Stentless valves for bicuspid and tricuspid aortic valve disease

Commentary: Aortic valve replacement in young adults: An open question

“…In this issue of the JTCVS Open , a propensity-matched study presented by Brown 3 raises an important finding in that aortic valve morphology had a significant impact on late mortality, which is in agreement with 2 other recent publications. 4 , 5 Patients with degenerative tricuspid aortic valves had worse survival at 10 to 15 years when compared with those with congenital bicuspid aortic valves (BAVs), despite a higher incidence of reoperations due to structural valve deterioration (SVD) in the latter cohort.…”

“…Because of the longer life expectancy in young patients with BAV, we agree with Brown 3 to recommend caution when considering surgical or transcatheter biological valves in these patients. Besides the old controversy on mechanical versus biological valves, results with aortic valve repair 8 and the recent data on the long-term outcomes with the Ross operation in selected middle-aged patients 9 have established benchmarks with which other options must be compared.…”

“…Definitions of SVD, based on valve reintervention, markedly underestimate the actual incidence of SVD; therefore, recent statements redefined SVD based on identification of structural and hemodynamic valve deterioration at echocardiographic follow-up. 7 Brown and colleagues 3 have shown a statistically significant, but not clinically impressive, higher incidence of reoperations in patients with BAV, but because the completeness of follow-up for reoperation was incomplete and no data were provided regarding the actual hemodynamic performance of the valves at different time periods, their findings in this regard are subject to criticisms. As an additional confounder, even in the hands of experienced surgeons, insertion of stentless valves in BAV roots is more prone to anatomic distortions that may ultimately lead to increased stresses on bioprosthetic valve leaflets, and subsequent earlier SVD and need for reoperation.…”

CFD Based on The Visualisation of Aortic Valve Mechanism in Aortic Valve Stenosis for Risk Prediction at The Peak Velocity

“…Patients who are financially burdened may view these methods as costly, causing them to lose motivation in addressing their aortic valve stenosis and increasing the risk of a fatal outcome [5]. Brown et al, stated that two prevailing treatment options used to determine the long-term survival and reoperation necessity in patients with an asymptomatic aortic valve are surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) [7]. Instead of SAVR and TAVR, medical officers typically rely on computational analysis methods to assess the condition of asymptotic aortic valves through echocardiogram images.…”

Commentary: Stentless valve for bicuspid aortic valve replacement: Some answers just lead to more questions

“…In this issue of JTCVS Open , Brown and colleagues 1 present a retrospective analysis of patients undergoing stentless aortic valve replacement for aortic stenosis and/or regurgitation in patients with bicuspid aortic valves (BAV) or tricuspid aortic valves (TAV). From 1992 to 2014, 1293 patients underwent stentless aortic valve replacement with modified inclusion technique at the University of Michigan and were followed for a median of 7.8 years (interquartile range, 4.2 years).…”