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Dolci G, Singh GK, Wang X, van der Kley F, de Weger A, Bootsma M, Ajmone Marsan N, Bax JJ, Delgado V. Effects of Left Bundle Branch Block and Pacemaker Implantation on Left Ventricular Systolic Function After Transcatheter Aortic Valve Implantation. Am J Cardiol 2022; 179:64-69. [PMID: 35843731 DOI: 10.1016/j.amjcard.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/01/2022]
Abstract
Permanent pacemaker implantation (PPI) and left bundle branch block (LBBB) frequency after transcatheter aortic valve implantation (TAVI) and their effect on left ventricular ejection fraction (LVEF) remain controversial. We evaluated the incidence of PPI and new-onset LBBB after TAVI and their impact on LVEF at 6-month follow-up. Moreover, the impact of right ventricular (RV) pacing burden on changes in LVEF after TAVI was analyzed. The electrocardiograms of 377 patients (age 80 ± 7 years, 52% male) treated with TAVI were collected at baseline, after the procedure, at discharge, and at each outpatient follow-up. LVEF was measured at baseline before TAVI and 6 months after the procedure. Patients were divided into 3 groups according to the occurrence of LBBB, the need for PPI, or the absence of new conduction abnormalities. In patients with PPI, the influence of RV pacing burden on LVEF was analyzed. New-onset LBBB after TAVI occurred in 92 patients (24%), and PPI was required in 55 patients (15%). In patients without new conduction abnormalities, LVEF significantly increased during follow-up (56 ± 14% to 61 ± 12%, p <0.001). Patients with a baseline LVEF ≤50% presented with a significant recovery in LVEF, although the recovery was less pronounced in patients with new-onset LBBB. Moreover, patients with a baseline LVEF ≤50% who received PPI showed an improvement in LVEF at 6 months regardless of the RV pacing burden. New-onset LBBB hampers the recovery of LVEF after TAVI. Among patients with an LVEF ≤50%, pressure overload relief counteracts the effects of new-onset LBBB or RV pacing.
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Affiliation(s)
- Giulia Dolci
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Gurpreet K Singh
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Xu Wang
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arend de Weger
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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Hokken TW, Muhemin M, Okuno T, Veulemans V, Lopes BB, Beneduce A, Vittorio R, Ooms JF, Adrichem R, Neleman T, Kardys I, Daemen J, Chieffo A, Montorfano M, Cavalcante J, Zeus T, Pilgrim T, Toggweiler S, Van Mieghem NM. Impact of membranous septum length on pacemaker need with different transcatheter aortic valve replacement systems: The INTERSECT registry. J Cardiovasc Comput Tomogr 2022; 16:524-530. [PMID: 35872136 DOI: 10.1016/j.jcct.2022.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/09/2022] [Accepted: 07/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND New permanent pacemaker implantation (new-PPI) remains a compelling issue after Transcatheter Aortic Valve Replacement (TAVR). Previous studies reported the relationship between a short MS length and the new-PPI post-TAVR with a self-expanding THV. However, this relationship has not been investigated in different currently available THV. Therefore, the aim of this study was to investigate the association between membranous septum (MS)-length and new-PPI after TAVR with different Transcatheter Heart Valve (THV)-platforms. METHODS We included patients with a successful TAVR-procedure and an analyzable pre-procedural multi-slice computed tomography. MS-length was measured using a standardized methodology. The primary endpoint was the need for new-PPI within 30 days after TAVR. RESULTS In total, 1811 patients were enrolled (median age 81.9 years [IQR 77.2-85.4], 54% male). PPI was required in 275 patients (15.2%) and included respectively 14.2%, 20.7% and 6.3% for Sapien3, Evolut and ACURATE-THV(p < 0.01). Median MS-length was significantly shorter in patients with a new-PPI (3.7 mm [IQR 2.2-5.1] vs. 4.1 mm [IQR 2.8-6.0], p = <0.01). Shorter MS-length was a predictor for PPI in patients receiving a Sapien3 (OR 0.87 [95% CI 0.79-0.96], p = <0.01) and an Evolut-THV (OR 0.91 [95% CI 0.84-0.98], p = 0.03), but not for an ACURATE-THV (OR 0.99 [95% CI 0.79-1.21], p = 0.91). By multivariable analysis, first-degree atrioventricular-block (OR 2.01 [95% CI 1.35-3.00], p = <0.01), right bundle branch block (OR 8.33 [95% CI 5.21-13.33], p = <0.01), short MS-length (OR 0.89 [95% CI 0.83-0.97], p < 0.01), annulus area (OR 1.003 [95% CI 1.001-1.005], p = 0.04), NCC implantation depth (OR 1.13 [95% CI 1.07-1.19] and use of Evolut-THV(OR 1.54 [95% CI 1.03-2.27], p = 0.04) were associated with new-PPI. CONCLUSION MS length was an independent predictor for PPI across different THV platforms, except for the ACURATE-THV. Based on our study observations within the total cohort, we identified 3 risk groups by MS length: MS length ≤3 mm defined a high-risk group for PPI (>20%), MS length 3-7 mm intermediate risk for PPI (10-20%) and MS length > 7 mm defined a low risk for PPI (<10%). Anatomy-tailored-THV-selection may mitigate the need for new-PPI in patients undergoing TAVR.
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Affiliation(s)
- Thijmen W Hokken
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mohammed Muhemin
- Heart Center Lucerne, Lucerner Kantonsspital, Lucerne, Switzerland
| | - Taishi Okuno
- Department of Cardiology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland
| | - Verena Veulemans
- Department of Cardiology, Pulmonology and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Bernardo B Lopes
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Alessandro Beneduce
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Romano Vittorio
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Joris F Ooms
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rik Adrichem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Tara Neleman
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Joao Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Tobias Zeus
- Department of Cardiology, Pulmonology and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland
| | | | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands. https://twitter.com/drnvanmieghem
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Pinto RA, Proença T, Carvalho MM, Pestana G, Lebreiro A, Adão L, Macedo F. Dependência de Pacing a Longo-Prazo e Preditores de Implante de Pacemaker após Implante Percutâneo de Prótese Valvular Aórtica – 1 Ano de Seguimento. Arq Bras Cardiol 2022; 119:522-530. [PMID: 35857943 PMCID: PMC9563875 DOI: 10.36660/abc.20210613] [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: 07/19/2021] [Accepted: 03/09/2022] [Indexed: 11/23/2022] Open
Abstract
Fundamento Os distúrbios de condução (DC) são a complicação mais frequente após a substituição da válvula aórtica transcateter (TAVR) e ainda não há consenso sobre seu tratamento. Objetivo Avaliar novos DC e implante de marca-passo definitivo (MPD) após a TAVR e avaliar a porcentagem de estimulação ventricular (EV) até 1 ano de acompanhamento. Métodos Pacientes submetidos a TAVR de outubro de 2014 a novembro de 2019 foram cadastrados; pacientes com MPD anterior foram excluídos. Dados clínicos, do procedimento, do ECG e do MPD foram coletados até 1 ano após o implante. O nível de significância adotado para a análise estatística foi 0,05%. Resultados Um total de 340 indivíduos foram submetidos a TAVR. O DC mais comum foi bloqueio de ramo esquerdo novo (BRE; 32,2%), sendo que 56% destes foram resolvidos após 6 meses. O bloqueio do ramo direito (BRD) foi o maior fator de risco para bloqueio atrioventricular avançado (BAV) [RC=8,46; p<0,001] e implante de MPD [RC=5,18; p<0,001], seguido de BAV de baixo grau prévio [RC=2,25; p=0,016 para implante de MPD]. Em relação às características do procedimento, válvulas de gerações mais recentes e procedimentos de válvula-em-válvula foram associados a menos DC. No total, 18,5% dos pacientes tiveram MPD implantado após a TAVR. Na primeira avaliação do MPD, pacientes com BAV avançado tinham uma porcentagem mediana de EV de 80%, e, após um ano, de 83%. Em relação aos pacientes com BRE e BAV de baixo grau, a EV mediana foi mais baixa (6% na primeira avaliação, p=0,036; 2% após um ano, p = 0,065). Conclusão O BRE foi o DC mais frequente após a TAVR, com mais da metade dos casos se resolvendo nos primeiros 6 meses. O BRD foi o principal fator de risco para BAV avançado e implante de MPD. O BAV avançado foi associado a uma porcentagem mais alta de EV no acompanhamento de 1 ano.
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Andò G, De Santis G. Transcatheter aortic valve implantation 20 years later: early discharge after transfemoral minimalist procedures as a proof of effectiveness. J Cardiovasc Med (Hagerstown) 2022; 23:463-465. [PMID: 35763767 DOI: 10.2459/jcm.0000000000001334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Giuseppe Andò
- Department of Clinical and Experimental Medicine, Postgraduate School of Cardiovascular Medicine, University of Messina, and Azienda Ospedaliera Universitaria Policlinico 'Gaetano Martino', Messina, Italy
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Evolving Indications of Transcatheter Aortic Valve Replacement—Where Are We Now, and Where Are We Going. J Clin Med 2022; 11:jcm11113090. [PMID: 35683476 PMCID: PMC9180932 DOI: 10.3390/jcm11113090] [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: 04/06/2022] [Revised: 05/04/2022] [Accepted: 05/27/2022] [Indexed: 01/14/2023] Open
Abstract
Indications for transcatheter aortic valve replacement (TAVR) have steadily increased over the last decade since the first trials including inoperable or very high risk patients. Thus, TAVR is now the most common treatment of aortic valve stenosis in elderly patients (vs. surgical aortic valve replacement -SAVR-). In this review, we summarize the current indications of TAVR and explore future directions in which TAVR indications can expand.
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Castro-Mejía AF, Amat-Santos I, Ortega-Armas ME, Baz JA, Moreno R, Diaz J, Travieso A, Jimenez-Quevedo P, Santos-Martínez S, McInerney A, Galeote G, Díaz VAJ, Garrido JR, Tirado-Conte G, Barrero A, Marroquin L, Nuñez-Gil I, Gonzalo N, Fernandez-Ortiz A, Escaned J, Nombela-Franco L. Development of atrioventricular and intraventricular conduction disturbances in patients undergoing transcatheter aortic valve replacement with new generation self-expanding valves: A real world multicenter analysis. Int J Cardiol 2022; 362:128-136. [PMID: 35550389 DOI: 10.1016/j.ijcard.2022.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 05/01/2022] [Accepted: 05/06/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND High degree cardiac conduction disturbances (HDCD) remain a major complication after transcatheter aortic valve replacement (TAVR), especially with self-expandable valves (SEV). Our aim was to investigate peri-procedural and in-hospital modification of atrioventricular and intracardiac conduction associated to new generation SEV implantation, and the development of new HDCD resulting in permanent pacemaker implantation (PPM) in patients undergoing TAVR. METHODS AND RESULTS Three-hundred forty-four consecutive patients with severe aortic stenosis who underwent TAVR with a new generation SEV [Evolut-R/Pro (n = 130), Acurate-neo (n = 79), Portico (n = 75) and Allegra (n = 60)] were included. An analysis of baseline, post-TAVR and pre-discharge ECG and procedural aspects were centrally performed. A significant increase in baseline PR interval (169.6 ± 28.2 ms) and QRS complex width (101.7 ± 25.9 ms) was noted immediately post-TAVR (188.04 ± 34.49; 129.55 ± 30.02 ms), with a partial in-hospital reversal (179.4 ± 30.1; 123.06 ± 30.94 ms), resulting in a net increase at hospital discharge of 12.6 ± 38.8 ms and 21.4 ± 31.6 ms (p < 0.001), respectively. The global incidence of new onset persistent HDCD at hospital discharge was 46.3%, with 17.7% of patients requiring PPM. Independent predictors of new onset HCDC at hospital discharge were valve recapture (OR: 2.8; 95% IC: 1.1-7.2, p = 0.033) and implantation depth ≥ 6 mm (OR: 1.9 05% IC 1.1-3.3, p = 0.015), while higher implantation (<3 mm (OR: 0.3, 95% IC 0.1-0.7, p = 0.014) and use of Acurate-Neo valve (OR: 0.4; 95% IC 0.2-0.8, p = 0.009) were protective factor. CONCLUSIONS New generation self-expanding aortic valves were associated with a significant increase in PR and QRS interval at hospital discharge leading to a very high rate of HDCD. While valve recapture and implantation depth were independent predictors for the occurrence of HDCD, use of Accurate-Neo valve was a protective factor.
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Affiliation(s)
- Alex F Castro-Mejía
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Ignacio Amat-Santos
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Maria E Ortega-Armas
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Jose A Baz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Raúl Moreno
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Jose Diaz
- Hospital Juan Ramón Jimenez, Huelva, Spain
| | - Alejandro Travieso
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Pilar Jimenez-Quevedo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Sandra Santos-Martínez
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Angela McInerney
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Guillermo Galeote
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Victor Alfonso Jimenez Díaz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | | | - Gabriela Tirado-Conte
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Alejandro Barrero
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Luis Marroquin
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Ivan Nuñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Nieves Gonzalo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Fernandez-Ortiz
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain.
