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Balloon-Expandable versus Self-Expandable Valves in Transcatheter Aortic Valve Implantation: Complications and Outcomes from a Large International Patient Cohort. J Clin Med 2021; 10:jcm10174005. [PMID: 34501454 PMCID: PMC8432462 DOI: 10.3390/jcm10174005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/12/2021] [Accepted: 08/31/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Both balloon-expandable (BE) and self-expandable (SE) valves for transcatheter aortic valve implantation (TAVI) are broadly used in clinical practice. However, adequately powered randomized controlled trials comparing these two valve designs are lacking. Methods: The CENTER-study included 12,381 patients undergoing transfemoral TAVI. Patients undergoing TAVI with a BE-valve (n = 4096) were compared to patients undergoing TAVI with an SE-valve (n = 4096) after propensity score matching. Clinical outcomes including one-year mortality and stroke rates were assessed. Results: In the matched population of n = 5410 patients, the mean age was 81 ± 3 years, 60% was female, and the STS-PROM predicted 30-day mortality was 6.2% (IQR 4.0–12.4). One-year mortality was not different between patients treated with BE- or SE-valves (BE: 16.4% vs. SE: 17.0%, Relative Risk 1.04, 95%CI 0.02–1.21, p = 0.57). One-year stroke rates were also comparable (BE: 4.9% vs. SE: 5.3%, RR 1.09, 95%CI 0.86–1.37, p = 0.48). Conclusion: This study suggests that one-year mortality and stroke rates were comparable in patients with severe aortic valve stenosis undergoing TAVI with either BE or SE-valves.
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Fukuhara S, Tanaka D, Brescia AA, Wai Sang SL, Grossman PM, Sukul D, Chetcuti SJ, He C, Eng MH, Patel HJ, Deeb GM. Aortic valve reintervention in patients with failing transcatheter aortic bioprostheses: A statewide experience. J Thorac Cardiovasc Surg 2021; 165:2011-2020.e5. [PMID: 34538638 DOI: 10.1016/j.jtcvs.2021.08.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/11/2021] [Accepted: 08/23/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Despite the rapid adoption of transcatheter aortic valve replacement since its approval, the frequency and outcomes of aortic valve reintervention after transcatheter aortic valve replacement are poorly understood. METHODS Valve reinterventions, either surgical transcatheter aortic valve replacement valve explantation or repeat transcatheter aortic valve replacement, between 2012 and 2019 were queried using the Society of Thoracic Surgeons Database and the Transcatheter Valve Therapy Registry through the Michigan Statewide quality collaborative. The reintervention frequency and clinical outcomes including observed-to-expected mortality ratio using Society of Thoracic Surgeons Predicted Risk of Mortality were reviewed. RESULTS Among 9694 transcatheter aortic valve replacement recipients, a total of 87 patients (0.90%) received a reintervention, consisting of 34 transcatheter aortic valve replacement explants and 53 repeat transcatheter aortic valve replacement procedures. The transcatheter aortic valve replacement explant group demonstrated a higher Society of Thoracic Surgeons Predicted Risk of Mortality. Reintervention cases increased from 0 in 2012 and 2013 to 26 in 2019. The proportion of transcatheter aortic valve replacement explants among all reinterventions increased and was 65% in 2019. Self-expandable devices had a higher reintervention rate than balloon-expandable devices secondary to a higher transcatheter aortic valve replacement explant frequency (0.58% [23/3957] vs 0.19% [11/5737]; P = .001), whereas repeat transcatheter aortic valve replacement rates were similar (0.61% [24/3957] vs 0.51% [29/5737]; P = .51). Among patients with transcatheter aortic valve replacement explants, contraindications to repeat transcatheter aortic valve replacement included unfavorable anatomy (75%), need for other cardiac surgery (29%), other structural issues by transcatheter aortic valve replacement device (18%), and endocarditis (12%). For transcatheter aortic valve replacement explant and repeat transcatheter aortic valve replacement, the 30-day mortality was 15% and 2% (P = .032) and the observed-to-expected mortality ratio was 1.8 and 0.3 (P = .018), respectively. CONCLUSIONS Aortic valve reintervention remains rare but is increasing. The clinical impact of transcatheter aortic valve replacement explant was substantial, and the proportion of transcatheter aortic valve replacement explants was significantly higher in patients with a self-expandable device.
