51
|
Kananathan S, Perera LA, Mohanarajan M, Sherif M, Harky A. The management of paravalvular leaks post aortic valve replacement. J Card Surg 2022; 37:2786-2798. [PMID: 35695718 DOI: 10.1111/jocs.16672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Paravalvular leak (PVL) is uncommon but can lead to severe complications after surgical or transcatheter aortic valve implantation. Conditions associated with PVLs such as heart failure, hemolysis, and infective endocarditis can lead to catastrophic results if not treated promptly; the therapeutic goals differ according to the presentation. It is vital that PVLs are diagnosed early using various imaging modalities. Different approaches have been studied in managing PVLs; there is an increased interest in the transcatheter aortic valve closure procedure as it is minimally invasive and decreases the occurrence of further reinterventions. AIM To discuss the classification of PVLs, diagnostic approaches, and available management options. METHOD A literature review was performed using 28 studies. RESULTS This review evaluated the relationship between the time of diagnosis, management of PVL and the resulting outcomes. DISCUSSION Patients with PVL should be assessed through a multidisciplinary team approach and a patient-selective plan should be in place. CONCLUSION Open surgical intervention is reserved for complex cases where minimally invasive techniques cannot be utilized.
Collapse
Affiliation(s)
- Shalini Kananathan
- Dnipro Medical Institute of Traditional and Non-Traditional Medicine, Dnipro, Ukraine
| | | | - Maneeshaa Mohanarajan
- Dnipro Medical Institute of Traditional and Non-Traditional Medicine, Dnipro, Ukraine
| | - Mohamed Sherif
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| |
Collapse
|
52
|
van Nieuwkerk AC, Santos RB, Fernandez-Nofrerias E, Tchétché D, de Brito FS, Barbanti M, Kornowski R, Latib A, D'Onofrio A, Ribichini F, Mainar V, Dumonteil N, Baan J, Abizaid A, Sartori S, D'Errigo P, Tarantini G, Lunardi M, Orvin K, Pagnesi M, Larraya GL, Ghattas A, Dangas G, Mehran R, Delewi R. Outcomes in Valve-in-Valve Transcatheter Aortic Valve Implantation. Am J Cardiol 2022; 172:81-89. [PMID: 35351288 DOI: 10.1016/j.amjcard.2022.02.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Abstract
The use of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is increasing, but studies evaluating clinical outcomes in these patients are scarce. Also, there are limited data to guide the choice of valve type in ViV-TAVI. Therefore, this CENTER-study evaluated clinical outcomes in patients with ViV-TAVI compared to patients with native valve TAVI (NV-TAVI). In addition, we compared outcomes in patients with ViV-TAVI treated with self-expandable versus balloon-expandable valves. A total of 256 patients with ViV-TAVI and 11333 patients with NV-TAVI were matched 1:2 using propensity score matching, resulting in 256 patients with ViV-TAVI and 512 patients with NV-TAVI. Mean age was 81±7 years, 58% were female, and the Society of Thoracic Surgeons Predicted Risk of Mortality was 6.3% (4.0% to 12.8%). Mortality rates were comparable between ViV-TAVI and NV-TAVI patients at 30 days (4.1% vs 5.9%, p = 0.30) and 1 year (14.2% vs 17.3%, p = 0.34). Stroke rates were also similar at 30 days (2.8% vs 1.8%, p = 0.38) and 1 year (4.9% vs 4.3%, p = 0.74). Permanent pacemakers were less frequently implanted in patients with ViV-TAVI (8.8% vs 15.0%, relative risk 0.59, 95% confidence interval [CI] 0.37 to 0.92, p = 0.02). Patients with ViV-TAVI were treated with self-expandable valves (n = 162) and balloon-expandable valves (n = 94). Thirty-day major bleeding was less frequent in patients with self-expandable valves (3% vs 13%, odds ratio 5.12, 95% CI 1.42 to 18.52, p = 0.01). Thirty-day mortality was numerically lower in patients with self-expandable valves (3% vs 7%, odds ratio 3.35, 95% CI 0.77 to 14.51, p = 0.11). In conclusion, ViV-TAVI seems a safe and effective treatment for failing bioprosthetic valves with low mortality and stroke rates comparable to NV-TAVI for both valve types.
Collapse
Affiliation(s)
- Astrid C van Nieuwkerk
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands
| | - Raquel B Santos
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands; Department of Cardiology, Centro Hospitalar Universitário do Porto, Serviço Cardiologia, Porto, Portugal
| | | | | | - Fabio S de Brito
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Marco Barbanti
- Division of Cardiology, Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, New York; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | | | - Jan Baan
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands
| | - Alexandre Abizaid
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paola D'Errigo
- National Centre for Global Health - Istituto Superiore di Sanità, Rome, Italy
| | | | - Mattia Lunardi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Katia Orvin
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Matteo Pagnesi
- Department of Medical and Surgical specialties, Institute of Cardiology, ASST Spedali Civili, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | | | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ronak Delewi
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands.
| |
Collapse
|
53
|
Rouleau SG, Brady WJ, Koyfman A, Long B. Transcatheter aortic valve replacement complications: A narrative review for emergency clinicians. Am J Emerg Med 2022; 56:77-86. [DOI: 10.1016/j.ajem.2022.03.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/11/2022] [Accepted: 03/20/2022] [Indexed: 02/07/2023] Open
|
54
|
Freixa X, Gabani R, Cepas-Guillén P, Flores-Umanzor E, Estévez-Loureiro R, Onorato EM. Paravalvular Leakages after Surgical Aortic-Valve Replacement and after Transcatheter Aortic-Valve Implantation: Strategies to Increase the Success Rate of Percutaneous Closure. J Clin Med 2022; 11:jcm11112989. [PMID: 35683375 PMCID: PMC9181351 DOI: 10.3390/jcm11112989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/15/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023] Open
Abstract
Moderate to severe paravalvular-leak (PVL) regurgitation after surgical aortic-valve replacement or after transcatheter valve implantation represents a well-known complication associated with symptoms related to heart failure, hemolysis, or both in patients with multiple comorbidities and with poor prognostic outcomes. The transcatheter closure of aortic paravalvular leaks (APVLs) is currently considered a valid alternative to cardiac surgery. Nevertheless, careful patient selection, optimal cardiac imaging for intraprocedural guidance, and expert operators are key for success. Although technically demanding, particularly in APVLs after transcatheter valve implantation, catheter-based closure is an effective, less invasive, and often the only option for high-risk patients with symptomatic PVL regurgitation.
Collapse
Affiliation(s)
- Xavier Freixa
- Interventional Cardiology Department, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain; (X.F.); (R.G.); (P.C.-G.); (E.F.-U.)
| | - Rami Gabani
- Interventional Cardiology Department, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain; (X.F.); (R.G.); (P.C.-G.); (E.F.-U.)
| | - Pedro Cepas-Guillén
- Interventional Cardiology Department, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain; (X.F.); (R.G.); (P.C.-G.); (E.F.-U.)
| | - Eduardo Flores-Umanzor
- Interventional Cardiology Department, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain; (X.F.); (R.G.); (P.C.-G.); (E.F.-U.)
| | | | - Eustaquio Maria Onorato
- Interventional Cardiology Department, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20138 Milan, Italy
- Correspondence:
| |
Collapse
|
55
|
Simplified TAVR Procedure: How Far Is It Possible to Go? J Clin Med 2022; 11:jcm11102793. [PMID: 35628919 PMCID: PMC9145302 DOI: 10.3390/jcm11102793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 02/01/2023] Open
Abstract
Increasing operators’ experience and improvement of the technique have resulted in a drastic reduction in complications following transcatheter aortic valve replacement (TAVR) in patients with lower surgical risk. In parallel, the procedure was considerably simplified, with a routine default approach including local anesthesia in the catheterization laboratory, percutaneous femoral approach, radial artery as the secondary access, prosthesis implantation without predilatation, left ventricle wire pacing and early discharge. Thus, the “simplified” TAVR adopted in most centers nowadays is a real revolution of the technique. However, simplified TAVR must be accompanied upstream by a rigorous selection of patients who can benefit from a minimalist procedure in order to guarantee its safety. The minimalist strategy must not become dogmatic and careful pre-, per- and post-procedural evaluation of patients with well-defined protocols guarantee optimal care following TAVR. This review aims to evaluate the benefits and limits of the simplified TAVR procedure in a current and future vision.
Collapse
|
56
|
Okuno T, Tomii D, Heg D, Lanz J, Praz F, Stortecky S, Reineke D, Windecker S, Pilgrim T. Five-year outcomes of mild paravalvular regurgitation after transcatheter aortic valve implantation. EUROINTERVENTION 2022; 18:33-42. [PMID: 34930717 PMCID: PMC9904370 DOI: 10.4244/eij-d-21-00784] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mild paravalvular regurgitation (PVR) remains a frequent and underappreciated adverse event after transcatheter aortic valve implantation (TAVI) despite remarkable progress in device technology and implantation technique. AIMS This study sought to investigate the impact of mild PVR after TAVI on five-year clinical outcomes. METHODS In a prospective TAVI registry, PVR prior to discharge was retrospectively assessed in an echocardiographic core laboratory. Patients with ≥moderate PVR were excluded. Mild PVR was categorised into mild and mild-to-moderate PVR using a recently proposed unifying 5-class grading scheme. RESULTS A total of 1,128 patients undergoing TAVI between 2007 and 2015 were enrolled. Of these, 560 patients had mild PVR, including 433 with mild (5-class) PVR and 127 with mild-to-moderate PVR. Patients with mild PVR were older (83 years vs 82 years, p=0.013) and had a higher surgical risk compared to patients with none/trace PVR (STS-PROM: 6.49±4.68 vs 5.41±3.48, p<0.001). At five years, patients with mild PVR had a higher risk of mortality than those with none/trace PVR (54.6% vs 43.8%; HRadjusted 1.26, 95% CI: 1.06-1.50). When applying the 5-class grading scheme, only mild-to-moderate PVR was associated with an increased risk of mortality at five years (mild PVR: HRadjusted 1.19, 95% CI: 0.99-1.43, mild-to-moderate PVR: HRadjusted 1.56, 95% CI: 1.20-2.02). The effect of mild PVR on five-year mortality was consistent across major subgroups. CONCLUSIONS Mild PVR was associated with an increased risk of mortality at five years after TAVI. The detrimental effect was primarily driven by mild-to-moderate PVR using the 5-class grading scheme. CLINICAL TRIAL REGISTRATION https://www. CLINICALTRIALS gov. NCT01368250.
Collapse
Affiliation(s)
- Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Daijiro Tomii
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| |
Collapse
|
57
|
Khokhar AA, Giannini F, Colombo A. Peri‐procedural Complications of Transcatheter Aortic Valve Replacement (TAVR). Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
58
|
Incremental Prognostic Value of Left Ventricular Global Longitudinal Strain in Patients with Preserved Ejection Fraction Undergoing Transcatheter Aortic Valve Implantation. J Am Soc Echocardiogr 2022; 35:947-955.e7. [DOI: 10.1016/j.echo.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/19/2022] [Accepted: 04/24/2022] [Indexed: 11/18/2022]
|
59
|
Guddeti RR, Gill GS, Garcia-Garcia HM, Alla VM. Transcatheter aortic valve replacement in mixed aortic valve disease: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:169-176. [PMID: 34788825 DOI: 10.1093/ehjqcco/qcab080] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Utilization of transcatheter aortic valve replacement (TAVR) has expanded from high-risk patients to intermediate- and select low-risk candidates with severe aortic stenosis (AS). TAVR is currently not indicated for patients with aortic insufficiency, and its outcomes in mixed aortic valve disease (MAVD) are unclear. METHODS A systematic search of PubMed, Medline, CINHAL, and Cochrane databases was performed to identify studies comparing TAVR outcomes in patients with AS vs. MAVD. Primary outcomes included 30-day and late all-cause mortality, and paravalvular regurgitation (PVR). Secondary outcomes were major bleeding, vascular complications, device implantation success, permanent pacemaker, and stroke. Pooled odds ratios (OR) and 95% confidence intervals (CIs) were calculated using Der Simonian-Laird random-effects model. RESULTS Six observational studies with 58 879 patients were included in the analysis. There was no significant difference in 30-day all-cause mortality [OR 1.03 (95% CI 0.92-1.15); P = 0.63], however, MAVD group had higher odds of moderate-to-severe PVR [1.81 (1.41-2.31); P < 0.01]. MAVD patients had lower odds of device implantation success [0.60 (0.40-0.91); P = 0.02] while other secondary outcomes were similar in the two groups. CONCLUSIONS TAVR in MAVD is associated with increased odds of paravalvular regurgitation and lower odds of device implantation success when compared to severe aortic stenosis.
