valve compared with a stented bioprosthesis in …
Measurement of the internal diameter between the stent posts (arrows) of the previously implanted mitral bioprosthesis.
Stentless Versus Stented Aortic Valve Bioprostheses in …
We report the successful management of a rare case of early failure of a stentless aortic bioprosthesis within 4 months of implantation. The patient presented with severe noncalcific aortic regurgitation secondary to prolapse of the noncoronary leaflet.
Stented bioprostheses are used more commonly than stentless ones because of their relative ease of implantation, their extensively documented long-term results, and the low risk associated with reoperation.
Survival advantage of stentless aortic bioprostheses
The Freedom Solo is a new-generation stentless bovine pericardial bioprosthesis designed for supra-annular implantation using a single suture line. Proper implantation of this prosthesis permits good alignment of the valve orifice with the patient's annulus, resulting in low postoperative gradients and decreased cross-clamping time.
Stentless bioprostheses provide good hemodynamic performance and favorable rates of morbidity and mortality. Although long-term structural degeneration is a major drawback, early complications of the bioprosthesis are very uncommon and usually relate to acute leaflet mineral deposition or failures in surgical technique. This case report describes a rare, but potentially fatal, early failure of the Freedom Solo stentless bioprosthetic valve in the aortic position.
LivaNova's stented aortic bioprosthesis CROWN PRT …
– (A) Coronary protection with guide wire to facilitate access and stent placement in case of coronary obstruction after aortic valve transcatheter implantation for the treatment of bioprosthesis dysfunction. (B) Interaction between the guide wire and the transcatheter heart valve.
The mechanism associated with coronary obstruction after TAVI-ViV has been the displacement of the bioprosthesis leaflet towards the coronary ostium in all patients; no cases of coronary obstruction related to the metal frame of transcatheter valves, nor to their leaflets, have been reported. Furthermore, according to the TAVI-ViV Global Registry, the coronary obstruction following TAVI-ViV was more frequent in supported bioprosthesis leaflets and in externally mounted leaflets (especially the Mitroflow® prosthesis) and also with supportless bioprostheses. In the case of the Mitroflow® prosthesis, the relatively long (~13mm) leaflets externally mounted on the supports (with stent), rather than internally as in most other supported prostheses, may be associated with a higher rate of coronary obstruction. In addition, the supportless bioprostheses (stentless) may also be associated with an increased risk of this complication. These bioprostheses are generally implanted in a supra-annular position, resulting in a shortening of the position of the coronary ostia in relation to the valve leaflets, which, together with the rodless stents, may facilitate an interaction of the prosthesis with the aortic wall and the coronary ostium ().
Stented aortic bioprosthesis > Bioprothèse aortique …
Stentless Versus Stented Bioprosthetic Aortic ..
Carpentier-Edwards PERIMOUNT Magna bioprosthesis: A stented valve with stentless performance?
A stentless aortic bioprosthesis ..
Stentless vs Stented Aortic Valve Bioprostheses in the Small Aortic ..
01/03/2017 · Stentless vs
AVR in patients with a small aortic root in comparison with a stented Mitroflow bioprosthesis.
Bioprostheses are xenografts that are mounted on a cloth-covered ..
After the institution of cardiopulmonary bypass by femorofemoral cannulation, the dense pericardial adhesions were released. Aortotomy revealed an intact aortic bioprosthesis, without evidence of endocarditis, leaflet perforation, pannus formation, paravalvular dehiscence, abscess formation, or calcification. However, the noncoronary leaflet of the prosthesis appeared to be elongated and it prolapsed into the left ventricle, thereby preventing proper leaflet coaptation. There was severe inflammation, tissue fragility, and fibrosis on the inner surface of the aorta along the sewing ring suture line, secondary to the healing process of the implanted stentless valve. The aortic prosthesis was well attached to the aortic wall and had not loosened, nor did the aortic wall changes alter the geometric relationships between the posts of the prolapsing cusp. The valve leaflets were excised along with the adjoining aortic sewing ring and sent for bacteriologic and histologic analysis to rule out secondary endocarditis, although there were no macroscopic signs of endocarditis. The intense intra-aortic fibrosis had reduced the luminal diameter and permitted the implantation of only a 19-mm Carpentier-Edwards PERIMOUNT Magna bovine aortic prosthesis (Edwards Lifesciences LLC; Irvine, Calif) in a supra-annular position using interrupted mattress sutures. Weaning the patient from cardiopulmonary bypass was difficult, despite inotropic and intra-aortic balloon pump support. Transesophageal echocardiography showed anterolateral akinesia of the left ventricle, for which reason we bypassed the left anterior descending coronary artery (LAD) with a vein graft. Subsequent recovery was uneventful. Postoperative angiography confirmed occlusion of the left main coronary ostium, with patency of the RCA and of both vein grafts (to the left LAD and obtuse marginal branch). Histologic analysis of the excised leaflets revealed numerous macrophages and giant cells with focal fibrin deposition. At the 2-year follow-up examination, echocardiography showed good functioning of the new aortic prosthesis, with well-preserved left ventricular function.
Carpentier-Edwards PERIMOUNT Magna bioprosthesis…
Coronary obstruction following ViV-TAVI occurred more frequently in women with stented bioprosthetic valves with externally mounted leaflets or with stentless bioprosthesis. The LCA was involved in all cases and PCI was successful in 60% of them. Continued efforts may help identify the factors associated with this complication so that appropriate prevention measures may be implemented.
Carpentier-Edwards PERIMOUNT Magna bioprosthesis: …
A total of four publications describing seven patients were identified. Most patients (71%) were women, with mean age of 82±5 years, and STS-PROM score of 9.4±2.6%. Mean left coronary artery (LCA) ostium height and aortic root width were 8.8±1.5mm and 28.0±5.0mm, respectively. Most patients had stented bioprosthetic valves with externally mounted leaflets or stentless aortic bioprosthesis, and the LCA was involved in all patients. Percutaneous coronary intervention (PCI) was attempted in all patients and was successful in four (57%). In-hospital mortality was 42.9% (three cases), all of them after failed PCI.
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