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Matheus Simonato - One of the best experts on this subject based on the ideXlab platform.
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outcomes following transcatheter aortic valve replacement for degenerative stentless versus stented bioprostheses
Jacc-cardiovascular Interventions, 2019Co-Authors: Alison Duncan, Neil Moat, Matheus Simonato, Arend De Weger, Jorg Kempfert, Holger Eggebrecht, A Walton, Farrel Hellig, Ran Kornowski, Konstantinos SpargiasAbstract:Abstract Objectives A large comprehensive analysis of transcatheter aortic valve replacement (TAVR) was performed for failed stentless bioprostheses. Background Valve-in-valve (ViV) transcatheter aortic replacement (TAVR) is an alternative to redo surgery for patients with a failing aortic Bioprosthesis. Methods Unadjusted outcome data were collected from the VIVID (Valve-in-Valve International Data) registry between 2007 and 2016 from a total of 1,598 aortic ViV procedures (291 stentless, 1,307 stented bioprostheses). Results Bioprosthetic failure was secondary to aortic regurgitation in 56% of stentless and 20% stented devices (p Conclusions Stentless ViV-TAVR is associated with greater periprocedural complications (initial device malposition, second transcatheter device, coronary obstruction, paravalvular leak), but no difference in 30-day and 1-year outcome.
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incidence predictors and clinical outcomes of coronary obstruction following transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves insights from the vivid registry
European Heart Journal, 2018Co-Authors: Josep Rodescabau, Matheus Simonato, Henrique Barbosa Ribeiro, Philipp Blanke, Jonathon Leipsic, Jong Kwan Park, Vinayak Bapat, Raj MakkarAbstract:Aims: There are limited data on coronary obstruction following transcatheter valve-in-valve (ViV) implantation inside failed aortic bioprostheses. The objectives of this study were to determine the incidence, predictors, and clinical outcomes of coronary obstruction in transcatheter ViV procedures. Methods and results: A total of 1612 aortic procedures from the Valve-in-Valve International Data (VIVID) Registry were evaluated. Data were subject to centralized blinded corelab computed tomography (CT) analysis in a subset of patients. The virtual transcatheter valve to coronary ostium distance (VTC) was determined. A total of 37 patients (2.3%) had clinically evident coronary obstruction. Baseline clinical characteristics in the coronary obstruction patients were similar to controls. Coronary obstruction was more common in stented bioprostheses with externally mounted leaflets or stentless bioprostheses than in stented with internally mounted leaflets bioprostheses (6.1% vs. 3.7% vs. 0.8%, respectively; P < 0.001). CT measurements were obtained in 20 (54%) and 90 (5.4%) of patients with and without coronary obstruction, respectively. VTC distance was shorter in coronary obstruction patients in relation to controls (3.24 ± 2.22 vs. 6.30 ± 2.34, respectively; P < 0.001). Using multivariable analysis, the use of a stentless or stented Bioprosthesis with externally mounted leaflets [odds ratio (OR): 7.67; 95% confidence interval (CI): 3.14-18.7; P < 0.001] associated with coronary obstruction for the global population. In a second model with CT data, a shorter VTC distance predicted this complication (OR: 0.22 per 1 mm increase; 95% CI: 0.09-0.51; P < 0.001), with an optimal cut-off level of 4 mm (area under the curve: 0.943; P < 0.001). Coronary obstruction was associated with a high 30-day mortality (52.9% vs. 3.9% in the controls, respectively; P < 0.001). Conclusion: Coronary obstruction following aortic ViV procedures is a life-threatening complication that occurred more frequently in patients with prior stentless or stented bioprostheses with externally mounted leaflets and in those with a short VTC.
V Arena - One of the best experts on this subject based on the ideXlab platform.
