101
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Pibarot P, Ternacle J, Jaber WA, Salaun E, Dahou A, Asch FM, Weissman NJ, Rodriguez L, Xu K, Annabi MS, Guzzetti E, Beaudoin J, Bernier M, Leipsic J, Blanke P, Clavel MA, Rogers E, Alu MC, Douglas PS, Makkar R, Miller DC, Kapadia SR, Mack MJ, Webb JG, Kodali SK, Smith CR, Herrmann HC, Thourani VH, Leon MB, Hahn RT. Structural Deterioration of Transcatheter Versus Surgical Aortic Valve Bioprostheses in the PARTNER-2 Trial. J Am Coll Cardiol 2020; 76:1830-1843. [DOI: 10.1016/j.jacc.2020.08.049] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023]
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102
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Bavry AA, Okuno T, Aalaei-Andabili SH, Kumbhani DJ, Stortecky S, Asami M, Lanz J, Windecker S, Pilgrim T. The relationship between baseline diastolic dysfunction and postimplantation invasive hemodynamics with transcatheter aortic valve replacement. Clin Cardiol 2020; 43:1428-1434. [PMID: 32960991 PMCID: PMC7724241 DOI: 10.1002/clc.23457] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/17/2020] [Accepted: 08/22/2020] [Indexed: 12/30/2022] Open
Abstract
Background Abnormal invasive hemodynamics after transcatheter aortic valve replacement (TAVR) is associated with poor survival; however, the mechanism is unknown. Hypothesis Diastolic dysfunction will modify the association between invasive hemodynamics postTAVR and mortality. Methods Patients with echocardiographic assessment of diastolic function and postTAVR invasive hemodynamic assessment were eligible for the present analysis. Diastology was classified as normal or abnormal (Stages 1 to 3). The aorto‐ventricular index (AVi) was calculated as the difference between the aortic diastolic and the left ventricular end‐diastolic pressure divided by the heart rate. AVi was categorized as abnormal (AVi < 0.5 mmHg/beats per minute) or normal (≥ 0.5 mmHg/beats per minute). Results From 1339 TAVR patients, 390 were included in the final analysis. The mean follow‐up was 3.3 ± 1.7 years. Diastolic dysfunction was present in 70.9% of the abnormal vs 55.1% of the normal AVi group (P < .001). All‐cause mortality was 46% in the abnormal vs 31% in the normal AVi group (P < .001). Adjusted hazard ratio (HR) for AVi < 0.5 mmHg/beats per minute vs AVi ≥0.5 mmHg/beats per minute for intermediate‐term mortality was (HR = 1.5, 95% confidence interval [CI] 1.1 to 2.1, P = .017). This association was the same among those with normal diastolic function and those with diastolic dysfunction (P for interaction = .35). Conclusion Diastolic dysfunction is prevalent among TAVR patients. Low AVi is an independent predictor for poor intermediate‐term survival, irrespective of co‐morbid diastolic dysfunction.
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Affiliation(s)
- Anthony A Bavry
- Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Taishi Okuno
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Dharam J Kumbhani
- Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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103
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Useini D, Beluli B, Christ H, Mügge A, Patsalis P, Schlömicher M, Haldenwang P, Bechtel M, Strauch J. Oversized versus Non-oversized Prosthesis: Midterm Outcomes after Transcatheter Aortic Valve Replacement Using SAPIEN 3 Valve. Thorac Cardiovasc Surg 2020; 69:445-454. [PMID: 32688405 DOI: 10.1055/s-0040-1713168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A certain degree of prosthesis oversizing is recommended for the SAPIEN 3 (S3; Edwards Lifesciences Corp., Irvine, California, United States) to ensure device success. We aimed to investigate midterm outcomes in patients who received oversized (OS) S3 valve after transapical-transcatheter aortic valve replacement (TA-TAVR). METHODS Out of 122 patients with aortic stenosis who underwent TA-TAVR using S3 at our institution, 42 received OS prosthesis. We used computed tomography (CT) derived effective diameter to assess oversizing. We defined oversizing if the labeled diameter of the selected valve for implantation was ≥2 mm bigger than the effective annulus diameter calculated by the annulus area. We conducted a midterm follow-up and compared the OS cohort with the non-OS (nOS) cohort. RESULTS The study groups showed similar risk score and age (STS [Society of Thoracic Surgery] score: 5.4 ± 3; mean age: 80.7 ± 5.7). The 30-day mortality was 7.1% in OS versus 2.4% in nOS. The 30-day all-stroke was 2.4% in OS versus 0% in nOS. The 1- and 3-year all-cause mortality were 28.5 and 42.8% in OS versus 21.9 and 26.8% in nOS, respectively. Midterm freedom from death and from cardiocerebral events was similar in both groups. Moderate/severe paravalvular leakage occurred in 0% in OS versus 5.4% in nOS. The postdilation rate was 7.1% in OS versus 15.3% in nOS. The rate of new permanent pacemaker implantation (PPI) was 15.7% in OS versus 9.3% in nOS. The STS score was detected as an independent predictor of mortality. CONCLUSION Oversizing reduces the risk of device failure and intraprocedural postdilation but increases the risk of PPI. Early and midterm morbidity and mortality after OS and nOS with S3 are comparable.
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Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Blerta Beluli
- Department of Internal Medicine, St. Anna Hospital, Herne, Germany
| | - Hildegard Christ
- Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Cologne, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Polykarpos Patsalis
- Department of Cardiology and Angiology, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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104
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Raschpichler MC, Woitek F, Chakravarty T, Flint N, Yoon SH, Mangner N, Patel CG, Singh C, Kashif M, Kiefer P, Holzhey D, Linke A, Stachel G, Thiele H, Borger MA, Makkar RR. Valve-in-Valve for Degenerated Transcatheter Aortic Valve Replacement Versus Valve-in-Valve for Degenerated Surgical Aortic Bioprostheses: A 3-Center Comparison of Hemodynamic and 1-Year Outcome. J Am Heart Assoc 2020; 9:e013973. [PMID: 32646262 PMCID: PMC7660709 DOI: 10.1161/jaha.119.013973] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background As transcatheter aortic valve replacement (TAVR) is expected to progress into younger patient populations, valve‐in‐TAVR (ViTAVR) may become a frequent consideration. Data on ViTAVR, however, are limited. This study investigated the outcome of ViTAVR in comparison to valve in surgical aortic valve replacement (ViSAVR), because ViSAVR is an established procedure for higher‐risk patients requiring repeated aortic valve intervention. Methods and Results Clinical and procedural data of patients who underwent ViTAVR at 3 sites in the United States and Germany were retrospectively compared with data of patients who underwent ViSAVR at Cedars‐Sinai Medical Center, according to Valve Academic Research Consortium‐2 criteria. A total of 99 consecutive patients, 52.5% women, with a median Society of Thoracic Surgeons score of 7.2 were identified. Seventy‐four patients (74.7%) underwent ViSAVR, and 25 patients (25.3%) underwent ViTAVR. Balloon‐expandable devices were used in 72.7%. ViSAVR patients presented with smaller index devices (21.0 versus 26.0 mm median true internal diameter; P<0.001). Significantly better postprocedural hemodynamics (median prosthesis mean gradient, 12.5 [interquartile range, 8.8–16.2] versus 16.0 [interquartile range, 13.0–20.5] mm Hg; P=0.045) were observed for ViTAVR compared with the ViSAVR. Device success, however, was not different (79.2% and 66.2% for ViTAVR and ViSAVR, respectively; P=0.35), as were rates of permanent pacemaker implantation (16.7% versus 5.4%; P=0.1). One‐year‐mortality was 9.4% and 13.4% for ViTAVR and ViSAVR, respectively (log‐rank P=0.38). Conclusions Compared with ViSAVR, ViTAVR provides acceptable outcomes, with slightly better hemodynamics, similar device success rates, and similar 1‐year mortality.
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Affiliation(s)
- Matthias C Raschpichler
- Cedars-Sinai Smidt Heart Institute Los Angeles CA.,University Clinic of Cardiac Surgery Heart Center Leipzig Leipzig Germany
| | - Felix Woitek
- Department of Cardiology Dresden University Hospital Dresden Germany
| | | | - Nir Flint
- Cedars-Sinai Smidt Heart Institute Los Angeles CA.,Department of Cardiology Tel-Aviv Sourasky Medical Center Sackler Faculty of Medicine Tel-Aviv University Tel-Aviv Israel
| | | | - Norman Mangner
- Department of Cardiology Dresden University Hospital Dresden Germany
| | | | | | | | - Philip Kiefer
- University Clinic of Cardiac Surgery Heart Center Leipzig Leipzig Germany
| | - David Holzhey
- University Clinic of Cardiac Surgery Heart Center Leipzig Leipzig Germany
| | - Axel Linke
- Department of Cardiology Dresden University Hospital Dresden Germany
| | - Georg Stachel
- Department of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig Germany
| | - Michael A Borger
- University Clinic of Cardiac Surgery Heart Center Leipzig Leipzig Germany
| | - Raj R Makkar
- Cedars-Sinai Smidt Heart Institute Los Angeles CA
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105
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Auffret V, Bakhti A, Leurent G, Bedossa M, Tomasi J, Belhaj Soulami R, Verhoye JP, Donal E, Galli E, Loirat A, Sharobeem S, Sost G, Le Guellec M, Boulmier D, Le Breton H. Determinants and Impact of Heart Failure Readmission Following Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2020; 13:e008959. [DOI: 10.1161/circinterventions.120.008959] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Heart failure (HF) readmission is common post–transcatheter aortic valve replacement (TAVR). Nonetheless, limited data are available regarding its predictors and clinical impact. This study evaluated the incidence, predictors, and impact of HF readmission within 1-year post-TAVR, and assessed the effects of the prescription of HF therapies at discharge on the risk of HF readmission and death.
Methods:
Patients included in the TAVR registry of a single expert center from 2009 to 2017 were analyzed. Competing-risk and Cox regressions were performed to identify predictors of HF readmission and death.
Results:
Among 750 patients, 102 (13.6%) were readmitted for HF within 1-year post-TAVR. Overall, 53 patients (7.1%) experienced late readmissions (>30 days post-TAVR), and 17 (2.3%) had multiple readmissions. In ≈30% of readmissions, no trigger could be identified. Predominant causes of readmissions were changes in medication/nonadherence and supraventricular arrhythmia. Independent predictors of HF readmission included diabetes mellitus, chronic lung disease, previous acute HF, grade III or IV aortic regurgitation, and pulmonary hypertension both at discharge from the index hospitalization but not HF therapies. Overall, HF readmission did not significantly impact all-cause mortality (hazard ratio [HR], 1.36 [95% CI, 0.99–1.85]). However, late (HR, 1.90 [95% CI, 1.30–2.78]) and multiple HF readmissions (HR, 2.10 [95% CI,1.17–3.76]) were significantly associated with all-cause mortality. Prescription of renin-angiotensin system inhibitors at discharge was associated with a lower rate of all-cause mortality, especially among patients receiving doses of 25% to <50% (HR, 0.67 [95% CI, 0.48–0.94]) and 75% to 100% (HR, 0.61 [95% CI, 0.37–0.98]) of the optimal daily dose.
Conclusions:
HF readmission is common within 1-year of TAVR. Late and multiple HF readmissions associate with an increased risk of long-term all-cause mortality. Baseline comorbidities (diabetes, chronic lung disease, previous acute HF) and echocardiographic findings at discharge (grade III or IV aortic regurgitation, pulmonary hypertension) identified patients at high risk of HF readmission.
