151
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Bayar N, Erkal Z, Köklü E, Güven R, Arslan Ş. Increased Intima-Media Thickness of the Ascending Aorta May Predict Neurological Complications Associated with TAVI. J Stroke Cerebrovasc Dis 2021; 30:105665. [PMID: 33631476 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/11/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Neurological complications associated with transcatheter aortic valve implantation (TAVI) are important due to its morbidity and mortality risks. The purpose of this study was to investigate the importance of the features of the aortic valve and ascending aorta to predict the neurological complications associated with TAVI. METHODS The patients for whom the heart team decided to perform TAVI were included in the study. In order to assess possible neurological complications, cerebral diffusionweighted magnetic resonance imaging(MRI) was performed pre- and post-operatively. The diameter of the patients' aortic root and ascending aorta, aortic valve scores, intima media thickness of the ascending aorta were measured from their transesophageal echocardiography records. RESULTS A total of 108 patients constituted the study population. 31 patients were found to develop a new lesion (MR+) detected on MRI after TAVI, while 76 patients did not have any new lesions (MR-). The groups did not have any significant differences in their aortic valve features and scores. However, AA-IMT was found to be higher in the MR+ group (1.8mm [1.6-2.3] vs 1.4mm [1.2-1.8] interquartile range). The multivariate logistic regression analysis conducted to detect new lesions revealed that AA-IMT led to a significantly increased risk. CONCLUSION The features of the ascending are more important than the demographic characteristics of patients and features of the native valve in predicting new lesions on MRI scans and thus neurological events after TAVI.
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Affiliation(s)
- Nermin Bayar
- Antalya Training and Research Hospital, Cardiology Department, University of Health Sciences, Antalya, Turkey.
| | - Zehra Erkal
- Antalya Training and Research Hospital, Cardiology Department, University of Health Sciences, Antalya, Turkey
| | - Erkan Köklü
- Antalya Training and Research Hospital, Cardiology Department, University of Health Sciences, Antalya, Turkey
| | - Ramazan Güven
- Emergency Medicine Department, Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Şakir Arslan
- Antalya Training and Research Hospital, Cardiology Department, University of Health Sciences, Antalya, Turkey
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152
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Bagur R, Sposato L. Cerebral embolic protection during TAVI: the game is not over. EUROINTERVENTION 2021; 16:1123-1125. [PMID: 33605879 PMCID: PMC9707453 DOI: 10.4244/eijv16i14a201] [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)
- Rodrigo Bagur
- Division of Cardiology, University Hospital, London Health Sciences Centre, 339 Windermere Road, University Hospital, London, ON N6A 5A5, Canada
| | - Luciano Sposato
- Department of Clinical Neurological Sciences, Stroke, Dementia & Heart Disease Laboratory, London Health Sciences Centre, Western University, London, ON, Canada
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153
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Kroon H, von der Thusen J, Ziviello F, van Wiechen M, Ooms JF, Kardys I, Schipper M, van Gils L, Daemen J, de Jaegere PP, Van Mieghem NM. Heterogeneity of debris captured by cerebral embolic protection filters during TAVI. EUROINTERVENTION 2021; 16:1141-1147. [PMID: 32894232 PMCID: PMC9724925 DOI: 10.4244/eij-d-20-00744] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to investigate the total amount, size and heterogeneity of debris captured among different transcatheter valve types and while repositioning. METHODS AND RESULTS A total of 328 patients who underwent transcatheter aortic valve implantation (TAVI) with the SENTINEL cerebral embolic protection (CEP) at our centre were eligible. Histopathological and semiquantitative analysis of captured debris was performed and data were entered into our prospective database. TAVI was performed with either the Evolut R/PRO (N=123), SAPIEN 3 (N=113) or Lotus valve (N=92). Capture of debris occurred in 98% of patients. Lotus TAVI resulted in more frequent foreign body material (62% vs 40% vs 47%, p=0.006), endothelium (49% vs 30% vs 16%, p<0.0005), calcified material (33% vs 12% vs 24%, p=0.001) and myocardial tissue (19% vs 11% vs 2%, p<0.0005) compared to SAPIEN 3 or Evolut R/PRO. Native (functional) bicuspid valves (OR 2.91, 95% CI: 1.20-7.03, p=0.02) and Lotus (OR 2.44, 95% CI: 1.14-5.24, p=0.02) were associated with the highest risk for dislodging particles ≥1,000 um. Valve repositioning was independently associated with larger amounts of debris (OR 2.96, 95% CI: 1.42-6.16, p=0.004). CONCLUSIONS All THV platforms had similar amounts of captured debris. THV repositioning seemed to be associated with a higher risk for dislodging greater amounts of debris to the brain.
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Affiliation(s)
- Herbert Kroon
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jan von der Thusen
- Department of Pathology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Francesca Ziviello
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Maarten van Wiechen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joris F. Ooms
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Lennart van Gils
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Peter P. de Jaegere
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Nicolas M. Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Room NT-645, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
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154
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Jagielak D, Targonński R, Ciećwierz D. First-in-Human Use of the Next-generation ProtEmbo Cerebral Embolic Protection System During Transcatheter Aortic Valve-in-valve Implantation. Interv Cardiol 2021; 16. [PMID: 33786063 PMCID: PMC7919677 DOI: 10.15420/icr.2021.s1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cerebral embolic protection (CEP) devices aim to reduce the risk of periprocedural cerebrovascular events during transcatheter aortic valve implantation (TAVI). Here, the authors describe the first-in-human experience with the ProtEmbo Cerebral Protection System (Protembis), a next-generation CEP device, during TAVI. This case is part of a larger European trial evaluating the safety and performance of this device. After deployment of the ProtEmbo in the aortic arch, a first transcatheter heart valve was implanted. Despite postdilatation, moderate to severe aortic regurgitation persisted. The operating team decided to perform a valve-in-valve procedure using a second transcatheter heart valve. The ProtEmbo demonstrated good coverage of all three head vessels and no interaction with TAVI catheters in the aortic arch throughout the entire procedure. No adverse events were observed during hospitalisation or follow-up, and there was a significant reduction in aortic regurgitation at follow-up echocardiography. Despite a challenging overall procedure with presumably high embolic burden, diffusion-weighted MRI at follow-up showed a low number (n=3) and volume (156 mm3) of new hyperintense lesions. The first-in-human use of the ProtEmbo was safe and feasible, despite a challenging TAVI valve-in-valve procedure.
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Affiliation(s)
- Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk Gdansk, Poland
| | - Radoslaw Targonński
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk Gdansk, Poland
| | - Dariusz Ciećwierz
- First Department of Cardiology, Medical University of Gdansk Gdansk, Poland
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155
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Voss S, Ernst A, Erlebach M, Ruge H, Sideris K, Bleiziffer S, Voss B, Tassani-Prell P, Mayr NP. Effects of a dual-filter-based cerebral embolic protection device in transcatheter aortic valve replacement on cerebral oxygen saturation: A prospective pilot study. J Card Surg 2021; 36:1241-1248. [PMID: 33484180 DOI: 10.1111/jocs.15355] [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: 10/30/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The Sentinel Cerebral Protection System (Sentinel-CPS) is increasingly used in transcatheter aortic valve replacement (TAVR). However, the impact of inserting the Sentinel-CPS inside the brain-supplying arteries on cerebral perfusion and oxygenation is unknown. METHODS Twenty patients undergoing transfemoral TAVR with (n = 10) and without (n = 10) cerebral embolic protection using the Sentinel-CPS were prospectively observed. All patients received conscious sedation and cerebral oxygen saturation (rSO2 ) was continuously measured with near-infrared spectroscopy (NIRS). The cumulative perioperative cerebral desaturation was calculated for each patient by multiplying rSO2 below an individualized desaturation threshold by time. In addition, rSO2 values at the time of Sentinel-CPS insertion, filter positioning, and device retraction were analyzed. RESULTS There was no significant difference in cumulative cerebral desaturation in patients with Sentinel-CPS (median [IQR]) (0 [0/81] s%) and without (median [IQR]) (0 [0/23] s%), p = .762. A total of 6 patients (33.3%) experienced a perioperative decrease in rSO2 below the individualized desaturation threshold (n = 3 with Sentinel-CPS, n = 3 without Sentinel-CPS; p = 1.000). Cerebral desaturation was detected during valve deployment (n = 5) and after postdilatation (n = 1). No desaturation events occurred during Sentinel-CPS insertion, filter positioning, or retraction. CONCLUSION Our pilot study revealed no difference in cumulative perioperative cerebral desaturation between TAVR with and without Sentinel-CPS. Catheter- and filter-based manipulations in the brain-supplying arteries for Sentinel-CPS application were not associated with a decrease of cerebral perfusion and oxygenation.
