101
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El-Medany A, Doolub G, Dastidar A, Joshi N, Johnson T, Dorman S. Case Report: Emergency High-Risk Percutaneous Coronary Intervention Following Transcatheter Aortic Valve Implantation in Bicuspid Anatomy. Front Cardiovasc Med 2021; 7:620272. [PMID: 33553265 PMCID: PMC7854893 DOI: 10.3389/fcvm.2020.620272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Transcatheter aortic valve implantation (TAVR) continues to develop as a valuable alternative to surgical aortic valve replacement (SAVR) in an increasingly wide spectrum of patients with severe symptomatic aortic stenosis (AS). AS frequently coexists with coronary artery disease, and performing technically challenging percutaneous coronary intervention (PCI) following TAVR will become more frequent with increased use of TAVR. Case Summary: We herein report the case of a 53-years-old man with complex medical history including type 1 diabetes and dialysis-dependent renal failure and prior Evolut-R TAVR for critical bicuspid aortic valve stenosis who underwent intravascular ultrasound study (IVUS)-guided PCI to a critical distal left main stem (LMS) and proximal left anterior descending (LAD) lesion after presenting with ventricular fibrillation (VF) secondary to an acute coronary syndrome (ACS). Discussion: Selective engagement of coronary ostia through the side cells of TAVR prosthesis can be challenging, especially in an emergency setting. The particular challenges associated with this case are described, as well as an up-to-date literature search on strategies and equipment that can help in this situation.
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Affiliation(s)
- Ahmed El-Medany
- Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom
| | - Gemina Doolub
- Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom
| | - Amardeep Dastidar
- Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom.,Department of Cardiology, Southmead Hospital, Bristol, United Kingdom
| | - Nikhil Joshi
- Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom
| | - Thomas Johnson
- Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom
| | - Stephen Dorman
- Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom
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102
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A systematic review and meta-analysis of delayed coronary artery access for coronary angiography with or without percutaneous coronary intervention (PCI) in patients who underwent transcatheter aortic valve replacement (TAVR). Cardiovasc Interv Ther 2021; 37:167-181. [PMID: 33453034 DOI: 10.1007/s12928-020-00753-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
Coronary artery disease (CAD) and severe aortic valve stenosis frequently coexist. Given the progressive nature of CAD, silent or non-significant CAD may become symptomatic or functionally relevant years after TAVR. However, there is a paucity of data documenting the feasibility of either coronary angiography and/or PCI after TAVR. We systematically searched Medline, Pubmed, Embase, Cochrane database, Google Scholar, Science Direct, Web of Science, and conference abstracts from conception to March 2020 using OvidSP in TAVR patients undergoing coronary angiography with or without PCI at least 6 months after TAVR. Patients and procedural characteristics were summarized. The primary outcome of interest was successful coronary angiography for either the left main coronary artery (LMCA) or right coronary artery (RCA) with or without PCI. Pooled estimates were calculated using a random-effects meta-analysis. The study protocol was registered in PROSPERO. Eleven reports for a total of 696 coronary angiograms and 287 PCI were included in the analysis. Patients were slightly predominantly male, older and had a mean left ventricular ejection fraction of more than 50% with an intermediate STS. The summary estimate rates of successful LMCA and RCA angiography with a Medtronic self-expandable valve (SEV) were 84% (95% CI 73-90%, I2 = 79, p = 0.015) and 69% (95% CI 37-89%, I2 = 86, p = 0.23), respectively, while with the Edwards Lifesciences balloon expandable valve (BEV), the summary estimate rates for successful LMCA and RCA angiography were 94% (95% CI 72-99%, I2 = 66, p = 0.003) and 95% (95% CI 48-99%, I2 = 83, p = 0.05), respectively. The summary estimate rate of successful PCI post TAVR with either a Medtronic SEV or Edwards Lifesciences BEV was 93% (95% CI 86-96%, I2 = 33, p = 0.0001). The overall achievement of a successful coronary angiography with or without PCI in post-TAVR patients is high, with a lower success rate for RCA angiography in patients with the Medtronic SEV Mortality and bleeding did not differ in our analysis.
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103
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Choe YH, Kim SM, Park SJ. Computed tomography and magnetic resonance imaging assessment of aortic valve stenosis: an update. PRECISION AND FUTURE MEDICINE 2020. [DOI: 10.23838/pfm.2020.00093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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104
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Forrestal BJ, Case BC, Yerasi C, Shea C, Torguson R, Zhang C, Ben-Dor I, Deksissa T, Ali S, Satler LF, Shults C, Weissman G, Wang JC, Khan JM, Waksman R, Rogers T. Risk of Coronary Obstruction and Feasibility of Coronary Access After Repeat Transcatheter Aortic Valve Replacement With the Self-Expanding Evolut Valve: A Computed Tomography Simulation Study. Circ Cardiovasc Interv 2020; 13:e009496. [PMID: 33272031 DOI: 10.1161/circinterventions.120.009496] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The supra-annular leaflet position and tall stent frame of the self-expanding Evolut PRO or Evolut PRO+ transcatheter heart valves (THVs) may cause coronary occlusion during transcatheter aortic valve replacement (TAVR)-in-TAVR and present challenges for future coronary access. We sought to evaluate the risk of TAVR-in-TAVR with Evolut PRO or Evolut PRO+ THVs and the feasibility of future coronary access. METHODS The CoreValve Evolut PRO Prospective Registry (EPROMPT; NCT03423459) prospectively enrolled patients with symptomatic severe aortic stenosis to undergo TAVR using a commercially available latest generation self-expanding THV at 2 centers in the United States. Computed tomography was performed 30 days after TAVR, which we used to simulate TAVR-in-TAVR with a second Evolut PRO or Evolut PRO+ THV and evaluate for risk of coronary obstruction and feasibility of future coronary access. RESULTS Eighty-one patients enrolled with interpretable computed tomography are reported herein. Computed tomography simulation predicted sinus of Valsalva sequestration and resultant coronary obstruction during future TAVR-in-TAVR in up to 23% of patients. Computed tomography simulation predicted that the position of the pinned THV leaflets would hinder future coronary access in up to 78% of patients after TAVR-in-TAVR. CONCLUSIONS Further THV design improvements and leaflet modification strategies are needed to mitigate the risk of coronary obstruction during TAVR-in-TAVR with self-expanding THVs and to facilitate future coronary access. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03423459.
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Affiliation(s)
- Brian J Forrestal
- Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC
| | - Brian C Case
- Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC
| | - Charan Yerasi
- Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC
| | - Corey Shea
- Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC.,Division of Cardiovascular Surgery (C.S.), MedStar Washington Hospital Center, Washington, DC
| | - Rebecca Torguson
- Department of Cardiovascular Research and Clinical Trials, Mount Sinai School of Medicine, New York, NY (R.T.)
| | - Cheng Zhang
- Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC
| | - Itsik Ben-Dor
- Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC
| | - Teshome Deksissa
- Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC
| | - Syed Ali
- Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC
| | - Lowell F Satler
- Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC
| | | | - Gaby Weissman
- Section of Cardiovascular Imaging (G.W.), MedStar Washington Hospital Center, Washington, DC
| | - John C Wang
- Section of Interventional Cardiology, MedStar Union Memorial Hospital, Baltimore, MD (J.C.W.)
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K., T.R.)
| | - Ron Waksman
- Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC
| | - Toby Rogers
- Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC.,Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K., T.R.)
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105
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Grines CL, Tummala PE. Coronary Revascularization Before Transcatheter Aortic Valve Replacement: It Is Safe, But Is It Necessary? JACC Cardiovasc Interv 2020; 13:2614-2616. [PMID: 33069646 DOI: 10.1016/j.jcin.2020.08.018] [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: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Cindy L Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia.
