Abstract:

Introduction: incidence of aortic valve stenosis is 3rd in the group of cardio-vascular diseases. Most important questions of aortic valve replacement (AVR) are: prosthesis effective orifice area (EOA) sufficiency for certain patient and need of posterior aortoplasty (PA). Each prosthesis of certain number has technical data and size. Reasonable frequency of posterior aortoplasty is a discussed question.

Aim: was to analyze echocardiographic data in two groups: isolated AVR and AVR + PA in order to study the reasonable frequency of posterior aortoplasty application while using stented bioprosthesis NeoCor-21 «UniLine».

Materials and methods: 99 patients with bioprosthesis NeoCor-21 «UniLine» implantation were enrolled in study for investigation of problem of aortoplasty need. According to application/absence of posterior aortoplasty patients were divided in two groups. In postoperative period groups were compared in echocardiographic data calculations: left ventricle end-diastolic volume (LV EDV), ejection fraction (LV EF), stroke volume (LV SV), peak and mean valve gradients. Indexes were calculated and compared: stroke volume index (SVI) and prosthesis effective orifice area index (EOAI).

Results: the group of AVR + PA consisted of 14 (14,14%) patients. Immediate postoperative echocardiographic calculations revealed no statistic difference between two groups: in left ventricle end diastolic volume (LV EDV), ejection fraction (LV EF), stroke volume (LV SV), peak and mean valve gradients, stroke volume index (SVI) and valve effective orifice area index (EOAI). Group without posterior aortoplasty had slightly higher end diastolic volume (LV EDV), stroke volume (LV SV), peak and mean valve gradients. Opposite patients with posterior aortoplasty had slightly higher ejection fraction (LV EF), stroke volume index (SVI), slightly less peak and mean valve gradients. Left ventricle function was more optimal in the posterior aortoplasty group.

Conclusion: in our practice, incidence of posterior aortoplasty in using stented bioprosthesis NeoCor-21 «UniLine» was 14,14%. Echocardiographic calculations of postoperative data demonstrated that this frequency was reasonable. Probably posterior aortoplasty is to be applied more frequently.

Conflict of interest: the authors declare no conflict of interest.

References

1.     Bokeriya LA, Belaya G. Methods of echocardiographic assessment of aortic valve hemodynamics after prosthetics: methods and precautions. Kreativnaya kardiologiya-Creative cardiology. 2012; 6(1): 73-79 [In Russ].

2.     Iqbal A, Panicker VT, Karunakaran J. Patient prosthesis mismatch and its impact on left ventricular regression following aortic valve replacement in aortic stenosis patients. Indian J Thorac Cardiovasc Surg. 2019; 35: 6-14.

https://doi.org/10.1007/s12055-018-0706-3

3.     Malhotra A. Prosthesis patient mismatch: myth or reality? Indian J Thorac Cardiovasc Surg. 2019; 35: 3-5.

https://doi.org/10.1007/s12055-018-0708-1

4.     Rashimtoola SH. The problem of valve prosthesis-patient mismatch. Circulation. 1978; 58: 20-24.

5.    Sazonenkov MA, Ismatov KhH, Prisyazhnyuk EI, et al. Comparison of the manufacturers technical specification with postoperative results in four types of stented bioprostheses in the aortic position. Actualnye problemy mediciny. 2020; 43(1): 113-123 [In Russ].

6.     Klyshnikov KYu, Ovcharenko EA, Shcheglova NA, Barbarash L.S. Functional characteristics of Uniline bioprostheses. Kompleksnye problemy serdechno-sosudistykh zabolevaniy. 2017; 3: 6-12 [In Russ].

https://doi.org/10.17802/2306-1278-2017-6-3-6-12

7.     Manufacturers information. ZAO «NeoCor» 1978-2020 [In Russ].

https://neocor.ru/aortalnyyklapan-3

8.     Nicks R, Cartmill T, Bernstein L. Hypoplasia of the aortic root. The problem of aortic valve replacement. Thorax. 1970; 25(3): 339-346.

