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[PMID]:29297076
[Au] Autor:Feldman TE; Reardon MJ; Rajagopal V; Makkar RR; Bajwa TK; Kleiman NS; Linke A; Kereiakes DJ; Waksman R; Thourani VH; Stoler RC; Mishkel GJ; Rizik DG; Iyer VS; Gleason TG; Tchétché D; Rovin JD; Buchbinder M; Meredith IT; Götberg M; Bjursten H; Meduri C; Salinger MH; Allocco DJ; Dawkins KD
[Ad] Endereço:Evanston Hospital Cardiology Division, Northshore University Health System, Evanston, Illinois.
[Ti] Título:Effect of Mechanically Expanded vs Self-Expanding Transcatheter Aortic Valve Replacement on Mortality and Major Adverse Clinical Events in High-Risk Patients With Aortic Stenosis: The REPRISE III Randomized Clinical Trial.
[So] Source:JAMA;319(1):27-37, 2018 01 02.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Transcatheter aortic valve replacement (TAVR) is established for selected patients with severe aortic stenosis. However, limitations such as suboptimal deployment, conduction disturbances, and paravalvular leak occur. Objective: To evaluate if a mechanically expanded valve (MEV) is noninferior to an approved self-expanding valve (SEV) in high-risk patients with aortic stenosis undergoing TAVR. Design, Setting, and Participants: The REPRISE III trial was conducted in 912 patients with high or extreme risk and severe, symptomatic aortic stenosis at 55 centers in North America, Europe, and Australia between September 22, 2014, and December 24, 2015, with final follow-up on March 8, 2017. Interventions: Participants were randomized in a 2:1 ratio to receive either an MEV (n = 607) or an SEV (n = 305). Main Outcomes and Measures: The primary safety end point was the 30-day composite of all-cause mortality, stroke, life-threatening or major bleeding, stage 2/3 acute kidney injury, and major vascular complications tested for noninferiority (margin, 10.5%). The primary effectiveness end point was the 1-year composite of all-cause mortality, disabling stroke, and moderate or greater paravalvular leak tested for noninferiority (margin, 9.5%). If noninferiority criteria were met, the secondary end point of 1-year moderate or greater paravalvular leak was tested for superiority in the full analysis data set. Results: Among 912 randomized patients (mean age, 82.8 [SD, 7.3] years; 463 [51%] women; predicted risk of mortality, 6.8%), 874 (96%) were evaluable at 1 year. The primary safety composite end point at 30 days occurred in 20.3% of MEV patients and 17.2% of SEV patients (difference, 3.1%; Farrington-Manning 97.5% CI, -∞ to 8.3%; P = .003 for noninferiority). At 1 year, the primary effectiveness composite end point occurred in 15.4% with the MEV and 25.5% with the SEV (difference, -10.1%; Farrington-Manning 97.5% CI, -∞ to -4.4%; P<.001 for noninferiority). The 1-year rates of moderate or severe paravalvular leak were 0.9% for the MEV and 6.8% for the SEV (difference, -6.1%; 95% CI, -9.6% to -2.6%; P < .001). The superiority analysis for primary effectiveness was statistically significant (difference, -10.2%; 95% CI, -16.3% to -4.0%; P < .001). The MEV had higher rates of new pacemaker implants (35.5% vs 19.6%; P < .001) and valve thrombosis (1.5% vs 0%) but lower rates of repeat procedures (0.2% vs 2.0%), valve-in-valve deployments (0% vs 3.7%), and valve malpositioning (0% vs 2.7%). Conclusions and Relevance: Among high-risk patients with aortic stenosis, use of the MEV compared with the SEV did not result in inferior outcomes for the primary safety end point or the primary effectiveness end point. These findings suggest that the MEV may be a useful addition for TAVR in high-risk patients. Trial Registration: ClinicalTrials.gov Identifier: NCT02202434.