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Affiliation(s)
- Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich.
| | - Daizo Tanaka
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich; Division of Cardiac Surgery, Henry Ford Hospital, Detroit, Mich
| | - Alex A Brescia
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich
| | - Stephane Leung Wai Sang
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich; Meijer Heart and Vascular Institute, Cardiothoracic Surgery, Grand Rapids, Mich
| | - P Michael Grossman
- Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Blue Cross Blue Shield Cardiovascular Consortium, Ann Arbor, Mich
| | - Devraj Sukul
- Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Blue Cross Blue Shield Cardiovascular Consortium, Ann Arbor, Mich
| | - Stanley J Chetcuti
- Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Blue Cross Blue Shield Cardiovascular Consortium, Ann Arbor, Mich
| | - Chang He
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich
| | - Marvin H Eng
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Mich
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich
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Rahman F, Resar JR. TAVI Beyond 3 Years: Durability and Predictors for Survival. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:417-425. [PMID: 34182824 DOI: 10.1177/15569845211017558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of transcatheter aortic valve implantation (TAVI) has greatly increased over the past 2 decades and now has overtaken surgical aortic valve replacement. We have limited data regarding the long-term durability of TAVI and the predictors of survival. Calcification, inflammation, fibrous tissue deposition, and mechanical stress are important in the structural deterioration of surgical bioprosthetic valves and likely contribute to TAVI durability. However, TAVI has several differences to surgical valve replacement such as valve preparation, valve to native anatomy interaction, and valve sizing which all likely contribute to durability and long-term survival. Most procedures have been performed on older patients and therefore long-term follow-up studies have noted mortality of approximately 50% at 5 years and 75% by 7 years. Current data are limited by the high mortality of patients who have received TAVI often as a result of age, frailty, and other competing comorbidities. TAVI as compared with surgical valve replacement is associated with several differences including higher conduction abnormalities (i.e., need for pacemakers) and paravalvular leak, both of which may affect long-term morbidity and mortality. In this review, we discuss the current status of our knowledge and identify areas that require further investigation.
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Affiliation(s)
- Faisal Rahman
- 1501 Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jon R Resar
- 1501 Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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104
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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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105
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Leone PP, Fazzari F, Cannata F, Sanz-Sanchez J, Mangieri A, Monti L, Cozzi O, Stefanini GG, Bragato R, Colombo A, Reimers B, Regazzoli D. Clinical and Technical Challenges of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Implantation. Front Cardiovasc Med 2021; 8:670457. [PMID: 34150868 PMCID: PMC8211887 DOI: 10.3389/fcvm.2021.670457] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/22/2021] [Indexed: 12/30/2022] Open
Abstract
Prosthesis-patient mismatch (PPM) is present when the effective area of a prosthetic valve inserted into a patient is inferior to that of a normal human valve; the hemodynamic consequence of a valve too small compared with the size of the patient's body is the generation of higher than expected transprosthetic gradients. Despite evidence of increased risk of short- and long-term mortality and of structural valve degeneration in patients with PPM after surgical aortic valve replacement, its clinical impact in patients subject to transcatheter aortic valve implantation (TAVI) is yet unclear. We aim to review and update on the definition and incidence of PPM after TAVI, and its prognostic implications in the overall population and in higher-risk subgroups, such as small aortic annuli or valve-in-valve procedures. Last, we will focus on the armamentarium available in order to reduce risk of PPM when planning a TAVI procedure.
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Affiliation(s)
- Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Jorge Sanz-Sanchez
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | | | - Ottavia Cozzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Giulio Giuseppe Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
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106
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Herrmann HC. Small Annulus, Hemodynamic Status, and TAVR. JACC Cardiovasc Interv 2021; 14:1229-1230. [PMID: 34112459 DOI: 10.1016/j.jcin.2021.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Howard C Herrmann
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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107
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Leone PP, Regazzoli D, Pagnesi M, Sanz-Sanchez J, Chiarito M, Cannata F, Van Mieghem NM, Barbanti M, Tamburino C, Teles R, Adamo M, Miura M, Maisano F, Kim WK, Bedogni F, Stefanini G, Mangieri A, Giannini F, Colombo A, Reimers B, Latib A. Predictors and Clinical Impact of Prosthesis-Patient Mismatch After Self-Expandable TAVR in Small Annuli. JACC Cardiovasc Interv 2021; 14:1218-1228. [PMID: 34112458 DOI: 10.1016/j.jcin.2021.03.060] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/01/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to define predictors of prosthesis-patient mismatch (PPM) and its impact on mortality after transcatheter aortic valve replacement (TAVR) with self-expandable valves (SEVs) in patients with small annuli. BACKGROUND TAVR seems to reduce the risk for PPM compared with surgical aortic valve replacement, especially in patients with small aortic annuli. Nevertheless, predictors and impact of PPM in this population have not been clarified yet. METHODS Predictors of PPM and all-cause mortality were investigated using multivariable logistic regression analysis from the cohort of the TAVI-SMALL (International Multicenter Registry to Evaluate the Performance of Self-Expandable Valves in Small Aortic Annuli) registry, which included patients with severe aortic stenosis and small annuli (annular perimeter <72 mm or area <400 mm2 on computed tomography) treated with transcatheter SEVs: 445 patients with (n = 129) and without (n = 316) PPM were enrolled. RESULTS Intra-annular valves conferred increased risk for PPM (odds ratio [OR]: 2.36; 95% confidence interval [CI]: 1.16 to 4.81), while post-dilation (OR: 0.46; 95% CI: 0.25-0.84) and valve oversizing (OR: 0.53; 95% CI: 0.28-1.00) seemed to protect against PPM occurrence. At a median follow-up of 354 days, patients with severe PPM, but not those with moderate PPM, had a higher all-cause mortality rate compared with those without PPM (log-rank p = 0.008). Multivariable Cox regression confirmed severe PPM as an independent predictor of all-cause mortality (hazard ratio: 4.27; 95% CI: 1.34 to 13.6). CONCLUSIONS Among patients with aortic stenosis and small aortic annuli undergoing transcatheter SEV implantation, use of intra-annular valves yielded higher risk for PPM; conversely, post-dilation and valve oversizing protected against PPM occurrence. Severe PPM was independently associated with all-cause mortality.
