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Transcatheter Aortic Valve Replacement (TAVR) | New …

Five patients (3%) in each group required re‐replacement of their aortic valve (p = n.s.).

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Indications for valve replacement in aortic stenosis in …

AB - Background: Many centers advocate bioprosthetic valves in the elderly to avoid anticoagulation, in particular when patient survival is less than the expected valve durability. Because expected survival in the elderly is increasing and age-specific risk of anticoagulation in the elderly is not known, we examined valve- and anticoagulation-related morbidity in elderly patients after aortic valve replacement (AVR) with bioprostheses or mechanical prostheses. Methods and Results: Between January 1980 and June 1994, 211 patients age ≤70 years underwent isolated AVR; there were 109 men (52%) and 102 women (48%). Mean age was 75.9±4.8 years. Aortic stenosis was present in 194 (92%) patients. Bioprostheses were used in 145 (69%) and mechanical prostheses were used in 66 (31%). Chronic anticoagulation was maintained in all patients with a mechanical valve and in 18 patients (12%) with a bioprosthetic valve. Follow-up data were obtained for 98% (194 of 197) of hospital survivors at a mean follow up of 3.8 years. Operative mortality was 6.6%; survival at 3 and 5 years was 75.3±3% and 64.6±4%, respectively. There was no significant difference in operative or late mortality between patient groups. Rates of freedom from thromboembolic events, endocarditis, and anticoagulant-related hemorrhage for bioprosthetic and mechanical valve patients were similar. Prosthetic failure was identified in three bioprosthetic valves (2%); furthermore, the 4 patients in the series who required reoperation had received bioprostheses at the first operation. Conclusions: In conclusion, (1) elderly patients undergoing isolated AVR can be managed with either mechanical or bioprosthetic valves with similar early and late risk, as long as there are no specific contraindications to anticoagulation; (2) anticoagulation-related risk of hemorrhage is low in this group of elderly patients; and (3) the low but significant risk of reoperation following the use of bioprostheses suggests that mechanical valves may be underused in the elderly.

What happens after heart valve replacement surgery? Answers to common questions.

Background: The Carpentier-Edwards Perimount Magna mitral valve bioprosthesis (Edwards Lifesciences, Irvine, CA) is a low-profile version of the earlier Perimount valve that uses the ThermaFix process for enhanced calcium removal. The Magna valve has been in use since 2008, yet no publication, until now, has verified its intermediate-term safety and efficacy. Methods: From 2008 through 2011 (our 4-year study period), 70 Magna valves were implanted in the mitral position at a single institution (the Cleveland Clinic). Echocardiograms were prospectively interpreted. For this study, we reviewed patients' charts; endpoints included hemodynamic measurements, in-hospital morbidity and mortality, valve-related events, resource utilization, and 5-year survival rates. Results: The mean patient age was 68 years; 43 % of the patients had New York Heart Association (NYHA) class III or IV disease, and 51.4 % had moderately severe, or worse, mitral regurgitation (MR). For 43 % of the patients, the Magna valve implantation was a reoperation. For 83 %, the Magna valve implantation also included a concomitant cardiac procedure. The median survival rate was 4.7 years and 90 % of patients were free from significant structural valve degeneration at 5 years. Preoperative atrial fibrillation, ischemic MR, intraaortic balloon pump placement, cardiogenic shock, cardiac arrest, and renal failure were associated with increased mortality. Right ventricular systolic pressure decreased from 50 mmHg preoperatively to 40 mmHg postoperatively, according to our matched-pair analysis (P = 0.003). Per their final echocardiogram during our study period, 98 % of surviving patients had trivial or no MR, one patient had mild MR, and one patient had severe MR. Conclusions: Our 5-year experience indicates that the Magna valve offers excellent intermediate-term durability and substantial echocardiographic improvement; its low-profile design make it ideal for reoperations and for concomitant cardiac procedures, including valve replacement.

Hancock II Bioprosthesis for Aortic Valve Replacement: …

Left ventricular function after aortic valve replacement appears to be better with stentless than with stented bioprostheses.

Objectives This study sought to evaluate the safety and efficacy of the CoreValve transcatheter heart valve (THV) for the treatment of severe aortic stenosis in patients at extreme risk for surgery. Background Untreated severe aortic stenosis is a progressive disease with a poor prognosis. Transcatheter aortic valve replacement (TAVR) with a self-expanding bioprosthesis is a potentially effective therapy. Methods We performed a prospective, multicenter, nonrandomized investigation evaluating the safety and efficacy of self-expanding TAVR in patients with symptomatic severe aortic stenosis with prohibitive risks for surgery. The primary endpoint was a composite of all-cause mortality or major stroke at 12 months, which was compared with a pre-specified objective performance goal (OPG). Results A total of 41 sites in the United States recruited 506 patients, of whom 489 underwent attempted treatment with the CoreValve THV. The rate of all-cause mortality or major stroke at 12 months was 26.0% (upper 2-sided 95% confidence bound: 29.9%) versus 43.0% with the OPG (p

In patients with severe aortic stenosis, there are multiple techniques that can be used to replace the aortic valve. These include traditional , , and transcatheter aortic valve replacement described here. The decision to perform a specific type of surgery is complex, and involves a complete evaluation of the patient to determine which method will have the best outcome. One advantage of Raney Zusman medical group is that our surgeons are familiar with each of these techniques, and can offer the best option for each patient.