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Affiliation(s)
- Stephanie Voss
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Annick Ernst
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Magdalena Erlebach
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, 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 Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Konstantinos Sideris
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Sabine Bleiziffer
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Bernhard Voss
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Peter Tassani-Prell
- Department of Anaesthesiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - N Patrick Mayr
- Department of Anaesthesiology, German Heart Center Munich, Technische Universität München, Munich, Germany
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156
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Kharbanda RK, Newton JD. Smoke signals - do they help to predict TAVI-associated stroke risk? EUROINTERVENTION 2021; 16:1046-1047. [PMID: 33470218 PMCID: PMC9707432 DOI: 10.4244/eijv16i13a191] [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)
- Rajesh K Kharbanda
- Oxford University NHS Trust and Oxford NIHR Biomedical Research Centre, Oxford, United Kingdom
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157
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Nazir S, Zafrullah F, Virk HU, Sandhu CS, Ameen M, Ahuja KR. Meta-Analysis of Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement. Am J Cardiol 2021; 139:138-139. [PMID: 33164763 DOI: 10.1016/j.amjcard.2020.10.038] [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: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
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158
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Park H, Kang DY, Ahn JM, Kim KW, Wong AYT, Lam SCC, Yin WH, Wei J, Lee YT, Kao HL, Lin MS, Ko TY, Kim WJ, Kang SH, Ko E, Kim DH, Koo HJ, Yang DH, Kang JW, Jung SC, Lee JH, Yun SC, Park SJ, Park DW. Rationale and design of the ADAPT-TAVR trial: a randomised comparison of edoxaban and dual antiplatelet therapy for prevention of leaflet thrombosis and cerebral embolisation after transcatheter aortic valve replacement. BMJ Open 2021; 11:e042587. [PMID: 33402409 PMCID: PMC7786793 DOI: 10.1136/bmjopen-2020-042587] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Optimal antithrombotic strategy following transcatheter aortic valve replacement (TAVR) is still unknown. We hypothesised that the direct factor Xa inhibitor edoxaban can potentially prevent subclinical leaflet thrombosis and cerebral embolisation compared with conventional dual antiplatelet therapy (DAPT) in patients undergoing TAVR. METHODS AND ANALYSIS The ADAPT-TAVR trial is an international, multicentre, randomised, open-label, superiority trial comparing edoxaban-based strategy and DAPT strategy in patients without an indication for oral anticoagulation who underwent successful TAVR. A total of 220 patients are randomised (1:1 ratio), 1-7 days after successful TAVR, to receive either edoxaban (60 mg daily or 30 mg daily if patients had dose-reduction criteria) or DAPT using aspirin (100 mg daily) plus clopidogrel (75 mg daily) for 6 months. The primary endpoint was an incidence of leaflet thrombosis on four-dimensional, volume-rendered cardiac CT imaging at 6 months post-TAVR. The key secondary endpoints were the number of new lesions and new lesion volume on brain diffusion-weighted MRI and the changes in neurological and neurocognitive function assessment between immediate post-TAVR and 6 months of study drug administration. Detailed clinical information on thromboembolic and bleeding events were also assessed. ETHICS AND DISSEMINATION Ethic approval has been obtained from the Ethics Committee/Institutional Review Board of Asan Medical Center (approval number: 2017-1317) and this trial is also approved by National Institute of Food and Drug Safety Evaluation of Republic of Korea (approval number: 31511). Results of this study will be disseminated in scientific publication in reputed journals. TRIAL REGISTRATION NUMBER NCT03284827.
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Affiliation(s)
- Hanbit Park
- Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Kyung Won Kim
- Asan Image Metrics, Clinical Trial Center, Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Anthony Y T Wong
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Simon C C Lam
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yung-Tsai Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsien-Li Kao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsung-Yu Ko
- Division of Cardiology, Department of Internal Medicine, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan
| | - Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, Seongnam, Gyeonggi-do, The Republic of Korea
| | - Se Hun Kang
- Department of Cardiology, CHA Bundang Medical Center, Seongnam, Gyeonggi-do, The Republic of Korea
| | - Euihong Ko
- Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Sung-Cheol Yun
- Department of Biostatistics, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
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159
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Hassanein M, Abdelfattah OM, Saad AM, Isogai T, Gad MM, Ahuja KR, Ahmed T, Shekhar S, Fatica R, Poggio E, Kapadia SR. Short-Term Outcomes of Transcatheter Aortic Valve Replacement in Kidney Transplant Recipients: A Nationwide Representative Study. STRUCTURAL HEART 2021. [DOI: 10.1080/24748706.2020.1845918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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160
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Dual Filter Cerebral Embolic Protection (CEP) for Stroke Prevention During Transcatheter Aortic Valve Implantation (TAVI): A Meta-Analysis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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161
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Koga M, Izumo M, Tanabe Y, Akashi YJ. Cerebral infarction due to dispersal of aortic atheromas detected by transoesophageal echocardiography during transcatheter aortic valve implantation. BMJ Case Rep 2020; 13:13/12/e238337. [PMID: 33376091 PMCID: PMC7778744 DOI: 10.1136/bcr-2020-238337] [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: 12/31/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a rapidly evolving treatment option with an inherent risk of causing cerebral infarctions. The mechanism of cerebral infarction during TAVI mainly involves embolisms from the aortic wall and valve. Transoesophageal echocardiography (TEE) is useful for detecting aortic atheromas. We present the case of a patient in whom the dispersal of aortic atheromas was monitored by TEE during TAVI. This report demonstrates the importance of preoperatively predicting embolisms from aortic atheromas in patients with severe aortic stenosis.
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Affiliation(s)
- Masashi Koga
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yasuhiro Tanabe
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yoshihiro John Akashi
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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162
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TAVR: A Review of Current Practices and Considerations in Low-Risk Patients. J Interv Cardiol 2020; 2020:2582938. [PMID: 33447165 PMCID: PMC7781688 DOI: 10.1155/2020/2582938] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/30/2020] [Accepted: 09/08/2020] [Indexed: 11/17/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is an established treatment for severe, symptomatic, aortic stenosis (AS) in patients of all risk categories and now comprises 12.5% of all aortic valve replacements. TAVR is a less invasive alternative to traditional surgical aortic valve replacement (SAVR), with equivalent or superior outcomes. The use of TAVR has increased rapidly. The success and increase in use of TAVR are a result of advances in technology, greater operator experience, and improved outcomes. Indications have recently expanded to include patients considered to be at low risk for SAVR. While TAVR outcomes have improved, remaining challenges include the management of coexistent coronary artery disease, prevention of periprocedural stroke, and issue of durability. These issues are even more relevant for low-risk, younger patients.
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163
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Feasibility and Safety of Cerebral Embolic Protection Device Insertion in Bovine Aortic Arch Anatomy. J Clin Med 2020; 9:jcm9124118. [PMID: 33419286 PMCID: PMC7766100 DOI: 10.3390/jcm9124118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Cerebral embolic protection devices (CEPDs) have emerged as a mechanical barrier to prevent debris from reaching the cerebral vasculature, potentially reducing stroke incidence. Bovine aortic arch (BAA) is the most common arch variant and represents challenge anatomy for CEPD insertion during transcatheter aortic valve replacement (TAVR). Methods: Cohort study reporting the SentinelTM Cerebral Protection System insertion’s feasibility and safety in 165 adult patients submitted to a transfemoral TAVR procedure from April 2019 to April 2020. Patients were divided into 2 groups: (1) BAA; (2) non-BAA. Results: Median age, EuroScore II, and STS score were 79 years (74–84), 2.9% (1.7–6.2), and 2.2% (1.6–3.2), respectively. BAA was present in 12% of cases. Successful two-filter insertion was 86.6% (89% non-BAA vs. 65% BAA; p = 0.002), and debris was captured in 95% (94% non-BAA vs. 95% BAA; p = 0.594). No procedural or vascular complications associated with Sentinel insertion and no intraprocedural strokes were reported. There were two postprocedural non-disabling strokes, both in non-BAA. Conclusion: This study demonstrated Sentinel insertion feasibility and safety in BAA. No procedural and access complications related to Sentinel deployment were reported. Being aware of the bovine arch prevalence and having the techniques to navigate through it allows operators to successfully use CEPDs in this anatomy.
