The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform

Craig D Miller - One of the best experts on this subject based on the ideXlab platform.

  • incidence and progression of mild Aortic Regurgitation after tirone david reimplantation valve sparing Aortic root replacement
    The Journal of Thoracic and Cardiovascular Surgery, 2014
    Co-Authors: Elizabeth H Stephens, David Liang, Johnpeder Escobar Kvitting, Fabian A Kari, Michael P Fischbein, Scott R Mitchell, Craig D Miller
    Abstract:

    Objective The study objective was to determine whether recurrent or residual mild Aortic Regurgitation, which occurs after valve-sparing Aortic root replacement, progresses over time. Methods Between 2003 and 2008, 154 patients underwent Tirone David-V valve-sparing Aortic root replacement; 96 patients (62%) had both 1-year (median, 12 ± 4 months) and mid-term (62 ± 22 months) transthoracic echocardiograms available for analysis. Age of patients averaged 38 ± 13 years, 71% were male, 31% had a bicuspid Aortic valve, 41% had Marfan syndrome, and 51% underwent Aortic valve repair, predominantly cusp free margin shortening. Results Forty-one patients (43%) had mild Aortic Regurgitation on 1-year echocardiogram. In 85% of patients (n = 35), mild Aortic Regurgitation remained stable on the most recent echocardiogram (median, 57 ± 20 months); progression to moderate Aortic Regurgitation occurred in 5 patients (12%) at a median of 28 ± 18 months and remained stable thereafter; severe Aortic Regurgitation developed in 1 patient, eventually requiring reoperation. Five patients (5%) had moderate Aortic Regurgitation at 1 year, which did not progress subsequently. Two patients (2%) had more than moderate Aortic Regurgitation at 1 year, and both ultimately required reoperation. Conclusions Although mild Aortic Regurgitation occurs frequently after valve-sparing Aortic root replacement, it is unlikely to progress over the next 5 years and should not be interpreted as failure of the valve-preservation concept. Further, we suggest that mild Aortic Regurgitation should not be considered nonstructural valve dysfunction, as the 2008 valve reporting guidelines would indicate. We need 10- to 15-year follow-up to learn the long-term clinical consequences of mild Aortic Regurgitation early after valve-sparing Aortic root replacement.

  • acute type a Aortic dissection complicated by Aortic Regurgitation composite valve graft versus separate valve graft versus conservative valve repair
    The Journal of Thoracic and Cardiovascular Surgery, 2003
    Co-Authors: David T Lai, Scott R Mitchell, Craig D Miller, Philip E Oyer, Kathleen A Moore, Robert C Robbins, Norman E Shumway, Bruce A Reitz
    Abstract:

    Abstract Objective To clarify the merits of various surgical approaches, we studied the outcome after composite valve graft versus separate valve and graft replacement versus conservative valve treatment with replacement of the ascending aorta in patients with acute type A Aortic dissection complicated by Aortic Regurgitation. Methods Between 1967 and 1999, 123 patients (mean age 56 ± 15 years) underwent composite valve graft replacement (n = 21), separate valve and graft replacement (n = 20), or conservative valve treatment (n = 82 [commissural resuspension in 46]); follow-up averaged 6.5 years (95% complete). Results The 30-day, 1-year, and 6-year survival estimates of 85% ± 4%, 79% ± 5%, and 69% ± 5% (±1 standard error of mean), respectively, after conservative valve treatment were similar to 86% ± 8%, 81% ± 9%, and 65% ± 16%, respectively, with composite valve graft replacement and better (but insignificantly so) than 70% ± 10%, 70% ± 10%, and 45% ± 11%, respectively, with separate valve and graft replacement. The 6-year freedom from proximal reoperation was 95% ± 3%, 89% ± 10%, and 100% in conservative valve graft, separate valve and graft, and composite valve graft subgroups, respectively ( P = not significant). Cox regression multivariable analysis identified that previous sternotomy (hazard ratio [or e β ] 95% confidence interval 1.4-10.9, P = .006), hypertension (0.99-2.9, P = .05), cardiac tamponade (1.1-4.0, P = .03), and stroke (1.7-7.0, P = .001) increased the hazard of death. No factors predicting a higher likelihood of late proximal reoperation were identified. Conclusions In patients with acute type A Aortic dissection and Aortic Regurgitation, there was no significant difference in overall survival or reoperation rates among these surgical approaches. We try to save the valve whenever possible unless the Aortic root is pathologically dilated (eg, Marfan syndrome or annuloAortic ectasia) or destroyed by the dissection process, when composite valve graft or valve-sparing Aortic root replacement is indicated.

