatile Option

Objective: The Medtronic Freestyle bioprosthesis is a stentless porcine aortic root. It provides a versatile implantation option either as a full root replacement or a sub-coronary aortic valve replacement. In this study we present our experience with the Freestyle valve in all circumstances over a 10-year period. Methods: All consecutive patients (n=70) undergoing Freestyle valve implantation either in the isolated or concomitant (n=9) setting were included between Jan 2009 to Jan 2020. A retrospective analysis of prospectively collected data was undertaken over 10 years. All case notes were reviewed (operation notes and follow up correspondence). Serial follow up echocardiography was reviewed to assess prosthesis function for structural valve deterioration. Echocardiography data was correlated with patient’s clinical status during the follow up period. Mortality data was checked with national registries. Results: In-hospital mortality was 5.7% (n=4). Of the 66 patients, there were 6 deaths during follow up. Surviving patients were followed for a median period of 2 years (IQR 1-3 years). No patients underwent re-intervention for structural valve deterioration. At follow up, 90% patients’ symptoms were consistent with NYHA class I-II and were successfully discharged to their primary care physician. Conclusions: Our experience with the Freestyle valve shows this to be a feasible bioprosthetic valve with good early and late outcomes. It is a versatile option both in the subcoronary position or as a complete aortic root replacement with low morbidity. Our experience has shown that the Freestyle valve is a preferable option in the setting of infective endocarditis with tissue destruction. Long-term follow-up has shown no structural valve deterioration in our experience, with good clinical outcomes. Freestyle valve used as aortic root versus subcoronary position Valve Position Root Replacement Subcoronary 35 35 Redo 18 16 Infective Endocarditis 12 19 Death (follow up) 3 3 Mean Bypass (Cross clamp) time/min 269 (185) 240 (156) Mean haemodynamic data MG- mmHg/PG-mmHg/AVA-cm2 6.6/12.5/1.6 6.0/8.0/0.7 Aortic regurgitation at follow up 0 0

Transapical Transcatheter Valve Replacement Using J-Valve for Aortic Valve Diseases

The J-Valve system (Jie ChengMedical Technologies, Suzhou, China) is designed specifically for transapical transcatheter aortic valve replacement and has three U-shaped graspers. With the unique structure, the J-Valve is suitable for both aortic stenosis and aortic regurgitation. We used the J-Valve system for patients with aortic valve diseases and observed favorable results. From January 2018 to August 2019, 23 patients underwent transapical transcatheter valve replacement using the J-Valve system. High-risk patients with diseased peripheral vessels (small diameter, heavily calcified, and tortuous arteries), pure aortic regurgitation, and complex prosthetic valve-in-valve cases were enrolled. Ten patients mainly had aortic stenosis, 11 patients had pure aortic regurgitation, and 2 patients had valve-in-valve aortic valve position. The Society of Thoracic Surgeons and European System for Cardiac Operative Risk Evaluation average preoperative scores were 8.9% and 8.7%, respectively. The technique success rate was 91.3% (21 of 23; 1 patient was referred for open surgery and 1 patient received intraoperative valve-in-valve), and 1 patient died of cardiogenic shock after the procedure (mortality 4.3%, 1 of 22). One patient had stroke postoperatively and recovered well; no cases needed to undergo permanent pacemaker implantation. During the follow-up period, 1 patient died of acute heart attack. No moderate or severe paravalvular leakage was found. Transcatheter aortic valve replacement surgery with the J-Valve system is effective, even when it is traumatic and requires the transapical route. The applicability of the J-Valve system in pure aortic regurgitation patients is the advantage of this system.

Abstract 14902: The Impact of Bicuspid Pulmonary Valve in Aortic Position After Arterial Switch for Transposition of the Great Arteries onNeoaortic Root and Neoaortic Valve Function; Propensity Score Matched Analysis