[Mh] Termos MeSH primário: Estenose da Valva Aórtica/cirurgia
Valva Aórtica/cirurgia
Próteses Valvulares Cardíacas
Substituição da Valva Aórtica Transcateter/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Estenose da Valva Aórtica/mortalidade
Bioprótese
Doenças Cardiovasculares/etiologia
Doenças Cardiovasculares/mortalidade
Feminino
Seguimentos
Seres Humanos
Masculino
Complicações Pós-Operatórias/etiologia
Desenho de Prótese
Fatores de Risco
Substituição da Valva Aórtica Transcateter/métodos
Substituição da Valva Aórtica Transcateter/mortalidade
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180104
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.19132


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[PMID]:27773869
[Au] Autor:Doose C; Kütting M; Egron S; Farhadi Ghalati P; Schmitz C; Utzenrath M; Sedaghat A; Fujita B; Schmitz-Rode T; Ensminger S; Steinseifer U
[Ad] Endereço:Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz-Institute Aachen, RWTH Aachen University, Aachen, Germany.
[Ti] Título:Valve-in-valve outcome: design impact of a pre-existing bioprosthesis on the hydrodynamics of an Edwards Sapien XT valve.
[So] Source:Eur J Cardiothorac Surg;51(3):562-570, 2017 03 01.
[Is] ISSN:1873-734X
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:Objectives: Bioprosthetic aortic heart valves are increasingly implanted in younger patients. Therefore, a strategy for potential valve failure should be developed before implanting the 'first valve'. The goal of this in vitro study was to provide insight into the effects of the design of a bioprosthesis on a valve-in-valve implanted Sapien XT valve. Methods: The hydrodynamic performance of a 23-mm Sapien XT valve implanted in Vascutek Aspire, Edwards Perimount, Medtronic Mosaic and St. Jude Medical Trifecta heart valves was investigated in a left heart simulator. In addition to the hydrodynamic results, the leaflet dynamics were analysed in high-speed video recordings of the tests. Results: All valve-in-valve combinations in this study fulfilled the minimum acceptance criteria defined by relevant approval standards (e.g. ISO 5840) but displayed significant differences in their performances. Small inner diameters of the bioprostheses were associated with increased mean pressure gradients, decreased effective orifice areas and geometric opening areas as well as with pin-wheeling and uneven leaflet motion. In addition, implantation in bioprostheses with internally mounted leaflets was associated with lower paravalvular leakage. Conclusions: The results of this study suggest that a surgical bioprosthesis with a large inner diameter and internally mounted leaflets improves the heamodynamics and potentially the durability of a valve-in-valve combination. These results should give the attending physicians critical information to consider when deciding on a bioprosthesis for younger patients.
[Mh] Termos MeSH primário: Valva Aórtica/cirurgia
Bioprótese
Implante de Prótese de Valva Cardíaca/métodos
Próteses Valvulares Cardíacas
[Mh] Termos MeSH secundário: Valva Aórtica/fisiopatologia
Seres Humanos
Hidrodinâmica
Desenho de Prótese
Falha de Prótese
Reoperação/instrumentação
Reoperação/métodos
Resultado do Tratamento
Gravação em Vídeo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1093/ejcts/ezw317


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[PMID]:29466153
[Au] Autor:Goldstone AB; Chiu P; Woo YJ
[Ad] Endereço:Stanford University School of Medicine, Stanford, CA
[Ti] Título:Prosthesis Type for Aortic- and Mitral-Valve Replacement.
[So] Source:N Engl J Med;378(8):778-779, 2018 02 22.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Valva Aórtica/cirurgia
Próteses Valvulares Cardíacas
[Mh] Termos MeSH secundário: Implante de Prótese de Valva Cardíaca
Seres Humanos
Valva Mitral/cirurgia
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMc1716336


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[PMID]:29178215
[Au] Autor:Rene AG; Desai N; Wald J; Rame JE; Frogel JK; Anwaruddin S
[Ad] Endereço:Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
[Ti] Título:Transfemoral transcatheter aortic valve replacement with a self-expanding valve for severe aortic regurgitation in a patient with left ventricular assist device.
[So] Source:J Card Surg;32(11):741-745, 2017 Nov.