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Affiliation(s)
- Vincent Auffret
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Abdelkader Bakhti
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Guillaume Leurent
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Marc Bedossa
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Jacques Tomasi
- Université de Rennes 1, CHU Rennes Service de Chirurgie Cardiaque, Inserm LTSI U1099, F 35000 Rennes, France (J.T., R.B.S., J.-P.V.)
| | - Reda Belhaj Soulami
- Université de Rennes 1, CHU Rennes Service de Chirurgie Cardiaque, Inserm LTSI U1099, F 35000 Rennes, France (J.T., R.B.S., J.-P.V.)
| | - Jean-Philippe Verhoye
- Université de Rennes 1, CHU Rennes Service de Chirurgie Cardiaque, Inserm LTSI U1099, F 35000 Rennes, France (J.T., R.B.S., J.-P.V.)
| | - Erwan Donal
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Elena Galli
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Aurélie Loirat
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Sam Sharobeem
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Gwenaelle Sost
- Université de Rennes 1, CHU Rennes Service de Gériatrie, F 35000 Rennes, France (G.S.)
| | - Marielle Le Guellec
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Dominique Boulmier
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Hervé Le Breton
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
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106
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Virtanen MPO, Eskola M, Savontaus M, Juvonen T, Niemelä M, Laakso T, Husso A, Jalava MP, Tauriainen T, Ahvenvaara T, Maaranen P, Kinnunen EM, Dahlbacka S, Laine M, Mäkikallio T, Valtola A, Raivio P, Rosato S, D'Errigo P, Vento A, Airaksinen J, Biancari F. Mid-term outcomes of Sapien 3 versus Perimount Magna Ease for treatment of severe aortic stenosis. J Cardiothorac Surg 2020; 15:157. [PMID: 32600369 PMCID: PMC7325109 DOI: 10.1186/s13019-020-01203-1] [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: 03/18/2020] [Accepted: 06/22/2020] [Indexed: 11/12/2022] Open
Abstract
Background There is limited information on the longer-term outcome after transcatheter aortic valve replacement (TAVR) with new-generation prostheses compared to surgical aortic valve replacement (SAVR). The aim of this study was to compare the mid-term outcomes after TAVR with Sapien 3 and SAVR with Perimount Magna Ease bioprostheses for severe aortic stenosis. Methods In a retrospective study, we included patients who underwent transfemoral TAVR with Sapien 3 or SAVR with Perimount Magna Ease bioprosthesis between January 2008 and October 2017 from the nationwide FinnValve registry. Propensity score matching was performed to adjust for differences in the baseline characteristics. The Kaplan-Meir method was used to estimate late mortality. Results A total of 2000 patients were included (689 in the TAVR cohort and 1311 in the SAVR cohort). Propensity score matching resulted in 308 pairs (STS score, TAVR 3.5 ± 2.2% vs. SAVR 3.5 ± 2.8%, p = 0.918). In-hospital mortality was 3.6% after SAVR and 1.3% after TAVR (p = 0.092). Stroke, acute kidney injury, bleeding and atrial fibrillation were significantly more frequent after SAVR, but higher rate of vascular complications was observed after TAVR. The cumulative incidence of permanent pacemaker implantation at 4 years was 13.9% in the TAVR group and 6.9% in the SAVR group (p = 0.0004). At 4-years, all-cause mortality was 20.6% for SAVR and 25.9% for TAVR (p = 0.910). Four-year rates of coronary revascularization, prosthetic valve endocarditis and repeat aortic valve intervention were similar between matched cohorts. Conclusions The Sapien 3 bioprosthesis achieves comparable midterm outcomes to a surgical bioprosthesis with proven durability such as the Perimount Magna Ease. However, the Sapien 3 bioprosthesis was associated with better early outcome. Trial registration ClinicalTrials.gov Identifier: NCT03385915.
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Affiliation(s)
- Marko P O Virtanen
- Heart Hospital, Tampere University Hospital, Tampere, Finland. .,Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland.
| | - Markku Eskola
- Heart Hospital, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Mikko Savontaus
- Heart Center, Turku University Hospital, and Department of Surgery, University of Turku, Turku, Finland
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Department of Surgery, Oulu University Hospital and Research Unit of Surgery, Anesthesia and Intensive Care, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Matti Niemelä
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Teemu Laakso
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | | | - Maina P Jalava
- Heart Center, Turku University Hospital, and Department of Surgery, University of Turku, Turku, Finland
| | - Tuomas Tauriainen
- Department of Surgery, Oulu University Hospital and Research Unit of Surgery, Anesthesia and Intensive Care, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Tuomas Ahvenvaara
- Department of Surgery, Oulu University Hospital and Research Unit of Surgery, Anesthesia and Intensive Care, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Pasi Maaranen
- Heart Hospital, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | | | | | - Mika Laine
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Timo Mäkikallio
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Antti Valtola
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Peter Raivio
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Stefano Rosato
- National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Paola D'Errigo
- National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Antti Vento
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Juhani Airaksinen
- Heart Center, Turku University Hospital, and Department of Surgery, University of Turku, Turku, Finland
| | - Fausto Biancari
- Heart Center, Turku University Hospital, and Department of Surgery, University of Turku, Turku, Finland.,Department of Surgery, Oulu University Hospital and Research Unit of Surgery, Anesthesia and Intensive Care, Faculty of Medicine, University of Oulu, Oulu, Finland
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107
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Tham JLM, Adams H, Paleri S, Wright C, Dimitriou J, Newcomb A, MacIsaac AI, Whitbourn RJ, Palmer SC. Clinical outcomes of self-expandable vs. balloon-expandable TAVI for severe aortic stenosis. Acta Cardiol 2020; 75:218-225. [PMID: 30931804 DOI: 10.1080/00015385.2019.1572959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is an established therapy for patients with severe aortic stenosis (AS). There is limited data exploring differences in outcomes post-TAVI SEV vs. BEV. This study compared procedural success and 30-d clinical outcomes self-expandable valves (SEV), vs. balloon-expandable valves (BEV) for patients with severe AS.Methods: Retrospective analysis was undertaken of patients receiving TAVI at St Vincent's Hospital, Melbourne between August 2009 and May 2018. The primary endpoints included procedural success, clinical outcomes and complication rates at 30-d.Results: Out of 151 patients undergoing TAVI, 70 received (46.3%) SEV (Medtronic CoreValve & Evolut-R) and 81 (53.6%) BEV (Edwards SAPIEN-XT & S3). The mean Society of Thoracic Surgery (STS) risk score did not differ between the groups, SEV (83.6 ± 4.9 years, STS 4.4 ± 3.8) compared to BEV (82.3 ± 5.8 years, STS 4.9 ± 4.9). Procedural success was similar SEV 67 (95.7%) vs. BEV 78 (96.3%). Rates of ≥ moderate paravalvular aortic regurgitation (PAR) at 30-d were significantly higher in SEV compared to BEV (6.7 vs. 0.0%; p = .02). SEV patients had higher rates of pacemaker insertion (36.4 vs. 9.5%; p = .001) and stroke rates (12.4 vs. 1.4%; p = .04) compared to BEV patients. The difference in 30-d mortality between the two groups was similar (SEV 4.6% vs. BEV 1.3%; p = .23).Conclusions: This real-world retrospective analysis demonstrates higher rates of ≥ moderate PAR, stroke and pacemaker insertion with SEV compared to BEV at 30 d post-TAVI for severe symptomatic AS.
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Affiliation(s)
| | - Heath Adams
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Sarang Paleri
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Christine Wright
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Jim Dimitriou
- Department of Cardiac Surgery, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Andrew Newcomb
- Department of Cardiac Surgery, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Andrew I. MacIsaac
- Department of Medicine, University of Melbourne, Fitzroy, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Robert J. Whitbourn
- Department of Medicine, University of Melbourne, Fitzroy, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Sonny C. Palmer
- Department of Medicine, University of Melbourne, Fitzroy, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
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108
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Siqueira DA, Simonato M, Ramos AA, Bignoto T, Le Bihan D, Barreto RBM, Senra T, Pinto IM, Kambara AM, Santos MA, Viana R, Sousa AGMR, Abizaid AAC. Mid‐ to long‐term clinical and echocardiographic outcomes after transcatheter aortic valve replacement with a new‐generation, self‐expandable system. Catheter Cardiovasc Interv 2020; 97:167-174. [DOI: 10.1002/ccd.28999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 04/03/2020] [Accepted: 05/12/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Dimytri A. Siqueira
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Matheus Simonato
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Auristela A. Ramos
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Tiago Bignoto
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - David Le Bihan
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Rodrigo B. M. Barreto
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Tiago Senra
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Ibraim M. Pinto
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Antonio M. Kambara
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Magaly A. Santos
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Renata Viana
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Amanda G. M. R. Sousa
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
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109
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Pibarot P, Salaun E, Dahou A, Avenatti E, Guzzetti E, Annabi MS, Toubal O, Bernier M, Beaudoin J, Ong G, Ternacle J, Krapf L, Thourani VH, Makkar R, Kodali SK, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Leipsic J, Blanke P, Williams MR, McCabe JM, Brown DL, Babaliaros V, Goldman S, Szeto WY, Généreux P, Pershad A, Alu MC, Xu K, Rogers E, Webb JG, Smith CR, Mack MJ, Leon MB, Hahn RT. Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients. Circulation 2020; 141:1527-1537. [DOI: 10.1161/circulationaha.119.044574] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background:
This study aimed to compare echocardiographic findings in low-risk patients with severe aortic stenosis after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR).
Methods:
The PARTNER 3 trial (Placement of Aortic Transcatheter Valves) randomized 1000 patients with severe aortic stenosis and low surgical risk to undergo either transfemoral TAVR with the balloon-expandable SAPIEN 3 valve or SAVR. Transthoracic echocardiograms obtained at baseline and at 30 days and 1 year after the procedure were analyzed by a consortium of 2 echocardiography core laboratories.
Results:
The percentage of moderate or severe aortic regurgitation (AR) was low and not statistically different between the TAVR and SAVR groups at 30 days (0.8% versus 0.2%;
P
=0.38). Mild AR was more frequent after TAVR than SAVR at 30 days (28.8% versus 4.2%;
P
<0.001). At 1 year, mean transvalvular gradient (13.7±5.6 versus 11.6±5.0 mm Hg;
P
=0.12) and aortic valve area (1.72±0.37 versus 1.76±0.42 cm
2
;
P
=0.12) were similar in TAVR and SAVR. The percentage of severe prosthesis–patient mismatch at 30 days was low and similar between TAVR and SAVR (4.6 versus 6.3%;
P
=0.30). Valvulo-arterial impedance (Z
va
), which reflects total left ventricular hemodynamic burden, was lower with TAVR than SAVR at 1 year (3.7±0.8 versus 3.9±0.9 mm Hg/mL/m
2
;
P
<0.001). Tricuspid annulus plane systolic excursion decreased and the percentage of moderate or severe tricuspid regurgitation increased from baseline to 1 year in SAVR but remained unchanged in TAVR. Irrespective of treatment arm, high Z
va
and low tricuspid annulus plane systolic excursion, but not moderate to severe AR or severe prosthesis–patient mismatch, were associated with increased risk of the composite end point of mortality, stroke, and rehospitalization at 1 year.
Conclusions:
In patients with severe aortic stenosis and low surgical risk, TAVR with the SAPIEN 3 valve was associated with similar percentage of moderate or severe AR compared with SAVR but higher percentage of mild AR. Transprosthetic gradients, valve areas, percentage of severe prosthesis–patient mismatch, and left ventricular mass regression were similar in TAVR and SAVR. SAVR was associated with significant deterioration of right ventricular systolic function and greater tricuspid regurgitation, which persisted at 1 year. High Z
va
and low tricuspid annulus plane systolic excursion were associated with worse outcome at 1 year whereas AR and severe prosthesis–patient mismatch were not.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02675114.