Collapse
Affiliation(s)
- Raviteja R Guddeti
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE 68154, USA.,Division of Cardiovascular Diseases, Minneapolis Heart Institute, Minneapolis, MN 55407, USA
| | - Gauravpal S Gill
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE 68154, USA
| | - Hector M Garcia-Garcia
- Department of Medicine, Georgetown University, Washington, DC 20057, USA.,Division of Cardiovascular Medicine, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Venkata Mahesh Alla
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE 68154, USA
| |
Collapse
|
60
|
Eikelboom R, Moran RM, Yan W, Yamashita M, Patel A, Reardon M, Spooner A. Current and future transcatheter aortic valve replacement valves. Curr Opin Cardiol 2022; 37:173-179. [PMID: 34596067 DOI: 10.1097/hco.0000000000000935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review analyzes currently available commercial transcatheter aortic valve replacement (TAVR) valves as well as valves in investigational status and those in preclinical testing. The design features and clinical outcomes of the Edwards SAPIEN S3 and Medtronic Evolut PRO+ are described and compared with highlight clinical circumstances where one may be favoured over the other. RECENT FINDINGS Multiple randomized and nonrandomized trials have compared commercial and investigational TAVR valves. The results of these are summarized and discussed within this review with a focus on how the SAPIEN S3 and Evolut PRO+ both compare to each other as well as various valves in different investigational stages. SUMMARY TAVR is an innovative and ground-breaking technology that will forever have revolutionized the management of aortic stenosis. Though the technology and valves themselves have come a long way, further developments are necessary if we are to continue to expand its indications and achieve a safer perioperative experience with more durable valves.
Collapse
Affiliation(s)
- Rachel Eikelboom
- St. Boniface Hospital, University of Manitoba, WInnipeg, Manitoba, Canada
| | - Ricky Muller Moran
- St. Boniface Hospital, University of Manitoba, WInnipeg, Manitoba, Canada
| | - Weiang Yan
- St. Boniface Hospital, University of Manitoba, WInnipeg, Manitoba, Canada
| | - Michael Yamashita
- St. Boniface Hospital, University of Manitoba, WInnipeg, Manitoba, Canada
| | - Apurva Patel
- Lennox Hill Hospital, Chinatown Cardiology, New York, New York, USA
| | - Michael Reardon
- Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas, USA
| | - Aaron Spooner
- St. Boniface Hospital, University of Manitoba, WInnipeg, Manitoba, Canada
| |
Collapse
|
61
|
Chau KH, Chen S, Crowley A, Redfors B, Li D, Hahn RT, Douglas PS, Alu MC, Finn MT, Kodali SK, Jaber WA, Rodriguez L, Thourani VH, Pibarot P, Leon MB. Paravalvular regurgitation after transcatheter aortic valve replacement in intermediate-risk patients: a pooled PARTNER 2 study. EUROINTERVENTION 2022; 17:1053-1060. [PMID: 34483095 PMCID: PMC9724907 DOI: 10.4244/eij-d-20-01293] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Moderate or worse paravalvular regurgitation (PVR) post transcatheter aortic valve replacement (TAVR) is associated with increased mortality. The mechanisms by which this occurs are not fully understood. AIMS The aim of this study was to determine the mechanism by which PVR leads to worse outcomes. METHODS A total of 1,974 intermediate-risk patients who received TAVR in the PARTNER 2 trial and registries were grouped by PVR severity. Clinical and echocardiographic outcomes were compared. RESULTS Overall 1,176 (60%) patients had none/trace, 680 (34%) had mild, and 118 (6%) had ≥moderate PVR. At two years, ≥moderate PVR patients had increased risks of all-cause (HR 2.33 [1.41-3.85], p-value=0.001) and cardiovascular death (HR 3.30 [1.74-6.28], p-value <0.001), rehospitalisation (HR 2.68 [1.57-4.58], p-value <0.001), and reintervention (HR 14.72 [3.13-69.32], p-value <0.001). Moderate or worse PVR was associated with larger increases in left ventricular (LV) end-diastolic and systolic dimensions and volumes, LV mass indices, and reductions in LV ejection fractions (LVEFs) from 30 days to two years. Mild PVR was not associated with worse outcomes. Adjusting for LV dimensions and LVEF from the one-year echocardiogram, patients with ≥moderate PVR still had an increased risk of all-cause death or rehospitalisation at two years (HR 2.84 [1.25-5.78], p-value=0.009). CONCLUSIONS Moderate or worse PVR, but not mild PVR, is associated with an increased risk of all-cause and cardiovascular death, rehospitalisation, and reintervention at two years. Moderate or worse PVR is also associated with adverse LV remodelling, which partially mediates how ≥moderate PVR leads to worse outcomes. These results provide dual insights on the deleterious impact of ≥moderate PVR and the contributing mechanisms of poor clinical outcomes.
Collapse
Affiliation(s)
- Katherine H. Chau
- NewYork-Presbyterian/Columbia University Medical Center, PH 10-203, 622 W 168 Street, New York, NY 10032, USA
| | - Shmuel Chen
- Cardiovascular Research Foundation, New York, NY, USA,Structural Heart and Valve Center, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Aaron Crowley
- Cardiovascular Research Foundation, New York, NY, USA
| | - Björn Redfors
- Cardiovascular Research Foundation, New York, NY, USA
| | - Ditian Li
- Cardiovascular Research Foundation, New York, NY, USA
| | - Rebecca T. Hahn
- Cardiovascular Research Foundation, New York, NY, USA,Structural Heart and Valve Center, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Pamela S. Douglas
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Maria C. Alu
- Cardiovascular Research Foundation, New York, NY, USA
| | - Matthew T. Finn
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Susheel K. Kodali
- Cardiovascular Research Foundation, New York, NY, USA,Structural Heart and Valve Center, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Wael A. Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Leonardo Rodriguez
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Philippe Pibarot
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, QC, Canada
| | - Martin B. Leon
- Cardiovascular Research Foundation, New York, NY, USA,Structural Heart and Valve Center, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
62
|
OUP accepted manuscript. Eur Heart J 2022; 43:2729-2750. [DOI: 10.1093/eurheartj/ehac105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/22/2022] [Accepted: 02/01/2022] [Indexed: 11/12/2022] Open
|
63
|
Lee CH, Inohara T, Hayashida K, Park DW. Transcatheter Aortic Valve Replacement in Asia: Present Status and Future Perspectives. JACC. ASIA 2021; 1:279-293. [PMID: 36341218 PMCID: PMC9627874 DOI: 10.1016/j.jacasi.2021.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/01/2021] [Accepted: 10/07/2021] [Indexed: 05/28/2023]
Abstract
Over the last decade, based on evidence from multiple randomized clinical trials, transcatheter aortic valve replacement (TAVR) has become the established treatment for patients with symptomatic severe aortic stenosis. Despite the overwhelming expansion of TAVR in Western countries, the initial uptake and widespread adoption of this procedure have been relatively delayed in Asian countries, owing to the high cost of devices; limited local health and reimbursement policies; and lack of specific training/proctoring program, specialized heart team, or dedicated infrastructure. Furthermore, it has not yet been determined whether there are substantial interracial and ethnic differences in the clinical characteristics, comorbidities, and anatomic features, as well as procedural and long-term outcomes, in patients receiving TAVR. In this review, we provide not only a comprehensive look at the current status and outcomes of TAVR in Asian populations compared with those of Western populations but also a perspective on the future of TAVR in Asia.
Collapse
Key Words
- AR, aortic regurgitation
- AS, aortic stenosis
- BAV, bicuspid aortic valve
- BSA, body surface area
- PPI, permanent pacemaker insertion
- PPM, patient-prosthesis mismatch
- PVL, paravalvular leak
- RCT, randomized clinical trial
- SAVR, surgical aortic valve replacement
- STS, Society of Thoracic Surgeons
- TAVR, transcatheter aortic valve replacement
- VHD, valvular heart disease
- aortic stenosis
- outcomes
- race and ethnicity
- valvular disease
Collapse
Affiliation(s)
- Cheol Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Deagu, South Korea
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
64
|
Dowling C, Gooley R, McCormick L, Firoozi S, Brecker SJ. Patient-specific computer simulation to predict long-term outcomes after transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 2021; 16:254-261. [PMID: 34887238 DOI: 10.1016/j.jcct.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/02/2021] [Accepted: 11/24/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Patient-specific computer simulation may predict the development of paravalvular regurgitation (PVR) after transcatheter aortic valve replacement (TAVR). We hypothesised that patient-specific computer simulation might identify patients at risk for long-term adverse outcomes after TAVR. METHODS A multi-centre retrospective study was performed on patients with symptomatic severe aortic stenosis who had undergone TAVR with a self-expanding transcatheter heart valve (THV). Pre-procedural cardiac computed tomography imaging was used to create finite element models of the aortic root. Finite element analysis (FEA) was performed in order to simulate the interaction between the THV and the native anatomy. The blood domain was extracted from the FEA output and computational fluid dynamics (CFD) simulation undertaken. Predicted PVR was recorded in the left ventricular outflow tract. Patients were classified into those where computer simulation predicted no significant PVR (predicted PVR from CFD <16.0 mL/s) and those where computer simulation predicted significant PVR (predicted PVR from CFD ≥16.0 mL/s). RESULTS A total of 203 patients were included in the study. THVs implanted were CoreValve (n = 20), Evolut R (n = 90) and Evolut PRO (n = 93). At 2 years, the Kaplan-Meier estimate of the rate of death from any cause was higher in the group where CFD simulation predicted significant PVR (35.8% vs. 16.3%; hazard ratio, 2.62; 95% confidence interval, 1.29 to 5.30; P = 0.006 by log-rank test). CONCLUSIONS Computer simulation may identify patients who are at a higher risk for death after TAVR.
Collapse
Affiliation(s)
- Cameron Dowling
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Robert Gooley
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Liam McCormick
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Sami Firoozi
- Cardiovascular Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Stephen J Brecker
- Cardiovascular Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom.
| |
Collapse
|
65
|
McInerney A, Vera-Urquiza R, Tirado-Conte G, Marroquin L, Jimenez-Quevedo P, Nuñez-Gil I, Pozo E, Gonzalo N, de Agustín JA, Escaned J, Fernández-Ortiz A, Macaya C, Nombela-Franco L. Pre-dilation and Post-dilation in Transcatheter Aortic Valve Replacement: Indications, Benefits and Risks. Interv Cardiol 2021; 16:e28. [PMID: 34721667 PMCID: PMC8532006 DOI: 10.15420/icr.2020.35] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/17/2021] [Indexed: 12/12/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is an established treatment for patients with symptomatic severe aortic stenosis. In recent years, an emphasis has been placed on simplification of the procedure. Balloon predilation was initially considered a mandatory step to cross and prepare the stenotic aortic valve, but several studies demonstrated the feasibility of performing TAVR without balloon valvuloplasty. Balloon postdilation of the implanted valve is sometimes required to optimise results, although many patients do not require this step. Contemporary consensus advocates an individualised approach to TAVR procedures and so balloon pre- and post-dilation are performed selectively. This review aims to outline the advantages and disadvantages of balloon pre- and post-dilation and to identify the scenarios in which they are required during TAVR procedures.
