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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]

Ventricular septal defect (VSD) is a common congenital heart disease. However, consensus on the utility of echocardiography in predicting spontaneous closure (SC) of VSD remains lacking. This study aimed to identify and validate significant predictors of SC through a predictive scoring system. This retrospective study included medical records of 712 echocardiography instances performed on 304 patients diagnosed with VSD from 2016 to 2020 in their first year of life. A novel scoring system for predicting the SC of VSD was developed and validated using another dataset from different hospitals. Of the 304 patients, 215 (70.7%) had perimembranous (PM) VSDs and 89 had muscular (29.3%) VSDs. The median follow-up periods were 36.2 (interquartile range [IQR], 13–59) months and 13.7 9 (IQR, 5–37.4) days for PM and muscular VSDs, respectively. The overall SC rate during follow-up was 29.3%. Pulmonary hypertension (HTN), concomitant left ventricle (LV)–right atrium (RA) shunt, VSD size to aortic valve (AV) annulus size ratio, and left ventricular end-diastolic dimension (LVEDD) z-score were significant risk factors affecting SC of VSD. The "P-VSD" score, a new scoring system, demonstrated an area under the curve for predictability of 0.769. Pulmonary HTN, concomitant LV–RA shunt, LVEDD z-score, and VSD size-to-AV annulus size ratio at diagnosis were significantly associated with non-SC VSD after infancy. The P-VSD score can predict the SC of VSD in clinical settings and simplify the identification and appropriate management of high-risk patients. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve replacement (TAVR) offers a solution, especially for high-risk aortic stenosis (AS) patients. However, patient outcomes post-TAVR show variability, highlighting the need for reliable prognostic indicators. Brachial–ankle pulse wave velocity (baPWV), a measure of arterial stiffness, may predict outcomes post-TAVR. This study aims to explore baPWV's prognostic value in relation to all-cause mortality post-TAVR. This study prospectively enrolled 212 severe AS patients undergoing TAVR between September 2015 and December 2021, focusing on pre- and post-TAVR baPWV measurements to explore associations with all-cause mortality. Of the 212 patients (119 females, 93 males, mean age 85 years), post-TAVR baPWV increased significantly from 1589 ± 376 to 2010 ± 521 cm/s (p < 0.001). Aortic valve (AV) peak velocity and mean pressure gradient decreased, while AV area increased, indicating procedural success. Despite this, 88% of patients experienced an increase in baPWV, with higher pre-procedure AV peak velocity and mean pressure gradient identified as predictors of increased baPWV post-TAVR. Over 23 months, 29 patients (14%) reached the primary endpoint of all-cause mortality. Notably, changes in baPWV, rather than baseline values, were significantly associated with event-free survival (HR: 0.64 per 1SD increase, p = 0.009). The study highlights the prognostic value of baPWV changes post-TAVR in predicting patient outcomes. Elevated baPWV post-TAVR may reflect a beneficial adaptation to altered hemodynamics, suggesting the need for individualized patient evaluation and the integration of baPWV measurements into clinical practice for improved post-TAVR management. [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]