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Affiliation(s)
- Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Erwan Salaun
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Abdellaziz Dahou
- Cardiovascular Research Foundation, New York, NY (A.D., E.A., M.C.A., M.B.L., R.T.H.)
| | - Eleonora Avenatti
- Cardiovascular Research Foundation, New York, NY (A.D., E.A., M.C.A., M.B.L., R.T.H.)
| | - Ezequiel Guzzetti
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Mohamed-Salah Annabi
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Oumhani Toubal
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Mathieu Bernier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Jonathan Beaudoin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Géraldine Ong
- St Michael’s Hospital, University of Toronto, Canada (G.O.)
| | - Julien Ternacle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Laura Krapf
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Atlanta, GA (V.H.T.)
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, CA (R.M.)
| | - Susheel K. Kodali
- Columbia University Irving Medical Center/New York–Presbyterian Hospital, New York (S.K.K., M.C.A., C.R.S., M.B.L., R.T.H.)
| | - Mark Russo
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (M.R.)
| | | | - S. Chris Malaisrie
- Feinberg School of Medicine, Northwestern University, Chicago, IL (S.C.M.)
| | | | | | - Philipp Blanke
- St Paul’s Hospital, Vancouver, Canada (J.L., P.B., J.G.W.)
| | | | | | - David L. Brown
- Baylor Scott & White Healthcare, Plano, TX (D.L.B., M.J.M.)
| | | | | | | | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.)
| | | | - Maria C. Alu
- Cardiovascular Research Foundation, New York, NY (A.D., E.A., M.C.A., M.B.L., R.T.H.)
- Columbia University Irving Medical Center/New York–Presbyterian Hospital, New York (S.K.K., M.C.A., C.R.S., M.B.L., R.T.H.)
| | - Ke Xu
- Edwards Lifesciences, Irvine, CA (K.X., E.R.)
| | - Erin Rogers
- Edwards Lifesciences, Irvine, CA (K.X., E.R.)
| | - John G. Webb
- St Paul’s Hospital, Vancouver, Canada (J.L., P.B., J.G.W.)
| | - Craig R. Smith
- Columbia University Irving Medical Center/New York–Presbyterian Hospital, New York (S.K.K., M.C.A., C.R.S., M.B.L., R.T.H.)
| | | | - Martin B. Leon
- Cardiovascular Research Foundation, New York, NY (A.D., E.A., M.C.A., M.B.L., R.T.H.)
- Columbia University Irving Medical Center/New York–Presbyterian Hospital, New York (S.K.K., M.C.A., C.R.S., M.B.L., R.T.H.)
| | - Rebecca T. Hahn
- Cardiovascular Research Foundation, New York, NY (A.D., E.A., M.C.A., M.B.L., R.T.H.)
- Columbia University Irving Medical Center/New York–Presbyterian Hospital, New York (S.K.K., M.C.A., C.R.S., M.B.L., R.T.H.)
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110
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Randomised comparison of a balloon-expandable and self-expandable valve with quantitative assessment of aortic regurgitation using magnetic resonance imaging. Neth Heart J 2020; 28:253-265. [PMID: 32246266 PMCID: PMC7190770 DOI: 10.1007/s12471-020-01414-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction Transcatheter aortic valve implantation (TAVI) is a safe and effective treatment for inoperable, intermediate- or high-risk patients with severe symptomatic aortic stenosis and has been associated with excellent clinical outcomes. A clinically relevant remaining problem is aortic regurgitation (AR) post-TAVI, which is associated with increased mortality. Therefore, we conducted a prospective randomised trial to assess the safety and efficacy of a first-generation self-expandable valve (SEV; CoreValve) and a third-generation balloon-expandable valve (BEV; Sapien 3) with respect to clinical outcomes and AR as determined quantitatively by magnetic resonance imaging (MRI). Methods The ELECT study was an investigator-initiated, single-centre trial involving patients with severe symptomatic aortic stenosis and with a clinical indication for transfemoral TAVI. Fifty-six patients were randomly assigned to the BEV or SEV group. Results AR determined quantitatively by MRI was lower in the BEV than in the SEV group [regurgitant fraction: 1.1% (0–8.0) vs 8.7% (3.0–14.8) for SEV; p = 0.01]. Secondary endpoints according to the criteria of the Second Valve Academic Research Consortium (VARC-2) showed BEV to have better early safety [0 (0%) vs 8 (30%); p = 0.002] at 30 days and a lower risk of stroke [0 (0%) vs 5 (21%); p = 0.01], major adverse cardiac and cerebrovascular events [0 (0%) vs 10 (38%); p < 0.001] or death [0 (0%) vs 5 (19%); p = 0.02] in the 1st year compared with SEV. Conclusions The use of the latest generation of BEV was associated with less AR as quantitatively assessed by MRI. Although the use of MRI to quantify AR is not feasible in daily clinical practice, it should be considered as a surrogate endpoint for clinical outcomes in comparative studies of valves for TAVI. ClinicalTrials.gov number NCT01982032.
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111
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Mas-Peiro S, Fichtlscherer S, Walther C, Vasa-Nicotera M. Current issues in transcatheter aortic valve replacement. J Thorac Dis 2020; 12:1665-1680. [PMID: 32395310 PMCID: PMC7212163 DOI: 10.21037/jtd.2020.01.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aortic stenosis is the most common valvular disease worldwide. With transcatheter aortic valve replacement (TAVR) being increasingly expanded to lower-risk populations, several challenging issues remain to be solved. The present review aims at discussing modern approaches to such issues as well as the current status of TAVR. TAVR has undergone several developments in the recent years: an increased use of transfemoral access, the development of prostheses in order to adapt to challenging anatomies, improved delivery systems with repositioning features, and outer skirts aiming at reducing paravalvular leak. The indication of TAVR is increasingly being expanded to patients with lower surgical risk. The main clinical trials supporting such expansion are reviewed and the latest data on low-risk patients are discussed. A number of challenges need still to be addressed and are also reviewed in this paper: the need for updated international guidelines including the latest evidence; a reduction of main complications such as permanent pacemaker implantation, paravalvular leak, and stroke (and its potential prevention by using anti-embolic protection devices); the appropriate role of TAVR in patients with concomitant cardiac ischemic disease; and durability of bio-prosthetic implanted valves. Finally, the future perspectives for TAVR use and next device developments are discussed.
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Affiliation(s)
- Silvia Mas-Peiro
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Claudia Walther
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| |
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112
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Halim SA, Edwards FH, Dai D, Li Z, Mack MJ, Holmes DR, Tuzcu EM, Thourani VH, Harrison JK, Brennan JM. Outcomes of Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve Disease. Circulation 2020; 141:1071-1079. [DOI: 10.1161/circulationaha.119.040333] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Patients with bicuspid aortic valve (AV) stenosis were excluded from the pivotal evaluations of transcatheter AV replacement (TAVR) devices. We sought to evaluate the outcomes of TAVR in patients with bicuspid AV stenosis in comparison with those with tricuspid AV stenosis.
Methods:
We used data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry (November 2011 through November 2018) to determine device success, procedural outcomes, post-TAVR valve performance, and in-hospital clinical outcomes (mortality, stroke, and major bleeding) according to valve morphology (bicuspid versus tricuspid). Results were stratified by older and current (Sapien 3 and Evolut R) generation valve prostheses. Medicare administrative claims were used to evaluate mortality and stroke to 1 year among eligible individuals (≥65 years).
Results:
After exclusions, there were 170 959 eligible procedures at 593 sites during the specified interval. Of these, 5412 TAVR procedures (3.2%) were performed in patients with bicuspid AV, including 3705 with current-generation devices. In comparison with patients with tricuspid valves, patients with bicuspid AV were younger and had a lower Society of Thoracic Surgeons Predicted Risk of Operative Mortality score. When current-generation devices were used to treat patients with bicuspid AV, device success increased (93.5 versus 96.3;
P
=0.001) and the incidence of 2+ aortic insufficiency declined (14.0% versus 2.7%;
P
<0.001) in comparison with older-generation devices. With current-generation devices, device success was slightly lower in the bicuspid (versus tricuspid) AV group (96.3% in bicuspid versus 97.4% in tricuspid,
P
=0.07), with a slightly higher incidence of residual moderate or severe aortic insufficiency among patients with bicuspid AV (2.7% versus 2.1%;
P
<0.001). A lower 1-year adjusted risk of mortality (hazard ratio, 0.88 [95% CI, 0.78–0.99]) was observed for patients with bicuspid AV versus patients with tricuspid AV in the Medicare-linked cohort, whereas no difference was observed in the 1-year adjusted risk of stroke (hazard ratio, 1.14 [95% CI, 0.94–1.39]).
Conclusions:
Using current-generation devices, procedural, postprocedural, and 1-year outcomes were comparable following TAVR for bicuspid AV versus tricuspid AV disease. With newer-generation devices, TAVR is a viable treatment option for patients with bicuspid AV disease.
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Affiliation(s)
- Sharif A. Halim
- Duke Clinical Research Institute (S.A.H., D.D., Z.L., J.K.H.), Duke University Medical Center, Durham, NC
- Presbyterian Heart Center, Albuquerque, NM (S.A.H.)
| | - Fred H. Edwards
- University of Florida Health Science Center, Jacksonville (F.H.E.)
| | - David Dai
- Duke Clinical Research Institute (S.A.H., D.D., Z.L., J.K.H.), Duke University Medical Center, Durham, NC
| | - Zhuokai Li
- Duke Clinical Research Institute (S.A.H., D.D., Z.L., J.K.H.), Duke University Medical Center, Durham, NC
| | | | | | | | | | - J. Kevin Harrison
- Duke Clinical Research Institute (S.A.H., D.D., Z.L., J.K.H.), Duke University Medical Center, Durham, NC
| | - J. Matthew Brennan
- Duke University School of Medicine (J.M.B.), Duke University Medical Center, Durham, NC
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113
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Arnold SV, Zhang Y, Baron SJ, McAndrew TC, Alu MC, Kodali SK, Kapadia S, Thourani VH, Miller DC, Mack MJ, Leon MB, Cohen DJ. Impact of Short-Term Complications on Mortality and Quality of Life After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 12:362-369. [PMID: 30784641 DOI: 10.1016/j.jcin.2018.11.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/05/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of this study was to examine the independent association of short-term complications of transcatheter aortic valve replacement (TAVR) with survival and quality of life at 1 year. BACKGROUND Prior studies have examined the mortality and cost implications of various complications of TAVR. However, many of these complications may primarily affect patients' quality of life after TAVR, which has not been previously studied. METHODS Among patients at intermediate or high surgical risk who underwent TAVR as part of the PARTNER (Placement of Aortic Transcatheter Valve) 2 studies and survived 30 days, the association between complications within the 30 days after TAVR and mortality and quality of life at 1 year was examined. Quality of life was assessed using the Kansas City Cardiomyopathy Questionnaire and the Short-Form 12. Complications assessed included major and minor stroke, life-threatening and major bleeding, vascular injury, stage 3 acute kidney injury, new pacemaker implantation, and mild and moderate or severe paravalvular leak (PVL). Multivariable models that included all complications as well as baseline clinical factors were used to examine the independent association of each complication with outcomes. RESULTS Among 3,763 TAVR patients, major stroke and stage 3 acute kidney injury were associated with markedly increased risk for 1-year mortality, with adjusted hazard ratios of 5.4 (95% confidence interval [CI]: 3.1 to 9.5) and 4.9 (95% CI: 2.7 to 8.8), respectively, as well as poorer quality of life among survivors (reductions in 1-year Kansas City Cardiomyopathy Questionnaire overall summary score of 15.1 points [95% CI: 24.8 to 5.3 points] and 14.7 points [95% CI: 25.6 to 3.8 points], respectively). Moderate or severe PVL, life-threatening bleeding, and major bleeding were each associated with a more modest increase in mortality and decrement in quality of life, whereas mild PVL was associated with a small decrease in quality of life. After adjusting for baseline characteristics and other complications, need for a new pacemaker, minor stroke, and vascular injury were not independently associated with poor outcomes. CONCLUSIONS Among patients undergoing TAVR, similar events are associated with increased mortality and impaired quality of life at 1 year. These results suggest that despite considerable progress, efforts to further reduce stroke, acute kidney injury, bleeding, and moderate or severe PVL are likely to yield important clinical benefits and remain key targets for device iteration and procedural improvement.
