51
|
Petronio AS, Sinning JM, Van Mieghem N, Zucchelli G, Nickenig G, Bekeredjian R, Bosmans J, Bedogni F, Branny M, Stangl K, Kovac J, Schiltgen M, Kraus S, de Jaegere P. Optimal Implantation Depth and Adherence to Guidelines on Permanent Pacing to Improve the Results of Transcatheter Aortic Valve Replacement With the Medtronic CoreValve System. JACC Cardiovasc Interv 2015; 8:837-846. [DOI: 10.1016/j.jcin.2015.02.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
|
52
|
Hahn RT, Gillam LD, Little SH. Echocardiographic Imaging of Procedural Complications During Self-Expandable Transcatheter Aortic Valve Replacement. JACC Cardiovasc Imaging 2015; 8:319-336. [DOI: 10.1016/j.jcmg.2015.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 12/30/2014] [Accepted: 01/06/2015] [Indexed: 11/28/2022]
|
53
|
Weber M, Sinning JM, Hammerstingl C, Werner N, Grube E, Nickenig G. Permanent Pacemaker Implantation after TAVR - Predictors and Impact on Outcomes. Interv Cardiol 2015; 10:98-102. [PMID: 29588683 DOI: 10.15420/icr.2015.10.2.98] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The number of patients undergoing transcatheter aortic valve replacement (TAVR) worldwide is increasing steadily. Atrioventricular conduction disturbances, with or without the need for permanent pacemaker (PPM) implantation, are one of the most common adverse events after TAVR. Among transcatheter heart valves (THV), rates of conduction abnormalities vary from less than 10 % to more than 50 %. Depending on the reported data referred to, historical data showed that up to one-third of the patients required implantation of a PPM following TAVR. Although generally considered as a minor complication, PPM may have a profound impact on prognosis and quality of life after TAVR. Current data support the hypothesis that conduction abnormalities leading to pacemaker dependency result from mechanical compression of the conduction system by the prosthesis stent frame and individual predisposing conduction defects such as right bundle-branch block (RBBB). With several large randomised trials and registry studies having been published recently and second generation THV having been introduced, the debate about predictors for pacemaker implantation and their impact on outcome after TAVR is still ongoing.
Collapse
Affiliation(s)
- Marcel Weber
- University of Bonn, Department of Internal Medicine II, Cardiology, Pulmonology and Angiology, Germany
| | - Jan-Malte Sinning
- University of Bonn, Department of Internal Medicine II, Cardiology, Pulmonology and Angiology, Germany
| | - Christoph Hammerstingl
- University of Bonn, Department of Internal Medicine II, Cardiology, Pulmonology and Angiology, Germany
| | - Nikos Werner
- University of Bonn, Department of Internal Medicine II, Cardiology, Pulmonology and Angiology, Germany
| | - Eberhard Grube
- University of Bonn, Department of Internal Medicine II, Cardiology, Pulmonology and Angiology, Germany
| | - Georg Nickenig
- University of Bonn, Department of Internal Medicine II, Cardiology, Pulmonology and Angiology, Germany
| |
Collapse
|
54
|
Katsanos S, van Rosendael P, Kamperidis V, van der Kley F, Joyce E, Debonnaire P, Karalis I, Bax JJ, Marsan NA, Delgado V. Insights into new-onset rhythm conduction disorders detected by multi-detector row computed tomography after transcatheter aortic valve implantation. Am J Cardiol 2014; 114:1556-61. [PMID: 25245414 DOI: 10.1016/j.amjcard.2014.08.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 08/01/2014] [Accepted: 08/01/2014] [Indexed: 11/15/2022]
Abstract
New-onset rhythm conduction disorders are frequent after transcatheter aortic valve implantation (TAVI). Multidetector row computed tomography may shed light on the pathophysiology of rhythm conduction disorders in patients who undergo TAVI with the Edwards SAPIEN valve. A total of 94 patients (mean age 81 ± 7 years, 48% men) treated with TAVI with the Edwards SAPIEN valve who underwent pre- and post-TAVI multidetector row computed tomography were included. Patients with preexisting right bundle branch block or left bundle branch block (LBBB) and permanent pacemakers were excluded. Pacemaker implantation or new-onset LBBB at 1-month follow-up was the combined end point. Overall, 1 pacemaker was implanted, and 14 cases of new-onset LBBB were recorded. Among several clinical and multi-detector row computed tomographic variables, overexpansion of the transcatheter valve >15% of native annular area (odds ratio 5.277, 95% confidence interval 1.398 to 19.919, p = 0.014) and depth of frame into the left ventricular outflow tract (odds ratio 1.401, 95% confidence interval 1.066 to 1.770, p = 0.010) were independently related to the need for a pacemaker or new-onset LBBB. In conclusion, overexpansion of the transcatheter prosthesis by >15% of native aortic annular area and implantation depth of the frame into the left ventricular outflow tract were independently associated with the need for a pacemaker or new-onset LBBB in patients who underwent TAVI with the Edwards SAPIEN valve.
