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Novel Surgical Strategy for Aortic Valve Surgery
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Novel Surgical Strategy for Aortic Valve Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (15 June 2022) | Viewed by 15189

Special Issue Editors

Prof. Dr. Francesco Formica

E-Mail Website
Guest Editor
Department of Medicine and Surgery, University of Parma, Cardiac Surgery Clinic, Parma General Hospital, Viale Gramsci 14, 43126 Parma, Italy
Interests: surgery of heart failure; complex myocardial revascularization; minimally invasive surgery; mitral valve surgery; aortic valve and aortic thoracic surgery
Prof. Dr. Gurmeet Singh

E-Mail Website
Guest Editor
Departments of Critical Care Medicine and Surgery, University of Alberta, Edmonton, AB, Canada
Interests: advanced heart failure; mechanical circulatory support; extracorporeal life support (ECLS); cardiothoracic transplantation; education/simulation

Special Issue Information

Dear Colleagues,

Since the early 1950s, continuous progress in aortic valve surgery has steadily improved results. The journey began with aortic valvulotomy, leading to contemporary sophisticated surgical approaches. Aortic valve sparing procedures, complex repair, and aortic valve replacement with the latest-generation bioprosthetic valves using minimally invasive surgical techniques and transcatheter aortic valve replacement/implantation have all become part of the armamentarium.

Technological improvements, coupled with advancements in pharmacology, biomaterials, surgical instruments, cardiopulmonary bypass management, cardiac anesthesia techniques, cardiology guidelines, cardiac surgical approaches, perioperative critical care management, and postoperative rehabilitation have been decisive in the continuous evolution of aortic valve surgery.

The aim of this Special Issue is to provide the readers with a broad sampling of the spectrum of aortic valve surgery, ranging from repair and replacement innovations, conventional and minimally invasive surgical approaches, as well as transcatheter techniques. 

We intend to highlight long-term results of newer approaches, in addition to the outcomes from “old-fashioned” surgical procedures. In this way, we endeavor to provide readers with a state-of-the-art review of aortic valve surgery.

We invite and encourage your submissions of original articles, systematic reviews, and meta-analyses regarding: aortic valve repair/reconstruction surgery; aortic valve replacement surgery; bicuspid aortic valve; minimally invasive aortic valve approaches; transcatheter aortic valve replacement/implantation, both transfemoral and transapical; valve-in-valve procedure; echocardiographic and radiological assessment; hypertrophic obstructive cardiomyopathy (surgical management and genetics); surgical treatment and management of endocarditis; and prosthesis valve replacement.

Prof. Dr. Francesco Formica
Prof. Dr. Gurmeet Singh
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • aortic valve surgery
  • minimally invasive technique
  • transcatheter valve replacement therapy
  • aortic valve repair
  • aortic valve surgery
  • infective endocarditis
  • prosthesis valve replacement

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Published Papers (6 papers)