Collapse
Affiliation(s)
- Angela McInerney
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | | | | | - Luis Marroquin
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | | | - Iván Nuñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | - Eduardo Pozo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | - Nieves Gonzalo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | | | - Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | | | - Carlos Macaya
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | | |
Collapse
|
66
|
Parikh PB, Romeiser JL, Dhautel B, Mitchell D, Holecek W, Bilfinger T, Poppers J, Bennett-Guerrero E. Predictors and impact of low diastolic blood pressure and widened pulse pressure following transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 39:20-25. [PMID: 34764032 DOI: 10.1016/j.carrev.2021.10.011] [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: 05/16/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The association between post-operative diastolic blood pressure (DBP) and pulse pressure (PP) with outcomes following transcatheter aortic valve replacement (TAVR) remains unclear. We sought to assess the prevalence, predictors, and impact of post-operative DBP and PP on presence of post-procedural aortic insufficiency (AI) and mortality in adults undergoing TAVR. METHODS The study population included 194 patients who underwent TAVR from 2016 to 2017 at an academic tertiary medical center, of which 176 had invasive arterial pressures available postoperatively. Low DBP and widened PP were defined as ≤40 mmHg and ≥80 mmHg respectively on invasive arterial line on post-operative day 1. Clinical outcomes of interest included post-procedural AI and 1-year all-cause mortality. RESULTS Post-operative low DBP and widened PP were noted in 32.4% and 58.5% of the study population. No significant association between post-operative AI and low DBP (p = 0.82) or widened PP (p = 0.32) was noted. There was a trend toward higher rates of mortality in patients with low DBP (19.3% vs 9.2%, p = 0.06) but no difference in mortality in patients with widened PP (10.7% vs 15.1%, p = 0.39) or those with ≥1+ post-procedural AI (16.7% vs 10.7%, p = 0.32). In multivariable analysis, low DBP was associated with a trend toward higher rates of 1-year mortality [odds ratio (OR) 2.43, 95% confidence interval (CI) 0.97-6.11, p = 0.06]. When excluding patients with a post-operative invasive systolic blood pressure < 80 mmHg, low DBP was associated with significantly higher risk-adjusted mortality at 1 year [OR 2.75, 95% CI (1.07-7.07), p = 0.04]. CONCLUSIONS In this contemporary study of adults undergoing TAVR, low DBP and widened PP were widely prevalent post TAVR. Low DBP was associated with a trend toward higher rates of 1-year mortality but not with post-procedural AI.
Collapse
Affiliation(s)
- Puja B Parikh
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America.
| | - Jamie L Romeiser
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Britney Dhautel
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Duran Mitchell
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - William Holecek
- Department of Surgery, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Thomas Bilfinger
- Department of Surgery, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Jeremy Poppers
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Elliott Bennett-Guerrero
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| |
Collapse
|
67
|
Choe J, Koo HJ, Kang JW, Kim JB, Kang HJ, Yang DH. Aortic annulus sizing in bicuspid and tricuspid aortic valves using CT in patients with surgical aortic valve replacement. Sci Rep 2021; 11:21005. [PMID: 34697359 PMCID: PMC8549004 DOI: 10.1038/s41598-021-00406-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/05/2021] [Indexed: 12/30/2022] Open
Abstract
The purpose of this study was to evaluate whether bicuspid anatomy affects the discrepancy between CT-derived annular size and intraoperative size. We retrospectively analyzed annular measurements in 667 patients who underwent surgical aortic valve replacement (AVR). Preoperative CT measurements of the aortic annulus were compared to surgically implanted valve sizes. To evaluate whether the bicuspid valve affects the differences between CT annulus diameter and surgical AVR size, patients with diameter larger by > 10% (CT-Lg group) on CT, compared to surgical AVR size, were compared with those having size difference < 10% (CT-Sim group). Propensity score matching yielded 183 matched patients from each group. Bicuspid aortic valve annulus parameters significantly correlated with surgical aortic valve size (r = 0.52-0.71; for all, p < 0.01). The most representative measurements corresponded to surgical aortic valve size were area-derived diameters in tricuspid aortic valve (r = 0.69, p < 0.001) and bicuspid without raphe (r = 0.71, p < 0.001), and perimeter-derived diameter in bicuspid with raphe (r = 0.63, p < 0.001). After propensity score matching, native valve type was not different between CT-Sim and CT-Lg groups. In multivariable analysis, the difference between CT-derived diameter and surgical AVR size was affected by the operator factor and types of prosthesis. Bicuspid aortic annulus diameters measured on CT showed a significant correlation with surgical aortic valve size. The difference between CT-derived diameter and surgical AVR size is affected by operator factor and the types of prosthesis but not affected by the bicuspid valve.
Collapse
Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil, 88, Song-pa gu, Seoul, 05505, South Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil, 88, Song-pa gu, Seoul, 05505, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil, 88, Song-pa gu, Seoul, 05505, South Korea
| | - Joon Bum Kim
- Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee Jun Kang
- Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil, 88, Song-pa gu, Seoul, 05505, South Korea.
| |
Collapse
|
68
|
Ihdayhid AR, Leipsic J, Hahn RT, Pibarot P, Thourani V, Makkar R, Kodali S, Russo M, Kapadia S, Chen Y, Mack M, Webb J, Bax J, Leon MB, Blanke P. Impact of Annular Oversizing on Paravalvular Regurgitation and Valve Hemodynamics: New Insights From PARTNER 3. JACC Cardiovasc Interv 2021; 14:2158-2169. [PMID: 34620395 DOI: 10.1016/j.jcin.2021.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/16/2021] [Accepted: 07/13/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study sought to investigate the impact of computed tomography (CT)-based area and perimeter oversizing on the incidence of paravalvular regurgitation (PVR) and valve hemodynamics in patients treated with the SAPIEN 3 transcatheter heart valve (THV). BACKGROUND The incremental value of considering annular perimeter or left ventricular outflow tract measurements and the impact of THV oversizing on valve hemodynamics are not well defined. METHODS The PARTNER 3 (Placement of Aortic Transcatheter Valves 3) trial included 495 low-surgical-risk patients with severe aortic stenosis who underwent THV implantation. THV sizing was based on annular area assessed by CT. Area- and perimeter-based oversizing was determined using systolic annular CT dimensions and nominal dimensions of the implanted THV. PVR, effective orifice area, and mean gradient were assessed on 30-day transthoracic echocardiography. RESULTS Of 485 patients with available CT and echocardiography data, mean oversizing was 7.9 ± 8.7% for the annulus area and 2.1 ± 4.1% for the perimeter. A very low incidence of ≥moderate PVR (0.6%) was observed, including patients with minimal annular oversizing. Incidence of ≥mild PVR and need for procedural post-dilatation were inversely related to the degree of oversizing. For patients with annular dimensions suitable for 2 THV sizes, the larger THV with both area and perimeter oversizing was associated with the lowest incidence of ≥mild PVR (12.0% vs 43.4%; P < 0.0001). Left ventricular outflow tract area oversizing was not associated with PVR. THV prosthesis size, rather than degree of oversizing, had greatest impact on effective orifice area and mean gradient. CONCLUSIONS In low-surgical-risk patients, a low incidence of ≥moderate PVR was observed, including patients with minimal THV oversizing. The degree of prosthesis oversizing had the greatest impact on reducing mild PVR and incidence of post-dilatation, without impacting valve hemodynamics. In selected patients with annular dimensions in between 2 valve sizes, the larger THV device oversized to both the annular area and perimeter reduced PVR and optimized THV hemodynamics.
Collapse
Affiliation(s)
- Abdul Rahman Ihdayhid
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; Department of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; Department of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca T Hahn
- Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
| | | | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Susheel Kodali
- Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Mark Russo
- Rutgers Health, New Brunswick, New Jersey, USA
| | | | - Yanjun Chen
- Department of Biostatistics, Edwards Lifesciences, Irvine, California, USA
| | - Michael Mack
- Baylor Scott and White Health, Plano, Texas, USA
| | - John Webb
- Department of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeroen Bax
- Leiden University Medical Center, Leiden, the Netherlands
| | - Martin B Leon
- Department of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; Department of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
69
|
Kim WK, Walther T, Burgdorf C, Möllmann H, Linke A, Redwood S, Thilo C, Hilker M, Joner M, Thiele H, Conzelmann L, Conradi L, Barth S, Prendergast B, Husser O, Stortecky S, Rheude T, Blumenstein J, Heg D, Windecker S, Pilgrim T, Lanz J. Predictors of Prosthetic Valve Regurgitation After Transcatheter Aortic Valve Implantation With ACURATE neo in the SCOPE I Trial. JACC Cardiovasc Imaging 2021; 15:367-369. [PMID: 34656481 DOI: 10.1016/j.jcmg.2021.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
|
70
|
Greason KL. To understand a meta-analysis, best read the fine print. J Card Surg 2021; 36:4743-4745. [PMID: 34608675 DOI: 10.1111/jocs.16050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
The results of a meta-analysis are more than just the reported odds ratio, 95% confidence interval (CI), and p value. Of equal importance is the fine print of the study which should include assessment of the risk of bias, certainty in evidence, and heterogeneity in the individual point estimates and CIs. These areas all have an influence on the quality of the data in the analysis. Reading and understanding the fine print is important.
Collapse
Affiliation(s)
- Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
71
|
Nazif TM, Cahill TJ, Daniels D, McCabe JM, Reisman M, Chakravarty T, Makkar R, Krishnaswamy A, Kapadia S, Chehab BM, Wang J, Spies C, Rodriguez E, Kaneko T, Hahn RT, Leon MB, George I. Real-World Experience With the SAPIEN 3 Ultra Transcatheter Heart Valve: A Propensity-Matched Analysis From the United States. Circ Cardiovasc Interv 2021; 14:e010543. [PMID: 34433290 DOI: 10.1161/circinterventions.121.010543] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Tamim M Nazif
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York City, NY (T.M.N., T.J.C., R.T.H., M.B.L., I.G.)
| | - Thomas J Cahill
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York City, NY (T.M.N., T.J.C., R.T.H., M.B.L., I.G.)
| | - David Daniels
- Bay Area Structural Heart (BASH) @ Sutter Health, Burlingame, CA (D.D., C.S.)
| | - James M McCabe
- University of Washington Medical Center, Seattle (J.M.M., M.R.)
| | - Mark Reisman
- University of Washington Medical Center, Seattle (J.M.M., M.R.)
| | | | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, CA (T.C., R.M.)
| | | | - Samir Kapadia
- Cleveland Clinic Foundation, Cleveland, OH (A.K., S.K.)
| | | | - John Wang
- MedStar Union Memorial Hospital, Baltimore, MD (J.W.)
| | - Christian Spies
- Bay Area Structural Heart (BASH) @ Sutter Health, Burlingame, CA (D.D., C.S.)
| | | | | | - Rebecca T Hahn
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York City, NY (T.M.N., T.J.C., R.T.H., M.B.L., I.G.)
| | - Martin B Leon
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York City, NY (T.M.N., T.J.C., R.T.H., M.B.L., I.G.)
| | - Isaac George
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York City, NY (T.M.N., T.J.C., R.T.H., M.B.L., I.G.)