9.     Rittenhouse EA, Sauvage LR, Stamm SJ, et al. Radical enlargement of the aortic root and outflow tract to allow valve replacement. Ann Thorac Surg. 1979; 27(4): 367-73.

10.   Clinical guidelines: Aortic stenosis. Association of Cardiovascular Surgeons of Russia. Moscow 2020 [In Russ].

11.   Manouguian S, Seybold-Epting W. Patch enlargement of the aortic valve ring by extending the aortic incision into the anterior mitral leaflet. New operative technique. J Thorac Cardiovasc Surg. 1979; 78(3): 402-412.

12.   Belov YuV, Charchyan ER, Katkov AI, et al. Influence of the discrepancy between the diameter of the prosthesis and the patient's body surface area on the long-term results of aortic valve replacement. Kardiologiya i serdechno-sosudistaya khirurgiya. 2016; 9 (2): 46-51 [In Russ].

https://doi.org/10.17116/kardio20169246-51

13.   Pibarot P, Magne J, Leipsic J, et al. Imaging for Predicting and Assessing Prosthesis-Patient Mismatch After Aortic Valve Replacement. JACC Cardiovasc Imaging. 2019; 12(1): 149-162.

https://doi.org/10.1016/j.jcmg.2018.10.020

14.   Tam DY, Dharma C, Rocha RV, et al. Early and late outcomes of aortic root enlargement: a multicenter propensity score-matched cohort analysis. J Thorac Cardiovasc Surg. 2020; 160: 908-19.

https://doi.org/10.1016/j.jtcvs.2019.09.062

15.   Concistr? G, Dell'aquila A, Pansini S, et al. Aortic valve replacement with smaller prostheses in elderly patients: does patient prosthetic mismatch affect outcomes? J Card Surg. 2013; 28(4): 341-7.

16.   Dumani S, Likaj E, Dibra L, et al. Aortic Annular Enlargement during Aortic Valve Replacement. Open Access Maced J Med Sci. 2016; 15; 4(3): 455-457.

https://doi.org/10.3889/oamjms.2016.098

17.   S? MP, Zhigalov K, Cavalcanti LRP, et al. Impact of aortic annulus enlargement on the outcomes of aortic valve replacement: a meta-analysis. Semin Thorac Cardiovasc Surg. 2021; 33(2): 316-325.

18.   Yu W, Tam DY, Rocha RV, et al. Aortic Root Enlargement Is Safe and Reduces the Incidence of Patient-Prosthesis Mismatch: A Meta-analysis of Early and Late Outcomes. Can J Cardiol. 2019; 35(6): 782-790.

Abstract:

Aim: was to assess the consistency of measurements of anatomic and functional parameters performed with EchoCG and MRI and to determine the possibility of MRI to visualize the coaptation of valve leaflets after reconstruction of the aortic valve (AV) using the Ozaki technique.

Material and methods: the study included 124 patients who underwent MRI of the heart anc transthoracic EchoCG, 9,3±4,0 days after the Ozaki operation. With EchoCG and MRI, EDV and LV EF were calculated. Dopplerography determined the area of AV opening and the transaortal pressure gradient. At MRI, the area of AV opening was planetically measured, and the transoortal pressure gradient was calculated from results of phase contrast study To assess the consistency of measurement results, the Blend-Altman method was used.

Results: mean values obtained with EchoCG and MRI were statistically significantly different (p<0,001) only when measuring LV EDV The greatest accordance between measurements of EchoCG and MRI was observed in the evaluation of the transaortal pressure gradient (0,04±3,7 mm Hg). Less coordinated were measurements of the opening area of AV (0,22±0,79 cm2) and LV EF (0,22±8,9%). Less consistency was in measurement of EDV (26,4±33,0 ml). The mean value of the difference was statistically significantly different from zero when measuring the opening area of AV (p=0,180) and the transaortal pressure gradient (p=0,120). The article presents 5 clinical examples of visual evaluation of leaflets coaptation after AV reconstruction by the Ozaki method.