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Affiliation(s)
- Suzanne V Arnold
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri.
| | - Yiran Zhang
- Columbia-Presbyterian Hospital, New York, New York
| | - Suzanne J Baron
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | | | - Maria C Alu
- Columbia-Presbyterian Hospital, New York, New York
| | | | | | - Vinod H Thourani
- Medstar Washington Hospital Center/Georgetown University, Washington, District of Columbia
| | - D Craig Miller
- Stanford University Medical School, Stanford, California
| | | | | | - David J Cohen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
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114
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Keshavarz-Motamed Z, Khodaei S, Rikhtegar Nezami F, Amrute JM, Lee SJ, Brown J, Ben-Assa E, Garcia Camarero T, Ruano Calvo J, Sellers S, Blanke P, Leipsic J, de la Torre Hernandez JM, Edelman ER. Mixed Valvular Disease Following Transcatheter Aortic Valve Replacement: Quantification and Systematic Differentiation Using Clinical Measurements and Image-Based Patient-Specific In Silico Modeling. J Am Heart Assoc 2020; 9:e015063. [PMID: 32106747 PMCID: PMC7335548 DOI: 10.1161/jaha.119.015063] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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 Mixed valvular disease (MVD), mitral regurgitation (MR) from pre‐existing disease in conjunction with paravalvular leak (PVL) following transcatheter aortic valve replacement (TAVR), is one of the most important stimuli for left ventricle (LV) dysfunction, associated with cardiac mortality. Despite the prevalence of MVD, the quantitative understanding of the interplay between pre‐existing MVD, PVL, LV, and post‐TAVR recovery is meager. Methods and Results We quantified the effects of MVD on valvular‐ventricular hemodynamics using an image‐based patient‐specific computational framework in 72 MVD patients. Doppler pressure was reduced by TAVR (mean, 77%; N=72; P<0.05), but it was not always accompanied by improvements in LV workload. TAVR had no effect on LV workload in 22 patients, and LV workload post‐TAVR significantly rose in 32 other patients. TAVR reduced LV workload in only 18 patients (25%). PVL significantly alters LV flow and increases shear stress on transcatheter aortic valve leaflets. It interacts with mitral inflow and elevates shear stresses on mitral valve and is one of the main contributors in worsening of MR post‐TAVR. MR worsened in 32 patients post‐TAVR and did not improve in 18 other patients. Conclusions PVL limits the benefit of TAVR by increasing LV load and worsening of MR and heart failure. Post‐TAVR, most MVD patients (75% of N=72; P<0.05) showed no improvements or even worsening of LV workload, whereas the majority of patients with PVL, but without that pre‐existing MR condition (60% of N=48; P<0.05), showed improvements in LV workload. MR and its exacerbation by PVL may hinder the success of TAVR.
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Affiliation(s)
- Zahra Keshavarz-Motamed
- Department of Mechanical Engineering McMaster University Hamilton Ontario Canada.,Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering McMaster University Hamilton Ontario Canada
| | - Farhad Rikhtegar Nezami
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA
| | - Junedh M Amrute
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA.,Division of Biology and Biological Engineering California Institute of Technology Pasadena CA
| | | | - Jonathan Brown
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA
| | - Eyal Ben-Assa
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA.,Cardiology Division Massachusetts General Hospital
| | | | | | - Stephanie Sellers
- St. Paul's Hospital Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Philipp Blanke
- St. Paul's Hospital Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Jonathon Leipsic
- St. Paul's Hospital Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Jose M de la Torre Hernandez
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA.,Hospital Universitario Marques de Valdecilla IDIVAL Santander Spain
| | - Elazer R Edelman
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA.,Cardiovascular Division Brigham and Women's Hospital
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115
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Hahn RT. All that glitters is not gold: can videodensitometry replace echocardiography for the assessment of paravalvular aortic regurgitation? EUROINTERVENTION 2020; 15:1219-1222. [PMID: 32044729 DOI: 10.4244/eijv15i14a218] [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: 11/23/2022]
Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center, NY Presbyterian Hospital, New York, NY, USA
| |
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116
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Van Belle E, Vincent F, Labreuche J, Auffret V, Debry N, Lefèvre T, Eltchaninoff H, Manigold T, Gilard M, Verhoye JP, Himbert D, Koning R, Collet JP, Leprince P, Teiger E, Duhamel A, Cosenza A, Schurtz G, Porouchani S, Lattuca B, Robin E, Coisne A, Modine T, Richardson M, Joly P, Rioufol G, Ghostine S, Bar O, Amabile N, Champagnac D, Ohlmann P, Meneveau N, Lhermusier T, Leroux L, Leclercq F, Gandet T, Pinaud F, Cuisset T, Motreff P, Souteyrand G, Iung B, Folliguet T, Commeau P, Cayla G, Bayet G, Darremont O, Spaulding C, Le Breton H, Delhaye C. Balloon-Expandable Versus Self-Expanding Transcatheter Aortic Valve Replacement. Circulation 2020; 141:243-259. [DOI: 10.1161/circulationaha.119.043785] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background:
No randomized study powered to compare balloon expandable (BE) with self expanding (SE) transcatheter heart valves (THVs) on individual end points after transcatheter aortic valve replacement has been conducted to date.
Methods:
From January 2013 to December 2015, the FRANCE-TAVI nationwide registry (Registry of Aortic Valve Bioprostheses Established by Catheter) included 12 141 patients undergoing BE-THV (Edwards, n=8038) or SE-THV (Medtronic, n=4103) for treatment of native aortic stenosis. Long term mortality status was available in all patients (median 20 months; interquartile range, 14 to 30). Patients treated with BE-THV (n=3910) were successfully matched 1:1 with 3910 patients treated with SE-THV by using propensity score (25 clinical, anatomical, and procedural variables) and by date of the procedure (within 3 months). The first coprimary outcome was ≥ moderate occurrence of paravalvular regurgitation or in-hospital mortality, or both. The second coprimary outcome was 2-year all-cause mortality.
Results:
In propensity–matched analyses, the incidence of the first coprimary outcome was higher with SE-THV (19.8%) compared with BE-THV (11.9%; relative risk, 1.68 [95% CI, 1.46–1.91];
P
<0.0001). Each component of the outcome was also higher in patients receiving SE-THV: ≥ moderate paravalvular regurgitation (15.5% versus 8.3%; relative risk, 1.90 [95% CI, 1.63–2.22];
P
<0.0001) and in hospital mortality (5.6% versus 4.2%; relative risk, 1.34 [95% CI, 1.07–1.66];
P
=0.01). During follow up, all cause mortality occurred in 899 patients treated with SE-THV (2-year mortality, 29.8%) and in 801 patients treated with BE-THV (2-year mortality, 26.6%; hazard ratio, 1.17 [95% CI, 1.06–1.29];
P
=0.003). Similar results were found using inverse probability of treatment weighting using propensity score analysis.
Conclusion:
The present study suggests that use of SE-THV was associated with a higher risk of paravalvular regurgitation and higher in-hospital and 2-year mortality compared with use of BE-THV. These data strongly support the need for a randomized trial sufficiently powered to compare the latest generation of SE-THV and BE-THV.
Clinical Trial Registration:
https://www.clinicaltrials.gov
. Unique identifier: NCT01777828.
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Affiliation(s)
- Eric Van Belle
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Flavien Vincent
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Julien Labreuche
- Department of Biostatistics, EA 2694-Santé Publique: épidémiologie et Qualité des Soins (J.L., A.D.)
| | - Vincent Auffret
- CHU de Lille, Université de Lille, France. CHU Pontchaillou, Service de Cardiologie et Maladies Vasculaires, CIC-IT 804, Université de Rennes 1, Laboratoire de Traitement du Signal et de l’Image, Inserm U1099, Rennes, France (V.A., J.P.-V., H.L.B.)
| | - Nicolas Debry
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Thierry Lefèvre
- Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques-Cartier, Massy, France (T. Lefèvre)
| | - Helene Eltchaninoff
- CHU Rouen–Charles-Nicolle, Service de Cardiologie, Inserm U644, Rouen, France (H.E.)
| | - Thibaut Manigold
- CHU Guillaume et René Laennec, Institut du Thorax, Service de Cardiologie, Nantes, France (T. Manigold)
| | - Martine Gilard
- CHU La Cavale Blanche, Département de Cardiologie, Optimisation des Régulations Physiologiques, UFR Sciences et Techniques, Brest, France (M.G.)
| | - Jean-Phillipe Verhoye
- CHU de Lille, Université de Lille, France. CHU Pontchaillou, Service de Cardiologie et Maladies Vasculaires, CIC-IT 804, Université de Rennes 1, Laboratoire de Traitement du Signal et de l’Image, Inserm U1099, Rennes, France (V.A., J.P.-V., H.L.B.)
| | - Dominique Himbert
- AP–HP, Hôpital Bichat, Département de Cardiologie, Université Paris-Diderot, France (D.H., B.I.)
| | - Rene Koning
- Clinique Saint-Hilaire, Service de Cardiologie, Rouen, France (R.K.)
| | - Jean-Phillipe Collet
- AP–HP, CHU La Pitié-Salpêtrière, Service de Cardiologie, Paris, France (J.-P.C., P.L.)
| | - Pascal Leprince
- AP–HP, CHU La Pitié-Salpêtrière, Service de Cardiologie, Paris, France (J.-P.C., P.L.)
| | - Emmanuel Teiger
- Hôpital Henri-Mondor Assistance Publique Hôpitaux de Paris, Département de Cardiologie, Créteil, France (E.T.)
| | - Alain Duhamel
- Department of Biostatistics, EA 2694-Santé Publique: épidémiologie et Qualité des Soins (J.L., A.D.)
| | - Alessandro Cosenza
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Guillaume Schurtz
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Sina Porouchani
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Benoit Lattuca
- CHU Nîmes, Cardiologie, Université Montpellier, Nimes, France (B.L., G.C.)
| | - Emmanuel Robin
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Augustin Coisne
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Thomas Modine
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Marjorie Richardson
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Patrick Joly
- Hopital Saint-Joseph, Fédération de Cardiologie, Marseille, France (P.J.)
| | - Gilles Rioufol
- CHU Louis Pradel, Division de Cardiologie, Centre d’Investigation Clinique de Lyon (CIC), Bron, France (G.R.)
| | - Said Ghostine
- Centre Marie Lannelongue, Département de Cardiologie, Le Plessis Robinson, France (S.G.)
| | - Olivier Bar
- Clinique Saint Gatien, Service de Cardiologie, Tours, France (O.B.)
| | - Nicolas Amabile
- Institut Mutualiste Montsouris, Département de Cardiologie, Paris, France (N.A.)
| | - Didier Champagnac
- Clinique du Tonkin, Service de Cardiologie, Villeurbanne, France (D.C.)
| | - Patrick Ohlmann
- CHU de Strasbourg, Nouvel Hôpital Civil, Département de Cardiologie, Université de Strasbourg, France (P.O.)
| | - Nicolas Meneveau
- CHU Besançon, Cardiologie, Hopital Jean Minjoz, Besançon, France (N.M.)
| | - Thibaut Lhermusier
- CHU de Toulouse, Département de Cardiologie, Inserm U1048, Université de Toulouse 3, France (T. Lhermusier)
| | - Lionel Leroux
- Hôpital Cardiologique du Haut-Lévêque, Département de Cardiologie Interventionnelle, Université de Bordeaux, Pessac, France (L.L.)
