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Personalised Treatment in Aortic Stenosis: A Patient-Tailored Transcatheter Aortic Valve Implantation Approach. J Cardiovasc Dev Dis 2022; 9:jcdd9110407. [PMID: 36421942 PMCID: PMC9694505 DOI: 10.3390/jcdd9110407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVI) has become a game changer in the management of severe aortic stenosis shifting the concept from inoperable or high-risk patients to intermediate or low surgical-risk individuals. Among devices available nowadays, there is no clear evidence that one device is better than the other or that one device is suitable for all patients. The selection of the optimal TAVI valve for every patient represents a challenging process for clinicians, given a large number of currently available devices. Consequently, understanding the advantages and disadvantages of each valve and personalising the valve selection based on patient-specific clinical and anatomical characteristics is paramount. This review article aims to both analyse the available devices in the presence of specific clinical and anatomic features and offer guidance to select the most suitable valve for a given patient.
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Ahmad Y, Agarwal V, Williams ML, Wang DD, Reardon MJ, Cavalcante JL, Makkar R, Forrest JK. Imaging, Treatment Options, Patient Selection, and Outcome Considerations for Patients With Bicuspid Aortic Valve Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100506. [PMID: 39132366 PMCID: PMC11307905 DOI: 10.1016/j.jscai.2022.100506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 08/13/2024]
Abstract
Transcatheter aortic valve replacement has emerged as a safe and effective alternative to surgical aortic valve replacement for patients with severe symptomatic aortic stenosis across the spectrum of surgical risks based on a series of foundational randomized clinical trials. Of note, patients with bicuspid aortic valve (BAV) disease were excluded from all these pivotal randomized trials, leaving a significant knowledge gap because BAVs are commonly encountered in patients referred for aortic valve surgery or intervention. In this comprehensive review, we aim to provide heart teams with a detailed insight into how to approach patients with BAV disease, focusing on imaging and characterization of bicuspid valves, an overview of surgical approaches, and an understanding of the current data behind the role of transcatheter aortic valve replacement for patients with BAV disease.
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Affiliation(s)
- Yousif Ahmad
- Division of Cardiology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Vratika Agarwal
- Division of Cardiology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Matthew L. Williams
- Division of Cardiac Surgery, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Dee Dee Wang
- Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan
| | | | - João L. Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - John K. Forrest
- Division of Cardiology, Yale School of Medicine, Yale University, New Haven, Connecticut
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Ueyama H, Block PC. Data are data: Do we need a randomized trial of transcatheter aortic valve replacement for bicuspid valves? Catheter Cardiovasc Interv 2022; 100:1132-1133. [DOI: 10.1002/ccd.30479] [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: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hiroki Ueyama
- Division of Cardiology Emory University School of Medicine Atlanta Georgia USA
| | - Peter C. Block
- Division of Cardiology Emory University School of Medicine Atlanta Georgia USA
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Russo G, Tang GHL, Sangiorgi G, Pedicino D, Enriquez-Sarano M, Maisano F, Taramasso M. Lifetime Management of Aortic Stenosis: Transcatheter Versus Surgical Treatment for Young and Low-Risk Patients. Circ Cardiovasc Interv 2022; 15:915-927. [PMID: 36378737 DOI: 10.1161/circinterventions.122.012388] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transcatheter aortic valve replacement is now indicated across all risk categories of patients with symptomatic severe aortic stenosis and has been proposed as first line option for the majority of patients >74 years old. However, median age of patients enrolled in the transcatheter aortic valve replacement low-risk trials is 74 years and transcatheter aortic valve replacement has never been systematically investigated in young low risk patients. Although the long-term data in surgical aortic valve replacement in young patients (age <75) are well known, such data remain lacking in transcatheter aortic valve replacement. In the absence of clear guideline recommendations in patients with challenging anatomies (eg, hostile calcium, bicuspid), it is important to know the potential advantages and disadvantages of each treatment and to consider how they might integrate with each other in the lifetime management of such patients. In this review, we discuss current outstanding issues on the management of severe aortic stenosis from a lifetime management perspective, particularly in terms of initial intervention and future reinterventions.
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Affiliation(s)
- Giulio Russo
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome (G.R., G.S.)
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York (G.H.L.T.)
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome (G.R., G.S.)
| | - Daniela Pedicino
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italia (D.P.).,Università Cattolica del Sacro Cuore, Roma, Italia (D.P.)
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Ullah W, Zahid S, Muhammadzai H, Khalil F, Kumar A, Minhas AMK, Khan MZ, Virani SS, Fischman DL, Shah P, Bhatt DL. Trends, predictors, and outcomes of transcatheter aortic valve implantation in patients with bicuspid aortic valve related disease: Insights from the Nationwide Inpatient Sample and Nationwide Readmission Database. Catheter Cardiovasc Interv 2022; 100:1119-1131. [PMID: 36183395 PMCID: PMC10092271 DOI: 10.1002/ccd.30407] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has increasingly been utilized in patients with bicuspid aortic valve (BAV) related aortic stenosis (AS) with insufficient large-scale data on its safety. METHODS The Nationwide Inpatient Sample and Nationwide Readmission Database (2011-2018) were queried to identify patients undergoing TAVI for BAV versus trileaflet aortic valve (TAV) associated AS. The in-hospital, 30- and 180-day odds of outcomes were assessed using a propensity-matched analysis (PSM) to calculate adjusted odds ratios (aOR) with its 95% confidence interval (CI). RESULTS A total of 216,723 TAVI (TAV: 214,050 and BAV: 2,673) crude and 5,347 matched population (TAV: 2,674 and BAV: 2,673) was included in the final analysis. At index admission, the adjusted odds of in-hospital mortality (aOR: 1.57, 95% CI: 0.67-3.66), stroke (aOR: 0.77, 95% CI: 0.38-1.57), cardiac tamponade (aOR: 0.75, 95% CI: 0.17-3.36), vascular complications (aOR: 0.33, 95% CI: 0.09-1.22), cardiogenic shock (aOR: 1.77, 95% CI: 0.93-3.38), paravalvular leak (aOR: 0.55, 95% CI: 0.26-1.14), need for mechanical circulatory support device, and permanent pacemaker implantation (PPM) (aOR: 1.02, 95% CI: 0.69-1.52) were not significantly different between TAVI for BAV versus TAV. At 30- and 180-day follow-up duration, the risk of stroke and major postprocedural complications remained similar, except that TAVI in BAV had a higher incidence of PPM implantation compared with TAV. The yearly trend showed an increase in the utilization of TAVI for both TAV and BAV and a steady decline in the overall annual rate of in-hospital complications. CONCLUSION TAVI utilization in patients with BAV has increased over the recent years. The relative odds of in-hospital mortality, and all other major complications, were similar between patients undergoing TAVI for BAV- and TAV-related AS.
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Affiliation(s)
- Waqas Ullah
- Division of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Salman Zahid
- Department of Internal Medicine, Rochester Regional Health, Rochester, New York, USA
| | - Hamza Muhammadzai
- Department of Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Fouad Khalil
- Department of Internal Medicine, University of South Dakota, Vermillion, South Dakota, USA
| | - Arnav Kumar
- Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center, Boston, Massachusetts, USA
| | | | - Muhammad Zia Khan
- Division of Cardiology, West Virginia University Hospital, Morgantown, West Virginia, USA
| | - Salim S Virani
- Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA.,Division of Cardiology, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - David L Fischman
- Division of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Pinak Shah
- Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center, Boston, Massachusetts, USA
| | - Deepak L Bhatt
- Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center, Boston, Massachusetts, USA
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Bhushan S, Huang X, Li Y, He S, Mao L, Hong W, Xiao Z. Paravalvular Leak After Transcatheter Aortic Valve Implantation Its Incidence, Diagnosis, Clinical Implications, Prevention, Management, and Future Perspectives: A Review Article. Curr Probl Cardiol 2022; 47:100957. [DOI: https:/doi.org/10.1016/j.cpcardiol.2021.100957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Fan J, Chen J, Wang L, Dai H, Guo Y, Jiang J, Hu P, Lin X, Li C, Liu X, Wang J. Feasibility and safety of next-day discharge following transcatheter bicuspid aortic valve replacement. IJC HEART & VASCULATURE 2022; 42:101101. [PMID: 35937949 PMCID: PMC9350863 DOI: 10.1016/j.ijcha.2022.101101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/09/2022] [Accepted: 07/27/2022] [Indexed: 11/22/2022]
Abstract
Background Decreased length of stay in the index hospitalization is a tendency in transcatheter aortic valve replacement (TAVR) era. In this study, we aim to evaluate the feasibility and safety of next-day discharge (NDD) in bicuspid aortic valve (BAV) patients following TAVR. Methods The study analyzed patients who received TAVR in 2019 to 2022. Thirty-day mortality and readmission rate were compared between BAV and tricuspid aortic valve (TAV) patients. Results The proportion of NDD was similar between the BAV and TAV group (45.3 % vs 41.3 %, p = 0.487). In NDD patients, the lower age (72.0 [67.0, 77.0] yrs vs 74.0 [70.0, 80.0] yrs, p = 0.011) and STS score (2.33 [1.56, 3.54] % vs 3.82 [2.38, 5.70] %, p < 0.001) were observed in the BAV group. The NDD BAV patients had higher proportion of post-dilatation (74.3 % vs 50.7 %, p = 0.003) when compared with the TAV patients. The NDD patients was safe with no death both in BAV and TAV patients at 30-day follow-up. Moreover, the readmission rate was comparable between BAV and TAV patients who discharged on the next day after TAVR (8.1 % vs 14.0 %, p = 0.397). Conclusions NDD after TAVR was feasible and safe in both BAV and TAV patients. The younger BAV patients with fast recovery deserve the next-day discharge after TAVR.
