Valvular Heart Disease
Valvular Heart Disease are becoming more and more frequent in developed countries.
Our hospital benefits from a top level valve surgery and we developed a valvular heart clinic to follow patients with various valve disease.
We follow outcomes of patients with valve disease before and after surgery in a prospective registry (SALVARE) and study predictors of natural history and postoperative outcome. Also are particularly interested in cardiac imaging, by echocardiography, cardiac MR and cardiac CT to better characterize the pathophysiology of valvular heart disease and to study predictors of outcome
Aortic stenosis is the most common acquired heart disease. It is mainly degenerative and affects elderly patients due to calcareous invasion of the aortic valve leaflets. In calcific aortic stenosis, the valve cusps become gradually thickened and fibrosed, with calcified lesions increasing valve rigidity, decreasing cusp excursion, and gradually causing valve-orifice narrowing and obstruction to the ejection of blood from the left ventricle to the aorta. This leads to rising in left ventricular systolic pressure and increase in left ventricular parietal stress, compensated by concentric myocardial hypertrophy. This condition is initially well tolerated, but when it progresses, may lead to development of angina, heart failure or sudden death. Therefore severe aortic stenosis requires replacement of the valve.
Our research focuses on studying the pathophysiology of hypertrophy and development of myocardial fibrosis by cardiac MR and pathology in calcific aortic stenosis. We also evaluated prevalence of aortic stenosis in elderly populations, and evaluated predictors of outcome and indications for surgical valve replacement in aortic stenosis. Further, we evaluated the use of new less invasive surgical techniques making use of catheter-based valve replacement (TAVR) and new techniques to resect the calcified valve.
Mitral regurgitation is another common valve disease. It most often results from degenerative changes to the leaflets and cordae, with development of valve prolapse due to leaflet elongation and rupture of cordae. It leads to reflow of blood from the left ventricle to the left atria, causing volume and pressure overload in the pulmonary circulation. Our surgical team is expert in repair of mitral valve regurgitation and developed minimal invasive robotic techniques for valve repair (Da Vinci).
Our research focusses on defining optimal indications for valve repair by studying natural history and postoperative outcome of patients undergoing mitral regurgitation in a multicenter registry (Mitral Regurgitation International Database).
In aortic regurgitation, blood flows back from the aorta to the leaking valve to the left ventricle. It is often caused by dilatation of the aortic root or by prolapse of dysfunctional (bicuspid) valves. Our center has leadership in surgical repair of aortic regurgitation.
Our research focusses on improving surgical repair techniques, on predicting outcomes and failures in this novel type of surgery. Furthermore we also study left ventricular remodeling and fibrosis development in this disease.