Twenty-one patients (age four to 25 years) with bicuspid aortic valves proved by surgery and angiography (12) or angiography alone (9) were studied by echocardiography. Seventeen patients had aortic valve disease (11 stenosis, 6 incompetence) and four had coarctation of the aorta with normally functioning aortic valves. A comparison group of 16 patients (9 with aortic valve disease and 7 without aortic valve disease) who had proven tricuspid aortic valves was also studied. Echocardiograms in tricuspid aortic valve patients showed the closed position of the cusps near the middle of the aortic lumen. In contrast marked eccentricity of the aortic valve cusp echoes in diastole could be demonstrated in all with bicuspid aortic valves. The Eccentricity Index (½ aortic lumen diameter/minimum distance of the diastolic cusp echo from the nearest aortic margin) was low (range 1.0-1.25) with tricuspid aortic valves and high (range 1.5-5.6) with bicuspid aortic valves (P , 0.001). This index was not ...
Compared to patients with a tricuspid aortic valve, patients with a bicuspid valve appear to have ascending aorta dilation that is out of proportion to the severity of aortic stenosis or regurgitation; further, patients with a bicuspid aortic valve are thought to be at greater risk of progressive aortic dilation after aortic valve replacement. These observations form the basis of a proposed genetic aortopathy associated with bicuspid aortic valve, and are the basis of current guideline recommendations for more aggressive treatment of proximal ascending aorta dilation among patients with bicuspid aortic valve at the time of surgical aortic valve replacement. However, other data suggest that flow abnormalities related to fusion patterns may be a major contributor to aortic dilation among patients with bicuspid valve (e.g., MM Bissell, et al. Circ Cardiovasc Imaging 2013;6:499-507). The present study suggests that patients with a bicuspid aortic valve undergoing aortic valve replacement for aortic ...
Percutaneous aortic valve replacement (PAVR), also known as transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR), is the replacement of the aortic valve of the heart through the blood vessels (as opposed to valve replacement by open heart surgery). The replacement valve is delivered via one of several access methods: transfemoral (in the upper leg), transapical (through the wall of the heart), subclavian (beneath the collar bone), direct aortic (through a minimally invasive surgical incision into the aorta), and transcaval (from a temporary hole in the aorta near the belly button through a vein in the upper leg). Severe symptomatic aortic stenosis carries a poor prognosis. Until recently, surgical aortic valve replacement was the standard of care in adults with severe symptomatic aortic stenosis. However, the risks associated with surgical aortic valve replacement are increased in elderly patients and those with concomitant severe systolic heart failure ...
Calcific aortic valve disease (CAVD) is a chronic pathological process involving inflammation, fibrosis and calcification. Pharmacological intervention for prevention of CAVD progression remains unavailable. Calcified aortic valves display higher levels of oxidized low-density lipoprotein (oxLDL), and oxLDL has the potential to interact with Toll-like receptors (TLRs). Interleukin (IL)-37 is an anti-inflammatory cytokine and has been shown to inhibit TLR4-mediated inflammatory responses. We tested the hypotheses that oxLDL induces the osteogenic responses in human aortic valve interstitial cells (AVICs) via TLRs and that IL-37 suppresses the responses and may have therapeutic potential for suppression of CAVD progression.. Methods and Results: Human AVICs from normal valves were treated with oxLDL (20-80 μg/ml) for 72 hours in vitro. OxLDL up-regulated the expression of bone morphogenetic protein-2 (BMP-2) and alkaline phosphatase (ALP) in a dose-dependent fashion. Further, oxLDL induced NF-κB ...
The heart has four chambers and four valves. The valves open and close to keep blood flowing through the heart. One of these valves, the aortic valve, usually has three flaps, or leaflets. But sometimes people are born with an aortic valve that has two flaps. This is called a bicuspid aortic valve.. A bicuspid aortic valve makes certain heart problems, like aortic valve stenosis and aortic valve regurgitation, more likely.. In aortic valve stenosis, the valve has narrowed. Your heart has to work harder to pump blood throughout your body. Symptoms may include chest pain, dizziness, fainting, or shortness of breath. In aortic valve regurgitation, the valve does not close properly. Some of the blood leaks back (regurgitates) through the valve into the heart. Your heart has to work harder to pump blood throughout your body. Symptoms may include weakness and tiredness, shortness of breath, or an uneven heartbeat. Although you have a bicuspid heart valve, your heart can work normally. But you have a ...