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164
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Cahill TJ, Terre JA, George I. Over 15 years: the advancement of transcatheter aortic valve replacement. Ann Cardiothorac Surg 2020; 9:442-451. [PMID: 33312902 DOI: 10.21037/acs-2020-av-24] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The management of aortic stenosis has been revolutionized by transcatheter aortic valve replacement (TAVR). Initially only undertaken in patients at prohibitive or high surgical risk, as the evidence base and indications have expanded, TAVR is now approved and undertaken in patients at all risk levels. Evolution of valve technology, delivery systems and pathways for patient work-up have been rapid, with associated reductions in the complication profile, particularly vascular complications. Challenges remain as TAVR continues to advance, however, specifically achieving further reduction in paravalvular regurgitation, the requirement for permanent pacemaker implantation, and balancing the risks of thrombosis and bleeding. In this review, we outline the historical advances leading to contemporary TAVR practice, and discuss the future trajectory.
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Affiliation(s)
- Thomas J Cahill
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Juan A Terre
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Isaac George
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
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165
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Worku B, Gaudino M. Commentary: Covert or overt? Depends on how hard you look. JTCVS OPEN 2020; 4:12-13. [PMID: 36004288 PMCID: PMC9390687 DOI: 10.1016/j.xjon.2020.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Berhane Worku
- Address for reprints: Mario Gaudino, MD, MSCE, Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th St, M-404, New York, NY 10065.
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166
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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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167
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Nagaraja V, Krishnaswamy A, Yun J, Kapadia SR. Same-Day Discharge After Transcatheter Native Aortic and Mitral Valve-in-Valve Replacement. JACC Case Rep 2020; 2:2199-2201. [PMID: 34317138 PMCID: PMC8299845 DOI: 10.1016/j.jaccas.2020.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 11/18/2022]
Abstract
Transcatheter aortic valve replacement has become the gold standard of care in the management of patients with severe aortic stenosis and transcatheter mitral valve-in-valve replacement seems to be an attractive alternative to redo surgery. We report the first case of concomitant transcatheter aortic valve replacement/transcatheter mitral valve-in-valve replacement that was performed under conscious sedation who was subsequently discharged the same day. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Vinayak Nagaraja
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - James Yun
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
- Address for correspondence: Dr. Samir R. Kapadia, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195.
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168
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Voss S, Schechtl J, Nöbauer C, Bleiziffer S, Lange R. Patient eligibility for application of a two-filter cerebral embolic protection device during transcatheter aortic valve implantation: does one size fit all? Interact Cardiovasc Thorac Surg 2020; 30:605-612. [PMID: 31904829 DOI: 10.1093/icvts/ivz306] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study sought to determine the percentage of patients potentially eligible for implantation of the Sentinel™ Cerebral Protection System (Sentinel-CPS) during transcatheter aortic valve implantation (TAVI) and to identify the reasons for treatment exclusion. METHODS We retrospectively performed an analysis of pre-TAVI multislice computed tomography (MSCT) aortograms and data review of all patients undergoing a TAVI procedure in 2017 (n = 317). MSCT evaluation included the assessment of aortic arch anatomy and the vascular dimensions of the brachiocephalic and left common carotid artery. Data analysis focused on comorbid conditions, precluding 6-Fr sheath radial access and filter deployment due to history of previous artery interventions. RESULTS MSCT and data analysis showed Sentinel-CPS compatibility in 61.5% of patients (n = 195). Sentinel-CPS would have been contraindicated in 38.5% (n = 122) due to one or more of the following: (i) measured diameters of the filter-landing zones <9 or >15 mm in the brachiocephalic artery and <6.5 or >10 mm in the left common carotid artery (n = 116; 88 with carotid dimensions too small); (ii) significant subclavian artery stenosis (n = 4) or an aberrant subclavian artery (n = 3) precluding Sentinel-CPS implantation and (iii) clinical characteristics including hypersensitivity to nickel-titanium (n = 1), radial artery occlusion (n = 1) or previous left common carotid artery interventions (n = 5). CONCLUSIONS MSCT and clinical data supported Sentinel-CPS compatibility in 61.5% of patients. The most common reason for treatment exclusion was inappropriate diameter within the target landing zone of the left carotid artery. Future device development should address this limitation.
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Affiliation(s)
- Stephanie Voss
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, German Heart Centre Munich, Insure (Institute of Translational Cardiac Surgery), Technische Universität München, Munich, Germany
| | - Johanna Schechtl
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, German Heart Centre Munich, Insure (Institute of Translational Cardiac Surgery), Technische Universität München, Munich, Germany
| | - Christian Nöbauer
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, German Heart Centre Munich, Insure (Institute of Translational Cardiac Surgery), Technische Universität München, Munich, Germany
| | - Sabine Bleiziffer
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, German Heart Centre Munich, Insure (Institute of Translational Cardiac Surgery), Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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169
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Latib A, Mangieri A, Vezzulli P, Spagnolo P, Sardanelli F, Fellegara G, Pagnesi M, Giannini F, Falini A, Gorla R, Montorfano M, Bedogni F, Colombo A, Popma J, Merhi WM, De Marco F. First-in-Man Study Evaluating the Emblok Embolic Protection System During Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 13:860-868. [PMID: 32273098 DOI: 10.1016/j.jcin.2019.11.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study sought to evaluate the feasibility of complete cerebral protection during transcatheter aortic valve replacement (TAVR) with a novel embolic protection device. BACKGROUND Evidences and data about new cerebral embolic protection devices are lacking and scarce. METHODS A prospective, nonrandomized, multicenter, first-in-man pilot study designed to evaluate the efficacy and safety of cerebral embolic protection utilizing the Emblok embolic protection system (Innovative Cardiovascular Solutions, Grand Rapids, Michigan) during TAVR. The Emblok is a transfemoral aortic filter that provide full coverage of the epiaortic vessels. Brain diffusion-weighted magnetic resonance imaging (DW-MRI) was performed at baseline and 2 to 5 days after TAVR. Primary endpoints were technical success and immediate cerebral embolic burden after TAVR, defined as number and volume of new brain lesions detected with DW-MRI at days 2 to 5 post-TAVR compared with baseline. RESULTS A total of 20 subjects were enrolled. The Emblok system was successfully positioned in all the cases. At 30-day follow-up, no major adverse cardiovascular and cerebrovascular events occurred. Nineteen (95%) patients had new ischemic defects at post-procedural DW-MRI. The median number of new lesions per patient was 10.00 (interquartile range [IQR]: 4.75 to 15.25). The total new lesion volume was 199.9 mm3 (IQR: 83.9 to 447.5 mm3) and the mean lesion volume per lesion was 42.5 mm3 (IQR: 21.5 to 75.6 mm3). Histopathologic analysis showed evidence of significant debris in 18 (90%) filters. CONCLUSIONS The Emblok embolic protection system appears to be feasible and safe during TAVR. The device was successfully placed and retrieved in all cases and no neurological events were observed. Cerebral total new lesion volume was similar to other trials on cerebral protection during TAVR, thus warranting a larger study. (European Study Evaluating the Emblok Embolic Protection System During TAVR; NCT03130491).
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Affiliation(s)
- Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Cardiology, Montefiore Medical Center, New York, New York.