Collapse
Affiliation(s)
- Spyridon Katsanos
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Vasileios Kamperidis
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Emer Joyce
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Philippe Debonnaire
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ioannis Karalis
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
| |
Collapse
|
55
|
Panayiotides IM, Nikolaides E. Transcatheter Aortic Valve Implantation (TAVI): Is it Time for This Intervention to be Applied in a Lower Risk Population? CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2014; 8:93-102. [PMID: 25452701 PMCID: PMC4234280 DOI: 10.4137/cmc.s19217] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 09/24/2014] [Accepted: 10/03/2014] [Indexed: 12/13/2022]
Abstract
Patients with severe aortic stenosis are sometimes not candidates for conventional open heart surgery because of severe deconditioning, excessive risk factors, and multiple comorbidities. Transcatheter aortic valve implantation (TAVI) is a relatively recent intervention, which was initially addressed to individuals with severe symptomatic aortic stenosis at substantial or prohibitive surgical risk. Despite the documented beneficial effects of this therapeutic intervention in certain carefully selected individuals, it has not yet been applied to lower risk patients. This is a review of the current literature and accumulated clinical data of this rapidly evolving invasive procedure in an attempt to resolve whether it can now be applied to a wider portion of patients with aortic stenosis.
Collapse
Affiliation(s)
- Ioannis M Panayiotides
- Cardiologist in private practice, affiliated with Nicosia General Hospital, Cardiology Department, Nicosia, Cyprus
| | - Evagoras Nikolaides
- Director of Cardiology Department, Nicosia General Hospital, Nicosia, Cyprus
| |
Collapse
|
56
|
Calvi V, Pruiti GP. Pacemaker implantation and need for ventricular pacing during follow-up after transcatheter aortic valve implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1589-91. [PMID: 25319956 DOI: 10.1111/pace.12524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/21/2014] [Accepted: 08/26/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Valeria Calvi
- From the Arrhythmology Unit, Ferrarotto Hospital, University of Catania, Via Citelli, Italy
| | | |
Collapse
|
57
|
Predictors of permanent pacemaker requirement after transcatheter aortic valve implantation: Insights from a Brazilian Registry. Int J Cardiol 2014; 175:248-52. [DOI: 10.1016/j.ijcard.2014.05.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/28/2014] [Accepted: 05/11/2014] [Indexed: 11/18/2022]
|
58
|
Clinical significance of conduction disturbances after aortic valve intervention: current evidence. Clin Res Cardiol 2014; 104:1-12. [DOI: 10.1007/s00392-014-0739-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/24/2014] [Indexed: 12/16/2022]
|
59
|
Siontis GC, Jüni P, Pilgrim T, Stortecky S, Büllesfeld L, Meier B, Wenaweser P, Windecker S. Predictors of Permanent Pacemaker Implantation in Patients With Severe Aortic Stenosis Undergoing TAVR. J Am Coll Cardiol 2014; 64:129-40. [DOI: 10.1016/j.jacc.2014.04.033] [Citation(s) in RCA: 371] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/10/2014] [Accepted: 04/03/2014] [Indexed: 01/31/2023]
|
60
|
Linke A, Wenaweser P, Gerckens U, Tamburino C, Bosmans J, Bleiziffer S, Blackman D, Schafer U, Muller R, Sievert H, Sondergaard L, Klugmann S, Hoffmann R, Tchetche D, Colombo A, Legrand VM, Bedogni F, lePrince P, Schuler G, Mazzitelli D, Eftychiou C, Frerker C, Boekstegers P, Windecker S, Mohr FW, Woitek F, Lange R, Bauernschmitt R, Brecker S. Treatment of aortic stenosis with a self-expanding transcatheter valve: the International Multi-centre ADVANCE Study. Eur Heart J 2014; 35:2672-84. [DOI: 10.1093/eurheartj/ehu162] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
61
|
Abstract
Transcatheter aortic valve replacement emerged ≈20 years ago and changed the landscape of structural interventional cardiology. The first experiments in animal models provided proofs of the concept and the substrate for the first percutaneous valve implantation in patients. The initial promising results in a clinical setting drew the attention of the industry and of the scientific community, and an effort was made for the past 12 years to address the limitations of the technology, facilitate the procedure, minimize the risk of complications, and broaden the applications of transcatheter aortic valve replacement. This article reviews the evolution of transcatheter aortic valve replacement, presents the first steps in this field, cites the evidence from registries and clinical trials, highlights the limitations of this treatment, and discusses the future perspectives and the developments proposed to address the current pitfalls.