Follow-up of a group of subjects in whom an aortic ejection sound was the only abnormal finding revealed a bicuspid aortic valve at necropsy or operation in 6 cases. High speed echophonocardiographic studies in 15 subjects with aortic stenosis and known to have bicuspid valves, showed the ejection sound to be exactly synchronous with final halting of the opening aortic valve cusps. Echocardiographic visualisation of the aortic valve from the apex, looking up the left ventricular outflow tract, showed valve echoes during systole indicating abnormal cusp configuration. This proved a more sensitive indicator of a bicuspid aortic valve than the finding of an eccentric aortic valve closure line. These findings were used to evaluate 37 subjects with the auscultatory finding of an isolated aortic ejection sound and the diagnosis of a non-stenotic bicuspid aortic valve was confirmed in 30. The usual cause of misdiagnosis was a sound associated with late tricuspid valve closure. The auscultatory finding ...
Currently, aortic valve replacement procedures require a sternotomy and use of cardiopulmonary bypass (CPB) to arrest the heart and provide a bloodless field in which to operate. A less invasive alternative to open heart surgery is transapical or transcatheter aortic valve replacement (TAVR), already emerging as a feasible treatment for patients with high surgical risk. The bioprosthetic valves are delivered via catheters using transarterial or transapical approaches and are implanted within diseased aortic valves. This paper reports the development of a new self-expanding stent for minimally invasive aortic valve replacement and its delivery device for the transapical approach under real-time magnetic resonance imaging (MRI) guidance. Made of nitinol, the new stent is designed to implant and embed a commercially available bioprosthetic aortic valve in aortic root. An MRI passive marker was affixed onto the stent and an MRI active marker to the delivery device. These capabilities were tested in ...
Cells sense forces from the extracellular matrix (ECM) and transduce them into biochemical signals. The molecules produced cause in turn remodeling of the ECM. Molecular altered expression will affect this force sensing mechanism changing cellular properties as migration, differentiation, etc. Therefore, cells mechanical properties can be used as a marker for the early diagnosis of pathologies as cancer or cardiovascular diseases. In this framework, Atomic Force Microscopy (AFM) represents an excellent tool to evaluate the mechanical properties of different cellular systems. In this talk, we will analyze the mechanical properties of aortic valve interstitial cells (VICs), the predominant constituent of aortic valves, governing ECM structure and composition, in the onset of calcific aortic valve disease (CAVD). In particular, we obtained adhesion polymeric substrates with different stiffness onto which human AoV VICs were plated, and subsequently investigated for the cytoskeleton dynamics and the
McKellar S.H., Tester D.J., Yagubyan M., Majumdar R., Ackerman M.J., Sundt T.M.. OBJECTIVES: Bicuspid aortic valve is a common condition and is associated with a significantly increased risk of developing thoracic aortic aneurysms and acute aortic dissection. Patient-specific prediction of the risk of developing thoracic aortic aneurysm, however, is imprecise. We hypothesize that genotypic variations in patients with bicuspid aortic valves contribute to this observed variability in aortic phenotype. We, therefore, investigated the potential relationship between mutations in regions of NOTCH1 recently reported to be associated with bicuspid aortic valve and the phenotype of bicuspid aortic valve and thoracic aortic aneurysms in unrelated patients undergoing surgical repair. METHODS: We performed a targeted mutational analysis of NOTCH1 using genomic DNA from 48 unrelated subjects with concomitant bicuspid aortic valve and thoracic aortic aneurysm using denaturing high-performance liquid ...
The aortic valve allows oxygen-rich blood to flow from the heart to the aorta. It prevents the blood from flowing back from the aorta into the heart when the pumping chamber relaxes.. Bicuspid aortic valve is present at birth (congenital). An abnormal aortic valve develops during the early weeks of pregnancy, when the babys heart develops. The cause of this problem is unclear, but it is the most common congenital heart disease. It often runs in families.. The bicuspid aortic valve may not be completely effective at stopping blood from leaking back into the heart. This is called aortic regurgitation. The aortic valve may also become stiff and not open up as well, causing the heart to have to pump harder than usual to get blood past the valve (aortic stenosis). The aorta may become enlarged with this condition.. This condition is more common among males than females.. A bicuspid aortic valve often exists in babies with coarctation of the aorta and other diseases in which there is a blockage to ...
