101
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Barbanti M, Costa G. Repeat Transcatheter Aortic Valve Implantation: All That Glitters Is Not Gold…Yet. Circ Cardiovasc Interv 2021; 14:e010884. [PMID: 34092090 DOI: 10.1161/circinterventions.121.010884] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Marco Barbanti
- A.O.U. Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Giuliano Costa
- A.O.U. Policlinico "G. Rodolico - San Marco", Catania, Italy
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102
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Testa L, Agnifili M, Van Mieghem NM, Tchétché D, Asgar AW, De Backer O, Latib A, Reimers B, Stefanini G, Trani C, Colombo A, Giannini F, Bartorelli A, Wojakowski W, Dabrowski M, Jagielak D, Banning AP, Kharbanda R, Moreno R, Schofer J, van Royen N, Pinto D, Serra A, Segev A, Giordano A, Brambilla N, Popolo Rubbio A, Casenghi M, Oreglia J, De Marco F, Tanja R, McCabe JM, Abizaid A, Voskuil M, Teles R, Biondi Zoccai G, Bianchi G, Sondergaard L, Bedogni F. Transcatheter Aortic Valve Replacement for Degenerated Transcatheter Aortic Valves: The TRANSIT International Project. Circ Cardiovasc Interv 2021; 14:e010440. [PMID: 34092097 DOI: 10.1161/circinterventions.120.010440] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Luca Testa
- IRCCS Policlinico S. Donato, Milan, Italy (L.T., M.A., N.B., A.P.R., M.C., F.D.M., G.B., F.B.)
| | - Mauro Agnifili
- IRCCS Policlinico S. Donato, Milan, Italy (L.T., M.A., N.B., A.P.R., M.C., F.D.M., G.B., F.B.)
| | | | - Didier Tchétché
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France (D.T.)
| | | | - Ole De Backer
- Rigshospitalet, Copenhagen University Hospital, Denmark (O.D.B.)
| | | | - Bernhard Reimers
- Humanitas Research Center, IRCCS, Rozzano-Milan, Italy (B.R., G.S.)
| | - Giulio Stefanini
- Humanitas Research Center, IRCCS, Rozzano-Milan, Italy (B.R., G.S.)
| | - Carlo Trani
- Policlinico Universitario A. Gemelli, Rome, Italy (C.T.)
| | - Antonio Colombo
- Maria Cecilia Hospital, Cotignola, Ravenna, Italy (A.C., F.G.)
| | | | - Antonio Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy (A.B.).,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy (A.B.)
| | | | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland (M.D.)
| | | | | | | | - Raul Moreno
- Hospital La Paz, IdiPAZ, CIBER-CV, Madrid, Spain (R.M.)
| | - Joachim Schofer
- MVZ Department Structural Heart Disease at St. Georg, Hamburg, Germany (J.S.)
| | - Niels van Royen
- Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.)
| | - Duane Pinto
- Beth Israel Deaconess Medical Center, Boston, MA (D.P.)
| | - Antoni Serra
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (A. Serra)
| | - Amit Segev
- The Heart and Vascular Center, Chaim Sheba Medical Center, Israel (A. Segev)
| | | | - Nedy Brambilla
- IRCCS Policlinico S. Donato, Milan, Italy (L.T., M.A., N.B., A.P.R., M.C., F.D.M., G.B., F.B.)
| | - Antonio Popolo Rubbio
- IRCCS Policlinico S. Donato, Milan, Italy (L.T., M.A., N.B., A.P.R., M.C., F.D.M., G.B., F.B.)
| | - Matteo Casenghi
- IRCCS Policlinico S. Donato, Milan, Italy (L.T., M.A., N.B., A.P.R., M.C., F.D.M., G.B., F.B.)
| | | | - Federico De Marco
- IRCCS Policlinico S. Donato, Milan, Italy (L.T., M.A., N.B., A.P.R., M.C., F.D.M., G.B., F.B.)
| | - Rudolph Tanja
- Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (R. Tanja)
| | | | | | | | - Rui Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal (R. Teles)
| | - Giuseppe Biondi Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy (G.B.Z.)
| | - Giovanni Bianchi
- IRCCS Policlinico S. Donato, Milan, Italy (L.T., M.A., N.B., A.P.R., M.C., F.D.M., G.B., F.B.)
| | | | - Francesco Bedogni
- IRCCS Policlinico S. Donato, Milan, Italy (L.T., M.A., N.B., A.P.R., M.C., F.D.M., G.B., F.B.)
