Leaflet replacement for aortic stenosis using the 3f stentless aortic bioprosthesis: midterm results.
ABSTRACT The 3f aortic bioprosthesis is a stentless valve resembling the native aortic valve. It has been postulated that improved hemodynamic performance with this prosthesis may translate into superior durability. We hereby report the midterm results using this valve substitute.
Fifty patients with severe aortic stenosis received the 3f aortic bioprosthesis between 2002 and 2004 in our unit. Clinical outcomes, effective orifice area, mean gradients, and ejection fraction were evaluated at discharge, at 6 and 12 months, and yearly thereafter.
Mean follow-up was 52 ± 10 months and was complete in 96% of surviving patients. Hemodynamic performance of the 3f valve was satisfactory for substitutes in the range of 25 mm and 27 mm; smaller valve substitutes showed unfavorable hemodynamic performance with mean gradients of 18 ± 7 mm Hg for 21-mm prosthesis, and 14 ± 5 mm Hg for 23-mm prosthesis. Consequently, the regression of left ventricular hypertrophy was incomplete. Late mortality included 10 patients (valve-related in 1, cardiac-related in 3) for a survival of 77% ± 3% at 4 years. Four patients required reoperation owing to endocarditis in 2 and paravalvular leak in other 2. Freedom from reoperation was 93% at 4 years. Six patients experienced 9 neurologic events, accounting for 82% freedom from neurologic events.
Its unique design makes the 3f aortic bioprosthesis less complex to implant than conventional stentless valves, as only a single suture line is necessary. The hemodynamic profile and clinical performance of the prosthesis are inconsistent with the established stentless valves, especially with regard to higher incidence of neurologic complications seen during the follow-up.
- [Show abstract] [Hide abstract]
ABSTRACT: Aortic valve reconstruction surgery (AVRS), consisting of aortic leaflet reconstruction with tailored pericardial patches and fixation of the sinotubular junction with properly sized fabric rings, is performed for the treatment of aortic valve diseases. The early and midterm outcomes of AVRS were analyzed. Between December 2007 and December 2012, 262 patients with isolated aortic valve disease underwent AVRS in one center. Clinical outcomes, effective orifice area, mean gradients, and left ventricular mass index were evaluated yearly. Mean follow-up duration was 36.0 ± 17.1 months and was complete in 100% of surviving patients. There was no hospital mortality, but there were 3 late deaths (1.1% late mortality). Seven patients (2.7%) required reoperation: 5 because of endocarditis and 2 because of suture disruption of the leaflets. Ten patients (3.8%) experienced neurologic events. Aortic valve regurgitation was absent or trivial in 226 patients (87.3%) and mild in 29 (11.2%), mild to moderate in 3 (1.2%), and moderate to severe in 1 (0.4%). The mean valve gradient and valve orifice index were 10.6 ± 5.3 mm Hg and 1.3 ± 0.4 cm(2)/m(2), respectively. The data from the first 5 years after AVRS reveal good clinical and hemodynamic outcomes, suggesting that AVRS is a new alternative technique to the practice of replacement with stented bioprostheses and mechanical prostheses. However, whether the reconstructed aortic valve represents a truly long-term valve remains to be demonstrated.The Annals of thoracic surgery 01/2014; · 3.45 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: In this study, we retrospectively analyzed the outcomes of adults with bicuspid aortic valve (BAV) disease who underwent aortic valve reconstructive surgery (AVRS), consisting of replacement of the diseased BAV with 2 or 3 pericardial leaflets plus fixation of the sinotubular junction for accurate and constant leaflet coaptation. From December 2007 through April 2013, 135 consecutive patients (mean age, 49.2 ± 13.1 yr; 73.3% men) with symptomatic BAV disease underwent AVRS. Raphe was observed in 84 patients (62.2%), and the remaining 51 patients had pure BAV without raphe. A total of 122 patients (90.4%) underwent 3-leaflet reconstruction, and 13 (9.6%) underwent 2-leaflet reconstruction. Concomitant aortic wrapping with an artificial graft was performed in 63 patients (46.7%). There were no in-hospital deaths and 2 late deaths (1.5%); 6 patients (4.4%) needed valve-related reoperation. The 5-year cumulative survival rate was 98% ± 1.5%, and freedom from valve-related reoperation at 5 years was 92.7% ± 3.6%. In the last available echocardiograms, aortic regurgitation was absent or trivial in 116 patients (85.9%), mild in 16 (11.9%), moderate in 2 (1.5%), and severe in one (0.7%). The mean aortic valve gradient was 10.2 ± 4.5 mmHg, and the mean aortic valve orifice area index was 1.3 ± 0.3 cm(2)/m(2). The 3-leaflet technique resulted in lower valve gradients and greater valve areas than did the 2-leaflet technique. Thus, in patients with BAV, AVRS yielded satisfactory early and midterm results with low mortality rates and low reoperation risk after the initial procedure.12/2014; 41(6):585-91.
- [Show abstract] [Hide abstract]
ABSTRACT: The general approach in heart valve tissue engineering is to mimic the shape of the native valve in the attempt to recreate the natural haemodynamics. In this paper we report the fabrication of the first tissue engineered heart valve (TEHV) based on a tubular leaflet design, where the function of the leaflets of semilunar heart valves is performed by a simple tubular construct sutured along a circumferential line at the root and at three single points at the sinotubular junction. The tubular design is a recent development in pericardial (non viable) bioprostheses which has attracted interest because of the simplicity of the construction and the reliability of the implantation technique. Here we push the potential of the concept further from the fabrication and material point of view to realize the tube-in-tube valve: an autologous, living HV with remodelling and growing capability, physiological haemocompatibility, simple to construct and fast to implant. We developed two different fabrication/conditioning procedures and produced fibrin-based constructs embedding cells from the ovine umbilical cord artery according to the two different approaches. Tissue formation was confirmed by histology and immunohistology. The design of the tube-in-tube foresees the possibility of using a textile co-scaffold (here demonstrated with a warp-knitted mesh) to achieve enhanced mechanical properties in vision of implantation in the aortic position. The tube-in-tube represents an attractive alternative to the conventional design of TEHVs aiming at reproducing the valvular geometry.Tissue Engineering Part C Methods 07/2013; · 4.64 Impact Factor