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Panoulas VF, Francis DP, Ruparelia N, Malik IS, Chukwuemeka A, Sen S, Anderson J, Nihoyannopoulos P, Sutaria N, Hannan EL, Samadashvili Z, D'Errigo P, Schymik G, Mehran R, Chieffo A, Latib A, Presbitero P, Mehilli J, Petronio AS, Morice MC, Tamburino C, Thyregod HGH, Leon M, Colombo A, Mikhail GW. Female-specific survival advantage from transcatheter aortic valve implantation over surgical aortic valve replacement: Meta-analysis of the gender subgroups of randomised controlled trials including 3758 patients. Int J Cardiol 2018; 250:66-72. [PMID: 29169764 DOI: 10.1016/j.ijcard.2017.05.047] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/05/2017] [Accepted: 05/09/2017] [Indexed: 01/09/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) is the first area of interventional cardiology where women are treated as often as men. In this analysis of the gender specific results of randomised controlled trials (RCTs) comparing TAVI with surgical aortic valve replacement (SAVR) we aimed to determine whether gender affects the survival comparison between TAVI and SAVR. We identified all RCTs comparing TAVI versus SAVR for severe AS and reporting 1 and/or 2year survival. Summary odds ratios (ORs) were obtained using a random-effects model. Heterogeneity was assessed using the Q statistic and I2. Four RCTs met the criteria, totalling 3758 patients, 1706 women and 2052 men. Amongst females, TAVI recipients had a significantly lower mortality than SAVR recipients, at 1year (OR 0.68; 95%CI 0.50 to 0.94) and at 2years (OR 0.74; 95%CI 0.58 to 0.95). Amongst males there was no difference in mortality between TAVI and SAVR, at 1year (OR 1.09; 95%CI 0.86 to 1.39) or 2years (OR 1.05; 95%CI 0.85 to 1.3). The difference in treatment effect between genders was significant at both 1year (pinteraction=0.02) and 2years (pinteraction=0.04). In women TAVI has a 26 to 31% lower mortality odds than SAVR. In men, there is no difference in mortality between TAVI and SAVR.
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Affiliation(s)
- Vasileios F Panoulas
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Darrel P Francis
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
| | - Neil Ruparelia
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Iqbal S Malik
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Andrew Chukwuemeka
- Cardiothoracic Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Sayan Sen
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jonathan Anderson
- Cardiothoracic Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Petros Nihoyannopoulos
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nilesh Sutaria
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
| | - Edward L Hannan
- School of Public Health, University at Albany, State University of New York, Albany, NY, USA
| | - Zaza Samadashvili
- School of Public Health, University at Albany, State University of New York, Albany, NY, USA
| | - Paola D'Errigo
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - Gerhard Schymik
- Medical Clinic IV, Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Freiburg, Germany
| | - Roxana Mehran
- Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alaide Chieffo
- Cardiology department, San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Cardiology department, San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Presbitero
- Hemodynamic and Invasive Cardiology Unit, IRCCS Istituto Clinico Humanitas, Milan, Italy
| | - Julinda Mehilli
- Munich University Clinic, Ludwig-Maximilians University, Munich, Germany,; Munich Heart Alliance at Deutsches Zentrum für Herz-Kreislauf-Forschung, Munich, Germany
| | | | - Marie-Claude Morice
- RAMSAY, Génerale de Santé,ICPS, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy; ETNA Foundation, Catania, Italy
| | - Hans G H Thyregod
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Leon
- Columbia University Medical Center, New York, USA
| | - Antonio Colombo
- Cardiology department, San Raffaele Scientific Institute, Milan, Italy
| | - Ghada W Mikhail
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Wernly B, Zappe AK, Unbehaun A, Sinning JM, Jung C, Kim WK, Fichtlscherer S, Lichtenauer M, Hoppe UC, Alushi B, Beckhoff F, Wewetzer C, Franz M, Kretzschmar D, Navarese E, Landmesser U, Falk V, Lauten A. Transcatheter valve-in-valve implantation (VinV-TAVR) for failed surgical aortic bioprosthetic valves. Clin Res Cardiol 2018; 108:83-92. [DOI: 10.1007/s00392-018-1326-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/26/2018] [Indexed: 12/19/2022]
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203
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Zenses AS, Dahou A, Salaun E, Clavel MA, Rodés-Cabau J, Ong G, Guzzetti E, Côté M, De Larochellière R, Paradis JM, Doyle D, Mohammadi S, Dumont É, Chamandi C, Rodriguez-Gabella T, Rieu R, Pibarot P. Haemodynamic outcomes following aortic valve-in-valve procedure. Open Heart 2018; 5:e000854. [PMID: 30018783 PMCID: PMC6045709 DOI: 10.1136/openhrt-2018-000854] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 05/24/2018] [Accepted: 06/13/2018] [Indexed: 11/23/2022] Open
