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Chakravarty T, Abramowitz Y, Jilaihawi H, Makkar RR. Leaflet motion abnormality after TAVI: genuine threat or much ado about nothing? EUROINTERVENTION 2016; 12:Y28-32. [DOI: 10.4244/eijv12sya7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Suchá D, Symersky P, van den Brink RB, Tanis W, Laufer EM, Meijs MF, Habets J, de Mol BA, Mali WP, Chamuleau SA, van Herwerden LA, Budde RP. Diagnostic evaluation and treatment strategy in patients with suspected prosthetic heart valve dysfunction: The incremental value of MDCT. J Cardiovasc Comput Tomogr 2016; 10:398-406. [DOI: 10.1016/j.jcct.2016.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 11/30/2022]
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Barbanti M, Webb JG, Tamburino C, Van Mieghem NM, Makkar RR, Piazza N, Latib A, Sinning JM, Won-Keun K, Bleiziffer S, Bedogni F, Kapadia S, Tchetche D, Rodés-Cabau J, Fiorina C, Nombela-Franco L, De Marco F, de Jaegere PP, Chakravarty T, Vaquerizo B, Colombo A, Svensson L, Lange R, Nickenig G, Möllmann H, Walther T, Della Rosa F, Elhmidi Y, Dvir D, Brambilla N, Immè S, Sgroi C, Gulino S, Todaro D, Pilato G, Petronio AS, Tamburino C. Outcomes of Redo Transcatheter Aortic Valve Replacement for the Treatment of Postprocedural and Late Occurrence of Paravalvular Regurgitation and Transcatheter Valve Failure. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.003930. [DOI: 10.1161/circinterventions.116.003930] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 08/03/2016] [Indexed: 01/11/2023]
Abstract
Background—
Transcatheter aortic valves can degenerate in a manner similar to surgical bioprostheses.
Methods and Results—
Clinical and echocardiographic outcomes of patients who underwent redo transcatheter aortic valve replacement (TAVR) procedures >2 weeks post procedure were collected from 14 centers. Among 13 876 patients, 50 (0.4%) underwent redo TAVR procedure at participating centers. Indications for redo TAVR were moderate–severe prosthetic aortic valve stenosis (n=10, 21.7%), moderate–severe central prosthetic aortic valve regurgitation (n=13, 28.3%), and moderate–severe paraprosthetic aortic valve regurgitation (n=25, 50.0%). The index TAVR was most commonly a Medtronic CoreValve (N=38, 76.0%), followed by Edwards SAPIEN-type valves (n=12, 24.0%) and Portico (n=1, 2.0%). The redo TAVR device was most commonly a CoreValve/Evolut R (n=29, 58.0%), followed by a SAPIEN-type valve (n=20,40.0%) or a Boston Lotus valve (n=1, 2.0%). In 40 patients (80.0%), redo TAVR was performed using the identical device type or that of the succeeding generation. Valve performance was uniformly good after redo TAVR (mean transvalvular gradient post redo TAVR: 12.5±6.1 mm Hg). At hospital discharge, all patients remained alive, with 1 nondisabling stroke (2.0%) and 1 life-threatening bleed (2.0%). Permanent pacemaker implantation was required in 3 out of 35 patients without a prior pacemaker (8.6%). Late survival was 85.1% at a median follow-up of 1589 days (range: 31–3775) after index TAVR and 635 days (range: 8–2460) after redo TAVR.
Conclusions—
Redo TAVR for the treatment of postprocedural and late occurrence of paravalvular regurgitation and transcatheter aortic valve prosthesis failure seems to be safe, and it is associated with favorable acute and midterm clinical and echocardiographic outcomes.
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Affiliation(s)
- Marco Barbanti
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - John G. Webb
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Claudia Tamburino
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Nicolas M. Van Mieghem
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Raj R. Makkar
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Nicolò Piazza
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Azeem Latib
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Jan-Malte Sinning
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Kim Won-Keun
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Sabine Bleiziffer
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Francesco Bedogni
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Samir Kapadia
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Didier Tchetche
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Josep Rodés-Cabau
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Claudia Fiorina
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Luis Nombela-Franco
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Federico De Marco
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Peter P. de Jaegere
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Tarun Chakravarty
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Beatriz Vaquerizo
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Antonio Colombo
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Lars Svensson
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Rüdiger Lange
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Georg Nickenig
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Helge Möllmann
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Thomas Walther
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Francesco Della Rosa
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Yacine Elhmidi
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Danny Dvir
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Nedy Brambilla
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Sebastiano Immè
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Carmelo Sgroi
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Simona Gulino
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Denise Todaro
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Gerlando Pilato
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Anna Sonia Petronio
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
| | - Corrado Tamburino
- From the Ferrarotto Hospital, University of Catania, Italy (M.B., Claudia Tamburino, S.I., C.S., S.G., D.T., G.P., Corrado Tamburino); St Paul’s Hospital, Vancouver, Canada (J.G.W., D.D.); Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (N.M.V.M., P.P.d.J.); Cedars-Sinai Heart Institute, Los Angeles, CA (R.R.M., T.C.); McGill University Health Center, Montreal, Québec, Canada (N.P.); EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy (A.L., A.C.)
