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BACKGROUND: The American College of Cardiology, American Heart Association, and Centers for Medicare and Medicaid Services recommend shared decision-making (SDM) for patients with severe aortic stenosis choosing between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Although tools such as patient decision aids (DAs) and training in SDM have been shown to improve SDM, implementation of SDM and DAs is limited. The IMproving treatment decisions for Patients with AortiC stenosis Through Shared Decision Making (IMPACT SDM) study aims to (1) determine the effectiveness of the interventions (a DA and clinician SDM training) in achieving SDM (primary outcome) and improving the quality of decisions about aortic valve replacement, (2) determine the reach of the DAs and adoption of training, and (3) explore potential mechanisms of effectiveness and implementation at the patient-, clinician-, and clinic-level. METHODS: The study is a hybrid type II effectiveness-implementation study using a cluster randomized batched stepped wedge trial with 8 sites across the USA. Eligible patients will be surveyed before and after visits with the heart valve team; clinicians will be surveyed after visits. Reach of DAs and adoption of training will be tracked. Clinicians will be interviewed regarding barriers and facilitators to implementation. DISCUSSION: The IMPACT SDM Study seeks to provide evidence of the ability of the interventions to improve SDM and decision quality, and also to shed light on barriers and facilitators to SDM implementation to promote future implementation efforts. TRIAL REGISTRATION: ClinicalTrials.gov NCT06171737. Registered on December 15, 2023.

BACKGROUND: Bicuspid aortic valve (BAV) is often associated with a concomitant aortopathy. However, few studies have evaluated the effect of the aortic valve (AV) phenotype on the rate of dilation of the aorta. This study aimed to compare the progression rate of aorta dimensions according to AV phenotype (BAV vs tricuspid AV (TAV)), fusion type and sex in patients with aortic stenosis (AS). METHODS: 310 patients with AS (224 TAV and 86 BAV) recruited in the Metabolic Determinants of the Progression of Aortic Stenosis study (PROGRESSA, NCT01679431) were included in this analysis. Doppler echocardiography was performed annually to assess AS severity and measure ascending aorta (AA) dimensions. Baseline and last follow-up visit measurements were used to assess the annualised change. RESULTS: Median AA annualised change was larger in BAV versus TAV (0.33±0.65 mm/year vs 0.21±0.56 mm/year, p=0.04). In the whole cohort, BAV phenotype and higher low-density lipoprotein (LDL) levels were significantly associated with fast progression of AA dilation in univariate analysis (OR 1.80, 95% CI 1.08 to 2.98, p=0.02; 1.37, 95% CI 1.04 to 1.80, p=0.03, respectively). AA dilation rate did not vary according to the BAV subtype (p=0.142). Predictors of AA progression rate were different between valve phenotypes, with higher apolipoprotein B/apolipoprotein A-I ratio, higher baseline peak aortic jet velocity (Vpeak) and smaller baseline AA diameter in the TAV cohort (all p

Calcification of aortic valve leaflets is a growing mortality threat for the 18 million human lives claimed globally each year by heart disease. Extensive research has focused on the cellular and molecular pathophysiology associated with calcification, yet the detailed composition, structure, distribution and etiological history of mineral deposition remains unknown. Here transdisciplinary geology, biology and medicine (GeoBioMed) approaches prove that leaflet calcification is driven by amorphous calcium phosphate (ACP), ACP at the threshold of transformation toward hydroxyapatite (HAP) and cholesterol biomineralization. A paragenetic sequence of events is observed that includes: (1) original formation of unaltered leaflet tissues: (2) individual and coalescing 100s nm- to 1 μm-scale ACP spherules and cholesterol crystals biomineralizing collagen fibers and smooth muscle cell myofilaments; (3) osteopontin coatings that stabilize ACP and collagen containment of nodules preventing exposure to the solution chemistry and water content of pumping blood, which combine to slow transformation to HAP; (4) mm-scale nodule growth via ACP spherule coalescence, diagenetic incorporation of altered collagen and aggregation with other ACP nodules; and (5) leaflet diastole and systole flexure causing nodules to twist, fold their encasing collagen fibers and increase stiffness. These in vivo mechanisms combine to slow leaflet calcification and establish previously unexplored hypotheses for testing novel drug therapies and clinical interventions as viable alternatives to current reliance on surgical/percutaneous valve implants.

Background: Transcatheter aortic valve replacement (TAVR) has been widely used to treat patients with aortic stenosis (AS). The anchoring of most transcatheter heart valves (THV) depends on friction with the native aortic valve (AV). Methods: A total of 9 patients with severe AS accepted TAVR using Xcor system with transapical access in our center. Clinical outcomes were collected at baseline, before discharge, and at the 30-day follow-up. Results: All patients achieved procedural success, postprocedural transesophageal echocardiography showed that all of the patients had no/trace paravalvular leakage. The mean AV pressure gradient decreased from 50 mmHg (range 18-76 mmHg) to 10 mmHg (range 8-14 mmHg) (P <.001). At the 30-day follow-up, all patients had an improvement of ⩾1 New York Heart Association functional class (P <.001). The average 6-minute walk distance (377.2 [range 330.0-430.0] m vs 276.1 [range 245.0-320.0] m, P <.001) and Kansas City cardiomyopathy questionnaire score (53.4 [range 45.0-62.0] vs 38.9 [range 35.0-43.0], P <.001) were both improved. Conclusions: Our early experience shows that the Xcor system is safe and feasible in the treatment of patients with severe AS. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to critically revise the published literature on clinical outcomes and cost-effectiveness of Inspiris Resilia valve. Methods: This work was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Full text research articles discussing clinical or cost-effectiveness aspects of Inspiris Resilia bioprosthesis published in English were included in this analysis. Studies were excluded if they weren't exclusively conducted on patients submitted to surgical aortic valve replacement using the Inspiris Resilia bioprosthesis. Results: The technical success rate was almost perfect in all studies. Reported complications included severe prosthesis-patient mismatch, reoperation, endocarditis, and paravalvular leak. In almost all studies, there were significant improvement of NYHA at the end of follow up as compared to baseline. In all studies, there were significant improvement of one or more hemodynamic parameters at the end of follow up as compared to baseline. Conclusions: Surgical aortic valve replacement using Inspiris Resilia tissue valve appears to be safe and effective with low rate of aortic valve and systemic complications and mortality. Its performance appears to be equal to or better than many other bioprosthetic valves. As compared to mechanical valves, its use is suggested to be more cost-effective. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve replacement (TAVR) is a minimally invasive interventional solution for treating aortic stenosis. The complex post-TAVR complications are associated with the type of valve implanted and the position of the implantation. The study aimed to establish a rapid numerical research method for TAVR to assess the performance differences of self-expanding valves released at various positions. It also aimed to calculate the risks of postoperative paravalvular leak and atrioventricular conduction block, comparing these risks to clinical outcomes to verify the method's effectiveness and accuracy. Based on medical images, six cases were established, including the aortic wall, native valve and calcification; one with a bicuspid aortic valve and five with tricuspid aortic valves. The parameters for the stent materials used by the patients were customized. High strain in the contact area between the stent and the valve annulus may lead to atrioventricular conduction block. Postoperatively, the self-expanding valve maintained a circular cross-section, reducing the risk of paravalvular leak and demonstrating favorable hemodynamic characteristics, consistent with clinical observations. The outcomes of the six simulations showed no significant difference in valve frame morphology or paravalvular leak risk compared to clinical results, thereby validating the numerical simulation process proposed for quickly selecting valve models and optimal release positions, aiding in TAVR preoperative planning based on patients'geometric characteristics. [ABSTRACT FROM AUTHOR]