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single suture line placement of a pericardial stentless valve
The Journal of Thoracic and Cardiovascular Surgery, 2005Co-Authors: Alberto Repossini, Riad Bouchikhi, Bruno Passaretti, Tiziano Torre, Igor A. Kotelnikov, Oberdan Parodi, V ArenaAbstract:Objective Implantation of bioprostheses in the supra-annular position with the single suture line was first applied by O'Brien to porcine stentless valves. The aim of this study was to evaluate the clinical performance of the Pericarbon Freedom stentless Bioprosthesis (Sorin Biomedica Cardio, Saluggia, Italy) implanted in supra-annular position with the single–suture line technique. The single-suture approach for the Pericarbon Freedom stentless Bioprosthesis is obtained by trimming away all the extra tissue of the valve inflow side and scalloping the outflow side. Methods Between February 2002 and August 2004, a total of 65 consecutive patients at our institution (48% male, mean age 69 ± 12 years) underwent aortic valve replacement with Pericarbon Freedom stentless bioprostheses implanted with a single suture line. Most recurrent etiology was senile degeneration (80%). Pericarbon Freedom 25-mm and 27-mm valves were the most frequently implanted. Thirty patients had concomitant procedures (mainly coronary artery bypass grafting, 16 patients). Overall crossclamp time was 76 ± 21 minutes. Results All patients survived intervention. One patient died early of multiorgan failure (postoperative day 16). There were 4 early non–valve-related complications and no late complications at a mean follow-up of 491 ± 270 days. Four patients showed trivial central prosthetic regurgitation at intraoperative transesophageal echocardiography; among these cases, only 1 was confirmed at 6-month transthoracic echocardiography. At postoperative echocardiographic assessment, mean pressure gradient for the 25- through 29-mm size group was 10.2 ± 7.1 mm Hg, and peak pressure gradient was 18.1 ± 12.3 mm Hg. Conclusion Our initial experience combined a well-established supra-annular implantation technique with the Pericarbon Freedom stentless Bioprosthesis, a latest-generation pericardial stentless valve. The combination showed excellent results in terms of safety and reliability, although this technique required adequate experience. Clinical outcomes are similar to those obtained with other techniques, with satisfactory hemodynamic performance.
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Single–suture line placement of a pericardial stentless valve
The Journal of Thoracic and Cardiovascular Surgery, 2005Co-Authors: Alberto Repossini, Riad Bouchikhi, Bruno Passaretti, Tiziano Torre, Igor A. Kotelnikov, Oberdan Parodi, V ArenaAbstract:Objective Implantation of bioprostheses in the supra-annular position with the single suture line was first applied by O'Brien to porcine stentless valves. The aim of this study was to evaluate the clinical performance of the Pericarbon Freedom stentless Bioprosthesis (Sorin Biomedica Cardio, Saluggia, Italy) implanted in supra-annular position with the single–suture line technique. The single-suture approach for the Pericarbon Freedom stentless Bioprosthesis is obtained by trimming away all the extra tissue of the valve inflow side and scalloping the outflow side. Methods Between February 2002 and August 2004, a total of 65 consecutive patients at our institution (48% male, mean age 69 ± 12 years) underwent aortic valve replacement with Pericarbon Freedom stentless bioprostheses implanted with a single suture line. Most recurrent etiology was senile degeneration (80%). Pericarbon Freedom 25-mm and 27-mm valves were the most frequently implanted. Thirty patients had concomitant procedures (mainly coronary artery bypass grafting, 16 patients). Overall crossclamp time was 76 ± 21 minutes. Results All patients survived intervention. One patient died early of multiorgan failure (postoperative day 16). There were 4 early non–valve-related complications and no late complications at a mean follow-up of 491 ± 270 days. Four patients showed trivial central prosthetic regurgitation at intraoperative transesophageal echocardiography; among these cases, only 1 was confirmed at 6-month transthoracic echocardiography. At postoperative echocardiographic assessment, mean pressure gradient for the 25- through 29-mm size group was 10.2 ± 7.1 mm Hg, and peak pressure gradient was 18.1 ± 12.3 mm Hg. Conclusion Our initial experience combined a well-established supra-annular implantation technique with the Pericarbon Freedom stentless Bioprosthesis, a latest-generation pericardial stentless valve. The combination showed excellent results in terms of safety and reliability, although this technique required adequate experience. Clinical outcomes are similar to those obtained with other techniques, with satisfactory hemodynamic performance.
Alison Duncan - One of the best experts on this subject based on the ideXlab platform.
