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Valvular Heart Disease > Valve Prosthesis > Flashcards

Valve Prosthesis Flashcards

1
Q

What marked the beginning of modern valve surgery?

A

The successful operation by Harken to remove foreign bodies from the heart after World War II

This led to further developments in correcting congenital defects and acquired valve disease.

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2
Q

What are the common pathologies that may necessitate intervention on the aortic valve?

A

Aortic stenosis, aortic insufficiency, and aneurysmal disease of the root and ascending aorta

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3
Q

What is the primary indication for aortic valve surgery in cases of aortic stenosis?

A

The presence of symptoms such as angina, syncope, or dyspnea on exertion

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4
Q

According to the 2014 AHA/ACC guidelines, what are the indications for aortic valve replacement in symptomatic patients with severe aortic stenosis?

A

Symptomatic patients with severe AS, symptomatic patients with low flow/low gradient severe AS, and asymptomatic patients with severe AS

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5
Q

List the common diseases leading to aortic regurgitation.

A
  • Calcific degeneration
  • Myxomatous degeneration
  • Rheumatic disease
  • Infective endocarditis
  • Bicuspid aortic valves
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6
Q

What are the criteria for determining the severity of aortic stenosis?

A

Aortic valve area (AVA) and mean pressure gradient

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7
Q

Fill in the blank: Aortic stenosis is the most prevalent valvular heart disease in _______.

A

adults

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8
Q

What factors should be considered when planning for aortic valve replacement?

A
  • Patient’s age
  • Ability to tolerate long-term anticoagulation
  • Aortic root size
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9
Q

What are the advantages of mechanical valves?

A
  • Excellent durability
  • Greater freedom from valve-related events
  • Improved survival compared to biologic prosthesis
  • Excellent hemodynamics
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10
Q

What is the primary disadvantage of mechanical valves?

A

The need for anticoagulation

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11
Q

What are bioprosthetic valves typically made from?

A

Bovine or porcine tissue

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12
Q

What is a significant advantage of bioprosthetic valves compared to mechanical valves?

A

Freedom from therapeutic anticoagulation

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13
Q

What are the indications for using homografts in valve replacement?

A
  • Treatment of aortic valve endocarditis affecting the root
  • Patients with a small aortic root
  • Patients who cannot be anticoagulated
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14
Q

What is the Ross procedure?

A

Replacement of the diseased aortic valve with a pulmonary autograft and reconstruction of the right ventricular outflow tract with a homograft or xenograft

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15
Q

True or False: The Ross procedure requires long-term anticoagulation.

A

False

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16
Q

Who are ideal candidates for the Ross procedure?

A
  • Young adults with aortic valve disease
  • Women of childbearing age
  • High-level athletes
  • Patients with a life expectancy greater than 20 years
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17
Q

What is a common risk associated with mechanical valves?

A

Anticoagulation-related hemorrhage

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18
Q

What are the AHA/ACC guidelines for the severity of aortic regurgitation based on jet width?

A
  • Mild: <25%
  • Moderate: 25–64%
  • Severe: ≥65%
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19
Q

What are the expected long-term outcomes for patients with mechanical valves?

A

Less than 2% valve replacement rate over 25 years

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20
Q

What is the risk of thromboembolism with mechanical valves?

A

0.8% to 2.3% per patient year when anticoagulated

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21
Q

What is structural valve deterioration (SVD) and how does it affect bioprosthetic valves?

A

SVD leads to higher reoperation rates and falls rapidly after 15 years of follow-up

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22
Q

What is the Ross procedure?

A

A surgical technique for aortic valve replacement using the patient’s own pulmonary valve

It converts a single valve pathology to a double-valve pathology, increasing reoperation rates.

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23
Q

What are the age considerations for the Ross procedure?

A

Safe for selected patients up to age 70, but not recommended for those with significantly reduced life expectancy beyond that age

Reports indicate excellent outcomes for both elderly and infants.

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24
Q

List contraindications to the Ross procedure.

A
  • Multivessel coronary artery disease
  • Severely depressed left ventricular function
  • Multiple valvular pathology
  • Disease of the native pulmonary valve
  • Connective tissue disease
  • Significant aortic root dilation
25
Q

What is a major criticism of the Ross procedure?

A

It increases the incidence of reoperations on both the pulmonary autograft and the homograft

Reported incidences of reoperation range from 8 to 15% at 10 years.

26
Q

What are the long-term outcomes of the Ross procedure compared to mechanical or bioprosthetic valve replacement?

A

Patients who underwent the Ross procedure showed survival rates approaching that of the general population

This highlights its effectiveness relative to traditional valve replacements.

27
Q

What is a valve conduit?

A

A mechanical valve annealed to a Dacron graft or created by suturing a valve to a graft

Considered the gold standard for aortic root replacement.

28
Q

What is patient prosthesis mismatch (PPM)?

A

Occurs when a valve prosthesis’s effective orifice area is insufficient for the patient’s body surface area

Can result in elevated gradients across the valve postoperatively.