Maurice Enriquezsarano - One of the best experts on this subject based on the ideXlab platform.

  • contemporary differences between bicuspid and tricuspid Aortic valve in chronic Aortic Regurgitation
    Heart, 2020
    Co-Authors: Li Tan Yang, Maurice Enriquezsarano, Christopher G Scott, Patricia A Pellikka, Giovanni Benfari, Mackram F Eleid, Vuyisile T Nkomo, Nandan S Anavekar, Hector I Michelena
    Abstract:

    Objective To comprehensively explore contemporary differences between bicuspid Aortic valve (BAV) and tricuspid Aortic valve (TAV) patients with chronic haemodynamically significant Aortic Regurgitation (AR). Methods Consecutive patients with chronic ≥moderate-severe AR from a tertiary referral centre (2006–2017) were included. All-cause mortality, surgical indications and Aortic valve surgery (AVS) were analysed. Results Of 798 patients (296 BAV-AR, age 46±14 years; 502 TAV-AR, age 67±14 years, p 20 mm/m2; similar thresholds were observed for BAV-AR patients. Conclusion BAV-AR patients were two decades younger than TAV-AR and underwent AVS more frequently, resulting in a considerable real-life survival advantage for BAV-AR that was determined primarily by age and not valve anatomy. Pragmatically, regardless of valve anatomy, patients with haemodynamically significant AR and age >50–55 years require a low-threshold for surgical referral to prevent symptom development where LVEF 20 mm/m2 seem appropriate referral thresholds.

  • concomitant mitral Regurgitation in patients with chronic Aortic Regurgitation
    Journal of the American College of Cardiology, 2020
    Co-Authors: Li Tan Yang, Maurice Enriquezsarano, Christopher G Scott, Ratnasari Padang, Joseph F Maalouf, Patricia A Pellikka, Hector I Michelena
    Abstract:

    Abstract Background Etiology, mechanisms, and survival of mitral Regurgitation (MR) plus hemodynamically-significant chronic Aortic Regurgitation (AR) are mostly unknown. Objectives The purpose of ...

  • outcomes in chronic hemodynamically significant Aortic Regurgitation and limitations of current guidelines
    Journal of the American College of Cardiology, 2019
    Co-Authors: Li Tan Yang, Maurice Enriquezsarano, Christopher G Scott, Hector I Michelena, Hartzell V Schaff, Sorin V Pislaru, Patricia A Pellikka
    Abstract:

    Abstract Background Few data exist on the contemporary profiles and outcomes of patients with significant Aortic Regurgitation (AR). Objectives This study sought to assess the benefits of Aortic valve repair or replacement (AVR) and the prognostic value of left ventricular (LV) dimensions in significant AR. Methods From 2006 to 2017, consecutive patients with ≥moderate-severe chronic AR without prior heart surgery, myocardial infarction, or overt coronary artery disease were included. Results Of 748 participants (58 ± 17 years of age; 82% men), 387 (52%) were medically treated, and 361 (48%) had AVR. Of 361 patients having AVR, 334 (93%) met guideline criteria: Class I indications in 284 (79%) patients, which included symptoms in 236, and Class II indications in 50 (14%). The remaining 27 (7%) opted for surgery without Class I or II indications. At a median follow-up of 4.9 years (interquartile range: 2.3 to 8.3 years), 125 (17%) patients had died. Age, comorbidities, baseline symptoms, and higher LV end-systolic dimension index (LVESDi) were associated with all-cause mortality (all p ≤ 0.01). Compared with patients having LVESDi  Conclusions Class I indications for surgery, mainly symptoms, are the most common triggers for AVR. Class II indications were associated with better post-operative outcome and thus merit more attention. LVESDi was the only LV parameter independently associated with all-cause mortality and the ideal cutoff seems to be lower than previously recommended.