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outcomes following transcatheter aortic valve replacement for degenerative stentless versus stented bioprostheses
Jacc-cardiovascular Interventions, 2019Co-Authors: Alison Duncan, Neil Moat, Matheus Simonato, Arend De Weger, Jorg Kempfert, Holger Eggebrecht, A Walton, Farrel Hellig, Ran Kornowski, Konstantinos SpargiasAbstract:Abstract Objectives A large comprehensive analysis of transcatheter aortic valve replacement (TAVR) was performed for failed stentless bioprostheses. Background Valve-in-valve (ViV) transcatheter aortic replacement (TAVR) is an alternative to redo surgery for patients with a failing aortic Bioprosthesis. Methods Unadjusted outcome data were collected from the VIVID (Valve-in-Valve International Data) registry between 2007 and 2016 from a total of 1,598 aortic ViV procedures (291 stentless, 1,307 stented bioprostheses). Results Bioprosthetic failure was secondary to aortic regurgitation in 56% of stentless and 20% stented devices (p Conclusions Stentless ViV-TAVR is associated with greater periprocedural complications (initial device malposition, second transcatheter device, coronary obstruction, paravalvular leak), but no difference in 30-day and 1-year outcome.
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valve in valve transcatheter aortic valve implantation for failing surgical aortic stentless bioprosthetic valves a single center experience
The Journal of Thoracic and Cardiovascular Surgery, 2015Co-Authors: Alison Duncan, Simon J Davies, Carlo Di Mario, Neil MoatAbstract:Abstract Background Valve-in-valve (ViV) transcatheter aortic implantation (TAVI) is an alternative to redo surgery for patients with a failing aortic Bioprosthesis. A lack of anatomic markers may complicate the procedure. This study reports procedural and midterm outcomes of patients undergoing ViV-TAVI for failing stentless bioprostheses, at a single institution. Methods A total of 22 consecutive patients with failing homograft (n = 17), stented porcine valve (n = 3), aortic root Bioprosthesis (n = 1), or native resuspended aortic valve (n = 1) (aged 74 ± 12 years; Society of Thoracic Surgeons 30-day predicted risk of mortality score: 14% ± 8%) were treated with ViV-TAVI, between 2007 and 2014. All had severe aortic regurgitation and were highly symptomatic before TAVI: 41% had chronic kidney disease; 32% had undergone previous coronary bypass grafts; 27% had previous percutaneous coronary intervention; 14% had severe pulmonary disease; 14% had had a stroke. All underwent TAVI with a self-expanding device. Results The 30-day mortality was 0%. No cases occurred of myocardial infarction, tamponade, stroke, severe bleeding, acute kidney injury, or major vascular complications. Three instances of device migration, and 1 of device embolization, occurred. Permanent pacing was required in 14%. Paravalvular aortic regurgitation was absent or mild in 19, and mild to moderate in 3. Average hospital stay was 8 ± 3 days; all patients were discharged home. Six-month and 1-year mortality was 4.8% and 14.3%, respectively. Aortic valve area and paravalvular aortic regurgitation were unchanged at 1 year. Conclusions The ViV-TAVI procedure may be performed in high-risk patients with a degenerate stentless Bioprosthesis with low 30-day mortality, and 1-year mortality of 14.3%. Although technically challenging, owing to a lack of anatomic markers, satisfactory positioning is possible in most cases, with excellent clinical and echocardiographic outcomes.
Alain Leguerrier - One of the best experts on this subject based on the ideXlab platform.
