51
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Forrest JK, Ramlawi B, Deeb GM, Zahr F, Song HK, Kleiman NS, Chetcuti SJ, Michelena HI, Mangi AA, Skiles JA, Huang J, Popma JJ, Reardon MJ. Transcatheter Aortic Valve Replacement in Low-risk Patients With Bicuspid Aortic Valve Stenosis. JAMA Cardiol 2021; 6:50-57. [PMID: 33031491 PMCID: PMC7542521 DOI: 10.1001/jamacardio.2020.4738] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/20/2020] [Indexed: 11/14/2022]
Abstract
Importance The outcomes of transcatheter aortic valve replacement (TAVR) in low-risk patients with bicuspid aortic valve stenosis have not been studied in a large scale, multicentered, prospective fashion. Objective To evaluate the procedural safety, efficacy, and 30-day outcomes of TAVR in patients with bicuspid aortic stenosis at low surgical risk. Design, Setting, and Participants The Low Risk Bicuspid Study is a prospective, single-arm trial study with inclusion/exclusion criteria developed from the Evolut Low Risk Randomized Trial. Follow-up is planned for 10 years. Patients underwent TAVR at 25 centers in the United States who were also participating in the Evolut Low Risk Randomized Trial from December 2018 to October 2019. Eligible patients had severe bicuspid aortic valve stenosis and met American Heart Association/American College of Cardiology guideline indications for aortic valve replacement. Interventions Patients underwent attempted implant of an Evolut or Evolut PRO transcatheter aortic valve, with valve size based on annular measurements. Main Outcomes and Measures The prespecified primary end point was the incidence of all-cause mortality or disabling stroke at 30 days. The prespecified primary efficacy end point was device success defined as the absence of procedural mortality, the correct position of 1 bioprosthetic heart valve in the proper anatomical location, and the absence of more than mild aortic regurgitation postprocedure. Results A total of 150 patients underwent an attempted implant. Baseline characteristics include mean age of 70.3 (5.5) years, 48.0% female (n = 72), and a mean Society of Thoracic Surgeons score of 1.4 (0.6%). Most patients (136; 90.7%) had Sievers type I valve morphology. The incidence of all-cause mortality or disabling stroke was 1.3% (95% CI, 0.3%-5.3%) at 30 days. The device success rate was 95.3% (95% CI, 90.5%-98.1%). At 30 days, the mean (SD) AV gradient was 7.6 (3.7) mm Hg and effective orifice area was 2.3 (0.7) cm2. A new permanent pacemaker was implanted in 22 patients (15.1%). No patients had greater than mild paravalvular leak. Conclusions and Relevance Transcatheter aortic valve replacement in low-surgical risk patients with bicuspid aortic valve stenosis achieved favorable 30-day results, with low rates of death and stroke and high device success rate. Trial Registration ClinicalTrials.gov Identifier: NCT03635424.
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Affiliation(s)
- John K. Forrest
- Departments of Internal Medicine (Cardiology) and Surgery (Cardiac Surgery), Yale University School of Medicine, New Haven, Connecticut
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery and Cardiology, Valley Health System, Winchester, Virginia
| | - G. Michael Deeb
- Departments of Cardiac Surgery and Interventional Cardiology, University of Michigan Hospitals, Ann Arbor
| | - Firas Zahr
- Departments of Interventional Cardiology and Cardiothoracic Surgery, Oregon Health and Science University, Portland
| | - Howard K. Song
- Departments of Interventional Cardiology and Cardiothoracic Surgery, Oregon Health and Science University, Portland
| | - Neal S. Kleiman
- Departments of Interventional Cardiology and Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Institute, Houston, Texas
| | - Stanley J. Chetcuti
- Departments of Cardiac Surgery and Interventional Cardiology, University of Michigan Hospitals, Ann Arbor
| | | | - Abeel A. Mangi
- Departments of Internal Medicine (Cardiology) and Surgery (Cardiac Surgery), Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey A. Skiles
- Department of Cardiothoracic Surgery and Cardiology, Valley Health System, Winchester, Virginia
| | - Jian Huang
- Department of Statistics, Medtronic, Minneapolis, Minnesota
| | - Jeffrey J. Popma
- Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael J. Reardon
- Departments of Interventional Cardiology and Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Institute, Houston, Texas
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52
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Tamburino C, Bleiziffer S, Thiele H, Scholtz S, Hildick-Smith D, Cunnington M, Wolf A, Barbanti M, Tchetchè D, Garot P, Pagnotta P, Gilard M, Bedogni F, Van Belle E, Vasa-Nicotera M, Chieffo A, Deutsch O, Kempfert J, Søndergaard L, Butter C, Trillo-Nouche R, Lotfi S, Möllmann H, Joner M, Abdel-Wahab M, Bogaerts K, Hengstenberg C, Capodanno D. Comparison of Self-Expanding Bioprostheses for Transcatheter Aortic Valve Replacement in Patients With Symptomatic Severe Aortic Stenosis. Circulation 2020; 142:2431-2442. [DOI: 10.1161/circulationaha.120.051547] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background:
Few randomized trials have compared bioprostheses for transcatheter aortic valve replacement, and no trials have compared bioprostheses with supra-annular design. The SCOPE 2 trial (Safety and Efficacy Comparison of Two TAVI Systems in a Prospective Randomized Evaluation 2) was designed to compare the clinical outcomes of the ACURATE neo and CoreValve Evolut bioprostheses for transcatheter aortic valve replacement.
Methods:
SCOPE 2 was a randomized trial performed at 23 centers in 6 countries between April 2017 and April 2019. Patients ≥75 years old with an indication for transfemoral transcatheter aortic valve replacement as agreed by the heart team were randomly assigned to receive treatment with either the ACURATE neo (n=398) or the CoreValve Evolut bioprostheses (n=398). The primary end point, powered for noninferiority of the ACURATE neo bioprosthesis, was all-cause death or stroke at 1 year. The key secondary end point, powered for superiority of the ACURATE neo bioprosthesis, was new permanent pacemaker implantation at 30 days.
Results:
Among 796 randomized patients (mean age, 83.2±4.3 years; mean Society of Thoracic Surgeons Predicted Risk of Mortality score, 4.6±2.9%), clinical follow-up information was available for 778 (98%) patients. Within 1 year, the primary end point occurred in 15.8% of patients in the ACURATE neo group and in 13.9% of patients in the CoreValve Evolut group (absolute risk difference, 1.8%, upper 1-sided 95% confidence limit, 6.1%;
P
=0.0549 for noninferiority). The 30-day rates of new permanent pacemaker implantation were 10.5% in the ACURATE neo group and 18.0% in the CoreValve Evolut group (absolute risk difference, –7.5% [95% CI, –12.4 to –2.60];
P
=0.0027). No significant differences were observed in the components of the primary end point. Cardiac death at 30 days (2.8% versus 0.8%;
P
=0.03) and 1 year (8.4% versus 3.9%;
P
=0.01), and moderate or severe aortic regurgitation at 30 days (10% versus 3%;
P
=0.002) were significantly increased in the ACURATE neo group.
Conclusions:
Transfemoral transcatheter aortic valve replacement with the self-expanding ACURATE neo did not meet noninferiority compared with the self-expanding CoreValve Evolut in terms of all-cause death or stroke at 1 year, and it was associated with a lower incidence of new permanent pacemaker implantation. In secondary analyses, the ACURATE neo was associated with more moderate or severe aortic regurgitation at 30 days and cardiac death at 30 days and 1 year.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03192813.
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Affiliation(s)
- Corrado Tamburino
- Department of General Surgery and Medical-Surgical Subspecialties, University of Catania, Italy (C.T., D.C.)
| | - Sabine Bleiziffer
- Department of Cardiothoracic Surgery (S.B.), Heart and Diabetes Center Northrhein-Westfalia, Bad Oeynhausen, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Germany (H.T., M.A.-W.)
| | - Smita Scholtz
- Department of Interventional Cardiology (S.S.), Heart and Diabetes Center Northrhein-Westfalia, Bad Oeynhausen, Germany
| | - David Hildick-Smith
- Department of Cardiology, Brighton and Sussex University Hospitals National Health Service Trust, Brighton, United Kingdom (D.H.-S.)
| | - Michael Cunnington
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals National Health Service Trust, United Kingdom (M.C.)
| | - Alexander Wolf
- Department of Cardiology, Elisabeth Hospital Essen, Germany (A.W.)
| | - Marco Barbanti
- Department of Cardio-Thoracic-Vascular Diseases and Transplantations, Azienda Ospedaliero-Universitaria Policlinico “G. Rodolico-San Marco,” Catania, Italy (M.B.)
| | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France (D.T.)
| | - Philippe Garot
- Hôpital Privé Jacques Cartier, Institut Cardio-vasculaire Paris-Sud, Ramsay-Santé, Massy, France (P.G.)
| | - Paolo Pagnotta
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Milano, Italy (P.P.)
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, France (M.G.)
| | - Francesco Bedogni
- Cardiology Department, Istituti di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milano, Italy (F.B.)
| | - Eric Van Belle
- Department of Cardiology, University Hospital, Lille, France (E.V.B.)
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany (M.V.-N.)
| | - Alaide Chieffo
- Interventional Cardiology Unit, Istituti di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy (A.C.)
| | - Oliver Deutsch
- Department of Cardiovascular Surgery, German Heart Centre Munich, Germany (O.D.)
| | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany (J.K.)
| | | | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg in Bernau and Brandenburg Medical School, Germany (C.B.)
| | - Ramiro Trillo-Nouche
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Spain (R.T.-N.)
| | - Shahram Lotfi
- Department of Cardiovascular Surgery, University Hospital RWTH Aachen, Germany (S.L.)
| | - Helge Möllmann
- Department of Cardiology, St Johannes Hospital, Dortmund, Germany (H.M.)
| | - Michael Joner
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (M.J.)
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Germany (H.T., M.A.-W.)
| | - Kris Bogaerts
- Department of Public Health and Primary Care, I-BioStat, KU Leuven, Belgium (K.B.)
- I-BioStat, Universiteit Hasselt, Belgium (K.B.)
| | | | - Davide Capodanno
- Department of General Surgery and Medical-Surgical Subspecialties, University of Catania, Italy (C.T., D.C.)
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53
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Armario X, Rosseel L, Kharbanda R, Khogali S, Abdel-Wahab M, Van Mieghem NM, Tchétché D, Dumonteil N, De Backer O, Cotton J, McGrath B, Balakrishnan D, Ali N, Farhan S, Joseph J, Charbonnier G, Okuno T, McHugh F, Hildick-Smith D, Gilgen N, Hokken T, Spence MS, Frerker C, Angelillis M, Grygier M, Cockburn J, Bjursten H, Jeger RV, Teles R, Petronio AS, Pilgrim T, Sinning JM, Nickenig G, Søndergaard L, Blackman DJ, Mylotte D. Transcatheter Aortic Valve Replacement With the LOTUS Edge System: Early European Experience. JACC Cardiovasc Interv 2020; 14:172-181. [PMID: 33478633 DOI: 10.1016/j.jcin.2020.09.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/10/2020] [Accepted: 09/29/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the short-term safety and efficacy of transcatheter aortic valve replacement (TAVR) with the LOTUS Edge system. BACKGROUND The LOTUS Edge system was commercially re-released in April 2019. The authors report the first European experience with this device. METHODS A multicenter, single-arm, retrospective registry was initiated to evaluate short-term clinical outcomes. Included cases are the first experience with this device and new implantation technique in Europe. Clinical, echocardiographic, and computed tomographic data were analyzed. Endpoints were defined according to Valve Academic Research Consortium-2 and were site reported. RESULTS Between April and November 2019, 286 consecutive patients undergoing TAVR with the LOTUS Edge system at 18 European centers were included. The mean age and Society of Thoracic Surgeons score were 81.2 ± 6.9 years and 5.2 ± 5.4%, respectively. Nearly one-half of all patients (47.9%) were considered to have complex anatomy. Thirty-day major adverse events included death (2.4% [n = 7]) and stroke (3.5% [n = 10]). After TAVR, the mean aortic valve area was 1.9 ± 0.9 cm2, and the mean transvalvular gradient was 11.9 ± 5.7 mm Hg. None or trace paravalvular leak (PVL) occurred in 84.4% and moderate PVL in 2.0%. There were no cases of severe PVL. New permanent pacemaker (PPM) implantation was required in 25.9% among all patients and 30.8% among PPM-naive patients. CONCLUSIONS Early experience with the LOTUS Edge system demonstrated satisfactory short-term safety and efficacy, favorable hemodynamic data, and very low rates of PVL in an anatomically complex cohort. New PPM implantation remained high. Further study will evaluate if increasing operator experience with the device and new implantation technique can reduce the incidence of PPM implantation.
