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Bioprosthetic valve Size Selection to Optimize aortic valve replacementSurgical Outcome: A Fluid-Structure Interaction Modeling Study

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Computer Modeling in Engineering & Sciences 2021年第4期127卷 159-174页

作者： Caili Li Dalin Tang Jing Yao Christopher Baird Haoliang Sun Chanjuan Gong Luyao Ma Yanjuan Zhang Liang Wang Han Yu Chun Yang Yongfeng Shao School of Mathematics Southeast UniversityNanjing210096China School of Biological Science&Medical Engineering Southeast UniversityNanjing210096China Mathematical Sciences Department Worcester Polytechnic InstituteWorcesterMA 01609USA Department of Cardiology First Affiliated Hospital of Nanjing Medical UniversityNanjing210029China Department of Cardiac Surgery Boston Children’s HospitalHarvard Medical SchoolBostonMA 02115USA Department of Cardiovascular Surgery First Affiliated Hospital of Nanjing Medical UniversityNanjing210029China Department of Anesthesiology First Affiliated Hospital of Nanjing Medical UniversityNanjing210029China China Information Technology Designing&Consulting Institute Co. Ltd.Beijing100048China

aortic valve replacement(AVR)remains a major treatment option for patients with severe aortic valve *** outcome of AVR is strongly dependent on implanted prosthetic valve ***-structure interaction(FSI)aortic root models were constructed to investigate the effect of valve size on hemodynamics of the implanted bioprosthetic valve and optimize the outcome of AVR *** models with 4 sizes of bioprosthetic valves(19(No.19),21(No.21),23(No.23)and 25 mm(No.25))were *** ventricle outflow track flow data from one patient was collected and used as model flow *** Mooney–Rivlin models were used to describe mechanical properties of aortic valve *** flow pressure,velocity,systolic valve orifice pressure gradient(SVOPG),systolic cross-valve pressure difference(SCVPD),geometric orifice area,and flow shear stresses from the four valve models were *** results indicated that larger valves led to lower transvalvular pressure gradient,which is linked to better post AVR *** SVOPG,mean SCVPD and maximum velocity for valve No.25 were 48.17%,49.3%,and 44.60%lower than that from valve No.19,*** orifice area from valve No.25 was 52.03%higher than that from valve No.19(1.87 cm2 vs.1.23 cm2).Implantation of larger valves can significantly reduce mean flow shear stress on valve *** initial results suggested that larger valve size may lead to improved hemodynamic performance and valve cardiac function post *** patient studies are needed to validate our findings.

关键词： Fluid-structure interaction aortic valve aortic valve replacement bioprosthetic valve prosthesis–patient mismatch

Balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis： a new paradigm for the heart team decision making

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Journal of Geriatric Cardiology 2016年第6期13卷 475-482页

作者： Francesco Saia Carolina Moretti Gianni Dall'Ara Cristina Ciuca Nevio Taglieri Alessandra Berardini Pamela Gallo Marina Cannizzo Matteo Chiarabelli Niccolo Ramponi Linda Taffani Maria Letizia Bacchi-Reggiani Cinzia Marrozzini Claudio Rapezzi Antonio Marzocchi Cardio-Thoraco-Vascular Department University Hospital of Bologna Bologna Italy

Background Whilst the majority of the patients with severe aortic stenosis can be directly addressed to surgical aortic valve replace- ment （AVR） or transcatheter aortic valve implantation （TAVI）, in some instances additional information may be needed to complete the diagnostic workout. We evaluated the role of balloon aortic valvuloplasty （BAV） as a bridge-to-decision （BTD） in selected high-risk patients. Methods Between 2007 and 2012, the heart team in our Institution required BTD BAV in 202 patients. Very low left ventricular ejection fraction, mitral regurgitation grade 〉 3, frailty, hemodynamic instability, serious comorbidity, or a combination of these factors were the main drivers for this strategy. We evaluated how BAV influenced the final treatment strategy in the whole patient group and in each specific subgroup. Results Mean logistic European System for Cardiac Operative Risk Evaluation （EuroSCORE） was 23.5%±15.3%, age 81 ± 7 years. In-hospital mortality was 4.5%, cerebrovascular accident 1% and overall vascular complications 4% （0.5% major; 3.5% minor）. Of the 193 patients with BTD BAV who survived and received a second heart team evaluation, 72.6% were finally deemed eligible for definitive treatment （25.4% for AVR; 47.2% for TAVI）： 96.7% of patients with left ventricular ejection fraction recovery; 70.5% of patients with mitral regurgitation reduction; 75.7% of patients who underwent BAV in clinical hemodynamic instability; 69.2% of frail patients and 68% of patients who presented serious comorbidities. Conclusions Balloon aortic valvuloplasty can be considered as bridge-to- decision in high-risk patients with severe aortic stenosis who cannot be immediate candidates for definitive transcatheter or surgical treatment.