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Affiliation(s)
- Jiaqi Fan
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jun Chen
- Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Lihan Wang
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Hanyi Dai
- Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Yuchao Guo
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jubo Jiang
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Po Hu
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xinping Lin
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Cheng Li
- Department of Nursing, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Corresponding authors at: Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
| | - Jian'an Wang
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Corresponding authors at: Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
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Xie CM, Yao YT. The current practice of transcatheter aortic valve replacement in China. J Card Surg 2022; 37:3168-3177. [PMID: 35924996 DOI: 10.1111/jocs.16815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/29/2022] [Accepted: 06/19/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The purpose of this study is to summarize the current practice and experience of transcatheter aortic valve replacement in China. METHODS The relevant articles were identified through computerized searches of the CNKI, WANFANG, VIP, and PubMed databases through February 1, 2022, using the search terms: "transcatheter aortic valve replacement," "transcatheter aortic valve implantation," "China." RESULTS The database searches identified 22 articles, 2092 patients, 57.65% were male, with a mean age of 74.2 ± 6.0 years, 71.51% of patients were classified by New York Heart Association as class Ⅲ/Ⅳ, Society of Thoracic Surgeons score 8.4 ± 4.1, mean left ventricular ejection fraction 52.8 ± 14.2%, mean transvalvular aortic pressure gradient 59.9 ± 18.9 mmHg. The overall procedural success rate was 97.85%, and 2.15% of patients were converted to sternotomy, mainly due to transcatheter aortic bioprosthesis dislocation. The most common vascular access approach was transfemoral (1071 patients, 51.20%). General anesthesia (48.90%) was the commonly used anesthesia technique. The incidence of postprocedural complications was as follows: permanent pacemaker implantation (10.47%), bleeding events (8.60%), mild paravalvular leakage (17.73%), moderate and severe paravalvular leakage (4.16%), vascular complications (3.30%), stroke (1.43%), respectively. The overall periprocedural period and postprocedural 30-day mortality was 2.72%. CONCLUSIONS Among patients undergoing transcatheter aortic valve replacement in China, device implantation success was achieved in 97.85% of cases. The most common vascular access approach was transfemoral. General anesthesia was the most commonly used anesthetic technique. Paravalvular leakage (458 patients, 21.89%) was the most common complication.
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Affiliation(s)
- Chun-Mei Xie
- Department of Anesthesiology, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China
| | - Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Moriyama N, Miyashita H, Lehtola H, Yamanaka F, Vähasilta T, Piuhola J, Saito S, Niemelä M, Laine M. Device Failure in Bicuspid Aortic Stenosis Following Transcatheter Aortic Valve Implantation. Am J Cardiol 2022; 176:96-104. [PMID: 35643552 DOI: 10.1016/j.amjcard.2022.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 11/18/2022]
Abstract
Recent studies showed the favorable outcomes of transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve (BAV) stenosis. However, data on the relation between BAV morphology and optimal transcatheter heart valve (THV) selection are limited. This study sought to evaluate the determinants of device performance in patients with BAV who underwent TAVI. Consecutive patients with BAV who underwent TAVI with the SAPIEN 3 from multicenters were evaluated. Outcomes were the incidence and predictors of device failure. Device failure was defined as peak aortic velocity >3.0 m/s, mean pressure gradient >20 mm Hg, moderate or severe paravalvular leakage and/or procedure mortality. A total of 187 patients with BAV were identified, aged 77 years, and 38.0% were women. A total of 37 patients (19.8%) were treated with 23-mm valve, 58 (31.0%) with 26-mm valve, and 92 (49.2%) with 29-mm valve. Predischarge echocardiogram demonstrated 37 patients (19.8%) with device failure. BAV with excessive leaflet calcification plus calcified raphe (EC-BAV) (OR 16.7, 95% CI 1.99 to 39.6) and smaller THV (OR 4.41, 95% CI 1.43 to 13.6) were independently associated with increased risk of device failure. In addition, 4.0%, 5.1%, and 11.1% of device failures were observed in patients without EC-BAV who underwent TAVI with 23-, 26- and 29-mm THV (p = 0.47), respectively, and 91.7%, 31.6% and 23.2% in those with EC-BAV, respectively (p <0.001). In conclusion, EC-BAV morphology was the major determinant of a device failure after TAVI. Moreover, TAVI in patients with EC-BAV requiring small SAPIEN 3 could be challenging. Further data on device and treatment selection in patients with BAV are still warranted.
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Affiliation(s)
- Noriaki Moriyama
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan; Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
| | | | - Heidi Lehtola
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Tommi Vähasilta
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Jarkko Piuhola
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Matti Niemelä
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Mika Laine
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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Ohira S, Pena CDL. The role of sutureless or rapid-deployment aortic valve prosthesis in bicuspid aortic valve: Standard AVR, TAVR, or somewhere in between? J Card Surg 2022; 37:3363-3364. [PMID: 35904124 DOI: 10.1111/jocs.16802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Suguru Ohira
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Corazon De La Pena
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
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Bicuspid Aortic Valves: an Up-to-Date Review on Genetics, Natural History, and Management. Curr Cardiol Rep 2022; 24:1021-1030. [PMID: 35867195 DOI: 10.1007/s11886-022-01716-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality. It has a wide spectrum of clinical manifestations including aortic regurgitation (AR), aortic stenosis, and an associated aortopathy with a small but increased risk of aortic dissection. This review describes current knowledge of BAV, from anatomy and genetics to a discussion of multifaceted strategies utilized in the management of this unique patient population. This review will also highlight critical knowledge gaps in areas of basic and clinical research to enhance further understanding of this clinical entity. RECENT FINDINGS The current knowledge regarding pathophysiologic mechanisms, screening, and surveillance guidelines for BAV and the associated aortopathy is discussed. We also discuss current management techniques for aortic valve repair versus replacement, indications for aortic surgery (root or ascending aorta), and the emergence of the Ross procedure as a viable management option not only in children, but also in adolescents and adults. The varied clinical phenotype of the BAV, resulting in its specific complex hemodynamic interactions, renders it an entity which is separate and distinct from the tricuspid aortic valve pathologies. While various aortic histopathologic and protein alterations in BAV patients have been described, it remains unclear if these changes are causal or the result of hemodynamic alterations imposed by sheer stress on the intrinsically dysfunctional BAV. Medical management for patients with BAV with AS, AI, or dilated aortic roots/ascending aortas remains challenging and needs further investigation. More than 50% of patients with BAV will undergo AVR during their lifetime, and more than 25% of patients with BAV undergo aortic surgery performed for dilation of the aortic root or ascending aorta, often concurrently with AVR. The search for the ultimate genetic or epigenetic cause of the different bicuspid phenotypes will ultimately be facilitated by the next-generation sequencing tools that allow for study of large populations at low cost. Improvements in diagnostic and stratification criteria to accurately risk assess BAV patients are critical to this process.
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Zhang X, Puehler T, Frank D, Sathananthan J, Sellers S, Meier D, Both M, Blanke P, Seoudy H, Saad M, Müller OJ, Sondergaard L, Lutter G. TAVR for All? The Surgical Perspective. J Cardiovasc Dev Dis 2022; 9:jcdd9070223. [PMID: 35877585 PMCID: PMC9323639 DOI: 10.3390/jcdd9070223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 02/01/2023] Open
Abstract
In spite of the noninferiority of transcatheter aortic valve replacement (TAVR) in high- and intermediate-risk patients, there are still obstacles that need to be overcome before the procedure is further expanded and clinically integrated. The lack of evidence on the long-term durability of the bioprostheses used for TAVR remains of particular concern. In addition, surgery may be preferred over TAVR in patients with bicuspid aortic valve (BAV) or with concomitant pathologies such as other valve diseases (mitral regurgitation/tricuspid regurgitation), aortopathy, and coronary artery disease. In this review, we discuss and summarize relevant data from clinical trials, current trends, and remaining obstacles, and provide our perspective on the indications for the expansion of TAVR.
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Affiliation(s)
- Xiling Zhang
- Department of Cardiovascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (X.Z.); (T.P.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany
| | - Thomas Puehler
- Department of Cardiovascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (X.Z.); (T.P.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany
| | - Derk Frank
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (D.F.); (H.S.); (M.S.); (O.J.M.)
| | - Janarthanan Sathananthan
- Centre for Heart Lung Innovation & Providence Research, Vancouver, BC V6Z 1Y6, Canada; (J.S.); (S.S.); (D.M.)
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC V6Z 1Y6, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
- Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, St Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Stephanie Sellers
- Centre for Heart Lung Innovation & Providence Research, Vancouver, BC V6Z 1Y6, Canada; (J.S.); (S.S.); (D.M.)
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC V6Z 1Y6, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
- Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, St Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - David Meier
- Centre for Heart Lung Innovation & Providence Research, Vancouver, BC V6Z 1Y6, Canada; (J.S.); (S.S.); (D.M.)
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC V6Z 1Y6, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Marcus Both
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
| | - Philipp Blanke
- Department of Radiology, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6E 1M7, Canada;
| | - Hatim Seoudy
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (D.F.); (H.S.); (M.S.); (O.J.M.)
| | - Mohammed Saad
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (D.F.); (H.S.); (M.S.); (O.J.M.)
| | - Oliver J. Müller
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (D.F.); (H.S.); (M.S.); (O.J.M.)
| | - Lars Sondergaard
- Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark;
| | - Georg Lutter
- Department of Cardiovascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (X.Z.); (T.P.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany
- Correspondence: ; Tel.: +49-(0)4-3150-0220-31; Fax: +49-(0)0-4315-0022-048
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Zghouzi M, Osman H, Ullah W, Suleiman AR, Razvi P, Abdalrazzak M, Rabbat F, Alraiyes M, Sattar Y, Bagur R, Paul T, Matetic A, Mamas MA, Lakkis N, Alraies MC. Safety and efficacy of transcatheter aortic valve implantation in stenotic bicuspid aortic valve compared to tricuspid aortic valve: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2022; 20:581-588. [PMID: 35770517 DOI: 10.1080/14779072.2022.2094368] [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: 01/10/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has emerged as a safe and effective alternative to surgical replacement for tricuspid aortic valve (TAV) stenosis. However, utilization of TAVI for aortic stenosis in bicuspid aortic valve (BAV) compared to TAV remains controversial. METHODS We queried online databases with various keywords to identify relevant articles. We compared major cardiovascular events and procedural outcomes using a random effect model to calculate odds ratios (OR). RESULTS We included a total of 22 studies comprising 189,693 patients (BAV 12,669 vs. TAV 177,024). In the pooled analysis, there were no difference in TAVI for BAV vs. TAV for all-cause mortality, cardiovascular mortality, myocardial infarction (MI), vascular complications, acute kidney injury (AKI), coronary occlusion, annulus rupture, and reintervention/reoperation between the groups. The incidence of stroke (OR 1.24; 95% CI 1.1-1.39), paravalvular leak (PVLR) (OR 1.42; 95% CI 1.26-1.61), and the need for pacemaker (OR 1.15; 95% CI 1.06-1.26) was less in the TAV group compared to the BAV group, while incidence of life-threatening bleeding was higher in the TAV group. Subgroup analysis mirrored pooled outcomes except for all-cause mortality. CONCLUSION The use of TAVI for the treatment of aortic stenosis in selective BAV appears to be safe and effective.