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Affiliation(s)
- Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Matteo Pagnesi
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marco Barbanti
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, P.O.G. Rodolico, A.O.U. Policlinico-V. Emanuele, Università di Catania, Catania, Italy
| | - Corrado Tamburino
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, P.O.G. Rodolico, A.O.U. Policlinico-V. Emanuele, Università di Catania, Catania, Italy
| | - Rui Teles
- Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Lisbon, Portugal
| | - Marianna Adamo
- Civil Hospital and University of Brescia, Brescia, Italy
| | - Mizuki Miura
- Cardiac Surgery, University of Zürich, Zürich, Switzerland
| | | | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | | | - Antonio Colombo
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy; GVM Care and Research, Maria Cecilia Hospital, Ravenna, Italy
| | - Bernhard Reimers
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
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108
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2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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109
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D'Ascenzo F, Bruno F, Baldetti L, De Filippo O, Marengo G, Breviario S, Melillo F, Thyregod HGH, Thiele H, Sondergaard L, Popma JJ, Kodali S, Franchin L, Annaratone M, Marruncheddu L, Gallone G, Crimi G, La Torre M, Rinaldi M, Omedè P, Conrotto F, Salizzoni S, De Ferrari GM. Aortic valve replacement vs. balloon-expandable and self-expandable transcatheter implantation: A network meta-analysis. Int J Cardiol 2021; 337:90-98. [PMID: 33974961 DOI: 10.1016/j.ijcard.2021.04.068] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Recently, observational data have raised concerns about safety of selfexpandable (SE) compared to balloon-expandable (BE) valves in TAVI, although potentially limited by patient selection bias. METHODS All Randomized Controlled Trials (RCTs) comparing BE vs. SE TAVI or/and vs. aortic valve replacement (AVR) were included and compared through Network Meta Analysis (NMA). All-cause and cardiovascular (CV) mortality were the primary endpoints, stroke, rates of permanent pacemaker implantation (PPI), moderate/severe paravalvular leak (PVL) and reintervention were the secondary endpoints. Results We obtained data from 11 RCTs, encompassing 9752 patients. After one and two years, no significant differences for allcause and CV mortality were observed. Compared to surgical bioprostheses, both BE and SE TAVI reduced the risk of acute kidney injury (OR 0.42; CI 95% 0.30-0.60 and OR 0.44; CI 95% 0.32-0.60), new-onset atrial fibrillation (OR 0.24; CI 95% 0.14-0.42 and OR 0.21; CI 95% 0.13-0.34) and major bleedings (OR 0.32; CI 95% 0.16-0.65 and OR 0.47; CI 95% 0.25-0.89). The BE prostheses reduced the risk of moderate/severe PVL at 30-day (OR 0.31; CI 95% 0.17-0.55) and of PPI both at 30-day (OR 0.51; CI 95% 0.33-0.79) and 1 year (OR 0.40; CI 95% 0.30-0.55) as compared to SE TAVI. Conclusions A TAVI strategy, independently from BE or SE prostheses, offers a midterm survival comparable to AVR. The BE prostheses are associated with a reduction of PPI and PVL compared to SE prostheses without any differences in all-cause and CV mortality during two years of follow up. PROSPERO ID CRD42020182407.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy.
