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2 . 2021

First clinical experience of the implantation of the new generation xenopericardial semi-framed bioprothesis TiAra

Abstract

Background. Aortic valve replacement is still the procedure of choice for the correction of aortic valve diseases in patients with low and intermediate surgical risk. In the older age group, bioprostheses are using non-alternatively. This article describes the first experience of implantation the new generation of xenoperiocardial semi-framed bioprosthesis of the aortic valve TiAra in older patients.

Aim of the study - to summarize the first single-center experience of the clinical use of semiframed bioprostheses TiAra.

Material and methods. The study involved 22 patients: 14 women, 8 men; average age was 68 (65; 69) years. All had NYHA III. In all cases, calcified stenosis of the aortic orifice with an average gradient of 49 (40; 52) mm Hg was diagnosed. The implanted valves diameters were 23 mm in 11 cases, in 9 - 21 mm, in 2 patients - 25 mm.

Results. The average aortic cross-clamping time was 80 (72; 87) minute. No in-hospital mortality, prolonged intubation and inotropes or major adverse cardiac and cerebrovascular events (MACCE) were noticed. Mean transprosthetic gradient was 12 (7; 14) mm Hg.

Conclusion. The initial experience of the bioprosthetic TiAra implantation showed the technical simplicity and feasibility of its implantation and high hemodynamic efficiency in the early period after surgery, even in a narrow aortic root.

Keywords:aortic valve, prosthetics, bioprosthesis, results, TiAra

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Evtushenko A.V., Stasev A.N., Kokorin S.G., Sotnikov A.V., Dvadtsatov I.V., Barbarash L.S. First clinical experience of the implantation of the new generation xenopericardial semi-framed bioprothesis TiAra. Clinical and Experimental Surgery. Petrovsky Journal. 2021; 9 (2): 14-20. DOI: https://doi.org/10.33029/2308-1198-2021-9-2-14-20 (in Russian) 

References 

1.    Bockeria L.A., Milievskaya E.B., Kudzoeva Z.F., Pryanishnikov V.V. Cardiovascular Surgery-2017. Diseases and congenital anomalies of the circulatory system. Moscow: NMITsSSH im. A.N. Bakuleva MZ RF, 2018: 252 p. (in Russian)

2.    Yacoub M.H., Takkenberg J.J. Will heart valve tissue engineering change the world? Nat Clin Pract Cardiovasc Med. 2005; 2: 60-1. DOI: https://doi.org/10.1038/ncpcardio0112

3.    Sazonenkov M.A, Ismatov H.H, Popovichev S.V., Prisyazhnyuk E.I., Selyukova E.I., Grechishkina Yu.K., Kovalenko I.B., Kulikovskij V.F.. Comparative assessment of immediate outocmes of aortic valve replacement with CE Perimount, Aspire, Hancock-2, UniLine. Complex Issues of Cardiovascular Diseases. 2020; 9 (1): 34-41. DOI: https://doi.org/10.17802/2306-1278-2020-9-1-34-41 (in Russian)

4.    Goldstone A.B., Chiu P., Baiocchi M., Lingala B., Patrick W.L., Fischbein M.P., et al. Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement. New England Journal of Medicine. 2017; 377(19): 1847 -57. DOI: https://doi.org/10.1056/NEJMoa1613792

5.    David T.E., Ivanov J., Armstrong S., Feindel C.M., Cohen G. Late results of heart valve replacement with the Hancock II bioprosthesis. J Thorac Cardiovasc Surg. 2001; 121: 268-77. DOI: https://doi.org/10.1067/mtc.2001.112208

6.    Dellgren G., David T.E., Raanani E., Armstrong S., Ivanov J., Rakowski H. Late hemodynamic and clinical outcomes of aortic valve replacement with the Carpenti-er-Edwards Perimount pericardial bioprosthesis. J Thorac Cardiovasc Surg. 2002; 124: 146-54. DOI: https://doi.org/10.1067/mtc.2002.121672