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy
| | - Paolo Vezzulli
- Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Spagnolo
- Unit of Radiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Giovanni Fellegara
- Department of Surgical Pathology, Centro Diagnostico Italiano, Milan, Italy
| | - Matteo Pagnesi
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy
| | - Andrea Falini
- Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Gorla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Jeffrey Popma
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - William M Merhi
- Department of Cardiology, Spectrum Health Hospital, Grand Rapids, Michigan
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
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170
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Mayer B, Tadler S, Rothenbacher D, Seeger J, Wöhrle J. A hierarchical algorithm for multicentric matched cohort study designs. Curr Med Res Opin 2020; 36:1889-1896. [PMID: 32783543 DOI: 10.1080/03007995.2020.1808453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Lack of structural equality is a major issue to be addressed in observational studies. Their major disadvantage of these studies compared to randomized controlled trials is the vulnerability towards confounding, but they often better mirror real world patients and, therefore, entail an increased external validity. Numerous approaches have been developed to account for confounding in observational research, including multiple regression, subgroup analysis and matched cohort designs. The latter has been often described as a useful tool if large control data sets are available. METHODS In this paper we present a hierarchical matching algorithm entailing two stages which enables a multicentric matched cohort study to be conducted. In particular, the algorithm defines the matching strategy as a combination of exact matching and a subsequent consideration of further matching variables to be controlled using a distance measure (e.g. the propensity score). RESULTS The algorithm is applied to a study in interventional cardiology and demonstrates high flexibility and usefulness with regard to the aim of finding comparable cases of exposed and non-exposed patients from observational data. The algorithm increased structural equality by balancing the most important covariates which might be of different importance for the matching process. CONCLUSION The implementation of the algorithm in the statistical software SAS offers high flexibility regarding an application to various data analysis projects. Specifically, it provides a broader range of features (e.g. diverse distance measures) when compared to other existing solutions for conducting matched cohort analyses.
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Affiliation(s)
- Benjamin Mayer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Simone Tadler
- Cancer Registry Baden-Wuerttemberg, Stuttgart, Germany
| | | | - Julia Seeger
- Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
- Department of Cardiology, Medical Campus Lake Constance, Friedrichshafen, Germany
| | - Jochen Wöhrle
- Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
- Department of Cardiology, Medical Campus Lake Constance, Friedrichshafen, Germany
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171
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Laricchia A, Khokhar AA, Gallo F, Giannini F, Colombo A, Latib A, Mangieri A. Transcatheter aortic valve replacement: potential use in lower-risk aortic stenosis. Expert Rev Cardiovasc Ther 2020; 18:723-731. [PMID: 33021849 DOI: 10.1080/14779072.2020.1833717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The widespread use of transcatheter aortic valve implantation (TAVI) is expanding to low-risk patients. Nevertheless, a low clinical risk does not always correspond to a low procedural risk for the percutaneous approach. AREAS COVERED The initial trials on TAVI in low-risk populations had encouraging results, showing non-inferiority in comparison to surgical aortic valve replacement (SAVR). However, the low-risk definition is based on risk score calculators developed for the surgical setting and not including other specific features that are more relevant to TAVI and can affect procedural outcomes. For example, the presence of bicuspid aortic valves, high calcific burden, low coronary height or conduction disturbances is all potentially associated with suboptimal results or even procedural complications. In addition, the lack of longer follow-up prevents us to draw conclusions about long-term outcomes, including data about valve durability and coronary re-access. EXPERT OPINION Although current evidence suggest similar results for TAVI and SAVR in low-risk populations, there are some technical and procedural limitations that still need to be addressed in order to close the gap between TAVI and surgery. Optimal, lasting results with a low rate of procedural complications are highly expected in low-risk, otherwise healthy subjects, with potential for longevity.
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Affiliation(s)
- Alessandra Laricchia
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Arif A Khokhar
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Francesco Gallo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Francesco Giannini
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Antonio Colombo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center , Bronx, NY, USA
| | - Antonio Mangieri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
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172
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Gaudino M, Benesch C, Bakaeen F, DeAnda A, Fremes SE, Glance L, Messé SR, Pandey A, Rong LQ. Considerations for Reduction of Risk of Perioperative Stroke in Adult Patients Undergoing Cardiac and Thoracic Aortic Operations: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e193-e209. [DOI: 10.1161/cir.0000000000000885] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Perioperative stroke is one of the most severe and feared complications of cardiac surgery. Based on the timing of onset and detection, perioperative stroke can be classified as intraoperative or postoperative. The pathogenesis of perioperative stroke is multifactorial, which makes prediction and prevention challenging. However, information on its incidence, mechanisms, diagnosis, and treatment can be helpful in minimizing the perioperative neurological risk for individual patients. We herein provide suggestions on preoperative, intraoperative, and postoperative strategies aimed at reducing the risk of perioperative stroke and at improving the outcomes of patients who experience a perioperative stroke.
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173
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Lansky A, Pietras C, Shah T. Cerebral Embolic Protection: Burden of Proof. JACC Cardiovasc Interv 2020; 13:2156-2158. [PMID: 32972579 DOI: 10.1016/j.jcin.2020.06.030] [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: 06/08/2020] [Accepted: 06/13/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Alexandra Lansky
- Section of Cardiology, Yale School of Medicine, New Haven, Connecticut.
| | - Cody Pietras
- Section of Cardiology, Yale School of Medicine, New Haven, Connecticut
| | - Tayyab Shah
- Section of Cardiology, Yale School of Medicine, New Haven, Connecticut
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174
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Patel NJ, Rodriguez-Paz E, Mhatre AU, Heuser RR. Permanent Carotid Filter Placement and Atrial Fibrillation: An Alternative to Anticoagulation or Left Atrial Appendage Exclusion? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1594-1595. [PMID: 32952081 DOI: 10.1016/j.carrev.2020.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Nachiket J Patel
- University of Arizona College of Medicine, Phoenix, AZ, United States of America; Southwest Cardiovascular Associates, Mesa, AZ, United States of America
| | | | - Ajay U Mhatre
- Vascular Heart and Lung Associates, Mesa, AZ, United States of America
| | - Richard R Heuser
- University of Arizona College of Medicine, Phoenix, AZ, United States of America; Vascular Heart and Lung Associates, Mesa, AZ, United States of America.
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175
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Jhand A, Apala DR, Dhawan R, Katta N, Aronow HD, Daniels MJ, Porter TR, Altin E, Goldsweig AM. Meta-analysis Comparing Transradial Versus Transfemoral Secondary Access in Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 131:74-81. [PMID: 32718554 DOI: 10.1016/j.amjcard.2020.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/21/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022]
Abstract
Up to a quarter of vascular complications during transcatheter aortic valve implantation (TAVI) result from secondary access via the femoral artery (FA). The radial artery (RA) is increasingly used as an alternative to the FA for secondary access in TAVI. Limited data exist on the outcomes of RA secondary access versus FA secondary access. We therefore conducted a systematic review and meta-analysis comparing secondary access sites. PubMed, EMBASE, Scopus, Cochrane library and CINAHL were searched systematically for studies comparing RA and FA as secondary access sites for TAVI. Primary outcomes of interest were vascular complications and major bleeding. Secondary outcomes included all-cause mortality, stroke and myocardial infarction (MI). Risk ratio (RR), standardized mean difference and corresponding 95% confidence intervals (CI) were calculated using a random effects model. Six observational studies comprising 6,373 patients (RA: 1,514, FA: 4,859) met inclusion criteria. Secondary access was utilized for aortography during valve deployment and to manage primary access site complications. Procedural characteristics were similar in both groups. RA was associated with a lower risk of major bleeding (RR: 0.51, 95% CI: 0.40 to 0.64, p <0.00001). No statistically significant difference was observed in the incidence of overall vascular complications, however, the risk of major vascular complications was lower with RA (RR: 0.45, 95% CI: 0.32 to 0.63, p <0.00001). The incidence of stroke and all-cause mortality was lower in RA, whereas no difference was observed in the risk of MI. In conclusion, our meta-analysis suggests that RA secondary access is associated with better outcomes for TAVI than FA.
