1,721,141 research outputs found

    Enlargement of the aortic annulus during aortic valve replacement: a review

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    The main goal of aortic valve replacement (AVR) is to obtain relief from the fixed left ventricular (LV) obstruction by replacing the aortic valve with a prosthesis, either mechanical or biological, of adequate size. Most currently available prostheses provide satisfactory hemodynamic performance, but small-sized prostheses may be associated with high transvalvular gradients and suboptimal effective orifice area that result in prosthesis-patient mismatch (PPM), and thus are far from ideal for use in young, active patients. The avoidance of PPM is advisable as it has been repeatedly associated with increased mortality, decreased exercise tolerance and an impaired regression of LV hypertrophy after AVR for severe aortic stenosis. Enlargement of the aortic annulus (EAA) has proved to be a valuable method to prevent PPM in the presence of a diminutive aortic root. This review outlines the various techniques described for EAA, presenting technical details, long-term results and major procedure-related complications, and discussing the current role of EAA in patients requiring AVR

    The Stented Porcine Bioprosthesis: A 50-Year Journey Through Hopes and Realities

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    The year 2018 marked the 50th anniversary of the first implant of a commercially manufactured stented porcine bioprosthesis. During the subsequent years considerable clinical and pathologic research was done to evaluate the overall performance of such devices and to identify the leading causes of failure. This brief review covers 5 decades, summarizing the initial hopes and the realities faced by surgeons who have believed from the start in these cardiac valve substitutes. From reported failures and long-term results a new generation of durable and reliable stented porcine bioprosthetic valves is currently available
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