A novel simple technique to enlarge the aortic annulus by two valve sizes.
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ABSTRACT:
SUBMITTER: Yang B
PROVIDER: S-EPMC7899136 | biostudies-literature | 2021 Feb
REPOSITORIES: biostudies-literature
Publications
A novel simple technique to enlarge the aortic annulus by two valve sizes.
JTCVS techniques 20201105
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Project description:For a fifth-time redo aortic valve replacement, a Y incision was made through the left-noncommissure post into the aortomitral curtain above the mitral annulus, undermining the aortic annulus below the nadirs of left coronary and noncoronary cusps without violating the left atrium or mitral valve. A rectangular Hemashield (Maquet Cardiovascular, San Jose, CA) patch was used to extensively enlarge the aortomitral curtain. The aortic annulus was increased from 21 mm to 27 mm for a mechanical aortic valve replacement. The patient was discharged without blood transfusion or any complications. Our enlargement technique was simple and effective to enlarge the aortic annulus for mechanical aortic valve replacement.
| S-EPMC8316270 | biostudies-literature
Project description:BackgroundThe characteristics of aortic annulus changes in aortic regurgitation (AR) patients are poorly understood, and predictive factors among aortic valve disease are yet to be established.ObjectiveThis study seeks to elucidate the pattern of annular size fluctuations across different cardiac phases in AR patients and to identify predictors for annular enlargement during either systole or diastole in aortic valve diseases.MethodsA retrospective analysis was conducted on 55 patients with severe aortic valve diseases, including 26 patients with aortic stenosis (AS) and 29 with AR, to discern the two groups' contrasting and analogous patterns of annular changes. The patient sample was expanded to 107 to investigate the factors influencing the size of the annulus during different cardiac phases. Based on our findings, patients were then divided into two groups: those with an annulus that is larger during systole (83 patients) and those where the annulus is larger during diastole (24 patients).ResultsTypically, AR patients exhibit a dynamic annulus, with both perimeter and area being largest during mid-systole. These dimensions diminish progressively and then increase again in early diastole, a pattern consistent with observations in AS patients. Among 107 patients, 21% had diastolic enlargement. Systolic measurements would lead to prosthesis undersizing in 17% of these. Male gender and lower systolic annulus minimum relative to body surface area (AnMin index) were predictors of diastolic enlargement, with ROC curve areas of 0.70 and 0.87 for AR and AS, respectively.ConclusionsSystolic measurements are recommended for AR patients. Gender and the AnMin index are significant predictors, particularly potent in AS patients.
| S-EPMC10755897 | biostudies-literature
Project description: Not available
| S-EPMC5889984 | biostudies-literature
Project description:To evaluate the prognostic relevance of aortic annulus (AA) and left ventricular outflow tract (LVOT) Fractal dimension (FD). FD is a mathematical concept that describes geometric complexity of a structure and has been shown to predict adverse outcomes in several contexts. Computed tomography (CT) scans from the SOLVE-TAVI trial, which, in a 2 × 2 factorial design, randomized 447 patients to TAVI with the balloon-expandable Edwards Sapien 3 or the self-expanding Medtronic Evolut R, and conscious sedation or general anesthesia, were analyzed semi-automatically with a custom-built software to determine border of AA and LVOT. FD was measured by box counting using grid calibers between 0.8 and 6.75 mm and was compared between patients with none/trivial and mild/moderate paravalvular regurgitation (PVR). Overall, 122 patients had CT scans sufficient for semi-automatic PVR in 30-day echocardiography. PVR was none in 65(53.3%) patients, trace in 9(7.4%), mild in 46(37.7%), moderate in 2(1.6%) and severe in 0 patients. FD determined in diastolic images was significantly higher in patients with mild/moderate PVR (1.0558 ± 0.0289 vs. 1.0401 ± 0.0284, p = 0.017). Annulus eccentricity was the only conventional measure of AA and LVOT geometry significantly correlated to FD (R = 0.337, p < 0.01). Area under the curve (AUC) of diastolic annular FD for prediction of mild/moderate PVR in ROC analysis was 0.661 (0.542-0.779, p = 0.014). FD shows promise in prediction of PVR after TAVI. Further evaluation using larger patient numbers and refined algorithms to better understand its predictive performance is warranted.Trial Registration: www.clinicaltrials.gov , identifier: NCT02737150, date of registration: 13.04.2016.