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704
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Abstract
OPINION STATEMENT Transcatheter aortic valve replacement (TAVR) has emerged as an effective treatment alternative in patients with severe aortic stenosis (AS) who are deemed surgically high-risk or ineligible for surgery. Pre-procedural imaging, in particular computed tomography (CT), plays an integral part in the planning and performance of TAVR and is crucial for a successful treatment. Novel technological advances in CT include high-pitch, low kV acquisitions, and iterative reconstruction resulting in high image quality at substantially reduced scan duration, contrast volume, and radiation exposure. Given the high spatial and temporal resolution of the acquisitions, CT angiography provides critical information on the eligibility for the peripheral vascular access, aortic root assessment, as well as the aortic annulus measurements, including the coronary ostia and concomitant cardiac pathology. Pre-procedural CT imaging is key for appropriate device size selection to minimize peri-procedural complications and optimize procedural success. In this article, we review the current state of imaging in the pre-interventional setting of TAVR with a special emphasis on CT.
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705
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Hansson NC, Grove EL, Andersen HR, Leipsic J, Mathiassen ON, Jensen JM, Jensen KT, Blanke P, Leetmaa T, Tang M, Krusell LR, Klaaborg KE, Christiansen EH, Terp K, Terkelsen CJ, Poulsen SH, Webb J, Bøtker HE, Nørgaard BL. Transcatheter Aortic Valve Thrombosis: Incidence, Predisposing Factors, and Clinical Implications. J Am Coll Cardiol 2016; 68:2059-2069. [PMID: 27580689 DOI: 10.1016/j.jacc.2016.08.010] [Citation(s) in RCA: 272] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/04/2016] [Accepted: 08/09/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are limited data on the incidence, clinical implications, and predisposing factors of transcatheter heart valve (THV) thrombosis following transcatheter aortic valve replacement (TAVR). OBJECTIVES The authors assessed the incidence, potential predictors, and clinical implications of THV thrombosis as determined by contrast-enhanced multidetector computed tomography (MDCT) after TAVR. METHODS Among 460 consecutive patients who underwent TAVR with the Edwards Sapien XT or Sapien 3 (Edwards Lifesciences, Irvine, California) THV, 405 (88%) underwent MDCT in addition to transthoracic and transesophageal echocardiography 1 to 3 months post-TAVR. MDCT scans were evaluated for hypoattenuated leaflet thickening that indicated THV thrombosis. RESULTS MDCT verified THV thrombosis in 28 of 405 (7%) patients. A total of 23 patients had subclinical THV thrombosis, whereas 5 (18%) patients experienced clinically overt obstructive THV thrombosis. THV thrombosis risk did not differ among different generations of THVs (8% vs. 6%; p = 0.42). The risk of THV thrombosis in patients who did not receive warfarin was higher compared with patients who received warfarin (10.7% vs. 1.8%; risk ratio [RR]: 6.09; 95% confidence interval [CI]: 1.86 to 19.84). A larger THV was associated with an increased risk of THV thrombosis (p = 0.03). In multivariable analysis, a 29-mm THV (RR: 2.89; 95% CI: 1.44 to 5.80) and no post-TAVR warfarin treatment (RR: 5.46; 95% CI: 1.68 to 17.7) independently predicted THV thrombosis. Treatment with warfarin effectively reverted THV thrombosis and normalized THV function in 85% of patients as documented by follow-up transesophageal echocardiography and MDCT. CONCLUSIONS Incidence of THV thrombosis in this large study was 7%. A larger THV size may predispose to THV thrombosis, whereas treatment with warfarin appears to have a protective effect. Although often subclinical, THV thrombosis may have important clinical implications.
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Affiliation(s)
- Nicolaj C Hansson
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Erik L Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Jonathon Leipsic
- Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ole N Mathiassen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kaare T Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Philipp Blanke
- Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tina Leetmaa
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mariann Tang
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Lars R Krusell
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kaj E Klaaborg
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Kim Terp
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Steen H Poulsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - John Webb
- Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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706
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Kounis NG, Lianas D, Kounis GN, Soufras GD. Very Early, Early, and Late Thrombus Formation Following Transcatheter Aortic Valve Replacement: A Kounis Syndrome Involvement? JACC Cardiovasc Interv 2016; 9:861. [PMID: 27101913 DOI: 10.1016/j.jcin.2016.01.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/28/2016] [Indexed: 10/21/2022]
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707
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Bosmans J, Paelinck B. Transcatheter aortic valve replacement: a further step towards a patient-tailored therapy. EUROINTERVENTION 2016; 12:695-7. [PMID: 27542779 DOI: 10.4244/eijv12i6a112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Johan Bosmans
- Department of Cardiology, Interventional Cardiology, University Hospital Antwerp, Antwerp, Belgium
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708
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Schoen FJ. Morphology, Clinicopathologic Correlations, and Mechanisms in Heart Valve Health and Disease. Cardiovasc Eng Technol 2016; 9:126-140. [PMID: 27502286 DOI: 10.1007/s13239-016-0277-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
Abstract
The clinical and pathological features of the most frequent intrinsic structural diseases that affect the heart valves are well established, but heart valve disease mechanisms are poorly understood, and effective treatment options are evolving. Major advances in the understanding of the structure, function and biology of native valves and the pathobiology, biomaterials and biomedical engineering, and the clinical management of valvular heart disease have occurred over the past several decades. This communication reviews contemporary considerations relative to the pathology of valvular heart disease, including (1) clinical significance and epidemiology of valvular heart disease; (2) functional and dynamic valvular macro-, micro- and ultrastructure; (3) causes, morphology and mechanisms of human valvular heart disease; and (4) pathologic considerations in valve replacement, repair and, potentially, regeneration of the heart valves.