[Is] ISSN:1540-8191
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Aortic insufficiency following left ventricular assist device implantation (LVAD) has been reported in up to 40% of patients and is associated with a worse prognosis. We describe the case of a successful transfemoral transcatheter aortic valve replacement with a self-expanding bioprosthesis for aortic insufficiency following destination LVAD implantation.
[Mh] Termos MeSH primário: Insuficiência da Valva Aórtica/cirurgia
Valva Aórtica/cirurgia
Bioprótese
Próteses Valvulares Cardíacas
Ventrículos do Coração
Coração Auxiliar
Substituição da Valva Aórtica Transcateter/métodos
[Mh] Termos MeSH secundário: Adulto
Insuficiência da Valva Aórtica/diagnóstico por imagem
Insuficiência da Valva Aórtica/terapia
Ecocardiografia Transesofagiana
Artéria Femoral
Seres Humanos
Masculino
Índice de Gravidade de Doença
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1111/jocs.13238


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[PMID]:28457950
[Au] Autor:Bettinger N; Khalique OK; Krepp JM; Hamid NB; Bae DJ; Pulerwitz TC; Liao M; Hahn RT; Vahl TP; Nazif TM; George I; Leon MB; Einstein AJ; Kodali SK
[Ad] Endereço:Division of Cardiology, New-York-Presbyterian Hospital and Columbia University Medical Center, New York, NY, United States; Division of Cardiology, Hospital Charles Nicolle, University Hospital of Rouen, Rouen, France.
[Ti] Título:Practical determination of aortic valve calcium volume score on contrast-enhanced computed tomography prior to transcatheter aortic valve replacement and impact on paravalvular regurgitation: Elucidating optimal threshold cutoffs.
[So] Source:J Cardiovasc Comput Tomogr;11(4):302-308, 2017 Jul - Aug.
[Is] ISSN:1876-861X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The threshold for the optimal computed tomography (CT) number in Hounsfield Units (HU) to quantify aortic valvular calcium on contrast-enhanced scans has not been standardized. Our aim was to find the most accurate threshold to predict paravalvular regurgitation (PVR) after transcatheter aortic valve replacement (TAVR). METHODS: 104 patients who underwent TAVR with the CoreValve prosthesis were studied retrospectively. Luminal attenuation (LA) in HU was measured at the level of the aortic annulus. Calcium volume score for the aortic valvular complex was measured using 6 threshold cutoffs (650 HU, 850 HU, LA × 1.25, LA × 1.5, LA+50, LA+100). Receiver-operating characteristic (ROC) analysis was performed to assess the predictive value for > mild PVR (n = 16). Multivariable analysis was performed to determine the accuracy to predict > mild PVR after adjustment for depth and perimeter oversizing. RESULTS: ROC analysis showed lower area under the curve (AUC) values for fixed threshold cutoffs (650 or 850 HU) compared to thresholds relative to LA. The LA+100 threshold had the highest AUC (0.81), and AUC was higher than all studied protocols, other than the LA x 1.25 and LA + 50 protocols, where the difference approached statistical significance (p = 0.05, and 0.068, respectively). Multivariable analysis showed calcium volume determined by the LAx1.25, LAx1.5, LA+50, and LA+ 100 HU protocols to independently predict PVR. CONCLUSIONS: Calcium volume scoring thresholds which are relative to LA are more predictive of PVR post-TAVR than those which use fixed cutoffs. A threshold of LA+100 HU had the highest predictive value.