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Affiliation(s)
- Xavier Armario
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Liesbeth Rosseel
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Rajesh Kharbanda
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Saib Khogali
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | | | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Didier Tchétché
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | | | - Ole De Backer
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - James Cotton
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Brian McGrath
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Deepu Balakrishnan
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Noman Ali
- Department of Cardiology, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Serdar Farhan
- Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - Jubin Joseph
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | | | - Taishi Okuno
- Department of Cardiology, University of Bern, Bern, Switzerland
| | - Fiachra McHugh
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - David Hildick-Smith
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Nicole Gilgen
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thijmen Hokken
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Mark S Spence
- Department of Cardiology, Belfast City Hospital Trust, Belfast, United Kingdom
| | - Christian Frerker
- Department of Cardiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Marco Angelillis
- Cardiothoracic Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - James Cockburn
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
| | - Raban V Jeger
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Rui Teles
- Department of Interventional Cardiology, UNICARV, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Anna S Petronio
- Cardiothoracic Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Thomas Pilgrim
- Department of Cardiology, University of Bern, Bern, Switzerland
| | | | - Georg Nickenig
- Department of Cardiology, University Hospital Bonn, Bonn, Germany
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Daniel J Blackman
- Department of Cardiology, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, Galway, Ireland; National University of Ireland Galway, Galway, Ireland.
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54
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Thiele H, Kurz T, Feistritzer HJ, Stachel G, Hartung P, Lurz P, Eitel I, Marquetand C, Nef H, Doerr O, Vigelius-Rauch U, Lauten A, Landmesser U, Treskatsch S, Abdel-Wahab M, Sandri M, Holzhey D, Borger M, Ender J, Ince H, Öner A, Meyer-Saraei R, Hambrecht R, Fach A, Augenstein T, Frey N, König IR, Vonthein R, Rückert Y, Funkat AK, Desch S, Berggreen AE, Heringlake M, de Waha-Thiele S. General Versus Local Anesthesia With Conscious Sedation in Transcatheter Aortic Valve Implantation. Circulation 2020; 142:1437-1447. [DOI: 10.1161/circulationaha.120.046451] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background:
In clinical practice, local anesthesia with conscious sedation (CS) is performed in roughly 50% of patients undergoing transcatheter aortic valve replacement. However, no randomized data assessing the safety and efficacy of CS versus general anesthesia (GA) are available.
Methods:
The SOLVE-TAVI (Comparison of Second-Generation Self-Expandable Versus Balloon-Expandable Valves and General Versus Local Anesthesia in Transcatheter Aortic Valve Implantation) trial is a multicenter, open-label, 2×2 factorial, randomized trial of 447 patients with aortic stenosis undergoing transfemoral transcatheter aortic valve replacement comparing CS versus GA. The primary efficacy end point was powered for equivalence (equivalence margin 10% with significance level 0.05) and consisted of the composite of all-cause mortality, stroke, myocardial infarction, infection requiring antibiotic treatment, and acute kidney injury at 30 days.
Results:
The primary composite end point occurred in 27.2% of CS and 26.4% of GA patients (rate difference, 0.8 [90% CI, −6.2 to 7.8];
P
equivalence
=0.015). Event rates for the individual components were as follows: all-cause mortality, 3.2% versus 2.3% (rate difference, 1.0 [90% CI, −2.9 to 4.8];
P
equivalence
<0.001); stroke, 2.4% versus 2.8% (rate difference, −0.4 [90% CI, −3.8 to 3.8];
P
equivalence
<0.001); myocardial infarction, 0.5% versus 0.0% (rate difference, 0.5 [90% CI, −3.0 to 3.9];
P
equivalence
<0.001), infection requiring antibiotics 21.1% versus 22.0% (rate difference, −0.9 [90% CI, −7.5 to 5.7];
P
equivalence
=0.011); acute kidney injury, 9.0% versus 9.2% (rate difference, −0.2 [90% CI, −5.2 to 4.8];
P
equivalence
=0.0005). There was a lower need for inotropes or vasopressors with CS (62.8%) versus GA (97.3%; rate difference, −34.4 [90% CI, −41.0 to −27.8]).
Conclusions:
Among patients with aortic stenosis undergoing transfemoral transcatheter aortic valve replacement, use of CS compared with GA resulted in similar outcomes for the primary efficacy end point. These findings suggest that CS can be safely applied for transcatheter aortic valve replacement.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02737150.
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Affiliation(s)
- Holger Thiele
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Thomas Kurz
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Germany (T.K., I.E., C.M., R.M.-S., A.E.B., M.H., S.d.W.-T.)
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
| | - Hans-Josef Feistritzer
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Georg Stachel
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Philipp Hartung
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Ingo Eitel
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Germany (T.K., I.E., C.M., R.M.-S., A.E.B., M.H., S.d.W.-T.)
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
| | - Christoph Marquetand
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Germany (T.K., I.E., C.M., R.M.-S., A.E.B., M.H., S.d.W.-T.)
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
| | - Holger Nef
- Universitätsklinikum Marburg/Gießen, Gießen, Germany (H.N., O.D., U.V.-R.)
| | - Oliver Doerr
- Universitätsklinikum Marburg/Gießen, Gießen, Germany (H.N., O.D., U.V.-R.)
| | | | - Alexander Lauten
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
- Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, Germany (A.L., U.L., S.T.)
| | - Ulf Landmesser
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
- Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, Germany (A.L., U.L., S.T.)
| | - Sascha Treskatsch
- Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, Germany (A.L., U.L., S.T.)
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Marcus Sandri
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
| | - David Holzhey
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Michael Borger
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Jörg Ender
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Hüseyin Ince
- Universitätsklinikum Rostock, Germany (H.I., A.Ö.)
| | - Alper Öner
- Universitätsklinikum Rostock, Germany (H.I., A.Ö.)
| | - Roza Meyer-Saraei
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Germany (T.K., I.E., C.M., R.M.-S., A.E.B., M.H., S.d.W.-T.)
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
| | | | - Andreas Fach
- Klinikum Links der Weser, Bremen, Germany (R.H., A.F., T.A.)
| | | | - Norbert Frey
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
- University Clinic Schleswig-Holstein, Kiel, Germany (N.F.)
| | - Inke R. König
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
- Institut für Medizinische Biometrie und Statistik, University of Lübeck, Germany (I.R.K., R.V.)
| | - Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, University of Lübeck, Germany (I.R.K., R.V.)
| | - Yvonne Rückert
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Anne-Kathrin Funkat
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Steffen Desch
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
| | - Astrid E. Berggreen
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Germany (T.K., I.E., C.M., R.M.-S., A.E.B., M.H., S.d.W.-T.)
| | - Matthias Heringlake
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Germany (T.K., I.E., C.M., R.M.-S., A.E.B., M.H., S.d.W.-T.)
| | - Suzanne de Waha-Thiele
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Germany (T.K., I.E., C.M., R.M.-S., A.E.B., M.H., S.d.W.-T.)
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
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55
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Moriyama N, Lehtola H, Miyashita H, Piuhola J, Niemelä M, Laine M. Hemodynamic comparison of transcatheter aortic valve replacement with the SAPIEN 3 Ultra versus SAPIEN 3: The HomoSAPIEN registry. Catheter Cardiovasc Interv 2020; 97:E982-E991. [PMID: 32966682 PMCID: PMC8247002 DOI: 10.1002/ccd.29281] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/21/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022]
Abstract
Objectives The study aims to compare the hemodynamic and clinical outcomes of the SAPIEN 3 Ultra (S3‐Ultra) with the SAPIEN 3 (S3) system in patients who underwent transfemoral transcatheter aortic valve replacement (TF‐TAVR). Background The new balloon‐expandable S3‐Ultra system incorporates new features to reduce paravalvular leakage (PVL). However, the data after the S3‐Ultra implantation is very limited. Methods A total of 282 consecutive patients who underwent TF‐TAVR with the S3‐Ultra and the S3 were evaluated. The primary outcome of this study was to compare the incidence of ≥mild PVL after the S3‐Ultra and S3 implantation. Results Between June 2017 and November 2019, 141 patients with the S3‐Ultra and 141 patients with the S3 were identified with similar baseline and preprocedural imaging characteristics (mean age: 79.6 ± 6.7 years and mean aortic annulus area: 492.5 ± 91.2 mm2). In total, 83 patients (29.4%) were treated with 29‐mm valve. Predischarge echocardiography demonstrated a significantly lower incidence of ≥mild PVL (the total cohort: 7.2 vs. 22.3%, p < .001, and the cohort excluding 29‐mm valve: 4.0 vs. 21.4%, p = .03) for the S3‐Ultra. The S3‐Ultra system, especially 20‐, 23‐, and 26‐mm valve, was associated with significantly lower risk of ≥mild PVL compared with the S3 system in multivariate analysis. There were no significant differences in clinical outcomes at 30‐day between these groups, except for the lower incidence of major vascular complication (4.5 vs. 11.4%, p = .05) in patients with the S3‐Ultra. Conclusions In this registry, the S3‐Ultra system performed superiorly to the S3, as demonstrated by reduced ≥mild PVL, with comparable safety.
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Affiliation(s)
- Noriaki Moriyama
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland.,Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Heidi Lehtola
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Hirokazu Miyashita
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
| | - Jarkko Piuhola
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Matti Niemelä
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Mika Laine
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
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56
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Claessen BE, Tang GHL, Kini AS, Sharma SK. Considerations for Optimal Device Selection in Transcatheter Aortic Valve Replacement: A Review. JAMA Cardiol 2020; 6:102-112. [PMID: 32902569 DOI: 10.1001/jamacardio.2020.3682] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Aortic valve stenosis (AS) is the most common manifestation of acquired valvular heart disease in developed countries. Several large-scale randomized clinical trials investigating the entire spectrum of patients with severe symptomatic AS from low to prohibitive risk have established transcatheter aortic valve replacement (TAVR) as a safe and effective alternative to surgical aortic valve replacement. Observations There are currently only 3 types of TAVR devices commercially available in the US, but several other valve types are undergoing clinical trials in the US. Because of fundamental differences in engineering features, each TAVR device type has specific strengths and limitations. This review aims to provide an overview of design features and clinical outcomes of various TAVR devices that are either commercially available or undergoing clinical investigation. Conclusions and Relevance Given the lack of large-scale head-to-head comparisons of various TAVR devices and the rapid development of new device iterations, there is insufficient evidence to claim superiority of one device type over another. Nonetheless, as each TAVR device has unique design characteristics, certain patient-related and anatomy-related factors may slightly favor one or several particular designs.
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Affiliation(s)
- Bimmer E Claessen
- Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York.,Division of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna S Kini
- Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K Sharma
- Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
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57
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Yin WH, Lee YT, Tsao TP, Wei J. Delayed Coronary Obstruction after Transcatheter Aortic Valve Replacement - An Uncommon But Serious Complication. ACTA CARDIOLOGICA SINICA 2020; 36:409-415. [PMID: 32952350 PMCID: PMC7490610 DOI: 10.6515/acs.202009_36(5).20200516a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
As transcatheter aortic valve replacement (TAVR) becomes the mainstream treatment for valvular aortic stenosis, it is vitally important to recognize its associated procedural complications. Among the clinically relevant but uncommonly seen complications, the development of delayed coronary obstruction (DCO) occurring during the early post-procedural phase or even later following the index TAVR procedure, has been reported. These reports have raised concerns as TAVR comes more common in lower-risk patients. In this review article, we explored the implications of DCO for pre-procedural computed tomography evaluation, valve selection and sizing, intra-procedural manipulation, and approaches to post-procedural management.
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Affiliation(s)
- Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital;
,
Faculty of Medicine
| | - Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital;
,
Institute of Microbiology and Immunology, School of Medicine, National Yang Ming University
| | - Tien-Ping Tsao
- Heart Center, Cheng Hsin General Hospital;
,
Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital;
,
Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
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58
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Goel K, O'Leary JM, Barker CM, Levack M, Rajagopal V, Makkar RR, Bajwa T, Kleiman N, Linke A, Kereiakes DJ, Waksman R, Allocco DJ, Rizik DG, Reardon MJ, Lindman BR. Clinical Implications of Physical Function and Resilience in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2020; 9:e017075. [PMID: 32856530 PMCID: PMC7660783 DOI: 10.1161/jaha.120.017075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Gait speed is a reliable measure of physical function and frailty in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). Slow gait speed pre‐TAVR predicts worse clinical outcomes post‐TAVR. The consequences of improved versus worsened physical function post‐TAVR are unknown. Methods and Results The REPRISE III (Repositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of Lotus Valve System–Randomized Clinical Evaluation) trial randomized high/extreme risk patients to receive a mechanically‐expanded or self‐expanding transcatheter heart valve. Of 874 patients who underwent TAVR, 576 with complete data at baseline and 1 year were included in this analysis. Slow gait speed in the 5‐m walk test was defined as <0.83 m/s. A clinically meaningful improvement (≥0.1 m/s) in gait speed 1 year after TAVR occurred in 39% of patients, 35% exhibited no change, and 26% declined (≥0.1 m/s). Among groups defined by baseline/1‐year post‐TAVR gait speeds, 1‐ to 2‐year mortality or hospitalization rates were as follows: 6.6% (normal/normal), 8.0% (slow/normal), 20.9% (normal/slow), and 21.5% (slow/slow). After adjustment, slow gait speed at 1 year (regardless of baseline speed) was associated with a 3.5‐fold increase in death/hospitalization between 1 and 2 years compared with those with normal baseline/1‐year gait speed. Patients whose slow gait speed normalized at 1 year had no increased risk. One‐year, but not baseline, gait speed was associated with death or hospitalization between 1 and 2 years (adjusted hazard ratio, 0.83 per 0.1 m/s faster gait; 95% CI, 0.74–0.93, P=0.001). Conclusions Marked heterogeneity exists in the trajectory of physical function after TAVR and this, more than baseline function, has clinical consequences. Identifying and optimizing factors associated with physical resilience after TAVR may improve outcomes. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02202434.