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103
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Mendoza CE. Dawn of a new era: The Matryoshka procedure. J Card Surg 2021; 36:3384-3385. [PMID: 34096102 DOI: 10.1111/jocs.15716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Cesar E Mendoza
- Division of Cardiovascular Disease, Jackson Memorial Hospital, Miami, Florida, USA
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104
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Yerasi C, Rogers T, Forrestal BJ, Case BC, Khan JM, Ben-Dor I, Satler LF, Garcia-Garcia HM, Cohen JE, Kitahara H, Shults C, Waksman R. Transcatheter Versus Surgical Aortic Valve Replacement in Young, Low-Risk Patients With Severe Aortic Stenosis. JACC Cardiovasc Interv 2021; 14:1169-1180. [PMID: 34112453 DOI: 10.1016/j.jcin.2021.03.058] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 01/24/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is approved for all patient risk profiles and is an option for all patients irrespective of age. However, patients enrolled in the low- and intermediate-risk trials were in their 70s, and those in the high-risk trials were in their 80s. TAVR has never been systematically tested in young (<65 years), low-risk patients. Unanswered questions remain, including the safety and effectiveness of TAVR in patients with bicuspid aortic valves; future coronary access; durability of transcatheter heart valves; technical considerations for surgical transcatheter heart valve explantation; management of concomitant conditions such as aortopathy, mitral valve disease, and coronary artery disease; and the safety and feasibility of future TAVR-in-TAVR. The authors predict that balancing these questions with patients' clear preference for less invasive treatment will become common. In this paper, the authors consider each of these questions and discuss risks and benefits of theoretical treatment strategies in the lifetime management of young patients with severe aortic stenosis.
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Affiliation(s)
- Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, 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, Maryland, USA
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 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, Maryland, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jeffrey E Cohen
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hiroto Kitahara
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Christian Shults
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
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105
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Calcaterra D, Kaur N, Dasari G, Daniel G. A case report of open-aorta, direct transcatheter valve-in-valve implantation: an innovative approach to manage the hazard of coronary flow compromise in transcatheter aortic valve re-interventions. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab137. [PMID: 34124562 PMCID: PMC8189306 DOI: 10.1093/ehjcr/ytab137] [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: 11/16/2020] [Revised: 12/07/2020] [Accepted: 04/06/2021] [Indexed: 11/16/2022]
Abstract
Background Coronary flow compromise is a significant risk of transcatheter aortic valve therapy. Warranting preservation of coronary flow is even more challenging with transcatheter aortic valve re-intervention since the implantation of a transcatheter valve within a degenerated bioprosthetic or transcatheter valve increases significantly this hazard. Case summary We present a case of heart failure secondary to transcatheter aortic valve degeneration requiring a transcatheter aortic valve re-intervention. Pre-operative imaging studies demonstrated a high risk for iatrogenic coronary flow impairment. The patient underwent a successful surgical removal of the prosthetic valve leaflets followed by direct transcatheter aortic valve implantation. Conclusion We reviewed the literature on the approach to difficult coronaries in transcatheter aortic valve therapy, and we describe an innovative hybrid approach that may represent a viable alternative in cases where catheter techniques of coronary flow preservation are not applicable.
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Affiliation(s)
- Domenico Calcaterra
- Division of Cardiothoracic Surgery, Department of Surgery, Bethesda Heart Hospital, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL 33431, USA
| | - Navneet Kaur
- Division of Cardiology, Bethesda Heart Hospital, Florida Atlantic University, Boca Raton, FL, USA
| | - Gopika Dasari
- Division of Cardiology, Bethesda Heart Hospital, Florida Atlantic University, Boca Raton, FL, USA
| | - George Daniel
- Division of Cardiology, Bethesda Heart Hospital, Florida Atlantic University, Boca Raton, FL, USA
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106
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Casenghi M, Oliva OA, Squillace M, Bellamoli M, Poletti E, Popolo Rubbio A, Testa L, Bedogni F, De Marco F. Bailout From Sinus Jailing: In-Series TAVR-in-TAVR to Avoid Coronary Flow Obstruction. JACC Case Rep 2021; 3:678-681. [PMID: 34317602 PMCID: PMC8302790 DOI: 10.1016/j.jaccas.2021.02.022] [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: 12/08/2020] [Revised: 02/01/2021] [Accepted: 02/28/2021] [Indexed: 06/10/2023]
Abstract
Redo transcatheter aortic valve replacement (TAVR) may pose the risk of coronary flow obstruction. We report 2 cases of severe TAVR regurgitation due to different physiopathological mechanisms in which TAVR-in-TAVR could be at high risk for sinus sequestration. Both cases were successfully treated by in-series implantation of a second transcatheter heart valve, thus avoiding sinus sequestration. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Matteo Casenghi
- Address for correspondence: Dr. Matteo Casenghi, IRCCS Policlinico San Donato, San Donato Milanese, Milan 20097, Italy.
