Heart Valve Prosthesis Implantation/trends

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Original Article

Prediction of Stress Map in Ascending Aorta – Optimization of the Coaxial Position in Transcatheter Aortic Valve Replacement

Diego Celis et al. Bruno Alvares de Azevedo Gomes Ivan Ibanez Pedro Nieckele Azevedo … Pedro Soares Teixeira Angela Ourivio Nieckele

Abstract

Backgroud

Transcatheter aortic valve replacement (TAVR) can reduce mortality among patients with aortic stenosis. Knowledge of pressure distribution and shear stress at the aortic wall may help identify critical regions, where aortic remodeling process may occur. Here a numerical simulation study of the influence of positioning of the prosthetic valve orifice on the flow field is presented.

Objective

The present analysis provides a perspective of great variance on flow behavior due only to angle changes.

Methods

A 3D model was generated from computed tomography angiography of a patient who had undergone a TAVR. Different mass flow rates were imposed at the inlet valve.

Results

Small variations of the tilt angle could modify the nature of the flow, displacing the position of the vortices, and altering the prerssure distribution and the location of high wall shear stress.

Conclusion

These hemodynamic features may be relevant in the aortic remodeling process and distribution of the stress mapping and could help, in the near future, the optimization of the percutaneous prosthesis implantation. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

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Original Article

Percutaneous Transseptal Bioprosthetic Implantation in Failed Prosthetic Surgical Mitral Valve – Brazilian Multicenter Experience

Pedro Felipe Gomes Nicz et al. Pedro Henrique M. Craveiro de Melo Pedro Henrique Ferro de Brito Eliane Nogueira Lima … Ricardo Cavalcante e Silva Maurício Lopes Prudente Fernando Henrique Fernandes Maurilio Onofre Deininger Marcelo Antônio Cartaxo Queiroga Lopes Fúlvio Soares Petrucci Fernando Roquette Reis Filho Marcos Antonio Marino Rodrigo de Castro Bernardes Eduardo Pessoa de Melo Marco Antonio Praça Oliveira José Armando Mangione Fernanda Marinho Mangione Carlos Henrique Eiras Falcão Estêvão Carvalho de Campos Martins Walter Lunardi Fernando Bacal Flávio Tarasoutchi Fábio Sândoli de Brito Jr

Abstract

Background

Percutaneous intervention in patients with bioprosthetic mitral valve dysfunction is an alternative to conventional surgical treatment.

Objectives

To report the first Brazilian experience with transseptal transcatheter bioprosthetic mitral valve-in-valve implantation (transseptal-TMVIV).

Methods

Patients with surgical bioprosthetic dysfunction submitted to transseptal-TMVIV in 12 Brazilian hospitals were included. The significance level adopted was p<0.05.

Results

From June/2016 to February/2019, 17 patients underwent transseptal-TMVIV. Their median age was 77 years (IQR,70-82) and median Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) score was 8.7% (IQR,7.2-17.8). All patients had limiting symptoms of heart failure (FC≥III) and 5 (29.4%) had undergone more than one previous thoracotomy. Transseptal-TMVIV was successful in all patients. Echocardiographic assessment showed a significant reduction in mean mitral valve gradient (pre-intervention, 12±3.8 mmHg; post-intervention, 5.3±2.6 mmHg; p<0.001), in addition to an increase in mitral valve area (pre-intervention, 1.06±0.59 cm²; post-intervention, 2.18±0.36 cm²; p<0.001) sustained for 30 days. There was a significant and immediate reduction in the pulmonary artery systolic pressure, with an additional reduction in 30 days (pre-intervention, 68.9±16.4 mmHg; post-intervention, 57.7±16.5 mmHg; 30 days, 50.9±18.7 mmHg; p<0.001). During follow-up (median, 162 days; IQR, 102-411), significant clinical improvement (FC≤II) was observed in 87.5% of the patients. One patient (5.9%) had left ventricular outflow tract (LVOT) obstruction and died right after the procedure, and another died at 161 days of follow-up.