  • outcomes after Aortic valve replacement in patients with severe Aortic Regurgitation and markedly reduced left ventricular function
    Circulation, 2002
    Co-Authors: Hari P Chaliki, Christopher G Scott, Hartzell V Schaff, Jamil A Tajik, Dania Mohty, Jean Francois Avierinos, Maurice Enriquezsarano
    Abstract:

    Background— Left ventricular dysfunction is an indication for Aortic valve replacement (AVR) in patients with severe Aortic Regurgitation (AR). However, the postoperative outcome of patients with s...

  • mortality and morbidity of Aortic Regurgitation in clinical practice a long term follow up study
    Circulation, 1999
    Co-Authors: Karl S Dujardin, Maurice Enriquezsarano, Hartzell V Schaff, Kent R Bailey, James B Seward, Jamil A Tajik
    Abstract:

    Background —The outcome of Aortic Regurgitation conservatively followed in clinical practice is poorly defined. Methods and Results —Long-term outcome of 246 patients with severe or moderately severe Aortic Regurgitation diagnosed by color Doppler echocardiography was analyzed. With conservative management, mortality rate was higher than expected (at 10 years, 34±5%, P P P P =0.033), atrial fibrillation ( P =0.002), and left ventricular end-systolic diameter corrected for body surface area ( P =0.025). Ejection fraction was also an independent predictor of overall survival, including postoperative follow-up of surgically treated patients ( P P P =0.02) and in asymptomatic patients with left ventricular ejection fraction P =0.03) or with end-systolic diameter normalized to body surface area ≥25 mm/m 2 (7.8% yearly, P =0.004). Surgery performed during follow-up was independently associated with reduced cardiovascular mortality (adjusted hazard ratio, 0.54; P =0.048). Conclusions —Patients diagnosed with severe Aortic Regurgitation in clinical practice incur excess mortality and high morbidity, underscoring the serious prognosis of the disease. Surgery, which reduces cardiac mortality rates, should be considered promptly in high-risk patients.

Lenard Conradi - One of the best experts on this subject based on the ideXlab platform.

  • initial german experience with transapical implantation of a second generation transcatheter heart valve for the treatment of Aortic Regurgitation
    Jacc-cardiovascular Interventions, 2014
    Co-Authors: Moritz Seiffert, Ralf Bader, Utz Kappert, A Rastan, Stephan Krapf, Sabine Bleiziffer, Steffen Hofmann, Martin Arnold, Klaus Kallenbach, Lenard Conradi
    Abstract:

    Abstract Objectives This analysis reports on the initial German multicenter experience with the JenaValve (JenaValve Technology GmbH, Munich, Germany) transcatheter heart valve for the treatment of pure Aortic Regurgitation. Background Experience with transcatheter Aortic valve implantation (TAVI) for severe Aortic Regurgitation is limited due to the risk of insufficient anchoring of the valve stent within the noncalcified Aortic annulus. Methods Transapical TAVI with a JenaValve for the treatment of severe Aortic Regurgitation was performed in 31 patients (age 73.8 ± 9.1 years) in 9 German centers. All patients were considered high risk for surgery (logistic EuroSCORE [European System for Cardiac Operative Risk Evaluation] 23.6 ± 14.5%) according to a local heart team consensus. Procedural results and clinical outcomes up to 6 months were analyzed. Results Implantation was successful in 30 of 31 cases (Aortic annulus diameter 24.7 ± 1.5 mm); transcatheter heart valve dislodgement necessitated valve-in-valve implantation in 1 patient. Post-procedural Aortic Regurgitation was none/trace in 28 of 31 and mild in 3 of 31 patients. During follow-up, 2 patients underwent valvular reinterventions (surgical Aortic valve replacement for endocarditis, valve-in-valve implantation for increasing paravalvular Regurgitation). All-cause mortality was 12.9% and 19.3% at 30 days and 6 months, respectively. In the remaining patients, a significant improvement in New York Heart Association class was observed and persisted up to 6 months after TAVI. Conclusions Aortic Regurgitation remains a challenging pathology for TAVI. After initial demonstration of feasibility, this multicenter study revealed the JenaValve transcatheter heart valve as a reasonable option in this subset of patients. However, a significant early noncardiac mortality related to the high-risk population emphasizes the need for careful patient selection.

