A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether transcatheter aortic valve-in-valve replacement (viv-TAVR) or redo aortic valve replacement (rAVR) is the best strategy in a patient with a degenerative bioprosthetic aortic valve. Altogether, 162 papers were found using the reported search, of which 12 represented the best evidence to answer the question. The authors, journal, date, country of publication, patient group, study type, outcomes and results of papers are tabulated. The results of the studies provided interesting results. All the studies are retrospective. Four papers reported the results of redo aortic valve replacement in patients with failed aortic bioprosthetic valve, six papers demonstrated their results with transcatheter aortic valve-in-valve replacement for the same indication and two papers reported their propensity-matched analysis of outcomes between viv-TAVR and rAVR in patients with previous cardiac surgery. Thirty-day mortality for rAVR was 2.3-15.5% and 0-17% for viv-TAVR. For rAVR, survival rate at 30 days was 83.6%, 76.1% at 1 year, 70.8% at 3 years, at 51.3-66% at 5 years, 61% at 8 years and 61.5% at 10 years. For viv-TAVR, the overall Kaplan-Meier survival rate at 1 year was 83.2%. After viv-TAVR at 1 year, 86.2% of surviving patients were at New York Heart Association (NYHA) class I/II. The complications after rAVR were stroke (4.6-5.8%), reoperation for bleeding (6.9-9.7%), low-cardiac output syndrome (9.9%) whereas complications after viv-TAVR at 30 days were major stroke (1.7%), aortic regurgitation of at least moderate degree (25%), new permanent pacemaker implantation rate (0-11%), ostial coronary obstruction (2%), need for implantation of a second device (5.7%) and major vascular complications (9.2%). It is noteworthy to mention that there is a valve-in-valve application that provides information to surgeons for choosing the correct size of the TAVR valve. Transcatheter aortic valve-in-valve procedures are clinically effective, at least in the short term, and could be an acceptable approach in selected high-risk patients with degenerative bioprosthetic valves. Redo AVR achieves acceptable medium and long-term results. Both techniques could be seen as complementary approaches for high-risk patients.
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http://dx.doi.org/10.1093/icvts/ivv037 | DOI Listing |
Int J Legal Med
January 2025
Institute for Legal Medicine, Faculty of Medicine, Saarland University, Campus Homburg, Building 49.1, Kirrberger Straße 100, 66421, Homburg/Saar, Germany.
Aortic regurgitation is a common valve disease and can be caused by delineated findings such as fenestrations or hardly discernible alterations of the aortic root geometry. Therefore, aortic regurgitation can be a challenging diagnosis during an autopsy. Cardiac surgeons, however, are confronted with comparable problems during surgery and have developed a refined knowledge of the anatomy of the aortic root including its geometry.
View Article and Find Full Text PDFCirc Res
January 2025
Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, PA. (R.A.C., C.C.C., R.W., A.C., C.B., C.R., W.J.M., M.J. Bashline, A.P., A.M.P., P.B., M.J. Brown, C.S.H.).
Background: Calcific aortic valve disease is the pathological remodeling of valve leaflets. The initial steps in valve leaflet osteogenic reprogramming are not fully understood. As TERT (telomerase reverse transcriptase) overexpression primes mesenchymal stem cells to differentiate into osteoblasts, we investigated whether TERT contributes to the osteogenic reprogramming of valve interstitial cells.
View Article and Find Full Text PDFis rarely associated with neurological manifestations. This report describes a rare case of endocarditis complicated by a cerebral stroke caused by . We also briefly reviewed the neurological clinical spectrum of disease described in the literature.
View Article and Find Full Text PDFCureus
December 2024
Department of Clinical Research and Quality Management, Graduate School of Medicine, University of the Ryukyus, Okinawa, JPN.
Background Patients undergoing transcatheter aortic valve implantation (TAVI) are often elderly, and perioperative and long-term risk assessments should primarily consider cognitive function, comorbidities, and procedural complexity. This study investigated the association between cognitive function and mortality in patients with severe aortic valve stenosis (AS) who underwent TAVI. Methodology This single-center, retrospective cohort study consecutively registered patients who underwent TAVI between December 2014 and December 2018.
View Article and Find Full Text PDFInt J Emerg Med
January 2025
Microbiology and Virology Unit, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy.
Purpose: Here we describe a patient admitted for a stroke that was unexpectedly correlated with subclinical infective endocarditis attributable to a rarely opportunistic pathogen, Abiotrophia defectiva.
Case Report: A 75-year-old man presented with a stroke. Transesophageal echocardiography suggested vegetation on all aortic valve cusps, despite the absence of clinical or laboratory signs of infection.
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