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Affiliation(s)
- Mohamed Zghouzi
- Department of Internal Medicine, Detroit Medical Center, Detroit, MI, USA
| | - Heba Osman
- Department of Internal Medicine, Detroit Medical Center, Detroit, MI, USA
| | - Waqas Ullah
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Parveen Razvi
- Department of Internal Medicine, Detroit Medical Center, Detroit, MI, USA
| | - Mukhlis Abdalrazzak
- Division of Cardiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Firas Rabbat
- Division of Cardiolog, Internal medicine, Baptist hospital, Miami, FL, USA
| | - Mowaffak Alraiyes
- Division of Cardiology, Vernon Hills High School, Vernon Hills, IL, USA
| | - Yasar Sattar
- Division of cardiology, West Virginia University, Morgantown, WV, USA
| | - Rodrigo Bagur
- Division of Cardiology, London Health Sciences Centre, Western University, London, ON, Canada
| | - Timir Paul
- Department of Medical Education, University of Tennessee at Nashville, Nashville, TN, USA
| | - Andrija Matetic
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Nasser Lakkis
- Division of cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - M Chadi Alraies
- Division of cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, USA
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Esposito G, Kumar N, Pugliese F, Sayers M, Chow AW, Kennon S, Ozkor M, Mathur A, Baumbach A, Lloyd G, Mullen A, Cook A, Mullen M, Patel KP. Predictors of post-TAVI conduction abnormalities in patients with bicuspid aortic valves. Open Heart 2022; 9:e001995. [PMID: 35790318 PMCID: PMC9258482 DOI: 10.1136/openhrt-2022-001995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/06/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study evaluates predictors of conduction abnormalities (CA) following transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valves (BAV). BACKGROUND TAVI is associated with CA that commonly necessitate a permanent pacemaker. Predictors of CA are well established among patients with tricuspid aortic valves but not in those with BAV. METHODS This is a single-centre, retrospective, observational study of patients with BAV treated with TAVI. Pre-TAVI ECG and CT scans and procedural characteristics were evaluated in 58 patients with BAV. CA were defined as a composite of high-degree atrioventricular block, new left bundle branch block with a QRS >150 ms or PR >240 ms and right bundle branch block with new PR prolongation or change in axis. Predictors of CA were identified using regression analysis and optimum cut-off values determined using area under the receiver operating characteristic curve analysis. RESULTS CA occurred in 35% of patients. Bioprosthesis implantation depth, the difference between membranous septum (MS) length and implantation depth (δMSID) and device landing zone (DLZ) calcification adjacent to the MS were identified as univariate predictors of CA. The optimum cut-off for δMSID was 1.25 mm. Using this cut-off, low δMSID and DLZ calcification adjacent to MS predicted CA, adjusted OR 8.79, 95% CI 1.88 to 41.00; p=0.01. Eccentricity of the aortic valve annulus, type of BAV and valve calcium quantity and distribution did not predict CA. CONCLUSIONS In BAV patients undergoing TAVI, short δMSID and DLZ calcification adjacent to MS are associated with an increased risk of CA.
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Affiliation(s)
- Giulia Esposito
- King's College London Faculty of Life Sciences and Medicine, London, UK
- Cardiology, Barts Health NHS Trust, London, UK
| | - Niraj Kumar
- Cardiology, Barts Health NHS Trust, London, UK
- University College London Institute of Cardiovascular Science, London, UK
| | - Francesca Pugliese
- Cardiology, Barts Health NHS Trust, London, UK
- Centre for Advanced Cardiovascular Imaging, Queen Mary University William Harvey Research Institute, London, UK
| | - Max Sayers
- Cardiology, Barts Health NHS Trust, London, UK
| | | | | | - Mick Ozkor
- Cardiology, Barts Health NHS Trust, London, UK
| | - Anthony Mathur
- Barts Health NHS Trust, London, UK
- Centre for Cardiovascular Medicine and Devices, Queen Mary University William Harvey Research Institute, London, UK
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, Queen Mary University William Harvey Research Institute, London, UK
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Guy Lloyd
- Cardiology, Barts Health NHS Trust, London, UK
| | - Aigerim Mullen
- University College London Institute of Cardiovascular Science, London, UK
| | - Andrew Cook
- University College London Institute of Cardiovascular Science, London, UK
| | | | - Kush P Patel
- Cardiology, Barts Health NHS Trust, London, UK
- University College London Institute of Cardiovascular Science, London, UK
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65
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Miyashita H, Moriyama N, Yamanaka F, Saito S, Lehtola H, Piuhola J, Niemelä M, Laine M. Predictors of conduction disturbances after transcatheter aortic valve implantation with balloon-expandable valve for bicuspid aortic valve stenosis. J Cardiovasc Electrophysiol 2022; 33:1576-1586. [PMID: 35543515 DOI: 10.1111/jce.15525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/20/2022] [Accepted: 05/02/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Implantation depth and membranous septum (MS) length have been established as the predictors of new-onset conduction disturbance (CD) after transcatheter aortic valve replacement (TAVR) for tricuspid aortic valve (TAV) stenosis. However, little is known about the predictors with bicuspid aortic valve (BAV). This study investigated the role of MS length and implantation depth in predicting CD following TAVR with a balloon-expandable valve in patients with BAV. METHODS This retrospective study analyzed 169 patients who underwent TAVR for BAV with balloon-expandable valve, and TAV cohort was established as a control group using propensity score (PS) matching. The primary endpoints were in-hospital new permanent pacemaker implantation (PPI) and new-onset CD (the composite outcome of new-onset left bundle branch block and new PPI). RESULTS PPI developed in 14 patients (8.3%) and new-onset CD in 37 patients (21.9%) in the BAV cohort. Multivariate analysis revealed severe left ventricle outflow tract (LVOT) calcification (odds ratio [OR]: 5.83, 95% confidence interval [CI]: 1.08-31.5, p = .0407) and implantation depth-MS length (OR: 1.30, 95% CI: 1.12-1.51, p = .0005) as the predictors of new-onset CD within the BAV cohort. The matched comparison between BAV and TAV groups showed similar MS length (3.0 vs. 3.2 mm, p = .5307), but valves were implanted more deeply in the BAV group than in the TAV group (3.9 vs. 3.0 mm, p < .0001). New-onset CD was more frequent in patients who had BAV (22.3% vs. 13.9%, p = .0458). CONCLUSION The implantation depth-MS length, and severe LVOT calcification predicted new-onset CD following TAVR in BAV with balloon-expandable valve. Among BAV patients, valves were implanted more deeply compared to TAV patients. High deployment technique could be considered to avoid new-onset CD in BAV anatomy.
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Affiliation(s)
- Hirokazu Miyashita
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
| | | | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Heidi Lehtola
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Jarkko Piuhola
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Matti Niemelä
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Mika Laine
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
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66
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Gasecka A, Walczewski M, Witkowski A, Dabrowski M, Huczek Z, Wilimski R, Ochała A, Parma R, Scisło P, Rymuza B, Zbroński K, Szwed P, Grygier M, Olasińska-Wiśniewska A, Jagielak D, Targoński R, Opolski G, Kochman J. Long-Term Mortality After TAVI for Bicuspid vs. Tricuspid Aortic Stenosis: A Propensity-Matched Multicentre Cohort Study. Front Cardiovasc Med 2022; 9:894497. [PMID: 35800165 PMCID: PMC9253589 DOI: 10.3389/fcvm.2022.894497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesPatients with bicuspid aortic valve (BAV) stenosis were excluded from the pivotal trials of transcatheter aortic valve implantation (TAVI). We compared the in-hospital and long-term outcomes between patients undergoing TAVI for bicuspid and tricuspid aortic valve (TAV) stenosis.MethodsWe performed a retrospective registry-based analysis on patients who underwent TAVI for BAV and TAV at five different centers between January 2009 and August 2017. The primary outcome was long-term all-cause mortality. Secondary outcomes were in-hospital mortality, procedural complications, and valve performance.ResultsOf 1,451 consecutive patients who underwent TAVI, two propensity-matched cohorts consisting of 130 patients with BAV and 390 patients with TAV were analyzed. All-cause mortality was comparable in both groups up to 10 years following TAVI (HR 1.09, 95% CI: 0.77–1.51). Device success and in-hospital mortality were comparable between the groups (96 vs. 95%, p = 0.554 and 2.3 vs. 2.1%, p = 0.863, respectively). Incidence of procedural complications was similar in both groups, with a trend toward a higher rate of stroke in patients with BAV (5 vs. 2%, p = 0.078). Incidence of moderate or severe paravalvular leak (PVL) at discharge was comparable in both groups (2 vs. 2%, p = 0.846). Among patients with BAV, all-cause mortality was similar in self-expanding and balloon-expandable prostheses (HR 1.02, 95% CI: 0.52–1.99) and lower in new-generation devices compared to old-generation valves (HR 0.27, 95% CI 0.12–0.62).ConclusionPatients who had undergone TAVI for BAV had comparable mortality to patients with TAV up to 10 years after the procedure. The device success, in-hospital mortality, procedural complications, and PVL rate were comparable between the groups. The high rate of neurological complications (5%) in patients with BAV warrants further investigation.
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Affiliation(s)
- Aleksandra Gasecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Walczewski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
- *Correspondence: Michał Walczewski
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Zenon Huczek
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Radosław Wilimski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Ochała
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Radosław Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Piotr Scisło
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Bartosz Rymuza
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Karol Zbroński
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Szwed
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Grygier
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Olasińska-Wiśniewska
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Radosław Targoński
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochman
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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67
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Valvular Heart Disease Epidemiology. Med Sci (Basel) 2022; 10:medsci10020032. [PMID: 35736352 PMCID: PMC9228968 DOI: 10.3390/medsci10020032] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Valvular heart disease is a rapidly growing cause of global cardiovascular morbidity and mortality with diverse and evolving geographic distribution. The prevalence of rheumatic heart disease, the most common valvular heart disease (affecting approximately 41 million people), has been rising in developing nations, likely due to the expansion of the young adult population and the decrease in premature mortality that has resulted from improved access to antibiotics, microbiological testing, and echocardiography. Rheumatic heart disease has also been rising among the impoverished and, often, indigenous populations of developed nations, spurring public health initiatives that are aimed at alleviating healthcare disparities. Aortic valve stenotic disease is the most commonly occurring valvular pathology in developed nations (afflicting 9 million people worldwide) and its prevalence has been increasing with population aging and the increased prevalence of atherosclerosis. Aortic regurgitation is associated with diastolic, but not systolic, hypertension and it has likewise seen a rise in the developed world. Mitral regurgitation affects 24 million people worldwide, with great variability between and among nations. Primary mitral regurgitation arises as a consequence of myxomatous degeneration and mitral valve prolapse, which is largely due to genetic predispositions, while secondary mitral regurgitation accounts for 65% of cases and arises secondary to dilation and heart failure. Tricuspid regurgitation has become more prevalent in developed nations due to the increased usage of intracardiac pacemakers. Infective endocarditis prevalence has also grown in developed nations, likely due to population aging and the increased utilization of transcatheter valve replacement and prosthetic valves as interventions against the previously discussed valvular pathologies.
