Transcatheter aortic valve replacement
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
As represents the most common cause of left ventricular outflow tract (LVOT) obstruction and has three principal etiologies: congenital, rheumatic, and degenerative. The aortic valve is mostly tricuspid, rarely unicuspid (0.02%), bicuspid (1%-2%), or even quadricuspid (0.008%-0.043%).22 Nontricuspid valves undergo degeneration that may pro-voke severe symptoms already in infancy or in early adult-hood. A bicuspid aortic valve is the most common cardiac congenital anomaly, with an incidence of 1%-2% in the gen-eral population. Bicuspid aortic valves may degenerate very early in childhood due to turbulent flow inducing trauma to the leaflets, finally resulting in fibrosis and calcification of the valve. However, in the majority of patients, bicuspid valves typically show signs of sclerosis in the second decade of life and calcification in the fourth decade. The majority of patients with a bicuspid valve will develop stenosis or insufficiency around the age of 70 years.23 Three different anatomic types of bicuspid aortic valve anatomy have been identified: type 0 without any raphe found in 7%, type 1 with one raphe found in 88% of bicuspid valves, and type II with two raphes in 5% (Figure 42.1).24
Transcatheter aortic valve implantation
John Edward Boland, David W. M. Muller in Interventional Cardiology and Cardiac Catheterisation, 2019
A bicuspid aortic valve is the most common congenital cardiac anomaly, with an estimated incidence of 0.4%–2.25% in the general population. Bicuspid anatomy actually comprises a spectrum of deformed aortic valves, presenting on gross examination with two functional cusps forming a valve mechanism with less than three zones of parallel apposition between cusps. Bicuspid valves are most commonly classified using the Sievers method (Figure 39.8), where phenotypes were classified according to (1) numbers of raphes, (2) spatial position of the cusps or raphes, (3) functional status of the valve. The first characteristic was found to be the most significant it terms of how the anomaly affects the valve anatomy and three major types are described: type 0 (no raphe), type 1 (one raphe) and type 2 (two raphes), as shown in Figure 39.8.62
Interventional cardiac catheterisation in adults with congenital heart disease
Ever D. Grech in Practical Interventional Cardiology, 2017
Unlike senile aortic stenosis, balloon aortic valvuloplasty (BAV) remains an excellent alternative to surgical valvotomy or valve replacement in young adults with congenital valvar aortic stenosis. The pathology involved in the latter involves more commissural fusion and less leaflet rigidity compared to the calcified senile aortic valves. In the presence of heavily calcified bicuspid aortic valve, however, surgical valve replacement is the treatment of choice. Experience with trans-catheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve disease remains limited with high incidence of post-implantation aortic regurgitation observed.18 This is thought to be related to the larger annulus size, larger sinus of valsalva and ascending aortic dimension encountered with bicuspid aortic valves. Nevertheless, the enhanced paravalvular sealing effect of the third-generation SAPIEN 3 valve has shown promising results in bicuspid aortic valve stenosis.19
Early, Single Center Experience with Ozaki Technique for Aortic Valve Reconstruction
Published in Structural Heart, 2020
Alberto Albertini, Eliana Raviola, Simone Calvi, Alberto Tripodi, Paola Quagliara, Fabio Zucchetta, Elisa Mikus
Results: The mean age was 52.95 ± 14.72 years old (21–74 years, 76.2% male). The predominant pathology was aortic valve stenosis (61.9%) followed by aortic regurgitation (33.3%) and one patient was treated for endocarditis (4.7%). Nine patients (42.8%) presented with a bicuspid aortic valve and in one patient a monocuspid valve was found. Concomitant procedures included: coronary arteries by-pass grafts (5 patients, 23.8%), ascending aorta replacement (1 patient, 4.7%), mitral valve valvuloplasty (5 patients, 23.8%), interventricular septal myectomy (1 patient, 4.7%). The mean aortic cross-clamp time and cardiopulmonary bypass time were respectively 131.95 and 119.57 minutes. All patients have been extubated (mean intubation time 9.76 ± 4.99 hours) and intensive care unit and hospital stay was respectively 2.5 ± 1.25 and 6.10 ± 4.68 days. There was no in-hospital mortality. Transthoracic echocardiography showed a peak aortic pressure gradient of 14.09 ± 7.62 mmHg and a mean aortic pressure gradient of 7.91 ± 3.33 mmHg. Aortic valve regurgitation was trivial in 8 patients (38%) and no valve stenosis was detected.
Progress in surgical interventions for aortic root aneurysms and dissections
Published in Expert Review of Cardiovascular Therapy, 2022
Shamini Parameswaran, Bulat A. Ziganshin, Mohammad Zafar, John A. Elefteriades
Valve sparing surgery that is being considered in a patient with a bicuspid aortic valve raises additional complexities. The incidence of bicuspid aortic valves is approximately 2% within the population [18] and bicuspid valve is frequently found to be associated with ascending aortic aneurysms (about 10% of cases with bicuspid valve or complex congenital anomalies) [29,30]. In fact, these patients tend to present at an earlier age compared with those who have degenerative aortic aneurysmal disease [31–34] and have more than a 25-fold increased risk in developing an ascending aortic aneurysm compared to the general population [35]. It is believed that the patients with bicuspid valves are at risk for regurgitation or stenosis or both. When there is moderate or greater aortic insufficiency, this leads to an increased stroke volume and higher aortic wall stress that may contribute to the ascending aortic dilation [34,36–38].
Aortic Valve Neocuspidization (Ozaki Procedure) in Patients with Small Aortic Annulus (≤21 mm): A Multicenter Study
Published in Structural Heart, 2020
Michel Pompeu B. O. Sá, Igor Chernov, Andrey Marchenko, Vahe Chagyan, Roman Komarov, Magomedganipa Askadinov, Soslan Enginoev, Bakytbek Kadyraliev, Alisher Ismailbaev, Maxim Tcheglov, Marie-Annick Clavel, Philippe Pibarot, Arjang Ruhparwar, Alexander Weymann, Konstantin Zhigalov
One hundred three (97.2%) patients had aortic stenosis (AS), 3 patients had endocarditis and no patient had aortic regurgitation. Twenty-eight (26.4%) patients had a bicuspid aortic valve. One of the patients underwent a surgical procedure combining Bentall and Ozaki procedures to treat patients with the concomitant ascending aorta and root replacement and AVNeo, described as Russian conduit.15 Preoperative echocardiography showed average peak and mean pressure gradients through the aortic valve of 64.8 ± 20.7 and 46.1 ± 12.2 mm Hg for patients with aortic stenosis and a surgical annular diameter of 19.8 ± 1.1 mm for all patients. EOA and iEOA averaged 0.7 ± 0.2 cm2 and 0.4 ± 0.2 cm2/m2 before surgery, respectively.