Key Points: Question: Is early aortic valve intervention superior to guideline-directed conservative management in asymptomatic patients with severe aortic stenosis and myocardial fibrosis? Findings: In this multicenter randomized clinical trial of 224 patients with asymptomatic severe aortic stenosis and myocardial fibrosis, there was no significant difference in the primary composite end point of all-cause death or unplanned aortic stenosis–related hospitalization in patients randomized to receive early intervention vs patients randomized to receive guideline-directed conservative management: 18% vs 23%. Meaning: Among patients with asymptomatic severe aortic stenosis and myocardial fibrosis, early aortic valve intervention did not improve clinical outcomes compared with guideline-directed conservative management. Importance: Development of myocardial fibrosis in patients with aortic stenosis precedes left ventricular decompensation and is associated with an adverse long-term prognosis. Objective: To investigate whether early valve intervention reduced the incidence of all-cause death or unplanned aortic stenosis–related hospitalization in asymptomatic patients with severe aortic stenosis and myocardial fibrosis. Design, Setting, and Participants: This prospective, randomized, open-label, masked end point trial was conducted between August 2017 and October 2022 at 24 cardiac centers across the UK and Australia. Asymptomatic patients with severe aortic stenosis and myocardial fibrosis were included. The final date of follow-up was July 26, 2024 Intervention: Early valve intervention with transcatheter or surgical aortic valve replacement or guideline-directed conservative management. Main Outcomes and Measures: The primary outcome was a composite of all-cause death or unplanned aortic stenosis–related hospitalization in a time-to-first-event intention-to-treat analysis. There were 9 secondary outcomes, including the components of the primary outcome and symptom status at 12 months. Results: The trial enrolled 224 eligible patients (mean [SD] age, 73 [9] years; 63 women [28%]; mean [SD] aortic valve peak velocity of 4.3 [0.5] m/s) of the originally planned sample size of 356 patients. The primary end point occurred in 20 of 113 patients (18%) in the early intervention group and 25 of 111 patients (23%) in the guideline-directed conservative management group (hazard ratio, 0.79 [95% CI, 0.44-1.43]; P =.44; between-group difference, −4.82% [95% CI, −15.31% to 5.66%]). Of 9 prespecified secondary end points, 7 showed no significant difference. All-cause death occurred in 16 of 113 patients (14%) in the early intervention group and 14 of 111 (13%) in the guideline-directed group (hazard ratio, 1.22 [95% CI, 0.59-2.51]) and unplanned aortic stenosis hospitalization occurred in 7 of 113 patients (6%) and 19 of 111 patients (17%), respectively (hazard ratio, 0.37 [95% CI, 0.16-0.88]). Early intervention was associated with a lower 12-month rate of New York Heart Association class II-IV symptoms than guideline-directed conservative management (21 [19.7%] vs 39 [37.9%]; odds ratio, 0.37 [95% CI, 0.20-0.70]). Conclusions and Relevance: In asymptomatic patients with severe aortic stenosis and myocardial fibrosis, early aortic valve intervention had no demonstrable effect on all-cause death or unplanned aortic stenosis–related hospitalization. The trial had a wide 95% CI around the primary end point, with further research needed to confirm these findings. Trial Registration: ClinicalTrials.gov Identifier: NCT03094143 This randomized clinical trial examines whether early valve intervention will reduce the incidence of all-cause death or unplanned aortic stenosis–related hospitalization in asymptomatic patients with severe aortic stenosis and myocardial fibrosis. [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]

[Display omitted] [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]

The article "Compliance of the Ascending Aorta After Aortic Root Replacement with a Decellularized Aortic Homograft—An MRI Study" explores the impact of decellularized aortic homografts (DAH) on aortic compliance compared to healthy controls. The study found that the proximal ascending aorta of the DAH group exhibited reduced compliance, indicated by lower relative area change (RAC) and higher maximum blood flow velocity (Vmax) compared to healthy controls. These findings suggest potential localized changes in the graft due to the decellularization process or degenerative effects, emphasizing the importance of long-term follow-up to understand the effects of decellularized human tissue. [Extracted from the article]

The article in the "Thoracic & Cardiovascular Surgeon" journal explores the long-term outcomes of implanting the largest available Epic Supra aortic bioprosthesis (size 29). The study reviewed 1,845 patients who received the Epic Supra bioprosthesis between 2011 and 2023, with 360 patients receiving the size 29 prosthesis. Results showed low mortality rates at 30 days, with no significant differences between recommended sizing and upsizing. The study concludes that the 29-size prosthesis can be safely implanted into patients with smaller annuli, potentially improving future valve-in-valve options. [Extracted from the article]

This article from the journal "Thoracic & Cardiovascular Surgeon" examines the impact of aortic annular geometry on patients undergoing transcatheter aortic valve implantation (TAVI) for aortic stenosis. The study analyzes how the elliptical shape of the native annulus, compared to the circular design of transcatheter valves, affects procedural outcomes. While patients with more elliptical annuli experienced longer procedure times and higher contrast agent usage, there were no significant differences in key clinical outcomes such as paravalvular leakage or conduction disturbances, suggesting that procedural success is not compromised by annular shape. [Extracted from the article]

