J Heart Valve Dis
-
Transcatheter aortic valve replacement (TAVR) is a widely established alternative to surgery in intermediate- and high-risk patients. TAVR program development within the Veterans Affairs (VA) system has been previously described. However, national TAVR registries do not capture VA outcomes data, and few data have been reported regarding TAVR outcomes at lower-volume federal institutions. The study aim was to demonstrate the evolution of a successful VA TAVR program. ⋯ Successful outcomes were demonstrated for a VA TAVR program that compared favorably with benchmarks established by the National Transcatheter Valve Therapies Registry. These results provide a necessary transparency of TAVR outcomes at a federal institution.
-
The study aim was to investigate the hemodynamic behavior over time and ease of implant and durability of the Sorin Pericarbon Freedom (SPF)® stentless pericardial aortic xenograft. ⋯ The study results confirmed the favourable hemodynamic behavior, low risk of implantation and acceptable durability of the pericardial stentless SPF aortic prosthesis. The data also endorsed use of the SPF as an aortic valve substitute, even in a young and active population, and particularly in the presence of a small aortic annulus. The accuracy of implantation remains a crucial factor for durability and subsequent satisfactory hemodynamic performance. A longer follow up would provide further information with regards to complications and durability of the SPF prosthesis.
-
Comparative Study
Intraoperative Transesophageal Echocardiography for Surgical Repair of Degenerative Mitral Regurgitation.
Segmental analysis of diseased mitral valves is important to predict a successful surgical valve repair. An assessment was made of the comparative accuracy of intraoperative three-dimensional (3D) and two-dimensional (2D) transesophageal echocardiography (TEE) in the evaluation of mitral valve lesions when compared with intraoperative surgical segmental analysis. ⋯ 3D-TEE allowed a more accurate identification of mitral valve lesions compared with 2D-TEE. The greatest accuracy was achieved for analysis of the anterior leaflet. 3D-TEE should be regarded as an important adjunct to standard 2D-TEE in decisions regarding mitral valve repair.
-
Comparative Study
Incremental Value of Transesophageal Echocardiography Integrated with Transthoracic Echocardiography in the Assessment of Aortic Stenosis Severity.
Transthoracic echocardiography (TTE) is the standard method for evaluating the severity of aortic stenosis (AS), while transesophageal echocardiography (TEE) is useful for morphologic characterization. The study aim was to assess the impact of complementary TEE to TTE in refining hemodynamic assessment of AS severity. ⋯ TEE integrated with TTE may improve the detection of severe AS, particularly in patients with moderate AS criteria assessed by TTE, but with a DVI ratio ≤0.24.
-
Comment Letter
Letter to the Editor: Thrombocytopenia After Sutureless Aortic Valve Implantation: Does It Really Matter?
Despite the limited clinical relevance of thrombocytopenia after bioprosthetic aortic valve replacement (AVR), the postoperative depletion of platelet count continues to attract the attention of many authors. The development of thrombocytopenia has been evaluated either in patients receiving a sutureless bioprosthesis (1,2) or in those undergoing transcatheter aortic valve implantation, where cardiopulmonary bypass bears little or no relation to this phenomenon (3). Recently, Sánchez et al. (1) have published their findings on this topic, but their limited experience with the devices used makes their study of doubtful interest. ⋯ Pozzoli A, De Maat GE, Hillege HL, Boogaard JJ, Natour E, Mariani MA. Severe thrombocytopenia and its clinical impact after implant of the stentless Freedom Solo bioprosthesis. Ann Thorac Surg 2013;96:1581-1586.