Aortic Valve Repair: Where Are We Now?

Rimmer, Lara; Ahmad, Maqbool; Chaplin, Grace; Joshi, Mihika; Harky, Amer

doi:10.1016/j.hlc.2019.02.007

Cited by 14 publications

(8 citation statements)

References 48 publications

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“… 28 , 32 , 34 , 47 Aortic valve repair is indicated in selected cases and the use of the TAVR is not recommended in current guidelines. 17 , 116 - 118 Homografts were more commonly used in NVE with extensive annular destruction or abscess formation, in extirpative heart surgery and prosthetic valve endocarditis. In the previous decade, allogenic tissue was used in 7% of primary interventions and up to 32% for secondary intervention.…”

Section: Discussionmentioning

confidence: 99%

“…We designed a systematic review and conducted an electronic search of Pub Med, EMBASE, and Cochrane database from January 2001 to December 2019, using the terms "infective endocarditis," "heart valve endocarditis," "left side endocarditis," "aortic valve endocarditis," "heart valve prosthesis," "allograft," "autograft," "aortic valve replacement," and "aortic valve repair" was conducted. We assessed a large number of publications from 2001 16 (Table 1) and 2019 17 (Table 2) in patients who received the use of homograft, Ross operation, conventional mechanical, stented xenograft or stentless prosthesis or who received an aortic valve repair for infective aortic valve replacement. In detail, pertinent abstracts were reviewed and the related articles were examined.…”

Section: Methodsmentioning

confidence: 99%

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Learning From Controversy: Contemporary Surgical Management of Aortic Valve Endocarditis

Nappi

Singh

Timofeeva

2020

Clin Med Insights Cardiol

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Aortic valve replacement is the commonest cardiac surgical operation performed worldwide for infective endocarditis (IE). Long-term durability and avoidance of infection relapse are goals of the procedure. However, no detailed guidelines on prosthesis selection and surgical strategies guided by the comprehensive evaluation of the extension of the infection and its microbiological characteristics, clinical profile of the patient, and risk of infection recurrence are currently available. Conventional mechanical or stented xenografts are the preferred choice for localized aortic infection. However, in cases of complex IE with the involvement of the root or the aortomitral continuity, the use of homograft is suggested according to the surgeon and center experience. Homograft use should be counterbalanced against the risk of structural degeneration. Prosthetic bioroot or prosthetic valved conduit (mechanical and bioprosthetic) are also potentially suitable alternatives. Further development of preservation techniques enabling longer durability of allogenic substitutes is required. We evaluate the current evidence for the use of valve substitutes in aortic valve endocarditis and propose an evidence-based algorithm to guide the choice of therapy. We performed a systemic review to clarify the contemporary surgical management of aortic valve endocarditis.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Learning From Controversy: Contemporary Surgical Management of Aortic Valve Endocarditis

Nappi

Singh

Timofeeva

2020

Clin Med Insights Cardiol

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“…Carr and Savage demonstrated in their meta‐analysis that AVr is associated with a superior midterm survival than patient treated with bioprosthetic AVR, but the AVr patients in their cohort are much younger than the AVR cohort. Younger patient age with relatively lower prevalence of comorbidities has often been attributed to the favorable outcome following AVr . The current study would provide a more comprehensive picture eliminating the confounding effect of age.…”

Section: Discussionmentioning

confidence: 94%

Aortic valve repair or replacement in patients with aortic regurgitation: A systematic review and meta‐analysis

et al. 2019

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Objective: To systematically compare clinical outcomes between aortic valve repair and replacement in patients with aortic regurgitation. Methods: A comprehensive literature search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all published data comparing clinical outcomes of aortic valve repair vs replacement. Database searched from inception to November 2018.Results: A total of 1071 patients were analyzed in eight articles. Mean age was similar in both groups of patients (47.2 ± 12.8 vs 48.3 ± 12.7 years, P = 0.83, aortic valve repair and replacement, respectively). The preoperative left ventricular ejection fraction was better in the repair group (56.7% ± 4.8 vs 53.3% ± 4.2, P = 0.005). The rate of moderate-to-severe regurgitation and bicuspid aortic valve were similar in both cohorts (81% vs 78%, P = 0.90% and 58% vs 55%, P = 0.46). In-hospital and 1-year mortality was lower in repair cohort, although not reaching statistical significance (1.3% vs 3.6%, P = 0.12; 5.9% vs 9.3%, P = 0.77). Reoperation rate was higher in repair patients at 1 year (8.8% vs 3.7%, P = 0.03).Conclusion: Aortic valve repair offers comparable perioperative outcomes to aortic valve replacement in aortic regurgitation patients at the expense of higher late reintervention rate. Larger trials with long-term follow-up are required to confirm the long-term benefits of aortic valve repair.

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“…Several retrospective studies involving national databases around the world should be carried out to get a more thorough representation of the data and understanding of the outcomes. There should be further studies to understand the choice of valve types and approaches treating aortic diseases in this cohort of patients 53‐57 …”

Section: Future Researchmentioning

confidence: 99%

Pregnancy and cardiac interventions: What are the optimal management options?

et al. 2020

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Cardiac disease is the leading cause of maternal mortality in the United Kingdom. Major causes of cardiac death in pregnant women include cardiomyopathies, myocardial infarction, ischemic heart disease, and aortic dissection. Uncorrected congenital heart disease and women who have had corrective or palliative surgery may have complicated pregnancies as well. Some women with significant cardiac disease are unable to meet the increased physiological demands of pregnancy. Of these, those who do not respond to medical treatment may require surgical correction such as coronary artery bypass grafting. The risk of cardiac operations for pregnant women is similar to that for nonpregnant women but the fetal mortality rate remains high. Contributing factors to high fetal mortality rates include timing, urgency of operation, and the fetal/fetoplacental response to cardiopulmonary bypass. The aim of this review is to summarize current evidence in utilizing the different management approaches of cardiac issues during pregnancy.

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Aortic Valve Repair: Where Are We Now?

Cited by 14 publications

References 48 publications

Learning From Controversy: Contemporary Surgical Management of Aortic Valve Endocarditis

Learning From Controversy: Contemporary Surgical Management of Aortic Valve Endocarditis

Aortic valve repair or replacement in patients with aortic regurgitation: A systematic review and meta‐analysis

Pregnancy and cardiac interventions: What are the optimal management options?

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