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Bidar E, Folliguet T, Kluin J, Muneretto C, Parolari A, Barili F, Suwalski P, Bonaros N, Punjabi P, Sadaba R, De Bonis M, Al-Attar N, Obadia JF, Czerny M, Shrestha M, Zegdi R, Natour E, Lorusso R. Postimplant biological aortic prosthesis degeneration: challenges in transcatheter valve implants. Eur J Cardiothorac Surg 2019; 55:191-200. [PMID: 30541101 DOI: 10.1093/ejcts/ezy391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/15/2018] [Indexed: 12/29/2022] Open
Abstract
Surgical aortic valve replacement (SAVR) is highly effective and can be achieved with relatively low risk in patients with severe aortic stenosis. Bioprostheses have been used most frequently during the past 60 years. However, the function of biological valves usually declines after 10-15 years from implant when structural valve degeneration occurs often mandating a reoperation once valve dysfunction becomes haemodynamically significant. Known for many years by surgeons and cardiologists taking care of patients with SAVR, the issue of postimplant structural valve degeneration has been recently highlighted also in patients with transcatheter aortic valve implant (TAVI). There is growing concern that TAVI valves exhibit structural valve degeneration due to inherent challenges of the deployment mode. The impact on postimplant degeneration of TAVI valves compared to SAVR has still to be understood and defined. Based on the ongoing process of expanding TAVI indications, several potential shortcomings and caveats, learned during the last 60 years of SAVR experience, should be taken into consideration to refine this technique.
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Affiliation(s)
- Elham Bidar
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Thierry Folliguet
- Centre Hospitalo-Universitaire Brabois ILCV, Hôpital Henri Mondor, Division of Cardio Thoracic Surgery and Transplantation, Université Paris 12 UPEC, France
| | - Jolanda Kluin
- Department of Cardio-Thoracic Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - Claudio Muneretto
- Cardiac Surgery Unit, University of Brescia Medical School, Brescia, Italy
| | - Alessandro Parolari
- Cardiac Surgery and Translational Research Units, IRCCS, Policlinico S. Donato, University of Milan, Milan, Italy
| | - Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Prakash Punjabi
- Department of Cardio-Thoracic Surgery, Imperial College Healthcare NHS Trust, Imperial College School of Medicine, London, UK
| | - Rafa Sadaba
- Department of Cardiac Surgery, Hospital de Navarra, Pamplona, Spain
| | - Michele De Bonis
- Department of Cardiac Surgery, S. Raffaele University Hospital, Milan, Italy
| | - Nawwar Al-Attar
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | - Jean Francois Obadia
- Department of Cardio-Thoracic Surgery, Hôpital Cardiothoracique Louis Pradel, Lyon, France
| | - Martin Czerny
- Department of Cardio-Vascular Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Malakh Shrestha
- Department of Cardio-Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Rachid Zegdi
- Hôpital Européen Georges Pompidou, Paris, France
| | - Ehsan Natour
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
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Romano M, Daprati A, Saitto G, Tizzano F, Le Houérou D, Donzeau-Gouge P, Farge A, Lefèvre T, Hovasse T, Garatti A. Safety and effectiveness of a transaortic approach for TAVI: procedural and midterm outcomes of 265 consecutive patients in a single centre. Interact Cardiovasc Thorac Surg 2019; 30:400-407. [DOI: 10.1093/icvts/ivz269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 09/17/2019] [Accepted: 10/20/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVES
Transcatheter aortic valve implantation with a transaortic approach (TAo-TAVI) is an alternative to transapical or femoral access. We studied the procedural and midterm efficacy and safety of TAo-TAVI with Edwards Sapien XT and Medtronic CoreValve devices.
METHODS
Among 901 patients receiving TAVI since 2006, 265 consecutive patients underwent TAo-TAVI between January 2011 and September 2014. Procedural and midterm results were evaluated according to Valve Academic Research Consortium-2 criteria.
RESULTS
The mean age was 83 ± 5 years. Sapien XT and CoreValve were used in 191 (72.1%) and 74 (27.9%) patients, respectively. Full sternotomy made elective concomitant off-pump coronary artery bypass grafting possible in 38 patients (14.3%) with severe coronary artery disease unsuitable for percutaneous coronary intervention. The device success rate was 95.5%. Postprocedural paravalvular leak ≥2/4 was observed in 16 patients (6.4%). Emergency open chest surgery was required in 10 patients (3.8%) (3 aortic dissections, 3 valve embolizations, 2 LMCA occlusions, 1 aortic annulus rupture and 1 aortic rupture). Cerebrovascular accidents occurred in 3 patients (1.1%). Transfusions ≥4 units were required in 36 patients (13.6%). New pacemakers were implanted in 26 patients (9.8%). Thirty-day and 1-year mortality were 8.7% and 16.2%, respectively. Mean follow-up duration was 24 ± 6 months. At 3 years, freedom from all-cause death was 80% ± 4%. New York Heart Association class <III included 81% (n = 172) of patients alive and without prosthetic echocardiographic dysfunction at follow-up (mean gradient 10.5 ± 5.6 mmHg).
CONCLUSION
The TAo-TAVI approach confirms its safety and effectiveness with satisfactory procedural and midterm outcomes with both currently available devices.
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Affiliation(s)
- Mauro Romano
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Andrea Daprati
- Department of Cardiac Surgery, Policlinico S. Donato Hospital, S. Donato Milanese, Milan, Italy
| | - Guglielmo Saitto
- Department of Cardiac Surgery, Policlinico S. Donato Hospital, S. Donato Milanese, Milan, Italy
| | - Francesco Tizzano
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Daniel Le Houérou
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Patrick Donzeau-Gouge
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Arnaud Farge
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Thierry Lefèvre
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Thomas Hovasse
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Andrea Garatti
- Department of Cardiac Surgery, Policlinico S. Donato Hospital, S. Donato Milanese, Milan, Italy
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Change in mitral regurgitation severity impacts survival after transcatheter aortic valve replacement. Int J Cardiol 2019; 294:32-36. [DOI: 10.1016/j.ijcard.2019.07.075] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/20/2019] [Accepted: 07/23/2019] [Indexed: 11/20/2022]
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Goldsweig A, Aronow HD. Identifying patients likely to be readmitted after transcatheter aortic valve replacement. Heart 2019; 106:256-260. [PMID: 31649048 DOI: 10.1136/heartjnl-2019-315381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 11/03/2022] Open
Abstract
Hospital readmission following transcatheter aortic valve replacement (TAVR) contributes considerably to the costs of care. Readmission rates following TAVR have been reported to be as high as 17.4% at 30 days and 53.2% at 1 year. Patient and procedural factors predict an increased likelihood of readmission including non-transfemoral access, acute and chronic kidney impairment, chronic lung disease, left ventricular systolic dysfunction, atrial fibrillation, major bleeding and prolonged index hospitalisation. Recent studies have also found the requirement for new pacemaker implantation and the severity of paravalvular aortic regurgitation and tricuspid regurgitation to be novel predictors of readmission. Post-TAVR readmission within 30 days of discharge is more likely to occur for non-cardiac than cardiac pathology, although readmission for cardiac causes, especially heart failure, predicts higher mortality than readmission for non-cardiac causes. To combat the risk of readmission and associated mortality, the routine practice of calculating and considering readmission risk should be adopted by the heart team. Furthermore, because most readmissions following TAVR occur for non-cardiac reasons, more holistic approaches to readmission prevention are necessary. Familiarity with the most common predictors and causes of readmission should guide the development of initiatives to address these conditions proactively.
