Aortic Valve Surgery in Nonelderly Patients: Insights Gained From AVIATOR

Lansac, Emmanuel; Youssefi, Pouya; Heer, Frederiek de; Bavaria, Joseph E.; Kerchove, Laurent de; El-Hamamsy, Ismaı̈l; Elkhoury, Gebrine; Enríquez-Sarano, Maurice; Jondeau, Laurent de Guillaume; Kluin, Jolanda; Pîbarot, Philippe; Schäfers, Hans‐Joachim; Vanoverschelde, Jean–Louis; Takkenberg, Johanna J.M.; Dinges, Christian; Steindl, Johannes; Ziller, Rosina; Benkacem, Taoufik; Coulon, C; Kaddouri, Fadoua; Meester, Christophe de; Pasquet, Agnès; Nijs, Jan; Mossevelde, Veerle Van; Loeys, Bart; Meuris, Bart; Schepmans, Evi; Bossche, Klaartje Van den; Verbrugghe, Peter; Goossens, Wenke; Gutermann, Herbert; Pettinari, Matteo; Lenoir, Marien; Noly, Pierre‐Emmanuel; Tousch, Michael; Shah, Pallav; Boodhwani, Munir; Rudež, Igor; Barić, Davor; Unić, Daniel; Varvodić, Josip; Gjorgijevska, Savica; Vojacek, Jan; Žáček, Pavel; Karalko, Mikita; Hlubocký, Jaroslav; Novotný, Róbert; Slautin, Andrey; Soliman, Said; Arnaud-Crozat, Eric; Boignard, Aude; Fayad, Georges; Bouchot, Olivier; Albat, Bernard; Leguerrier, Alain; Doguet, Fabien; Fuzellier, Jean‐François; Glock, Y; Fernandez, Guy; Chatel, Didier; Zeitoun, David Messika; Jouan, Jérôme; Centa, Isabelle Di; Obadia, Jean-François; Leprince, Pascal; Houël, Rémi; Bergoend, Éric; Lopez, Stéphane; Berrébi, Alain; Tubach, Florence; Monin, Jean‐Luc; Pousset, Sarah; Mankoubi, Leila; Noghin, Milean; Diakov, Christelle; Czytrom, Daniel; Borger, Michael A.; Aicher, Diana; Rauch, Svenja; Theisohn, Frank; Ferrero, Paolo; Stoica, Șerban; Matuszewski, Maciej; Yiu, Patrick; Bashir, Mohamad; Ceresa, Fabrizio; Patanè, Francesco; Paulis, Ruggero De; Chirichilli, Ilaria; Masat, Mauro; Antona, Carlo; Contino, Monica; Mangini, Andrea; Romagnoni, Claudia; Grigioni, Francesco; Rosa, Rubina; Okita, Yutaka; Miyairi, Takeshi; Kunihara, Takashi; Koolbergen, David R.; Bekkers, Jos A.; Klautz, Robert J.M.; Brakel, Thomas van; Arabkhani, Bardia; Mecozzi, Gianclaudio; Accord, Ryan E.; Jasiński, Marek; Aminov, Vladislav; Svetkin, Mihail; Kolesár, Adrián; Sabol, František; Toporcer, Tomáš; Bibiloni, Ignacio; Rábago, Gregorio; Alvarez-Asiain, Virginia; Melero, Amaia; Sádaba, Rafael; Aramendi, José I.; Crespo, Alejandro; Porras, Carlos; Masip, Arturo Evangelista; Milewski, Rita K.; Moeller, Patrick; Wenger, Isaac; Leon, Christine R.; Marnette, J. M.; Doisy, Vincent; Wautot, Fabrice; Bourguignon, Thierry; Cameron, Duke E.; Chen, Edward

doi:10.1053/j.semtcvs.2019.05.033

Cited by 12 publications

(3 citation statements)

References 30 publications

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“…Every year 20% of patients who undergo aortic valve replacement surgery (AVR) are under 60 years of age (1). In this category of patients, the best therapeutic choice in terms of technique and aortic valve prosthesis presents a controversial issue.…”

Section: Introductionmentioning

confidence: 99%

Aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium to avoid the prosthesis-patient mismatch of a severely obese 57-year-old patient—a case report

