Sutureless Aortic Prosthesis Valves versus Transcatheter Aortic Valve Implantation in Intermediate Risk Patients with Severe Aortic Stenosis: A Literature Review

: Aortic stenosis remains the most frequently occurring valvular pathology in the elderly population of Western countries. According to the latest guidelines, the therapeutic choice of aortic stenosis depends on the age of the patient (<75 years or >75 years) and the risk class (STS-Prom/Euroscore II < o >4%). Therefore, if the surgical indication is clear in young and low-risk patients and percutaneous treatment is the gold standard in older and high-risk patients, the therapeutic choice is still debated in intermediate-risk patients. In this group of patients, aortic valve stenosis treatment depends on the patient's global evaluation, the experience of the center, and, no less importantly, the patient's will. Two main therapeutic options are debated: surgical aortic valve replacement with sutureless prosthesis versus transcatheter aortic valve implantation. In addition, the progressive development of mininvasive techniques for aortic valve surgery (right-anterior minithoracotomy) has also reduced the peri- and post-operative risk in this group of patients. The purpose of this review is to compare sutureless aortic valve replacement (SuAVR) versus TAVI in intermediate-risk patients with severe aortic stenosis

Oxidative Stress in the Pathogenesis of Aorta Diseases as a Source of Potential Biomarkers and Therapeutic Targets, with a Particular Focus on Ascending Aorta Aneurysms

: Aorta diseases, such as ascending aorta aneurysm (AsAA), are complex pathologies, currently defined as inflammatory diseases with a strong genetic susceptibility. They are difficult to manage, being insidious and silent pathologies whose diagnosis is based only on imaging data. No diagnostic and prognostic biomarkers or markers of outcome have been known until now. Thus, their identification is imperative. Certainly, a deep understanding of the mechanisms and pathways involved in their pathogenesis might help in such research. Recently, the key role of oxidative stress (OS) on the pathophysiology of aorta disease has emerged. Here, we describe and discuss these aspects by revealing some OS pathways as potential biomarkers, their underlying limitations, and potential solutions and approaches, as well as some potential treatments

A Narrative Review: Syndecans in Aortic Aneurysm Pathogenesis and Course—Biomarkers and Targets?

The maintenance of the integrity of the entire endothelium, glycocalyx included, and, therefore, of tissue aorta’s homeostasis, depends on the expressions of several molecu- lar pathways and their interactions, such as syndecan molecules. Alterations in syndecans, i.e., quantitative alterations or linking to their shedding, contributes to invoking endothe- lium dysfunction, which causes damage to the vessel wall due to the increased production of growth-stimulating and pro-inflammatory gene products. Inflammatory processes neg- atively affect the integrity of the endothelial glycocalyx, a dynamic layer of the luminal portion of endothelial cells composed of proteoglycans, glycoproteins, and glycosaminogly- cans, i.e., syndecans. In turn, structural alterations in the endothelial glycocalyx influence the coagulative state, increasing pro-thrombotic processes. The family of syndecans con- stitutes a major component of glycocalyx or, more accurately, the major source of cell surface heparan sulfate. It encompasses four components: syndecan-1, syndecan-2, and syndecan-4 (with syndecan-3 only expressed in neural tissue), which have a fundamental role in regulating the events of acute and chronic aorta damage subsequently correlated with the formation of aneurysms. As such, the aim of our review is to highlight the current knowledge on the roles of syndecans and to analyze their relationship with the pathological processes of the aortic wall based on the most recent literature

Hydrodynamic Alterations Produced by Subaortic Membranes: An in Vitro Study

Background: Subaortic stenosis is an aortic disease characterised by the presence of a membrane located at the aortic valve inlet, that causes a sudden reduction of the inflow lumen. The membrane develops as a tissue growth of variable thickness that can cause a major increase in the pressure gradient. In this case, when diagnosed, it is removed by surgical resection. Methods: To investigate the haemodynamic alteration introduced by subaortic membranes, an in vitro study was designed and performed. Stiff and flexible membranes were implanted at the inlet of a bioprosthetic control valve. These mock membranes had different radial and angular alignment, modelling concentric and eccentric orifice positions. For each configuration, a range of different membrane extensions was studied, progressively reducing the orifice area at the inlet of the control valve. Results: Analysis of the hydrodynamic performances indicates that the detrimental effect of subaortic membranes becomes significant when the membrane orifice areas reduce below 75% of the unobstructed inflow lumen. Video analysis of the valve leaflets dynamics indicates that, together with a worsening in the systolic pressure gradient, the presence of subaortic membranes increases cusps fluttering. As the membrane orifice area reduces, leaflets experience faster oscillation frequencies at decreasing amplitudes. Conclusions: The fibromuscular or thin nature of the membrane has a significant role on the severity of the pathology, with higher stiffnesses generally producing worse hydrodynamics. The orifice dimension and position are also important on the systolic performance and can determine potential structural degradation and haematic damage