[Mh] Termos MeSH primário: Insuficiência da Valva Aórtica/etiologia
Estenose da Valva Aórtica/diagnóstico por imagem
Valva Aórtica/diagnóstico por imagem
Valva Aórtica/patologia
Calcinose/diagnóstico por imagem
Meios de Contraste/administração & dosagem
Tomografia Computadorizada por Raios X
Substituição da Valva Aórtica Transcateter/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Valva Aórtica/fisiopatologia
Valva Aórtica/cirurgia
Insuficiência da Valva Aórtica/fisiopatologia
Estenose da Valva Aórtica/fisiopatologia
Estenose da Valva Aórtica/cirurgia
Área Sob a Curva
Calcinose/fisiopatologia
Calcinose/cirurgia
Ecocardiografia Transesofagiana
Feminino
Próteses Valvulares Cardíacas
Seres Humanos
Modelos Logísticos
Masculino
Análise Multivariada
Valor Preditivo dos Testes
Modelos de Riscos Proporcionais
Curva ROC
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Índice de Gravidade de Doença
Substituição da Valva Aórtica Transcateter/instrumentação
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Contrast Media)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


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[PMID]:29338037
[Au] Autor:Schaefer A; Dickow J; Schoen G; Westhofen S; Kloss L; Al-Saydali T; Reichenspurner H; Philipp SA; Detter C
[Ad] Endereço:Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
[Ti] Título:Stentless vs. stented bioprosthesis for aortic valve replacement: A case matched comparison of long-term follow-up and subgroup analysis of patients with native valve endocarditis.
[So] Source:PLoS One;13(1):e0191171, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Current retrospective evidence suggests similar clinical and superior hemodynamic outcomes of the Sorin Freedom Solo stentless aortic valve (SFS) (LivaNova PLC, London, UK) compared to the Carpentier Edwards Perimount stented aortic valve (CEP) (Edwards Lifesciences Inc., Irvine, California, USA). To date, no reports exist describing case-matched long-term outcomes and analysis for treatment of native valve endocarditis (NVE). METHODS: From 2004 through 2014, 77 consecutive patients (study group, 59.7% male, 68.9 ± 12.5 years, logEuroSCORE II 7.6 ± 12.3%) received surgical aortic valve replacement (SAVR) with the SFS. A control group of patients after SAVR with the CEP was retrieved from our database and matched to the study group regarding 15 parameters including preoperative endocarditis. Acute perioperative outcomes and follow-up data (mean follow-up time 48.7±29.8 months, 95% complete) were retrospectively analyzed. RESULTS: No differences in early mortality occurred during 30-day follow up (3/77; 3.9% vs. 4/77; 5.2%; p = 0.699). Echocardiographic findings revealed lower postprocedural transvalvular pressure gradients (max. 17.0 ± 8.2 vs. 24.5 ± 9.2 mmHg, p< 0.001/ mean pressure of 8.4 ± 4.1 vs. 13.1 ± 5.9 mmHg, p< 0.001) in the SFS group. Structural valve degeneration (SVD) (5.2% vs. 0%; p = 0.04) and valve explantation due to SVD or prosthetic valve endocarditis (PVE) (9.1% vs. 1.3%; p = 0.04) was more frequent in the SFS group. All-cause mortality during follow-up was 20.8% vs. 14.3% (p = 0.397). When patients were divided into subgroups of NVE and respective utilized bioprosthesis, the SFS presented impaired outcomes regarding mortality in NVE cases (p = 0.031). CONCLUSIONS: The hemodynamic superiority of the SFS was confirmed in this comparison. However, clinical outcomes in terms of SVD and PVE rates, as well as survival after NVE, were inferior in this study. Therefore, we are reluctant to recommend utilization of the SFS for treatment of NVE.
[Mh] Termos MeSH primário: Valva Aórtica/cirurgia
Bioprótese
Endocardite/cirurgia
Doenças das Valvas Cardíacas/cirurgia
Próteses Valvulares Cardíacas
Desenho de Prótese
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Valva Aórtica/diagnóstico por imagem
Valva Aórtica/fisiopatologia
Bioprótese/efeitos adversos
Estudos de Casos e Controles
Ecocardiografia
Endocardite/diagnóstico por imagem
Endocardite/fisiopatologia
Feminino
Seguimentos
Doenças das Valvas Cardíacas/diagnóstico por imagem
Doenças das Valvas Cardíacas/fisiopatologia
Próteses Valvulares Cardíacas/efeitos adversos
Hemodinâmica
Seres Humanos
Masculino
Meia-Idade
Desenho de Prótese/efeitos adversos
Falha de Prótese
Stents/efeitos adversos
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180117
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191171


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[PMID]:28454636
[Au] Autor:Udesh R; Mehta A; Gleason T; Thirumala PD
[Ad] Endereço:Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
[Ti] Título:Carotid artery disease and perioperative stroke risk after surgical aortic valve replacement: A nationwide inpatient sample analysis.