Transcatheter aortic valve replacement (TAVR) is a way to replace the aortic valve without open-heart surgery. This procedure is done to treat aortic valve stenosis.. TAVR is often done through an incision (cut) in the groin. But sometimes a small cut is made in the chest. The doctor uses a tube called a catheter and tools that fit inside the catheter. The doctor puts the catheter into a blood vessel and moves it through the blood vessel and into the heart. The artificial valve fits inside the catheter. The doctor then moves the new valve into the damaged aortic valve. The artificial valve expands and takes the place of the damaged valve.. You may have general anesthesia, which makes you sleep during the surgery. Or you may get a sedative that will help you relax.. To see if TAVR might be a choice for you, a team of doctors will check many things about your heart and your overall health. Together you can decide if you want to have the procedure.. ...
Repair of the Transcatheter aortic valve is a minimally invasive procedure. This technique is used without removing it to treat or restore old and damaged aortic valve. The technique used to insert a new valve to the place of the old aortic valve is called the Transcatheter aortic valve replacement system. Between the left atrium and the left ventricle is the mitral valve. Mitral valve disorder is a condition in which the valve ceases working properly, leading to abnormal blood flow. This abnormal blood flow can lead to diseases such as prolapse of the mitral valve and regurgitation of the mitral valve.. Renub Research latest study report "Transcatheter Heart Valve Replacement Market, Volume, Share by Materials (Mechanical and Tissue) Position (Transcather Mitral Valve Replacement and Transcatheter Aortic Valve Replacement), Region (United States, Germany, China, France, Italy, Japan, Spain, United Kingdom, India and Brazil), Company Analysis" provides a detailed and comprehensive insight of the ...
Transcatheter aortic valve replacement (TAVR - also known as TAVI or transcatheter aortic valve implantation) is a new technology for use in treating aortic stenosis. A bioprosthetic valve is inserted percutaneously using a catheter and implanted in the orifice of the native aortic valve ...
Valve replacement surgery is the replacement of one or more of the heart valves with either an artificial heart valve or a bioprosthesis (homograft from human tissue or xenograft e.g. from pig). It is an alternative to valve repair. There are four procedures Aortic valve replacement Mitral valve replacement Tricuspid valve replacement Pulmonary valve replacement Current aortic valve replacement approaches include closed heart surgery, Very invasive cardiac surgery (VICS) and Very invasive, Scapulae-based aortic valve replacement. Catheter replacement of the aortic valve (called trans-aortic valve replacement or implementation [TAVR or TAVI]) is a minimally invasive option for those suffering from aortic valve stenosis. TAVR is commonly performed by guiding a catheter from the groin to the narrowed valve via the aorta using realtime x-ray technology. A metal stent containing a valve is then deployed using a balloon to press the stent into the valve in effect opening the stenosed (or narrowed) ...
Bicuspid aortic valve (BAV) disease is the most frequent congenital cardiac malformation, occurring in 0.5-1.2% of the US population. In young adults, it is generally a benign abnormality; but in older adults it is associated with thoracic aortic aneurysm or dissection in 20-30% of those with BAV. BAV is strongly associated with early development of aortic valve calcification or incompetence in ,50% of BAV patients, and accounts for ~40% of the ,30,000 aortic valve replacements (AVR) performed in the US each year. Yet, we know little of the etiology, cellular events and modifiers of progression of BAV to calcific aortic valve disease and we still do not understand the genetic cause(s) of BAV despite evidence for its high heritability.. The Specific Aims of this study are:. ...
Patients who are suffering with severe aortic stenosis, which is the narrowing of the hearts aortic valve opening that restricts blood flow, have a minimally invasive surgical option available at the Heart and Vascular Center at Manatee Memorial Hospital. Transcatheter Aortic Valve Replacement (TAVR) is an advanced heart valve replacement procedure that offers new hope to patients who have aortic valve stenosis and are at high or extreme risk for open-heart surgery. TAVR patient Eugene Vaadi describes his experience:
Aortic Valve Replacement India offers information on Aortic Valve Repair or replacement in India, Aortic Valve Repair cost India, Aortic Valve Replacement hospital in India, Delhi, Mumbai, Chennai, Hyderabad & Bangalore.
... (TAVI), also referred to as transcatheter aortic valve replacement (TAVR), is a procedure that replaces your diseased aortic valve with a man-made valve.
