51
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Kalra A, Raza S, Hussain M, Shorbaji K, Delozier S, Deo SV, Khera S, Kleiman NS, Reardon MJ, Kolte D, Gupta T, Mustafa R, Bhatt DL, Sabik JF. Aortic Valve Replacement in Bioprosthetic Failure: Insights From The Society of Thoracic Surgeons National Database. Ann Thorac Surg 2020; 110:1637-1642. [DOI: 10.1016/j.athoracsur.2019.08.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 07/11/2019] [Accepted: 08/08/2019] [Indexed: 10/25/2022]
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52
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Bozso SJ, Kang JJH, Basu R, Adam B, Dyck JRB, Oudit GY, Moon MC, Freed DH, Nagendran J, Nagendran J. Structural Valve Deterioration Is Linked to Increased Immune Infiltrate and Chemokine Expression. J Cardiovasc Transl Res 2020; 14:503-512. [PMID: 33089488 DOI: 10.1007/s12265-020-10080-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/15/2020] [Indexed: 01/04/2023]
Abstract
We aim to investigate whether structural valve deterioration (SVD) of bioprosthetic xenogenic tissue heart valves (XTHVs) is associated with increased immune cell infiltration and whether co-expression of several chemokines correlates with this increase in immune infiltrate. Explanted XTHVs from patients undergoing redo valve replacement for SVD were obtained. Immunohistochemical, microscopic, and gene expression analysis approaches were used. XTHVs (n = 37) were obtained from 32 patients (mean 67.7 years) after a mean time of 11.6 years post-implantation. Significantly increased immune cellular infiltration was observed in the explanted SVD valves for all immune cell types examined, including T cells, macrophages, B cells, neutrophils, and plasma cells, compared to non-SVD controls. Furthermore, a significantly increased chemokine gradient in explanted SVD valves accompanied immune cell infiltration. These data suggest the development of SVD is associated with a significantly increased burden of immune cellular infiltrate correlated to the induction of a chemokine gradient around the XHTV, representing chronic immune rejection.Graphical abstract Proposed interaction between innate and adaptive immunity leading to the development of structural valve deterioration in xenogenic tissue heart valves.
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Affiliation(s)
- Sabin J Bozso
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Jimmy J H Kang
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Ratnadeep Basu
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Benjamin Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Division of Pediatrics, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Gavin Y Oudit
- Cardiovascular Research Centre, Division of Cardiology, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Michael C Moon
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Darren H Freed
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Jayan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, T6G 2R3, Canada.
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Preprocedural circulating galectin-3 and the risk of mortality after transcatheter aortic valve replacement: a systematic review and meta-analysis. Biosci Rep 2020; 40:226344. [PMID: 32893848 PMCID: PMC7494980 DOI: 10.1042/bsr20202306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/27/2020] [Accepted: 09/03/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Galectin-3 may predict mortality for patients with aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR). However, the results were inconsistent. We aimed to evaluate the association between baseline galectin and mortality after TAVR in a meta-analysis. Methods: Related follow-up studies were obtained by systematic search of PubMed, Cochrane’s Library, and Embase databases. Both the fixed- and the random-effect models were used for the meta-analysis. Subgroup analyses were performed to evaluate the influences of study characteristics on the outcome. Results: Five prospective cohort studies with 854 patients were included, with a follow-up period between 1 and 1.9 years. Patients with higher baseline circulating galectin-3 had an increased risk of all-cause mortality after TAVR (random-effects model: risk ratio [RR]: 1.63, 95% confidence interval [CI]: 1.19–2.23, P=0.002; fixed-effects model: RR: 1.62, 95% CI: 1.19–2.20, P=0.002; I2 = 4%). Adjustment of estimated glomerular filtration rate (RR: 1.73, P=0.02) or B-type natriuretic peptide (BNP) or N-terminal pro-BNP (RR: 1.83, P=0.02) did not significantly affect the result. A trend of stronger association between higher baseline circulating galectin-3 and increased risk of all-cause mortality after TAVR was observed in studies with an enzyme-linked fluorescent assay (ELFA) (RR: 3.04, P=0.003) compared with those with an enzyme-linked immunosorbent assay (ELISA) (RR: 1.42, P=0.04; P for subgroup difference =0.06). Conclusion: Higher circulating galectin-3 before the procedure may predict all-cause mortality of AS patients after TAVR.
