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Komlev AE, Lepilin PM, Kurilina EV, Romakina VV, Imaev TE. [Delayed coronary obstruction of the left main artery after transcatheter aortic valve replacement]. TERAPEVT ARKH 2020; 92:70-75. [PMID: 32598701 DOI: 10.26442/00403660.2020.04.000466] [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: 05/18/2020] [Indexed: 11/22/2022]
Abstract
Coronary arteries obstruction associated with transcatheter aortic valve implantation (TAVI) may occur either during the procedure or after it. In the latter coronary obstruction can be further divided into early (7 days after procedure) or delayed one (7 days). Delayed coronary obstruction (DCO) is referred as a rare but devastating complication after TAVI and is associated with the extremely high mortality. This case demonstrates the objective difficulties of timely diagnostics of DCO. Since the results of non-invasive methods are indetermined in most cases, the authors conclude that even low-specific clinical symptoms must be interpreted as the definite rationale for the implementation of invasive diagnostic and treatment strategy.
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Affiliation(s)
- A E Komlev
- National Medical Research Center of Cardiology
| | - P M Lepilin
- National Medical Research Center of Cardiology
| | | | | | - T E Imaev
- National Medical Research Center of Cardiology
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102
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Looking Toward the Post-TAVR Period and Keeping Options Open for Easy Coronary Access. JACC Cardiovasc Interv 2020; 13:951-953. [DOI: 10.1016/j.jcin.2019.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 11/22/2022]
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103
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Garot P. TAVR-Related Coronary Obstruction: Preventive Wires or Stenting? JACC Cardiovasc Interv 2020; 13:748-750. [PMID: 32061610 DOI: 10.1016/j.jcin.2020.01.201] [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: 12/04/2019] [Revised: 12/20/2019] [Accepted: 01/02/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Philippe Garot
- Institut Cardiovasculaire Paris-Sud, Ramsay-Santé, Massy, France.
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104
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Seki R, Higuchi R, Saji M, Takamisawa I. Sinus of Valsalva Obstruction Following TAVR. JACC Cardiovasc Interv 2020; 13:e43-e44. [PMID: 32113925 DOI: 10.1016/j.jcin.2020.01.217] [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: 01/02/2020] [Accepted: 01/14/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Ruiko Seki
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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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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106
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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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Mentias A, Desai MY, Saad M, Horwitz PA, Rossen JD, Panaich S, Elbadawi A, Abbott JD, Sorajja P, Jneid H, Tuzcu EM, Kapadia S, Vaughan-Sarrazin M. Incidence and Outcomes of Acute Coronary Syndrome After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 13:938-950. [PMID: 32061612 DOI: 10.1016/j.jcin.2019.11.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/22/2019] [Accepted: 11/15/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study sought to address a knowledge gap by examining the incidence, timing, and predictors of acute coronary syndrome (ACS) after transcatheter aortic valve replacement (TAVR) in Medicare beneficiaries. BACKGROUND Evidence about incidence and outcomes of ACS after TAVR is scarce. METHODS We identified Medicare patients who underwent TAVR from 2012 to 2017 and were admitted with ACS during follow-up. We compared outcomes based on the type of ACS: ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina. In patients with non-ST-segment elevation ACS, we compared outcomes based on the treatment strategy (invasive vs. conservative) using inverse probability weighting analysis. RESULTS Out of 142,845 patients with TAVR, 6,741 patients (4.7%) were admitted with ACS after a median time of 297 days (interquartile range: 85 to 662 days), with 48% of admissions occurring within 6 months. The most common presentation was NSTEMI. Predictors of ACS were history of coronary artery disease, prior revascularization, diabetes, valve-in-TAVR, and acute kidney injury. STEMI was associated with higher 30-day and 1-year mortality compared with NSTEMI (31.4% vs. 15.5% and 51.2% vs. 41.3%, respectively; p < 0.01). Overall, 30.3% of patients with non-ST-segment elevation ACS were treated with invasive approach. On inverse probability weighting analysis, invasive approach was associated with lower adjusted long-term mortality (adjusted hazard ratio: 0.69; 95% confidence interval: 0.66 to 0.73; p < 0.01) and higher risk of repeat revascularization (adjusted hazard ratio: 1.29; 95% confidence interval: 1.16 to 1.43; p < 0.001). CONCLUSIONS After TAVR, ACS is infrequent (<5%), and the most common presentation is NSTEMI. Occurrence of STEMI after TAVR is associated with a high mortality with nearly one-third of patients dying within 30 days. Optimization of care is needed for post-TAVR ACS patients and if feasible, invasive approach should be considered in these high-risk patients.