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Khokhar AA, Giannini F, Colombo A. Peri‐procedural Complications of Transcatheter Aortic Valve Replacement (TAVR). Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Pascual I, Almendárez M, Avanzas P, Álvarez R, Arboine LA, del Valle R, Hernández-Vaquero D, Alfonso F, Morís C. La técnica de superposición de cúspides en TAVI con dispositivo autoexpandible optimiza la profundidad del implante y reduce la necesidad de marcapasos permanente. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Pascual I, Almendárez M, Avanzas P, Álvarez R, Arboine LA, Del Valle R, Hernández-Vaquero D, Alfonso F, Morís C. Cusp-overlapping TAVI technique with a self-expanding device optimizes implantation depth and reduces permanent pacemaker requirement. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:412-420. [PMID: 34226165 DOI: 10.1016/j.rec.2021.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/20/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES This study aimed to determine the safety and efficacy of modifying the classic implantation technique for aortic transcatheter heart valve (THV) implantation to a cusp-overlap-projection (COP) technique to achieve a higher implantation depth and to reduce the burden of new permanent pacemaker implantation (PPMI) at 30 days. Aortic self-expanding THV carries an elevated risk for PPMI. A higher implantation depth minimizes the damage in the conduction system and may reduce PPMI rates. METHODS From March 2017, 226 patients were consecutively included: 113 patients were treated using the COP implantation technique compared with the previous 113 consecutive patients treated using the classic technique. In all patients, implantation depth was assessed by 3 methods (noncoronary cusp to the THV, mean of the noncoronary cusp and the left coronary cusp to the THV, and the deepest edge from the left coronary cusp and the noncoronary cusp to the THV). RESULTS The COP group had a lower implantation depth than the group treated with the classic technique (4.8 mm± 2.2 vs 5.7 mm± 3.1; P=.011; 5.8 mm± 3.1 vs 6.5 mm± 2.4; P=.095; 7.1 mm± 2.8 vs 7.4 mm±3.2; P=.392). Forty patients (17.7%) required a new PPMI after the 30-day follow-up but this requirement was significantly lower in the COP group (12.4% vs 23%, P=.036). The COP implantation technique consistently protected against the main event (OR, 0.45; 95%CI, 0.21-0.97; P=.043), with similar procedural success rates and complications. CONCLUSIONS The COP implantation technique is a simple modification of the implantation protocol and provides a higher implantation depth of self-expanding-THV with lower conduction disturbances and PPMI rates.
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Affiliation(s)
- Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación del Principado de Asturias, Oviedo, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Marcel Almendárez
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación del Principado de Asturias, Oviedo, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación del Principado de Asturias, Oviedo, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain.
| | - Rut Álvarez
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luis A Arboine
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Raquel Del Valle
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Daniel Hernández-Vaquero
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación del Principado de Asturias, Oviedo, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Fernando Alfonso
- Departamento de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - César Morís
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación del Principado de Asturias, Oviedo, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain
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Abu Rmilah AA, Al-Zu’bi H, Haq IU, Yagmour AH, Jaber SA, Alkurashi AK, Qaisi I, Kowlgi GN, Cha YM, Mulpuru S, DeSimone CV, Deshmukh AJ. Predicting Permanent Pacemaker Implantation following Trans-catheter Aortic Valve Replacement: A Contemporary Meta-Analysis of 981,168 patients. Heart Rhythm O2 2022; 3:385-392. [PMID: 36097458 PMCID: PMC9463692 DOI: 10.1016/j.hroo.2022.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Heart block requiring permanent pacemaker (PPM) implantation is a relatively frequent complication of transcatheter aortic valve replacement (TAVR). Objective The purpose of this study was to perform a contemporary meta-analysis to provide an updated assessment of clinically useful predictors of PPM implantation post-TAVR. Methods Medline and EMBASE searches were performed to include all studies reporting PPM post-TAVR between 2015 and 2020. Pertinent data were extracted from the studies for further analysis. RevMan was used to create forest plots and calculate risk ratios (RRs). Results We evaluated 41 variables from 239 studies with a total of 981,168 patients. From this cohort, 17.4% received a PPM following TAVR. Strong predictors for PPM implant were right bundle branch block (RBBB) (RR 3.12; P <.001) and bifascicular block (RR 2.40; P = .002). Intermediate factors were chronic kidney disease (CKD) (RR 1.53; P <.0001) and first-degree atrioventricular block (FDAVB) (RR 1.44; P <.001). Weak factors (RR 1–1.50; P <.05) were male gender, age ≥80 years, body mass index ≥25, diabetes mellitus (DM), atrial fibrillation (AF), and left anterior fascicular block (LAFB). These factors along with increased left ventricular outflow tract (LVOT) area (>435 mm2) and/or aortic annulus diameter (>24.4 mm) were incorporated to propose a new scoring system to stratify patients into high- and low-risk groups. Conclusion Male gender, age ≥80 years, FDAVB, RBBB, AF, DM, CKD, Medtronic CoreValve, transfemoral TAVR, increased LVOT, and aortic annulus diameter were significant predictors of post-TAVR PPM implantation. Preprocedural assessment should consider these factors to guide clinical decision-making before TAVR. Validation of our scoring system is warranted.
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Affiliation(s)
- Anan A. Abu Rmilah
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hossam Al-Zu’bi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ikram-Ul Haq
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Suhaib A. Jaber
- Department of Internal Medicine, Al Hamadi Hospital, Riyadh, Saudi Arabia
| | - Adham K. Alkurashi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ibraheem Qaisi
- An-Najah National University School of Medicine, Palestine
| | | | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Siva Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Abhishek J. Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Address reprint requests and correspondence: Dr Abhishek J. Deshmukh, Department of Cardiovascular Disease, Mayo Clinic, 200 First St SW, Rochester, MN 55902.
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Early and midterm outcomes of transcatheter aortic-valve replacement with balloon-expandable versus self-expanding valves: A meta-analysis. J Cardiol 2022; 80:204-210. [DOI: 10.1016/j.jjcc.2022.04.011] [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: 12/22/2021] [Revised: 04/15/2022] [Accepted: 04/17/2022] [Indexed: 11/19/2022]
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62
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Siddique S, Khanal R, Vora AN, Gada H. Transcatheter Aortic Valve Replacement Optimization Strategies: Cusp Overlap, Commissural Alignment, Sizing, and Positioning. US CARDIOLOGY REVIEW 2022. [DOI: 10.15420/usc.2021.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
As transcatheter aortic valve replacement (TAVR) rapidly expands to younger patients and those at low surgical risk, there is a compelling need to identify patients at increased risk of post-procedural complications, such as paravalvular leak, prosthesis–patient mismatch, and conduction abnormalities. This review highlights the incidence and risk factors of these procedural complications, and focuses on novel methods to reduce them by using newer generation transcatheter heart valves and the innovative cusp-overlap technique, which provides optimal fluoroscopic imaging projection to allow for precise implantation depth which minimizes interaction with the conduction system. Preserving coronary access after TAVR is another important consideration in younger patients. This paper reviews the significance of commissural alignment to allow coronary cannulation after TAVR and discusses recently published data on modified delivery techniques to improve commissural alignment.
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Affiliation(s)
- Saima Siddique
- University of Pittsburgh Medical Center Heart and Vascular Institute, Harrisburg, PA
| | - Resha Khanal
- University of Pittsburgh Medical Center Heart and Vascular Institute, Harrisburg, PA
| | - Amit N Vora
- University of Pittsburgh Medical Center Heart and Vascular Institute, Harrisburg, PA; Duke University Medical Center, Durham, NC
| | - Hemal Gada
- University of Pittsburgh Medical Center Heart and Vascular Institute, Harrisburg, PA
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63
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Peel JK, Neves Miranda R, Naimark D, Woodward G, Mamas MA, Madan M, Wijeysundera HC. Financial Incentives for Transcatheter Aortic Valve Implantation in Ontario, Canada: A Cost-Utility Analysis. J Am Heart Assoc 2022; 11:e025085. [PMID: 35411786 PMCID: PMC9238449 DOI: 10.1161/jaha.121.025085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transcatheter aortic valve implantation (TAVI) is a minimally invasive therapy for patients with severe aortic stenosis, which has become standard of care. The objective of this study was to determine the maximum cost‐effective investment in TAVI care that should be made at a health system level to meet quality indicator goals. Methods and Results We performed a cost‐utility analysis using probabilistic patient‐level simulation of TAVI care from the Ontario, Canada, Ministry of Health perspective. Costs and health utilities were accrued over a 2‐year time horizon. We created 4 hypothetical strategies that represented TAVI care meeting ≥1 quality indicator targets, (1) reduced wait times, (2) reduced hospital length of stay, (3) reduced pacemaker use, and (4) combined strategy, and compared these with current TAVI care. Per‐person costs, quality‐adjusted life years, and clinical outcomes were estimated by the model. Using these, incremental net monetary benefits were calculated for each strategy at different cost‐effectiveness thresholds between $0 and $100 000 per quality‐adjusted life year. Clinical improvements over the current practice were estimated with all comparator strategies. In Ontario, achieving quality indicator benchmarks could avoid ≈26 wait‐list deaths and 200 wait‐list hospitalizations annually. Compared with current TAVI care, the incremental net monetary benefit for this strategy varied from $10 765 (±$8721) and $17 221 (±$8977). This would translate to an annual investment of between ≈$14 to ≈$22 million by the Ontario Ministry of Health to incentivize these performance measures being cost‐effective. Conclusions This study has quantified the modest annual investment required and substantial clinical benefit of meeting improvement goals in TAVI care.
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Affiliation(s)
- John K Peel
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada.,Department of Anesthesiology and Pain Medicine University of Toronto Ontario Canada.,Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada
| | - Rafael Neves Miranda
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada.,Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada
| | - David Naimark
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada.,Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada.,Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada.,Department of Medicine University of Toronto Ontario Canada
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group Keele University Keele United Kingdom
| | - Mina Madan
- Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada.,Department of Medicine University of Toronto Ontario Canada
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada.,Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada.,Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada.,Department of Medicine University of Toronto Ontario Canada
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64
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Risk of conduction disturbances following different transcatheter aortic valve prostheses: the role of aortic valve calcifications. J Geriatr Cardiol 2022; 19:167-176. [PMID: 35464642 PMCID: PMC9002082 DOI: 10.11909/j.issn.1671-5411.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To assess the impact of prosthesis choice and aortic valve calcifications on the occurrence of conduction disturbances after transcatheter aortic valve implantation (TAVI). METHODS We retrospectively analyzed the preoperative clinical characteristics, electrocardiograms, contrast-enhanced multidetector computed tomography scans and procedural strategies of patients who underwent TAVI in our center between January 2012 and June 2017. Quantification of calcium volume was performed for each aortic cusp above (aortic valve) and below (left ventricular outflow tract, LVOT) the basal plane. Multivariate analysis was performed to evaluate risk factors for the onset of new bundle branch block (BBB), transient and permanent atrioventricular block (tAVB, pAVB). RESULTS A total of 569 patients were included in the study. Six different prostheses were implanted (Edwards Sapien XT, n = 162; Edwards Sapien 3, n = 240; Medtronic CoreValve, n = 27; Medtronic CoreValve Evolut R, n = 21; Symetis Acurate, n = 56; Symetis Acurate neo, n = 63). The logistic regression analysis for BBB showed association with baseline left anterior hemiblock. The logistic regression for tAVB, found the prior valvuloplasty and the balloon post-dilatation associated with the outcome. Baseline left and right BBB, degree of oversizing, and LVOT calcification beneath the non-coronary cusp were associated with pAVB. Neither the prosthesis model, nor the use of a self-expandable prosthesis showed statistical significance with the above-mentioned outcomes on univariate analysis. CONCLUSIONS LVOT calcification beneath the non-coronary cusp, baseline left anterior hemiblock, right BBB, balloon post-dilatation, prior valvuloplasty and oversizing are independently associated with postprocedural conduction disturbances after TAVI. Use of a self-expandable prosthesis may show a lower incidence of AVB, if applied in lower calcified aortic valves.