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54
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Latif A, Lateef N, Ahsan MJ, Kapoor V, Usman RM, Cooper S, Andukuri V, Mirza M, Ashfaq MZ, Khouzam R. Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Cardiac Surgery: Meta-Analysis and Systematic Review of the Literature. J Cardiovasc Dev Dis 2020; 7:jcdd7030036. [PMID: 32927705 PMCID: PMC7570107 DOI: 10.3390/jcdd7030036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 11/16/2022] Open
Abstract
The number of patients with severe aortic stenosis (AS) and a history of prior cardiac surgery has increased. Prior cardiac surgery increases the risk of adverse outcomes in patients undergoing aortic valve replacement. To evaluate the impact of prior cardiac surgery on clinical endpoints in patients undergoing transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR), we performed a literature search using PubMed, Embase, Google Scholar, and Scopus databases. The clinical endpoints included in our study were 30-day mortality, 1-2-year mortality, acute kidney injury (AKI), bleeding, stroke, procedural time, and duration of hospital stay. Seven studies, which included a total of 8221 patients, were selected. Our study found that TAVR was associated with a lower incidence of stroke and bleeding complications. There was no significant difference in terms of AKI, 30-day all-cause mortality, and 1-2-year all-cause mortality between the two groups. The average procedure time and duration of hospital stay were 170 min less (p ≤ 0.01) and 3.6 days shorter (p < 0.01) in patients with TAVR, respectively. In patients with prior coronary artery bypass graft and severe AS, both TAVR and SAVR are reasonable options. However, TAVR may be associated with a lower incidence of complications like stroke and perioperative bleeding, in addition to a shorter length of stay.
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Affiliation(s)
- Azka Latif
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
- Correspondence: ; Tel.: +1-402-651-4961
| | - Noman Lateef
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Muhammad Junaid Ahsan
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Vikas Kapoor
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Rana Mohammad Usman
- Department of Internal Medicine, University of Tennessee, Memphis, TN 38152, USA;
| | - Stephen Cooper
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Venkata Andukuri
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Mohsin Mirza
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Muhammad Zubair Ashfaq
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Rami Khouzam
- Department of Cardiology, University of Tennessee, Memphis, TN 38152, USA;
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55
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Malik IS, Jabbour RJ, Ruparelia N, Sen S, Hadjizoulou N, Rana B, Chukwuemeka AO, Gopalan D, Kotecha T, Mikhail GW. Rescue Valve-in-Valve-in-Valve TAVR for Acute Transvalvular Aortic Regurgitation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:11-13. [PMID: 32747197 DOI: 10.1016/j.carrev.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/11/2020] [Accepted: 07/01/2020] [Indexed: 11/19/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is a well-established treatment option for severe symptomatic aortic stenosis (Leon et al., 2016), and recently has also been utilised for bioprosthetic surgical aortic valve (sAVR) failure (valve-in-valve TAVR (ViV-TAVR)) (Yoon et al., 2017; Nalluri et al., 2018). Data supporting ViV-TAVR are limited to observational studies but suggest similar outcomes to re-do sAVR in high risk patients (Barbanti et al., n.d.). Whilst bioprosthetic SAVR failure is well documented, TAVR failure is less well described (Barbanti et al., n.d.). Here, we describe a case of TAVR failure in a previous sAVR resulting in the need for emergent valve-in-valve-in-valve TAVR (ViViV-TAVR).