Aims Sex-specific low flow was recently defined as stroke volume index (SVi) ≤ 40 mL/m² in men and ≤32 mL/m² in women. We tested the prognostic association of these cut-offs in patients with aortic stenosis (AS) with concordantly and discordantly graded AS [concordantly graded AS by energy loss (CGASEL) and discordantly graded AS by energy loss (DGASEL)] based on pressure recovery adjusted aortic valve area [energy loss (EL)]. Methods and results Data from 1351 patients with asymptomatic AS, peak jet velocity <4 m/s, and preserved left ventricular ejection fraction enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study were used. DGASEL was defined as EL <1.0 cm² with mean aortic gradient <40 mmHg and CGASEL as EL ≥1.0 cm² with mean aortic gradient <40 mmHg. Patients were further grouped into normal and low flow. The outcome was combined all-cause death and hospitalization for heart failure (HF). CGASEL with normal/low flow was present in 915/253 patients, and DGASEL with normal/low flow was present in 57/126 patients. During a median follow-up of 4.3 years, event-free survival was lower in patients with DGASEL irrespective of flow compared to CGASEL with normal flow (P < 0.05). In Cox regression analysis, DGASEL with normal or low flow were both associated with increased risk of all-cause death and hospitalization for HF after adjustment for age, sex, heart rate, randomized study treatment, hypertension, aortic valve replacement, and aortic valve calcification (P < 0.05). No survival difference was found between patients with normal vs. low flow within groups of DGASEL or CGASEL. Conclusion Identification of low flow by the proposed sex-specific thresholds of SVi needs more prognostic validation before application in clinical practice. ClinicalTrials.gov identifier NCT00092677. [ABSTRACT FROM AUTHOR]

We describe a 30-year-old Caribbean-Black woman with a clinical presentation suggestive of a transient ischemic attack (TIA) with no conventional cerebrovascular risk factors, albeit with a newly diagnosed quadricuspid aortic valve (QAV) with moderate aortic regurgitation (AR). Although QAV is a recognized congenital cardiac defect, its association with TIA remains elusive. This case highlights the importance of considering potential atypical etiologies, such as QAV, in the evaluation and management of young patients presenting with cerebrovascular events. [ABSTRACT FROM AUTHOR]

Background: Paravalvular leak (PVL) was initially recognized as one of the most common complications after transcatheter aortic valve implantation (TAVI) and has been linked to adverse clinical outcomes, including mortality. This study aims to assess the long-term clinical effects of PVL in patients undergoing TAVI with the latest generation of transcatheter aortic valves, as part of the national observational prospective multicenter study OBSERVANT II. Methods: OBSERVANT II included all consecutive patients with severe aortic stenosis who underwent TAVI across 28 Italian centers from December 2016 to September 2018. A total of 2125 patients were included in this analysis and stratified according to the presence of moderate-to-severe PVL (significant PVL, n = 155) versus no/trace-to-mild PVL (no significant PVL, n = 1970). The primary endpoint was 5-year major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, stroke, myocardial infarction, and coronary revascularization. Five-year all cause death and re-hospitalization for heart failure (HF) were the secondary endpoints. Results: In our cohort, the incidence of moderate-to-severe PVL was 7%. Age, aortic anulus perimeter, and self-expandable valves were determinants of PVL. The risk of MACCE, all-cause death, and re-hospitalization for HF at the 5-year follow-up were not different between the study groups [HR = 1.07 (95% CI: 0.85–1.34) p = 0.571; HR = 1.10 (95% CI: 0.87–1.39) p = 0.435; HR = 1.20 (95% CI: 0.88–1.62) p = 0.245, respectively]. Conclusions: In this analysis of the OBSERVANT II study, moderate/severe PVL was not associated with a higher incidence of MACCE and re-hospitalization for heart failure at the 5-year follow-up. [ABSTRACT FROM AUTHOR]

Background: Extracellular volume (ECV) by cardiovascular magnetic resonance (CMR) imaging is associated with disease burden and clinical outcomes. Recent studies in patients with valvular heart disease (VHD) have suggested that the indexed total ECV (iECV) = ECVx(LVmass/1.05)/body surface area may supersede ECV in terms of prognostication. In this study, we aimed to compare the prognostic capability of conventional ECV and iECV in an all-comer CMR cohort. Methods: From January 2012 to 2023, ECV and iECV were measured in consecutive CMR patients. Adverse outcomes were defined as a composite of hospitalization for heart failure (HF) and/or death. All patients underwent transthoracic echocardiography within 3 weeks of CMR. Results: Overall, 1525 patients (44% female, mean age 65 ± 18 years) were included. The mean ECV was 29 ± 9% and the mean iECV was 21 ± 13 mL/m2. During 52 ± 36 months of follow-up, 414 (27%) events occurred. Both ECV (HR = 1.04, 95% CI = 1.04–1.05, p < 0.001) and iECV (HR = 1.03, 95% CI = 1.02–1.03, p < 0.001) were significantly associated with outcomes. Having been stratified for ECV and iECV tertiles, Kaplan-Meier analyses showed a significant association with event-free survival for both parameters (log-rank, p < 0.001 for both; central illustration). Regarding multivariate analysis, adjusted for age, sex, left ventricular function, and NT-proBNP, both ECV and iECV remained independently associated with the composite endpoint (ECV: HR = 1.31, 95% CI = 1.20–1.44, p < 0.001; iECV: HR = 1.17, 95% CI = 1.06–1.29, p = 0.002). In addition, ECV was significantly associated with aortic valve velocity (p < 0.001) pertaining to echocardiography, whereas iECV did not show an association (p = 0.41). Conclusions: Both conventional ECV and iECV provided profound prognostic information regarding the risk of HF hospitalizations and death. However, iECV, which is more complex to determine, did not add value. [ABSTRACT FROM AUTHOR]

Background: Frailty and severe aortic stenosis (AoS) are critical conditions in older adults, both of which share pathophysiological mechanisms including chronic inflammation and calcium metabolism dysregulation, potentially influencing the development and progression of these conditions. This study aimed to analyze systemic inflammation and calcium homeostasis biomarkers and their associations with frailty in older adults with severe AoS. Methods: This prospective study included 191 patients aged ≥75 years with severe AoS who were candidates for aortic valve replacement and were evaluated at a Geriatrics Frailty Assessment and Intervention Clinic. Frailty was defined as a score ≤6 on the Short Physical Performance Battery (SPPB). Biomarkers analyzed included aortic valve calcium score, parathyroid hormone (PTH), calcidiol (vitamin D), calcium, phosphate, creatinine, interleukin-6 (IL-6), and the Systemic Immune-Inflammation Index. Multivariate logistic regression was performed to identify independent predictors of frailty. Results: Of the 191 patients studied, 53.9% were women, with a mean age of 84.1 ± 4.1 years. Frailty was identified in 28.3% of patients (mean SPPB score 7.6 ± 2.5). Statistically significant differences between frail and non-frail patients were observed for PTH (87.7 ± 61.1 pg/mL vs. 70 ± 44.4 pg/mL, p = 0.028) and IL-6 (10.4 ± 11.2 pg/mL vs. 7 ± 8.2 pg/mL, p = 0.049). Notably, in the multivariate model, IL-6 emerged as a significant independent predictor of frailty (OR 1.037; CI 1.001–1.074, p = 0.043). Conclusions: IL-6 was identified as a biomarker significantly associated with frailty in older adults with severe AoS. Evaluating IL-6 could enhance the precision of frailty assessments, complement functional measures, and support clinical decision-making in this population. [ABSTRACT FROM AUTHOR]

Deregulation of micro-RNAs (miRNAs) may contribute to mechanisms of injury in the bicuspid aortic valve (BAV). Our objective was to investigate the expression of miRNAs in aortic tissue from patients who underwent aortic valve replacement for aortic stenosis and its relationship with aortic dilatation. The study included 78 patients, 40 with bicuspid aortic valve (BAV) and 38 with tricuspid aortic valve (TAV). The expression of miRNA-17-5p, hsa-let-7e, and miRNA-196a-5p in human aortic tissue was evaluated by a reverse transcriptase polymerase chain reaction (RT-qPCR). Comparative analysis between patients with BAV and controls with TAV explored the association between the miRNAs and aortic dilatation (AD), calcification, valve dysfunction, and stenosis. The results showed that the expression levels of miRNA-Let-7e-5p and miRNA-196-5p were mostly increased in patients with BAV and aortic dilatation (p = 0.01 and p = 0.01), respectively. In contrast, the levels of miRNA-17a-5p (p < 0.20) were lower but without a statistically significant difference. The downregulation of miRNA-17a-5p and the upregulation of miR-Let-7e-5p and miR-196-5p were related to an increased risk of AD risk. Subjects with BAVs with or without double aortic lesions had higher expression levels of Let-7e-5p and miRNA-17a-5p vs. TAV. In all patients, we found an inverse correlation of MiRNA-196-5p with High-Density Lipoprotein-Cholesterol (HDL-C) and indexed valvular area. In subjects with a higher expression of miRNA196, lower levels of HDL-C correlation (r2) [r2 0.27 (p = 0.02)] and a lower indexed valvular area [r2 0.28 (p = 0.05)] were observed. In the specific analysis for each patient group, it was found that in control subjects with tricuspid aortic valve (TAV), miRNA-196-5p had a positive correlation with valvular calcification (r2 = 0.60, p = 0.02). Deregulation of miRNAs in the aortic tissue of a BAV may influence valvular stenosis, dysfunction, and concomitant aortic dilation. This information could help to define potential therapeutic target strategies to improve the prognosis and treatment of BAV. [ABSTRACT FROM AUTHOR]