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107
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Barbanti M, Costa G. Repeat Transcatheter Aortic Valve Implantation Through an Embolized Transcatheter Aortic Valve: No Matter of Concern. JACC Case Rep 2021; 3:636-638. [PMID: 34317593 PMCID: PMC8302788 DOI: 10.1016/j.jaccas.2021.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Marco Barbanti
- Division of Cardiology, Centro Alta Specialità e Trapianti, Azienda Ospedaliero Universitaria Policlinico “G. Rodolico–San Marco,” Catania, Italy
| | - Giuliano Costa
- Division of Cardiology, Centro Alta Specialità e Trapianti, Azienda Ospedaliero Universitaria Policlinico “G. Rodolico–San Marco,” Catania, Italy
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108
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Doshi SN, Nadir A, Moody W, Townend JN. Acute Presentation of Structural Valve Degeneration in a Transcatheter Heart Valve (Sapien XT) at 7.5 Years; Successful Redo TAVR With a Sapien 3 Ultra. CJC Open 2021; 3:383-386. [PMID: 33778458 PMCID: PMC7984999 DOI: 10.1016/j.cjco.2020.11.007] [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: 09/28/2020] [Accepted: 11/02/2020] [Indexed: 11/06/2022] Open
Abstract
Little is known about the presentation of structural valve degeneration complicating transcatheter heart valves (THVs). We report a case of acute heart failure, secondary to leaflet prolapse, in a previously well 77-year-old man, 7.5 years after successful transcatheter aortic valve replacement with a 26-mm balloon-expandable Sapien XT (Edwards Lifesciences, Irvine, CA) THV. This case highlights that structural valve degeneration complicating THVs might lead to acute presentation with little warning from previous echocardiograms. Calcification might be absent on imaging. Redo transcatheter aortic valve replacement is feasible and appears safe. Post deployment optimization with a highly noncompliant balloon might improve full expansion of the newly implanted THV and improve valve performance.
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Affiliation(s)
- Sagar N Doshi
- Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Adnan Nadir
- Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom
| | - William Moody
- Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Jonathan N Townend
- Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom
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109
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Fischer MA, Williams TM, Harvey R, Neelankavil J. TAVR Explantation: Re-Do Risk Without the Re-Do Sternotomy. J Cardiothorac Vasc Anesth 2021; 35:2256-2259. [PMID: 33888403 DOI: 10.1053/j.jvca.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew A Fischer
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Tiffany M Williams
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Reed Harvey
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jacques Neelankavil
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
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110
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Brescia AA, Deeb GM, Sang SLW, Tanaka D, Grossman PM, Sukul D, He C, Theurer PF, Clark M, Shannon FL, Chetcuti SJ, Fukuhara S. Surgical Explantation of Transcatheter Aortic Valve Bioprostheses: A Statewide Experience. Circ Cardiovasc Interv 2021; 14:e009927. [PMID: 33719506 DOI: 10.1161/circinterventions.120.009927] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Alexander A Brescia
- Department of Cardiac Surgery (A.A.B., G.M.D., S.F.), University of Michigan, Ann Arbor
| | - G Michael Deeb
- Department of Cardiac Surgery (A.A.B., G.M.D., S.F.), University of Michigan, Ann Arbor.,Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.)
| | - Stephane Leung Wai Sang
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.).,Spectrum Health Medical Group, Cardiothoracic Surgery, Grand Rapids, MI (S.L.W.S.)
| | - Daizo Tanaka
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.).,Henry Ford Hospital Division of Cardiac Surgery, Detroit, MI (D.T.)
| | - P Michael Grossman
- Department of Internal Medicine (P.M.G., D.S., S.J.C.), University of Michigan, Ann Arbor.,Blue Cross Blue Shield Cardiovascular Consortium, Ann Arbor, MI (P.M.G., D.S., S.J.C.)
| | - Devraj Sukul
- Department of Internal Medicine (P.M.G., D.S., S.J.C.), University of Michigan, Ann Arbor.,Blue Cross Blue Shield Cardiovascular Consortium, Ann Arbor, MI (P.M.G., D.S., S.J.C.)
| | - Chang He
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.)
| | - Patricia F Theurer
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.)
| | - Melissa Clark
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.)
| | - Francis L Shannon
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.).,Division of Cardiovascular Surgery, Beaumont Health, Royal Oak, MI (F.L.S.)
| | - Stanley J Chetcuti
- Department of Internal Medicine (P.M.G., D.S., S.J.C.), University of Michigan, Ann Arbor.,Blue Cross Blue Shield Cardiovascular Consortium, Ann Arbor, MI (P.M.G., D.S., S.J.C.)
| | - Shinichi Fukuhara
- Department of Cardiac Surgery (A.A.B., G.M.D., S.F.), University of Michigan, Ann Arbor.,Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.)