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68
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Rafael Sádaba J, Tribouilloy C, Wojakowski W. Guía ESC/EACTS 2021 sobre el diagnóstico y tratamiento de las valvulopatías. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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69
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Amri A, Chevallier P, Guay-Bégin AA, Bilem I, Gauvin G, Alamdari H, Heim F, Laroche G. Polyethylene terephthalate textile heart valve: How poly(ethylene glycol) grafting limits fibrosis. J Biomed Mater Res B Appl Biomater 2022; 110:2110-2120. [PMID: 35420261 DOI: 10.1002/jbm.b.35065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/24/2022] [Accepted: 03/21/2022] [Indexed: 11/11/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is an alternative technique to surgical valve replacement for over 300,000 patients worldwide. The valve material used in the TAVR is made of biological tissues, whose durability remains unknown. The success of the TAVR favors the research toward synthetic valve leaflet materials as an alternative to biological tissues. In particular, polyethylene terephthalate (PET) textile valves have recently proven durability over a 6-month period in animal sheep models. Excessive fibrotic tissue formation remains, however, a critical issue to be addressed. The aim of this work was therefore to investigate the potential of PET textiles covalently conjugated with polyethylene glycol (PEG), known for its antifouling properties, to modulate the fibrosis formation both in vitro and in vivo. For this purpose, the surfaces of heart valves made of PET textiles were functionalized with an atmospheric pressure plasma, leading to the formation of carboxylic acid (COOH) groups, further used for PEG-NH2 conjugation. Surface modification efficiency was assessed by X-ray photoelectron spectroscopy and water contact angle measurements. The biological behavior of the as-modified surfaces was evaluated by in vitro assays, using rat cardiac fibroblast cells. The results show that PEG treated substrates restrained the fibroblasts adhesion and proliferation. The PEG treated valve, implanted in a juvenile sheep model, showed a significant fibrosis reduction. The explant also revealed calcification issues that need to be addressed.
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Affiliation(s)
- Amna Amri
- Laboratoire d'ingénierie de surface (LIS), Centre de Recherche du CHU de Québec-Université Laval, Hôpital Saint-François d'Assise, Québec City, Québec, Canada.,Département de génie des mines, de la métallurgie et des matériaux, Centre de recherche sur les Matériaux Avancés, Université Laval, Québec City, Québec, Canada.,Laboratoire de Physique et Mécanique Textiles, GEPROVAS, Mulhouse, France
| | - Pascale Chevallier
- Laboratoire d'ingénierie de surface (LIS), Centre de Recherche du CHU de Québec-Université Laval, Hôpital Saint-François d'Assise, Québec City, Québec, Canada.,Département de génie des mines, de la métallurgie et des matériaux, Centre de recherche sur les Matériaux Avancés, Université Laval, Québec City, Québec, Canada
| | - Andrée-Anne Guay-Bégin
- Laboratoire d'ingénierie de surface (LIS), Centre de Recherche du CHU de Québec-Université Laval, Hôpital Saint-François d'Assise, Québec City, Québec, Canada.,Département de génie des mines, de la métallurgie et des matériaux, Centre de recherche sur les Matériaux Avancés, Université Laval, Québec City, Québec, Canada
| | - Ibrahim Bilem
- Laboratoire d'ingénierie de surface (LIS), Centre de Recherche du CHU de Québec-Université Laval, Hôpital Saint-François d'Assise, Québec City, Québec, Canada.,Département de génie des mines, de la métallurgie et des matériaux, Centre de recherche sur les Matériaux Avancés, Université Laval, Québec City, Québec, Canada
| | - Guillaume Gauvin
- Département de génie des mines, de la métallurgie et des matériaux, Centre de recherche sur les Matériaux Avancés, Université Laval, Québec City, Québec, Canada
| | - Houshang Alamdari
- Département de génie des mines, de la métallurgie et des matériaux, Centre de recherche sur les Matériaux Avancés, Université Laval, Québec City, Québec, Canada
| | - Frédéric Heim
- Laboratoire de Physique et Mécanique Textiles, GEPROVAS, Mulhouse, France
| | - Gaétan Laroche
- Laboratoire d'ingénierie de surface (LIS), Centre de Recherche du CHU de Québec-Université Laval, Hôpital Saint-François d'Assise, Québec City, Québec, Canada.,Département de génie des mines, de la métallurgie et des matériaux, Centre de recherche sur les Matériaux Avancés, Université Laval, Québec City, Québec, Canada
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Lee YT, Yin WH, Tsao TP, Lee KC, Hsiung MC, Tzeng YH, Wei J. The Presence of Calcified Raphe Is an Independent Predictor of Adverse Long-Term Clinical Outcomes in Patients With Bicuspid Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement. Front Cardiovasc Med 2022; 9:767906. [PMID: 35497985 PMCID: PMC9043529 DOI: 10.3389/fcvm.2022.767906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/10/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Current guidelines recommend that transcatheter aortic valve replacement (TAVR) for bicuspid aortic valve (BAV) with aortic stenosis (AS) should only be performed in selected patients. However, we consider it even more crucial to identify what the really important factors are while determining long-term outcomes in patients with BAV undergoing TAVR, which is precisely the aim of this study. Methods We retrospectively evaluated consecutive patients who underwent TAVR with balloon-expandable Sapien XT or Sapien 3 valves (Edwards Lifesciences, Irvine, CA) for the treatment of severe bicuspid AS. The primary end points were major adverse cardiac and cerebral events (MACCE), that is, mortality, non-fatal myocardial infarction (MI), disabling stroke, valve failure needing reintervention, or clinically relevant valve thrombosis during follow-up. Results A total of 56 patients who underwent TAVR with Sapien XT (n = 20) or Sapien 3 (n = 36) were included. The device and procedural success rates were similar between the two TAVR valves; however, the newer-generation Sapien 3 yielded a trend toward better long-term clinical outcomes than the early-generation Sapien XT did (MACCE rates 35 vs. 11%, p = 0.071). In the multivariate Cox proportional hazards analyses, the presence of calcified raphe > 4 mm was the only independent predictor of long-term MACCE (hazard ratio: 6.76; 95% confidence interval: 1.21–37.67, p = 0.029). Conclusion TAVR performed by a skilled heart team, while using newer-generation balloon-expandable Sapien 3 valve, may yield better long-term clinical outcomes compared to TAVR using early-generation Sapien XT valve. Moreover, the presence of calcified raphe >4 mm is an independent determinant of adverse clinical outcomes.
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Affiliation(s)
- Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Wei-Hsian Yin
| | - Tien-Ping Tsao
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Chen Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
| | | | - Yun-Hsuan Tzeng
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Medical Imaging, Health Management Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
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71
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Fried EA, Salter BS, Weiner MM, Faloye AO, Richter EW, Pineda AM. Type A Aortic Dissection Following a Transcatheter Aortic Valve Replacement in a Prohibitive Surgical Risk Candidate. J Cardiothorac Vasc Anesth 2022; 36:2803-2810. [DOI: 10.1053/j.jvca.2022.04.009] [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: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/11/2022]
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Karout L, Salman R, Ershaid F, Sawaya F, Abi-Ghanem AS. Imaging Modalities Employed in the TAVR Procedure With a Focus on CTA: What the Radiologist Needs to Know. Acad Radiol 2022; 29 Suppl 4:S69-S81. [PMID: 34551883 DOI: 10.1016/j.acra.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES Aortic stenosis (AS) is one of the most common valvular heart disease. Symptomatic AS is associated with a high mortality rate which prompts fast intervention. The introduction of transcatheter aortic valve replacement (TAVR) has drastically improved the outcome of high surgical risk for mortality patients with severe AS. However, this procedure requires the employment of multimodality imaging in the pre-procedural planning, intra-procedural optimization, and post-procedural follow-up stages. This also requires an accurate understanding of the indications, measurements, strength, and limitations of each imaging modality during the different TAVR stages. CONCLUSION In this review, we aim to outline to radiologists the evidence-based approach and indications of different imaging modalities through the pre, peri, and post TAVR stages.
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Zhang Y, Xiong TY, Li YM, Yao YJ, He JJ, Yang HR, Zhu ZK, Chen F, Ou Y, Wang X, Liu Q, Li X, Li YJ, Liao YB, Huang FY, Zhao ZG, Li Q, Wei X, Peng Y, He S, Wei JF, Zhou WX, Zheng MX, Bao Y, Zhou X, Tang H, Meng W, Feng Y, Chen M. Patients With Bicuspid Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:794850. [PMID: 35369357 PMCID: PMC8965870 DOI: 10.3389/fcvm.2022.794850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/07/2022] [Indexed: 01/10/2023] Open
Abstract
Objective We sought to conduct a systematic review and meta-analysis of clinical adverse events in patients undergoing transcatheter aortic valve replacement (TAVR) with bicuspid aortic valve (BAV) vs. tricuspid aortic valve (TAV) anatomy and the efficacy of balloon-expandable (BE) vs. self-expanding (SE) valves in the BAV population. Comparisons aforementioned will be made stratified into early- and new-generation devices. Differences of prosthetic geometry on CT between patients with BAV and TAV were presented. In addition, BAV morphological presentations in included studies were summarized. Method Observational studies and a randomized controlled trial of patients with BAV undergoing TAVR were included according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Results A total of 43 studies were included in the final analysis. In patients undergoing TAVR, type 1 BAV was the most common phenotype and type 2 BAV accounted for the least. Significant higher risks of conversion to surgical aortic valve replacement (SAVR), the need of a second valve, a moderate or severe paravalvular leakage (PVL), device failure, acute kidney injury (AKI), and stroke were observed in patients with BAV than in patients with TAV during hospitalization. BAV had a higher risk of new permanent pacemaker implantation (PPI) both at hospitalization and a 30-day follow-up. Risk of 1-year mortality was significantly lower in patients with BAV than that with TAV [odds ratio (OR) = 0.85, 95% CI 0.75–0.97, p = 0.01]. BE transcatheter heart valves (THVs) had higher risks of annular rupture but a lower risk of the need of a second valve and a new PPI than SE THVs. Moreover, BE THV was less expanded and more elliptical in BAV than in TAV. In general, the rates of clinical adverse events were lower in new-generation THVs than in early-generation THVs in both BAV and TAV. Conclusions Despite higher risks of conversion to SAVR, the need of a second valve, moderate or severe PVL, device failure, AKI, stroke, and new PPI, TAVR seems to be a viable option for selected patients with severe bicuspid aortic stenosis (AS), which demonstrated a potential benefit of 1-year survival, especially among lower surgical risk population using new-generation devices. Larger randomized studies are needed to guide patient selection and verified the durable performance of THVs in the BAV population.
