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New Challenges in Heart Valve Surgery
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New Challenges in Heart 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 (25 November 2023) | Viewed by 5972

Special Issue Editor

Dr. Christina Grothusen

E-Mail Website
Guest Editor
Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, Kiel, Germany
Interests: transcatheter aortic valve implantation; coronary artery bypass grafting; aortic stenosis; valve repair

Special Issue Information

Dear Colleagues,

Treatment of heart valve pathologies has revolutionized during the last two decades and led to a unique interdisciplinary approach. New techniques have enabled improved survival and quality of life of patients formerly considered untreatable.

This Special Issue will summarize the latest clinical advancements and treatment recommendations for patients with heart valve diseases. The issue will cover treatment aspects as well future developments in both, AV-valve and aortic/pulmonary valve disease.

It will also include data concerning the role of echocardiography, MRI and CT in this setting. Thereby, the readers of this issue should be able to get an extensive insight into the essential aspects of modern heart valve treatment. The interdisciplinary assembly of authors from cardiology as well as heart surgery mirror the close collaboration between the two specialties.

Dr. Christina Grothusen
Guest Editor

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

  • coronary artery bypass grafting
  • aortic valve replacement
  • valve repair
  • heart valve prosthesis
  • heart valve pathologies
  • heart valve treatment

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Published Papers (4 papers)

