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BACKGROUND: Bioprosthetic valve thrombosis may have implications for valve function and durability.OBJECTIVES: Using a novel glycoprotein IIb/IIIa receptor radiotracer 18F-GP1, we investigated whether positron emission tomography (PET)-computed tomography (CT) could detect thrombus formation on bioprosthetic aortic valves.METHODS: Ex vivo experiments were performed on human platelets and explanted bioprosthetic aortic valves. In a prospective cross-sectional study, patients with either bioprosthetic or normal native aortic valves underwent echocardiography, CT angiography, and 18F-GP1 PET-CT.RESULTS: Flow cytometric analysis, histology, immunohistochemistry, and autoradiography demonstrated selective binding of 18F-GP1 to activated platelet glycoprotein IIb/IIIa receptors and thrombus adherent to prosthetic valves. In total, 75 participants were recruited: 53 with bioprosthetic valves (median time from implantation 37 months [IQR: 12-80 months]) and 22 with normal native aortic valves. Three participants had obstructive valve thrombosis, and a further 3 participants had asymptomatic hypoattenuated leaflet thickening on CT angiography. All bioprosthetic valves, but none of the native aortic valves, demonstrated focal 18F-GP1 uptake on the valve leaflets: median maximum target-to-background ratio 2.81 (IQR: 2.29-3.48) vs 1.43 (IQR: 1.28-1.53) (P < 0.001). Higher 18F-GP1 uptake was independently associated with duration of valve implantation and hypoattenuated leaflet thickening. All 3 participants with obstructive valve thrombosis were anticoagulated for 3 months, leading to resolution of their symptoms, improvement in mean valve gradients, and a reduction in 18F-GP1 uptake.CONCLUSIONS: Adherence of activated platelets is a common and sustained finding on bioprosthetic aortic valves. 18F-GP1 uptake is higher in the presence of thrombus, regresses with anticoagulation, and has potential use as an adjunctive clinical tool. (18F-GP1 PET-CT to Detect Bioprosthetic Aortic Valve Thrombosis; NCT04073875).

A cluster of aortic bioprosthetic valve failures, most of which were Trifecta bioprostheses, was observed in Southampton General Hospital, Southampton, United Kingdom. This study was performed to assess whether the cluster represents a significant failure of this valve model or whether there is a selection bias that can explain the failure of these valves.This retrospective study evaluated all bioprosthetic aortic valve replacement operations performed between 2011 and 2016 inclusive in our center. The study compared the performance of the Trifecta valve (Abbott, Abbott Park, IL) with that of Perimount (Edwards Lifesciences, Irvine, CA), Perimount Magna Ease, and Mitroflow (LivaNova, London, United Kingdom) bioprostheses. In addition, the study analyzed patient-related and valve-related risk factors for early failure in the failed valves.A total of 2807 bioprosthetic aortic valve replacements were performed. Of these, 836 were Trifecta valves, 1031 were Perimount, 449 were Perimount Magna Ease, and 351 were Mitroflow valves. A total of 24 Trifecta valves had premature structural failure, a number significantly higher than seen with Perimount or Perimount Magna Ease (no failure, P.001 and P.005, respectively) valves and the Mitroflow valve (1 failure, P .05). There was no difference in the incidence of endocarditis or death. At the time of valve failure, 17 (71%) of the failed Trifecta valves had moderate or severe regurgitation, and the average peak gradient was 61 ± 29 mm Hg. The median failed prosthetic size was 23 mm. One failed valve had severe patient-prosthesis mismatch. The mean time to failure was 4.5 ± 1.7 years.The Trifecta bioprosthesis has an increased incidence of early structural valve failure, which is significantly higher than that of Perimount, Perimount Magna Ease, or Mitroflow. No patient-related or valve-related cause for the failure could be identified.