Bicuspid aortic valves (BAVs) represent a wide morphologic and functional spectrum. In coarctation of the aorta, BAVs are common, but the proportion of BAV subtypes and their relation to aortic dimensions and development of late valve dysfunction are unknown. Sixty-two cardiovascular magnetic resonance investigations of patients with coarctation of the aorta were reviewed with respect to aortic valve morphology, aortic valve function, and aortic dimensions. BAVs were identified in 45 patients (72.6 %), of which 13 (20.9 %) were type-0 (two commissures), 28 (45.1 %) type-1 (three commissures but fusion of one commissure with a raphe) and 4 (6.5 %) valves were bicuspid but not possible to classify further. Patients with BAVs type-0 had larger dimensions in their sinus of Valsalva (35.5 ± 6.8 vs. 29.7 ± 2.7 mm, p = 0.002), ascending aorta (33.1 ± 6.2 vs. 26.0 ± 4.3 mm, p = 0.005) and sino-tubular junction (29.3 ± 7.4 vs. 24.2 ± 3.5 mm, p = 0.040) compared with tricuspid aortic valves (TAVs). ...
... Transcatheter aortic valve replacement (TAVR) Market - - Market research report and industry analysis - 10925577
Methods and Results-Data were obtained using the national inpatient sample between the years 2011 and 2014. We used the International Classification of Diseases, Ninth Edition, Clinical Modification procedure codes 350.5 and 350.6 to identify patients undergoing transcatheter aortic valve replacement. Primary outcome of interest was in-hospital mortality. A 2-tailed P value ,0.01 was considered to denote statistical significance for all analyses. We identified 42 189 patients who underwent transcatheter aortic valve replacement between the years 2011 and 2014. Of these, 62.1% (n=26 229) had no CKD/ESRD, 33.7% (n=14 252) had CKD, and 4% (n=1708) had ESRD. Patients with CKD or ESRD had greater in-hospital mortality, hospital length of stay, hemorrhage requiring transfusion, and permanent pacemaker implantation (P,0.001). ...
BACKGROUND: Patients undergoing surgical aortic valve replacement (SAVR) are considered at high risk of infective endocarditis (IE). However, data on the risk of IE following transcatheter aortic valve replacement (TAVR) are sparse and limited by the lack of long-term follow-up as well as a direct comparison with patients undergoing SAVR.. OBJECTIVES: This study sought to investigate the long-term incidence of IE in patients undergoing TAVR and to compare the long-term risk of IE with patients undergoing isolated SAVR.. METHODS: In this nationwide observational cohort study, all patients undergoing TAVR and isolated SAVR from January 1, 2008, to December 31, 2016, with no history of IE and alive at discharge were identified using data from Danish nationwide registries.. RESULTS: A total of 2,632 patients undergoing TAVR and 3,777 patients undergoing isolated SAVR were identified. During a mean follow-up of 3.6 years, 115 patients (4.4%) with TAVR and 186 patients (4.9%) with SAVR were admitted ...
Since the pioneering works by Andersen et al. (1) and Cribier et al. (2), transcatheter aortic valve replacement (TAVR) has become a well-established and evidence-based therapy for severe and symptomatic aortic stenosis in patients at higher surgical risk. TAVR has been associated with lower all-cause mortality than best medical therapy in patients who were ineligible for surgical aortic valve replacement (SAVR) (3), as well as noninferiority or even superiority to SAVR with respect to all-cause mortality in patients at high surgical risk (4,5). In patients at intermediate risk, TAVR has been reported non-inferior to SAVR regarding death from any cause or disabling stroke (6). In addition, the first randomized trial comparing TAVR and SAVR in all-comer patients indicated that these findings may apply to patients at lower surgical risk (7). Furthermore, a meta-analysis of the 4 randomized clinical trials including 3,806 patients comparing TAVR and SAVR showed that TAVR was associated with a 13% ...
Risk assessment models for transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement in high-risk patients and TAVR versus palliation in inoperable patients are based on surgical data and have limited discrimination and calibration in the setting of TAVR. Several novel risk models specifically designed for TAVR have improved discrimination over existing models but require further validation. Several clinical and echocardiographic variables, such as chronic lung disease, mitral regurgitation, and stroke volume index, influence outcomes. This article reviews current and novel risk models and important predictors of TAVR outcomes and proposes a framework to integrate them into clinical decision-making for patients with severe, symptomatic aortic stenosis.