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Affiliation(s)
- Kashish Goel
- Structural Heart and Valve Center Vanderbilt University Medical Center Nashville TN.,Cardiovascular Medicine Division Vanderbilt University Medical Center Nashville TN
| | - Jared M O'Leary
- Structural Heart and Valve Center Vanderbilt University Medical Center Nashville TN.,Cardiovascular Medicine Division Vanderbilt University Medical Center Nashville TN
| | - Colin M Barker
- Structural Heart and Valve Center Vanderbilt University Medical Center Nashville TN.,Cardiovascular Medicine Division Vanderbilt University Medical Center Nashville TN
| | - Melissa Levack
- Structural Heart and Valve Center Vanderbilt University Medical Center Nashville TN.,Cardiac Surgery Department Vanderbilt University Medical Center Nashville TN
| | - Vivek Rajagopal
- Marcus Heart Valve Center Piedmont Heart Institute Atlanta GA
| | - Raj R Makkar
- Smidt Heart Institute, Cedars - Sinai Heart Institute Los Angeles CA
| | - Tanvir Bajwa
- Aurora Cardiovascular Services Aurora Sinai/Aurora St. Luke's Medical Centers Milwaukee WI
| | - Neal Kleiman
- Department of Cardiovascular Surgery Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Axel Linke
- Department of Internal Medicine and Cardiology Heart Center Dresden Technical University of Dresden Germany
| | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center Lindner Research Center Cincinnati OH
| | - Ron Waksman
- Section of Interventional Cardiology MedStar Washington Hospital Center Washington DC
| | | | - David G Rizik
- HonorHealth and the Scottsdale-Lincoln Health Network Scottsdale AZ
| | - Michael J Reardon
- Department of Cardiovascular Surgery Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Brian R Lindman
- Structural Heart and Valve Center Vanderbilt University Medical Center Nashville TN.,Cardiovascular Medicine Division Vanderbilt University Medical Center Nashville TN
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59
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Barthélémy O, Collet JP. Would Anyone Dare Abandon Repositioning of Self-Expanding TAVR? JACC Cardiovasc Interv 2020; 13:1825-1827. [PMID: 32763074 DOI: 10.1016/j.jcin.2020.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Olivier Barthélémy
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié-Salpêtrière University Hospital (AP-HP), Paris, France.
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié-Salpêtrière University Hospital (AP-HP), Paris, France
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60
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Meta-analysis Comparing Outcomes of Self-Expanding Versus Balloon-Expandable Valves for Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 128:202-209. [PMID: 32534734 DOI: 10.1016/j.amjcard.2020.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 01/08/2023]
Abstract
There are two commercially available transcatheter heart valve systems: balloon expandable valves (BEV) and self-expanding valves (SEV). However, there is a paucity of randomized trials comparing both systems. Electronic databases (Medline, the Cochrane Library, Web of Science, and clinicaltrials.gov) and major conference proceedings were searched for randomized trials of patients with symptomatic severe aortic stenosis and received transcatheter aortic valve implantation (TAVI) with a SEV or BEV or surgical aortic valve replacement. The main efficacy outcomes were all-cause mortality and stroke at the longest available follow-up. The main analysis was performed using a random-effects network meta-analysis complemented by several subgroup and sensitivity analyses. Ten trials with 9,439 patients (mostly undergoing transfemoral TAVI) were included. At a median of 27 months, there was no difference between BEV and SEV valves in terms of all-cause mortality (odds ratio [OR] 1.05, 95% confidence interval [CI] 0.79 to 1.42). The incidence of any stroke was higher with BEV (OR 1.51, 95% CI 1.01 to 2.26), but there was no difference in the incidence of disabling stroke. At 30-days, BEV valves were associated with lower incidence of new permanent pacemaker placement (OR 0.50, 95% CI 0.32 to 0.79) and moderate/severe paravalvular regurgitation (OR 0.39, 95% CI 0.22 to 0.68). In conclusion, in patients with severe symptomatic aortic stenosis undergoing transfemoral TAVI, SEV and BEV were associated with similar all-cause mortality. BEV were associated with a higher incidence of any stroke driven by nondisabling strokes, but lower incidence of new permanent pacemaker placement and moderate/severe paravalvular regurgitation compared with SEV.
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61
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Lin SI, Miura M, Tagliari AP, Lee YH, Shirai S, Puri R, Maisano F, Taramasso M. Intraventricular Conduction Disturbances After Transcatheter Aortic Valve Implantation. ACTA ACUST UNITED AC 2020; 15:e11. [PMID: 32905123 PMCID: PMC7463330 DOI: 10.15420/icr.2020.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/09/2020] [Indexed: 12/12/2022]
Abstract
Despite significant improvements in transcatheter aortic valve implantation (TAVI) outcomes, periprocedural conduction disturbances, such as new-onset left bundle branch block (LBBB) and new pacemaker implantation (PMI), remain relatively frequent concerns. The development of periprocedural conduction disturbances can be explained by the proximity between the aortic valve and the conduction system. Although prior studies reported heterogeneity in PMI rates after TAVI, current evidence supports the potentially deleterious consequence of LBBB and PMI, and several predisposing factors have been reported. Therefore, new strategies to avoid conduction disturbances and to improve their management are required, particularly with the current trend to expand TAVI to a low-risk population.
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Affiliation(s)
- Shu-I Lin
- Cardiovascular Center, MacKay Memorial Hospital Taipei, Taiwan
| | - Mizuki Miura
- Department of Cardiac Surgery, University Hospital Zurich Zurich, Switzerland
| | - Ana Paula Tagliari
- Department of Cardiac Surgery, University Hospital Zurich Zurich, Switzerland
| | - Ying-Hsian Lee
- Cardiovascular Center, MacKay Memorial Hospital Taipei, Taiwan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital Fukuoka, Japan
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic Cleveland, OH, US
| | - Francesco Maisano
- Department of Cardiac Surgery, University Hospital Zurich Zurich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiac Surgery, University Hospital Zurich Zurich, Switzerland
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62
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Fontana GP, Bedogni F, Groh M, Smith D, Chehab BM, Garrett HE, Yong G, Worthley S, Manoharan G, Walton A, Hermiller J, Dhar G, Waksman R, Ramana RK, Mahoney P, Asch FM, Chakravarty T, Jilaihawi H, Makkar RR. Safety Profile of an Intra-Annular Self-Expanding Transcatheter Aortic Valve and Next-Generation Low-Profile Delivery System. JACC Cardiovasc Interv 2020; 13:2467-2478. [PMID: 33153563 DOI: 10.1016/j.jcin.2020.06.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of this study was to characterize the safety profile of an intra-annular self-expanding valve with a next-generation low-profile delivery system (DS). BACKGROUND Key design modifications to the FlexNav DS include the addition of a hydrophilic-coated, integrated sheath and stability layer to facilitate gradual, controlled deployment in vessels with diameter ≥5 mm. METHODS Patients were pooled from 2 concurrent prospective, multicenter, single-arm studies (FlexNav DS arm of PORTICO IDE [Portico Re-Sheathable Transcatheter Aortic Valve System U.S. IDE Trial] [n = 134] and the FlexNav EU CE Mark Study [n = 46]) for the analysis. The primary endpoint was Valve Academic Research Consortium-2-defined major vascular complications at 30 days. Clinical outcomes and valve performance were assessed through 30 days by an independent clinical events committee and an echocardiography core laboratory, respectively. RESULTS One hundred forty high-risk and 40 extreme-risk subjects enrolled between October 15, 2018, and December 10, 2019, from 28 sites in the United States, Australia, and Europe who underwent attempted transfemoral Portico valve implantation were included. The mean age was 85.1 ± 5.6 years, 60% were women, the mean Society of Thoracic Surgeons score was 5.3%, and 96.1% presented with ≥1 frailty factor. Technical device success was 96.7%. At 30 days, the rate of major vascular complications was 5.0%, with 4.4% of complications adjudicated as access site-related (3.3% transcatheter aortic valve replacement DS access site-related). Death (0.6%) and disabling stroke (1.1%) were rare. The rate of new permanent pacemaker implantation was 15.4%. Echocardiography revealed a mean gradient of 7.1 ± 3.2 mm Hg, mean valve area of 1.77 ± 0.41 cm2, and a 4.1% rate of moderate paravalvular leak at 30 days. CONCLUSIONS Portico valve implantation with the FlexNav DS was associated with an excellent safety profile at 30 days.
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Affiliation(s)
- Gregory P Fontana
- Cardiovascular Institute, Los Robles Regional Medical Center, Thousand Oaks, California.
| | | | - Mark Groh
- Mission Health and Hospitals, Asheville, North Carolina
| | - David Smith
- Morriston Hospital - Swansea Bay University Health Board, Swansea, United Kingdom
| | - Bassem M Chehab
- Ascension Via Christi Hospital, University of Kansas, Wichita, Kansas
| | - H Edward Garrett
- Department of Surgery, University of Tennessee, Memphis, Tennessee
| | | | - Stephen Worthley
- Royal Adelaide Hospital, Adelaide, Australia; Genesis Care, Sydney, Australia
| | | | | | | | - Gaurav Dhar
- Sparrow Clinical Research Institute, Lansing, Michigan
| | - Ron Waksman
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Ravi K Ramana
- Advocate Christ Medical Center, Oak Lawn, Illinois; Heart Care Centers of Illinois, Palos Park, Illinois
| | - Paul Mahoney
- Sentara Norfolk General Hospital, Norfolk, Virginia
| | - Federico M Asch
- MedStar Health Research Institute, Washington, District of Columbia
| | - Tarun Chakravarty
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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63
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The Sky Is Not Falling: Surgical Perspectives on a New Transcatheter Paradigm. Can J Cardiol 2020; 37:22-26. [PMID: 32649869 DOI: 10.1016/j.cjca.2020.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 11/21/2022] Open
Abstract
The role of cardiac surgeons in the treatment of aortic valve disease is changing with the expansion of transcatheter aortic valve replacement. Recent trials in patients at low surgical risk will further this paradigm shift, and the future cardiac surgeons in this space remain uncertain. In this Viewpoint article, we discuss the role that surgeons can play in the future of structural heart medicine. We examine the potential effects of the low-risk transcatheter aortic valve replacement trials on overall operative volumes and how these effects may be limited through structured training programs and strong collaboration within the heart team. Finally, future considerations and cautions for the cardiac surgical community are discussed. The coming era presents an opportunity for growth, leadership, and strong interdisciplinary collaboration for the cardiac surgery community.