7.    Pibarot P., Dumesnil J.G. Prosthesis-patient mismatch: definition, clinical impact, and prevention. Heart. 2006; 92: 1022-9. DOI: https://doi.org/10.1136/hrt.2005.067363

8.    Kulik A., Al-Saigh M., Chan V., et al. Enlargement of the small aortic root during aortic valve replacement: is there a benefit? Ann Thorac Surg. 2008; 85: 94-100. DOI: https://doi.org/10.1016/j.athoracsur.2007.07.058

9.    Botzenhardt F., Eichinger W.B., Bleiziffer S., et al. Hemodynamic comparison of bioprostheses for complete supraannular position in patients with small aortic annulus. J Am Coll Cardiol. 2005; 45: 2054-60. DOI: https://doi.org/10.1016/j.jacc.2005.03.039

10.    Lim E., Ali A., Theodorou P, et al. Longitudinal study of the profile and predictors of left ventricular mass regression after stentless aortic valve replacement. Ann Thorac Surg. 2008; 85: 2026-9. DOI: https://doi.org/10.1016/j.athoracsur.2008.02.023

11.    Palka P., Harrocks S., Lange A., Burstow D.J., O’Brien M.F. Primary aortic valve replacement with cryo-preserved aortic allograft: an echocardiographic followup study of 570 patients. Circulation. 2002; 105: 61-6. DOI: https://doi.org/10.1161/hc0102.101357

12.    Baur L.H., Houdas Y., Peels K.H., et al. Stentless bioprostheses have ideal haemodynamics, even in the small aortic root. Int J Cardiovasc Imaging. 2000; 16: 35964. DOI: https://doi.org/10.1023/A:1026521211249

13.    El-Hamamsy I., Clark L., Stevens L.M., Sarang Z., Melina G., Takkenberg J.J., et al. Late outcomes following freestyle versus homograft aortic root replacement results from a prospective randomized trial. J Am Coll Cardiol. 2010; 55: 368-76. DOI: https://doi.org/10.1016/jjacc.2009.09.030

14.    El-Hamamsy I., Zaki M., Stevens L.M., et al. Rate of progression and functional significance of aortic root calcification after homograft versus Freestyle aortic root replacement. Circulation. 2009; 120 (suppl): 269-75. DOI: https://doi.org/10.1161/CIRCULATIONAHA.108.843748

15.    Ennker J., Rosendahl U., Albert A., Dumlu E., Ennker I.C., Florath I. Stentless bioprostheses in small aortic roots: impact of patient-prosthesis mismatch on survival and quality of life. J Heart Valve Dis. 2005; 14: 523-30. PMID: 16116880

16.    Vilela Batista R.J., Dobrianskij A., Comazzi M. Jr, Lessa Neto L.T., Rocha G., Sartori F., et al. Clinical experience with stentless pericardial aortic monopatch for aortic valve replacement. J Thorac Cardiovasc Surg. 1987; 93 (1): 19-26. PMID: 3796028.

17.    Ozaki S., Kawase I., Yamashita H., Uchida S., Nozawa Y., Takatoh M., et al. A total of 404 cases of aortic valve reconstruction with glutaraldehyde-treat-ed autologous pericardium. J Thorac Cardiovasc Surg. 2014; 147 (1): 301-6. DOI: https://doi.org/10.1016/jjtcvs.2012.11.012

18.    Becerra V., Labbe J., Cataldo A., Becerra E. Longterm survival with a stentless free-hand Batista pericardial aortic valve prosthesis: a case report. Int J Surg Case Rep. 2015; 6C: 46-7. DOI: https://doi.org/10.1016/j.ijscr.2014.11.035

19.    Astapov D.A., Demidov D.P., Semenova E.I., Zheleznev S.I., Zorina I.G., Syrtseva Ya.V. The first experience of implantation of a xenopericardial prosthesis with a frame of variable stiffness «TIARA» in the aortic position. Patologiya krovoobrashcheniya i kardiokhirurgiya [Pathology of Blood Circulation and Cardiac Surgery]. 2013; (2): 73-5. (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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