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65
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Ghauri H, Iqbal R, Ahmed S, Ashraf A, Khan MSQ, Malik J, Zaidi SMJ, Almas T. Predictors of permanent pacemaker insertion after mitral valve replacement: a systematic review. Pacing Clin Electrophysiol 2022; 45:681-687. [PMID: 35304920 DOI: 10.1111/pace.14484] [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] [Received: 12/30/2021] [Revised: 03/01/2022] [Accepted: 02/27/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE As the established surgical mitral valve replacement (MVR) expands towards various contemporary techniques and access routes, the predictors and burden of procedure-related complications including the need for permanent pacemaker (PPM) implantation need to be identified. METHODS Digital databases were searched systematically to identify studies reporting the incidence of PPM implantation after MVR. Detailed study and patient-level baseline characteristics including the type of study, sample size, follow-up, number of post-MVR PPM implantations, age, gender, and baseline ECG abnormalities were abstracted. RESULTS A total of 12 studies, recruiting 37,124 patients were included in the final analysis. Overall, 2,820 (7.6%) patients required a PPM with the net rate ranging from 1.7% to 10.96%. Post-MVR atrioventricular (AV) block was the most commonly observed indication for PPM, followed by sinoatrial (SA) node dysfunction, and bradycardia. Age, male gender, pre-existing comorbid conditions, prior CABG, history of arrhythmias or using anti-arrhythmic drugs, AF ablation, and double valve replacement were predictors of PPM implantation post-MVR. CONCLUSION Age, male gender, comorbid conditions like diabetes and renal impairment, prior CABG, double valve replacement, and anti-arrhythmic drugs served as positive predictors of PPM implantation in patients undergoing MVR. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hamza Ghauri
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Raafe Iqbal
- Department of Cardiology, Wah Medical College, Wah, Pakistan
| | - Sohail Ahmed
- Department of Cardiology, DHQ Hospital, Chakwal, Pakistan
| | - Amna Ashraf
- Department of Medicine, Military Hospital, Rawalpindi, Pakistan
| | | | - Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | | | - Talal Almas
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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66
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Piayda K, Bauer T, Beckmann A, Bekeredjian R, Bleiziffer S, Ensminger S, Frerker C, Möllmann H, Walther T, Balaban Ü, Herrmann E, Hamm C, Beyersdorf F, Lichtenberg A, Zeus T, Mehdiani A. Procedural Results of Patients Undergoing Transcatheter Aortic Valve Implantation With Aortic Annuli Diameter ≥26 mm: insights from the German Aortic Valve Registry. Am J Cardiol 2022; 164:111-117. [PMID: 34844737 DOI: 10.1016/j.amjcard.2021.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
Patients presenting with severe aortic stenosis and large aortic annuli are challenging to treat because of the size limitations of available transcatheter heart valves. In this study, we aimed to determine clinical and hemodynamic outcomes in patients presenting with large aortic annuli who underwent transcatheter aortic valve implantation (TAVI). Patients from the German Aortic Valve Registry who underwent TAVI either with the Edwards Sapien (ES) or Medtronic CoreValve (MCV) systems from 2011 to 2017 were included. They were further stratified into a large (aortic annulus diameter 26 to 29 mm for ES; 26 to 30 mm for MCV) and extra-large (aortic annulus diameter >29 mm for ES; >30 mm for MCV) group and analyzed using propensity score adjustment. Extra-large was set beyond the sizing limitations according to the manufacturer's instructions for use. Patients in the large (n = 5,628) and extra-large (n = 509) groups were predominantly male (large: 92.6% vs extra-large: 91.9%). The 30-day mortality was comparable (large: 3.9% vs extra-large: 5.0%, p = 0.458). Procedure duration (large: 78.9 minutes ± 0.82 vs extra-large: 86.4 minutes ± 1.9, p <0.001) was longer in the extra-large group. Likewise, vascular complications (large: 6.2% vs extra-large: 12%, p = 0.002) and the need for a permanent pacemaker implantation (large: 18.8% vs extra-large: 26.0%, p = 0.027) were more often present in the extra-large group. Aortic regurgitation ≥II after valve implantation was numerically higher (large: 3.0% vs extra-large: 5.3%, p = 0.082) in patients with extra-large anatomy. In conclusion, patients with large and extra-large aortic annulus diameters who underwent TAVI have comparable 30-day mortality. Beyond the recommended annulus range, there is a higher risk for vascular complications and permanent pacemaker implantation.
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Affiliation(s)
- Kerstin Piayda
- Division of Cardiology, Pulmonology and Vascular Medicine
| | - Timm Bauer
- Department of Cardiology, General Internal Medicine, Intensive Care, Sana Clinic Offenbach, Offenbach, Germany
| | - Andreas Beckmann
- German Society for Thoracic and Cardiovascular Surgery, Berlin, Germany
| | - Raffi Bekeredjian
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Sabine Bleiziffer
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany; German Center for Cardiovascular Research, Berlin, Germany
| | - Stephan Ensminger
- Department of Cardiac Surgery, University of Lübeck, Lübeck, Germany
| | - Christian Frerker
- Department of Cardiology, Vascular Medicine and Intensive Care, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research DZHK, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Helge Möllmann
- Department of Internal Medicine I, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | - Thomas Walther
- Department of Cardiothoracic Surgery, University Hospital Frankfurt, Frankfurt, Germany; German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main, Frankfurt, Germany
| | - Ümniye Balaban
- German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main, Frankfurt, Germany; Institute of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt, Frankfurt, Germany
| | - Eva Herrmann
- German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main, Frankfurt, Germany; Institute of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt, Frankfurt, Germany
| | - Christian Hamm
- Department of Cardiology, Kerckhoff Klinik Bad Nauheim, Bad Nauheim, Germany
| | | | - Artur Lichtenberg
- Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine.
| | - Arash Mehdiani
- Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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67
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Mitsis A, Eftychiou C, Christophides T, Sakellaropoulos S, Avraamides P. The conjunction conundrum in Transcatheter Aortic Valve Implantation. Curr Probl Cardiol 2022; 48:101130. [PMID: 35114293 DOI: 10.1016/j.cpcardiol.2022.101130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
A continuous discussion regarding the predictors for permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI) is ongoing, especially in the era of low and medium risk patients. The aim of this article is to review the data so far regarding the pathophysiology, risk factors, and the indications for permanent pacemaker implantation after TAVI. The factors that contribute to rhythm abnormalities post TAVI can be divided into pre-existing conduction abnormalities, patient-related anatomical factors, and peri-procedural technical factors. The latter components are potentially modifiable, and this is where attention should be directed, particularly now that in an era of TAVI expansion towards lower-risk patients.
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Key Words
- AF, Atrial fibrillation
- AS, Aortic stenosis
- AV, Atrioventricular
- BAV, Balloon aortic valvuloplasty
- BBB, Bundle branch block
- BEV, Balloon expandable valve
- CAVB, Complete Atrioventricular block
- CRT,
- CT, Computer tomography
- Cardiac resynchronization therapy
- ECG, Electrocardiogram
- EPS, Electrophysiology study
- ID, Implantation depth
- LAH, Left anterior hemiblock
- LBBB, Left bundle branch block
- LCC, Left coronary cusp
- LVEF, Left ventricular ejection function
- LVOT, Left ventricular outflow track
- LVOT- EI, Left ventricular outflow track eccentricity index
- LVOT-CA, Left ventricular outflow track calcification
- MS, Membranous septum
- NCC, Non coronary cusp
- PPI, Permanent pacemaker implantation
- PVL, Paravalvular leak
- RAO, Right anterior oblique
- RBBB, Right bundle branch block
- RCC, Right coronary cusp
- SAS, Severe aortic stenosis
- SEV, Self-expandable valve
- TAVI, Transcatheter aortic valve implantation
- Transcatheter aortic valve implantation, pacemaker implantation, LBBB, balloon expandable valves, self-expandable valves, LVOT. List of abbreviations, AMCC, Aortomitral continuity calcification
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Affiliation(s)
- Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, 2029, Nicosia, Cyprus.
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Servito M, Khoury W, Payne D, Baranchuk A, El Diasty M. Long-term impact of permanent cardiac pacing after surgical aortic valve replacement: systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2022; 20:81-86. [DOI: 10.1080/14779072.2022.2031981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maria Servito
- Faculty of Medicine, Queen’s University, Kingston, ON, Canada
| | - William Khoury
- Faculty of Medicine, Queen’s University, Kingston, ON, Canada
| | - Darrin Payne
- Division of Cardiac Surgery, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Mohammad El Diasty
- Division of Cardiac Surgery, Kingston Health Sciences Centre, Kingston, ON, Canada
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69
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Permanent Pacemaker Reduction Using Cusp-Overlapping Projection in TAVR: A Propensity Score Analysis. JACC Cardiovasc Interv 2022; 15:150-161. [PMID: 35057985 DOI: 10.1016/j.jcin.2021.10.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this study was to determine if modifying the classical implantation technique for self-expanding (SE) transcatheter aortic valve replacement to a novel cusp-overlapping projection (COP) technique results in a higher implantation depth (ID) and subsequently reduces the rate of permanent pacemaker implantation (PPMI). BACKGROUND The COP technique presents the potential benefit of an optimized ID to reduce the rate of PPMI. However, only a few studies have compared clinical outcomes with those achieved using the standard technique. This is the first study to systematically evaluate this approach for SE transcatheter heart valves (THVs) in different populations METHODS: Beginning in February 2015, 444 patients were consecutively included. Propensity score matching was used to control baseline characteristics because of the observational nature of the study. In total, 161 pairs of patients were analyzed. Three methods were used to measure ID (noncoronary cusp [NCC] to the THV, mean of the NCC and the left coronary cusp [LCC] to the THV, and the deepest edge from the LCC and the NCC to the THV). RESULTS ID was significantly higher in COP cases when measuring from the NCC (4.2 mm vs 5.3 mm; P < 0.001) and the mean from the NCC and the LCC (5.3 mm vs 5.9 mm; P = 0.04), but not from the deepest edge. The PPMI rate was lower in the COP group: 19 (11.8%) vs 35 (21.7%) (P = 0.03; relative risk: 0.54; 95% CI: 0.32-0.91). CONCLUSIONS The present study showed that the COP technique significantly reduces PPMI in SE THV implantation compared with the classical implantation technique, with similar rates of complications.
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70
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Pietrasanta L, Zheng S, De Marinis D, Hasler D, Obrist D. Characterization of Turbulent Flow Behind a Transcatheter Aortic Valve in Different Implantation Positions. Front Cardiovasc Med 2022; 8:804565. [PMID: 35097022 PMCID: PMC8794584 DOI: 10.3389/fcvm.2021.804565] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/14/2021] [Indexed: 11/21/2022] Open
Abstract
The development of turbulence after transcatheter aortic valve (TAV) implantation may have detrimental effects on the long-term performance and durability of the valves. The characterization of turbulent flow generated after TAV implantation can provide fundamental insights to enhance implantation techniques. A self-expandable TAV was tested in a pulse replicator and the three-dimensional flow field was extracted by means of tomographic particle image velocimetry. The valve was fixed inside a silicone phantom mimicking the aortic root and the flow field was studied for two different supra-annular axial positions at peak systole. Fluctuating velocities and turbulent kinetic energy were compared between the two implantations. Velocity spectra were derived at different spatial positions in the turbulent wakes to characterize the turbulent flow. The valve presented similar overall flow topology but approximately 8% higher turbulent intensity in the lower implantation. In this configuration, axial views of the valve revealed smaller opening area and more corrugated leaflets during systole, as well as more accentuated pinwheeling during diastole. The difference arose from a lower degree of expansion of the TAV's stent inside the aortic lumen. These results suggest that the degree of expansion of the TAV in-situ is related to the onset of turbulence and that a smaller and less regular opening area might introduce flow instabilities that could be detrimental for the long-term performance of the valve. The present study highlights how implantation mismatches may affect the structure and intensity of the turbulent flow in the aortic root.
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Affiliation(s)
- Leonardo Pietrasanta
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- *Correspondence: Leonardo Pietrasanta
| | - Shaokai Zheng
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Dario De Marinis
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Dipartimento di Meccanica Matematica e Management, Centro di Eccellenza in Meccanica Computazionale, Politecnico di Bari, Bari, Italy
| | - David Hasler
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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71
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Aidietis A, Srimahachota S, Dabrowski M, Bilkis V, Buddhari W, Cheung GSH, Nair RK, Mussayev AA, Mattummal S, Chandra P, Mahajan AU, Chmielak Z, Govindan SC, Jose J, Hiremath MS, Chandra S, Shetty R, Mohanan S, John JF, Mehrotra S, Søndergaard L. 30-Day and 1-Year Outcomes With HYDRA Self-Expanding Transcatheter Aortic Valve: The Hydra CE Study. JACC Cardiovasc Interv 2022; 15:93-104. [PMID: 34991828 DOI: 10.1016/j.jcin.2021.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/17/2021] [Accepted: 09/07/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study sought to evaluate the 30-day and 1-year safety and performance of the Hydra transcatheter aortic valve (THV) (in the treatment of symptomatic severe aortic stenosis in patients at high or extreme surgical risk. BACKGROUND The Hydra THV is a novel repositionable self-expanding system with supra-annular bovine pericardial leaflets. METHODS The Hydra CE study was a premarket, prospective, multicenter, single-arm study conducted across 18 study centers in Europe and Asia-Pacific countries. The primary endpoint was all-cause mortality at 30 days. All endpoints were adjudicated by an independent clinical events committee. RESULTS A total of 157 patients (79.2 ± 7.1 years of age, 58.6% female; Society of Thoracic Surgeons score 4.7 ± 3.4%) were enrolled. Successful implantation was achieved in 94.3% cases. At 30 days, there were 11 (7.0%) deaths, including 9 (5.7%) cardiovascular deaths, of which 5 (3.2%) were device related. At 1 year, there were 23 (14.6%) deaths, including 13 (8.3%) cardiovascular deaths. At 30 days, there were significant improvement of effective orifice area (from 0.7 ± 0.2 cm2 to 1.9 ± 0.6 cm2) and mean aortic valve gradient (from 49.5 ± 18.5 mm Hg to 8.1 ± 3.7 mm Hg), which were sustained up to 1 year. Moderate or severe paravalvular leak was observed in 6.3% of patients at 30 days and 6.9% of patients at 1 year. The rate of new permanent pacemaker implantation was 11.7% at 30 days and 12.4% at 1 year. CONCLUSIONS The Hydra CE study demonstrated that transcatheter aortic valve replacement with Hydra THV offered favorable efficacy at 1 year, providing large effective orifice area and low transvalvular gradient as well as acceptable complication rates with regard to new permanent pacemaker and paravalvular leak. (A Clinical Evaluation of the HYDRA Self Expanding Transcatheter Aortic Valve; NCT02434263).