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Affiliation(s)
- Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
| | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Marwan Saad
- Cardiovascular Institute, The Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Phillip A Horwitz
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - James D Rossen
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Sidakpal Panaich
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Ayman Elbadawi
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
| | - J Dawn Abbott
- Cardiovascular Institute, The Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Hani Jneid
- Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - E Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mary Vaughan-Sarrazin
- Comprehensive Access and Delivery Research and Evaluation Center (CADRE), Iowa City VA Medical Center, Iowa City, Iowa
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Palmerini T, Chakravarty T, Saia F, Bruno AG, Bacchi-Reggiani ML, Marrozzini C, Patel C, Patel V, Testa L, Bedogni F, Ancona M, Montorfano M, Chieffo A, Olivares P, Bartorelli AL, Buscaglia A, Porto I, Nickenig G, Grube E, Sinning JM, De Carlo M, Petronio AS, Barbanti M, Tamburino C, Iadanza A, Burzotta F, Trani C, Fraccaro C, Tarantini G, Aranzulla TC, De Benedictis M, Pagnotta P, Stefanini GG, Miura M, Taramasso M, Kang JH, Kim HS, Codner P, Kornowski R, Pelliccia F, Vignali L, Taglieri N, Ghetti G, Leone A, Galiè N, Makkar R. Coronary Protection to Prevent Coronary Obstruction During TAVR: A Multicenter International Registry. JACC Cardiovasc Interv 2020; 13:739-747. [PMID: 32061608 DOI: 10.1016/j.jcin.2019.11.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/12/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the safety and efficacy of coronary protection by preventive coronary wiring and stenting across the coronary ostia in patients at high risk for coronary obstruction after transcatheter aortic valve replacement (TAVR). BACKGROUND Coronary obstruction following TAVR is a life-threatening complication with high procedural and short-term mortality. METHODS Data were collected retrospectively from a multicenter international registry between April 2011 and February 2019. RESULTS Among 236 patients undergoing coronary protection with preventive coronary wiring, 143 had eventually stents implanted across the coronary ostia after valve deployment. At 3-year follow-up, rates of cardiac death were 7.8% in patients receiving stents and 15.7% in those not receiving stents (adjusted hazard ratio: 0.42; 95% confidence interval: 0.14 to 1.28; p = 0.13). There were 2 definite stent thromboses (0.9%) in patients receiving stents, both occurring after TAVR in "valve-in-valve" procedures. In patients not receiving stents, there were 4 delayed coronary occlusions (DCOs) (4.3%), occurring from 5 min to 6 h after wire removal. Three cases occurred in valve-in-valve procedures and 1 in a native aortic valve procedure. Distance between the virtual transcatheter valve and the protected coronary ostia <4 mm was present in 75.0% of patients with DCO compared with 30.4% of patients without DCO (p = 0.19). CONCLUSIONS In patients undergoing TAVR at high risk for coronary obstruction, preventive stent implantation across the coronary ostia is associated with good mid-term survival rates and low rates of stent thrombosis. Patients undergoing coronary protection with wire only have a considerable risk for DCO.
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Affiliation(s)
- Tullio Palmerini
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy.
| | | | - Francesco Saia
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Antonio G Bruno
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | | | | | - Chinar Patel
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Vivek Patel
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Luca Testa
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Francesco Bedogni
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Marco Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Olivares
- Centro Cardiologico Monzino, University of Milan, Milan, Italy
| | | | - Angelo Buscaglia
- University of Genova, Cardiovascular Unit, Department of Internal Medicine and Specialties and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Italo Porto
- University of Genova, Cardiovascular Unit, Department of Internal Medicine and Specialties and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Eberhard Grube
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | | | | | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | | | - Paolo Pagnotta
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | | | - Mizuki Miura
- Heart Valve Clinic, University Hospital of Zürich, Zürich, Switzerland
| | | | - Jee-Hoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | | | | | | | - Luigi Vignali
- UO Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Nevio Taglieri
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Gabriele Ghetti
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Alessandro Leone
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Nazzareno Galiè
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California
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Naik M, McNamara C, Jabbour RJ, Gopalan D, Mikhail GW, Mirsadraee S, Ariff B. Imaging of transcatheter aortic valve replacement complications. Clin Radiol 2020; 76:27-37. [PMID: 31964536 DOI: 10.1016/j.crad.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/11/2019] [Indexed: 01/05/2023]
Abstract
Aortic stenosis is increasing in incidence and is now commonly managed with transcatheter aortic valve replacement (TAVR) in intermediate and high-risk patients. Radiologists are likely to encounter patients undergoing this procedure both pre- and postoperatively, and therefore, an understanding of procedural complications is essential. Complications may relate to the access site or approach, or the valve itself. This article will review the most common complications described in literature and focuses on the role of multidetector computed tomography (CT) in their evaluation either exclusively, or complementary to other imaging methods.
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Affiliation(s)
- M Naik
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - C McNamara
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - R J Jabbour
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - D Gopalan
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - G W Mikhail
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - S Mirsadraee
- Department of Radiology, Harefield Hospital, Hill End Road, Uxbridge, UB9 6JH, UK
| | - B Ariff
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.
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110
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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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111
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Salmonsmith JA, Ducci A, Burriesci G. Does transcatheter aortic valve alignment matter? Open Heart 2019; 6:e001132. [PMID: 31803486 PMCID: PMC6887501 DOI: 10.1136/openhrt-2019-001132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/10/2019] [Accepted: 11/07/2019] [Indexed: 11/06/2022] Open
Abstract
Objective This study investigates the effect of transcatheter aortic valve (TAV) angular alignment on the postprocedure haemodynamics. TAV implantation has emerged as an effective alternative to surgery when treating valve dysfunction. However, the benefit of avoiding surgery is paid back by the inability to remove the native diseased leaflets and accurately position the device in relation to the aortic root, and the literature has shown the root anatomy and substitute position can play an essential role on valve function. Methods A commercial TAV was placed in a silicone mock aortic root in vitro, including mock native leaflets, and either aligned commissure-to-commissure or in maximum misalignment. Haemodynamic performance data at various stroke volumes were measured, and Particle Image Velocimetry analysis was performed at a typical stroke volume for rest conditions. The two configurations were also studied without mock native leaflets, for comparison with previous in vitro studies. Results Haemodynamic performance data were similar for all configurations. However, imaging analysis indicated that valve misalignment resulted in the central jet flow not extending to the root wall in the native commissures’ vicinity, replaced by a low shear flow, and a reduction of upper sinus flow of 40%, increasing flow stagnation in the sinus. Conclusions TAV misalignment did not result in a significant change in valve hydrodynamic performance, but determined some change in the fluid flow patterns, which may promote pathological scenarios, such as increased thrombogenicity of blood flow within the sinuses of Valsalva, and plaque formation around the lumen of the sinotubular junction.