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Affiliation(s)
- Frederick J Schoen
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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709
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Jung C, Lichtenauer M, Figulla HR, Wernly B, Goebel B, Foerster M, Edlinger C, Lauten A. Microparticles in patients undergoing transcatheter aortic valve implantation (TAVI). Heart Vessels 2016; 32:458-466. [PMID: 27488119 PMCID: PMC5371631 DOI: 10.1007/s00380-016-0885-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/29/2016] [Indexed: 12/13/2022]
Abstract
Degenerative aortic stenosis (AS) is the most frequent form of acquired valvular heart disease. AS is known to entail endothelial dysfunction caused by increased mechanical shear stress leading to elevated circulatory levels of microparticles. Endothelial and platelet microparticles (EMP and PMP) are small vesicles that originate from activated cells and thrombocytes. We sought to evaluate whether transcatheter aortic valve implantation (TAVI) procedure would elicit effects on circulating EMP and PMP. 92 patients undergoing TAVI procedure for severe AS were included in this study. Samples were obtained at each visit before TAVI, 1 week post-procedure and at 1, 3 and after 6 months after TAVI and were evaluated using flow cytometry. A 12 month clinical follow-up was also performed. CD62E+ EMP concentration before TAVI was 21.11 % (±6.6 % SD) and declined to 20.99 % (±6.8 % SD) after 1 week, to 16.63 % (±5.4 % SD, p < 0.0001) after 1 month, to 17.08 % (±4.6 % SD, p < 0.0001) after 3 months and to 15.94 % (±5.4 % SD, p < 0.0001) after 6 months. CD31+/CD42b-, CD31+/Annexin+/- EMP remained unchanged. CD31+/CD41b+ PMP evidenced a slight, but statistically significant increase after TAVI and remained elevated during the entire follow-up. Apart from a procedure-related improvement in echocardiographic parameters, TAVI procedure led also to a decline in CD62E+ EMP. The reduction in pressure gradients with less hemodynamic shear stress seems also to have beneficially affected endothelial homeostasis.
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Affiliation(s)
- Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, University Duesseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany.
| | - Michael Lichtenauer
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Hans-Reiner Figulla
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Bernhard Wernly
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Bjoern Goebel
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Martin Foerster
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Christoph Edlinger
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Alexander Lauten
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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710
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Masri A, Gillinov AM, Johnston DM, Sabik JF, Svensson LG, Rodriguez LL, Kapadia SR, Stewart WJ, Grimm RA, Griffin BP, Desai MY. Anticoagulation versus antiplatelet or no therapy in patients undergoing bioprosthetic valve implantation: a systematic review and meta-analysis. Heart 2016; 103:40-48. [DOI: 10.1136/heartjnl-2016-309630] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/07/2016] [Accepted: 07/10/2016] [Indexed: 12/18/2022] Open
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711
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D’Onofrio A, Rizzo S, Besola L, Isabella G, Rancitelli V, Randi ML, Campello E, Falasco G, Basso C, Thiene G, Gerosa G. Hyperacute Valve Thrombosis After Transapical Transcatheter Aortic Valve Replacement in a Patient With Polycythemia Vera. JACC Cardiovasc Interv 2016; 9:1746-7. [DOI: 10.1016/j.jcin.2016.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 05/06/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
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712
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Valve Type, Size, and Deployment Location Affect Hemodynamics in an In Vitro Valve-in-Valve Model. JACC Cardiovasc Interv 2016; 9:1618-28. [DOI: 10.1016/j.jcin.2016.05.030] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 11/20/2022]
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713
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Tseng EE. When valve-in-valve implantation is not sufficient: Bioprosthetic Russian dolls. J Thorac Cardiovasc Surg 2016; 152:624-5. [DOI: 10.1016/j.jtcvs.2016.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 11/17/2022]
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714
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Anticoagulation Treatment After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2016; 9:1718-20. [DOI: 10.1016/j.jcin.2016.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 07/09/2016] [Accepted: 07/11/2016] [Indexed: 11/20/2022]
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715
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Cerebral Embolism During Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2016; 68:589-599. [DOI: 10.1016/j.jacc.2016.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/07/2016] [Indexed: 11/22/2022]
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716
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Abstract
For the year 2015, almost 19,000 published references can be found in PubMed when entering the search term "cardiac surgery". The last year has been again characterized by lively discussions in the fields where classic cardiac surgery and modern interventional techniques overlap. Lacking evidence in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery has been added. As in the years before, CABG remains the gold standard for the revascularization of complex stable triple-vessel disease. Plenty of new information has been presented comparing the conventional to transcatheter aortic valve implantation (TAVI) demonstrating similar short- and mid-term outcomes at high and low risk, but even a survival advantage with transfemoral TAVI at intermediate risk. In addition, there were many relevant and interesting other contributions from the purely operative arena. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While the article does not have the expectation of being complete and cannot be free of individual interpretation, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery.