Transcatheter aortic valve replacement (TAVR) continues to grow and flourish with more than 300,000 procedures performed to date worldwide and an expected expansion over the next decade. Currently restricted to high-risk and otherwise inoperable patients (1), recent data favor TAVR rather than surgical aortic valve replacement in intermediate risk patients (2,3). A combination of new-generation devices, increased experience, better understanding of the disease, and improved screening is associated with improved outcomes, and there is a continuous trend to simplifying the procedure (4). Consequently, among early major issues associated with TAVR, paravalvular regurgitation may now be considered as a thing of the past and bleeding/vascular complications are on the decrease thanks to smaller size devices and better selection. Hence, overt stroke remains the most feared complication and is strongly associated with morbidity and mortality.. Early randomized studies have raised concerns about stroke ...
The perfect heart valve substitute has not yet been developed and matching the patient to existing options to optimize survival and reduce valve-related complications remains challenging. The choices for aortic valve replacement (AVR) are mechanical valves, bioprosthetic valves, and biological valves such as aortic valve homograft and the Ross procedure (pulmonary autograft). The latter is a complex operation because it transfers the patients own pulmonary valve into the aortic position and uses a biological valve to replace the pulmonary valve, transforming a single-valve disease into a 2-valve disease. These considerations are not important to most North American patients who undergo AVR because they are older and the durability of bioprosthetic valves in this age group is excellent (1,2). The risk of bioprosthetic valve failure 20 years after AVR is ,10% in patients 70 years of age and older (1,2). A report based on the Society of Thoracic Surgeons Database from January 1997 to December 2006 ...
The aortic valve controls blood flow from the heart to the body. In some people, the valve becomes stiff and has trouble opening. This condition is called aortic stenosis. It is a progressive disease. In aortic stenosis, the heart has to work harder to push blood through the valve to the rest of the body. Over time, the extra stress can cause the heart muscle to get weaker. People who have aortic stenosis can feel tired and short of breath and have chest pain and fainting.. At Hackensack University Medical Center, our multidisciplinary team is offering transcatheter aortic valve replacement (TAVR) as a life-changing option for many patients with aortic stenosis. TAVR is a minimally invasive procedure that allows our cardiac experts to repair a valve without removing it. If you have aortic stenosis and your doctor feels that traditional open-heart surgery may be a risk, TAVR can be an option for you. TAVR is sometimes recommended for people who are older, have a weaker heart, had previous heart ...
OBJECTIVE: There is an ongoing discussion regarding the mechanism of aortic dilatation in bicuspid aortic valve (BAV) disease, that is, is this a hemodynamic effect or related to an inborn weakness of the aortic wall? This study evaluated the possibility of BAV morphology being related to ascending aorta morphology as such a correlation would strengthen the idea that hemodynamic alterations cause the dilatation of the aorta. METHODS: The morphology of the ascending aorta of 300 patients admitted for aortic valve and/or ascending aorta disease was evaluated by echocardiography and related to the surgeons inspection of the aortic valve. RESULTS: A tricuspid aortic valve (TAV), BAV, or unicuspid aortic valve (UAV) was present in 130, 160, and 10 patients, respectively. Ascending aortic aneurysm was more common in patients with BAV compared with TAV (36% and 12%, respectively; p < 0.001), while ectasia of the aorta was similarly common (8% in both groups). Aortic stenosis or regurgitation was ...
Aortic valve replacement is recommended as standard management for patients with symptomatic aortic valve disease, independent of age.19-22 Following surgery, patients usually have a dramatic improvement in their cardiovascular symptoms and have improved survival rates at 5, 10, and 15 years.23,24 Persistent AV block requiring permanent pacing is an uncommon but serious postoperative complication which increases mechanical ventilation times, intensive care unit stay, and overall hospital day.12-15. Previous studies have already evaluated perioperative risk predictors of PPI after cardiac surgery in large cohorts of patients with different diseases.12-18 However, there are only scanty data on the development of irreversible AV block requiring PPI after aortic valve replacement, especially in the presence of isolated aortic regurgitation or in the case of combined aortic stenosis and regurgitation.. In our series of 276 patients (39% with isolated aortic stenosis, 29% with isolated aortic ...
Minimally invasive aortic valve replacement versus aortic valve replacement through full sternotomy: the Brigham and Womens Hospital experience
Valve replacement surgery has a high rate of success and a low risk of causing other problems if you are otherwise healthy. Although most people have successful outcomes, there is a risk of death and serious problems during surgery. Valve replacement surgery is high-risk for people who have a failing left ventricle and who have had a heart attack. About 5 or less out of 100 people who have valve surgery die.footnote 3. If you have severe aortic valve regurgitation or stenosis, the risks of not replacing the valve may be greater than the risks of surgery, unless you have other health problems that make surgery too dangerous.. Even if valve replacement surgery is a success, you may have problems after surgery, such as:. ...