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10 pages, 3383 KiB  
Article
Redefining Unilateral Pulmonary Edema after Mitral Valve Surgery on Chest X-ray Imaging Using the RALE Scoring System
by Karim Mostafa, Carmen Wolf, Svea Seehafer, Agreen Horr, Nina Pommert, Assad Haneya, Georg Lutter, Thomas Pühler, Marcus Both, Olav Jansen and Patrick Langguth
J. Clin. Med. 2023, 12(18), 6043; https://doi.org/10.3390/jcm12186043 - 19 Sep 2023
Cited by 1 | Viewed by 1419
Abstract
Introduction: Unilateral pulmonary edema (UPE) is a potential complication after mitral valve surgery (MVS), and its cause is not yet fully understood. Definitions are inconsistent, and previous studies have reported wide variance in the incidence of UPE. This research aims at the [...] Read more.
Introduction: Unilateral pulmonary edema (UPE) is a potential complication after mitral valve surgery (MVS), and its cause is not yet fully understood. Definitions are inconsistent, and previous studies have reported wide variance in the incidence of UPE. This research aims at the evaluation of the Radiographic Assessment of Lung Edema (RALE) score concerning assessment of UPE after MVS in order to provide an accurate and consistent definition of this pathology. Methods and Results: Postoperative chest X-ray images of 676 patients after MVS (minimally invasive MVS, n = 434; conventional MVS, n = 242) were retrospectively analyzed concerning presence of UPE. UPE was diagnosed only after exclusion of other pathologies up until the eighth postoperative day. RALE values were calculated for each patient. ROC analysis was performed to assess diagnostic performance. UPE was diagnosed in 18 patients (2.8%). UPE occurred significantly more often in the MI-MVS group (p = 0.045; MI-MVS n = 15; C-MVS n = 3). Postoperative RALE values for the right hemithorax (Q1 + Q2) > 12 and the right-to-left RALE difference ((Q1 + Q2) − (Q3 + Q4)) > 13 provide a sensitivity of up to 100% and 94.4% and a specificity of up to 88.4% and 94.2% for UPE detection. Conclusion: The RALE score is a practical tool for assessment of chest X-ray images after MVS with regard to UPE and provides a clear definition of UPE. In addition, it enables objective comparability when assessing of the postoperative course. The given score thresholds provide a sensitivity and specificity of up to 94%. Further, UPE after MVS seems to be a rather rare pathology with an incidence of 2.6%. Full article
(This article belongs to the Special Issue New Challenges in Heart Valve Surgery)
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11 pages, 1462 KiB  
Article
Transcatheter Aortic Valve Implantation by Intercostal Access: Initial Experience with a No-Touch Technique
by Nina Sophie Pommert, Xiling Zhang, Thomas Puehler, Hatim Seoudy, Katharina Huenges, Jan Schoettler, Assad Haneya, Christine Friedrich, Janarthanan Sathananthan, Stephanie L. Sellers, David Meier, Oliver J. Mueller, Mohammed Saad, Derk Frank and Georg Lutter
J. Clin. Med. 2023, 12(16), 5211; https://doi.org/10.3390/jcm12165211 - 10 Aug 2023
Viewed by 1273
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is now a well-established therapeutic option in an elderly high-risk patient cohort with aortic valve disease. Although most commonly performed via a transfemoral route, alternative approaches for TAVI are constantly being improved. Instead of the classical mini-sternotomy, [...] Read more.
Background: Transcatheter aortic valve implantation (TAVI) is now a well-established therapeutic option in an elderly high-risk patient cohort with aortic valve disease. Although most commonly performed via a transfemoral route, alternative approaches for TAVI are constantly being improved. Instead of the classical mini-sternotomy, it is possible to achieve a transaortic access via a right anterior mini-thoracotomy in the second intercostal space. We describe our experience with this sternum- and rib-sparing technique in comparison to the classical transaortic approach. Methods: Our retrospective study includes 173 patients who were treated in our institution between January 2017 and April 2020 with transaortic TAVI via either upper mini-sternotomy or intercostal thoracotomy. The primary endpoint was 30-day mortality, and secondary endpoints were defined as major postoperative complications that included admission to the intensive care unit and overall hospital stay, according to the Valve Academic Research Consortium 3. Results: Eighty-two patients were treated with TAo-TAVI by upper mini-sternotomy, while 91 patients received the intercostal approach. Both groups were comparable in age (mean age: 82 years) and in the proportion of female patients. The intercostal group had a higher rate of peripheral artery disease (41% vs. 22%, p = 0.008) and coronary artery disease (71% vs. 40%, p < 0.001) with a history of percutaneous coronary intervention or coronary artery bypass grafting, resulting in significantly higher preinterventional risk evaluation (EuroScore II 8% in the intercostal vs. 4% in the TAo group, p = 0.005). Successful device implantation and a reduction of the transvalvular gradient were achieved in all cases with a significantly lower rate of trace to mild paravalvular leakage in the intercostal group (12% vs. 33%, p < 0.001). The intercostal group required significantly fewer blood transfusions (0 vs. 2 units, p = 0.001) and tended to require less reoperation (7% vs. 15%, p = 0.084). Hospital stays (9 vs. 12 d, p = 0.011) were also shorter in the intercostal group. Short- and long-term survival in the follow-up showed comparable results between the two approaches (30-day, 6-month- and 2-year mortality: 7%, 23% and 36% in the intercostal vs. 9%, 26% and 33% in the TAo group) with acute kidney injury (AKI) and reintubation being independent risk factors for mortality. Conclusions: Transaortic TAVI via an intercostal access offers a safe and effective treatment of aortic valve stenosis. Full article