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Affiliation(s)
- Iqbal S Malik
- Dept of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
| | - Richard J Jabbour
- Dept of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Neil Ruparelia
- Dept of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Sayan Sen
- Dept of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Nearchos Hadjizoulou
- Dept of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Bushra Rana
- Dept of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Andrew O Chukwuemeka
- Dept of Cardiac Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Deepa Gopalan
- Dept of Imaging, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Tushar Kotecha
- Dept of Imaging, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK; Dept of Cardiology, Royal Free Hospital, London, UK
| | - Ghada W Mikhail
- Dept of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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56
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Iung B, Wendler O. Valve-in-valve vs. repeat surgical aortic valve replacement: a new match but the game is not over! Eur Heart J 2020; 41:2756-2758. [PMID: 32533138 DOI: 10.1093/eurheartj/ehaa441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
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Affiliation(s)
- Bernard Iung
- Cardiology Department, Bichat Hospital, AP-HP, DHU FIRE, Paris, France.,Université de Paris, Paris, France
| | - Olaf Wendler
- Cleveland Clinic London, King's College Hospital, London, UK
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57
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Deharo P, Bisson A, Herbert J, Lacour T, Etienne CS, Porto A, Theron A, Collart F, Bourguignon T, Cuisset T, Fauchier L. Transcatheter Valve-in-Valve Aortic Valve Replacement as an Alternative to Surgical Re-Replacement. J Am Coll Cardiol 2020; 76:489-499. [DOI: 10.1016/j.jacc.2020.06.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022]
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58
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Ram E, Sternik L. Recent improvement in outcomes following aortic valve replacement in low-risk patients. J Card Surg 2020; 35:2442. [PMID: 32652614 DOI: 10.1111/jocs.14753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Eilon Ram
- Department of Cardiac Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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59
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Commentary: The pericardial autologous solution. JTCVS Tech 2020; 3:106-107. [PMID: 34317835 PMCID: PMC8302934 DOI: 10.1016/j.xjtc.2020.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 11/22/2022] Open
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Deharo P, Bisson A, Herbert J, Lacour T, Saint Etienne C, Jaussaud N, Theron A, Collart F, Bourguignon T, Cuisset T, Fauchier L. Valve-in-valve transcatheter aortic valve implantation after failed surgically implanted aortic bioprosthesis versus native transcatheter aortic valve implantation for aortic stenosis: Data from a nationwide analysis. Arch Cardiovasc Dis 2020; 114:41-50. [PMID: 32532695 DOI: 10.1016/j.acvd.2020.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/14/2020] [Accepted: 04/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Valve-in-valve transcatheter aortic valve implantation (TAVI) has emerged as a treatment for aortic bioprosthesis failure in case of prohibitive risk for redo surgery. However, clinical evaluation of valve-in-valve TAVI remains limited by the number of patients analysed. AIM To evaluate outcomes of valve-in-valve TAVI compared with native aortic valve TAVI at a nationwide level in France. METHODS Based on the French administrative hospital discharge database, the study collected information for all consecutive patients treated with TAVI for aortic stenosis or with isolated valve-in-valve TAVI for aortic bioprosthesis failure between 2010 and 2019. Propensity score matching was used for the analysis of outcomes. RESULTS A total of 44,218 patients were found in the database. After matching on baseline characteristics, 2749 patients were analysed in each arm. At 30 days, no significant differences were observed regarding the occurrence of major clinical events (composite of cardiovascular mortality, all-cause stroke, myocardial infarction, major or life-threatening bleeding and conversion to open heart surgery) (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.68-1.01; P=0.32). During follow-up (mean 516 days), the combined endpoint of cardiovascular death, all-cause stroke or rehospitalization for heart failure was not different between the valve-in-valve TAVI and native TAVI groups (RR 1.03, 95% CI 0.94-1.13; P=1.00). CONCLUSION We observed that valve-in-valve TAVI was associated with good short- and long-term outcomes. No significant differences were observed compared with native valve TAVI regarding clinical follow-up.
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Affiliation(s)
- Pierre Deharo
- Département de cardiologie, CHU Timone, 13005 Marseille, France; Inserm, Inra, C2VN, Aix-Marseille université, 13005 Marseille, France.