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Luca Baldetti
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Giorgio Marengo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Susanna Breviario
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Francesco Melillo
- Unit of echocardiography, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Germany
| | | | | | - Susheel Kodali
- Columbia University Medical Center (SKK), United States of America
| | - Luca Franchin
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | | | - Laura Marruncheddu
- Department of Clinical Internal, Anesthesiological and Cardiovascular Science, Sapienza University of Rome, Rome, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | | | - Michele La Torre
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
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Abstract
Aortic stenosis is the most common valvular disease requiring valve replacement. Valve replacement therapies have undergone progressive evolution since the 1960s. Over the last 20 years, transcatheter aortic valve replacement has radically transformed the care of aortic stenosis, such that it is now the treatment of choice for many, particularly elderly, patients. This review provides an overview of the pathophysiology, presentation, diagnosis, indications for intervention, and current therapeutic options for aortic stenosis.
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Affiliation(s)
- Marko T Boskovski
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
| | - Thomas G Gleason
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
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111
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Neurocognitive Status after Aortic Valve Replacement: Differences between TAVI and Surgery. J Clin Med 2021; 10:jcm10081789. [PMID: 33924077 PMCID: PMC8074293 DOI: 10.3390/jcm10081789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
Over the past decade, indications for transcatheter aortic valve implantation (TAVI) have progressed rapidly—procedural numbers now exceed those of surgical aortic valve replacement (SAVR) in many countries, and TAVI is now a realistic and attractive alternative to SAVR in low-risk patients. Neurocognitive outcomes after TAVI and SAVR remain an issue and sit firmly under the spotlight as TAVI moves into low-risk cohorts. Cognitive decline and stroke carry a significant burden and predict future functional decline, reduced mobility, poor quality of life and increased mortality. Early TAVI trials used varying neurocognitive definitions, and outcomes differed significantly as a result. Recent international consensus statements defining endpoints following TAVI and SAVR have standardised neurological outcomes and facilitate interpretation and comparison between trials. The latest TAVI and SAVR trials have demonstrated more consistent and favourable neurocognitive outcomes for TAVI patients, and cerebral embolic protection devices offer the prospect of further refinement and improvement.
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112
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Costa G, D'Errigo P, Rosato S, Valvo R, Biancari F, Tamburino C, Cerza F, Cicala SD, Seccareccia F, Barbanti M. Long-term outcomes of self-expanding versus balloon-expandable transcatheter aortic valves: Insights from the OBSERVANT study. Catheter Cardiovasc Interv 2021; 98:1167-1176. [PMID: 33847447 DOI: 10.1002/ccd.29701] [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: 02/04/2021] [Accepted: 03/19/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To compare clinical outcomes of balloon-expandable (BE) and self-expanding (SE) transcatheter aortic valves (TAVs) up to 5 years. BACKGROUND To date, no robust, comparative data of BE and SE TAVs at long-term are available. METHODS We considered a total of 1,440 patients enrolled in the multicenter OBSERVANT study and undergoing transfemoral transcatheter aortic valve implantation (TF-TAVI) with either supra-annular SE (n = 830, 57.6%) and intra-annular BE (n = 610, 42.4%) valves. Clinical outcomes of the two groups were compared after adjustment using inverse probability of treatment weighting (IPTW) and confirmed by sensitivity analysis with propensity score matching. RESULTS Patients receiving SE valve showed a higher all-cause mortality at 5 years (Kaplan-Meier estimates 52.3% vs. 47.7%; Hazard ratio [HR] 1.18, 95% confidence interval [CI] 1.01-1.38, p = .04). Landmark analyses showed that there was a not statistically significant reversal of risk excess against the BE group starting from 3 years after TAVI (3-5 years HR 0.97, 95% CI 0.76-1.25, p = .86). Post-procedural, moderate/severe paravalvular regurgitation (PVR)(HR 1.46, 95% CI 1.14-1.87; p < .01) and acute kidney injury (AKI)(HR 3.89, 95% CI 2.47-6.38; p < .01) showed to be independent predictors of 5-year all-cause mortality in multivariable analysis. CONCLUSIONS Considering the intrinsic limitations of the OBSERVANT study, we found that patients undergoing TF-TAVI with a supra-annular SE valve had a higher all-cause mortality compared to those receiving an intra-annular BE valve at 5 years. A late catch up phenomenon of patients receiving the BE valve was observed beyond 3 years. Post-procedural moderate/severe PVR seems to play a crucial role in determining this finding. Comparative studies of new generation devices with longer follow-up are needed to evaluate the benefit of each specific TAV type.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Valvo
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Fausto Biancari
- Department of Surgery, University of Oulu, Oulu, Finland.,Department of Surgery, University of Turku, Turku, Finland.,Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Francesco Cerza
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | | | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
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113
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Henning RJ. The current diagnosis and treatment of patients with aortic valve stenosis. Future Cardiol 2021; 17:1143-1160. [PMID: 33728942 DOI: 10.2217/fca-2020-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aortic valve stenosis (AS) is the third most frequent cardiovascular abnormality after coronary artery disease and hypertension. A bicuspid aortic valve is the most common cause for AS until seventh decade and calcific valve degeneration is responsible thereafter. In symptomatic patients, The risk of death increases from ≤1%/year to 2%/month. An echo valve area ≤1 cm2, peak transaortic velocity ≥4 m/s, mean valve gradient ≥40 mmHg and/or computerized tomography valve calcium score >2000 Agatston units (AU) for males or more than 1200 AU for females indicate severe AS. AS stages and management are discussed. Valve replacement is based on surgical risk, valve durability/hemodynamics, need for anticoagulation and patient preferences. EuroSCORE ≥20%, Society of Thoracic Surgeons Predicted Risk of Mortality ≥8% and co-morbidities indicate high surgical risk. Surgery is recommended for low-intermediate risk patients. Transcatheter aortic valve implantation is an alternative in older patients at low, intermediate, high or prohibitive risk. Transaortic valve implantation/replacement trials are summarized.