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111
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Erlebach M, Ruge H, Lange R. Transcatheter Aortic Valve Replacement for a Degenerated Transcatheter Valve-A Single Center Experience. Thorac Cardiovasc Surg 2021; 70:213-216. [PMID: 33626590 DOI: 10.1055/s-0041-1724038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The transcatheter valve-in-valve treatment (TAV-in-TAV) of degenerated transcatheter aortic valves is becoming more relevant, as the use of transcatheter aortic valve replacement (TAVR) increases. We report our experience with TAV-in-TAV in patients with a degenerated transcatheter heart valve (THV). METHODS We retrospectively analyzed prospectively collected data from our designated TAVR database. Intraprocedural and intrahospital outcomes were reported. RESULTS Ten patients out of a total of 3,144 TAVR implantations since 2007 presented with a degenerated THV, among those six with an Edwards Sapien XT (Edwards Lifesciences, Irvine, California, United States) valve, treated with a Medtronic Evolut R (Medtronic, Dublin, Ireland) valve. Four patients had severe stenosis, one pure insufficiency, and five combined stenosis and insufficiency. Average time between initial implantation and re-intervention was 6.8 ± 1.3 years. The mean preoperative maximum and mean gradients were 54.2 ± 14.8 mm Hg and 31.6 ± 9.9 mm Hg, respectively. Nine patients underwent transfemoral and one patient underwent transaortic TAV-in-TAV. Mean procedural time was 86.2 ± 51.5 minutes. Post-implantation, the maximum and mean gradients decreased to 18 ± 6.9 mm Hg and 8.4 ± 3.2 mm Hg (16 ± 8 mm Hg and 6.4 ± 1.7 mm Hg in the Evolut-in-Sapien subgroup), respectively. The valve area increased from 0.98 ± 0.28 mm Hg to 1.72 ± 0.32 mm Hg (0.8 ± 0.07 mm Hg to 1.9 ± 0.16 mm Hg in the Evolut-in-Sapien subgroup). Two patients experienced a vascular complication. No further Valve Academic Research Consortium-2 criteria complications occurred during hospitalization. CONCLUSION TAV-in-TAV resulted in low procedural and peri-procedural complication rates. In particular, the usage of a supra-annular valve resulted in excellent hemodynamic results. Larger studies are required to validate this observational data and to establish a protocol for this procedure.
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Affiliation(s)
- Magdalena Erlebach
- Department of Cardiovascular Surgery, German Heart Centre, Munich, Germany.,Department of Cardiovascular Surgery, INSURE (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Hendrik Ruge
- Department of Cardiovascular Surgery, German Heart Centre, Munich, Germany.,Department of Cardiovascular Surgery, INSURE (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Ruediger Lange
- Department of Cardiovascular Surgery, German Heart Centre, Munich, Germany.,Department of Cardiovascular Surgery, INSURE (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
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112
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Bermejo J, Postigo A, Baumgartner H. The year in cardiovascular medicine 2020: valvular heart disease. Eur Heart J 2021; 42:647-656. [PMID: 33388778 PMCID: PMC7878012 DOI: 10.1093/eurheartj/ehaa1060] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/11/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Dr Esquerdo 46, Madrid 28007, Spain
| | - Andrea Postigo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Dr Esquerdo 46, Madrid 28007, Spain
| | - Helmut Baumgartner
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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113
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Thourani VH, Edelman JJ, Holmes SD, Nguyen TC, Carroll J, Mack MJ, Kapadia S, Tang GHL, Kodali S, Kaneko T, Meduri CU, Forcillo J, Ferdinand FD, Fontana G, Suwalski P, Kiaii B, Balkhy H, Kempfert J, Cheung A, Borger MA, Reardon M, Leon MB, Popma JJ, Ad N. The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:3-16. [PMID: 33491539 DOI: 10.1177/1556984520978316] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE There is an increasing amount of evidence supporting use of transcatheter aortic valve replacement (TAVR) for treatment of aortic stenosis in patients at low or intermediate risk for surgical aortic valve replacement (SAVR). TAVR is now approved for use in all patient cohorts. Despite this, there remains debate about the relative efficacy of TAVR compared with SAVR in lower-risk cohorts and various subgroups of patients. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and propensity-matched trials to guide a consensus among expert cardiologists and surgeons. METHODS Studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a thorough search of the major databases. Mortality, stroke, and other perioperative outcomes were assessed at 30 days and 1 year. RESULTS Early mortality was lower in TAVR compared to SAVR in RCTs, but not propensity-matched studies in low-risk cohorts (0.66% vs 1.5%; odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20 to 0.98, I2 = 0%). No difference in mortality between TAVR and SAVR was identified in intermediate-risk patients at early or later time points. Incidence of perioperative stroke in 3 low-risk RCTs was significantly lower in TAVR (0.4%) than SAVR (1.4%; OR = 0.33, 95% CI 0.13 to 0.81, I2 = 0%). There was no difference in stroke for intermediate-risk patients between TAVR and SAVR. The expert panel of cardiologists and cardiac surgeons provided recommendations for TAVR and SAVR in various clinical scenarios. CONCLUSIONS In RCTs comparing TAVR and SAVR in low-risk patients, early mortality and stroke were lower in TAVR, but did not differ at 1 year. There was no difference in mortality and stroke in intermediate-risk patients. The Multidisciplinary Heart Team must consider individual patient characteristics and preferences when recommending TAVR or SAVR. The decision must consider the long-term management of each patient's aortic valve disease.