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Affiliation(s)
- Aravdeep Jhand
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Dinesh Reddy Apala
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Rahul Dhawan
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Natraj Katta
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Herbert D Aronow
- Warren Alpert Medical School, Brown University, and Lifespan Cardiovascular Institute, Providence, Rhode Island
| | - Matthew J Daniels
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Thomas R Porter
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elissa Altin
- Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
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176
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Seeger J, Kapadia SR, Kodali S, Linke A, Wöhrle J, Haussig S, Makkar R, Mehran R, Rottbauer W, Leon M. Rate of peri-procedural stroke observed with cerebral embolic protection during transcatheter aortic valve replacement: a patient-level propensity-matched analysis. Eur Heart J 2020; 40:1334-1340. [PMID: 30590554 DOI: 10.1093/eurheartj/ehy847] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/23/2018] [Accepted: 12/05/2018] [Indexed: 12/22/2022] Open
Abstract
AIMS The role of cerebral embolic protection (CEP) in transcatheter aortic valve replacement (TAVR) remains controversial. Randomized trials have not been powered to demonstrate a reduction in stroke rates. The aim of this patient level pooled analysis was to validate the impact of the dual-filter CEP device (Claret Medical Inc., CA, USA) on peri-procedural stroke in a large number of TAVR patients. METHODS AND RESULTS Patients from the SENTINEL US IDE trial were combined with the CLEAN-TAVI and SENTINEL-Ulm study in a patient level pooled analysis (N = 1306). Propensity score matching was performed to adjust for possible confounders. The primary endpoint was procedural stroke within 72 h post-TAVR according to Valve Academic Research Consortium-2 criteria. The secondary endpoint was the combination of all-cause mortality or all-stroke within 72 h after TAVR. In the propensity-matched population, 533 patients underwent TAVR without CEP and 533 patients underwent TAVR with CEP. TAVR patients without vs. with CEP were similar with respect to baseline characteristics, procedural approach, or valve type. In patients undergoing TAVR with dual-filter CEP, procedural all-stroke was significantly lower compared with unprotected procedures [1.88% vs. 5.44%, odds ratio 0.35, 95% confidence interval (CI) 0.17-0.72, relative risk reduction 65%, P = 0.0028]. In addition, all-cause mortality and all-stroke were significantly lower (2.06% vs. 6.00%, odds ratio 0.34, 95% CI 0.17-0.68, relative risk reduction 66%, P = 0.0013). CONCLUSION Our findings suggest that TAVR with the dual-filter CEP device is associated with a significant lower rate of peri-procedural stroke compared with unprotected procedures. However, randomized trials are still needed to clarify this issue.
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Affiliation(s)
- Julia Seeger
- Department of Internal Medicine II - Cardiology, University of Ulm, Albert-Einstein-Allee 23, Ulm, Germany
| | - Samir R Kapadia
- Cleveland Clinic, Department of Cardiology, Euclid Ave, Cleveland, OH, USA
| | - Susheel Kodali
- Columbia University Medical Centre, 161 Fort Washington Ave, New York, NY, USA
| | - Axel Linke
- Herzzentrum Dresden Universitätsklinik, Fetscherstraße 76, Dresden, Germany
| | - Jochen Wöhrle
- Department of Internal Medicine II - Cardiology, University of Ulm, Albert-Einstein-Allee 23, Ulm, Germany
| | - Stephan Haussig
- Herzzentrum Dresden Universitätsklinik, Fetscherstraße 76, Dresden, Germany
| | - Raj Makkar
- Cedars-Sinai Medical Centre, 8631 W 3rd St, Los Angeles, CA, USA
| | - Roxana Mehran
- Mount Sinai School of Medicine, 1190 5th Avenue, 1 South, New York, NY, USA
| | - Wolfgang Rottbauer
- Department of Internal Medicine II - Cardiology, University of Ulm, Albert-Einstein-Allee 23, Ulm, Germany
| | - Martin Leon
- Columbia University Medical Centre, 161 Fort Washington Ave, New York, NY, USA
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177
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Kidney injury as post-interventional complication of TAVI. Clin Res Cardiol 2020; 110:313-322. [PMID: 32844282 DOI: 10.1007/s00392-020-01732-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/12/2020] [Indexed: 12/17/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an accepted treatment approach of aortic stenosis. In the beginning, this technique was executed in high-risk patients only. Today, intermediate-risk patients are also amenable for TAVI, as long as the transfemoral approach is chosen. Numerous predictors have been identified that could lead to periprocedural complications and are defined by patient co-morbidities as well as being inherent to the technical approach. Although vascular complications and postinterventional paravalvular regurgitation have been minimized over the past years by revised technologies and techniques, there is a prevailing individual risk brought about by the specific pathophysiology of the cardiorenal syndrome.
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178
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Spitzer E, Mylotte D, Lauten A, O'Sullivan CJ. Editorial: TAVI and the Challenges Ahead. Front Cardiovasc Med 2020; 7:149. [PMID: 33062644 PMCID: PMC7477082 DOI: 10.3389/fcvm.2020.00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/16/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ernest Spitzer
- Cardiology Department, Erasmus University Rotterdam, Rotterdam, Netherlands
- Cardialysis, Rotterdam, Netherlands
- *Correspondence: Ernest Spitzer
| | - Darren Mylotte
- Cardiology Department, Galway University Hospital and National University of Ireland Galway, Galway, Ireland
| | - Alexander Lauten
- Cardiology Department, Charité Medical University of Berlin, Berlin, Germany
| | - Crochan J. O'Sullivan
- Cardiology Department, Bon Secours Hospital, Cork, Ireland
- Cardiology Department, University College Cork, Cork, Ireland
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179
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Saji M, Takayama M. Ultrasound carotid artery blood-flow monitoring: A potential game changer in transcatheter aortic valve replacement. J Cardiol 2020; 76:557-558. [PMID: 32819800 DOI: 10.1016/j.jjcc.2020.07.025] [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: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
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Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement: From Computed Tomography to BASILICA. JACC Cardiovasc Interv 2020; 12:1197-1216. [PMID: 31272666 DOI: 10.1016/j.jcin.2019.04.052] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 11/24/2022]
Abstract
Coronary artery obstruction is an uncommon but devastating complication of transcatheter aortic valve replacement (TAVR). Computed tomography appears to be a sensitive but nonspecific predictor of coronary artery obstruction. Transcatheter approaches to prevent and treat coronary artery obstruction, such as "snorkel" stenting, are unsatisfactory because of serious early and late ischemic complications. Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR (BASILICA) is an early-stage transcatheter procedure to prevent coronary artery obstruction. It works by splitting the native or bioprosthetic leaflets so that they splay after TAVR and preserve coronary artery inflow. Because of the paucity of suitable alternatives, there is interest in the BASILICA technique despite its infancy. This tutorial review summarizes current thinking about how to predict and prevent coronary artery obstruction using BASILICA. First, the authors depict the main pathophysiological mechanisms of TAVR-associated coronary artery obstruction, along with the factors thought to contribute to coronary obstruction. Next, the authors provide a step-by-step guide to analyzing pre-procedural computed tomographic findings to assess obstruction risk and, if desirable, to plan BASILICA. Next, the authors describe the mechanisms underlying transcatheter electrosurgery. Finally, they provide step-by-step guidance on how to perform the procedure, along with a required equipment list.
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181
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Matsushita K, Marchandot B, Trimaille A, Kibler M, Heger J, Peillex M, Hess S, Grunebaum L, Reydel A, Kindo M, Hoang MT, Sato C, De Poli F, Leddet P, Ohana M, Jesel L, Ohlmann P, Susen S, Morel O. Paradoxical Increase of Stroke in Patients with Defect of High Molecular Weight Multimers of the von Willebrand Factors following Transcatheter Aortic Valve Replacement. Thromb Haemost 2020; 120:1330-1338. [PMID: 32726854 DOI: 10.1055/s-0040-1713424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Stroke is a major cause of disability after transcatheter aortic valve replacement (TAVR) and stroke prediction models and data are crucially needed. Following TAVR, high molecular weight (HMW) multimers defect of von Willebrand factor (VWF) as assessed by closure time of adenosine diphosphate (CT-ADP) value > 180 seconds is an independent predictor of bleeding events. This study sought to identify predictors of ischemic neurological events in patients who underwent TAVR and the specific impact of HMW multimers defect of VWF. METHODS Patients were prospectively enrolled between November 2012 and May 2018 at our institution. The CT-ADP, a point-of-care measure of hemostasis, was assessed the day before and 24 hours after the procedures. The rate of ischemic stroke and transient ischemic attack (TIA) was recorded up to 30 days after the procedures. RESULTS Of 565 TAVR patients, ischemic stroke/TIA was observed in 21 (3.7%) patients within 30 days. Ischemic stroke/TIA was associated with major/life-threatening bleeding complications (MLBCs) (9 [43%] vs. 88 [16%], p = 0.002) and postprocedure CT-ADP > 180 seconds (10 [48%] vs. 116 [21%], p = 0.01). By multivariate analysis, MLBCs (odds ratio [OR]: 3.58; 95% confidence interval [CI]: 1.45-8.84; p = 0.006) and postprocedure CT-ADP > 180 seconds (OR: 3.38; 95% CI: 1.38-8.25; p = 0.008) were evidenced as independent predictors of ischemic stroke/TIA. CONCLUSION MLBCs and CT-ADP > 180 seconds were identified as predictors for ischemic stroke or TIA. The present study suggests that the defects of HMW multimers of the VWFs may contribute not only to bleeding events but also to thrombotic events.