Abstract
Background and objectives Transcatheter aortic valve-in-valve implantation (ViV) has emerged as a valuable technique to treat failed surgical bioprostheses (BPs) in patients with high risk for redo surgical aortic valve replacement (SAVR). Small BP size (≤21 mm), stenotic pattern of degeneration and pre-existing prosthesis–patient mismatch (PPM) have been associated with worse clinical outcomes after ViV. However, no study has evaluated the actual haemodynamic benefit associated with ViV. This study aims to compare haemodynamic status observed at post-ViV, pre-ViV and early after initial SAVR and to determine the factors associated with worse haemodynamic outcomes following ViV, including the rates of high residual gradient and ‘haemodynamic futility’. Methods Early post-SAVR, pre-ViV and post-ViV echocardiographic data of 79 consecutive patients who underwent aortic ViV at our institution were retrospectively analysed. The primary study endpoint was suboptimal valve haemodynamics (SVH) following ViV defined by the Valve Academic Research Consortium 2 as the presence of high residual aortic mean gradient (≥20 mm Hg) and/or at least moderate aortic regurgitation (AR). Haemodynamic futility of ViV was defined as <10 mm Hg decrease in mean aortic gradient and no improvement in AR compared with pre-ViV. Results SVH was found in 61% of patients (57% high residual gradient, 4% moderate AR) after ViV versus 24% early after SAVR. Pre-existing PPM and BP mode of failure by stenosis were independently associated with the primary endpoint (OR: 2.87; 95% CI 1.08 to 7.65; p=0.035 and OR: 3.02; 95% CI 1.08 to 8.42; p=0.035, respectively) and with the presence of high residual gradient (OR: 4.38; 95% CI 1.55 to 12.37; p=0.005 and OR: 5.37; 95% CI 1.77 to 16.30; p=0.003, respectively) following ViV. Criteria of ViV haemodynamic futility were met in 7.6% overall and more frequently in patients with pre-existing PPM and stenotic BP (18.5%) compared with other patients (2.0%). ViV restored haemodynamic function to early post-SAVR level in only 34% of patients. Conclusion Although ViV was associated with significant haemodynamic improvement compared with pre-ViV in >90% of patients, more than half harboured SVH outcome. Furthermore, only one-third of patients had a restoration of valve haemodynamic function to the early post-SAVR level. Pre-existing PPM and stenosis pattern of BP degeneration were the main factors associated with SVH and haemodynamic futility following ViV. These findings provide strong support for the prevention of PPM at the time of initial SAVR and careful preprocedural patient screening.
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Affiliation(s)
- Anne-Sophie Zenses
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada.,IFSTTAR, LBA UMR_T24, Aix-Marseille Univ, Marseille, France
| | - Abdellaziz Dahou
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Erwan Salaun
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | | | | | - Géraldine Ong
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | | | - Mélanie Côté
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | | | | | - Daniel Doyle
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Éric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | | | | | - Régis Rieu
- IFSTTAR, LBA UMR_T24, Aix-Marseille Univ, Marseille, France
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
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204
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Mihos CG, Klassen SL, Yucel E. Sex-Specific Considerations in Women with Aortic Stenosis and Outcomes After Transcatheter Aortic Valve Replacement. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:52. [PMID: 29923126 DOI: 10.1007/s11936-018-0651-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aortic stenosis (AS) is the most common valvular disease in the elderly and is associated with poor outcomes. Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) in high-risk patients. Herein, we describe the gender-related differences in baseline characteristics and pathophysiologic response to severe AS, imaging considerations unique to females, and short- and long-term outcomes after TAVR. Women undergoing TAVR are older and frailer, have less cardiovascular comorbidities, smaller femoral artery size, better left ventricular systolic function, hypertrophied and small left ventricles leading to a higher incidence of paradoxical low-flow low-gradient AS, and a greater prevalence of porcelain aorta, smaller aortic annulus size, and lower coronary ostia heights. Imaging and histopathological data also suggests a sex-related myocardial response to pressure overload from AS. Women experience more vascular complications and blood transfusion requirements, serious procedural complications, and a greater incidence of stroke, but have better long-term outcomes than men. Patient-prosthesis mismatch, which is a concern in patients with a small aortic annulus size undergoing SAVR, has not been problematic with TAVR. The aforementioned findings suggest that TAVR may be preferable for women with severe AS. Further studies are warranted to directly compare TAVR with SAVR in women.