[So] Source:J Clin Neurosci;42:91-96, 2017 Aug.
[Is] ISSN:1532-2653
[Cp] País de publicação:Scotland
[La] Idioma:eng
[Ab] Resumo:To study the role of carotid stenosis (CS) and cerebrovascular disease as independent risk factors for perioperative stroke following surgical aortic valve replacement (SAVR). The National Inpatient Sample (NIS) database was used for our study. All patients who underwent SAVR from 1999 to 2011 were identified using ICD-9 codes. Univariate and multivariate analysis of baseline characteristics, Elixhauser comorbidities and other covariates were examined to identify independent predictors of perioperative strokes following SAVR. Data on 50,979 patients who underwent SAVR from 1999 to 2011 was obtained. The mean age of the study cohort was 60.5. The study patients were predominantly Caucasian (79.3%) and males (60.01%). The incidence of perioperative stroke was 2.48%. CS (OR 1.8, 95%CI 1.1-2.8, p=0.009) and cerebral arterial occlusion (OR 3.4, 95% CI 1.3-8.9) significantly increased perioperative stroke risk following SAVR. Infective endocarditis (OR 4.6, 95%CI 3.8-5.6, p=0.00) and neurological disorders (OR 4.8, 95% CI 4-5.8, p=0.00) appeared to be the strongest risk factors for strokes. Other risk factors found to be significant predictors of perioperative strokes (p<0.05) were - age, higher VWR scores, CS, cerebral arterial occlusion, infective endocarditis, DM, HTN, renal failure, neurological disorders, coagulopathy and hypothyroidsm. In conclusion, perioperative stroke risk has remained more or less constant despite advancements in surgical techniques with risk having gone up in patients <65years of age. CS and cerebral arterial occlusion significantly increase stroke risk following SAVR. Improved patient selection with pre-operative risk stratification and institution of preventive strategies are necessary to improve operative outcomes following SAVR.
[Mh] Termos MeSH primário: Estenose da Valva Aórtica/epidemiologia
Valva Aórtica/cirurgia
Estenose das Carótidas/epidemiologia
Transtornos Cerebrovasculares/epidemiologia
Complicações Intraoperatórias/epidemiologia
Acidente Vascular Cerebral/epidemiologia
[Mh] Termos MeSH secundário: Idoso
Comorbidade
Feminino
Próteses Valvulares Cardíacas
Seres Humanos
Incidência
Pacientes Internados
Masculino
Meia-Idade
Fatores de Risco
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE


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[PMID]:29235147
[Au] Autor:Gualis J; Estevez-Loureiro R; Alonso D; Castaño M
[Ad] Endereço:Deparment of Cardiac Surgery, Complejo Asistencial Universitario de León, León, Spain.
[Ti] Título:Transapical mitral valve-in-valve ring implantation with the Edwards Sapien 3 prosthesis.
[So] Source:J Card Surg;32(12):791-793, 2017 Dec.
[Is] ISSN:1540-8191
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We present the case of a high-risk patient with symptomatic severe mitral regurgitation following a surgical annuloplasty ring. An inverted aortic Edwards Sapien 3 bioprosthesis (Edwards Lifesciences, Irvine, CA) was successfully implanted through a transapical approach inside the previously implanted annuloplasty ring.
[Mh] Termos MeSH primário: Bioprótese
Implante de Prótese de Valva Cardíaca/métodos
Próteses Valvulares Cardíacas
Anuloplastia da Valva Mitral/métodos
Insuficiência da Valva Mitral/cirurgia
Valva Mitral/cirurgia
Reoperação/métodos
[Mh] Termos MeSH secundário: Idoso
Implante de Prótese de Valva Cardíaca/instrumentação
Seres Humanos
Masculino
Anuloplastia da Valva Mitral/instrumentação
Recidiva
Reoperação/instrumentação
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE
[do] DOI:10.1111/jocs.13506


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[PMID]:28454910
[Au] Autor:Luraghi G; Wu W; De Gaetano F; Rodriguez Matas JF; Moggridge GD; Serrani M; Stasiak J; Costantino ML; Migliavacca F
[Ad] Endereço:Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.