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Affiliation(s)
- Kensuke Matsushita
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France.,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
| | - Benjamin Marchandot
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Antonin Trimaille
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Marion Kibler
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Joe Heger
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Marilou Peillex
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Sebastien Hess
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Lelia Grunebaum
- Department of Haemostasis, Centre Hospitalier Universitaire, Strasbourg, France
| | - Antje Reydel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Michel Kindo
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Minh Tam Hoang
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Chisato Sato
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Fabien De Poli
- Department of Cardiology, Centre Hospitalier de Haguenau, Haguenau, France
| | - Pierre Leddet
- Department of Cardiology, Centre Hospitalier de Haguenau, Haguenau, France
| | - Mickael Ohana
- Department of Radiology, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Laurence Jesel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France.,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
| | - Patrick Ohlmann
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Sophie Susen
- INSERM U1011 - EGID, Institut Pasteur de Lille, University of Lille, Lille, France.,Hematology Transfusion, CHU Lille, Lille, France
| | - Olivier Morel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France.,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
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Drakopoulou M, Soulaidopoulos S, Oikonomou G, Stathogiannis K, Latsios G, Synetos A, Tousoulis D, Toutouzas K. Novel Perspective for Antithrombotic Therapy in TAVI. Curr Pharm Des 2020; 26:2789-2803. [DOI: 10.2174/1381612826666200413083746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/16/2020] [Indexed: 12/29/2022]
Abstract
:
While surgical aortic valve replacement (SAVR) was for years the only available treatment for symptomatic
aortic stenosis, the introduction of transcatheter aortic valve implantation (TAVI) in 2002 and the improvement
of its technical aspects in the following years, has holistically changed the synchronous therapeutic
approach of aortic valve stenosis. Recent evidence has expanded the indication of TAVI from high to lower surgical
risk populations with symptomatic aortic stenosis. The administration of antithrombotic therapy periprocedurally
and its maintenance after a successful TAVI is crucial for the prevention of complications and affects
postprocedural survival. Randomized controlled trials investigating the appropriate combination and the
duration of antithrombotic treatment after TAVI are for the moment scarce. This review article sheds light on the
underlying pathogenetic mechanisms contributing in periprocedural TAVI thrombotic complications and discuss
the efficacy of current antithrombotic policies as evaluated in randomized trials.
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Affiliation(s)
- Maria Drakopoulou
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - George Oikonomou
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Konstantinos Stathogiannis
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - George Latsios
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Andreas Synetos
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
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183
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Milhorini Pio S, Bax J, Delgado V. How valvular calcification can affect the outcomes of transcatheter aortic valve implantation. Expert Rev Med Devices 2020; 17:773-784. [PMID: 32597265 DOI: 10.1080/17434440.2020.1789456] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction In transcatheter aortic valve implantation (TAVI), assessment of aortic valve calcification is not as standardized as aortic annulus measurement. Aortic valve calcification is important for stable anchoring of the prosthesis to the aortic annulus. However, excessive aortic valve calcification is related to procedural complications. Areas covered This review covers the methods to assess aortic valve calcification and the implications of aortic valve calcium burden for TAVI outcomes. We performed a systematic review of the literature in Pubmed and secondary sources. Furthermore, future perspectives on how to integrate aortic valve calcification assessment in the management of patients with aortic stenosis is discussed. Expert opinion Thorough assessment of the aortic valve and aortic root components including aortic valve calcification is key in the planning of TAVI. Aortic valve calcification load, location and extension are important contributors to paravalvular regurgitation. Asymmetric calcification burden with greater calcification of the left-coronary cusp related to higher need of permanent pacemaker implantation. Patients with moderate and severe left ventricular outflow tract/subannular calcification are more susceptible to aortic annular rupture. Periprocedural dislodgement of calcium form cusps and commissures is one of the main reasons of coronary artery ostial occlusion during transcatheter aortic valve implantation. Abbreviations Ao, aorta; LA, left atrium; LAA, left atrial appendage; LV, left ventricle; LVOT, left ventricular outflow tract; THV, transcatheter heart valve.
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Affiliation(s)
- Stephan Milhorini Pio
- Department of Cardiology, Leiden University Medical Center , Leiden, The Netherlands
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center , Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center , Leiden, The Netherlands
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184
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Haussig S, Linke A, Mangner N. Cerebral Protection Devices during Transcatheter Interventions: Indications, Benefits, and Limitations. Curr Cardiol Rep 2020; 22:96. [PMID: 32651654 PMCID: PMC7351861 DOI: 10.1007/s11886-020-01335-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Purpose of Review Stroke remains a devastating complication of cardiovascular interventions. This review is going to discuss stroke rates and outcomes in different cardiovascular procedures with a highlight on the current evidence for the use of cerebral protection devices (CPD). Recent Findings Depending on the quality of neurological assessment, stroke occurs in up to 9.1% after TAVI, 3.9% after mitral clipping, 3.1% in LAAO patients, 0.4% after PCIs, and 1.8% after catheter ablation. CPDs are available for routine use. They are easy to use in most anatomies, feasible, and safe. Data on clinical impact and stroke reduction from RCTs are still missing. Summary Most evidence for the routine use of CPDs exists in TAVI patients, who are at the highest risk. The PROTECTED TAVI RCT will shed more light on the clinical impact of CPD-use in TAVI patients. In other cardiovascular procedures like mitral clipping, PCIs, and ablation, the current data do not support the routine use of CPDs in these patients.
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Affiliation(s)
- Stephan Haussig
- Herzzentrum Dresden, University Clinic, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Fetscherstr, 76, 01307, Dresden, Germany.
| | - Axel Linke
- Herzzentrum Dresden, University Clinic, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Fetscherstr, 76, 01307, Dresden, Germany
| | - Norman Mangner
- Herzzentrum Dresden, University Clinic, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Fetscherstr, 76, 01307, Dresden, Germany
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185
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Latib A, Rahgozar K. TAVR in Patients With Left Ventricular Thrombus: The Search for a More "Complete" Understanding. JACC Case Rep 2020; 2:1106-1108. [PMID: 34317426 PMCID: PMC8311868 DOI: 10.1016/j.jaccas.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Kusha Rahgozar
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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186
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Goldsweig AM, Aronow HD. Editorial: Cerebral Embolic Protection for TAVR: Don't Let It Go to Your Head. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:723-725. [PMID: 32593597 DOI: 10.1016/j.carrev.2020.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America.
| | - Herbert D Aronow
- Lifespan Cardiovascular Institute and Warren Alpert Medical School of Brown University, Providence, RI, United States of America
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187
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Brain Protection in the Endo-Management of Proximal Aortic Aneurysms. HEARTS 2020. [DOI: 10.3390/hearts1020005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Neurological brain injury (NBI) remains the most feared complication following thoracic endovascular aortic repair (TEVAR), and can manifest as clinically overt stroke and/or more covert injury, detected only on explicit neuropsychological testing. Microembolic signals (MES) detected on transcranial Doppler (TCD) monitoring of the cerebral arteries during TEVAR and the high prevalence and incidence of new ischaemic infarcts on diffusion-weighted magnetic resonance imaging (DW-MRI) suggests procedure-related solid and gaseous cerebral microembolisation to be an important cause of NBI. Any intervention that can reduce the embolic burden during TEVAR may, therefore, help mitigate the risk of stroke and the covert impact of ischaemic infarcts to the function of the brain. This perspective article provides an understanding of the mechanism of stroke and reviews the available evidence regarding potential neuroprotective strategies that target high-risk procedural steps of TEVAR to reduce periprocedural cerebral embolisation.