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Affiliation(s)
| | - Andrea Ducci
- UCL Mechanical Engineering, University College London, London, UK
| | - Gaetano Burriesci
- UCL Mechanical Engineering, University College London, London, UK.,Unit of Bioengineering, Ri.MED Foundation, Palermo, Italy
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112
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Hernando Marrupe L, del Castillo Medina R, Núñez García A, González Doforno Y, Marco Quirós C, Botas Rodríguez J. Stent profiláctico en chimenea en el tronco coronario durante implante percutáneo de válvula aórtica. ¿Una opción adecuada? Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2019.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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113
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Ng VG, Hahn RT, Nazif TM. Planning for Success: Pre-procedural Evaluation for Transcatheter Aortic Valve Replacement. Cardiol Clin 2019; 38:103-113. [PMID: 31753169 DOI: 10.1016/j.ccl.2019.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Vivian G Ng
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY 10032, USA
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY 10032, USA
| | - Tamim M Nazif
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY 10032, USA.
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114
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Valvo R, Costa G, Barbanti M. How to Avoid Coronary Occlusion During TAVR Valve-in-Valve Procedures. Front Cardiovasc Med 2019; 6:168. [PMID: 31803761 PMCID: PMC6877473 DOI: 10.3389/fcvm.2019.00168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/04/2019] [Indexed: 11/22/2022] Open
Abstract
Transcatheter aortic valve-in-valve replacement has been recently reported as a less-invasive alternative to re-do surgery in patients with bioprosthetic valve failure. Although procedural success is achieved in the great majority of patients, this therapy is associated with several potential complications, and coronary occlusion is one of the most feared. This is a rare event, but it is associated with an extremely poor prognosis. In this review, the mechanisms, the identification of patients at high risk, the primary prevention strategies, and treatment of coronary occlusion will be discussed.
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Affiliation(s)
- Roberto Valvo
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
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115
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Hernando Marrupe L, Del Castillo Medina R, Núñez García A, González Doforno Y, Marco Quirós C, Botas Rodríguez J. Pre-emptive Left Main Stenting During Transcatheter Aortic Valve Implantation. A Viable Option? ACTA ACUST UNITED AC 2019; 72:1090-1092. [PMID: 31706710 DOI: 10.1016/j.rec.2019.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/19/2019] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Alberto Núñez García
- Servicio de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Yago González Doforno
- Servicio de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Cecilia Marco Quirós
- Servicio de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Javier Botas Rodríguez
- Servicio de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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Nejjari M, Cacoub L, Digne F. [Management of non-rhythmic complications of TAVI procedures]. Ann Cardiol Angeiol (Paris) 2019; 68:439-442. [PMID: 31676032 DOI: 10.1016/j.ancard.2019.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 12/20/2022]
Abstract
Transcatheter aortic valve (TAVI) is the treatment of choice in patients with severe symptomatic aortic stenosis at high surgical risk. Recent data have also shown favorable results in patients considered to have an intermediate operative risk, which broadens the application of this new technology. Despite its success, the TAVI procedure has been associated with life-threatening complications. Advances in preoperative screening and patient selection have reduced the incidence of these complications. When these complications occur, early recognition and rapid management are essential. The purpose of this review is to describe non-rhythmic mechanical complications attributable to TAVI procedures with their predictive factors, how to prevent and manage them.
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Affiliation(s)
- M Nejjari
- Département d'hémodynamique, centre cardiologique du Nord, 32, rue des Moulins-Gémeaux, 93200 Saint-Denis, France.
| | - L Cacoub
- Département d'hémodynamique, centre cardiologique du Nord, 32, rue des Moulins-Gémeaux, 93200 Saint-Denis, France
| | - F Digne
- Département d'hémodynamique, centre cardiologique du Nord, 32, rue des Moulins-Gémeaux, 93200 Saint-Denis, France
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117
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Laricchia A, Mangieri A, Gallo F, Latib A, Fisicaro A, Conti R, Squeri A, Mantovani L, Colombo A, Giannini F. Valve-in-Valve Transcatheter Aortic Valve Implantation With Acurate neo for a Degenerated bio-Bentall. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:18-20. [PMID: 31669110 DOI: 10.1016/j.carrev.2019.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/15/2019] [Accepted: 09/17/2019] [Indexed: 11/30/2022]
Abstract
A 79-year-old man with heart failure was referred to our attention for a degenerated bio-Bentall Mitroflow 27. The Heart Team decided for a valve-in-valve (ViV) transcatheter aortic valve implantation with an Acurate neo M associated to coronary protection due to high risk of coronary obstruction (CO). Besides the supra-anular design, this case shows additional potential advantages of the Acurate neo in ViV procedures: the upper crown, which is meant to favor supra-anular anchoring, also let to cap the bioprosthesis leaflets and minimize the risk of CO; there is not any interference between the valve cage and the stents protruding into the aorta, avoiding potential stent crushing and assuming an easier future coronary engagement.
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Affiliation(s)
- Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy.
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Francesco Gallo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, USA
| | - Andrea Fisicaro
- Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Rita Conti
- Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Angelo Squeri
- Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Lorenzo Mantovani
- Anesthesia and Intensive Care, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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118
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Tzeng YH, Lee YT, Tsao TP, Lee KC, Huang KC, Hsiung MC, Wei J, Yin WH. Performance and short-term outcomes of three different transcatheter aortic valve replacement devices in patients with aortic stenosis: A single-center experience. J Chin Med Assoc 2019; 82:827-834. [PMID: 31693532 DOI: 10.1097/jcma.0000000000000187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Data on whether different transcatheter aortic valve replacement (TAVR) devices and delivery approaches can achieve equally favorable outcomes when performed by a single heart team are scarce. We sought to compare the performance and short-term outcomes of three different TAVR devices-self-expanding Medtronic CoreValve (MCV), mechanically expanded Lotus valve, and balloon-expandable Edwards SAPIEN XT (SXT)-for the treatment of severe aortic stenosis (AS) in a single large-volume center in Taiwan. METHODS We retrospectively reviewed consecutive patients who underwent TAVR for the treatment of severe AS. Clinical outcomes were reported following Valve Academic Research Consortium 2 (VARC-2) criteria. The composite primary endpoint was combined all-cause mortality, myocardial infarction (MI), or disabling stroke within 180 days. RESULTS A total of 231 patients (MCV n=112, Lotus n=18, and SXT n=101) were included. The device and procedural success rates were similar among all three TAVR devices. At 30 days, there was no significant difference in all-cause mortality, cardiovascular mortality, periprocedural MI, stroke, major vascular complications, life-threatening bleeding, acute kidney injury (AKI, stage 2/3), or VARC-2 composite early safety endpoints. There was no difference among groups in the rate of primary endpoint within 180 days. Lack of procedural success, presence of acute coronary occlusion during TAVR, and presence of AKI (stage 3) after TAVR were independent predictors of adverse outcomes. CONCLUSION TAVR using MCV, Lotus, or SXT was associated with similar 30- and 180-day clinical outcomes. The presence of periprocedural complications was one of the main determinants of short-term adverse outcomes.