It is critical that the surgeon, cardiologist, or endovascular specialist performing transcatheter aortic valve replacement has the most up to date equipment and a strong supporting team. A hybrid operating room is essential. In the hybrid operating room, a minimally invasive procedure can quickly be converted into a full “open heart” procedure if problems arise. The surgeons of Raney Zusman will be performing the procedure in the recently opened . This state-of-the-art facility has highly sophisticated imaging equipment to facilitate the procedure. Hoag Heart and Vascular Institute also has an established multi-disciplinary team involving cardiac surgeons, interventional cardiologists, cardiac anesthesiologists and perfusion team for potential cardiopulmonary bypass. They work in close contact with support staff, including cardiac nurses and physicians specializing in cardiac intensive care after the procedure has been completed.

How a prosthesis in aortic valve replacement is chosen

Overview Mosaic Tissue Valve The Mosaic Bioprosthesis is obtained from the heart of a pig

N2 - Objective: Recommendations for aortic valve replacement in severe aortic stenosis are based primarily on the presence of symptoms. However, the onset f symptoms is often insidious, potentially leading to delayed intervention and suboptimal results. Identifying factors that reduce the survival of patients undergoing aortic valve replacement could lead to revised treatment guidelines and improved outcomes. Methods: We conducted a single-center observational clinical study of 3049 patients with aortic stenosis who underwent native aortic valve replacement with a single type of bioprosthesis. The primary end point was all-cause mortality from the date of operation. Multivariable analysis of risk factors for death was performed in the multiphase hazard function domain. Results: The presence of severe left ventricular hypertrophy at operation, which preceded symptoms in 17% of patients, was associated with decreased survival. This effect was magnified by the severity of aortic stenosis (P = .02) and use of small prostheses (P = .01). The presence of left ventricular dysfunction reduced survival (P = .0003). Although older age was a risk factor for death (P

T1 - Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery

Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients
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  • Stentless Bioprostheses for Aortic Valve Replacement …

    Aortic valve replacement vs

  • Aortic Valve Replacement with Edwards INTUITY …

    Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients

  • aortic valve replacement with ..

    Aortic valve replacement vs

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Prognosis After Aortic Valve Replacement With a Bioprosthesis

In transcatheter aortic valve implantation, the patient is “put to sleep” with general anesthesia. In traditional aortic valve replacement, the patient is placed on a heart-lung machine, also known as cardiopulmonary bypass. The chest wall is then opened, and the patient’s heart can be directly accessed to remove the old valve and implant a new valve. With TAVI, a balloon is used to expand the patient’s own aortic valve to make room for the transcatheter valve. The new transcatheter heart valve is then inserted across the patient’s own aortic valve, and another balloon is used to expand the valve in place. There are two main methods used to place the valve, the transfemoral and transapical approach. The decision to use a particular approach is complex, and best discussed with a physician.

Prognosis After Aortic Valve Replacement With a Bioprosthesis ..

N2 - Background: Many centers advocate bioprosthetic valves in the elderly to avoid anticoagulation, in particular when patient survival is less than the expected valve durability. Because expected survival in the elderly is increasing and age-specific risk of anticoagulation in the elderly is not known, we examined valve- and anticoagulation-related morbidity in elderly patients after aortic valve replacement (AVR) with bioprostheses or mechanical prostheses. Methods and Results: Between January 1980 and June 1994, 211 patients age ≤70 years underwent isolated AVR; there were 109 men (52%) and 102 women (48%). Mean age was 75.9±4.8 years. Aortic stenosis was present in 194 (92%) patients. Bioprostheses were used in 145 (69%) and mechanical prostheses were used in 66 (31%). Chronic anticoagulation was maintained in all patients with a mechanical valve and in 18 patients (12%) with a bioprosthetic valve. Follow-up data were obtained for 98% (194 of 197) of hospital survivors at a mean follow up of 3.8 years. Operative mortality was 6.6%; survival at 3 and 5 years was 75.3±3% and 64.6±4%, respectively. There was no significant difference in operative or late mortality between patient groups. Rates of freedom from thromboembolic events, endocarditis, and anticoagulant-related hemorrhage for bioprosthetic and mechanical valve patients were similar. Prosthetic failure was identified in three bioprosthetic valves (2%); furthermore, the 4 patients in the series who required reoperation had received bioprostheses at the first operation. Conclusions: In conclusion, (1) elderly patients undergoing isolated AVR can be managed with either mechanical or bioprosthetic valves with similar early and late risk, as long as there are no specific contraindications to anticoagulation; (2) anticoagulation-related risk of hemorrhage is low in this group of elderly patients; and (3) the low but significant risk of reoperation following the use of bioprostheses suggests that mechanical valves may be underused in the elderly.

Bioprosthetic valve - definition of bioprosthetic valve …

AB - Objective: Recommendations for aortic valve replacement in severe aortic stenosis are based primarily on the presence of symptoms. However, the onset f symptoms is often insidious, potentially leading to delayed intervention and suboptimal results. Identifying factors that reduce the survival of patients undergoing aortic valve replacement could lead to revised treatment guidelines and improved outcomes. Methods: We conducted a single-center observational clinical study of 3049 patients with aortic stenosis who underwent native aortic valve replacement with a single type of bioprosthesis. The primary end point was all-cause mortality from the date of operation. Multivariable analysis of risk factors for death was performed in the multiphase hazard function domain. Results: The presence of severe left ventricular hypertrophy at operation, which preceded symptoms in 17% of patients, was associated with decreased survival. This effect was magnified by the severity of aortic stenosis (P = .02) and use of small prostheses (P = .01). The presence of left ventricular dysfunction reduced survival (P = .0003). Although older age was a risk factor for death (P

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