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Affiliation(s)
- Andrew Goldsweig
- Department of Cardiovascular Medicine, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska, USA
| | - Herbert David Aronow
- Department of Cardiovascular Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.,Cardiovascular Institute, Lifespan Health System, Providence, Rhode Island, USA
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Witberg G, Shamekhi J, Van Mieghem NM, Ferrero-Guadagnoli A, Soendergaard L, Dvir D, Latib A, Testa L, Guerrero M, Piazza N, Bleiziffer S, Webb JG, Barbash I, Finkelstein A, Makkar R, Mylotte D, Sinning JM, El Faquir N, Masiano F, De Backer O, Birs A, Lanzillo G, Bedogni F, Iftikhar O, Pighi M, Deutsch MA, Attinger-Toller A, Maor E, Rozenbaum Z, Yoon SH, Neylon A, Kornowski R. Transcatheter Aortic Valve Replacement Outcomes in Patients With Native vs Transplanted Kidneys: Data From an International Multicenter Registry. Can J Cardiol 2019; 35:1114-1123. [DOI: 10.1016/j.cjca.2019.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 10/27/2022] Open
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Vollenbroich R, Wenaweser P, Macht A, Stortecky S, Praz F, Rothenbühler M, Roost E, Hunziker L, Räber L, Windecker S, Pilgrim T. Long-term outcomes with balloon-expandable and self-expandable prostheses in patients undergoing transfemoral transcatheter aortic valve implantation for severe aortic stenosis. Int J Cardiol 2019; 290:45-51. [DOI: 10.1016/j.ijcard.2019.03.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/09/2019] [Accepted: 03/24/2019] [Indexed: 01/05/2023]
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Akodad M, Meilhac A, Lefèvre T, Cayla G, Lattuca B, Autissier C, Duflos C, Gandet T, Macia JC, Delseny D, Roubille F, Maupas E, Schmutz L, Piot C, Targosz F, Robert G, Rivalland F, Albat B, Chevalier B, Leclercq F. Hemodynamic Performances and Clinical Outcomes in Patients Undergoing Valve-in-Valve Versus Native Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 124:90-97. [PMID: 31076081 DOI: 10.1016/j.amjcard.2019.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/22/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) emerged has a less invasive treatment than surgery for patients with degenerated bioprosthesis. However, few data are currently available regarding results of ViV versus TAVI in native aortic valve. We aimed to compare hemodynamic performances and 1-year outcomes between patients who underwent ViV procedure and patients who underwent non-ViV TAVI. This bicentric study included all patients who underwent aortic ViV procedure for surgical bioprosthetic aortic failure between 2013 and 2017. All patients who underwent TAVI were included in the analysis during the same period. ViV and non-ViV patients were matched with 1:2 ratio according to size, type of TAVI device, age (±5 years), sex, and STS score. Primary end point was hemodynamic performance including mean aortic gradient and aortic regurgitation at 1-year follow-up. A total of 132 patients were included, 49 in the ViV group and 83 in the non-ViV group. Mean age was 82.8 ± 5.9 years, 55.3% were female. Mean STS score was 5.2% ± 3.1%. Self-expandable valves were implanted in 78.8% of patients. At 1-year follow-up, aortic mean gradient was significantly higher in ViV group (18.1 ± 9.4 mm Hg vs 11.4 ± 5.4 mm Hg; p < 0.0001) and 17 (38.6%) patients had a mean aortic gradient ≥20 mm Hg vs 6 (7.8%) in the non-ViV group (p = 0.0001). Aortic regurgitation > grade 2 were similar in both groups (p = 0.71). In the ViV group, new pacemaker implantation was less frequent (p = 0.01) and coronary occlusions occurred only in ViV group (n = 2 [4.1%]). At 1-year follow-up, 3 patients (2.3%) died from cardiac cause, 1 (2.1%) in the ViV group vs 2 (2.4%) in the non-ViV group (p = 0.9). There was no stroke. In conclusion, compared with TAVI in native aortic stenosis, ViV appears as a safe and feasible strategy in patients with impaired bioprosthesis. As 1-year hemodynamic performances seem better in native TAVI procedure, long-term follow-up should be assessed to determinate the impact of residual stenosis on outcomes and durability.
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Tanner R, Moran B, Margey R, Blake G, McGorrian C, Geraghty J, Groarke S, Boleckova J, Hurley J, Roy A, Barton D, Sugrue D, Casserly IP. Clinical experience with trans-catheter aortic valve implantation at a tertiary hospital in the Republic of Ireland. Ir J Med Sci 2019; 189:139-148. [PMID: 31197575 DOI: 10.1007/s11845-019-02030-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 04/30/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION There is a paucity of published data on the clinical experience with trans-catheter aortic valve implantation (TAVI) in the Republic of Ireland. We sought to examine the clinical outcomes of patients with medium-term follow-up treated with TAVI at our institution. METHODS A prospective TAVI registry was used to assess the baseline demographics, procedural variables and clinical outcomes of patients treated with TAVI between the inception of the programme in 2008 and November 2017. RESULTS A total of 354 patients (mean age 80.9 ± 8.1 years, 58% male, mean STS score 6.1 ± 4.3%) were treated during the study period. Major in-hospital outcomes included in-lab death (n = 2, 0.6%), stroke (n = 8, 2.2%), device embolisation (n = 4, 1.2%), permanent pacemaker implantation (n = 22, 6.2%) and major vascular complication (n = 2, 0.6%). The median length of hospital stay was 4 days (IQR 2-8 days). The Kaplan-Meier estimate of freedom from death at 30 days and 1 year for the entire cohort was 97 ± 1% and 85.4 ± 2.3%, respectively. Trans-femoral access was associated with a significantly lower rate of death and/or stroke at 1 year compared to trans-apical access (84.9 ± 2.4% versus 60 ± 8.9%, p = 0.0005). There was no significant difference in freedom from death and/or stroke at 1 year between balloon-expandable and self-expanding valves (81.6 ± 2.6% versus 84.4 ± 7.4%, p = 0.63). CONCLUSION This study documents low complication rates and favourable rates of survival following TAVI in a consecutive series of patients undergoing TAVI at a tertiary referral centre in the Republic of Ireland. These data support the application of this therapy in the Irish context.
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Affiliation(s)
- Richard Tanner
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Barbara Moran
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - Ronan Margey
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - Gavin Blake
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Catherine McGorrian
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Jacqueline Geraghty
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Susan Groarke
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | | | - John Hurley
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - Andrew Roy
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - David Barton
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - Declan Sugrue
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - Ivan P Casserly
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.,Mater Private Hospital, Eccles Street, Dublin 7, Ireland
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Comparison of early and midterm outcomes after transsubclavian/axillary versus transfemoral, transapical, or transaortic transcatheter aortic valve implantation. Heart Lung 2019; 48:519-529. [PMID: 31076179 DOI: 10.1016/j.hrtlng.2019.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/30/2019] [Accepted: 04/05/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Outcomes after transsubclavian/transaxillary (TSc/TAx)-transcatheter aortic valve implantation (TAVI) have been unclear. OBJECTIVES To compare outcomes after TSc/TAx-TAVI versus transfemoral (TF)-TAVI, transapical (TAp)-TAVI, or transaortic (TAo)-TAVI, we performed meta-analysis of currently available studies. METHODS Studies considered for inclusion met the following criteria: the study population was patients undergoing TAVI; patients were assigned to TSc/TAx-TAVI and TF-TAVI, TAp-TAVI, or TAo-TAVI; and at least one of postprocedural early (30-day or in-hospital) or late (including early) outcomes was reported. An odds or hazard ratio of each early or late outcome with its 95% confidence interval for TSc/TAx-TAVI versus the other approach was extracted from each individual study and combined in the random-effects model. RESULTS Our search identified 15 eligible reports from 12 studies including 10,528 patients. Pooled analysis of early all-cause mortality demonstrated a statistically significant reduction after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.003) or TAo-TAVI (P = 0.03). Pooled analysis of early pacemaker implantation demonstrated a statistically significant increase after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.0001) or TAo-TAVI (P < 0.00001). Pooled analysis of midterm all-cause mortality demonstrated a statistically significant increase after TSc/TAx-TAVI compared with TF-TAVI (P = 0.007). CONCLUSIONS Early all-cause mortality was lower after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, early pacemaker implantation was more frequent after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, and midterm all-cause mortality was higher after TSc/TAx-TAVI than TF-TAVI.
