Functional interaction of aortic valve and ascending aorta in patients after valve-sparing procedures.

Pressure recovery (PR) is essential part of the post stenotic fluid mechanics and depends on the ratio of EOA/A, the effective aortic valve orifice area (EOA) and aortic cross-sectional area (A). In patients with advanced ascending aortic aneurysm and mildly diseased aortic valves, the effect of A on pressure recovery and corresponding functional aortic valve opening area (ELCO) was evaluated before and after valve-sparing surgery (Dacron graft implantation). 66 Patients with ascending aortic aneurysm (mean aortic diameter 57 +/- 10 mm) and aortic valve-sparing surgery (32 reimplantation technique (David), 34 remodeling technique (Yacoub)) were routinely investigated by Doppler echocardiography.

New insights into the hemodynamics of pulmonary homograft patients under stress echocardiography: The contribution of pressure recovery.

Background: The importance of pulmonary artery pressure recovery (PR) in patients with Ross procedures in whom a homograft substitutes the resected pulmonary valve, is unknown. The aim of the study was to evaluate the occurrence and extent of PR in the pulmonary artery in 65 asymptomatic patients with pulmonary homograft after Ross surgery during rest and exercise.

Methods: Stress echocardiography was performed in 65 pulmonary homograft patients and 31 controls with native pulmonary valves up to 75 W.

GPA-Induced Granulomatous Endocarditis Mimicking a Thrombotic Mitral Valve Stenosis.

We present the case of a patient with granulomatous endocarditis of the mitral valve leading to severe valve stenosis caused by granulomatosis with polyangiitis. Endocarditis is a rare complication of granulomatosis with polyangiitis that may be misdiagnosed as infectious endocarditis or, as in our case, thrombotic lesions. ().

Long-Term Outcomes of Patients Undergoing the Ross Procedure.

Background: Treatment of aortic-valve disease in young patients still poses challenges. The Ross procedure offers several potential advantages that may translate to improved long-term outcomes.

Objectives: This study reports long-term outcomes after the Ross procedure.

Reduced left ventricular contractility, increased diastolic operant stiffness and high energetic expenditure in patients with severe aortic regurgitation without indication for surgery.

Objectives: Recent mortality studies showed worse prognosis in patients (ARNS) with severe aortic regurgitation and preserved ejection fraction (EF) not fulfilling the criteria of current guidelines for surgery. The aim of our study was to analyse left ventricular (LV) systolic and diastolic function and mechanical energetics to find haemodynamic explanations for the reduced prognosis of these patients and to seek a new concept for surgery.

Methods: Global longitudinal strain (GLS) and echo-based single-beat pressure-volume analyses were performed in patients with ARNS (LV end-diastolic diameter <70 mm, EF >50%, GLS > -19% n = 41), with indication for surgery (ARS; n = 19) and in mild hypertensive controls (C; n = 20).

Valve performance classification in 630 subcoronary Ross patients over 22 years.

Objective: To define the function of the "Ross valves" and its clinical meaning in a practical valve performance classification as part of the outcome analysis.

Methods: From 1994 to 2017, 630 consecutive patients underwent the subcoronary Ross procedure at our institution. The valve performance classification combines hemodynamics, symptoms, and management criteria.

Survival and reoperation pattern after 20 years of experience with aortic valve-sparing root replacement in patients with tricuspid and bicuspid valves.

Objective: Remodeling or reimplantation are established operative techniques of aortic valve-sparing root replacement. Long-term follow-up is necessary comparing tricuspid and bicuspid aortic valves.

Methods: A total of 315 patients (tricuspid, n = 225, bicuspid, n = 89, quadricuspid, n = 1; remodeling, n = 101, reimplantation, n = 214) were evaluated.

Decellularized Versus Standard Pulmonary Allografts in the Ross Procedure: Propensity-Matched Analysis.

Background: It is hypothesized that decellularization of allografts used for right ventricular outflow tract reconstruction may result in decreased valve deterioration. This study compared the durability of fresh decellularized pulmonary allografts with standard cryopreserved pulmonary allografts in patients undergoing the Ross procedure.

Methods: The Ross procedure was performed in 144 patients with decellularized allografts (DA) from 2005 to 2014 and in 619 with standard cryopreserved allografts (SCA) from 1990 to 2014.

Rest and exercise haemodynamics in patients with one of two stented bioprostheses and in healthy controls with small aortic annuli.

Objectives: Because bioprosthetic aortic valve replacement remains one of the most frequent cardiac surgical procedures, it is necessary to study patient haemodynamics in more detail. Until now, a few studies assessed haemodynamics during exercise, but none with special regard to small aortic annuli. We compared patients who had the differently designed bioprostheses, Trifecta and Perimount Magna Ease (PME), size ≤ 23 mm, and a healthy control group during rest and exercise.

Longer-term results, z scores, and decision nomograms for treatment of the ascending aorta in 1693 bicuspid aortic valve operations.

Objective: This study aims to fine-tune the decision making for ascending aorta treatment in bicuspid aortic valve surgery.

Methods: A total of 1693 patients with a primary indication for aortic valve surgery were investigated retrospectively with respect to a multifactorial decision-making policy including the z score and the clinical outcome in relation to different techniques for ascending aorta treatment (no intervention n = 1116; intervention n = 577 either by ascending aorta replacement n = 404 or aortoplasty n = 173). Follow-up was 99.

Ross Procedure in Neonates and Infants: A European Multicenter Experience.

Background: Infants and neonates with severe left ventricular outflow tract obstruction may require pulmonary autograft replacement of the aortic root. In this retrospective multicenter cohort study, we present our experience with the Ross procedure in neonates and infants with a focus on midterm survival and pulmonary autograft durability.