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Affiliation(s)
- Audrius Aidietis
- Cardiology and Angiology Centre, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Suphot Srimahachota
- Cardiac Center and Division of Cardiovascular Disease, Department of Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Vaildas Bilkis
- Cardiology and Angiology Centre, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Wacin Buddhari
- Cardiac Center and Division of Cardiovascular Disease, Department of Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | - Gary S H Cheung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR
| | - Rajesh K Nair
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Abdurashid A Mussayev
- Catheterization Laboratory, National Research Center for Cardiac Surgery, Astana, Kazakhstan
| | - Shafeeq Mattummal
- Department of Adult Cardiology, ASTER MIMS Hospital, Kozhikode, India
| | - Praveen Chandra
- Division of Interventional Cardiology, Medanta The Medicity Hospital, Gurgaon, India
| | - Ajay U Mahajan
- Department of Cardiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, India
| | - Zbigniew Chmielak
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Sajeev C Govindan
- Department of Cardiology, Government Medical College, Calicut, India
| | - John Jose
- Department of Cardiology, Cardiology Unit 2, Christian Medical College Hospital, Vellore, India
| | | | - Sharad Chandra
- Department of Cardiology (Lari Heart Center), King George's Medical University, Lucknow, India
| | - Ranjan Shetty
- Department of Cardiology, Manipal Hospital, Bengaluru, India
| | - Sandeep Mohanan
- KMCT Heart Institute, KMCT Medical College Hospital, Kozhikode, India
| | - John F John
- Department of Cardiology, Baby Memorial Hospital, Calicut, India
| | - Sanjay Mehrotra
- Department of Cardiology, NH Institute of Cardiac Sciences, Bangalore, India
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Ou-Yang WB, Wang W, Dong J, Xie YQ, Wan JY, Yue ZQ, Wang SZ, Meng H, Wang X, Xu DH, Zhang FW, Dong J, Pan XB, Zhang GJ. Propensity-matched comparison of balloon-expandable and self-expanding valves for transcatheter aortic valve replacement in a Chinese population. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:97. [PMID: 35282054 PMCID: PMC8848425 DOI: 10.21037/atm-21-6637] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/19/2022] [Indexed: 11/06/2022]
Abstract
Background Balloon-expandable valves (BEV) and self-expanding valves (SEV) for transcatheter aortic valve replacement (TAVR) have shown promising results in Western populations. Herein, we comparatively evaluated their hemodynamics and early clinical outcomes in a Chinese population. Methods One hundred seventy-eight patients with symptomatic aortic stenosis who had undergone transfemoral TAVR using SEV (n=153; Venus-A, 97; VitaFlow, 56) or BEV (n=25; Sapien3) from September 2020 to April 2021 were retrospectively enrolled, and 25 pairs were propensity-score matched for 10 baseline variables. The primary study outcomes were aortic valve hemodynamics and postoperative complications at discharge and 3-month follow-up. Results TAVR was successful in all patients. Compared with SEV group, the BEV group had similarly distributed baseline characteristics, procedural time, hospital stay, new pacemaker implantation, and paravalvular regurgitation grade. We also observed that the BEV group had lower rates of balloon pre-dilation (60% vs. 92%, P=0.018), post-dilation (0 vs. 20%, P=0.050) and second valve implantation (0 vs. 24%, P=0.022); higher mean transaortic gradient (14.3±6.1 vs. 10.8±4.9, P=0.030) and proportion of patients with elevated gradients (20% vs. 0, P=0.050) at discharge; and similar rehospitalization, mean transaortic gradient, new pacemaker implantation, and paravalvular regurgitation grade than the SEV group at the 3-month follow-up. There were no deaths in either group. However, the proportion of patients with elevated gradients in SEV group was higher at 3 months than before discharge (24% vs. 0, P=0.022). Conclusions BEV and SEV for transfemoral TAVR appear comparably safe and effective, with high device success and favorable 3-month clinical outcomes. However, the transaortic gradient and new pacemaker implantation in the SEV group increased during follow-up, warranting larger studies with longer-term follow-up.
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Affiliation(s)
- Wen-Bin Ou-Yang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wei Wang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jie Dong
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yong-Quan Xie
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jun-Yi Wan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zi-Qi Yue
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shou-Zheng Wang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hong Meng
- Department of Echocardiography, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xu Wang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dong-Hui Xu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Feng-Wen Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Dong
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiang-Bin Pan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ge-Jun Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Santos-Martinez S, Halim J, Castro-Mejía A, De Marco F, Trani C, Martin P, Infusino F, Ancona M, Moreno R, den Heijer P, Nombela-Franco L, Bedogni F, Sardella G, Montorfano M, Revilla-Orodea A, Delgado-Arana JR, Barrero A, Gómez-Salvador I, IJsselmuiden AJJ, Redondo A, Gutiérrez H, Serrador A, Serruys PW, Román JAS, Amat-Santos IJ. Myval versus alternative balloon- and self-expandable transcatheter heart valves: A central core lab analysis of conduction disturbances. Int J Cardiol 2022; 351:25-31. [PMID: 34979152 DOI: 10.1016/j.ijcard.2021.12.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several studies have compared surface electrocardiographic changes following different self-expandable (SE) (Evolut (Medtronic, USA); Acurate (Boston Scientific, USA); Portico (Abbott, USA); and Allegra (NVT, Germany)) and balloon-expandable (BE) Sapien-3 (Edwards Lifesciences, USA) transcatheter heart valves. We aimed to compare these prosthesis with the novel Myval BE prosthesis (Meril Life, India). METHODS Academic European registry of consecutive patients with severe aortic stenosis who received any of the 6 aforementioned valves. Baseline, post-procedural, and discharge 12‑leads electrocardiograms (ECG) were centrally analyzed and compared. RESULTS A total of 1131 patients were included: 135 Myval (11.9%), 290 Sapien-3 (25.6%), 298 Evolut (26.3%), 180 Acurate (15.9%), 125 Portico (11.1%), and 103 Allegra (9.1%). There were no baseline differences in intraventricular conduction disturbances rate. Compared to the novel BE Myval, there were similar procedural and in-hospital outcomes. Similar rates of early new permanent pacemaker implant (PPI) were observed amongst Myval (7.4%), Sapien-3 (13.4%), and Acurate (9.1%), but Evolut, Portico, and Allegra presented significantly higher rates (18.5%, p = 0.003; 29.5% p < 0.001 and 22%, p = 0.001, respectively). Central analysis of ECGs, unraveled significant prolongation of the PR segment with Evolut, Portico and Allegra whereas Evolut, Acurate, and Portico showed significant QRS widening compared to Myval. However, at discharge no differences in PR segment duration were observed while, Evolut, and Portico- but not Acurate, Allegra or Sapien-3 - still presented significant widening of QRS segment compared to Myval. CONCLUSIONS After blinded central ECG analysis, the novel Myval balloon-expandable prosthesis was associated with a low rate of early conduction disturbances.
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Affiliation(s)
| | | | | | | | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Pedro Martin
- Hospital Universitario de Gran Canaria Dr Negrin, Gran Canaria, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alfredo Redondo
- CIBERCV, Hospital Clinico Universitario de Valladolid, Spain
| | | | - Ana Serrador
- CIBERCV, Hospital Clinico Universitario de Valladolid, Spain
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland
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Dogdus M. Evaluation of ımpact of sigmoid septum on periprocedural outcomes following transcatheter aortic valve ımplantation. Int J Cardiovasc Imaging 2021; 38:181-182. [PMID: 34935089 DOI: 10.1007/s10554-021-02501-y] [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: 11/30/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Mustafa Dogdus
- Department of Cardiology, Training and Research Hospital, Usak University, 64100, Usak, Turkey.
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75
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Guo Y, Zhou D, Dang M, He Y, Zhang S, Fang J, Wu S, Huang Q, Chen L, Yuan Y, Fan J, Jilaihawi H, Liu X, Wang J. The Predictors of Conduction Disturbances Following Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: A Multicenter Study. Front Cardiovasc Med 2021; 8:757190. [PMID: 34912864 PMCID: PMC8667767 DOI: 10.3389/fcvm.2021.757190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/15/2021] [Indexed: 12/29/2022] Open
Abstract
Objective: To evaluate the predictors of new-onset conduction disturbances in bicuspid aortic valve patients using self-expanding valve and identify modifiable technical factors. Background: New-onset conduction disturbances (NOCDs), including complete left bundle branch block and high-grade atrioventricular block, remain the most common complication after transcatheter aortic valve replacement (TAVR). Methods: A total of 209 consecutive bicuspid patients who underwent self-expanding TAVR in 5 centers in China were enrolled from February 2016 to September 2020. The optimal cut-offs in this study were generated from receiver operator characteristic curve analyses. The infra-annular and coronal membranous septum (MS) length was measured in preoperative computed tomography. MSID was calculated by subtracting implantation depth measure on postoperative computed tomography from infra-annular MS or coronal MS length. Results: Forty-two (20.1%) patients developed complete left bundle branch block and 21 (10.0%) patients developed high-grade atrioventricular block after TAVR, while 61 (29.2%) patients developed NOCDs. Coronal MS <4.9 mm (OR: 3.08, 95% CI: 1.63-5.82, p = 0.001) or infra-annular MS <3.7 mm (OR: 2.18, 95% CI: 1.04-4.56, p = 0.038) and left ventricular outflow tract perimeter <66.8 mm (OR: 4.95 95% CI: 1.59-15.45, p = 0.006) were powerful predictors of NOCDs. The multivariate model including age >73 years (OR: 2.26, 95% CI: 1.17-4.36, p = 0.015), Δcoronal MSID <1.8 mm (OR: 7.87, 95% CI: 2.84-21.77, p < 0.001) and prosthesis oversizing ratio on left ventricular outflow tract >3.2% (OR: 3.42, 95% CI: 1.74-6.72, p < 0.001) showed best predictive value of NOCDs, with c-statistic = 0.768 (95% CI: 0.699-0.837, p < 0.001). The incidence of NOCDs was much lower (7.5 vs. 55.2%, p < 0.001) in patients without Δcoronal MSID <1.8 mm and prosthesis oversizing ratio on left ventricular outflow tract >3.2% compared with patients who had these two risk factors. Conclusion: The risk of NOCDs in bicuspid aortic stenosis patients could be evaluated based on MS length and prosthesis oversizing ratio. Implantation depth guided by MS length and reducing the oversizing ratio might be a feasible strategy for heavily calcified bicuspid patients with short MS.
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Affiliation(s)
- Yuchao Guo
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dao Zhou
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengqiu Dang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuxing He
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shenwei Zhang
- Department of Cardiology, Zhengzhou Cardiovascular Hospital (The Seventh People' Hospital of Zheng Zhou), Zhengzhou, China
| | - Jun Fang
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shili Wu
- Department of Cardiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Qiong Huang
- Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Lianglong Chen
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yiqiang Yuan
- Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Jiaqi Fan
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hasan Jilaihawi
- Heart Valve Center, NYU Langone Health, New York City, NY, United States
| | - Xianbao Liu
- 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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Wang X, Chen F, Xiong TY, Li YJ, Ou YW, Li Q, Peng Y, Wei JF, He S, Chen M, Feng Y. A CT-based technique to predict optimal projection for self-expanding TAVI in patients with different aortic valve anatomies. BMC Cardiovasc Disord 2021; 21:590. [PMID: 34876008 PMCID: PMC8650525 DOI: 10.1186/s12872-021-02387-7] [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: 06/22/2021] [Accepted: 11/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background Optimal projection is essential for valve deployment during transcatheter aortic valve implantation (TAVI). The purpose of this study was to propose an approach to predict optimal projection in TAVI candidates with different aortic valve anatomies. Methods 331 patients undergoing self-expanding TAVI were included and the so-called non-coronary cusp (NCC)-parallel technique was utilized, which generated the predicted projection by connecting NCC commissures on the transverse plane on the pre-procedural computed tomography images. Results 37.8% of the study cohort were bicuspid aortic valve (BAV) patients. Around 80% of both NCC-parallel views and final views were in the right anterior oblique (RAO) and caudal (CAU) quadrant. There was less than 5° change required from the NCC-parallel view to the final implanted view in 79% of tricuspid aortic valve (TAV) patients but only in 27% (13/48) of type 0 BAV patients with coronary arteries originated from the different cusps. After excluding the above mentioned BAV patients, 62.3% (48/77) of BAV patients needed less than 5° change to achieve optimal projection and only in 8 patients, the angular change was larger than 10° in either left/right anterior oblique or cranial/caudal direction. Conclusions The NCC-parallel technique provides reliable prediction for optimal projection in self-expanding TAVI in all TAV and most BAV patients, with a vast majority of views in the RAO and CAU quadrant. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02387-7.