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Affiliation(s)
- Yun-Hsuan Tzeng
- Division of Medical Imaging, Health Management Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Institute of Microbiology and Immunology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tien-Ping Tsao
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Kuo-Chen Lee
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Kuan-Chih Huang
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
| | | | - Jeng Wei
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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119
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Barbanti M, Webb JG, Dvir D, Prendergast BD. Residual challenges in TAVI: moving forward. EUROINTERVENTION 2019; 15:857-866. [DOI: 10.4244/eij-d-19-00788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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120
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[TAVI and coronary revascularization]. Ann Cardiol Angeiol (Paris) 2019; 68:423-428. [PMID: 31648796 DOI: 10.1016/j.ancard.2019.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 09/20/2019] [Indexed: 11/23/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has become the major approach to manage the severe aortic stenosis in inoperable patients that frequently present a coronary artery disease. To date, the available data related to the impact of these coronary lesions on survival is conflicting. When indicated, coronary revascularization could be beneficial for proximal lesions when performed before or during TAVI. The per-procedure coronary artery occlusion is rare, but with a bad prognosis. The coronary occlusion is more frequent with short distance of the coronary implantation and the small aortic sinuses, mostly occurring in the left main coronary. The scan analysis to identify high-risk cases is therefore important before the procedure in order to anticipate and prevent complications by specific techniques. Recently, late occlusion cases have been described and linked to thrombus or fibrosis mechanisms. The rate of success of percutaneous coronary intervention (PCI) after TAVI approach is weak, because of the difficulties of selective catheterization due to the stent of prosthesis. The different techniques of PCI have been outlined according to the type of the prosthesis.
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121
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Bouisset F, Marcheix B, Grunenwald E, Lhermusier T. Late Right Coronary Obstruction Following TAVR in a Degenerated Surgical Aortic Bioprosthetic Valve. JACC Case Rep 2019; 1:419-420. [PMID: 34316842 PMCID: PMC8288631 DOI: 10.1016/j.jaccas.2019.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 06/13/2023]
Abstract
We present a case of an 80-year-old woman with severe aortic insufficiency due to a degenerated 21-mm biological prosthetic aortic valve implanted 9 years earlier, treated by using a transcatheter aortic valve replacement valve-in-valve procedure and who experienced a delayed right coronary obstruction. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Frederic Bouisset
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Bertrand Marcheix
- Department of Cardiac Surgery, Rangueil University Hospital, Toulouse, France
| | - Etienne Grunenwald
- Department of Cardiac Surgery, Rangueil University Hospital, Toulouse, France
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122
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Dhamija Y, Kalra A, Puri R. Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement. JACC Case Rep 2019; 1:319-321. [PMID: 34316816 PMCID: PMC8288806 DOI: 10.1016/j.jaccas.2019.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Ankur Kalra
- Cleveland Clinic Akron General, Akron, Ohio
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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123
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Cardiogenic Shock Due to Late Chimney Stent Failure Following Valve-in-Valve Transcatheter Aortic Valve Replacement. JACC Case Rep 2019; 1:313-318. [PMID: 34316815 PMCID: PMC8289152 DOI: 10.1016/j.jaccas.2019.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/26/2019] [Indexed: 11/27/2022]
Abstract
Although the safety of valve-in-valve transcatheter aortic valve replacement has improved, coronary ostium obstruction remains a significant complication, with chimney stenting a possible solution to circumvent this complication. In this case, we discuss the failure of a chimney stent in a case of valve-in-valve transcatheter aortic valve replacement resulting in cardiogenic shock. (Level of Difficulty: Advanced.)
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124
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Bernardi FLM, Dvir D, Rodes-Cabau J, Ribeiro HB. Valve-in-Valve Challenges: How to Avoid Coronary Obstruction. Front Cardiovasc Med 2019; 6:120. [PMID: 31508426 PMCID: PMC6716332 DOI: 10.3389/fcvm.2019.00120] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/06/2019] [Indexed: 11/13/2022] Open
Abstract
Coronary obstruction is a rare but life-threatening complication in patients undergoing transcatheter aortic valve replacement (TAVR). Aortic valve-in-valve (VIV) procedures to treat failed surgical bioprosthesis is associated with ~6-fold higher risk for coronary obstruction in certain situations. The primary mechanism consists in the occlusion of the coronary ostium by the dislodged leaflet from the bioprosthesis after deployment of the transcatheter heart valve (THV), which most commonly occurs during the index procedure, but in up to 1/3 of cases a delayed presentation ensues. The clinical presentation consists of severe hypotension and ECG changes in most of the patients, with very high mortality rates. Therefore, pre-procedural multi-slice computed tomography is crucial for identifying high-risk features, such as low coronary heights, shallow sinuses of Valsalva, and short virtual THV to coronary ostial distance (VTC). Also, some models of surgical bioprosthesis present an increased risk for this dreadful complication. Preemptive protective strategies with coronary wiring, with or without placement of an undeployed stent, could mitigate the risks associated with this complication in high-risk patients, even though studies are lacking. This review aims to take a clinical perspective on the challenges in avoiding this complication during VIV procedures.
