Leaflet Dimensions as a Guide to Remodeling Annuloplasty During Aortic Valve Repair.

Objective: In chronic aortic insufficiency (AI), the method and degree of annular downsizing required to achieve durable coaptation in aortic valve repair (AVr) remains poorly defined. This study evaluated the relationship between leaflet size and annular diameter to predict adequate annular sizing in remodeling AVr.

Methods: Under regulatory supervision, 74 patients with chronic tri-leaflet AI underwent AVr using ring annuloplasty and leaflet reconstruction.

Bicuspid aortic valve repair using geometric ring annuloplasty: A first-in-humans pilot trial.

Objective: As bicuspid aortic valve (BAV) repair evolves, more effective annular reduction and stabilization could be advantageous. A geometric annuloplasty ring has been developed, and 2-year regulatory outcomes of a first-in-humans pilot trial are reported.

Methods: A prospective first-in-humans trial of BAV ring annuloplasty was completed in 16 patients.

Geometric Ring Annuloplasty for Aortic Valve Repair During Aortic Aneurysm Surgery: Two-Year Clinical Trial Results.

Objective: An aortic annuloplasty ring could be useful for aortic valve repair. This trial evaluated intermediate-term outcomes of internal geometric ring annuloplasty for repair of trileaflet and bicuspid aortic insufficiency associated with ascending aortic and/or aortic root aneurysms.

Methods: Under regulatory supervision, 47 patients with aortic insufficiency and ascending aortic (n = 22) and/or aortic root (n = 25) aneurysms were managed with aortic valve repair and aneurysm resection.

Eliciting Preferences for Clinical Follow-Up in Patients with Head and Neck Cancer Using Best-Worst Scaling.

Objectives: There are no commonly accepted standards for monitoring patients treated for head and neck cancer. The aim of this study was to assess patients' preferences for different aspects of follow-up.

Methods: A best-worst survey was conducted in a sample of head and neck cancer patients in clinical follow-up at the National Cancer Institute (Milan, Italy).

Right Minithoracotomy Versus Full Sternotomy for Mitral Valve Repair: A Propensity Matched Comparison.

Background: Mitral valve (MV) repair through a right minithoracotomy (RT) is technically more demanding than through a median sternotomy (MS) and has been cited for a higher rate of reoperation, increased postoperative bleeding, thromboembolic events, poor visualization, and longer operative times. Randomized studies are not available, however, and specific characteristics of patients who undergo operation with either technique are usually highly different. Therefore, a propensity matching study was performed to reduce selection bias.

Placement of Neochords in Mitral Valve Repair: Enhanced Exposure of the Papillary Muscles Using a Standard Valve Sizer.

Minimally invasive mitral valve repair with placement of artificial chordae for mitral valve regurgitation has become the standard of care. In some cases, such as Barlow's disease or bileaflet prolapse, papillary muscle exposure may be difficult. By using a valve sizer to retract both leaflets, visualization can be optimized, thus simplifying suture placement and thereby minimizing cross-clamp and cardiopulmonary bypass times.

Complete Aortic Valve Cusp Replacement in the Pediatric Population Using Tissue-Engineered Bovine Pericardium.

Three clinical cases of severe pediatric aortic valve defects undergoing complete aortic valve cusp replacement using tissue-engineered bovine pericardium are reported. All patients achieved excellent early results, and are being followed without complications.

Comparison of sedation and general anaesthesia for transcatheter aortic valve implantation on cerebral oxygen saturation and neurocognitive outcome†.

Background: Transcatheter aortic valve implantation (TAVI) is a treatment strategy for patients with severe aortic stenosis. Although general anaesthesia (TAVI-GA) and sedation (TAVI-S) have previously been described for TAVI, the difference in safety and efficacy of both methods has not been studied in a randomized trial.

Methods: The INSERT trial was a single centre, controlled parallel-group trial with balanced randomization.

First-in-Man, Mitral Valve-in-Valve Transcatheter Implantation Through an Innovative Minimally Invasive Surgical Approach.

Degeneration of a surgically implanted valve bioprosthesis may occur in elderly, frail patients with an extremely high risk to undergo redo cardiac surgery. Transapical or fully percutaneous transseptal approaches have been described in order to treat degenerated aortic and mitral bioprosthesis. We performed the first-in-man successful mitral transcatheter valve delivery with a valve-in-valve technique through an innovative route; ie, a video-assisted endoscopic direct access to the left atrium, in an 82-year-old patient who previously underwent surgical replacement of the mitral valve and with a prohibitive surgical risk.

Geometric ring annuloplasty as an adjunct to aortic valve repair: clinical investigation of the HAART 300 device.

Objectives: This study assessed the safety and efficacy of an internal geometric annuloplasty ring in a regulatory trial of aortic valve reconstruction (ClinicalTrials.gov Identifier: NCT01400841).

Methods: Sixty-five patients with predominant moderate-to-severe trileaflet aortic insufficiency (AI) underwent aortic valve repair with an average age of 63 ± 13 years (mean ± SD).

A Regulated Trial of Bicuspid Aortic Valve Repair Supported by Geometric Ring Annuloplasty.

