Structural valve deterioration of bioprosthetic aortic valves: An underestimated complication

Sénage, Thomas; Gillaizeau, Florence; Tourneau, Thierry Le; Marie, Basile; Roussel, Jean‐Christian; Foucher, Yohann

doi:10.1016/j.jtcvs.2018.08.086

Cited by 14 publications

(4 citation statements)

References 41 publications

(29 reference statements)

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“…Univariable parametric irreversible illness-death models (IDM) were used to investigate associations between risk factors and the development of a postoperative PVL, while accounting for interval-censored event times and death as a competing risk. [13][14][15] This analysis excluded any patient with a persistent PVL and any patient who did not have at least 1 postdischarge echocardiogram. In the IDM, there were 3 states: alive and free of postoperative PVL (state 0), alive with postoperative PVL (state 1), and death (state 2).…”

Section: Discussionmentioning

confidence: 99%

Incidence, Natural History, and Factors Associated With Paravalvular Leak Following Surgical Aortic Valve Replacement

Shah

Орлов

Orlov

et al. 2019

Innovations�(Phila)

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Objective: Our study investigates the incidence, cumulative incidence, natural history, and factors associated with intraoperative paravalvular leak (PVL) and the development of a postoperative PVL in a contemporary consecutive cohort of patients following surgical aortic valve replacement. Methods: A total of 636 patients underwent surgical aortic valve replacement from 2006 to 2016; 410 (64.5%) underwent minimally invasive aortic valve replacement and 226 (35.5%) underwent conventional aortic valve replacement. Primary outcomes were the incidence of intraoperative PVL and cumulative incidence of postoperative PVL. Secondary outcomes were the incidence of in-hospital and long-term death and need for reoperation. Results: The overall incidence of intraoperative PVL was 1.4% (95% confidence interval [CI]: 1% to 3%). All intraoperative PVLs developed in the hand-tied group. The overall incidence of postoperative PVL was 5.3% (95% CI: 4% to 7%). In the univariable and multivariable analyses, postoperative renal failure was the only factor significantly associated with the development of a postoperative PVL. Conclusions: The incidence of intraoperative PVL is low. Cumulative incidence of postoperative PVL was 3.1% (95% CI: 1.0% to 13.6%), 4.3% (95% CI: 1.3% to 16.5%), and 5.0% (95% CI: 1.4% to 17.9%) at 1, 3, and 5 years, respectively. All intraoperative PVLs occurred with hand-tied knots. A larger cohort may identify additional risk factors.

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Section: Discussionmentioning

confidence: 99%

Incidence, Natural History, and Factors Associated With Paravalvular Leak Following Surgical Aortic Valve Replacement

Shah

Орлов

Orlov

et al. 2019

Innovations�(Phila)

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“…СЕРДЕЧНАЯ И СОСУДИСТАЯ ХИРУРГИЯ Л ечение пациентов молодого и среднего возраста с пороком аортального клапана (АК) остается сложной задачей. Обычно используемые варианты хирургической замены АК имеют определенные недостатки: биопротезы подвержены дегенерации, требующей повторного вмешательства, а механические протезы -пожизненной антикоагулянтной терапии [1]. И альтернативой протезам является протезирование АК (ПАК) легочным аутографтом, предложенная Д. Россом в 1967 г.…”

Section: клиническая и экспериментальная хирургияunclassified

Long-term results of the Ross operation in adults

Chernov,

Enginoev,

Аbdulmedzhidova

et al. 2023

Clinical and Experimental Surgery. Petrovsky journal

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Критерии исключения отсутствуют. Медиана возраста составила 35 [26-44] лет. Инфекционный эндокардит в качестве дисфункции АК был диагностирован у 56 (27,2%) больных, а двустворчатый АК -у 125 (60,7%) пациентов. Медиана периода наблюдения составила 94 [42-115] мес. Результаты. Комбинированные вмешательства были выполнены в 38 (18,4%) случаях. Модифицированные методики были применены в 23,3% случаях. Медиана продолжительности операции составила 220 [195-255] мин, искусственного кровообращения -138 [123-155] мин, ишемии миокарда 115 [103-127] мин. Госпитальная летальность составила 0,5%. В раннем послеоперационном периоде 5 (2,4%) пациентам была показана имплантация постоянного электрокардиостимулятора в связи с нарушениями проводимости. У 9 (4,4%) пациентов развилось периоперационное повреждение миокарда, количество инсультов -2 (1%). 10-летняя общая выживаемость, свобода от реоперации на легочном аутографте и гомографте составила 95,6; 87,8; 96,5% соответственно. К концу периода наблюдения медиана пикового и среднего градиента на легочном аутографте составила 6 [4-8] и 3 [2-5] мм рт.ст., а аортальная регургитация II степени выявлена у 34 (17,8%) пациентов. Заключение. Процедура Росса является безопасной альтернативой протезированию АК в опытных руках с низкой госпитальной летальностью и приемлемыми отдаленными результатами. Финансирование. Исследование не имело спонсорской поддержки. Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

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“…However, BHVs may undergo irreversible dysfunction known as structural valve deterioration (SVD). SVD increases over time and is more accelerated in young people who have a greater likelihood of reoperation, which carries a twofold increase in the risk of death [ 2 ]. Nevertheless, BHV may be a reasonable choice in patients above 50 years old [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Oxidative Stress in Structural Valve Deterioration: A Longitudinal Clinical Study

et al. 2022

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The cause of structural valve deterioration (SVD) is unclear. Therefore, we investigated oxidative stress markers in sera from patients with bioprosthetic heart valves (BHVs) and their association with SVD. Blood samples were taken from SVD (Phase A) and BHV patients during the first 24 (Phase B1) and >48 months (Phase B2) after BHV implantation to assess total antioxidant capacity (TAC), malondialdehyde (MDA), and nitrotyrosine (NT). The results show that MDA levels increased significantly 1 month after surgery in all groups but were higher at 6 months only in incipient SVD patients. NT levels increased gradually for the first 24 months after implantation in the BHV group. Patients with transcatheter aortic valve implantation (TAVI) showed even higher levels of stress markers. After >48 months, MDA and NT continued to increase in BHV patients with a further elevation after 60–72 months; however, these levels were significantly lower in the incipient and established SVD groups. In conclusion, oxidative stress may play a significant role in SVD, increasing early after BHV implantation, especially in TAVI cases, and also after 48 months’ follow-up, but decreasing when SVD develops. Oxidative stress potentially represents a target of therapeutic intervention and a biomarker of BHV dysfunction.

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Structural valve deterioration of bioprosthetic aortic valves: An underestimated complication

Cited by 14 publications

References 41 publications

Incidence, Natural History, and Factors Associated With Paravalvular Leak Following Surgical Aortic Valve Replacement

Incidence, Natural History, and Factors Associated With Paravalvular Leak Following Surgical Aortic Valve Replacement

Long-term results of the Ross operation in adults

Oxidative Stress in Structural Valve Deterioration: A Longitudinal Clinical Study

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