| | - Arnaud Bisson
- Service de cardiologie, CHU Trousseau, 37044 Tours, France
| | - Julien Herbert
- Service de cardiologie, CHU Trousseau, 37044 Tours, France; Unité d'épidémiologie hospitalière régionale, service d'information médicale, CHU Tours, 37044 Tours, France; EA7505, université de Tours, 37044 Tours, France
| | - Thibaud Lacour
- Service de cardiologie, CHU Trousseau, 37044 Tours, France
| | | | - Nicolas Jaussaud
- Département de chirurgie cardiaque, CHU Timone, 13005 Marseille, France
| | - Alexis Theron
- Département de chirurgie cardiaque, CHU Timone, 13005 Marseille, France
| | - Frederic Collart
- Inserm, Inra, C2VN, Aix-Marseille université, 13005 Marseille, France; Département de chirurgie cardiaque, CHU Timone, 13005 Marseille, France
| | | | - Thomas Cuisset
- Département de cardiologie, CHU Timone, 13005 Marseille, France; Inserm, Inra, C2VN, Aix-Marseille université, 13005 Marseille, France
| | - Laurent Fauchier
- Service de cardiologie, CHU Trousseau, 37044 Tours, France; EA7505, université de Tours, 37044 Tours, France
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61
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Lee HA, Chou AH, Wu VCC, Chen DY, Lee HF, Lee KT, Chu PH, Cheng YT, Chang SH, Chen SW. Balloon-expandable versus self-expanding transcatheter aortic valve replacement for bioprosthetic dysfunction: A systematic review and meta-analysis. PLoS One 2020; 15:e0233894. [PMID: 32479546 PMCID: PMC7263630 DOI: 10.1371/journal.pone.0233894] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/14/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve-in-valve (VIV) procedure is a safe alternative to conventional reoperation for bioprosthetic dysfunction. Balloon-expandable valve (BEV) and self-expanding valve (SEV) are the 2 major types of devices used. Evidence regarding the comparison of the 2 valves remains scarce. METHODS A systematic review and meta-analysis was conducted to compare the outcomes of BEV and SEV in transcatheter VIV for aortic bioprostheses dysfunction. A computerized search of Medline, PubMed, Embase, and Cochrane databases was performed. English-language journal articles reporting SEV or BEV outcomes of at least 10 patients were included. RESULTS In total, 27 studies were included, with 2,269 and 1,671 patients in the BEV and SEV groups, respectively. Rates of 30-day mortality and stroke did not differ significantly between the 2 groups. However, BEV was associated with significantly lower rates of postprocedural permanent pacemaker implantation (3.8% vs. 12%; P < 0.001). Regarding echocardiographic parameters, SEV was associated with larger postprocedural effective orifice area at 30 days (1.53 cm2 vs. 1.23 cm2; P < 0.001) and 1 year (1.55 cm2 vs. 1.22 cm2; P < 0.001). CONCLUSIONS For patients who underwent transcatheter aortic VIV, SEV was associated with larger postprocedural effective orifice area but higher rates of permanent pacemaker implantation. These findings provide valuable information for optimizing device selection for transcatheter aortic VIV.
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Affiliation(s)
- Hsiu-An Lee
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Dong-Yi Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Hsin-Fu Lee
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Kuang-Tso Lee
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Shang-Hung Chang
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- * E-mail:
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62
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Stankowski T, Aboul-Hassan SS, Seifi Zinab F, Herwig V, Stępiński P, Grimmig O, Just S, Harnath A, Muehle A, Fritzsche D, Perek B. Femoral transcatheter valve-in-valve implantation as alternative strategy for failed aortic bioprostheses: A single-centre experience with long-term follow-up. Int J Cardiol 2020; 306:25-34. [DOI: 10.1016/j.ijcard.2020.02.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/15/2020] [Accepted: 02/12/2020] [Indexed: 02/02/2023]
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63
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Malik AH, Yandrapalli S, Zaid S, Shetty SS, Aronow WS, Ahmad H, Tang GHL. Valve-in-Valve Transcatheter Implantation Versus Redo Surgical Aortic Valve Replacement. Am J Cardiol 2020; 125:1378-1384. [PMID: 32139158 DOI: 10.1016/j.amjcard.2020.02.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/01/2020] [Accepted: 02/04/2020] [Indexed: 11/17/2022]
Abstract
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) for a failing prosthesis is an appealing alternative to redo surgical AVR. We utilized data from the US National Inpatient Sample for the period 2012 to 2016 to identify hospitalizations for either ViV-TAVI or redo-SAVR. The primary outcomes of interest were in-hospital adverse events composite outcome (comprising of mortality, myocardial infarction, stroke, or acute kidney injury) and all-cause mortality. We used propensity score matching to adjust for the baseline differences between ViV-TAVI and redo-SAVR cohorts. Survey techniques were employed to compare the 2 groups. Over 5 years, there has been a considerable increase in both interventions for prosthetic aortic valve failure, with significantly higher utilization of ViV-TAVI compared to redo-SAVR (p <0.01). Out of the 3,305 hospitalizations for prosthetic aortic valve failure, 1,420 in matched pairs underwent either ViV-TAVI (n = 710) or redo-SAVR (n = 710). ViV-TAVI was associated with lower in-hospital composite adverse outcomes (14.1% vs 25.4%, p = 0.018), and numerically lower but statistically insignificant mortality (<1.0% vs 5.2%; p = 0.06). ViV-TAVI was associated with a decreased length of hospitalization (mean 6.6 vs 9.7 days; p <0.01). In the matched cohort, postoperative bleeding and transfusions were significantly lower for ViV-TAVI compared with redo-SAVR (17.6% vs 31.0% and 12% vs 31% respectively, p <0.01 for both). Acute kidney injury, sepsis, permanent pacemaker implantation, and vascular complications, although numerically better, did not differ between 2 strategies. In conclusion, ViV-TAVI is associated with lower in-hospital MACE rates and reduced length of hospitalization compared with redo-SAVR.