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Affiliation(s)
- Xi Wang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Fei Chen
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yi-Jian Li
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yuan-Weixiang Ou
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Qiao Li
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Jia-Fu Wei
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Sen He
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
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Carey J, Buckley A, O'Connor S, Hensey M. The Wattson temporary pacing guidewire for transcatheter heart valve implantation. Future Cardiol 2021; 18:275-283. [PMID: 34875868 DOI: 10.2217/fca-2021-0105] [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] Open
Abstract
Transcatheter aortic valve implantation and implantation of other transcatheter heart valves, generally requires insertion of a temporary venous pacemaker. Implantation of a temporary venous pacemaker adds complexity, time and risk to the procedure. Guidewire modification to allow pacing is increasingly popular, however it requires technical expertise and provides unipolar pacing resulting in high thresholds and potential capture loss. The Wattson temporary pacing guidewire is a novel device which offers guidewire support for valve delivery and concomitant bipolar pacing. It may offer a safe and effective solution to guidewire pacing for transcatheter aortic valve implantation and other transcatheter heart valve implantations. Herein, we review the literature surrounding left ventricular guidewire pacing along with the features and clinical data of the Wattson wire.
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Affiliation(s)
- James Carey
- St James's Hospital, James St, Dublin 8, Ireland
| | | | | | - Mark Hensey
- St James's Hospital, James St, Dublin 8, Ireland
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78
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Jiménez-Quevedo P, Nombela-Franco L, Muñoz-García E, Del Valle-Fernández R, Trillo R, de la Torre Hernández JM, Salido L, Elizaga J, Ojeda S, Sánchez Gila J, García Del Blanco B, Berenguer A, Lasa-Larraya G, Urbano Carrillo C, Albarrán A, Ruiz-Salmerón R, Moreu J, Gheorghe L, Arzamendi D, Yanes-Bowden G, Díaz J, Pérez-Moreiras I, Artaiz M, Vaquerizo B, Cruz-González I, Ruiz-Quevedo V, Blanco-Mata R, Baz JA, Villa M, Ortiz de Salazar Á, Tascón-Quevedo V, Casellas S, Moreno R. Early clinical outcomes after transaxillary versus transfemoral TAVI. Data from the Spanish TAVI registry. ACTA ACUST UNITED AC 2021; 75:479-487. [PMID: 34711513 DOI: 10.1016/j.rec.2021.07.019] [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: 03/25/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Transaxillary access (TXA) has become the most widely used alternative to transfemoral access (TFA) in patients undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to compare total in-hospital and 30-day mortality in patients included in the Spanish TAVI registry who were treated by TXA or TFA access. METHODS We analyzed data from patients treated with TXA or TFA and who were included in the TAVI Spanish registry. In-hospital and 30-day events were defined according to the recommendations of the Valve Academic Research Consortium. The impact of the access route was evaluated by propensity score matching according to clinical and echocardiogram characteristics. RESULTS A total of 6603 patients were included; 191 (2.9%) were treated via TXA and 6412 via TFA access. After adjustment (n=113 TXA group and n=3035 TFA group) device success was similar between the 2 groups (94%, TXA vs 95%, TFA; P=.95). However, compared with the TFA group, the TXA group showed a higher rate of acute myocardial infarction (OR, 5.3; 95%CI, 2.0-13.8); P=.001), renal complications (OR, 2.3; 95%CI, 1.3-4.1; P=.003), and pacemaker implantation (OR, 1.6; 95%CI, 1.01-2.6; P=.03). The TXA group also had higher in-hospital and 30-day mortality rates (OR, 2.2; 95%CI, 1.04-4.6; P=.039 and OR, 2.3; 95%CI, 1.2-4.5; P=.01, respectively). CONCLUSIONS Compared with ATF, TXA is associated with higher total mortality, both in-hospital and at 30 days. Given these results, we believe that TXA should be considered only in those patients who are not suitable candidates for TFA.
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Affiliation(s)
- Pilar Jiménez-Quevedo
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
| | - Luis Nombela-Franco
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Erika Muñoz-García
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - Ramiro Trillo
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - José M de la Torre Hernández
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Luisa Salido
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jaime Elizaga
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Joaquín Sánchez Gila
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Alberto Berenguer
- Servicio de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Agustín Albarrán
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - José Moreu
- Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Livia Gheorghe
- Servicio de Cardiología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Dabit Arzamendi
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Geoffrey Yanes-Bowden
- Servicio de Cardiología, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - José Díaz
- Servicio de Cardiología, Hospital Universitario Juan Ramón Jimenez, Huelva, Spain
| | | | - Miguel Artaiz
- Servicio de Cardiología, Clínica Universitaria de Navarra, Pamplona, Navarra, Spain
| | - Beatriz Vaquerizo
- Servicio de Cardiología, Hospital del Mar, Instituto de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Ignacio Cruz-González
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | | | | | - José Antonio Baz
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Manuel Villa
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Valentín Tascón-Quevedo
- Servicio de Cirugía Cardiaca, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Sandra Casellas
- Servicio de Cirugía Cardiaca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Raúl Moreno
- Servicio de Cardiología, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Madrid, Spain
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Hasimbegovic E, Papp L, Grahovac M, Krajnc D, Poschner T, Hasan W, Andreas M, Gross C, Strouhal A, Delle-Karth G, Grabenwöger M, Adlbrecht C, Mach M. A Sneak-Peek into the Physician's Brain: A Retrospective Machine Learning-Driven Investigation of Decision-Making in TAVR versus SAVR for Young High-Risk Patients with Severe Symptomatic Aortic Stenosis. J Pers Med 2021; 11:jpm11111062. [PMID: 34834414 PMCID: PMC8622882 DOI: 10.3390/jpm11111062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/10/2021] [Accepted: 10/16/2021] [Indexed: 12/22/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has rapidly become a viable alternative to the conventional isolated surgical aortic valve replacement (iSAVR) for treating severe symptomatic aortic stenosis. However, data on younger patients is scarce and a gap exists between data-based recommendations and the clinical use of TAVR. In our study, we utilized a machine learning (ML) driven approach to model the complex decision-making process of Heart Teams when treating young patients with severe symptomatic aortic stenosis with either TAVR or iSAVR and to identify the relevant considerations. Out of the considered factors, the variables most prominently featured in our ML model were congestive heart failure, established risk assessment scores, previous cardiac surgeries, a reduced left ventricular ejection fraction and peripheral vascular disease. Our study demonstrates a viable application of ML-based approaches for studying and understanding complex clinical decision-making processes.
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Affiliation(s)
- Ena Hasimbegovic
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (T.P.); (M.A.); (C.G.)
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Laszlo Papp
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria; (L.P.); (D.K.)
| | - Marko Grahovac
- Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Denis Krajnc
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria; (L.P.); (D.K.)
| | - Thomas Poschner
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (T.P.); (M.A.); (C.G.)
| | - Waseem Hasan
- Faculty of Medicine, Imperial College London, London SW7 2AZ, UK;
| | - Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (T.P.); (M.A.); (C.G.)
| | - Christoph Gross
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (T.P.); (M.A.); (C.G.)
- Vienna North Hospital—Floridsdorf Clinic and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, 1090 Vienna, Austria
| | - Andreas Strouhal
- Department of Cardiovascular Surgery, Hospital Hietzing and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, 1090 Vienna, Austria; (A.S.); (G.D.-K.); (C.A.)
| | - Georg Delle-Karth
- Department of Cardiovascular Surgery, Hospital Hietzing and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, 1090 Vienna, Austria; (A.S.); (G.D.-K.); (C.A.)
| | - Martin Grabenwöger
- Faculty of Medicine, Sigmund Freud University, 1090 Vienna, Austria;
- Imed19—Internal Medicine Doebling, 1090 Vienna, Austria
| | - Christopher Adlbrecht
- Department of Cardiovascular Surgery, Hospital Hietzing and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, 1090 Vienna, Austria; (A.S.); (G.D.-K.); (C.A.)
- Imed19—Internal Medicine Doebling, 1090 Vienna, Austria
| | - Markus Mach
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (T.P.); (M.A.); (C.G.)
- Department of Cardiovascular Surgery, Hospital Hietzing and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, 1090 Vienna, Austria; (A.S.); (G.D.-K.); (C.A.)
- Correspondence: ; Tel.: +43-40400-52620
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80
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Hughes E, Grossman PM. Transcatheter Aortic Valve Replacement with a Self-Expanding Prosthesis. Interv Cardiol Clin 2021; 10:441-453. [PMID: 34593108 DOI: 10.1016/j.iccl.2021.06.004] [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: 11/26/2022]
Abstract
The self-expanding transcatheter heart valve (Medtronic Cardiovascular Corevalve and Evolut) is a supra-annular, trileafet porcine pericardial valves on a diamond lattice nickel-titanium alloy frame. The TAVR device has undergone significant improvements in design and procedural techniques to further increase safety, efficacy, and durability since they it was first released. Unique design characteristics, as well as patient and procedural factors, favor self-expanding over balloon-expandable prostheses in certain situations. The self-expanding transcatheter heart valve has proven to be an excellent option for severe aortic stenosis patients with any level of surgical risk and preliminary data suggest a comparable durability to surgical tissue valves.
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Affiliation(s)
- Erinn Hughes
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Frankel Cardiovascular Center, 1500 East Medical Center Drive, SPC 5869, Ann Arbor, MI 48109-5869, USA
| | - Paul Michael Grossman
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Frankel Cardiovascular Center, 1500 East Medical Center Drive, SPC 5869, Ann Arbor, MI 48109-5869, USA.
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81
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Cha MJ, Oh GC, Ki YJ, Chang M, Kang J, Han JK, Yang HM, Park KW, Kang HJ, Koo BK, Oh S, Kim HS. Time Course and Risk Factors of New-Onset Complete Atrioventricular Block After Transcatheter Aortic Valve Implantation. Int Heart J 2021; 62:988-996. [PMID: 34544968 DOI: 10.1536/ihj.20-824] [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: 11/18/2022]
Abstract
In this study, we aimed to investigate the time course of new-onset complete atrioventricular block (CAVB) and its reversibility after transcatheter aortic valve implantation (TAVI). We analyzed 206 consecutive patients without baseline CAVB who underwent successful TAVI. The incidence of new-onset CAVB was determined to be 12.6% (26/206). Among these patients, 14 recovered from CAVB within 2 weeks (6.8%, 14/206), while the remaining 12 (5.8%, 12/206) underwent permanent pacemaker (PPM) insertion. Among the 12 patients who received the PPM, 4 were able to recover from CAVB within 4 months. Thus, only 8 among 206 patients (3.8%) showed persistent CAVB. Early-onset CAVB on the day of the procedure was the strongest predictor of PPM implantation (OR = 127). The electrocardiographic changes that occurred after TAVI were mostly recovered after 1 month. The most critical procedural factor that predicts CAVB and PPM insertion is the deep implantation (>4 mm) of a big valve (oversizing index >5.9%). In conclusion, the incidence of CAVB after TAVI was estimated to be at 12.6%. Two-thirds of these patients recovered from CAVB within 3 days, resulting in a final rate of persistent CAVB of 4%. To prevent CAVB, we have to implant an appropriate valve type with an optimal size and depth.