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Research

12 pages, 3057 KiB  
Article
Transapical Transcatheter Aortic Valve Replacement: A Real-World Early and Mid-Term Outcome of a Third-Level Centre
by Alessandra Francica, Filippo Tonelli, Alberto Saran, Gabriele Pesarini, Igor Vendramin, Rocco Tabbì, Cecilia Rossetti, Giovanni Battista Luciani, Flavio L. Ribichini and Francesco Onorati
J. Clin. Med. 2022, 11(14), 4158; https://doi.org/10.3390/jcm11144158 - 18 Jul 2022
Viewed by 1576
Abstract
Background: Transapical transcatheter aortic valve replacement (TA-TAVR) is generally considered to be associated with higher morbidity compared with transfemoral-TAVR. However, TA-TAVR remains a feasible alternative for patients who are unsuitable for TF-TAVR. It has been shown that outcomes after TAVR are linked to [...] Read more.
Background: Transapical transcatheter aortic valve replacement (TA-TAVR) is generally considered to be associated with higher morbidity compared with transfemoral-TAVR. However, TA-TAVR remains a feasible alternative for patients who are unsuitable for TF-TAVR. It has been shown that outcomes after TAVR are linked to the operator’s expertise. Therefore, the purpose of this study is to report short- and mid-term outcomes after TA-TAVR performed by an expert Heart-Team of a third-level centre. Methods: From 2015 to 2022, 154 consecutive patients underwent TA-TAVR. The outcomes were analysed according to the VARC-3 criteria. Kaplan–Meier curves were estimated for major clinical events at mid-term follow-up. Results: The mean age of the population was 79.3 years and the STS risk-score of mortality was 4.2 ± 3.6%. Periprocedural mortality was 1.9%. Acute kidney injury and prolonged ventilation occurred in 1.9%. Incidence of stroke was 0.6%. Pacemaker implantation rate was 1.9%. Freedom from cardiovascular mortality was 75.7%, and 60.2% at 3 and 5 years. Freedom from stroke was 92.3% and 88.9% at 3 and 5 years, respectively; freedom from endocarditis was 94.4% and 90.8% at 3 and 5 years, respectively. Conclusion: TA-TAVR may be considered a safe and effective alternative approach in patients unsuitable for TF-TAVR, especially when performed by a proficient Heart-Team. Full article
(This article belongs to the Special Issue Novel Surgical Strategy for Aortic Valve Surgery)
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11 pages, 4786 KiB  
Article
Frozen Elephant Trunk: Technical Overview and Our Experience with a Patient-Tailored Approach
by Alan Gallingani, Andrea Venturini, Matteo Scarpanti, Domenico Mangino and Francesco Formica
J. Clin. Med. 2022, 11(4), 1120; https://doi.org/10.3390/jcm11041120 - 20 Feb 2022
Cited by 6 | Viewed by 3786
Abstract
Ever since the first hybrid prosthesis was used for a total aortic arch replacement, many other techniques have been developed to comply with the need for the treatment of a wide spectrum of patients and their clinical pictures. We hereby provide an overview [...] Read more.
Ever since the first hybrid prosthesis was used for a total aortic arch replacement, many other techniques have been developed to comply with the need for the treatment of a wide spectrum of patients and their clinical pictures. We hereby provide an overview of the most popular surgical techniques to perform a frozen elephant trunk, including our tailored approach revolving around the antegrade deployment of a Gore C-TAG endovascular stent graft sutured to a four-branched vascular prosthesis. This technique was applied to three cases of acute type A aortic dissection. Although our small series of patients consists of acute aortic dissections only, this technique could be applied to any other aortic arch pathology, such as chronic dissections or aneurysms. Moreover, we believe that, because of the individually tailored approach and widespread availability of the necessary materials, this technique can reveal itself useful in many different operative scenarios. Full article
(This article belongs to the Special Issue Novel Surgical Strategy for Aortic Valve Surgery)
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7 pages, 536 KiB  
Article
Minimally Invasive versus Full Sternotomy SAVR in the Era of TAVR: An Institutional Review
by Tyler W. Wilson, Joshua J. Horns, Vikas Sharma, Matthew L. Goodwin, Hiroshi Kagawa, Sara J. Pereira, Stephen H. McKellar, Craig H. Selzman and Jason P. Glotzbach
J. Clin. Med. 2022, 11(3), 547; https://doi.org/10.3390/jcm11030547 - 22 Jan 2022
Cited by 1 | Viewed by 2317
Abstract