Objectives. This study was undertaken to elucidate the prevalence of aortic valve abnormalities in the elderly.. Background. The age of persons treated actively for valve disorders is increasing. More information is needed about the prevalence of aortic valve disease in old age.. Methods. Randomly selected men and women in the age groups 75 to 76, 80 to 81 and 85 to 86 years (n = 501) participating in the Helsinki Ageing Study were studied with imaging and Doppler echocardiography. Additionally, 76 persons 55 to 71 year of age were included. The systolic aortic valve area was calculated by the continuity equation. The velocity ratio (peak velocity in the left ventricular outflow tract/peak velocity across the aortic valve) was a supplementary criterion for aortic stenosis. Valve regurgitation and cusp calcification were assessed visually.. Results. Evaluation of the aortic valve was possible in 552 persons (96%). Mild calcification was found in 222 (40%) and severe calcification in 72 (13%). Two ...
40 mmHg or peak aortic valve velocity >4 m/sec 3. Symptomatology due to aortic stenosis resulting in one of the following: 1. NYHA Functional Classification of II or greater 2. Presence of angina 3. Presence of syncope 4. Aortic valve annular diameter ≥ 24 and ≤26 mm measured by MSCT based on area or perimeter 5. STS score of ≥8, or documented heart team agreement of high risk for surgical aortic valve replacement (SAVR) due to frailty or comorbidities. 6. Geographically available, willing to comply with follow up and able to provide written informed consent Exclusion Criteria: 1. Congenital unicuspid or bicuspid aortic valve, or noncalcified aortic valve; or valve eccentricity (calcific or otherwise) that in the opinion of the investigator could compromise procedural success. 2. Patients at high risk for coronary obstruction in the opinion of the investigator (e.g. combination of a coronary height < 12 mm and coronary sinus diameter < 30 mm) 3. Patients with low flow/low gradient aortic ...
Aortic valve calcification (AVC) without outflow obstruction (stenosis) is common in the elderly and increases the risk of cardiovascular morbidity and mortality. Although high blood pressure (BP) measured at the doctors office is known to be associated with AVC, little is known about the association between 24-hour ambulatory BP (ABP) and AVC. Our objective was to clarify the association between ABP variables and AVC. The study population consisted of 737 patients (mean age, 71±9 years) participating in the Cardiovascular Abnormalities and Brain Lesions study who underwent 24-hour ABP monitoring. Each aortic valve leaflet was graded on a scale of 0 (normal) to 3 (severe calcification). A total valve score (values 0-9) was calculated as the sum of all leaflet scores. Advanced AVC (score ≥4) was present in 77 subjects (10.4%). All of the systolic ABP variables (except systolic BP nocturnal decline) and mean asleep diastolic BP were positively associated with advanced calcification, whereas normal
Technology Assessment Unit of the McGill University Health Centre (MUHC) Surgical aortic valve replacement with the ATS Enable sutureless aortic valve for aortic stenosis Report number: 71 DATE: September
Approach and Results-Here, we show that Wnt/β-catenin signaling inhibits Sox9 nuclear localization and proteoglycan expression in cultured chicken embryo aortic valves. Loss of β-catenin in vivo in mice, using Periostin(Postn)Cre-mediated tissue-restricted loss of β-catenin (Ctnnb1) in valvular interstitial cells, leads to the formation of aberrant chondrogenic nodules and induction of chondrogenic gene expression in adult aortic valves. These nodular cells strongly express nuclear Sox9, and Sox9 downstream chondrogenic extracellular matrix genes, including Aggrecan, Col2a1, and Col10a1. Excessive chondrogenic proteoglycan accumulation and disruption of stratified extracellular matrix maintenance in the aortic valve leaflets are characteristics of myxomatous valve disease. Both in vitro and in vivo data demonstrate that the loss of Wnt/β-catenin signaling leads to increased nuclear expression of Sox9 concomitant with induced expression of chondrogenic extracellular matrix proteins.. ...
This is a retrospective cohort analysis of more than 500 patients undergoing the David I procedure. They specifically looked into the outcome of 50 patients with bicuspid aortic valve undergoing this procedure. While the freedom from reoperation was not different between the two groups, the freedom from reoperation at 10 years was 79% in bicuspid valve patients. Unfortunately, the authors cannot provide markers of success for the David I procedure in patients with bicuspid valves, like geometric findings of the valve prior to reconstruction. However, these results are very encouraging for valve repair success in patients with bicuspid aortic valves.. ...