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114
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Umukoro PE, Yeung-Lai-Wah P, Pathak S, Elkhidir S, Soodi D, Delgoffe B, Berg R, Anderson KP, Garcia-Montilla RJ. Three-Year Survival after Transcatheter Aortic Valve Replacement: Findings from the Marshfield Aortic Valve Experience (MAVE) Study. Clin Med Res 2021; 19:10-18. [PMID: 33060110 PMCID: PMC7987094 DOI: 10.3121/cmr.2020.1539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 06/30/2020] [Accepted: 09/10/2020] [Indexed: 11/18/2022]
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a rapidly evolving treatment for severe aortic stenosis. However, uncertainties exist for optimal valve selection as there are few long-term studies comparing patient survival by valve type.Objective: We hypothesized that self-expandable valves (SEV) would provide a survival advantage over balloon expandable valves (BEV), as SEV continue to expand and might better accommodate to the anatomy of the aortic valve over time.Methods: We examined outcomes according to valve type from a rural tertiary referral center between 2012 and 2017.Results: Out of 269 patients, 77 deaths (28.6%) occurred over the study period with 6 deaths by 1 month post-TAVR and 37 deaths by 1 year post-TAVR. The median observation time for survivors was 21.5 months. The probability of survival at 3 years was 60.7% and 61.9% for patients who underwent treatment with SEV and BEV, respectively. There was no statistically significant difference in overall patient survival with or without adjustment for factors such as age, sex, race, and aortic valve area. Additionally, in a secondary analysis restricted to those patients treated in later years (2015-2017) survival among patients with BEV appeared superior (HR=0.456, P=0.015).Conclusion: Patients who underwent TAVR at a rural medical center with SEV showed similar survival compared to those who received a BEV. Superior survival was observed among those who received BEV versus SEV between 2015 and 2017.
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Affiliation(s)
- Peter E Umukoro
- Current affiliation: Physician, Indiana University School of Medicine, Indianapolis, IN, USA Institution where this work was completed: Marshfield Medical Center, Marshfield, Wisconsin.