Objective: Neoaortic valve regurgitation which might be related to root dilatation is one of the major concerns following arterial switch operation (ASO) for transposition of the great arteries (TGA). This study investigated the effect of bicuspid neoaortic valve on neoaortic root morphology, function, and the long-term clinical outcomes after ASO for TGA using propensity score matching (PSM). Methods: From 1997 to 2018, 442 patients underwent ASO for TGA. Patients who underwent staged repair (n=15), were repaired at extremely old age (> 1 year, n=9), and died before discharge (n=46), and were lack of echocardiographic data at discharge (n=20) were excluded. Among a total of 352 eligible patients, 18 patients (5.1%) had a BPV. After PSM (1:4), 15 patients with BPV and 60 corresponding patients with tricuspid pulmonary valve were enrolled for analysis. Results: Baseline characteristics in both groups were similar. The median duration of follow-up was 9.9 years (4 months ~ 22.3 years). There was one late death. Freedom from reoperation at 10 years was 93.3 ± 6.4 % in bicuspid group and 88.7 ± 4.4 % in tricuspid group ( p =0.84). Reoperation for aortic valve or aortic root was rarely required during follow-up. Indexed dimension (z-score) of neoaortic annulus was not increased in both groups ( p =0.57) (Figure 1A), although there was a little increasing tendency in z-score of neoaortic sinus without intergroup difference ( p =0.69) (Figure 1B). Deterioration in neoaortic valve function was more prominent in bicuspid group (common odds ratio; 1.40 in bicuspid group [ p <0.01], and 1.12 in tricuspid group [ p =0.03], p =0.03) (Figure 1C). Conclusions: Arterial switch operation could be a safe option in selected patients with TGA associated with BPV without increasing the risk of reoperation. Deterioration of aortic valve function was more prominent in bicuspid group, which suggests that the neoaortic valve function would be deteriorated mainly by valve itself not root pathology.

Hemodynamic results of TTK-Chitra valve in aortic position in patients undergoing aortic valve replacement for aortic stenosis

TTK Chitra valve is one of the most extensively used prosthetic heart valves in our country, yet not many studies of this valve are available pertaining to the Indian population. TTK Chitra valve is commonly used in our Institute and we decided to do a prospective study on short and mid-term results of TTK Chitra valve in aortic position in patients with aortic stenosis. Patients were taken up for aortic valve replacement after detailed informed consent including consent for lifelong anticoagulation and it’s management. Aortic valve replacement was done under general anaesthesia, on cardiopulmonary bypass as per existing standard operating practice detailed later. The intra-operative and postoperative data were collected in the study Performa. Echocardiography was performed postoperatively, on the day of surgery, prior to shifting to ward, prior to discharge, once at three months and once at one year follow up and then yearly thereafter. Sixty seven of 75 patients [89.3%] were in NYHA II, 7 patients [9.3%] and 1 patient [1.3%] in class III and IV respectively. There was significant improvement in functional class post operatively following the aortic valve replacement. 70 patients [93.3%] patients were in NYHA class I following surgery.

Antegrade transseptal transcatheter aortic valve replacement: Back to the future?

Antegrade transseptal approach was utilized in the first human case of transcatheter aortic valve replacement (TAVR) and in the early phase of TAVR. Various challenges with the antegrade transseptal approach including procedural complexity, need for atrial septal crossing, and potential for injury to the mitral valve apparatus led it to being supplanted by other approaches. These challenges have now largely been mitigated as structural interventionalists routinely perform left atrial procedures. We report a case of antegrade transseptal TAVR using a large bore sheath placed in the mid left ventricle across the mitral orifice to protect the mitral valve apparatus and facilitate valve deployment. An 84-year-old man with heart failure symptoms was seen for severe aortic stenosis. The severity of peripheral arterial disease precluded femoral, axillary, carotid, or transcaval routes. After transseptal puncture and creation of an arteriovenous rail, a long 26-Fr sheath was advanced from the right femoral vein transseptally over the arteriovenous rail, past the mitral valve inflow to the mid left ventricular cavity. The sheath provided a stable platform with stable intraprocedure hemodynamics. Balloon valvuloplasty was performed in an antegrade manner, after which a 29-mm SAPIEN S3 prosthesis was advanced into the aortic valve position and deployed under rapid pacing. We observed no injury to the mitral leaflets or subvalvular apparatus after the procedure. The antegrade transseptal approach should be revisited as an option for patients at high surgical risk with no other suitable access site. The use of a large bore sheath facilitates this approach.