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Affiliation(s)
- Vinod H Thourani
- 165591 Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart and Vascular Institute, Atlanta, GA, USA
| | - J James Edelman
- 2720 Department of Cardiac Surgery, Fiona Stanley Hospital, University of Western Australia, Perth, Australia
| | - Sari D Holmes
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tom C Nguyen
- Division of Adult Cardiothoracic Surgery, University of California, San Francisco, CA, USA
| | - John Carroll
- 1878 Division of Cardiology, University of Colorado, Denver, CO, USA
| | - Michael J Mack
- 384526 Department of Cardiology, Baylor Health Care System, Heart Hospital Baylor Plano, Dallas, TX, USA
| | - Samir Kapadia
- 2569 Department of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Gilbert H L Tang
- 5944 Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Susheel Kodali
- 5798 Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Tsuyoshi Kaneko
- 1861 Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher U Meduri
- 165591 Division of Cardiology, Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Jessica Forcillo
- 5622 Department of Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Francis D Ferdinand
- 6595 Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine & UPMC Hamot Heart and Vascular Institute, University of Pittsburgh Medical Center, PA, USA
| | - Gregory Fontana
- Cardiovascular Institute, Los Robles Hospital and Medical Center, Thousand Oaks, CA, USA
| | - Piotr Suwalski
- 359917 Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Bob Kiaii
- 8789 Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Husam Balkhy
- 12246 Section of Cardiac Surgery, University of Chicago Medicine, IL, USA
| | - Joerg Kempfert
- Department of Cardiac Surgery, German Heart Institute, Berlin, Germany
| | - Anson Cheung
- Department of Cardiac Surgery, The University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | | | - Michael Reardon
- Department of Cardiac Surgery, Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Martin B Leon
- 5798 Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Jeffrey J Popma
- 1859 Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Niv Ad
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,Cardiovascular Surgery, Adventist White Oak Medical Center, Silver Spring, MD, USA
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Rohm CL, Farhat S, Al-Hijji M, Goel K, Greason K, Gulati R, El Sabbagh A. Endovascular snare technique to facilitate delivery of self-expanding valve during transcatheter aortic valve-in-valve replacement in angulated aortas: A case series. Catheter Cardiovasc Interv 2021; 97:736-742. [PMID: 33427384 DOI: 10.1002/ccd.29459] [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] [Received: 11/02/2020] [Revised: 12/03/2020] [Accepted: 12/13/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Transcatheter aortic valve-in-valve replacement (ViV) has been widely accepted as a less invasive alternative to treat failed aortic surgical or transcatheter bioprosthetic valves. Angulated aortas present an additional challenge, particularly when using self-expanding transcatheter heart valves (SE-THV). METHODS Two patients with failed surgical bioprosthetic aortic valves and one patient with a failed transcatheter bioprosthetic aortic valve underwent transcatheter aortic ViV using SE-THV. All were deemed high-risk for surgical aortic valve replacement by a heart team. All three patients had initial failed SE-THV delivery using a conventional approach with subsequent successful delivery using the endovascular snare technique. RESULTS In Cases 1 and 2, the SE-THV was biased towards the greater curve of the angulated aorta and behind the outer frame of the bioprosthetic valve frame. An endovascular snare was deployed through a secondary left femoral artery access, and the valve delivery system was advanced through the snare in the ascending aorta. The snare was tightened around the SE-THV capsule proximal to the hat-marker, allowing deflection of the SE-THV and successful delivery. In Case 3, the SE-THV interacted with the tall frame of a failed SE-THV. A snare via the left femoral artery was deployed in the descending artery. The SE-THV was advanced through the snare, and both the snare and SE-THV were advanced together to the ascending aorta where the SE-THV was deflected and successfully delivered. CONCLUSIONS The endovascular snare technique is a feasible option for successful delivery of SE-THV during transcatheter aortic ViV in failed transcatheter or surgical bioprosthetic valves in angulated aortas.