Approximately 300,000 patients in the United States have aortic stenosis (narrowing of the aortic heart valve), and about one third of these patients are too sick or too old to undergo surgical replacement. Under the leadership of NewYork-Presbyterian Hospitals Division of Cardiothoracic Surgery, Transcatheter aortic valve replacement (TAVR) has been under study as a less invasive alternative for these patients.
Surgery to replace an aortic valve is done for aortic valve stenosis and aortic valve regurgitation. During this surgery, the damaged valve is removed and replaced with an artificial valve. The valve replacement is typically an open-heart surgery. A minimally invasive surgery or a catheter procedure to replace the...
0008]The three major factors to preserve the function of the aortic valve include maintaining the appropriate diameter of the sinotubular junction and the aortic annulus, and state of the leaflets per se. Only when the functions of these three factors are optimally recovered, the aortic valve function can be successfully restored. Existing methods to repair the aortic valve havent met these requirements entirely. For example, resuspension of the aortic valve leaflets inside an artificial vascular conduit has been suggested as an effective method of repairing ascending aortic aneurysm due to Marfan syndrome with morphologically normal aortic leaflets (David T. E. `Aortic valve repair in patients with Marfan syndrome and ascending aorta aneurysms due to degenerative disease` J. Card. Surg. 1994; 9(2 Suppl):182-7). However, this method is applicable only to limited situations. One drawback is that the sinus portion in the proximal aortic root has to be removed. Furthermore, this method may lead to ...
Objectives. Primary objective:. To determine if rivaroxaban (Xarelto) is feasible and safe for prevention of major complications in patients undergoing a mechanical aortic heart valve replace-ment.. Secondary objectives:. To identify the value of molecular markers suitable for monitoring of anticoagulation effectiveness of rivaroxaban and its correlation with transcranial Doppler emboli count in patients undergoing a mechanical aortic heart valve replacement.. Design This is a prospective, open-label phase 2 pilot study with independent evaluation of all outcomes and a historical control group.. Number of patients 30 in experimental group (patients in the centers registry database serve as control group).. Main eligibility criteria All patients between 18 and 70 years old receiving a mechanical aortic valve replacement with a pre-operative left ventricular ejection fraction ,/=35%.. Interventions Experimental: Rivaroxaban 20mg p.o., once daily, for six months Historical control: Phenprocoumon ...
Until now, the only treatment for severe aortic stenosis has been open aortic valve replacement, but if a cardiac surgeon determines that you are not a candidate for open-heart surgery and if medicine is not helping you feel better, the TAVR procedure may be an alternative. TAVR is approved for patients who have shortness of breath or chest pain from a severely narrowed aortic valve and who are to sick for an open aortic valve operation.Most people who have this procedure are in their 70s or 80s and often have other medical conditions that make them a better candidate for this type of surgery. ...
TY - JOUR. T1 - Surgical Aortic Valve Replacement-Clinical Update on Recent Advances in the Contemporary Era. AU - Ramakrishna, Harish. AU - Patel, Prakash A.. AU - Gutsche, Jacob T.. AU - Vallabhajosyula, Prashanth. AU - Szeto, Wilson Y.. AU - MacKay, Emily. AU - Feinman, Jared W.. AU - Shah, Ronak. AU - Zhou, Elizabeth. AU - Weiss, Stuart J.. AU - Augoustides, John G.. PY - 2016/12/1. Y1 - 2016/12/1. KW - bleeding. KW - cardiopulmonary bypass. KW - clinical outcomes. KW - duration of stay. KW - femoral artery. KW - femoral vein. KW - full sternotomy. KW - guidelines. KW - mechanical ventilation. KW - meta-analysis. KW - minimally invasive aortic valve replacement. KW - mortality. KW - right anterior thoracotomy. KW - stroke. KW - surgical aortic valve replacement. KW - sutureless aortic valve. KW - transesophageal echocardiography. KW - transfusion. KW - upper hemisternotomy. UR - http://www.scopus.com/inward/record.url?scp=84995489189&partnerID=8YFLogxK. UR - ...