Results of correction of aortic valve defects using small‑diameter «BioLAB» xenopericardial prosthesis in old patients

A prosthesis-patient mismatch (PPM) describes a state in which the valve prosthesis implanted during surgery is too small in relation to the patient’s body size. This leads to high transvalvular pressure gradients. We investigate direct results and dependence of transvalvular pressure gradients on body mass index and surface area in patients after correction of aortic valve defects using small-diameter BioLAB prosthesis. Material and methods . From January 2011 to August 2018, 65 small-diameter (18, 20) BioLAB scaffold xenopericardial prostheses were implanted in aortic position at the Department of Emergency Surgery for Acquired Heart Defects, Bakulev National Medical Research Center of Cardiovascular Surgery. The average age of the patients was 75.4 ± 4.1 (65–86 years). The average patient body mass index was 25.74 ± 5.11 kg/m2 (19.57–39.54). The average body surface area was 1.79 ± 0.15 (1.54–2.18). Results . Isolated aortic valve replacement was performed in 38 (58%) patients, the rest of the surgeries were combined with other techniques. There were no reoperations due to early prosthetic endocarditis or prosthetic dysfunction in hospital. Hospital mortality was 6% (4 patients). Correlation dependence of peak pressure prosthesis gradient on body surface area and body mass index was 10% and 8%, respectively. Conclusions . This study confirmed the safety and effectiveness of using small-diameter BioLAB scaffold xenopericardial prostheses in aortic valve position.

In vitro performance of trans-valve left ventricular assist device installed at aortic valve position.

In this study, we developed a trans-valve left ventricular assist device (LVAD) that unites a rear-impeller axial-flow blood pump (AFBP) and a polymer membrane valve placed at the aortic valve position. The diameter and length of the rear impeller AFBP was 12 and 63mm, respectively. The polymer membrane valve was similar to the jelly-fish valve consisting of a valve leaflet made of silicone rubber (thickness 0.5mm), valve ring (diameter: 25mm), and valve spokes. The trans-valve LVAD was examined in a mock circulation. An implantable pulsatile flow (PF) VAD was connected to an atrial reservoir to simulate the left ventricle (LV), and the Hall valve was worn in the inflow port, and the trans-valve LVAD was placed in the outflow port as an outflow valve. When the motor rotational speed increasedto 26400rpm, the mean aortic flow increased from 4.2 to 5.3 L/min, mean aortic pressure increased from 83.4 to 100mm Hg, and mean motor current of the implantable PF VAD decreased from 1.18 to 0.94 A (unloading effect on LV -21%). The energy equivalent pressure increased from 85.2 to 102mm Hg, and surplus hemodynamic energy (SHE) decreased by -15.4% from the baseline. In conclusion, the trans-valve LVAD has an advantage of preserving pulsatility without any complicated mechanism and is a novel and promising LV support device.

Relevance of New Conduction Disorders After Implantation of the ACURATE Neo Transcatheter Heart Valve in the Aortic Valve Position

The ACURATE neo transcatheter heart valve has been associated with very low rates of new conduction disorders (CDs). We assessed the clinical relevance of new CDs in patients undergoing transcatheter aortic valve replacement (TAVR) with this valve. Data of consecutive patients without a pre-existing left bundle branch block (LBBB) or a permanent pacemaker (PPM) undergoing TAVR with the ACURATE neo were analyzed from the prospective SwissTAVI registry. Patients with new CDs were compared with patients with an unchanged electrocardiogram (ECG). ACURATE neo was implanted in 203 patients (mean age 82 ± 6 years, 63% women), CDs occurred in 28 patients (22 [11%] developed a LBBB, 6 [3%] required a PPM). New CDs resulted in a longer median duration of hospitalization (7 vs 5 days, interquartile range 4 to 13 vs 3 to 8 days, p = 0.04). At 1-year follow-up, left ventricular ejection fraction was significantly lower in patients with new CDs comparedwith patients with an unchanged ECG (54% ± 13% vs 61% ± 9%, p <0.01). Kaplan-Meier estimates of survival at 1-year were 89% in patients with new CDs and 95% in patients with an unchanged ECG (hazard ratio 2.0, 95% confidence interval 0.7 to 6.2, p = 0.22). After TAVR with the self-expanding ACURATE neo valve, the rate of new CDs, including complete LBBB was low and very few patients required a new PPM. However, new CDs prolonged initial hospitalization and increased the risk for left ventricular-dysfunction at 1-year follow-up. Patients without new CDs had excellent outcomes with a very high survival rate at 1-year follow-up.