(This article belongs to the Special Issue New Challenges in Heart Valve Surgery)
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10 pages, 2041 KiB  
Article
Comparison of the New-Generation Self-Expanding NAVITOR Transcatheter Heart Valve with Its Predecessor, the PORTICO, in Severe Native Aortic Valve Stenosis
by Clemens Enno Eckel, Won-Keun Kim, Christina Grothusen, Vedat Tiyerili, Albrecht Elsässer, Dagmar Sötemann, Judith Schlüter, Yeong-Hoon Choi, Efstratios I. Charitos, Matthias Renker, Christian W. Hamm, Guido Dohmen, Helge Möllmann and Johannes Blumenstein
J. Clin. Med. 2023, 12(12), 3999; https://doi.org/10.3390/jcm12123999 - 12 Jun 2023
Cited by 1 | Viewed by 1521
Abstract
Background: Third-generation transcatheter heart valves (THVs) are designed to improve outcomes. Data on the new intra-annular self-expanding NAVITOR are scarce. Aims: The aim of this analysis was to compare outcomes between the PORTICO and the NAVITOR systems. Methods: Data from 782 patients with [...] Read more.
Background: Third-generation transcatheter heart valves (THVs) are designed to improve outcomes. Data on the new intra-annular self-expanding NAVITOR are scarce. Aims: The aim of this analysis was to compare outcomes between the PORTICO and the NAVITOR systems. Methods: Data from 782 patients with severe native aortic stenosis treated with PORTICO (n = 645) or NAVITOR (n = 137) from 05/2012 to 09/2022 were evaluated. The clinical and hemodynamic outcomes of 276 patients (PORTICO, n = 139; NAVITOR, n = 137) were evaluated according to VARC-3 recommendations. Results: Rates of postprocedural more-than-mild paravalvular leakage (PVL) were significantly lower for NAVITOR than for PORTICO (7.2% vs. 1.5%, p = 0.041). In addition, severe bleeding rates (27.3% vs. 13.1%, p = 0.005) and major vascular complications (5.8% vs. 0.7%, p = 0.036) were lower in the NAVITOR group. The mean gradients (7 vs. 8 mmHg, p = 0.121) and calculated aortic valve areas (1.90 cm2 vs. 1.99 cm2, p = 0.235) were comparable. Rates of PPI were similarly high in both groups (15.3 vs. 21.6, p = 0.299). Conclusions: The NAVITOR demonstrated favorable in-hospital procedural outcome data, with lower rates of relevant PVL, major vascular complications, and severe bleeding than its predecessor the PORTICO and preserved favorable hemodynamic outcomes. Full article
(This article belongs to the Special Issue New Challenges in Heart Valve Surgery)
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8 pages, 234 KiB  
Brief Report
Surgery for Infective Endocarditis after Primary Transcatheter Aortic-Valve Replacement—A Retrospective Single-Center Analysis
by Romina Maria Rösch, Lena Brendel, Katja Buschmann, Christian-Friedrich Vahl, Hendrik Treede and Daniel-Sebastian Dohle
J. Clin. Med. 2023, 12(16), 5177; https://doi.org/10.3390/jcm12165177 - 9 Aug 2023
Viewed by 1157
Abstract
Transcatheter aortic-valve replacement (TAVR) is increasingly being used for the treatment of aortic-valve stenosis. Therefore, the total number of patients with an aortic-valve prosthesis is increasing, causing the incidence of prosthetic-valve endocarditis to increase. Methods: Between March 2016 and July 2019, ten patients [...] Read more.
Transcatheter aortic-valve replacement (TAVR) is increasingly being used for the treatment of aortic-valve stenosis. Therefore, the total number of patients with an aortic-valve prosthesis is increasing, causing the incidence of prosthetic-valve endocarditis to increase. Methods: Between March 2016 and July 2019, ten patients underwent surgery due to prosthetic-valve endocarditis after TAVR. They were identified in our institutional database and analyzed. Results: Infective endocarditis was diagnosed 17 ± 16 month after TAVR. Mean age was 79 ± 4.4 years. Microbiological detection showed 6/10 positive blood cultures for enterococcus faecalis. Median EuroScore II was 24.64%. The mean size of the surgically replaced aortic prosthesis was 23.6 ± 1.3 and that of the TAVR was 28.4 ± 2.3 mm. The surgically implanted aortic valves had a mean gradient of 8.5 ± 2.2 mmHg. One patient died in hospital due to septic multiorgan failure. After discharge, all patients survived with a mean follow-up of 9 ± 8 month. Conclusions: With a rising number of patients after TAVR, prosthetic-valve endocarditis will increasingly occur in patients who were previously considered high or intermediate risk. Our results show that patients with TAVR infective endocarditis can be operated on with good results. Surgical therapy should not be withheld from TAVR patients with infective endocarditis. Full article
(This article belongs to the Special Issue New Challenges in Heart Valve Surgery)
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