FRIDAY, Feb. 2, 2018 (HealthDay News) - The presence of depressive symptoms among older adults undergoing transcatheter (TAVR) or surgical (SAVR) aortic valve replacement increases the risk of mortality, according to research published online Jan. 17 in JAMA Cardiology.. Laura M. Drudi, M.D., from Jewish General Hospital in Montreal, and colleagues assessed depressive symptoms in preplanned analysis of the Frailty Aortic Valve Replacement prospective cohort study (14 centers in three countries from Nov. 15, 2011, through April 7, 2016). Participants included individuals (mean age, 81.4 years) who underwent TAVR or SAVR aortic valve replacement.. Among 1,035 participants, the researchers found that 31.5 percent had a positive screening result for depression, but only 8.6 percent had depression documented in their clinical record. Baseline depression was associated with mortality at one month (odds ratio, 2.20) and at 12 months (odds ratio, 1.532), after adjusting for clinical and geriatric ...
OHSU heart surgeons perform Transcatheter Aortic Valve Replacement (TAVR), a minimally invasive approach to replacing the aortic valve. Learn more.
Trans Aortic Valve Implantation is done by administering local anesthesia by an experienced cardiac surgeon and typically takes between 45 to 60 minutes. TAVI is a minimally invasive procedure to repair the aortic valve functioning without removing the old, damaged valve. Instead, bioprosthetic valve is implanted as a replacement valve. TAVI involves the insertion of the catheter via either of the three approaches (Transfemora, Transapical and Transaortic) to access the heart. A hollow tube, called catheter, is inserted through the incision and guided to the heart. Ultrasound (high frequency sound wave imaging) and X-ray imaging is used by the doctor to guide the catheter during the procedure. After carefully positioning the catheter, the replacement valve is passed through it. This valve pushes away the damaged vessel and uses it as an anchor to sit in its place. Once the doctor is sure the valve is securely in place, the catheter is withdrawn. One of the advantages of this technique is that ...
What is Aortic Valve Disease?. The aortic valve consists of three leaflets or cusps and is located between the left ventricle of the heart and the aorta. The aortic valve prevents blood from leaking back into the heart after it has been ejected during the contraction. When the valve fails, patients may be severely affected. The aortic valve is one of the four major valves in the heart in addition to the tricuspid or right atrioventricular valve, mitral valve, and pulmonary value. ...
Aortic valve and mitral valve are commonly replaced valves. The pulmonary and the tricuspid valve replacements also are uncommon among adults.. Replacing narrowed valve:. Most common valve procedure is the aortic valve replacement Singapore for the aortic stenosis, and narrowing of aortic valve. The mitral stenosis is one more condition that at times need valve replacement method.. Replacing leaky valve:. The aortic regurgitation, (at times referred as the aortic insufficiency) is one common valve problem, which might need valve replacement. The regurgitation means valve allows the blood to go back through valve and in heart rather than moving it ahead and out to your body. The aortic regurgitation will eventually lead to the heart failure.. ...
Abstract: Background: Aortic valve replacement (AVR) using extracorporeal circulation is currently the treatment of choice for symptomatic aortic stenosis. However, patients with multiple high-risk comorbid conditions may benefit from reduced ECC time by a simplified and faster resection in conjunction with quick sutureless valve implantation. Methods: A prototype of a new minimally invasive aortic valve resection tool equipped with rotating and foldable Nitinol cutting edges was designed. Commercially available aortic valve bioprostheses were artificially calcified (group 1: moderate calcified, n =8, group 2: severely calcified, n =8). In vitro resection was performed using a 21mm cutting blade. Resection time (RT), maximum turning moment (MTM) and number of required rotations (NR) were measured. Furthermore, particle generation during the process of cutting was obtained and quantified. Results: Aortic valve cutting could be obtained without any complications in all cases. Cutting process ...
Calcific aortic valve disease (CAVD) affects a large number of elder people (65 or older) and is one of the leading cardiovascular diseases in older adults in industrial countries.1, 2 This disease is an active pathobiological process involving fibrosis and calcification of aortic valve leaflets.3 Severe CAVD causes morbidity and results in the second most common cardiovascular surgery performed.4 The growing prevalence of this disease, associated with prolongation of the human life span, and the unavailability of pharmacological intervention for limitation of disease progression emphasize the importance of investigations of pathobiological mechanisms. In particular, it is critical to elucidate the cellular and molecular mechanisms by which aortic valve leaflets become fibrotic and calcified.. Aortic valve interstitial cells (AVICs) play an important role in maintaining valvular structure and function. In normal human aortic valves, AVICs primarily assume a fibroblastic phenotype.5 They produce ...