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Affiliation(s)
- Myung-Jin Cha
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Gyu Chul Oh
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - You-Jeong Ki
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Mineok Chang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Jung-Kyu Han
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Han-Mo Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Hyun-Jae Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Seil Oh
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
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82
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McCalmont G, Durand E, Lauck S, Muir DF, Spence MS, Vasa-Nicotera M, Wood D, Saia F, Chatel N, Lüske CM, Kurucova J, Bramlage P, Frank D. Setting a benchmark for resource utilization and quality of care in patients undergoing transcatheter aortic valve implantation in Europe-Rationale and design of the international BENCHMARK registry. Clin Cardiol 2021; 44:1344-1353. [PMID: 34499383 PMCID: PMC8495089 DOI: 10.1002/clc.23711] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 12/19/2022] Open
Abstract
Background The use of transcatheter aortic valve implantation (TAVI) for treating aortic stenosis (AS) has increased exponentially in recent years. Despite the availability of clinical practice guidelines for the management of valvular heart disease, disparities in quality of care (QoC) for TAVI patients remain widespread across Europe. Tailored QoC measures will help to reduce resource utilization and improve patient outcomes without compromising patient safety. Using a clear set of QoC measures, the BENCHMARK registry aims to document the progress that can be achieved if such tailored QoC measures are implemented. Methods The BENCHMARK registry (BENCHMARK) is a non‐interventional, multicenter registry in patients with severe symptomatic AS undergoing TAVI with a 1‐ and 12‐months follow‐up. BENCHMARK will be conducted at 30 centers across Europe and will enroll a total of 2400 consecutive TAVI patients. Patients suffering from severe symptomatic AS who undergo TAVI with a balloon‐expandable transcatheter aortic valve will be included. The registry will comprise four phases: (1) a retrospective baseline evaluation phase; (2) an education phase; (3) an implementation phase; and (4) a prospective effect documentation phase (prospective phase). The registry's primary objectives are to reduce the length of hospital stay and accelerate the post‐procedural patient recovery pathway, but without compromising safety. The study started in April 2021 and has an estimated completion date of May 2023. Discussion BENCHMARK will establish QoC measures to reduce resource utilization, intensive care unit bed occupancy, and overall length of hospitalization with uncompromised patient safety post‐TAVI (ClinicalTrials.gov Identifier: NCT04579445). HighlightsThe BENCHMARK registry is a non‐interventional, multicenter international registry. A total of 2400 patients with severe AS will be enrolled at 30 European centers. The registry is designed to be partly retrospective and partly prospective. The BENCHMARK registry will help to improve TAVI QoC standards across Europe.
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Affiliation(s)
- Gemma McCalmont
- Cardiology Department, James Cook University Hospital, Middlesbrough, UK
| | - Eric Durand
- Department of Cardiology, FHU CARNAVAL, Normandie University, UNIROUEN, Rouen, France
| | - Sandra Lauck
- Center for Heart Valve Innovation, St Paul's Hospital, University of Vancouver, Vancouver, British Columbia, Canada
| | - Douglas F Muir
- Cardiology Department, James Cook University Hospital, Middlesbrough, UK
| | - Mark S Spence
- Cardiology Department, Royal Victoria Hospital, Belfast, UK
| | | | - David Wood
- Center for Heart Valve Innovation, St Paul's Hospital, University of Vancouver, Vancouver, British Columbia, Canada
| | - Francesco Saia
- Department of Cardiology, University of Bologna, Bologna, Italy
| | | | - Claudia M Lüske
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Derk Frank
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), University Clinical Center Schleswig-Holstein (UKSH), Kiel, Germany.,German Center for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Kiel, Germany
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83
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Jiménez-Quevedo P, Nombela-Franco L, Muñoz-García E, del Valle-Fernández R, Trillo R, de la Torre Hernández JM, Salido L, Elizaga J, Ojeda S, Sánchez Gila J, García del Blanco B, Berenguer A, Lasa-Larraya G, Urbano Carrillo C, Albarrán A, Ruiz-Salmerón R, Moreu J, Gheorghe L, Arzamendi D, Yanes-Bowden G, Díaz J, Pérez-Moreiras I, Artaiz M, Vaquerizo B, Cruz-González I, Ruiz-Quevedo V, Blanco-Mata R, Baz JA, Villa M, Ortiz de Salazar Á, Tascón-Quevedo V, Casellas S, Moreno R. Resultados clínicos tempranos tras el implante percutáneo de válvula aórtica por acceso transaxilar comparado con el acceso transfemoral. Datos del registro español de TAVI. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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84
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Aymond JD, Benn F, Williams CM, Bernard ML, Hiltbold AE, Khatib S, Polin GM, Rogers PA, Tafur Soto JD, Ramee SR, Parrino PE, Falterman JB, Al-Khatib SM, Morin DP. Epidemiology, evaluation, and management of conduction disturbances after transcatheter aortic valve replacement. Prog Cardiovasc Dis 2021; 66:37-45. [PMID: 34332660 DOI: 10.1016/j.pcad.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aortic stenosis is the most common valvulopathy requiring replacement by means of the surgical or transcatheter approach. Transcatheter aortic valve replacement (TAVR) has quickly become a viable and often preferred treatment strategy compared to surgical aortic valve replacement. However, transcatheter heart valve system deployment not infrequently injures the specialized electrical system of the heart, leading to new conduction disorders including high-grade atrioventricular block and complete heart block (CHB) necessitating permanent pacemaker implantation (PPI), which may lead to deleterious effects on cardiac function and patient outcomes. Additional conduction disturbances (e.g., new-onset persistent left bundle branch block, PR/QRS prolongation, and transient CHB) currently lack clearly defined management algorithms leading to variable strategies among institutions. This article outlines the current understanding of the pathophysiology, patient and procedural risk factors, means for further risk stratification and monitoring of patients without a clear indication for PPI, our institutional approach, and future directions in the management and evaluation of post-TAVR conduction disturbances.
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Affiliation(s)
- Joshua D Aymond
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Francis Benn
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Cody M Williams
- Ochsner Medical Center, New Orleans, LA, United States of America
| | | | - A Elise Hiltbold
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Sammy Khatib
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Glenn M Polin
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Paul A Rogers
- Ochsner Medical Center, New Orleans, LA, United States of America
| | | | - Stephen R Ramee
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - P Eugene Parrino
- Ochsner Medical Center, New Orleans, LA, United States of America
| | | | - Sana M Al-Khatib
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Daniel P Morin
- Ochsner Medical Center, New Orleans, LA, United States of America.
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85
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Rajah FT, Alaamiri AA, Mahmoodurrahman M, Alhowaish TS, Aldosari SF, Hussain AO, Masuadi EM, Arifi AA, Balgaith MA, Ayoub KM, Almutairi FQ, Alanazi HA. Incidence, predictors, and clinical outcomes of permanent pacemaker insertion following transcatheter aortic valve implantation in an Arab population. J Interv Card Electrophysiol 2021; 63:545-554. [PMID: 34427830 DOI: 10.1007/s10840-021-01039-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Conduction defects requiring permanent pacemaker insertion (PPI) are one of the most common complications after transcatheter aortic valve implantation (TAVI). The purpose of this study was to identify the incidence and predictors of this complication as well as to assess clinical outcomes of patients requiring PPI after TAVI in an Arab population. METHODS In this single-center, retrospective cohort analysis, all patients who underwent TAVI from 2010 to 2018 were reviewed; seventy-four independent variables were collected per patient, and multivariate analysis was performed to identify predictors. In-hospital outcomes were examined as well as 30-day and 1-year endpoints as defined by the Valve Academic Research Consortium-2. RESULTS There were 48 of 170 patients (28.2%) who required PPI within 30 days of TAVI. The median time from TAVI to PPI was 2 days (interquartile range: 0 to 5 days). Positive predictors of 30-day PPI were prior right bundle branch block (odds ratio [OR]: 4.10; 95% confidence interval [CI]: 0.37 to 0.79; p < 0.001), post-procedural development of new right bundle branch block (OR: 3.59; 95% CI: 1.07 to 12.03; p = 0.038), post-procedural development of new left bundle branch block (LBBB) (OR: 1.85; 95% CI: 1.21 to 2.84; p = 0.005), post-procedural prolongation of PR interval (OR: 1.02; 95% CI: 1.01 to 1.02; p < 0.001), and post-procedural QRS duration (OR: 1.01; 95% CI: 1.00 to 1.03; p = 0.02). However, post-procedural development of new LBBB no longer remained a significant predictor of PPI after excluding six patients with LBBB who underwent prophylactic PPI (p = 0.093). Negative predictors of 30-day PPI were the presence of diabetes (OR: 0.54; 95% CI: 037 to 0.79; p = 0.001), the use of prosthesis size 29 compared to 23 (OR: 0.55; 95% CI: 0.35 to 0.87; p = 0.010), and the use of prosthesis size 26 compared to 23 (OR: 0.31; 95% CI: 0.20 to 0.50; p < 0.001). PPI was associated with longer median hospital stay, but the result was borderline significant after multivariate adjustment (19 vs. 14 days; p = 0.052). There was no statistically significant difference in 30-day and 1-year clinical outcomes. CONCLUSION One-third of patients required PPI after TAVI. Several risk factors can identify patients at risk for PPI particularly pre-existing right bundle branch block. Further studies are needed to assess the association between PPI and negative clinical outcomes.
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Affiliation(s)
- Fares Tofailahmed Rajah
- Department of Medicine, King Abdulaziz Medical City - Riyadh, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulkhaliq Ali Alaamiri
- Department of Medicine, King Abdulaziz Medical City - Riyadh, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,College of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | - Thamer Saad Alhowaish
- College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shaya Fahad Aldosari
- College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulwahab Omer Hussain
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Electrophysiology, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Emad Mohammad Masuadi
- College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed A Arifi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Cardiac Surgery, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Ali Balgaith
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Interventional Cardiology, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Kamal Mohammed Ayoub
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Interventional Cardiology, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Fawaz Q Almutairi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Interventional Cardiology, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Haitham Ahmed Alanazi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. .,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,Department of Electrophysiology, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia. .,Department of Cardiac Sciences, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, P.O. Box: 22490, 1413, Riyadh, Saudi Arabia.
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86
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Three-year outcome after transcatheter aortic valve implantation: Comparison of a restrictive versus a liberal strategy for pacemaker implantation. Heart Rhythm 2021; 18:2040-2047. [PMID: 34400310 DOI: 10.1016/j.hrthm.2021.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Conduction disturbances after transcatheter aortic valve implantation (TAVI) are common, heterogeneous, and frequently result in permanent pacemaker implantation (PPI). Pacemaker therapy with a high rate of right ventricular pacing is associated with heart failure, hospitalizations, and reduced quality of life. OBJECTIVE The purpose of this study was to compare medium-term outcomes between PPI implantation strategies, as choosing the right indication for PPI is still an area of uncertainty and information on outcomes of PPI regimens beyond 1 year is rare. METHODS We compared outcomes after 3 years between a restrictive PPI strategy, in which the lowest threshold for PPI was left bundle branch block (LBBB) (QRS >120 ms) with the presence of new atrioventricular block (PQ >200 ms), and a liberal PPI regimen, in which PPI already was performed in patients with new-onset LBBB. RESULTS Between January 2014 and December 2016, TAVI was performed in 884 patients at our center. Of these, 383 consecutive, pacemaker-naive patients underwent TAVI with the liberal PPI strategy and subsequently 384 with the restrictive strategy. The restrictive strategy significantly reduced the percentage of patients undergoing PPI before discharge (17.2% vs 38.1%; P <.001). The incidence of the primary endpoint (all-cause-mortality and hospitalization for heart failure) after 3 years was similar in both groups (30.7% vs 35.2%; P = .242), as was all-cause-mortality (26.6% vs 29.2%; P = .718). Overall, patients who required PPI post-TAVI had significantly more hospitalizations due to heart failure (14.8% vs 7.8%; P = .004). CONCLUSION A restrictive PPI strategy after TAVI reduces PPI significantly and is safe in medium-term follow-up over 3 years.
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87
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Ravaux JM, Di Mauro M, Vernooy K, Kats S, Mariani S, Ronco D, Actis Dato G, Simons J, Hof AWV, Maessen JG, Lorusso R. Permanent pacemaker implantation following transcatheter aortic valve implantation using self-expandable, balloon-expandable, or mechanically expandable devices: a network meta-analysis. Europace 2021; 23:1998-2009. [PMID: 34379760 DOI: 10.1093/europace/euab209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/17/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Permanent pacemaker implantation (PPI) still limits the expansion of indications for transcatheter aortic valve implantation (TAVI). Comparison between different systems remains scarce. We aimed to determine the impact of the device type used on post-TAVI PPI. METHODS AND RESULTS A systematic literature review was performed to identify studies reporting the use of balloon-expandable valve (BEV), self-expandable valve (SEV), and mechanically expandable valve (MEV) and post-TAVI PPI. A network meta-analysis was used to compare TAVI mechanisms (Analysis A) and transcatheter heart valves (Analysis B) with respect to post-TAVI PPI. Analysis A included 40 181 patients with a pooled PPI rate of 19.2% in BEV, 24.7% in SEV, and 34.8% in MEV. Balloon-expandable valve showed lower risk compared to either SEV or MEV and SEV demonstrated lower risk for PPI than MEV. Implantation of BEV was associated with 39% and 62% lower PPI rate with respect to SEV and MEV. Implantation of SEV was associated with 38% lower PPI rate with respect to MEV. Analysis B included 36.143 patients with the lowest pooled PPI rate of 9.6% for Acurate Neo or others, and the highest pooled PPI rate of 34.3% for Lotus. CoreValve, Evolut Portico, and Lotus influenced significantly PPI rate, while Sapien group did not. CONCLUSION Implantation of BEV and also SEV were associated with lower post-TAVI PPI rate, while MEV were associated with higher post-TAVI PPI. Patient tailored-approach including devices characteristics may help to reduce post-TAVI PPI and to allow TAVI to take the leap towards extension of use in younger patients. PROSPERO NUMBER CRD42021238671.