The article discusses how radiotherapy can lead to aortic valve calcification by re-activating human endogenous retroviruses (HERVs) through epigenetic changes. The study found that irradiation induced inflammation and osteogenesis in valvular interstitial cells (VICs), which was inhibited by genetic deletion of Tlr3. The research suggests that targeting TLR3 could potentially prevent the long-term cardiotoxic effects of radiotherapy on the aortic valve. [Extracted from the article]

This article examines the safety and outcomes of redo aortic valve surgery in patients who previously had a full root replacement with a Freestyle stentless prosthesis. The study analyzed data from 38 patients who underwent redo surgery between 2006 and 2024, with indications for reoperation including structural valve deterioration (SVD) and endocarditis. The findings suggest that redo aortic valve surgery following Freestyle stentless full root replacement can have acceptable outcomes, but cases involving endocarditis and urgent surgery may carry higher risks. The choice of prosthesis and careful management of cross-clamp time are crucial in minimizing postoperative complications. [Extracted from the article]

The article discusses the mid-term outcomes of minimally invasive bicuspid aortic valve repair (AVr) as a treatment for aortic valve regurgitation (AR) in young individuals with bicuspid aortic valve (BAV). The study analyzed 371 patients who underwent AVr with standardized echocardiography follow-up, comparing outcomes between partial upper sternotomy (MIC) and complete sternotomy (CS) approaches. The results showed that AVr through a partial upper sternotomy led to shorter cross-clamp time and ICU stay, with no significant difference in freedom from AV re-intervention compared to the complete sternotomy approach. [Extracted from the article]

The article explores the impact of minimally invasive aortic valve replacement on patients with impaired liver function and potential portal hypertension. By analyzing data from 1,840 patients who underwent aortic valve surgery, the study found that patients with signs of liver dysfunction and portal hypertension had significantly lower perioperative mortality when surgery was performed through a sternotomy-sparing mini-thoracotomy. The findings suggest that this approach may be beneficial for patients with liver issues undergoing aortic valve replacement surgery. [Extracted from the article]

The article reports on the midterm outcomes of surgical aortic valve replacement (SAVR) using bioprosthetic valves in young patients with pre-existing comorbidities. The study, based on the IMPACT registry, followed 556 patients for 3 years and found favorable survival rates, improved hemodynamic performance, and functional status post-SAVR. The results indicate a decrease in left ventricular volume and mass index, improved ejection fraction, and reduced aortic valve gradient, with low rates of complications such as prosthetic endocarditis and paravalvular leak. [Extracted from the article]

The article discusses the Ozaki procedure for aortic valve neocuspidization (AVneo) as a new technique for treating aortic valve disorders. A total of 174 patients underwent AVneo between November 2016 and September 2024, with a mean follow-up of 4.6 years. The study found excellent survival rates and stable hemodynamic parameters up to 7 years after the procedure, with low mortality and reoperation rates. The main indications for AVneo were aortic stenosis and aortic regurgitation, with promising results reported in the medium to long term. [Extracted from the article]

The article explores the hemodynamic differences between rapid-deployment aortic valve replacement (RDAVR) and transcatheter aortic valve implantation (TAVI) prostheses through in vitro analysis. Using advanced imaging modalities, the study compared flow rates, wall shear stress, pressure gradient, kinetic energy loss, and effective orifice area of the prostheses. The findings suggest that despite similar label sizes, there are significant differences in hemodynamic performance, emphasizing the importance of standardizing label sizes based on hemodynamic parameters to reduce the risk of patient-prosthesis mismatch. [Extracted from the article]

The article "Outcomes after Surgical Treatment of Infectious Endocarditis with Partial or Severe Destruction of the Heart Skeleton" published in the journal Thoracic & Cardiovascular Surgeon discusses the incidence and outcomes of patients who underwent complex cardiac surgery due to infectious endocarditis (IE) with heart skeleton destruction. The study included 757 patients operated on for IE, with 97 patients requiring patch reconstruction due to severe heart skeleton damage. The results showed a 30-day mortality rate of 23% and a 1-year mortality rate of 41%, emphasizing the importance of early diagnosis and treatment for advanced IE cases. [Extracted from the article]