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Affiliation(s)
- Aaqib H Malik
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York.
| | - Srikanth Yandrapalli
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Syed Zaid
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Suchith S Shetty
- Division of Cardiology, Department of Internal Medicine, University of Iowa Health Care, Carver College of Medicine, Iowa City, Iowa
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Hasan Ahmad
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York
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Abstract
Structural heart disease (SHD) emergencies include acute deterioration of a stable lesion or development of a new critical lesion. Structural heart disease emergencies can produce heart failure and cardiogenic shock despite preserved systolic function that may not respond to standard medical therapy and typically necessitate surgical or percutaneous intervention. Comprehensive Doppler echocardiography is the initial diagnostic modality of choice to determine the cause and severity of the underlying SHD lesion. Patients with chronic SHD lesions which deteriorate due to intercurrent illness (eg, infection or arrhythmia) may not require urgent intervention, whereas patients with an acute SHD lesion often require definitive therapy. Medical stabilization prior to definitive intervention differs substantially between stenotic lesions (aortic stenosis, mitral stenosis, left ventricular outflow tract obstruction) and regurgitant lesions (aortic regurgitation, mitral regurgitation, ventricular septal defect). Patients with regurgitant lesions typically require aggressive afterload reduction and inotropic support, whereas patients with stenotic lesions may paradoxically require β-blockade and vasoconstrictors. Emergent cardiac surgery for patients with decompensated heart failure or cardiogenic shock carries a substantial mortality risk but may be necessary for patients who are not eligible for catheter-based percutaneous SHD intervention. This review explores initial medical stabilization and subsequent definitive therapy for patients with SHD emergencies.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, 4352Mayo Clinic Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, 4352Mayo Clinic Rochester, MN, USA
| | - Bradley Ternus
- Division of Cardiovascular Medicine, 5228University of Wisconsin, Madison, WI, USA
| | - Mackram Eleid
- Department of Cardiovascular Medicine, 4352Mayo Clinic Rochester, MN, USA
| | - Charanjit Rihal
- Department of Cardiovascular Medicine, 4352Mayo Clinic Rochester, MN, USA
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65
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Cinelli M, Schwartz L, Spagnola J, Gulkarov I, Rosell F, Lackey A, Imam M, Schwartz C. Early Structural Deterioration of a Sutureless Bioprosthetic Aortic Valve. Cardiol Res 2020; 11:113-117. [PMID: 32256918 PMCID: PMC7092772 DOI: 10.14740/cr1013] [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: 01/27/2020] [Accepted: 02/18/2020] [Indexed: 11/29/2022] Open
Abstract
Sutureless bioprosthetic valves such as the Sorin Perceval S valve (SPV) have been used in patients with aortic stenosis that require surgical aortic valve replacement (SAVR). These prostheses have been marketed on the basis of their rapid implantation techniques with avoidance of sutures and reduced aortic cross-clamp times. We report a case of an early failure of a SPV nearly 4 years after implantation in a 58-year-old woman who was low-risk. While the patient’s symptoms initially improved with SAVR with a sutureless bioprosthetic valve, they progressively worsened as the valve degraded, and the leaflets became increasingly calcified and stenotic ultimately, requiring reoperative SAVR with a St. Jude mechanical valve. This case raises the issue of the lack of much-needed data describing the long-term durability and hemodynamic performance of these valves, particularly in a low-risk patient with excellent functional status. We hope to shed further insight into the lack of long-term studies on patients with SPV to assess their longevity and long-term effectiveness, as well as elucidation of possible prevention and monitoring of these potential complications. The use of newer generation prostheses, although attractive for their ease of implantation, potentially carries higher long-term risk due to shorter durability leading to reintervention to address valve deterioration. This is especially true in low-risk patients who are young and active. Cardiology and cardiothoracic surgery societies need to develop a universal registry with follow-up of all valves in order to track and study the durability of these valves, and to evaluate for incidence of known and potential complications.
