Search

Objective: Infection of valved aortic grafts is a rare entity whose diagnosis remains challenging. Positron emission tomography (PET)/CT has become a criterion for the diagnosis of infective endocarditis (IE) in prosthetic valves, but its role on ascending aortic graft infections remains unclear. This study aims to assess the diagnostic value of PET/CT in patients with valved aortic graft infection., Methods: 12 episodes with a valved aortic graft who had undergone a PET/CT due to suspicion of IE were prospectively included (group I) and compared with five controls free of infection who underwent PET/CT for other reasons (group II). Pathological uptake of 18 F-fluorodeoxyglucose (FDG) and its pattern at the prosthetic valve and aortic graft were studied., Results: Diagnosis of IE was confirmed in 9 out of 12 episodes of group I. 18 F-FDG uptake was detectable in eight out of nine cases with a final diagnosis of IE. The most repeated pattern of uptake was homogeneous around the valve and heterogeneous around the tube. There was one false-negative study. Of the three patients in which IE was ruled out, there were two false positives and one true negative. In group II, there were three patients with a positive PET/CT study, two of them had active aortitis and the third was considered false positive., Conclusions: 18 F-FDG PET/CT shows high sensitivity in the detection of infected aortic grafts. Thus, this technique should be considered in the diagnostic work-up of patients with suspicion of aortic graft infection. However, further validation of this approach is needed., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objectives: The evidence of the benefits of transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) for patients of high or intermediate surgical risk is not consistent. We performed a meta-analysis to compare major adverse outcomes after TAVR or SAVR., Methods: We searched propensity score matched studies or randomized clinical trials comparing the risks of mortality, stroke, major bleeding, acute renal injury, pacemaker implantation, vascular complications and prostheses haemodynamic performance between TAVR and SAVR in patients with moderate or high risk. Combined odds ratios (ORs), relative risk or mean differences with corresponding 95% confidence intervals (CIs) were calculated using a random effects model. Analyses of sensitivity and publication bias were also conducted., Results: We included 5 clinical trials and 37 observational studies, enrolling 20 224 patients (TAVR, n  = 9099 and SAVR, n  = 11 125). The pooled analysis suggested no differences in early (OR = 1.11, 95% CI 0.9-1.39, P  = 0.355) or late mortality (relative risk = 0.91, 95% CI 0.78-1.05, P  = 0.194). TAVR was associated with a lower risk of major bleeding (OR = 0.42, 95% CI 0.25-0.69, P  < 0.001) and acute kidney injury (OR = 0.51, 95% CI 0.34-0.71) but with an increase in the incidence of pacemaker implantation (OR = 2.31, 95% CI 1.73-3.08) and vascular complications (OR = 4.88, 95% CI 2.84-8.39). Residual aortic regurgitation was more frequent after TAVR (OR= 6.83, 95% CI 4.87-9.6). SAVR prostheses were associated with poor trans-prosthetic gradients (mean difference: -2.4 mmHg, 95% CI - 3.27 to - 1.53)., Conclusions: TAVR and SAVR have similar short and long-term all-cause mortality and risk of stroke among patients of moderate or high surgical risk. TAVR decreases the risk of major bleeding, acute kidney injury and improves haemodynamic performance compared with SAVR but increases the risk of vascular complications, the need for a pacemaker and residual aortic regurgitation., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Aims: Data regarding the effects of TAVI on LV after are scarce and conflicting results have been reported immediately after aortic valvuloplasty. This study aimed to determine the acute haemodynamic effects of transcatheter aortic valve implantation (TAVI) in left ventricle (LV) diastolic performance, immediately after aortic valvuloplasty and prosthesis deployment., Methods and Results: Sixty-one patients with severe aortic valve stenosis, and preserved LV systolic function submitted to successful TAVI, were included. All procedures were guided through transoesophageal echocardiography, and parameters of diastolic function were evaluated before and minutes after TAVI. The mean age was 83.5±6 years and mean log EuroSCORE was 18.2±9.4. Before the procedure, all patients presented LV diastolic dysfunction. Immediately after TAVI, fewer patients presented a restrictive pattern [27 (44.3%), before the procedure, vs. 20 (34.4%), after TAVI (P=0.047)], and an increase in E wave deceleration time (211.2±75.5 vs. 252.7±102.3 cm/s, P=0.001), in E wave velocity (109.5±41.2 vs. 120.3±43.6 cm/s, P=0.025), and in isovolumetric relaxation time (83±36.5 vs. 97.1±36.0 ms, P=0.013) was observed. On multivariate analysis of covariance (ANCOVA), adjusting to LV systolic function, heart rate, blood pressure, and haematocrit values, the results remained significant. Patients referred to percutaneous approach had invasive haemodynamic data collected, showing a decrease in LV end-diastolic pressure after valve implantation [18.8±5.7 vs. 14.7±4.7, mean difference -4.1 (95% CI: -5.9; -2.9)]. Patients with a restrictive pattern immediately after TAVI presented a smaller decrease in LV end diastolic pressure (-3.3±4.7) than those with diastolic dysfunction grade I or II (-9.5±4.7; P=0.017)., Conclusion: This is the first study describing LV diastolic performance during TAVI. Our results show improvement in diastolic function parameters in patients with preserved LV systolic function, immediately after successful TAVI.

Re-operative heart-valve replacement is a high-risk procedure and even more so in elderly patients. Another option in high-risk patients with a degenerated aortic xenograft is the implant of a second aortic bioprosthesis using a transcatheter approach. We report two cases of patients with a severely degenerated porcine aortic bioprosthesis who were successfully treated by a transapical valve-in-a-valve implantation., (Copyright (c) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.)

Degenerative aortic stenosis is the most common valvulopathy in Europe. In symptomatic patients, aortic valve replacement with a prosthesis substantially improves prognosis. However, a high percentage of candidates for valve replacement surgery are rejected because of the high risk of serious complications. In recent years, percutaneous and minimally invasive surgical techniques have been developed for the transcatheter implantation of prosthetic aortic valves. These developments could lead to an increase in the number of interventions carried out in high-risk patients as the positive effect of treatment on prognosis would be retained while the complication rate would be reduced. We describe the use of transesophageal echocardiography (TEE) for intraoperative monitoring in 21 patients who underwent transcatheter aortic valve replacement using an transapical approach, and report morphologic findings, hemodynamic results, and complications observed. We propose a standard approach to imaging, in which real-time three-dimensional TEE is used to provide additional information during intraoperative monitoring of transapical transcatheter aortic valve replacement.

Trans-apical aortic bioprosthesis implantation is currently evaluated as an alternative technique in high-risk patients. We report the case of a delayed upward displacement of a prosthesis after this procedure. It is hypothesised that the asymmetric calcification of the native valve and the presence of a mitral prosthesis caused the dislocation.

We report our initial experience with transapical aortic valve implantation. All six of our patients were octogenarians, all had significant associated comorbid conditions and, according to the logistic EuroSCORE, their mortality was expected to be 22%. All procedures were performed successfully and there were no intraoperative or postoperative complications. Five patients were discharged between postoperative days 5 and 7 with normally functioning prostheses.