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Affiliation(s)
- Yi Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi-Ming Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi-Jun Yao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing-Jing He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hao-Ran Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhong-Kai Zhu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanweixiang Ou
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi-Jian Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fang-Yang Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhen-Gang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Sen He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jia-Fu Wei
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wen-Xia Zhou
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming-Xia Zheng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Bao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuan Zhou
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Tang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Meng
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Yuan Feng
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Mao Chen
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Propensity-Matched 1-Year Outcomes Following Transcatheter Aortic Valve Replacement in Low-Risk Bicuspid and Tricuspid Patients. JACC Cardiovasc Interv 2022; 15:511-522. [PMID: 35272776 DOI: 10.1016/j.jcin.2021.10.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/11/2021] [Accepted: 10/26/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to compare 1-year outcomes after transcatheter aortic valve replacement (TAVR) in low surgical risk patients with bicuspid aortic stenosis to patients with tricuspid aortic stenosis. BACKGROUND The pivotal TAVR trials excluded patients with bicuspid aortic valves. The Low Risk Bicuspid Study 30-day primary endpoint of death or disabling stroke was 1.3%. METHODS The Low Risk Bicuspid Study is a prospective, single-arm, TAVR trial that enrolled patients from 25 U.S. sites. A screening committee confirmed bicuspid anatomy and valve classification on computed tomography using the Sievers classification. Valve sizing was by annular measurements. An independent clinical events committee adjudicated all serious adverse events, and an independent core laboratory assessed all echocardiograms. The 150 patients from the Low Risk Bicuspid Study were propensity matched to the TAVR patients in the randomized Evolut Low Risk Trial using the 1:1 5- to-1-digit greedy method, resulting in 145 pairs. RESULTS All-cause mortality or disabling stroke at 1 year was 1.4% in the bicuspid and 2.8% in the tricuspid group (P = 0.413). A pacemaker was implanted in 16.6% of bicuspid and 17.9% of tricuspid patients (P = 0.741). The effective orifice area was similar between groups at 1 year (2.2 ± 0.7 cm2 vs 2.3 ± 0.6 cm2, P = 0.677) as was the mean gradient (8.7 ± 3.9 mm Hg vs 8.5 ± 3.1 mm Hg, P = 0.754). Fewer patients in the bicuspid group had mild or worse paravalvular leak (21.3% vs 42.6%, P < 0.001). CONCLUSIONS There were no significant differences in clinical or forward flow hemodynamic outcomes between the propensity-matched groups at 1 year.
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75
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On the Modeling of Transcatheter Therapies for the Aortic and Mitral Valves: A Review. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a milestone for the management of aortic stenosis in a growing number of patients who are unfavorable candidates for surgery. With the new generation of transcatheter heart valves (THV), the feasibility of transcatheter mitral valve replacement (TMVR) for degenerated mitral bioprostheses and failed annuloplasty rings has been demonstrated. In this setting, computational simulations are modernizing the preoperative planning of transcatheter heart valve interventions by predicting the outcome of the bioprosthesis interaction with the human host in a patient-specific fashion. However, computational modeling needs to carry out increasingly challenging levels including the verification and validation to obtain accurate and realistic predictions. This review aims to provide an overall assessment of the recent advances in computational modeling for TAVR and TMVR as well as gaps in the knowledge limiting model credibility and reliability.
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76
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Contorni F, Fineschi M, Iadanza A, Santoro A, Mandoli GE, Cameli M. How to deal with low-flow low-gradient aortic stenosis and reduced left ventricle ejection fraction: from literature review to tips for clinical practice. Heart Fail Rev 2022; 27:697-709. [PMID: 33683509 PMCID: PMC8898219 DOI: 10.1007/s10741-021-10090-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 01/01/2023]
Abstract
Low-flow low-gradient aortic stenosis (LFLG AS) with reduced left ventricle ejection fraction (LVEF) is still a diagnostic and therapeutic challenge. The aim of this paper is to review the latest evidences about the assessment of the valvular disease, usually difficult because of the low-flow status, and the therapeutic options. Special emphasis is given to the available diagnostic tools for the characterization of LFLG AS without functional reserve at stress echocardiography and to the factors that clinicians should evaluate to choose between surgical aortic valve repair, transcatheter aortic valve implantation, or medical therapy.
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Affiliation(s)
- F Contorni
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | - M Fineschi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - A Iadanza
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - A Santoro
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - G E Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - M Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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Perrin N, Ibrahim R, Dürrleman N, Basmadjian A, Leroux L, Demers P, Modine T, Ben Ali W. Bicuspid Aortic Valve Stenosis: From Pathophysiological Mechanism, Imaging Diagnosis, to Clinical Treatment Methods. Front Cardiovasc Med 2022; 8:798949. [PMID: 35211518 PMCID: PMC8860891 DOI: 10.3389/fcvm.2021.798949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Bicuspid aortic valve (BAV) is the most frequent congenital anomaly and has a natural evolution toward aortic regurgitation or stenosis due to the asymmetrical valve function associated with an evolutive ascending aortopathy. Several BAV classifications exist describing the presence and number of raphe, amount and location of calcium, and the symmetry of the functional cusps. The impact of BAV morphology on transcatheter aortic valve implantation (TAVI) outcomes still remains little investigated. Pivotal randomized trials comparing TAVI with surgery have excluded BAV until yet. However, data from registries and observational studies including highly selected patients have shown promising results of TAVI in BAV. With this review, we aimed at describing anatomical and pathophysiological characteristics of BAV, discussing the main aspects to assess diagnostic imaging modalities, and giving an overview of TAVI outcomes and technical considerations specific to BAV morphology.
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Affiliation(s)
- Nils Perrin
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
| | - Réda Ibrahim
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Nicolas Dürrleman
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Arsène Basmadjian
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Lionel Leroux
- Service Médico-Chirurgical, Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
| | - Philippe Demers
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Thomas Modine
- Service Médico-Chirurgical, Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
| | - Walid Ben Ali
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. EUROINTERVENTION 2022; 17:e1126-e1196. [PMID: 34931612 PMCID: PMC9725093 DOI: 10.4244/eij-e-21-00009] [Citation(s) in RCA: 146] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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79
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Treatment of Bicuspid Aortic Valve Stenosis with TAVR: Filling Knowledge Gaps Towards Reducing Complications. Curr Cardiol Rep 2022; 24:33-41. [PMID: 35099762 DOI: 10.1007/s11886-021-01617-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Bicuspid aortic valve (BAV) disease is the most common congenital heart defect worldwide. When severe, symptomatic aortic stenosis ensues, the treatment has increasingly become transcatheter aortic valve replacement (TAVR). The purpose of this review is to identify BAV classification and imaging methods, outline TAVR outcomes in BAV anatomy, and discuss how computational modeling can enhance TAVR treatment in BAV patients. RECENT FINDINGS TAVR use in BAV patients, when compared to use in tricuspid aortic valves, showed lower device success rate, and there remains no long-term randomized trial data. It has been reported that BAV patients with severe calcification increase the rate of complications. Additionally, the asymmetrical morphology of BAVs often results in asymmetric stent geometries which have implications for increased thrombosis risk and decreased durability. These adverse outcomes are currently very difficult to predict from routine pre-procedural imaging alone. Recently developed patient specific experimental and computational techniques have the potential to assist in filling knowledge gaps in the mechanisms of these complications and provide more information during preclinical planning for better TAVR selection in low surgical risk BAV patients. Efficacy of TAVR for irregular BAV anatomies remains concerning due to the lack of a long-term randomized trial data, their increased rate of short-term complications, and signs that long-term durability could be an issue. More knowledge on identifying which BAV anatomies are at greater risk for these adverse outcomes can potentially improve patient selection for TAVR versus SAVR in low surgical risk BAV patients.
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80
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Wang M, Song G, Chen M, Feng Y, Wang J, Liu X, Zhou S, Fang Z, Han Y, Xu K, Yu B, Xu B, Yang Y, Piazza N, Wu Y, Gao RL. Twelve-month outcomes of the TaurusOne valve for transcatheter aortic valve implantation in patients with severe aortic stenosis. EUROINTERVENTION 2022; 17:1070-1076. [PMID: 34338639 PMCID: PMC9725063 DOI: 10.4244/eij-d-21-00040] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the last decade, transcatheter aortic valve implantation (TAVI) has developed rapidly in China. As TAVI progresses towards low surgical risk patients, the total number of TAVI procedures will grow exponentially. There is a need to develop a domestic TAVI device designed for Chinese patients. AIMS The aim of this study was to evaluate the safety and efficacy of a self-expanding valve (TaurusOne transcatheter aortic valve system) in the treatment of patients with symptomatic severe aortic stenosis in China. METHODS A prospective, multicentre, single-arm study was designed to enrol 120 patients with symptomatic severe aortic stenosis undergoing TAVI using the TaurusOne valve. The primary endpoint was all-cause mortality at one year. RESULTS From September 2017 to April 2019, 120 patients were enrolled (35% bicuspid aortic valve, mean Society of Thoracic Surgeons [STS] score 9.95%). One-year mortality in 120 patients (follow-up rate, 100%), was 6.7% (upper 95% confidence interval: 12.9%), which was significantly lower than the performance goal of 30% (p<0.0001). All stroke, myocardial infarction, paravalvular leak ≥moderate, and new pacemaker implantation occurred in 4.4%, 1.8%, 0.8%, and 22.1% of patients, respectively, at one year. The haemodynamic results and quality of life scores also improved significantly. Patients with a bicuspid valve had similar outcomes to those with a tricuspid aortic valve. CONCLUSIONS The one-year clinical results confirm the safety and efficacy of the TaurusOne transcatheter aortic valve system in the treatment of patients with symptomatic severe tricuspid and bicuspid aortic stenosis.
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Affiliation(s)
- Moyang Wang
- National Centre for Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Guangyuan Song
- National Centre for Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Mao Chen
- West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Feng
- West China Hospital, Sichuan University, Chengdu, China
| | - Jian’an Wang
- The 2nd Affiliated Hospital ZheJiang University School of Medicine, Hangzhou, China
| | - Xianbao Liu
- The 2nd Affiliated Hospital ZheJiang University School of Medicine, Hangzhou, China
| | - Shenghua Zhou
- The 2nd XiangYa Hospital of Central South University, Changsha, China
| | - Zhenfei Fang
- The 2nd XiangYa Hospital of Central South University, Changsha, China
| | - Yaling Han
- General Hospital of Northern Theater Command, Shenyang, China
| | - Kai Xu
- General Hospital of Northern Theater Command, Shenyang, China
| | - Bo Yu
- The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bo Xu
- National Centre for Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Yuejin Yang
- National Centre for Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Nicolo Piazza
- McGill University Health Center, Montréal, QC, Canada
| | - Yongjian Wu
- National Centre for Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Run-Lin Gao
- Department of Cardiology, Beijing Fuwai Hospital, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
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81
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Costa G, Angelillis M, Petronio AS. Bicuspid Valve Sizing for Transcatheter Aortic Valve Implantation: The Missing Link. Front Cardiovasc Med 2022; 8:770924. [PMID: 35155597 PMCID: PMC8828944 DOI: 10.3389/fcvm.2021.770924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/27/2021] [Indexed: 12/21/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a well-recognized and established therapy for severe aortic stenosis, with expanding indications toward younger patients with low surgical risk profile. As bicuspid aortic valve (BAV) affects ~1-2% of the population, it may be speculated that an increasing number of patients with degenerated BAV may eventually need TAVI during the course of the disease. On the other hand, BAV represents a challenge due to its peculiar anatomical features and the lack of consensus on the optimal sizing strategy. The aim of this paper is to review the peculiar aspects of BAV and to discuss and compare the currently available sizing methods. Special attention is given to the role of pre-procedural imaging, mostly with multislice computed tomography, and to the aspects that operators should evaluate in order to ensure an optimal procedural planning and avoid procedural-related complications.