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64
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Goldsweig AM, Aronow HD. Editorial: Cerebral Embolic Protection for TAVR: Don't Let It Go to Your Head. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:723-725. [PMID: 32593597 DOI: 10.1016/j.carrev.2020.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America.
| | - Herbert D Aronow
- Lifespan Cardiovascular Institute and Warren Alpert Medical School of Brown University, Providence, RI, United States of America
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65
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Bruno AG, Santona L, Palmerini T, Taglieri N, Marrozzini C, Ghetti G, Orzalkiewicz M, Galiè N, Saia F. Predicting and improving outcomes of transcatheter aortic valve replacement in older adults and the elderly. Expert Rev Cardiovasc Ther 2020; 18:663-680. [DOI: 10.1080/14779072.2020.1778465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Antonio Giulio Bruno
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Laura Santona
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Tullio Palmerini
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Nevio Taglieri
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
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66
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Reichlin T, Pilgrim T. Functional Assessment of the Conduction System: The Key to Early Discharge After TAVR? JACC Cardiovasc Interv 2020; 13:1055-1057. [PMID: 32305397 DOI: 10.1016/j.jcin.2020.02.017] [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: 02/05/2020] [Accepted: 02/11/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Guedeney P, Huchet F, Manigold T, Overtchouk P, Rouanet S, Balagny P, Leprince P, Lebreton G, Letocart V, Barthelemy O, Vicaut E, Montalescot G, Guerin P, Collet JP. Effect of oral anticoagulation on clinical outcomes and haemodynamic variables after successful transcatheter aortic valve implantation. Arch Cardiovasc Dis 2020; 113:341-349. [DOI: 10.1016/j.acvd.2019.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/11/2019] [Accepted: 12/19/2019] [Indexed: 11/27/2022]
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Esposito G, Franzone A. Transcatheter Heart Valves. JACC Cardiovasc Interv 2020; 13:1083-1085. [DOI: 10.1016/j.jcin.2020.01.236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/21/2020] [Indexed: 11/16/2022]
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Katta N, Abbott JD, Kalra A, Alenezi F, Goldsweig A, Aronow H, Velagapudi P. Management of Coronary Artery Disease in the Setting of Transcatheter Aortic Valve Replacement. Heart Int 2020; 14:24-28. [PMID: 36277671 PMCID: PMC9524713 DOI: 10.17925/hi.2020.14.1.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/06/2020] [Indexed: 07/21/2023] Open
Abstract
Aortic stenosis and coronary artery disease (CAD) frequently co-exist, as they share a common pathophysiology and risk factors. Due to lack of randomised controlled trials (RCTs) and exclusion of significant CAD in transcatheter aortic valve replacement (TAVR) trials, the optimal method of revascularisation of CAD in patients undergoing TAVR remains unknown. Observational studies and meta-analyses have shown varied results in outcomes for patients with CAD undergoing TAVR, and no significant difference in post-TAVR outcomes in patients who underwent revascularisation either prior to or during TAVR versus those who did not. However, some observational studies have shown that patients with lower residual SYNTAX score (rSS) post-revascularisation have better outcomes post-TAVR compared to those with higher rSS. RCTs are needed to clearly understand whether revascularisation is beneficial in these patients. Until then, management of CAD in patients undergoing TAVR must be individualised based on discussion with the heart team.
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Affiliation(s)
- Natraj Katta
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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Ueyama H, Kuno T, Ando T, Hayashida K, Takagi H. Network Meta-analysis of Surgical Aortic Valve Replacement and Different Transcatheter Heart Valve Systems for Symptomatic Severe Aortic Stenosis. Can J Cardiol 2020; 37:27-36. [PMID: 32569594 DOI: 10.1016/j.cjca.2020.02.088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/14/2020] [Accepted: 02/23/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although different transcatheter heart valve (THV) systems have been introduced to overcome transcatheter aortic valve replacement (TAVR)-specific complications, head-to-head comparisons of these THV systems are scarce. The aim of this study was to compare different THV systems and surgical aortic valve replacement (SAVR) by conducting a network meta-analysis. METHODS PubMed and EMBASE were searched through November 2019 for studies comparing safety and efficacy of balloon-expandable valve (BEV), self-expanding valve (SEV), mechanically expandable valve (MEV), and SAVR for symptomatic severe aortic stenosis. End points in the short term at 30 days or discharge and the long term up to 2 years were assessed. RESULTS We identified 11 randomized controlled trials with a total of 10,300 patients eligible for inclusion in our study. There were no significant differences in all-cause death among different THV systems and SAVR in both short and long terms. Disabling stroke was significantly lower with MEV vs BEV and SAVR (hazard ratios [HRs] 0.31 [95% confidence interval [CI] 0.12-0.77] and 0.33 [95% CI 0.14-0.76], respectively) in the long term. MEV was associated with an increased risk of new permanent pacemaker implantation compared with BEV, SEV, and SAVR (HRs 3.82 [95% CI 1.83-7.97], 1.85 [95% CI 1.02-3.36], and 5.23 [95% CI 2.61-10.47], respectively) in the long term. CONCLUSIONS In patients with symptomatic severe aortic stenosis undergoing intervention, there were no significant differences in all-cause death among different THV systems and SAVR. MEV had low frequency of disabling stroke compared with BEV and SAVR, but an increased frequency of permanent pacemaker implantation compared with other interventions.
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Affiliation(s)
- Hiroki Ueyama
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA.
| | - Tomo Ando
- Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA
| | - Kentaro Hayashida
- Division of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
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Reiff C, Zhingre Sanchez JD, Mattison LM, Iaizzo PA, Garcia S, Raveendran G, Gurevich S. 3-Dimensional printing to predict paravalvular regurgitation after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 96:E703-E710. [PMID: 32077222 DOI: 10.1002/ccd.28783] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/29/2019] [Accepted: 02/10/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is no effective method to predict paravalvular regurgitation prior to transcatheter aortic valve replacement (TAVR). METHODS We retrospectively analyzed pre-TAVR computed tomography (CT) scans of 20 patients who underwent TAVR for severe, calcific aortic stenosis and subsequently printed 3-dimensional (3D) aortic root models of each patient. Models were printed using Ninjaflex thermoplastic polyurethane (TPU) (Ninjatek Manheim, PA) and TPU 95A (Ultimaker, Netherlands) on Ultimaker 3 Extended 3D printer (Ultimaker, Netherlands). The models were implanted at nominal pressure with same sized Sapien balloon-expandable frames (Edwards Lifesciences, CA) as received in-vivo. Ex-vivo implanted TAVR models (eTAVR) were scanned using Siemens SOMATOM flash dual source CT (Siemens, Malvern, PA) and then analyzed with Mimics software (Materialize NV, Leuven, Belgium) to evaluate relative stent appositions. eTAVR were then compared to post-TAVR echocardiograms for each patient to assess for correlations of identified and predicted paravalvular leak (PVL) locations. RESULTS A total of 20 patients (70% male) were included in this study. The median age was 77.5 (74-83.5) years. Ten patients were characterized to elicit mild (9/10) or moderate (1/10) PVL, and 10 patients presented no PVL. In patients with echocardiographic PVL, eTAVR 3D model analyses correctly identified the site of PVL in 8/10 cases. In patients without echocardiographic PVL, eTAVR 3D model analyses correctly predicted the lack of PVL in 9/10 cases. CONCLUSION 3D printing may help predict the potential locations of associated PVL post-TAVR, which may have implications for optimizing valve selection and sizing.
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Affiliation(s)
- Christopher Reiff
- University of Minnesota Fairview Medical Center, Minneapolis, Minnesota
| | - Jorge D Zhingre Sanchez
- Department of Surgery, The Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Lars M Mattison
- Department of Surgery, The Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Paul A Iaizzo
- Department of Surgery, The Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Santiago Garcia
- University of Minnesota Fairview Medical Center, Minneapolis, Minnesota.,Minneapolis Heart Institute, Minneapolis, Minnesota
| | - Ganesh Raveendran
- University of Minnesota Fairview Medical Center, Minneapolis, Minnesota
| | - Sergey Gurevich
- University of Minnesota Fairview Medical Center, Minneapolis, Minnesota
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Thiele H, Kurz T, Feistritzer HJ, Stachel G, Hartung P, Eitel I, Marquetand C, Nef H, Doerr O, Lauten A, Landmesser U, Abdel-Wahab M, Sandri M, Holzhey D, Borger M, Ince H, Öner A, Meyer-Saraei R, Wienbergen H, Fach A, Frey N, König IR, Vonthein R, Rückert Y, Funkat AK, de Waha-Thiele S, Desch S. Comparison of newer generation self-expandable vs. balloon-expandable valves in transcatheter aortic valve implantation: the randomized SOLVE-TAVI trial. Eur Heart J 2020; 41:1890-1899. [DOI: 10.1093/eurheartj/ehaa036] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/09/2019] [Accepted: 01/23/2020] [Indexed: 12/14/2022] Open
Abstract
Abstract
Aims
Transcatheter aortic valve implantation (TAVI) has emerged as established treatment option in patients with symptomatic aortic stenosis. Technical developments in valve design have addressed previous limitations such as suboptimal deployment, conduction disturbances, and paravalvular leakage. However, there are only limited data available for the comparison of newer generation self-expandable valve (SEV) and balloon-expandable valve (BEV).
Methods and results
SOLVE-TAVI is a multicentre, open-label, 2 × 2 factorial, randomized trial of 447 patients with aortic stenosis undergoing transfemoral TAVI comparing SEV (Evolut R, Medtronic Inc., Minneapolis, MN, USA) with BEV (Sapien 3, Edwards Lifesciences, Irvine, CA, USA). The primary efficacy composite endpoint of all-cause mortality, stroke, moderate/severe prosthetic valve regurgitation, and permanent pacemaker implantation at 30 days was powered for equivalence (equivalence margin 10% with significance level 0.05). The primary composite endpoint occurred in 28.4% of SEV patients and 26.1% of BEV patients meeting the prespecified criteria of equivalence [rate difference −2.39 (90% confidence interval, CI −9.45 to 4.66); Pequivalence = 0.04]. Event rates for the individual components were as follows: all-cause mortality 3.2% vs. 2.3% [rate difference −0.93 (90% CI −4.78 to 2.92); Pequivalence < 0.001], stroke 0.5% vs. 4.7% [rate difference 4.20 (90% CI 0.12 to 8.27); Pequivalence = 0.003], moderate/severe paravalvular leak 3.4% vs. 1.5% [rate difference −1.89 (90% CI −5.86 to 2.08); Pequivalence = 0.0001], and permanent pacemaker implantation 23.0% vs. 19.2% [rate difference −3.85 (90% CI −10.41 to 2.72) in SEV vs. BEV patients; Pequivalence = 0.06].
Conclusion
In patients with aortic stenosis undergoing transfemoral TAVI, newer generation SEV and BEV are equivalent for the primary valve-related efficacy endpoint. These findings support the safe application of these newer generation percutaneous valves in the majority of patients with some specific preferences based on individual valve anatomy.
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Affiliation(s)
- Holger Thiele
- Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, D-04289 Leipzig, Germany
| | - Thomas Kurz
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Hans-Josef Feistritzer
- Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, D-04289 Leipzig, Germany
| | - Georg Stachel
- Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, D-04289 Leipzig, Germany
| | - Philipp Hartung
- Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, D-04289 Leipzig, Germany
| | - Ingo Eitel
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Christoph Marquetand
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Holger Nef
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Marburg/Gießen, Klinikstr. 33, D-35392 Gießen, Germany
| | - Oliver Doerr
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Marburg/Gießen, Klinikstr. 33, D-35392 Gießen, Germany
| | - Alexander Lauten
- German Center for Cardiovascular Research (DZHK), Ratzeburger Allee 160, D-23538 Lübeck, Germany
- Universitätsklinikum Charité, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany
| | - Ulf Landmesser
- German Center for Cardiovascular Research (DZHK), Ratzeburger Allee 160, D-23538 Lübeck, Germany
- Universitätsklinikum Charité, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, D-04289 Leipzig, Germany
| | - Marcus Sandri
- Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, D-04289 Leipzig, Germany
| | - David Holzhey
- Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, D-04289 Leipzig, Germany
| | - Michael Borger
- Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, D-04289 Leipzig, Germany
| | - Hüseyin Ince
- Medizinische Klinik I im Zentrum für Innere Medizin (ZIM), Universitätsklinikum Rostock, Ernst-Heydemann-Str. 6, D-18057 Rostock, Germany
| | - Alper Öner
- Medizinische Klinik I im Zentrum für Innere Medizin (ZIM), Universitätsklinikum Rostock, Ernst-Heydemann-Str. 6, D-18057 Rostock, Germany
| | - Roza Meyer-Saraei
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Harm Wienbergen
- Klinikum Links der Weser, Herzzentrum Bremen, Senator-Wessling-Str. 1, D-28277 Bremen, Germany
| | - Andreas Fach
- Klinikum Links der Weser, Herzzentrum Bremen, Senator-Wessling-Str. 1, D-28277 Bremen, Germany
| | - Norbert Frey
- German Center for Cardiovascular Research (DZHK), Ratzeburger Allee 160, D-23538 Lübeck, Germany
- Department of Cardiology, University Clinic Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 12, D-24105 Kiel, Germany
| | - Inke R König
- German Center for Cardiovascular Research (DZHK), Ratzeburger Allee 160, D-23538 Lübeck, Germany
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23562 Lübeck, Germany
| | - Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23562 Lübeck, Germany
| | - Yvonne Rückert
- Leipzig Heart Institute, Russenstraße 69a, D-04289 Leipzig, Germany
| | | | - Suzanne de Waha-Thiele
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Steffen Desch
- Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, D-04289 Leipzig, Germany
- German Center for Cardiovascular Research (DZHK), Ratzeburger Allee 160, D-23538 Lübeck, Germany
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De Backer O, Søndergaard L. Strengths and weaknesses of different types of TAVI study. EUROINTERVENTION 2020; 15:e1301-e1304. [PMID: 32014834 DOI: 10.4244/eijv15i15a236] [Citation(s) in RCA: 1] [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)
- Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Braghiroli J, Kapoor K, Thielhelm TP, Ferreira T, Cohen MG. Transcatheter aortic valve replacement in low risk patients: a review of PARTNER 3 and Evolut low risk trials. Cardiovasc Diagn Ther 2020; 10:59-71. [PMID: 32175228 DOI: 10.21037/cdt.2019.09.12] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a mainstay in treatment for patients with severe aortic stenosis who are considered high-risk surgical candidates. The use of TAVR in low-risk patients with severe aortic stenosis is being explored as an alternative to surgical aortic valve replacement (SAVR). Recent results from the Medtronic Evolut Low Risk trial and the Placement of Aortic Transcatheter Valves (PARTNER) 3 trial shed light on the use of TAVR in low-risk surgical candidates. The Evolut Low Risk trial compared TAVR with a self-expanding supra-annular bioprosthesis to SAVR in 1468 patients with severe aortic stenosis who were low surgical risk. Patients with a mean age of 74 and a mean Society of Thoracic Surgeons (STS) risk score of 1.9% were randomized to either TAVR or SAVR groups. Using the composite end point of death or disabling stroke at 24 months, the study found an incidence of 5.3% in the TAVR arm and 6.7% in the surgical arm. The Evolut Low Risk trial thus concluded that TAVR was statistically noninferior but not superior to SAVR (difference, -1.4 percentage points; 95% Bayesian credible interval for the difference, -4.9 to 2.1; posterior probability of noninferiority, >0.999). The PARTNER 3 trial assigned 1,000 patients with severe aortic stenosis and low surgical risk to either TAVR with transfemoral placement of balloon expandable valve or SAVR. Patients with a mean age of 73 and a mean STS score of 1.9% were randomized to either TAVR or SAVR groups. With respect to the primary endpoint of composite death from any cause, stroke, or rehospitalization, the study found an occurrence of 8.5% in TAVR and 15.1% in SAVR, confirming both noninferiority and superiority in the TAVR group [absolute difference, -6.6 percentage points; 95% confidence interval (CI), -10.8 to -2.5; P<0.001 for noninferiority; hazard ratio, 0.54; 95% CI, 0.37 to 0.79; P=0.001 for superiority]. Both the Evolut low risk trial and the PARTNER 3 trial provide evidence that the use of TAVR extends beyond the scope of high and intermediate risk surgical patients and is at the very least equivalent to SAVR in the treatment low-risk surgical candidates when using a transfemoral approach in patients without bicuspid aortic valves. In this article we provide an extensive review on the Evolute low risk and PARTNER 3 trials, including a discussion on clinically relevant outcomes.