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717
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Mack MJ, Douglas PS, Holmes DR. Shedding More Light on Valve Thrombosis After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2016; 67:656-658. [PMID: 26868690 DOI: 10.1016/j.jacc.2015.11.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 11/30/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Michael J Mack
- Department of Cardiovascular Surgery, Baylor Scott & White Health, Plano, Texas.
| | - Pamela S Douglas
- Department of Cardiology, Duke University, Durham, North Carolina
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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718
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719
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Kumbhani DJ, Banerjee S. 3-Year Results of a TAVR Trial in High Surgical Risk Patients ∗. J Am Coll Cardiol 2016; 67:2575-7. [DOI: 10.1016/j.jacc.2016.03.526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
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720
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Deeb GM, Reardon MJ, Chetcuti S, Patel HJ, Grossman PM, Yakubov SJ, Kleiman NS, Coselli JS, Gleason TG, Lee JS, Hermiller JB, Heiser J, Merhi W, Zorn GL, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Maini B, Mumtaz M, Conte J, Resar J, Aharonian V, Pfeffer T, Oh JK, Qiao H, Adams DH, Popma JJ. 3-Year Outcomes in High-Risk Patients Who Underwent Surgical or Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2016; 67:2565-74. [DOI: 10.1016/j.jacc.2016.03.506] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 11/26/2022]
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721
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Clinical trials in transcatheter aortic valve replacement. Curr Opin Cardiol 2016; 31:343-8. [PMID: 27218682 DOI: 10.1097/hco.0000000000000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Clinical trials in transcatheter aortic valve replacement (TAVR) have been essential in establishing the effectiveness as well as the limitations of this exciting and disruptive technology. This review will focus on clinical trials related to TAVR that have been presented in the past year or are currently enrolling, as well as future trials that are in the planning stages. RECENT FINDINGS The currently available devices have gone through iterations to improve safety and outcomes, including lower profiles to reduce bleeding complications as well as adding a sealing skirt or allowing for re-positioning in order to decrease para-valvular regurgitation and need for a permanent pacemaker. The intermediate-risk clinical trials will be finishing soon and will be followed by low-risk trials. Ancillary devices will likely continue to expand the access to this therapy. One of the main challenges moving forward will be the post-TAVR pharmacotherapy. SUMMARY Recently, improvements in first-generation devices have led to improved outcomes. Current trials evaluating novel TAVR platforms and lower risk patients as well as ancillary devices will likely continue to expand the access to this therapy.
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722
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Schoen FJ, Gotlieb AI. Heart valve health, disease, replacement, and repair: a 25-year cardiovascular pathology perspective. Cardiovasc Pathol 2016; 25:341-352. [PMID: 27242130 DOI: 10.1016/j.carpath.2016.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 01/24/2023] Open
Abstract
The past several decades have witnessed major advances in the understanding of the structure, function, and biology of native valves and the pathobiology and clinical management of valvular heart disease. These improvements have enabled earlier and more precise diagnosis, assessment of the proper timing of surgical and interventional procedures, improved prosthetic and biologic valve replacements and repairs, recognition of postoperative complications and their management, and the introduction of minimally invasive approaches that have enabled definitive and durable treatment for patients who were previously considered inoperable. This review summarizes the current state of our understanding of the mechanisms of heart valve health and disease arrived at through innovative research on the cell and molecular biology of valves, clinical and pathological features of the most frequent intrinsic structural diseases that affect the valves, and the status and pathological considerations in the technological advances in valvular surgery and interventions. The contributions of many cardiovascular pathologists and other scientists, engineers, and clinicians are emphasized, and potentially fruitful areas for research are highlighted.
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Affiliation(s)
- Frederick J Schoen
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115; Pathology and Health Sciences and Technology (HST), Harvard Medical School, 75 Francis Street, Boston, MA 02115.
| | - Avrum I Gotlieb
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Laboratory Medicine Program, University Health Network, Medical Sciences Building, 1 King's College Circle, Rm. 6275A, Toronto, Ontario M5S 1A8, Canada.