关键词： aortic valve replacement aortic valve stenosis Heart team Mitral valve regurgitation Transcatheter aortic valve implantation

Minimally invasive aortic valve surgery

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Journal of Geriatric Cardiology 2016年第6期13卷 499-503页

作者： Sebastiano Castrovinci Sam Emmanuel Marco Moscarelli Giacomo Murana Giuseppa Caccamo Emanuela Clara Bertolino Giuseppe Nasso Giuseppe Speziale Khalil Fattouch Department of Cardiovascular Surgery G VM Care and Research Maria Eleonora Hospital Palermo Italy Department of Cardiothoracic Surgery St Vincent's Hospital Sydney Australia Department of Cardiovascular Surgery GVM Care and Research Anthea Hospital Bari Italy Department of Cardiothoracic Surgery NHLI Imperial College London UK Department of Cardiovascular Surgery S. Orsola-Malpighi Hospital Alma Mater Studiorum University of Bologna Bologna Italy Cardiac Department Ospedale Buccheri La Ferla Fatebenefratelli Palermo Italy Department of Cardiology Policlinieo 'P. Giaccone' University of Palermo Palermo Italy Department of Surgery and Cancer University of Palermo Palermo Italy

aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replace- ment is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper stemotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease.

关键词： aortic valve replacement aortic valve stenosis Minimally invasive Outcomes

Incidence of coronary artery disease before valvular surgery in isolated severe aortic stenosis

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Chinese Medical Journal 2014年第22期127卷 3963-3969页

作者： Eun Jeong Cho Sung-Ji Park Sung-A Chang Dong Seop Jeong Sang-Chol Lee Seung Woo Park Pyo Won Park Division of Cardiology Department of Internal MedicineCardiovascular Imaging Center Cardiac and Vascular Center Samsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea Department of Thorax Surgery Samsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea

Background Angina pectoris has been recognized as one of the principal symptoms of aortic valve stenosis （AS）,even in patients without significant coronary artery disease （CAD）.However,the incidence of angina pectoris and related CAD in such patients is *** is continuing debate as to whether coronary angiography is necessary before aortic valve replacement （AVR） in patients with severe *** purpose of this study was to evaluate the incidence and predictors of CAD in patients with severe AS in a Korean *** Data from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Korea were entered in a prospective registry beginning in *** and echocardiographic follow-up data were recorded into the database *** CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70％ and left main coronary arteries having an estimated narrowing of ≥50％ on coronary *** excluded patients with multiple valve disease,significant aortic regurgitation,or prior CAD or valve *** Totally 574 patients with severe AS （mean age,（65.9±9.6） years） were enrolled in this *** CAD was found in 61 patients （10.6％）.Factors associated with increased likelihood of CAD were age,hypertension,diabetes mellitus,chronic renal failure,carotid disease,and aorta *** Logistic regression analysis,the independent predictor of the presence of CAD was age （P=0.011）.The incidence of CAD increased significantly at 69.2 years of *** two risk factors for cardiovascular disease was the most useful cutoff to predict whether a patient was going to have significant *** There was a low incidence of significant CAD in a population of Korean patients with severe ***,coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients more than 69 years of

关键词： severe aortic stenosis coronary artery disease aortic valve replacement

Current treatment status in patients with severe aortic valve stenosis and outcome of long term follow-up at advanced age： a Chinese single center study

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Chinese Medical Journal 2011年第18期124卷 2879-2882页

作者： PEI Han-jun WU Yong-jian YANG Yue-jin XU Bo CHEN Ji-lin QIAO Shu-bin LI Jian-jun QIN Xue-wen YAO Min YUAN Jin-qing CHEN Jue LIU Hai-bo YOU Shi-jie GAO Run-lin Department of Cardiology Cardiovascular Institute and Fu WaiHospital Chinese Academy of Medical Sciences and Peking UnionMedical College Beijing 100037 China

