Reoperative Aortic Valve surgery

Question 1

reop AV surgery

Poor Risk Factors

Answer 1

Outcomes are incrementally worse at a higher preoperative NYHA class.

Concomitant coronary artery disease and pulmonary hypertension are also strong independent risk factors for worse outcome. Therefore,

Question 2

Severe prosthetic aortic stenosis is defined as aortic valve area < * cm2, mean AV gradient ≥* mm Hg, or dimensionless index < ***s.

Answer 2

Severe prosthetic aortic stenosis is defined as aortic valve area < 0.8 cm2, mean AV gradient ≥ 40 mm Hg, or dimensionless index < 0.25, according to AHA guidelines.

Question 3

A root enlargement procedure may be considered in cases where a less than ideal sized valve, (target EOA to BSA ratio of *** cm2/ m2 or greater),

Answer 3

A root enlargement procedure may be considered in cases where a less than ideal sized valve, (target EOA to BSA ratio of 0.85 cm2/ m2 or greater),

Question 4

The predominant mechanism of coronary obstruction during TViV?

Answer 4

The predominant mechanism of coronary obstruction during TViV involves the displacement of the bioprosthetic valve leaflet towards the sinuses of Valsalva, causing obstruction in the diastolic perfusion of the coronaries. The left coronary artery is more often involved.

Question 5

Preoperative characteristics associated with an increased risk of coronary obstruction include:

Answer 5

1. lower height of the coronary ostium above the valve annulus,
2. narrow sinuses,
3. narrow or low sinotubular junction,
4. tall and bulky leaflets, and
5. externally fixed leaflets or stentless valves.

Question 6

Important contraindications to TAVR include:

Answer 6

Important contraindications to TAVR include patients with a subaortic membrane, endocarditis, intra-cardiac mass/ thrombus, prohibitive access, mobile aortic atheroma, and isolated aortic insufficiency (AI without associated stenosis).