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60
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Alfieri O, Vahanian A. The year in cardiology 2016: valvular heart disease. Eur Heart J 2019; 38:628-633. [PMID: 28043978 DOI: 10.1093/eurheartj/ehw636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/09/2016] [Indexed: 12/16/2022] Open
Affiliation(s)
- Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, Milan 20132, Italy
| | - Alec Vahanian
- Department of Cardiology, Bichat University Hospital & University Paris VII, 46 Rue Henri Huchard, Paris 75018, France
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Jimenez C, Ohana M, Marchandot B, Kibler M, Carmona A, Peillex M, Heger J, Trimaille A, Matsushita K, Reydel A, Hess S, Jesel L, Ohlmann P, Morel O. Impact of Antithrombotic Regimen and Platelet Inhibition Extent on Leaflet Thrombosis Detected by Cardiac MDCT after Transcatheter Aortic Valve Replacement. J Clin Med 2019; 8:jcm8040506. [PMID: 31013785 PMCID: PMC6518225 DOI: 10.3390/jcm8040506] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/01/2019] [Accepted: 04/09/2019] [Indexed: 01/14/2023] Open
Abstract
The impact of antithrombotic regimen and platelet inhibition extent on subclinical leaflet thrombosis (SLT) detected by cardiac multidetector computed tomography (MDCT) after transcatheter aortic valve replacement (TAVR) is not well established. Hypoattenuation affecting motion (HAM) has been proposed as a surrogate marker of SLT, and is characterized by hypoattenuated leaflet thickening (HALT) and concomitant reduction in leaflet motion (RELM). We sought to investigate (i) the prevalence of HAM and HALT after TAVR detected by MDCT, (ii) the predictors of SLT, (iii) the impact of oral anticoagulant (OAC) and platelet inhibition extent assessed by platelet reactivity index vasodilator stimulated phosphoprotein (PRI-VASP) and closure time adenosine diphosphate (CT-ADP) on SLT. Of 187 consecutive patients who underwent TAVR from 1 August 2017 to 31 March 2018, 90 of them had cardiac CT at relevant follow-up. Clinical, biological, echocardiographic, procedural characteristics and treatments were collected before, at discharge, and 1 year after TAVR. P2Y12 platelet inhibition extent and primary haemostasis disorders were investigated using platelet PRI-VASP and CT-ADP point-of-care assays. Eighty-five post-TAVR CTs out of 90 were ranked for clarity and assessed with sufficient diagnostic quality. HAM was evidenced in 13 patients (15.3%) and HALT in 30 patients (35%). Procedural characteristics, including aortic valve calcium score, annulus size, or procedural heparin regimens, were equivalent between groups. Likewise, no impact of P2Y12 inhibition (PRI-VASP) nor primary haemostasis disorders (CT-ADP) on SLT could be evidenced. No impact of SLT on valve deterioration evaluated by transthoracic echocardiography (TTE) and clinical events could be established at 12 months follow-up. By multivariate analysis, lack of oral anticoagulant therapy at discharge (HR 12.130 CI 95% (1.394-150.582); p = 0.028) and higher haemoglobin levels were evidenced as the sole independent predictors of SLT. In four patients with HAM, MDCT follow-up was obtained after initiation of OAC therapy and showed a complete regression of HAM. SLT was evidenced in a sizeable proportion of patients treated by TAVR and was mainly determined by the lack of oral anticoagulant therapy. Conversely, no impact of platelet inhibition extent on SLT could be evidenced.
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Affiliation(s)
- Charline Jimenez
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France.
| | - Mickaël Ohana
- Université de Strasbourg, Département de Radiologie, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France.
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France.
| | - Marion Kibler
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France.
| | - Adrien Carmona
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France.
| | - Marilou Peillex
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France.
| | - Joe Heger
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France.
| | - Antonin Trimaille
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France.
| | - Kensuke Matsushita
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France.
| | - Antje Reydel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France.
| | - Sébastien Hess
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France.
| | - Laurence Jesel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France.
- UMR INSERM 1260 Regenerative Nanomedicine, Université de Strasbourg, 67000 Strasbourg, France.
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France.
| | - Olivier Morel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France.
- UMR INSERM 1260 Regenerative Nanomedicine, Université de Strasbourg, 67000 Strasbourg, France.
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Markowiak T, Holzamer A, Hilker M, Pregler B, Debl K, Hofmann HS, Ried M. Incidental thoracic findings in computed tomography scans before transcatheter aortic valve implantation. Interact Cardiovasc Thorac Surg 2019; 28:559-565. [PMID: 30380069 DOI: 10.1093/icvts/ivy299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/10/2018] [Accepted: 09/16/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Preoperative computed tomography (CT) scans for transcatheter aortic valve implantation (TAVI) are used routinely. In elderly high-risk patients, incidental radiographic findings are frequently reported. The aim of this study was to investigate the impact of auxiliary findings on the patients' mid-term survival, which might affect the treatment strategy. METHODS Between March 2011 and April 2016, all radiological reports of contrast-enhanced CT scans of 976 patients scheduled for TAVI were analysed retrospectively for incidental thoracic findings including solitary pulmonary nodules (SPN) and thoracic lymphadenopathy (LAP). The minimum follow-up period was 1 year after TAVI. RESULTS The median age of all patients was 79 years; 51.9% (n = 507) were women. Approximately 37% (n = 361) of patients showed 1 of the determined findings. An SPN ≥5 mm was diagnosed in 16.4% (n = 160) of patients. Four of them developed lung cancer and 2 nodules were identified as metastases during follow-up. In addition, 12% (n = 117) of the patients had thoracic LAP. Whereas SPN had no significant effect on the overall survival rate, evidence of LAP turned out to be a statistically significant factor regarding 4-year survival (P = 0.001; hazard ratio 1.66; 95% confidence internal 1.19-2.31). CONCLUSIONS SPN ≥5 mm were detected in 16.4% of patients scheduled for TAVI. Nevertheless, the incidence of lung cancer was low and the effect on survival in this high-risk group of patients was statistically not significant. In contrast, thoracic LAP had a significant negative effect on survival. It needs to be proven if the outcome of this cohort can be enhanced by further diagnostics and therapy.
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Affiliation(s)
- Till Markowiak
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Holzamer
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Hilker
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Benedikt Pregler
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Kurt Debl
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
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Chiocchi M, Forcina M, Morosetti D, Pugliese L, Cavallo AU, Citraro D, De Stasio V, Presicce M, Floris R, Romeo F. The role of computed tomography in the planning of transcatheter aortic valve implantation: a retrospective analysis in 200 procedures. J Cardiovasc Med (Hagerstown) 2019; 19:571-578. [PMID: 30015782 DOI: 10.2459/jcm.0000000000000695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIM The aim of our study is to show the importance of multislice computed tomography (CT) assessment in the overall management and diagnostic framework of transcatheter aortic valve replacement (TAVI) procedure candidates. METHODS Between June 2015 and April 2017, 200 patients with severe aortic stenosis, not eligible for surgery, were enrolled, as defined by EuroSCORE; they were submitted to TAVI at the interventional cardiology department of the Tor Vergata Polyclinic. CT studies were performed using a 64-slice scanner. RESULTS The reports and datasets produced during the pre-TAVI CT evaluation were retrospectively evaluated. DISCUSSION In TAVI candidates, accurate aortic valve shape and dimensions evaluation is crucial for the proper deployment of the prosthetic valve and in order to reduce postprocedural complications. ECG retrospective gated cardiac CT gives the clinician three-dimensional images of the heart, with high spatial resolution and multiplanar reconstructions allowing accurate visualization of the aortic annulus and coronary ostia to be obtained, and the evaluation of arterial calcifications. Furthermore, CT can provide data on the suitability of peripheral vascular accesses. Moreover, this technique can point out the presence of clinically relevant extracardiac findings. Therefore, CT evaluation assures a safe, reliable and prognostically relevant method for TAVI preprocedural planning. CONCLUSION Our study remarks the importance of CT assessment in the overall management and diagnostic framework of TAVI candidates; the information provided is essential in order to minimize possible complications and to improve the quality of the therapeutic planning.
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Affiliation(s)
- Marcello Chiocchi
- Fondazione PTV Policlinico Tor Vergata, Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Rome, Italy
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Alos B, Akodad M, Avinee G, Bouleti C, Chemaly P, Desnos C, Didier R, Garcia R, Mirabel M, Mika D, Lattuca B, Le Ven F, Probst V, Gilard M. Safeguarding continuing cardiovascular research excellence and quality publications in France: A working document from the French Society of Cardiology. Arch Cardiovasc Dis 2019; 112:234-240. [PMID: 30639198 DOI: 10.1016/j.acvd.2018.11.002] [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] [Received: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND France has a long history of successful cardiovascular research and scientific innovations, but its continued success cannot be taken for granted. AIMS To identify current obstacles to cardiovascular research in France and to crystallize the analysis into recommendations for maintained and enhanced research excellence in the future. METHODS The French Society of Cardiology set up seven Working Groups, each comprising four to eight cardiologists, covering a spectrum of research institutes, hospitals, specialties, ages and research experience. The Working Groups met regularly in person or by conference call to analyse experiences, refine situation assessments and formulate recommendations for improvements. Results and suggestions were presented to a Core Team, which worked to synthesize, prioritize and organize the findings into a consolidated situation assessment and generate a set of action-orientated recommendations. RESULTS Four key areas of action were identified: stronger focus on the generation of high-quality data; facilitation of future cardiovascular research; greater promotion and support for research among young cardiologists; and increased focus and support for communications. Most recommendations targeted structural shortcomings and may be implemented at low additional financial cost. CONCLUSIONS It is possible to maintain, and even increase, the quality of cardiovascular research in France and to boost the conversion of successful projects into high-impact publications, without major increases in funding. Intense collaboration between specialties and organizations is necessary to achieve sustainable results.