Background: Repair of the regurgitant bicuspid aortic valve is an attractive alternative to valve replacement. Although good long-term outcomes have been reported, postoperative aortic stenosis remains a major late cause of repair failure in bicuspid aortic valves. Sinus plication is effective for creating a more symmetrical commissural angle, leading to a decrease in the mean transvalvular pressure gradient. Herein, we report a successful case of aortic valve repair with sinus plication for a regurgitant bicuspid aortic valve. Case presentation: The patient was a 34-year-old man with bicuspid aortic valve, severe aortic regurgitation, and left ventricular dilatation. Echocardiography revealed an eccentric aortic regurgitation jet caused by a fused cusp prolapse. The commissural angle was approximately 136°, classified as asymmetrical. The patient underwent surgery via median sternotomy. Cardiopulmonary bypass was initiated using the ascending aortic and single two-stage atrial cannulation with left ventricular venting via the right superior pulmonary vein. After the ascending aorta was cross-clamped, transection was performed 5–10 mm above the sinotubular junction. Based on the valve configuration, annuloplasty, sinus plication, and ascending aortic replacement were planned in addition to triangular resection of the bulking raphe tissue with central cusp plication. Mattress sutures of 4–0 polypropylene, reinforced with autologous pericardium, were placed outside the fused cusp for sinus plication. The sutures extended from the basal ring to the sinotubular junction, reducing the sinus circumference by approximately 15 mm. Intraoperative transesophageal echocardiography revealed trivial aortic regurgitation and modified commissural angulation. The operation, cardiopulmonary bypass, and aortic cross-clamping times were 311, 129, and 95 min, respectively. The clinical course was uneventful, without major complications. Postoperative echocardiography demonstrated an improved commissural angle. Follow-up echocardiography demonstrated trivial aortic regurgitation and a decreased mean transvalvular pressure gradient. Conclusions: Sinus plication may be one of the most effective repair techniques for asymmetrical bicuspid aortic valves, especially in cases without Valsalva sinus dilation. This technique helps avoid postoperative aortic valve stenosis. [ABSTRACT FROM AUTHOR]

Bicuspid Aortic Valve (BAV) is a prevalent congenital heart defect, characterized by the presence of two cusps instead of three, leading to significant clinical implications such as aortic stenosis, regurgitation, and aneurysms. Understanding the genetic underpinnings of BAV is essential for early diagnosis and management, which can prevent severe complications like aortic dissection and heart failure. Recent studies have identified critical genes associated with BAV, including NOTCH1, GATA4, GATA5, SMAD6, NKX2.5, BMP2, and ROBO4, all of which play vital roles in aortic valve development and function. Imaging advancements, particularly in cardiac MRI and echocardiography, have enhanced the assessment of valve morphology and hemodynamics, with Wall Shear Stress emerging as a promising biomarker. This review consolidates current genetic and imaging research, elucidating the contributions of genetic variants to the etiology and progression of BAV, while emphasizing the importance of imaging biomarkers in clinical management. The findings aim to improve genetic screening strategies, facilitate early diagnosis, and guide the development of targeted therapies for individuals with BAV. [ABSTRACT FROM AUTHOR]

Objective: To explore the diagnostic value of crucial parameters of echocardiography for fetal bicuspid aortic valve (BAV) and improve diagnostic accuracy. Methods: Fetuses with a prenatal suspected diagnosis of BAV were followed, and confirmed and misdiagnosed cases were obtained. Prenatal echocardiography was reviewed and analyzed. ROC curves were plotted to evaluate the diagnostic capabilities of different echo signs. Results: 14 cases were confirmed, and 7 patients were misdiagnosed. Some abnormal ultrasound signs were observed in both groups, including direct ultrasound signs of the aortic valve: Two commissures and a "fish-mouth" opening; Thickening, hyperechogenicity, or the presence of a raphe; Restricted motion or opening; Eccentric or a-linear valve leaflet closure line and indirect ultrasound signs: Increased supra-aortic valve velocity; Post-stenotic widening of the ascending aorta. The combination of "Increased supra-aortic valve velocity" and "Two commissures and a 'fish-mouth' opening" had the highest AUC (AUC: 0.893, 95%CI: 0.752-1.000, Sensitivity: 0.786, Specificity: 1.000). Conclusions: We first found that the combination of "Increased supra-aortic valve velocity" and "Two commissures and a 'fish-mouth' opening" had the best diagnostic capability and could reduce the rate of misdiagnosis. Fetuses with BAV should be followed up prenatally for the aortic valve and ascending aorta as they progressively deteriorate with gestational age. [ABSTRACT FROM AUTHOR]

Background: Aortic valve calcification results from degenerative processes associated with several pathologies. These processes are influenced by age, chronic inflammation, and high concentrations of phosphate ions in the plasma, which contribute to induce mineralization in the aortic valve and deterioration of cardiovascular health. Environmental factors, such as wood smoke that emits harmful and carcinogenic pollutants, carbon monoxide (CO), and nitrogen oxide (NOx), as well as other reactive compounds may also be implicated. The purpose of this research was to study the impact of wood smoke on specific aortic valve characteristics, including lesion size and percentage of mineralization, in patients with aortic valve stenosis (AS). Methods: This observational study included 65 patients who underwent primary valve replacement surgery at the National Institute of Cardiology, 11 of whom were exposed to wood smoke. For each patient, approximately 0.5 cm of aortic valve tissue was collected along with a blood sample anticoagulated with sodium citrate. The valves were analyzed using scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (SEM–EDS). Since extracellular microvesicles (MVs) may induce epigenetic changes in target cells by transferring their cargo, we also analyzed their mineral content. Results: Individuals exposed to wood smoke exhibit more extensive lesion (835 µm2) characteristics compared to those with no exposure (407.5 µm2). Interestingly, FESEM images of MVs showed the presence of minerals on their surface, thus providing evidence on their possible role in the pathophysiology of mineralization. Conclusions: Our study uniquely demonstrates imaging-based evidence of structural damage and mineralization in aortic valve tissue, with chronic wood smoke exposure emerging as a significant causative factor. [ABSTRACT FROM AUTHOR]

The advancement of medical 3D printing technology includes several enhancements, such as decreasing the length of surgical procedures and minimizing anesthesia exposure, improving preoperative planning, creating personalized replicas of tissues and bones specific to individual patients, bioprinting, and providing alternatives to human organ transplants. The range of materials accessible for 3D printing within the healthcare industry is significantly narrower when compared with conventional manufacturing techniques. Liquid silicone rubber (LSR) is characterized by its remarkable stability, outstanding biocompatibility, and significant flexibility, thus presenting substantial opportunities for manufacturers of medical devices who are engaged in 3D printing. The main objective of this study is to develop, refine, and assess a 3D printer that can employ UV-cured silicone for the fabrication of aortic heart valves. Additionally, the research aims to produce a 3D-printed silicone aortic heart valve and evaluate the feasibility of the final product. A two-level ANOVA experimental design was utilized to investigate the impacts of print speed, nozzle temperature, and layer height on the print quality of the aortic heart valve. The findings demonstrated that the 3D-printed heart valve's UV-cured silicone functioned efficiently, achieving the target flow rates of 5 L/min and 7 L/min. Two distinct leaflet thicknesses (LT) of the heart valve, namely 0.8 mm and 1.6 mm, were also analyzed to simulate calcium deposition on the leaflets. [ABSTRACT FROM AUTHOR]