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Affiliation(s)
- Fernando L M Bernardi
- Hospital São Francisco-São Camilo, Concórdia, Brazil.,Heart Institute of São Paulo (InCor), University of São Paulo, São Paulo, Brazil
| | - Danny Dvir
- Division of Cardiology, University of Washington, Seattle, WA, United States
| | - Josep Rodes-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Henrique B Ribeiro
- Heart Institute of São Paulo (InCor), University of São Paulo, São Paulo, Brazil
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125
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Shishido K, Yamanaka F, Noguchi K, Ota T, Fushimi T, Saito S. Novel Mechanism of Delayed Coronary Obstruction after Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis: "Uppercut Phenomenon". CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:79-84. [PMID: 31350193 DOI: 10.1016/j.carrev.2019.06.017] [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: 02/17/2019] [Revised: 05/22/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022]
Abstract
Delayed coronary obstruction is a rare complication after transcatheter aortic valve replacement (TAVR), and leads to a high in-hospital mortality rate. Here, we present a case of unpredictable delayed coronary obstruction in the left main trunk (LMT) after self-expandable device implantation because the left coronary height was enough over 15 mm. LMT obstruction was caused by a heavy calcification that was pushing up from the outside of the LMT, like an "uppercut" phenomenon. Stent-in-stent technique was a useful option for this type of LMT obstruction.
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Affiliation(s)
- Koki Shishido
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan.
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kenichiro Noguchi
- Department of Cardiovascular Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takashi Ota
- Department of Anesthesiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takahiro Fushimi
- Department of Radiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
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126
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Edelman JJ, Khan JM, Rogers T, Shults C, Satler LF, Ben-Dor II, Waksman R, Thourani VH. Valve-in-Valve TAVR: State-of-the-Art Review. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:299-310. [DOI: 10.1177/1556984519858020] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An increasing number of surgically implanted bioprostheses will require re-intervention for structural valve deterioration. Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become an alternative to reoperative surgery, currently approved for high-risk and inoperable patients. Challenges to the technique include higher rates of prosthesis–patient mismatch and coronary obstruction, compared to native valve TAVR. Herein, we review results of ViV TAVR and novel techniques to overcome the aforementioned challenges.
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Affiliation(s)
- J. James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Jaffar M. Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christian Shults
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Lowell F. Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - I. Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Vinod H. Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
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127
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Khan JM, Greenbaum AB, Babaliaros VC, Rogers T, Eng MH, Paone G, Leshnower BG, Reisman M, Satler L, Waksman R, Chen MY, Stine AM, Tian X, Dvir D, Lederman RJ. The BASILICA Trial: Prospective Multicenter Investigation of Intentional Leaflet Laceration to Prevent TAVR Coronary Obstruction. JACC Cardiovasc Interv 2019; 12:1240-1252. [PMID: 31202947 PMCID: PMC6669893 DOI: 10.1016/j.jcin.2019.03.035] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/20/2019] [Accepted: 03/11/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The BASILICA (Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction during TAVR) investigational device exemption trial was a prospective, multicenter, single-arm safety and feasibility study. BACKGROUND Coronary artery obstruction is a rare but devastating complication of transcatheter aortic valve replacement (TAVR). Current stent-based preventative strategies are suboptimal. Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR (BASILICA) is a novel transcatheter technique performed immediately before TAVR to prevent coronary artery obstruction. METHODS Subjects with severe native or bioprosthetic aortic valve disease at high or extreme risk for surgery, and at high risk of coronary artery obstruction, were included. The primary success endpoint was successful BASILICA and TAVR without coronary obstruction or reintervention. The primary safety endpoint was freedom from major adverse cardiovascular events. Data were independently monitored. Endpoints were independently adjudicated. A core laboratory analyzed computed tomography images. RESULTS Between February 2018 and July 2018, 30 subjects were enrolled. Primary success was met in 28 (93%) subjects. BASILICA traversal and laceration was successful in 35 of 37 (95%) attempted leaflets. There was 100% freedom from coronary obstruction and reintervention. Primary safety was met in 21 (70%), driven by 6 (20%) major vascular complications related to TAVR but not BASILICA. There was 1 death at 30 days. There was 1 (3%) disabling stroke and 2 (7%) nondisabling strokes. Transient hemodynamic compromise was rare (7%) and resolved promptly with TAVR. CONCLUSIONS BASILICA was feasible in both native and bioprosthetic valves. Hemodynamic compromise was uncommon. Safety was acceptable and needs confirmation in larger studies. BASILICA appears effective in preventing coronary artery obstruction from TAVR in subjects at high risk.
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Affiliation(s)
- Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Adam B Greenbaum
- Center for Structural Heart Disease, Division of Cardiology, and Division of Cardiac Surgery, Henry Ford Health System, Detroit, Michigan; Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
| | | | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Medstar Washington Hospital Center, Washington, DC
| | - Marvin H Eng
- Center for Structural Heart Disease, Division of Cardiology, and Division of Cardiac Surgery, Henry Ford Health System, Detroit, Michigan
| | - Gaetano Paone
- Center for Structural Heart Disease, Division of Cardiology, and Division of Cardiac Surgery, Henry Ford Health System, Detroit, Michigan
| | - Bradley G Leshnower
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
| | | | | | - Ron Waksman
- Medstar Washington Hospital Center, Washington, DC
| | - Marcus Y Chen
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Annette M Stine
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Xin Tian
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Danny Dvir
- University of Washington, Seattle, Washington
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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128
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Commentary: Avoiding danger-Addressing the specter of coronary obstruction during transcatheter aortic valve replacement. J Thorac Cardiovasc Surg 2019; 159:839-841. [PMID: 31256956 DOI: 10.1016/j.jtcvs.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 11/22/2022]
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129
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Tang GH, Zaid S, Gupta E, Ahmad H, Patel N, Khan M, Khan A, Kovacic JC, Lansman SL, Dangas GD, Sharma SK, Kini A. Impact of Initial Evolut Transcatheter Aortic Valve Replacement Deployment Orientation on Final Valve Orientation and Coronary Reaccess. Circ Cardiovasc Interv 2019; 12:e008044. [DOI: 10.1161/circinterventions.119.008044] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gilbert H.L. Tang
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY (G.H.L.T.)