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Affiliation(s)
- Benjamin Alos
- Department of Cardiology, CHU La Milétrie, 86021 Poitiers, France
| | - Mariama Akodad
- Department of Cardiology, CHU Arnaud de Villeneuve, 34090 Montpellier, France
| | | | - Claire Bouleti
- Department of Cardiology, CHU Bichat-Claude-Bernard, 75877 Paris, France
| | - Pascale Chemaly
- Department of Cardiology, centre hospitalier André-Mignot, 78150 Le Chesnay, France
| | - Cyrielle Desnos
- Department of Cardiology, CHU Pitié-Salpêtrière, 75013 Paris, France
| | - Romain Didier
- Department of Cardiology, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest cedex, France
| | - Rodrigue Garcia
- Department of Cardiology, CHU La Milétrie, 86021 Poitiers, France
| | - Marianna Mirabel
- Department of Cardiology, hôpital européen Georges-Pompidou, 75015 Paris, France
| | - Delphine Mika
- Inserm UMR-S 1180, université Paris-Sud, 92296 Chatenay-Malabry, France
| | - Benoît Lattuca
- Department of Cardiology, CHU Carémeau, 30029 Nîmes, France
| | - Florent Le Ven
- Department of Cardiology, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest cedex, France
| | - Vincent Probst
- Department of Cardiology, CHU hôtel-Dieu, 44093 Nantes, France
| | - Martine Gilard
- Department of Cardiology, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
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Lantelme P, Eltchaninoff H, Rabilloud M, Souteyrand G, Dupré M, Spaziano M, Bonnet M, Becle C, Riche B, Durand E, Bouvier E, Dacher JN, Courand PY, Cassagnes L, Dávila Serrano EE, Motreff P, Boussel L, Lefèvre T, Harbaoui B. Development of a Risk Score Based on Aortic Calcification to Predict 1-Year Mortality After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Imaging 2019; 12:123-132. [DOI: 10.1016/j.jcmg.2018.03.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 03/06/2018] [Accepted: 03/20/2018] [Indexed: 12/12/2022]
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Kim C, Hong MK. Aortic Stenosis and Transcatheter Aortic Valve Implantation: Current Status and Future Directions in Korea. Korean Circ J 2019; 49:283-297. [PMID: 30895756 PMCID: PMC6428950 DOI: 10.4070/kcj.2019.0044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/11/2019] [Indexed: 01/11/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has been accepted as one of primary options for treatment of symptomatic severe aortic stenosis. Although TAVI has been predominantly used for patients at high risk or with old age who were not considered optimal candidates for surgical aortic valve replacement (SAVR), its indication is now expanding toward low risk profile and younger age. Many clinical trials are now ongoing to test the possibility of TAVI for use in patients even with uncharted indications who are not eligible for SAVR in current guidelines but may benefit from valve replacement. Current issues including periprocedural safety, long-term adverse events, hemodynamics and durability associated with TAVI should be also solved for expanding use of TAVI. The review presents current status and future directions of TAVI and discusses perspectives in Korea.
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Affiliation(s)
- Choongki Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Myeong Ki Hong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Didier R, Eltchaninoff H, Donzeau-Gouge P, Chevreul K, Fajadet J, Leprince P, Leguerrier A, Lièvre M, Prat A, Teiger E, Lefevre T, Tchetché D, Carrié D, Himbert D, Albat B, Cribier A, Sudre A, Blanchard D, Rioufol G, Collet F, Houel R, Dos Santos P, Meneveau N, Ghostine S, Manigold T, Guyon P, Cuisset T, Le Breton H, Delepine S, Favereau X, Souteyrand G, Ohlmann P, Doisy V, Lognoné T, Gommeaux A, Claudel JP, Bourlon F, Bertrand B, Iung B, Gilard M. Five-Year Clinical Outcome and Valve Durability After Transcatheter Aortic Valve Replacement in High-Risk Patients. Circulation 2018; 138:2597-2607. [DOI: 10.1161/circulationaha.118.036866] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Romain Didier
- Department of Cardiology, Brest University Hospital, France (R.D., M.G.)
| | | | - Patrick Donzeau-Gouge
- Department of Cardiology and Surgery, Institut Cardiovasculaire Paris Sud, Massy, France (P.D.-G., T.L.)
| | - Karine Chevreul
- Department of Unité de Recherche Clinique en Économie de la Santé D’île-de-France and Cardiology, Creteil University, Paris, France (K.C., E.T.)
| | - Jean Fajadet
- Department of Cardiology, Clinique Pasteur, Toulouse, France (J.F., D.T.)
| | - Pascal Leprince
- Department of Surgery, Pitié Salpêtrière University Hospital, Paris, France (P.L.)
| | - Alain Leguerrier
- Department of Cardiology and Surgery, Rennes University Hospital, France (A.L., H.L.B.)
| | - Michel Lièvre
- UMR and Department of Cardiology, Lyon University Hospital, France (M.L., G.R.)
| | - Alain Prat
- Department of Cardiology and Surgery, Lille University Hospital, France (A.P., A.S.)
| | - Emmanuel Teiger
- Department of Unité de Recherche Clinique en Économie de la Santé D’île-de-France and Cardiology, Creteil University, Paris, France (K.C., E.T.)
| | - Thierry Lefevre
- Department of Cardiology and Surgery, Institut Cardiovasculaire Paris Sud, Massy, France (P.D.-G., T.L.)
| | - Didier Tchetché
- Department of Cardiology, Clinique Pasteur, Toulouse, France (J.F., D.T.)
| | - Didier Carrié
- Department of Cardiology, Toulouse University Hospital, France (D.C.)
| | - Dominique Himbert
- Department of Cardiology, AP-HP, Bichat Hospital, Paris-Diderot University, DHU Fire, France (D.H., B.I.)
| | - Bernard Albat
- Department of Surgery, Montpellier University Hospital, France (B.A.)
| | - Alain Cribier
- Department of Cardiology, Rouen University Hospital, France (H.E., A.C.)
| | - Arnaud Sudre
- Department of Cardiology and Surgery, Lille University Hospital, France (A.P., A.S.)
| | - Didier Blanchard
- Department of Cardiology, Georges Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Paris Descartes, France (D.B.)
| | - Gilles Rioufol
- UMR and Department of Cardiology, Lyon University Hospital, France (M.L., G.R.)
| | - Frederic Collet
- Department of Surgery, Clairval Hospital, Marseille, France (F.C.)
| | - Remi Houel
- Department of Cardiology, Saint Joseph Hospital, Marseille, France (R.H.)
| | - Pierre Dos Santos
- Department of Cardiology, Bordeaux University Hospital, France (P.D.S.)
| | - Nicolas Meneveau
- Department of Cardiology, Besancon University Hospital, France (N.M.)
| | - Said Ghostine
- Department of Cardiology, Centre Cardiologique Marie Lannelongue, Le Plessis-Robinson, France (S.G.)
| | - Thibaut Manigold
- Department of Cardiology, Nantes University Hospital, France (T.M.)
| | - Philippe Guyon
- Department of Cardiology, Centre Cardiologique Nord, Saint Denis, France (P.G.)
| | - Thomas Cuisset
- Department of Cardiology, Marseille University Hospital, France (T.C.)
| | - Herve Le Breton
- Department of Cardiology and Surgery, Rennes University Hospital, France (A.L., H.L.B.)
| | | | - Xavier Favereau
- Department of Cardiology, Parly 2 Hospital, Le Chesnay, France (X.F.)
| | - Geraud Souteyrand
- Department of Cardiology, Clermont Ferrand University Hospital, France (G.S.)
| | - Patrick Ohlmann
- Department of Cardiology, Strasbourg University Hospital, France (P.O.)
| | - Vincent Doisy
- Department of Surgery, Clinique du Tonkin, Lyon, France (V.D.)
| | - Thérèse Lognoné
- Department of Cardiology, Saint-Malo Hospital, France (T.L.)
| | | | | | - Francois Bourlon
- Department of Cardiology, Centre Cardio-Thoracique, Monaco (F.B.)
| | - Bernard Bertrand
- Department of Cardiology, Grenoble University Hospital, France (B.B.)
| | - Bernard Iung
- Department of Cardiology, AP-HP, Bichat Hospital, Paris-Diderot University, DHU Fire, France (D.H., B.I.)
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, France (R.D., M.G.)
