Surgical aortic valve replacement and left ventricular remodeling: Survival and sex‐related differences

Barletta, Giuseppe; Bene, Maria Riccarda Del; Venditti, F.; Pilato, Giuseppe; Stefàno, Pierluigi

doi:10.1111/echo.15122

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…In two-thirds of patients with AS, pressure overload drives LV remodeling, resulting in loss of LV compliance and eventually in diastolic and/or systolic dysfunction (8)(9)(10). This complication of AS causes higher mortality and rehospitalization rates after aortic valve replacement and may eventually lead to heart failure (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Soft robotic patient-specific hydrodynamic model of aortic stenosis and ventricular remodeling

et al. 2023

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Aortic stenosis (AS) affects about 1.5 million people in the United States and is associated with a 5-year survival rate of 20% if untreated. In these patients, aortic valve replacement is performed to restore adequate hemodynamics and alleviate symptoms. The development of next-generation prosthetic aortic valves seeks to provide enhanced hemodynamic performance, durability, and long-term safety, emphasizing the need for high-fidelity testing platforms for these devices. We propose a soft robotic model that recapitulates patient-specific hemodynamics of AS and secondary ventricular remodeling which we validated against clinical data. The model leverages 3D-printed replicas of each patient’s cardiac anatomy and patient-specific soft robotic sleeves to recreate the patients’ hemodynamics. An aortic sleeve allows mimicry of AS lesions due to degenerative or congenital disease, whereas a left ventricular sleeve recapitulates loss of ventricular compliance and diastolic dysfunction (DD) associated with AS. Through a combination of echocardiographic and catheterization techniques, this system is shown to recreate clinical metrics of AS with greater controllability compared with methods based on image-guided aortic root reconstruction and parameters of cardiac function that rigid systems fail to mimic physiologically. Last, we leverage this model to evaluate the hemodynamic benefit of transcatheter aortic valves in a subset of patients with diverse anatomies, etiologies, and disease states. Through the development of a high-fidelity model of AS and DD, this work demonstrates the use of soft robotics to recreate cardiovascular disease, with potential applications in device development, procedural planning, and outcome prediction in industrial and clinical settings.

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Section: Introductionmentioning

confidence: 99%

Soft robotic patient-specific hydrodynamic model of aortic stenosis and ventricular remodeling

et al. 2023

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“…In two thirds of AS patients, pressure overload drives LV remodeling, resulting in loss of LV compliance and eventually in diastolic and systolic dysfunction (8)(9)(10). This complication of AS causes higher mortality and rehospitalization rates after aortic valve replacement, and may eventually lead to heart failure (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Tunable, soft robotics-enabled patient-specific hydrodynamic model of aortic stenosis and secondary ventricular remodeling

Rosalia

Ozturk

Goswami

et al. 2022

Preprint

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Aortic stenosis (AS) affects approximately 1.5 million people in the US and is associated with a 5-year survival rate of 20% if untreated. In these patients, aortic valve replacement is performed to restore adequate hemodynamics and alleviate symptoms. The development of next-generation prosthetic aortic valves seeks to provide enhanced hemodynamic performance, durability, and long-term safety, emphasizing the need of high-fidelity testing platforms for these devices. We propose a soft robotic model of AS capable of recapitulating patient-specific hemodynamics of AS and secondary ventricular remodeling, validated against clinical data. The model leverages 3D printed replicas of each patient’s cardiac anatomy and patient-specific soft robotic sleeves to recreate the patients’ hemodynamics. An aortic sleeve allows mimicry of AS lesions due to degenerative or congenital disease, while a left ventricular sleeve recapitulates loss of ventricular compliance, and impaired filling associated with AS. Through a combination of echocardiographic and catheterization techniques, this system is shown to recreate clinical metrics of AS with greater controllability compared to methods based on image-guided aortic root reconstruction, and parameters of cardiac function which rigid systems fail to mimic physiologically. Finally, we demonstrate the use of this model for the evaluation of transcatheter aortic valves in a subset of patients with diverse anatomies, etiologies, and disease states. Through the development of a high-fidelity model of AS and secondary remodeling, this work pioneers the use of patient-specific soft robotic platforms of cardiovascular disease, with potential application in device development, procedural planning, and outcome prediction in industrial and clinical settings.One Sentence SummaryA high-fidelity, soft robotics-driven model recreates patient-specific biomechanics and hemodynamics of cardiovascular disease.

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Comparative study of male and female patients undergoing surgical aortic valve replacement

Çelik

Milojevic

Durko

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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Background Sex does have an effect on disease perception and outcomes after cardiac surgery. Objectives Quantify the differences in cardiovascular risk profiles within an age-matched cohort and assess the long-term survival differences in males and females who underwent surgical aortic valve replacement with or without concomitant coronary artery bypass surgery. Methods All-comers patients who underwent surgical aortic valve replacement with or without coronary artery bypass surgery were included. Characteristics, clinical features, and survival up to 30 years were compared between female and male patients. Propensity- and age-matching using propensity scores were used to compare both groups. Results During the total study period between 1987 and 2017, there were 3462 patients (mean age 66.8 (SD:11.1) years, 37.1% female) who underwent surgical aortic valve replacement with or without coronary artery bypass surgery at our institution. In general, female patients were older than male patients (69.1 (SD:10.3) versus 65.5 (SD:11.3), respectively). In the age-matched cohort, female patients were less likely to have multiple comorbidities and undergo concomitant coronary artery bypass surgery. Twenty-year survival following the index procedure was higher in age-matched female patients (27.1%) compared to male patients (24.4%) in the overall cohort), p = 0.018. Conclusions Substantial sex differences in cardiovascular risk profile exist. However, when surgical aortic valve replacement with or without coronary artery bypass surgery is performed, extended long-term mortality is comparable between males and females. More research regarding sex-dimorphic mechanisms of aortic stenosis and coronary atherosclerosis would promote more awareness in terms of sex-specific risk factors after cardiac surgery and contribute to more guided personalized surgery in the future.

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Surgical aortic valve replacement and left ventricular remodeling: Survival and sex‐related differences

Cited by 3 publications

References 29 publications

Soft robotic patient-specific hydrodynamic model of aortic stenosis and ventricular remodeling

Soft robotic patient-specific hydrodynamic model of aortic stenosis and ventricular remodeling

Tunable, soft robotics-enabled patient-specific hydrodynamic model of aortic stenosis and secondary ventricular remodeling

Comparative study of male and female patients undergoing surgical aortic valve replacement

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