  • transapical implantation of a second generation transcatheter heart valve in patients with noncalcified Aortic Regurgitation
    Jacc-cardiovascular Interventions, 2013
    Co-Authors: Moritz Seiffert, Patrick Diemert, Dietmar Koschyk, Johannes Schirmer, Lenard Conradi, Renate B Schnabel, Stefan Blankenberg, Hermann Reichenspurner, Stephan Baldus, Hendrik Treede
    Abstract:

    Objectives This study sought to report on the feasibility and early results of transcatheter Aortic valve implantation employing a second-generation device in a series of patients with pure Aortic Regurgitation. Background Efficacy and safety of transcatheter Aortic valve implantation in patients with calcific Aortic stenosis and high surgical risk has been demonstrated. However, experience with implantation for severe noncalcified Aortic Regurgitation has been limited due to increased risk for valve dislocation or annular rupture. Methods Five patients (mean age: 66.6 ± 7 years) underwent transapical implantation of a JenaValve (JenaValve Technology GmbH, Munich, Germany) transcatheter heart valve for moderate to severe, noncalcified Aortic Regurgitation. All patients were considered high risk for surgical Aortic valve replacement after evaluation by an interdisciplinary heart team (logistic EuroSCORE [European System for Cardiac Operative Risk Evaluation] range 3.1% to 38.9%). Procedural and acute clinical outcomes were analyzed. Results Implantation was successful in all cases without relevant remaining Aortic Regurgitation or signs of stenosis in any of the patients. No major device- or procedure-related adverse events occurred and all 5 patients were alive with improved exercise tolerance at 3-month follow-up. Conclusions Noncalcified Aortic Regurgitation continues to be a challenging pathology for transcatheter Aortic valve implantation due to the risk for insufficient anchoring of the valve stent within the Aortic annulus. This report provides first evidence that the JenaValve prosthesis may be a reasonable option in these specific patients due to its unique stent design, clipping the native Aortic valve leaflets, and offering promising early results.

Janmalte Sinning - One of the best experts on this subject based on the ideXlab platform.

  • evaluation and management of paravalvular Aortic Regurgitation after transcatheter Aortic valve replacement
    Journal of the American College of Cardiology, 2013
    Co-Authors: Janmalte Sinning, Mariuca Vasanicotera, Derek Chin, Christoph Hammerstingl, Alexander Ghanem, Johan Bence, Jan Kovac, Eberhard Grube, Georg Nickenig, Nikos Werner
    Abstract:

    Paravalvular Aortic Regurgitation (PAR) negatively affects the prognosis after transcatheter Aortic valve replacement (TAVR) with dramatically increased morbidity and mortality in patients with more than mild PAR. Because transcatheter heart valves are implanted in a sutureless fashion using oversizing to anchor the prosthesis stent frame at the level of the virtual Aortic annulus, stent frame underexpansion due to heavily calcified cusps, suboptimal placement of the prosthesis, and/or annulus-prosthesis-size mismatch due to malsizing can contribute to paravalvular leakage. In contrast to open heart surgery, TAVR does not offer the opportunity to measure the Aortic annulus under direct vision during the procedure. Therefore, the dilemma before each TAVR procedure is the appropriate sizing of the dimensions of the Aortic annulus and to choose not only the size but also the transcatheter heart valve type (self-expanding vs. balloon-expandable) that fits the given anatomy best. Because precise echocardiographic quantification of PAR in patients with TAVR remains challenging especially in the acute implantation situation, a multimodal approach for the evaluation of PAR with the use of hemodynamic measurements and imaging modalities is imperative to precisely quantify the severity of Aortic Regurgitation immediately after valve implantation and to identify patients who will benefit from corrective measures such as post-dilation or valve-in-valve implantation. Every measure has to be taken to prevent or reduce PAR to provide a satisfying long-term clinical outcome.