| | - Syed Zaid
- Division of Cardiology, Westchester Medical Center, Valhalla, NY (S.Z., H.A.)
| | - Eisha Gupta
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY (G.H.L.T.)
| | - Hasan Ahmad
- Division of Cardiology, Westchester Medical Center, Valhalla, NY (S.Z., H.A.)
| | - Nish Patel
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY (G.H.L.T.)
| | - Muhammad Khan
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY (G.H.L.T.)
| | - Asaad Khan
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY (G.H.L.T.)
| | - Jason C. Kovacic
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY (G.H.L.T.)
| | - Steven L. Lansman
- Section of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, NY (S.L.L.)
| | - George D. Dangas
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY (G.H.L.T.)
| | - Samin K. Sharma
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY (G.H.L.T.)
| | - Annapoorna Kini
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY (G.H.L.T.)
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130
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Jabbour RJ, Latib A. The changing landscape of interventional cardiology. Aging (Albany NY) 2019; 11:2914-2915. [PMID: 31141789 PMCID: PMC6555454 DOI: 10.18632/aging.102005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 05/17/2019] [Indexed: 11/26/2022]
Affiliation(s)
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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131
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Webb JG, Sathananthan J, Wood DA. Increasing awareness of the need to protect the coronary arteries in patients with failed surgical and transcatheter aortic valves. EUROINTERVENTION 2019; 15:21-23. [PMID: 31105068 DOI: 10.4244/eijv15i1a3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- John G Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
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132
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Bob-Manuel T, Jenkins JS, Morin DP. Non-arrhythmic causes of sudden death: A comprehensive review. Prog Cardiovasc Dis 2019; 62:265-271. [PMID: 31075277 DOI: 10.1016/j.pcad.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
Abstract
Sudden cardiac death (SCD) is a major public health issue in the United States and worldwide. It is estimated to affect between 1 and 1.5 million patients worldwide annually, with the global burden expected to rise due to the concomitant rise in coronary artery disease in the developing world. Although arrhythmic causes of SCD such as ventricular tachycardia and ventricular fibrillation are common and well-studied, non-arrhythmic causes are also important, with diverse etiologies from ischemia-related structural heart disease to non-ischemic heart diseases, non-atherosclerotic coronary pathologies, and inflammatory states. Recent research has also found that risk factors and/or demographics predispose certain individuals to a higher risk of non-arrhythmia-related SCD. This review discusses the epidemiology, mechanisms, etiologies, and management of non-arrhythmic SCD.
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Affiliation(s)
| | - J Stephen Jenkins
- John Ochsner Heart and Vascular Center, New Orleans, LA, United States of America; University of Queensland Ochsner Clinical School, New Orleans, LA, United States of America
| | - Daniel P Morin
- John Ochsner Heart and Vascular Center, New Orleans, LA, United States of America; University of Queensland Ochsner Clinical School, New Orleans, LA, United States of America.
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133
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Fetahovic T, Hayman S, Cox S, Cole C, Rafter T, Camuglia A. The Prophylactic Chimney Snorkel Technique for the Prevention of Acute Coronary Occlusion in High Risk for Coronary Obstruction Transcatheter Aortic Valve Replacement/Implantation Cases. Heart Lung Circ 2019; 28:e126-e130. [PMID: 31113727 DOI: 10.1016/j.hlc.2019.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/09/2019] [Accepted: 04/11/2019] [Indexed: 11/19/2022]
Abstract
Coronary occlusion (immediate or delayed) is an uncommon but potentially devastating complication of transcatheter aortic valve replacement/implantation (TAVR/TAVI). Several patient-related, anatomical, device and procedural risk factors can be assessed to risk-stratify patients and assist in procedural planning. In patients at high risk for coronary occlusion, coronary protection measures should be employed. In the highest risk patients, consideration should be given to prophylactic techniques to prevent coronary occlusion. This how-to-do-it report provides a framework for risk assessment for coronary occlusion followed by a step-wise description of the emerging chimney snorkel coronary stenting technique as a predictable procedural approach for the management of this potentially challenging clinical scenario.
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Affiliation(s)
- Taufik Fetahovic
- Department of Cardiology, University of Queensland, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Sam Hayman
- GenesisCare, The Wesley Hospital, Brisbane, Qld, Australia; Department of Cardiology, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - Stephen Cox
- Department of Cardiology, University of Queensland, Princess Alexandra Hospital, Brisbane, Qld, Australia; GenesisCare, The Wesley Hospital, Brisbane, Qld, Australia
| | - Chris Cole
- Department of Cardiology, University of Queensland, Princess Alexandra Hospital, Brisbane, Qld, Australia; GenesisCare, The Wesley Hospital, Brisbane, Qld, Australia
| | - Tony Rafter
- Department of Cardiology, University of Queensland, Princess Alexandra Hospital, Brisbane, Qld, Australia; GenesisCare, The Wesley Hospital, Brisbane, Qld, Australia
| | - Anthony Camuglia
- Department of Cardiology, University of Queensland, Princess Alexandra Hospital, Brisbane, Qld, Australia; GenesisCare, The Wesley Hospital, Brisbane, Qld, Australia.
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134
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Simonato M, Dvir D. Transcatheter aortic valve replacement in failed surgical valves. Heart 2019; 105:s38-s43. [DOI: 10.1136/heartjnl-2018-313517] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 11/22/2018] [Accepted: 11/28/2018] [Indexed: 11/03/2022] Open
Abstract
Aortic valve-in-valve is a less invasive alternative to surgical redo in the treatment of failed bioprosthetic valves. While only inoperable patients underwent the procedure before, operators currently offer it to those at lower risk and worldwide experience is in the thousands. Early mortality has diminished in recent analyses and improvements in symptoms and quality of life have been documented. Main considerations with aortic valve-in-valve include elevated postprocedural gradients, coronary obstruction and leaflet thrombosis. Risk factors for each of these adverse events have been described at length. Aortic valve-in-valve offers a safe and effective option in the management of failed bioprosthetic valves.
