Current surgical strategies and techniques of aortic valve diseases in children

Wang, Kun; Zhang, Huifeng; Jia, Bing

doi:10.21037/tp.2018.02.03

Cited by 13 publications

(7 citation statements)

References 44 publications

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“…The aortic homograft (allograft) comes from the human donor and is thought to be a suitable substitute for patients who are too small for mechanical or bio-prosthetic valves [12]. In addition, the aortic homograft offers several advantages, including good hemodynamics, low thrombogenicity, and no anticoagulation after implantation.…”

Section: Introductionmentioning

confidence: 99%

Numerical and in-vitro experimental assessment of the performance of a novel designed expanded-polytetrafluoroethylene stentless bi-leaflet valve for aortic valve replacement

et al. 2019

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The expanded polytetrafluoroethylene (ePTFE) heart valve can serve as a viable option for prosthetic aortic valve. In this study, an ePTFE bi-leaflet valve design for aortic valve replacement (AVR) is presented, and the performance of the proposed valve was assessed numerically and experimentally. The valve was designed using CAE software. The dynamic behavior of the newly designed bi-leaflet valve under time-varying physiological pressure loading was first investigated by using commercial finite element code. Then, in-vitro tests were performed to validate the simulation and to assess the hemodynamic performance of the proposed design. A tri-leaflet ePTFE valve was tested in-vitro under the same conditions as a reference. The maximum leaflet coaptation area of the bi-leaflet valve during diastole was 216.3 mm2. When fully closed, no leakage gap was observed and the free edges of the molded valve formed S-shaped lines. The maximum Von Mises stress during a full cardiac cycle was 4.20 MPa. The dynamic performance of the bi-leaflet valve was validated by the in-vitro test under physiological aortic pressure pulse. The effective orifice area (EOA), mean pressure gradient, regurgitant volume, leakage volume and energy loss of the proposed valve were 3.14 cm2, 8.74 mmHg, 5.93 ml/beat, 1.55 ml/beat and 98.99 mJ, respectively. This study reports a novel bi-leaflet valve design for AVR. The performance of the proposed valve was numerically and experimentally assessed. Compared with the reference valve, the proposed design exhibited better structural and hemodynamic performances, which improved valve competency. Moreover, the performance of the bi-leaflet design is comparable to commercialized valves available on the market. The results of the present study provide a viable option for the future clinical applications.

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Section: Introductionmentioning

confidence: 99%

Numerical and in-vitro experimental assessment of the performance of a novel designed expanded-polytetrafluoroethylene stentless bi-leaflet valve for aortic valve replacement

et al. 2019

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“…Assuming the measured diameter of annulus of the aortic valve is D, here we designed our leaflet using these equations derived from series of computational fluid dynamics (CFD) experiments and clinical studies of valved conduit ( 13 - 15 ) ( Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

A midterm follow-up study of the application of a confluent aortic valve neocuspidization technique with pericardium in children

Huang,

Zhang,

Jia

et al. 2023

Transl Pediatr

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Background The treatment of aortic valve diseases in children remains a great challenge. We aim to report outcomes and midterm follow-up data of our confluent neocuspidization technique with pericardium for aortic valve replacement (AVR) in children. Methods A retrospective analysis was performed on all 20 children who underwent the confluent neocuspidization technique with pericardium at Children’s Hospital of Fudan University from March 2017 to May 2022. Outcome measures included echocardiographic measurements, surgical intervention, and mortality. Results A total of 20 patients (17 males vs. 3 females), with a median age of 7.5 years [min–max, 0.3–12 years; interquartile range (IQR), 4.4–9.7 years], a median body weight of 24.0 kg (min–max, 6.0–52.3 kg; IQR, 15.6–31.0 kg), and median aortic valve annulus size before surgery of 19.0 mm (min–max, 11.0–25.0 mm; IQR, 17.1–21.5 mm), underwent the neocuspidization technique with pericardium (17 autologous pericardia and 3 bovine patch). With 50% of bicuspid aortic valve and 50% of tricuspid, they were respectively diagnosed as aortic stenosis (AS) (7/20, 35%), aortic regurgitation (AR) (8/20, 40%) and mixed AS and AR (AS & AR) (5/20, 25%). The median postoperative follow-up time was 19 months (min–max, 5–61 months; IQR, 16.3–35 months). The peak pressure gradient across the aortic valve decreased from 81.0±37.0 mmHg in AS group and AS & AR group before surgery to 25.9±15.8 mmHg within 24 hours after surgery (P<0.001) and was mostly around 25 mmHg during follow-up. All patients presented mild or less than mild regurgitation within 24 hours after surgery. There were no hospital mortalities. Three patients needed reintervention during follow-up. There was one late death related to mitral valve stenosis. Conclusions Though the confluent neocuspidization technique with pericardium provided immediate relief of significant AS or regurgitation, the midterm outcome was suboptimal. More research is needed to find the optimal material for AVR.