Methods: A retrospective observational study was performed in 76 infants (aged less than 1 year) operated on in six congenital cardiac centers in The Netherlands and Germany between 1990 and 2013.

European multicenter experience with valve-sparing reoperations after the Ross procedure.

Background: Autograft valve preservation at reoperation may conserve some of the advantages of the Ross procedure. However, results of long-term follow-up are lacking. In this retrospective multicenter study, we present our experience with valve-sparing reoperations after the Ross procedure, with a focus on long-term outcome.

Long-term outcomes after surgical ablation for atrial fibrillation in patients with continuous heart rhythm monitoring devices.

Objectives: Surgical ablation for atrial fibrillation (AF) is an established therapy for the treatment of concomitant AF in cardiac surgery patients. We aim to present our prospective experience with 99 continuously monitored patients and investigate whether enhanced monitoring can identify patterns and factors influencing AF recurrence after surgical AF ablation.

Methods: Ninety-nine patients (73 males; age: 68.

Age-related reoperation rate after the Ross procedure: a report from the German Ross Registry.

Background And Aim Of The Study: An increasing number of young adult patients are choosing bioprostheses for aortic valve replacement (AVR). In this context, the Ross operation deserves renewed consideration as an alternative biological substitute. After both the Ross procedure and bioprosthetic AVR, reoperation rates remain a concern and may be related to age at surgery.

Long-Term Results after Aortic Valve-Sparing-Reimplantation Operation (David) in Bicuspid Aortic Valve.

Background And Aim Of The Study: The aortic valve-sparing reimplantation operation (David) is increasingly used in patients with aortic root aneurysm and intact cusps. David's procedure is also feasible in patients with bicuspid aortic valve (BA), though few long-term data are available.

Methods: An analysis was conducted of the long-term echocardiographic data from patients with BAV who had undergone David's procedure at early and long-term follow up (FU) examinations.

Clinical outcomes and lessons learned with aortic valve repair in 508 patients.

Background And Aim Of The Study: Aortic valve repair is an attractive alternative to valve replacement. Herein is presented the authors' single-center experience and lessons learned from 508 patients undergoing AVR, in three different groups.

Methods: Between 1993 and 2010, a total of 508 patients (148 females, 360 males; mean age 54 ± 17 years) underwent aortic valve repair.

New insights in the association between bicuspid aortic valve phenotype, aortic configuration and valve haemodynamics.

Objectives: Patients with a bicuspid aortic valve (BAV) present with various phenotypes of the valve, the aortic root (AoR) and/or the ascending aorta (AAo) and various valve haemodynamics (vHs). The aim of the present study was to investigate the association between the above parameters.

Methods: Between February 1999 and April 2014, the preoperative aortographies of 828 surgical patients with BAV were evaluated.

A multicentre evaluation of the autograft procedure for young patients undergoing aortic valve replacement: update on the German Ross Registry†.

Objectives: Conventional aortic valve replacement (AVR) in young, active patients represents a suboptimal solution in terms of long-term survival, durability and quality of life. The aim of the present work is to present an update on the multicentre experience with the pulmonary autograft procedure in young, adult patients.

Methods: Between 1990-2013, 1779 adult patients (1339 males; 44.

Toward individualized management of the ascending aorta in bicuspid aortic valve surgery: the role of valve phenotype in 1362 patients.

Objective: Decision making regarding the management of the ascending aorta (AA) in patients with a bicuspid aortic valve (BAV) undergoing valve surgery has hardly been individualized and remains controversial. We analyzed our individualized, multifactorial approach, focusing on the BAV phenotype.

Methods: In 1362 patients (1044 men) undergoing aortic valve surgery, the BAV phenotypes were intraoperatively classified and retrospectively analyzed.

Atrial fibrillation burden estimates derived from intermittent rhythm monitoring are unreliable estimates of the true atrial fibrillation burden.

Background: Estimates of atrial fibrillation (AF) burden (AFB) derived from intermittent rhythm monitoring (IRM) are increasingly being used as an outcome measure after therapeutic interventions; however, their accuracy has never been validated. The aim of this study was to compare IRM-derived AFB estimates to the true AFB as measured by implantable continuous monitoring (CM) devices.

Methods: Rhythm histories from 647 patients (mean AFB: 12 ± 22%; 687 patient·years) with CM devices were analyzed.

How often should we monitor for reliable detection of atrial fibrillation recurrence? Efficiency considerations and implications for study design.

Objective: Although atrial fibrillation (AF) recurrence is unpredictable in terms of onset and duration, current intermittent rhythm monitoring (IRM) diagnostic modalities are short-termed and discontinuous. The aim of the present study was to investigate the necessary IRM frequency required to reliably detect recurrence of various AF recurrence patterns.

Methods: The rhythm histories of 647 patients (mean AF burden: 12 ± 22% of monitored time; 687 patient-years) with implantable continuous monitoring devices were reconstructed and analyzed.

The fate of the bicuspid valve aortopathy after aortic valve replacement.

Objectives: The fate of the aortic dimensions in patients with a bicuspid aortic valve (BAV) after aortic valve replacement (AVR) is unclear. We investigated the evolution of aortic root and ascending aorta dimensions in patients with a BAV after AVR. To neutralize the effect of pathological transvalvular haemodynamics on aortic dimensions, we evaluated our hypotheses in patients with normal transvalvular haemodynamics after a subcoronary autograft procedure, which preserves intact the native aortic wall.

Patient age at the Ross operation in children influences aortic root dimensions and aortic regurgitation.

Background: The Ross operation provides the advantage of growth potential of the pulmonary autograft in the aortic position. However, development of autograft dilatation and regurgitation may occur. We sought to assess the progression of autograft diameters and aortic regurgitation (AR) with regard to patient age at the time of the Ross operation.