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188
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Matsuda Y, Nai Fovino L, Giacoppo D, Scotti A, Massussi M, Ueshima D, Sasano T, Fabris T, Tarantini G. Association between surgical risk and 30‐day stroke after transcatheter versus surgical aortic valve replacement: a systematic review and meta‐analysis. Catheter Cardiovasc Interv 2020; 97:E536-E543. [DOI: 10.1002/ccd.29105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/07/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Yuji Matsuda
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
- Department of Cardiovascular Medicine Graduate School of General Medical and Dental Science, Tokyo Medical and Dental University Tokyo Japan
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Daniele Giacoppo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Mauro Massussi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Daisuke Ueshima
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine Graduate School of General Medical and Dental Science, Tokyo Medical and Dental University Tokyo Japan
| | - Tommaso Fabris
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
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189
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Al-Azizi K, Hamandi M, Mack M. Clinical trials of transcatheter aortic valve replacement. Heart 2020; 105:s6-s9. [PMID: 30846518 DOI: 10.1136/heartjnl-2018-313511] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 11/04/2022] Open
Abstract
Transcatheter aortic valve replacement(TAVR) has emerged as an effective treatment option in patients with severe aortic stenosis, in large part due to a robust evidence base generated by a series of randomised controlled trials (RCTs). During the past decade more than 15 000 patients have been randomised worldwide in nine clinical trials, mostly for regulatory approval in the USA, making it one of the most carefully scrutinised medical devices at the time of introduction into clinical practice. Initial trials were performed in inoperable or extreme risk patients compared to medical therapy and demonstrated superiority. Subsequent RCTs compared TAVR to surgical aortic valve replacement in high and intermediate surgical risk patients and TAVR was found to be non-inferior in all studies. RCTs of low surgical risk patients have completed enrolment and 1 year outcomes will be available in early 2019. The details of the trials, trial results, outcomes and remaining clinical questions are summarised in this article.
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Affiliation(s)
- Karim Al-Azizi
- Baylor Scott and White Heart Hospital Plano, Plano, Texas, USA
| | - Mohanad Hamandi
- Baylor Scott and White Heart Hospital Plano, Plano, Texas, USA
| | - Michael Mack
- Baylor Scott and White Heart Hospital Plano, Plano, Texas, USA
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190
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Bruno AG, Santona L, Palmerini T, Taglieri N, Marrozzini C, Ghetti G, Orzalkiewicz M, Galiè N, Saia F. Predicting and improving outcomes of transcatheter aortic valve replacement in older adults and the elderly. Expert Rev Cardiovasc Ther 2020; 18:663-680. [DOI: 10.1080/14779072.2020.1778465] [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] [Indexed: 12/13/2022]
Affiliation(s)
- Antonio Giulio Bruno
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Laura Santona
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Tullio Palmerini
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Nevio Taglieri
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
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191
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Insights on Embolic Protection, Repositioning, and Stroke: A Subanalysis of the RESPOND Study. J Interv Cardiol 2020; 2020:3070427. [PMID: 32518532 PMCID: PMC7251468 DOI: 10.1155/2020/3070427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/12/2020] [Indexed: 11/21/2022] Open
Abstract
RESPOND is a prospective, single-arm study enrolling 1014 transcatheter aortic valve replacement (TAVR) patients. The objective of this analysis is to assess the impact of cerebral embolic protection (CEP) devices and prosthetic valve repositioning on the risk of neurologic complications in patients treated with the fully repositionable Lotus Valve in the RESPOND postmarket study. Valve repositioning and CEP use were at the operators' discretion. Stroke events were adjudicated by an independent medical reviewer. This analysis assessed the baseline differences among patients according to CEP use and valve repositioning and evaluated the neurological complications at 72 hours after TAVR, hospital discharge, and 30-day follow-up. A multivariate analysis was performed to identify the potential predictors of stroke. Of the 996 patients implanted with the Lotus Valve (mean age: 80.8 years, 50.8% female, STS score 6.0 ± 6.9), 92 cases (9.2%) used CEP. The overall rate of acute stroke/transient ischemic attack (TIA) was 3.0% at 72 hours after TAVR. The 72-hour stroke/TIA rate was 1.1% in patients who had CEP and 3.2% in those who did not. Use of CEP was associated with a 2.1% absolute reduction in the risk of acute neurological events (relative risk reduction: 65.6%), although the difference was not statistically significant (p=0.51). Repositioning of the Lotus Valve occurred in 313/996 procedures (31.4%). The 72-hour rate of stroke/TIA was similar in patients who had valve repositioning (2.9%) compared with those who did not (3.1%; p=0.86). The selective use of a CEP device in the RESPOND study was associated with a nonsignificantly lower risk for stroke within 72 hours. The use of the repositioning feature of the Lotus Valve did not increase the stroke risk.
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192
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De Carlo M, Liga R, Migaleddu G, Scatturin M, Spaccarotella C, Fiorina C, Orlandi G, De Caro F, Rossi ML, Chieffo A, Indolfi C, Reimers B, Cosottini M, Petronio AS. Evolution, Predictors, and Neurocognitive Effects of Silent Cerebral Embolism During Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 13:1291-1300. [PMID: 32417094 DOI: 10.1016/j.jcin.2020.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to assess the characteristics, predictors, evolution, and neurocognitive effects of silent cerebral ischemic lesions (SCILs). BACKGROUND Most patients undergoing transcatheter aortic valve replacement (TAVR) develop SCILs detectable on magnetic resonance imaging (MRI). The natural history and clinical relevance of SCILs are not well established. METHODS Cerebral MRI was performed within 7 days before TAVR to assess baseline status and age-related white matter change score. MRI was repeated post-operatively to assess the occurrence, location, number, and dimensions of SCILs. Patients developing SCILs underwent a third MRI examination at 3- to 5-month follow-up. A neurocognitive evaluation was performed before TAVR, at discharge, and at 3-month follow-up. RESULTS Of the 117 patients enrolled, 96 underwent post-procedural MRI; SCILs were observed in 76% of patients, distributed in all vascular territories, with a median number of 2 lesions, a median diameter of 4.5 mm, and a median total volume of 140 mm3. Independent predictors of SCIL occurrence were higher baseline age-related white matter change score and the use of self-expanding or mechanically expanded bioprostheses. Among 47 patients who underwent follow-up MRI, only 26.7% of post-procedural SCILs evolved into gliotic scar. SCIL occurrence was associated with a more pronounced transient neurocognitive decline early after TAVR and with lower recovery at follow-up. CONCLUSIONS SCILs occur in the vast majority of patients undergoing TAVR and are predicted by more diffuse white matter damage at baseline and by the use of non-balloon-expandable prostheses. Although most SCILs disappear within months, their occurrence has a limited but significant impact on neurocognitive function.
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Affiliation(s)
- Marco De Carlo
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Riccardo Liga
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Gianmichele Migaleddu
- Department of Translational Research and New Technologies in Medicine and Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Melania Scatturin
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Carmen Spaccarotella
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Claudia Fiorina
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | - Giovanni Orlandi
- Neurological Clinic, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesco De Caro
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marco L Rossi
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Bernhard Reimers
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - A Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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193
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Messika-Zeitoun D, Al-Atassi T, Labinaz M. Neurocognitive Impact of Silent Cerebral Embolisms After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 13:1301-1302. [PMID: 32417091 DOI: 10.1016/j.jcin.2020.03.042] [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: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Affiliation(s)
| | - Talal Al-Atassi
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marino Labinaz
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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194
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Samarendra P. A Precipitous Decision: Transcatheter Aortic Valve Replacement in Low-Risk Patients. Cardiol Res 2020; 11:200-203. [PMID: 32494331 PMCID: PMC7239588 DOI: 10.14740/cr1062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Padmaraj Samarendra
- Division of Cardiology, Pittsburgh V.A. Medical Center, University of Pittsburgh, Pittsburgh, PA 15260, USA.