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106
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Case BC, Yerasi C, Forrestal BJ, Musallam A, Chezar-Azerrad C, Hahm J, Kumar S, Satler LF, Ben-Dor I, Hashim H, Waksman R, Rogers T. Utility of Routine Invasive Coronary Angiography Prior to Transcatheter Aortic Valve Replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 26:1-5. [PMID: 33246809 DOI: 10.1016/j.carrev.2020.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND/PURPOSE Despite the high prevalence of coronary artery disease (CAD) in patients with severe aortic stenosis (AS), the optimal management of concomitant CAD, including revascularization before transcatheter aortic valve replacement (TAVR), remains controversial. Contemporary, real-world practice patterns have not yet been described. We aimed to characterize the burden of CAD in contemporary TAVR patients and evaluate revascularization practices at a high-volume center. METHODS/MATERIALS We retrospectively analyzed all adult patients referred for TAVR at our center between January 2019 and January 2020. Presence of significant CAD and subsequent management were recorded. Presenting symptoms, use of non-invasive and invasive ischemia testing, and pre-TAVR computed tomography (CT) imaging were analyzed. RESULTS A total of 394 patients with severe AS were referred for TAVR. Thirty-nine patients (9.9%) instead underwent surgery, of whom only 5 (1.3%) received coronary artery bypass grafting. Of the remaining 355 patients, 218 patients (61.4%) had insignificant CAD. Of the 137 patients (38.6%) with significant CAD, only 30 (8.5%) underwent percutaneous coronary intervention (PCI). Of these, less than half had anginal symptoms, a third had CAD in proximal segments, and a third underwent ischemia testing before PCI. Pre-TAVR CT accurately identified significant CAD in 28/30 patients (93.3%) who underwent PCI. CONCLUSIONS Only 1 in 25 contemporary TAVR patients had significant CAD and angina requiring intervention, calling into question the utility of routine invasive coronary angiography before TAVR. A Heart Team approach integrating anginal symptoms, ischemia testing and possibly pre-TAVR CT is needed to guide the need, timing, and strategy of revascularization.
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Affiliation(s)
- Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Anees Musallam
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Chava Chezar-Azerrad
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Joshua Hahm
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Sant Kumar
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Hayder Hashim
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America.
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107
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Abdel-Wahab M. Revisiting the Coronary Arteries After TAVR: A Potentially Challenging Endeavor. JACC Cardiovasc Interv 2020; 13:2556-2559. [PMID: 33069652 DOI: 10.1016/j.jcin.2020.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Mohamed Abdel-Wahab
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
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108
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Arshi A, Yakubov SJ, Stiver KL, Sanchez CE. Overcoming the transcatheter aortic valve replacement Achilles heel: coronary re-access. Ann Cardiothorac Surg 2020; 9:468-477. [PMID: 33312904 PMCID: PMC7724072 DOI: 10.21037/acs-2020-av-38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/09/2020] [Indexed: 01/30/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for the treatment of symptomatic severe aortic stenosis (AS). Coronary artery disease (CAD) is common in patients with severe AS. As the indications for TAVR extend to lower risk patients with longer life expectancy and as CAD is a progressive condition, coronary angiography will become increasingly common in patients who have had a previous TAVR. Coronary artery re-access after TAVR may be challenging but is possible in most cases. Commissural alignment of the prosthesis with the native coronary ostia plays an important role in successful coronary re-access. Coronary artery obstruction is a potentially devastating complication of TAVR, particularly in valve-in-valve procedures. In the present keynote lecture, we review techniques used to mitigate the risk of coronary obstruction, as well as catheter selection and strategies for selective coronary artery engagement for specific transcatheter aortic valve (TAV) bioprostheses.
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Affiliation(s)
- Arash Arshi
- OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Kevin L Stiver
- OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
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109
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Alexis SL, Zaid S, Sengupta A, Lerakis S, Khera S, Sharma SK, Kini A, Tang GHL. Transcatheter aortic valve replacement aortic root orientation: implications for future coronary access and redo transcatheter aortic valve replacement. Ann Cardiothorac Surg 2020; 9:502-504. [PMID: 33312911 DOI: 10.21037/acs-2020-av-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sophia L Alexis
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Syed Zaid
- Division of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Aditya Sengupta
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | | | - Sahil Khera
- Division of Cardiology, Mount Sinai Hospital, New York, NY, USA
| | - Samin K Sharma
- Division of Cardiology, Mount Sinai Hospital, New York, NY, USA
| | - Annapoorna Kini
- Division of Cardiology, Mount Sinai Hospital, New York, NY, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
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110
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Barbanti M, Costa G, Picci A, Criscione E, Reddavid C, Valvo R, Todaro D, Deste W, Condorelli A, Scalia M, Licciardello A, Politi G, De Luca G, Strazzieri O, Motta S, Garretto V, Veroux P, Giaquinta A, Giuffrida A, Sgroi C, Leon MB, Webb JG, Tamburino C. Coronary Cannulation After Transcatheter Aortic Valve Replacement: The RE-ACCESS Study. JACC Cardiovasc Interv 2020; 13:2542-2555. [PMID: 33069648 DOI: 10.1016/j.jcin.2020.07.006] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aims of this study were to investigate the feasibility of coronary ostia cannulation after transcatheter aortic valve replacement (TAVR) and to assess potential predictors of coronary access impairment. BACKGROUND Certain data concerning the feasibility and reproducibility of coronary cannulation after TAVR are lacking. METHODS RE-ACCESS (Reobtain Coronary Ostia Cannulation Beyond Transcatheter Aortic Valve Stent) was an investigator-driven, single-center, prospective, registry-based study that enrolled consecutive patients undergoing TAVR using all commercially available devices. All patients underwent coronary angiography before and after TAVR. The primary endpoint was the rate of unsuccessful coronary ostia cannulation after TAVR. Secondary endpoints were the identification of factors associated with the inability to selectively cannulate coronary ostia after TAVR. RESULTS Among 300 patients enrolled in the RE-ACCESS study from December 2018 to January 2020, a total of 23 cases (7.7%) of unsuccessful coronary cannulation after TAVR were documented. This issue occurred in 22 of 23 cases with the use of Evolut R/PRO transcatheter aortic valves (TAVs) (17.9% vs. 0.4%; p < 0.01). In multivariate analysis, the use of Evolut R/PRO TAVs (odds ratio [OR]: 29.6; 95% confidence interval [CI]: 2.6 to 335.0; p < 0.01), the TAV-sinus of Valsalva relation (OR: 1.1 per 1-mm increase; 95% CI: 1.0 to 1.2; p < 0.01), and the mean TAV implantation depth (OR: 1.7 per 1-mm decrease; 95% CI: 1.3 to 2.3; p < 0.01) were found to be independent predictors of unsuccessful coronary cannulation after TAVR. A model combining these factors was demonstrated to predict with very high accuracy the risk for unsuccessful coronary cannulation after TAVR (area under the curve: 0.94; p < 0.01). CONCLUSIONS Unsuccessful coronary cannulation following TAVR was observed in 7.7% of patients and occurred almost exclusively in those receiving Evolut TAVs. The combination of Evolut TAV, a higher TAV-sinus of Valsalva relation, and implantation depth predicts with high accuracy the risk for unsuccessful coronary cannulation after TAVR. (Reobtain Coronary Ostia Cannulation Beyond Transcatheter Aortic Valve Stent [RE-ACCESS]; NCT04026204).
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Affiliation(s)
- Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy.
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Andrea Picci
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Enrico Criscione
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Claudia Reddavid
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Denise Todaro
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Wanda Deste
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | | | - Matteo Scalia
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | | | - Giorgia Politi
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Giuseppe De Luca
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Orazio Strazzieri
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Silvia Motta
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Valeria Garretto
- Division of Radiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Pierfrancesco Veroux
- Division of Vascular Surgery, A.O.U. Policlinico-San Marco, University of Catania, Catania, Italy
| | - Alessia Giaquinta
- Division of Vascular Surgery, A.O.U. Policlinico-San Marco, University of Catania, Catania, Italy
| | - Angelo Giuffrida
- Division of Cardiac Surgery, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Martin B Leon
- Cardiology Department, NewYork-Presbyterian/Columbia University Medical Center, New York, New York
| | - John G Webb
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
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111
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Chiocchi M, Ricci F, Pasqualetto M, D'Errico F, Benelli L, Pugliese L, Cavallo AU, Forcina M, Presicce M, De Stasio V, Di Donna C, Di Tosto F, Spiritigliozzi L, Floris R, Romeo F. Role of computed tomography in transcatheter aortic valve implantation and valve-in-valve implantation: complete review of preprocedural and postprocedural imaging. J Cardiovasc Med (Hagerstown) 2020; 21:182-191. [PMID: 32012138 DOI: 10.2459/jcm.0000000000000899] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
: Since 2002, transcatheter aortic valve implantation (TAVI) has revolutionized the treatment and prognosis of patients with aortic stenosis. A preprocedural assessment of the patient is vital for achieving optimal outcomes from the procedure. Retrospective ECG-gated cardiac computed tomography (CT) today it is the gold-standard imaging technique that provides three-dimensional images of the heart, thus allowing a rapid and complete evaluation of the morphology of the valve, ascending aorta, coronary arteries, peripheral access vessels, and prognostic factors, and also provides preprocedural coplanar fluoroscopic angle prediction to obtain complete assessment of the patient. The most relevant dimension in preprocedural planning of TAVI is the aortic annulus, which can determine the choice of prosthesis size. CT is also essential to identify patients with increased anatomical risk for coronary artery occlusion in Valve in Valve (ViV) procedures.Moreover, CT is very useful in the evaluation of late complications, such as leakage, thrombosis and displacements. At present, CT is the cornerstone imaging modality for the extensive and thorough work-up required for planning and performing each TAVI procedure, to achieve optimal outcomes. Both the CT procedure and analysis should be performed by trained and experienced personnel, with a radiological background and a deep understanding of the TAVI procedure, in close collaboration with the implantation team. An accurate pre-TAVI CT and post-processing for the evaluation of all the points recommended in this review allow a complete planning for the choice of the valve dimensions and type (balloon or self-expandable) and of the best percutaneous access.
