Stroke After Aortic Valve Replacement

Waksman, Ron; Minha, Sa’ar

doi:10.1161/circulationaha.114.009684

Cited by 8 publications

(6 citation statements)

References 24 publications

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“…This particular finding is in agreement with results from a study by Ducci et al (20). Such stagnation zones are often associated with thrombosis, which could explain an increased risk of leaflet thrombosis and elevated gradients for patients with TAV (9,10). …”

Section: Discussionmentioning

confidence: 99%

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Aortic sinus flow stasis likely in valve-in-valve transcatheter aortic valve implantation

Hatoum

Moore

Maureira

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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Objective Valve in valve (ViV) procedures using transcatheter aortic valves (TAV) are increasingly performed to treat degenerated bioprosthetic surgical aortic valves (SAV) due to being less invasive than redo aortic valve replacement. The objective of this study is to quantify the changes in aortic sinus blood flow dynamics before and after ViV to gain insight into mechanisms for clinical and sub-clinical thrombosis of leaflets. Methods A detailed description of the sinus hemodynamics for ViV implantation was performed in-vitro. A Medtronic Hancock II porcine bioprosthesis was modeled as SAV and a Medtronic CoreValve and Edwards Sapien were used as the TAVs. High-resolution particle image velocimetry (PIV) was employed to compare the flow patterns from these two valves within both the left coronary and non-coronary sinuses in vitro. Results Velocity and vorticity within the surgical valve sinuses reached peak values of 0.7 m/s and 1000 s−1, with a 70% decrease in peak fluid shear stress near the aortic side of the leaflet in the non-coronary sinus. With the introduction of TAV, peak velocity and vorticity were reduced to around 0.4 m/s and 550 s−1 and 0.58 m/s and 653 s−1 without coronary flow and 0.60 m/s and 631 s−1 and 0.81 m/s and 669 s−1 with coronary flow for CoreValve and Sapien ViV respectively. Also, peak shear stress was around 38% higher along the aortic side of the coronary vs non-coronary TAV leaflet. Conclusions Decreased flow and shear stress in ViV indicates higher risk of leaflet thrombosis secondary to flow stasis in the non-coronary sinus.

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Section: Discussionmentioning

confidence: 99%

“…Chief among these complications is the difficulty of placement. This difficulty can lead to breaking off of tissue as well as numerous other detrimental effects(6) like blockage of coronary arteries(7,8), paravalvular regurgitation as well as unfavorable hemodynamic environments that leave the patient susceptible to stroke (9,10). …”

Section: Introductionmentioning

confidence: 99%

Aortic sinus flow stasis likely in valve-in-valve transcatheter aortic valve implantation

Hatoum

Moore

Maureira

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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“…Postoperative stroke has tremendous implications on a patient's hospitalization and is a significant burden to our health care system [2][3][4][5][6][7][8][9][10]23]. In this study, stroke resulted in a doubling of in-hospital mortality, a 4-day increase in hospital stay, and more than $10,000 in additional hospital costs compared with patients without stroke complications.…”

Section: Commentmentioning

confidence: 96%

“…Therefore, we used the ECS for risk stratification because it is more commonly used for analyzing large administrative data sets. For this study, patients were stratified using the ECS into low-(0-5), medium- (6)(7)(8)(9)(10)(11)(12)(13)(14)(15), and high-risk (16þ) categories. Results of patientlevel stratification based on the ECS are shown in Supplemental Table 1.…”

Section: Covariablesmentioning

confidence: 99%

“…At highvolume centers, mortality from surgical AVR is even lower: between 2011 and 2013 at the Cleveland Clinic, mortality for all surgical AVR was 0.6%, 0.4%, and 0.7%, respectively [5]. Despite these improvements, postoperative stroke remains a major cause of morbidity after AVR, especially in high-risk and elderly patients, and the true incidence of this complication from a population-based perspective remains unclear [2][3][4][5][6][7][8][9][10].…”

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confidence: 99%

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