The article "Exploring Hypoattenuated Leaflet Thickening: Clinical Insights and Origins Post-Aortic Root and Arch Surgery with Biologically Valved Conduits" discusses the phenomenon of hypoattenuated leaflet thickening (HALT) in aortic valve prosthesis leaflets following surgery. A retrospective study of 519 patients who underwent aortic root replacement with biological valved conduits and arch repair revealed that 28% of patients showed signs of HALT, with a higher incidence of neurological events. While no long-term implications were identified, further research with extended follow-up periods and advanced diagnostic tools is recommended. [Extracted from the article]

This article from the journal "Thoracic & Cardiovascular Surgeon" discusses the challenges and outcomes of secondary aortic root replacement surgeries. The study analyzed data from 131 patients who underwent reoperation at a high-volume aortic center between 2000 and 2021. Results showed that patients with infectious etiology had worse outcomes, with higher rates of stroke and postoperative sepsis. The study emphasizes the importance of careful patient selection and prevention of infections in initial aortic surgeries to minimize complications in redo procedures. [Extracted from the article]

The article discusses the long-term outcomes of aortic valve-sparing root surgery (VSRS) with concomitant aortic valve repair (AVRep) for aortic root aneurysms. The study included 378 patients who underwent VSRS, with a follow-up period ranging from 1 to 18.25 years. Results showed high long-term survival rates and low occurrence of major adverse cardiac and cerebrovascular events (MACCE) for patients undergoing VSRS. However, patients who required concomitant AVRep had a higher risk of aortic valve reintervention compared to those who underwent isolated VSRS. Close monitoring is recommended for patients with concomitant AVRep to detect recurrent aortic regurgitation early. [Extracted from the article]

The article "Long Non-coding RNAs: Emerging Biomarkers in Thoracic Aortic Aneurysms" explores the role of long non-coding RNAs (lncRNAs) in the development of thoracic aortic aneurysms (TAA). Through single cell RNA sequencing (scRNAseq) and RT-qPCR analysis, specific lncRNAs such as NEAT1, ADAMTS9-AS2, NORAD, LINC00910, LINC01578, and MIR100HG were found to be differentially expressed in TAA patients with various aortic valve pathologies. These findings suggest the potential of lncRNAs as non-invasive biomarkers for prognostic and diagnostic purposes in TAA, although further research is needed for clinical application. [Extracted from the article]

This article explores the clinical and histological predictors of aortic distensibility in patients with thoracic aortic aneurysms. Through a study of 80 patients who underwent thoracic aortic surgery, researchers found that factors such as aortic regurgitation, family history, smooth muscle cell loss, and medial fibrosis were associated with reduced distensibility, while statin therapy and elastic fiber fragmentation were linked to increased distensibility. The findings suggest the need for further research to understand the mechanisms behind these predictors and develop interventions to maintain or improve aortic distensibility. [Extracted from the article]

This article from the journal "Thoracic & Cardiovascular Surgeon" discusses the impact of wall shear stress on aortic tissue properties in thoracic aortic aneurysms (TAA). The study found that areas of altered wall shear stress in TAA patients, particularly those with bicuspid aortic valves, exhibited increased stiffness and fragility in the aortic tissue. Gene expression analysis revealed changes in shear stress-responsive genes and collagen genes, highlighting the complex interplay of molecular, genetic, and biomechanical factors in the pathophysiology of TAA. These findings suggest the need for individualized risk stratification and treatment decision-making for TAA patients. [Extracted from the article]

This article examines the risk factors for late adverse events following primary surgical repair of isolated aortic coarctation in patients under 18 years old. The study included 359 patients operated on between 1972 and 2020, with follow-up times averaging 22.7 years. Results showed that patients who underwent primary surgical patch aortoplasty had an increased risk of developing aortic aneurysms, while concomitant aortic valve anomalies were associated with earlier onset of hypertension. Regular follow-up exams are recommended due to the potential for complications even years after the initial repair. [Extracted from the article]