| | - Florence Leclercq
- CHU Arnaud de Villeneuve, Service de Cardiologie, Montpellier, France (F.L., T.G.)
| | - Thomas Gandet
- CHU Arnaud de Villeneuve, Service de Cardiologie, Montpellier, France (F.L., T.G.)
| | - Frédéric Pinaud
- CHU d’Angers, Service de Chirurgie Cardiaque, CNRS UMR 6214, INSERM 1083, Université d’Angers, France (F.P.)
| | - Thomas Cuisset
- CHU La Timone Assistance Publique Hôpitaux de Marseille, Département de Cardiologie, Inserm UMR1062, INRA UMR 1260, Université d’Aix-Marseille, France (T.C.)
| | - Pascal Motreff
- CHU Gabriel Montpied, Département de Cardiologie, ISIT, CaVITI, CNRS (UMR-6284), Université d’Auvergne, Clermont-Ferrand, France (P.M., G. Souteyrand)
| | - Géraud Souteyrand
- CHU Gabriel Montpied, Département de Cardiologie, ISIT, CaVITI, CNRS (UMR-6284), Université d’Auvergne, Clermont-Ferrand, France (P.M., G. Souteyrand)
| | - Bernard Iung
- AP–HP, Hôpital Bichat, Département de Cardiologie, Université Paris-Diderot, France (D.H., B.I.)
| | - Thierry Folliguet
- CHU de Nancy, Service de Chirurgie Cardiovasculaire, Vandoeuvre-lès-Nancy, France (T.F.)
| | | | - Guillaume Cayla
- CHU Nîmes, Cardiologie, Université Montpellier, Nimes, France (B.L., G.C.)
| | - Gilles Bayet
- Hôpital Privé Clairval, Service de Cardiologie, Marseille, France (G.B.)
| | - Olivier Darremont
- Clinique Saint Augustin, Service de Cardiologie, Bordeaux, France (O.D.)
| | | | - Hervé Le Breton
- CHU de Lille, Université de Lille, France. CHU Pontchaillou, Service de Cardiologie et Maladies Vasculaires, CIC-IT 804, Université de Rennes 1, Laboratoire de Traitement du Signal et de l’Image, Inserm U1099, Rennes, France (V.A., J.P.-V., H.L.B.)
| | - Cédric Delhaye
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
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117
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Quintana RA, Monlezun D, Davogustto G, Saenz H, Lugo Baruqui D, Denktas AE, Jneid H, Paniagua D. Network Analysis of Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement for Stenotic Bicuspid Aortic Valves According to Valve Type. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1076-1085. [PMID: 31980400 DOI: 10.1016/j.carrev.2020.01.011] [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: 07/03/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND It is currently unknown if outcomes after transcatheter aortic valve replacement (TAVR) differ according to the prosthetic valve deployed in patients with bicuspid aortic valves (BAV). OBJECTIVES This study evaluated valve-specific outcomes post-TAVR in patients with BAV. METHODS Literature search was performed using the Cochrane databases, PubMed, ClinicalTrials, SCOPUS and EMBASE databases from inception until July 2018. We computed risk ratios and their 95% confidence intervals for all outcomes of interest. For each outcome, the data were pooled using a multivariate random-effects meta-analysis including multiple treatment as well as direct and indirect comparisons. RESULTS Ten studies enrolling a total of 1547 BAV patients undergoing TAVR using 6 different prosthetic valve types were analyzed. There were no significant differences in 30-day all-cause mortality, life-threatening bleeding and device success among the diverse prosthetic valve types implanted. However, 2nd generation balloon-expandable valves had consistently lower risk of moderate-to-severe prosthetic valve regurgitation. CONCLUSION In patients with BAV, there were no significant differences in 30-day all-cause mortality after TAVR among the various prosthetic valve types.
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Affiliation(s)
- Raymundo A Quintana
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Dominique Monlezun
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Giovanni Davogustto
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Humberto Saenz
- Division of Geriatrics, Department of Internal Medicine, University of California San Diego, San Diego, CA, USA.
| | - Diego Lugo Baruqui
- Department of Internal Medicine, Mount Sinai Medical Center, Miami, FL, USA
| | - Ali E Denktas
- Division of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, TX, USA.
| | - Hani Jneid
- Division of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, TX, USA.
| | - David Paniagua
- Division of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, TX, USA.
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118
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Van Belle E, Vincent F, Rauch A, Casari C, Jeanpierre E, Loobuyck V, Rosa M, Delhaye C, Spillemaeker H, Paris C, Debry N, Verdier B, Vincentelli A, Dupont A, Lenting PJ, Susen S. von Willebrand Factor and Management of Heart Valve Disease: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 73:1078-1088. [PMID: 30846101 DOI: 10.1016/j.jacc.2018.12.045] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/30/2018] [Indexed: 10/27/2022]
Abstract
For decades, numerous observations have shown an intimate relationship between von Willebrand factor (VWF) multimer profile and heart valve diseases (HVD). The current knowledge of the unique biophysical properties of VWF helps us to understand the longstanding observations concerning the bleeding complications in patients with severe HVD. Not only does the analysis of the VWF multimer profile provide an excellent evaluation of HVD severity, it is also a strong predictor of clinical events. Also of importance, VWF responds within minutes to any significant change in hemodynamic valve status, making it an accurate marker of the quality of surgical and transcatheter therapeutic interventions. The authors provide in this review a practical, comprehensive, and evidence-based framework of the concept of VWF as a biomarker in HVD, advocating for its implementation into the clinical decision-making process besides usual clinical and imaging evaluation. They also delineate critical knowledge gaps and research priorities to definitely validate this concept.
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Affiliation(s)
- Eric Van Belle
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Institut Coeur Poumon, Cardiology, Lille, France
| | - Flavien Vincent
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Institut Coeur Poumon, Cardiology, Lille, France
| | - Antoine Rauch
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology and Transfusion, Lille, France
| | - Caterina Casari
- Inserm, UMR_S 1176, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Emmanuelle Jeanpierre
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology and Transfusion, Lille, France
| | - Valentin Loobuyck
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Institut Coeur Poumon, Cardiac Surgery, Lille, France
| | - Mickael Rosa
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France
| | - Cedric Delhaye
- CHU Lille, Institut Coeur Poumon, Cardiology, Lille, France
| | | | - Camille Paris
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology and Transfusion, Lille, France
| | - Nicolas Debry
- CHU Lille, Institut Coeur Poumon, Cardiology, Lille, France
| | - Basile Verdier
- CHU Lille, Institut Coeur Poumon, Cardiology, Lille, France
| | - André Vincentelli
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Institut Coeur Poumon, Cardiac Surgery, Lille, France
| | - Annabelle Dupont
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France
| | - Peter J Lenting
- Inserm, UMR_S 1176, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Sophie Susen
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology and Transfusion, Lille, France.
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119
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Naik M, McNamara C, Jabbour RJ, Gopalan D, Mikhail GW, Mirsadraee S, Ariff B. Imaging of transcatheter aortic valve replacement complications. Clin Radiol 2020; 76:27-37. [PMID: 31964536 DOI: 10.1016/j.crad.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/11/2019] [Indexed: 01/05/2023]
Abstract
Aortic stenosis is increasing in incidence and is now commonly managed with transcatheter aortic valve replacement (TAVR) in intermediate and high-risk patients. Radiologists are likely to encounter patients undergoing this procedure both pre- and postoperatively, and therefore, an understanding of procedural complications is essential. Complications may relate to the access site or approach, or the valve itself. This article will review the most common complications described in literature and focuses on the role of multidetector computed tomography (CT) in their evaluation either exclusively, or complementary to other imaging methods.
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Affiliation(s)
- M Naik
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - C McNamara
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - R J Jabbour
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - D Gopalan
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - G W Mikhail
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - S Mirsadraee
- Department of Radiology, Harefield Hospital, Hill End Road, Uxbridge, UB9 6JH, UK
| | - B Ariff
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.
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Arnold SV, Manandhar P, Vemulapalli S, Kosinski A, Desai ND, Bavaria JE, Carroll JD, Mack MJ, Thourani VH, Cohen DJ. Impact of short-term complications of transcatheter aortic valve replacement on longer-term outcomes: results from the STS/ACC Transcatheter Valve Therapy Registry. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 7:208-213. [DOI: 10.1093/ehjqcco/qcaa001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/26/2019] [Accepted: 01/06/2020] [Indexed: 12/22/2022]
Abstract
Abstract
Aims
While complications of transcatheter aortic valve replacement (TAVR) have decreased, they still occur commonly and may negatively impact both short- and long-term outcomes. We sought to examine the association of complications after TAVR with survival and health status in a real-world cohort.
Methods and results
Among 45 884 TAVR patients from 513 US sites who survived 30 days, 21.4% had at least one major complication [stroke, bleed, vascular complication, new pacemaker, acute kidney injury (AKI), and moderate/severe paravalvular leak (PVL)]. In multivariable models, Stage 3 AKI [hazard ratio (HR) 3.43, 95% confidence interval (CI) 2.64–4.45], stroke (HR 2.62, 95% CI 2.06–3.32), and bleeding (HR 1.83, 95% CI 1.55–2.16) were independently associated with significantly increased risk of early death (<3 months) with slight attenuation in these hazards between 3 and 12 months. Moderate/severe PVL (HR 1.37, 95% CI 1.21–1.55) and new pacemaker (HR 1.15, 95% CI 1.05–1.25) were associated with more modest risk of excess mortality that was consistent through 12 months. Among surviving patients, stroke (−6.1 points, 95% CI −8.4 to −3.7), moderate/severe PVL (−3.2 points, 95% CI −4.9 to −1.6), and new pacemaker (−2.3 points, 95% CI −3.2 to −1.5) were associated with less improvement in 1-year health status, as assessed by the Kansas City Cardiomyopathy Questionnaire.
Conclusion
In this study of contemporary TAVR, we found that complications remain common within the first 30 days after TAVR and are associated with worse 1-year survival and health status among survivors. These findings support continued efforts to reduce major complications of TAVR and may also help define quality of care.
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Affiliation(s)
- Suzanne V Arnold
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111, USA
- Department of Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA
| | - Pratik Manandhar
- Department of Medicine, Duke University, 2301 Erwin Road, Durham, NC 27710, USA
| | | | - Andrzej Kosinski
- Department of Medicine, Duke University, 2301 Erwin Road, Durham, NC 27710, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - John D Carroll
- Department of Medicine, University of Colorado School of Medicine, 12605 E 16th Ave, Aurora, CO 80045, USA
| | - Michael J Mack
- Division of Cardiothoracic Surgery, Baylor Scott and White Health, 4716 Alliance Blvd, Plano, TX 75093, USA
| | - Vinod H Thourani
- Division of Cardiothoracic Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, 95 Collier Road NW, Atlanta, GA 30309, USA
| | - David J Cohen
- Department of Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA
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Sengupta A, Zaid S, Kamioka N, Terre J, Miyasaka M, Hirji SA, Hensey M, Geloo N, Petrossian G, Robinson N, Sarin E, Ryan L, Yoon SH, Tan CW, Khalique OK, Kodali SK, Kaneko T, Shah PB, Wong SC, Salemi A, Sharma K, Kozina JA, Szerlip MA, Don CW, Gafoor S, Zhang M, Newhart Z, Kapadia SR, Mick SL, Krishnaswamy A, Kini A, Ahmad H, Lansman SL, Mack MJ, Webb JG, Babaliaros V, Thourani VH, Makkar RR, Leon MB, George I, Tang GH. Mid-Term Outcomes of Transcatheter Aortic Valve Replacement in Extremely Large Annuli With Edwards SAPIEN 3 Valve. JACC Cardiovasc Interv 2020; 13:210-216. [DOI: 10.1016/j.jcin.2019.08.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/22/2019] [Accepted: 08/29/2019] [Indexed: 12/21/2022]
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122
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Yucel-Finn A, Nicol E, Leipsic JA, Weir-McCall JR. CT in planning transcatheter aortic valve implantation procedures and risk assessment. Clin Radiol 2019; 76:73.e1-73.e19. [PMID: 31883615 DOI: 10.1016/j.crad.2019.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/13/2019] [Indexed: 12/31/2022]
Abstract
For surgical aortic valve replacement, the Society of Thoracic Surgeons score (STSS) is the reference standard for the prediction of operative risk. In transcatheter aortic valve implantation (TAVI) though, where the procedure itself is minimally invasive, the traditional risk assessment is supplemented by CTA. Through a consistent approach to the acquisition of high-quality images and the standardised reporting of annular measurements and adverse root and vascular features, patients at risk of complications can be identified. In turn, this may allow for a personalised procedural approach and treatment strategies devised to potentially reduce or mitigate this risk. This article provides a systematic and standardised approach to pre-procedural work-up with computed tomography angiography (CTA) and explores the current state of evidence and future areas of development in this rapidly developing field.