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Affiliation(s)
| | | | - Anna Sonia Petronio
- Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
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82
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Bhatia M, Kumar P, Maity P, Arora N. Computed Tomographic Assessment before Transcatheter Aortic and Mitral Valve Replacement. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2022. [DOI: 10.4103/jiae.jiae_38_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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83
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Suzuki R, Suzuki M, Takayanagi R, Ohori S, Ito T. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac099. [PMID: 35350214 PMCID: PMC8937851 DOI: 10.1093/jscr/rjac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/26/2022] [Indexed: 11/20/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is the treatment of choice for aortic stenosis. However, its safety and efficacy in patients with the bicuspid aortic valve (BAV) remain controversial. Especially, whether the BAV phenotype affects outcomes following TAVR remains debated. Despite the higher ellipticity index and more calcifications of the aortic annulus in type 1 BAV, a high residual gradient was observed in type 0 anatomy. Moreover, severe calcification of the cusps rather than aortic annulus in type 0 is predisposed to asymmetrical under-expansion of the prosthesis at the edge of the native aortic cusp. We report the rare case of a patient with BAV stenosis type 0 and single coronary artery receiving TAVR, subsequently requiring surgical aortic valve replacement. The extensive non-coronary cusp calcification caused under-expansion of the prosthesis and was protruded into the left ventricular outflow tract, leading to an obstruction.
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Affiliation(s)
- Ryo Suzuki
- Corresponding address. Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, 2-1-16-1 Miyanosawa, Nishi-ku, Sapporo 063-0052, Japan. Tel: +81-8070027161; E-mail:
| | - Masato Suzuki
- Department of Cardiovascular Surgery, Ohno Memorial Hospital, Hokkaido, 2-1-16-1 Miyanosawa, Nishi-ku, Sapporo 063-0052, Japan
| | - Ryo Takayanagi
- Department of Cardiovascular Surgery, Ohno Memorial Hospital, Hokkaido, 2-1-16-1 Miyanosawa, Nishi-ku, Sapporo 063-0052, Japan
| | - Shunsuke Ohori
- Department of Cardiovascular Surgery, Ohno Memorial Hospital, Hokkaido, 2-1-16-1 Miyanosawa, Nishi-ku, Sapporo 063-0052, Japan
| | - Toshiro Ito
- Department of Cardiovascular Surgery, Ohno Memorial Hospital, Hokkaido, 2-1-16-1 Miyanosawa, Nishi-ku, Sapporo 063-0052, Japan
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84
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Alperi A, Pascual I, Moris C, Avanzas P. Valve type selection for bicuspid aortic valves in TAVR: Does the key lie in the annular size? Int J Cardiol 2021; 351:40-41. [PMID: 34973972 DOI: 10.1016/j.ijcard.2021.12.046] [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: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Alberto Alperi
- Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Spain
| | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Spain; Universidad de Oviedo, Spain
| | - Cesar Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Spain; Universidad de Oviedo, Spain
| | - Pablo Avanzas
- Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Spain; Universidad de Oviedo, Spain.
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85
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Stentless valves for bicuspid and tricuspid aortic valve disease. JTCVS OPEN 2021; 8:177-188. [PMID: 36004130 PMCID: PMC9390591 DOI: 10.1016/j.xjon.2021.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/21/2021] [Indexed: 11/20/2022]
Abstract
Objective To determine long-term survival and reoperation rate in patients with a bicuspid aortic valve (BAV) and patients with a tricuspid aortic valve (TAV) after stentless aortic valve replacement (AVR)/aortic root replacement (ARR). Methods Between 1992 and 2014, 1293 patients underwent first AVR/ARR with a stentless aortic valve using the modified inclusion operating technique, including 741 patients with a TAV and 552 with a BAV. Using propensity scoring with 26 variables, 330 matched pairs were identified with AVR with or without ascending aorta/arch replacement. Data were obtained through chart review, surveys, and the National Death Index. Results Patient demographics were similar in the propensity score–matched groups. Both groups had similar cardiopulmonary bypass, cross-clamp, and hypothermia circulatory arrest times, cerebral protection strategies, and rate of aortic arch replacement. The median size of implanted valves was similar (BAV: 27 mm [range, 25-29 mm] vs TAV: 27 mm [range, 25-27 mm]). Compared with the TAV group, the BAV group had a shorter hospital stay (6 days vs 7 days; P = .001) but similar 30-day mortality (1.8% vs 1.2%). The BAV group had better long-term (15-year) survival (46% vs 33%; P = .002) but a higher cumulative incidence of reoperation for structural valve deterioration (15-year: 15% vs 11%; P = .048). Cox proportional hazard analysis identified a BAV as a protective factor for long-term mortality (hazard ratio [HR], 0.71; 95% CI, 0.56-0.91; P = .006), but a risk factor for reoperation due to structural valve deterioration (HR, 1.4 [95% CI, 0.8-2.6; P = .27] in the matched cohort and 2.2 [95% CI, 1.3-3.7; P = .004] in the unmatched cohort). Conclusions The BAV patients had better long-term survival but a higher reoperation rate compared with TAV patients after stentless AVR. Our findings suggest caution in the use of bioprostheses for BAV patients.
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Lee CH, Inohara T, Hayashida K, Park DW. Transcatheter Aortic Valve Replacement in Asia: Present Status and Future Perspectives. JACC. ASIA 2021; 1:279-293. [PMID: 36341218 PMCID: PMC9627874 DOI: 10.1016/j.jacasi.2021.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/01/2021] [Accepted: 10/07/2021] [Indexed: 05/28/2023]
Abstract
Over the last decade, based on evidence from multiple randomized clinical trials, transcatheter aortic valve replacement (TAVR) has become the established treatment for patients with symptomatic severe aortic stenosis. Despite the overwhelming expansion of TAVR in Western countries, the initial uptake and widespread adoption of this procedure have been relatively delayed in Asian countries, owing to the high cost of devices; limited local health and reimbursement policies; and lack of specific training/proctoring program, specialized heart team, or dedicated infrastructure. Furthermore, it has not yet been determined whether there are substantial interracial and ethnic differences in the clinical characteristics, comorbidities, and anatomic features, as well as procedural and long-term outcomes, in patients receiving TAVR. In this review, we provide not only a comprehensive look at the current status and outcomes of TAVR in Asian populations compared with those of Western populations but also a perspective on the future of TAVR in Asia.
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Key Words
- AR, aortic regurgitation
- AS, aortic stenosis
- BAV, bicuspid aortic valve
- BSA, body surface area
- PPI, permanent pacemaker insertion
- PPM, patient-prosthesis mismatch
- PVL, paravalvular leak
- RCT, randomized clinical trial
- SAVR, surgical aortic valve replacement
- STS, Society of Thoracic Surgeons
- TAVR, transcatheter aortic valve replacement
- VHD, valvular heart disease
- aortic stenosis
- outcomes
- race and ethnicity
- valvular disease
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Affiliation(s)
- Cheol Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Deagu, South Korea
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Moscarella E, Mangieri A, Giannini F, Tchetchè D, Kim WK, Sinning JM, Landes U, Kornowski R, De Backer O, Nickenig G, De Biase C, Søndergaard L, De Marco F, Bedogni F, Ancona M, Montorfano M, Regazzoli D, Stefanini G, Toggweiler S, Tamburino C, Immè S, Tarantini G, Sievert H, Schäfer U, Kempfert J, Wöehrle J, Latib A, Calabrò P, Medda M, Tespili M, Colombo A, Ielasi A. Annular size and interaction with trans-catheter aortic valves for treatment of severe bicuspid aortic valve stenosis: Insights from the BEAT registry. Int J Cardiol 2021; 349:31-38. [PMID: 34843819 DOI: 10.1016/j.ijcard.2021.11.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/15/2021] [Accepted: 11/24/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is safe and feasible in patients with bicuspid aortic valve (BAV), but whether annular size may influence TAVR results in BAV patients remains unclear. We aimed at evaluating the impact of aortic annular size on procedural and clinical outcomes of BAV patients undergoing TAVR, as well as potential interactions between annular dimension and trans-catheter heart valve (THV) type (balloon-expandable (BEV) vs. self-expanding (SEV). METHODS BEAT is a multicenter registry of consecutive BAV stenosis undergoing TAVR. For this sub-study patients were classified according to annular dimension in small-annulus (area < 400 mm2 or perimeter <72 mm), medium-annulus (area ≥ 400 and < 575 mm2, perimeter ≥72 mm and< 85 mm), large-annulus (area ≥ 575 mm2 or perimeter ≥85 mm). Primary endpoint was Valve Academic Research Consortium-2 (VARC-2) device success. RESULTS 45(15.5%) patients had small, 132(45.3%) medium, and 114(39.2%) large annuli. Compared with other groups, patients with large annuli were more frequently male, younger, with higher body mass index, larger aortic valve area, higher rate of moderate-severe calcification, lower mean trans-aortic valve gradient and lower left ventricular ejection fraction. In large-annuli SEVs were associated with a lower VARC-2 device success (75.9% vs. 90.6%, p = 0.049) driven by a higher rate of paravalvular valvular leak (PVL) compared to BEVs (20.7% vs. 1.2%, p < 0.001). However, no differences in clinical outcomes were observed according to annular size nor THV type. CONCLUSIONS TAVR in BAV patients is feasible irrespective of annular size. However in patients with large aortic annulus SEVs were associated with a significantly higher rate of PVLs compared to BEVs.
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Affiliation(s)
- Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Francesco Giannini
- Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
| | | | - Uri Landes
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ole De Backer
- The Heart Center-Rigshospitalet, Copenhagen, Denmark
| | - Georg Nickenig
- Cardiology Department, University Hospital Bonn, Bonn, Germany
| | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | | | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | | | - Corrado Tamburino
- Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy
| | | | | | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, United Kingdom
| | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, NY, United States of America; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Massimo Medda
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Antonio Colombo
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France; EMO GVM Centro Cuore Columbus, Milan, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy.
