Impact of Aortic Annulus Enlargement on the Outcomes of Aortic Valve Replacement: A Meta-analysis

Zhigalov, Konstantin; Cavalcanti, Luiz Rafael Pereira; Neto, Amadeu Lombardi; Rayol, Sérgio C.; Weymann, Alexander; Ruhparwar, Arjang; Lima, Ricardo Carvalho

doi:10.1053/j.semtcvs.2020.06.046

Cited by 21 publications

(12 citation statements)

References 23 publications

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“…The largest meta‐analysis 20 published so far assessing the impact of ARE on the outcomes of SAVR included 13 studies with 40,447 patients (SAVR with ARE: 4686 patients; SAVR without ARE: 35,761 patients). On the one hand, this study failed to show any statistically significant difference between groups in the risk of death for SAVR with ARE without other concomitant procedures and in matched populations.…”

Section: Acting Upon the Aortic Root During Index Savr–bhv Size Is Th...mentioning

confidence: 99%

Lifetime management of aortic valve disease: Aligning surgical and transcatheter armamentarium to set the tone for the present and the future

Sá

Ramlawi

Sicouri

et al. 2021

Journal of Cardiac Surgery

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Transcatheter aortic valve replacement (TAVR) has already received the green light for high‐, intermediate‐ and low‐risk profiles and is an alternative for all patients regardless of age. It is clear that there has been a push towards the use of TAVR in younger and younger patients (<65 years), which has never been formally tested in randomized controlled trials but seems inevitable as TAVR technology makes steady progress. Lifetime management as a concept will set the tone in the field of the structural heart. Some subjects in this scenario arise, including the importance of optimized prosthetic hemodynamics for lifetime care; surgical procedures in the aortic root; management of structural valve degeneration with valve‐in‐valve procedures (TAVR‐in‐surgical aortic valve replacement [SAVR] and TAVR‐in‐TAVR) and redo SAVR; commissural alignment and cusp overlap for TAVR; the rise in the number of surgical procedures for TAVR explantation; and the renewed interest in the Ross procedure. This article reviews all these issues which will become commonplace during heart team meetings and preoperative conversations with patients in the coming years.

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Section: Acting Upon the Aortic Root During Index Savr–bhv Size Is Th...mentioning

confidence: 99%

Lifetime management of aortic valve disease: Aligning surgical and transcatheter armamentarium to set the tone for the present and the future

Sá

Ramlawi

Sicouri

et al. 2021

Journal of Cardiac Surgery

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“…The solution to this problem may be the liberal adoption of surgical techniques to enlarge the aortic root/annulus, which would enable cardiac surgeons to implant larger bioprosthetic valves during the index SAVR. Although most cardiac surgeons have been reluctant to enlarge the aortic root for fear of higher rates of death and complications, the most comprehensive meta‐analysis published so far 19 showed no statistically significant differences in the risk of death in isolated SAVR + AAE (without other concomitant cardiac procedures such as mitral or coronary surgery) and in matched populations either. The overall risk for myocardial infarction, stroke, complete heart block/permanent pacemaker implantation, and reoperation for bleeding showed no statistically significant difference either.…”

Section: Discussionmentioning

confidence: 99%

Bioprosthetic valve fracture for valve‐in‐valve transcatheter aortic valve implantation in patients with structural valve degeneration: Systematic review with meta‐analysis

Sá

Rayol²,

Eynde

et al. 2021

Journal of Cardiac Surgery

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Objectives: To determine the outcomes of bioprosthetic valve fracture (BVF) in valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) for patients with structural valve degeneration (SVD) of bioprosthetic surgical valves (BSV) implanted during surgical aortic valve replacement (SAVR).Methods: A systematic review was conducted including studies published by May 2021. The primary endpoints of the study were 30-day mortality, annular rupture, stroke, paravalvular leak, pacemaker implantation, and coronary obstruction. The secondary endpoints were mean valve gradients (mmHg) and aortic valve area (AVA-cm 2 ). A meta-analysis was conducted using the software R, version 3.6.3 (R Foundation for Statistical Computing).Results: Four studies including 242 patients met our eligibility criteria. The overall proportions for 30-day mortality, annular rupture, stroke, paravalvular leak, pacemaker implantation and coronary obstruction were 2.1%, <1.0%, <1.5%, <1.0%, <1.0%, and <1.5%, respectively. After ViV-TAVI with BVF, the difference in means for mean valve gradients showed a significant reduction (random-effects model: −26.7; −28.8 to −24.7; p < .001), whereas the difference in means for AVA showed a significant increase (random-effects model: 0.55 cm 2 ; 0.13-0.97; p = .029). Despite the improvement in AVA means, these remain too low after the procedure highly likely due to the small size of the bioprosthetic valves implanted during the index SAVR. Conclusion:ViV-TAVI with BVF has proven to be a promising option but data are still too scarce to enable us to draw definitive conclusions. Despite the decrease in gradients, postprocedural AVA remains worrisome. Studies with better designs and larger sample sizes are needed to advance this treatment option.

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“… 8 If surgeons are unable to implant an appropriate valve, they should resort to surgical techniques to enlarge the aortic annulus, making sure that the patient will receive a large valve and will not leave with PPM. 9 …”

Section: Discussionmentioning

confidence: 99%

Bioprosthetic Valve Fracture After TAVR Complicated by Balloon Rupture

Attisano

Bellino²,

Vigorito³

et al. 2022

JACC: Case Reports

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Impact of Aortic Annulus Enlargement on the Outcomes of Aortic Valve Replacement: A Meta-analysis

Cited by 21 publications

References 23 publications

Lifetime management of aortic valve disease: Aligning surgical and transcatheter armamentarium to set the tone for the present and the future

Lifetime management of aortic valve disease: Aligning surgical and transcatheter armamentarium to set the tone for the present and the future

Bioprosthetic valve fracture for valve‐in‐valve transcatheter aortic valve implantation in patients with structural valve degeneration: Systematic review with meta‐analysis

Bioprosthetic Valve Fracture After TAVR Complicated by Balloon Rupture

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