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Affiliation(s)
- Christos G Mihos
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Sheila L Klassen
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA.
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205
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center, New York Presbyterian Hospital.
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206
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Abstract
PURPOSE OF REVIEW Sutureless aortic valve replacement (AVR) has emerged as an alternative to traditional AVR for patients with aortic stenosis who present a higher surgical risk, such as the elderly, or those with small or highly calcified aortic roots. With transcatheter aortic valve implantation - the other major AVR alternative - being used in increasingly lower-risk patients, the place of sutureless valves in the AVR landscape needs to be defined. In this review, we discuss recent data and expert opinion as it pertains to the subject of sutureless AVR. RECENT FINDINGS Several recent studies have evaluated the performance of sutureless valves in a variety of clinical contexts, including minimally invasive operations and high-risk surgical procedures. The optimal surgical technique for sutureless AVR has been refined through the publication of several reports addressing technical considerations. Reduction in operative times represents the main advantage of sutureless valves over conventional surgical prostheses, and the possibility of complete annular decalcification - and hence a reduced incidence of paravalvular leak - is the primary advantage over TAVI. SUMMARY Sutureless valves have emerged as an attractive option for high-risk patients or for complex surgeries where a minimization of bypass time is critical. However, there is limited data regarding long-term outcomes, durability or reoperation.
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207
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Klautz RJM, Kappetein AP, Lange R, Dagenais F, Labrousse L, Bapat V, Moront M, Misfeld M, Zeng C, Sabik Iii JF. Safety, effectiveness and haemodynamic performance of a new stented aortic valve bioprosthesis. Eur J Cardiothorac Surg 2018; 52:425-431. [PMID: 28475690 PMCID: PMC5848807 DOI: 10.1093/ejcts/ezx066] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/07/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We assessed the safety, effectiveness and haemodynamic performance of a new bovine stented aortic valve bioprosthesis (Avalus™). METHODS The PERIGON Pivotal Trial is a prospective, non-randomized, multicentre study. Subjects had symptomatic moderate or severe aortic stenosis or chronic, severe aortic regurgitation. Death, valve-related adverse events (AEs), functional recovery and haemodynamic performance were assessed at discharge, 3-6 months and 1 year. The primary analysis compared 'late' (>30 days post-implant) linearized rates of valve-related thromboembolism, thrombosis, all and major haemorrhage, all and major paravalvular leak (PVL) and endocarditis after implantation with objective performance criteria (OPC) for AEs, in accordance with EN ISO 5840:2009. We hypothesized that the upper 95% confidence bounds of the true linearized AE rates would be ≥ 2 × OPC; rejection of the null hypothesis would demonstrate that these rates were below acceptable rates. The analysis was required to include at least 150 patients followed to 1 year and 400 valve-years. Kaplan-Meier survival analysis was also performed. RESULTS Total number of valve-years was 459.5 (n = 686). Linearized rates were <2 × OPC for death and valve-related thromboembolism, valve thrombosis, all and major PVL, and endocarditis, but ≥2 × OPC for all and major haemorrhage. Survival at 1 year (n = 270) was 96.4%. Patients showed good functional recovery, and haemodynamic performance was within expected range. CONCLUSIONS This analysis demonstrated a good safety profile and clinical effectiveness of the Avalus valve except for bleeding rates. The linearized rates of all and major haemorrhage may be related to long-term anticoagulation for non-valvular indications and the length of follow-up of this cohort. Trial registration NCT02088554 (www.clinicaltrials.gov).