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88
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Ten-year experience with transcatheter aortic valve implantation in bicuspid aortic valve: lessons learned and future perspectives. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:251-258. [PMID: 34819961 PMCID: PMC8596720 DOI: 10.5114/aic.2021.109226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/01/2021] [Indexed: 11/17/2022] Open
Abstract
Bicuspid aortic valve (BAV) stenosis has traditionally been perceived as a contraindication to transcatheter aortic valve implantation (TAVI) due to its specific anatomical characteristics including extensive calcifications, high leaflet coaptation and frequently encountered aortic root dilation, which may result in worse procedural outcomes and higher risk of complications. Hence, BAV patients were not included in previous clinical trials. In the recent years, improved pre-procedural imaging and technological advances have gradually enabled expansion of TAVI to patients with complex anatomy, including those with BAV. Moreover, indications for TAVI are expanding to a younger group of patients with fewer comorbidities, and BAV is more prevalent in this population. Contemporary multicenter registry-based studies indicate that patients undergoing TAVI for BAV have similar outcomes as those with tricuspid aortic valve stenosis. In this article, we provide a thorough overview of the available clinical data regarding the outcomes of TAVI in BAV, from the perspective of an experienced TAVI center with over 150 TAVIs in this group of patients, performed in our institution since the year 2009. We present anatomical and clinical classifications of BAV, differences in outcomes in patients with bicuspid and tricuspid valves, as well as important topics regarding choice of an adequate valve and valve size.
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Du Y, Wang Z, Liu W, Guo Y, Han W, Shen H, Jia S, Yu Y, Han K, Shi D, Zhao Y, Zhou Y. Transcatheter Aortic Valve Implantation in Sievers Type 0 vs. Type 1 Bicuspid Aortic Valve Morphology: Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:771789. [PMID: 34805325 PMCID: PMC8604151 DOI: 10.3389/fcvm.2021.771789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/06/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has achieved satisfactory outcomes in the selected patients with bicuspid aortic valve (BAV), predominately type 1 BAV (~90%). However, there are few reports about the safety and efficacy of TAVI in type 0 BAV. Therefore, in the current study, we aimed to compare procedural and 30-day outcomes after TAVI between type 0 and type 1 BAV. Methods: Studies comparing the outcomes of TAVI in Sievers type 0 vs. type 1 BAV were retrieved from PubMed, EMBASE, Cochrane Library, and Web of Science from inception to May 2021. The data were extracted regarding the study characteristics and outcomes. The odds ratios (ORs) with 95% CIs were pooled for procedural and 30-day outcomes. Results: Six observational studies were included with determined type 0 BAV in 226 patients and type 1 BAV in 902 patients. The patients with type 0 BAV were slightly younger, had larger supra-annular structure, and more frequently implanted self-expanding prosthesis compared with type 1 BAV. In the pooled analyses, the patients with type 0 BAV had a similar incidence of procedural death (OR = 2.6, 95% CI 0.7–10.3), device success (OR = 0.6; 95% CI 0.3–1.3), and ≥ mild (OR = 0.8; 95% CI 0.4–1.6) or moderate (OR = 0.9, 95% CI 0.4–1.8) paravalvular leak, whereas significantly higher mean aortic gradient (mean difference = 1.4 mmHg, 95% CI 0.03–2.7) and increased coronary compromise risk (OR = 7.2; 95% CI 1.5–34.9), compared with type 1 BAV. Meanwhile, the incidence of death (OR = 1.2; 95% CI 0.5–3.1), stroke (OR = 0.5; 95% CI 0.1–2.4), and new pacemaker (OR = 0.6; 95% CI 0.2–2.2) at 30 days were not significantly different between the BAV morphologies (p > 0.05). The treatment effect heterogeneity across the studies for the above outcomes were low. Conclusions: The patients with type 0 BAV appear to have similar short-term outcomes after TAVI compared with type 1 BAV. Whereas, TAVI for type 0 BAV aortic stenosis might lead to an elevated coronary obstruction risk and suboptimal aortic valvular hemodynamics.
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Affiliation(s)
- Yu Du
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhijian Wang
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Liu
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yonghe Guo
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Han
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hua Shen
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuo Jia
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yi Yu
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kangning Han
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dongmei Shi
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yingxin Zhao
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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90
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Affiliation(s)
- Christiane Haeffele
- Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
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91
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Characteristics and outcomes following transcatheter aortic valve replacement in China: a report from China aortic valve transcatheter replacement registry (CARRY). Chin Med J (Engl) 2021; 134:2678-2684. [PMID: 34802024 PMCID: PMC8631376 DOI: 10.1097/cm9.0000000000001882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: The past decade has witnessed an ever-increasing momentum of transcatheter aortic valve replacement (TAVR) and a subsequent paradigm shift in the contemporary management of severe aortic stenosis (AS). We conducted a multi-centric TAVR registry based on Chinese patients (the China Aortic valve tRanscatheter Replacement registrY [CARRY]) to delineate the clinical characteristics and outcomes of Chinese patients who underwent TAVR and compare the results between different valve types in different Chinese regions. Methods: CARRY is an all-comer registry of aortic valve disease patients undergoing TAVR across China and was designed as an observational study that retrospectively included all TAVR patients at each participating site. Seven hospitals in China participated in the CARRY, and 1204 patients from April 2012 to November 2020 were included. Categorical variables were compared using the chi-squared test, and continuous variables were analyzed using a t test or analysis of variance (ANOVA) test. The Kaplan–Meier curve was used to estimate the risk of adverse events during follow-up. Results: The mean age of the patients was 73.8 ± 6.5 years and 57.2% were male. The median Society of Thoracic Surgeon-Predicted Risk of Mortality score was 6.0 (3.7–8.9). Regarding the aortic valve, the proportion of bicuspid aortic valve (BAV) was 48.5%. During the hospital stay, the stroke rate was 0.7%, and the incidence of high-degree atrioventricular block indicating permanent pacemaker implantation was 11.0%. The in-hospital all-cause mortality rate was 2.2%. After 1 year, the overall mortality rate was 4.5%. Compared to patients with tricuspid aortic valve (TAV), those with BAV had similar in-hospital complication rates, but a lower incidence of in-hospital mortality (1.4% vs. 3.3%) and 1 year mortality (2.3% vs. 5.8%). Conclusions: TAVR candidates in China were younger, higher proportion of BAV, and had lower rates of post-procedural complications and mortality than other international all-comer registries. Given the use of early generation valves in the majority of the population, patients with BAV had similar rates of complications, but lower mortality than those with TAV. These findings further propel the extension of TAVR in low-risk patients. Trial Registration: https://www.chictr.org.cn/ (No. ChiCTR2000038526).
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92
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Avvedimento M, Tang GHL. Transcatheter aortic valve replacement (TAVR): Recent updates. Prog Cardiovasc Dis 2021; 69:73-83. [PMID: 34800439 DOI: 10.1016/j.pcad.2021.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/14/2021] [Indexed: 12/21/2022]
Abstract
Within the last two decades, transcatheter aortic valve replacement (TAVR) has revolutionized the management of symptomatic severe aortic stenosis (AS). Newer generations of transcatheter valve design, optimized imaging planning, growing operator experience, and technical refinements have driven enhancements in safety and reduction of procedural complications over time. These improvements have allowed expansion to lower risk patients, in which TAVR confirmed favorable outcomes compared to surgical aortic valve replacement (SAVR). Based on current evidence, the 2020 AHA/ACC guidelines provided updated recommendations on indications for TAVR, with several clinical indications remain with SAVR. As TAVR expands to younger, low-risk patients with longer life expectancies, different issues of utmost importance have emerged, such as long-term durability, bioprosthetic valve performance, coronary reaccess, prognostic impact of conduction disturbances and paravalvular leak, reintervention after TAVR, and optimal pharmacological management after the procedure. In this review, we provide an update of recent clinical guidelines and available data from clinical trials and registries, and highlight novel strategies to further reduce procedural complications.
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Affiliation(s)
- Marisa Avvedimento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, NY, New York, USA
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93
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Bamford P, Said C, Al-Omary MS, Bhagwandeen R, Boyle A. Aortic Valve Replacement Rates in Australia from 2004 to 2019. Intern Med J 2021; 53:525-530. [PMID: 34780091 DOI: 10.1111/imj.15624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several surgical and percutaneous treatments are available for patients with aortic valve disease. AIM Our aim is to establish whether trends in aortic valve replacements (AVR) in Australia reflect recent evidence. METHODS Using Australian Institute of Health and Welfare data, this study counted all AVR and balloon aortic valvuloplasty (BAV) procedures conducted in all Australian hospitals from 2004 to 2019. Linear regression analysis was performed to determine whether age-adjusted rates had changed over the study period. RESULTS There were 80,883 AVRs performed. 66% were men and 64% were over aged 70. Absolute rates of AVR increased from 3,631 to 7,277 with a significant 22% age-adjusted rise seen (1.9% increase per year (+0.26 per 100,000 per year, 95% CI 0.19 - 0.34); p < 0.001). This trend was more pronounced in men than women and in over 80 year-olds (+0.23 per 100,000 per year, p < 0.001). Proportion of mechanical AVRs implanted fell from 38.4% to 8.6% (p<0.001). 2,683 transcatheter aortic valve implantation (TAVI) procedures were performed in 2019, representing a 52% annual increase from 2014. BAV increased from 66 procedures in 2004 to 862 in 2019. CONCLUSION Rates of AVR have increased significantly over the past 16 years, particularly in the elderly. Despite international guideline recommendations, fewer mechanical AVRs are being used in younger cohorts. The uptake in TAVI rates might reflect evidence that suggests it is a safe alternative, at least in the medium term. BAV has also seen a resurgence during this time period. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Paul Bamford
- John Hunter Hospital, Newcastle, New South Wales.,University of Newcastle, Newcastle, New South Wales
| | | | - Mohammed S Al-Omary
- John Hunter Hospital, Newcastle, New South Wales.,University of Newcastle, Newcastle, New South Wales
| | - Rohan Bhagwandeen
- John Hunter Hospital, Newcastle, New South Wales.,University of Newcastle, Newcastle, New South Wales
| | - Andrew Boyle
- John Hunter Hospital, Newcastle, New South Wales.,University of Newcastle, Newcastle, New South Wales
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The incidence and predictors of high-degree atrioventricular block in patients with bicuspid aortic valve receiving self-expandable transcatheter aortic valve implantation. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:825-835. [PMID: 34754294 PMCID: PMC8558740 DOI: 10.11909/j.issn.1671-5411.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The high-degree atrioventricular block (HAVB) in patients with bicuspid aortic valve (BAV) treated with transcatheter aortic valve implantation (TAVI) remains high. The study aims to explore this poorly understood subject of mechanisms and predictors for HAVB in BAV self-expandable TAVI patients. METHODS We retrospectively included 181 BAV patients for analysis. Using computed tomography data, the curvature of ascending aorta (AAo) was quantified by the angle (AAo angle) between annulus and the cross-section at 35 mm above annulus (where the stent interacts with AAo the most). The valvular anatomy and leaflet calcification were also characterized. RESULTS The 30-day HAVB rate was 16.0% (median time to HAVB was three days). Type-1 morphology was found in 79 patients (43.6%) (left- and right-coronary cusps fusion comprised 79.7%). Besides implantation below membrane septum, large AAo angle [odds ratio (OR) = 1.08, P = 0.016] and type-1 morphology (OR = 4.97, P = 0.001) were found as the independent predictors for HAVB. Together with baseline right bundle branch block, these predictors showed strong predictability for HAVB with area under the cure of 0.84 (sensitivity = 62.1%, specificity = 92.8%). Bent AAo and calcified raphe had a synergistic effect in facilitating high implantation, though the former is associated with at-risk deployment (device implanted above annulus + prothesis pop-out, versus straight AAo: 9.9% vs. 2.2%, P = 0.031).