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Affiliation(s)
- Marcello Chiocchi
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Francesca Ricci
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Monia Pasqualetto
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | | | - Leonardo Benelli
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Luca Pugliese
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | | | - Marco Forcina
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Matteo Presicce
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | | | - Carlo Di Donna
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Federica Di Tosto
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | | | - Roberto Floris
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Francesco Romeo
- Unit of Cardiology and Interventional Cardiology, University of Rome 'Tor Vergata', Rome, Italy
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112
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Laricchia A, Khokhar AA, Gallo F, Giannini F, Colombo A, Latib A, Mangieri A. Transcatheter aortic valve replacement: potential use in lower-risk aortic stenosis. Expert Rev Cardiovasc Ther 2020; 18:723-731. [PMID: 33021849 DOI: 10.1080/14779072.2020.1833717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The widespread use of transcatheter aortic valve implantation (TAVI) is expanding to low-risk patients. Nevertheless, a low clinical risk does not always correspond to a low procedural risk for the percutaneous approach. AREAS COVERED The initial trials on TAVI in low-risk populations had encouraging results, showing non-inferiority in comparison to surgical aortic valve replacement (SAVR). However, the low-risk definition is based on risk score calculators developed for the surgical setting and not including other specific features that are more relevant to TAVI and can affect procedural outcomes. For example, the presence of bicuspid aortic valves, high calcific burden, low coronary height or conduction disturbances is all potentially associated with suboptimal results or even procedural complications. In addition, the lack of longer follow-up prevents us to draw conclusions about long-term outcomes, including data about valve durability and coronary re-access. EXPERT OPINION Although current evidence suggest similar results for TAVI and SAVR in low-risk populations, there are some technical and procedural limitations that still need to be addressed in order to close the gap between TAVI and surgery. Optimal, lasting results with a low rate of procedural complications are highly expected in low-risk, otherwise healthy subjects, with potential for longevity.
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Affiliation(s)
- Alessandra Laricchia
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Arif A Khokhar
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Francesco Gallo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Francesco Giannini
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Antonio Colombo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center , Bronx, NY, USA
| | - Antonio Mangieri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
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Azumi Y, Nakama T, Obunai K, Watanabe H. A case of challenging percutaneous coronary intervention following surgical aortic valve replacement with a sutureless aortic bioprosthesis. J Cardiol Cases 2020; 22:198-201. [PMID: 33014205 DOI: 10.1016/j.jccase.2020.06.018] [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: 04/29/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 10/23/2022] Open
Abstract
A 71-year-old man with symptomatic severe aortic valve stenosis and stenosis of the proximal right coronary artery (RCA) underwent aortic valve replacement with Perceval (LivaNova, London, UK), a sutureless aortic bioprosthesis with a self-expanding open-cell designed nitinol frame (SL-AVR). Seven weeks after the SL-AVR, percutaneous coronary intervention (PCI) to the RCA was required. However, engagement of the guiding catheter (GC) was challenging because the RCA ostium was jailed by the strut of the Perceval. Therefore, the "Mother, Child, and Grandchild Technique" was used. A 4-Fr diagnostic catheter (DC) was partially engaged, and a support type 0.014-inch guidewire (GW) was inserted into the distal RCA. The DC was replaced by a 6-Fr GC. To fill the gap between the 0.014-inch GW and 6-Fr GC, a 5-Fr tapered inner sheath (IS, tip size was 3.0-Fr, used as Child catheter) was inserted into the 6-Fr GC (Mother catheter), and a 2.6-Fr microcatheter (Grandchild catheter) was inserted into the 5-Fr IS. Therefore, the gap between the 0.014-inch GW and 6-Fr GW was obliterated. Finally, we successfully inserted the PCI system and engaged the GC. RCA stenosis was treated using the conventional PCI technique. Herein, we report a case of successful PCI subsequent to SL-AVR. <Learning objective: The technical feasibility of percutaneous coronary intervention (PCI) following aortic valve replacement with a sutureless aortic bioprosthesis with a self-expanding open-cell designed nitinol frame (SL-AVR) remains unclear. In this report, we describe a case of challenging PCI following SL-AVR.>.
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Affiliation(s)
- Yuta Azumi
- Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan
| | - Kotaro Obunai
- Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan
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Coronary angiography and percutaneous coronary intervention after transcatheter aortic valve replacement with medtronic self-expanding prosthesis: Insights from correlations with computer tomography. Int J Cardiol 2020; 317:18-24. [DOI: 10.1016/j.ijcard.2020.05.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 11/20/2022]
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Miura S, Yamashita T, Iwakiri N, Yoshida N, Ohkawa Y. Usefulness of Multislice Computed Tomography in Percutaneous Coronary Intervention Following Valve-in-Valve Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 13:e167-e168. [PMID: 32861627 DOI: 10.1016/j.jcin.2020.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/09/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Shiro Miura
- Department of Cardiology, Hokkaido Ohno Memorial Hospital, Sapporo, Japan.
| | - Takehiro Yamashita
- Department of Cardiology, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Naoki Iwakiri
- Department of Cardiology, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Naoya Yoshida
- Division of Diagnostic Radiology Imaging, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Youhei Ohkawa
- Department of Thoracic and Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
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Wood DA, Webb JG, Landes U, Sathananthan J. Is Aiming High Always Best? STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2020. [DOI: 10.1080/24748706.2020.1813356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- David A. Wood
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Uri Landes
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Gonçalves M, de Araújo Gonçalves P, Campante Teles R, de Sousa Almeida M, Félix de Oliveira A, Brito J, Raposo L, Mesquita Gabriel H, Nolasco T, Neves JP, Mendes M, Garcia-Garcia HM. Low Rate of Invasive Coronary Angiography Following Transcatheter Aortic Valve Implantation: Real-World Prospective Cohort Findings. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 28:42-49. [PMID: 32921596 DOI: 10.1016/j.carrev.2020.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 11/18/2022]
Abstract
AIM To evaluate the real need for coronary access after transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS Prospective observational single-center registry, including 563 consecutive patients who underwent TAVI between April 2008 and November 2018, with both self- and balloon-expandable valves in a tertiary European center. Mean age was 82.4 ± 6.9 years, 53.3% were female, 16% had previous history of coronary artery bypass grafting, 33% of previous percutaneous coronary intervention (PCI), and 16.6% of myocardial infarction (MI). Twenty-four percent of the patients were revascularized within one year before TAVI in preparation for the procedure. Median Society of Thoracic Surgeons score was 4.82 (IQ 2.84). In a median follow-up of 24 months (IQ 21.5), 18 patients (3.2%) were identified as potentially in need for invasive coronary angiography: 9 (1.6%) in the setting of stable coronary artery disease and 9 (1.6%) for an acute coronary syndrome. A total of 11 PCIs were performed in 9 patients, with a complete success rate of 63.6%. Procedures that were unsuccessful or partially unsuccessful were due to the inability to cross the stent or the drug-eluting balloon through the valve struts or misplacement within the coronary artery due to lack of catheter support. CONCLUSION In this population, a strategy of previous guideline-directed revascularization before TAVI was associated with a low rate of MI and repeated need of coronary access, with a scattered distribution over time. Assuring future access to coronary arteries in patients at increased risk may depend on the revascularization strategy rather than device selection.
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Affiliation(s)
- Mariana Gonçalves
- Division of Interventional Cardiology of Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Pedro de Araújo Gonçalves
- Division of Interventional Cardiology of Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Rui Campante Teles
- Division of Interventional Cardiology of Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal.
| | - Manuel de Sousa Almeida
- Division of Interventional Cardiology of Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Afonso Félix de Oliveira
- Division of Interventional Cardiology of Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - João Brito
- Division of Interventional Cardiology of Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Luís Raposo
- Division of Interventional Cardiology of Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Henrique Mesquita Gabriel
- Division of Interventional Cardiology of Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Tiago Nolasco
- Division of Cardiac Surgery of Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - José Pedro Neves
- Division of Cardiac Surgery of Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Mendes
- Division of Interventional Cardiology of Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Hector M Garcia-Garcia
- Division of Interventional Cardiology of MedStar Cardiovascular Research Network at MedStar Washington Hospital Center, USA.