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195
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Tham JLM, Adams H, Paleri S, Wright C, Dimitriou J, Newcomb A, MacIsaac AI, Whitbourn RJ, Palmer SC. Clinical outcomes of self-expandable vs. balloon-expandable TAVI for severe aortic stenosis. Acta Cardiol 2020; 75:218-225. [PMID: 30931804 DOI: 10.1080/00015385.2019.1572959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is an established therapy for patients with severe aortic stenosis (AS). There is limited data exploring differences in outcomes post-TAVI SEV vs. BEV. This study compared procedural success and 30-d clinical outcomes self-expandable valves (SEV), vs. balloon-expandable valves (BEV) for patients with severe AS.Methods: Retrospective analysis was undertaken of patients receiving TAVI at St Vincent's Hospital, Melbourne between August 2009 and May 2018. The primary endpoints included procedural success, clinical outcomes and complication rates at 30-d.Results: Out of 151 patients undergoing TAVI, 70 received (46.3%) SEV (Medtronic CoreValve & Evolut-R) and 81 (53.6%) BEV (Edwards SAPIEN-XT & S3). The mean Society of Thoracic Surgery (STS) risk score did not differ between the groups, SEV (83.6 ± 4.9 years, STS 4.4 ± 3.8) compared to BEV (82.3 ± 5.8 years, STS 4.9 ± 4.9). Procedural success was similar SEV 67 (95.7%) vs. BEV 78 (96.3%). Rates of ≥ moderate paravalvular aortic regurgitation (PAR) at 30-d were significantly higher in SEV compared to BEV (6.7 vs. 0.0%; p = .02). SEV patients had higher rates of pacemaker insertion (36.4 vs. 9.5%; p = .001) and stroke rates (12.4 vs. 1.4%; p = .04) compared to BEV patients. The difference in 30-d mortality between the two groups was similar (SEV 4.6% vs. BEV 1.3%; p = .23).Conclusions: This real-world retrospective analysis demonstrates higher rates of ≥ moderate PAR, stroke and pacemaker insertion with SEV compared to BEV at 30 d post-TAVI for severe symptomatic AS.
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Affiliation(s)
| | - Heath Adams
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Sarang Paleri
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Christine Wright
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Jim Dimitriou
- Department of Cardiac Surgery, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Andrew Newcomb
- Department of Cardiac Surgery, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Andrew I. MacIsaac
- Department of Medicine, University of Melbourne, Fitzroy, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Robert J. Whitbourn
- Department of Medicine, University of Melbourne, Fitzroy, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Sonny C. Palmer
- Department of Medicine, University of Melbourne, Fitzroy, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
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196
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Clinical Outcomes of Sentinel Cerebral Protection System Use During Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:717-722. [DOI: 10.1016/j.carrev.2019.04.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/11/2019] [Accepted: 04/19/2019] [Indexed: 11/21/2022]
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197
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Jain P, Jacobs N, Muller DW, Gunalingam B. 1% Aspiration, 99% Perspiration. JACC Case Rep 2020; 2:866-869. [PMID: 34317369 PMCID: PMC8302059 DOI: 10.1016/j.jaccas.2020.03.010] [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: 01/09/2020] [Revised: 02/24/2020] [Accepted: 03/11/2020] [Indexed: 11/25/2022]
Abstract
A 71-year-old man with chronic atrial fibrillation underwent insertion of a left atrial appendage occlusion device. Before release, a large thrombus was noted within the left atrium, attached to the left atrial appendage occluder delivery system. With continuous negative pressure, the device was deployed and thrombus successfully aspirated with no clinical sequelae. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Pankaj Jain
- Address for correspondence: Dr. Pankaj Jain, Cardiology Department, Level 4, Xavier Building, St. Vincent’s Hospital, 390 Victoria Street, Darlinghurst, New South Wales, Australia 2010. @pankajjain185
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198
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Stachel G, Woitek FJ, Crusius L, Haussig S, Kiefer P, Leontyev S, Schlotter F, Spindler A, Höllriegel R, Hommel J, Borger MA, Thiele H, Holzhey D, Linke A, Mangner N. Left-Atrial Appendage Thrombosis in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation. Can J Cardiol 2020; 37:450-457. [PMID: 32450289 DOI: 10.1016/j.cjca.2020.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/25/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Data about the impact of left-atrial appendage thrombosis (LAAT) on early safety and mortality in patients undergoing transfemoral transcatheter aortic valve implantation (TF-TAVI) are scarce. We aimed to investigate the prevalence and predictors of LAAT and the outcome associated with this condition in patients treated by TF-TAVI. METHODS Retrospective data analysis was derived from a prospective single-centre registry comparing patients with and without LAAT regarding early safety at 30 days, according to Valve Academic Research Consortium-2 (VARC-2) and 2-year mortality. RESULTS LAAT was found in 7.6% of the whole cohort (n = 2527) and in 16.6% in those patients with known pre-existing atrial fibrillation (AF cohort, n = 1099). Compared with controls, patients with LAAT were sicker, indicated by a higher Society of Thoracic Surgeons (STS) score and burden of comorbidities. Neither VARC-2-defined early safety at 30 days nor the rate of stroke was different between LAAT and controls in both the whole (early safety: 29.2% vs 24.2%, P = 0.123; stroke: 5.9% vs 4.7%, P = 0.495) and AF cohort (early safety: 29.1% vs 22.9%, P = 0.072; stroke: 5.6% vs 3.3%, P = 0.142). Evaluating the whole cohort in a univariate analysis, the 2-year mortality was significantly higher in LAAT compared with controls (hazard ratio, 1.41; 95% confidence interval, 1.07-1.86; P = 0.014). However, multivariate analysis of the whole cohort and the AF cohort revealed no association between LAAT and 2-year mortality. CONCLUSIONS LAAT was frequent in patients undergoing TF-TAVI- in particular, in patients with histories of AF-but it was not associated with an increase in periprocedural complications and did not predict 2-year mortality.
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Affiliation(s)
- Georg Stachel
- Heart Center Leipzig at the University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - Felix J Woitek
- Herzzentrum Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | - Lisa Crusius
- Heart Center Leipzig at the University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - Stephan Haussig
- Herzzentrum Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | - Philipp Kiefer
- Heart Center Leipzig-University Hospital, Department of Cardiac Surgery, Leipzig, Germany
| | - Sergey Leontyev
- Heart Center Leipzig-University Hospital, Department of Cardiac Surgery, Leipzig, Germany
| | - Florian Schlotter
- Heart Center Leipzig at the University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - Aileen Spindler
- Heart Center Leipzig at the University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - Robert Höllriegel
- Herzzentrum Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | - Jennifer Hommel
- Herzzentrum Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | - Michael A Borger
- Heart Center Leipzig-University Hospital, Department of Cardiac Surgery, Leipzig, Germany
| | - Holger Thiele
- Heart Center Leipzig at the University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - David Holzhey
- Heart Center Leipzig-University Hospital, Department of Cardiac Surgery, Leipzig, Germany
| | - Axel Linke
- Herzzentrum Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | - Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany.
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199
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Sachedina AK, Ajluni SC, Jumean MF. The use of a sentinel cerebral protection system during Impella
CP
removal in a patient with left ventricular thrombus. Catheter Cardiovasc Interv 2020; 96:504-506. [DOI: 10.1002/ccd.28956] [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: 09/07/2019] [Revised: 01/18/2020] [Accepted: 04/25/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Ayaaz K. Sachedina
- Center for Advanced Heart Failure University of Texas Health Science Center of Houston Houston Texas USA
| | - Steven C. Ajluni
- McGovern Medical School The University of Texas Health Science Center at Houston Houston Texas USA
| | - Marwan F. Jumean
- Center for Advanced Heart Failure University of Texas Health Science Center of Houston Houston Texas USA
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200
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Alkhouli M, Alqahtani F, Harris AH, Hohmann SF, Rihal CS. Early Experience With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in the United States. JAMA Intern Med 2020; 180:783-784. [PMID: 32091552 PMCID: PMC7042802 DOI: 10.1001/jamainternmed.2019.6767] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This survey study evaluates the early post–US Food and Drug Administration approval experience with an embolic protection device used during transcatheter aortic valve replacement procedures.
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Affiliation(s)
- Mohamad Alkhouli
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown.,Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Fahad Alqahtani
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown
| | | | - Samuel F Hohmann
- Center for Advanced Analytics and Informatics, Chicago, Illinois.,Department of Health Systems Management, Rush University, Chicago, Illinois
| | - Charanjit S Rihal
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota
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