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Affiliation(s)
- Charlene L Rohm
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Salman Farhat
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Mohammed Al-Hijji
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Kashish Goel
- Division of Cardiovascular Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Kevin Greason
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajiv Gulati
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida, USA
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115
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Transcatheter Replacement of Transcatheter Versus Surgically Implanted Aortic Valve Bioprostheses. J Am Coll Cardiol 2021; 77:1-14. [DOI: 10.1016/j.jacc.2020.10.053] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/22/2020] [Indexed: 12/30/2022]
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116
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Faroux L, Alperi A, Muntané-Carol G, Rodes-Cabau J. Safety and efficacy of repeat transcatheter aortic valve replacement for the treatment of transcatheter prosthesis dysfunction. Expert Rev Med Devices 2020; 17:1303-1310. [PMID: 33196328 DOI: 10.1080/17434440.2020.1848540] [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] [Indexed: 12/14/2022]
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) has recently expanded toward the treatment of younger patients with lower surgical risk and longer life expectancy. Thus, transcatheter heart valve (THV) durability has become a central issue, and an important increase in the number of TAVR-in-TAVR is expected in the coming years. Areas covered: Overview of the current status of TAVR-in-TAVR for the treatment of THV dysfunction, focusing on safety and efficacy of repeat TAVR procedures. Expert opinion: An accurate analysis of the pre-procedure cardiac computed tomography, incorporating new parameters such as the position of the top of the first THV in relation to the sinotubular-junction, will be necessary to assess the risk of coronary occlusion. Subsequent coronary angiography will be necessary in a proportion of TAVR-in-TAVR patients, but coronary access may be very difficult or even impossible in some of them. Therefore, the choice between TAVR and SAVR in young low-risk patients should incorporate the potential need for treating coronary events at mid- to long-term follow-up. Likewise, the choice of the valve type and the implantation position at the time of the first TAVR procedure should take into account the possibility of TAVR-in-TAVR in the future.Abbreviations ACS: acute coronary syndrome; CO: coronary obstruction; EOA: effective orifice area; SAVR: surgical aortic valve replacement; SVD: structural valve degenerationTAVR: transcatheter aortic valve replacement; THV: transcatheter heart valve.
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Affiliation(s)
- Laurent Faroux
- Cardiology Department, Quebec Heart and Lung Institute, Laval University , Quebec City, Quebec, Canada
| | - Alberto Alperi
- Cardiology Department, Quebec Heart and Lung Institute, Laval University , Quebec City, Quebec, Canada
| | - Guillem Muntané-Carol
- Cardiology Department, Quebec Heart and Lung Institute, Laval University , Quebec City, Quebec, Canada
| | - Josep Rodes-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University , Quebec City, Quebec, Canada
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Tang GHL, Zaid S. Coronary re-access after redo TAVI: a proposed classification to simplify evaluation. EUROINTERVENTION 2020; 16:e960-e962. [PMID: 33337324 DOI: 10.4244/eijv16i12a176] [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] [Indexed: 11/23/2022]
Affiliation(s)
- Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
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118
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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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Patel KV, Omar W, Gonzalez PE, Jessen ME, Huffman L, Kumbhani DJ, Bavry AA. Expansion of TAVR into Low-Risk Patients and Who to Consider for SAVR. Cardiol Ther 2020; 9:377-394. [PMID: 32875469 PMCID: PMC7584721 DOI: 10.1007/s40119-020-00198-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Indexed: 12/15/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis (AS) over the last decade. The results of the Placement of Aortic Transcatheter Valves (PARTNER) 3 and Evolut Low Risk trials demonstrated the safety and efficacy of TAVR in low-surgical-risk patients and led to the approval of TAVR for use across the risk spectrum. Heart teams around the world will now be faced with evaluating a deluge of younger, healthier patients with severe AS. Prior to the PARTNER 3 and Evolut Low Risk studies, this heterogenous patient population would have undergone surgical aortic valve replacement (SAVR). It is unlikely that TAVR will completely supplant SAVR for the treatment of severe AS in patients with a low surgical risk, as SAVR has excellent short- and long-term outcomes and years of durability data. In this review, we outline the critical role that SAVR will continue to play in the treatment of severe AS in the post-PARTNER 3/Evolut Low Risk era.
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Affiliation(s)
- Kunal V Patel
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Wally Omar
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Pedro Engel Gonzalez
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Michael E Jessen
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, USA
| | - Lynn Huffman
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, USA
| | - Dharam J Kumbhani
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Anthony A Bavry
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA.
