Comparison between three types of stented pericardial aortic valves (Trivalve trial): study protocol for a randomized controlled trial

International audienceBackgroundAortic valve stenosis is one of the most common heart diseases in older patients. Nowadays, surgical aortic valve replacement is the 'gold standard' treatment for this pathology and the most implanted prostheses are biological ones. The three most implanted bovine bioprostheses are the Trifecta valve (St. Jude Medical, Minneapolis, MN, USA), the Mitroflow valve (Sorin Group, Saluggia, Italy), and the Carpentier-Edwards Magna Ease valve (Edwards Lifesciences, Irvine, CA, USA). We propose a randomized trial to objectively assess the hemodynamic performances of these bioprostheses.Methods and designFirst, we will measure the aortic annulus diameter using CT-scan, echocardiography and by direct sizing in the operating room after native aortic valve resection. The accuracy of information, in terms of size and spatial dimensions of each bioprosthesis provided by manufacturers, will be checked. Their hemodynamic performances will be assessed postoperatively at the seventh day and the sixth month after surgery.DiscussionThis prospective controlled randomized trial aims to verify and compare the hemodynamic performances and the sizing of these three bioprostheses. The data obtained may help surgeons to choose the best suitable bioprosthesis according to each patient's morphological characteristics.Trial registrationClinicalTrials.gov Identifier: NCT0152235

Rapid-deployment aortic valve replacement in high-risk patients: A case-control study

Introduction: Aortic valve stenosis is the most frequent cardiac valve pathology in the western world. In high-risk patients, conventional aortic valve replacement (C-AVR) carries high rates of morbidity and mortality. In the last few years, rapid-deployment valves (RDV) have been developed to reduce the surgical risks. In this work, we aimed to compare the mid-term outcomes of rapid-deployment AVR (RD-AVR) with those of the C-AVR in high-risk patients. Methods: This retrospective case-control study identified 23 high-risk patients who underwent RD-AVR between 12/2015 to 01/2018. The study group was compared with a control group of 46 patients who were retrospectively selected from a database of 687 C-AVR patients from 2016 to 2017 which matched with the study group for age and Euro SCORE II. Results: RD-AVR group presented more cardiovascular risk factors. Euro SCORE II was higher in the RD-AVR group (P=0.06). In the RD-AVR group, we observed significantly higher mean prosthetic size (P<0.001). In-hospital mortality was zero in RD-AVR group versus 2 deaths in C-AVR group. Hospital stay was longer in the RD-AVR group with statistical significance (P=0.03). In the group AVR with associated cardiac procedures, while comparing subgroups RD-AVR versus C-AVR, early mean gradient was lower in the first cited (P=0.02). The overall mean follow-up was 10.9 ± 4.3 months. Conclusion: The RD-AVR technique is reliable and lead to positive outcomes. This procedure provides a much larger size with certainly better flow through the aortic root. It is an alternative to C-AVR in patients recognized to be surgically fragile

Interventional planning and assistance for ascending aorta dissections

International audienceIn this paper, we present our global image processing framework of interventional planning and assistance for ascending aorta dissections. The preoperative stage of that framework performs the extraction of aortic dissection features in Computed Tomography Angiography (CTA) images. It mainly consists of a customized fast marching segmentation. The intraoperative stage of that framework realizes medical images registration and proposes data visualization enhancement; standard X-ray fluoroscopic images are used as the reference modality. We use our recently introduced registration method based on image transformation descriptors (ITDs) and usual 3D/2D techniques (based on digitally reconstructed radiographs). The first stage provides aortic dissection features and is to help clinicians for the planning. The second stage provides an augmented reality visualization and would be used for assistance during the intervention. As far as we know, this is the first complete image processing framework which focuses on the ascending aorta dissection (minimally invasive) endovascular treatment

Trends in SAVR with biological vs. mechanical valves in middle-aged patients: results from a French large multi-centric survey

Background/introductionCurrently, despite continued issues with durability ( 1), biological prosthetic valves are increasingly chosen over mechanical valves for surgical aortic valve replacement (SAVR) in adult patients of all ages, at least in Western countries. For younger patients, this choice means assuming the risks associated with a redo SAVR or valve-in-valve procedure.PurposeTo assess the use of mechanical vs. biological valve prostheses for SAVR relative to patient's age and implant time in a large population extracted from the French National Database EPICARD.MethodsPatients in EPICARD undergoing SAVR from 2007 to 2022 were included from 22 participating public or private centers chosen to represent a balanced representation of centre sizes and geographical discrepancies. Patients with associated pathology of the aorta (aneurysm or dissection) and requiring a vascular aortic prosthesis were excluded. Comparisons were made amongst centers, valve choice, implant date range, and patient age.ResultsWe considered 101,070 valvular heart disease patients and included 72,375 SAVR (mean age 71.4 ± 12.2 years). We observed a mechanical vs. biological prosthesis ratio (MBPR) of 0.14 for the overall population. Before 50 years old (y-o), MBPR was >1.3 (p < 0.001) while patients above 60 years-old received principally biological SAVR (p < 0.0001). Concerning patients between 50 and 60 years-old patients, MPVR was 1.04 (p = 0.03). Patients 50–60 years-old from the first and second study duration quartile (before August 2015) received preferentially mechanical SAVR (p < 0.001). We observed a shift towards more biological SAVR (p < 0.001) for patients from the third and fourth quartile to reach a MBPR at 0.43 during the last years of the series. Incidentally, simultaneous mitral valve replacement were more common in case of mechanical SAVR (p < 0.0001), while associated CABGs were more frequent in case of biological SAVR (p < 0.0001).ConclusionIn a large contemporary French patient population, real world practice showed a recent shift towards a lower age-threshold for biological SAVR as compared to what would suggest contemporary guidelines