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Appraisal of Long-Term Outcomes of Tricuspid Valve Replacement in the Current Perspective
Annals of Thoracic Surgery, 2016Co-Authors: Amedeo Anselmi, Vito Giovanni Ruggieri, Jean-philippe Verhoye, Majid Harmouche, Erwan Flécher, Hervé Corbineau, Thierry Langanay, Bernard Lelong, Alain LeguerrierAbstract:Background We address the differential long-term results of tricuspid valve replacement and late valve-related events among bioprostheses versus mechanical prostheses. Methods In a single-institution investigation, we reviewed the patients’ prospectively collected data and performed a clinical follow-up. Both the Kaplan-Meier (actuarial) and the competing risks (actual) methodologies were used. Results Overall, 188 tricuspid valve replacements were performed during 1971 to 2012. In this complex population (reoperations, 48.1%; associated procedures in 71.3%), operative mortality was 27.6% (significantly declining in recent years). A Bioprosthesis was used in 82.4%. Follow-up was 10.2 ± 9.1 years (as long as 37.3 years, or 1,270 patient-years; 91.2% complete). At 15 years, freedom from structural valve deterioration was 93.3% ± 6.4% (competing risks 94.7 ± 5.1%) in the mechanical group and 85.2% ± 5.4% (competing risks 92% ± 2.9%) in the bioprostheses group (p = 0.19). Freedom from any valve-related adverse events was lower among mechanical valves versus bioprostheses (although not statistically significant). Mechanical valves showed significantly lower freedom from thromboembolic events (actuarial 62.3% ± 14.3% versus 97.7% ± 1.6%; competing risks 74.1% ± 10% versus 98% ± 1.4%; p < 0.001) and earlier adverse events (4.9 ± 4.5 versus 11.1 ± 9.4 years) than bioprostheses. There were 11 reoperations for bioprosthetic structural valve deterioration (89.8% and 94.3% actuarial and actual freedom, respectively). Conclusions Bioprostheses for tricuspid valve replacement have a very good long-term durability. Mechanical valves display earlier and more severe morbidity at follow-up
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CT-scan images preprocessing and segmentation to improve Bioprosthesis leaflets morphological analysis.
Medical Hypotheses, 2013Co-Authors: Vito Giovanni Ruggieri, Pascal Haigron, Qian Wang, Simon Esneault, Raphael Madeleine, Jean-françois Heautot, Alain Leguerrier, Jean-philippe VerhoyeAbstract:The visualization of Bioprosthesis leaflet morphology might help to better understand the underlying mechanism of dysfunction in degenerated aortic Bioprosthesis. Because today such visualization of Bioprosthesis leaflet morphology is intricate to impossible with other imaging techniques, we hypothesized that the processing of multi-detector CT images would allow better visualization of the prosthetic valve leaflets after biological aortic valve replacement. The purpose of our study was to prospectively evaluate patients with a degenerated aortic Bioprosthesis, waiting for reoperation, by using 64-slice CT to evaluate prosthetic leaflets morphology. A semi-automatic segmentation of pre-operative tomodensitometric images was conducted, using 2 different implementations of the region growing algorithm. Here we report all segmentation steps (selection of the region of interest, filtering, segmentation). Studied degenerated aortic bioprostheses were represented by two Carpentier-Edwards Supra Annular Valve (porcine leaflets), one Edwards Perimount (pericardial leaflets) and one Medtronic Mosaic (porcine leaflets). Both segmentation methods (Isotropic Region Growing and Stick Region Growing) allowed a semi-automatic segmentation with 3D reconstruction of all bioprosthetic components (stent, leaflets, degeneration/calcifications). Explanted Bioprosthesis CT images were also processed and used as reference. Segmentation results were compared by means of quantitative criteria. Semi-automatic segmentation using region growing algorithm seems to provide an interesting approach for the morphological characterization of degenerated aortic bioprostheses. We believe that in the next future CT scan images segmentation may play an important role to better understand the mechanism of dysfunction in failing aortic bioprostheses. Moreover, bioprostheses 3D reconstructions could be integrated into preoperative planning tools to optimize valve-in-valve procedure.