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Affiliation(s)
- Michael Cinelli
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Leonard Schwartz
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Jonathan Spagnola
- Division of Cardiology, Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Iosif Gulkarov
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Frank Rosell
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Adam Lackey
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Mohammed Imam
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Charles Schwartz
- Division of Cardiology, Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
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Suresh R, Fatima S, Ratnani I, Masud F, Reardon MJ. Emergent Transcatheter Aortic Valve Replacement (TAVR) Performed on Patient With DiGeorge Syndrome. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:36-38. [PMID: 32171679 DOI: 10.1016/j.carrev.2020.03.011] [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: 12/07/2019] [Revised: 02/11/2020] [Accepted: 03/05/2020] [Indexed: 11/24/2022]
Abstract
Emergent Transcatheter Aortic Valve Replacement (TAVR) is a strategy that has been used for management of severely decompensated patients who are unlikely to tolerate an open procedure (Kolte et al., 2018). Recently, in the context of degenerated valve bioprosthesis, valve-in-valve (ViV) transcatheter aortic valve replacement has become an acceptable management strategy (Kalra et al., 2019 [2]). Here, we present this rare case of a 25-year-old, post-partum female with DiGeorge Syndrome, who presented with severe bioprosthetic valve stenosis leading to heart failure. She initially had received a biologic valve in order to have children; however, following delivery of her child, she developed valve failure that was severe enough to preclude her from receiving a surgical aortic valve replacement. ViV TAVR was performed emergently to improve heart failure and bridge the time to definitive treatment, when she would be able to safely receive a mechanical valve. After valve placement, echocardiogram showed no evidence of aortic regurgitation or paravalvular leak with a mean gradient of 2 mmHg, and she was ultimately discharged. Our patient was recovering well at her two-month follow up appointment. This case highlights the need for further research in the use of ViV TAVR in younger patient populations in emergent situations.
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Affiliation(s)
- Rishi Suresh
- Texas A&M College of Medicine, 8447 Riverside Parkway, Bryan, TX, USA; Houston Methodist Hospital, Department of Anesthesiology and Critical Care, Houston, TX, USA.
| | - Sahar Fatima
- Houston Methodist Hospital, Department of Anesthesiology and Critical Care, Houston, TX, USA.
| | - Iqbal Ratnani
- Houston Methodist Hospital, Department of Anesthesiology and Critical Care, Houston, TX, USA.
| | - Faisal Masud
- Houston Methodist Hospital, Department of Anesthesiology and Critical Care, Houston, TX, USA.
| | - Michael J Reardon
- Houston Methodist Hospital, Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston, TX, USA.
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67
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Woitek FJ, Stachel G, Kiefer P, Haussig S, Leontyev S, Schlotter F, Mende M, Hommel J, Crusius L, Spindler A, Mohr FW, Schuler G, Thiele H, Borger MA, Linke A, Holzhey D, Mangner N. Treatment of failed aortic bioprostheses: An evaluation of conventional redo surgery and transfemoral transcatheter aortic valve-in-valve implantation. Int J Cardiol 2020; 300:80-86. [DOI: 10.1016/j.ijcard.2019.09.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/10/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
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Von Stumm M, Petersen J, Westermann D, Reichenspurner H, Girdauskas E. Treatment strategies for mixed aortic valve disease in nonelderly patients. Expert Rev Cardiovasc Ther 2019; 17:873-882. [DOI: 10.1080/14779072.2019.1702520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Maria Von Stumm
- Department of Cardiovascular Surgery, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J. Petersen
- Department of Cardiovascular Surgery, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D. Westermann
- Department of Cardiology, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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69
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Vrachatis DA, Vavuranakis M, Tsoukala S, Giotaki S, Papaioannou TG, Siasos G, Deftereos G, Giannopoulos G, Raisakis K, Tousoulis D, Deftereos S, Vavuranakis M. "TAVI: Valve in valve. A new field for structuralists? Literature review". Hellenic J Cardiol 2019; 61:148-153. [PMID: 31809790 DOI: 10.1016/j.hjc.2019.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/23/2019] [Accepted: 10/16/2019] [Indexed: 12/30/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) led to the foundation of the subspecialty of structural heart interventions and created an emerging area of clinical and technical issues. Soon after TAVI introduction into clinical practice, boundaries were expanded with utilization of valve-in-valve (V-i-V) techniques. V-i-V comprised a diverse subset of patients including TAVI within TAVI, TAVI within a degenerated surgically implanted bioprosthesis, or even TAVI-in-TAVI-in-surgical bioprosthesis. In the present review, we summarize the available literature and present initial experience on the field in Greece.