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Rudziński PN, Mach M, Gross C, Andreas M. Non-ST-elevation myocardial infarction after complex percutaneous coronary intervention and transcatheter aortic valve implantation: a case report of bioprosthesis-related delayed coronary obstruction and its difficult diagnosis. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 33204974 PMCID: PMC7649483 DOI: 10.1093/ehjcr/ytaa207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/27/2020] [Accepted: 06/14/2020] [Indexed: 11/13/2022]
Abstract
Background There is a high coincidence of significant coronary artery disease and severe aortic stenosis. Coronary revascularization should be performed prior to transcatheter aortic valve implantation (TAVI). We report a case of non-ST-elevation myocardial infarction (NSTEMI) after complex percutaneous coronary intervention (PCI) prior to TAVI, where differential diagnosis between coronary stent failure and bioprosthesis-related sinus obstruction was substantial. Case summary A 79-year-old woman was re-admitted to the hospital 5 days after TAVI due to troponin-negative new-onset angina. She underwent complex PCI 3 days before TAVI and was not compliant to medications. Symptoms initially resolved after re-establishment of anti-hypertensive treatment. There were no signs of aortic bioprosthesis failure, paravalvular leak, or myocardial ischaemia. After 1 month, the symptoms re-occurred. Due to elevated troponins, myocardial ischaemia in electrocardiogram and new contractility disorders, NSTEMI was diagnosed. Because it was impossible to intubate the left coronary artery (LCA), cardiac surgery was performed. Calcified native coronary leaflet was pushed by the stent frame of aortic bioprosthesis towards LCA ostium causing its subtotal occlusion. Transcatheter heart valve (THV) was removed and the new surgical aortic bioprosthesis was implanted. Further hospitalization and 1-month follow-up were uneventful. Discussion Pre-procedural assessment is crucial prior to THV interventions. Delayed coronary obstruction caused by the native leaflet is extremely rare and potentially fatal complication of TAVI. The diagnosis is difficult and high clinical suspicion is required to detect this pathology. Given our experience, the indication towards interventional or surgical repair should be established faster to avoid coronary ischaemia.
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Affiliation(s)
- Piotr Nikodem Rudziński
- Department of Coronary and Structural Heart Diseases, The Cardinal Stefan Wyszynski National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Markus Mach
- Division of Cardiac Surgery, Department of Surgery, Vienna General Hospital (AKH - Allgemeines Krankenhaus), Gürtel 18-20, 1090 Vienna, Austria
| | - Christoph Gross
- Division of Cardiac Surgery, Department of Surgery, Vienna General Hospital (AKH - Allgemeines Krankenhaus), Gürtel 18-20, 1090 Vienna, Austria
| | - Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Vienna General Hospital (AKH - Allgemeines Krankenhaus), Gürtel 18-20, 1090 Vienna, Austria
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Claessen BE, Tang GHL, Kini AS, Sharma SK. Considerations for Optimal Device Selection in Transcatheter Aortic Valve Replacement: A Review. JAMA Cardiol 2020; 6:102-112. [PMID: 32902569 DOI: 10.1001/jamacardio.2020.3682] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Aortic valve stenosis (AS) is the most common manifestation of acquired valvular heart disease in developed countries. Several large-scale randomized clinical trials investigating the entire spectrum of patients with severe symptomatic AS from low to prohibitive risk have established transcatheter aortic valve replacement (TAVR) as a safe and effective alternative to surgical aortic valve replacement. Observations There are currently only 3 types of TAVR devices commercially available in the US, but several other valve types are undergoing clinical trials in the US. Because of fundamental differences in engineering features, each TAVR device type has specific strengths and limitations. This review aims to provide an overview of design features and clinical outcomes of various TAVR devices that are either commercially available or undergoing clinical investigation. Conclusions and Relevance Given the lack of large-scale head-to-head comparisons of various TAVR devices and the rapid development of new device iterations, there is insufficient evidence to claim superiority of one device type over another. Nonetheless, as each TAVR device has unique design characteristics, certain patient-related and anatomy-related factors may slightly favor one or several particular designs.
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Affiliation(s)
- Bimmer E Claessen
- Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York.,Division of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna S Kini
- Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K Sharma
- Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
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Çelik M, Durko AP, Head SJ, Mahtab EA, van Mieghem NM, Cummins PA, Kappetein AP, Bogers A. Coronary revascularization after surgical aortic valve replacement. JTCVS OPEN 2020; 3:91-101. [PMID: 36003865 PMCID: PMC9390258 DOI: 10.1016/j.xjon.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 10/27/2022]
Abstract
Objective It remains unclear how often coronary revascularization is necessary after aortic valve interventions, either by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement. However, these data are relevant for treatment and prosthesis choice. The authors sought to analyze the incidence and characteristics of coronary revascularization after SAVR during follow-up. Methods Of 2256 patients undergoing isolated SAVR between 1987 and 2015, 420 patients (mean age 56.9 ± 15.5 years, 66.9% male) were followed at the Erasmus Medical Center. Incidence, predictors, and characteristics of coronary revascularization were analyzed. Cumulative incidence of revascularization was assessed using a competing risk approach. Results Mean follow-up after SAVR was 17.2 years (total of 4541 patient-years). A total of 24 patients underwent 28 procedures of revascularization. The cumulative incidence of revascularization after SAVR was 0.5%, 2.2%, 4.1%, and 6.9% at 1, 5, 10, and 20 years, respectively. The linearized rate of revascularization was 6.2 per 1000 patient-years. Percutaneous coronary intervention was the most common revascularization method (64%; N = 18/28). Revascularization before SAVR (N = 36/420; of whom 27 percutaneous coronary intervention) was an independent predictor of revascularization during follow-up (hazard ratio, 6.6; 95% confidence interval, 2.6-17.1; P < .001). Conclusions After SAVR, the rate of coronary revascularization was 6.9% (N = 24/420) at 20-year follow-up. Patients were at particular risk if they had undergone previous revascularization before SAVR. These data may furthermore be relevant to the transcatheter aortic valve replacement population.
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Affiliation(s)
- Mevlüt Çelik
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Andras P. Durko
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Stuart J. Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
- Medtronic, Maastricht, The Netherlands
| | - Edris A.F. Mahtab
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Paul A. Cummins
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arie P. Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
- Medtronic, Maastricht, The Netherlands
| | - Ad.J.J.C. Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Costa G, Criscione E, Reddavid C, Barbanti M. Balloon-expandable versus self-expanding transcatheter aortic valve replacement: a comparison and evaluation of current findings. Expert Rev Cardiovasc Ther 2020; 18:697-708. [DOI: 10.1080/14779072.2020.1807326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Giuliano Costa
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Enrico Criscione
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Claudia Reddavid
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, C.A.S.T., University of Catania, Catania, Italy
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Abstract
Purpose of Review Critical appraisal of the available evidence on the self-expanding ACURATE neo transcatheter heart valve (THV) for the treatment of aortic valve disease. Recent Findings In an investigator-initiated, multicenter, randomized non-inferiority trial with broad inclusion criteria, ACURATE neo failed to meet non-inferiority compared with SAPIEN 3 with regard to a primary composite safety and efficacy endpoint at 30 days. The difference was driven by higher rates of moderate or severe paravalvular regurgitation and higher rates of acute kidney injury. In turn, registry data suggest that the safety and efficacy profile of the ACURATE neo is comparable to that of other commercially available devices. Randomized evidence indicated favorable hemodynamic results with large effective orifice areas and low residual gradients. Summary The self-expanding ACURATE neo THV is associated with higher rates of residual aortic regurgitation compared to the balloon-expandable SAPIEN 3 THV. The supra-annular design with low residual gradients may be advantageous in patients with small anatomy and mild degree of calcification.
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Affiliation(s)
- Taishi Okuno
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland.
