Aortic valve replacement in young patients: should the biological prosthesis be recommended over the mechanical?

Alperi, Alberto; Hernández-Vaquero, Daniel; Pascual, Isaac; Díaz, Rocío; Silva, Iria; Álvarez-Cabo, Rubén; Avanzas, Pablo; Morís, César

doi:10.21037/atm.2018.02.21

Cited by 7 publications

(3 citation statements)

References 9 publications

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“…The attractiveness of a mechanical prostheses owing to their durability is limited by the thrombotic risk and the necessity of lifelong anticoagulation, which is associated with the increased risk of bleeding and is not acceptable for some patient groups (i.e., women planning to have children) [9,10]. On the contrary, biological prostheses do not require anticoagulation, but have a limited durability, which may require reintervention, especially in younger patients [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Aortic Valve Replacement in Adult Patients with Decellularized Homografts: A Single-Center Experience

Andreeva,

Coti,

Werner

et al. 2023

JCM

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Background: decellularized aortic homografts (DAH) represent a promising alternative for aortic valve replacement in young adults due to their low immunogenicity and thrombogenicity. Herein, we report our midterm, single-center experience in adult patients with non-frozen DAH from corlife. Methods: safety, durability, and hemodynamic performance were evaluated according to current guidelines in all consecutive patients who had received a DAH at our center since 03/2016. Results: seventy-three (mean age 47 ± 11 years, 68.4% (n = 50) male) patients were enrolled. The mean diameter of the implanted DAH was 24 ± 2 mm. Mean follow-up was 36 ± 27 months, with a maximum follow-up of 85 months and cumulative follow-up of 215 years. No cases of stenosis were observed, in four (5.5%) cases moderate aortic regurgitation occurred, but no reintervention was required. No cases of early mortality, non-structural dysfunction, reoperation, valve endocarditis, or thrombosis were observed. Freedom from bleeding and thromboembolic events was 100%; freedom from re-intervention was 100%; survival was 98.6% (n = 72). Conclusions: early and mid-term results showed low mortality and 100% freedom from reoperation, thromboembolic events, and bleeding at our center. However, in order for this novel approach to be established as a valid alternative to aortic valve replacement in young patients, long-term data are required.

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Section: Introductionmentioning

confidence: 99%

Aortic Valve Replacement in Adult Patients with Decellularized Homografts: A Single-Center Experience

Andreeva,

Coti,

Werner

et al. 2023

JCM

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“…When fabricating biografts from xenopericardium, glutaraldehyde (GA) is often used for cross-linking of xenopericardial collagen providing its resistance to biodegradation and prolonged functioning in the patient's organism. However, it has been shown [1] that GA-fixed biografts may be subjected to calcification in the recipient's organism. And there exists correlation between the speed and intensity of calcification and patient age: the process runs faster in young patients.…”

Section: Introductionmentioning

confidence: 99%

Cytotoxicity of Xenogeneic Pericardium Preserved by Epoxy Cross-Linking Agents

Bondarenko¹,

Суровцева²,

Лыков³

et al. 2021

Sovrem Tehnol Med

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The aim of the study was to assess the cytotoxic effect of xenopericardial biomaterial treated with di-and pentaepoxides on the cell cultures in vitro.Materials and Methods. Samples of bovine and porcine pericardium were used in the work. Three different modes were employed for preservation: 1) 0.625% solution of glutaraldehyde (GA) and a two-fold change on days 2 and 7; 2) 5% solution of ethylene glycol diglycidyl ether (EGDE) changed on day 2; 3) 5% EGDE solution for 10 days, then 2% pentaepoxide solution also for 10 days. The cytotoxicity of the biomaterial was assessed by the extraction method. To determine the cytotoxicity of the biomaterial, EA.hy926 cells, multipotent mesenchymal stem cells (MMSCs), and fibroblasts were used. Cell viability was determined by the MTT test. The level of apoptosis and necrosis in the cell cultures was assessed by staining with acridine orange and ethidium bromide after cultivation with xenopericardial extracts employing different modes of preservation.Results. Extracts of bovine and porcine pericardium preserved with GA have been found to have the greatest toxic effect on the cell cultures showing 20-33% reduction of cell viability. Extracts from bovine and porcine pericardium preserved with di-and pentaepoxy compounds do not have a toxic effect on endothelial cells, MMSCs, and fibroblasts since cell viability reduction is by no more than 15%. The lowest level of apoptosis and necrosis is observed in the cell cultures under the influence of extracts from the pericardium, preserved with diepoxide and pentaepoxide compounds. Conclusion.According to the MTT test for cytotoxicity and determination of the level of apoptosis and necrosis in cell cultures, bovine and porcine pericardia treated with di-and pentaepoxides have been established to have no cytotoxic effect on the culture of endothelial EA.hy926 cells, MMSCs, fibroblasts in vitro, whereas GA, in comparison with di-and pentaepoxides, has a toxic impact on the cells.

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“…Bioprostheses have limited durability and 10‐15 years following primary surgery they require replacement, predominantly due to structural valve deterioration (SVD) . One of the risk factors for the development of earlier SVD is the small size of aortic bioprostheses and freedom from reoperation is usually significantly lower in these patients …”

Section: Introductionmentioning

confidence: 99%

Severe structural deterioration of small aortic bioprostheses treated with valve-in-valve transcatheter aortic valve implantation

et al. 2019

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Objectives The aim of this study was to evaluate outcomes of valve‐in‐valve transcatheter aortic valve implantation (VIV‐TAVI) in patients with degenerated small bioprostheses. Methods Outcomes of consecutive 27 high‐risk patients (logistic EuroSCORE 35.5 ± 18.5%) with a mean age of 81.0 ± 5.9 years who underwent VIV‐TAVI for degenerated small bioprostheses (19 mm‐11.1%; 20 mm‐11.1%; 21 mm‐77.8%) were analyzed. Medtronic CoreValve (n = 11) or CoreValve Evolut‐R prostheses (n = 16) were implanted. Follow‐up was 3.2 ± 2.0 years. Results Early mortality was 11.1%. One patient died intraoperatively due to left ventricle perforation, two others during the in‐hospital period as a result of sudden cardiac death and pulmonary embolism. VIV‐TAVI was completed in 26 cases (96.3%—success rate). Two patients required pacemaker implantation. Acute kidney injury occurred in two other patients. At discharge, mean transvalvular gradient was 19.2 ± 9.5 mmHg and in 25.9% of patients mean gradient exceeded 20 mmHg. Overall mortality was 25.9% and mortality from cardiac or unknown causes at 18.5%. Ninety percent of survivors were in New York Heart Association (NYHA) class I or II. Conclusions Transfemoral VIV‐TAVI in patients with small, degenerated bioprostheses appears to be a promising alternative to surgery. Although the vast majority of patients have significant improvement in their NYHA class, the rate of persistent, residual gradients is relatively high and will need to be followed closely with serial echocardiograms.

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Aortic valve replacement in young patients: should the biological prosthesis be recommended over the mechanical?

Cited by 7 publications

References 9 publications

Aortic Valve Replacement in Adult Patients with Decellularized Homografts: A Single-Center Experience

Aortic Valve Replacement in Adult Patients with Decellularized Homografts: A Single-Center Experience

Cytotoxicity of Xenogeneic Pericardium Preserved by Epoxy Cross-Linking Agents

Severe structural deterioration of small aortic bioprostheses treated with valve-in-valve transcatheter aortic valve implantation

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