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Affiliation(s)
| | - E Nicol
- Royal Brompton Hospital, London, UK
| | - J A Leipsic
- St Paul's Hospital, Vancouver, British Columbia, Canada
| | - J R Weir-McCall
- Royal Papworth Hospital, Cambridge, UK; University of Cambridge School of Clinical Medicine, Cambridge, UK.
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Li YM, Mei FY, Yao YJ, Tsauo JY, Peng Y, Chen M. Causes and predictors of readmission after transcatheter aortic valve implantation : A meta-analysis and systematic review. Herz 2019; 46:1-8. [PMID: 31807789 DOI: 10.1007/s00059-019-04870-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 09/13/2019] [Accepted: 11/11/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Since readmission rate is an important clinical index to determine the quality of inpatient care and hospital performance, the aim of this study was to explain the causes and predictors of readmission following transcatheter aortic valve implantation (TAVI) at short-term and mid-term follow-up. METHODS AND RESULTS A systematic review and meta-analysis of all published articles from Embase, Pubmed/MEDLINE, and Ovid was carried out. In all, 10 studies including 52,702 patients were identified. The pooled estimate for the overall event rate was 0.15, and cardiovascular causes were the main reason for 30-day readmission (0.42, 95% confidence interval [CI]: 0.39-0.45). In addition, the pooled incidence of 1‑year readmission was 0.31, and cardiovascular events were still the main cause (0.41, 95% CI: 0.33-0.48). Patients with major and life-threatening bleeding, new permanent pacemaker implantation, and clinical heart failure were associated with a high risk for early readmission after TAVI. Moreover, an advanced (≥3) New York Heart Association classification, acute kidney injury, paravalvular leak, mitral regurgitation (≥ moderate), and major bleeding predicted unfavorable outcome to 1‑year readmission. Female gender and transfemoral TAVI was associated with a lower risk for unplanned rehospitalization. CONCLUSIONS This meta-analysis found cardiovascular factors to be the main causes for both 30-day and 1‑year rehospitalization. Heart failure represented the most common cardiovascular event at both short-term and mid-term follow-up. Several baseline characteristics and procedure-related factors were deemed unfavorable predictors of readmission. Importantly, transfemoral access and female gender were associated with a lower risk of readmission.
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Affiliation(s)
- Yi-Ming Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, China
| | - Fu-Yang Mei
- Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Yi-Jun Yao
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jia-Yu Tsauo
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, China.
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124
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Goel H, Kumar A, Garg N, Mills JD. Men are from mars, women are from venus: Factors responsible for gender differences in outcomes after surgical and trans-catheter aortic valve replacement. Trends Cardiovasc Med 2019; 31:34-46. [PMID: 31902553 DOI: 10.1016/j.tcm.2019.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/21/2019] [Accepted: 11/23/2019] [Indexed: 01/09/2023]
Abstract
Females suffer higher operative (30-day) mortality than males after surgical aortic valve replacement (SAVR). In contrast, outcomes after trans-catheter aortic valve replacement (TAVR) seem to favor females, both in terms of procedural mortality, and more prominently, medium to long-term survival. With an ever-greater number of TAVR procedures being performed, an understanding of factors responsible for gender differences in outcomes after the two AVR modalities is critical for better patient selection. Current evidence suggests that this gender difference in outcomes after SAVR and TAVR stems from differences in baseline risk profiles, as well as inherent anatomic/physiological differences between genders. This review attempts to examine these clinical and physiological factors, with a goal of guiding better patient selection for each AVR modality, and to highlight areas that beg further investigation.
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Affiliation(s)
- Harsh Goel
- Department of Medicine, St. Luke's University Hospital, Bethlehem, PA, United States; Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States.
| | - Ashish Kumar
- Department of Medicine, Wellspan York Hospital, York, PA, United States
| | - Nadish Garg
- Department of Medicine, St Barnabas Medical Center, Livingston, NJ, United States
| | - James D Mills
- Department of Medicine, Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, United States
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125
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Mattke S, Schneider S, Orr P, Lakdawalla D, Goldman D. Temporal Trends in Mortality after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Regression Analysis. STRUCTURAL HEART 2019. [DOI: 10.1080/24748706.2019.1689321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Soeren Mattke
- Center for Improving Chronic Illness Care, University of Southern California, Los Angeles, California, USA
| | - Stefan Schneider
- Center for Self-Report Science, University of Southern California, Los Angeles, California, USA
| | - Patrick Orr
- Center for Improving Chronic Illness Care, University of Southern California, Los Angeles, California, USA
| | - Darius Lakdawalla
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
| | - Dana Goldman
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
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126
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Vincent F, Rauch A, Spillemaeker H, Vincentelli A, Paris C, Rosa M, Dupont A, Delhaye C, Verdier B, Robin E, Lenting PJ, Susen S, Van Belle E. Real-Time Monitoring of von Willebrand Factor in the Catheterization Laboratory: The Seatbelt of Mini-Invasive Transcatheter Aortic Valve Replacement? JACC Cardiovasc Interv 2019; 11:1775-1778. [PMID: 30190067 DOI: 10.1016/j.jcin.2018.05.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 11/28/2022]
Abstract
Significant paravalvular regurgitation (PVR) remains a relatively frequent (4% to 9%) and deleterious complication of transcatheter aortic valve replacement (TAVR), even with the latest generation of bioprosthesis. Although mini-invasive TAVR without general anesthesia or transesophageal echocardiography (TEE) is progressively becoming the predominant approach, identification and grading of PVR in the catheterization laboratory remain an important and challenging clinical issue. The authors discuss how a recently reported blood biomarker reflecting the von Willebrand factor activity, that is, the closure time with adenosine diphosphate, can be successfully applied during the TAVR procedure to detect and monitor PVR in real time, with an excellent negative predictive value. This point-of-care testing performed directly in the catheterization laboratory may improve the diagnosis of PVR and rationalize the decision of whether or not to perform corrective measures. They further discuss how such a test could be a substitute for the multimodal approach combining TEE, hemodynamics, and cine-angiography, and help to secure the transition to the mini-invasive approach and facilitate the expanding indications of less invasive procedures to lower-risk patients without jeopardizing procedural and clinical outcomes.
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Affiliation(s)
- Flavien Vincent
- CHU Lille, Institut Coeur-Poumon, Cardiology, Lille, France; University Lille, Inserm U1011 - EGID, Lille, France; Institut Pasteur de Lille, Lille, France
| | - Antoine Rauch
- University Lille, Inserm U1011 - EGID, Lille, France; Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology Transfusion, Lille, France
| | | | - André Vincentelli
- University Lille, Inserm U1011 - EGID, Lille, France; Institut Pasteur de Lille, Lille, France; CHU Lille, Cardiac surgery, Lille, France
| | - Camille Paris
- University Lille, Inserm U1011 - EGID, Lille, France; Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology Transfusion, Lille, France
| | - Mickael Rosa
- University Lille, Inserm U1011 - EGID, Lille, France; Institut Pasteur de Lille, Lille, France
| | - Annabelle Dupont
- University Lille, Inserm U1011 - EGID, Lille, France; Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology Transfusion, Lille, France
| | - Cedric Delhaye
- CHU Lille, Institut Coeur-Poumon, Cardiology, Lille, France
| | - Basile Verdier
- CHU Lille, Institut Coeur-Poumon, Cardiology, Lille, France
| | - Emmanuel Robin
- University Lille, Inserm U1011 - EGID, Lille, France; Institut Pasteur de Lille, Lille, France; CHU Lille, Anesthesia and Intensive Care, Lille, France
| | - Peter J Lenting
- Inserm, UMR_S 1176, University Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Sophie Susen
- University Lille, Inserm U1011 - EGID, Lille, France; Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology Transfusion, Lille, France.
| | - Eric Van Belle
- CHU Lille, Institut Coeur-Poumon, Cardiology, Lille, France; University Lille, Inserm U1011 - EGID, Lille, France; Institut Pasteur de Lille, Lille, France.
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127
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Goldsweig A, Aronow HD. Identifying patients likely to be readmitted after transcatheter aortic valve replacement. Heart 2019; 106:256-260. [PMID: 31649048 DOI: 10.1136/heartjnl-2019-315381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 11/03/2022] Open
Abstract
Hospital readmission following transcatheter aortic valve replacement (TAVR) contributes considerably to the costs of care. Readmission rates following TAVR have been reported to be as high as 17.4% at 30 days and 53.2% at 1 year. Patient and procedural factors predict an increased likelihood of readmission including non-transfemoral access, acute and chronic kidney impairment, chronic lung disease, left ventricular systolic dysfunction, atrial fibrillation, major bleeding and prolonged index hospitalisation. Recent studies have also found the requirement for new pacemaker implantation and the severity of paravalvular aortic regurgitation and tricuspid regurgitation to be novel predictors of readmission. Post-TAVR readmission within 30 days of discharge is more likely to occur for non-cardiac than cardiac pathology, although readmission for cardiac causes, especially heart failure, predicts higher mortality than readmission for non-cardiac causes. To combat the risk of readmission and associated mortality, the routine practice of calculating and considering readmission risk should be adopted by the heart team. Furthermore, because most readmissions following TAVR occur for non-cardiac reasons, more holistic approaches to readmission prevention are necessary. Familiarity with the most common predictors and causes of readmission should guide the development of initiatives to address these conditions proactively.
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Affiliation(s)
- Andrew Goldsweig
- Department of Cardiovascular Medicine, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska, USA
| | - Herbert David Aronow
- Department of Cardiovascular Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.,Cardiovascular Institute, Lifespan Health System, Providence, Rhode Island, USA
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128
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Dowling C, Kondapally Seshasai SR, Firoozi S, Brecker SJ. Transcatheter aortic valve replacement versus surgery for symptomatic severe aortic stenosis: A reconstructed individual patient data meta-analysis. Catheter Cardiovasc Interv 2019; 96:158-166. [PMID: 31566902 DOI: 10.1002/ccd.28504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/07/2019] [Accepted: 09/05/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES We wished to undertake a reconstructed individual patient data meta-analysis of randomized clinical trials comparing transcatheter aortic valve replacement (TAVR) and surgery for patients with severe symptomatic aortic stenosis. BACKGROUND TAVR and surgery are both well-established methods for treating patients with symptomatic severe aortic stenosis who are at low, intermediate, and high risk for surgery. METHODS Data were identified by searches of Medline, Embase, CENTRAL and ClinicalTrials.gov for all randomized clinical trials, which compared TAVR and surgery that had published at least 1 year of follow-up. Individual patient data were reconstructed from Kaplan-Meier curves. RESULTS A total of 7,770 patients from seven randomized clinical trials were included in this meta-analysis. At 1 year, TAVR was associated with a lower risk of death from any cause (hazard ratio [HR], 0.85, 95% confidence interval [CI], 0.73-0.98; p = .03), disabling stroke (HR, 0.71; 95% CI, 0.54-0.93; p = .01) and the composite end point of death or disabling stroke (HR, 0.79; 95% CI, 0.67-0.92; p = .002). Significant interactions were found for access suitability, with TAVR associated with a lower risk of these end points in patients suitable for transfemoral access. TAVR was associated with a lower risk of periprocedural events, whereas the risk of late events was similar between TAVR and surgery. CONCLUSIONS At 1 year, TAVR was associated with a lower risk of death, disabling stroke and the composite end point, when compared with surgery. These associations were strongest within the subgroup of patients in whom transfemoral access was feasible.