  • incidence predictors and outcomes of Aortic Regurgitation after transcatheter Aortic valve replacement meta analysis and systematic review of literature
    Journal of the American College of Cardiology, 2013
    Co-Authors: Ganesh Athappan, Janmalte Sinning, Georg Nickenig, Eshan Patvardhan, Murat E Tuzcu, L Svensson, Pedro A Lemos, Chiara Fraccaro, Giuseppe Tarantini, Davide Capodanno
    Abstract:

    Objectives This study was designed to establish the incidence, impact, and predictors of post-transcatheter Aortic valve replacement (TAVR) Aortic Regurgitation (AR). Background AR is an important limitation of TAVR with ill-defined predictors and unclear long-term impact on outcomes. Methods Studies published between 2002 and 2012 with regard to TAVR were identified using an electronic search and reviewed using the random-effects model of DerSimonian and Laird. From 3,871 initial citations, 45 studies reporting on 12,926 patients (CoreValve [Medtronic CV Luxembourg S.a.r.l., Tolochenaz, Switzerland] n = 5,261 and Edwards valve [Edwards Lifesciences, Santa Ana, California] n = 7,279) were included in the analysis of incidence and outcomes of post-TAVR AR. Results The pooled estimate for moderate or severe AR post-TAVR was 11.7% (95% confidence interval [CI]: 9.6 to 14.1). Moderate or severe AR was more common with use of the CoreValve (16.0% vs. 9.1%, p = 0.005). The presence of moderate or severe AR post-TAVR increased mortality at 30 days (odds ratio: 2.95; 95% CI: 1.73 to 5.02) and 1 year (hazard ratio: 2.27; 95% CI: -1.84 to 2.81). Mild AR was also associated with an increased hazard ratio for mortality, 1.829 (95% CI: 1.005 to 3.329) that was overturned by sensitivity analysis. Twenty-five studies reported on predictors of post-TAVR AR. Implantation depth, valve undersizing, and Agatston calcium score (r = 0.47, p = 0.001) were identified as important predictors. Conclusions Moderate or severe Aortic Regurgitation is common after TAVR and an adverse prognostic indicator of short- and long-term survival. Incidence of moderate or severe AR is higher with use of the CoreValve. Mild AR may be associated with increased long-term mortality. Therefore, every effort should be made to minimize AR by a comprehensive pre-procedural planning and meticulous procedural execution.

  • Aortic Regurgitation index defines severity of peri prosthetic Regurgitation and predicts outcome in patients after transcatheter Aortic valve implantation
    Journal of the American College of Cardiology, 2012
    Co-Authors: Janmalte Sinning, Mariuca Vasanicotera, Christoph Hammerstingl, Alexander Ghanem, Viktoria Adenauer, Sisa Josefina Lema Cachiguango, Annecatherine Scheer, Sven Hausen, Alexander Sedaghat, Cornelius Muller
    Abstract:

    Objectives The aim of this study was to provide a simple, reproducible, and point-of-care assessment of peri-prosthetic Aortic Regurgitation (periAR) during transcatheter Aortic valve implantation (TAVI) and to decipher the impact of this peri-procedural parameter on outcome. Background Because periAR after TAVI might be associated with adverse outcome, precise quantification of periAR is of paramount importance but remains technically challenging. Methods The severity of periAR was prospectively evaluated in 146 patients treated with the Medtronic CoreValve (Minneapolis, Minnesota) prosthesis by echocardiography, angiography, and measurement of the Aortic Regurgitation (AR) index, which is calculated as ratio of the gradient between diastolic blood pressure (DBP) and left ventricular end-diastolic pressure (LVEDP) to systolic blood pressure (SBP): [(DBP − LVEDP)/SBP] × 100. Results After TAVI, 53 patients (36.3%) showed no signs of periAR and 71 patients (48.6%) showed only mild periAR, whereas 18 patients (12.3%) and 4 patients (2.7%) suffered from moderate and severe periAR, respectively. The AR index decreased stepwise from 31.7 ± 10.4 in patients without periAR, to 28.0 ± 8.5 with mild periAR, 19.6 ± 7.6 with moderate periAR, and 7.6 ± 2.6 with severe periAR (p Conclusions The assessment of the AR index allows a precise judgment of periAR, independently predicts 1-year mortality after TAVI, and provides additional prognostic information that is complementary to the echocardiographically assessed severity of periAR.

Moritz Seiffert - One of the best experts on this subject based on the ideXlab platform.