Collapse
Affiliation(s)
- Christos V. Bourantas
- From the Department of Interventional Cardiology, ThoraxCenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B., P.W.S.); and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom (P.W.S.)
| | - Patrick W. Serruys
- From the Department of Interventional Cardiology, ThoraxCenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B., P.W.S.); and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom (P.W.S.)
| |
Collapse
|
62
|
Binder RK, Webb JG, Toggweiler S, Freeman M, Barbanti M, Willson AB, Alhassan D, Hague CJ, Wood DA, Leipsic J. Impact of post-implant SAPIEN XT geometry and position on conduction disturbances, hemodynamic performance, and paravalvular regurgitation. JACC Cardiovasc Interv 2014; 6:462-8. [PMID: 23702010 DOI: 10.1016/j.jcin.2012.12.128] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 11/30/2012] [Accepted: 12/21/2012] [Indexed: 01/29/2023]
Abstract
OBJECTIVES This report sought to study the impact of the balloon-expandable SAPIEN XT (Edwards Lifesciences, Irvine, California) transcatheter heart valve (THV) stent frame geometry and position on outcomes of transcatheter aortic valve replacement (TAVR). BACKGROUND Post-implant THV geometry and position might impact atrioventricular conduction, hemodynamic performance, and annular sealing. METHODS Eighty-nine consecutive patients who underwent TAVR with a Sapien XT THV had pre- and post-implant multidetector computed tomography, transthoracic echocardiography, and electrocardiograms performed to assess THV stent geometry, atrioventricular conduction, and hemodynamic performance. RESULTS The THV Circularity (THV eccentricity <10% [eccentricity = minimum stent diameter/maximum stent diameter]) and under-expansion (THV area/nominal THV area <90%) were present in 97.8% (2 of 89) and 0%, respectively. Low THV implantation was associated with new left bundle branch block and complete heart block (3.4 ± 2.0 mm vs. 5.5 ± 2.9 mm, p = 0.01) and with the need for permanent pacemaker implantation (3.5 ± 2.0 mm vs. 7.1 ± 2.5 mm, p = 0.001). In contrast, labeled THV size and THV area oversizing was not associated with atrioventricular conduction disturbances. The relation between inflow stent frame area and annular area was related to paravalvular regurgitation (p = 0.025). Labeled prosthesis size but not prosthesis expansion or eccentricity was related to valve gradient (p = 0.005) and effective orifice area (p < 0.001). CONCLUSIONS Low implantation depth of balloon-expandable THVs is associated with clinically significant new conduction disturbances and permanent pacemaker implantation. Importantly, annular area oversizing was not associated with these complications.