A promising therapeutic peptide and preventive/diagnostic biomarker for age-related diseases: The Elabela/Apela/Toddler peptide

Elabela (ELA), Apela or Toddler peptide is a hormone peptide belonging to the adipokine group and a component of apelinergic system, discovered in 2013-2014. Given its high homology with apelin, the first ligand of APJ receptor, ELA likely mediates similar effects. Increasing evidence shows that ELA has a critical function not only in embryonic development, but also in adulthood, contributing to physiological and pathological conditions, such as the onset of age-related diseases (ARD). However, still little is known about the mechanisms and molecular pathways of ELA, as well as its precise functions in ARD pathophysiology. Here, we report the mechanisms by which ELA/APJ signaling acts in a very complex network of pathways for the maintenance of physiological functions of human tissue and organs, as well as in the onset of some ARD, where it appears to play a central role. Therefore, we describe the possibility to use the ELA/APJ pathway, as novel biomarker (predictive and diagnostic) and target for personalized treatments of ARD. Its potentiality as an optimal peptide candidate for therapeutic ARD treatments is largely described, also detailing potential current limitations

Hydrodynamic Alterations Produced by Subaortic Membranes: An in Vitro Study

Background Subaortic stenosis is an aortic disease characterised by the presence of a membrane located at the aortic valve inlet, that causes a sudden reduction of the inflow lumen. The membrane develops as a tissue growth of variable thickness that can cause a major increase in the pressure gradient. In this case, when diagnosed, it is removed by surgical resection. Methods To investigate the haemodynamic alteration introduced by subaortic membranes, an in vitro study was designed and performed. Stiff and flexible membranes were implanted at the inlet of a bioprosthetic control valve. These mock membranes had different radial and angular alignment, modelling concentric and eccentric orifice positions. For each configuration, a range of different membrane extensions was studied, progressively reducing the orifice area at the inlet of the control valve. Results Analysis of the hydrodynamic performances indicates that the detrimental effect of subaortic membranes becomes significant when the membrane orifice areas reduce below 75% of the unobstructed inflow lumen. Video analysis of the valve leaflets dynamics indicates that, together with a worsening in the systolic pressure gradient, the presence of subaortic membranes increases cusps fluttering. As the membrane orifice area reduces, leaflets experience faster oscillation frequencies at decreasing amplitudes. Conclusions The fibromuscular or thin nature of the membrane has a significant role on the severity of the pathology, with higher stiffnesses generally producing worse hydrodynamics. The orifice dimension and position are also important on the systolic performance and can determine potential structural degradation and haematic damage

A rare localization of papillary fibroelastoma

Papillary fibroelastoma is a benign cardiac tumor, generally small and with papillary fronds, third in frequency after cardiac myxoma and lipoma, with a prevalence of about 10% of all cardiac tumors [1, 2]. Its localization, similarly to other benign cardiac tumors, prefers the endothelium of the valve leaflets, most commonly the aortic valve (44% to 59%), less frequently the mitral (13% to 35%) and tricuspid (4% to 15%) valves [3–5]. It is discovered occasionally or following symptoms due to systemic or coronary embolization. Symptoms due to obstruction of the ventricular flow tract are rare. Surgical excision is curative and its recurrence rare if the resection of margins are disease-free

How Refined Surgical Technical Solutions Can Make Bentall Operation a Low-Risk Procedure: 20-Year Personal Experience at the “Root” of the Aortic Diseases—It Is Time to Change Surgical Guidelines

(1) objective: twenty years' experience of bentall-de bono operations by one surgeon. (2) methods: from January 2003 to september 2023, four-hundred-and-two patients aged 65.9 +/- 15 years underwent a bentall operation. the euroScore-2 was 5.0% +/- 3.8%. associated procedures were performed on 113 patients (28.1%). results: operative mortality was 1.2% (n = 5), in particular 0.69% (n = 2/289) for isolated bentall operation, 2.65% (n = 3/113) for combined procedures (p < 0.05). postoperative acute heart failure occurred in 38 patients (9.45%). preoperative pulmonary hypertension (44 +/- 14 vs. 33 +/- 7 mmHg), cardiopulmonary bypass time (169 +/- 61 min. vs. 124 +/- 42 min.) and aortic cross-clamp time (133 +/- 45 min. vs. 107 +/- 34 min.) have been recognized as independent predictors of mortality and cardiac complications (p < 0.05). conclusions: In our experience, the bentall operation was associated with low operative mortality and low rate of complications. for this reason, in agreement with the patients, we have modified surgical indication for ascending aortic aneurysms and now we think that it is time to change surgical guidelines