| S-EPMC9700572 | biostudies-literature
Project description:The implantation of a left ventricular assist device (LVAD) has become an essential requirement for managing patients with end-stage heart failure. However, aortic valve insufficiency is a contraindication for LVAD implantation in patients with end-stage heart failure, partly because of the decreasing efficiency of mechanical circulatory support and the eventual development of right ventricular failure. Herein, we present the first case of performing transcatheter aortic valve replacement in valve-in-ring along with LVAD implantation for the treatment of a 60-year-old male suffering from refractory heart failure due to dilated cardiomyopathy and pure aortic insufficiency in need of a new aortic bioprosthesis. A balloon-expandable bioprosthetic transcatheter heart valve was implanted into a previously sewn annulus ring into the aortic root via transaortic access. Subsequently, a centrifugal-flow LVAD was implanted. Postoperatively, the patient was in New York Heart Association Functional Class (NYHA) II with 6-min walk test of 310 m. The patient has completed 6 months of follow-up with no events. This novel and feasible surgical technique reduced the cardiopulmonary bypass time and duration of surgery. Furthermore, it avoids the risk of redo sternotomy and decreases the chances of paravalvular leakage and worsening of aortic regurgitation.
| S-EPMC10117784 | biostudies-literature
Project description: Not available
| S-EPMC8987397 | biostudies-literature
Project description: Not available
| S-EPMC11925031 | biostudies-literature
Project description: Not available
| S-EPMC11845361 | biostudies-literature
Project description:ObjectivesThis study aimed to investigate mid-term outcomes of aortic valve repair with valve-sparing aortic root replacement based on different grades of annulus-cusp mismatch and identify optimal aortic root geometries for this procedure.MethodsA retrospective analysis was conducted between October 2011 and July 2022. Patients were stratified into three groups based on predicted coaptation length calculated using an annulus-cusp mismatch formula: no-mismatch (coaptation length > 4 mm, n = 52), mild-mismatch (2 mm ≤ coaptation length ≤ 4 mm, n = 28) and severe-mismatch (coaptation length < 2 mm, n = 25), and mid-term outcomes were compared.ResultsWe included 105 patients who underwent valve-sparing root replacement using the reimplantation technique. During the median follow-up of 6.0 years, 21 moderate aortic valve regurgitation events and 6 reoperation events were observed. No significant inter-group differences in overall survival or cumulative incidence of cardiac death or hospitalization for heart failure were observed. However, the groups significantly differed in the cumulative incidence of moderate aortic regurgitation at 5 years (2.0%, 14.8% and 60.1% for no-mismatch, mild-mismatch and severe-mismatch groups, respectively; P < 0.001) and cumulative incidence of reoperation at 5 years (0%, 0% and 11.8%, respectively; P = 0.002).ConclusionsOur findings suggest that severe annulus-cusp mismatch is associated with higher rates of valve regurgitation and reoperation following aortic valve repair with valve-sparing aortic root replacement; however, larger studies are needed for confirmation. Preoperative computed tomography-based assessment of annulus-cusp mismatch shows promise in surgical planning and patient selection for aortic valve repair procedures.Clinical registration number4392.
| S-EPMC11906396 | biostudies-literature
Project description:BackgroundTranscatheter aortic valve implantation (TAVI) is a well-established treatment for patients with severe aortic valve stenosis. This procedure requires pre-operative planning by assessment of aortic dimensions on CT Angiography (CTA). It is well-known that the aortic root dimensions vary over the heart cycle. However, sizing is commonly performed at either mid-systole or end-diastole only, which has resulted in an inadequate understanding of its full dynamic behavior.Study goalWe studied the variation in annulus measurements during the cardiac cycle and determined if this variation is dependent on the amount of calcification at the annulus.MethodsWe measured and compared aortic root annular dimensions and calcium volume in CTA acquisitions at 10 cardiac cycle phases in 51 aortic stenosis patients. Sub-group analysis was performed based on the volume of calcium by splitting the population into mildly and severely calcified valves subgroups.ResultsFor most annulus measurements, the largest differences were found between 10% and 70 to 80% cardiac cycle phases. Mean difference (±standard deviation) in annular minimum diameter, maximum diameter, area, and aspect ratio between mid-systole and end-diastole phases were 1.0 ± 0.29 mm (p = 0.065), 0.30 ± 0.24 mm (p = 0.7), 24.1 ± 7.6 mm2 (p < 0.001), and 0.041 ± 0.012 (p = 0.039) respectively. Calcium volume measurements varied strongly during the cardiac cycle. The dynamic annulus area was behaving differently between mildly and severely calcified subgroups (p = 0.02). Furthermore, patients with severe aortic calcification were associated with larger annulus diameters.ConclusionThere is a significant variation of annulus area and calcium volume measurement during the cardiac cycle. In our measurements, only the dynamic variation of the annulus area is dependent on the severity of the aortic calcification. For TAVI candidates, the annulus area is significantly larger in mid-systole compared to end-diastole.
| S-EPMC5590871 | biostudies-literature