Simulating the cardiac valves is one of the most complex tasks in cardiovascular modeling. As fluid–structure interaction simulations are highly computationally demanding, machine-learning techniques can be considered a good alternative. Nevertheless, it is necessary to design many aortic valve geometries to generate a training set. A method for the design of a synthetic database of geometric models is presented in this study. We suggest using synthetic geometries that enable the development of several aortic valve and left ventricular models in a range of sizes and shapes. In particular, we developed 22 variations of left ventricular geometries, including one original model, seven models with varying wall thicknesses, seven models with varying heights, and seven models with varying shapes. To guarantee anatomical accuracy and physiologically acceptable fluid volumes, these models were verified using actual patient data. Numerical simulations of left ventricle contraction and aortic valve leaflet opening/closing were performed to evaluate the electro-physiological potential distribution in the left ventricle and wall shear stress distribution in aortic valve leaflets. The proposed synthetic database aims to increase the predictive power of machine-learning models in cardiovascular research and, eventually, improve patient outcomes after aortic valve surgery. [ABSTRACT FROM AUTHOR]

The use of RDV in SAVR is associated with risk of conduction abnormality requiring PPM implantation, when compared to conventional bioprosthetic valves. We aimed to evaluate the outcome after selective placement of annular compression sutures during surgical aortic valve replacement (SAVR) using Intuity rapid deployment valve (RDV). This is a retrospective study of prospectively enrolled patients receiving SAVR using Intuity RDV. Selective placement of commissural compression suture was assessed for all patients based on their annular morphology. Outcomes including operative mortality, rate of pacemaker rate, paravalvular leak and change in trans -valvular pressure gradient were analyzed. 56 consecutive patients underwent SAVR with the INTUITY RDV at our institution from January 2020 to November 2021. The Mean age of our cohort was 69.9 ± 10.6 years with a EuroSCORE II of 3.4 ± 2.4%. 28.6% (16/56) of patients had notable conduction abnormalities pre-operatively, which included atrial fibrillation and left/right bundle branch block. Compression sutures were selectively applied in 19/56 (33.9%) patients. Of which, 13 were bicuspid aortic valve. Post-operatively, we observed no conduction abnormality requiring PPM implantation. In addition, only 3 of the 56 (5.4%) had any degree of paravalvular leak on post-operative echocardiography (all ≤ mild). The mean reduction in trans -valvular gradient was 29.9 mmHg and the mean pressure gradient at 1 month and 1 year follow-up were 9.3 ± 3.6 mmHg and 10.2 ± 4.1 mmHg, respectively. Selective placement of compression suture helps to avoid unnecessary oversizing, which may reduce the risk of paravalvular leak and post-operative PPM implantation. [ABSTRACT FROM AUTHOR]

Background Valve sparing aortic root replacement (VSARR) is a treatment for aortic root dilatation and aortic regurgitation (AR), which preserves the aortic valve. However, AR may recur, and redo surgery often carries high risk. Transcatheter aortic valve replacement (TAVR) can be performed but there is a paucity of literature to guide procedural planning. Case summary Two cases are presented herein with recurrence of severe AR following VSARR (David procedure). In both cases, computed tomography (CT) scans demonstrated absence of calcium and a narrow sinus of valsalva. Both cases were considered at prohibitive risk for redo surgery and were successfully treated with TAVR using balloon-expandable valves. The valves were sized based on CT (aiming for moderate oversizing of 10%–11%) and by assessing the anchoring and waist of sizing balloons. Post-procedure aortography and echocardiography revealed no transvalvular or paravalvular regurgitation. Both patients were successfully discharged with follow-up CT scans also showing no migration and preservation of coronary access, together with suitability of future redo TAVR if required. Discussion TAVR can be successfully performed after VSARR surgery with a balloon-expandable valve in the absence of aortic valve calcification. Moderate THV oversizing (10%–11%) appears safe and effective. Careful assessment with a sizing balloon is recommended to ensure adequate anchoring, without the need for aggressive oversizing which risks rupture at the graft suture line. [ABSTRACT FROM AUTHOR]

Background Transcatheter aortic valve replacement (TAVR) is a well-established treatment option for patients with severe aortic valve stenosis; however, clinical valve thrombosis is a major challenge. Case summary A 92-year-old woman underwent TAVR for severe aortic stenosis. One month later, the patient developed acute heart failure. As the progression of anaemia due to renal anaemia seemed to cause acute heart failure exacerbation, we started an oral hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitor. After 2 weeks, the patient redeveloped shortness of breath. Transthoracic echocardiography revealed that the mean aortic valve pressure gradient (Δ P) increased from 9 to 54 mmHg, and the aortic valve area decreased from 1.93 to 0.86 cm2. Blood work revealed a markedly elevated haemoglobin level from 8.0 to 13.2 g/dL, and transoesophageal echocardiography revealed markedly decreased left coronary and non-coronary cusp mobility. We diagnosed that the rapid increase in the haemoglobin level caused by the HIF-PH inhibitor was related to valve thrombosis and bioprosthetic dysfunction of the transcatheter aortic valve. The HIF-PH inhibitor was discontinued, and anticoagulation therapy was started. Transthoracic echocardiography at 16 days later revealed that the mean aortic valve Δ P improved by 15 mmHg, and the subjective symptoms resolved. Discussion This is the first report on a successful treatment of TAVR thrombosis formation associated with HIF-PH inhibitor use. When treating renal anaemia in patients undergoing TAVR, care should be taken to avoid rapid anaemia resolution and valve thrombosis development. [ABSTRACT FROM AUTHOR]

Background: Transcatheter aortic valve implantation (TAVI) has emerged as a pivotal intervention for managing severe aortic stenosis in high-risk surgical patients. Objective: This study aimed to evaluate the impacts of procedural factors and patient characteristics on TAVI outcomes, with a focus on survival rates, cardiac mortality, and associated complications. Methods: A retrospective, single-center study involving 224 patients who underwent TAVI at the Lithuanian University of Health Sciences from September 2021 to April 2023 was conducted. Data encompassing demographic characteristics, medical history, procedural specifics, and follow-up outcomes were analyzed. Survival and adverse events were assessed at 30 days, 6 months, and 12 months post-TAVI. Results: The study included 224 patients. The mean age in the non-death group was 80 ± 6.17 years (range, 49–91), while that in the cardiac death group was 81.5 ± 6.14 years (range, 70–94; p = 0.079). Males accounted for 37.7% of the non-death group and 50% of the cardiac death group (p = 0.304). Statistical analyses identified factors significantly associated with mortality and complications. The overall survival rate was 88.8%, with cardiac-related mortality observed in 8% of patients. Increased fluoroscopy time (p < 0.001), a higher contrast volume (p = 0.005), and less improvement in aortic valve velocity post-TAVI (p = 0.031) were significantly associated with cardiac mortality. Advanced age and a reduced left ventricular ejection fraction (<50%) were prominent predictors of adverse outcomes. Patients with non-coronary cusp calcification exhibited lower cardiac mortality (p = 0.005), while mitral valve regurgitation was linked to poorer outcomes (p = 0.015). Logistic regression analysis underscored the incremental risks posed by procedural complexities and comorbidities. Conclusions: Procedural factors such as fluoroscopy duration and contrast volume, along with patient-specific attributes including age, left ventricular function, and valve calcification patterns, critically influence TAVI outcomes. These findings emphasize the need for tailored procedural strategies and patient management protocols to mitigate risks and enhance the efficacy of TAVI interventions. [ABSTRACT FROM AUTHOR]