The article "How much is Necessary when Managing the Arch in Acute Type A Aortic Dissection?" published in the journal Thoracic & Cardiovascular Surgeon discusses the outcomes of conservative operative treatment for acute type A aortic dissection, focusing on aortic arch reoperations during follow-up. The study analyzed 375 patients treated between 2010 and 2023, with a mean age of 64 and a majority having DeBakey type I dissections. The results suggest that a relatively conservative operative strategy can achieve good patient survival, with a small percentage requiring redo surgery involving complete arch replacement within 5 years. Further research is needed to compare outcomes of primary aggressive arch operations with the presented data. [Extracted from the article]

The study analyzed images of patients with acute aortic dissection type A (AADA) to assess sex differences in aortic diameters. Women were found to have smaller aortic diameters at the time of dissection compared to men, with less aortic elongation. However, when indexed for patient height, the sex differences disappeared. Only half of the patients had aortic segments larger than 5 cm, indicating that not all would have met the current threshold for prophylactic surgery. [Extracted from the article]

The article discusses a modified technique for aortic annuloplasty in bicuspid aortic valve repair, involving external fixation of looping sutures to prevent complications associated with the original implantation technique. The modified technique was applied to 16 patients, showing no significant difference in procedural times and hemodynamics compared to the original technique, but a significant reduction in complications. The authors suggest that further studies are needed to confirm the effectiveness of the modified technique. [Extracted from the article]

The article "Sutureless Aortic Valve Replacement Superior to Transcatheter Aortic Valve Implantation" explores the debate surrounding the optimal treatment approach for aortic valve pathologies in the "gray zone." The study compares sutureless aortic valve replacement (SUAVR) with transcatheter aortic valve implantation (TAVI) through meta-analyses, finding that SUAVR has lower complication rates and better mid-term overall survival than TAVI. While SUAVR is associated with higher rates of new-onset atrial fibrillation and major bleeding, it is considered a valuable option for patients in the "gray zone" of aortic valve pathologies. [Extracted from the article]

The article explores the use of preprocedural biomarkers to predict outcomes after transcatheter aortic valve implantation (TAVI). A study of 3,687 patients undergoing TAVI found that preoperative hemoglobin, creatinine, troponin, CRP, and NT-proBNP were significant predictors of 30-day mortality and acute kidney injury. These biomarkers may indicate baseline cardiac and/or end-organ injury, and further studies are needed to evaluate combined stratification models with established risk tools like EuroSCORE II. [Extracted from the article]

The article "Impact of Calcification on Hemodynamic Performance of Tubular Heart Valves" explores the influence of calcifications on the hemodynamic properties of different heart valve geometries. The study compares a newly developed tubular aortic valve prosthesis with a conventional tricuspid AVP, finding that the tubular valve design shows a more favorable response to calcification in terms of pressure gradients and effective orifice area. The research suggests that alternative valve geometries, such as the tubular design, could offer significant benefits over current biological aortic valve prostheses, but further studies are needed to confirm long-term viability. [Extracted from the article]

The study published in the journal "Thoracic & Cardiovascular Surgeon" focused on the outcomes of pure aortic valve reoperation (rAVR) after primary isolated aortic valve replacement (AVR). The research included 68 adult patients who underwent isolated rAVR for non-infectious reasons, with a mean EuroSCORE II of 9.95 ± 10.10 indicating a high-risk subgroup. The study found that postoperative mortality and morbidity were mainly related to patient comorbidities, with the observed clinical mortality of the pure aortic valve exchange being lower than predicted. [Extracted from the article]