Aims Modern imaging techniques provide evermore-detailed anatomical and physiological information for use in computational fluid dynamics to predict the behaviour of physiological phenomena. Computer modelling can help plan suitable interventions. Our group used magnetic resonance imaging and computational fluid dynamics to study the haemodynamic variables in the ascending aorta in patients with bicuspid aortic valve before and after isolated tissue aortic valve replacement. Computer modelling requires turning a physiological model into a mathematical one, solvable by equations that undergo multiple iterations in four dimensions. Creating these models involves several steps with manual inputs, making the process prone to errors and limiting its inter- and intra-operator reproducibility. Despite these challenges, we created computational models for each patient to study ascending aorta blood flow before and after surgery. Methods and results Magnetic resonance imaging provided the anatomical and velocity data required for the blood flow simulation. Patient-specific in- and outflow boundary conditions were used for the computational fluid dynamics analysis. Haemodynamic variables pertaining to blood flow pattern and derived from the magnetic resonance imaging data were calculated. However, we encountered problems in our multi-step methodology, most notably processing the flow data. This meant that other variables requiring computation with computational fluid dynamics could not be calculated. Conclusion Creating a model for computational fluid dynamics analysis is as complex as the physiology under scrutiny. We discuss some of the difficulties associated with creating such models, along with suggestions for improvements in order to yield reliable and beneficial results.

The prevalence of non-vitamin K oral anticoagulant use after cardiac surgery is unknown, particularly in patients with bioprosthetic valves. We sought to define the contemporary use and short-term safety of non-vitamin K oral anticoagulants after cardiac surgery.All patients undergoing bioprosthetic aortic valve replacement, bioprosthetic mitral valve replacement, or isolated coronary artery bypass grafting (2011-2018) were evaluated from a multicenter, regional Society of Thoracic Surgeons database. Patients were stratified by anticoagulant type (non-vitamin K oral anticoagulant vs vitamin K antagonist) and era (early [2011-2014] vs contemporary [2015-2018]).Of 34,188 patients, 18% (6063) were discharged on anticoagulation, of whom 23% were prescribed non-vitamin K oral anticoagulants. Among those receiving anticoagulation, non-vitamin K oral anticoagulant use has significantly increased from 10.3% to 35.4% in contemporary practice (P .01). This trend was observed for each operation type (coronary artery bypass grafting 0.86%/year, bioprosthetic aortic valve replacement: 2.15%/year, bioprosthetic mitral valve replacement: 2.72%/year, all P .01). In patients with postoperative atrial fibrillation receiving anticoagulation, non-vitamin K oral anticoagulant use has increased from 6.3% to 35.4% and 12.3% to 40.3% after bioprosthetic valve replacement and isolated coronary artery bypass grafting, respectively (both P .01). In patients receiving anticoagulation at discharge, adjusted 30-day mortality (odds ratio, 1.94; P = .12) and reoperation (odds ratio, 0.79; P = .34) rates were not associated with anticoagulant choice, whereas non-vitamin K oral anticoagulant use was associated with an adjusted 0.9-day decrease (P .01) in postoperative length of stay.Non-vitamin K oral anticoagulant use after cardiac surgery has dramatically increased since 2011. This trend is consistent regardless of indication for anticoagulation including bioprosthetic valves. Short-term outcomes support their safety in the cardiac surgery setting with shorter postoperative hospital stays. Long-term studies on the efficacy of non-vitamin K oral anticoagulants after cardiac surgery are still necessary.

Blunt chest trauma can lead to severe, life-threatening injury to chest organs, including the aorta, heart, lungs, and major airways. We describe a 64-year-old man who had undergone replacement of his aortic valve and ascending aorta 14 years earlier (at age 50) and suddenly developed severe aortic regurgitation after firing his shotgun while hunting. Such an event has not been reported previously.