Intra-cardiac kinetic energy (KE) and ventricular flow analysis (VFA), as derived from 4D-flow MRI, can be used to understand the physiological burden placed on the left ventricle (LV) due to bicuspid aortic valve (BAV). Our hypothesis was that the KE of each VFA component would impact the surgical referral outcome depending on LV function decrement, BAV phenotype, and aortic dilation severity. A total of 11 healthy controls and 49 BAV patients were recruited. All subjects underwent cardiac magnetic resonance imaging (MRI) examination. The LV mass was inferior in the controls than in the BAV patients (90 ± 26 g vs. 45 ± 17 g, p = 0.025), as well as the inferior ascending aorta diameter indexed (15.8 ± 2.5 mm/m2 vs. 19.3 ± 3.5 mm/m2, p = 0.005). The VFA KE was higher in the BAV group; significant increments were found for the maximum KE and mean KE in the VFA components (p < 0.05). A total of 14 BAV subjects underwent surgery after the scans. When comparing BAV nonsurgery vs. surgery-referred cohorts, the maximum KE and mean KE were elevated (p < 0.05). The maximum and mean KE were also associated with surgical referral (r = 0.438, p = 0.002 and r = 0.371, p = 0.009, respectively). In conclusion, the KE from VFA components significantly increased in BAV patients, including in BAV patients undergoing surgery. [ABSTRACT FROM AUTHOR]

Background: Takayasu arteritis is a large-vessel vasculitis, in addition to giant cell arteritis. Various post-operative complications associated with the cardiac macrovasculature have been reported. Detachment of the prosthetic valve, pseudoaneurysm formation, and dilatation of the aortic root are well-known post-operative complications associated with vasculitis syndromes, including Takayasu arteritis. Here, we report a rare complication involving aortic bioprosthetic valve dislodgement in the left ventricular outflow tract due to Takayasu arteritis. Case presentation: A 76-year-old female underwent aortic valve replacement with a 21-mm Carpentier–Edwards Perimount valve for severe aortic regurgitation and a coronary artery bypass graft from the left internal thoracic artery to the left anterior descending artery for ischemic heart disease. Fourteen years after the initial surgery, echocardiography revealed severe aortic valve sclerosis due to structural valve deterioration of the bioprosthesis. Upon scrutiny, the bioprosthetic aortic valve was found to have dislodged into the left ventricular outflow tract. We performed re-implantation of the bioprosthetic aortic valve and replacement of the ascending aorta. Conclusions: Although dislodgement of the bioprosthetic aortic valve is an extremely rare complication associated with Takayasu arteritis, the possibility that it could occur should be considered when treating the post-operative patients. [ABSTRACT FROM AUTHOR]

Background: Windsock deformities, though rare, represent a severe form of valvular aneurysm distinguished by localized balloon-like protrusions of the leaflet body. Here, we present a compelling case of windsock mitral valve (MV) formation subsequent to incompletely managed aortic valve (AV) endocarditis. The case is illustrated through radiographic, intraoperative, and histopathologic images. Case presentation: We present the case of a 44 year old male patient who presented with symptoms suggestive of infective endocarditis. Despite initiation of appropriate antimicrobial therapy and surgical intervention for AV involvement, the patient developed progressive valvular dysfunction. Subsequent imaging studies revealed the emergence of windsock deformity in the mitral valve apparatus. Intraoperative assessment confirmed the presence of this rare valvular anomaly, which was further corroborated by histopathologic examination. Conclusions: We provide, for the first time in the literature, a clear intraoperative view and example of windsock mitral valve (MV) developing after incompletely treated aortic valve (AV) endocarditis. [ABSTRACT FROM AUTHOR]

Aortic dissection (AoD) is a rare fatal condition in which tearing in the intima causes a false channel in the aorta and can lead to rupture. AoD is classified as the DeBakey classification (Types I, II, III) and Stanford classification (Types A and B). Women with underlying risk factors such as hypertension, smoking, bicuspid aortic valve, and connective tissue disorders are at risk for pregnancy‐related AoD. These risk factors may not be recognized until the AoD occurs during pregnancy. We describe an acute incidence of type A AoD in the second trimester of pregnancy. A multiparous woman with no previously known risk factor presented with nonspecific chest pain. She was found to have AoD and underwent successful surgical intervention. This case demonstrates the importance of vigilance in the evaluation of pregnant women with new cardiopulmonary symptoms. A multidisciplinary approach can save the mother and the fetus. [ABSTRACT FROM AUTHOR]

Calcific aortic valve disease (CAVD), a common heart valve disease, is increasingly prevalent worldwide and causes high morbidity and mortality. Here, we aimed to investigate a possible role for miR-34c in the development of osteogenic differentiation during CAVD and to find out the underlying mechanisms. Valvular interstitial cells (VICs) were isolated from the clinical aortic valve tissue samples of CAVD patients and patients with acute aortic dissection and collected. Then, RT-qPCR was performed to determine miR-34c expression and western blot analysis was applied to confirm the relevant protein expression in these VICs. Dual luciferase reporter gene assay was applied to confirm the relation between miR-34c and STC1. Alkaline phosphatase (ALP) staining and alizarin red staining was performed to further confirm the degree of calcification in these samples. MiR-34c was lowly expressed and STC1 was highly expressed in the CAVD tissues. Furthermore, STC1 was the target of miR-34c and was negatively regulated by miR-34c. Overexpression of miR-34c in VICs was concomitant with suppression of both STC1 expression and phosphorylation level of c-Jun N-terminal kinase (JNK). In addition, significant decrease of bone morphogenetic protein-2 (BMP2) and osteocalcin, as well as the decrease of calcification degree were also observed in VICs with miR-34c overexpressed. Taken together, miR-34c could inhibit osteogenic differentiation and calcification of VICs by suppressing the STC1/JNK signaling pathway in CAVD, making miR-34c a novel therapeutic target for the treatment of CAVD. [ABSTRACT FROM AUTHOR]

Background: Abnormal blood flow patterns are known to contribute to the ascending aortic dilation in patients with bicuspid aortic valve (BAV). The present study elucidated the blood flow characteristics in the dilated ascending aorta before and after transcatheter aortic valve replacement (TAVR) using computational fluid dynamics (CFD) analysis. Methods: We performed CFD analysis in three BAV patients with ascending aortic dilation (maximum diameter ≥ 45 mm) who underwent TAVR. The blood flow streamline was visualized to evaluate the pre- and post-operative flow velocity, severity of vortex and helix, and wall shear stress (WSS) in the ascending aorta. Results: Before the procedure, all three patients showed abnormal blood flow patterns, with vortex and helix in the ascending aorta. Regionally elevated WSS was also observed in the lateral or posterior ascending aortic wall (16.7 Pa, 12.2 Pa, and 14.5 Pa in patient 1, 2, and 3, respectively). After the procedure, the blood flow patterns significantly improved, and the maximum WSS also decreased (4.2 Pa, 1.1 Pa, and 3.2 Pa in patient 1, 2, and 3, respectively). Conclusion: Abnormal blood flow patterns and WSS appeared to improve after TAVR in BAV patients with ascending aortic dilation. The impact on the long-term aortic growth rate and the incidence of aortic dissection requires further studies. Trial Registration: Changes of Ascending Aortic Diameter in Patients Undergoing Transcatheter Aortic Valve Replacement. ClinicalTrial.gov number NCT05739253. Trial registration date 20,230,212. [ABSTRACT FROM AUTHOR]