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Affiliation(s)
- Joao Braghiroli
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Kunal Kapoor
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Torin P Thielhelm
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Tanira Ferreira
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Mauricio G Cohen
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
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Reardon MJ, Feldman TE, Meduri CU, Makkar RR, O'Hair D, Linke A, Kereiakes DJ, Waksman R, Babliaros V, Stoler RC, Mishkel GJ, Rizik DG, Iyer VS, Gleason TG, Tchétché D, Rovin JD, Lhermusier T, Carrié D, Hodson RW, Allocco DJ, Meredith IT. Two-Year Outcomes After Transcatheter Aortic Valve Replacement With Mechanical vs Self-expanding Valves: The REPRISE III Randomized Clinical Trial. JAMA Cardiol 2020; 4:223-229. [PMID: 30810703 DOI: 10.1001/jamacardio.2019.0091] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance To our knowledge, REPRISE III is the first large randomized comparison of 2 different transcatheter aortic valve replacement platforms: the mechanically expanded Lotus valve (Boston Scientific) and self-expanding CoreValve (Medtronic). Objective To evaluate outcomes of Lotus vs CoreValve after 2 years. Design, Setting, and Participants A total of 912 patients with high/extreme risk and severe, symptomatic aortic stenosis enrolled between September 22, 2014, and December 24, 2015, were randomized 2:1 to receive Lotus (607 [66.6%]) or CoreValve (305 [33.4%] at 55 centers in North America, Europe, and Australia. The first 2-year visit occurred on October 17, 2016, and the last was conducted on April 12, 2018. Clinical and echocardiographic assessments are complete through 2 years and will continue annually through 5 years. Main Outcomes and Measures All-cause mortality and all-cause mortality or disabling stroke at 2 years. Other clinical factors included overall stroke, disabling stroke, repeated procedures, rehospitalization, valve thrombosis, and pacemaker implantation. Echocardiographic analyses included effective orifice area, mean gradient, and paravalvular leaks (PVLs). Results Of 912 participants, the mean (SD) age was 82.8 (7.3) years, 465 (51%) were women, and the mean (SD) Society of Thoracic Surgeons predicted risk of mortality was 6.8% (4.0%). At 2 years, all-cause death was 21.3% with Lotus vs 22.5% with CoreValve (hazard ratio [HR], 0.94; 95% CI, 0.69-1.26; P = .67) and all-cause mortality or disabling stroke was 22.8% with Lotus and 27.0% with CoreValve (HR, 0.81; 95% CI, 0.61-1.07; P = .14). Overall stroke was 8.4% vs 11.4% (HR, 0.75; 95% CI, 0.48-1.17; P = .21); disabling stroke was more frequent with CoreValve vs Lotus (4.7% Lotus vs 8.6% CoreValve; HR, 0.53; 95% CI, 0.31-0.93; P = .02). More Lotus patients received a new permanent pacemaker (41.7% vs 26.1%; HR, 1.87; 95% CI, 1.41-2.49; P < .01) or had a valve thrombosis (3.0% vs 0.0%; P < .01) compared with CoreValve. More patients who received CoreValve experienced a repeated procedure (0.6% Lotus vs 2.9% CoreValve; HR, 0.19; 95% CI, 0.05-0.70; P < .01), valve migration (0.0% vs 0.7%; P = .05), or embolization (0.0% vs 2.0%; P < .01) than Lotus. Valve areas remained significantly larger and the mean gradient was lower with CoreValve than Lotus (valve area, mean [SD]: Lotus, 1.53 [0.49] cm2 vs CoreValve, 1.76 [0.51] cm2; P < .01; valve gradient, mean [SD]: Lotus, 13.0 [6.7] mm Hg vs 8.1 [3.7] mm Hg; P < .01). Moderate or greater PVL was more frequent with CoreValve (0.3% Lotus vs 3.8% CoreValve; P < .01) at 2 years. Larger improvements in New York Heart Association (NYHA) functional class were observed with Lotus compared with CoreValve (improved by ≥1 NYHA class: Lotus, 338 of 402 [84.1%] vs CoreValve, 143 of 189 [75.7%]; P = .01; improved by ≥2 NYHA classes: 122 of 402 [37.3%] vs 65 of 305 [21.3%]). Conclusions and Relevance After 2 years, all-cause mortality rates, mortality or disabling stroke were similar between Lotus and CoreValve. Disabling stroke, functional class, valve migration, and PVL favored the Lotus arm whereas valve hemodynamics, thrombosis, and new pacemaker implantation favored the CoreValve arm. Trial Registration clinicaltrials.gov Identifier: NCT02202434.
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Affiliation(s)
- Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Ted E Feldman
- Evanston Hospital Cardiology Division, Northshore University Health System, Evanston, Illinois
| | | | - Raj R Makkar
- Cedars-Sinai Heart Institute, Los Angeles, California
| | - Daniel O'Hair
- Aurora St Luke's Medical Center, Milwaukee, Wisconsin
| | - Axel Linke
- Heart Center Dresde, Dresden University Hospital, Dresden, Germany
| | - Dean J Kereiakes
- The Lindner Research Center, The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio
| | | | | | | | | | - David G Rizik
- HonorHealth, Scottsdale-Lincoln Health Network, Scottsdale, Arizona
| | - Vijay S Iyer
- Gates Vascular Institute, University at Buffalo, Buffalo, New York
| | - Thomas G Gleason
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Didier Tchétché
- Department of Internal Medicine/Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Joshua D Rovin
- Morton Plant Mease Healthcare System, Clearwater, Florida
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Schäfer U, Kempfert J, Verheye S, Maisano F, Thiele H, Landt M, Haude M, Rudolph TK, Ince H, Kische S, Treede H, Tonino P, Conradi L. Safety and Performance Outcomes of a Self-Expanding Transcatheter Aortic Heart Valve: The BIOVALVE Trials. JACC Cardiovasc Interv 2020; 13:157-166. [PMID: 31629751 DOI: 10.1016/j.jcin.2019.07.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/20/2019] [Accepted: 07/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to assess the safety and performance of a newly introduced transfemoral self-expanding supra-annular transcatheter heart valve. BACKGROUND Transcatheter aortic valve replacement has become an established procedure, and newer transcatheter heart valves aim to supplement the current armamentarium. METHODS BIOVALVE-I is a prospective, single-center feasibility study enrolling 13 high-risk patients with severe aortic stenosis, and BIOVALVE-II is a multicenter pilot study enrolling a further 55 patients under the same protocol. RESULTS Patients' mean age was 82.4 ± 5.3 years, 57.4% had concomitant coronary artery disease, 50.0% had renal insufficiency stage ≥3, 32.4% had diabetes mellitus, 29.4% had current anemia, 19.1% had chronic obstructive pulmonary disease, 19.1% were frail, and 17.6% had prior cerebrovascular events. The primary endpoint, early safety according to the Valve Academic Research Consortium-2 guidelines, was observed in 13 patients (19.1%). One patient (1.5%) died through 30 days of a noncardiac cause, and 4 patients (7.8%) died through 180 days. Disabling stroke occurred at 30 days in 1 patient (1.5%) and at 180 days in 2 patients (3.2%). New permanent pacemakers up to 30 days were implanted in 9 patients (13.4%). Two patients (3.8%) had moderate or severe paravalvular leakage at 30 days and 4 (9.1%) at 6 months, mean effective orifice area was 2.0 ± 0.4 cm2 and 1.9 ± 0.5 cm2, and mean gradient was 6.4 mm Hg at 30 days and 6 months. CONCLUSIONS Clinical outcomes with the Biovalve self-expanding transcatheter heart valve were similar to those seen in other first-in-human studies with first-generation devices for severe aortic stenosis.
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Affiliation(s)
- Ulrich Schäfer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Stefan Verheye
- Interventional Cardiology, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Francesco Maisano
- Division of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Martin Landt
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Michael Haude
- Medical Clinic I Städtische Kliniken Neuss Lukaskrankenhaus, Neuss, Germany
| | - Tanja K Rudolph
- Clinic for Cardiology, Angiology, and Pneumology and Intensive Care Medicine, Heart Center of the University Clinic Cologne, Cologne, Germany
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany; Department of Cardiology, Universitätsmedizin Rostock, Rostock, Germany
| | - Stephan Kische
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany; Department of Cardiology, Universitätsmedizin Rostock, Rostock, Germany
| | - Hendrik Treede
- Department of Cardiac Surgery, Mid-German Heart Centre, University Hospital Halle, Halle, Germany
| | - Pim Tonino
- Department of Cardiology, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
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Boskovski MT, Nguyen TC, McCabe JM, Kaneko T. Outcomes of Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis. JAMA Surg 2020; 155:69-77. [DOI: 10.1001/jamasurg.2019.4449] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Marko T. Boskovski
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Tom C. Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas at Houston
| | | | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
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Barth S, Reents W, Zacher M, Kerber S, Diegeler A, Schieffer B, Schreiber M, Lauer B, Kuntze T, Dahmer M, Hamm C, Hamm K. Multicentre propensity-matched comparison of transcatheter aortic valve implantation using the ACURATE TA/neo self-expanding versus the SAPIEN 3 balloon-expandable prosthesis. EUROINTERVENTION 2019; 15:884-891. [PMID: 31270034 DOI: 10.4244/eij-d-18-01120] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS In the absence of randomised data, we aimed to compare the transapical ACURATE and transfemoral ACURATE neo with the SAPIEN 3 prosthesis using propensity matching. METHODS AND RESULTS From 2012 to 2016, 1,306 patients at three German centres received either the ACURATE/ACURATE neo prosthesis (n=591) or the SAPIEN 3 prosthesis (n=715). Through nearest neighbour matching with exact allocation for access route and centre, pairs of 329 patients (250 transfemoral, 79 transapical) per group were determined. Patients were 81 years old on average and had a logistic EuroSCORE I of 19%. Predilatation and post-dilatation were more frequent in the ACURATE group (97.6% versus 52.1%, p<0.001 for predilatation and 40.4% versus 11.6%, p<0.001 for post-dilatation), but rapid pacing for implantation was used less frequently (37.1% versus 98.2%, p<0.001). More-than-mild aortic regurgitation at postoperative echocardiography was 12.0% for the ACURATE group and 3.1% for the SAPIEN group, p≤0.001). More-than-mild aortic regurgitation in the ACURATE group differed amongst the centres with 6.0% (3/50) in centre A, 34.1% (29/85) in centre B and 3.4% (6/181) in centre C. Patients in the ACURATE group less frequently had pacemaker implantation compared to the SAPIEN 3 group (11.9% versus 18.5%, p=0.020), 30-day mortality was 4.6% versus 2.1%, respectively, p=0.134, and one-year survival was 83.1% (95% CI: 77.6-87.4) versus 88.8% (95% CI: 84.0-92.2). CONCLUSIONS In this propensity score analysis, patients treated with the transapical ACURATE or transfemoral ACURATE neo prosthesis less frequently had pacemakers at 30 days but had more aortic regurgitation and lower one-year survival.