Conclusions: differences in consistency in the assessment of the opening area of the AV and the transaortal pressure gradient in echocardiography and MRI are not clinically significant, indicating that these measurement methods can be used interchangeably after AV reconstruction using the Ozaki technique.

Results of measurements of EDV size and LV EF in EchoCG and MRI are less consistent and not interchangeable, therefore, measurement results should be interpreted in the context of the specific method

MRI should be a part of the diagnostic algorithm after Ozaki surgery, but its use in the early postoperative period may be limited to cases of poor quality or inconsistent Echocardiography

References

1.      Salem M. A.; Abd El-Razek M. A.; Bassiouny M. I. et al. Diagnostic Value of Cardiac MRI in Aortic Valve Stenosis in Comparison with Echocardiography. Med J Cairo Univ., 2016; 84 (2):271-278.

2.      Sondergaard L., Hildebrandt P., Lindvig K., et al. Quantification by magnetic resonance velocity mapping. Am Heart J., 1993; 26(5):156-1164.

3.      Bellenger N.G., Burgess M.I., Ray S.G. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionucleide ventriculography and cardiovascular magnetic resonance. Are they interchangeable?. Eur Heart J., 2000; 21:1387-1396.

4.      Bellenger N.G., Francis J.M., Davies L.C. et al. Establishment and performance of a magnetic resonance cardiac function clinic. J Cardiovasc Magn Reson. 1999; 1(4):323-330.

5.      Bernard Y, Meneveau N., Boucher S. et al. Lack of agreement between left ventricular volumes and ejection fraction determined by two-dimensional echocardiography and contrast cineangiography in postinfarction patients. Echocardiography. 2001;18:113-122.

6.      Darasz K.H., Underwood S.R., Bayliss J. et al. Measurement of left ventricular volume after anterior myocardial infarction: comparison of magnetic resonance imaging, echocardiography, and radionuclide ventriculography. The Int J of Cardiovasc Imaging. 2002;18(2):135-142.

7.      Gardner B., Bingham S., Allen M. et al. Cardiac magnetic resonance versus transthoracic echocardiography for the assessment of cardiac volumes and regional function after myocardial infarction: an intrasubject comparison using simultaneous intrasubject recordings. The J of Cardiovasc ultrasound. 2009;7:38-44.

8.      Li C., Lossnitzer D., Katus H.A. et al. Comparison of left ventricular volumes and ejection fraction by monoplane cineventriculography, unenhanced echocardiography and cardiac magnetic resonance imaging. Int J Cardiovasc Imaging. 2012; 28(5):1003-1010.

9.      Malm S., Frigstad S., Sagberg E.; et al. Accurate and reproducible measurement of left ventricular volume and ejection fraction by contrast echocardiography a comparison with magnetic resonance imaging. J Am Coll Cardiol. 2004; 44(5):1030-1035.

10.    Ozaki S. Pathophysiology of calcification of bioprosthetic heart valves: an experimental investigation. LeuvenUniversity Press. 2001;238.

11.    Ozaki S., KawaseI., Yamashita H., et al. A total of 404 cases of aortic valve reconstruction with glutaraldehyde-treated autologous pericardium. J. Thora Cardiovasc Surg. 2014; 147(1):301-306.

12.    Rossejkin E.V., Bazylev V.V., Batrakov P.A. i dr. Neposredstvennye rezul'taty protezirovanija stvorok aortal'nogo klapana autoperikardom po metodike Ozaki [Immediate results of aortic valve leaflets replacement with auto pericardium due to Ozaki technique]. Patobgija krovoobrashhenija i kardiohirurgija. 2016; 20(2):44-48 [ In Russ].

13.    Ozaki S., Kawase I., Yamashita H., et al. Aortic Valve Reconstruction Using Autologous Pericardium for Aortic Stenosis. Circ J. 2015; 79(7):1504-1510.