| |
Collapse
|
72
|
Yu T, Yang W, Zhuang W, Tian Y, Kong Q, Chen X, Li G, Wang Y. A bioprosthetic heart valve cross-linked by a non-glutaraldehyde reagent with improved biocompatibility, endothelialization, anti-coagulation and anti-calcification properties. J Mater Chem B 2021; 9:4031-4038. [PMID: 33908590 DOI: 10.1039/d1tb00409c] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Valvular heart disease is an important disease that endangers human health and heart valve replacement has become one of the main treatments for patients with severe valvular heart disease. However, the traditional surgical valve replacement (SVR) suffers several drawbacks such as high risk, great trauma and long recovery time, and more than 30% of patients are intolerant to SVR, especially elderly patients. In recent years, with the development of minimally invasive technology, transcatheter heart valve replacement (THVR) as a method of implantation without thoracotomy has become an optimal treatment for severe valvular heart disease due to its advantages of minimal trauma, low risk and fast recovery. Meanwhile, the usage of bioprosthetic heart valves (BHVs) has been enlarged greatly with the rapid development of THVR and the aging population. Most BHVs in clinics are crosslinked by glutaraldehyde (Glut), which shows great mechanical properties and chemical stability. However, some problems such as poor biocompatibility, calcification, coagulation and endothelialization difficulty also need to be solved urgently for Glut-treated BHVs. In this work, a non-Glut treated BHV from 7a-ethyltetrahydro-oxazolo[3,4-c]oxazole (OX-Et) crosslinked porcine pericardium (PP) has been developed. Compared with glutaraldehyde-crosslinked porcine pericardium (Glut-PP), good physical and chemical properties similar to Glut-PP are shown for OX-Et treated porcine pericardium (OX-Et-PP). It is noteworthy that better biocompatibility, endothelialization performance, and anti-coagulant effect as well as the improved anti-calcification property can also be observed for OX-Et-PP in the in vitro and in vivo study, potentially making OX-Et-PP a good candidate in the application of BHVs.
Collapse
Affiliation(s)
- Tao Yu
- National Engineering Research Center for Biomaterials, Sichuan University, 29 Wangjiang Road, Chengdu 610064, China.
| | - Wenxuan Yang
- National Engineering Research Center for Biomaterials, Sichuan University, 29 Wangjiang Road, Chengdu 610064, China.
| | - Weihua Zhuang
- National Engineering Research Center for Biomaterials, Sichuan University, 29 Wangjiang Road, Chengdu 610064, China.
| | - Yuan Tian
- National Engineering Research Center for Biomaterials, Sichuan University, 29 Wangjiang Road, Chengdu 610064, China.
| | - Qunshou Kong
- National Engineering Research Center for Biomaterials, Sichuan University, 29 Wangjiang Road, Chengdu 610064, China.
| | - Xiaotong Chen
- National Engineering Research Center for Biomaterials, Sichuan University, 29 Wangjiang Road, Chengdu 610064, China.
| | - Gaocan Li
- National Engineering Research Center for Biomaterials, Sichuan University, 29 Wangjiang Road, Chengdu 610064, China.
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, 29 Wangjiang Road, Chengdu 610064, China.
| |
Collapse
|
73
|
Paravalvular Leak After Transcatheter Aortic Valve Implantation Its Incidence, Diagnosis, Clinical Implications, Prevention, Management, and Future Perspectives: A Review Article. Curr Probl Cardiol 2021; 47:100957. [PMID: 34364915 DOI: 10.1016/j.cpcardiol.2021.100957] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/30/2021] [Indexed: 02/05/2023]
Abstract
Paravalvular leak (PVL) is very common after TAVI and has been reported to have a negative impact on both short- and long-term survival. The current study identified incidence, diagnosis, clinical implications, and prevention, management and future perspectives for post-TAVI paravalvular leak. A systematic literature search was conducted using PubMed and EMBASE, using the MeSH terms and key words "paravalvular leak," "diagnostic criteria," "implication," "influencing factors," and "prevention strategies." Studies were retained for review after meeting strict inclusion criteria that included only prospective studies evaluating Paravalvular leak in patients who had TAVI. Thirty articles were selected for inclusion, incidence of PVL across the studies ranged from 7% to 40%. Many factors have been associated with incidence and increased risk of PVL, including AVC volume, larger annulus dimensions, pre-TAVI transvalvular peak velocity, under sizing of the prosthesis, surgical, and other factors. PVL after TAVI is common and can be predicted by aortic root calcification volume, larger annulus dimensions, and pre-TAVI transvalvular peak velocity, with calcification volume being an independent predictor for PVL. The strength and nature of the association of various degrees of post-TAVI PVL and mortality are still to be further evaluated.
Collapse
|
74
|
Bhushan S, Huang X, Li Y, He S, Mao L, Hong W, Xiao Z. Paravalvular Leak After Transcatheter Aortic Valve Implantation Its Incidence, Diagnosis, Clinical Implications, Prevention, Management, and Future Perspectives: A Review Article. Curr Probl Cardiol 2021. [DOI: https://doi.org/10.1016/j.cpcardiol.2021.100957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
75
|
Kitamura M, Von Roeder M, Abdel-Wahab M. Quantitative assessment of aortic regurgitation following transcatheter aortic valve replacement. Expert Rev Cardiovasc Ther 2021; 19:633-645. [PMID: 33945360 DOI: 10.1080/14779072.2021.1924675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) is expanding to lower risk and younger patients with severe symptomatic aortic valve disease. Despite clinical and technological improvements, post-procedural aortic regurgitation (AR) remains a limitation of TAVR, particularly when compared to surgical aortic valve replacement. Although several methods for AR quantification after TAVR are currently available, its exact graduation in everyday clinical practice remains challenging.Areas covered: This review describes the currently available evaluation methods of AR after TAVR, with a special emphasis on the quantitative assessment using videodensitometric angiography, echocardiography and cardiac magnetic resonance imaging.Expert opinion: In the majority of clinical scenarios, satisfactory evaluation of post-TAVR AR can be achieved with a combination of post-procedural angiography, hemodynamic indices and transthoracic echocardiography. Nevertheless, some TAVR patients show 'intermediate' forms of post-procedural AR, in which quantitative evaluation is mandatory for prognostic purposes and further decision-making. Notably, interpretation of quantitative measures early post-TAVR is challenging because of the lack of left ventricular enlargement. Video-densitometric angiography is an emerging method that appears to be clinically attractive for immediate post-TAVR assessment, but requires further validation in everyday clinical practice.
Collapse
Affiliation(s)
- Mitsunobu Kitamura
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Maximilian Von Roeder
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| |
Collapse
|
76
|
Panagides V, Alperi A, Mesnier J, Philippon F, Bernier M, Rodes-Cabau J. Heart failure following transcatheter aortic valve replacement. Expert Rev Cardiovasc Ther 2021; 19:695-709. [PMID: 34227916 DOI: 10.1080/14779072.2021.1949987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Over the past decade, the number of transcatheter aortic valve replacement (TAVR) procedures has increased exponentially. Despite major improvements in both device and successes, the rate of hospital readmission after TAVR remains high, with heart failure (HF) decompensation being one of the most important causes.Areas covered: This review provides an overview of the current status of HF following TAVR, including details about its incidence, clinical impact, contributing factors, and current and future treatment perspectives.Expert opinion: HF decompensation has been identified as the most common cause of rehospitalization following TAVR, and it has been associated with a negative prognosis. Multiple preexisting factors including low flow status, cardiac amyloidosis, myocardial fibrosis, multivalvular disease, pulmonary hypertension, coronary artery disease, and atrial fibrillation have been associated with an increased risk of HF events. Also, multiple post-procedural factors like the occurrence of significant paravalvular leaks, severe prosthesis-patient mismatch, and conduction disturbances have also contributed to increase this risk . Thus, reducing HF events in TAVR recipients would require a multifactorial and multidisciplinary effort including the optimization of the medical treatment and close follow-up and treatment of residual or concomitant valvular disease and conduction disturbance issues. Future studies in this challenging group of patients are warranted.
Collapse
Affiliation(s)
- Vassili Panagides
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alberto Alperi
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jules Mesnier
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Francois Philippon
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mathieu Bernier
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodes-Cabau
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| |
Collapse
|
77
|
Laakso T, Laine M, Moriyama N, Dahlbacka S, Airaksinen J, Virtanen M, Husso A, Tauriainen T, Niemelä M, Mäkikallio T, Valtola A, Eskola M, Juvonen T, Biancari F, Raivio P. Impact of paravalvular regurgitation on the mid-term outcome after transcatheter and surgical aortic valve replacement. Eur J Cardiothorac Surg 2021; 58:1145-1152. [PMID: 33057657 DOI: 10.1093/ejcts/ezaa254] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/03/2020] [Accepted: 06/11/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the incidence and prognostic impact of paravalvular regurgitation (PVR) on the outcome after transcatheter (TAVR) and surgical aortic valve replacement (SAVR) for aortic stenosis. METHODS The nationwide FinnValve registry included data on 6463 consecutive patients who underwent TAVR (n = 2130) or SAVR (n = 4333) with a bioprosthesis for the treatment of aortic stenosis during 2008-2017. The impact of PVR at discharge after TAVR and SAVR on 4-year mortality was herein investigated. RESULTS The rate of mild PVR was 21.7% after TAVR and 5.2% after SAVR. The rate of moderate-to-severe PVR was 3.7% after TAVR and 0.7% after SAVR. After TAVR, 4-year survival was 69.0% in patients with none-to-trace PVR, 54.2% with mild PVR [adjusted hazard ratio (HR) 1.64, 95% confidence interval (CI) 1.35-1.99] and 48.9% with moderate-to-severe PVR (adjusted HR 1.61, 95% CI 1.10-2.35). Freedom from PVR-related reinterventions was 100% for none-to-mild PVR and 95.2% for moderate-to-severe PVR. After SAVR, mild PVR (4-year survival 78.9%; adjusted HR 1.29, 95% CI 0.93-1.78) and moderate-to-severe PVR (4-year survival 67.8%; adjusted HR 1.36, 95% CI 0.72-2.58) were associated with worse 4-year survival compared to none-to-trace PVR (4-year survival 83.7%), but the difference did not reach statistical significance in multivariable analysis. Freedom from PVR-related reinterventions was 99.5% for none-to-trace PVR patients, 97.9% for mild PVR patients and 77.0% for moderate-to-severe PVR patients. CONCLUSIONS This multicentre study showed that both mild and moderate-to-severe PVR were independent predictors of worse survival after TAVR. Mild and moderate-to-severe PVR are not frequent after SAVR, but tend to decrease survival also in these patients. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT03385915.