The heart team (HT) approach, recommended for managing cardiovascular diseases, emphasizes multidisciplinary collaboration. Despite its potential benefits, evidence on its effectiveness and implementation is varied and sparse. This review assesses the HT approach's impact on patient outcomes and care delivery in cardiovascular care. A systematic review was conducted across MEDLINE, EMBASE, PubMed, Cochrane and Google Scholar up to July 2023, focusing on studies that implemented an HT approach in coronary and heart valve disease management. Exclusion criteria included non-human studies, case reports and studies not focusing on HT outcomes. From 6270 identified articles, 20 met the inclusion criteria. These studies demonstrated significant variability in HT composition and organization, coupled with a lack of standardized metrics for evaluating clinical outcomes and the impact of the HT. Significant variability was observed in HT composition, with 13 of the 20 studies did not utilize structured templates, those that did demonstrated more consistent decision-making. In mitral valve interventions, HTs were linked to reduced in-hospital mortality and improved long-term survival (5-year survival probability of 0.74 vs 0.70, P  = 0.04). In aortic valve interventions, 80% of patients underwent tailored valve procedures following HT evaluation. The HT approach in cardiovascular care demonstrates improved patient outcomes, particularly in specialized interventions for mitral and aortic valve diseases and coronary artery disease management. Despite these positive findings, the variability in HT implementation and the need for standardized outcome metrics call for further advances to optimize this collaborative care model. [ABSTRACT FROM AUTHOR]

OBJECTIVES We sought to assess whether post-implant transcatheter aortic valve prosthesis multidetector computed characteristics differ between patients with native tricuspid and bicuspid aortic valve stenosis, as well as the effect on valve performance and clinical implications. METHODS We analysed 100 consecutive post-implant multidetector computed tomography scans to assess self-expandable prosthesis non-uniform expansion at 6 pre-specified valvular levels, and other specific parameters, including valvular and perivalvular thrombosis at 6 months follow-up. Echocardiographic prosthesis performance and clinical outcome were also evaluated. RESULTS Mean eccentricity was significantly higher in the bicuspid group (0.43 (0.09) vs 0.37 (0.08), P  = 0.005, bicuspid vs tricuspid); valvular and perivalvular thrombosis were also significantly more frequent in the bicuspid than in the tricuspid group (81% vs 36.9%, P  = 0.031); there was no significant difference in terms of mean prosthetic gradient at follow-up between (7.31 (5.53 mmHg) vs 7.09 (3.05 mmHg), P  = 0.825); EOAi (indexed effective orifice area) was also similar between bicuspid and tricuspid (1.08 (0.12 cm2) vs 1.03 (0.13 cm2), P  = 0.101), with no significant changes compared to discharge. However, the bicuspid valve was associated with a significantly higher risk of adverse events (HR: 3.72, 95% CI: 1.07–13.4, P  = 0.027). CONCLUSIONS Higher level of eccentricity, which indicates prosthesis deformation, is often detected in bicuspid valves. Although echocardiographic performance was not affected, this might have led to an increased incidence of thrombosis at valvular and perivalvular levels and worse outcomes. [ABSTRACT FROM AUTHOR]

Background: Aortic stenosis (AS) and aortic valve calcification (AVC) are occasionally observed in patients receiving maintenance dialysis. However, their prevalence and factors associated with them in patients undergoing dialysis remain unknown. We aimed to elucidate the aortic valve status at the time of dialysis initiation and patient prognosis based on aortic valve status. Methods: We analyzed 289 patients initiating dialysis (hemodialysis: peritoneal dialysis = 275:14) between 2016 and 2023. "AS and/or AVC" was detected using echocardiography. AS was defined as a maximum transaortic velocity > 2.0 m/s. Statistical analyses including multivariable logistic regression and Cox regression were used to assess the association between patient characteristics and survival outcomes. Results: Aortic valve changes were observed in 121 (42%) patients, among which 33 (11%) met the AS criteria. The mean age of patients in the AS, AVC without AS, and control groups was 79.1 ± 8.9, 75.9 ± 9.2, and 68.3 ± 12.9, respectively (P < 0.001). Multivariable logistic regression models showed that only age was associated with aortic valve changes (P < 0.001). Age and other important factor-adjusted multivariable Cox regression models showed that AS was an independent risk factor for death after dialysis initiation (hazard ratio (HR): 1.95, 95% confidence interval (CI): 1.06 − 3.59, P = 0.04). However, aortic valve changes ("AS and/or AVC") were not a risk factor for death (HR: 1.51, 95% CI 0.95 − 2.39, P = 0.08). Conclusions: With the growing older population undergoing dialysis, aortic valve changes should be closely monitored. Particularly, AS is crucial because of its impact on patient prognosis. [ABSTRACT FROM AUTHOR]