Conclusion

The first Brazilian experience with transseptal-TMVIV shows the safety and effectivity of the new technique. The LVOT obstruction is a potentially fatal complication, reinforcing the importance of patients’ selection and of procedural planning. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

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Editorial

How to Choose the Right Valve Prosthesis for My Patient?

Roney Orismar Sampaio

The manuscript: “Comparison of Biological and Mechanical Prostheses for Heart Valve Surgery: Systematic Review of Randomized Controlled Trials” addresses a controversial issue. The authors conducted a meta-analysis of randomized trials involving long-term follow-up of patients requiring cardiac valve replacement revealing similar mortality among patients who underwent implantation of biological prostheses and those who underwent implantation of mechanical prosthesis. There were no significant differences in the risk of thromboembolism and endocarditis. However, the risk of bleeding was approximately one-third lower among patients treated with biological prostheses than those treated with mechanical prostheses. In contrast, the need for reoperation among patients treated with bioprostheses was at least three times greater than that of patients treated with mechanical prostheses.

The authors selected “randomized” trials to avoid evaluation bias. The trial is interesting, as it seeks to be faithful to randomized evaluations, which are very unusual in the literature on valve diseases, especially at the time when the trials were conducted.

[…]

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Original Article

Comparison of Biological and Mechanical Prostheses for Heart Valve Surgery: A Systematic Review of Randomized Controlled Trials

Alberto Takeshi Kiyose et al. Erica Aranha Suzumura Lígia Laranjeira Anna Maria Buehler … José Amalth Espírito Santo Otavio Berwanger Antonio Carlos de Camargo Carvalho Angelo Amato de Paola Valdir Ambrósio Moises Alexandre Biasi Cavalcanti

Abstract

Background:

The choice of a mechanical (MP) or biological prosthesis (BP) for patients with valvular heart disease undergoing replacement is still not a consensus.

Objective:

We aimed to determine the clinical outcomes of MP or BP placement in those patients.

Methods:

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared biological prostheses and mechanical prostheses in patients with valvular heart diseases and assessed the outcomes. RCTs were searched in the MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS and Web of Science (from inception to November 2014) databases. Meta-analyses were performed using inverse variance with random effects models. The GRADE system was used to rate the quality of the evidence. A P-value lower than 0.05 was considered significant.

Results:

A total of four RCTs were included in the meta-analyses (1,528 patients) with follow up ranging from 2 to 20 years. Three used old generation mechanical and biological prostheses, and one used contemporary prostheses. No significant difference in mortality was found between BP and MP patients (risk ratio (RR = 1.07; 95% CI 0.99-1.15). The risk of bleeding was significantly lower in BP patients than MP patients (RR = 0.64; 95% CI 0.52-0.78); however, reoperations were significantly more frequent in BP patients (RR = 3.60; 95% CI 2.44-5.32). There were no statistically significant differences between BP and MP patients with respect to systemic arterial embolisms and infective endocarditis (RR = 0.93; 95% CI 0.66-1.31, RR = 1.21; CI95% 0.78-1.88, respectively). Results in the trials with modern and old prostheses were similar.

Conclusions:

The mortality rate and the risk of thromboembolic events and endocarditis were similar between BP and MP patients. The risk of bleeding was approximately one third lower for BP patients than for MP patients, while the risk of reoperations was more than three times higher for BP patients.

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Prediction of Stress Map in Ascending Aorta – Optimization of the Coaxial Position in Transcatheter Aortic Valve Replacement

Abstract

Backgroud

Objective

Methods

Results

Conclusion

Percutaneous Transseptal Bioprosthetic Implantation in Failed Prosthetic Surgical Mitral Valve – Brazilian Multicenter Experience

Abstract

Background

Objectives

Methods

Results

Conclusion

How to Choose the Right Valve Prosthesis for My Patient?

Comparison of Biological and Mechanical Prostheses for Heart Valve Surgery: A Systematic Review of Randomized Controlled Trials

Abstract

Background:

Objective:

Methods:

Results:

Conclusions:

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