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Influence of permanent pacemaker implantation after transcatheter aortic valve implantation with new-generation devices. Neth Heart J 2018; 26:620-627. [PMID: 30443709 PMCID: PMC6288034 DOI: 10.1007/s12471-018-1194-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Permanent pacemaker implantation (PPMI) after transcatheter aortic valve implantation (TAVI) is the most common complication after the procedure. PPMI rates remain high with the new-generation TAVI devices despite improved outcomes concerning paravalvular aortic regurgitation and vascular access complications. However, the impact of PPMI on mortality and clinical outcome is still a matter of debate, and data with new-generation devices on this matter are scarce. Therefore, we sought to analyse the influence of PPMI in patients treated with the new-generation devices on one-year outcome. Methods We enrolled 612 consecutive patients without prior pacemaker undergoing transfemoral TAVI with the new-generation devices. Patients with or without PPMI were compared with respect to clinical outcome within one year. Results PPMI was performed in 168 patients (24.4% of the overall study population). There was no significant difference in one-year outcome concerning all-cause mortality (PPMI vs. no-PPMI: 12.2% vs. 12.5%, p = 0.94), rate of major adverse events including cardiac, cerebral or valve-related events and bleeding complications (22.1% vs. 24.5%, p = 0.55) or need for rehospitalisation due to cardiac symptoms (16.1% vs. 18.1%, p = 0.63). In patients with reduced ejection fraction (<45%) there was also no impact of PPMI on one-year mortality (14.3% vs. 15.7%, p = 0.86). Furthermore, multivariate analysis did not reveal PPMI to be independently associated with one-year mortality (odds ratio 0.94, 95% confidence interval 0.50–1.74, p = 0.83). Conclusions In this large all-comers TAVI population with new-generation devices the need for postprocedural PPMI did not show a statistical significant impact on survival or combined endpoint of major adverse events within one year.
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Stortecky S, Franzone A, Heg D, Tueller D, Noble S, Pilgrim T, Jeger R, Toggweiler S, Ferrari E, Nietlispach F, Taramasso M, Maisano F, Grünenfelder J, Muller O, Huber C, Roffi M, Carrel T, Wenaweser P, Windecker S. Temporal trends in adoption and outcomes of transcatheter aortic valve implantation: a SwissTAVI Registry analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2018; 5:242-251. [DOI: 10.1093/ehjqcco/qcy048] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/03/2018] [Accepted: 10/08/2018] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
To describe temporal trends in adoption and performance of transcatheter aortic valve implantation (TAVI) in Switzerland over a period of 5 years.
Methods and results
Between 2011 and 2015, a total of 3493 patients were consecutively included in the SwissTAVI Registry (NCT01368250) and analysed for the purpose of this study. The primary outcome measure was all-cause mortality at 1 year after TAVI. Over the 5-year period, a six-fold increase in the number of procedures was observed, whereas the baseline surgical risk estimated by the Society of Thoracic Surgeon (STS) score declined (from 6.8 ± 4.4% to 4.6 ± 3.6, P < 0.001). Overall, 1-year mortality amounted to 12.8%; mortality was highest in the first annual cohorts (14.6%, 14.8%, and 15.9% in 2011, 2012, and 2013, respectively) and decreased to 13.4% in 2014 and 9.7% in 2015. While rates of cerebrovascular events, peri-procedural myocardial infarction, moderate/severe paravalvular regurgitation, and Stage 3 acute kidney injury did not significantly change over time, a significant reduction in life threatening or major bleeding was noted at 30-day follow-up during the latest compared with earlier years of recruitment.
Conclusion
This long-term recruitment analysis of a national TAVI registry showed rapid adoption paralleled by a progressive decrease of patients’ baseline risk profile. Early and late survival significantly improved over time as did the rate of life threatening or major bleeding.
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Affiliation(s)
- Stefan Stortecky
- Department of Cardiology and Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Franzone
- Department of Cardiology and Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dik Heg
- Department of Clinical Research, Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - David Tueller
- Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland
| | - Stephane Noble
- Division of Cardiology and Cardiovascular Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology and Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raban Jeger
- Department of Cardiology, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Stefan Toggweiler
- Department of Cardiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Enrico Ferrari
- Department of Cardiovascular Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology and Department of Cardiovascular Surgery, University Heart Centre Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiology and Department of Cardiovascular Surgery, University Heart Centre Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Maisano
- Department of Cardiology and Department of Cardiovascular Surgery, University Heart Centre Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Jürg Grünenfelder
- Department of Cardiology and Cardiovascular Surgery, Heart Clinic Hirslanden, Hirslanden Clinic Zurich, Zurich, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital—CHUV, Lausanne, Switzerland
| | - Christoph Huber
- Division of Cardiology and Cardiovascular Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Marco Roffi
- Division of Cardiology and Cardiovascular Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Thierry Carrel
- Department of Cardiology and Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Wenaweser
- Department of Cardiology and Cardiovascular Surgery, Heart Clinic Hirslanden, Hirslanden Clinic Zurich, Zurich, Switzerland
| | - Stephan Windecker
- Department of Cardiology and Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Abstract
Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure to treat severe symptomatic aortic stenosis. While the TAVI procedure can be performed safely and provide excellent 5-year results, little is known about long-term durability. TAVI valves are composed of bioprosthetic leaflets are prone to deterioration, which are categorized as structural valve deterioration (SVD) and non-SVD. SVD refers to an intrinsic pathology of the leaflets or stent structure with mechanisms that include leaflet calcification, leaflet tear, stent fracture, or stent creep. Non-SVD processes include valve thrombosis, infective endocarditis and patient prosthesis mismatch. TAVI valves degenerate by similar mechanisms as bioprosthetic surgical aortic valves. Unique mechanisms that contribute to TAVI degeneration include valve crimpling, balloon expansion, stent under-expansion and valve thrombosis. The absence of a universally accepted definition of SVD poses a challenge in estimating valve durability. Traditional surgical bioprosthetic aortic valves have demonstrated excellent durability with clinically relevant SVD of 6.6% at 10-year follow up. Long-term durability of TAVI valves, however, remain poorly defined. From meta-analysis TAVI trials, SVD was estimated at 7% at 5 years. With iterative improvements in TAVI valve construction and deployment techniques, long-term durability may improve. Until long-term outcomes are better understood, TAVI should be used with caution in younger patients.
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Affiliation(s)
- Akash Kataruka
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA, USA
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Wee IJY, Syn N, Choong AM. Transcaval approach for endovascular aortic interventions: A systematic review. J Cardiol 2018; 72:369-376. [DOI: 10.1016/j.jjcc.2018.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/17/2018] [Accepted: 04/11/2018] [Indexed: 11/15/2022]
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Dedicated heart valve networks for improving the outcome of patients with valvular heart disease? Arch Cardiovasc Dis 2018; 111:465-469. [DOI: 10.1016/j.acvd.2018.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/01/2018] [Accepted: 03/05/2018] [Indexed: 02/04/2023]
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Eltchaninoff H, Durand E, Avinée G, Tron C, Litzler PY, Bauer F, Dacher JN, Werhlin C, Bouhzam N, Bettinger N, Candolfi P, Cribier A. Assessment of structural valve deterioration of transcatheter aortic bioprosthetic balloon-expandable valves using the new European consensus definition. EUROINTERVENTION 2018; 14:e264-e271. [PMID: 29599103 DOI: 10.4244/eij-d-18-00015] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Durability of transcatheter aortic bioprosthetic valves remains a major issue. Standardised definitions of deterioration and failure of bioprosthetic valves have recently been proposed. The aim of this study was to assess structural transcatheter valve deterioration (SVD) and bioprosthetic valve failure (BVF) using these new definitions. METHODS AND RESULTS All TAVI patients implanted up to September 2012 with a minimal theoretical five-year follow-up were included. Systematic clinical and echocardiographic follow-up was performed annually. New standardised definitions were used to assess durability of transcatheter aortic bioprosthetic valves. From 2002 to 2012, 378 patients were included. Mean age and logistic EuroSCORE were 83.3±6.8 years and 22.8±13.1%. Thirty-day mortality was 13.2%. Nine patients had SVD including two severe forms and two patients had definite late BVF. The incidence of SVD and BVF at eight years was 3.2% (95% CI: 1.45-6.11) and 0.58% (95% CI: 0.15-2.75), respectively. CONCLUSIONS Even though limited by the poor survival of the very high-risk/compassionate early population, our data do not demonstrate any alarm concerning transcatheter aortic valve durability. Careful prospective assessment in younger and lower-risk patients and comparison with surgical bioprosthetic valves are required for further assessment of the long-term durability of transcatheter valves.