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Affiliation(s)
- Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - A Pieter Kappetein
- Department of Cardio-Thoracic Surgery, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Rüdiger Lange
- German Heart Centre, Technical University of Munich, Munich, Germany
| | - Francois Dagenais
- Deparment of Cardiac Surgery, Québec Heart and Lung Institute, Québec City, Canada
| | - Louis Labrousse
- Department of Cardiac and Vascular Surgery, University Hospital of Bordeaux, Bordeaux, France
| | - Vinayak Bapat
- Department of Cardiothoracic Surgery, St Thomas' Hospital, London, UK
| | - Michael Moront
- Department of Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, OH, USA
| | - Martin Misfeld
- Department of Cardiac Surgery, Leipzig Heart Centre, University Hospital, Leipzig, Germany
| | - Cathy Zeng
- Statistical Services Department, Medtronic, Minneapolis, MN, USA
| | - Joseph F Sabik Iii
- Department of Surgery, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Liu Z, Kidney E, Bem D, Bramley G, Bayliss S, de Belder MA, Cummins C, Duarte R. Transcatheter aortic valve implantation for aortic stenosis in high surgical risk patients: A systematic review and meta-analysis. PLoS One 2018; 13:e0196877. [PMID: 29746546 PMCID: PMC5944928 DOI: 10.1371/journal.pone.0196877] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 04/21/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Symptomatic aortic stenosis has a poor prognosis. Many patients are considered inoperable or at high surgical risk for surgical aortic valve replacement (SAVR), reflecting their age, comorbidities and frailty. The clinical effectiveness and safety of TAVI have not been reviewed systematically for these high levels of surgical risk. This systematic review compares mortality and other important clinical outcomes up to 5 years post treatment following TAVI or other treatment in these risk groups. METHODS A systematic review protocol was registered on the PROSPERO database (CRD42016048396). The Cochrane Library, Centre for Reviews and Dissemination Databases, MEDLINE, EMBASE, and ZETOC were searched from January 2002 to August 2016. Clinical trials or matched studies comparing TAVI with other treatments for AS in patients surgically inoperable or operable at a high risk were included. Data extraction and quality assessment were conducted by two reviewers. Data were pooled using random-effects meta-analysis. The main outcomes were all-cause mortality, efficacy and major complications. RESULTS Three good quality randomised controlled trials (RCTs) were included. Patients' mean age ranged from 83-85 years, around half were female and New York Heart Association (NYHA) functional class III or IV ranged from 83.8% to 94.2% with frequent comorbidities. In 358 surgically inoperable patients from one RCT, TAVI was superior to medical therapy for all-cause mortality at 1 year (hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.36-0.92), 2 years (HR 0.50, 95% CI 0.39-0.65), 3 years (HR 0.53, 95% CI 0.41to 0.68) and 5 years (HR 0.50, 95% CI 0.39-0.65), and NYHA class III or IV at 2 years (TAVI 16.8% (16/95), medical therapy 57.5% (23/40), p<0.001), quality of life and re-hospitalisation. TAVI had higher risks of major bleeding up to 1 year, of stroke up to 3 years (at one year 11.2% versus 5.5%, p = .06; HR at 2 years 2.79, 95% CI 1.25-6.22; HR at 3 years 2.81; 95% CI 1.26-6.26) and of major vascular complication at 3 years (HR 8.27, 95% CI 2.92-23.44). Using the GRADE tool, this evidence was considered to be of moderate quality. In a meta-analysis including 1,494 high risk surgically operable patients from two non-inferiority RCTs TAVI showed no significant differences from SAVR in all-cause mortality at two years (HR 1.03, 95% CI 0.82-1.29) and up to 5 years (HR 0.83, 95% CI 0.83-1.12). There were no statistically significant differences in major vascular complications and myocardial infarction at any time point, discrepant results for major bleeding on variable definitions and no differences in stroke rate at any time point. Using the GRADE tool, this evidence was considered of low quality. CONCLUSIONS Symptomatic aortic stenosis can be lethal without intervention but surgical resection is contraindicated for some patients and high risk for others. We found that all-cause mortality up to 5 years of follow-up did not differ significantly between TAVI and SAVR in patients surgically operable at a high risk, but favoured TAVI over medical therapy in patients surgically inoperable. TAVI is a viable life-extending treatment option in these surgical high risk groups.