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Affiliation(s)
- Justine M Ravaux
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Michele Di Mauro
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
| | - Suzanne Kats
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Silvia Mariani
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Daniele Ronco
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.,Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giulia Actis Dato
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Jorik Simons
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Arnoud W Van't Hof
- Department of Cardiology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jos G Maessen
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Roberto Lorusso
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
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88
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Minha S, Yarkoni Y, Segev A, Finkelstein A, Danenberg H, Fefer P, Orvin K, Steinvil A, Maor E, Beinart R, Rosso R, Golovchiner G, Kornowski R, Guetta V, Barbash IM. Comparison of permanent pacemaker implantation rate after first and second generation of transcatheter aortic valve implantation-A retrospective cohort study. Catheter Cardiovasc Interv 2021; 98:E990-E999. [PMID: 34347381 DOI: 10.1002/ccd.29891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/01/2021] [Accepted: 07/17/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study aimed to compare permanent pacemaker implantation (PPMI) rates among patients undergoing Trans-catheter Aortic Valve Implantation (TAVI) with first generation (G1) versus second generation (G2) valves and the impact of PPMI on long-term mortality. BACKGROUND PPMI is a known adverse event after TAVI. Recently, two novel iterations of valve designs of both the balloon expandable valves (BEV) and self-expanding valves (SEV) were introduced as a second generation valves. METHODS All patients included in the Israeli multicenter TAVI registry were grouped according to valve type (BEV vs. SEV) and generation (G1 vs. G2). A comparison was made for clinical and outcome indices of patients undergoing TAVI with G1 and G2 in each of the valve systems. RESULTS A total of 1377 patients were included. The incidence of PPMI did not differ between G1-BEV versus G2-BEV (15.3% vs. 17.4%; p = 0.598) nor between G1-SEV versus G2-SEV (23.4% vs. 20.3%; p = 0.302). Depth of implantation and complete right bundle branch block were independently associated with PPMI post-TAVI in both valve systems. PPMI was not associated with an increased risk for 2-year mortality. CONCLUSIONS The incidence of PPMI remains a relevant adverse event post-TAVI even when the newer generation valves are used. Since the predictors for PPMI are well established, a standardized approach for the management of conduction disorders is much needed.
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Affiliation(s)
- Sa'ar Minha
- Cardiology Department, Shamir Medical Center, Be'er Yaakov, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Yuval Yarkoni
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Amit Segev
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Ariel Finkelstein
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Haim Danenberg
- Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Paul Fefer
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Katia Orvin
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel
| | - Arie Steinvil
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Elad Maor
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Beinart
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Raphael Rosso
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gregory Golovchiner
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel
| | - Ran Kornowski
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel
| | - Victor Guetta
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Israel M Barbash
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
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89
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Bui HT, Khair N, Yeats B, Gooden S, James SP, Dasi LP. Transcatheter Heart Valves: A Biomaterials Perspective. Adv Healthc Mater 2021; 10:e2100115. [PMID: 34038627 DOI: 10.1002/adhm.202100115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/23/2021] [Indexed: 11/11/2022]
Abstract
Heart valve disease is prevalent throughout the world, and the number of heart valve replacements is expected to increase rapidly in the coming years. Transcatheter heart valve replacement (THVR) provides a safe and minimally invasive means for heart valve replacement in high-risk patients. The latest clinical data demonstrates that THVR is a practical solution for low-risk patients. Despite these promising results, there is no long-term (>20 years) durability data on transcatheter heart valves (THVs), raising concerns about material degeneration and long-term performance. This review presents a detailed account of the materials development for THVRs. It provides a brief overview of THVR, the native valve properties, the criteria for an ideal THV, and how these devices are tested. A comprehensive review of materials and their applications in THVR, including how these materials are fabricated, prepared, and assembled into THVs is presented, followed by a discussion of current and future THVR biomaterial trends. The field of THVR is proliferating, and this review serves as a guide for understanding the development of THVs from a materials science and engineering perspective.
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Affiliation(s)
- Hieu T. Bui
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Nipa Khair
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Breandan Yeats
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Shelley Gooden
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Susan P. James
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
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90
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Sammour Y, Krishnaswamy A, Kumar A, Puri R, Tarakji KG, Bazarbashi N, Harb S, Griffin B, Svensson L, Wazni O, Kapadia SR. Incidence, Predictors, and Implications of Permanent Pacemaker Requirement After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2021; 14:115-134. [PMID: 33478630 DOI: 10.1016/j.jcin.2020.09.063] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/04/2020] [Accepted: 09/29/2020] [Indexed: 12/29/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is a safe and feasible alternative to surgery in patients with symptomatic severe aortic stenosis regardless of the surgical risk. Conduction abnormalities requiring permanent pacemaker (PPM) implantation remain a common finding after TAVR due to the close proximity of the atrioventricular conduction system to the aortic root. High-grade atrioventricular block and new onset left bundle branch block (LBBB) are the most commonly reported conduction abnormalities after TAVR. The overall rate of PPM implantation after TAVR varies and is related to pre-procedural and intraprocedural factors. The available literature regarding the impact of conduction abnormalities and PPM requirement on morbidity and mortality is still conflicting. Pre-procedural conduction abnormalities such as right bundle branch block and LBBB have been linked with increased PPM implantation and mortality after TAVR. When screening patients for TAVR, heart teams should be aware of various anatomical and pathophysiological conditions that make patients more susceptible to increased risk of conduction abnormalities and PPM requirement after the procedure. This is particularly important as TAVR has been recently approved for patients with low surgical risk. The purpose of this review is to discuss the incidence, predictors, impact, and management of the various conduction abnormalities requiring PPM implantation in patients undergoing TAVR.
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Affiliation(s)
- Yasser Sammour
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA; Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Arnav Kumar
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rishi Puri
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Khaldoun G Tarakji
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Najdat Bazarbashi
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Serge Harb
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Brian Griffin
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Lars Svensson
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Oussama Wazni
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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91
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[Influence of deep implantation on conduction disturbances after transcatheter aortic valve implantation]. Herzschrittmacherther Elektrophysiol 2021; 32:371-379. [PMID: 34259933 PMCID: PMC8413173 DOI: 10.1007/s00399-021-00784-1] [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: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND Conduction disturbances are common complications of transcatheter aortic valve implantation (TAVI). One influencing factor is implantation depth (ID) of the TAVI prosthesis. Since this should be standardized, a differentiated consideration of ID is necessary. OBJECTIVE Examination of the impact of ID at different anatomical regions of the left ventricular outflow tract on new conduction disturbances, new permanent pacemaker implantation (PPI) and survival. MATERIALS AND METHODS The retrospective cohort study included 420 patients who underwent transfemoral TAVI with new-generation devices, including 352 patients without pre-existing pacemakers, for analyses on new pacemaker implantation. Of them, 46 patients underwent PPI. ID at non- (NCC) and left-coronary cusp (LCC) were measured using fluoroscopy after valve implantation. Deep ID was defined as the 4th quartile of each prosthesis' ID. Survival was determined from the two-year follow-up. RESULTS AND CONCLUSIONS Deep ID was associated with higher PPI rate only at NCC (p = 0.013). At LCC deep ID resulted in more frequent permanent left bundle branch block (p = 0.014). DI, preexisting pacemaker or new PPI did not affect 2‑year survival. No patients with new PPI suffered moderate to severe paravalvular leak. ID at NCC could be a predictor for PPI after TAVI. A detailed consideration of ID in intervention planning might predict outcome after TAVI and common complications. PPI after TAVI and deep ID at NCC and LCC can be considered safe regarding survival in absence of moderate-to-severe paravalvular leak.
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92
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Ciardetti N, Ciatti F, Nardi G, Di Muro FM, Demola P, Sottili E, Stolcova M, Ristalli F, Mattesini A, Meucci F, Di Mario C. Advancements in Transcatheter Aortic Valve Implantation: A Focused Update. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:711. [PMID: 34356992 PMCID: PMC8306774 DOI: 10.3390/medicina57070711] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 01/07/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) has become the leading technique for aortic valve replacement in symptomatic patients with severe aortic stenosis with conventional surgical aortic valve replacement (SAVR) now limited to patients younger than 65-75 years due to a combination of unsuitable anatomies (calcified raphae in bicuspid valves, coexistent aneurysm of the ascending aorta) and concerns on the absence of long-term data on TAVI durability. This incredible rise is linked to technological evolutions combined with increased operator experience, which led to procedural refinements and, accordingly, to better outcomes. The article describes the main and newest technical improvements, allowing an extension of the indications (valve-in-valve procedures, intravascular lithotripsy for severely calcified iliac vessels), and a reduction of complications (stroke, pacemaker implantation, aortic regurgitation).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Clinica Medica, Room 124, Careggi University Hospital, Largo Brambilla 3, 50139 Florence, Italy; (N.C.); (F.C.); (G.N.); (F.M.D.M.); (P.D.); (E.S.); (M.S.); (F.R.); (A.M.); (F.M.)
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93
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Ullah W, Zahid S, Zaidi SR, Sarvepalli D, Haq S, Roomi S, Mukhtar M, Khan MA, Gowda SN, Ruggiero N, Vishnevsky A, Fischman DL. Predictors of Permanent Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement - A Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e020906. [PMID: 34259045 PMCID: PMC8483489 DOI: 10.1161/jaha.121.020906] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background As transcatheter aortic valve replacement (TAVR) technology expands to healthy and lower‐risk populations, the burden and predictors of procedure‐related complications including the need for permanent pacemaker (PPM) implantation needs to be identified. Methods and Results Digital databases were systematically searched to identify studies reporting the incidence of PPM implantation after TAVR. A random‐ and fixed‐effects model was used to calculate unadjusted odds ratios (OR) for all predictors. A total of 78 studies, recruiting 31 261 patients were included in the final analysis. Overall, 6212 patients required a PPM, with a mean of 18.9% PPM per study and net rate ranging from 0.16% to 51%. The pooled estimates on a random‐effects model indicated significantly higher odds of post‐TAVR PPM implantation for men (OR, 1.16; 95% CI, 1.04–1.28); for patients with baseline mobitz type‐1 second‐degree atrioventricular block (OR, 3.13; 95% CI, 1.64–5.93), left anterior hemiblock (OR, 1.43; 95% CI, 1.09–1.86), bifascicular block (OR, 2.59; 95% CI, 1.52–4.42), right bundle‐branch block (OR, 2.48; 95% CI, 2.17–2.83), and for periprocedural atriorventricular block (OR, 4.17; 95% CI, 2.69–6.46). The mechanically expandable valves had 1.44 (95% CI, 1.18–1.76), while self‐expandable valves had 1.93 (95% CI, 1.42–2.63) fold higher odds of PPM requirement compared with self‐expandable and balloon‐expandable valves, respectively. Conclusions Male sex, baseline atrioventricular conduction delays, intraprocedural atrioventricular block, and use of mechanically expandable and self‐expanding prosthesis served as positive predictors of PPM implantation in patients undergoing TAVR.
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Affiliation(s)
- Waqas Ullah
- Thomas Jefferson University Hospitals Philadelphia PA
| | | | | | | | | | | | - Maryam Mukhtar
- University Hospitals of Leicester NHS Trust Leicester UK
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94
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Sammour Y, Sato K, Kumar A, Gajulapalli RD, Lak H, Chawla S, Banerjee K, Kaur M, Patel J, Incognito C, Svensson L, Popovic Z, Tarakji K, Wazni O, Reed GW, Yun J, Puri R, Krishnaswamy A, Kapadia SR. Impact of baseline conduction abnormalities on outcomes after transcatheter aortic valve replacement with SAPIEN-3. Catheter Cardiovasc Interv 2021; 98:E127-E138. [PMID: 33010100 DOI: 10.1002/ccd.29309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 09/21/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Baseline conduction abnormalities are known risk factors for permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR). We sought to determine the impact of baseline right bundle branch block (RBBB), left bundle branch block (LBBB), left anterior hemiblock (LAHB), first-degree atrioventricular block (AVB) and atrial fibrillation/flutter (AF) on TAVR outcomes. METHODS Consecutive patients who underwent transfemoral TAVR with SAPIEN-3 (S3) were included. We excluded patients with prior PPM, nontransfemoral access or valve-in-valve. RESULTS Among 886 patients, baseline RBBB was seen in 15.9%, LBBB in 6.3%, LAHB in 6.2%, first-degree AVB in 26.3% and AF in 37.5%. The rate of 30-day PPM was 10.1%. Baseline RBBB (OR 4.005; 95% CI 2.386-6.723; p < .001) and first-degree AVB (OR 1.847; 95% CI 1.133-3.009; p = .014) were independent predictors of 30 day PPM. LAHB also resulted in higher PPM rates but only in unadjusted analysis (21.8% vs. 9.4%; p = .003). Baseline LBBB and AF were associated with lower left ventricular ejection fraction (LVEF) at both baseline and 1 year after TAVR. However, Δ LVEF over time were noted to be similar with baseline LBBB (1.8% vs. 1.4%; p = .809) and AF (1.1% vs. 1.7%; p = .458). Moreover, baseline AF was also associated with higher stroke/transient ischemic attack (TIA) at 1 year (4.4% vs. 1.8%; p = .019), 1-year major adverse cardiac and cerebrovascular events (MACCE) (19.5% vs. 13.3%; p = .012) and 2 year mortality (23.5% vs. 15.2%; p = .016). None of the other baseline conduction defects affected long-term mortality or MACCE. CONCLUSION In our S3 TAVR population, baseline RBBB and first-degree AVB predicted higher PPM risk. Prior LBBB and AF were associated with lower LVEF at both baseline and 1 year. Lastly, preexisting AF was associated with higher rates of mortality, stroke/TIA, and MACCE.