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Affiliation(s)
- Hélène Eltchaninoff
- Rouen University Hospital, Department of Cardiology, FHU REMOD-VHF, Rouen, France
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Siordia JA, Loera JM, Scanlon M, Evans J, Knight PA. Three-Year Survival Comparison between Transcatheter and Surgical Aortic Valve Replacement for Intermediate- and Low-Risk Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Juan A. Siordia
- Department of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY USA
| | - Jackquelin M. Loera
- Department of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY USA
| | - Matt Scanlon
- Department of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY USA
| | - Jessie Evans
- Department of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY USA
| | - Peter A. Knight
- Department of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY USA
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Three-Year Survival Comparison between Transcatheter and Surgical Aortic Valve Replacement for Intermediate- and Low-Risk Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:153-162. [DOI: 10.1097/imi.0000000000000507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transcatheter aortic valve implantation is a suitable therapeutic intervention for patients deemed inoperable or high risk for surgical aortic valve replacement. Current investigations question whether it is a suitable alternative to surgery for intermediate- and low-risk patients. The following meta-analysis presents a comparison between transcatheter versus surgical aortic valve replacement in patients that are intermediate and low risk for surgery. Articles were collected via an electronic search using Google Scholar and PubMed. Articles of interest included studies comparing the survival of intermediate- and low-risk patients undergoing transcatheter aortic valve implantation to those undergoing surgical aortic valve replacement. Primary end points included 1-, 2-, and 3-year survival. Secondary end points included postintervention thromboembolic events, stroke, transient ischemic attacks, major vascular complications, permanent pacemaker implantation, life-threatening bleeding, acute kidney injury, atrial fibrillation, and moderate-to-severe aortic regurgitation. Six studies met the criteria for the meta-analysis. One- and two-year survival comparisons showed no difference between the two interventions. Surgical aortic valve replacement, however, presented with favorable 3-year survival compared with the transcatheter approach. Transcatheter aortic valve implantation had more major vascular complications, permanent pacemaker implantation, and moderate-to-severe aortic regurgitation rates compared with surgery. Surgical aortic valve replacement presented more life-threatening bleeding, acute kidney injury, and atrial fibrillation compared with a transcatheter approach. There was no statistical difference between the two approaches in terms of thromboembolic events, strokes, or transient ischemic attack rates. Surgical aortic valve replacement presents favorable 3-year survival rates compared with transcatheter aortic valve implantation.
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Aortic stenosis is a risk factor for all-cause mortality in patients on dialysis: a multicenter prospective cohort analysis. BMC Nephrol 2018; 19:80. [PMID: 29614972 PMCID: PMC5883521 DOI: 10.1186/s12882-018-0877-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/19/2018] [Indexed: 11/24/2022] Open
Abstract
Background Aortic stenosis (AS) is common in patients on dialysis as well as in the general population. AS leads to difficulty with dialysis therapy because of unstable conditions such as intradialytic hypotension due to low cardiac output. However, the precise morbidity rates and risk factors of AS in patients on dialysis are unknown. Moreover, there are no large-scale observational studies regarding the association between AS in patients on dialysis and mortality. Therefore, we will investigate whether morbidity of AS in patients on dialysis is associated with mortality. Methods This is a multicenter prospective cohort analysis in the Tokai region of Japan. The 75 participating centers in this study will enroll approximately 2400 patients during 12 months, with or without AS. We started enrollment in July 2017 and will follow patents until June 2023. Transthoracic echocardiography will be performed to evaluate aortic valve. Parameters used for evaluation of aortic valve are mean pressure gradient between left ventricle and ascending aorta, aortic valve area, and maximum aortic jet velocity. We will diagnose AS using the criteria based on the 2014 American Heart Association/ American College of Cardiology Guideline. We will also perform transthoracic echocardiography at 12, 24, 36, 48, and 60 months. Survival prognosis and CV events will be determined at the end of June 2019, 2020, 2021, 2022, and 2023. Development of AS will be also evaluated as new onset or annual change in AS parameters. We will classify patients based on the presence or absence of AS and the stages of AS and will compare outcomes. Study outcomes will include the following: 1) all-cause mortality rates; 2) incidence of cardiovascular (CV) events; 3) CV-related mortality rates; 4) infection-related mortality rates; 5) new onset or development of AS. Discussion We will consider the following hypotheses in this study, among others: The prevalence of AS is higher in dialysis patients; new onset and development of AS are associated with factors that are specific for dialysis, such as hyperphosphatemia, hyperparathyroidism, and medication; and outcomes in AS patients are poorer than in patients without AS at baseline. Trial registration UMIN000026756, Registered March 29 2017.
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Puntmann VO, Zeiher AM, Nagel E. T1 and T2 mapping in myocarditis: seeing beyond the horizon of Lake Louise criteria and histopathology. Expert Rev Cardiovasc Ther 2018; 16:319-330. [DOI: 10.1080/14779072.2018.1455499] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Valentina O. Puntmann
- Institute for Experimental and Translational Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt, Germany
- Department of Cardiology, Division of Internal Medicine III, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Andreas M. Zeiher
- Department of Cardiology, Division of Internal Medicine III, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt, Germany
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78
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Pressler A, Förschner L, Hummel J, Haller B, Christle JW, Halle M. Long-term effect of exercise training in patients after transcatheter aortic valve implantation: Follow-up of the SPORT:TAVI randomised pilot study. Eur J Prev Cardiol 2018; 25:794-801. [PMID: 29553289 DOI: 10.1177/2047487318765233] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Increased exercise capacity favourably influences clinical outcomes after transcatheter aortic valve implantation. In our SPORT:TAVI randomised pilot trial, eight weeks of endurance and resistance training (training group, TG) shortly after transcatheter aortic valve implantation resulted in significantly improved exercise capacity, muscular strength and quality of life compared to usual care (UC). However, the long-term clinical benefits of such an intervention are unknown. Design A randomised controlled trial. Methods SPORT:TAVI participants underwent reassessment of trial endpoints 24 ± 6 months after baseline: maximal oxygen uptake (VO2peak) and anaerobic threshold (VO2AT) were assessed with cardiopulmonary exercise testing, muscular strength with one-repetition maximum testing, quality of life with the Kansas City cardiomyopathy and medical outcomes study 12-item short-form health survey questionnaires, and prosthetic aortic valve function with echocardiography. Results Of 27 original participants (TG 13; UC 14; age 81 ± 6 years), more patients had died during follow-up in UC ( n = 5) than in TG ( n = 2; P = 0.165); three further patients (TG 1; UC 2) were unavailable for other reasons. In the remaining patients (TG 10; UC 7), a significant between-group difference in favour of TG was observed for change in VO2AT from baseline (2.7 ml/min/kg (95% confidence interval 0.8-4.6); P = 0.008), but not for change in VO2peak (2.1 ml/min/kg (-1.1-5.4); P = 0.178). Changes in muscular strength and quality of life did not differ between groups over time. Overall, prosthetic valve function remained intact in both groups. Conclusions Eight weeks of exercise training shortly after transcatheter aortic valve implantation resulted in preserved long-term improvements in VO2AT, but not VO2peak, muscular strength or quality of life compared to usual care. The findings emphasise the importance of ongoing exercise interventions following transcatheter aortic valve implantation to maintain initial improvements long term. Clinical Trial Registration (original trial): Clinicaltrials.gov NCT01935297.
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Affiliation(s)
- Axel Pressler
- 1 Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Germany
| | - Leonie Förschner
- 1 Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Germany
| | - Jana Hummel
- 1 Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Germany
| | - Bernhard Haller
- 2 Institute for Medical Statistics and Epidemiology, Technische Universität München, Germany
| | - Jeffrey W Christle
- 1 Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Germany.,3 Department of Medicine, Stanford University, USA
| | - Martin Halle
- 1 Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Germany.,4 DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany
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Schneider HE, Gravenhorst V, Paul T, Jacobshagen C. Insufficiency of a Damus-Kaye-Stansel anastomosis in a Fontan patient: Transfemoral implantation of an Edwards Sapien 3 valve. Catheter Cardiovasc Interv 2018; 91:292-295. [PMID: 29239142 DOI: 10.1002/ccd.27445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/28/2017] [Accepted: 11/16/2017] [Indexed: 11/07/2022]
Abstract
We present a 22-year-old patient with a univentricular heart who had already undergone five open heart surgeries including a Damus-Kaye-Stansel procedure, Fontan completion and tricuspid valve replacement. In addition, epimyocardial pacemaker implantation and repeated revisions had been necessary. He developed symptomatic free regurgitation of the pulmonary portion of his DKS anastomosis. To avoid additional high-risk open-heart surgery, we successfully implanted an Edwards Sapien 3 valve transfemorally in the pulmonary portion of the DKS anastomosis relieving insufficiency.