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Affiliation(s)
- Sebastian Barth
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt a. d. Saale, Germany
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Lanz J, Kim WK, Walther T, Burgdorf C, Möllmann H, Linke A, Redwood S, Thilo C, Hilker M, Joner M, Thiele H, Conzelmann L, Conradi L, Kerber S, Schymik G, Prendergast B, Husser O, Stortecky S, Heg D, Jüni P, Windecker S, Pilgrim T. Safety and efficacy of a self-expanding versus a balloon-expandable bioprosthesis for transcatheter aortic valve replacement in patients with symptomatic severe aortic stenosis: a randomised non-inferiority trial. Lancet 2019; 394:1619-1628. [PMID: 31570258 DOI: 10.1016/s0140-6736(19)32220-2] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is the preferred treatment option for older patients with symptomatic severe aortic stenosis. Differences in the properties of available TAVR systems can affect clinical outcomes. Among patients undergoing TAVR, we compared the self-expanding ACURATE neo TAVR system with the balloon-expandable SAPIEN 3 TAVR system with regard to early safety and efficacy. METHODS In this randomised non-inferiority trial, patients (aged ≥75 years) undergoing transfemoral TAVR for treatment of symptomatic severe aortic stenosis, and who were deemed to be at increased surgical risk, were recruited at 20 tertiary heart valve centres in Germany, the Netherlands, Switzerland, and the UK. Participants were randomly assigned (1:1) to receive treatment with the ACURATE neo or the SAPIEN 3 with a computer-based randomly permuted block scheme, stratified by study centre and Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) category. The primary composite safety and efficacy endpoint comprised all-cause death, any stroke, life-threatening or disabling bleeding, major vascular complications, coronary artery obstruction requiring intervention, acute kidney injury (stage 2 or 3), rehospitalisation for valve-related symptoms or congestive heart failure, valve-related dysfunction requiring repeat procedure, moderate or severe prosthetic valve regurgitation, or prosthetic valve stenosis within 30 days of the procedure. Endpoint assessors were masked to treatment allocation. Non-inferiority of ACURATE neo compared with SAPIEN 3 was assessed in the intention-to-treat population on the basis of a risk-difference margin of 7·7% for the primary composite endpoint, with a one-sided α of 0·05. This trial is registered with ClinicalTrials.gov (number NCT03011346) and is ongoing but not recruiting. FINDINGS Between Feb 8, 2017, and Feb 2, 2019, up to 5132 patients were screened and 739 (mean age 82·8 years [SD 4·1]; median STS-PROM score 3·5% [IQR 2·6-5·0]) were enrolled. 30-day follow-up was available for 367 (99%) of 372 patients allocated to the ACURATE neo group, and 364 (99%) of 367 allocated to the SAPIEN 3 group. Within 30 days, the primary endpoint occurred in 87 (24%) patients in the ACURATE neo and in 60 (16%) in the SAPIEN 3 group; thus, non-inferiority of the ACURATE neo was not met (absolute risk difference 7·1% [upper 95% confidence limit 12·0%], p=0·42). Secondary analysis of the primary endpoint suggested superiority of the SAPIEN 3 device over the ACURATE neo device (95% CI for risk difference -1·3 to -12·9, p=0·0156). The ACURATE neo and SAPIEN 3 groups did not differ in incidence of all-cause death (nine patients [2%] vs three [1%]) and stroke (seven [2%] vs 11 [3%]); whereas acute kidney injury (11 [3%] vs three [1%]) and moderate or severe prosthetic aortic regurgitation (34 [9%] vs ten [3%]) were more common in the ACURATE neo group. INTERPRETATION TAVR with the self-expanding ACURATE neo did not meet non-inferiority compared to the balloon-expandable SAPIEN 3 device in terms of early safety and clinical efficacy outcomes. An early composite safety and efficacy endpoint was useful in discriminating the performance of different TAVR systems. FUNDING Boston Scientific (USA).
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Affiliation(s)
- Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Thomas Walther
- Department of Cardiac, Thoracic and Thoracic Vascular Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Helge Möllmann
- Department of Internal Medicine I, St-Johannes-Hospital, Dortmund, Germany
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Heart Centre Dresden, Technische Universität Dresden, Dresden, Germany
| | - Simon Redwood
- Department of Cardiology, St Thomas' Hospital, London, UK
| | - Christian Thilo
- Department of Cardiology, Klinikum Augsburg, Augsburg, Germany
| | - Michael Hilker
- Department of Cardiothoracic Surgery, University Medical Centre, Regensburg, Germany
| | - Michael Joner
- German Heart Centre, Technical University of Munich, Munich, Germany
| | | | - Lars Conzelmann
- Department of Cardiac Surgery, Helios Klinik, Karlsruhe, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Centre Hamburg, Hamburg, Germany
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Centre Bad Neustadt, Bad Neustadt, Germany
| | - Gerhard Schymik
- Department of Cardiology, Städtisches Klinikum Karlsruhe, Karslruhe, Germany
| | | | - Oliver Husser
- Department of Internal Medicine I, St-Johannes-Hospital, Dortmund, Germany
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Dik Heg
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland.
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Tzeng YH, Lee YT, Tsao TP, Lee KC, Huang KC, Hsiung MC, Wei J, Yin WH. Performance and short-term outcomes of three different transcatheter aortic valve replacement devices in patients with aortic stenosis: A single-center experience. J Chin Med Assoc 2019; 82:827-834. [PMID: 31693532 DOI: 10.1097/jcma.0000000000000187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Data on whether different transcatheter aortic valve replacement (TAVR) devices and delivery approaches can achieve equally favorable outcomes when performed by a single heart team are scarce. We sought to compare the performance and short-term outcomes of three different TAVR devices-self-expanding Medtronic CoreValve (MCV), mechanically expanded Lotus valve, and balloon-expandable Edwards SAPIEN XT (SXT)-for the treatment of severe aortic stenosis (AS) in a single large-volume center in Taiwan. METHODS We retrospectively reviewed consecutive patients who underwent TAVR for the treatment of severe AS. Clinical outcomes were reported following Valve Academic Research Consortium 2 (VARC-2) criteria. The composite primary endpoint was combined all-cause mortality, myocardial infarction (MI), or disabling stroke within 180 days. RESULTS A total of 231 patients (MCV n=112, Lotus n=18, and SXT n=101) were included. The device and procedural success rates were similar among all three TAVR devices. At 30 days, there was no significant difference in all-cause mortality, cardiovascular mortality, periprocedural MI, stroke, major vascular complications, life-threatening bleeding, acute kidney injury (AKI, stage 2/3), or VARC-2 composite early safety endpoints. There was no difference among groups in the rate of primary endpoint within 180 days. Lack of procedural success, presence of acute coronary occlusion during TAVR, and presence of AKI (stage 3) after TAVR were independent predictors of adverse outcomes. CONCLUSION TAVR using MCV, Lotus, or SXT was associated with similar 30- and 180-day clinical outcomes. The presence of periprocedural complications was one of the main determinants of short-term adverse outcomes.
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Affiliation(s)
- Yun-Hsuan Tzeng
- Division of Medical Imaging, Health Management Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Institute of Microbiology and Immunology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tien-Ping Tsao
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Kuo-Chen Lee
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Kuan-Chih Huang
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
| | | | - Jeng Wei
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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Batchelor W, Anwaruddin S, Ross L, Alli O, Young MN, Horne A, Cestoni A, Welt F, Mehran R. Aortic Valve Stenosis Treatment Disparities in the Underserved. J Am Coll Cardiol 2019; 74:2313-2321. [DOI: 10.1016/j.jacc.2019.08.1035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022]
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Meduri CU, Kereiakes DJ, Rajagopal V, Makkar RR, O'Hair D, Linke A, Waksman R, Babliaros V, Stoler RC, Mishkel GJ, Rizik DG, Iyer VS, Schindler J, Allocco DJ, Meredith IT, Feldman TE, Reardon MJ. Pacemaker Implantation and Dependency After Transcatheter Aortic Valve Replacement in the REPRISE III Trial. J Am Heart Assoc 2019; 8:e012594. [PMID: 31640455 PMCID: PMC6898843 DOI: 10.1161/jaha.119.012594] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background As transcatheter aortic valve replacement expands to younger and/or lower risk patients, the long‐term consequences of permanent pacemaker implantation are a concern. Pacemaker dependency and impact have not been methodically assessed in transcatheter aortic valve replacement trials. We report the incidence and predictors of pacemaker implantation and pacemaker dependency after transcatheter aortic valve replacement with the Lotus valve. Methods and Results A total of 912 patients with high/extreme surgical risk and symptomatic aortic stenosis were randomized 2:1 (Lotus:CoreValve) in REPRISE III (The Repositionable Percutaneous Replacement of Stenotic Aortic Valve through Implantation of Lotus Valve System—Randomized Clinical Evaluation) trial. Systematic assessment of pacemaker dependency was pre‐specified in the trial design. Pacemaker implantation within 30 days was more frequent with Lotus than CoreValve. By multivariable analysis, predictors of pacemaker implantation included baseline right bundle branch block and depth of implantation; diabetes mellitus was also a predictor with Lotus. No association between new pacemaker implantation and clinical outcomes was found. Pacemaker dependency was dynamic (30 days: 43%; 1 year: 50%) and not consistent for individual patients over time. Predictors of pacemaker dependency at 30 days included baseline right bundle branch block, female sex, and depth of implantation. No differences in mortality or stroke were found between patients who were pacemaker dependent or not at 30 days. Rehospitalization was higher in patients who were not pacemaker dependent versus patients without a pacemaker or those who were dependent. Conclusions Pacemaker implantation was not associated with adverse clinical outcomes. Most patients with a new pacemaker at 30 days were not dependent at 1 year. Mortality and stroke were similar between patients with or without pacemaker dependency and patients without a pacemaker. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier NCT02202434.
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Affiliation(s)
| | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center The Lindner Research Center Cincinnati OH
| | | | | | | | - Axel Linke
- Dresden University Hospital, Heart Center Dresden Germany
| | | | | | | | | | - David G Rizik
- HonorHealth and the Scottsdale-Lincoln Health Network Scottsdale AZ
| | - Vijay S Iyer
- University at Buffalo/Gates Vascular Institute Buffalo NY
| | | | | | | | - Ted E Feldman
- Edwards Lifesciences Irvine California.,Northshore University Health System Evanston Hospital Evanston Illinois
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Bjursten H, Rasmussen M, Nozohoor S, Götberg M, Olaison L, Rück A, Ragnarsson S. Infective endocarditis after transcatheter aortic valve implantation: a nationwide study. Eur Heart J 2019; 40:3263-3269. [PMID: 31433472 PMCID: PMC6911164 DOI: 10.1093/eurheartj/ehz588] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/02/2019] [Accepted: 07/31/2019] [Indexed: 01/05/2023] Open
Abstract
AIMS Transcatheter aortic valve implantation (TAVI), now a common procedure to treat high-risk patients with severe aortic stenosis, has rapidly been expanding into younger and lower-risk populations, creating a need to better understand long-term outcome after TAVI. The aim of the present investigation was to determine the incidence, risk factors for, clinical presentation of, and outcome after prosthetic valve endocarditis (PVE) in patients treated with TAVI in a nationwide study. METHODS AND RESULTS Three registries were used: a national TAVI registry, a national diagnosis registry, and a national infective endocarditis registry. Combining these registries made it possible to perform a nationwide, all-comers study with independent and validated reporting of PVE in 4336 patients between 2008 and mid-2018. The risk for PVE after TAVI was 1.4% (95% confidence interval 1.0-1.8%) the first year and 0.8% (0.6-1.1%) per year thereafter. One-year survival after PVE diagnosis was 58% (49-68%), and 5-year survival was 29% (17-41%). Body surface area, estimated glomerular filtration rate <30 mL/min/1.73 m2, critical pre-operative state, mean pre-procedural valve gradient, amount of contrast dye used, transapical access, and atrial fibrillation were identified as independent risk factors for PVE. Staphylococcus aureus was more common in early (<1 year) PVE. Infection with S. aureus, root abscess, late PVE, and non-community acquisition was associated with higher 6-month mortality. CONCLUSION The incidence of PVE was similar to that of surgical bioprostheses. Compromised renal function was a strong risk factor for developing PVE. In the context of PVE, TAVI seems to be a safe option for patients. CLINICAL TRIAL REGISTRATION NCT03768180 (http://clinicaltrials.gov/).
