Aortic Valve

Early and Late Outcomes Following Valve Sparing Aortic Root Reconstruction: The ANZSCTS Database

by

Dhurandhar V, Parikh R, Saxena A, Vallely MP, Wilson MK, Black DA, Tran L, Reid C, Bannon PG

Heart Lung Circ 2016 May;25(5):505-11

PMID: 26795638

Abstract

BACKGROUND: Valve sparing aortic root reconstruction (VSARR) has become an alternative to traditional aortic root replacement with a valved conduit. There have been various modifications but the two broad types are aortic root reimplantation and the aortic root remodelling procedure. We present the early and late outcomes following valve sparing aortic root reconstruction surgery in Australia.

METHODS: We reviewed the ANZSCTS database for patients undergoing these procedures. Preoperative, intraoperative and postoperative variables were analysed. Multivariable regression was performed to determine independent predictors of 30-day mortality. We also obtained five- and 10-year survival estimates by cross-linking the ANZSCTS database with the Australian Institute of Health and Welfare’s National Death Index.

RESULTS: Between January 2001 and January 2012, 169 consecutive patients underwent VSARR procedures. The mean age of the study population was 54.4 years with 31.4% being females. Overall, nine patients (5.9%) died within 30 days post procedure and five patients (3%) had permanent strokes. However, out of 132 elective cases, only five patients died (3.8%). Independent predictors of 30-day mortality were female gender [OR 5.65(1.24-25.80), p=0.025], preoperative atrial arrhythmia [OR 6.07(1.14-32.35), p=0.035] and acute type A aortic dissection [OR 7.71(1.63-36.54), p=0.01]. Long-term survival was estimated as 85.3% and 72.7% at five- and 10-years, respectively.

CONCLUSIONS: Along with an acceptable rate of early mortality and stroke, VSARR procedures provide good long-term survival according to the ANZSCTS database. As promising procedure for pathologies that impair the aortic root integrity, they can be adopted more widely, especially in Australian and New Zealand centres with experienced aortic units. Future studies are planned to assess freedom from valve deterioration and repeat surgery.

Mechanical Versus Bioprosthetic Aortic Valve Replacement in Middle-Aged Adults: A Systematic Review and Meta-Analysis

by

Zhao DF, Seco M, Wu JJ, Edelman JB, Wilson MK, Vallely MP, Byrom MJ, Bannon PG

Ann. Thorac. Surg. 2016 Jan;

PMID: 26794881

Abstract

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.

Nonsyndromic Thoracic Aortic Aneurysm and Dissection: Outcomes With Marfan Syndrome Versus Bicuspid Aortic Valve Aneurysm

by

Sherrah AG, Andvik S, van der Linde D, Davies L, Bannon PG, Padang R, Vallely MP, Wilson MK, Keech AC, Jeremy RW

J. Am. Coll. Cardiol. 2016 Feb;67(6):618-26

PMID: 26868685

Abstract

BACKGROUND: Genetic aortopathy (GA) underlies thoracic aortic aneurysms (TAA) in younger adults. Comparative survival and predictors of outcomes in nonsyndromic TAA (NS-TAA) are incompletely defined compared to Marfan syndrome (MFS) and bicuspid aortic valve (BAV).

OBJECTIVES: The study sought to compare survival and clinical outcomes for individuals with NS-TAA, MFS, and BAV.

METHODS: From 1988 to 2014, all patients presenting with GA 16 to 60 years of age were enrolled in a prospective study of clinical outcomes. Risk factors for death and aortic dissection were identified by Cox proportional hazards modeling and a mortality risk score developed.

RESULTS: Diagnosis of GA was made for 760 patients (age 36.9 ± 13.6 years, 26.8% female; NS-TAA, n = 311; MFS, n = 221; BAV, n = 228). MFS patients were younger than NS-TAA and BAV. Presentation with aortic dissection was more common for NS-TAA than MFS or BAV. The 687 patients surviving >30 days after presentation were followed for a median of 7 years. Calculated 10-year mortality was 7.8% for NS-TAA, 8.7% for MFS, and 3.5% for BAV (NS-TAA and MFS vs. BAV p <0.05). Factors associated with all-cause mortality were MFS (p = 0.04), age at presentation, and family history of dissection.

CONCLUSIONS: Clinical outcomes for MFS and NS-TAA are similar but worse than BAV. Independent predictors of mortality, including family history of aortic dissection and age, can be included in an Aortopathy Mortality Risk Score to predict survival. Management of NS-TAA, including surgical intervention, should be similar to that of MFS.