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Buzzatti N, Montorfano M, Romano V, De Backer O, Søndergaard L, Rosseel L, Maurovich-Horvat P, Karady J, Merkely B, Prendergast BD, De Bonis M, Colombo A, Latib A. A computed tomography study of coronary access and coronary obstruction after redo transcatheter aortic valve implantation. EUROINTERVENTION 2020; 16:e1005-e1013. [DOI: 10.4244/eij-d-20-00475] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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121
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Tarantini G, Nai Fovino L. Coronary Access and TAVR-in-TAVR: Don't Put Off Until Tomorrow What You Can Do Today. JACC Cardiovasc Interv 2020; 13:2539-2541. [PMID: 33153568 DOI: 10.1016/j.jcin.2020.06.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy.
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
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122
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Webb J, Landes U, Wood D. A New and Improved Transcatheter Aortic Valve for Routine Use? JACC Cardiovasc Interv 2020; 13:2479-2481. [PMID: 33153564 DOI: 10.1016/j.jcin.2020.07.042] [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: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 12/01/2022]
Affiliation(s)
- John Webb
- Centre for Heart Valve Innovation and Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada.
| | - Uri Landes
- Centre for Heart Valve Innovation and Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada
| | - David Wood
- Centre for Heart Valve Innovation and Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada
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Ochiai T, Oakley L, Sekhon N, Komatsu I, Flint N, Kaewkes D, Yoon SH, Raschpichler M, Patel V, Tiwana R, Enta Y, Mahani S, Kim Y, Stegic J, Chakravarty T, Nakamura M, Cheng W, Makkar R. Risk of Coronary Obstruction Due to Sinus Sequestration in Redo Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 13:2617-2627. [DOI: 10.1016/j.jcin.2020.09.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/28/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
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125
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Redo aortic valve intervention after transcatheter aortic valve replacement: Analysis of the nationwide readmission database. Int J Cardiol 2020; 325:115-120. [PMID: 33144095 DOI: 10.1016/j.ijcard.2020.10.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/24/2020] [Accepted: 10/15/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Outcomes of redo aortic valve intervention (AVI) following transcatheter aortic valve replacement (TAVR) have not been well described. We thought to investigate the incidence, predictors, and outcomes of redo AVI after TAVR. METHODS The Nationwide Readmission Database (from 2012 to 2017) was queried to identify admissions for TAVR. Redo AVI was defined as readmissions that required either TAVR or balloon aortic valvuloplasty (BAV) or surgical aortic valve replacement (SAVR). A multivariable regression model was used to identify independent predictors of redo AVI. In-hospital outcomes of redo TAVR or BAV and redo SAVR were compared in the unadjusted model. RESULTS A total of weighted 148,200 (unweighted redo AVI 297, no redo AVI 73,804) index TAVRs were identified. A weighted 593 (435 TAVR or BAV and 158 SAVR) redo AVI was included with an incidence of 1.0 per 100 person-year during a median of 105 (interquartile range 41-195) days follow-up. Predictors of redo AVI were female, heart failure, obesity, atrial fibrillation, transapical approach, oral anticoagulant use, and acute kidney injury. In-hospital mortality of redo AVI was 7.6% (5.3% for redo TAVR or BAV vs. 13.8% for redo SAVR, unadjusted p = 0.10). Stroke, myocardial infarction, bleeding requiring transfusion, new pacemaker, and acute kidney injury rates were 4.7%, 2.6%, 9.3%, 10.0%, and 31.2%, respectively in redo AVI. Length of stay and hospital cost was 4.8 days and 55,826 U.S. dollars, respectively. CONCLUSIONS The incidence of redo AVI was low following TAVR but was associated with high mortality and morbidities.
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Sá MPBO, Simonato M, Van den Eynde J, Cavalcanti LRP, Roever L, Bisleri G, Dokollari A, Dvir D, Zhigalov K, Ruhparwar A, Weymann A. Asymptomatic severe aortic stenosis, bicuspid aortic valves and moderate aortic stenosis in heart failure: New indications for transcatheter aortic valve implantation. Trends Cardiovasc Med 2020; 31:435-445. [PMID: 33065313 DOI: 10.1016/j.tcm.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 11/15/2022]
Abstract
Aortic stenosis (AS) remains one of the most common valvular heart diseases, with enormous impact on patient survival. Over the past years, transcatheter aortic valve implantation (TAVI) has become a reality worldwide, offering a less invasive method to treat AS. Apart from the classical indications for aortic valve disease, recent studies tried to address unanswered questions for TAVI - asymptomatic severe AS, bicuspid aortic valves and moderate AS in patients with heart failure. This review discusses the rationale of those possible indications, pitfalls and current evidence in the medical literature.
