Valve - aortic

Question 1

What are the different surgical approaches for minimally invasive aortic valve replacement?

Answer 1

right anterior thoracotomy, upper versus lower partial sternotomy

Question 2

Disadvantages of minimally invasive aortic valve replacement

Answer 2

Longer crossclamp and bypass times

Question 3

advantages of minimally invasive aortic valve replacement

Answer 3

Cosmesis

Possible decrease blood loss, ventilator requirement, and hospital stay

Question 4

Most common bicuspid aortic valve morphology

Answer 4

2 commissures oriented anteroposterior; giving left and right cusps

Question 5

Most rare bicuspid aortic valve morphology

Answer 5

Fusion of the left and non-coronary cusps

Question 6

Bicuspid aortic valve classification

Answer 6

Sievers classification; based on how many raphe

Question 7

Sievers type 0

Answer 7

No raphe; true bicuspid

Question 8

Sievers type 1

Answer 8

1 raphe; either L-R, R-N, N-L. This is the most common type. Likely to develop stenosis in adulthood.

Question 9

Sievers type 2

Answer 9

2 raphe; either L-R, R-N. This usually leads to complication at a younger age

Question 10

Mechanism of deterioration of prosthetic bovine pericardial valve

Answer 10

80% stenosis from dystrophic calcification

Question 11

Mechanism of deterioration of prosthetic porcine pericardial valve

Answer 11

Leaflet tears and aortic regurgitation (80%) due to calcification

Question 12

Which is better (bioprosthetic or mechanical valve) for patients >65 years

Answer 12

No difference

Question 13

How long does a mechanical valve last?

Answer 13

15-25 years

Question 14

How long does a bioprosthetic valve last?

Answer 14

10-14 years

Question 15

Patients undergoing CABG with concomitant aortic stenosis should have AV replacement only if?

Answer 15

the aortic stenosis is moderate or severe (class I)

Question 16

Patients undergoing CABG with concomitant mild aortic stenosis may have AV replacement only if?

Answer 16

there is evidence of rapid progression

Question 17

Bioprosthetic valve lifespan

Answer 17

Tissue valves in the mitral position generally deteriorate more quickly than in the aortic position.

Also deteriorate more quickly in younger patients

Question 18

Aortic valve replacement (AVR) stroke risk

Answer 18

~1.5 % in STS database (2.4% in partner trial)

Question 19

What is thought to be the cause of Aortic valve replacement (AVR) stroke risk

Answer 19

Aortic cross-clamping

Question 20

High stroke risk factors for Aortic valve replacement (AVR)

Answer 20

STS Risk > 10%
Age > 80 
Presence of aortic calcifications
Addition of CABG or other procedures
Ejection fraction <40%

Question 21

Most common Bicuspid Aortic Valve configuration

Answer 21

Right-left cusp fusion: 2 commissures located in AP direction, giving right and left cusp. Associated with root dilation. In contrast, the left and non-coronary fusion is the rarest.

Question 22

Bicuspid aortic valve with right-non coronary fusion configuration

Answer 22

Has 2 commissures on the right and left sides of the annulus, which creates anterior and posterior cusps
Associated with ascending and arch dilation.

Question 23

In patients with bicuspid valve and has a valve-related indication for surgery, what aortic size should warrant an aortic replacement?

Answer 23

> 4.5 cm

Question 24

In patients with bicuspid valve and has no valve-related indication for surgery, what aortic size should warrant an aortic replacement?

Answer 24

aortic diameter > 5 cm, or change in diameter >0.5 cm in 1 year

Question 25

Incidence of need for a permanent pacemaker after AVR

Answer 25

3-6%

Question 26

Incidence of transient postop AV block of some magnitude

Answer 26

45%

Question 27

Peak incidence of post op AV block (in days)

Answer 27

2-5 days

Question 28

Generally how long should you wait before placing a permanent pacemaker after AVR

Answer 28

Wait 7 days after conventional AVR

Question 29

Risk factors of a permanent pacemaker after AVR

Answer 29

1) Pre-existing conducting system disease

Stentless prostheses
Smaller sized valves (<21 mm)
AVR in children/women (possibly due to smaller size?)
Reoperations
Combined: (MVR or CABG plus AV surgery) 
Aortic regurgitation > aortic stenosis.

Question 30

Patient prosthesis mismatch definition

Answer 30

Effective orifice index area (EOIA) of a prosthetic valve

Question 31

Criteria for mild, moderate and severe patient prosthesis mismatch (PPM)

Answer 31

Mild if >0.85 cm2/m2
Moderate at 0.65-0.85 cm2/m2
Severe if <0.65 cm2/m2