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Affiliation(s)
- Cameron Dowling
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Sreenivasa Rao Kondapally Seshasai
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, UK
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129
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Mehran R, Sorrentino S, Claessen BE. Paravalvular Leak: An Interesting Interplay of Acquired vWF-Disease and Late Bleeding After TAVR. J Am Coll Cardiol 2019; 72:2149-2151. [PMID: 30360824 DOI: 10.1016/j.jacc.2018.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/01/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Sabato Sorrentino
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bimmer E Claessen
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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130
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Atianzar K, Gafoor S, Wang DD. Aortic regurgitation assessment using quantitative aortography in transcatheter aortic valve replacement: can this tool have a significant impact on the procedure? EUROINTERVENTION 2019; 15:396-397. [PMID: 31456570 DOI: 10.4244/eijv15i5a72] [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: 11/23/2022]
Affiliation(s)
- Kimberly Atianzar
- Division of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA, USA
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131
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132
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Tang GHL, Zaid S, Schnittman SR, Ahmad H, Kaple R, Undemir C, Dutta T, Poniros A, Bennett J, Feng C, Cohen M, Lansman SL. Novel predictors of mild paravalvular aortic regurgitation in SAPIEN 3 transcatheter aortic valve implantation. EUROINTERVENTION 2019; 14:58-68. [PMID: 29488887 DOI: 10.4244/eij-d-18-00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Paravalvular leak (PVL) remains an important issue in TAVI. The Edwards SAPIEN 3 (S3) valve has reduced PVL but in up to one third of patients mild leak remains. Our study aimed to identify predictors of mild PVL after TAVI with the S3 valve. METHODS AND RESULTS From October 2015 to May 2017, 122 consecutive patients underwent S3 TAVI for symptomatic severe aortic stenosis. Thirty-three patients with mild PVL on transthoracic echocardiography at 30-day follow-up were compared to 89 with none/trace PVL. Thirty-day mortality was 2.5% (n=3), with zero stroke and major vascular complications. There were no differences between the two groups in patient characteristics, annular and left ventricular outflow tract (LVOT) sizing, distribution and severity of annular calcification, valve implantation technique, post-dilatation and implant depth. Mild PVL was associated with higher annular eccentricity (p=0.04) and moderate-severe LVOT calcification (p=0.03). Independent predictors of mild PVL were LVOT eccentricity (OR 1.05 per % ellipticity, 95% CI: 1.02-1.09, p=0.005), discordant sizing (OR 3.08, 95% CI: 1.20-7.90, p=0.02) and three-leaflet calcification (OR 13.3, 95% CI: 2.66-66.7, p=0.002). CONCLUSIONS LVOT eccentricity and discordant sizing predict PVL after S3 TAVI. Further studies are needed to understand their mechanism and significance.
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Affiliation(s)
- Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
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133
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Moriyama N, Vento A, Laine M. Safety of Next-Day Discharge After Transfemoral Transcatheter Aortic Valve Replacement With a Self-Expandable Versus Balloon-Expandable Valve Prosthesis. Circ Cardiovasc Interv 2019; 12:e007756. [DOI: 10.1161/circinterventions.118.007756] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Noriaki Moriyama
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Finland (N.M., A.V., M.L.)
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Japan (N.M.)
| | - Antti Vento
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Finland (N.M., A.V., M.L.)
| | - Mika Laine
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Finland (N.M., A.V., M.L.)
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134
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Yoshijima N, Yanagisawa R, Hase H, Tanaka M, Tsuruta H, Shimizu H, Fukuda K, Naganuma T, Mizutani K, Araki M, Tada N, Yamanaka F, Shirai S, Tabata M, Ueno H, Takagi K, Higashimori A, Watanabe Y, Yamamoto M, Hayashida K. Update on the clinical impact of mild aortic regurgitation after transcatheter aortic valve implantation: Insights from the Japanese multicenter OCEAN-TAVI registry. Catheter Cardiovasc Interv 2019; 95:35-44. [PMID: 30977256 DOI: 10.1002/ccd.28279] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/29/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study aimed to compare the clinical impact of mild postprocedural aortic regurgitation (post-AR) to that of none-trivial post-AR after transcatheter aortic valve implantation (TAVI) and to identify the vulnerability factors to mild post-AR. BACKGROUND Moderate-severe post-AR, associated with increased mortality, is an important issue. However, the clinical impact of mild post-AR remains controversial. METHODS AND RESULTS We analyzed data from 1,572 consecutive patients (1,026 of none-trivial post-AR and 546 of mild post-AR) obtained from the Optimized transCathEter vAlvular Intervention (OCEAN-TAVI) Japanese multicenter registry. We evaluated the 1-year cumulative cardiovascular death and re-hospitalization rates for heart failure (HF) after TAVI according to the degree of post-AR. Kaplan-Meier curves showed no significant difference between "none-trivial post-AR" and "mild post-AR" in terms of cardiovascular death, but a significant difference was noted in the cumulative incidence of re-hospitalization for HF between the two groups (hazard ratio 1.57, 95% confidence interval 1.02-2.41, p = .04). In the stratified analysis, only in patients with not more than 50% of left ventricular ejection fraction (LVEF), concentric left ventricular hypertrophy (LVH), and none-trivial pre-procedural aortic regurgitation (pre-AR), mild post-AR resulted in a higher incidence of re-hospitalization for HF. CONCLUSIONS In this study, the clinical impact of mild post-AR compared to none-trivial post-AR tended to be augmented in the presence of reduced LVEF, concentric LVH, and none-trivial pre-AR. Pre-procedure echocardiographic findings including LVEF, left ventricular geometry, and pre-AR may help to judge the necessity of postdilatation in case of mild post-AR just after the bioprosthesis deployment.
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Affiliation(s)
- Nobuhiro Yoshijima
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Yanagisawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiromu Hase
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Tanaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hikaru Tsuruta
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Kazuki Mizutani
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | | | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.,Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Zoghbi WA, Asch FM, Bruce C, Gillam LD, Grayburn PA, Hahn RT, Inglessis I, Islam AM, Lerakis S, Little SH, Siegel RJ, Skubas N, Slesnick TC, Stewart WJ, Thavendiranathan P, Weissman NJ, Yasukochi S, Zimmerman KG. Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement. J Am Soc Echocardiogr 2019; 32:431-475. [DOI: 10.1016/j.echo.2019.01.003] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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136
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Miyasaka M, Yoon SH, Sharma RP, Maeno Y, Jaideep S, Taguri M, Kato S, Kawamori H, Nomura T, Ochiai T, Nemanpour S, Chakravarty T, Nakamura M, Wen C, Makkar R. Clinical Outcomes of Transcatheter Aortic Valve Implantation in Patients With Extremely Large Annulus and SAPIEN 3 Dimensions Based on Post-Procedural Computed Tomography. Circ J 2019; 83:672-680. [DOI: 10.1253/circj.cj-18-1059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | - Masataka Taguri
- Department of Data Science, Yokohama City University School of Data Science
- Sendai Kosei Hospital, Cardiovascular Center
| | - Shigeaki Kato
- Sendai Kosei Hospital, Cardiovascular Center
- Center for Regional Cooperation Iwaki, Meisei University
| | | | | | | | | | | | | | - Cheng Wen
- Cedars-Sinai Medical Center, Heart Institute
| | - Raj Makkar
- Cedars-Sinai Medical Center, Heart Institute
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137
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The Lotus Valve Is Safe and Effective, But Will Atrioventricular Block Improve With the Next-Generation System? JACC Cardiovasc Interv 2019; 12:50-51. [PMID: 30621977 DOI: 10.1016/j.jcin.2018.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/13/2018] [Indexed: 11/20/2022]
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138
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Vlastra W, Chandrasekhar J, Muñoz-Garcia AJ, Tchétché D, de Brito FS, Barbanti M, Kornowski R, Latib A, D’Onofrio A, Ribichini F, Baan J, Tijssen JGP, Trillo-Nouche R, Dumonteil N, Abizaid A, Sartori S, D’Errigo P, Tarantini G, Lunardi M, Orvin K, Pagnesi M, del Valle R, Modine T, Dangas G, Mehran R, Piek JJ, Delewi R. Comparison of balloon-expandable vs. self-expandable valves in patients undergoing transfemoral transcatheter aortic valve implantation: from the CENTER-collaboration. Eur Heart J 2018; 40:456-465. [DOI: 10.1093/eurheartj/ehy805] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/13/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Wieneke Vlastra
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jaya Chandrasekhar
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, USA
| | - Antonio J Muñoz-Garcia
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Campus de Teatinos, S/N, Málaga, Spain
| | - Didier Tchétché
- Clinique Pasteur, 45 Avenue de Lombez - BP 27617 - 31076 TOULOUSE, Toulouse, France
| | - Fabio S de Brito
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 44 - Cerqueira César, São Paulo - SP, Brazil
| | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Via Salvatore Citelli, 6, Catania CT, Italy
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Ze'ev Jabotinsky St 39, Petah Tikva, Israel
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina Milano, 58, Milano MI, Italy
| | - Augusto D’Onofrio
- Department of Cardiac, Thoracic and Vascular Sciences, Interventional Cardiology Unit, University of Padova, Via Nicolò Giustiniani, 2, Padova PD, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro 10, Verona, Italy
| | - Jan Baan
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jan G P Tijssen
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ramiro Trillo-Nouche
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Rúa da Choupana, s/n, 15706 Santiago de Compostela, A Coruña, Spain
| | - Nicolas Dumonteil
- Clinique Pasteur, 45 Avenue de Lombez - BP 27617 - 31076 TOULOUSE, Toulouse, France
| | - Alexandre Abizaid
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500 - Vila Mariana, São Paulo - SP, Brazil
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, USA
| | - Paola D’Errigo
- National Centre for Global Helath—Istituto Superiore di Sanità, Viale Regina Elena, 299, Roma RM, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, Interventional Cardiology Unit, University of Padova, Via Nicolò Giustiniani, 2, Padova PD, Italy
| | - Mattia Lunardi
- Division of Cardiology, Department of Medicine, University of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro 10, Verona, Italy
| | - Katia Orvin
- Cardiology Department, Rabin Medical Center, Ze'ev Jabotinsky St 39, Petah Tikva, Israel
| | - Matteo Pagnesi
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina Milano, 58, Milano MI, Italy
| | - Raquel del Valle
- Hospital Universitario Central de Asturias, Julian Claveria. S/N, 33011 Oviedo, Asturias, Spain
| | - Thomas Modine
- Centre Hospitalier Universitaire, 2, avenue Oscar Lambret - 59037 Lille, France
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, USA
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ronak Delewi
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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139
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Pibarot P. The CHOICE Between Self-Expanding and Balloon-Expandable Valves for Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:2519-2522. [DOI: 10.1016/j.jcin.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 10/02/2018] [Indexed: 10/27/2022]
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140
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Kinno M, Raissi SR, Olson KA, Rigolin VH. Three-dimensional echocardiography in the evaluation and management of paravalvular regurgitation. Echocardiography 2018; 35:2056-2070. [DOI: 10.1111/echo.14194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Menhel Kinno
- Division of Cardiology; Department of Medicine; Feinberg School of Medicine; Northwestern University; Chicago Illionis
| | - Sasan R. Raissi
- Division of Cardiology; Department of Medicine; Feinberg School of Medicine; Northwestern University; Chicago Illionis
| | - Kristoff A. Olson
- Division of Cardiology; Department of Medicine; Feinberg School of Medicine; Northwestern University; Chicago Illionis
| | - Vera H. Rigolin
- Division of Cardiology; Department of Medicine; Feinberg School of Medicine; Northwestern University; Chicago Illionis
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141
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Thakur K, Nazif TM, Khalique OK, Paradis JM, Harjai KJ. Transcatheter aortic valve replacement: The year in review 2017. J Interv Cardiol 2018; 31:543-552. [PMID: 30225907 DOI: 10.1111/joic.12562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 01/20/2023] Open
Abstract
This article is a continuation of our previously published annual reviews of transcatheter aortic valve replacement (TAVR). In 2017, TAVR further established a foothold in the management of intermediate risk patients with the publication of SURTAVI trial. Randomized trials also addressed the use of cerebral protection during TAVR and single versus dual antiplatelet therapy after TAVR. Newer generation valve systems continued to be studied for their efficacy and safety. This paper summarizes the major studies published in 2017.