Background The choice between a mechanical versus a bioprosthetic valve in aortic valve replacement (AVR) is based on life expectancy, bleeding risk and co-morbidities, since bioprosthetic AVR (bAVR) as compared to mechanical AVR (mAVR), are associated with a more rapid structural deterioration. However, refinements in bioprosthetic valves and the introduction of transcatheter aortic valve replacement (TAVR) (potential for valve-in-valve procedures), will most likely influence valve selection in the future. The impact of widespread transcatheter valve replacements, on the decision to use bAVR versus mAVR, in the contemporary era and subsequent outcomes remain to be determined. Purpose The goal of our study was to assess trends in utilization of bAVR and mAVR in the United States while, assessing in-hospital mortality over time. Methods The National Inpatient database (2009–18) was used to study trends in admissions for bAVR and mAVR and in-hospital mortality over time. Survey estimation commands were used to determine weighted national estimates. Results There were 700,896 inpatient visits for AVR with 70.1% (95% CI 69.2%-71.1%) and 29.9% (95% CI 28.9%-30.8%) visits for bAVR and mAVR, respectively. Those undergoing bAVR were significantly older, [bAVR (69.8 years) vs mAVR (62.7 years) p Conclusions In the contemporary TAVR era, the utilization of mAVR has decreased across all age groups, including those younger than 50 years old. Although mAVR recipients were healthier with significantly less co-morbidities, inpatient mortality was higher after mAVR compared to bAVR. In addition to understanding the causes accounting for the higher mortality after mAVR, future research should focus on developing TAVR friendly bAVR; possibly enhancing our ability to perform percutaneous valve-in-valve procedures in the future. Funding Acknowledgement Type of funding sources: None.

Aim Rapid deployment valves are being used widely. We wanted to compare outcomes for rapid-deployment valves and conventional bioprosthetic aortic valve replacements in order to assess if their use is justifiable. Method Outcomes of the last 120 patients who received a rapid-deployment AVR (RDAVR) between Sept 2014-Sept 2019 were compared to the last 120 patients who had conventional bioprosthetic aortic valve replacement (Conv AVR). Results Age of RDAVR 77.5±4.93 was compared to Conv AVR 67.9±11.9 years (p > 0.05). Other baseline characteristics were similar. RDAVR group included more elderly (>80 years; 40 vs 11, p 0.05). Survival rates in group 1 and 2 were 97.5% vs 99.2% at 1 year, 95.8% vs 96.7% at 2 years. and 95% vs 96.7% at 3 years, respectively. Conclusions RDAVR had similar haemodynamic outcomes and survival. Where shorter cross clamp and pump times may be desirable RDAVR may be preferred in older high-risk patients.

Reoperative aortic root replacement, following prior biologic or mechanical valved conduit aortic root prosthesis, presents a technical challenge. The rapid-deployment aortic valve prosthesis is an approved alternative to traditional bioprosthetic aortic valve replacement. We present three clinical cases in which rapid-deployment aortic valve prostheses were utilized in lieu of reoperative full aortic root replacement. All three patients recovered uneventfully. The rapid-deployment valve insertion in a prior surgical aortic root prosthesis is a safe option to avoid reoperative full aortic root replacement.

A 61-year-old male with severe aortic valve stenosis was scheduled for a minimally invasive bioprosthetic aortic valve replacement. Intraoperative transesophageal echocardiography (TEE) showed a unicuspid aortic valve and extensive aortic atheromatous disease. A large atheroma with mobile components existed near the distal aortic arch. A 17-French aortic cannula was successfully placed using TEE guidance with the tip proximal to the mobile atheroma to avoid inadvertent disruption and subsequent embolic sequelae. The patient had no evidence of perioperative stroke or other complications postoperatively. This case demonstrates one strategy to manage severe atheromatous disease intraoperatively. We also review additional management options.