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So CY, Kang G, Villablanca PA, Lee JC, Frisoli TM, Wyman JF, Wang DD, O'Neill WW, Eng MH. Procedural and Mid-Term Outcomes of Coronary Protection During Transcatheter Aortic Valve Replacement in Patients at Risk of Coronary Occlusion: Insight From a Single-Centre Retrospective Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 27:7-13. [PMID: 32741589 DOI: 10.1016/j.carrev.2020.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/09/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Detailed procedural analysis and long-term data is limited for coronary protection (CP) during transcatheter aortic valve replacement (TAVR) for patients with high anatomical risk for coronary occlusion (CO). We aim to assess the procedural and mid-term outcomes of CP during TAVR. METHODS We retrospectively analyzed patients who underwent TAVR at Henry Ford Hospital, USA from January 2015 to August 2019 and identified those considered at risk of CO and underwent pre-emptive CP with or without subsequent "chimney" stenting (i.e. coronary stenting with intentional protrusion into the aorta). Procedural features, immediate and mid-term clinical outcomes were reviewed. RESULTS Twenty-five out of 1166 (2.1%) patients underwent TAVR with CP, including 10 (40%) valve-in-valve procedures. Twenty-eight coronary arteries (Left: n = 11, Right: n = 11; Left + Right: n = 3) were protected. Eleven coronaries (39.3%) were electively "chimney"-stented due to angiographic evidence of coronary impingement (63.6%), tactile resistance while withdrawing stent (27.3%) and electrocardiogram change (9.1%). Twenty-four patients (24/25, 96%) had successful TAVR without CO. Procedure-related complications included stent-balloon entrapment (n = 1), stent entrapment (n = 1) and occlusive distal stent edge dissection (n = 1). After a mean follow-up of 19.1 months, there was 1 cardiac death but no target vessel re-intervention or myocardial infarction. CONCLUSIONS Our study found that angiographic evidence of coronary impingement (63.6%) was the most common reason for stent deployment during TAVR with CP. The mid-term clinical outcome of CP with TAVR was favorable.
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Affiliation(s)
- Chak-Yu So
- Center for Structural Heart Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Guson Kang
- Center for Structural Heart Diseases, Henry Ford Hospital, Detroit, MI, USA
| | | | - James C Lee
- Center for Structural Heart Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Tiberio M Frisoli
- Center for Structural Heart Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Janet F Wyman
- Center for Structural Heart Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Dee Dee Wang
- Center for Structural Heart Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - William W O'Neill
- Center for Structural Heart Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Marvin H Eng
- Center for Structural Heart Diseases, Henry Ford Hospital, Detroit, MI, USA.
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Meers JB, Townsley MM. Aortic Stenosis and Noncardiac Surgery in the Era of Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2020; 34:2234-2244. [DOI: 10.1053/j.jvca.2019.11.001] [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: 07/19/2019] [Revised: 10/28/2019] [Accepted: 11/04/2019] [Indexed: 01/21/2023]
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Sathananthan J, Lauck S, Polderman J, Yu M, Stephenson A, Sathananthan G, Moss R, Cheung A, Ye J, Blanke P, Leipsic J, Wood DA, Webb JG. Ten year follow-up of high-risk patients treated during the early experience with transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 97:E431-E437. [PMID: 32940418 DOI: 10.1002/ccd.29124] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/07/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The long-term clinical performance of transcatheter heart valves (THV) is unknown. AIMS This study assessed the clinical outcomes, rate of structural valve deterioration (SVD) and bioprosthetic valve failure in patients after transcatheter aortic valve replacement (TAVR) to 10-year follow-up. METHODS Consecutive patients undergoing TAVI for native aortic valve stenosis or failed aortic surgical bioprosthesis, between 2005 and 2009 at our institution were included. A total of 235 consecutive patients. RESULTS At the time of TAVI mean age was 82.4 ± 7.9 years. All patients were judged to be high risk, with a STS score > 8 in 53.6%. THVs implanted were the Cribier-Edwards (20.9%), Edwards SAPIEN (77.4%) or CoreValve (1.7%). Mortality at 1, 5, and 10-year follow-up was 23.4%, 63%, and 91.6%, respectively. Of the total cohort, 15 patients had structural valve deterioration/bioprosthetic valve failure, with a cumulative incidence at 10-years of 6.5% (95% CI 3.3%, 9.6%). The rate of SVD/BVF at 4, 6, 8, and 10 years was 0.4%, 1.7%, 4.7%, and 6.5%, respectively. Nine patients had moderate SVD and six patients had severe SVD. Of the six patients with severe SVD, two patients had reintervention (one patient had redo TAVR, and the second had surgical aortic valve replacement). Survivors (n = 19) at 10-year follow-up, had a mean gradient of 14.0 ± 7.6 mmHg and aortic regurgitation ≥moderate in 5%. Quality of life measures in 10-year survivors demonstrated ADLs 6/6 in 43.8%, and ambulation without a mobility aid of 62.5%. CONCLUSION Using early generation balloon expandable THVs in a high-risk population, there was a low rate of structural valve deterioration and valve failure at 10-year follow-up. This study provides insights into the long-term performance of transcatheter heart valves and patients self-reported derived benefits.
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Affiliation(s)
- Janarthanan Sathananthan
- Center for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Sandra Lauck
- Center for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jopie Polderman
- Center for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Maggie Yu
- Center for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Anna Stephenson
- Center for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Gnalini Sathananthan
- Center for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Robert Moss
- Center for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Anson Cheung
- Center for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jian Ye
- Center for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Philipp Blanke
- Center for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jonathon Leipsic
- Center for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - David A Wood
- Center for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - John G Webb
- Center for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
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Tarantini G, Nai Fovino L, Le Prince P, Darremont O, Urena M, Bartorelli AL, Vincent F, Hovorka T, Alcalá Navarro Y, Dumonteil N, Ohlmann P, Wendler O. Coronary Access and Percutaneous Coronary Intervention Up to 3 Years After Transcatheter Aortic Valve Implantation With a Balloon-Expandable Valve. Circ Cardiovasc Interv 2020; 13:e008972. [PMID: 32580586 PMCID: PMC7373469 DOI: 10.1161/circinterventions.120.008972] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Coronary artery disease and aortic stenosis often coexist. Transcatheter aortic valve implantation (TAVI) has emerged as a valid therapeutic option for younger, lower-risk patients who may eventually require coronary artery disease treatment. Thus, post-TAVI coronary access (CA) and percutaneous coronary intervention are expected to increase. The purpose of this study was to retrospectively evaluate patients who were enrolled in the SOURCE 3 (SAPIEN 3 Aortic Bioprosthesis European Outcome) European registry for treatment with the balloon-expandable SAPIEN 3 transcatheter heart valve and underwent CA with or without percutaneous coronary intervention after TAVI. Methods: Baseline characteristics and clinical outcomes of patients with or without CA up to 3 years after TAVI were compared. A Kaplan-Meier estimate with a univariate model determined the impact of CA on cardiac mortality. Results: Of 1936 TAVI patients (mean age 81.6 years, 52% male), 68 (3.5%) had CA within 3 years (mean 441±332 days) after TAVI. At baseline, the logistic EuroSCORE was similar (20.2% versus 18.3%, P=0.2, CA and non-CA groups, respectively). Higher rates of coronary artery disease (76.5% versus 50.6%, P<0.001), myocardial infarction (20.6% versus 11.5%, P=0.03) and previous coronary artery bypass graft (22.1% versus 11.0%, P=0.01) were present in the CA group. In 100% of patients, CA was successfully achieved. The clinical success of percutaneous coronary intervention was 97.9%. Cardiovascular mortality was numerically higher in patients with CA than in those without CA. Conclusions: In the large SOURCE 3 European registry, CA was needed at 3-year follow-up after TAVI with a balloon-expandable valve in 3.5% of patients and was successful in all patients. The clinical success of percutaneous coronary intervention was 97.9%. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02698956.
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Affiliation(s)
- Giuseppe Tarantini
- Cardiology Clinic, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health Padova, University of Padua, Italy (G.T., L.N.F.)
| | - Luca Nai Fovino
- Cardiology Clinic, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health Padova, University of Padua, Italy (G.T., L.N.F.)
| | | | | | | | | | | | - Tomas Hovorka
- Edwards Lifesciences, Prague, Czech Republic (T.H., Y.A.N.)
| | | | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel (GCVI), Clinique Pasteur, Toulouse, France (N.D.)
| | - Patrick Ohlmann
- Department of Interventional Cardiology, University Hospital of Strasbourg, France (P.O.)
| | - Olaf Wendler
- King's College Hospital, London, United Kingdom (O.W.)
