Heart Valve - Heart Valve - 375 · heart-valve

Dr. Park, Duk-woo is a cardiologist who practices in Seoul, South Korea. He earned his MBBS from Kung Hee University and his MD in cardiology from Ulsan University. Later, he completed a cardiology super specialization at the University of Ulsan. In this video Dr. Park discusses Racial Differences in the Incidence and Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement.

Link to Abstract-
https://www.jacc.org/doi/10.1016/j.jcin.2021.08.038

Abstract
The goal of this study was to assess the incidence and prognostic relevance of prosthesis-patient mismatch (PPM) following TAVR by racial groupings.
Because Asian persons have smaller annulus and valve diameters than Western ones, background PPM after TAVR may be of more concern.

Methods

From January 2015 through November 2019, the TP-TAVR (Transpacific TAVR Registry) was an international multicenter cohort study of patients with severe aortic stenosis who underwent TAVR in the United States and South Korea. At the indexed effective orifice area, PPM was classified as moderate (0.65-0.85 cm2/m2) or severe (0.655 cm2/m2). At one year, the primary outcome was a combination of mortality, stroke, or rehospitalization.

Results

The incidence of PPM was substantially lower in the Asian population (33.6 percent; moderate, 26.5 percent; severe, 7.1 percent) than in the non-Asian population among 1,101 eligible patients (533 Asian and 569 non-Asian) (54.5 percent ; moderate, 29.8 percent ; severe, 24.7 percent ). PPM and non-PPM patients had similar 1-year rates of the primary outcome (27.5 percent vs 28.1 percent; P = 0.69); this pattern was constant for Asian (25.4 percent vs 25.2 percent; P = 0.31) and non-Asian (28.7 percent vs 32.1 percent; P = 0.97) individuals. In the overall population (HR: 0.95; 95 percent CI: 0.74-1.21), Asian patients (HR: 1.07; 95 percent CI: 0.74-1.55), and non-Asian patients (HR: 1.07; 95 percent CI: 0.74-1.55), the risk for the primary outcome did not differ significantly between the PPM and non-PPM groups after multivariable adjustment (HR: 0.86; 95 percent CI: 0.63-1.19).

Conclusions

The incidence of PPM was considerably lower in Asian patients than in non-Asian individuals in this study of patients with severe aortic stenosis who underwent TAVR. Regardless of racial group, the 1-year risk for the major composite outcome was similar in the PPM and non-PPM groups. (NCT03826264; Transpacific TAVR Registry [TP-TAVR])

Dr. Park, Duk-woo is a cardiologist who practices in Seoul, South Korea. He earned his MBBS from Kung Hee University and his MD in cardiology from Ulsan University. Later, he completed a cardiology super specialization at the University of Ulsan. In this video Dr. Park discusses Racial Differences in the Incidence and Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement.

Link to Abstract-
https://www.jacc.org/doi/10.1016/j.jcin.2021.08.038

Abstract
The goal of this study was to assess the incidence and prognostic relevance of prosthesis-patient mismatch (PPM) following TAVR by racial groupings.
Because Asian persons have smaller annulus and valve diameters than Western ones, background PPM after TAVR may be of more concern.

Methods

From January 2015 through November 2019, the TP-TAVR (Transpacific TAVR Registry) was an international multicenter cohort study of patients with severe aortic stenosis who underwent TAVR in the United States and South Korea. At the indexed effective orifice area, PPM was classified as moderate (0.65-0.85 cm2/m2) or severe (0.655 cm2/m2). At one year, the primary outcome was a combination of mortality, stroke, or rehospitalization.

Results

The incidence of PPM was substantially lower in the Asian population (33.6 percent; moderate, 26.5 percent; severe, 7.1 percent) than in the non-Asian population among 1,101 eligible patients (533 Asian and 569 non-Asian) (54.5 percent ; moderate, 29.8 percent ; severe, 24.7 percent ). PPM and non-PPM patients had similar 1-year rates of the primary outcome (27.5 percent vs 28.1 percent; P = 0.69); this pattern was constant for Asian (25.4 percent vs 25.2 percent; P = 0.31) and non-Asian (28.7 percent vs 32.1 percent; P = 0.97) individuals. In the overall population (HR: 0.95; 95 percent CI: 0.74-1.21), Asian patients (HR: 1.07; 95 percent CI: 0.74-1.55), and non-Asian patients (HR: 1.07; 95 percent CI: 0.74-1.55), the risk for the primary outcome did not differ significantly between the PPM and non-PPM groups after multivariable adjustment (HR: 0.86; 95 percent CI: 0.63-1.19).

Conclusions

The incidence of PPM was considerably lower in Asian patients than in non-Asian individuals in this study of patients with severe aortic stenosis who underwent TAVR. Regardless of racial group, the 1-year risk for the major composite outcome was similar in the PPM and non-PPM groups. (NCT03826264; Transpacific TAVR Registry [TP-TAVR])

Bart Meuris, prof. dr. from the University Hospitals Leuven Presentation on the HVS 2021 Abstract In-vivo Evaluation Of A Novel Surgical Heart Valve Prosthesis Designed To Be Durable, Anticoagulant-free And Silent.


Link to Abstract:
https://heartvalvesociety.org/meeting/abstracts/2021/A2.cgi


PURPOSE: 

Reoperations of tissue valves or permanent anticoagulation of artificial valves are also drawbacks for heart valve prostheses. The Triflo valve, a tri-leaflet valve made of bio-inert materials with high resistance, was designed to overcome these limitations. In a chronic sheep model, we looked at protection and efficiency.
TECHNIQUES: The Triflo valve (size 21mm) was inserted in two models: in the aortic position for 90 days (n=7) and in the pulmonary position for 70 days (n=4). On-X valves (n=2) were used as a monitor in the pulmonary model. There was no more anticoagulant given after 7 days of low-molecular-weight heparin. Blood tests, echocardiography, acoustic measurements, fluoroscopy, and an autopsy were all performed.


END RESULTS:

The Triflo valve performed admirably during surgery. In the aortic analysis, there was one aborted surgery and one early death, all unrelated to the prosthesis. All of the other sheep (n=9) recovered well and continued in good clinical condition until they were slaughtered. We found low peak and mean gradients (8.1+/-2.7 and 4.8+/-1.9 mmHg, respectively), a large effective orifice area (2.3+/-0.2 cm2), no valvular regurgitation, and complete left ventricular activity in the aortic role. Both Triflo valves had a smooth surface at explantation, with no valve thrombosis. Thrombo-embolic (TE) damage was not found in any of the main organs. Both valve leaflet mobility was natural in the pulmonary role, and no TE-damage was observed in the lungs. Hematological parameters were stable, and no signs of hemolysis were present. In the pulmonary location, On-X valves performed well, but they produced slightly quieter acoustic signals (p0.05).

RECOMMENDATIONS:

In both the aortic and pulmonary positions, the Triflo valve proved to be safe and reliable. These promising in-vivo effects, which include excellent hemodynamic activity and long-term operation even without anticoagulants, show that this valve is ready for human trials.