Background: Studies performed to date reporting outcomes after mechanical or bioprosthetic aortic valve replacement (AVR) have largely neglected the young female population. This study compares long-term outcomes in female patients aged < 50 years undergoing AVR with either a mechanical or bioprosthetic valve. Methods: In this propensity-matched study, we compared outcomes after mechanical AVR (n = 57) and bioprosthetic AVR (n = 57) between 2004 and 2018. The primary outcome of this study is survival. Secondary outcomes include the rate of reoperation, stroke, myocardial infarction, rehospitalization for heart failure, and incidence of serious adverse events. Outcomes were measured over 15 years, with a median follow-up of 7.8 years. Results: In patients receiving a mechanical AVR vs a bioprosthetic AVR, overall survival at median follow-up was equivalent, at 93%. There is a lower rate of reoperation in patients receiving a mechanical AVR vs a bioprosthetic AVR (1.8% vs 8.8%). The rate of new-onset atrial fibrillation was significantly higher in the mechanical AVR group vs the bioprosthetic AVR group (18.2% vs 7.3%). No significant difference was seen in the rate of serious adverse events. Conclusions: These results provide contemporary data demonstrating equivalent long-term survival between mechanical and bioprosthetic AVR, with higher rates of new atrial fibrillation after mechanical AVR, and higher rates of reoperation after bioprosthetic AVR. These results suggest that either valve type is safe, and that preoperative assessment and counselling, as well as the follow-up, medical treatment and indications for intervention, must be a collaborative decision-making process between the clinician and the patient. Résumé: Contexte: Les études réalisées à ce jour portant sur le bilan après un remplacement mécanique ou bioprothétique de la valve aortique (RVA) ont largement négligé la population de jeunes femmes. Cette étude compare le pronostic à long terme chez les patientes âgées de moins de 50 ans qui subissent un RVA par une valve mécanique ou bioprothétique. Méthodes: Dans cette étude d’appariement par score de propension, nous avons comparé les résultats après un RVA mécanique (n = 57) et un RVA bioprothétique (n = 57) entre 2004 et 2018. Le principal critère d’évaluation consiste en l’étude de la survie. Les critères d'évaluation secondaires comprennent le taux de réopération, d'accident vasculaire cérébral, d'infarctus du myocarde, de réhospitalisation pour insuffisance cardiaque et l'incidence des événements indésirables graves. Les critères d’évaluation ont été mesurés sur une période de 15 ans, avec un suivi médian de 7,8 ans. Résultats: Pour les patientes soumises à un RVA mécanique par rapport à un RVA bioprothétique, la survie globale au suivi médiane était équivalente à 93 %. Le taux de réopération est plus faible chez les patientes avec un RVA mécanique que chez celles soumises à un RVA bioprothétique (1,8 % contre 8,8 %). Le taux de fibrillation auriculaire d’apparition récente était significativement plus élevé dans le groupe ayant eu un RVA mécanique que dans le groupe ayant eu un RVA bioprothétique (18,2 % contre 7,3 %). Aucune différence significative n'a été observée concernant le taux d'événements indésirables graves. Conclusions: Ces résultats fournissent des données actualisées démontrant une survie à long terme équivalente entre les RVA mécaniques et bioprothétiques, avec des taux plus élevés de fibrillation auriculaire d’apparition récente après une RVA mécanique, et des taux plus élevés de réopération après une RVA bioprothétique. Ces résultats suggèrent que chaque type de valve est sûr, et que l'évaluation et le counselling préopératoire, ainsi que le suivi, le traitement médical et les indications d'intervention, doivent être un processus de décision concerté entre le clinicien et le patient.

Since the initial TAVR in a degenerated surgical aortic bioprosthesis (ViV TAVR) in 2007, 1 ViV TAVR has grown in prominence in treating degenerative aortic bioprosthetic valves. Coupled with the c...

A 66-year-old woman underwent elective re-do aortic valve replacement, having previously undergone a Mitroflow bioprosthetic aortic valve replacement (Sorin Group USA, Arvada, Colorado), which had become severely stenosed. A 21-mm mechanical Carbomedics supra-annular Top Hat valve (Carbomedics