Collapse
Affiliation(s)
- Teemu Laakso
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Mika Laine
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Noriaki Moriyama
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | | | | | - Marko Virtanen
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Tuomas Tauriainen
- Research Units of Surgery, Anesthesiology and Critical Care, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Matti Niemelä
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Timo Mäkikallio
- Research Units of Surgery, Anesthesiology and Critical Care, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Antti Valtola
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Markku Eskola
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Heart Center, Turku University Hospital, Turku, Finland.,Research Units of Surgery, Anesthesiology and Critical Care, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Peter Raivio
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
78
|
Barili F, Freemantle N, Pilozzi Casado A, Rinaldi M, Folliguet T, Musumeci F, Gerosa G, Parolari A. Mortality in trials on transcatheter aortic valve implantation versus surgical aortic valve replacement: a pooled meta-analysis of Kaplan-Meier-derived individual patient data. Eur J Cardiothorac Surg 2021; 58:221-229. [PMID: 32236543 DOI: 10.1093/ejcts/ezaa087] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES This meta-analysis of Kaplan-Meier-estimated individual patient data was designed to evaluate the effects of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) on the long-term all-cause mortality rate, to examine the potential time-varying effect and to model their hazard ratios (HRs) over time. Moreover, we sought to compare traditional meta-analytic tools and estimated individual patient data meta-analyses. METHODS Trials comparing TAVI versus SAVR were identified through Medline, Embase, Cochrane databases and specialist websites. The primary outcome was death from any cause at follow-up. Enhanced secondary analyses of survival curves were performed estimating individual patient time-to-event data from published Kaplan-Meier curves. Treatments were compared with the random effect Cox model in a landmark framework and fully parametric models. RESULTS We identified 6 eligible trials that included 6367 participants, randomly assigned to undergo TAVI (3252) or SAVR (3115). According to the landmark analysis, the incidence of death in the first year after implantation was significantly lower in the TAVI group [risk-profile stratified HR 0.85, 95% confidence interval (CI) 0.73-0.99; P = 0.04], whereas there was a reversal of the HR after 40 months (risk-profile stratified HR 1.31, 95% CI 1.01-1.68; P = 0.04) favouring SAVR over TAVI. This time-varying trend of HRs was also confirmed by a fully parametric time-to-event model. Traditional meta-analytic tools were shown to be biased because they did not intercept heterogeneity and the time-varying effect. CONCLUSIONS The mortality rates in trials of TAVI versus SAVR are affected by treatments with a time-varying effect. TAVI is related to better survival in the first months after implantation whereas, after 40 months, it is a risk factor for all-cause mortality.
Collapse
Affiliation(s)
- Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - Nicholas Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Mauro Rinaldi
- Department of Cardiac Surgery, AOU "Città della Salute e della Scienza di Torino", University of Turin, Turin, Italy
| | | | - Francesco Musumeci
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart Transplantation Center, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Gino Gerosa
- Department of Cardiac Surgery, University of Padua, Padua, Italy
| | - Alessandro Parolari
- Unit of Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, University of Milan, Milan, Italy
| |
Collapse
|
79
|
Ternacle J, Al-Azizi K, Szerlip M, Potluri S, Hamandi M, Blanke P, Leipsic J, Dahou A, Salaun E, Vincent F, Rogers E, Alu MC, Lu M, Yu X, Thourani VH, Hahn RT, Leon MB, Pibarot P, Mack MJ. Impact of Predilation During Transcatheter Aortic Valve Replacement: Insights From the PARTNER 3 Trial. Circ Cardiovasc Interv 2021; 14:e010336. [PMID: 34139864 DOI: 10.1161/circinterventions.120.010336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Julien Ternacle
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (J.T., E.S., F.V., P.P.)
| | - Karim Al-Azizi
- Department of Cardiology, Baylor Scott and White, The Heart Hospital Plano, TX (K.A.-A., M.S., S.P., M.H., M.J.M.).,Baylor Research Institute, Baylor Scott and White, Plano, TX (K.A.-A., M.S., S.P., M.H., M.J.M.)
| | - Molly Szerlip
- Department of Cardiology, Baylor Scott and White, The Heart Hospital Plano, TX (K.A.-A., M.S., S.P., M.H., M.J.M.).,Baylor Research Institute, Baylor Scott and White, Plano, TX (K.A.-A., M.S., S.P., M.H., M.J.M.)
| | - Srinivasa Potluri
- Department of Cardiology, Baylor Scott and White, The Heart Hospital Plano, TX (K.A.-A., M.S., S.P., M.H., M.J.M.).,Baylor Research Institute, Baylor Scott and White, Plano, TX (K.A.-A., M.S., S.P., M.H., M.J.M.)
| | - Mohanad Hamandi
- Department of Cardiology, Baylor Scott and White, The Heart Hospital Plano, TX (K.A.-A., M.S., S.P., M.H., M.J.M.).,Baylor Research Institute, Baylor Scott and White, Plano, TX (K.A.-A., M.S., S.P., M.H., M.J.M.)
| | - Philipp Blanke
- St Paul's Hospital, Vancouver, British Columbia, Canada (P.B., J.L.)
| | - Jonathon Leipsic
- St Paul's Hospital, Vancouver, British Columbia, Canada (P.B., J.L.)
| | - Abdellaziz Dahou
- Columbia University Medical Center/New York-Presbyterian Hospital (A.D., M.C.A., R.T.H., M.B.L.).,Cardiovascular Research Foundation, New York, NY (A.D., F.V., M.C.A., R.T.H., M.B.L.)
| | - Erwan Salaun
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (J.T., E.S., F.V., P.P.)
| | - Flavien Vincent
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (J.T., E.S., F.V., P.P.).,Cardiovascular Research Foundation, New York, NY (A.D., F.V., M.C.A., R.T.H., M.B.L.)
| | - Erin Rogers
- Edwards Lifesciences, Irvine, CA (E.R., M.L., X.Y.)
| | - Maria C Alu
- Columbia University Medical Center/New York-Presbyterian Hospital (A.D., M.C.A., R.T.H., M.B.L.).,Cardiovascular Research Foundation, New York, NY (A.D., F.V., M.C.A., R.T.H., M.B.L.)
| | - Michael Lu
- Edwards Lifesciences, Irvine, CA (E.R., M.L., X.Y.)
| | - Xiao Yu
- Edwards Lifesciences, Irvine, CA (E.R., M.L., X.Y.)
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Atlanta, GA (V.H.T.)
| | - Rebecca T Hahn
- Columbia University Medical Center/New York-Presbyterian Hospital (A.D., M.C.A., R.T.H., M.B.L.).,Cardiovascular Research Foundation, New York, NY (A.D., F.V., M.C.A., R.T.H., M.B.L.)
| | - Martin B Leon
- Columbia University Medical Center/New York-Presbyterian Hospital (A.D., M.C.A., R.T.H., M.B.L.).,Cardiovascular Research Foundation, New York, NY (A.D., F.V., M.C.A., R.T.H., M.B.L.)
| | - Philippe Pibarot
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (J.T., E.S., F.V., P.P.)
| | - Michael J Mack
- Department of Cardiology, Baylor Scott and White, The Heart Hospital Plano, TX (K.A.-A., M.S., S.P., M.H., M.J.M.).,Baylor Research Institute, Baylor Scott and White, Plano, TX (K.A.-A., M.S., S.P., M.H., M.J.M.)
| |
Collapse
|
80
|
Leone PP, Fazzari F, Cannata F, Sanz-Sanchez J, Mangieri A, Monti L, Cozzi O, Stefanini GG, Bragato R, Colombo A, Reimers B, Regazzoli D. Clinical and Technical Challenges of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Implantation. Front Cardiovasc Med 2021; 8:670457. [PMID: 34150868 PMCID: PMC8211887 DOI: 10.3389/fcvm.2021.670457] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/22/2021] [Indexed: 12/30/2022] Open
Abstract
Prosthesis-patient mismatch (PPM) is present when the effective area of a prosthetic valve inserted into a patient is inferior to that of a normal human valve; the hemodynamic consequence of a valve too small compared with the size of the patient's body is the generation of higher than expected transprosthetic gradients. Despite evidence of increased risk of short- and long-term mortality and of structural valve degeneration in patients with PPM after surgical aortic valve replacement, its clinical impact in patients subject to transcatheter aortic valve implantation (TAVI) is yet unclear. We aim to review and update on the definition and incidence of PPM after TAVI, and its prognostic implications in the overall population and in higher-risk subgroups, such as small aortic annuli or valve-in-valve procedures. Last, we will focus on the armamentarium available in order to reduce risk of PPM when planning a TAVI procedure.
Collapse
Affiliation(s)
- Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Jorge Sanz-Sanchez
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | | | - Ottavia Cozzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Giulio Giuseppe Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | | | | | | |
Collapse
|
81
|
Abstract
PURPOSE OF REVIEW The PARTNER 3 trial was conducted to compare outcomes after transcatheter aortic valve replacement (TAVR) with a balloon-expandable valve and surgical aortic valve replacement (SAVR) in individuals at low surgical risk with aortic stenosis. Recently reported rates of death, stoke and valve thrombosis in the TAVR arm have raised concerns about the longevity of this intervention in low-risk individuals. It is incumbent on all members of the Heart Team to understand the potential consequences of these findings. RECENT FINDINGS TAVR was initially superior to SAVR at 1 year for a primary composite endpoint of death, stroke and rehospitalization. Results at 2 years now indicate noninferiority. Potential causative factors, comparisons with other transcatheter valves and implications for patients, providers and trainees are explored. Recommendations are additionally provided regarding TAVR and SAVR in individuals with aortic stenosis. SUMMARY Concerns regarding the longevity of TAVR in low-risk individuals notwithstanding, results from PARTNER 3 indicate that TAVR is at least noninferior to SAVR out to 2 years. Longer follow-up will be required to determine whether these newly founded concerns are justifiable.
Collapse
|
82
|
Chandra P, Jose J, Mattummal S, Mahajan AU, Govindan SC, Makhale CN, Chandra S, Shetty R, Mohanan S, John JF, Mehrotra S, Søndergaard L. Clinical evaluation of the Hydra self-expanding transcatheter aortic valve: 6 month results from the GENESIS trial. Catheter Cardiovasc Interv 2021; 98:371-379. [PMID: 33876881 DOI: 10.1002/ccd.29733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/31/2021] [Accepted: 04/12/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To evaluate the safety and performance of the Hydra transcatheter aortic valve (THV) in the treatment of symptomatic severe aortic stenosis in patients at high or extreme surgical risk. BACKGROUND The Hydra THV (Vascular Innovations Co. Ltd., Nonthaburi, Thailand) is a novel flexible repositionable self-expanding system with supra-annular bovine pericardial leaflets, available in three sizes, covering aortic annuli between 17 and 27 mm. METHODS The GENESIS trial was a prospective, multi-center, single-arm, 6 month follow-up study conducted in India. The primary performance endpoint was device success defined as per VARC-II criteria at 30 days. The primary safety endpoint was all-cause mortality at 30 days. All endpoints were adjudicated by an independent clinical events committee. RESULTS Forty high-risk patients (74.5 ± 6.7 years, 60% men; STS Score:5.6 ± 4.2%) were enrolled in 11 centres. Device success was achieved in 92.5%. The effective orifice area improved from 0.7 ± 0.2 to 2.3 ± 0.6 cm2 at 30 days and to 2.2 ± 0.7 cm2 at 6 months (p < .0001). Mean aortic valve gradient decreased from 53.5 ± 18.1 to 8.9 ± 4.9 mmHg at 30 days and to 7.6 ± 2.7 mmHg at 6 months (p < .0001). The rate of new permanent pacemaker implantation was 7.5% at 30 days, and no patient had more than mild paravalvular leak at 6 months. The 30 days and 6 month all-cause mortality was 10.0 and 17.5%, cardiovascular mortality 7.5 and 7.5%, device-related mortality 5.0 and 5.0%, respectively. No patients had stroke up to 6 months. CONCLUSIONS The GENESIS trial demonstrated high efficacy of the self-expanding Hydra THV. The cardiovascular mortality rate of 7.5% may partly be explained by the inclusion of some centres with no or limited previous experience in transcatheter aortic valve implantation.