14.    Izgi C. MRI evaluation of aortic stenosis: flow evaluation. https://www.escardio.org/Education/PracticeTools/ EACVI-toolboxes/Valvular-Imaging/Atlas-of-valvular-imaging/Aortic-stenosis/MRI-evaluation-of-aortic- stenosis-flow-evaluation

15.    La Manna A., Sanfilippo A., Capodanno D. et al. Cardiovascular magnetic resonance for the assessment of patients undergoing transcatheter aortic valve implantation: a pilot study. J Cardiovasc Magn Reson. 2011;13: 82-90.

16.    Rajani R., Hancock J., Chambers J.B. The art of assessing aortic stenosis. Heart. 2012;98(4):14-22.

17.    Oosterhof T, Mulder B.J.M., Vliegen H.W. et al. Cardiovascular magnetic resonance in the follow-up of patients with corrected tetralogy of Fallot. American Heart J. 2006;151:265-272.

18.    Bazylev V.V., Paramonova T.I., Vdovkin A.V., Pal'kova V.A. Pri kakom razmere KDO u bol'nyh s sistolicheskoj disfunkciej levogo zheludochka predpochtitel'no vypolnenie magnitno-rezonansnoj tomografii [What dimensions of EDV in patients with systolic dysfunction of the left ventricle is preferable to perform MRI?.]. Diagnosticheskaja i intervencionnaja radiologija. 2017;11(2):30-37 [In Russ].

19.    Bazylev V.V., Paramonova T.I., Vdovkin A.V., Karpuhin V.G., Pal'kova V.A. Soglasovannost' JehoKG i MRT v ocenke mitral'noj regurgitacii i KDO u bol'nyh s dilataciej levogo zheludochka [Accordance of MRI and EchoCG in estimation of mitral regurgitation and EDV in patients with left ventricle dilatation]. Luchevaja diagnostika i terapija. 2017;1 (8): 64-68 [ In Russ].

Abstract:

Purpose. Was to improve results of aortic stenosis (AS) treatment by transluminalballoon valvuloplasty (TLBVP) technicalskill's mprovement

Materials and methods. The article reviews a group of 56 patients who underwent TLBVP of at Republic specialized surgery centre named after V. Vakhidov

Results. It is noted that after TLBVP the peak systolic pressure gradient drecreases from 136,0 ± 39,36 to 38,27 ± 12,55 mm Hg (67,1% shift., р < 0,001), that confirms efficiency of the AS TLBVP All the patients notice better health conditions, increased stability to physical activities and had been discharged from hospital in satisfactory condition.

Conclusions. TLBVP of aortic valve (AV) is an effective and safe method that can be used for treatment of aortic valve stenosis. Indication for the procedure is occurrence of peak systolic gradient at AV of over 50 (with average at 35-40) mm Hg. At the same time aortic regurgitation type 1 is not a contraindication for the procedure. 

References 

1.    Алекян Б.Г., Бондарев Ю.И., Ильин В.Н. и др. Опыт баллонных дилатаций при врожденном клапанном и подклапанном стенозах аорты. М. Грудная и сердечно-сосудистая хирургия. 1996; 1: 121-126.

2.    Бокерия Л.А., Гудкова Р.Г. Тенденции развития кардиохирургии в 2007 году. М.: Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2008; 3-4.

3.    Дземешкевич    С.Л.,    Стивенсон    Л.У., Алексин-Месхишвили В.В. Болезни аортального клапана. Функция, диагностика,  лечение.   М.:   Гэотар-Мед.   2004;267-299.

4.    Feldman T. Core curriculum for interventional cardiology. Percutaneous valvuloplasty Cath. Cardiovas. Interv. 2003; 60: 48-56.

5.    Gao W. et al. Percutaneous balloon aortic valvuloplasty in the treatment of congenital valvular aortic stenosis in   children.   Chin.   Med. J.   2001;   114: 453-455.