CONCLUSIONS AAo curvature and type-1 morphology are novel predictors for HAVB in BAV patients following self-expandable TAVI. For patients with bent AAo or calcified raphe, a progressive approach to implant the device above the lower edge of membrane septum is favored, though should be done cautiously to avoid pop-out.
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95
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Choe J, Koo HJ, Kang JW, Kim JB, Kang HJ, Yang DH. Aortic annulus sizing in bicuspid and tricuspid aortic valves using CT in patients with surgical aortic valve replacement. Sci Rep 2021; 11:21005. [PMID: 34697359 PMCID: PMC8549004 DOI: 10.1038/s41598-021-00406-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/05/2021] [Indexed: 12/30/2022] Open
Abstract
The purpose of this study was to evaluate whether bicuspid anatomy affects the discrepancy between CT-derived annular size and intraoperative size. We retrospectively analyzed annular measurements in 667 patients who underwent surgical aortic valve replacement (AVR). Preoperative CT measurements of the aortic annulus were compared to surgically implanted valve sizes. To evaluate whether the bicuspid valve affects the differences between CT annulus diameter and surgical AVR size, patients with diameter larger by > 10% (CT-Lg group) on CT, compared to surgical AVR size, were compared with those having size difference < 10% (CT-Sim group). Propensity score matching yielded 183 matched patients from each group. Bicuspid aortic valve annulus parameters significantly correlated with surgical aortic valve size (r = 0.52-0.71; for all, p < 0.01). The most representative measurements corresponded to surgical aortic valve size were area-derived diameters in tricuspid aortic valve (r = 0.69, p < 0.001) and bicuspid without raphe (r = 0.71, p < 0.001), and perimeter-derived diameter in bicuspid with raphe (r = 0.63, p < 0.001). After propensity score matching, native valve type was not different between CT-Sim and CT-Lg groups. In multivariable analysis, the difference between CT-derived diameter and surgical AVR size was affected by the operator factor and types of prosthesis. Bicuspid aortic annulus diameters measured on CT showed a significant correlation with surgical aortic valve size. The difference between CT-derived diameter and surgical AVR size is affected by operator factor and the types of prosthesis but not affected by the bicuspid valve.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil, 88, Song-pa gu, Seoul, 05505, South Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil, 88, Song-pa gu, Seoul, 05505, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil, 88, Song-pa gu, Seoul, 05505, South Korea
| | - Joon Bum Kim
- Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee Jun Kang
- Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil, 88, Song-pa gu, Seoul, 05505, South Korea.
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2021; 60:727-800. [PMID: 34453161 DOI: 10.1093/ejcts/ezab389] [Citation(s) in RCA: 316] [Impact Index Per Article: 105.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Liu X, Fan J, Mortier P, He Y, Zhu Q, Guo Y, Lin X, Li H, Jiang J, Rocatello G, Oliveira V, Dezutter T, Sondergaard L, Wang J. Sealing Behavior in Transcatheter Bicuspid and Tricuspid Aortic Valves Replacement Through Patient-Specific Computational Modeling. Front Cardiovasc Med 2021; 8:732784. [PMID: 34708088 PMCID: PMC8542706 DOI: 10.3389/fcvm.2021.732784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/13/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Patient-specific computer simulation of transcatheter aortic valve replacement (TAVR) can provide unique insights in device-patient interaction. Aims: This study was to compare transcatheter aortic valve sealing behavior in patients with bicuspid aortic valves (BAV) and tricuspid aortic valves (TAV) through patient-specific computational modeling. Methods: Patient-specific computer simulation was retrospectively performed with FEops HEARTguide for TAVR patients. Simulation output was compared with postprocedural computed tomography and echocardiography to validate the accuracy. Skirt malapposition was defined by a distance larger than 1 mm based on the predicted device-patient interaction by quantifying the distance between the transcatheter heart valve (THV) skirt and the surrounding anatomical regions. Results: In total, 43 patients were included in the study. Predicted and observed THV frame deformation showed good correlation (R 2 ≥ 0.90) for all analyzed measurements (maximum diameter, minimum diameter, area, and perimeter). The amount of predicted THV skirt malapposition was strongly linked with the echocardiographic grading of paravalvular leakage (PVL). More THV skirt malapposition was observed for BAV cases when compared to TAV cases (22.7 vs. 15.5%, p < 0.05). A detailed analysis of skirt malapposition showed a higher degree of malapposition in the interleaflet triangles section for BAV cases as compared to TAV patients (11.1 vs. 5.8%, p < 0.05). Conclusions: Patient-specific computer simulation of TAVR can accurately predict the behavior of the Venus A-valve. BAV patients are associated with more malapposition of the THV skirt as compared to TAV patients, and this is mainly driven by more malapposition in the interleaflet triangle region.
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Affiliation(s)
- Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaqi Fan
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Yuxin He
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qifeng Zhu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuchao Guo
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinping Lin
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huajun Li
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jubo Jiang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | | | | | | | - Jian'an Wang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Montalto C, Sticchi A, Crimi G, Laricchia A, Khokhar AA, Giannini F, Reimers B, Colombo A, Latib A, Waksman R, Mangieri A. Outcomes After Transcatheter Aortic Valve Replacement in Bicuspid Versus Tricuspid Anatomy: A Systematic Review and Meta-Analysis. JACC Cardiovasc Interv 2021; 14:2144-2155. [PMID: 34620393 DOI: 10.1016/j.jcin.2021.07.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of this study was to compare the feasibility, safety, and clinical outcomes of transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV) stenosis. BACKGROUND At present, limited observational data exist supporting TAVR in the context of bicuspid anatomy. METHODS Primary endpoints were 1-year survival and device success. Secondary endpoints included moderate to severe paravalvular leak (PVL) and a composite endpoint of periprocedural complications; incidence rates of individual procedural endpoints were also explored individually. RESULTS In the main analysis, 17 studies and 181,433 patients undergoing TAVR were included, of whom 6,669 (0.27%) had BAV. A secondary analysis of 7,071 matched subjects with similar baseline characteristics was also performed. Device success and 1-year survival rates were similar between subjects with BAV and those with TAV (97% vs 94% [P = 0.55] and 91.3% vs 90.8% [P = 0.22], respectively). In patients with BAV, a trend toward a higher risk for periprocedural complications was observed in our main analysis (risk ratio [RR]: 1.12; 95% CI: 0.99-1.27; P = 0.07) but not in the matched population secondary analysis (RR: 1.00; 95% CI: 0.81-1.24; P = 0.99). The risk for moderate to severe PVL was higher in subjects with BAV (RR: 1.42; 95% CI: 1.29-1.58; P < 0.0001) as well as the incidence of cerebral ischemic events (2.4% vs 1.6%; P = 0.015) and of annular rupture (0.3% vs 0.02%; P = 0.014) in matched subjects. CONCLUSIONS TAVR is a feasible option among selected patients with BAV anatomy, but the higher rates of moderate to severe PVL, annular rupture, and cerebral ischemic events observed in the BAV group warrant caution and further evidence.
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Affiliation(s)
- Claudio Montalto
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Oxford Heart Center, Oxford University Hospital NHS Trust, Oxford, United Kingdom
| | - Alessandro Sticchi
- Centro per la Lotta Contro l'Infarto Foundation, Rome, Italy; Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Gabriele Crimi
- Cardio-Thoraco-Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Arif A Khokhar
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Azeem Latib
- Montefiore Medical Center, New York, New York, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy.
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99
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Choosing Between Transcatheter Aortic Valve Replacement and Surgery in the Low-Risk Transcatheter Aortic Valve Replacement Era. Interv Cardiol Clin 2021; 10:413-422. [PMID: 34593105 DOI: 10.1016/j.iccl.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The landmark results of the low surgical risk pivotal transcatheter aortic valve replacement (TAVR) trials fueled speculation that the role of surgical aortic valve replacement (SAVR) would be limited in the future. Instead, the field has pivoted away from reductive surgical risk stratification toward understanding the complex interplay of anatomy, timing, and surgical risk to optimize the lifetime management of aortic stenosis. In this review, we systematically explore the subtleties that influence the choice between TAVR and surgery in the low-risk TAVR era.
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100
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Lisko Iii JC, Shekiladze N, Sandesara P, Devireddy CM. Transcatheter Aortic Valve Replacement: Advances in Procedural Technology and Approaches. Interv Cardiol Clin 2021; 10:565-578. [PMID: 34593118 DOI: 10.1016/j.iccl.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is now the dominant form of aortic valve replacement in the United States. Continued innovation has allowed the technique to be safe and democratized. New advances will increase the number of patients eligible to receive this therapy while increasing safety and efficiency. Herein, the authors review new TAVR technologies, approaches to valve deployment, and dedicated devices for cerebral embolic protection and vascular closure.
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Affiliation(s)
- John C Lisko Iii
- Division of Cardiology, Emory University School of Medicine, Peachtree Street NE, 4th Floor Davis-Fischer Building, Atlanta, GA 30308, USA
| | - Nikoloz Shekiladze
- Division of Cardiology, Emory University School of Medicine, Peachtree Street NE, 4th Floor Davis-Fischer Building, Atlanta, GA 30308, USA
| | - Pratik Sandesara
- Division of Cardiology, Emory University School of Medicine, Peachtree Street NE, 4th Floor Davis-Fischer Building, Atlanta, GA 30308, USA
| | - Chandan M Devireddy
- Division of Cardiology, Emory University School of Medicine, Emory University Hospital Midtown, Peachtree Street NE, 4th Floor Davis-Fischer Building, Atlanta, GA 30308, USA.
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