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Affiliation(s)
- Henrik Bjursten
- Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - Magnus Rasmussen
- Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - Shahab Nozohoor
- Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - Mattias Götberg
- Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - Lars Olaison
- Department of Infectious Diseases, University of Gothenburg, Institute of Biomedicine, Gothenburg, Sweden
| | - Andreas Rück
- Department of Aortic Valve Disease, Karolinska University Hospital, Stockholm, Sweden
| | - Sigurdur Ragnarsson
- Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden
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van Gils L, Van Mieghem NM. Transcatheter Aortic Valve Replacement with the Lotus Valve: Concept and Current State of the Data. Interv Cardiol Clin 2019; 8:393-402. [PMID: 31445723 DOI: 10.1016/j.iccl.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Multiple transcatheter heart valve iterations have created an interesting range of options with which to perform transcatheter aortic valve replacement. The Lotus valve has several attractive features. The ability to eradicate even mild paravalvular leak mirrors the outcomes of surgical aortic valve replacement. New design iterations of the Lotus valve and refined sizing algorithms may help mitigate the need for permanent pacemaker implantation and consolidate its best-in-class results in terms of paravalvular leak. Ongoing trials should help define the safety and efficacy of the Lotus transcatheter heart valve in contemporary practice.
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Affiliation(s)
- Lennart van Gils
- Department of Interventional Cardiology, Thoraxcenter, ErasmusMC, Room Rg-628, 's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, ErasmusMC, Room Rg-628, 's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands.
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Sanchez CE, Hermiller JB, Pinto DS, Chetcuti SJ, Arshi A, Forrest JK, Huang J, Yakubov SJ. Predictors and Risk Calculator of Early Unplanned Hospital Readmission Following Contemporary Self-Expanding Transcatheter Aortic Valve Replacement from the STS/ACC TVT Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:263-270. [PMID: 31255552 DOI: 10.1016/j.carrev.2019.05.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Predictors of hospital readmissions and tools to predict readmissions after TAVR are scarce. Our objective was to identify predictors of early hospital readmission following TAVR in contemporary clinical practice and develop a risk calculator. METHODS Patients with a contemporary self-expanding TAVR between 2015 and 2017 in the STS/ACC/TVT Registry™ database were included. Patients were divided into a derivation and validation cohort (2:1). A risk score was calculated using the derivation cohort based on multivariable predictors of 30-day unplanned readmissions and applied to the validation cohort. RESULTS A total of 10,345 TAVR patients at 350 centers were included. Unplanned 30-day hospital readmission was 9.2%. Patients with an early readmission had higher 30-day rates for mortality (2.3% vs. 0.8%, p ≪ 0.001), stroke (4.1% vs. 2.7% p = 0.009), major vascular complications (2.0% vs. 1.0%, p = 0.003) and new pacemaker implantation (25.7% vs. 18.6%, p ≪ 0.001). Multivariable predictors of 30-day readmission included diabetes, atrial fibrillation, advanced heart failure symptoms, home oxygen, decreased 5-m gait speed or the inability to walk, serum creatinine ≫1.6 mg/dL, index hospitalization length of stay ≫5 days, major vascular complication and ≥ moderate post-procedure aortic or mitral valve regurgitation. Based on these predictors, we stratified 30-day readmission risk into low-, moderate- and high-risk subsets. There was a 2.5× difference in readmission rates between the low- (5.8%) and high-risk subsets (14.6%). CONCLUSION We stratified the risk of early hospital readmission after TAVR based on a simple scoring system. This score may improve discharge planning centered on the individual's readmission risk. SUMMARY Unplanned readmissions in the United States are prevalent and costly accounting for $41.3 billion in annual hospital payments and are associated with adverse clinical outcomes. We found that diabetes, atrial fibrillation, advanced heart failure symptoms, home oxygen, frailty, acute kidney injury, prolonged hospitalization, major vascular complications, and moderate or worse post-procedure aortic or mitral valve regurgitation predicted of 30-day readmission following self-expanding TAVR. This information may improve discharge planning centered on each patient's readmission risk.
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Affiliation(s)
- Carlos E Sanchez
- Department of Interventional Cardiology, Riverside Methodist Hospital-OhioHealth, 3705 Olentangy River Road, Columbus, OH 43214, United States of America.
| | - James B Hermiller
- Department of Interventional Cardiology, St. Vincent's Medical Center, I10590 N Meridian St Fl 2, Indianapolis, IN 46290, United States of America
| | - Duane S Pinto
- Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, 185 Pilgrim Road Palmer 4, Boston, MA 02215, United States of America.
| | - Stanley J Chetcuti
- Department of Interventional Cardiology, University of Michigan Hospitals, 1500 East Medical Center, SPC 5869, Ann Arbor, MI 48109, United States of America.
| | - Arash Arshi
- Department of Interventional Cardiology, Riverside Methodist Hospital-OhioHealth, 3705 Olentangy River Road, Columbus, OH 43214, United States of America.
| | - John K Forrest
- Department of Cardiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, United States of America.
| | - Jian Huang
- Statistical Services, Medtronic, 8200 Coral Sea Street, Mounds View, MN 55112, United States of America.
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist Hospital-OhioHealth, 3705 Olentangy River Road, Columbus, OH 43214, United States of America.
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87
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Paparella D, Santarpino G, Malvindi PG, Moscarelli M, Marchese A, Guida P, Carbone C, Gregorini R, Martinelli L, Comoglio C, Coppola R, Albertini A, Cremonesi A, Liso A, Fattouch K, Avolio M, Brunetti ND, Speziale G. Minimally invasive surgical versus transcatheter aortic valve replacement: A multicenter study. IJC HEART & VASCULATURE 2019; 23:100362. [PMID: 31061875 PMCID: PMC6487354 DOI: 10.1016/j.ijcha.2019.100362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/07/2019] [Accepted: 04/08/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Treatment of aortic valve stenosis is evolving, indications for transcatheter approach (TAVI) have increased but also surgical valve replacement has changed with the use of minimally invasive approaches. Comparisons between TAVI and surgery have rarely been done with minimally invasive techniques (mini-SAVR) in the surgical arm. Aim of the present study is to compare mini-SAVR and TAVI in a multicenter recent cohort. METHODS Evaluated were 2904 patients undergone mini-SAVR (2407) or TAVI (497) in 10 different centers in the period 2011-2016. The Heart Team approved treatment for complex cases. The primary outcome is the incidence of 30-day mortality following mini-SAVR and TAVI. Secondary outcomes are the occurrence of major complications following both procedures. Propensity matched comparisons was performed based on multivariable logistic regression model. RESULTS In the overall population TAVI patients had increased surgical risk (median EuroSCORE II 3.3% vs. 1.7%, p ≤ 0.001) and 30-day mortality was higher (1.5% and 2.8% in mini-SAVR and TAVI respectively, p = 0.048). Propensity score identified 386 patients per group with similar baseline profile (median EuroSCORE II ~3.0%). There was no difference in 30-day mortality (3.4% in mini-SAVR and 2.3% in TAVI; p = 0.396) and stroke, surgical patients had more blood transfusion, kidney dysfunction and required longer ICU and hospital length of stay while TAVI patients had more permanent pace maker insertion. CONCLUSIONS Mini-SAVR and TAVI are both safe and effective to treat aortic stenosis in elderly patients with comorbidities. A joint evaluation by the heart-team is essential to direct patients to the proper approach.
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Affiliation(s)
- Domenico Paparella
- Santa Maria Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari, Italy
- Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Italy
| | - Giuseppe Santarpino
- Città di Lecce Hospital, Department of Cardiac Surgery, GVM Care & Research, Lecce, Italy
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | | | - Marco Moscarelli
- Anthea Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari, Italy
| | - Alfredo Marchese
- Santa Maria Hospital, Department of Cardiology, GVM Care & Research, Bari, Italy
| | - Pietro Guida
- Maugeri Foundation, Cassano delle Murge, Bari, Italy
| | - Carmine Carbone
- Santa Maria Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari, Italy
| | - Renato Gregorini
- Città di Lecce Hospital, Department of Cardiac Surgery, GVM Care & Research, Lecce, Italy
| | - Luigi Martinelli
- ICLAS, Department of Cardiac Surgery, GVM Care & Research, Rapallo, Italy
| | - Chiara Comoglio
- Maria Pia Hospital, Department of Cardiac Surgery, GVM Care & Research, Torino, Italy
| | - Roberto Coppola
- ICLAS, Department of Cardiac Surgery, GVM Care & Research, Rapallo, Italy
| | - Alberto Albertini
- Maria Cecilia Hospital, Department of Cardiac Surgery, GVM Care & Research, Cotignola, Italy
| | - Alberto Cremonesi
- Maria Cecilia Hospital, Department of Cardiology, GVM Care & Research, Cotignola, Italy
| | - Armando Liso
- Città di Lecce Hospital, Department of Cardiology, GVM Care & Research, Lecce, Italy
| | - Khalil Fattouch
- Maria Eleonora Hospital, Department of Cardiac Surgery, GVM Care & Research, Palermo, Italy
| | - Maria Avolio
- Clinical Data Management, GVM Care & Research, Rome, Italy
| | | | - Giuseppe Speziale
- Anthea Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari, Italy
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88
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Overtchouk P, Prendergast B, Modine T. Why should we extend transcatheter aortic valve implantation to low-risk patients? A comprehensive review. Arch Cardiovasc Dis 2019; 112:354-362. [PMID: 31014990 DOI: 10.1016/j.acvd.2019.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 02/07/2023]
Abstract
Within the past decade, transcatheter aortic valve implantation (TAVI) has become established as the optimal treatment option for elderly, inoperable and high-risk patients with severe aortic stenosis, and is now recommended by international guidelines. Randomized controlled trials have demonstrated the non-inferiority of TAVI to open surgery in intermediate-risk patients and, most recently, in low-risk patients. Further randomized controlled trials are underway, but existing studies have already provided reassuring data in this cohort, and TAVI is offered routinely to younger and lower-risk patients in numerous centers. Improvements in the design of devices and delivery systems, accompanied by increased operator experience, have dramatically improved the safety of the procedure, and further expansion into low-risk groups seems inevitable once concerns about valve durability and device cost have been addressed. In this article, we provide a review of the existing literature, and estimate the clinical impact of TAVI in low-risk patients. Abbreviated title: Why should we extend TAVI to low-risk patients?
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Affiliation(s)
- Pavel Overtchouk
- Department of Cardiology and Cardiovascular Surgery, Centre Hospitalier Regional et Universitaire de Lille, 59000 Lille, France
| | | | - Thomas Modine
- Department of Cardiology and Cardiovascular Surgery, Centre Hospitalier Regional et Universitaire de Lille, 59000 Lille, France.
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89
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Tretter JT, Mori S, Anderson RH, Taylor MD, Ollberding N, Truong V, Choo J, Kereiakes D, Mazur W. Anatomical predictors of conduction damage after transcatheter implantation of the aortic valve. Open Heart 2019; 6:e000972. [PMID: 31168378 PMCID: PMC6519402 DOI: 10.1136/openhrt-2018-000972] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/20/2019] [Accepted: 03/04/2019] [Indexed: 01/09/2023] Open
Abstract
Objective Conduction damage following transcatheter aortic valve implantation (TAVI) remains common. Anatomical risk factors remain elusive. We assessed the impact of variability in the dimensions of the membranous septum and position of the aortic root on the occurrence of conduction damage following TAVI. Methods The dimensions of the membranous septum, the rotational position of the aortic root correlating to variability in the central fibrous body width, and wedging of the aortic root were assessed on pre-TAVI CT datasets. The depth of implantation was measured from the final aortic angiogram. The variables were compared with the occurrence of both permanent pacemaker insertion (PPI) and left bundle branch block (LBBB) following TAVI. Results Of 200 patients who met inclusion criteria (mean age = 81 years ± 7.7, 49% men), 20.5 % underwent PPI after TAVI. New LBBB occurred in 23.5%, 21.3 % of whom required PPI. Preprocedural right bundle branch block (OR = 7.00; CI 3.13 to 15.64), valve type (OR=2.35; CI 1.13 to 4.87), depth of implantation (OR=1.62; CI 1.01 to 2.61) and the difference between depth of implantation and the distance from the virtual basal ring to the inferior margin of the membranous septum (OR=0.61; CI 0.38 to 0.99) were all associated with PPI, with similar associations with LBBB. No gross anatomical variable alone was associated with conduction damage. Conclusions Gross anatomical variation of the aortic root and its underlying support, including the membranous septum, were not associated with the occurrence of either PPI or new LBBB. Procedural characteristics associated with these adverse outcomes suggest that the depth of implantation and radial force of the bioprosthesis, regardless of gross anatomical variability, increase the risk for conduction damage.