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135
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Tanaka A, Jabbour RJ, Testa L, Agnifili M, Ettori F, Fiorina C, Adamo M, Bruschi G, Giannini C, Petronio AS, Barbanti M, Tamburino C, De Felice F, Reimers B, Poli A, Colombo A, Latib A. Incidence, Technical Safety, and Feasibility of Coronary Angiography and Intervention Following Self-expanding Transcatheter Aortic Valve Replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:371-375. [PMID: 30857975 DOI: 10.1016/j.carrev.2019.01.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is a well-established treatment option for severe aortic stenosis (AS). AS and coronary artery disease frequently coincide, and therefore some patients may require coronary angiography (CAG) and/or intervention (PCI) post-TAVR. Due to valve stent design, most self-expanding prostheses always cover the coronary ostium, and therefore may hinder future access. The objective of this research was to evaluate the incidence, safety and feasibility of CAG/PCI in patients with prior self-expanding TAVR valves. METHODS Among 2170 patients (age 82 ± 6 years, 43% male) who underwent TAVR with Corevalve or Evolut prostheses, as part of the Italian CoreValve ClinicalService® framework (data from 13 Italian centers), the occurrence of CAG/PCI following TAVR and periprocedural characteristics were examined. RESULTS During median follow-up of 379 days, 41 patients (1.9%) required CAG and/or PCI (total 46; 16 CAG, 14 PCI, 16 both PCI/CAG). 56.5% of the procedures were performed under emergency/urgency settings. Left system coronary angiography was successfully performed in most cases (28/32, 87.5%), while right coronary angiography was successful only in 50.0% (16/32). PCI procedures (20 for left system, 3 for right system, 4 for graft) were successfully performed in 93.3% (28/30) of the procedures. No CAG/PCI procedure-related complications including prosthesis dislodgment or coronary ostium dissection occurred. CONCLUSIONS CAG and PCI procedures following CoreValve TAVR is safe and mostly feasible, although the success rate of selective right coronary angiography was relatively low when compared to the left system. Further investigations are required to explore this issue.
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Affiliation(s)
- Akihito Tanaka
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Richard J Jabbour
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Testa
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Mauro Agnifili
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Federica Ettori
- Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | - Claudia Fiorina
- Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | - Giuseppe Bruschi
- "De Gasperis" Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy
| | - Cristina Giannini
- Catheterisation Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Anna Sonia Petronio
- Catheterisation Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Marco Barbanti
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Bernhard Reimers
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Arnaldo Poli
- Interventional Cardiology Unit, ASST Ovest Milanese, Legnano Hospital, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Cardiology, Montefiore Medical Center, New York, USA.
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136
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137
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Stankowski T, Aboul-Hassan SS, Seifi-Zinab F, Herwig V, Kubikova M, Harnath A, Fritzsche D, Perek B. Severe structural deterioration of small aortic bioprostheses treated with valve-in-valve transcatheter aortic valve implantation. J Card Surg 2019; 34:7-13. [PMID: 30625244 DOI: 10.1111/jocs.13976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate outcomes of valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) in patients with degenerated small bioprostheses. METHODS Outcomes of consecutive 27 high-risk patients (logistic EuroSCORE 35.5 ± 18.5%) with a mean age of 81.0 ± 5.9 years who underwent VIV-TAVI for degenerated small bioprostheses (19 mm-11.1%; 20 mm-11.1%; 21 mm-77.8%) were analyzed. Medtronic CoreValve (n = 11) or CoreValve Evolut-R prostheses (n = 16) were implanted. Follow-up was 3.2 ± 2.0 years. RESULTS Early mortality was 11.1%. One patient died intraoperatively due to left ventricle perforation, two others during the in-hospital period as a result of sudden cardiac death and pulmonary embolism. VIV-TAVI was completed in 26 cases (96.3%-success rate). Two patients required pacemaker implantation. Acute kidney injury occurred in two other patients. At discharge, mean transvalvular gradient was 19.2 ± 9.5 mmHg and in 25.9% of patients mean gradient exceeded 20 mmHg. Overall mortality was 25.9% and mortality from cardiac or unknown causes at 18.5%. Ninety percent of survivors were in New York Heart Association (NYHA) class I or II. CONCLUSIONS Transfemoral VIV-TAVI in patients with small, degenerated bioprostheses appears to be a promising alternative to surgery. Although the vast majority of patients have significant improvement in their NYHA class, the rate of persistent, residual gradients is relatively high and will need to be followed closely with serial echocardiograms.