Background Structural valve deterioration (SVD) with associated bioprosthetic valve dysfunction remains an unsolved problem, exposing patients to the risk of aortic valve re-intervention after surgical aortic valve replacement (SAVR). Several strategies have been proposed to improve prosthesis design for optimal performance. The leaflets of the Trifecta valve are mounted on the outside of the prosthetic stent to achieve a larger orifice area. Although favourable early clinical outcomes have been reported, long-term durability still needs to be assessed. Purpose The aim of the current study was to assess the mid-term overall mortality and re-intervention rate in patients who received a Trifecta valve with a follow-up >5 years. Methods Patients who underwent SAVR at our centre between 2011 and 2012 were identified in the internal, prospective database. All patients with implantation of a Trifecta valve in aortic position were included. Primary endpoints were freedom from overall mortality and from re-operation at latest follow-up (FU). Additionally, assessment of echocardiographic parameters at baseline and follow-up was performed. Results Seventy-six patients (age 77.3±9.5 years, BMI 28.6±5.8, 68% male) were included in the study. EuroScore II was 7.2% (± 7.7) while mean STS-Mortality score was 2.4±1.1%. Of all procedures, 53% were isolated aortic valve replacements, whereas concomitant procedures were performed in 47% of cases (37% CABG, 12% mitral surgery, 8% tricuspid surgery). Baseline echocardiographic assessment showed a mean pressure gradient (MPG) of 51±21 mmHG, a peak pressure gradient (PPG) of 78±36 mmHG and a peak velocity (Vmax) of 4.2±1.1 m/s. Thirty-day mortality was 7%. Freedom from overall mortality at 1 year and 5 years was 84% and 73%, respectively. Freedom from death and freedom from re-operation at latest FU (6.7±0.5 years) was 68% and 90%, respectively. In a composite endpoint analysis, freedom from death or re-intervention at latest follow up was 60%. A total of 7 patients underwent aortic valve re-interventions (re-replacements n=5, valve-in-valve n=2). Indications for re-interventions were SVD (n=5), NSVD (n=1, pannus ingrowth) and endocarditis (n=1). One case of re-stenosis occurred in a patient who was deemed not feasible for aortic valve re-intervention and died. Kaplan Meier analysis Conclusion(s) To our knowledge, this patient cohort presents with the lowest rate of freedom from re-operation (90%, 6.7±0.5 years) after SAVR with the Trifecta valve. A relatively high number of SVD and NSVD has been observed, which might be attributable to the specific leaflet mounting or the deformable valve frame of the first generation. Current results call for further investigation with prospective echocardiographic follow-up in this patient group. Acknowledgement/Funding None

Aortic valve disease is one of the most common valvular heart diseases in the cardiovascular category. Surgical replacement of the diseased aortic valve remains the definitive intervention for most diseases. There is a clear consensus that in young patients who require aortic valve replacement, a mechanical prosthesis is the preferred choice due to its durable prosthesis without fear of wear and tear over time. However, this comes at the expense of increased risk of bleeding and thromboembolic events; in addition, there is a lack of strict evidence in using bioprosthesis in patients younger than 50 years. The objective of this review article is to assess the current evidence behind using bioprosthetic aortic valve in this young cohort.

Introduction We present a case of a patient with prior bioprosthetic aortic valve replacement who underwent Left Ventricular Assist Device (LVAD) explant and was found to have fused valve leaflets at the time of surgery. Case Report The patient is a 30 year old woman with a history of a congenital quadricuspid aortic valve (frequency Summary Patients with prior tissue aortic valve replacement require careful preoperative evaluation before LVAD explant. Though we had a good outcome, pre-procedural knowledge of valve dysfunction is critical in surgical planning. We have developed an algorithm which may be utilized in the future to improve outcomes (Figure 2).

The choice of a bioprosthetic valve (BV) or mechanical valve (MV) in middle-aged adults undergoing aortic valve replacement is a complex decision that must account for numerous prosthesis and patient factors. A systematic review and meta-analysis was performed to compare long-term survival, major adverse prosthesis-related events, anticoagulant-related events, major bleeding, reoperation, and structural valve degeneration in middle-aged patients receiving a BV or MV. A comprehensive search from six electronic databases was performed from their inception to February 2016. Results from patients aged less than 70 years undergoing aortic valve replacement with a BV or MV were included. There were 12 studies involving 8,661 patients. Baseline characteristics were similar. There was no significant difference in long-term survival among patients aged 50 to 70 or 60 to 70 years. Compared with MVs, BVs had significantly fewer long-term anticoagulant-related events (hazard ratio [HR] 0.54, p = 0.006) and bleeding (HR 0.48, p < 0.00001) but significantly greater major adverse prosthesis-related events (HR 1.82, p = 0.02), including reoperation (HR 2.19, p < 0.00001). The present meta-analysis found no significant difference in survival between BVs and MVs in patients aged 50 to 70 or 60 to 70 years. Compared with MVs, BVs have reduced risk of major bleeding and anticoagulant-related events but increased risk of structural valve degeneration and reoperation. However, the mortality consequences of reoperation appear lower than that of major bleeding, and recent advances may further lower the reoperation rate for BV. Therefore, this review supports the current trend of using BVs in patients more than 60 years of age.