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Nai Fovino L, Scotti A, Massussi M, Cardaioli F, Rodinò G, Matsuda Y, Pavei A, Masiero G, Napodano M, Fraccaro C, Fabris T, Tarantini G. Coronary Angiography After Transcatheter Aortic Valve Replacement (TAVR) to Evaluate the Risk of Coronary Access Impairment After TAVR-in-TAVR. J Am Heart Assoc 2020; 9:e016446. [PMID: 32578484 PMCID: PMC7670517 DOI: 10.1161/jaha.120.016446] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Transcatheter aortic valve replacement (TAVR)‐in‐TAVR is a possible treatment for transcatheter heart valve (THV) degeneration. However, the displaced leaflets of the first THV will create a risk plane (RP) under which the passage of a coronary catheter will be impossible. The aim of our study was to evaluate the potential risk of impaired coronary access (CA) after TAVR‐in‐TAVR. Methods and Results We prospectively performed coronary angiography after TAVR with different THVs in 137 consecutive patients, looking where the catheter crossed the valve frame. If coronary cannulation was achieved from below the RP, the distance between valve frame and aortic wall was measured by aortic angiography. CA after TAVR‐in‐TAVR was defined as feasible if the catheter passed above the RP, as theoretically feasible if passed under the RP with valve‐to‐aorta distance >2 mm, and as unfeasible if passed under the RP with valve‐to‐aorta distance ≤2 mm. Seventy‐two patients (53%) received a Sapien 3 THV, 26 (19%) received an Evolut Pro/R THV, and 39 (28%) received an Acurate Neo THV. CA after TAVR‐in‐TAVR was considered feasible in 40.9% (68.1%, 19.2%, and 5.1%, respectively; P<0.001), theoretically feasible in 27.7% (8.3%, 42.3%, and 53.8%, respectively; P<0.001), and unfeasible in 31.4% (23.6%, 38.5%, and 41.1%, respectively; P=0.116). Independent predictors of impaired CA after TAVR‐in‐TAVR were female sex (odds ratio [OR], 3.99; 95% CI, 1.07–14.86; P=0.040), sinotubular junction diameter (OR, 0.62; 95% CI, 0.48–0.80; P<0.001), and implantation of a supra‐annular THV (OR, 6.61; 95% CI, 1.98–22.03; P=0.002). Conclusions CA after TAVR‐in‐TAVR might be unfeasible in >30% of patients currently treated with TAVR. Patients with a small sinotubular junction and those who received a supra‐annular THV are at highest risk of potential CA impairment with TAVR‐in‐TAVR.
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Affiliation(s)
- Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Mauro Massussi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Giulio Rodinò
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Yuji Matsuda
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Andrea Pavei
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Massimo Napodano
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Tommaso Fabris
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
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Konsensuspapier der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG) zur kathetergestützten Aortenklappenimplantation (TAVI) 2020. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2020. [DOI: 10.1007/s00398-020-00373-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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129
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Kuck KH, Bleiziffer S, Eggebrecht H, Ensminger S, Frerker C, Möllmann H, Nef H, Thiele H, Treede H, Wimmer-Greinecker G, Walther T. Konsensuspapier der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG) zur kathetergestützten Aortenklappenimplantation (TAVI) 2020. KARDIOLOGE 2020. [DOI: 10.1007/s12181-020-00398-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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130
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Degenerative Severe Aortic Stenosis and Concomitant Coronary Artery Disease: What Is Changing in the Era of the “Transcatheter Revolution”? Curr Atheroscler Rep 2020; 22:17. [PMID: 32451750 DOI: 10.1007/s11883-020-0835-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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131
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Coronary Artery Disease and Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 74:362-372. [PMID: 31319919 DOI: 10.1016/j.jacc.2019.06.012] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/10/2019] [Indexed: 01/09/2023]
Abstract
About one-half of transcatheter aortic valve replacement (TAVR) candidates have coronary artery disease (CAD), and controversial results have been reported regarding the effect of the presence and severity of CAD on clinical outcomes post-TAVR. In addition to coronary angiography, promising data has been recently reported on both the use of computed tomography angiography and the functional invasive assessment of coronary lesions in the work-up pre-TAVR. While waiting for the results of ongoing randomized trials, percutaneous revascularization of significant coronary lesions has been the routine strategy in TAVR candidates with CAD. Also, scarce data exists on the incidence, characteristics, and management of coronary events post-TAVR, and increasing interest exist on potential coronary access challenges in patients requiring coronary angiography/intervention post-TAVR. This review provides an updated overview of the current landscape of CAD in TAVR recipients, focusing on its prevalence, clinical impact, pre- and post-procedural evaluation and management, unresolved issues and future perspectives.
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132
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Perrin N, Fassa A, Baroz A, Frangos C, Mock S, Frei A, Cimci M, Degrauwe S, Roffi M, Iglesias JF, Noble S. Complexity assessment and technical aspect of coronary angiogram and percutaneous coronary intervention following transcatheter aortic valve implantation. Cardiol J 2020; 29:197-204. [PMID: 32436588 PMCID: PMC9007485 DOI: 10.5603/cj.a2020.0073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/11/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Performing selective coronary angiogram (CA) and percutaneous coronary intervention (PCI) post transcatheter aortic valve implantation (TAVI) may be challenging with various success rates of coronary ostia engagement. METHODS Among all patients who underwent CA and/or PCI after TAVI from our single center TAVI registry, ostia cannulation success was reported according to the quality of ostia engagement and artery opacification, and was classified as either selective, partially selective or non-selective but sufficient for diagnosis. RESULTS Among the 424 consecutive TAVI procedures performed at the aforementioned institution, 20 (4.7%) CA were performed in 19 (4.5%) patients at a median time of 464 days post TAVI (25-75% IQ: 213-634 days). CA were performed in 7 CoreValve, 9 Evolut R, 1 Evolut PRO and 2 Edwards Sapien 3 devices. Transradial vascular approach was attempted in 9 procedures (45%, right n = 6 and left n = 3) and was successful in 8 (40%) patients. A total of 20 left main artery ostium cannulation were attempted leading to a diagnostic CA in all of them with selective engagement in 65%. Engagement of the right coronary artery in 2 out of 15 attempted cases failed due to a low ostium in conjunction with a high implantation of a CoreValve prosthesis. 11 PCI (55% of CA) including 2 left main lesions were performed. In 4 patients (36.4% of the PCI), an extension catheter was required to engage the left main. All planned PCI were successful. CONCLUSIONS Post TAVI CA and PCI are challenging but feasible even after supra-annular self-expandable valve implantation.
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Affiliation(s)
- Nils Perrin
- Cardiology Division of the University Hospital of Geneva, Switzerland
| | - Amir Fassa
- Cardiology Division of the University Hospital of Geneva, Switzerland
| | - Antoine Baroz
- Cardiology Division of the University Hospital of Geneva, Switzerland
| | - Caroline Frangos
- Cardiology Division of the University Hospital of Geneva, Switzerland
| | - Stephane Mock
- Cardiology Division of the University Hospital of Geneva, Switzerland
| | - Angela Frei
- Cardiology Division of the University Hospital of Geneva, Switzerland
| | - Murat Cimci
- Cardiology Division of the University Hospital of Geneva, Switzerland
| | - Sophie Degrauwe
- Cardiology Division of the University Hospital of Geneva, Switzerland
| | - Marco Roffi
- Cardiology Division of the University Hospital of Geneva, Switzerland
| | | | - Stephane Noble
- Cardiology Division of the University Hospital of Geneva, Switzerland.
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133
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Asgar AW, Ouzounian M, Adams C, Afilalo J, Fremes S, Lauck S, Leipsic J, Piazza N, Rodes-Cabau J, Welsh R, Wijeysundera HC, Webb JG. 2019 Canadian Cardiovascular Society Position Statement for Transcatheter Aortic Valve Implantation. Can J Cardiol 2020; 35:1437-1448. [PMID: 31679616 DOI: 10.1016/j.cjca.2019.08.011] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/29/2019] [Accepted: 08/02/2019] [Indexed: 01/12/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) or replacement has rapidly changed the treatment of patients with severe symptomatic aortic stenosis. It is now the standard of care for patients believed to be inoperable or at high surgical risk, and a reasonable alternative to surgical aortic valve replacement for those at intermediate surgical risk. Recent clinical trial data have shown the benefits of this technology in patients at low surgical risk as well. This update of the 2012 Canadian Cardiovascular Society TAVI position statement incorporates clinical evidence to provide a practical framework for patient selection that does not rely on surgical risk scores but rather on individual patient evaluation of risk and benefit from either TAVI or surgical aortic valve replacement. In addition, this statement features new wait time categories and treatment time goals for patients accepted for TAVI. Institutional requirements and recommendations for operator training and maintenance of competency have also been revised to reflect current standards. Procedural considerations such as decision-making for concomitant coronary intervention, antiplatelet therapy after intervention, and follow-up guidelines are also discussed. Finally, we suggest that all patients with aortic stenosis might benefit from evaluation by the heart team to determine the optimal individualized treatment decision.