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Affiliation(s)
- Tomasz Stankowski
- Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | | | | | - Volker Herwig
- Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Miroslava Kubikova
- Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Axel Harnath
- Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Dirk Fritzsche
- Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
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138
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Wojakowski W, Baumgartner H. The Year in Cardiology 2018: Valvular Heart Disease. Eur Heart J 2019; 40:414-421. [DOI: 10.1093/eurheartj/ehy893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 12/16/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45, Katowice, Poland
| | - Helmut Baumgartner
- Department of Cardiology III – Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert Schweitzer Campus 1, Building A1, Muenster, Germany
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139
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Jabbour RJ, Latib A. The "new" syndrome of delayed coronary obstruction after transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:81-83. [PMID: 30314834 DOI: 10.1016/j.carrev.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
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140
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Buscaglia A, Tini G, Bezante GP, Brunelli C, Balbi M. Sudden death after valve-in-valve procedure due to delayed coronary obstruction: a case report. J Med Case Rep 2018; 12:247. [PMID: 30180890 PMCID: PMC6123975 DOI: 10.1186/s13256-018-1785-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background Valve-in-valve transcatheter aortic valve implantation for degenerated aortic bioprostheses is an effective option for patients at high risk for redo surgery, even if it may be burdened by complications more common in specific settings, such as, coronary artery obstruction. Case presentation We present the case of a Caucasic 84-year-old woman with degeneration of a previously implanted aortic Mitroflow bioprosthesis. She underwent a valve-in-valve transcatheter aortic valve implantation with a CoreValve® bioprosthesis. End-procedure coronary angiography demonstrated maintained perfusion of both coronary arteries. However, few hours later, she experienced sudden cardiac death. An autopsy showed that Mitroflow prosthesis leaflets were higher than the left main coronary ostium, and no other possible cause for the sudden death. Fatality was thus ascribed to left main coronary ostium obstruction due to apposition of the Mitroflow leaflet pushed upward by the late expansion of CoreValve®. Conclusions Coronary artery obstruction is a frequently fatal complication which usually presents just after valve implantation, but, as reported in our case, it may also have a delayed presentation. Accurate patient’s selection and intraoperative preventive measures can reduce this eventuality. Electronic supplementary material The online version of this article (10.1186/s13256-018-1785-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Angelo Buscaglia
- Clinic of Cardiovascular Disease, San Martino Policlinic Hospital, University of Genova, Largo Rosanna Benzi, 10 1632, Genoa, Italy.
| | - Giacomo Tini
- Clinic of Cardiovascular Disease, San Martino Policlinic Hospital, University of Genova, Largo Rosanna Benzi, 10 1632, Genoa, Italy
| | - Gian Paolo Bezante
- Clinic of Cardiovascular Disease, San Martino Policlinic Hospital, University of Genova, Largo Rosanna Benzi, 10 1632, Genoa, Italy
| | - Claudio Brunelli
- Clinic of Cardiovascular Disease, San Martino Policlinic Hospital, University of Genova, Largo Rosanna Benzi, 10 1632, Genoa, Italy
| | - Manrico Balbi
- Clinic of Cardiovascular Disease, San Martino Policlinic Hospital, University of Genova, Largo Rosanna Benzi, 10 1632, Genoa, Italy
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Dvir D, Khan J, Kornowski R, Komatsu I, Chatriwalla A, Mackenson GB, Simonato M, Ribeiro H, Wood D, Leipsic J, Webb J, Mylotte D. Novel strategies in aortic valve-in-valve therapy including bioprosthetic valve fracture and BASILICA. EUROINTERVENTION 2018; 14:AB74-AB82. [DOI: 10.4244/eij-d-18-00667] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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142
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Das R, Puri R. Transcatheter Treatment of Bicuspid Aortic Valve Disease: Imaging and Interventional Considerations. Front Cardiovasc Med 2018; 5:91. [PMID: 30073170 PMCID: PMC6060433 DOI: 10.3389/fcvm.2018.00091] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/25/2018] [Indexed: 01/27/2023] Open
Abstract
Patients with bicuspid aortic valve disease have systematically been excluded from large randomized clinical trials investigating transcatheter aortic valve implantation (TAVI) due to their younger age, lower surgical risk and complex aortic anatomy. The asymmetric nature of the bicuspid valve orifice often accompanied by heavy regional calcification has led to concerns regarding valve positioning and expansion. Bicuspid aortic valve disease patients are at heightened risk of TAVI-related complications including coronary occlusion, aortic dissection and annular rupture, as well as the known risks of progressive aortopathy in these patients. These unique anatomical characteristics pose challenges for TAVI operators. However, with recent and ongoing refinements in implantation technique, improvements in pre-procedural imaging and iterations in device design, TAVI is emerging as a safe and feasible treatment option in this population. Paravalvular aortic regurgitation and high pacemaker rates have been the Achilles Heel for TAVI in bicuspid valve patients, yet newer generation devices are yielding promising results. Further studies are required before TAVI ultimately emerges as a viable option in low and intermediate surgical-risk patients with bicuspid valve disease. This review comprehensively summarizes the epidemiology, pathology and current evidence for TAVI in patients with bicuspid aortic valve disease. We also outline some practical tips for performing TAVI in these patients.
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Affiliation(s)
- Rajiv Das
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
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143
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Kennon S. Delayed Coronary Obstruction After Transcatheter Aortic Valve Implantation is not the Structural Equivalent of Late Stent Thrombosis After Percutaneous Coronary Intervention. Interv Cardiol 2018; 13:60-61. [PMID: 29946363 DOI: 10.15420/icr.2018:12:1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Simon Kennon
- Barts Heart Centre, St Bartholomew's Hospital, London, UK; Editor-in-Chief, Interventional Cardiology Review
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144
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145
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Jabbour RJ, Tanaka A, Colombo A, Latib A. Delayed Coronary Occlusion After Transcatheter Aortic Valve Implantation: Implications for New Transcatheter Heart Valve Design and Patient Management. Interv Cardiol 2018; 13:137-139. [PMID: 30443271 DOI: 10.15420/icr.2018.24.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Transcatheter aortic valve implantation has revolutionised the treatment of patients with severe aortic stenosis and is the preferred treatment option for patients with elevated surgical risk. Outcomes have continually improved, but because of the nature of the procedure infrequent catastrophic complications, such as coronary obstruction, persist. Recently, data were published regarding delayed coronary obstruction (DCO), a phenomenon in which the obstruction occurs after the index procedure. DCO has important consequences for future research. In this article we will explore the implications for new transcatheter heart valve design and approaches to patient management to minimise the risk of DCO occurring.
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Affiliation(s)
| | - Akihito Tanaka
- EMO-GVM Centro Cuore Columbus Milan, Italy.,San Raffaele Scientific Institute Milan, Italy
| | - Antonio Colombo
- EMO-GVM Centro Cuore Columbus Milan, Italy.,San Raffaele Scientific Institute Milan, Italy
| | - Azeem Latib
- EMO-GVM Centro Cuore Columbus Milan, Italy.,San Raffaele Scientific Institute Milan, Italy.,University of Cape Town Cape Town, South Africa
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