ObjectiveTo compare the outcomes of mechanical prosthetic versus bioprosthetic replacement of tricuspid valve. Methods We retrospectively analyzed the clinical data of 344 patients underwent tricuspid valve replacement (TVR) in Guangdong General Hospital between January 2000 and December 2010. There were 227 female and 117 male patients with their age of 8-74 (42.0±13.3) years. We allocated the patients into two groups: 168 patients (48.8%) at age of 37.0±11.6 years underwent mechanical tricuspid valve replacement (the MTVR group) and 176 (51.2%) patients at age of 46.0±13.4 years underwent biological tricuspid valve replacement (the BTVR group). Follow-up data were obtained via patients' visiting the outpatient clinic, telephone or mail contacts. ResultsThe mean follow-up time was 5.7 years (ranged from 2 months to 12.6 years). In the BTVR group, 149 patients survived to discharge from hospital, and 144 patients were followed-up successfully, giving a 96.6% follow-up rate. Early mortality (within 30 days post-operation) occurred in 29 patients (16.5%), and 14 patients (7.9%) died after 30 days post-operation. Eighteen bioprosthetic valve degeneration was found during follow-up, and infective endocarditis in 3 patients. In the MTVR group, 152 patients survived to discharge from hospital, 142 patients (93.4%) were followed-up. Early mortality in 13 patients (7.7%), and 14 patients (8.3%) died after 30 days post-operation. Nineteen patients suffered from mechanical prosthesis obstruction, no infective endocarditis patients was found in the MTVR group. There was no statistical difference between the BTVR group and the MTVR group in mortality rate (24.4% versus 16.1%, P=0.054) and in reoperation rate (4.2% versus 9.9%, P=0.051), respectively．There were statistical differences in long-term survival rates between the BTVR group and the MTVR group with 1 year survival rate(78% vs. 89%), 5 years survival rate(74% vs. 86%), and 10 years survival rate (66% versus 78%) with P value at 0.003. ConclusionsThis study suggests that the type of implanted prosthesis in tricuspid replacement does not affect long-term outcomes or the reoperation rate. The survival rate is higher in the MTVR group than that in the BTVR group, which may contribute to younger age in the MTVR group. There is a tendency in higher infective endocarditis incidence in the BTVR group than that in the MTVR group.
Valve replacement is one of the way to treat valvular heart disease. Valve replacement with bioprostheses, which occurs low rate of bleeding and thromboembolism events, needs no lifelong anticoagulation. However, the life of bioprostheses is limited. Leaflet tear, leaf calcification, and artificial valve infective endocarditis may occur with using a bioprostheses These adverse events appear early to some patients who fail to achieve the expected service life of bioprostheses. This review mainly summarizes factors influencing early valve degeneration(EVD) of bioprostheses to provide suggestion in clinic.
Surgical bioprosthetic valve in the mitral position typically degenerates in 10-15 years, when intervention is required again. In the past, redo surgical mitral valve replacement has been the only treatment choice for such patients suffering from bioprosthetic valve failure, despite the even higher risk associated with redo open-heart surgery. In recent years, transcatheter valve-in-valve implantation in the mitral position has evolved as an reasonable alternative to redo surgery for the treatment of surgical mitral bioprosthetic valve failure. Here we report an 81-year-old female patient with surgical mitral bioprosthetic valve failure, who successfully underwent valve-in-valve transcatheter mitral valve replacement via the transfemoral-transseptal approach. The procedure was successful owing to comprehensive CT imaging work-up, despite the technical challenges associated with bilateral giant atria and small left ventricle.
Biological valves can lead to structural valve degeneration (SVD) over time and due to various factors, reducing their durability. SVD patients need to undergo valve replacement surgery again, while traditional open chest surgery can cause significant trauma and patients often give up treatment due to intolerance. Research has shown that as an alternative treatment option for reoperation of thoracic valve replacement surgery, redo-transcatheter aortic valve replacement for SVD is safe and effective, but still faces many challenges, including prosthesis-patient mismatch, high cross valve pressure difference, and coronary obstruction. This article aims to review the strategies, clinical research status and progress of redo-transcatheter aortic valve replacement in SVD patients.