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Affiliation(s)
- Yasser Sammour
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kimi Sato
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Arnav Kumar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rama Dilip Gajulapalli
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Hassan Lak
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sanchit Chawla
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kinjal Banerjee
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Manpreet Kaur
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jay Patel
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Cameron Incognito
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Lars Svensson
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Zoran Popovic
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Khaldoun Tarakji
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Oussama Wazni
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - James Yun
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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95
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Weferling M, Liebetrau C, Renker M, Fischer-Rasokat U, Choi YH, Hamm CW, Kim WK. Right bundle branch block is not associated with worse short- and mid-term outcome after transcatheter aortic valve implantation. PLoS One 2021; 16:e0253332. [PMID: 34133470 PMCID: PMC8208572 DOI: 10.1371/journal.pone.0253332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is the standard treatment option for patients with severe aortic stenosis (AS) at intermediate or high surgical risk. Preexisting right bundle branch block (RBBB) is a strong predictor of new pacemaker implantation (PPM) after TAVI, and previous data indicate a worse short- and long-term outcome of patients. The aim of this study was to investigate whether preexisting RBBB has an effect on the short- and mid-term outcome of patients undergoing TAVI in a German high-volume TAVI center. Methods For the present retrospective analysis, a total of 1,891 patients with native severe AS with successful TAVI without preexisting PPM were included. The primary endpoint was all-cause mortality after 30 days and 12 months. Baseline RBBB was present in 190 (10.1%) of cases. Results Patients with preexisting RBBB had a considerably higher rate of new PPM after TAVI compared with patients without RBBB (87/190 [45.8%] vs. 219/1,701 [12.9%]; p<0.001). RBBB had no impact on all-cause mortality at 30 days (2.1% vs. 2.7%; p = 0.625) and at 12 months (14.4% vs. 13.6%; p = 0.765). Further stratification according to the presence of new PPM showed a difference in mid-term survival rates between the four groups, with the worst outcome for patients without RBBB and new PPM (log rank p = 0.024). However, no difference in mid-term cardiovascular survival was found. Conclusion Preexisting RBBB is a common finding in patients with severe AS undergoing TAVI and is associated with considerably higher PPM rates but not with worse short- and mid-term outcome.
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Affiliation(s)
- Maren Weferling
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Berlin, Germany
- * E-mail:
| | - Christoph Liebetrau
- Cardioangiological Center Bethanien (CCB), Department of Cardiology, Agaplesion Bethanien Hospital, Frankfurt, Germany
| | - Matthias Renker
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
- Kerckhoff Heart and Thorax Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | | | - Yeoung-Hoon Choi
- Kerckhoff Heart and Thorax Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | - Christian W. Hamm
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Berlin, Germany
- Department of Cardiology, University Hospital of Giessen, Giessen, Germany
| | - Won-Keun Kim
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
- Kerckhoff Heart and Thorax Center, Department of Cardiac Surgery, Bad Nauheim, Germany
- Department of Cardiology, University Hospital of Giessen, Giessen, Germany
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96
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Nicolas J, Guedeney P, Claessen BE, Mehilli J, Petronio AS, Sartori S, Lefèvre T, Presbitero P, Capranzano P, Iadanza A, Cao D, Chiarito M, Goel R, Roumeliotis A, Chandiramani R, Chen S, Sardella G, Van Mieghem NM, Sorrentino S, Meliga E, Tchétché D, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail GW, Ferrer-Gracia MC, Naber C, Kievit PC, Baber U, Sharma SK, Morice MC, Dangas GD, Chandrasekhar J, Chieffo A, Mehran R. Incidence, predictors and clinical impact of permanent pacemaker insertion in women following transcatheter aortic valve implantation: Insights from a prospective multinational registry. Catheter Cardiovasc Interv 2021; 98:E908-E917. [PMID: 34117817 DOI: 10.1002/ccd.29807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 02/03/2021] [Accepted: 06/05/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To describe the incidence, predictors, and clinical impact of permanent pacemaker insertion (PPI) following transcatheter aortic valve replacement (TAVR) in women. BACKGROUND Data on pacemaker insertion complicating TAVR in women are scarce. METHODS The Women's International Transcatheter Aortic Valve implantation (WIN-TAVI) is a prospective registry evaluating the safety and efficacy of TAVR in women. We included patients without preprocedural pacemakers and divided them into two groups: (1) PPI and (2) no-PPI. We identified PPI predictors using logistic regression and studied its clinical impact on the Valve Academic Research Consortium (VARC)-2 efficacy and safety endpoints. RESULTS Out of 1019 patients, 922 were included in the analysis. Post-TAVR PPI occurred in 132 (14.3%) patients. Clinical and procedural characteristics were similar in both groups. Pre-existing right bundle branch block (RBBB) was associated with a high risk of post-TAVR PPI (OR 3.62, 95% CI 1.85-7.06, p < 0.001), while implantation of balloon-expandable prosthesis was associated with a lower risk (OR 0.47, 95% CI 0.30-0.74, p < 0.001). Post-TAVR PPI prolonged in-hospital stay by a median of 2 days (11 [9-16] days in PPI vs. 9 [7-14] days in no-PPI, p = 0.005), yet risks of VARC-2 efficacy and safety endpoints at 1 year were similar in both groups (adj HR 0.95, 95% CI 0.60-1.52, p = 0.84 and adj HR 1.22, 95% CI 0.83-1.79, p = 0.31, respectively). CONCLUSION Pacemaker implantation following TAVR is frequent among women and is associated with pre-existing RBBB and valve type. PPI prolongs hospital stay, albeit without any significant impact on 1-year outcomes.
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Affiliation(s)
- Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paul Guedeney
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Cardiology, Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Bimmer E Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julinda Mehilli
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University and German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | | | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thierry Lefèvre
- Department of Cardiology, Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | | | | | - Alessandro Iadanza
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ridhima Goel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anastasios Roumeliotis
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rishi Chandiramani
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Siyan Chen
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gennaro Sardella
- Department of Cardiology, Policlinico Umberto I,"Sapienza" University of Rome, Rome, Italy
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Sabato Sorrentino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emanuele Meliga
- Department of Cardiology, Mauriziano Umberto I Hospital, Turin, Italy
| | - Didier Tchétché
- Department of Cardiology, Groupe CardioVasculaire Interventional, Clinique Pasteur, Toulouse, France
| | - Nicolas Dumonteil
- Department of Cardiology, Groupe CardioVasculaire Interventional, Clinique Pasteur, Toulouse, France
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Daniela Trabattoni
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Ghada W Mikhail
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | | | - Christoph Naber
- Department of Cardiology, Contilia Heart and Vascular Centre, Essen, Germany
| | - Peter C Kievit
- Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marie-Claude Morice
- Department of Cardiology, Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jaya Chandrasekhar
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alaide Chieffo
- Department of Cardiology, IRCCS San Raffael Hospital, Segrate, Italy
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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97
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Crea F. The central role of amygdala in stress-related cardiac diseases and an update on long-COVID. Eur Heart J 2021; 42:1813-1817. [PMID: 33990122 DOI: 10.1093/eurheartj/ehab255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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98
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Coccia M. Evolution of technology in replacement of heart valves: Transcatheter aortic valves, a revolution for management of valvular heart diseases. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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99
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Ravaux JM, Di Mauro M, Vernooy K, Van't Hof AW, Veenstra L, Kats S, Maessen JG, Lorusso R. One-year pacing dependency after pacemaker implantation in patients undergoing transcatheter aortic valve implantation: Systematic review and meta-analysis. JTCVS OPEN 2021; 6:41-55.e15. [PMID: 36003550 PMCID: PMC9390410 DOI: 10.1016/j.xjon.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 12/04/2022]
Abstract
Objectives Atrioventricular conductions disturbances, requiring permanent pacemaker implantation (PPI), represent a potential complication after transcatheter aortic valve implantation (TAVI), However, little is known about the pacemaker dependency after PPI in this patient setting. This systematic review analyses the incidence of PPI, the short-term (1-year) pacing dependency, and predictors for such a state after TAVI. Methods We performed a systematic search in PUBMED, EMBASE, and MEDLINE to identify potentially relevant literature investigating PPI requirement and dependency after TAVI. Study data, patients, and procedural characteristics were extracted. Odds ratio (OR) with 95% confidence intervals were extracted. Results Data from 23 studies were obtained that included 18,610 patients. The crude incidence of PPI after TAVI was 17% (range, 8.8%-32%). PPI occurred at a median time of 3.2 days (range, 0-30 days). Pacing dependency at 1-year was 47.5% (range, 7%-89%). Self-expandable prosthesis (pooled OR was 2.14 [1.15-3.96]) and baseline right bundle branch block (pooled OR was 2.01 [1.06-3.83]) showed 2-fold greater risk to maintain PPI dependency at 1 year after TAVI. Conclusions Although PPI represents a rather frequent event after TAVI, conduction disorders have a temporary nature in almost 50% of the cases with recovery and stabilization after discharge. Preoperative conduction abnormality and type of TAVI are associated with higher PPI dependency at short term.
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Affiliation(s)
- Justine M. Ravaux
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Address for reprints: Justine M. Ravaux, MD, Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.
| | - Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | - Arnoud W. Van't Hof
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Leo Veenstra
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Suzanne Kats
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Jos G. Maessen
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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100
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Ancona MB, Toscano E, Moroni F, Ferri LA, Russo F, Bellini B, Sorropago A, Mula C, Festorazzi C, Gamardella M, Vella C, Beneduce A, Romano V, Belluschi I, Buzzatti N, Agricola E, Montorfano M. Patients younger than 70 undergoing transcatheter aortic valve implantation: Procedural outcomes and mid-term survival. IJC HEART & VASCULATURE 2021; 34:100817. [PMID: 34169142 PMCID: PMC8207181 DOI: 10.1016/j.ijcha.2021.100817] [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: 05/16/2021] [Accepted: 05/31/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Based on recent data, the indication for transcatheter aortic valve implantation (TAVI) is expanding to individuals at lower surgical risk, who are generally younger than subjects historically treated for severe aortic stenosis. Indeed, younger patients have traditionally been under-represented in current TAVI literature. The aim of the present study is to report about clinical features, procedural outcomes and mid-term outcomes of patients younger than 70 who underwent TAVI in a single high-volume center. MATERIALS AND METHODS Consecutive patients younger than 70 years of age who underwent TAVI for severe, symptomatic aortic stenosis between 2007 and 2019 at a single, tertiary referral center have been included in this retrospective study. Procedural and mid-term outcomes were analyzed, comparing 1st generation with 2nd generation devices. RESULTS Between 2007 and 2019, 1740 TAVI procedures were performed in our center. Among these, one hundred twenty-nine (7.4%) patients were younger than 70 years at the time of the intervention and were included in the present analysis. Fifty-eight patients (45%) were implanted with a 1st generation prosthesis while seventy-one patients (55%) were implanted with a 2nd generation device. Reasons which lead to a transcatheter approach in this population were: previous CABG (27.9%); porcelain aorta (24%); severe left ventricular systolic dysfunction (21.7%); prior chest radiation (19.4%); severe lung disease (8.5%); hemodynamic instability (7.0%); advanced liver disease (4.6%) and active cancer (3.9%). Overall device success rate was 89%, with no differences among 1st and 2nd generation devices. Threeyears all-cause mortality was 34%, with no difference among the two groups. Low incidence of aortic-valve re-intervention was observed at mid-term follow-up (late valve re-intervention = 2.3%). CONCLUSIONS TAVI in young patient with appropriate indication for intervention is a safe procedure, associated with low rate of in hospital mortality and low rate of severe complications both with 1st and with 2nd generation devices. When considering long term durability, more data are needed; in our case series long-term follow up shows a good survival and also an extremely low rate of valve re-intervention.
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Affiliation(s)
- Marco B. Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Evelina Toscano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Interventional Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Francesco Moroni
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca A. Ferri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Sorropago
- Interventional Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Caterina Mula
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Costanza Festorazzi
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Gamardella
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ciro Vella
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Beneduce
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Romano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Igor Belluschi
- Heart Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Heart Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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