  • initial german experience with transapical implantation of a second generation transcatheter heart valve for the treatment of Aortic Regurgitation
    Jacc-cardiovascular Interventions, 2014
    Co-Authors: Moritz Seiffert, Ralf Bader, Utz Kappert, A Rastan, Stephan Krapf, Sabine Bleiziffer, Steffen Hofmann, Martin Arnold, Klaus Kallenbach, Lenard Conradi
    Abstract:

    Abstract Objectives This analysis reports on the initial German multicenter experience with the JenaValve (JenaValve Technology GmbH, Munich, Germany) transcatheter heart valve for the treatment of pure Aortic Regurgitation. Background Experience with transcatheter Aortic valve implantation (TAVI) for severe Aortic Regurgitation is limited due to the risk of insufficient anchoring of the valve stent within the noncalcified Aortic annulus. Methods Transapical TAVI with a JenaValve for the treatment of severe Aortic Regurgitation was performed in 31 patients (age 73.8 ± 9.1 years) in 9 German centers. All patients were considered high risk for surgery (logistic EuroSCORE [European System for Cardiac Operative Risk Evaluation] 23.6 ± 14.5%) according to a local heart team consensus. Procedural results and clinical outcomes up to 6 months were analyzed. Results Implantation was successful in 30 of 31 cases (Aortic annulus diameter 24.7 ± 1.5 mm); transcatheter heart valve dislodgement necessitated valve-in-valve implantation in 1 patient. Post-procedural Aortic Regurgitation was none/trace in 28 of 31 and mild in 3 of 31 patients. During follow-up, 2 patients underwent valvular reinterventions (surgical Aortic valve replacement for endocarditis, valve-in-valve implantation for increasing paravalvular Regurgitation). All-cause mortality was 12.9% and 19.3% at 30 days and 6 months, respectively. In the remaining patients, a significant improvement in New York Heart Association class was observed and persisted up to 6 months after TAVI. Conclusions Aortic Regurgitation remains a challenging pathology for TAVI. After initial demonstration of feasibility, this multicenter study revealed the JenaValve transcatheter heart valve as a reasonable option in this subset of patients. However, a significant early noncardiac mortality related to the high-risk population emphasizes the need for careful patient selection.

  • transapical implantation of a second generation transcatheter heart valve in patients with noncalcified Aortic Regurgitation
    Jacc-cardiovascular Interventions, 2013
    Co-Authors: Moritz Seiffert, Patrick Diemert, Dietmar Koschyk, Johannes Schirmer, Lenard Conradi, Renate B Schnabel, Stefan Blankenberg, Hermann Reichenspurner, Stephan Baldus, Hendrik Treede
    Abstract:

    Objectives This study sought to report on the feasibility and early results of transcatheter Aortic valve implantation employing a second-generation device in a series of patients with pure Aortic Regurgitation. Background Efficacy and safety of transcatheter Aortic valve implantation in patients with calcific Aortic stenosis and high surgical risk has been demonstrated. However, experience with implantation for severe noncalcified Aortic Regurgitation has been limited due to increased risk for valve dislocation or annular rupture. Methods Five patients (mean age: 66.6 ± 7 years) underwent transapical implantation of a JenaValve (JenaValve Technology GmbH, Munich, Germany) transcatheter heart valve for moderate to severe, noncalcified Aortic Regurgitation. All patients were considered high risk for surgical Aortic valve replacement after evaluation by an interdisciplinary heart team (logistic EuroSCORE [European System for Cardiac Operative Risk Evaluation] range 3.1% to 38.9%). Procedural and acute clinical outcomes were analyzed. Results Implantation was successful in all cases without relevant remaining Aortic Regurgitation or signs of stenosis in any of the patients. No major device- or procedure-related adverse events occurred and all 5 patients were alive with improved exercise tolerance at 3-month follow-up. Conclusions Noncalcified Aortic Regurgitation continues to be a challenging pathology for transcatheter Aortic valve implantation due to the risk for insufficient anchoring of the valve stent within the Aortic annulus. This report provides first evidence that the JenaValve prosthesis may be a reasonable option in these specific patients due to its unique stent design, clipping the native Aortic valve leaflets, and offering promising early results.