The aim of the present experimental study is to determine the effects of sinotubular junction diameter on artificial bioprosthesis valves. An experimental study was performed for aortic root models with different sinotubular junction taper under pulsatile flow condition. The sinotubular junction diameters were modified to create four models with different sinotubular junction tapers with 0, 1, 3 and 5 degrees, respectively, using three dimensional printing techniques. After installing the testing bioprosthesis valve on the aortic root models, we conducted experiments of the pulsatile flow testing with different stroke volume in the pulsatile circulation simulation system. The testing condition was set at the pulse frequency of 70 beats/min and the stroke volume of 2–7 L/min. The status of the valves in 10 continuous pulse cycles was tested and the average results were obtained for each stroke volume. The results of testing showed that the mean transvalvular pressure gradients agreed well with the national standard, and all smaller than 10 mm Hg. The sinotubular junction taper had an influence on regurgitation fraction of the artificial bioprosthesis valve. The smaller sinotubular junction taper showed beneficial effect to decrease the regurgitation fraction. In the case of smaller stroke volume, the smaller sinotubular junction taper was beneficial to increase the effective valve orifice area. In the case of larger stroke volume, the larger sinotubular junction taper was beneficial to increase the effective valve orifice area. This study indicates that a doctor should consider the smaller sinotubular junction taper in the case of smaller stroke volume more. In the case of larger stroke volume, the doctor should consider the larger sinotubular junction taper more.
Abstract: Objective To compare the change of left heart funct ion in pat ients w ith bio logical valves replacement of small ao rt ic roo t w ith mechanical valve rep lacement, and to find w hether there is p ro sthesis-patient mismatch (PPM ) or not after operation. Methods Left ventricular ejection fraction (LV EF ) , left ventricular fractional shortening (LVFS) , left vent ricular mass index, the indexed effective orifice area (EOA I) , and peak pressure gradients across aortic valve in 20 patients with small aortic root (≤21mm in diameter) receiving biological valves rep lacement (biological valves group ) were studied by Doppler echocardiography before the operation and 6 months to 1 year after operation. The results were compared with those of 20 patients who received mechanical valves replacement (mechanical valves group ). Results Comparing with those before operation, there was a significant increase in LVEF, LV FS, EOAI of all patients 6 months to 1 year after operation . There was a significant reduction in the left ventricular mass index, peak pressure gradients across aortic valve in all patients. EOAI of all patients were between 0.88 cm2/m2 and 1. 32 cm 2/m 2. LVEF, LVFS, EOAI, left ventricular mass index, and peak pressure gradients across aortic valve between biological valves group and mechanical valves group (79% ±8% vs. 81%±10%; 43%±9% vs. 37%±8%; 1. 11±0. 14 vs. 0. 92±0. 11; 89. 10±16. 70g/m 2 vs. 95. 30±15.10 g/m 2; 18. 80±12. 60 mmHg vs. 22. 30±12. 00 mmHg) showed no significant difference 6 months to 1 year after operation (P gt;0.05). Conclus ion Patients with small aortic root receiving biological valves have a significant increase in the left heart function, and have no PPM.
ObjectiveTo study the hemocompatibility of bioprosthetic heart valve materials respectively based on glutaraldehyde and non-glutaraldehyde treatment. MethodsFresh bovine pericardium was treated with glutaraldehyde or non-glutaraldehyde after adipose tissue was removed. To evaluate the hemocompatibility of the two bioprosthetic heart valve materials, hemolysis test, in vitro fibrinogen adsorption experiment, platelet adhesion experiment, thrombin-antithrombin complex (TAT) test, complement activation assay and ex vivo circulation experiment were performed. ResultsThe hemolysis test results demonstrated that both of the materials showed hemolytic rates lower than 5%. The results of TAT test and complement activation assay showed no statistical differences among the two materials and the blank control group. Compared to the bioprosthetic heart valve materials with glutaraldehyde-based treatment, the materials with non-glutaraldehyde-based treatment showed significantly decreased fibrinogen adsorption, platelet adhesion and thrombosis. ConclusionCompared to the bioprosthetic heart valve materials with glutaraldehyde-based treatment, the materials with non-glutaraldehyde-based treatment show better hemocompatibility.