Collapse
Affiliation(s)
- Praveen Chandra
- Department of cardiology, Medanta Medicity Hospital, Gurgaon, India
| | - John Jose
- Department of cardiology- 2, Cardiac valve and structural heart disease clinic, Christian Medical College Hospital, Vellore, India
| | | | - Ajaykumar U Mahajan
- Department of cardiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Sajeev C Govindan
- Department of cardiology, Government Medical College, Kozhikode, India
| | | | - Sharad Chandra
- Department of cardiology, King George's Medical University, Lucknow, India
| | - Ranjan Shetty
- Department of cardiology, Manipal Hospital, Bengaluru, India
| | - Sandeep Mohanan
- Department of cardiology, KMCT Medical College, Kozhikode, India
| | - John F John
- Department of cardiology, Baby Memorial Hospital, Calicut, India
| | - Sanjay Mehrotra
- Department of cardiology, Narayana Institute of Cardiac Sciences, Bengaluru, India
| | | |
Collapse
|
83
|
Généreux P, Piazza N, Alu MC, Nazif T, Hahn RT, Pibarot P, Bax JJ, Leipsic JA, Blanke P, Blackstone EH, Finn MT, Kapadia S, Linke A, Mack MJ, Makkar R, Mehran R, Popma JJ, Reardon M, Rodes-Cabau J, Van Mieghem NM, Webb JG, Cohen DJ, Leon MB. Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research. Eur Heart J 2021; 42:1825-1857. [DOI: 10.1093/eurheartj/ehaa799] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/22/2020] [Accepted: 09/24/2020] [Indexed: 12/17/2022] Open
Abstract
Abstract
Aims
The Valve Academic Research Consortium (VARC), founded in 2010, was intended to (i) identify appropriate clinical endpoints and (ii) standardize definitions of these endpoints for transcatheter and surgical aortic valve clinical trials. Rapid evolution of the field, including the emergence of new complications, expanding clinical indications, and novel therapy strategies have mandated further refinement and expansion of these definitions to ensure clinical relevance. This document provides an update of the most appropriate clinical endpoint definitions to be used in the conduct of transcatheter and surgical aortic valve clinical research.
Methods and results
Several years after the publication of the VARC-2 manuscript, an in-person meeting was held involving over 50 independent clinical experts representing several professional societies, academic research organizations, the US Food and Drug Administration (FDA), and industry representatives to (i) evaluate utilization of VARC endpoint definitions in clinical research, (ii) discuss the scope of this focused update, and (iii) review and revise specific clinical endpoint definitions. A writing committee of independent experts was convened and subsequently met to further address outstanding issues. There were ongoing discussions with FDA and many experts to develop a new classification schema for bioprosthetic valve dysfunction and failure. Overall, this multi-disciplinary process has resulted in important recommendations for data reporting, clinical research methods, and updated endpoint definitions. New definitions or modifications of existing definitions are being proposed for repeat hospitalizations, access site-related complications, bleeding events, conduction disturbances, cardiac structural complications, and bioprosthetic valve dysfunction and failure (including valve leaflet thickening and thrombosis). A more granular 5-class grading scheme for paravalvular regurgitation (PVR) is being proposed to help refine the assessment of PVR. Finally, more specific recommendations on quality-of-life assessments have been included, which have been targeted to specific clinical study designs.
Conclusions
Acknowledging the dynamic and evolving nature of less-invasive aortic valve therapies, further refinements of clinical research processes are required. The adoption of these updated and newly proposed VARC-3 endpoints and definitions will ensure homogenous event reporting, accurate adjudication, and appropriate comparisons of clinical research studies involving devices and new therapeutic strategies.
Collapse
Affiliation(s)
| | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | - Nicolo Piazza
- McGill University Health Centre, Montreal, QC, Canada
| | - Maria C Alu
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
| | - Tamim Nazif
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
| | - Philippe Pibarot
- Quebec Heart & Lung Institute, Laval University, Quebec, QC, Canada
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jonathon A Leipsic
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic and Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew T Finn
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Michael J Mack
- Baylor Scott & White Heart Hospital Plano, Plano, TX, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - John G Webb
- Department of Cardiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - David J Cohen
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Martin B Leon
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
| |
Collapse
|
84
|
Généreux P, Piazza N, Alu MC, Nazif T, Hahn RT, Pibarot P, Bax JJ, Leipsic JA, Blanke P, Blackstone EH, Finn MT, Kapadia S, Linke A, Mack MJ, Makkar R, Mehran R, Popma JJ, Reardon M, Rodes-Cabau J, Van Mieghem NM, Webb JG, Cohen DJ, Leon MB. Valve Academic Research Consortium 3: Updated Endpoint Definitions for Aortic Valve Clinical Research. J Am Coll Cardiol 2021; 77:2717-2746. [PMID: 33888385 DOI: 10.1016/j.jacc.2021.02.038] [Citation(s) in RCA: 430] [Impact Index Per Article: 143.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS The Valve Academic Research Consortium (VARC), founded in 2010, was intended to (i) identify appropriate clinical endpoints and (ii) standardize definitions of these endpoints for transcatheter and surgical aortic valve clinical trials. Rapid evolution of the field, including the emergence of new complications, expanding clinical indications, and novel therapy strategies have mandated further refinement and expansion of these definitions to ensure clinical relevance. This document provides an update of the most appropriate clinical endpoint definitions to be used in the conduct of transcatheter and surgical aortic valve clinical research. METHODS AND RESULTS Several years after the publication of the VARC-2 manuscript, an in-person meeting was held involving over 50 independent clinical experts representing several professional societies, academic research organizations, the US Food and Drug Administration (FDA), and industry representatives to (i) evaluate utilization of VARC endpoint definitions in clinical research, (ii) discuss the scope of this focused update, and (iii) review and revise specific clinical endpoint definitions. A writing committee of independent experts was convened and subsequently met to further address outstanding issues. There were ongoing discussions with FDA and many experts to develop a new classification schema for bioprosthetic valve dysfunction and failure. Overall, this multi-disciplinary process has resulted in important recommendations for data reporting, clinical research methods, and updated endpoint definitions. New definitions or modifications of existing definitions are being proposed for repeat hospitalizations, access site-related complications, bleeding events, conduction disturbances, cardiac structural complications, and bioprosthetic valve dysfunction and failure (including valve leaflet thickening and thrombosis). A more granular 5-class grading scheme for paravalvular regurgitation (PVR) is being proposed to help refine the assessment of PVR. Finally, more specific recommendations on quality-of-life assessments have been included, which have been targeted to specific clinical study designs. CONCLUSIONS Acknowledging the dynamic and evolving nature of less-invasive aortic valve therapies, further refinements of clinical research processes are required. The adoption of these updated and newly proposed VARC-3 endpoints and definitions will ensure homogenous event reporting, accurate adjudication, and appropriate comparisons of clinical research studies involving devices and new therapeutic strategies.
Collapse
Affiliation(s)
| | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Nicolo Piazza
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Maria C Alu
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA
| | - Tamim Nazif
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA
| | - Philippe Pibarot
- Quebec Heart & Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jonathon A Leipsic
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic and Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew T Finn
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Michael J Mack
- Baylor Scott & White Heart Hospital Plano, Plano, Texas, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey J Popma
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael Reardon
- Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Josep Rodes-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec, Quebec, Canada
| | | | - John G Webb
- Department of Cardiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - David J Cohen
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Martin B Leon
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA.
| |
Collapse
|
85
|
Sandhu A, Tzou WS. A Disruptive Technology: Determining Need for Permanent Pacing After TAVR. Curr Cardiol Rep 2021; 23:53. [PMID: 33871728 DOI: 10.1007/s11886-021-01481-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW Transcatheter aortic valve replacement (TAVR) has changed the paradigm for management of severe aortic stenosis. Despite evolution of TAVR over the past 2 decades, conduction system disturbances remain a concern post-TAVR. In this review, we describe (1) permanent pacemaker (PP) implant rates associated with TAVR, (2) risk factors predicting need for PP therapy post-TAVR, (3) management of perioperative conduction abnormalities, and (4) novel areas of research. RECENT FINDINGS Conduction disturbances remain a common issue post-TAVR, in particular, left bundle branch block (LBBB). Though newer data describes resolution of a significant fraction of these disturbances over time, rates of pacemaker therapy remain high despite improvements in valve technology and procedural technique. Recent consensus statements and guideline documents are important first steps in standardizing an approach to post-TAVR conduction disturbances. New areas of research show promise in both prediction and treatment of conduction disturbances post-TAVR.
Collapse
Affiliation(s)
- Amneet Sandhu
- Division of Cardiology, Cardiac Electrophysiology Section, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, 80045, USA.,Division of Cardiology, Denver VA Medical Center, Denver, CO, USA
| | - Wendy S Tzou
- Division of Cardiology, Cardiac Electrophysiology Section, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, 80045, USA.
| |
Collapse
|
86
|
Dowling C, Gooley R, McCormick L, Firoozi S, Brecker SJ. Patient-specific Computer Simulation: An Emerging Technology for Guiding the Transcatheter Treatment of Patients with Bicuspid Aortic Valve. Interv Cardiol 2021; 16:e26. [PMID: 34721665 PMCID: PMC8419845 DOI: 10.15420/icr.2021.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/19/2021] [Indexed: 12/21/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is increasingly being used to treat younger, lower-risk patients, many of whom have bicuspid aortic valve (BAV). As TAVI begins to enter these younger patient cohorts, it is critical that clinical outcomes from TAVI in BAV are matched to those achieved by surgery. Therefore, the identification of patients who, on an anatomical basis, may not be suitable for TAVI, would be desirable. Furthermore, clinical outcomes of TAVI in BAV might be improved through improved transcatheter heart valve sizing and positioning. One potential solution to these challenges is patient-specific computer simulation. This review presents the methodology and clinical evidence surrounding patient-specific computer simulation of TAVI in BAV.
Collapse
Affiliation(s)
- Cameron Dowling
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash UniversityMelbourne, Australia
| | - Robert Gooley
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash UniversityMelbourne, Australia
| | - Liam McCormick
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash UniversityMelbourne, Australia
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St George’s, University of London and St George’s University Hospitals NHS Foundation TrustLondon, UK
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St George’s, University of London and St George’s University Hospitals NHS Foundation TrustLondon, UK
| |
Collapse
|
87
|
Reynolds EE, Baron SJ, Kaneko T, Libman H. Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement: How Would You Manage This Patient With Severe Aortic Stenosis? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2021; 174:521-528. [PMID: 33844572 DOI: 10.7326/m21-0724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aortic stenosis (AS) is common, especially among the elderly. Left untreated, severe symptomatic AS is typically fatal. Surgical aortic valve replacement (SAVR) was the standard of care until transcatheter aortic valve replacement (TAVR) was shown to have lower mortality rates in patients at the highest surgical risk and was recommended for this group in the 2014 American Heart Association/American College of Cardiology (AHA/ACC) guidelines. In the 2017 AHA/ACC focused update, evidence of benefit and noninferiority extended the use of TAVR to intermediate-risk patients. More recent studies suggest potential benefit to low-risk patients, although no published guidelines yet recommend the use of TAVR for this population. An advantage of SAVR is a 30-year experience with valve durability, but SAVR may have higher rates of perioperative death and a slower return of quality of life. Although TAVR has less than 10-year experience with valve durability, it has lower or noninferior primary end points, such as mortality and stroke, and fewer periprocedural complications among anatomically permissive patients. Here, a cardiologist and a cardiothoracic surgeon debate the risks and benefits of TAVR versus SAVR for a patient with severe symptomatic AS who is at low risk for surgical death.
