Aortic Valve Repair-Current Status, Indications, and Outcomes

Department of Thoracic and Cardiovascular Surgery, University of Saarland Medical Center, Homburg/Saar, Germany.
Seminars in Thoracic and Cardiovascular Surgery 09/2012; 24(3):195-201. DOI: 10.1053/j.semtcvs.2012.08.003
Source: PubMed


Aortic valve repair is a new development with old roots. In the past 20 years, marked progress has been made in understanding the normal anatomy of the aortic valve and the interrelation between cusps and root. Aortic dilatation is the single most frequent pathogenetic factor in aortic regurgitation, accompanied by cusp pathology, that is, prolapse or congenital anomaly in most industrialized countries. Frequently, aortic and cusp pathology coexist. Different operative techniques have been established for correction of aortic and cusp pathology. Experience has shown that the combined application of repair procedures will lead to good results if normal valve and cusp configuration is achieved. Some congenital anomalies may require design alteration of the aortic valve. Low-operative mortality rates have been reported consistently. When adequate repair durability is achieved, the incidence of valve-related complications is lower than what has been reported for valve replacement. Aortic valve repair is currently in transition from surgical improvisation to a reproducible operation and an option for many patients with aortic regurgitation. Current research focuses on some special aspects, such as stabilization of the basal ring, ideal material and technique for cusp replacement, and more objective information on ideal valve configuration.

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Available from: Hans-Joachim Schäfers, Sep 14, 2014
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    • "Both AV replacement and repair are open-heart procedures which require the patient to be placed on cardiopulmonary bypass and for the heart to be temporarily arrested. However, AV repair, instead of replacement, presents important benefits for AI patients because it avoids or minimizes the risks associated with prosthetic valve replacement including long-term anticoagulation related hemorrhage, prosthetic valve structural deterioration, thromboembolism (clot formation on the prosthetic valve), and endocarditis (valve infection) late after surgery (Aicher and Shäfers, 2012). Indications for AV repair keep rising (Matalanis et al., 2010) although most AI cases still undergo replacement because few surgeons are trained in AV repair, a challenging procedure . "
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    ABSTRACT: In the past decades, developments in transesophageal echocardiography (TEE) have opened new horizons in reconstructive surgery of the aortic valve (AV), whereby corrections are made to normalize the geometry and function of the valve, and effectively treat leaks. To the best of our knowledge, we propose the first integrated framework to process subject-specific 3D+t TEE AV data, determine age-matched material properties for the aortic and leaflet tissues, build a finite element model of the unpressurized AV, and simulate the AV function throughout a cardiac cycle. For geometric reconstruction purposes, dedicated software was created to acquire the 3-D coordinates of 21 anatomical landmarks of the AV apparatus in a systematic fashion. Measurements from ten 3D+t TEE datasets of normal AVs were assessed for inter- and intra-observer variability. These tests demonstrated mean measurement errors well within the acceptable range. Simulation of a complete cardiac cycle was successful for all ten valves and validated the novel schemes introduced to evaluate age-matched material properties and iteratively scale the unpressurized dimensions of the valves such that, given the determined material properties, the dimensions measured in vivo closely matched those simulated in late diastole. The leaflet coaptation area, describing the quality of the sealing of the valve, was measured directly from the medical images and was also obtained from the simulations; both approaches correlated well. The mechanical stress values obtained from the simulations may be interpreted in a comparative sense whereby higher values are indicative of higher risk of tearing and/or development of calcification.
    Full-text · Article · Nov 2014 · Medical Image Analysis
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    • "Since this time aortic valve repair has evolved and become standardized and reproducible treatment option [5] [6] [7]. It is therefore an important part of contemporary cardiac surgery. "
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    ABSTRACT: Introduction The aim of this study was to analyze short- and mid-term results of aortic valve repair. Material and methods One hundred consecutive patients (24 females; mean age 50.3 years, range 23–77 years) with aortic regurgitation underwent aortic valve repair between November 2007 and October 2012. Sixty patients had bicuspid aortic valve, and 82 patients demonstrated aortic regurgitation greater than mild (> grade 2). The ascending aorta/aortic root was replaced in 67 patients. Aortic cusp repair was necessary in 74 patients and additional aortic annulus stabilization was required in 48 cases. Follow-up ranged from 1 to 59 months (cumulative of 220 patient-years, median 25 months) and was complete in 100%. Results There was no 30-day mortality and two patients died in the follow-up. The overall 4-year survival was 98% and freedom from cardiac death was 99% at 4 years. During the follow-up eight patients underwent aortic valve-related reoperation due to progression of aortic regurgitation and another six patients showed aortic regurgitation more than mild (> grade 2). In both aspects there was no statistically significant difference between patients without and with aortic root replacement (p=0.402 and p=0.650). There were no significant bleeding or thromboembolic events during the follow-up. Conclusions Short- and mid-term data analysis revealed an excellent survival and acceptable results of aortic repair, comparable with other larger published studies. We think, therefore, aortic valve repair should be a part of contemporary cardio-surgical armamentarium, especially in younger patients with an appropriate indication.
    Full-text · Article · Dec 2013 · Cor et vasa
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    • "Surgical treatment may involve the repair or the replacement of the original damaged valve. The ideal choice would be to keep the original valve [4]. However, for nearly 70% of the cases this procedure is no longer viable and valve substitution must be performed [5]. "
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    ABSTRACT: Prosthetic cardiac valves implantation is a common procedure used to treat heart valve diseases. Although there are different prostheses already available in the market (either mechanical or bioprosthetic), their use presents several problems, specifically concerning thrombogenicity and structural failure. Recently, some progresses have been achieved in developing heart valves based on synthetic materials with special emphasis in polymers. Among them, polyurethanes are one of the most commonly used for the production of these devices. Herein, Elastollan(®)1180A50, a thermoplastic polyurethane (TPU), was used to formulate films whose surfaces were modified by grafting 2-hydroxyethylmethacrylate (HEMA) either by ultra-violet (UV) or by plasma treatment. All films were analyzed before and after grafting. X-ray photoelectron spectroscopy (XPS) measurements were used to evaluate TPU surfaces functionalization. HEMA grafting was confirmed by the increase of the hydroxyl (OH) groups' concentration at the surface of the films. Atomic force microscopy (AFM) analysis was done to evaluate the surface topography of the biomaterials. Results showed that the roughness of the surface decreased when HEMA was grafted, especially for plasma treated samples. After grafting the films' hydrophilicity was improved, as well as the polar component of the surface energy, by 15-30%. Hydrophobic recovery studies using milli Q water or PBS were also performed to characterize the stability of the modified surface, showing that the films maintained their surface properties along time. Furthermore, blood-contact tests were performed to evaluate haemolytic and thrombogenic potential. The results obtained for HEMA grafted surfaces, using plasma treatment, confirmed biomaterials biocompatibility and low thrombogenicity. Finally, the cytotoxicity and antibacterial activity of the materials was assessed through in vitro assays for both modified films. The obtained results showed enhanced bactericidal activity, especially for the films modified with plasma.
    Full-text · Article · Sep 2013 · Colloids and surfaces B: Biointerfaces
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