Background: Annular stabilization is important during bicuspid aortic valve (BAV) repair to obtain the best long-term results. This report describes the early outcomes of a novel bicuspid annuloplasty ring for this purpose.

Methods: Under regulatory supervision (NCT02071849), a geometric bicuspid annuloplasty ring was used during valve repair in 16 patients.

A geometric model of the normal human aortic root and design of a fully anatomic aortic root graft.

Objective: Available aortic root grafts generally flare outward in the sinus region, and this feature improves procedural ease. However, no current device is based on normal aortic root geometry, and a fully anatomic aortic root graft could further facilitate valve-sparing root operations.

Methods: To develop a model of the normal human aortic root, high-resolution computed tomographic angiogram images from 11 normal human aortas generated high-density x, y, z coordinates of valve and root structures in Mathematica.

Leaflet reconstructive techniques for aortic valve repair.

Background: Refining leaflet reconstruction has become a primary issue in aortic valve repair. This descriptive analysis reviews leaflet pathology, repair techniques, and early results in a prospective regulatory trial of aortic valve repair.

Methods: Sixty-five patients underwent valve repair for predominant moderate to severe aortic insufficiency (AI).

Valve-sparing aortic root replacement in the presence of coronary anomalies.

Aortic root replacement in the presence of coronary anomalies can be challenging. Because the anomalous coronary often arises close to a commissure, reconstruction with traditional buttons can be technically difficult without compromising either the leaflets or the coronary artery. A method of valve sparing root surgery termed "aortic valve and root restoration," using aortic ring annuloplasty and formal valve repair, and then incorporating the anomalous coronary into the commissural suture line, may offer a simple solution to this problem.

Sex-related differences in 2197 patients undergoing isolated surgical aortic valve replacement.

Objectives: The aim of this study is to evaluate gender-related differences in clinical presentation and mortality in patients undergoing isolated surgical aortic valve replacement (SAVR).

Methods: We performed a retrospective analysis of all patients undergoing isolated SAVR from 2000 to 2011 in our center. Patient data were compared with regard to gender including baseline characteristics, 30-day, and late mortality.

Techniques of autologous pericardial leaflet replacement for aortic valve reconstruction.

Glutaraldehyde-fixed autologous pericardium rarely calcifies or retracts, and it is a useful substitute for cardiac valve leaflets. Current understanding of aortic valve geometry provides good models for aortic leaflet design, and pericardial leaflet construction is illustrated in this article for bicuspid and tri-leaflet valves. Outcomes have been characterized by low valve-related complication rates, and results of recent series are encouraging.

Erroneous measurement of the aortic annular diameter using 2-dimensional echocardiography resulting in inappropriate CoreValve size selection: a retrospective comparison with multislice computed tomography.

Objectives: This study sought to assess the differential adherence to transcatheter heart valve (THV)-oversizing principles between transesophageal echocardiography (TEE) and multislice computed tomography (CT) and its impact on the incidence of paravalvular leak (PVL).

Background: CT has emerged as an alternative to 2-dimensional TEE for THV sizing.

Methods: In our early experience, TEE-derived aortic annular diameters determined THV size selection.

Early hemodynamic performance of the BioValsalva valved conduit after aortic root replacement.

Background And Aim Of The Study: The study aim was to examine the hemodynamic performance of the BioValsalva porcine aortic valve conduit in the aortic root position.

Methods: Between February 2007 and April 2012, a total of 223 patients underwent aortic root replacement at the authors' institution. The BioValsalva valved conduit was implanted in 131 patients, and 86 of these patients (mean age 64.

Treatment of aortic stenosis with a self-expanding transcatheter valve: the International Multi-centre ADVANCE Study.

Aim: Transcatheter aortic valve implantation has become an alternative to surgery in higher risk patients with symptomatic aortic stenosis. The aim of the ADVANCE study was to evaluate outcomes following implantation of a self-expanding transcatheter aortic valve system in a fully monitored, multi-centre 'real-world' patient population in highly experienced centres.

Methods And Results: Patients with severe aortic stenosis at a higher surgical risk in whom implantation of the CoreValve System was decided by the Heart Team were included.

Transcatheter aortic valve implantation in patients with LV dysfunction: impact on mortality and predictors of LV function recovery.

Background: Aortic stenosis patients with left ventricular dysfunction are at increased risk for morbidity and mortality following surgical aortic valve replacement. There are few published data regarding the outcomes of patients with severe aortic stenosis and left ventricular (LV) dysfunction undergoing transcatheter aortic valve implantation (TAVI) and possible predictors of LV recovery.

Aims: To compare the baseline characteristics and outcomes between patients with normal LV function and those with LV dysfunction and to assess the predictors of LV recovery after TAVI.

Acute kidney injury after transcatheter aortic valve implantation: incidence, predictors and impact on mortality.

There is a paucity of data describing acute kidney injury (AKI) following transcatheter aortic valve implantation and its impact on mortality remains unknown. We therefore evaluate the incidence, predictors and impact of AKI following transcatheter aortic valve implantation. We searched MEDLINE for studies from 2008 to 2013, evaluating AKI after transcatheter aortic valve implantation.