Collapse
Affiliation(s)
- Eileen E Reynolds
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (E.E.R., H.L.)
| | - Suzanne J Baron
- Lahey Hospital & Medical Center, Burlington, Massachusetts (S.J.B.)
| | | | - Howard Libman
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (E.E.R., H.L.)
| |
Collapse
|
88
|
Tamm AR, Hell MM, Geyer M, Kreidel F, da Rocha E Silva JG, Seidl M, Ruf TF, Kornberger A, Beiras-Fernandez A, Münzel T, von Bardeleben RS. Minimizing Paravalvular Regurgitation With the Novel SAPIEN 3 Ultra TAVR Prosthesis: A Real-World Comparison Study. Front Cardiovasc Med 2021; 8:623146. [PMID: 33816574 PMCID: PMC8015438 DOI: 10.3389/fcvm.2021.623146] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives: We investigated performance and outcome of the latest-generation balloon-expandable SAPIEN 3 Ultra prosthesis (S3U) compared to the established SAPIEN 3 prosthesis (S3) in a real-world cohort, with focus on paravalvular regurgitation (PVR). Background: PVR is an adverse prognostic indicator of short- and long-term survival after transcatheter aortic valve replacement (TAVR). The S3U has been designed to improve sealing. Methods: We enrolled 343 consecutive patients presenting with severe native aortic valve stenosis eligible for a balloon-expandable prosthesis. The established S3 was implanted in the first 200 patients, the following 143 patients received the novel S3U after introduction in our institution. Primary endpoint was PVR after TAVR. Furthermore, we investigated procedural parameters and in-hospital and 30-day outcome. Results: PVR was significantly lower in the S3U cohort compared to the S3 cohort. They differed in their rate of mild PVR (11.2 vs. 48.0%, p < 0.001), whereas at least moderate PVR was similarly low in both cohorts (0.7 vs. 0.5%, p = 0.811). A significant reduction of post-dilatation rate, fluoroscopy time, and amount of contrast was observed in patients treated with the novel S3U (p < 0.001). The rate of adverse events in the in-hospital course and at 30 days were similarly low. At 30 days more patients receiving S3U improved in NYHA class (improvement ≥2 grades 34.6 vs. 19.9%, p = 0.003). Conclusion: The current study provides evidence that the novel S3U strongly minimizes PVR, thereby demonstrating the efficacy of improved sealing. Further studies will have to address if the observed reduction of PVR with S3U has prognostic significance.
Collapse
Affiliation(s)
- Alexander R Tamm
- Center of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Michaela M Hell
- Center of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Martin Geyer
- Center of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Felix Kreidel
- Center of Cardiology, University Medical Center Mainz, Mainz, Germany
| | | | - Meike Seidl
- Center of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Tobias F Ruf
- Center of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Angela Kornberger
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Mainz, Germany
| | | | - Thomas Münzel
- Center of Cardiology, University Medical Center Mainz, Mainz, Germany
| | | |
Collapse
|
89
|
Mangieri A, Laricchia A, Montalto C, Palena ML, Fisicaro A, Cereda A, Sticchi A, Latib A, Giannini F, Khokhar AA, Colombo A. Patient selection, procedural planning and interventional guidance for transcatheter aortic valve intervention. Minerva Cardiol Angiol 2021; 69:671-683. [PMID: 33703862 DOI: 10.23736/s2724-5683.21.05573-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is an established treatment for severe aortic stenosis across a broad spectrum of patient risk profiles. Pre-procedural planning using multislice computed tomography (MSCT) is a fundamental component to ensure acute and long-term procedural success. MSCT can establish the procedural feasibility, the type vascular of approach as well as the device which is more likely to give a good result. Moreover, MSCT is a key tool to estimate the risk of potentially life-threatening complications. In this review, the role of MSCT for pre-procedural TAVR planning will be discussed providing a panoramic overview of the key elements that should be considered when performing TAVR. Additionally, the adjunctive role of fluoroscopy and echocardiography to plan and guide a TAVR procedure will also be discussed.
Collapse
Affiliation(s)
- Antonio Mangieri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy -
| | - Alessandra Laricchia
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mariano L Palena
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Andrea Fisicaro
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alberto Cereda
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alessandro Sticchi
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Francesco Giannini
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Arif A Khokhar
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Antonio Colombo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| |
Collapse
|
90
|
Doyle MP, Woldendorp K, Ng M, Vallely MP, Wilson MK, Yan TD, Bannon PG. Minimally-invasive versus transcatheter aortic valve implantation: systematic review with meta-analysis of propensity-matched studies. J Thorac Dis 2021; 13:1671-1683. [PMID: 33841958 PMCID: PMC8024828 DOI: 10.21037/jtd-20-2233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Minimally invasive aortic valve replacement (MiAVR) and transcatheter aortic valve implantation (TAVI) provide aortic valve replacement (AVR) by less invasive methods than conventional surgical AVR, by avoiding complete sternotomy. This study directly compares and analyses the available evidence for early outcomes between these two AVR methods. Methods Electronic databases were searched from inception until August 2019 for studies comparing MiAVR to TAVI, according to predefined search criteria. Propensity-matched studies with sufficient data were included in a meta-analysis. Results Eight studies with 9,744 patients were included in the quantitative analysis. Analysis of risk-matched patients showed no difference in early mortality (RR 0.76, 95% CI, 0.37–1.54, P=0.44). MiAVR had a signal towards lower rate of postoperative stroke, although this did not reach statistical significance (OR 0.42, 95% CI, 0.13–1.29, P=0.13). MiAVR had significantly lower rates of new pacemaker (PPM) requirement (OR 0.29, 95% CI, 0.16–0.52, P<0.0001) and postoperative aortic insufficiency (AI) or paravalvular leak (PVL) (OR 0.05, 95% CI, 0.01–0.20, P<0.0001) compared to TAVI, (OR 0.42, 95% CI, 0.13–1.29, P=0.13), while acute kidney injury (AKI) was higher in MiAVR compared to TAVI (11.1% vs. 5.2%, OR 2.28, 95% CI, 1.25–4.16, P=0.007). Conclusions In patients of equivalent surgical risk scores, MiAVR may be performed with lower rates of postoperative PPM requirement and AI/PVL, higher rates of AKI and no statistical difference in postoperative stroke or short-term mortality, compared to TAVI. Further prospective trials are needed to validate these results.
Collapse
Affiliation(s)
- Mathew P Doyle
- The Royal Prince Alfred Hospital, Sydney, Australia.,The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia.,University of Wollongong School of Medicine, Keiraville, Australia
| | - Kei Woldendorp
- The Royal Prince Alfred Hospital, Sydney, Australia.,The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia.,The University of Sydney Medical School, Camperdown, Australia
| | - Martin Ng
- The Royal Prince Alfred Hospital, Sydney, Australia.,The University of Sydney Medical School, Camperdown, Australia
| | | | - Michael K Wilson
- Macquarie University Hospital, Macquarie University, Sydney, Australia
| | - Tristan D Yan
- The Royal Prince Alfred Hospital, Sydney, Australia.,Macquarie University Hospital, Macquarie University, Sydney, Australia.,Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Paul G Bannon
- The Royal Prince Alfred Hospital, Sydney, Australia.,The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia.,The University of Sydney Medical School, Camperdown, Australia
| |
Collapse
|
91
|
Chatfield A, Sathananthan J, Wood DA, Webb JG. Next generation balloon expandable transcatheter heart valve: the SAPIEN 3 Ultra valve. Future Cardiol 2021; 17:811-816. [PMID: 33470845 DOI: 10.2217/fca-2020-0001] [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] [Indexed: 01/24/2023] Open
Abstract
The next generation SAPIEN 3 Ultra (Edwards Lifesciences, CA, USA) builds on the success of the SAPIEN 3 (S3) transcatheter heart valve. The textured polyethylene terephthalate external skirt is 40% taller than the S3 valve skirt. The Edwards Commander delivery system and Edwards eSheath remain unchanged from S3 with proven results regarding valve deliverability and low rates of vascular complications.
Collapse
Affiliation(s)
| | | | - David A Wood
- Centre for Heart Valve Innovation, Vancouver BC V6Z 1Y6, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, Vancouver BC V6Z 1Y6, Canada
| |
Collapse
|
92
|
Useini D, Beluli B, Christ H, Schlömicher M, Ewais E, Haldenwang P, Patsalis P, Moustafine V, Bechtel M, Strauch J. Transcatheter aortic valve replacement using the SAPIEN 3 valve versus surgical aortic valve replacement using the rapid deployment INTUITY valve: Midterm outcomes. J Card Surg 2021; 36:610-617. [PMID: 33386755 DOI: 10.1111/jocs.15275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/18/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Little data have been published on the midterm effect of transapical/transfemoral-transcatheter aortic valve replacement (TA-/TF-TAVR) using the Edwards SAPIEN 3 valve (S3). We aimed to compare the outcomes after TA-/TF-TAVR utilizing the S3 (TA-/TF-S3) valve with those after surgical aortic valve replacement utilizing the rapid deployment Edwards INTUITY valve (RD-SAVR). METHODS Between March 2012 and April 2018, 122 patients with aortic stenosis underwent TA-S3, 77 patients underwent TF-S3 and 182 patients underwent RD-SAVR through partial sternotomy at our institution. We conducted clinical and echocardiographic midterm follow-ups. The primary outcomes of the study were the incidence of new pacemakers permanent pacemaker implantation (PPI), the occurrence of paravalvular leakage (PVL) and the hemodynamic performance of the valves. RESULTS All study groups were at intermediate surgical risk. The 30-day all-cause mortality and stroke rates in the TA-S3, TF-S3, and RD-SAVR groups were 4.1% and 1.6%, 3.9% and 2.6%, and 3.8% and 2.2%, respectively. The RD-SAVR group had significantly smaller PVL and PPI rates than did the TA-/TF-S3 group (p < .0001). At the discharge, the one-year postprocedure mean gradients were 9 ± 5.1/10 ± 4.5 mmHg, 11 ± 4.1/12 ± 3.8 mmHg, and 10.1 ± 4.3/10.4 ± 2.6 mmHg in the TA-S3, TF-S3, and RD-SAVR groups, respectively. Midterm valve thrombosis, Re-TAVR/SVAR were low and similar among the study groups, whereas endocarditis was higher in the TAVR group. CONCLUSION RD-SAVR was superior to TA-/TF-S3 in the PVL and PPI rates. We observed similar early outcomes and valve hemodynamics. The endocarditis was higher in the TAVR group.
Collapse
Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Blerta Beluli
- Department of Internal Medicine, St. Anna Hospital, Herne, Germany
| | - Hildegard Christ
- Department of Medical Statistics, Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Cologne, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Elias Ewais
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Polykarpos Patsalis
- Department of Cardiology and Angiology, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| |
Collapse
|
93
|
Vogt JC, Michelena HI, Nishimura RA, Nkomo VT, Pislaru SV, Reeder GS, Rihal CS, Eleid MF. Diastolic blood pressure predicts outcomes after aortic paravalvular leak closure. Catheter Cardiovasc Interv 2021; 97:E79-E87. [PMID: 32259389 DOI: 10.1002/ccd.28890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/14/2020] [Accepted: 03/25/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We sought to determine hemodynamic effects of aortic paravalvular leak (PVL) and predictors of clinical outcomes after aortic PVL closure. BACKGROUND The significance of hemodynamic alterations in PVL and relation to severity, procedural success of percutaneous closure and clinical outcomes have not been defined. METHODS Patients undergoing percutaneous PVL closure between July 21, 2004 and September 10, 2018 were included. PVL severity was assessed by echocardiography and aortic angiography. Hemodynamics were assessed by intra-arterial pressure tracings before and after PVL closure. The primary outcome was a composite of mortality, redo aortic valve replacement (AVR) and redo PVL closure. RESULTS One hundred and seventeen patients (mean age 70.3 ± 14.9 years, 79% surgical and 21% transcatheter prostheses) underwent PVL closure with 94% technical success. PVL was moderate or greater in 106 (91%) at baseline and 11 (11%) post-procedure. Diastolic BP for those with moderate or greater PVL was lower than for those with less PVL (50.3 ± 11.7 vs. 56.5 ± 12.4 mmHg, p < .001). Pulse pressure was similar between these groups (69.9 ± 20.3 vs. 67.4 ± 21.2 mmHg, p = .39). 35 patients (34%) had 40 events during a mean follow-up of 1.6 ± 1.9 years (23 deaths, 12 redo AVR, and five redo PVL closures). In a multivariate model, final diastolic BP <47 mmHg (HR 3.27 [1.45-7.36], p = .007) was a significant predictor of the composite endpoint. CONCLUSIONS Diastolic BP was significantly associated with aortic PVL severity and clinical outcomes after PVL closure. In contrast, pulse pressure did not correlate with PVL severity or outcomes. These findings have implications for clinical management of patients with aortic PVL.