Long Term Outcomes Following Freestyle Stentless Aortic Bioprosthesis Implantation: An Australian Experience

by

Sherrah AG, Jeremy RW, Puranik R, Bannon PG, Hendel PN, Bayfield MS, Wilson MK, Brady PW, Marshman D, Mathur MN, Brereton RJ, Edwards JR, Stuklis RG, Worthington M, Vallely MP

Heart Lung Circ 2015 Jun;

PMID: 26146198

Abstract

BACKGROUND: The Freestyle stentless bioprosthesis (FSB) has been demonstrated to be a durable prosthesis in the aortic position. We present data following Freestyle implantation for up to 10 years post-operatively and compare this with previously published results.

METHODS: A retrospective cohort analysis of 237 patients following FSB implantation occurred at five Australian hospitals. Follow-up data included clinical and echocardiographic outcomes.

RESULTS: The cohort was 81.4% male with age 63.2±13.0 years and was followed for a mean of 2.4±2.3 years (range 0-10.9 years, total 569 patient-years). The FSB was implanted as a full aortic root replacement in 87.8% patients. The 30-day all cause mortality was 4.2% (2.0% for elective surgery). Cumulative survival at one, five and 10 years was 91.7±1.9%, 82.8±3.8% and 56.5±10.5%, respectively. Freedom from re-intervention at one, five and 10 years was 99.5±0.5%, 91.6±3.7% and 72.3±10.5%, respectively. At latest echocardiographic review (mean 2.3±2.1 years post-operatively), 92.6% had trivial or no aortic regurgitation. Predictors of post-operative mortality included active endocarditis, acute aortic dissection and peripheral vascular disease.

CONCLUSIONS: We report acceptable short and long term outcomes following FSB implantation in a cohort of comparatively younger patients with thoracic aortic disease. The durability of this bioprosthesis in the younger population remains to be confirmed.

Comparative transcriptome profiling in human bicuspid aortic valve disease using RNA-sequencing

by

Padang R, Bagnall RD, Tsoutsman T, Bannon PG, Semsarian C

Physiol. Genomics 2014 Dec;:physiolgenomics.00115.2014

PMID: 25547111

Abstract

Intrinsic valvular degeneration and dysfunction is the most common complication of bicuspid aortic valve (BAV) disease. Phenotypically, it ranges from calcific aortic stenosis to redundant or prolapsing regurgitant leaflets. The underlying molecular mechanism underpinning phenotype heterogeneity of valvular degeneration in BAV is poorly understood. We used RNA-sequencing to identify genes and pathways responsible for valvular degeneration in BAV, compared to tricuspid aortic valve (TAV). Comparative transcriptome analysis on total RNA of aortic valve tissues of patients with diseased BAV (n=5) and calcified TAV (n=3). A total of 59 and 177 genes were significantly up- and downregulated, respectively, in BAV compared to TAV. Hierarchical clustering indicated heterogeneity within the BAV group, separating those with heavy calcification (BAVc) from those with redundant leaflets and/or minimal calcification (BAVr). Interestingly, the gene expression profile of the BAVc group closely resembled the TAV, with shared up- and downregulation of inflammatory and NOTCH1 signaling pathways, respectively. Downregulation of matrix protease ADAMTS9 and protein aggrecan were observed in BAVr compared to TAV. Dysregulation of fetal gene programs were also present, with notable downregulation of SEMA6B and SEMA3F in BAVr and BAVc compared to TAV, respectively. Upregulation of TBX20 was observed exclusively in BAVr compared to BAVc. In conclusion, diverging molecular mechanisms underpin phenotype heterogeneity of valvular degeneration in BAV and data from the present study suggest that there may be shared mechanisms leading to calcification in BAV and TAV. Recognition of these pathways is fundamental to improve our understanding of the molecular basis of human BAV disease.

Position Statement for the Operator and Institutional Requirements for a Transcatheter Aortic Valve Implantation (TAVI) Program

by

Walters DL, Webster M, Pasupati S, Walton A, Muller D, Stewart J, Williams M, MacIsaac A, Scalia G, Wilson M, Gamel AE, Clarke A, Bennetts J, Bannon P

Heart Lung Circ 2014 Oct;

PMID: 25488705

Abstract

The Cardiac Society of Australia and New Zealand (CSANZ) and the Australia and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) have joined together to provide recommendations for institutions and individual operators to assess their ability to initiate and maintain a transcatheter valve program. Transcatheter aortic valve replacement has been developed as an alternative to traditional surgical replacement of the aortic valve in high risk patients, particularly the frail elderly. The position paper has endorsed the important role of a multi-disciplinary “Heart Team” in selecting patients for TAVI as fundamental to the establishment of a successful program. The paper outlines recommendations for the cardiologist to have a background in structural intervention and the surgeon to have experience in high-risk aortic valve replacement. It is further recommended that TAVI programs be established in high volume cardiac surgical centres where on site valve surgery is performed. The paper is intended to provide guidance to individual operators and prospective institutions considering the establishment of a successful TAVI program.