- Department of Internal Medicine, Marshfield Clinic Health System, Marshfield, WI USA
| | - Paul Yeung-Lai-Wah
- Department of Internal Medicine, Marshfield Clinic Health System, Marshfield, WI USA
| | - Sunil Pathak
- Department of Internal Medicine, Marshfield Clinic Health System, Marshfield, WI USA
| | - Sabri Elkhidir
- Department of Internal Medicine, Marshfield Clinic Health System, Marshfield, WI USA
| | - Deepa Soodi
- Department of Internal Medicine, Marshfield Clinic Health System, Marshfield, WI USA
| | - Brooke Delgoffe
- Office of Research Computing and Analytics, Marshfield Clinic Research Institute, Marshfield, WI USA
| | - Richard Berg
- Office of Research Computing and Analytics, Marshfield Clinic Research Institute, Marshfield, WI USA
| | - Kelley P Anderson
- Department of Cardiology, Marshfield Clinic Health System, Marshfield, WI USA
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115
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The risk of valve thrombosis is higher with intra-annular versus supra-annular transcatheter aortic valve prosthesis. A meta-analysis from randomized controlled trials. Clin Res Cardiol 2021; 110:2007-2009. [PMID: 33604723 DOI: 10.1007/s00392-021-01818-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
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116
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 569] [Impact Index Per Article: 189.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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117
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 848] [Impact Index Per Article: 282.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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118
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Kawashima H, Soliman O, Wang R, Ono M, Hara H, Gao C, Zeller E, Thakkar A, Tamburino C, Bedogni F, Neumann FJ, Thiele H, Abdel-Wahab M, Morice MC, Webster M, Rosseel L, Mylotte D, Onuma Y, Wijns W, Baumbach A, Serruys PW. Rationale and design of a randomized clinical trial comparing safety and efficacy of myval transcatheter heart valve versus contemporary transcatheter heart valves in patients with severe symptomatic aortic valve stenosis: The LANDMARK trial. Am Heart J 2021; 232:23-38. [PMID: 33160946 DOI: 10.1016/j.ahj.2020.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/02/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The recent approval of transcatheter aortic valve replacement (TAVR) in patients with low operative risk has paved the way for the introduction of novel and potentially improved technologies. The safety and efficacy of these novel technologies should be investigated in randomized control trials against the contemporary TAVR devices. The objective of the LANDMARK trial is to compare the balloon-expandable Myval transcatheter heart valve (THV) series with contemporary THV (SAPIEN THV and Evolut THV series) series in patients with severe symptomatic native aortic stenosis. METHODS/DESIGN The LANDMARK trial (ClinicalTrials.govNCT04275726, EudraCT number 2020-000,137-40) is a prospective, randomized, multinational, multicenter, open-label, and noninferiority trial of approximately 768 patients treated with TAVR via the transfemoral approach. Patients will be allocated in a 1:1 randomization to Myval THV series (n = 384) or to contemporary THV (n = 384) (either of SAPIEN THV or Evolut THV series). The primary combined safety and efficacy endpoint is a composite of all-cause mortality, all stroke (disabling and nondisabling), bleeding (life-threatening or disabling), acute kidney injury (stage 2 or 3), major vascular complications, prosthetic valve regurgitation (moderate or severe), and conduction system disturbances (requiring new permanent pacemaker implantation), according to the Valve Academic Research Consortium-2 criteria at 30-day follow-up. All patients will have follow-up to 10 years following TAVR. SUMMARY The LANDMARK trial is the first randomized head-to-head trial comparing Myval THV series to commercially available THVs in patients indicated for TAVR. We review prior data on head-to-head comparisons of TAVR devices and describe the rationale and design of the LANDMARK trial.
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Affiliation(s)
- Hideyuki Kawashima
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Osama Soliman
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Hironori Hara
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Chao Gao
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Emeline Zeller
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | | | - Corrado Tamburino
- Ferrarotto Hospital, Policlinico Hospital and University of Catania, Catania, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy
| | - Franz-Josef Neumann
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Marie-Claude Morice
- Department of Cardiology, Cardiovascular Institute Paris-Sud, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | - Mark Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Liesbeth Rosseel
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Darren Mylotte
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - William Wijns
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Andreas Baumbach
- William Harvey Research Institute, Queen Mary University of London, and Barts Heart Centre, London, United Kingdom
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
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119
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Vondran M, Abt B, Nef H, Rastan AJ. Allegra Transcatheter Heart Valve inside a Degenerated Sutureless Aortic Bioprosthesis. Thorac Cardiovasc Surg Rep 2021; 10:e1-e5. [PMID: 33489712 PMCID: PMC7815337 DOI: 10.1055/s-0040-1721483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022] Open
Abstract
Transcatheter aortic valve-in-valve implantation (VIV) is increasingly being used to successfully treat degenerated surgical aortic valve bioprostheses (SAVs). The new self-expanding transcatheter heart valve Allegra, from New Valve Technology with its special implantation mechanism, has proven its safety and feasibility for patients with degenerated SAVs, but it has never been used in the latest-generation sutureless SAV. To the best of our knowledge, this is the first description of the successful VIV of the Allegra prosthesis into a degenerated sutureless SAV, and the procedure yielded an excellent postinterventional hemodynamic results.
