Selection of prosthetic aortic valve and root replacement in patients younger than age 30 years

Milewski, Rita K.; Habertheuer, Andreas; Bavaria, Joseph E.; Fuller, Stephanie; Desai, Nimesh D.; Szeto, Wilson Y.; Korutla, Varun; Vallabhajosyula, Prashanth

doi:10.1016/j.jtcvs.2018.06.102

Cited by 12 publications

(5 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Mazine and colleagues 11 reported mean aortic pressure gradients in adults after mechanical heart valve replacement between 9.3 and 17 mm Hg in a systemic review and meta-analysis. Interestingly, Milewski and colleagues 12 found an increase in the mean aortic transvalvular gradient over time even in mechanical valves, reaching 20 mm Hg at 9.5 years postoperatively. The mean transvalvular pressure gradient over time was low (<6 mm Hg) in this study, comparable to the in vitro data for this valve.…”

Section: Discussionmentioning

confidence: 99%

Aortic valve replacement in sheep with a novel trileaflet mechanical heart valve prosthesis without anticoagulation

et al. 2021

View full text Add to dashboard Cite

Background: Even after decades of intensive research, an ideal heart valve prosthesis remains elusive. Shortcomings of conventional devices include reduced durability of bioprostheses and the thrombogenicity of mechanical substitutes, necessitating anticoagulation and resulting in imperfect hemodynamics. Here we present in vivo results of a novel mechanical heart valve prosthesis aiming for freedom from anticoagulation.Methods: Four female sheep had their aortic valves replaced using the novel mechanical heart valve (size 21 mm), with no postoperative anticoagulation treatment. This trileaflet heart valve was designed with the pivots in the systolic central flow. Hemodynamics, biochemistry, hematology, and macroscopy and microscopy were studied at 90 days in 2 sheep and at 1 year in the other 2 sheep.Results: Mean (<6 mm Hg) and peak (<10 mm Hg) aortic transvalvular gradients remained low during the study period. Aortic regurgitation was trivial, and central traces were only rarely observed. The rate of thrombotic events was very low, with none macroscopically and microscopically visible thrombotic material on the device. Biochemistry and hemotology were unchanged without hemolysis. In 3 sheep, the fibrous pannus and mitral leaflet were partially folded over the edge of the annular body. Apart from organic/inorganic deposits on the leaflets after 1 year, the ultrastructurally evaluated leaflets were similar to those of nonimplanted controls. Conclusions:The preliminary in vivo results of this novel anticoagulation-free aortic mechanical heart valve are promising with excellent hemodynamics and a very low risk of thrombotic events. (JTCVS Open 2021;7:76-88) Novel trileaflet mechanical heart valve explanted after 375 days in a sheep model.

show abstract

Section: Discussionmentioning

confidence: 99%

Aortic valve replacement in sheep with a novel trileaflet mechanical heart valve prosthesis without anticoagulation

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Milewski et al [21] presented an 18-year experience with AV replacement. The study compared the immediate and long-term results of AV replacement with biological and mechanical prostheses in young people.…”

Section: Discussionmentioning

confidence: 99%

Immediate and Medium-Term Results of Aortic Valve Replacement With Biological Prosthesis in Elderly Patients: One Center’s Experience

Kadyraliev,

Belov,

Marchenko

et al. 2023

Preprint

View full text Add to dashboard Cite

Currently, aortic valve (AV) disease is the most common reason for heart valve surgery. The gold standard of care for people with aortic pathology is thought to be AV replacement. The issue of prosthesis selection has always been important. Although mechanical prosthesis are robust, lifelong anticoagulation medication is necessary due to the significant risk of thromboembolic consequences. Biological prostheses have a flow structure that is similar to the physiological one, and as malfunction gradually sets in, scheduled recurrent surgery can be carried out. The purpose of this study is to evaluate the short- and long-term effects of biological prosthetic aortic valve replacement (AVR) in elderly individuals. The study included 198 patients with AV pathology [85 men (42.9%)/113 women (57.1%)]. The median age was 70 [66–73] years. There were 175 (88.4%) patients with degenerative AV, 5 (2.5%) with infective endocarditis, and 30 patients (15.2%) had bicuspid AV. The median follow-up period was 26.3±1.4 months. Hospital mortality was 4.5%. No wound complications were detected. Thirty-one patients died in the long-term period. The causes of lethality were: cardiovascular disease (13 patients), malignant neoplasm (5 patients), gastrointestinal disease (2 patients), urinary system disease (1 patient), COVID-19 (1 patient), unknown cause (9 patients). Thus, the five-year postoperative survival rate was 63%, respectively. Throughout the observation period, two patients (2.9%) underwent reoperation on AV. 97.1% of patients were free of reoperation after five years. The five-year survival rate was 63% due to the history of severe concomitant pathology and mean age of the patients of 70 years.

show abstract

“…Em pacientes mais jovens, os estudos são bastante limitados a longo prazo, não sendo possível definir a diferença entre necessidade de reoperação ou taxas de mortalidade nos dois tipos de prótese. Dessa forma, o uso da prótese mecânica, apesar de ser o mais recomendado, deve ser avaliado de acordo com os desejos e necessidades de cada paciente (MILEWSKI et al, 2019).…”

Section: Revisão Bibliográficaunclassified

Implantação de prótese na insuficiência valvar cardíaca: mecânica ou biológica / Implantation of prosthesis in valvular heart disease: mechanical or biological

Floriano¹,

LIMA²,

Guerino³

et al. 2021

Braz. J. Hea. Rev.

View full text Add to dashboard Cite

Este artigo buscou analisar as próteses valvares biológicas e mecânicas por meio de comparações associadas às suas diferentes durabilidades, riscos de desenvolver endocardite, tromboembolismo, eventos hemorrágicos, necessidade de reoperações e sobrevida a longo prazo, além da relação de custo e benefício de cada tipo de prótese valvar. As válvulas cardíacas mecânicas possuem como principal vantagem sua longa durabilidade, apresentando um número reduzido de reoperação comparadas as válvulas cardíacas biológicas, que sofrem desgaste maior com o tempo. O grande destaque recebido pelas válvulas cardíacas biológicas é relacionado a sua independência de medicamentos, algo que se apresenta como obstáculo pelas válvulas mecânicas devido à necessidade do uso de anticoagulante de forma vitalícia, ocasionado pela alta probabilidade de desenvolvimento de trombose na região valvar e, consequentemente, embolia, eventos que não ocorrem nas valvas biológicas. A eleição do tipo de prótese valvar deve ser feita de acordo com o perfil de cada paciente, levando em consideração suas individualidades, como idade, comorbidades, riscos de reoperação e sobrevida após operação, com a finalidade de promover um melhor prognóstico e qualidade de vida para esse grupo.

show abstract

Selection of prosthetic aortic valve and root replacement in patients younger than age 30 years

Cited by 12 publications

References 31 publications

Aortic valve replacement in sheep with a novel trileaflet mechanical heart valve prosthesis without anticoagulation

Aortic valve replacement in sheep with a novel trileaflet mechanical heart valve prosthesis without anticoagulation

Immediate and Medium-Term Results of Aortic Valve Replacement With Biological Prosthesis in Elderly Patients: One Center’s Experience

Implantação de prótese na insuficiência valvar cardíaca: mecânica ou biológica / Implantation of prosthesis in valvular heart disease: mechanical or biological

Contact Info

Product

Resources

About