Replacement of the aortic root with a composite valve-graft conduit: risk factor analysis in 246 consecutive patients

by

Woldendorp K, Starra E, Seco M, Hendel PN, Jeremy RW, Wilson MK, Vallely MP, Bannon PG

Heart Lung Circ 2014 Dec;23(12):1187-93

PMID: 25038031

Abstract

BACKGROUND: Composite valve-graft (CVG) replacement of the aortic root is a well-studied and recognised treatment for various aortic root conditions, including valvular disease with associated aortopathy. There have been few previous studies of the procedure in large numbers in an Australian setting.

METHOD: From January 2006 to June 2013, 246 successive patients underwent CVG root replacements at our institution. Mean age was 56.8 years, 85.4% were male, and 87 had evidence of bicuspid aortic valve. Indications for operation included ascending aortic aneurysm in 222 patients, annuloaortic ectasia in 67 patients, and aortic dissection in 38 patients.

RESULTS: The overall unit 30-day mortality was 5.7%, including: elective 30-day mortality of 2.2%, and emergent 30-day mortality of 17.2%. Statistically significant multivariate predictors of 30-day mortality were: acute aortic dissection (OR=20.07), peripheral vascular disease (OR=11.17), new ventricular tachycardia (OR=30.17), re-operation for bleeding (OR=14.42), concomitant mitral stenosis (OR=68.30), and cerebrovascular accident (OR=144.85).

CONCLUSIONS: Low postoperative mortality in our series matches closely with results from similar sized international studies, demonstrating that this procedure can be performed with low risk in centres with sufficient experience in the operative procedure.

Our Mission

Our mission is to foster research and apply science to improve the outcomes for patients facing heart or lung surgery.

Donate by Phone

+61 2 9550 2350

Donate Now
Subscribe to Our Newsletter

Share with friends

About Us

Resources

You Can Help

The Baird Institute is a Registered Australian Charity

The Baird Institute is registered as a charity with the Australian Charities and Not-for-profits Commission (ACNC).
Eligible tax-deductible donations have Deductible Gift Recipient (DGR) status with the Australian Tax Office.

All content © 2024 The Baird Institute. All rights reserved. ABN 38 096 746 806.

Site by Weber Design Studio

The Baird Institute

Royal Prince Alfred Hospital
Cardiothoracic Department, Level 7,
50 Missenden Road, Camperdown, NSW, 2050

Stay in the loop

Subscribe to our Heart to Heart Newsletter to keep up with the latest developments in heart and lung research from The Baird Institute.

Honour a Loved One

  • Fundraise in memory of someone special to you.

Challenge Yourself

  • Run a marathon
  • Do a long bike ride
  • Walk 10km each day for a month
  • Do 50 sit ups every day for a week
  • Join an organised event such as the City to Surf

Organise a community event

  • Have a backyard sausage sizzle
  • Host a trivia night

Seek sponsorship to help you quit those bad habits

  • Give up smoking
  • Refrain from alcohol for a month or more

Celebrate Through Giving

  • Choose to give on your birthday: Instead of giving you gifts, ask your friends and family to donate to The Baird Institute.
  • Say “I do” to improving the lives of heart and lung patients: Invite guests to donate to The Baird Institute on your wedding day
  • Turn anniversaries or personal milestones into fundraising events.

Create a CrowdRaiser on GiveNow

  1. Go to CrowdRaiser for The Baird Institute.
  2. Click on the button “Fundraise for this cause” – just under the header image.
  3. Create your Crowdraiser. Fill in the requested details.
  4. Customise your campaign. Add images and messages to make your CrowdRaiser unique.
  5. Share the link to your fundraising page via email, social media, or any way you like.
  6. Let us know via [email protected] that you have created a fundraiser so we can say thank you.

Join a community passionate about making a difference. GiveNow provides a dedicated platform for Australian charities, ensuring your efforts directly support our mission.

Start a Facebook Fundraiser

  1. Go to Facebook fundraisers.
  2. Click on the blue button – “Select nonprofit”
  3. Search for and select The Baird Institute
  4. Set your fundraising target
  5. Choose your campaign end date & a title for your Fundraiser
  6. Personalise your fundraiser: Use the existing wording and photos or choose your own.
  7. Click on ‘Create’.
  8. Invite friends and family. Share the link for your fundraiser and encourage others to contribute.
  9. Let us know via [email protected] that you have created a fundraiser so we can say thank you.

Celebrate where your friends and family connect. Leverage your social network to make a real impact.