Infective endocarditis (IE) in patients with a quadricusp aortic valve (QAV) is a rare occurrence that has only been described nine times in English literature. Similar in rarity, IE by Gemella sanguinis has only been described ten times. It has never been described in a patient with QAV. We describe a case of Gemella sanguinis infective endocarditis of a quadricusp aortic valve in a patient in his 4th decade of life. His QAV was detected on pre-operative transesophageal echocardiogram and confirmed intra-operatively. The patient was managed with bioprosthetic aortic valve replacement and a 6-week course of intravenous antibiotics.

Background: To support decision-making in aortic valve replacement in nonelderly adults, we aim to provide a comprehensive overview of reported outcome after bioprosthetic aortic valve replacement and to translate this to age-specific patient outcome estimates. Methods and Results: A systematic review was conducted for papers reporting clinical outcome after aortic valve replacement with currently available bioprostheses in patients with a mean age Conclusions: Aortic valve replacement with bioprostheses in young adults is associated with high structural valve deterioration and reintervention rates and low, though not absent, hazards of thromboembolism and bleeding. Foremostly, most patients will require one or more reinterventions during their lifetime and survival is impaired in comparison with the age- and sex-matched general population. Prosthesis durability remains the main concern in nonelderly patients.

Objective To support decision-making in aortic valve replacement (AVR) in elderly patients, we provide a comprehensive overview of outcome after AVR with bioprostheses. Methods A systematic review was conducted of studies reporting clinical outcome after AVR with bioprostheses in elderly patients (mean age ≥70 years; minimum age ≥65 years) published between January 1, 2000, to September 1, 2016. Reported event rates and time-to-event data were pooled and entered into a microsimulation model to calculate life expectancy and lifetime event risks. Results Forty-two studies reporting on 34 patient cohorts were included, encompassing a total of 12,842 patients with 55,437 patient-years of follow-up (pooled mean follow-up 5.0 ± 3.3 years). Pooled mean age was 76.5 ± 5.5 years. Pooled early mortality risk was 5.42% (95% confidence interval [CI], 4.49-6.55), thromboembolism rate was 1.83%/year (95% CI, 1.28-3.61), and bleeding rate was 0.75%/year (95% CI, 0.50-1.11). Structural valve deterioration (SVD) was based on pooled time to SVD data (Gompertz; shape: 0.124, rate: 0.003). For a 75-year-old patient, this translated to an estimated life expectancy of 9.8 years (general population: 10.2 years) and lifetime risks of bleeding of 7%, thromboembolism of 17%, and reintervention of 9%. Conclusions The low risks of SVD and reintervention support the use of bioprostheses in elderly patients in need of AVR. The estimated life expectancy after AVR was comparable with the general population. The results of this study inform patients and clinicians about the expected outcomes after bioprosthetic AVR and thereby support treatment decision-making. Furthermore, our results can be used as a benchmark for long-term outcomes after transcatheter aortic valve implantation in patients who were eligible for surgery and other (future) alternative treatments (eg, tissue-engineered heart valves).

ST-Elevation Myocardial Infarction (STEMI) due to septic coronary embolism is a rare complication of fungemia that is associated with high morbidity and mortality compared to atherosclerotic STEMI. A 32-year-old female with a bioprosthetic aortic valve replacement secondary to aortic valve

Subclinical leaflet thrombosis (SLT) has been infrequently reported following bioprosthetic aortic valve replacement. Impact of different type of TVAR valves on SLT has not been well studied. Comprehensive search of PubMed, EMBASE, Google Scholar and Cochrane database were performed for all trials