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723
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Riaz H, Alansari SAR, Khan MS, Riaz T, Raza S, Luni FK, Khan AR, Riaz IB, Krasuski RA. Safety and Use of Anticoagulation After Aortic Valve Replacement With Bioprostheses: A Meta-Analysis. Circ Cardiovasc Qual Outcomes 2016; 9:294-302. [PMID: 27166205 DOI: 10.1161/circoutcomes.115.002696] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/29/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The American College of Cardiology guidelines recommend 3 months of anticoagulation after replacement of the aortic valve with a bioprosthesis. However, there remains great variability in the current clinical practice and conflicting results from clinical studies. To assist clinical decision making, we pooled the existing evidence to assess whether anticoagulation in the setting of a new bioprosthesis was associated with improved outcomes or greater risk of bleeding. METHODS AND RESULTS We searched the PubMed database from the inception of these databases until April 2015 to identify original studies (observational studies or clinical trials) that assessed anticoagulation with warfarin in comparison with either aspirin or no antiplatelet or anticoagulant therapy. We included the studies if their outcomes included thromboembolism or stroke/transient ischemic attacks and bleeding events. Quality assessment was performed in accordance with the Newland Ottawa Scale, and random effects analysis was used to pool the data from the available studies. I(2) testing was done to assess the heterogeneity of the included studies. After screening through 170 articles, a total of 13 studies (cases=6431; controls=18210) were included in the final analyses. The use of warfarin was associated with a significantly increased risk of overall bleeding (odds ratio, 1.96; 95% confidence interval, 1.25-3.08; P<0.0001) or bleeding risk at 3 months (odds ratio, 1.92; 95% confidence interval, 1.10-3.34; P<0.0001) compared with aspirin or placebo. With regard to composite primary outcome variables (risk of venous thromboembolism, stroke, or transient ischemic attack) at 3 months, no significant difference was seen with warfarin (odds ratio, 1.13; 95% confidence interval, 0.82-1.56; P=0.67). Moreover, anticoagulation was also not shown to improve outcomes at time interval >3 months (odds ratio, 1.12; 95% confidence interval, 0.80-1.58; P=0.79). CONCLUSIONS Contrary to the current guidelines, a meta-analysis of previous studies suggests that anticoagulation in the setting of an aortic bioprosthesis significantly increases bleeding risk without a favorable effect on thromboembolic events. Larger, randomized controlled studies should be performed to further guide this clinical practice.
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Affiliation(s)
- Haris Riaz
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.).
| | - Shehab Ahmad Redha Alansari
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.)
| | - Muhammad Shahzeb Khan
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.)
| | - Talha Riaz
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.)
| | - Sajjad Raza
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.)
| | - Faraz Khan Luni
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.)
| | - Abdur Rahman Khan
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.)
| | - Irbaz Bin Riaz
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.)
| | - Richard A Krasuski
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.)
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724
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The Effect of Valve-in-Valve Implantation Height on Sinus Flow. Ann Biomed Eng 2016; 45:405-412. [PMID: 27164838 DOI: 10.1007/s10439-016-1642-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/04/2016] [Indexed: 02/03/2023]
Abstract
Valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) has proven to be a successful treatment for high risk patients with failing aortic surgical bioprostheses. However, thrombus formation on the leaflets of the valve has emerged as a major issue in such procedures, posing a risk of restenosis, thromboembolism, and reduced durability. In this work we attempted to understand the effect of deployment position of the transcatheter heart valve (THV) on the spatio-temporal flow field within the sinus in VIV-TAVR. Experiments were performed in an in vitro pulsatile left heart simulator using high-speed Particle Image Velocimetry (PIV) to measure the flow field in the sinus region. The time-resolved velocity data was used to understand the qualitative and quantitative flow patterns. In addition, a particle tracking technique was used to evaluate relative thrombosis risk via sinus washout. The velocity data demonstrate that implantation position directly affects sinus flow patterns, leading to increased flow stagnation with increasing deployment height. The particle tracking simulations showed that implantation position directly affected washout time, with the highest implantation resulting in the least washout. These results clearly demonstrate the flow pattern and flow stagnation in the sinus is sensitive to THV position. It is, therefore, important for the interventional cardiologist and cardiac surgeon to consider how deployment position could impact flow stagnation during VIV-TAVR.
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725
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Gonska B, Seeger J, Rodewald C, Scharnbeck D, Rottbauer W, Wöhrle J. Transfemoral valve-in-valve implantation for degenerated bioprosthetic aortic valves using the new balloon-expandable Edwards Sapien 3 valve. Catheter Cardiovasc Interv 2016; 88:636-643. [DOI: 10.1002/ccd.26565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 03/28/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Birgid Gonska
- Department Of Internal Medicine II; University of Ulm; Ulm Germany
| | - Julia Seeger
- Department Of Internal Medicine II; University of Ulm; Ulm Germany
| | | | | | | | - Jochen Wöhrle
- Department Of Internal Medicine II; University of Ulm; Ulm Germany
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726
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Transcatheter Aortic Valve Replacement Planning with Cardiac CT: Protocols and Practical Tips. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-016-9376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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727
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Cicha I, Singh R, Garlichs CD, Alexiou C. Nano-biomaterials for cardiovascular applications: Clinical perspective. J Control Release 2016; 229:23-36. [DOI: 10.1016/j.jconrel.2016.03.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 01/22/2023]
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728
