Patient-Tailored Aortic Valve Replacement

Wong, Ivan; Wilkins, Ben; Carranza, Christian L; Søndergaard, Lars

doi:10.3389/fcvm.2021.658016

Cited by 5 publications

(5 citation statements)

References 40 publications

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“…Open Sci. 11: 230905 tailored disease handling and management to be considered [46]. This study extended our previous models in congenital calcified and non-calcified BAV [11,41] to inspect TAV calcific and fibrocalcific cases.…”

Section: Discussionmentioning

confidence: 91%

“…We introduce predictive computational methodology for evaluating the flow patterns coupled with the structural responses in post-procedure TAVR outcomes in severe aortic stenosis. Detailed biomechanical analysis of aortic stenosis, congenital BAV, CAS and FAS, indicated different responses that require tailored disease handling and management to be considered [ 46 ]. This study extended our previous models in congenital calcified and non-calcified BAV [ 11 , 41 ] to inspect TAV calcific and fibrocalcific cases.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of fibrocalcific aortic valve stenosis: computational pre-and-post TAVR haemodynamics behaviours

Morany,

Bardon,

Lavon

et al. 2024

R. Soc. Open Sci.

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Fibro-calcific aortic valve (AV) diseases are characterized by calcium growth or accumulation of fibrosis in the AV tissues. Fibrocalcific aortic stenosis (FAS) rises specifically in females, like calcification-induced aortic stenosis (CAS), may eventually necessitate valve replacement. Fluid-structure-interaction (FSI) computational models for severe CAS and FAS patients were developed using lattice Boltzmann method and multi-scale finite elements (FE). Three parametric AV models were introduced: pathology-free of non-calcified tri-and-bicuspid AVs with healthy collagen fibre network (CFN), a FAS model incorporated a thickened CFN with embedded small calcification volumes, and a CAS model employs healthy CFN with embedded high calcification volumes. The results indicate that the interaction between calcium deposits, adjacent tissue and fibres crucially influences haemodynamics and structural reactions. A fourth model of transcatheter aortic valve replacement (TAVR) post-procedure outcomes was created to study both CAS and FAS. TAVR-CAS had a higher maximum contact pressure and lower anchoring area than TAVR-FAS, making it prone to aortic tissue damage and migration. Finally, although the TAVR-CAS offered a larger opening area, its paravalvular leakage was higher. This may be attributed to a similar thrombogenicity potential characterizing both models. The computational framework emphasizes the significance of mechanobiology in FAS and underscores the requirement for tissue modelling at multiple scales.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Analysis of fibrocalcific aortic valve stenosis: computational pre-and-post TAVR haemodynamics behaviours

Morany,

Bardon,

Lavon

et al. 2024

R. Soc. Open Sci.

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“…Die Zahl von biologischen Klappenimplantationen ist stark angestiegen und liegt gegenwärtig bei 85 % [10]. Gerade bei jüngeren Patienten (< 65 Jahre), die leitliniengerecht primär einen mechanischen Klappenersatz erhalten sollten, wird bei über 90% der Patienten eine biologische Prothese implantiert.…”

Section: Prothesendegeneration Und Neue Herzklappenprothesenunclassified

Aktuelle Weiterentwicklungen und Fortschritte in der Herzchirurgie

Tugtekin,

Schöne,

Alexiou

et al. 2023

Kardiologie up2date

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“…Surgical valve replacement (SVR) remains the mainstay of treatment for valvular heart disease (VHD) affecting any of the four valves if they are not suitable for repair ( 1 , 2 ). Over six decades, mechanical or tissue valve prostheses have been used for SVR, and the advantages and disadvantages of both are well documented ( 1 , 3 , 4 ). Newer surgical bioprosthetic heart valves (BHVs) have demonstrated a marked improvement in durability ( 2 , 3 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

“…SVR has become preferable over annuloplasty and/or valvuloplasty in patients aged <60 years with aortic and/or mitral valve disease, due to the improvements in BHVs ( 1 , 10 ), and tissue valves composed of bovine pericardium or porcine tissue are preferred over mechanical valves ( 1 , 2 ).…”

Section: Introductionmentioning

confidence: 99%

Three-year outcomes of surgical valve replacement with Dafodil™ pericardial bioprosthesis: Dafodil™-1 trial

Hiremath,

Jain,

Garg

et al. 2024

Front. Cardiovasc. Med.

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BackgroundThe Dafodil™-1 trial was designed to evaluate the clinical safety and performance of Dafodil™ pericardial bioprosthesis for replacing diseased native or prosthetic aortic or mitral valves in patients with advanced valvular heart disease (VHD).MethodsThe Dafodil™-1 trial was a prospective, multicenter, first-in-human clinical trial. Patients were enrolled if they had advanced VHD requiring aortic valve replacement (AVR) or mitral valve replacement (MVR) with or without concomitant valve surgery and having surgical risk scores <4%. Major adverse cardiac events (MACE), including all-cause death, myocardial infarction (MI), and stroke; and hemodynamics were analyzed.ResultsA total of 136 patients (aortic: 67 and mitral: 69) were enrolled in the trial (with mean age—AVR group: 60.2 ± 8.3 years and MVR group: 49.7 ± 14.4 years). A total of 134 patients (aortic: 66 and mitral: 68) completed the 3-year follow-up (total 300 per 100 patient-years of follow-up). The AVR group demonstrated a significant reduction in the mean pressure gradients from 51.2 ± 24.1 mmHg at baseline to 11.1 ± 6.0 mmHg at the 3-year follow-up (p < 0.0001). The mean effective orifice area (EOA) improved from baseline (0.9 ± 0.6 cm2) to 3-year follow-up (1.8 ± 0.4 cm2) (p < 0.0001). In the MVR group, the mean indexed EOA (iEOA) increased significantly from baseline (0.7 ± 0.4 cm2/m2) to 3-year follow-up (1.1 ± 0.4 cm2/m2) (p < 0.001). There was significant improvement in New York Heart Association functional class and mean SF-12 scores in both groups. At 3-year follow-up, the MACE incidence was 2.3% per 100 patient-years (1.3% strokes per 100 patient-years and 1.3% deaths per 100 patient-years) for AVR group and 4.7% per 100 patient-years (0.6% strokes per 100 patient-years and 4.0% deaths per 100 patient-years) for MVR group. No cases of MI, structural valve deterioration and prosthetic valve endocarditis were reported. The AVR and MVR groups achieved 89.6% and 79.7% MACE-free survival, respectively at 3-year follow-up.ConclusionsThe Dafodil™-1 trial demonstrated satisfactory outcomes of clinical safety, hemodynamic performance, and quality-of-life metrics. Additionally, no incidence of structural valve deterioration and very low rates of valve thrombosis during the 3-year follow-up period of Dafodil™-1 first-in-human trial indicated acceptable valve durability up to three years and similar outcomes are warranted for longer follow-ups as a primary goal.Clinical Trial Registration Numberhttps://www.ctri.nic.in/Clinicaltrials/showallp.php?mid1=18377&EncHid=&userName=CTRI/2017/07/009008, CTRI/2017/07/009008.

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Patient-Tailored Aortic Valve Replacement

Cited by 5 publications

References 40 publications

Analysis of fibrocalcific aortic valve stenosis: computational pre-and-post TAVR haemodynamics behaviours

Analysis of fibrocalcific aortic valve stenosis: computational pre-and-post TAVR haemodynamics behaviours

Aktuelle Weiterentwicklungen und Fortschritte in der Herzchirurgie

Three-year outcomes of surgical valve replacement with Dafodil™ pericardial bioprosthesis: Dafodil™-1 trial

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