Collapse
Affiliation(s)
- Ronald K Binder
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
63
|
Gessat M, Hopf R, Pollok T, Russ C, Frauenfelder T, Sundermann SH, Hirsch S, Mazza E, Szekely G, Falk V. Image-Based Mechanical Analysis of Stent Deformation: Concept and Exemplary Implementation for Aortic Valve Stents. IEEE Trans Biomed Eng 2014; 61:4-15. [DOI: 10.1109/tbme.2013.2273496] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
64
|
Ghadimi K, Patel PA, Gutsche JT, Sophocles A, Anwaruddin S, Szeto WY, Augoustides JG. Perioperative Conduction Disturbances After Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2013; 27:1414-20. [DOI: 10.1053/j.jvca.2013.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Indexed: 11/11/2022]
|
65
|
A review of most relevant complications of transcatheter aortic valve implantation. ISRN CARDIOLOGY 2013; 2013:956252. [PMID: 23844292 PMCID: PMC3703377 DOI: 10.1155/2013/956252] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 04/15/2013] [Indexed: 01/15/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged for treating aortic stenosis in patients who are poor candidates for surgical aortic valve replacement. Currently, the balloon-expandable Edwards Sapien valve—which is usually implanted via a transfemoral or transapical approach—and the self-expanding CoreValve ReValving system—which is designed for retrograde application—are the most widely implanted valves worldwide. Although a promising approach for high-risk patients, the indication may be expanded to intermediate- and eventually low-risk patients in the future; however, doing so will require a better understanding of potential complications, risk factors for these complications, and strategies to individualize each patient to a different access route and a specific valve. This paper reviews the most relevant complications that may occur in patients who undergo catheter-based aortic valve implantation.
Collapse
|
66
|
Predictors and risk of pacemaker implantation after the Cox-maze IV procedure. Ann Thorac Surg 2013; 95:2015-20; disussion 2020-1. [PMID: 23642681 DOI: 10.1016/j.athoracsur.2013.03.064] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 03/19/2013] [Accepted: 03/22/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND The incidence of and causes for permanent pacemaker implantation (PPM) after surgical arrhythmia procedures remain poorly understood because of the varied lesion patterns and energy sources reported in small series. This study characterized the incidence, indications, and risk factors for PPM after the Cox-maze IV (CMIV) procedure when performed as either a lone or a concomitant procedure. METHODS A retrospective analysis of 340 patients undergoing a CMIV as either a lone (n = 112) or a concomitant (n = 228) procedure was conducted. The incidence, indication, and variables associated with PPM implantation within 1 year of the operation were assessed. Follow-up was conducted at 30 days and 1 year and was 90% complete. RESULTS The incidence of PPM after a lone CMIV procedure was 5%. Patients with concomitant cardiac operations had a nonsignificant increase in PPM insertion at 30 days (11% vs 5%, p = 0.14) and 1 year (15% vs 6%, p = 0.06) when compared with lone CMIV patients. Of patients who required pacemakers, sinus node dysfunction was present in 79% (35/44) of patients in the entire series and in 88% (8/9) after lone CMIV. After PPM, 84% (37/44) of patients remained paced at last follow-up. Multivariate analysis identified age (odds ratio = 1.10 [1.06-1.14], p < 0.001) as the only variable associated with higher risk of a PPM after any CMIV procedure. CONCLUSIONS The risk of PPM implantation after a lone CMIV is 5% and increases with age. The need for a PPM after a CMIV is largely due to SA node dysfunction, which appears unlikely to recover. These data should help physicians counsel patients regarding the perioperative risks associated with the CMIV.
Collapse
|
67
|
SCHWERG MARIUS, BALDENHOFER GERD, DREGER HENRYK, BONDKE HANSJÜRGEN, STANGL KARL, LAULE MICHAEL, MELZER CHRISTOPH. Complete Atrioventricular Block after TAVI: When Is Pacemaker Implantation Safe? Pacing Clin Electrophysiol 2013; 36:898-903. [DOI: 10.1111/pace.12150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 01/28/2013] [Accepted: 02/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- MARIUS SCHWERG
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte; Charité-Universitätsmedizin Berlin; Germany
| | - GERD BALDENHOFER
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte; Charité-Universitätsmedizin Berlin; Germany
| | - HENRYK DREGER
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte; Charité-Universitätsmedizin Berlin; Germany
| | - HANSJÜRGEN BONDKE
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte; Charité-Universitätsmedizin Berlin; Germany
| | - KARL STANGL
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte; Charité-Universitätsmedizin Berlin; Germany
| | - MICHAEL LAULE
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte; Charité-Universitätsmedizin Berlin; Germany
| | - CHRISTOPH MELZER
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte; Charité-Universitätsmedizin Berlin; Germany
| |
Collapse
|
68
|
Clinical and prognostic implications of existing and new-onset atrial fibrillation in patients undergoing transcatheter aortic valve implantation. J Thromb Thrombolysis 2012; 35:450-5. [DOI: 10.1007/s11239-012-0859-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|