[Ti] Título:Evaluation of an aortic valve prosthesis: Fluid-structure interaction or structural simulation?
[So] Source:J Biomech;58:45-51, 2017 06 14.
[Is] ISSN:1873-2380
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Bio-inspired polymeric heart valves (PHVs) are excellent candidates to mimic the structural and the fluid dynamic features of the native valve. PHVs can be implanted as prosthetic alternative to currently clinically used mechanical and biological valves or as potential candidate for a minimally invasive treatment, like the transcatheter aortic valve implantation. Nevertheless, PHVs are not currently used for clinical applications due to their lack of reliability. In order to investigate the main features of this new class of prostheses, pulsatile tests in an in-house pulse duplicator were carried out and reproduced in silico with both structural Finite-Element (FE) and Fluid-Structure interaction (FSI) analyses. Valve kinematics and geometric orifice area (GOA) were evaluated to compare the in vitro and the in silico tests. Numerical results showed better similarity with experiments for the FSI than for the FE simulations. The maximum difference between experimental and FSI GOA at maximum opening time was only 5%, as compared to the 46.5% between experimental and structural FE GOA. The stress distribution on the valve leaflets clearly reflected the difference in valve kinematics. Higher stress values were found in the FSI simulations with respect to those obtained in the FE simulation. This study demonstrates that FSI simulations are more appropriate than FE simulations to describe the actual behaviour of PHVs as they can replicate the valve-fluid interaction while providing realistic fluid dynamic results.
[Mh] Termos MeSH primário: Valva Aórtica/cirurgia
Próteses Valvulares Cardíacas
Modelos Cardiovasculares
[Mh] Termos MeSH secundário: Simulação por Computador
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180120
[Lr] Data última revisão:
180120
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE


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[PMID]:28740586
[Au] Autor:Kumar V; Kelly S; Raizada A; Yee J; Anuwatworn A; Stys A; Stys M
[Ad] Endereço:University of South Dakota, Sanford School of Medicine, Vermillion, South Dakota.
[Ti] Título:Mechanical Valve Thrombosis on Rivaroxaban: Are Novel Anticoagulants Really an Option?
[So] Source:Methodist Debakey Cardiovasc J;13(2):73-75, 2017 Apr-Jun.
[Is] ISSN:1947-6108
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This is a case of a 54-year-old female with a history of mechanical aortic valve replacement who presented in cardiogenic shock. Her primary care provider started her on rivaroxaban for anticoagulation therapy. An urgent transesophageal echocardiogram revealed a significant gradient and thrombosis on one leaflet of the valve that was immobile. Given that she was not a surgical candidate, she underwent thrombolysis. However, she later died due to complications from the thrombotic valve. The utility of target-specific oral anticoagulants has yet to be established in clinical practice.
[Mh] Termos MeSH primário: Estenose da Valva Aórtica/cirurgia
Valva Aórtica/cirurgia
Inibidores do Fator Xa/uso terapêutico
Implante de Prótese de Valva Cardíaca/instrumentação
Próteses Valvulares Cardíacas
Rivaroxabana/uso terapêutico
Trombose/etiologia
[Mh] Termos MeSH secundário: Valva Aórtica/diagnóstico por imagem
Valva Aórtica/fisiopatologia
Estenose da Valva Aórtica/diagnóstico por imagem
Estenose da Valva Aórtica/fisiopatologia
Ecocardiografia Doppler em Cores
Ecocardiografia Transesofagiana
Evolução Fatal
Feminino
Implante de Prótese de Valva Cardíaca/efeitos adversos
Seres Humanos
Meia-Idade
Uso Off-Label
Terapia Trombolítica
Trombose/diagnóstico por imagem
Trombose/tratamento farmacológico
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Factor Xa Inhibitors); 9NDF7JZ4M3 (Rivaroxaban)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE
[do] DOI:10.14797/mdcj-13-2-73



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