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Affiliation(s)
- Anita W Asgar
- Institut de Cardiologie de Montreal, Universite de Montreal, Montreal, Quebec, Canada.
| | - Maral Ouzounian
- Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Corey Adams
- Health Sciences Centre, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Jonathan Afilalo
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Stephen Fremes
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sandra Lauck
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Leipsic
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Josep Rodes-Cabau
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Universite de Laval, Quebec, Quebec, Canada
| | - Robert Welsh
- Mazankowski Alberta Heart Institute and University of Alberta, Edmonton, Alberta, Canada
| | | | - John G Webb
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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134
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Jilaihawi H. When the (Commissural) Stars (Mis)ALIGN. JACC Cardiovasc Interv 2020; 13:1043-1045. [PMID: 32381183 DOI: 10.1016/j.jcin.2020.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 11/16/2022]
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135
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Alignment of Transcatheter Aortic-Valve Neo-Commissures (ALIGN TAVR). JACC Cardiovasc Interv 2020; 13:1030-1042. [DOI: 10.1016/j.jcin.2020.02.005] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 11/19/2022]
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136
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Ochiai T, Yoon SH, Flint N, Sharma R, Chakravarty T, Kaewkes D, Patel V, Nakamura M, Cheng W, Makkar R. Timing and Outcomes of Percutaneous Coronary Intervention in Patients Who Underwent Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 125:1361-1368. [PMID: 32106928 DOI: 10.1016/j.amjcard.2020.01.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/27/2020] [Accepted: 01/31/2020] [Indexed: 12/12/2022]
Abstract
Limited data exist regarding the timing of percutaneous coronary intervention (PCI) in patients with coronary artery disease who underwent transcatheter aortic valve implantation (TAVI). We aimed to investigate clinical outcomes of patients who underwent TAVI and planned PCI according to the timing of PCI in relation to the TAVI. Consecutive patients with severe aortic stenosis who underwent TAVI with planned PCI between January 2013 and November 2017 were included. Patients were divided according to the timing of PCI. The primary end point was major adverse cardiac and cerebrovascular events, defined as a composite of all-cause death, myocardial infarction, unplanned revascularization, and stroke. Among 1,756 patients who underwent TAVI, 258 patients underwent planned PCI either before TAVI (n = 143, 55.4%), concomitantly with TAVI (n = 77, 29.8%), or after TAVI (n = 38, 14.7%). All patients in the post-TAVI PCI group were treated using balloon-expandable valves, and neither hemodynamic instability during TAVI nor PCI-related complications were observed. In a multivariable analysis, the timing of PCI was not associated with 2-year major adverse cardiac and cerebrovascular events rate (concomitant vs pre-TAVI, hazard ratio [HR]: 0.92; 95% confidence interval [CI]: 0.52 to 1.66; p = 0.79; post- vs pre-TAVI, HR: 0.45; 95% CI: 0.18 to 1.16; p = 0.10). In conclusion, there were no significant differences in terms of mid-term outcomes among pre-TAVI, concomitant, and post-TAVI PCI groups when the timing of PCI was carefully selected by heart team.
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Affiliation(s)
- Tomoki Ochiai
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Sung-Han Yoon
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nir Flint
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Tel Aviv Sourasky Medical Center affiliated to the Sackler faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rahul Sharma
- Stanford Health Care, and Stanford University, Stanford, California
| | - Tarun Chakravarty
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Danon Kaewkes
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Vivek Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mamoo Nakamura
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Wen Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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137
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Katta N, Abbott JD, Kalra A, Alenezi F, Goldsweig A, Aronow H, Velagapudi P. Management of Coronary Artery Disease in the Setting of Transcatheter Aortic Valve Replacement. Heart Int 2020; 14:24-28. [PMID: 36277671 PMCID: PMC9524713 DOI: 10.17925/hi.2020.14.1.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/06/2020] [Indexed: 07/21/2023] Open
Abstract
Aortic stenosis and coronary artery disease (CAD) frequently co-exist, as they share a common pathophysiology and risk factors. Due to lack of randomised controlled trials (RCTs) and exclusion of significant CAD in transcatheter aortic valve replacement (TAVR) trials, the optimal method of revascularisation of CAD in patients undergoing TAVR remains unknown. Observational studies and meta-analyses have shown varied results in outcomes for patients with CAD undergoing TAVR, and no significant difference in post-TAVR outcomes in patients who underwent revascularisation either prior to or during TAVR versus those who did not. However, some observational studies have shown that patients with lower residual SYNTAX score (rSS) post-revascularisation have better outcomes post-TAVR compared to those with higher rSS. RCTs are needed to clearly understand whether revascularisation is beneficial in these patients. Until then, management of CAD in patients undergoing TAVR must be individualised based on discussion with the heart team.
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Affiliation(s)
- Natraj Katta
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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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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139
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Stortecky S, Malebranche D. The EVOLUTion of Coronary Access After TAVR: Behind the Scenes With Computerized Tomography. JACC Cardiovasc Interv 2020; 13:723-725. [PMID: 32192692 DOI: 10.1016/j.jcin.2020.01.223] [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: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Daniel Malebranche
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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140
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Adams H, Roberts-Thomson R, Patterson T, Prendergast B, Redwood S. The Low-Risk TAVI Trials for Severe Aortic Stenosis: Future Implications for Australian and New Zealand Heart Teams. Heart Lung Circ 2020; 29:657-661. [PMID: 32115372 DOI: 10.1016/j.hlc.2020.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/16/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Heath Adams
- Department of Cardiology, St Thomas' Hospital, London, UK; Department of Cardiology, Royal Hobart Hospital, Hobart, Tas, Australia; School of Medicine, University of Tasmania, Hobart, Tas, Australia.
| | - Ross Roberts-Thomson
- Department of Cardiology, St Thomas' Hospital, London, UK; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Tiffany Patterson
- Department of Cardiology, St Thomas' Hospital, London, UK; Cardiovascular Department, King's College London, London, UK
| | | | - Simon Redwood
- Department of Cardiology, St Thomas' Hospital, London, UK; Cardiovascular Department, King's College London, London, UK
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141
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Tang GH, Kaneko T, Cavalcante JL. Predicting the Feasibility of Post-TAVR Coronary Access and Redo TAVR. JACC Cardiovasc Interv 2020; 13:736-738. [DOI: 10.1016/j.jcin.2020.01.222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/20/2020] [Indexed: 10/24/2022]
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142
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Ochiai T, Chakravarty T, Yoon SH, Kaewkes D, Flint N, Patel V, Mahani S, Tiwana R, Sekhon N, Nakamura M, Cheng W, Makkar R. Coronary Access After TAVR. JACC Cardiovasc Interv 2020; 13:693-705. [DOI: 10.1016/j.jcin.2020.01.216] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 11/26/2022]
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143
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Rogers T, Greenspun BC, Weissman G, Torguson R, Craig P, Shults C, Gordon P, Ehsan A, Wilson SR, Goncalves J, Levitt R, Hahn C, Parikh P, Bilfinger T, Butzel D, Buchanan S, Hanna N, Garrett R, Buchbinder M, Asch F, Garcia-Garcia HM, Okubagzi P, Ben-Dor I, Satler LF, Waksman R. Feasibility of Coronary Access and Aortic Valve Reintervention in Low-Risk TAVR Patients. JACC Cardiovasc Interv 2020; 13:726-735. [DOI: 10.1016/j.jcin.2020.01.202] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/23/2019] [Accepted: 01/02/2020] [Indexed: 11/16/2022]
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144
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Abdelghani M, Landt M, Traboulsi H, Becker B, Richardt G. Coronary Access After TAVR With a Self-Expanding Bioprosthesis. JACC Cardiovasc Interv 2020; 13:709-722. [DOI: 10.1016/j.jcin.2020.01.229] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/07/2020] [Accepted: 01/28/2020] [Indexed: 10/24/2022]
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145
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A meta-analysis of 1-year outcomes of transcatheter versus surgical aortic valve replacement in low-risk patients with severe aortic stenosis. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2020; 17:43-50. [PMID: 32095133 PMCID: PMC7008096 DOI: 10.11909/j.issn.1671-5411.2020.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Transcatheter aortic valve replacement (TAVR) for the treatment symptomatic severe aortic stenosis (AS) is indicated in patients with intermediate or higher surgical risk. Latest trials showed TAVR, and surgical aortic valve replacement (SAVR) perform similarly at 1-year for the composite outcomes of mortality, stroke and rehospitalization. We performed a comprehensive meta-analysis to compare individual outcomes at 1-year for TAVR compared to SAVR in low-risk patients. Methods PubMed, Embase, and Cochrane central were searched for all the randomized controlled trials (RCTs) that reported 1-year comparative outcomes of TAVR and surgical aortic valve replacement (SAVR). Our conclusions are based upon the random-effects model using DerSimonian-Laird estimator. Results Data from 4 trials and 2887 randomized patients showed that TAVR had lower rates of all-cause mortality, cardiovascular mortality, and atrial fibrillation compared to SAVR at 1-year follow-up (P < 0.05 for all). Also, TAVR was also associated with a significantly higher risk of permanent pacemaker implantation and moderate-severe paravalvular leak (P < 0.05). Conclusions The latest randomised trial data demonstrates that in short-term, TAVR is safe and effective in reducing all-cause mortality or stroke. Longer follow-up of RCTs is needed to determine the durability of clinical benefits in TAVR over SAVR in low-risk patients.