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Affiliation(s)
- Zulian Liu
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Elaine Kidney
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Danai Bem
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - George Bramley
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Susan Bayliss
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | | | - Carole Cummins
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Rui Duarte
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
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Workup and Management of Patients With Paradoxical Low-Flow, Low-Gradient Aortic Stenosis. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:49. [DOI: 10.1007/s11936-018-0642-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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210
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Yashima F, Yamamoto M, Tanaka M, Yanagisawa R, Arai T, Shimizu H, Fukuda K, Watanabe Y, Naganuma T, Shirai S, Araki M, Tada N, Yamanaka F, Hayashida K. Transcatheter aortic valve implantation in patients with an extremely small native aortic annulus: The OCEAN-TAVI registry. Int J Cardiol 2018; 240:126-131. [PMID: 28606674 DOI: 10.1016/j.ijcard.2017.01.076] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/08/2016] [Accepted: 01/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has been reported to be advantageous over surgical aortic valve replacement owing to the low incidence of prosthesis-patient mismatch (PPM) and large effective orifice area (EOA). However, data on TAVI for extremely small annuli are limited. The present study aimed to compare post-procedural hemodynamics and morphology between 20-mm and 23-mm Sapien XT (SXT) transcatheter heart valves (THVs) with extremely small annuli (<314mm2). METHODS All patients with severe aortic stenosis treated with TAVI at eight Japanese centers between October 2013 and January 2016 were prospectively included in the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) registry. In the overall cohort of 20-mm (19 patients) and 23-mm SXTs (492 patients) with extremely small annuli, the patient groups were matched one-to-one using propensity scores, and post-procedural echocardiography and multidetector computed tomography data were compared for 18 matched patients from each group (matched cohort). RESULTS In the matched cohort, the mean gradient was higher (15.4±4.1 vs. 12.2±4.8mmHg, p=0.04), EOA was lower (1.22±0.25 vs. 1.44±0.37cm2, p=0.02) and THV area was lower (245.6±19.1 vs. 298.5±33.3mm2, p<0.01) in the 20-mm group than in the 23-mm group. However, all patients in both groups were asymptomatic. Although moderate PPM was more prevalent in the 20-mm group than in the 23-mm group (31.6% vs. 7.9%, p<0.01), the incidence of severe PPM was low and similar between the groups (0% vs. 0.4%, p=1.00) in the overall cohort. CONCLUSION A 20-mm SXT in patients who require a small bioprosthesis leads to favorable short-term outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Motoharu Araki
- Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan
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Miyasaka M, Tada N, Taguri M, Kato S, Enta Y, Otomo T, Hata M, Watanabe Y, Naganuma T, Araki M, Yamanaka F, Shirai S, Ueno H, Mizutani K, Tabata M, Higashimori A, Takagi K, Yamamoto M, Hayashida K. Incidence, Predictors, and Clinical Impact of Prosthesis–Patient Mismatch Following Transcatheter Aortic Valve Replacement in Asian Patients. JACC Cardiovasc Interv 2018; 11:771-780. [DOI: 10.1016/j.jcin.2018.01.273] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/25/2018] [Accepted: 01/30/2018] [Indexed: 11/16/2022]
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Prendergast BD, McConkey HZ. Patient-Prosthesis Mismatch After Aortic Valve Intervention. JACC Cardiovasc Interv 2018; 11:781-783. [DOI: 10.1016/j.jcin.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
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213
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Impact of Annular Size on Outcomes After Surgical or Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2018; 105:1129-1136. [DOI: 10.1016/j.athoracsur.2017.08.059] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 08/11/2017] [Accepted: 08/15/2017] [Indexed: 11/20/2022]
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214
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Ribeiro HB, Lerakis S, Gilard M, Cavalcante JL, Makkar R, Herrmann HC, Windecker S, Enriquez-Sarano M, Cheema AN, Nombela-Franco L, Amat-Santos I, Muñoz-García AJ, Garcia del Blanco B, Zajarias A, Lisko JC, Hayek S, Babaliaros V, Le Ven F, Gleason TG, Chakravarty T, Szeto WY, Clavel MA, de Agustin A, Serra V, Schindler JT, Dahou A, Puri R, Pelletier-Beaumont E, Côté M, Pibarot P, Rodés-Cabau J. Transcatheter Aortic Valve Replacement in Patients With Low-Flow, Low-Gradient Aortic Stenosis. J Am Coll Cardiol 2018; 71:1297-1308. [DOI: 10.1016/j.jacc.2018.01.054] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 11/30/2022]
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215
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Stock S, Lohmann I, Hanke T, Stierle U, Richardt D, Tsvelodub S, Sievers HH. Rest and exercise haemodynamics in patients with one of two stented bioprostheses and in healthy controls with small aortic annuli. Interact Cardiovasc Thorac Surg 2018; 26:425-430. [PMID: 29095979 DOI: 10.1093/icvts/ivx356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/03/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Because bioprosthetic aortic valve replacement remains one of the most frequent cardiac surgical procedures, it is necessary to study patient haemodynamics in more detail. Until now, a few studies assessed haemodynamics during exercise, but none with special regard to small aortic annuli. We compared patients who had the differently designed bioprostheses, Trifecta and Perimount Magna Ease (PME), size ≤ 23 mm, and a healthy control group during rest and exercise. METHODS We determined the mean transvalvular gradient, the effective orifice area (EOA) and the EOA index during rest and exercise using transthoracic echocardiography in 35 patients with the Trifecta (mean age 71.4 years, follow-up 1 year, labelled valve size 21.7 mm), in 16 patients with the PME (mean age 66.2 years, follow-up 2.6 years, labelled valve size 21.6 mm) and in 25 healthy persons. The parameters derived were summarized in a simplified Valve Academic Research Consortium-2 classification to determine prosthetic valve dysfunction. RESULTS When we compared the Trifecta and the PME, a significant superiority of the Trifecta was seen at rest in mean transvalvular gradient (7.96 vs 12.19 mmHg) and EOA (1.57 vs 1.48 cm2), during exercise in all parameters (mean transvalvular gradient 11.06 vs 19.2 mmHg, EOA 1.77 vs 1.26 cm2, EOA index 0.96 vs 0.67 cm2/m2). The Trifecta showed a physiological increase in the EOA index during exercise. Exercise led to a shift to better simplified Valve Academic Research Consortium-2 categories in the Trifecta and to worse in the PME group. CONCLUSIONS This study reveals the haemodynamic superiority of the Trifecta to the PME. Especially in small aortic annuli, this difference might have some relevance for clinical and research issues.
