Degenerative Aortic Valve Disease, its Mechanism on Progression, its Effect on the Left Ventricle and the Postoperative Results

Valve Prosthesis Patient Mismatch

Author(s): Wilhelm Peter Mistiaen

Pp: 239-255 (17)

DOI: 10.2174/9781608052875113010013

* (Excluding Mailing and Handling)

Abstract

The problem of VPPM needs to be addressed in patients with small aortic annuli. The options for such patients are implantation of stentless valves or of homografts. The enlargement of the aortic root could also be performed. These techniques, however, can be very demanding. The implantation of a stented valve is easier but carries the risk for VPPM.

The type of stentless valves and their implantation techniques are described very briefly. Of more importance are the postoperative results. These are difficult to compare for two reasons:

1) Stentless valves do no form a homogenous group.

2) Patients series can differ in age, co-morbid conditions and other characteristics.

Therefore, patients baseline characteristics should be described as completely as possible. The postoperative results for stentless valves seemed to be comparable with those of stented counterparts. For both, stented ans stentless devices, patient related factors have the most impact on the outcome.

The presence or absence of VPPM could be related to hemodynamic parameters, such as EOAI and TVG. This relationship, however, is not straightforward. Moreover, VPPM needs to be defined and graded properly. VPPM seems only to be clinically relevant in patients with a decreased LVF. In patients with a normal LVF, VPPM does not seem to affect the postoperative outcome in terms of survival, LVM regression and freedom of CHF.

The development of SVD could be held responsible for a recurrent hemodynamic burden on the LV. This burden could play a role in reappearance of LVH. SVD was thought to occur less in stentless valves, since turbulence and hence stress on the leaflets would be reduced. In some stentless devices this seems not to be the case.

Availability of 15 year results is needed, but this is not easy to obtain since the median age in patient series is rather high.


Keywords: Aortic root enlargement, effective orifice area, left ventricular function, left ventricular mass, stentless heart valves, structural valve degeneration, survival, transvalvular gradients, valve prosthesis patient mismatch, valve size.

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      • 13. app/Models/UserAccess/UserAccess.php:1266
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      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59068240 and j.to_ip >=59068240 )) and ((j.from_date <= 1739848426 and j.to_date >= 1739848426 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4703) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59068240 and j.to_ip >=59068240 )) and ((j.from_date <= 1739848426 and j.to_date >= 1739848426 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4703) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59068240 and j.to_ip >=59068240 )) and ((j.from_date <= 1739848426 and j.to_date >= 1739848426 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4703)
      520μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 1141 and `b`.`banner_from_date` <= 1739848426 and `b`.`banner_to_date` >= 1739848426 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.05msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 1141
      • 3: 1739848426
      • 4: 1739848426
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='91e700844d320e80692e396678fad507'
      210μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    10Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        0UxmADuKUZ38MyD3GvGWRFNXO1pZBQgzIv41UN0g
        uc_cart_id
        91e700844d320e80692e396678fad507
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/4703" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/4703
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:17 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "cookie" => array:1 [ 0 => "wayfindertarget=eyJpdiI6InBkYU53ZUYybjJ4eituR1hGUUVmOVE9PSIsInZhbHVlIjoicDdvWW50cUdtaDRyK3NCaDBoVG8zcDFQN1B0eHRLTWlaQ0gzMmxZaVBaND0iLCJtYWMiOiIyMjg3Zjc0OGE1MGFkNzljN2UwOWM0YjNjNDY5ZmI5YmMxNzJmYzQxZTUwYWJhNWUwNDVhMDAzM2Q1ZTM1MTQwIiwidGFnIjoiIn0%3D; XSRF-TOKEN=eyJpdiI6InA0bTFqOXNQTHZOWkR1SWovNTdzcFE9PSIsInZhbHVlIjoiZ2xoSS9waUcwOHBFREpYZVpXeUZ0UUFES3VCVXdKbnNLbUhVMG5mbTRIbUdBNzFoVGI3a29TZUFxV2s2UmdDQUc0MkFCZWlGNXBxVDlxalVlRHQzdGQ0SGU1cFJVeG9oUGhmdTRIcEk3NkMvUVNVdzdUdVdMd29MR1dGRGhUTUgiLCJtYWMiOiJlNmI0MWIxZDdiNzYxYjMwZTAzMTc1ZjNmZTc3MzFjYmZmMTk4NGJjYTBkMGQ4NzI3YTNjNTRiMjIxYzA0NDU4IiwidGFnIjoiIn0%3D; alphaeurekaselectnet_session=eyJpdiI6IjByTXdTTHVVM0lvVEU3V0lVd2lxM1E9PSIsInZhbHVlIjoidTREcCtCeHRZaWdpOVBjdkFBMHNrK0ZFOWNkQWN6d0FFOVNsNWk2VkhwYzJEVVVlM1hReTZua01rVFJRbTFsdlNZc2NOQ2ErSlJMcGVsQndVd3U0S1dMWUtWYW5SajhPMk1iOWRrekdQNHp6bEQ1MHIxQitWVG9ON3F1bGJZRDkiLCJtYWMiOiIxNjM4YTNkNGY0NGVhNDUyZDllN2MxNDBhMzQxOGY1NzY4ZGY3ZjM4ZDQ1MmU3NGY4NTc3NTdjMTA1YTM4NTJhIiwidGFnIjoiIn0%3Dwayfindertarget=eyJpdiI6InBkYU53ZUYybjJ4eituR1hGUUVmOVE9PSIsInZhbHVlIjoicDdvWW50cUdtaDRyK3NCaDBoVG8zcDFQN1B0eHRLTWlaQ0gzMmxZaVBaND0iLCJtYWMiOiIyMjg3Zjc0OGE1MGFk" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        0 of 0
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        response_headers
        0 of 0
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        session_attributes
        0 of 0
        array:5 [ "_token" => "0UxmADuKUZ38MyD3GvGWRFNXO1pZBQgzIv41UN0g" "uc_cart_id" => "91e700844d320e80692e396678fad507" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/4703" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-18 03:13:46GET/chapter/47031121912