Albertini¹,

Raviola²,

Zucchetta³

et al. 2022

J Vis Surg

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Aortic valve repair is the gold standard for aortic valve diseases and it is mandatory, every time it is possible, to spare the valve, especially in adults. In non-repairable aortic valves, the most common treatment is replacement with valve prostheses. Despite the risk of reoperation, bioprosthesis are often implanted in non-elderly adults. The durability of the bioprostheses in youngers is lower than in the elderlies. Immune reaction, shear stress and calcium metabolism can play a fundamental role in degeneration.The alternative to prosthetic aortic valve replacement is the Ross procedure, which apparently is the best option for this patient, but its complexity combined with the need for intervention on both aortic and pulmonary valves have limited the use of this technique over time. A more recent alternative is aortic valve neocuspidization, as outlined by Ozaki, which consists in aortic valve reconstruction using glutaraldehyde treated autologous pericardium. Seen the recent positive outcomes reported with this technique, we decided to submit the patient, an obese 57 years old female affected by severe rheumatic aortic valve stenosis and moderate mitral valve stenosis, to this procedure. Our idea was to reduce the risk of prosthesis-patient mismatch (PPM) that this patient faced, seen that she had a small aortic annulus, but a high body mass index. Results have been great: aortic valve gradients were low at discharge and at follow up. Learning from this case, we can assert that this kind of surgery can be safely performed achieving superior hemodynamic results and quality of life. Thus, we did not perform many cases of Ozaki neocuspidization, we always looked for the "perfect patient": young, without big comorbidities, thin. The case we describe obliged us to face with a problem that today's surgeons find out more and more in their clinical practice: obesity in young adults. It is a matter of fact that when a prosthetic valve is implanted the risk of PPM is always behind the corner for the valve structure itself and the big amount of prosthetic material it is composed by. Performing echocardiography and angio CT scan in patients who underwent aortic valve neocuspidization the effective orifice of the valve and the transvalvular gradients where always lower than in those patients who underwent replacement with a prosthesis. This fact has been the starting point for the thought that, maybe, Ozaki technique is the best solution for obese patients and this case proved us right.

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Section: Introductionmentioning

confidence: 99%

Aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium to avoid the prosthesis-patient mismatch of a severely obese 57-year-old patient—a case report

Albertini¹,

Raviola²,

Zucchetta³

et al. 2022

J Vis Surg

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“…Heart valve surgery improves survival, morbidity and the quality of life (1). Heart valve repair is the preferred strategy in regurgant heart valves and results in a life expectancy similar to the general population (2,3). But not all valves can be repaired and in these cases, valve replacement represents a valid alternative.…”

Section: Introductionmentioning

confidence: 99%

Antithrombotic Treatment After Surgical and Transcatheter Heart Valve Repair and Replacement

Verstraete

Herregods

Verbrugghe

et al. 2021

Front. Cardiovasc. Med.

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New antithrombotic drugs have been developed, new valve types have been designed and minimally invasive transcatheter techniques have emerged, making the choice of antithrombotic therapy after surgical or transcatheter heart valve repair and replacement increasingly complex. Moreover, due to a lack of large randomized controlled trials many recommendations for antithrombotic therapy are based on expert opinion, reflected by divergent recommendations in current guidelines. Therefore, decision-making in clinical practice regarding antithrombotic therapy for prosthetic heart valves is difficult, potentially resulting in sub-optimal patient treatment. This article compares the 2017 ESC/EACTS and 2020 ACC/AHA guidelines on the management of valvular heart disease and summarizes the available evidence. Finally, we established a convenient consensus on antithrombotic therapy after valve interventions based on over 800 annual cases of surgical and transcatheter heart valve repair and replacement and a multidisciplinary team discussion between the department of cardiovascular diseases and cardiac surgery of the University Hospitals Leuven, Belgium.

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“…The estimated loss in life expectancy was substantial, and increased with younger age (Figure 1) [1]." Their observation may be explained, in part, by the fact that longer life expectancy predicts increased exposure to prostheticvalve-related complications such as degeneration leading to reoperation, bleeding, and thromboembolism [2].…”

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confidence: 99%

A Review of Surgical Aortic Valve Repair. Indications and techniques for the General Cardiologist

Docekal¹

2020

JCCI

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In a recently published study on this topic, the authors conclude that their study found a "shorter life expectancy in patients after aortic valve replacement (AVR) compared with the general population. The estimated loss in life expectancy was substantial, and increased with younger age (Figure 1) [1]." Their observation may be explained, in part, by the fact that longer life expectancy predicts increased exposure to prostheticvalve-related complications such as degeneration leading to reoperation, bleeding, and thromboembolism [2].

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Aortic Valve Surgery in Nonelderly Patients: Insights Gained From AVIATOR

Cited by 12 publications

References 30 publications

Aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium to avoid the prosthesis-patient mismatch of a severely obese 57-year-old patient—a case report

Aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium to avoid the prosthesis-patient mismatch of a severely obese 57-year-old patient—a case report

Antithrombotic Treatment After Surgical and Transcatheter Heart Valve Repair and Replacement

A Review of Surgical Aortic Valve Repair. Indications and techniques for the General Cardiologist

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