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Affiliation(s)
- Sina Stock
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - Inga Lohmann
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - Thorsten Hanke
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - Ulrich Stierle
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - Doreen Richardt
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - Stanislav Tsvelodub
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - Hans-Hinrich Sievers
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
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216
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Lahori A, Frogel J, Augoustides JG, Patel PA, Vernick WJ, Gutsche JT, Feinman JW, Patel S, Munroe R, MacKay EJ, Weiss SJ, Dwarakanath S, Sheu RD. Aortic Valve Prosthesis-Patient Mismatch in a Patient Undergoing Redo Mitral Valve Replacement for Infective Endocarditis. J Cardiothorac Vasc Anesth 2018; 32:2802-2809. [PMID: 29555388 DOI: 10.1053/j.jvca.2018.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Anna Lahori
- Cardiovascular and Thoracic Section, Department of Anesthesiology, Sheba Medical Center, Tel HaShomer, Israel
| | - Jonathan Frogel
- Cardiovascular and Thoracic Section, Department of Anesthesiology, Sheba Medical Center, Tel HaShomer, Israel
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - William J Vernick
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Saumil Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ray Munroe
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily J MacKay
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sanjay Dwarakanath
- Department of Anesthesiology, School of Medicine, University of Kentucky, Lexington, KY
| | - Richard D Sheu
- Department of Anesthesiology & Pain Medicine, University of Washington Medical Center, Seattle, WA
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Schlömicher M, Taghiyev Z, AlJabery Y, Haldenwang PL, Zumholz M, Sikole M, Useini D, Naraghi H, Moustafine V, Bechtel M, Strauch JT. Rapid deployment aortic valve replacement in a minimal access setting: intermediate clinical and echocardiographic outcomes†. Eur J Cardiothorac Surg 2018; 54:354-360. [DOI: 10.1093/ejcts/ezy023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/07/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Zulfugar Taghiyev
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Yazan AlJabery
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Michael Zumholz
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Magdalena Sikole
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Hamid Naraghi
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Thomas Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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Onishi T, Sengoku K, Ichibori Y, Mizote I, Maeda K, Kuratani T, Sawa Y, Sakata Y. The role of echocardiography in transcatheter aortic valve implantation. Cardiovasc Diagn Ther 2018. [PMID: 29541607 DOI: 10.21037/cdt.2018.01.06] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is an effective and less invasive treatment for the increasing population of individuals with severe aortic stenosis (AS). Echocardiography is crucial in the assessment of AS patients from pre- to post-procedure. Transthoracic echocardiography (TTE) may be used to assess patient suitability for TAVI, as well as evaluate the severity of AS, the aortic valve complex, aortic valve morphology, mitral regurgitation (MR), and left ventricular function. Transesophageal echocardiography (TEE) is usually used as an intra-procedural monitoring tool to provide feedback during the procedure, to assess prosthetic valve function, and to detect complications rapidly before and after balloon aortic valvuloplasty (BAV) or transcatheter heart valve (THV) deployment. In this review, the role of echocardiography in the pre-, intra-, and post-TAVI procedure periods is described in detail.