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Affiliation(s)
- Heike E Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center Goettingen, Goettingen, 37075, Germany
| | - Verena Gravenhorst
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center Goettingen, Goettingen, 37075, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center Goettingen, Goettingen, 37075, Germany
| | - Claudius Jacobshagen
- Department for Cardiology and Pneumology, University Medical Center Goettingen, Robert-Koch-Str. 40, Goettingen, 37075, Germany
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80
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Latsios G, Spyridopoulos TN, Toutouzas K, Synetos A, Trantalis G, Stathogiannis K, Penesopoulou V, Oikonomou G, Brountzos E, Tousoulis D. Multi-slice CT (MSCT) imaging in pretrans-catheter aortic valve implantation (TAVI) screening. How to perform and how to interpret. Hellenic J Cardiol 2018; 59:3-7. [DOI: 10.1016/j.hjc.2017.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/21/2017] [Accepted: 09/26/2017] [Indexed: 02/06/2023] Open
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Levi A, Codner P, Masalha A, Gargiulo G, Praz F, Hayashida K, Watanabe Y, Mylotte D, Debry N, Barbanti M, Lefèvre T, Modine T, Bosmans J, Windecker S, Barbash I, Sinning JM, Nickenig G, Barsheshet A, Kornowski R. Predictors of 1-Year Mortality After Transcatheter Aortic Valve Implantation in Patients With and Without Advanced Chronic Kidney Disease. Am J Cardiol 2017; 120:2025-2030. [PMID: 28965713 DOI: 10.1016/j.amjcard.2017.08.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/21/2017] [Accepted: 08/08/2017] [Indexed: 01/18/2023]
Abstract
Advanced chronic kidney disease (CKD) is an independent predictor of mortality in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to identify predictors of 1-year mortality in patients after TAVI stratified by the presence or absence of advanced CKD (defined as estimated glomerular filtration rate ≤30 ml/min/1.73 m2 or permanent renal replacement therapy). Patients (n = 1204) from 10 centers in Europe, Japan, and Israel were included: 464 with and 740 without advanced CKD. Advanced CKD was associated with a 2-fold increase in the adjusted risk of 1-year all-cause death (p <0.001), and a 1.9-fold increase in cardiovascular death (p = 0.016). Interaction-term analysis was used to identify and compare independent predictors of 1-year mortality in both groups. Impaired left ventricular ejection fraction and poor functional class were predictive of death in the advanced CKD group (odds ratio [OR] 2.27, p = 0.002 and OR 3.87, p = 0.003, respectively) but not in patients without advanced CKD (p for interaction = 0.035 and 0.039, respectively), whereas bleeding was a predictor of mortality in the nonadvanced CKD group (OR 3.2, p = 0.005) but not in advanced CKD (p for interaction = 0.006). Atrial fibrillation was associated with a 2.2-fold increase (p = 0.032) in the risk of cardiovascular death in the advanced CKD group but not in the absence of advanced CKD (p for interaction = 0.022). In conclusion, the coexistence of advanced CKD and either reduced left ventricular ejection fraction or poor functional class has an incremental effect on the risk of death after TAVI. In contrast, bleeding had a greater effect on risk of death in patients without advanced CKD.
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82
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Bagur R, Choudhury T, Mamas MA. Transcatheter aortic valve implantation with the repositionable and fully retrievable Lotus Valve System TM. J Thorac Dis 2017; 9:2798-2803. [PMID: 29221243 DOI: 10.21037/jtd.2017.08.78] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rodrigo Bagur
- Division of Cardiology, London Health Sciences Centre, Departments of Medicine and Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
| | - Tawfiq Choudhury
- Division of Cardiology, London Health Sciences Centre, Departments of Medicine and Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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Review of Major Registries and Clinical Trials of Late Outcomes After Transcatheter Aortic Valve Replacement. Am J Cardiol 2017; 120:331-336. [PMID: 28532778 DOI: 10.1016/j.amjcard.2017.04.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/12/2017] [Accepted: 04/12/2017] [Indexed: 11/23/2022]
Abstract
The results of the Placement of AoRtic TraNscathetER Valves (PARTNER) 2 trial established the feasibility of transcatheter aortic valve replacement (TAVR) for intermediate surgical risk patients. The expansion of TAVR into the low-risk patient population will largely depend on its durability outcomes due to the high life expectancy in low-risk patients. Long-term follow-up results from low-risk clinical trials will take several years to be reported. Given this, we performed a systematic review of current long-term data to provide further insights into TAVR durability and long-term patient survival. We searched MEDLINE, Embase, Google Scholar, BIOSIS, and major conference abstracts for TAVR studies with follow-up of at least 4 years. Abstracts were retrieved and independently reviewed for eligibility. Final studies were selected irrespective of the type of TAVR valve, route of vascular access, or surgical risk profile. A total of 12 studies met the inclusion criteria. We reviewed data from these studies with emphasis on long-term survival and echocardiographic findings.
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84
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Jones BM, Krishnaswamy A, Tuzcu EM, Mick S, Jaber WA, Svensson LG, Kapadia SR. Matching patients with the ever-expanding range of TAVI devices. Nat Rev Cardiol 2017; 14:615-626. [DOI: 10.1038/nrcardio.2017.82] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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85
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Foroutan F, Guyatt GH, Otto CM, Siemieniuk RA, Schandelmaier S, Agoritsas T, Vandvik PO, Bhagra S, Bagur R. Structural valve deterioration after transcatheter aortic valve implantation. Heart 2017; 103:1899-1905. [DOI: 10.1136/heartjnl-2017-311329] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/17/2017] [Accepted: 05/03/2017] [Indexed: 11/03/2022] Open
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86
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Levi A, Landes U, Assali AR, Orvin K, Sharony R, Vaknin-Assa H, Hamdan A, Shapira Y, Schwartzenberg S, Codner P, Shaul AA, Vaturi M, Gutstein A, Sagie A, Kornowski R. Long-Term Outcomes of 560 Consecutive Patients Treated With Transcatheter Aortic Valve Implantation and Propensity Score-Matched Analysis of Early- Versus New-Generation Valves. Am J Cardiol 2017; 119:1821-1831. [PMID: 28388992 DOI: 10.1016/j.amjcard.2017.02.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 12/30/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis in patients at high or prohibitive surgical risk. Nevertheless, long-term clinical and echocardiographic data are still lacking. We carried out an analysis of 560 consecutive patients who underwent TAVI at our institution from 2008 to 2016 to evaluate temporal changes in TAVI characteristics, predictors of 1-year and long-term outcomes, and to compare the performance of the early- and new-generation valve systems. With time, we have adopted lower risk threshold for patient selection and have been using conscious sedation and transfemoral access preferentially (p <0.001 for all). The incidence of greater than mild PVL decreased from 16% to 7.6%, p = 0.029. Within 5 years, 47% of the patients died, the majority (78%) due to noncardiac causes. Independent predictors of 1-year death included periprocedural aspects (i.e., vascular complications, stroke, and PVL), whereas death occurring later than 1 year was solely related to baseline co-morbidities. Transvalvular gradients and residual regurgitation remained nonclinically significant for up to 5 years of follow-up. New-generation valves were associated with less PVL compared with propensity score-matched early-generation valves (p <0.001). In conclusion, TAVI utilization at our institution has progressed to include lower risk patients with transfemoral access becoming applicable in the great majority. Poor long-term survival is attributable to population factors rather than to procedural factors. Intermediate- and long-term hemodynamics are excellent. PVL has diminished significantly with the new-generation valves. Efforts to improve long- and short-term outcomes remain a therapeutic challenge.
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Affiliation(s)
- Amos Levi
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Landes
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abid R Assali
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katia Orvin
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Sharony
- "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiothoracic Surgery, "Rabin Medical Center," Petah Tikva, Israel
| | - Hanna Vaknin-Assa
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ashraf Hamdan
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Shapira
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Schwartzenberg
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pablo Codner
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; Department of Cardiothoracic Surgery, "Rabin Medical Center," Petah Tikva, Israel
| | - Aviv A Shaul
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Vaturi
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Gutstein
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Sagie
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Effect of body mass index on clinical outcome and all-cause mortality in patients undergoing transcatheter aortic valve implantation. Neth Heart J 2017; 25:498-509. [PMID: 28536936 PMCID: PMC5571592 DOI: 10.1007/s12471-017-1003-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objectives To assess the effect of body mass index (BMI) on outcome among patients with severe aortic stenosis (AS) admitted for transcatheter aortic valve implantation (TAVI). Background Being overweight or obese is associated with improved outcome following certain medical treatments, suggesting the existence of a BMI paradox. However, the relationship between BMI and mortality after TAVI remains controversial. Methods Patients were classified according to World Health Organisation criteria such as normal weight, overweight, or obesity according to their BMI (18.5 to 24.9 kg/m2, 25.0 to 29.9 kg/m2, and ≥30.0 kg/m2, respectively). Results A total of 549 consecutive patients (age: 80.2 ± 7.5 years; logistic European system for cardiac operative risk evaluation [EuroSCORE]: 17.3 ± 9.9%) who underwent TAVI for AS were included. Of these patients, 43% (n = 237) had normal weight, 36% (n = 200) were overweight, and 20% (n = 112) were obese. There were no differences in peri-operative bleeding or vascular complication rates between the groups. All-cause mortality after 30 days, and 1 year, were higher in normal weight patients compared with overweight and obese patients (7% vs. 5 and 4%, p = 0.383, and 19% vs. 9 and 10%, p = 0.006, respectively). After adjustment for several confounding factors, overweight was associated with a decreased 30-day and 1‑year all-cause mortality outcome (hazard ratio [HR] 0.69; 95% confidence interval [CI] 0.47–0.99, and HR 0.65; 95% CI 0.45–0.94, respectively). Conclusions Despite the well-documented adverse effects of increased body weight on health, being overweight is associated with improved survival following TAVI when compared with normal weight.