Purpose of review The purpose of this study is to review the contemporary evidence surrounding aortic bioprosthetic valve deterioration, with a focus on early failure of surgically implanted valves. Recent findings Structural valve deterioration (SVD) remains the most frequent cause of premature bioprosthetic aortic valve failure. However, recent evidence suggests that SVD represents a spectrum, and that clinically silent hemodynamic valve deterioration frequently precedes and predisposes to overt SVD. Hemodynamic valve deterioration is defined as an increase in mean transprosthetic gradient and/or worsening transprosthetic regurgitation on echocardiography. Novel evidence suggests that a dysmetabolic profile may predispose to this phenomenon. Furthermore, subclinical leaflet thrombosis is increasingly recognized as a potential cause of hemodynamic deterioration of bioprosthetic valves. Collectively, these findings highlight the importance of systematic and regular imaging surveillance following bioprosthetic aortic valve replacement. Summary Early failure of bioprosthetic aortic valves is a complex and multifactorial phenomenon. Further studies are needed to determine the optimal timing and imaging modality for surveillance following bioprosthetic aortic valve replacement, and to establish strategies to prevent and treat aortic bioprosthetic failure.

The need for anticoagulation treatment following bioprosthetic aortic valve replacement remains controversial. We investigated the associations of warfarin treatment with the risks of major adverse cardiac and cerebrovascular events, including mortality, bleeding incidents, and reoperation requirement after bioprosthetic aortic valve replacement surgery.We identified 1086 patients who received first bioprosthetic aortic valve replacement between 2001 and 2010 using Taiwan's National Health Insurance Database. Patients were excluded for prior use of warfarin, warfarin use for3 months, dual valve procedures, prior valve surgeries, or concomitant surgeries. Enrolled patients were divided into 2 groups according to whether they were warfarin-naïve or received warfarin for3 months postsurgery. After propensity score matching, 282 patients not receiving warfarin were matched to 282 patients receiving warfarin for3 months. Patients were followed-up for minimum 36 months.Patients receiving warfarin were younger and showed less frequent kidney disease than those who did not use warfarin. The warfarin group demonstrated a gross decrease in major adverse cardiac and cerebrovascular events. Patients receiving warfarin for30 days were at an even lower risk for major adverse cardiac and cerebrovascular events than those treated for ≥30 days. No significant difference in bleeding or reoperation risk was observed between warfarin users and warfarin nonusers. Similar findings remained after propensity-score matching but the benefit of short-term warfarin use diminished in a younger population.Short-term use of postoperative warfarin (especially30 days) following bioprosthetic aortic valve replacement may be associated with a reduction in MACCE compared with nonuse.

Thrombocytopenia observed after bioprosthetic aortic valve replacement has remained a puzzle to solve.To analyze thrombocytopenia occurring after bioprosthetic aortic valve replacement by comparison to mechanical aortic valve replacement and coronary artery bypass grafting procedures.The study was conducted retrospectively on a total of 297 patients who underwent bioprosthetic aortic valve replacement, mechanical prosthetic aortic valve replacement and coronary artery bypass grafting at the cardiovascular surgery department of our clinical center between January 2013 and September 2017. Preoperative and postoperative first 14-day thrombocyte levels of the patients were analyzed.The postoperative blood thrombocyte level decrease was found to be more significant in patients who underwent bioprosthetic aortic valve replacement than in patients who underwent mechanical aortic valve replacement and coronary artery bypass grafting (When compared to the patients who underwent coronary artery bypass grafting and mechanical prosthetic aortic valve replacement, postoperative thrombocytopenia was found to be more severe in patients who underwent bioprosthetic aortic valve replacement, with a dramatic decrease in thrombocyte count being observed on the postoperative second day. It was found that the thrombocytopenia recovers without causing any problem. We think that the shear forces may play a role in this recovery through washout of chemicals responsible for thrombocytopenia from the glutaraldehyde treated bioprostheses.Trombocytopenia stwierdzana po wymianie bioprotezy zastawki aortalnej pozostaje zagadką, która wymaga rozwiązania.Analiza trombocytopenii występującej po wymianie bioprotezy zastawki aortalnej w porównaniu z trombocytopenią po wymianie mechanicznej zastawki aortalnej i pomostowaniu aortalno-wieńcowym.Retrospektywnym badaniem objęto łącznie 297 pacjentów, u których przeprowadzono wymianę bioprotezy zastawki aortalnej, wymianę mechanicznej zastawki aortalnej i pomostowanie aortalno-wieńcowe na oddziale kardiochirurgii w ośrodku autorów od stycznia 2013 do września 2017 r. Analizowano poziom płytek krwi przed operacją i w ciągu pierwszych 14 dni po zabiegu.Stwierdzono większe pooperacyjne zmniejszenie poziomu płytek krwi u pacjentów po wymianie bioprotezy zastawki aortalnej niż u pacjentów po wymianie mechanicznej zastawki aortalnej i po pomostowaniu aortalno-wieńcowym (W porównaniu z pacjentami, u których przeprowadzono pomostowanie aortalno-wieńcowe i wymianę mechanicznej zastawki aortalnej, poważniejszą pooperacyjną małopłytkowość stwierdzono u pacjentów, którzy przeszli wymianę bioprotezy zastawki aortalnej, przy czym gwałtowne zmniejszenie liczby płytek krwi zaobserwowano w drugim dniu po operacji. Trombocytopenia ustępuje, nie powodując żadnych problemów. Naszym zdaniem w tym przypadku ważną rolę odgrywają siły ścinające poprzez eliminację lub wymywanie substancji chemicznych odpowiadających za trombocytopenię spowodowaną przez bioprotezy poddane działaniu aldehydu glutarowego.