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Affiliation(s)
- Toshinari Onishi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kaoruko Sengoku
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasuhiro Ichibori
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Isamu Mizote
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koichi Maeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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219
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Bleiziffer S, Erlebach M, Simonato M, Pibarot P, Webb J, Capek L, Windecker S, George I, Sinning JM, Horlick E, Napodano M, Holzhey DM, Petursson P, Cerillo A, Bonaros N, Ferrari E, Cohen MG, Baquero G, Jones TL, Kalra A, Reardon MJ, Chhatriwalla A, Gama Ribeiro V, Alnasser S, Van Mieghem NM, Rustenbach CJ, Schofer J, Garcia S, Zeus T, Champagnac D, Bekeredjian R, Kornowski R, Lange R, Dvir D. Incidence, predictors and clinical outcomes of residual stenosis after aortic valve-in-valve. Heart 2018; 104:828-834. [DOI: 10.1136/heartjnl-2017-312422] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 11/04/2022] Open
Abstract
ObjectiveWe aimed to analyse the incidence of prosthesis–patient mismatch (PPM) and elevated gradients after aortic valve in valve (ViV), and to evaluate predictors and associations with clinical outcomes of this adverse event.MethodsA total of 910 aortic ViV patients were investigated. Elevated residual gradients were defined as ≥20 mm Hg. PPM was identified based on the indexed effective orifice area (EOA), measured by echocardiography, and patient body mass index (BMI). Moderate and severe PPM (cases) were defined by European Association of Cardiovascular Imaging (EACVI) criteria and compared with patients without PPM (controls).ResultsModerate or greater PPM was found in 61% of the patients, and severe in 24.6%. Elevated residual gradients were found in 27.9%. Independent risk factors for the occurrence of lower indexed EOA and therefore severe PPM were higher gradients of the failed bioprosthesis at baseline (unstandardised beta −0.023; 95% CI −0.032 to –0.014; P<0.001), a stented (vs a stentless) surgical bioprosthesis (unstandardised beta −0.11; 95% CI −0.161 to –0.071; P<0.001), higher BMI (unstandardised beta −0.01; 95% CI −0.013 to –0.007; P<0.001) and implantation of a SAPIEN/SAPIEN XT/SAPIEN 3 transcatheter device (unstandardised beta −0.064; 95% CI −0.095 to –0.032; P<0.001). Neither severe PPM nor elevated gradients had an association with VARC II-defined outcomes or 1-year survival (90.9% severe vs 91.5% moderate vs 89.3% none, P=0.44).ConclusionsSevere PPM and elevated gradients after aortic ViV are very common but were not associated with short-term survival and clinical outcomes. The long-term effect of poor post-ViV haemodynamics on clinical outcomes requires further evaluation.
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220
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Cerqueira RJ, Raimundo R, Moreira S, Saraiva FA, Andrade M, Salgueiro E, Almeida J, Amorim MJ, Pinho P, Lourenço AP, Leite-Moreira A. Freedom Solo® versus Trifecta® bioprostheses: clinical and haemodynamic evaluation after propensity score matching†. Eur J Cardiothorac Surg 2018; 53:1264-1271. [DOI: 10.1093/ejcts/ezx472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/23/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rui J Cerqueira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal
| | - Renata Raimundo
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Soraia Moreira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisca A Saraiva
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marta Andrade
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal
| | - Elson Salgueiro
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal
| | - Jorge Almeida
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal
| | - Mário Jorge Amorim
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal
| | - Paulo Pinho
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal
| | - André P Lourenço
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal
- Department of Anaesthesiology, São João Hospital Centre, Porto, Portugal
| | - Adelino Leite-Moreira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal
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221
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Hervault M, Clavel MA. Sex-related Differences in Calcific Aortic Valve Stenosis: Pathophysiology, Epidemiology, Etiology, Diagnosis, Presentation, and Outcomes. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2018. [DOI: 10.1080/24748706.2017.1420273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Maxime Hervault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
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Nakashima M, Watanabe Y. Transcatheter Aortic Valve Implantation in Small Anatomy: Patient Selection and Technical Challenges. Interv Cardiol 2018; 13:66-68. [PMID: 29928310 DOI: 10.15420/icr.2017:28:1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become a standard treatment for severe aortic stenosis. Although this technique has reached relative maturity, further optimisation of patient selection and device implantation is essential to improve prognosis. Smaller body size is a predictor of a challenging TAVI procedure due to specific anatomical difficulty and adverse events including annulus rupture, acute coronary obstruction and vascular complications. A newer generation, lower profile TAVI system is useful for patients with smaller anatomy. Moreover, TAVI is superior to surgical aortic valve replacement in patients with a narrowing annulus because this treatement has a low incidence of prosthesis-patient mismatch.