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Salido-Tahoces L, Hernandez-Antolin RA, Fernández-Golfin C, Palomera-Rico A, Ayala-Carbonero A, Jimenez-Nacher JJ, Mestre-Barceló JL, Moya-Mur JL, Zamorano-Gómez JL. Three Cases of Early Lotus Valve Thrombosis. JACC Cardiovasc Interv 2016; 9:983-6. [DOI: 10.1016/j.jcin.2016.02.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/10/2016] [Accepted: 02/25/2016] [Indexed: 10/21/2022]
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729
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Duration of antiplatelet or anticoagulant therapy after transcatheter aortic valve implantation in high risk patients; longer or shorter. Int J Cardiol 2016; 210:14-5. [PMID: 26922705 DOI: 10.1016/j.ijcard.2016.02.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/14/2016] [Indexed: 11/20/2022]
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730
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Condado JF, Block PC. Will Transcatheter Aortic Valve Replacement (TAVR) be the Primary Therapy for Aortic Stenosis? CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2016. [DOI: 10.15212/cvia.2016.0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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731
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Schwann TA, Habib RH, Suri RM, Brennan JM, He X, Thourani VH, Engoren M, Ailawadi G, Englum BR, Bonnell MR, Gammie JS. Variation in Warfarin Use at Hospital Discharge After Isolated Bioprosthetic Mitral Valve Replacement: An Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Chest 2016; 150:597-605. [PMID: 27132702 DOI: 10.1016/j.chest.2016.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/02/2016] [Accepted: 04/01/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Anticoagulation with warfarin following bioprosthetic mitral valve replacement (BMVR) is recommended by multiple practice guidelines. We assessed practice variability and patient characteristics associated with warfarin prescription following BMVR. METHODS We analyzed 7,637 patients in the Society of Thoracic Surgeons Database (January 1, 2008 to June 30, 2011) who were discharged following isolated primary nonemergent BMVR. Patients requiring preoperative warfarin, those with preoperative atrial fibrillation, or those with a contraindication to warfarin were excluded. The association between patient, hospital, and surgeon characteristics and warfarin prescription were evaluated. RESULTS Fifty-eight percent of this cohort (median age, 66 years; female sex, 58.7%) was prescribed warfarin. Patients receiving warfarin were older (67 vs 65 years; P < .0001), were less likely to have had preoperative stroke (9.3% vs 12.1%; P < .001), CHF (51.4% vs 54.1%; P < .02), or dialysis (4.9% vs 9.0%; P < 0.001), and had a longer postoperative length of stay (8.0 vs 7.0 days; P < 0.01). Warfarin was prescribed less often for patients with postoperative GI events (44.4% vs 55.6%; P < .001) but more often for patients with postoperative myocardial infarction (75.8% vs 24.2%; P < .001) or new atrial fibrillation (68% vs 32%; P < .001) and those requiring blood transfusions intraoperatively (55.7% vs 44.3%; P < .001) or postoperatively (57% vs 43%; P < .03). Similar rates of warfarin prescription were observed in patients requiring reoperation for bleeding (54.9% vs 45.1%; P = .20) and those with postoperative stroke (53.6 % vs 46.4 %; P = .30). After adjusting for patient characteristics, significant surgeon and hospital variation in warfarin prescription at hospitals was observed. CONCLUSIONS Although patient characteristics and postoperative events may be associated with the prescription of warfarin following BMVR, substantial surgeon and hospital variability remains. This variability largely ignores the established practice guidelines and warrants further study to define the optimal anticoagulation strategy in patients undergoing BMVR.
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Affiliation(s)
| | - Robert H Habib
- Outcomes Research Unit, American University of Beirut, Beirut, Lebanon
| | - Rakesh M Suri
- Department of Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Xia He
- Duke University and Duke Clinical Research Institute, Durham, NC
| | | | - Milo Engoren
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Gorav Ailawadi
- Department of Surgery, University of Virginia, Charlottesville, VA
| | - Brian R Englum
- Duke University and Duke Clinical Research Institute, Durham, NC
| | | | - James S Gammie
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
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732
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Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, Thourani VH, Tuzcu EM, Miller DC, Herrmann HC, Doshi D, Cohen DJ, Pichard AD, Kapadia S, Dewey T, Babaliaros V, Szeto WY, Williams MR, Kereiakes D, Zajarias A, Greason KL, Whisenant BK, Hodson RW, Moses JW, Trento A, Brown DL, Fearon WF, Pibarot P, Hahn RT, Jaber WA, Anderson WN, Alu MC, Webb JG. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med 2016; 374:1609-20. [PMID: 27040324 DOI: 10.1056/nejmoa1514616] [Citation(s) in RCA: 3578] [Impact Index Per Article: 447.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Previous trials have shown that among high-risk patients with aortic stenosis, survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve replacement. We evaluated the two procedures in a randomized trial involving intermediate-risk patients. METHODS We randomly assigned 2032 intermediate-risk patients with severe aortic stenosis, at 57 centers, to undergo either TAVR or surgical replacement. The primary end point was death from any cause or disabling stroke at 2 years. The primary hypothesis was that TAVR would not be inferior to surgical replacement. Before randomization, patients were entered into one of two cohorts on the basis of clinical and imaging findings; 76.3% of the patients were included in the transfemoral-access cohort and 23.7% in the transthoracic-access cohort. RESULTS The rate of death from any cause or disabling stroke was similar in the TAVR group and the surgery group (P=0.001 for noninferiority). At 2 years, the Kaplan-Meier event rates were 19.3% in the TAVR group and 21.1% in the surgery group (hazard ratio in the TAVR group, 0.89; 95% confidence interval [CI], 0.73 to 1.09; P=0.25). In the transfemoral-access cohort, TAVR resulted in a lower rate of death or disabling stroke than surgery (hazard ratio, 0.79; 95% CI, 0.62 to 1.00; P=0.05), whereas in the transthoracic-access cohort, outcomes were similar in the two groups. TAVR resulted in larger aortic-valve areas than did surgery and also resulted in lower rates of acute kidney injury, severe bleeding, and new-onset atrial fibrillation; surgery resulted in fewer major vascular complications and less paravalvular aortic regurgitation. CONCLUSIONS In intermediate-risk patients, TAVR was similar to surgical aortic-valve replacement with respect to the primary end point of death or disabling stroke. (Funded by Edwards Lifesciences; PARTNER 2 ClinicalTrials.gov number, NCT01314313.).