Background: Valve-sparing root replacement surgery is an alternative strategy for patients with aortic regurgitation with or without aortic root enlargement. A detailed understanding of the mechanisms of regurgitation and the morphology of the aortic root would be beneficial for predicting the feasibility and success of valve-sparing surgery. This is an exploratory study of the measurement of geometric height in 3D transesophageal echocardiography as a predictor of valve-sparing root replacement for aortic regurgitation. Methods: Transesophageal echocardiographic findings and long-term outcomes were compared in 124 patients undergoing either valve-sparing root replacement (VSRR group) or composite valve graft replacement (Bentall group) from September 2014 to March 2019. Results: The VSRR group was younger and had better left ventricular function than the Bentall group. Three-dimensional transesophageal echocardiography showed that geometric height was significantly larger in the VSRR group. In receiver-operating curve analysis, the cutoff values of geometric height for the feasibility of valve-sparing surgery were 15.9 mm and 19.8 mm in the tricuspid and bicuspid aortic valve, respectively. The overall survival was 98.6% and the freedom from reoperation rate was 89.7% at 5 years in the VSRR group. Conclusions: Appropriate patient selection and adequate GH may contribute to the success of VSSR and improve long-term outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyze the outcomes and challenges associated with surgical redo procedures following aortic valve replacement for acute infective endocarditis. While transcatheter aortic valve implantation is growing in terms of its utilization for degenerative bioprostheses failure, valve-in-valve procedures are limited in acute aortic endocarditis. Surgical interventions for aortic prosthesis endocarditis carry a significant risk, with a higher mortality and morbidity, often requiring concomitant complex procedures. Methods: This was a retrospective, monocentric, observational study. We identified 352 patients with infective endocarditis from the institutional database. After applying the inclusion and exclusion criteria, 54 patients who underwent surgical re-operation between 2016 and 2023 were included. Endpoints included early and late mortality, complications, and major adverse cardiac and cerebrovascular events (MACCEs). Results: From the cohort, predominantly male and with an average age of 71.9 ± 12.1 years old (79.6%), the following notable findings were derived: isolated aortic valve replacement was feasible only in 34 patients (63%) while more complex procedures were demanded in the other cases; the overall 30-day mortality rate was 18.5%, post-operative ECMO occurred in 9.3% of cases, and post-operative new stroke in 2.7%; the 5-year overall survival rate was 58.3 ± 18.6%, while freedom from MACCEs was 41.7 ± 19.7%. Another re-intervention was required in three patients during follow-up, with one case attributed to re-endocarditis. Conclusions: Despite advancements in surgical and perioperative care, redo procedures for acute infective endocarditis pose significant risks, as evidenced by the high 30-day mortality rate. However, the 5-year survival suggests a relatively acceptable outcome, underscoring the complexities and challenges inherent in managing this condition surgically. [ABSTRACT FROM AUTHOR]

Background: Aortic valvuloplasty for bicuspid aortic valve carries a risk of postoperative stenosis. We evaluated the haemodynamic differences between aortic valvuloplasty for bicuspid aortic valve, tricuspid aortic valve, and aortic valve replacement by echocardiography. We also assessed whether a higher postoperative pressure gradient affects the outcomes of aortic valvuloplasty for bicuspid aortic valve. Methods: From 2014 to 2021, patients undergoing aortic valvuloplasty were classified into aortic valvuloplasty for bicuspid aortic valve (Group-PB) and aortic valvuloplasty for tricuspid aortic valve (Group-PT). We also enrolled patients undergoing aortic valve replacement (Group-R) between 2002 and 2021. Mid-term outcomes were compared within Group-PB based on peak pressure gradients of ≥20 mmHg (subgroup-H) and <20 mmHg (subgroup-L). Results: Group-PB included 42 patients and Group-PT included 70 patients. Both 7-day and 1-year echocardiography showed the highest peak/mean pressure gradients in Group-PB (n = 41) and the lowest values in Group-PT (n = 67). Propensity scoring analysis yielded similar results to an unadjusted analysis. The mid-term outcomes were not significantly different between subgroup-H (n = 20) and subgroup-L (n = 22), with rates of freedom from aortic regurgitation >II at 5 years of 94.4% vs. 94.4% (p = 0.749) and freedom from reoperation of 94.4% vs. 100.0% (p = 0.317), respectively. Conclusions: Aortic valvuloplasty for tricuspid aortic valve shows favourable valve function in the early postoperative period, whereas aortic valvuloplasty for bicuspid aortic valve has a risk of postoperative stenosis. However, a high pressure gradient (peak pressure gradient of ≥20 mmHg) after aortic valvuloplasty for bicuspid aortic valve does not impact mid-term outcomes. [ABSTRACT FROM AUTHOR]

Background/Objectives: Infective endocarditis (IE) most commonly results from infections by Gram-positive bacteria, and, in this condition, the redox homeostasis is lost due to the overproduction of H2O2, leading to the overstimulation of the immune system and the upregulation of the production of proinflammatory cytokines. The aim of this study was to evaluate the levels of oxidative biomarkers and the enzymatic and non-enzymatic antioxidant systems in subjects with IE. Methods: The study included three cases with IE that had undergone aortic valve replacement (AVR) surgery that was complicated by IE, comparing them with subjects with AVR without IE. We determined the malondialdehyde (MDA), total antioxidant capacity (TAC), carbonyl group concentration, glutathione (GSH), thiols and the nitrate/nitrite ratio (NO3−/NO2−) in homogenized tissue from the cardiac valves. We also measured the activity of glutathione-S-transferase (GST), glutathione peroxidase (GPx), glutathione reductase (GR) and thioredoxin reductase (TrxR). The superoxide dismutase (SOD) isoforms and peroxidase activity were determined using native gels. Results: There were increases in the activity of antioxidant enzymes such as GST, SOD isoforms and peroxidases (p ≤ 0.01) and decreases in oxidative stress markers such as GSH (p = 0.05); meanwhile, MDA and carbonylation were increased (p ≤ 0.05). Conclusions: The results suggest that bacterial infections favor oxidative stress in the aortic valves, which increases the SOD isoforms and peroxidase activity. This contributes to the loss of the intricate redox homeostasis system in patients with IE, causing a positive feedback loop in the oxidative background that results in damage to the heart, likely leading to a fatal outcome. [ABSTRACT FROM AUTHOR]

The article in Clinical Genetics explores ABL1 deficiency syndromes, highlighting how mutations in different isoforms can lead to distinct diseases. The study focuses on a Lebanese consanguineous family with cardiac abnormalities, revealing a novel likely pathogenic variant in ABL1. The findings suggest that variants affecting different ABL1 isoforms may result in unique phenotypes, emphasizing the need for further research to fully understand ABL1-associated disorders. [Extracted from the article]

This article discusses a rare case of severe mitral stenosis caused by cardiac amyloidosis. The patient, a 51-year-old male with chronic kidney disease, presented with shortness of breath and a diastolic rumbling murmur. A transthoracic echocardiogram revealed severe mitral stenosis with thickened and calcified mitral valve leaflets, as well as a subvalvular non-mobile mass-like lesion. The patient underwent surgical mitral valve replacement and was followed up for 5 years without complications. The article highlights the uncommon manifestation of severe mitral stenosis in cardiac amyloidosis. [Extracted from the article]

Growth Differentiation Factor 15 (GDF15) is an emerging biomarker that significantly increases during acute stress responses, such as infections, and is moderately elevated in chronic and inflammation-driven conditions. While evidence suggests that high levels of GDF15 in cardiac surgery are associated with worse outcomes, its utility as an evaluator of early postoperative complications remains unclear. This study aims to characterize the postoperative profile of GDF15 in patients undergoing isolated surgical aortic valve replacement, evaluating its association with short-term outcomes. Serum samples from patients undergoing cardiac surgery were collected preoperatively and at defined postoperative time points (1 h, 6 h, 12 h, 24 h, and 48 h) to measure GDF15 levels. GDF15 levels significantly increased after surgery, peaking at 6 h. A positive correlation was observed between GDF15 levels and both cardiopulmonary bypass and aortic cross-clamp times. Notably, patients who developed postoperative acute kidney injury (AKI) or required prolonged hemodynamic support had significantly higher GDF15 levels, with increased mechanical ventilation time and extended intensive care unit length of stay. Furthermore, GDF15 levels correlated with postoperative SOFA scores at 24 h after surgery. GDF15 may be a valuable biomarker for risk stratification and guiding therapeutic decisions in cardiac surgery patients. Higher GDF15 levels were significantly associated with prolonged hemodynamic support, postoperative AKI, and measures of illness severity. [ABSTRACT FROM AUTHOR]

We report a case of a complex transcatheter aortic valve implantation (TAVI) complicated by severe calcifications, which prevented the delivery system from advancing through the aortic valve. To address this challenge, we employed an innovative solution using a Snare catheter. This approach enabled stabilization and guidance of the delivery system, facilitating the crossing of the calcified obstruction and the successful completion of the procedure. This case highlights the utility of the Snare catheter as a complementary technique to overcome anatomical challenges in complex TAVI procedures. [ABSTRACT FROM AUTHOR]