6.    Hidehiko H. et al. Percutaneous balloon аortic valvuloplasty. Revisited Circulation. 2007; 115: 334-338.

7.    Kusa J., Biaikowski J., Szkutnik M. Percutaneous balloon aortic valvuloplasty in children. Early and long-term outcome. Kardiol. Pol. 2004; 60: 48-56

Abstract:

Surgical treatment of aortic valve pathology is an actual problem of modern medicine. Aortic valve pathology is widely spread in population on a stable high level. Due to a large amount of patients with no possibility of open surgical treatment of aortic valve pathology modern hybrid methods of treatment, such as transcatheter aortic valve implantation are being actively proposed and modified.

MSCT angiography before transcatheter aortic valve implantation is obligatory procedure. Data obtained by MSCT is extremely necessary to define the possibility and the access path of transcatheter aortic valve implantation. MSCT allows to select the size and type of aortic valve prosthesis.

Appearance of modern MSCT scanners with 320-640 row of detectors will increase the leading role of MSCT in preoperative inquiry of patients with planned transcatheter aortic valve implantation.

References

1.     Nkomo V.T., Gardin J.M., Skelton T.N. Burden of valvular heart diseases: a population-based study. Lancet 2006; 368: 1005-1011.

2.     Charlson E., Legedza A.T.R., Hamel M.B. Decisionmaking and outcomes in severesymptomatic aortic stenosis. J. Heart Valve Dis. 2006; 15: 312-321.

3.     Iung B., Baron G., Butchart E.G., Delahaye F.. Gohlke-Barwolf C., Levang O.W., Tornos P., Vanoverschelde J.L., Vermeer F., Boersma E., Ravaud P, Vahanian A. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur. Heart J. 2003; 24: 1231-1243. 

4.     Varadarajan P., Kapoor N., Bansal R.C., Pai R.G. Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis. Ann. Thorac. Surg. 2006; 82: 2111-2115.

5.     Andersen H.R., Knudsen L.L., Hasenkam J.M. Transluminal implantation of artificial heart valves. Description of a new expandable aortic valve and initial results with implantation by catheter technique in closed chest pigs. Eur. Heart J. 1992; 13:704-708.

6.     Cribier A., Eltchaninoff H., Bash A., Borenstein N., Tron C., Bauer F., Derumeaux G., Anselme F., Laborde F., Leon M.B. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation. 2002; 106: 3006-3008.

7.     Webb J.G., Pasupati S., Humphries K., Thompson C., Altwegg L., Moss R., Sinhal A., Carere R.G., Munt B., Ricci D., Ye J., Cheung A., Lichtenstein S.V. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation. 2007; 116: 755-763.

8.     Callander V. Computed tomography. M. Technosphere, 2006. C-17-23 [In Russ.]

9.     Ternovoy S.K., Sinitsyn V.E. Spiral CT and cathode ray angiography. M. Vidar, 1998. C-23-47 [In Russ.]

10.   Sinitsyn V.E., Achenbach S. Electron Beam Computed Tomography. In: M.Oudkerk (ed). Coronary Radiology. Berlin: Springer, 2004.

11.   Bridgewater B., Keogh B., Kinsman R., Walton P Sixth national adult cardiac surgical database report. 2008 [cited 2011 Feb 9].

12.   Ludman PF. British Cardiovascular Intervention Society audit returns: adult interventional procedures Jan 2009 to Dec 2009. BCIS Meeting; 2010 Oct: Cardiff, Wales. Рр17-34.

Abstract:

Current indications for transcatheter aortic valve replacement (TAVR) are limited for inoperable and high risk patients only. Meanwhile, TAVR may be successfully performed in young patients with low risk and with high technical and functional results according to short- and long-term follow-up.

54 patients underwent TAVR, 7 (12,9%) of them were younger than 65. Cause for endovascular procedure was the presence of oncological process in liver/autoimmune hepatitis/liver cirrhosis/severe bronchial asthma/atherosclerotic lesion of major vessels/severe diabetes mellitus. In 3 cases additional visualization method (intracardiac ultrasound examination) was necessary. All patients underwent implantation of CoreValve.