Background Surgical aortic valve replacement is the standard treatment for patients with severe aortic stenosis, but some registries have indicated that 30% to 60% of these patients are not treated surgically, usually due to advanced age and/or comorbidities. This single center study in China investigated the current treatment status in the patients with severe aortic stenosis and evaluated the long term clinical outcome in advanced age patients whether or not undergoing aortic valve replacement. Methods Clinical data of 867 consecutive patients with severe aortic stenosis between January 2000 and December 2006 were retrospectively analyzed. The patients 〉65 years old were followed up by telephone or information from medical records. The primary end-point was all-cause mortality. Results The patients＇ average age was （52±19） years （range, 1-91 years）, and 34% were women. The percentages of the patients aged 〈15 years, between 15 and 34 years, between 35 and 54 years, between 55 and 64 years, between 65 and 74 years, and 〉75 years who underwent surgical aortic valve replacement were 82.3%, 87.2%, 88.8%, 78.2%, 65.3% and 22.2% respectively. In the patients （n=256）〉65 years old, 43.4% had New York Heart Association class III and IV symptoms, 39.1% had hypertension, 33.2% had coronary heart disease, and 3.1% had stroke. In the patients not undergoing aortic valve replacement, 1.6% had renal insufficiency, 4.7% had chronic obstructive pulmonary disease, 2.0% had critical hematopathy, and 0.4% had mammary cancer. A total of 186 （72.7%） patients finished the follow-up, and the average duration of the follow-up was （60±2.6） months. In the patients between 65 and 74 years old, the total deaths and cardiac deaths in the patients undergoing aortic valve replacement decreased significantly compared with those with conservative treatment （10.3% vs. 53.7%, P 〈0.001 and 6.3% vs. 50.7%, P〈0.001）. Similarly, in the patients ≥75 years old, there was a significant difference between

关键词： aortic stenosis aortic valve replacement advanced age comorbidity

Reoperation on aortic disease in patients with previous aortic valve surgery

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Chinese Medical Journal 2013年第18期126卷 3511-3514页

作者： SUN Xiao-gang ZHANG Liang YU Cun-tao QIAN Xiang-yang CHANG Qian State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Disease Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background aortic valve replacement （AVR） is a safe and effective method in the treatment of aortic valve diseases. This study aimed to increase the understanding on re-treatment of aortic diseases after aortic valve surgery through a retrospective analysis of 47 related cases. Methods Forty-seven patients （38 males and 9 females） with previous aortic valve surgery have received reoperation on aorta from January 2003 to June 2012, and the mean interval time of re-intervention to aortic disease was 6 years （（6.0＋ 3.8） years）. The secondary aortic surgery included aortic root replacement （14 cases）, ascending aorta replacement （10 cases）, aortic root/ascending aorta plus total arch replacement with stented elephant trunk implantation （21 cases）, and total thoracoabdominal aorta replacement （2 cases）. All these patients have received outpatient re-exams or follow-up by phone calls, Results After the initial aortic valve replacement, patients suffered from aortic dissection （25 cases, 53%）, ascending aortic aneurysm （12 cases, 26%） or aortic root aneurysm （10 cases, 21%）, Diameter in ascending aorta increased （5.2＋7.1） mm per year and aortic sinus （3.3＋3.1） mm per year. The annual growth value of diameter in ascending aorta was higher in patients with rheumatic heart disease than that in Marfan syndrome （P〈0,05）. All 47 patients have received reoperation on aorta. One patient died in operating room because aortic dissection seriously involved right coronary artery. Seven patients had renal insufficiency after operation; neurological complications occurred in 14 patients including 7 patients with stroke and the others with transient brain dysfunction. All patients were followed up, the mean survival time was （97.25~17.63） months, 95% confidence interval was 55.24-73.33 months. Eight cases were died during follow-up and five-year survival rate was 83%. Conclusion To reduce the aortic adverse events after first aortic valve surgery, it is necessary to actively treat and st

关键词： aortic valve replacement aortic disease reoperation

Congenital quadricuspid aortic valve： analysis of 11 surgical cases

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Chinese Medical Journal 2011年第17期124卷 2779-2781页