Objectives: The role of diabetes mellitus as a risk factor for the development of calcific aortic valve disease has not been fully clarified. Aortic valve interstitial cells (VICs) have been suggested to be crucial for calcification of the valve. Induced calcification in cultured VICs is a good in vitro model for aortic valve calcification. The purpose of this study was to investigate whether increased glucose levels increase experimentally induced calcification in cultured human VICs. Design: VICs were isolated from explanted calcified aortic valves after valve replacement. Osteogenic medium induced calcification of cultured VICs at different glucose levels (5, 15, and 25 mM). Calcium deposits were visualized using Alizarin Red staining and measured spectrophotometrically. Results: The higher the glucose concentration, the lower the level of calcification. High glucose (25 mM) reduced calcification by 52% compared with calcification at a physiological (5 mM) glucose concentration (correlation and regression analysis: r = −0.55, p =.025 with increased concentration of glucose). Conclusions: In vitro hyperglycemia-like conditions attenuated calcification in VICs. High glucose levels may trigger a series of events that secondarily stimulate calcification of VICs in vivo. [ABSTRACT FROM AUTHOR]

This research presents a numerical model dedicated for virtual patient diagnostics in the field of synthetic valve implantation. The model operates based on computational fluid dynamics solver with implemented rigid body motion solver. Characteristic indicators related to the prosthetic valve were determined to assess the correctness of cardiac system operation after implantation. A novel approach for dynamic time discretization was developed for reliable and time-efficient calculation. The solver efficiency and computational savings due to application of the developed time-discretization scheme is discussed. Numerical results were validated using experimental data acquired from a test rig, including mass flow meter, pressure transducers, and valve holder designed for this purpose. Multivariant analysis of the model constant was performed towards different levels of the valve resistance to motion. The in-house algorithm was prepared to automatically determine the prosthetic valve position from fast camera images.   [ABSTRACT FROM AUTHOR]

A stuck leaflet is a rare complication of transcatheter aortic valve implantation (TAVI). It occurs when one of the leaflets in the implanted valve doesn't open and close properly. This complication can lead to serious health problems, even death. We describe a rare case of a stuck "open" leaflet after TAVI. To our knowledge, this is the first reported case in which this frightening complication has been resolved by ballooning procedure, with no need for another valve implantation. This case highlights the potential role of ballooning procedure as a treatment for stuck leaflets after TAVI. [ABSTRACT FROM AUTHOR]

Objectives: Aortic valve sclerosis (AVS) is the thickening or calcification of the aortic valve without significant obstruction, primarily affecting the elderly and potentially progressing to calcific aortic valve disease with high morbidity and mortality. This study evaluates the diagnostic potential of the neutrophil-to-albumin ratio (NAR) in predicting AVS. Methods: In this retrospective study, 494 patients aged 18-75 who underwent transthoracic echocardiography between December 2022 and March 2024 were analyzed. Patients were divided into two groups: 401 with AVS and 93 without. NAR was calculated from laboratory data. Results: The AVS group had higher rates of diabetes mellitus, hypertension, and coronary artery disease compared to the control group (p<0.001 for all). Laboratory findings showed elevated fasting blood glucose, creatinine, cholesterol, HDL-C, LDL-C, WBC, and neutrophil counts in the AVS group. Multivariate analysis identified hypertension, diabetes mellitus, reduced left ventricular ejection fraction, and elevated NAR as independent predictors of AVS. Sensitivity of NAR in diagnosis of AVS was 56% and specificity 58%. Conclusion: Elevated NAR is significantly associated with AVS and is an independent predictor. These findings suggest NAR could be a valuable marker for early diagnosis and management of AVS. Further research is needed to explore the mechanisms and potential therapeutic interventions targeting inflammation in AVS [ABSTRACT FROM AUTHOR]

The article discusses a case study of a 77-year-old male with worsening aortic regurgitation and mitral valve issues, who underwent concurrent transapical transcatheter aortic valve and mitral valve-in-ring replacement. The patient had a complex medical history, including coronary artery disease, atrial fibrillation, and prior surgeries. The procedures were chosen due to the patient's high surgical risk and frailty, resulting in improved functional status post-discharge. The study highlights the effectiveness and safety of transcatheter interventions for high-risk surgical patients, emphasizing the importance of individualized treatment strategies. [Extracted from the article]

In this paper we discuss the relevance of continuity equation based aortic valve area (AVA) calculation as a robust parameter suitable for accurate grading of aortic stenosis (AS) irrespective of flow conditions. Combining the AVA-based grading and echocardiography-based staging, can provide with the most comprehensive clinical assessment of patients with AS and preserved left ventricular systolic function to streamline management decisions. [ABSTRACT FROM AUTHOR]

Background Bicuspid aortic valve (BAV) is the most common congenital heart defect (reported incidence of 0.5%–2%) and is commonly associated with proximal aortic dilation. Patients with severe aortic stenosis (AS) of BAV have been shown to have worse pre-operative left ventricular (LV) function as well as a higher incidence of post-operative heart failure hospitalization when compared with analogous patients with tri-leaflet aortic valve disease. While surgical aortic valve replacement (SAVR) may be favoured over transcatheter aortic valve implantation (TAVI) due to anatomical factors or concomitant aortopathy and coronary artery disease, surgical candidacy is often limited by prohibitive operative risk. Case summary We report on three cases of severe AS in BAV with concomitant aortopathy and severe left ventricular dysfunction in whom we proceeded with SAVR with a priori planned venoarterial extracorporeal membrane oxygenation (VA-ECMO) support and inotrope-assisted wean. All patients had severe LV dysfunction (ejection fraction < 25%) at baseline with gradual substantial improvement or normalization after successful SAVR. Discussion These cases demonstrate the utility of planned VA-ECMO with SAVR and aortic root replacement as an integral component of the operative strategy for high surgical risk patients with severe BAV AS not amenable to TAVI. Appropriate pre-operative planning and consent for VA-ECMO as well as a multi-disciplinary approach involving anaesthesia, intensive care, and heart failure cardiology are the key to offering this option as an alternative to palliative medical therapy to a selected group of patients. [ABSTRACT FROM AUTHOR]

Background Computed tomography (CT) assessment is the standard for predicting coronary obstruction (CO) caused by sinus sequestration (SS) during transcatheter aortic valve (TAV) implantation in degenerated TAV (TAV-in-TAV) procedure, but it may not always be accurate. This report describes a prediction method for CO by using balloon aortic valvuloplasty (BAV) during TAV-in-TAV. Case summary An 87-year-old woman with a history of balloon-expandable transcatheter heart valve (BE-THV) implantation 7 years prior was admitted with worsening dyspnoea. Echocardiography revealed severe THV deterioration, and CT confirmed calcium proliferation in the THV. Our heart team decided to perform a TAV-in-TAV procedure using a 23-mm BE-THV. Preoperative CT imaging indicated an intermediate risk of CO. To evaluate CO risk more precisely, the top of a 20-mm balloon was positioned near the top of a BE-THV stent and inflated, followed by simultaneous aortic root injection (SARI). During SARI, contrast flowed into both coronary arteries, predicting a low risk of CO. Based on these findings, TAV-in-TAV was performed without coronary protection. The procedure was completed successfully without CO. After the procedure, the patient's symptoms improved, and echocardiography showed normal valve function. She was discharged without complications and remains under outpatient follow-up care. Discussion The diagnostic method for predicting CO using BAV with SARI could serve as a valuable adjunctive diagnostic tool in patients with an intermediate or high risk of SS anatomy after TAV-in-TAV. In such cases, this method may provide additional insights concerning precise CO risk and the indication of leaflet modification technique during TAV-in-TAV. [ABSTRACT FROM AUTHOR]