Aortic prosthesis choice is controversial in young adults because robust comparative outcome data are lacking. We therefore compared mortality and morbidity in young adults after bioprosthetic versus mechanical aortic valve replacement.This was a retrospective analysis of 5111 patients aged 18 to 50 years undergoing primary aortic valve replacement in California and New York State from 1997 to 2006. Median follow-up time was 11.8 years (maximum 18.9 years). The primary endpoint was mortality; secondary endpoints were stroke, bleeding, and reoperation. Propensity score matching yielded 1175 patient pairs.Bioprosthetic valves increased from 14% to 47% of aortic valve replacements between 1997 and 2014 (P .001). There was no survival difference with bioprosthetic versus mechanical aortic valves in the propensity score-matched cohort: actuarial 15-year survival was 79.0% (95% confidence interval [CI], 75.8%-81.8%) versus 81.5% (95% CI, 78.5%-84.2%) respectively (hazard ratio [HR], 1.14; 95% CI, 0.93-1.40, P = .20). No interaction was found between age and prosthesis choice on survival (PAlthough lifetime risks are represented incompletely, these findings suggest that in adults aged 18-50 years, bioprostheses are a reasonable alternative to mechanical valves for aortic valve replacement.

BACKGROUND. The optimal antithrombotic regimen after bioprosthetic aortic valve replacement (bAVR) is unclear. We conducted a systematic review of various anti-coagulation strategies following surgical or transcatheter bAVR (TAVR). METHODS. We searched Medline, PubMed, Embase, Evidence-Based Medicine Reviews, and gray literature through June 2017 for controlled clinical trials and cohort studies that directly compared different antithrombotic strategies in nonpregnant adults who had undergone bAVR. We assessed risk of bias and graded the strength of the evidence using established methods. RESULTS. Of 4,554 titles reviewed, 6 clinical trials and 13 cohort studies met inclusion criteria. We found moderate-strength evidence that mortality, thromboembolic events, and bleeding rates are similar between aspirin and warfarin after surgical bAVR. Observational data suggest lower mortality and thromboembolic events with aspirin combined with warfarin compared with aspirin alone after surgical bAVR, but the effect size is small and the combination is associated with a substantial increase in bleeding risk. We found insufficient evidence for all other treatment comparisons in surgical bAVR. In TAVR patients, we found moderate-strength evidence that mortality, stroke, and major cardiac events are similar between dual antiplatelet therapy and aspirin alone, though a nonsignificantly lower rate of bleeding occurred with aspirin alone. CONCLUSIONS. Treatment with warfarin or aspirin leads to similar outcomes after surgical bAVR. Combining aspirin with warfarin may lead to a small decrease in thromboembolism and mortality, but is accompanied by increased bleeding. For TAVR patients, aspirin is equivalent to dual antiplatelet therapy for reducing thromboembolism and mortality, with a possible decrease in bleeding.