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Affiliation(s)
- Michel Pompeu B O Sá
- Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, University of Pernambuco, Pernambuco, Brazil
| | - Matheus Simonato
- Division of Cardiac Surgery, Escola Paulista de Medicina - UNIFESP, São Paulo, Brazil
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, and Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Luiz Rafael P Cavalcanti
- Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, University of Pernambuco, Pernambuco, Brazil
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Minas Gerais, Brazil
| | | | | | - Danny Dvir
- Division of Cardiology, University of Washington, Washington, United States of America
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Essen, Germany
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Hirji SA, Percy ED, McGurk S, Malarczyk A, Harloff MT, Yazdchi F, Sabe AA, Bapat VN, Tang GH, Bhatt DL, Thourani VH, Leon MB, O’Gara P, Shah PB, Kaneko T. Incidence, Characteristics, Predictors, and Outcomes of Surgical Explantation After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 76:1848-1859. [DOI: 10.1016/j.jacc.2020.08.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 12/22/2022]
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128
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van Nieuwkerk AC, Delewi R. Redo SAVR After Primary TAVR, A Dangerous Sequence? JACC Cardiovasc Interv 2020; 13:2186. [PMID: 32972581 DOI: 10.1016/j.jcin.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 11/19/2022]
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129
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Simonato M, Dvir D. The Ten Commandments of Aortic Valve-in-Valve. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:397-405. [PMID: 32955362 DOI: 10.1177/1556984520951874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Matheus Simonato
- 28105 Escola Paulista de Medicina Universidade Federal de São Paulo, Brazil
| | - Danny Dvir
- 26743 Jesselson Integrated Heart Centre, ShaareZedek Medical Center, Hebrew University, Jerusalem, Israel.,Division of Cardiology, University of Washington, Seattle, WA, USA
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Kostyunin AE, Yuzhalin AE, Rezvova MA, Ovcharenko EA, Glushkova TV, Kutikhin AG. Degeneration of Bioprosthetic Heart Valves: Update 2020. J Am Heart Assoc 2020; 9:e018506. [PMID: 32954917 PMCID: PMC7792365 DOI: 10.1161/jaha.120.018506] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The implantation of bioprosthetic heart valves (BHVs) is increasingly becoming the treatment of choice in patients requiring heart valve replacement surgery. Unlike mechanical heart valves, BHVs are less thrombogenic and exhibit superior hemodynamic properties. However, BHVs are prone to structural valve degeneration (SVD), an unavoidable condition limiting graft durability. Mechanisms underlying SVD are incompletely understood, and early concepts suggesting the purely degenerative nature of this process are now considered oversimplified. Recent studies implicate the host immune response as a major modality of SVD pathogenesis, manifested by a combination of processes phenocopying the long‐term transplant rejection, atherosclerosis, and calcification of native aortic valves. In this review, we summarize and critically analyze relevant studies on (1) SVD triggers and pathogenesis, (2) current approaches to protect BHVs from calcification, (3) obtaining low immunogenic BHV tissue from genetically modified animals, and (4) potential strategies for SVD prevention in the clinical setting.
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Affiliation(s)
- Alexander E Kostyunin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Arseniy E Yuzhalin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation.,Department of Molecular and Cellular Oncology The University of Texas MD Anderson Cancer Center Houston TX
| | - Maria A Rezvova
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Evgeniy A Ovcharenko
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Tatiana V Glushkova
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Anton G Kutikhin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
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131
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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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132
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Rogers T, Khan JM, Satler LF, Greenbaum AB, Lederman RJ. TAVR-in-TAVR?: Don't Bank on It! J Am Coll Cardiol 2020; 76:1003. [PMID: 32819458 DOI: 10.1016/j.jacc.2020.05.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/17/2022]
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133
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Komatsu I, Dvir D, Tang GHL. Coronary Artery Obstruction Risk With Redo TAVR: A Word of Caution. J Am Coll Cardiol 2020; 76:1004. [PMID: 32819459 DOI: 10.1016/j.jacc.2020.05.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/30/2022]
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134
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Landes U, Sathananthan J, Wood D, Webb JG. Reply: Redo-TAVR May Not Always Be an Option. J Am Coll Cardiol 2020; 76:1004-1005. [PMID: 32819460 DOI: 10.1016/j.jacc.2020.06.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/19/2020] [Indexed: 12/01/2022]
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135
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Mukherjee D, Lange RA. Coronary Angiography Challenges After Transcatheter Aortic Valve Replacement-in-Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2020; 9:e017409. [PMID: 32578467 PMCID: PMC7670524 DOI: 10.1161/jaha.120.017409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Debabrata Mukherjee
- Division of Cardiovascular Medicine Texas Tech University Health Sciences Center El Paso TX
| | - Richard A Lange
- Division of Cardiovascular Medicine Texas Tech University Health Sciences Center El Paso TX
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136
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