In the era of advancing transcatheter aortic valve replacement (TAVR) technology, traditional open surgery remains a valuable intervention for patients who are not TAVR candidates. We sought to compare perioperative variables and postoperative outcomes of minimally invasive and full sternotomy surgical aortic valve [...] Read more.
In the era of advancing transcatheter aortic valve replacement (TAVR) technology, traditional open surgery remains a valuable intervention for patients who are not TAVR candidates. We sought to compare perioperative variables and postoperative outcomes of minimally invasive and full sternotomy surgical aortic valve replacement (SAVR) at a single institution. A retrospective analysis of 113 patients who underwent isolated SAVR via full sternotomy or upper hemi-sternotomy between January 2015 and December 2019 at the University of Utah Hospital was performed. Preoperative comorbidities and demographic information were not different among groups, with the exception of diabetes, which was significantly more common in the full sternotomy group (p = 0.01). Median procedure length was numerically shorter in the minimally invasive group but was not significant following the Bonferroni correction (p = 0.047). Other perioperative variables were not significantly different. The two groups showed no difference in the incidence of postoperative adverse events (p = 0.879). As such, minimally invasive SAVR via hemi-sternotomy remains a safe and effective alternative to full sternotomy for patients who meet the criteria for aortic valve replacement. Full article
(This article belongs to the Special Issue Novel Surgical Strategy for Aortic Valve Surgery)
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8 pages, 699 KiB  
Article
The Aortic Annulus Stabilization Technique Prevents Paravalvular Leaks after Rapid Deployment Aortic Valve Implantation
by Elena Caporali, Roberto Lorusso, Tiziano Torre, Francesca Toto, Alberto Pozzoli, Giovanni Pedrazzini, Stefanos Demertzis and Enrico Ferrari
J. Clin. Med. 2021, 10(24), 5776; https://doi.org/10.3390/jcm10245776 - 10 Dec 2021
Cited by 1 | Viewed by 2205
Abstract
Background: Surgical aortic valve replacement with rapid deployment bioprosthesis guarantees good hemodynamic results but carries the risk of paravalvular leaks. To address this issue, an annulus stabilization technique has been recently developed. Methods: Clinical and hemodynamic parameters from patients treated for aortic valve [...] Read more.
Background: Surgical aortic valve replacement with rapid deployment bioprosthesis guarantees good hemodynamic results but carries the risk of paravalvular leaks. To address this issue, an annulus stabilization technique has been recently developed. Methods: Clinical and hemodynamic parameters from patients treated for aortic valve replacement with the rapid deployment bioprosthesis and a concomitant annulus stabilization technique were prospectively collected and retrospectively analyzed. Echocardiographic data at discharge and at 1-year follow-up were collected and analysed. Results: A total of 57 patients (mean age 74.3 ± 6.1 years) with symptomatic aortic valve stenosis underwent aortic valve replacement with the rapid deployment bioprosthesis and concomitant annulus stabilization technique (mean valve size: 23.8 ± 1.9 mm). Combined procedures accounted for 56.1%. Hospital mortality was 1.8% and a new pacemaker for conduction abnormalities was implanted in 10 patients. The pre-discharge echocardiographic control showed absence of paravalvular leaks of any degree in all patients with mean valve gradient of 9.6 ± 4.0 mmHg. The 1-year echocardiographic control confirmed the good valve hemodynamic (mean gradient of 8.0 ± 2.8 mmHg) and absence of leaks. Conclusion: In this preliminary clinical experience, the annulus stabilization technique prevents postoperative paravalvular leaks after rapid deployment aortic valve implantation, up to 1-year postoperatively. Studies on larger series are of paramount importance to confirm the long-term efficacy of this new surgical technique. Full article
(This article belongs to the Special Issue Novel Surgical Strategy for Aortic Valve Surgery)
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11 pages, 1007 KiB  
Article
Impact of Non-Valvular Non-Coronary Concomitant Procedures on Outcomes of Surgical Aortic Valve Replacement in Intermediate Risk Patients
by Fanar Mourad, Ali Haddad, Janine Nowak, Mohamed Elbarraki, Yacine Elhmidi, Marinela Jasarevic, Philipp Marx, Ender Demircioglu, Daniel Wendt, Matthias Thielmann, Bastian Schmack, Arjang Ruhparwar and Sharaf-Eldin Shehada
J. Clin. Med. 2021, 10(23), 5592; https://doi.org/10.3390/jcm10235592 - 28 Nov 2021
Cited by 1 | Viewed by 1565
Abstract