作者： TANG Yang-feng XU Ji-bin HAN Lin LU Fang-lin LANG Xi-long SONG Zhi-gang XU Zhi-yun Department of Cardiothoracic Surgery Changhai Hospital of the Second Military Medical University Shanghai 200433 China

Background Congenital quadricuspid aortic valve is rarely seen during aortic valve replacement （AVR）. The diagnosis and treatment of the disease were reported in 11 cases. Methods Eleven patients （nine men and two women, mean age 33.4 years） with quadricuspid aortic valve were retrospectively evaluated. Medical records, echocardiograms and surgical treatment were reviewed. Results In accordance with the Hurwitz and Roberts classification, the patients were classified as type A （n=-2）, type B （n=7）, type F （n=1） and type G （n=1）. Three patients were associated with other heart diseases, including infective endocarditis and mitral prolaps, left superior vena cava, aortic aneurysm. All had aortic regurgitation （AR） except two with aortic stenosis （AS）, detected by color-flow Doppler echocardiography. The congenital quadricuspid aortic valve deformity in seven patients was diagnosed by echocardiography. All patients underwent successful aortic valve replacement. Conclusion Quadricuspid aortic valve is a rare cause of aortic insufficiency, while echocardiography plays an important role in diaanosina the disease. aortic valve reelacement is the major therapy for the disease.

关键词： quadricuspid aortic valve surgery aortic valve replacement

Thrombocytopenia Following Perceval Suture-Less aortic valve Implantation

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World Journal of Cardiovascular Surgery 2022年第6期12卷 119-127页

作者： Nael Al-Sarraf Husain Esmaeil Sara Samani Moudhi Almaie Ashraf Abdelsalam Jamal Al-Fadhli Department of Cardiac Surgery Chest Diseases Hospital Kuwait City Kuwait

Objectives: Thrombocytopenia has been reported following implantation of Perceval suture-less aortic valve. However, the time course of thrombocytopenia and platelet recovery is unknown. In addition, the effect of thrombocytopenia on post-operative outcome is unknown. We sought to study this observation and correlate that with short-term outcome. Methods: This is a retrospective review of a prospectively collected database over a 3-year period of all isolated aortic valve replacements (70 patients) using bioprosthetic valves (sutured Magna and suture-less Perceval). All preoperative, intraoperative and postoperative variables were collected and analyzed. Platelets count and mean platelet volumes were collected and analyzed in respect to the type of valve used and their time course. Results: The cohort consisted of 70 consecutive patients of which 42 underwent Perceval suture-less valve (group Perceval) and 28 underwent bioprosthetic sutured valve (group Magna). There was no difference in platelets count and mean platelet volume at baseline. However, Perceval group had significant drop in platelet count from day 1 to day 3 post-operatively, followed by a gradual increase in platelet count until discharge. Mean platelet volume, however, was not different between the two types of valves. Postoperative outcomes were similar in the two groups with exception of intensive care and a hospital stay which were significantly shorter in Perceval group. Conclusion: Thrombocytopenia following Perceval suture-less valve is observed from day 1 postoperatively and it is a transient phenomenon. It does not correlate with worse clinical outcomes postoperatively. Larger studies are needed to elucidate the mechanism and its impact.

关键词： Thrombocytopenia Perceval aortic valve replacement Suture-Less

Trans-Frame aortic Regurgitation of New-Generation aortic Bioprosthesis

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World Journal of Cardiovascular Surgery 2024年第4期14卷 41-44页

作者： Michael Timothy Simpson Kasmir Ramo Vinayak Bapat Andrea Miltiades Isaac George Division of Cardiothoracic Surgery New York-Presbyterian Hospital Columbia University Medical Center New York USA Division of Cardiothoracic Anesthesia New York-Presbyterian Hospital Columbia University Irving Medical Center New York USA Division of Cardiothoracic Surgery Abbott Northwestern Hospital Minneapolis Heart Institute Minneapolis USA

A widely used aortic valve bioprosthesis is susceptible to regurgitation between the sewing ring and the frame of the valve due to its relatively thin fabric coverage. In some cases this leak has been shown to resolve with administration of protamine, however, tension on this area from annular sutures placed in an asymmetric bicuspid valve annulus may exacerbate the defect.

关键词： aortic valve replacement Bicuspid aortic valve Paravalvular Leak