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Affiliation(s)
- Maximilian Vondran
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany.,Department of Cardiac and Vascular Surgery, Herz-Kreislauf-Zentrum, Rotenburg an der Fulda, Germany
| | - Bernd Abt
- Department of Cardiology, Herz-Kreislauf-Zentrum, Rotenburg an der Fulda, Germany
| | - Holger Nef
- Department of Cardiology, Herz-Kreislauf-Zentrum, Rotenburg an der Fulda, Germany.,Department of Cardiology, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
| | - Ardawan J Rastan
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany.,Department of Cardiac and Vascular Surgery, Herz-Kreislauf-Zentrum, Rotenburg an der Fulda, Germany
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120
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Tamburino C, Bleiziffer S, Thiele H, Scholtz S, Hildick-Smith D, Cunnington M, Wolf A, Barbanti M, Tchetchè D, Garot P, Pagnotta P, Gilard M, Bedogni F, Van Belle E, Vasa-Nicotera M, Chieffo A, Deutsch O, Kempfert J, Søndergaard L, Butter C, Trillo-Nouche R, Lotfi S, Möllmann H, Joner M, Abdel-Wahab M, Bogaerts K, Hengstenberg C, Capodanno D. Comparison of Self-Expanding Bioprostheses for Transcatheter Aortic Valve Replacement in Patients With Symptomatic Severe Aortic Stenosis. Circulation 2020; 142:2431-2442. [DOI: 10.1161/circulationaha.120.051547] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background:
Few randomized trials have compared bioprostheses for transcatheter aortic valve replacement, and no trials have compared bioprostheses with supra-annular design. The SCOPE 2 trial (Safety and Efficacy Comparison of Two TAVI Systems in a Prospective Randomized Evaluation 2) was designed to compare the clinical outcomes of the ACURATE neo and CoreValve Evolut bioprostheses for transcatheter aortic valve replacement.
Methods:
SCOPE 2 was a randomized trial performed at 23 centers in 6 countries between April 2017 and April 2019. Patients ≥75 years old with an indication for transfemoral transcatheter aortic valve replacement as agreed by the heart team were randomly assigned to receive treatment with either the ACURATE neo (n=398) or the CoreValve Evolut bioprostheses (n=398). The primary end point, powered for noninferiority of the ACURATE neo bioprosthesis, was all-cause death or stroke at 1 year. The key secondary end point, powered for superiority of the ACURATE neo bioprosthesis, was new permanent pacemaker implantation at 30 days.
Results:
Among 796 randomized patients (mean age, 83.2±4.3 years; mean Society of Thoracic Surgeons Predicted Risk of Mortality score, 4.6±2.9%), clinical follow-up information was available for 778 (98%) patients. Within 1 year, the primary end point occurred in 15.8% of patients in the ACURATE neo group and in 13.9% of patients in the CoreValve Evolut group (absolute risk difference, 1.8%, upper 1-sided 95% confidence limit, 6.1%;
P
=0.0549 for noninferiority). The 30-day rates of new permanent pacemaker implantation were 10.5% in the ACURATE neo group and 18.0% in the CoreValve Evolut group (absolute risk difference, –7.5% [95% CI, –12.4 to –2.60];
P
=0.0027). No significant differences were observed in the components of the primary end point. Cardiac death at 30 days (2.8% versus 0.8%;
P
=0.03) and 1 year (8.4% versus 3.9%;
P
=0.01), and moderate or severe aortic regurgitation at 30 days (10% versus 3%;
P
=0.002) were significantly increased in the ACURATE neo group.
Conclusions:
Transfemoral transcatheter aortic valve replacement with the self-expanding ACURATE neo did not meet noninferiority compared with the self-expanding CoreValve Evolut in terms of all-cause death or stroke at 1 year, and it was associated with a lower incidence of new permanent pacemaker implantation. In secondary analyses, the ACURATE neo was associated with more moderate or severe aortic regurgitation at 30 days and cardiac death at 30 days and 1 year.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03192813.
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Affiliation(s)
- Corrado Tamburino
- Department of General Surgery and Medical-Surgical Subspecialties, University of Catania, Italy (C.T., D.C.)
| | - Sabine Bleiziffer
- Department of Cardiothoracic Surgery (S.B.), Heart and Diabetes Center Northrhein-Westfalia, Bad Oeynhausen, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Germany (H.T., M.A.-W.)
| | - Smita Scholtz
- Department of Interventional Cardiology (S.S.), Heart and Diabetes Center Northrhein-Westfalia, Bad Oeynhausen, Germany
| | - David Hildick-Smith
- Department of Cardiology, Brighton and Sussex University Hospitals National Health Service Trust, Brighton, United Kingdom (D.H.-S.)
| | - Michael Cunnington
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals National Health Service Trust, United Kingdom (M.C.)
| | - Alexander Wolf
- Department of Cardiology, Elisabeth Hospital Essen, Germany (A.W.)
| | - Marco Barbanti
- Department of Cardio-Thoracic-Vascular Diseases and Transplantations, Azienda Ospedaliero-Universitaria Policlinico “G. Rodolico-San Marco,” Catania, Italy (M.B.)
| | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France (D.T.)
| | - Philippe Garot
- Hôpital Privé Jacques Cartier, Institut Cardio-vasculaire Paris-Sud, Ramsay-Santé, Massy, France (P.G.)
| | - Paolo Pagnotta
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Milano, Italy (P.P.)
