The FRANCE TAVI registry provided reassuring data regarding trends in TAVR performance in an all-comers population on a national scale. Nonetheless, given that TAVR indications are likely to expand to patients at lower surgical risk, concerns remain regarding potentially life-threatening complications and pacemaker implantation. (Registry of Aortic Valve Bioprostheses Established by Catheter [FRANCE TAVI]; NCT01777828).
Objective
Valve in valve (ViV) procedures using transcatheter aortic valves
(TAV) are increasingly performed to treat degenerated bioprosthetic surgical
aortic valves (SAV) due to being less invasive than redo aortic valve
replacement. The objective of this study is to quantify the changes in
aortic sinus blood flow dynamics before and after ViV to gain insight into
mechanisms for clinical and sub-clinical thrombosis of leaflets.
Methods
A detailed description of the sinus hemodynamics for ViV implantation
was performed in-vitro. A Medtronic Hancock II porcine bioprosthesis was
modeled as SAV and a Medtronic CoreValve and Edwards Sapien were used as the
TAVs. High-resolution particle image velocimetry (PIV) was employed to
compare the flow patterns from these two valves within both the left
coronary and non-coronary sinuses in vitro.
Results
Velocity and vorticity within the surgical valve sinuses reached peak
values of 0.7 m/s and 1000 s−1, with a 70%
decrease in peak fluid shear stress near the aortic side of the leaflet in
the non-coronary sinus. With the introduction of TAV, peak velocity and
vorticity were reduced to around 0.4 m/s and 550 s−1 and
0.58 m/s and 653 s−1 without coronary flow and 0.60 m/s
and 631 s−1 and 0.81 m/s and 669 s−1
with coronary flow for CoreValve and Sapien ViV respectively. Also, peak
shear stress was around 38% higher along the aortic side of the
coronary vs non-coronary TAV leaflet.
Conclusions
Decreased flow and shear stress in ViV indicates higher risk of
leaflet thrombosis secondary to flow stasis in the non-coronary sinus.
(1) Comparable PGs were found among the TAVs in different models; (2) pinwheeling indices were found to be different between both TAVs; (3) turbulence patterns among both TAVs translated according to RSS were different. Rigid aortic models yield more conservative estimates of turbulence; (4) both TAVs exhibit peak maximal RSS that exceeds platelet activation 100 Pa threshold limit.
Cell therapy with bone marrow mesenchymal stem cells (BMSCs) is a new strategy for treating ischemic heart failure, but data concerning the distribution and retention of transplanted cells remain poor. We investigated the short-term myocardial retention of BMSCs when these cells are directly injected within necrotic or intact myocardium. 111 Indium-oxine-labeled autologous BMSCs were injected within either 1-month-old infarction (n = 6) or normal myocardium (n = 6) from rats. Serial in vivo pinhole scintigraphy was scheduled during 1 week in order to track the implanted cells. The myocardial retention of BMSCs was definitely higher in myocardial infarction than in normal myocardial area (estimated percent retention at 2 h: 63 ± 3% vs. 25 ± 4%, p < 0.001) and the estimated cardiac retention values were unchanged in both groups along the 7 days of follow-up. On heart sections at day 7, labeled BMSCs were still around the injection site and appeared confined to the scarred tissue corresponding either to the infarct area or to the myocardium damaged by needle insertion. BMSCs have a higher retention when they are injected in necrotic than in normal myocardial areas and these cells appear to stay around the injection site for at least a 7-day period.
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Transcarotid aortic valve implantation is a safe alternative to transfemoral transcatheter aortic valve implantation, with direct access to the aortic valve, which can be performed with limited incision.
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