Technical success was 100%. Function of valves was satisfactory. Light near-valve regurgitation was found in 6 cases, valve regurgitation class II was found in 1 case with decrease to class I after treatment.

Intracardiac ultrasound examination is useful to attend successful results in this group of patients. 

References

1.     2012 ACCF/AATS/SCAi/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. JACC. 2012; 59: 1200-1254.

2.     Lemos PA, Lee CH, Degertekin M, et al. Early outcome after sirolimus-eluting stent implantation in patients with acute coronary syndromes: insights from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. JACC. 2003; 41: 2093-2099.

3.     Ong A.T., Serruys P.W., Aoki J., et al. The unrestricted use of paclitaxel versus sirolimus-eluting stents for coronary artery disease in an unselected population: one-year results of the Taxus-Stent Evaluated at RotterdamCardiologyHospital (T-SEARCH) registry. JACC. 2005; 45: 1135-1141.

4.     Hoye A., Tanabe K., Lemos P.A., et al. Significant reduction in restenosis after the use of sirolimus-eluting stents in the treatment of chronic total occlusions. JACC. 2004; 43: 1954-1958.

5.     Rao S.V., Shaw R.E., Brindis R.G., Klein L.W., Weintraub W.S., Peterson E.D. On- versus off-label use of drug-eluting coronary stents in clinical practice (report from the American College of Cardiology National Cardiovascular Data Registry [NCDR]). Am. J. Cardiol. 2006; 97: 1478 -1481.

6.     Beohar N., Davidson C.J., Kip K.E., et al. Outcomes and complications associated with off-label and untested use of drug-eluting stents. JAMA. 2007; 297: 1992-2000.

7.     Grines C.L. Off-label use of drug-eluting stents putting it in perspective. JACC. 2008; 51: 615-617.

8.     Piazza N., Otten A., Schultz C., et al. Adherence to patient selection criteria in patients undergoing transcatheter aortic valve implantation with the 18F CoreValve ReValvingTM System: results from a single center study. Heart. 2010; 96: 19-26.

9.     Eltchaninoff H., Prat A., Gilard M., et al. Transcatheter aortic valve implantation: earlyresults of the FRANCE (FRench Aortic National CoreValve and Edwards) registry. Eur. Heart J. 2011; 32:19-197.

10.   Zahn R., GerckensU., Grube E., et al. Transcatheter aortic valve implantation: first results from a multi-centre real-world registry. Eur. Heart J. 2011; 3:198-204.

11.   Rodes-Cabau J., Webb J.G., Cheung A., et al. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. JACC. 2010; 55:1080-1090.

12.   Tamburino C., Capodanno D., Ramondo A., et al. incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation. 2011; 123: 299-308.

13.   Webb J.G., Altwegg L., Boone R.H., et al. Transcatheter aortic valve implantation: impact on clinical and valve-related outcomes. Circulation. 2009; 119: 3009-3016.

14.   Piazza N., Grube E., Gerckens U., et al. Procedural and 30-day outcomes following transcatheter aortic valve implantation using the third generation (18 Fr) corevalve revalving system: results from the multicentre, expanded evaluation registry 1-year following CE mark approval. EuroIntervention. 2008; 4: 242-249.

15.   Leon M.B., Smith C.R., Mack M., et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N. Engl. J. Med. 2010; 363: 1597-1607.

16.   Smith C.R., Leon M.B., Mack M.J., et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N. Engl. J. Med. 2011; 364: 2187-2198.

17.   Lee D.H., Buth K.J., Martin B.J., et al. Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation. 2010; 121: 973-978.

18.   Roques F., Nashef S.A., Michel P., et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur. J. Cardiothorac. Surg. 1999; 15: 816-822.

19.   Lange R., Bleiziffer S., Mazzitelli D., et al. improvements in Transcatheter Aortic Valve implantation Outcomes in Lower Surgical Risk Patients. JACC. 2012; 59: 280-287