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Affiliation(s)
- Dimitrios A Vrachatis
- Department of Cardiology, General Hospital of Athens, "G.Gennimatas", Athens, Greece.
| | - Michail Vavuranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Styliani Tsoukala
- Department of Cardiology, General Hospital of Athens, "G.Gennimatas", Athens, Greece
| | - Sotiria Giotaki
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Greece
| | | | - Gerasimos Siasos
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Greece
| | - Gerasimos Deftereos
- Department of Cardiology, General Hospital of Athens, "G.Gennimatas", Athens, Greece
| | - Georgios Giannopoulos
- Department of Cardiology, General Hospital of Athens, "G.Gennimatas", Athens, Greece
| | - Konstantinos Raisakis
- Department of Cardiology, General Hospital of Athens, "G.Gennimatas", Athens, Greece
| | - Dimitrios Tousoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Greece
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
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70
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Dimitrakakis G, Syed Nong Chek SAH, Kornaszewska M, Deglurkar I. The challenge of simultaneous major aortic surgery and pectus excavatum repair in a patient with Ehlers-Danlos type IV syndrome. J Card Surg 2019; 35:250-253. [PMID: 31730724 DOI: 10.1111/jocs.14358] [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: 11/30/2022]
Abstract
A unique case of a patient with Ehlers-Danlos type IV syndrome was referred with aortic root aneurysm and previous cosmetic primary repair of pectus excavatum (PE) through a solid silicone onlay prosthesis. The patient underwent successful removal of the silicone prosthesis and one-stage ascending aortic root replacement with concomitant Nuss procedure for repair of the PE.
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Affiliation(s)
| | | | | | - Indu Deglurkar
- Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK
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71
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Numerical models of valve-in-valve implantation: effect of intentional leaflet laceration on the anchorage. Biomech Model Mechanobiol 2019; 19:415-426. [DOI: 10.1007/s10237-019-01218-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/22/2019] [Indexed: 11/26/2022]
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72
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Russo E, Potenza DR, Casella M, Massaro R, Russo G, Braccio M, Dello Russo A, Cassese M. Rate and Predictors of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation: Current Status. Curr Cardiol Rev 2019; 15:205-218. [PMID: 30516109 PMCID: PMC6719385 DOI: 10.2174/1573403x15666181205105821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/15/2018] [Accepted: 11/27/2018] [Indexed: 11/22/2022] Open
Abstract
Transcather aortic valve implantation (TAVI) has become a safe and indispensable treatment option for patients with severe symptomatic aortic stenosis who are at high surgical risk. Recently, outcomes after TAVI have improved significantly and TAVI has emerged as a qualified alternative to surgical aortic valve replacement in the treatment of intermediate risk patients and greater adoption of this procedure is to be expected in a wider patients population, including younger patients and low surgical risk patients. However since the aortic valve has close spatial proximity to the conduction system, conduction anomalies are frequently observed in TAVI. In this article, we aim to review the key aspects of pathophysiology, current incidence, predictors and clinical association of conduction anomalies following TAVI.
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Affiliation(s)
- Eleonora Russo
- Department of Cardiovascular Disease, Division of Cardiac Surgery, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy.,Department of Cardiovascular Disease, Division of Cardiology, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Domenico R Potenza
- Department of Cardiovascular Disease, Division of Cardiology, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Michela Casella
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Raimondo Massaro
- Department of Cardiovascular Disease, Division of Cardiology, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Giulio Russo
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Maurizio Braccio
- Department of Cardiovascular Disease, Division of Cardiac Surgery, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Antonio Dello Russo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mauro Cassese
- Department of Cardiovascular Disease, Division of Cardiac Surgery, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
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