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Affiliation(s)
- Kamia Thakur
- Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | - Tamim M Nazif
- Department of Cardiology, Structural Heart and Valve Center, Columbia University Medical Center, New York, New York
| | - Omar K Khalique
- Department of Cardiology, Structural Heart and Valve Center, Columbia University Medical Center, New York, New York
| | - Jean-Michel Paradis
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Kishore J Harjai
- Department of Cardiology, Geisinger Northeast, Pearsall Heart Hospital, Wilkes Barre, Pennsylvania
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142
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Hahn RT, Pibarot P, Leipsic J, Blanke P, Douglas PS, Weissman NJ, Kapadia S, Thourani VH, Herrmann HC, Nazif T, McAndrew T, Webb JG, Leon MB, Kodali S. The Effect of Post-Dilatation on Outcomes in the PARTNER 2 SAPIEN 3 Registry. JACC Cardiovasc Interv 2018; 11:1710-1718. [PMID: 30121276 DOI: 10.1016/j.jcin.2018.05.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to understand the effects of balloon post-dilatation on outcomes following transcatheter aortic valve replacement with the SAPIEN 3 valve. BACKGROUND Hemodynamics and outcomes with balloon post-dilatation for the SAPIEN 3 valve have not been previously reported. METHODS The effects of balloon post-dilatation (BPD) in 1,661 intermediate (S3i cohort) and high surgical risk (S3HR cohort) patients with aortic stenosis enrolled in the PARTNER (Placement of Aortic Transcatheter Valves) 2, SAPIEN 3 observational study on outcomes, as well as procedural complications, were assessed. RESULTS 208 of 1,661 patients (12.5%) had BPD during the initial transcatheter aortic valve replacement. Baseline characteristics were similar except BPD had higher STS score (p < 0.001), significantly less % oversizing (p = 0.004), significantly more ≥moderate left ventricular outflow tract calcification (p = 0.005), and severe annular calcification (p = 0.006). BPD patients had no increase in permanent pacemaker, annular rupture, or valve embolization. Following transcatheter aortic valve replacement, BPD patients had significantly larger aortic valve area (1.72 ± 0.41 cm2 vs. 1.66 ± 0.37 cm2; p = 0.04) with no significant difference in prosthesis-patient mismatch (p = 0.08) or transvalvular aortic regurgitation (p = 0.65), but significantly more paravalvular regurgitation (p < 0.01). There was no significant difference in 30-day or 1-year outcomes of all-cause death (p = 0.65 to 0.76) or stroke (p = 0.28 to 0.72). However, at 1 year, there was a significantly higher incidence of minor stroke in BPD patients (p = 0.02). Adjusting for baseline differences, including calcium burden, minor strokes were no longer significantly different between the BPD and NoBPD groups (p = 0.21). CONCLUSIONS BPD is performed more frequently in patients with lower % oversizing and greater calcium burden. BPD is not associated with procedural complications or an increase in 1-year adverse events of death, rehospitalization, or stroke.
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center/NY Presbyterian Hospital, New York, New York.
| | - Philippe Pibarot
- Department of Medicine, Laval University, Quebec, Quebec, Canada
| | - Jonathon Leipsic
- University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Pamela S Douglas
- Duke University Medical Center, and Duke Clinical Research Institute, Durham, North Carolina
| | - Neil J Weissman
- Georgetown University School of Medicine, Medstar Health Research Institute, Washington, DC
| | | | - Vinod H Thourani
- Georgetown University School of Medicine, Medstar Health Research Institute, Washington, DC
| | | | - Tamim Nazif
- Columbia University Medical Center/NY Presbyterian Hospital, New York, New York
| | | | - John G Webb
- University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Martin B Leon
- Columbia University Medical Center/NY Presbyterian Hospital, New York, New York
| | - Susheel Kodali
- Columbia University Medical Center/NY Presbyterian Hospital, New York, New York
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143
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Ong G, Annabi MS, Clavel MA, Guzzetti E, Salaun E, Toubal O, Dahou A, Pibarot P. Paravalvular Regurgitation After Transcatheter Aortic Valve Replacement: Is the Problem Solved? Interv Cardiol Clin 2018; 7:445-458. [PMID: 30274611 DOI: 10.1016/j.iccl.2018.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Paravalvular regurgitation is a frequent complication after transcatheter aortic valve replacement and its association with worse outcomes depends on the degree of its severity. Despite substantial improvement in transcatheter heart valve design, sizing and implantation technique, moderate or severe paravalvular regurgitation still occurs in 2% to 7% of patients and is associated with a more than 2-fold increase in mortality. This review provides a state-of-the-art approach to (i) paravalvular regurgitation prevention by optimizing patient selection, valve sizing, and positioning and (ii) the detection, quantitation and management of paravalvular regurgitation during and after valve implantation.
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Affiliation(s)
- Géraldine Ong
- Department of Medicine, Laval University, Institut de cardiologie et de pneumologie de Québec/ Laval Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Mohammed-Salah Annabi
- Department of Medicine, Laval University, Institut de cardiologie et de pneumologie de Québec/ Laval Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Marie-Annick Clavel
- Department of Medicine, Laval University, Institut de cardiologie et de pneumologie de Québec/ Laval Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Ezequiel Guzzetti
- Department of Medicine, Laval University, Institut de cardiologie et de pneumologie de Québec/ Laval Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Erwan Salaun
- Department of Medicine, Laval University, Institut de cardiologie et de pneumologie de Québec/ Laval Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Oumhani Toubal
- Department of Medicine, Laval University, Institut de cardiologie et de pneumologie de Québec/ Laval Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Abdellaziz Dahou
- Department of Medicine, Laval University, Institut de cardiologie et de pneumologie de Québec/ Laval Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Philippe Pibarot
- Department of Medicine, Laval University, Institut de cardiologie et de pneumologie de Québec/ Laval Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada.
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144
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Impact of Aortic Root Anatomy and Geometry on Paravalvular Leak in Transcatheter Aortic Valve Replacement With Extremely Large Annuli Using the Edwards SAPIEN 3 Valve. JACC Cardiovasc Interv 2018; 11:1377-1387. [DOI: 10.1016/j.jcin.2018.03.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/14/2018] [Accepted: 03/26/2018] [Indexed: 11/18/2022]
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145
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center, New York Presbyterian Hospital.
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146
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Vincent F, Rauch A, Loobuyck V, Moussa M, Juthier F, Debry N, Jeanpierre E, Lenting PJ, Susen S, Van Belle E. von Willebrand Factor for Aortic Valve Intervention. Circ Res 2018; 122:1499-1500. [DOI: 10.1161/circresaha.118.312859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Flavien Vincent
- From the CHU Lille, Department of Cardiology, France (F.V., N.D., E.V.B.)
- University of Lille, Inserm U1011-EGID, France (F.V., A.R., V.L., M.M., F.J., S.S., E.V.B.)
- Institut Pasteur de Lille, France (F.V., A.R., V.L., M.M., F.J., S.S., E.V.B.)
| | - Antoine Rauch
- CHU Lille, Department of Hematology Transfusion, France (A.R., E.J., S.S.)
- University of Lille, Inserm U1011-EGID, France (F.V., A.R., V.L., M.M., F.J., S.S., E.V.B.)
- Institut Pasteur de Lille, France (F.V., A.R., V.L., M.M., F.J., S.S., E.V.B.)
| | - Valentin Loobuyck
- CHU Lille, Department of Cardiac Surgery, France (V.L., F.J.)
- University of Lille, Inserm U1011-EGID, France (F.V., A.R., V.L., M.M., F.J., S.S., E.V.B.)
- Institut Pasteur de Lille, France (F.V., A.R., V.L., M.M., F.J., S.S., E.V.B.)
| | - Mouhamed Moussa
- CHU Lille, Department of Anesthesia and Intensive Care, France (M.M.)
- University of Lille, Inserm U1011-EGID, France (F.V., A.R., V.L., M.M., F.J., S.S., E.V.B.)
- Institut Pasteur de Lille, France (F.V., A.R., V.L., M.M., F.J., S.S., E.V.B.)
| | - Francis Juthier
- CHU Lille, Department of Cardiac Surgery, France (V.L., F.J.)
- University of Lille, Inserm U1011-EGID, France (F.V., A.R., V.L., M.M., F.J., S.S., E.V.B.)
- Institut Pasteur de Lille, France (F.V., A.R., V.L., M.M., F.J., S.S., E.V.B.)
| | - Nicolas Debry
- From the CHU Lille, Department of Cardiology, France (F.V., N.D., E.V.B.)
| | | | - Peter J. Lenting
- Inserm, UMR-S 1176, University of Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France (P.J.L.)
| | - Sophie Susen
- CHU Lille, Department of Hematology Transfusion, France (A.R., E.J., S.S.)
- University of Lille, Inserm U1011-EGID, France (F.V., A.R., V.L., M.M., F.J., S.S., E.V.B.)
- Institut Pasteur de Lille, France (F.V., A.R., V.L., M.M., F.J., S.S., E.V.B.)
| | - Eric Van Belle
- From the CHU Lille, Department of Cardiology, France (F.V., N.D., E.V.B.)
- University of Lille, Inserm U1011-EGID, France (F.V., A.R., V.L., M.M., F.J., S.S., E.V.B.)
- Institut Pasteur de Lille, France (F.V., A.R., V.L., M.M., F.J., S.S., E.V.B.)
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147
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Hahn RT, Nicoara A, Kapadia S, Svensson L, Martin R. Echocardiographic Imaging for Transcatheter Aortic Valve Replacement. J Am Soc Echocardiogr 2018; 31:405-433. [DOI: 10.1016/j.echo.2017.10.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Indexed: 02/06/2023]
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148
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Asch FM, Weissman NJ. Echo Core Labs: Gold Standard or Fools' Gold? J Am Soc Echocardiogr 2018; 31:372-373. [PMID: 29502590 DOI: 10.1016/j.echo.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Federico M Asch
- MedStar Health Research Institute and MedStar Washington Hospital Center, Washington, District of Columbia.
| | - Neil J Weissman
- MedStar Health Research Institute and MedStar Washington Hospital Center, Washington, District of Columbia
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149
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Sealing the Achilles Heel of Transcatheter Aortic Valve Replacement? JACC Cardiovasc Interv 2018; 11:169-171. [DOI: 10.1016/j.jcin.2017.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/14/2017] [Indexed: 11/22/2022]
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150
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New Valves May Overcome Weaknesses of Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2017; 70:3137-3139. [PMID: 29268927 DOI: 10.1016/j.jacc.2017.10.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/30/2017] [Indexed: 11/21/2022]
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