Collapse
Affiliation(s)
- Joshua C Vogt
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Guy S Reeder
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
94
|
Cahill TJ, Terre JA, George I. Over 15 years: the advancement of transcatheter aortic valve replacement. Ann Cardiothorac Surg 2020; 9:442-451. [PMID: 33312902 DOI: 10.21037/acs-2020-av-24] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The management of aortic stenosis has been revolutionized by transcatheter aortic valve replacement (TAVR). Initially only undertaken in patients at prohibitive or high surgical risk, as the evidence base and indications have expanded, TAVR is now approved and undertaken in patients at all risk levels. Evolution of valve technology, delivery systems and pathways for patient work-up have been rapid, with associated reductions in the complication profile, particularly vascular complications. Challenges remain as TAVR continues to advance, however, specifically achieving further reduction in paravalvular regurgitation, the requirement for permanent pacemaker implantation, and balancing the risks of thrombosis and bleeding. In this review, we outline the historical advances leading to contemporary TAVR practice, and discuss the future trajectory.
Collapse
Affiliation(s)
- Thomas J Cahill
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Juan A Terre
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Isaac George
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
95
|
Mauri V, Frohn T, Deuschl F, Mohemed K, Kuhr K, Reimann A, Körber MI, Schofer N, Adam M, Friedrichs K, Kuhn EW, Scholtz S, Rudolph V, Wahlers TCW, Baldus S, Mader N, Schäfer U, Rudolph TK. Impact of device landing zone calcification patterns on paravalvular regurgitation after transcatheter aortic valve replacement with different next-generation devices. Open Heart 2020; 7:openhrt-2019-001164. [PMID: 32393655 PMCID: PMC7223472 DOI: 10.1136/openhrt-2019-001164] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/18/2020] [Accepted: 03/26/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Residual paravalvular regurgitation (PVR) has been associated to adverse outcomes after transcatheter aortic valve replacement (TAVR). This study sought to evaluate the impact of device landing zone (DLZ) calcification on residual PVR after TAVR with different next-generation transcatheter heart valves. METHODS 642 patients underwent TAVR with a SAPIEN 3 (S3; n=292), ACURATE neo (NEO; n=166), Evolut R (ER; n=132) or Lotus (n=52). Extent, location and asymmetry of DLZ calcification were assessed from contrast-enhanced CT imaging and correlated to PVR at discharge. RESULTS PVR was ≥moderate in 0.7% of S3 patients, 9.6% of NEO patients, 9.8% of ER patients and 0% of Lotus patients (p<0.001), and these differences remained after matching for total DLZ calcium volume. The amount of DLZ calcium was significantly related to the degree of PVR in patients treated with S3 (p=0.045), NEO (p=0.004) and ER (p<0.001), but not in Lotus patients (p=0.698). The incidence of PVR ≥moderate increased significantly over the tertiles of DLZ calcium volume (p=0.046). On multivariable analysis, calcification of the aortic valve cusps, LVOT calcification and the use of self-expanding transcatheter aortic valve implantation (TAVI) prostheses emerged as predictors of PVR. CONCLUSIONS The susceptibility to PVR depending on the amount of calcium was mainly observed in self-expanding TAVI prostheses. Thus, DLZ calcification is an important factor to be considered in prosthesis selection for each individual patient, keeping in mind the trade-off between PVR reduction, risk of new pacemaker implantation and unfavourable valve ha emodynamics.
Collapse
Affiliation(s)
- Victor Mauri
- Heart Center, University of Cologne, Koln, Germany
| | - Thomas Frohn
- Heart Center, University of Cologne, Koln, Germany
| | - Florian Deuschl
- Departement of Cardiology, University Hospital Hamburg Eppendorf University Heart Centre, Hamburg, Hamburg, Germany
| | - Kawa Mohemed
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Kathrin Kuhr
- Heart Center, University of Cologne, Koln, Germany
| | | | | | - Niklas Schofer
- Departement of Cardiology, University Hospital Hamburg Eppendorf University Heart Centre, Hamburg, Hamburg, Germany
| | - Matti Adam
- Heart Center, University of Cologne, Koln, Germany
| | - Kai Friedrichs
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Elmar W Kuhn
- Heart Center, University of Cologne, Koln, Germany
| | - Smita Scholtz
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Volker Rudolph
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Thorsten C W Wahlers
- Department of Cardiothoracic Surgery, Klinikum der Universität zu Köln, Klinik und Poliklinik für Herz- und Thoraxchirurgie, Cologne, Germany
| | - Stephan Baldus
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Klinikum der Universität zu Köln, Klinik und Poliklinik für Herz- und Thoraxchirurgie, Cologne, Germany
| | - Ulrich Schäfer
- Departement of Cardiology, University Hospital Hamburg Eppendorf University Heart Centre, Hamburg, Hamburg, Germany
| | - Tanja K Rudolph
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| |
Collapse
|
96
|
Patel KV, Omar W, Gonzalez PE, Jessen ME, Huffman L, Kumbhani DJ, Bavry AA. Expansion of TAVR into Low-Risk Patients and Who to Consider for SAVR. Cardiol Ther 2020; 9:377-394. [PMID: 32875469 PMCID: PMC7584721 DOI: 10.1007/s40119-020-00198-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Indexed: 12/15/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis (AS) over the last decade. The results of the Placement of Aortic Transcatheter Valves (PARTNER) 3 and Evolut Low Risk trials demonstrated the safety and efficacy of TAVR in low-surgical-risk patients and led to the approval of TAVR for use across the risk spectrum. Heart teams around the world will now be faced with evaluating a deluge of younger, healthier patients with severe AS. Prior to the PARTNER 3 and Evolut Low Risk studies, this heterogenous patient population would have undergone surgical aortic valve replacement (SAVR). It is unlikely that TAVR will completely supplant SAVR for the treatment of severe AS in patients with a low surgical risk, as SAVR has excellent short- and long-term outcomes and years of durability data. In this review, we outline the critical role that SAVR will continue to play in the treatment of severe AS in the post-PARTNER 3/Evolut Low Risk era.
Collapse
Affiliation(s)
- Kunal V Patel
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Wally Omar
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Pedro Engel Gonzalez
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Michael E Jessen
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, USA
| | - Lynn Huffman
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, USA
| | - Dharam J Kumbhani
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Anthony A Bavry
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA.
| |
Collapse
|
97
|
Cosyns B. Paravalvular Leak Assessment After TAVR: Can You Please Ask the Echocardiographer to Get Out of the Catheterization Laboratory? JACC Cardiovasc Interv 2020; 13:1312-1313. [PMID: 32499021 DOI: 10.1016/j.jcin.2020.03.046] [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: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Bernard Cosyns
- Department of Cardiology, Centrum voor Hart en Vaatziekten, Universitaire Ziekenhuis Brussels; In Vivo Molecular and Cellular Imaging Center; European Reference Network on Rare Cardiac Disease, Brussels, Belgium.
| |
Collapse
|
98
|
Wang R, Gao C, Kawashima H, Modolo R, Rosseel L, Onuma Y, Soliman O, Serruys PW, Mylotte D. Valvular heart interventions: advances from 2019 to 2020. EUROINTERVENTION 2020; 16:808-823. [PMID: 32958460 DOI: 10.4244/eij-d-20-00096] [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]
Affiliation(s)
- Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | | | | | | | | | | | | | | | | |
Collapse
|
99
|
Laricchia A, Khokhar AA, Gallo F, Giannini F, Colombo A, Latib A, Mangieri A. Transcatheter aortic valve replacement: potential use in lower-risk aortic stenosis. Expert Rev Cardiovasc Ther 2020; 18:723-731. [PMID: 33021849 DOI: 10.1080/14779072.2020.1833717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The widespread use of transcatheter aortic valve implantation (TAVI) is expanding to low-risk patients. Nevertheless, a low clinical risk does not always correspond to a low procedural risk for the percutaneous approach. AREAS COVERED The initial trials on TAVI in low-risk populations had encouraging results, showing non-inferiority in comparison to surgical aortic valve replacement (SAVR). However, the low-risk definition is based on risk score calculators developed for the surgical setting and not including other specific features that are more relevant to TAVI and can affect procedural outcomes. For example, the presence of bicuspid aortic valves, high calcific burden, low coronary height or conduction disturbances is all potentially associated with suboptimal results or even procedural complications. In addition, the lack of longer follow-up prevents us to draw conclusions about long-term outcomes, including data about valve durability and coronary re-access. EXPERT OPINION Although current evidence suggest similar results for TAVI and SAVR in low-risk populations, there are some technical and procedural limitations that still need to be addressed in order to close the gap between TAVI and surgery. Optimal, lasting results with a low rate of procedural complications are highly expected in low-risk, otherwise healthy subjects, with potential for longevity.
Collapse
Affiliation(s)
- Alessandra Laricchia
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Arif A Khokhar
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Francesco Gallo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Francesco Giannini
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Antonio Colombo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center , Bronx, NY, USA
| | - Antonio Mangieri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| |
Collapse
|
100
|
Eftychiou C, Eteocleous N, Zittis I, Simamonian K, Ioannou A, Loukaidou P, Ntaka A, Hadjigregoriou A, Vasiliades V, Adamou M, Constantinou E, Avraamides P. Outcomes of transfemoral transcatheter aortic valve implantation (TAVI) and predictors of thirty-day major adverse cardiovascular events (MACE) and one-year mortality. Hellenic J Cardiol 2020; 62:57-64. [PMID: 33007466 DOI: 10.1016/j.hjc.2020.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/05/2020] [Accepted: 09/10/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE TAVI is more frequently used to treat aortic stenosis with the mandate to have a low as possible rate of adverse events. We present our 30-day outcomes and one-year mortality and examine the factors associated with them. METHODS A prospective evaluation was performed of all patients who underwent transfemoral TAVI in Nicosia General Hospital from January 2015 until March 2020. MACE were defined as cardiac death, disabling stroke, and/or major vascular complications (VC). Multiple logistic and Cox regression analyses were used to identify the factors associated with 30-day MACE and one-year mortality, respectively. RESULTS A total of 235 TAVI procedures were performed (178 balloon-expandable, 57 self-expandable). Thirty-day outcomes were MACE: 4.3%, cardiovascular death: 2.1%, disabling stroke: 1.3%, major VC: 1.7%, and contrast induced nephropathy (CIN): 4.3%. There was a rate of 6.2% new pacemaker implantations and 0.9% of more than mild aortic valve regurgitation (AR) at 30 days. Mortality at one year was 15.1%. The balloon-expandable valves appear to have less new pacemakers, less mild AR, lower contrast volume used, and less days of hospitalization, while the self-expandable valves have lower post-procedural gradients. Low hemoglobulin, history of atrial fibrillation (AF), and lower BMI were predictors of 30-day MACE. Serum creatinine >2 mg/dL, history of AF, RVSP >60 mmHg and major VC are predictors of one-year mortality. CONCLUSION We have shown excellent 30-day results with low incidence of adverse events for both the balloon-expandable and self-expandable valves. Clinical factors are the main predictors of both 30-day MACE and one-year mortality; major VC is a strong predictor of one-year mortality.
Collapse
Affiliation(s)
| | | | - Ioannis Zittis
- Cardiology Department of Nicosia General Hospital, Cyprus
| | | | | | | | - Aliki Ntaka
- Anesthesiology Department of Nicosia General Hospital, Cyprus
| | | | | | - Maria Adamou
- Blood Bank Department of Nicosia General Hospital, Cyprus
| | | | | |
Collapse
|