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146
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Hatoum H, Hahn RT, Lilly S, Dasi LP. Differences in Pressure Recovery Between Balloon Expandable and Self-expandable Transcatheter Aortic Valves. Ann Biomed Eng 2020; 48:860-867. [PMID: 31792706 PMCID: PMC11043825 DOI: 10.1007/s10439-019-02425-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022]
Abstract
Pressure recovery downstream of the aortic valve constitutes an important factor affecting the calculation of pressure gradient (PG) across the valve and therefore the accuracy of the calculated aortic valve area. Some clinical studies hypothesized that stent and valve cusps design contribute to flow acceleration and Doppler-measured valve gradients across the balloon-expandable transcatheter aortic valve. This study aims at elucidating the physical mechanisms behind pressure recovery variations between Edwards SAPIEN 3 and Medtronic Evolut TAVs through the measurements of sensitive and precise axial pressure profiles. A 23 mm Edwards SAPIEN3 and a 26 mm Medtronic Evolut were deployed in a pulse duplicator. A Millar catheter was used to record 50 cycles of pressure data along the centerline of the valve chamber upstream and downstream of the valve. The peak PG obtained with SAPIEN at vena contracta (VC) is 18.83 ± 0.75 mmHg and after recovery, 9.56 ± 0.78 mmHg. For Evolut at VC, peak PG is 18.25 ± 0.63 mmHg and after recovery, 10.3 ± 0.57 mmHg. The differences in peak PG at VC and at the recovery were statistically significant (p < 0.001). With SAPIEN 3 at VC, the mean PG obtained is 10.11 ± 0.63 mmHg and after recovery 7.06 ± 0.46 mmHg. For Evolut, mean PG at VC is 10.45 ± 0.67 mmHg and after recovery 7.99 ± 0.61 mmHg. The differences between the mean PG between the two valves was not statistically significant at VC (p = 0.71) but significant post-recovery (p < 0.00001). While gradients at the VC are higher with the SAPIEN 3, the net gradient after pressure recovery is significantly lower compared to Evolut TAV. Efficiency of pressure recovery significantly depends on valve type due to stent interference with the recovering blood flow.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, 473 W 12th Ave, Columbus, OH, 43210, USA
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Scott Lilly
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, 473 W 12th Ave, Columbus, OH, 43210, USA.
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147
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Faroux L, Munoz-Garcia E, Serra V, Alperi A, Nombela-Franco L, Fischer Q, Veiga G, Donaint P, Asmarats L, Vilalta V, Chamandi C, Regueiro A, Gutiérrez E, Munoz-Garcia A, Garcia Del Blanco B, Bach-Oller M, Moris C, Armijo G, Urena M, Fradejas-Sastre V, Metz D, Castillo P, Fernandez-Nofrerias E, Sabaté M, Tamargo M, Del Val D, Couture T, Rodes-Cabau J. Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2020; 13:e008620. [PMID: 31992059 DOI: 10.1161/circinterventions.119.008620] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Scarce data exist on coronary events following transcatheter aortic valve replacement (TAVR), and no study has determined the factors associated with poorer outcomes in this setting. This study sought to determine the clinical characteristics, outcomes, and prognostic factors of acute coronary syndrome (ACS) events following TAVR. METHODS Multicenter cohort study including a total of 270 patients presenting an ACS after a median time of 12 (interquartile range, 5-17) months post-TAVR. Post-ACS death, myocardial infarction, stroke, and overall major adverse cardiovascular or cerebrovascular events were recorded. RESULTS The ACS clinical presentation consisted of non-ST-segment-elevation myocardial infarction (STEMI) type 2 (31.9%), non-STEMI type 1 (31.5%), unstable angina (28.5%), and STEMI (8.1%). An invasive strategy was used in 163 patients (60.4%), and a percutaneous coronary intervention was performed in 97 patients (35.9%). Coronary access issues were observed in 2.5% and 2.1% of coronary angiography and percutaneous coronary intervention procedures, respectively. The in-hospital mortality rate was 10.0%, and at a median follow-up of 17 (interquartile range, 5-32) months, the rates of death, stroke, myocardial infarction, and major adverse cardiovascular or cerebrovascular events were 43.0%, 4.1%, 15.2%, and 52.6%, respectively. By multivariable analysis, revascularization at ACS time was associated with a reduction of the risk of all-cause death (hazard ratio, 0.54 [95% CI, 0.36-0.81] P=0.003), whereas STEMI increased the risk of all-cause death (hazard ratio, 2.06 [95% CI, 1.05-4.03] P=0.036) and major adverse cardiovascular or cerebrovascular events (hazard ratio, 1.97 [95% CI, 1.08-3.57] P=0.026). CONCLUSIONS ACS events in TAVR recipients exhibited specific characteristics (ACS presentation, low use of invasive procedures, coronary access issues) and were associated with a poor prognosis, with a very high in-hospital and late death rate. STEMI and the lack of coronary revascularization determined an increased risk. These results should inform future studies to improve both the prevention and management of ACS post-TAVR.
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Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Canada (L.F., D.d.V., T.C., J.R.-C.)
| | - Erika Munoz-Garcia
- Hospital Universitario Virgen de la Victoria, Málaga, Spain (E.M.-G., A.M.-G.)
| | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., B.G.d.B., M.B.-O.)
| | - Alberto Alperi
- Hospital Universitario Central de Asturias, Oviedo, Spain (A.A., C.M.)
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain (L.N.-F., G.A.)
| | - Quentin Fischer
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France (Q.F., M.U.)
| | - Gabriela Veiga
- Hospital Marques de Valdecilla, Santander, Spain (G.V., V.F.-S.)
| | | | - Lluis Asmarats
- Hospital Santa Creu i Sant Pau, Barcelona, Spain (L.A., P.C.)
| | | | | | - Ander Regueiro
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (A.R., M.S.)
| | - Enrique Gutiérrez
- Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain (E.G., M.T.)
| | | | | | | | - Cesar Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain (A.A., C.M.)
| | - German Armijo
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain (L.N.-F., G.A.)
| | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France (Q.F., M.U.)
| | | | - Damien Metz
- Reims University Hospital, Reims, France (P.D., D.M.)
| | - Pablo Castillo
- Hospital Santa Creu i Sant Pau, Barcelona, Spain (L.A., P.C.)
| | | | - Manel Sabaté
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (A.R., M.S.)
| | - Maria Tamargo
- Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain (E.G., M.T.)
| | - David Del Val
- Quebec Heart and Lung Institute, Laval University, Canada (L.F., D.d.V., T.C., J.R.-C.)
| | - Thomas Couture
- Quebec Heart and Lung Institute, Laval University, Canada (L.F., D.d.V., T.C., J.R.-C.)
| | - Josep Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Canada (L.F., D.d.V., T.C., J.R.-C.)
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148
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Nai Fovino L, Scotti A, Massussi M, Fabris T, Cardaioli F, Rodinò G, Matsuda Y, Frigo F, Fraccaro C, Tarantini G. Incidence and feasibility of coronary access after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 96:E535-E541. [DOI: 10.1002/ccd.28720] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 12/31/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Mauro Massussi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Tommaso Fabris
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Giulio Rodinò
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Yuji Matsuda
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Francesca Frigo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
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149
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Sengupta A, Alexis SL, Kovacic JC, Tang GHL. Current challenges in TAVI: neo-commissural alignment to mimic more physiologic valve implantation. VESSEL PLUS 2020; 4. [PMID: 34085033 PMCID: PMC8171260 DOI: 10.20517/2574-1209.2020.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Commissural alignment during transcatheter aortic valve implantation (TAVI) has important clinical implications as TAVI expands to younger patients in whom lifetime treatment of aortic valve disease and coronary artery disease is of particular importance. Numerous studies have shown that lack of commissural alignment may adversely affect coronary reaccess and the feasibility of redo-TAVI in this patient population. To assess the risk of commissural misalignment more accurately, we have pioneered and validated the use of a preprocedural imaging protocol that determines valve orientation using multi-detector computed tomography-fluoroscopy co-registration. Furthermore, we have shown that a modified delivery system insertion technique during initial valve deployment results in improved commissural alignment and reduced coronary artery overlap following TAVI with a self-expanding device. However, numerous unanswered questions remain about the impact of commissural misalignment on balloon-expandable valve-in-valve TAVI, especially in patients with unfavorable aortic root anatomy. It is imperative that clinicians consider these anatomic, device-related, and procedure factors, among others, when evaluating patients for transcatheter therapies.
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Affiliation(s)
- Aditya Sengupta
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sophia L Alexis
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jason C Kovacic
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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150
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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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