Ascending Aortic Wall Cohesion: Comparison of Bicuspid and Tricuspid Valves

Objectives. Bicuspid aortic valve (AV) represents the most common form of congenital AV malformation, which is frequently associated with pathologies of the ascending aorta. We compared the mechanical properties of the aortic wall between patients with bicuspid and tricuspid AV using a new custom-made device mimicking transversal aortic wall shear stress. Methods. Between 03/2010 and 07/2011, 190 consecutive patients undergoing open aortic valve replacement at our institution were prospectively enrolled, presenting either with a bicuspid (group 1, n=44) or a tricuspid (group 2, n=146) AV. Aortic wall specimen were examined with the “dissectometer” resulting in nine specific aortic-wall parameters derived from tensile strength curves (TSC). Results. Patients with a bicuspid AV showed significantly more calcified valves (43.2% versus 15.8%, P<0.001), and a significantly thinner aortic wall (2.04±0.42 mm versus 2.24±0.41 mm, P=0.008). Transesophageal echocardiography diameters (annulus, aortic sinuses, and sinotubular junction) were significantly larger in the bicuspid group (P=0.003, P=0.02, P=0.01). We found no difference in the aortic wall cohesion between both groups as revealed by shear stress testing (P=0.72, P=0.40, P=0.41). Conclusion. We observed no differences of TSC in patients presenting with tricuspid or bicuspid AVs. These results may allow us to assume that the morphology of the AV and the pathology of the ascending aorta are independent

Vyuziti kratkodobe pusobiciho betablokatoru esmololu pri operacich v mimotelnim obehu, srovnani s krystaloidni a krevni kardioplegii.

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Transcatheter versus Surgical Aortic Valve Replacement after Previous Cardiac Surgery: A Systematic Review and Meta-Analysis

Aim. Aortic valve replacement (AVR) in patients with prior cardiac surgery might be challenging. Transcatheter aortic valve replacement (TAVR) offers a promising alternative in such patients. We therefore aimed at comparing the outcomes of patients with aortic valve diseases undergoing TAVR versus those undergoing surgical AVR (SAVR) after previous cardiac surgery. Methods and Results. MEDLINE, EMBASE, and the Cochrane Central Register were searched. Seven relevant studies were identified, published between 01/2011 and 12/2015, enrolling a total of 1148 patients with prior cardiac surgery (97.6% prior CABG): 49.2% underwent TAVR, whereas 50.8% underwent SAVR. Incidence of stroke (3.8 versus 7.9%, p=0.04) and major bleeding (8.3 versus 15.3%, p=0.04) was significantly lower in the TAVR group. Incidence of mild/severe paravalvular leakage (14.4/10.9 versus 0%, p<0.0001) and pacemaker implantation (11.3 versus 3.9%, p=0.01) was significantly higher in the TAVR group. There were no significant differences in the incidence of acute kidney injury (9.7 versus 8.7%, p=0.99), major adverse cardiovascular events (8.7 versus 12.3%, p=0.21), 30-day mortality (5.1 versus 5.5%, p=0.7), or 1-year mortality (11.6 versus 11.8%, p=0.97) between the TAVR and SAVR group. Conclusions. TAVR as a redo procedure offers a safe alternative for patients presenting with aortic valve diseases after previous cardiac surgery especially those with prior CABG

The investigation of systolic and diastolic leaflet kinematics of bioprostheses with a new <i>in-vitro</i> test method

<div><p></p><p><b>Objectives:</b> We aimed to investigate leaflet kinematics of bioprostheses with a novel high-speed imaging method. <b>Material and methods:</b> High-speed-imaging (1000Hz) was used to evaluate leaflet kinematics of the Carpentier-Edwards Perimount Magna (PM) and Magna Ease (PME) aortic bioprostheses. Both prostheses (diameter 23 mm) were placed inside a model aorta under pulsatile flow conditions. Frequencies (F) and different stroke volumes (S) were simulated. Maximum aortic valve area (AVA), total ejection time (TET), rapid valve opening time (RVOT) and rapid valve closing time (RVCT) as well as opening (OS) and closing (CS) speeds were evaluated. <b>Results</b>: Both bioprostheses showed different results dependent on flow conditions. The test setup was capable of identifying small AVA-differences between both valves (235 vs 202 mm², F60/S60; 272 vs 207 mm²; F70/S80), as well as differences in OS and CS (2.36 vs 1.62 mm²/ms; 2.97 vs 2.44 mm²/ms, F80/S60). TET was comparable (638 vs 645 ms F60/S60; 341 vs 343 ms, F90/S60), while results for RVOT and RVCT were equal, and dependent on frequency and stroke volume. <b>Conclusions</b>: The novel evaluation method is sensitive to detect differences between valves, although differences were found to be small. PM has a larger visible AVA associated with higher opening and closing speeds in contrast to PME.</p></div