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Affiliation(s)
- Martin B Leon
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Craig R Smith
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Michael J Mack
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Raj R Makkar
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Lars G Svensson
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Susheel K Kodali
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Vinod H Thourani
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - E Murat Tuzcu
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - D Craig Miller
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Howard C Herrmann
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Darshan Doshi
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - David J Cohen
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Augusto D Pichard
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Samir Kapadia
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Todd Dewey
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Vasilis Babaliaros
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Wilson Y Szeto
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Mathew R Williams
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Dean Kereiakes
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Alan Zajarias
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Kevin L Greason
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Brian K Whisenant
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Robert W Hodson
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Jeffrey W Moses
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Alfredo Trento
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - David L Brown
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - William F Fearon
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Philippe Pibarot
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Rebecca T Hahn
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Wael A Jaber
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - William N Anderson
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - Maria C Alu
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
| | - John G Webb
- From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and independent consultant (W.N.A.), Lake Forest - all in California; Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory University, Atlanta (V.H.T., V.B.); University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute, Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.); HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital, Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital, Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
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733
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Makkar RR, Fontana G, Søndergaard L. Possible Subclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves. N Engl J Med 2016; 374:1591. [PMID: 27096589 DOI: 10.1056/nejmc1600179] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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734
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In situ regeneration of bioactive coatings enabled by an evolved Staphylococcus aureus sortase A. Nat Commun 2016; 7:11140. [PMID: 27073027 PMCID: PMC4833859 DOI: 10.1038/ncomms11140] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 02/24/2016] [Indexed: 11/08/2022] Open
Abstract
Surface immobilization of bioactive molecules is a central paradigm in the design of implantable devices and biosensors with improved clinical performance capabilities. However, in vivo degradation or denaturation of surface constituents often limits the long-term performance of bioactive films. Here we demonstrate the capacity to repeatedly regenerate a covalently immobilized monomolecular thin film of bioactive molecules through a two-step stripping and recharging cycle. Reversible transpeptidation by a laboratory evolved Staphylococcus aureus sortase A (eSrtA) enabled the rapid immobilization of an anti-thrombogenic film in the presence of whole blood and permitted multiple cycles of film regeneration in vitro that preserved its biological activity. Moreover, eSrtA transpeptidation facilitated surface re-engineering of medical devices in situ after in vivo implantation through removal and restoration film constituents. These studies establish a rapid, orthogonal and reversible biochemical scheme to regenerate selective molecular constituents with the potential to extend the lifetime of bioactive films. Bioactive coatings offer a strategy to modulate host response to implants, but their translation to the clinic is hampered by their fast in vivo degradation. Here, the authors use an engineered bacterial protein to regenerate an anti-thrombogenic film in vitro and in situ after device implantation.
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735
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736
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Abdelghani M, Serruys PW. Transcatheter Aortic Valve Implantation in Lower-Risk Patients With Aortic Stenosis. Circ Cardiovasc Interv 2016; 9:e002944. [DOI: 10.1161/circinterventions.115.002944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/04/2016] [Indexed: 01/01/2023]
Abstract
Transcatheter aortic valve implantation underwent progressive improvements until it became the default therapy for inoperable patients, and a recommended therapy in high-risk operable patients with symptomatic severe aortic stenosis. In the lower-risk patient strata, a currently costly therapy that still has important complications with questionable durability is competing with the established effective and still-improving surgical replacement. This report tries to weigh the clinical evidence, the recent technical improvements, the durability, and the cost-effectiveness claims supporting the adoption of transcatheter aortic valve implantation in intermediate-low risk patients. The importance of appropriate patients’ risk stratification and a more comprehensive approach to estimate that risk are also emphasized in the present report.
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Affiliation(s)
- Mohammad Abdelghani
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (M.A.); and International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Patrick W. Serruys
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (M.A.); and International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
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737
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738
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Abstract
The management of aortic valve disease has been improved by accurate diagnosis and assessment of severity by echocardiography and advanced imaging techniques, efforts to elicit symptoms or objective markers of disease severity and progression, and consideration of optimum timing of aortic valve replacement, even in elderly patients. Prevalence of calcific aortic stenosis is growing in ageing populations. Conventional surgery remains the most appropriate option for most patients who require aortic valve replacement, but the transcatheter approach is established for high-risk patients or poor candidates for surgery. The rapid growth of transcatheter aortic valve replacement has been fuelled by improved technology, evidence-based clinical research, and setting up of multidisciplinary heart teams. Aortic regurgitation can be difficult to diagnose and quantify. Left ventricular dysfunction often precedes symptoms, needing active surveillance by echocardiography to determine the optimum time for aortic valve replacement. Development of transcatheter approaches for aortic regurgitation is challenging, owing to the absence of valvular calcification and distortion of aortic root anatomy in many patients.