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Bleiziffer S, Bosmans J, Brecker S, Gerckens U, Wenaweser P, Tamburino C, Linke A. Insights on mid-term TAVR performance: 3-year clinical and echocardiographic results from the CoreValve ADVANCE study. Clin Res Cardiol 2017; 106:784-795. [PMID: 28484830 DOI: 10.1007/s00392-017-1120-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/25/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Extensive evidence relating to transcatheter aortic valve replacement (TAVR) has accumulated in recent years, but mid-term outcomes are less reported. We investigated 996 patients after implantation of the CoreValve prosthesis for severe aortic stenosis in a real-world setting. OBJECTIVE To report clinical and echocardiographic 3-year results from the ADVANCE study. METHODS ADVANCE is a prospective, multicenter, fully monitored, nonrandomized clinical study. This analysis assessed valve-related events, predictors of early and mid-term mortality after TAVR, and systolic and diastolic prosthesis performance over 3 years. RESULTS Three years after TAVR, the rate of major adverse cardiac/cerebrovascular events was 38.5%. All-cause mortality was 33.7%; cardiovascular mortality, 22.3%; VARC-1 stroke, 6.5%; and New York Heart Association class III/IV, 19.5%. Mean effective orifice area was consistently 1.7 cm2 from discharge to 3 years, and average mean aortic valve gradient remained ≤10 mmHg. At 3 years, 12.6% of patients had moderate and none had severe paravalvular regurgitation. Multivariable analysis identified Society of Thoracic Surgeons (STS) score, device migration, prior atrial fibrillation, and major vascular complication as predictors of early mortality. Predictors of mid-term mortality included male gender, STS score, history of chronic obstructive pulmonary disease, history of cancer, stroke, life-threatening/disabling or major bleeding, and valve deterioration. CONCLUSIONS Our 3-year data demonstrate significant hemodynamic benefits and durable symptom relief after CoreValve prosthesis implantation. Postprocedural patient management should be carefully considered, since postprocedural valve-related events were identified as independent predictors of mid-term mortality. TRIAL REGISTRATION ClinicalTrials.gov, NCT01074658.
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Affiliation(s)
- Sabine Bleiziffer
- Clinic for Cardiovascular Surgery, Department of Cardiovascular Surgery, German Heart Center, Technical University Munich, Lazarettstr. 36, 80636, Munich, Germany.
| | - Johan Bosmans
- Cardiovascular Diseases Department, Antwerp University Hospital, Edegem, Belgium
| | - Stephen Brecker
- Cardiology Clinical Academic Group, St. George's Hospital, London, UK
| | - Ulrich Gerckens
- Cardiology Department, Gemeinschaftskrankenhaus, Bonn, Germany
| | - Peter Wenaweser
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Corrado Tamburino
- Cardiology Unit, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Axel Linke
- Department of Internal Medicine and Cardiology, University of Leipzig Heart Center, Leipzig, Germany
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McConkey H, Arri SS, Joseph JP, Prendergast BD, Redwood S. Adjuncts to transcatheter aortic valve implantation. Expert Rev Cardiovasc Ther 2017; 15:357-365. [PMID: 28271724 DOI: 10.1080/14779072.2017.1297230] [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: 10/20/2022]
Abstract
INTRODUCTION The appreciable rise in percutaneous valve procedures has been pursued by a wave of development in advanced technology to help guide straightforward, streamlined and safe intervention. This review article aims to highlight the adjunctive devices, tools and techniques currently used in transcatheter aortic valve implantation procedures to avoid potential pitfalls. Areas covered: The software and devices featured here are at the forefront of technological advances, most of which are not yet in widespread use. These products have been discussed in national and international structural intervention conferences and the authors felt it important to showcase particularly well designed adjuncts that improve procedural efficacy and safety. Whilst vascular pre-closure systems are used routinely and are an integral part of these complex cardiovascular procedures, these have been well summarised elsewhere and are beyond the scope of this article. Expert commentary: The rising volume of patients with aortic stenosis who are treatable with TAVI means that this exponential increase in procedures must be accompanied by a steady decline in procedural complications. This section provides an overview of our current perspective, and what we feel the direction of travel will be.
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Affiliation(s)
- Hzr McConkey
- a Cardiovascular Division , King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital Campus , London , UK
| | - S S Arri
- a Cardiovascular Division , King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital Campus , London , UK
| | - J P Joseph
- a Cardiovascular Division , King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital Campus , London , UK
| | - B D Prendergast
- a Cardiovascular Division , King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital Campus , London , UK
| | - S Redwood
- a Cardiovascular Division , King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital Campus , London , UK
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Harjai KJ, Grines CL, Paradis JM, Kodali S. Transcatheter aortic valve replacement: The year in review 2016. J Interv Cardiol 2017; 30:105-113. [PMID: 28256067 DOI: 10.1111/joic.12372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 01/01/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) continued to make major strides in 2016, simultaneously expanding its application to lower risk patients as well as more technically challenging subsets of patients with aortic stenosis (AS). The two major accomplishments this year were the establishment of TAVR as the preferred treatment strategy over surgical aortic valve replacement (SAVR) in intermediate risk patients, and initial signals that TAVR and SAVR may be clinically equivalent in low-risk populations. Meanwhile, there is continued expansion of TAVR to challenging clinical subsets (bicuspid aortic valve [BAV], patients with concomitant advanced coronary artery disease [CAD], and failed surgical bioprostheses), and encouraging initial experiences with newer transcatheter heart valve systems. This paper summarizes the major research studies published on TAVR in 2016.
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Affiliation(s)
- Kishore J Harjai
- Geisinger Clinic, Pearsall Heart Hospital, Wilkes-Barre, Pennsylvania
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91
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Grover FL, Vemulapalli S, Carroll JD, Edwards FH, Mack MJ, Thourani VH, Brindis RG, Shahian DM, Ruiz CE, Jacobs JP, Hanzel G, Bavaria JE, Tuzcu EM, Peterson ED, Fitzgerald S, Kourtis M, Michaels J, Christensen B, Seward WF, Hewitt K, Holmes DR. 2016 Annual Report of The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Ann Thorac Surg 2017; 103:1021-1035. [DOI: 10.1016/j.athoracsur.2016.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Indexed: 11/28/2022]
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92
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Grover FL, Vemulapalli S, Carroll JD, Edwards FH, Mack MJ, Thourani VH, Brindis RG, Shahian DM, Ruiz CE, Jacobs JP, Hanzel G, Bavaria JE, Tuzcu EM, Peterson ED, Fitzgerald S, Kourtis M, Michaels J, Christensen B, Seward WF, Hewitt K, Holmes DR. 2016 Annual Report of The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. J Am Coll Cardiol 2017; 69:1215-1230. [DOI: 10.1016/j.jacc.2016.11.033] [Citation(s) in RCA: 391] [Impact Index Per Article: 55.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/20/2016] [Accepted: 11/28/2016] [Indexed: 11/28/2022]
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93
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94
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Ailawadi G, Iung B. The TVT Registry: Collaboration Leading to Quality Control. Ann Thorac Surg 2017; 103:693-694. [PMID: 28219542 DOI: 10.1016/j.athoracsur.2017.01.024] [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: 01/13/2017] [Accepted: 01/15/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Gorav Ailawadi
- Department of Surgery, University of Virginia, Charlottesville, Virginia.
| | - Bernard Iung
- Cardiology Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire Fibrosis, Inflammation, Remodeling in Cardiovascular, Respiratory and Renal Diseases, Paris-Diderot University, Paris, France
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95
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TAVR Prognosis, Aging, and the Second TAVR Tsunami. J Am Coll Cardiol 2016; 68:1648-1650. [DOI: 10.1016/j.jacc.2016.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/09/2016] [Indexed: 11/22/2022]
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