Introduction: advanced age and concomitant procedures could increase the risk of perioperative complications during surgical aortic valve replacement (SAVR). We aimed to evaluate results of elderly patients undergoing SAVR and evaluate the impact of concomitant non-valvular, non-coronary procedures on the outcomes. Methods: A [...] Read more.
Introduction: advanced age and concomitant procedures could increase the risk of perioperative complications during surgical aortic valve replacement (SAVR). We aimed to evaluate results of elderly patients undergoing SAVR and evaluate the impact of concomitant non-valvular, non-coronary procedures on the outcomes. Methods: A retrospective single-centre study, evaluating 464 elderly patients (mean age = 75.6 ± 4 years) undergoing either isolated-SAVR (I-SAVR = 211) or combined-SAVR (C-SAVR = 253) between 01/2007 and 12/2017. Combined-SAVR involved non-valvular, non-coronary procedures. Study endpoints are postoperative results concerning the VARC-II criteria, valve dysfunction, long-term freedom from redo-AVR and survival. Results: males were 52.8%. Patients had an intermediate risk profile (mean EuroSCORE-II (%) 5.2 ± 5). Postoperative results reported no significant differences in incidence of re-exploration for bleeding (6.6% vs. 6.7%, p = 1.0), stroke (0.9% vs. 0.4%, p = 0.59), dialysis (6.2% vs. 9.5%, p = 0.23) and pacemaker implantation (3.3% vs. 2.8%, p = 0.79) between I-SAVR and C-SAVR groups. Thirty-day (2.4% vs. 7.1% p = 0.03), one-year (5.7% vs. 13.8%, p = 0.003) and overall mortality (24.6% vs. 37.5%, p = 0.002) were lower in the isolated-SAVR group. Re-AVR was indicated in 1.7% of patients due to endocarditis. Conclusions: SAVR in elderly patients offers good outcomes with increased life quality and rare re-operation for structural valvular deterioration. Mortality rates were significantly higher when SAVR was combined with another “non-valvular, non-coronary” procedure. Full article
(This article belongs to the Special Issue Novel Surgical Strategy for Aortic Valve Surgery)
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13 pages, 1207 KiB  
Article
One-Year Outcomes after Surgical versus Transcatheter Aortic Valve Replacement with Newer Generation Devices
by Stefano Rosato, Fausto Biancari, Paola D’Errigo, Marco Barbanti, Giuseppe Tarantini, Francesco Bedogni, Marco Ranucci, Giuliano Costa, Tatu Juvonen, Gian Paolo Ussia, Andrea Marcellusi, Giovanni Baglio, Stefano Domenico Cicala, Gabriella Badoni, Fulvia Seccareccia, Corrado Tamburino and on behalf of the OBSERVANT II Research Group
J. Clin. Med. 2021, 10(16), 3703; https://doi.org/10.3390/jcm10163703 - 20 Aug 2021
Cited by 8 | Viewed by 2634
Abstract
The superiority of transcatheter (TAVR) over surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS) has not been fully demonstrated in a real-world setting. This prospective study included 5706 AS patients who underwent SAVR from 2010 to 2012 and 2989 AS patients [...] Read more.
The superiority of transcatheter (TAVR) over surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS) has not been fully demonstrated in a real-world setting. This prospective study included 5706 AS patients who underwent SAVR from 2010 to 2012 and 2989 AS patients who underwent TAVR from 2017 to 2018 from the prospective multicenter observational studies OBSERVANT I and II. Early adverse events as well as all-cause mortality, major adverse cardiac and cerebrovascular events (MACCEs), and hospital readmission due to heart failure at 1-year were investigated. Among 1008 propensity score matched pairs, TAVR was associated with significantly lower 30-day mortality (1.8 vs. 3.5%, p = 0.020), stroke (0.8 vs. 2.3%, p = 0.005), and acute kidney injury (0.6 vs. 8.2%, p < 0.001) compared to SAVR. Moderate-to-severe paravalvular regurgitation (5.9 vs. 2.0%, p < 0.001) and permanent pacemaker implantation (13.8 vs. 3.3%, p < 0.001) were more frequent after TAVR. At 1-year, TAVR was associated with lower risk of all-cause mortality (7.9 vs. 11.5%, p = 0.006), MACCE (12.0 vs. 15.8%, p = 0.011), readmission due to heart failure (10.8 vs. 15.9%, p < 0.001), and stroke (3.2 vs. 5.1%, p = 0.033) compared to SAVR. TAVR reduced 1-year mortality in the subgroups of patients aged 80 years or older (HR 0.49, 95% CI 0.33–0.71), in females (HR 0.57, 0.38–0.85), and among patients with EuroSCORE II ≥ 4.0% (HR 0.48, 95% CI 0.32–0.71). In a real-world setting, TAVR using new-generation devices was associated with lower rates of adverse events up to 1-year follow-up compared to SAVR. Full article
(This article belongs to the Special Issue Novel Surgical Strategy for Aortic Valve Surgery)
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