Background Subaortic pannus formation complicates bioprosthetic aortic valve (AV) replacement. We report an extreme case in a continuous-flow left ventricular assist device (LVAD) patient. Case summary A 49-year-old Caucasian female with dilated cardiomyopathy was bridged to transplant with a HeartWare Ventricular Assist Device (Medtronic). Duration of support was prolonged, 6 years & 7 months, due to allosensitization requiring desensitization. Pump thrombosis occurred 2 years & 4 months post-LVAD requiring alteplase thrombolysis. The patient underwent bioprosthetic AV replacement 3 years & 10 months post-LVAD for symptomatic aortic incompetence. Transthoracic echocardiography (TTE) performed 1 year and 2 years post-bioprosthetic AV replacement repeatedly demonstrated an AV closed during all cardiac cycles without incompetence and nil flow through the left ventricular outflow tract (LVOT). Following transplant, analysis of explanted heart revealed a fused AV. A pannus adherent to the underside of the AV had formed across the entire AV outlet, with complete obliteration of LVOT. This subaortic pannus was not visualized on previous TTE. Histologically, the pannus consisted of hypocellular fibrous tissue with chronic inflammatory cells, spindle histiocytes, and myofibroblasts scattered throughout the loose fibromyxoid stroma, the latter highlighted on CD68 immunohistochemical stain (IHC). Partial endothelialization on the pannus surface was highlighted on ERG and CD31 IHC. Neither calcification nor signs of acute inflammation were noted. In contrast to previous cases, there was no evidence of associated thrombus macroscopically or microscopically. Discussion Prolonged LVAD support may facilitate subaortic pannus following bioprosthetic AV replacement due to AV closure and altered transvalvular flow. Due to the parallel LVAD circulation, subaortic pannus may develop asymptomatically, without haemodynamic compromise, allowing progression to total LVOT obstruction. This requires consideration prior to LVAD explantation in bridge-to-recovery patients. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate predictors of cardiac conduction disturbance associated with increased risk of temporary and permanent pacemaker implantation after endovascular aortic valve replacement (TAVR). Material and methods. We analyzed patients who underwent surgical treatment for aortic valve replacement by endovascular treatment in Krasnoyarsk Regional Clinical Hospital from January 2018 to May 2023. The total number of people included in the study is 157. Results and discussion. The association between the occurrence of atrioventricular block of II–III degree, left bundle branch block and atrial fibrillation after TAVR implantation, which required temporary pacemaker implantation and permanent pacemaker implantation, was revealed. Atrioventricular block of grade II-III was first detected in 11 (13.3 %) patients after TAVR, left bundle branch block – in 22 (26.5 %) and atrial fibrillation – in 11 (13.3 %). The need for temporary pacing during TAVR was necessary in 35 (23.6 %) patients. 34 (23.0 %) patients had a temporary pacemaker placed within the first 2 days after surgical intervention and 1 patient (0.7 %) after 3 days. Regression analysis revealed 6 significant risk factors for temporary pacemaker implantation: left bundle branch block (p = 0.002), atrial fibrillation (p = 0.030), 1st degree atrioventricular block (p = 0.032), age (p = 0.012), female gender (p = 0.033) and history of acute myocardial infarction (p = 0.024). Permanent pacemaker implantation was performed in 7 (4.5 %) patients in the period from 4 to 20 days, including 6 (85.7 %) patients due to complete atrioventricular block and 1 (14.3 %) patient due to sinus node dysfunction. Permanent pacemaker was implanted to five (3.2 %) patients in the period from 6 months to 3.6 years, including 3 (1.9 %) patients due to complete atrioventricular block and 2 (1.3 %) patients due to sinus node dysfunction. Regression analysis revealed 2 significant risk factors for permanent pacemaker implantation: presence of atrial fibrillation before surgical intervention (p = 0.002; r = 0.160) and presence of left bundle branch block before TAVR (p = 0.037; r = 0.108). Conclusions. Identification of predictors of atrioventricular block of II–III degrees after TAVR will facilitate timely temporary pacing and permanent pacemaker implantation to prevent complications due to bradyarrhythmias.

Background: Atrial fibrillation (AF) is a recognized risk factor for mortality after transcatheter aortic valve replacement for severe aortic stenosis, but the impact of different types of AF on clinical outcomes remains unclear. Methods: This retrospective study included 982 patients divided into 3 groups: no AF, paroxysmal AF, and nonparoxysmal AF (persistent or permanent). Clinical outcomes were analyzed using inverse probability weighting and multivariate models. Results: There were 610, 211, and 161 patients in the no-AF, paroxysmal AF, and nonparoxysmal AF groups, respectively. For the entire cohort, the mean (SD) age was 82 (7.7) years, and the periprocedural, 1-year, and 5-year mortality rates were 2.0%, 12%, and 50%, respectively. After inverse probability weighting, the periprocedural mortality rate was higher in the nonparoxysmal AF group than in the no-AF group (odds ratio, 4.71 [95% CI, 1.24-17.9]). During 5 years of follow-up (median [IQR], 22 [0-69] months), all-cause mortality was higher in the nonparoxysmal AF group than in the no-AF group (hazard ratio [HR], 1.56 [95% CI, 1.14-2.14]; P = .006). The paroxysmal AF group was not associated with worse clinical outcomes than the no-AF group (HR, 1.02 [95% CI, 0.81-1.49]) for all-cause mortality. Stroke rates were comparable among the 3 groups. Multivariate analysis also showed increased all-cause mortality in the nonparoxysmal AF group compared with the no-AF group (adjusted HR, 1.43 [95% CI, 1.06-1.93]; P = .018), while all-cause mortality was comparable between the paroxysmal AF and no-AF groups (adjusted HR, 1.00 [95% CI, 0.75-1.33]). Conclusion: In patients undergoing transcatheter aortic valve replacement for severe aortic stenosis, having nonparoxysmal AF was associated with a higher risk of periprocedural and all-cause mortality compared with having no AF. Paroxysmal AF showed no such association.

BACKGROUND: High circulating levels of Lp(a) (lipoprotein[a]) increase the risk of atherosclerosis and calcific aortic valve disease, affecting millions of patients worldwide. Although atherosclerosis is commonly treated with low-density lipoprotein-targeting therapies, these do not reduce Lp(a) or risk of calcific aortic valve disease, which has no available drug therapies. Targeting Lp(a) production and catabolism may provide therapeutic benefit, but little is known about Lp(a) cellular uptake. METHODS: Here, unbiased ligand-receptor capture mass spectrometry was used to identify MFSD5 (major facilitator superfamily domain containing 5) as a novel receptor/cofactor involved in Lp(a) uptake. RESULTS: Reducing MFSD5 expression by a computationally identified small molecule or small interfering RNA suppressed Lp(a) uptake and calcification in primary human valvular endothelial and interstitial cells. MFSD5 variants were associated with aortic stenosis (P=0.027 after multiple hypothesis testing) with evidence suggestive of an interaction with plasma Lp(a) levels. CONCLUSIONS: MFSD5 knockdown suppressing human valvular cell Lp(a) uptake and calcification, along with meta-analysis of MFSD5 variants associating with aortic stenosis, supports further preclinical assessment of MFSD5 in cardiovascular diseases, the leading cause of death worldwide.

Calcific Aortic Valve Disease (CAVD) is a disease in which a patient's aortic valve is biomineralized to form calcified plaques and cause damage to valve function, thus affecting the normal flow of blood to the heart. CAVD can lead to stenosis or insufficient closure of heart valves, which may lead to serious complications such as abnormal blood flow to the heart. The main components of natural valves are collagen, elastin, and glycosaminoglycans, of which collagen can be used as a nucleation site for calcium deposition, and when the valve surface suffers microinjury, the exposed collagen can easily induce calcium deposition and lead to the disease. In this study, we constructed a porcine aortic valve surface damage model to simulate the calcification process of the aortic valve in vitro. We analyzed the relevant samples by Scanning Electron Microscopy (SEM), Energy Spectrum Analysis (EDS), X-ray Powder Diffraction (XRD), Fourier Transform Infrared Spectroscopy Attenuation Total Reflection (FTIR-ATR), and Thermo-Gravimetric Analysis (TGA). The SEM and EDS spectroscopy confirmed that calcium deposition at the damaged parts of the valves was faster and that the sample contained a high concentration of calcium.; XRD analysis showed that the composition of the deposits was mainly dicalcium phosphate dihydrate (DCPD) and hydroxyapatite (HAp); FTIR-ATR results showed that the calcium deposits were carbonate-containing phosphates; TGA results further demonstrated that microinjury of heart valves accelerated the process of calcification and facilitated calcium deposition. The in vitro surface microinjury model used in this study is expected to be an effective model for rapid simulation of the in vivo calcification process.