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Analysis of degenerated aortic valve Bioprosthesis by segmentation of preoperative CT images
IRBM, 2012Co-Authors: Vito Giovanni Ruggieri, Qian Wang, Simon Esneault, Raphael Madeleine, Alain Leguerrier, Jean-philippe Verhoye, L. Luo, Pascal HaigronAbstract:International audienceIn the next future. transcatheter aortic valve implantation could represent a minimally invasive option in case of Bioprosthesis failure for patients at high surgical risk. CT based preoperative planning of this procedure could be useful to optimize valve-in-valve implantation. In this context, Bioprosthesis 3D analysis seems to be necessary. particularly for leaflets. The goal of this study was to propose different methods to segment and characterize a degenerated Bioprosthesis using standard preoperative CT scan images in order to map structural injury of Bioprosthesis and. ultimately, to plan the best positioning for valve-in-valve implantation. We report our preliminary results on segmentation of a degenerated Bioprosthesis in aortic position. Three different methods have been tested and all allowed obtaining segmentation of the different Bioprosthesis components. Results were compared by means of quantitative criteria. Explanted Bioprosthesis CT images were used as reference. Semi-automatic segmentation seems to provide an interesting approach for the morphological characterization of degenerated hioprosthesis
Neil Moat - One of the best experts on this subject based on the ideXlab platform.
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outcomes following transcatheter aortic valve replacement for degenerative stentless versus stented bioprostheses
Jacc-cardiovascular Interventions, 2019Co-Authors: Alison Duncan, Neil Moat, Matheus Simonato, Arend De Weger, Jorg Kempfert, Holger Eggebrecht, A Walton, Farrel Hellig, Ran Kornowski, Konstantinos SpargiasAbstract:Abstract Objectives A large comprehensive analysis of transcatheter aortic valve replacement (TAVR) was performed for failed stentless bioprostheses. Background Valve-in-valve (ViV) transcatheter aortic replacement (TAVR) is an alternative to redo surgery for patients with a failing aortic Bioprosthesis. Methods Unadjusted outcome data were collected from the VIVID (Valve-in-Valve International Data) registry between 2007 and 2016 from a total of 1,598 aortic ViV procedures (291 stentless, 1,307 stented bioprostheses). Results Bioprosthetic failure was secondary to aortic regurgitation in 56% of stentless and 20% stented devices (p Conclusions Stentless ViV-TAVR is associated with greater periprocedural complications (initial device malposition, second transcatheter device, coronary obstruction, paravalvular leak), but no difference in 30-day and 1-year outcome.
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valve in valve transcatheter aortic valve implantation for failing surgical aortic stentless bioprosthetic valves a single center experience
The Journal of Thoracic and Cardiovascular Surgery, 2015Co-Authors: Alison Duncan, Simon J Davies, Carlo Di Mario, Neil MoatAbstract:Abstract Background Valve-in-valve (ViV) transcatheter aortic implantation (TAVI) is an alternative to redo surgery for patients with a failing aortic Bioprosthesis. A lack of anatomic markers may complicate the procedure. This study reports procedural and midterm outcomes of patients undergoing ViV-TAVI for failing stentless bioprostheses, at a single institution. Methods A total of 22 consecutive patients with failing homograft (n = 17), stented porcine valve (n = 3), aortic root Bioprosthesis (n = 1), or native resuspended aortic valve (n = 1) (aged 74 ± 12 years; Society of Thoracic Surgeons 30-day predicted risk of mortality score: 14% ± 8%) were treated with ViV-TAVI, between 2007 and 2014. All had severe aortic regurgitation and were highly symptomatic before TAVI: 41% had chronic kidney disease; 32% had undergone previous coronary bypass grafts; 27% had previous percutaneous coronary intervention; 14% had severe pulmonary disease; 14% had had a stroke. All underwent TAVI with a self-expanding device. Results The 30-day mortality was 0%. No cases occurred of myocardial infarction, tamponade, stroke, severe bleeding, acute kidney injury, or major vascular complications. Three instances of device migration, and 1 of device embolization, occurred. Permanent pacing was required in 14%. Paravalvular aortic regurgitation was absent or mild in 19, and mild to moderate in 3. Average hospital stay was 8 ± 3 days; all patients were discharged home. Six-month and 1-year mortality was 4.8% and 14.3%, respectively. Aortic valve area and paravalvular aortic regurgitation were unchanged at 1 year. Conclusions The ViV-TAVI procedure may be performed in high-risk patients with a degenerate stentless Bioprosthesis with low 30-day mortality, and 1-year mortality of 14.3%. Although technically challenging, owing to a lack of anatomic markers, satisfactory positioning is possible in most cases, with excellent clinical and echocardiographic outcomes.