29
Q

What is one technique for aortic root enlargement?

A

Incorporation of a bovine pericardial or Dacron patch to enlarge the diameter

This can help accommodate a larger valve.

30
Q

What is Transcatheter Aortic Valve Replacement (TAVR)?

A

An alternative option to open surgical aortic valve replacement

Multiple access approaches include transapical, axillary, and percutaneous femoral.

31
Q

What did the PARTNER and CoreValve trials examine regarding TAVR?

A

The utility of TAVR in inoperable and high-risk surgical patients, showing improved one and two-year mortality compared to medical management

TAVR was found to have comparable short-term mortality rates to surgical options.

32
Q

List the indications for mitral valve repair.

A
  • Severe primary mitral regurgitation (MR) with LVEF >30%
  • Severe MR with LVEF <30% (considered)
  • Moderate MR undergoing cardiac surgery
  • Severe secondary MR during CABG or AVR
  • Severe symptomatic secondary MR despite optimal medical management
33
Q

What is the cornerstone of mitral valve repair?

A

Annuloplasty, which improves durability of the repair

Various device options exist including rigid and flexible rings.

34
Q

What are the common techniques for leaflet resection in mitral valve repair?

A
  • Quadrangular resection
  • Triangular resection
35
Q

What is the purpose of artificial chordae in mitral valve repair?

A

To provide support for the leaflet by connecting it to the papillary muscle

This helps maintain proper leaflet height and coaptation.

36
Q

What is the Alfieri or edge-to-edge repair technique?

A

Suturing the anterior and posterior leaflets together to create a double-orifice valve

Useful for bi-leaflet prolapse to maintain leaflet height.

37
Q

What is the MitraClip?

A

A percutaneous device used to treat symptomatic chronic mitral regurgitation in high-risk surgical patients

First approved alternative to open surgery in 2013.

38
Q

What is the MitraClip used for?

A

To treat patients with symptomatic chronic mitral regurgitation who are at high risk for surgery

39
Q

When was the MitraClip first implanted?

A

2003

40
Q

What significant approval did the MitraClip receive in 2013?

A

First device approved by the U.S. Food and Drug Administration as an alternative to open mitral valve surgery

41
Q

What are the indications for MitraClip use?

A

Severe symptomatic mitral regurgitation (MR > 3+), prohibitive risk for open mitral valve surgery, favorable valve anatomy for repair, reasonable life expectancy

42
Q

What are the contraindications for MitraClip?

A

Patients who cannot tolerate anticoagulation or antiplatelet agents, rheumatic mitral valve disease, active endocarditis, thrombus in femoral vein, inferior vena cava or intracardiac thrombus, unfavorable valve anatomy

43
Q

What technique does the MitraClip procedure utilize?

A

Edge-to-edge repair as described by Alfieri

44
Q

What is the outcome of the MitraClip procedure?

A

Improved coaptation of the mitral leaflets and reduction in the regurgitant jet

45
Q

What procedural guidance is used during the MitraClip procedure?

A

Transesophageal echocardiographic (TEE) guidance

46
Q

What was the rate of major adverse events in the EVEREST II clinical trial for MitraClip compared to surgery?

A

15% in the MitraClip group and 48% in the surgery group

47
Q

What is a major disadvantage of the MitraClip procedure?

A

It may further damage a potentially repairable valve

48
Q

What is indicated when mitral valve repair is not feasible?

A

Mitral valve replacement (MVR)

49
Q

What factors influence the decision for prosthesis type in mitral valve replacement?

A

Patient age, ability to anticoagulate, patient preference

50
Q

What is the first-line therapy for patients with mitral stenosis when anatomically feasible?

A

Percutaneous balloon commissurotomy

51
Q

What are the criteria for mitral valve surgery in patients with symptomatic severe mitral stenosis?

A

Patients not candidates for or have failed balloon commissurotomy, recurrent embolic events on anticoagulation, undergoing cardiac surgery for other indications

52
Q

What is the recommended INR for mechanical valves in the mitral position?

A

2.5–3.5

53
Q

What is the general anticoagulation recommendation for patients undergoing mitral valve replacement?

A

Anticoagulation for the initial 3 months after surgery, including patients with a bioprosthesis

54
Q

What should be considered for all patients with mitral replacements?

A

Aspirin

55
Q

What has increased interest in transcatheter mitral valve replacement (TMVR)?

A

The increasing adoption and success of TAVR

56
Q

What structural challenge does TMVR face compared to aortic valve replacement?

A

The mitral valve and its relationship to left ventricular function and outflow track is more complex

57
Q

What may provide a solid landing zone for TMVR?

A

Annuloplasty ring or stent of an implanted bioprosthetic mitral valve

58
Q

What are primary lesions of the tricuspid valve?

A

Direct involvement of the tricuspid valve

59
Q

What are congenital lesions of the tricuspid valve?

A

Ebstein’s anomaly, tricuspid atresia, and tricuspid stenosis

Valvular Heart Disease (13 decks)

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