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, France (M.G.)
| | - Francesco Bedogni
- Cardiology Department, Istituti di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milano, Italy (F.B.)
| | - Eric Van Belle
- Department of Cardiology, University Hospital, Lille, France (E.V.B.)
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany (M.V.-N.)
| | - Alaide Chieffo
- Interventional Cardiology Unit, Istituti di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy (A.C.)
| | - Oliver Deutsch
- Department of Cardiovascular Surgery, German Heart Centre Munich, Germany (O.D.)
| | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany (J.K.)
| | | | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg in Bernau and Brandenburg Medical School, Germany (C.B.)
| | - Ramiro Trillo-Nouche
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Spain (R.T.-N.)
| | - Shahram Lotfi
- Department of Cardiovascular Surgery, University Hospital RWTH Aachen, Germany (S.L.)
| | - Helge Möllmann
- Department of Cardiology, St Johannes Hospital, Dortmund, Germany (H.M.)
| | - Michael Joner
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (M.J.)
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Germany (H.T., M.A.-W.)
| | - Kris Bogaerts
- Department of Public Health and Primary Care, I-BioStat, KU Leuven, Belgium (K.B.)
- I-BioStat, Universiteit Hasselt, Belgium (K.B.)
| | | | - Davide Capodanno
- Department of General Surgery and Medical-Surgical Subspecialties, University of Catania, Italy (C.T., D.C.)
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Holman H, Kavarana MN, Rajab TK. Smart materials in cardiovascular implants: Shape memory alloys and shape memory polymers. Artif Organs 2020; 45:454-463. [PMID: 33107042 DOI: 10.1111/aor.13851] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/03/2020] [Accepted: 10/19/2020] [Indexed: 12/12/2022]
Abstract
Smart materials have intrinsic properties that change in a controlled fashion in response to external stimuli. Currently, the only smart materials with a significant clinical impact in cardiovascular implant design are shape memory alloys, particularly Nitinol. Recent prodigious progress in material science has resulted in the development of sophisticated shape memory polymers. In this article, we have reviewed the literature and outline the characteristics, advantages, and disadvantages of shape memory alloys and shape memory polymers which are relevant to clinical cardiovascular applications, and describe the potential of these smart materials for applications in coronary stents and transcatheter valves.
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Affiliation(s)
- Heather Holman
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Minoo Naozer Kavarana
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Taufiek Konrad Rajab
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
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122
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Thiele H, Abdel-Wahab M, Desch S. Stroke rates after transcatheter aortic valve replacement: does valve choice play a role? Eur Heart J 2020; 41:4362. [PMID: 32808007 DOI: 10.1093/eurheartj/ehaa631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany
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123
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Wang R, Gao C, Kawashima H, Modolo R, Rosseel L, Onuma Y, Soliman O, Serruys PW, Mylotte D. Valvular heart interventions: advances from 2019 to 2020. EUROINTERVENTION 2020; 16:808-823. [PMID: 32958460 DOI: 10.4244/eij-d-20-00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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124
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Abdel-Wahab M. Revisiting the Coronary Arteries After TAVR: A Potentially Challenging Endeavor. JACC Cardiovasc Interv 2020; 13:2556-2559. [PMID: 33069652 DOI: 10.1016/j.jcin.2020.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Mohamed Abdel-Wahab
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
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125
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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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126
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Costa G, Criscione E, Reddavid C, Barbanti M. Balloon-expandable versus self-expanding transcatheter aortic valve replacement: a comparison and evaluation of current findings. Expert Rev Cardiovasc Ther 2020; 18:697-708. [DOI: 10.1080/14779072.2020.1807326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Giuliano Costa
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Enrico Criscione
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Claudia Reddavid
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, C.A.S.T., University of Catania, Catania, Italy
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127
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Bisson A, Fauchier L, Collart F, Cuisset T, Deharo P. The CHOICE Randomized Clinical Trial. JACC Cardiovasc Interv 2020; 13:1609-1610. [PMID: 32646707 DOI: 10.1016/j.jcin.2020.04.049] [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: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022]
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128
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Abdel-Wahab M, Kitamura M, Richardt G. Reply: The CHOICE Randomized Clinical Trial. JACC Cardiovasc Interv 2020; 13:1610-1611. [PMID: 32646709 DOI: 10.1016/j.jcin.2020.05.044] [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: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 11/24/2022]
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129
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Esposito G, Franzone A. Transcatheter Heart Valves. JACC Cardiovasc Interv 2020; 13:1083-1085. [DOI: 10.1016/j.jcin.2020.01.236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/21/2020] [Indexed: 11/16/2022]
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