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Affiliation(s)
- Justin T Tretter
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Michael D Taylor
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nicholas Ollberding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Vien Truong
- Department of Ohio Heart and Vascular, The Christ Hospital and Lindner Center for Research and Education, Cincinnati, Ohio, USA
| | - Joseph Choo
- Department of Ohio Heart and Vascular, The Christ Hospital and Lindner Center for Research and Education, Cincinnati, Ohio, USA
| | - Dean Kereiakes
- Department of Ohio Heart and Vascular, The Christ Hospital and Lindner Center for Research and Education, Cincinnati, Ohio, USA
| | - Wojciech Mazur
- Department of Ohio Heart and Vascular, The Christ Hospital and Lindner Center for Research and Education, Cincinnati, Ohio, USA
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90
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Bourantas CV, Modolo R, Baumbach A, Søndergaard L, Prendergast BD, Ozkor M, Kennon S, Mathur A, Mullen MJ, Serruys PW. The evolution of device technology in transcatheter aortic valve implantation. EUROINTERVENTION 2019; 14:e1826-e1833. [PMID: 30719977 DOI: 10.4244/eij-d-18-01048] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has rapidly evolved and changed the landscape of structural interventional cardiology. Advances in transcatheter heart valve (THV) prostheses and TAVI-enabling devices have simplified the procedure, reduced the risk of complications, improved short- and long-term outcomes and broadened the applications of TAVI, not only in challenging patients and complex anatomies but also in intermediate-risk or even in low-risk patients, where surgical valve replacement constitutes an effective and well-established therapy. In this review article, we provide an overview of the developments in TAVI devices which have played a vital role in TAVI evolution: we describe the prostheses that failed to reach clinical practice, we present the characteristics of the first valves that were tested in the clinical arena, we summarise the evidence from the first studies that highlighted the potential but also the limitations of TAVI, and we present the advanced next-generation THV prostheses that have an improved performance and safety profile.
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Affiliation(s)
- Christos V Bourantas
- Department of Cardiology, Barts Heart Center, Barts Health NHS Trust, London, United Kingdom
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91
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Asami M, Pilgrim T, Stortecky S, Heg D, Roost E, Windecker S, Hunziker L. Impact of valvular resistance on aortic regurgitation after transcatheter aortic valve replacement according to the type of prosthesis. Clin Res Cardiol 2019; 108:1343-1353. [PMID: 30929034 DOI: 10.1007/s00392-019-01469-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/22/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The impact of aortic valvular resistance (VR) on the degree of post-transcatheter aortic valve replacement (TAVR) aortic regurgitation (AR) remains unclear. The objective of the study was to investigate the relationship between VR and paravalvular AR after TAVR. METHODS Between August 2007 and December 2015, 708 TAVR patients had sufficient data to calculate VR before the intervention and were eligible for the present analysis. The patient population was dichotomized according to VR. The association between VR and post-TAVR AR was separately assessed by prosthesis type. RESULTS Among patients with low VR (LVR; < 238 dynes/cm5), 176 (49.7%) patients were treated with balloon-expandable (BE) valves and 178 (51.3%) patients with self-expandable (SE) transcatheter valves. Among patients with high VR (HVR ≥ 238), 147 (41.5%) and 207 (68.5%) patients received BE and SE, respectively. Baseline characteristics were similar in both groups irrespective of the type of valve. Patients with HVR had a 2.5-fold risk of ≥ moderate post-TAVR AR compared to patients with LVR. Both, HVR (HRadj 2.45, 95% CI 1.33-4.51) and the use of SE (HRadj 3.11, 95% CI 1.66-5.82), emerged as independent predictors of ≥ moderate post-TAVR AR. Moderate or greater post-AR was consistently predicted in patients treated with SE (HRadj 2.42, 95% CI 1.22-4.80) irrespective of the level of VR. CONCLUSIONS HVR is associated with a nearly 2.5-fold increased risk of moderate or greater post-TAVR AR and is an independent predictor of post-TAVR AR.
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Affiliation(s)
- Masahiko Asami
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland
| | - Dik Heg
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Eva Roost
- Department of Cardiac Surgery, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland.
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92
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Shreenivas S, Schloss E, Choo J, Sarembock I, Lilly S, Kereiakes D. Transcatheter aortic valve replacement and cardiac conduction. Expert Rev Cardiovasc Ther 2019; 17:293-304. [DOI: 10.1080/14779072.2019.1598264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Satya Shreenivas
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
| | - Edward Schloss
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
| | - Joseph Choo
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
| | - Ian Sarembock
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
| | - Scott Lilly
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dean Kereiakes
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
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93
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Modine T, Overtchouk P. Acurate neo and Evolut PRO in the NEOPRO Registry: Adding Another String to the Bow? JACC Cardiovasc Interv 2019; 12:444-447. [PMID: 30846082 DOI: 10.1016/j.jcin.2018.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas Modine
- Institut Cœur-Poumon, Service de Chirurgie Cardiovasculaire, Hôpital Cardiologique, CHRU de Lille, Lille, France.
| | - Pavel Overtchouk
- Institut Cœur-Poumon, Service de Chirurgie Cardiovasculaire, Hôpital Cardiologique, CHRU de Lille, Lille, France
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95
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Blackman DJ, Van Gils L, Bleiziffer S, Gerckens U, Petronio AS, Abdel-Wahab M, Werner N, Khogali SS, Wenaweser P, Wöhrle J, Soliman O, Laborde JC, Allocco DJ, Meredith IT, Falk V, Van Mieghem NM. Clinical outcomes of the Lotus Valve in patients with bicuspid aortic valve stenosis: An analysis from the RESPOND study. Catheter Cardiovasc Interv 2019; 93:1116-1123. [PMID: 30773838 PMCID: PMC6593645 DOI: 10.1002/ccd.28120] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 01/04/2019] [Accepted: 01/20/2019] [Indexed: 11/08/2022]
Abstract
AIMS Patients with bicuspid valves represent a challenging anatomical subgroup for transcatheter aortic valve implantation (TAVI). This analysis evaluated the clinical outcomes of the fully repositionable and retrievable Lotus Valve System in patients with bicuspid aortic valves enrolled in the RESPOND post-market registry. METHODS AND RESULTS The prospective, open-label RESPOND study enrolled 1,014 patients at 41 centers in Europe, New Zealand, and Latin America, 31 (3.1%) of whom had bicuspid aortic valves. The mean age in the bicuspid patient cohort was 76.4 years, 64.5% were male, and the baseline STS score was 6.0 ± 10.2. Procedural success was 100%, with no cases of malpositioning, valve migration, embolization, or valve-in-valve. Repositioning was attempted in 10 cases (32.3%). There was one death (3.2%) and one stroke (3.2%) at 30-day follow-up. Mean AV gradient was reduced from 48.7 ± 17.0 mmHg at baseline to 11.8 ± 5.1 mmHg at hospital discharge (P < 0.001); mean effective orifice area (EOA) was increased from 0.6 ± 0.2 cm2 to 1.7 ± 0.4 cm2 (P < 0.001). There were no cases of moderate or severe paravalvular leak (PVL) adjudicated by the core laboratory; four subjects (13.8%) had mild PVL, 5 (17.2%) had trace PVL. The rate of pacemaker (PM) implantation for PM-naïve patients was 22.2% (6/27). CONCLUSIONS Data from the RESPOND registry demonstrate good clinical and echocardiographic outcomes up to 1 year postimplantation in patients with bicuspid aortic valves using the repositionable Lotus Valve.
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Affiliation(s)
- Daniel J Blackman
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Lennart Van Gils
- Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, CE, Rotterdam, The Netherlands
| | - Sabine Bleiziffer
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Ulrich Gerckens
- Department of Cardiology, University of Rostock, Rostock, Germany
| | - Anna Sonia Petronio
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Nikos Werner
- Interventional Cardiology, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Saib S Khogali
- The Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Peter Wenaweser
- Swiss Cardiovascular Center Bern, University Hospital Bern, Bern, Switzerland
| | - Jochen Wöhrle
- Department of Internal Medicine II, University of Ulm, Germany
| | - Osama Soliman
- Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, CE, Rotterdam, The Netherlands
| | - Jean-Claude Laborde
- Department of Cardiology and Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom
| | - Dominic J Allocco
- Interventional Cardiology, Boston Scientific Corporation, Marlborough, Massachusetts
| | - Ian T Meredith
- Interventional Cardiology, Boston Scientific Corporation, Marlborough, Massachusetts
| | - Volkmar Falk
- Deutsches Herzzentrum Berlin, Klinik für Herz-Thorax-Gefässchirurgie, Berlin, Germany
| | - Nicolas M Van Mieghem
- Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, CE, Rotterdam, The Netherlands
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Tang L, Lesser JR, Schneider LM, Burns MR, Gössl M, Garberich R, Niikura H, Witt D, Sorajja P. Prospective Evaluation for Hypoattenuated Leaflet Thickening Following Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 123:658-666. [PMID: 30528421 DOI: 10.1016/j.amjcard.2018.11.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 12/31/2022]
Abstract
Prospective investigations for the frequency of hypoattenuated leaflet thickening (HALT) and its clinical implications in transcatheter aortic valve implantation (TAVI) patients are limited. We initiated a prospective screening program of TAVI patients for HALT beginning in July 2015. Eligible patients were evaluated with gated, contrast-enhanced multidetector computed tomography within 30 days of TAVI, and examined for HALT and clinical outcomes. During the study period, 287 patients (81 ± 8 years; 53% men) who underwent TAVI with commercially approved devices were examined. Overall, 26 patients (9.1%) had occurrence of HALT, and only one of these patients had detectable hemodynamic changes on echocardiography at diagnosis. Notably, 9 of 26 HALT patients had been receiving warfarin, however, the HALT patients more often had subtherapeutic international normalized ratio whereas using warfarin than patients without HALT on index multidetector computed tomography imaging (p = 0.01). Patients who developed HALT had lower baseline aortic gradient, valvuloarterial impedance, and peak aortic velocity, and more commonly had been treated with balloon-expandable valves (73% of all HALT cases) with a higher incidence among those who received larger prostheses. All patients with HALT were placed on anticoagulation at diagnosis, and valvular function remained unchanged at follow-up. Two patients with HALT (7.7%) experienced ischemic stroke. A statistical trend for more major adverse clinical events was present in HALT patients. In conclusion, HALT was detected in 9% of TAVI cases in this prospective observational cohort, with a greater frequency in patients with large, balloon-expandable prostheses. Prospective screening may be considered as early HALT is reversible by timely therapeutic anticoagulation.
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van Gils L, Van Mieghem NM. New large-bore closure technology: time to plug in? EUROINTERVENTION 2019; 14:e1540-e1543. [DOI: 10.4244/eijv14i15a262] [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: 11/23/2022]
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98
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The Lotus Valve Is Safe and Effective, But Will Atrioventricular Block Improve With the Next-Generation System? JACC Cardiovasc Interv 2019; 12:50-51. [PMID: 30621977 DOI: 10.1016/j.jcin.2018.11.010] [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: 11/08/2018] [Accepted: 11/13/2018] [Indexed: 11/20/2022]
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99
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Van Mieghem NM, Wöhrle J, Hildick-Smith D, Bleiziffer S, Blackman DJ, Abdel-Wahab M, Gerckens U, Linke A, Ince H, Wenaweser P, Allocco DJ, Meredith IT, Falk V. Use of a Repositionable and Fully Retrievable Aortic Valve in Routine Clinical Practice. JACC Cardiovasc Interv 2019; 12:38-49. [DOI: 10.1016/j.jcin.2018.10.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 11/29/2022]
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100
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van Wiechen MP, Van Mieghem NM. Maturation from CoreValve ® to Evolut Pro ®: a clinical overview. Future Cardiol 2018; 15:1-8. [PMID: 30565481 DOI: 10.2217/fca-2018-0064] [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] [Indexed: 11/21/2022] Open
Abstract
The only curative treatment of aortic stenosis is through surgical or transcatheter aortic valve replacement. Transcatheter aortic valve implantation has evolved from its first in human experience in 2002 and matured to the treatment of first choice of symptomatic severe aortic stenosis in elderly patients with an elevated operative risk. The self-expanding CoreValve® bioprosthesis has been on the forefront of this growing transcatheter aortic valve implantation experience. Over the last decade, various device iterations resulted in the current Evolut PRO® self-expanding valve platform with reduced profile, repositioning/retrievable features and porcine pericardial wrap. Herein we provide a critical appraisal of the consecutive device iterations and highlight the clinical foundation for the use of the self-expanding CoreValve® /Evolut platforms in current clinical practice.
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Affiliation(s)
- Maarten P van Wiechen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
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