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“…Лишь 1 (3%) пациенту в группе министернотомии потребовалась имплантация ЭКС, в группе полной стернотомии имплантаций не было (р=1,0) [15]. В ряде других исследований, инициируемых Озаки (n=404, n=108) [11,16], в обзорах литературы [6,17] отсутствуют какие-либо упоминания о нарушениях проводимости, ассоциированных с про-цедурой Озаки. В опубликованном в 2020 году отечественном многоцентровом исследовании, изучающим непосредственные результаты операции Озаки, нарушения ритма, потребовавшие в послеоперационном периоде имплантации ЭКС, рассматривались как одна из вторичных конечных точек.…”

Section: таблица 1 клинико-демографические показатели пациентов включ...unclassified

Analysis of cardiac conduction disorders in adult patients in the early postoperative period after Ozaki surgery

Makarova

Дурманов

Batrakov

et al. 2022

Vestnik aritmologii

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Purpose. To assess the disorders of the cardiac conduction system (CCS) that occurred in the early postoperative period after aortic valve (AV) replacement by the Ozaki method.Methods. The study included 256 patients after a successfully performed Ozaki procedure. Patients with a history of open cardiac surgery, with an implanted pacemaker, with permanent atrial fibrillation, with simultaneous Ozaki surgery with correction of another pathology, in case of repeated surgery on AV in the next six months, with lethal outcome, under the age of 18 years, when it is impossible to analyze the CCS dynamics were excluded. The mean age was 57.9±11.1 years, the male sex was 119 people (46.5%), the body mass index was 29.7±5.5 kg/m2 , diabetes was observed in 40 patients (15.6%), anamnesis of CCS disorders in 10 (3.9%), CCS disorders on the baseline electrocardiogram (ECG) in 32 (12.5%). Conduction abnormalities were assessed according to the anamnesis and the results of daily ECG recording.Results. In the early postoperative period, CCS disorders were registered in 35 patients (13.7%), of whom 27 (10.6%) had their first occurrence, and 8 (3.1%) had previously existed. By the time of discharge, persistent CCS disorders (which occurred for the first time and in the case of progression of pre-existing blocks) remained in 11 (4.3%): 8 (3.1%) had bundle branch blocks, 3 (1.2%) had atrioventricular blocks that required implantation of a permanent pacemaker. Patients with pacemaker had initial conduction abnormalities. The most frequent dysfunction of the CСS was the left bundle branch block (LBBB) (45.5%). We analyzed 14 variables as predictors of the onset or progression of persistent CCS disorders. Two independent predictors were identified - the presence of conduction abnormalities on the baseline ECG and the time of cardiopulmonary bypass. In patients with persistent conduction disturbances in the postoperative period, CCS disorders on the baseline ECG were more common - 36.4% compared with patients without CCS disorders after surgery - 11.4% (p=0.035) and there was a longer duration of cardiopulmonary bypass 140.6±41.1 min. and 122.4±26.1 min. respectively (p=0.03).Conclusion. The most frequent disorder of the conduction was the LBBB. None of the first dysfunctions of CCS led to the implantation of the pacemaker. The presence of initial ECG conduction disturbances and the time of cardiopulmonary

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Current surgical strategies and techniques of aortic valve diseases in children

Cited by 13 publications

References 44 publications

Numerical and in-vitro experimental assessment of the performance of a novel designed expanded-polytetrafluoroethylene stentless bi-leaflet valve for aortic valve replacement

Numerical and in-vitro experimental assessment of the performance of a novel designed expanded-polytetrafluoroethylene stentless bi-leaflet valve for aortic valve replacement

A midterm follow-up study of the application of a confluent aortic valve neocuspidization technique with pericardium in children

Analysis of cardiac conduction disorders in adult patients in the early postoperative period after Ozaki surgery

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