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Affiliation(s)
- Robert O Bonow
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Martin B Leon
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Darshan Doshi
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
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739
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Toggweiler S, Schmidt K, Paul M, Cuculi F, Kobza R, Jamshidi P. Valve thrombosis 3 years after transcatheter aortic valve implantation. Int J Cardiol 2016; 207:122-4. [DOI: 10.1016/j.ijcard.2016.01.080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/02/2016] [Indexed: 11/16/2022]
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740
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Sustitución percutánea de válvula aórtica: ventajas y limitaciones de diferentes técnicas de imagen cardiaca. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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741
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Harjai KJ, Grines CL, Leon MB. Transcatheter Aortic Valve Replacement: 2015 in Review. J Interv Cardiol 2016; 29:27-46. [DOI: 10.1111/joic.12274] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Kishore J. Harjai
- Geisinger Clinic; Pearsall Heart Hospital; Wilkes-Barre Pennsylvania
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742
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Abstract
In 2015, the cardiac literature has pushed for change in cardiac practice. The areas are evolving quickly based on new technology, ranging from percutaneous valves in the aortic position to mechanical support. The new devices in both these fields are changing the way patients are cared for very quickly. Another topic evolving is temperature management in aortic arch cases. This field is being pushed more by the threat of endovascular technology creeping into the arch than technology directly causing change in care. But that threat is real and inevitable. Finally, the discussion about optimal conduits is unending in coronary bypass grafting. A new algorithm has been proposed for utilization of more arterial grafts; however, there remains trepidation in changing from more vein grafts. Furthermore, those pushing for more arterial grafting seem to be black and white about these approaches rather than using what is best for the patient. These topics, among others, have made the literature from cardiac surgery in 2015 worth reading.
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743
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Update: Cardiac Imaging (II). Transcatheter Aortic Valve Replacement: Advantages and Limitations of Different Cardiac Imaging Techniques. ACTA ACUST UNITED AC 2016; 69:310-21. [PMID: 26856791 DOI: 10.1016/j.rec.2015.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023]
Abstract
Transcatheter aortic valve replacement is an established therapy for patients with symptomatic severe aortic stenosis and contraindications or high risk for surgery. Advances in prostheses and delivery system designs and continuous advances in multimodality imaging, particularly the 3-dimensional techniques, have led to improved outcomes with significant reductions in the incidence of frequent complications such as paravalvular aortic regurgitation. In addition, data on prosthesis durability are accumulating. Multimodality imaging plays a central role in the selection of patients who are candidates for transcatheter aortic valve replacement, procedure planning and guidance, and follow-up of prosthesis function. The strengths and limitations of each imaging technique for transcatheter aortic valve replacement will be discussed in this update article.
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744
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Heart valve disease: looking back and moving forward. Curr Opin Cardiol 2016; 31:125-6. [PMID: 26841326 DOI: 10.1097/hco.0000000000000270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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745
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Pislaru SV, Nkomo VT, Sandhu GS. Assessment of Prosthetic Valve Function After TAVR. JACC Cardiovasc Imaging 2016; 9:193-206. [DOI: 10.1016/j.jcmg.2015.11.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 11/29/2022]
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746
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Iung B, Rahimtoola SH, Vahanian A. The year in cardiology 2015: valvular heart disease. Eur Heart J 2016; 37:442-8. [PMID: 26726047 DOI: 10.1093/eurheartj/ehv719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/09/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bernard Iung
- Cardiology Department, Bichat Hospital, AP-HP, Paris Diderot University, DHU Fire, 46 rue Henri Huchard, Paris 75018, France
| | | | - Alec Vahanian
- Cardiology Department, Bichat Hospital, AP-HP, Paris Diderot University, DHU Fire, 46 rue Henri Huchard, Paris 75018, France
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747
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Bax JJ, Delgado V, Prendergast B. Does computed tomography detect bioprosthetic aortic valve thrombosis? New findings, new questions? Eur Heart J 2016; 37:2272-5. [DOI: 10.1093/eurheartj/ehv742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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748
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Waksman R. TAVR for patients with low risk for mortality is here for investigation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:1-2. [DOI: 10.1016/j.carrev.2016.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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749
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Wunderlich NC, Küx H, Kreidel F, Birkemeyer R, Siegel RJ. The Changing Paradigm in the Treatment of Structural Heart Disease and the Need for the Interventional Imaging Specialist. Interv Cardiol 2016; 11:135-139. [PMID: 29588721 DOI: 10.15420/icr.2016:12:2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Percutaneous interventions in structural heart diseases are emerging rapidly. The variety of novel percutaneous treatment approaches and the increasing complexity of interventional procedures are associated with new challenges and demands on the imaging specialist. Standard catheterisation laboratory imaging modalities such as fluoroscopy and contrast ventriculography provide inadequate visualisation of the soft tissue or three-dimensional delineation of the heart. Consequently, additional advanced imaging technology is needed to diagnose and precisely identify structural heart diseases, to properly select patients for specific interventions and to support fluoroscopy in guiding procedures. As imaging expertise constitutes a key factor in the decision-making process and in the management of patients with structural heart disease, the sub-speciality of interventional imaging will likely develop out of an increased need for high-quality imaging.
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Affiliation(s)
| | - Harald Küx
- Cardiovascular Center Darmstadt, Darmstadt, Germany
| | - Felix Kreidel
- Department of Cardiology, Asklepios Klinik, St Georg Hospital, Hamburg, Germany
| | | | - Robert J Siegel
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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750
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