Evaluation gériatrique, nutritionnelle et cardiologique, pré et post opératoire d'une population de patients âgés de 75 ans et plus et bénéficiant d'un remplacement valvulaire aortique

La dénutrition protéino-énergétique affecte près de 20% de la population prise en charge en chirurgie cardiaque après 75 ans. Elle représente un facteur de risque indépendant de complications postopératoires. Le but de cette étude est de mettre en évidence quel est le retentissement de cet état nutritionnel sur la qualité de vie et sur les résultats postopératoires lors d'un remplacement valvulaire aortique. 113 patients ont été inclus lors de cette étude prospective descriptive monocentrique. Pour être classé dans le groupe dénutri, les patients devaient avoir au moins 2 critères de dénutrition : IMC < 24 kg/m2, perte de 4 kg en moins de 6 mois, albumine sérique corrigée < 35g/L, ingesta<20kcal/kg/j. 21 patients appartenaient au groupe dénutri. Une évaluation de la qualité de vie, cardiologique et gériatrique ainsi qu'une surveillance biologique étaient réalisées 1 mois avant et à 6 mois après l'opération. Des contrôles cardiologiques et biologiques étaient réalisés en préopératoire immédiat à J4, à J14 et à la 5ème semaine postopératoire. Les patients dénutris avaient en préopératoire un Euroscore et une incidence d'insuffisance cardiaque plus élevés que les non dénutris (p<0.05). Le bilan biologique mettait en évidence des taux inférieurs d'hémoglobine (p<0.05) et d'albumine (p<0.05) ainsi qu'un syndrome inflammatoire de base augmenté (p<0.05) pour ce groupe. Les patients dénutris avaient une incidence de complications infectieuses graves plus élevée (14,3%) sans retentissement sur la durée de séjour en réanimation ou hospitalière. en postopératoire, la dyspnée s'améliorait pour tous les patients (p<0.05). L'évaluation gériatrique montrait une diminution du risque de chute pour les patients non dénutris (p<0.05). Si de façon globale la qualité vie de tous les patients s'améliorait, au vue des résultats du questionnaire d'auto évaluation SF-36, cette amélioration portait sur 6 axes sur 8 pour les patients non dénutris (p<0.05) contre seulement 3 sur 8 pour les patients dénutris (p<0.05). La dénutrition apparaît comme un facteur de risque de complications, notamment infectieuses, en postopératoire. L'effectif limité de cette étude n'a pas permit de mettre en évidence d'allongement de la durée de séjour en réanimation ou en hospitalisation. L'évaluation gériatrique ne montre pas d'altération des fonctions supérieures en postopératoire. Par contre il persiste un risque de chute plus important et une autonomie moindre pour les patients dénutris. S'il n'apparaît pas de surmortalité dans les 2 groupes à 1 an, 3 ans et 5 ans, le bénéfice attendu en termes de qualité de vie est bien plus limité pour les patients dénutris où seul l'axe principal mental s'améliore. Le remplacement valvulaire aortique permet une amélioration du bilan cardiologique et de la qualité de vie chez les patients de plus de 75 ans. Cette amélioration est plus limitée chez les patients dénutris. Il n'apparaît pas de différence sur la mortalité pour les 2 groupes de patients.CLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

Mycotic aneurysm of the ascending aorta: an unusual infectious complication of left ventricular assist device explantation

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Off-pump open repair of false aneurysm of aortic isthmus: This technique is still relevant

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Ascending-to-descending aortic extra-anatomic graft.

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Eligibility for minithoracotomy aortic valve replacement: from Van Praet classification to complex scanner measurements

International audienceAbstract Van Praet proposed a classification to predict the ease of minithoracotomy aortic valve replacement (MT-AVR) based on the position of the aorta in the thorax. We have evaluated the relevance of complex computed tomography (CT) scan measurements to predict the ease of performing a MT-AVR. The first 57 patients who underwent MT-AVR from February 2018 to June 2020 were selected prior to surgery using Van Praet's IA and IB classes. We made additional measurements on aorta position related to the chest and the incision on the preoperative CT scan. The main objective was to correlate complex CT measurements with different operating durations. Van Praet criteria were significantly related to the distance from the center of the aorta to the midline ( p value < 0.001 ), the distance from the center of the aortic ring to the midline ( p value = 0.013 ) and aorto-sternal angle ( p < 0.001). We did not find a correlation between CT criteria and the different surgical steps durations in patients belonging to Van Praet classes IA and IB. Our cohort of Van Praet class Ia and Ib patients were able to benefit from a MT-AVR without the need for conversion. Complex CT measurements do not provide additional information to predict surgical difficulties. This classification appears to be sufficient to determine a patient's eligibility for MT-AVR, even for a surgeon experienced in sternotomy in his first MT-AVR