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Affiliation(s)
- Makoto Nakashima
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
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Hernandez-Vaquero D, Diaz R, Pascual I, Rozado J, De la Hera JM, Leon V, Avanzas P, Martín M, García-Iglesias D, Calvo D, Silva J, Moris C. The Prevalence of Patient-Prosthesis Mismatch Can Be Reduced Using the Trifecta Aortic Prosthesis. Ann Thorac Surg 2018; 105:144-151. [DOI: 10.1016/j.athoracsur.2017.05.076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/20/2017] [Accepted: 05/23/2017] [Indexed: 10/18/2022]
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Role of Echocardiography in Transcatheter Aortic Valve Implantation. Echocardiography 2018. [DOI: 10.1007/978-3-319-71617-6_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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225
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Valve in Valve for Failed Surgical Bioprostheses. JACC Cardiovasc Interv 2018; 11:142-144. [DOI: 10.1016/j.jcin.2017.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/21/2017] [Indexed: 11/20/2022]
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226
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Impact of Pre-Existing Prosthesis-Patient Mismatch on Survival Following Aortic Valve-in-Valve Procedures. JACC Cardiovasc Interv 2018; 11:133-141. [DOI: 10.1016/j.jcin.2017.08.039] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/14/2017] [Accepted: 08/29/2017] [Indexed: 11/20/2022]
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Mechanical Intervention for Aortic Valve Stenosis in Patients With Heart Failure and Reduced Ejection Fraction. J Am Coll Cardiol 2017; 70:3026-3041. [PMID: 29241492 DOI: 10.1016/j.jacc.2017.10.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 12/11/2022]
Abstract
The risk and benefit of mechanical interventions in valvular heart disease have been primarily described among patients with normal ejection fraction. The advent of nonsurgical mechanical interventions for aortic stenosis (transcatheter aortic valve replacement) may alter the risk-benefit ratio for patients who would otherwise be at increased risk for valve surgery. This review describes the epidemiology and pathophysiology of aortic stenosis with heart failure and reduced ejection fraction and summarizes the current registry and clinical trial data applicable to this frequently encountered high-risk group. It concludes with discussion of ongoing trials, new approaches, emerging indications, and a potential clinical algorithm incorporating optimal mechanical intervention for patients with aortic stenosis and concomitant reduced ejection fraction.
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Outcomes in 937 Intermediate-Risk Patients Undergoing Surgical Aortic Valve Replacement in PARTNER-2A. Ann Thorac Surg 2017; 105:1322-1329. [PMID: 29253463 DOI: 10.1016/j.athoracsur.2017.10.062] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 09/27/2017] [Accepted: 10/30/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Placement of Aortic Transcatheter Valves 2A (PARTNER-2A) randomized trial compared outcomes of transfemoral transcatheter and surgical aortic valve replacement (SAVR) in intermediate-risk patients with severe aortic stenosis. The purpose of the present study was to perform an in-depth analysis of outcomes after SAVR in the PARTNER-2A trial. METHODS From January 2012 to January 2014, 937 patients underwent SAVR at 57 centers. Mean age was 82 ± 6.7 years and 55% were men. Less-invasive operations were performed in 140 patients (15%) and concomitant procedures in 198 patients (21%). Major outcomes and echocardiograms were adjudicated by an independent events committee. Follow-up was 94% complete to 2 years. RESULTS Operative mortality was 4.1% (n = 38, Society of Thoracic Surgeons predicted risk of mortality: 5.2% ± 2.3%), observed to expected ratio (O/E) was 0.8, and in-hospital stroke was 5.4% (n = 51), twice expected. Aortic clamp and bypass times were 75 ± 30 minutes and 104 ± 46 minutes, respectively. Patients having severe prosthesis-patient mismatch (n = 260, 33%) had similar survival to patients without (p > 0.9), as did patients undergoing less-invasive SAVR (p = 0.3). Risk factors for death included cachexia (p = 0.004), tricuspid regurgitation (p = 0.01), coronary artery disease (p = 0.02), preoperative atrial fibrillation (p = 0.001), higher white blood cell count (p < 0.0001), and lower hemoglobin (p = 0.0002). CONCLUSIONS In this adjudicated prospective study, SAVR in intermediate-risk patients had excellent results at 2 years. However, there were more in-hospital strokes than expected, most likely attributable to mandatory neurologic assessment after the procedure. No pronounced structural valve deterioration was found during 2-year follow-up. Continued long-term surveillance remains important.
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Patient-prosthesis mismatch in patients treated with transcatheter aortic valve implantation - predictors, incidence and impact on clinical efficacy. A preliminary study. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:281-287. [PMID: 29362569 PMCID: PMC5770857 DOI: 10.5114/aic.2017.71608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/17/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Patient-prosthesis mismatch (PPM) is relatively frequent after surgical aortic valve replacement (SAVR) and negatively impacts prognosis. Aim We sought to determine the frequency and clinical effects of PPM after transcatheter aortic valve implantation (TAVI). Material and methods Overall, 238 patients who underwent TAVI were screened. Moderate PPM was defined as indexed effective orifice area (EOAi) between 0.65 and 0.85 cm2/m2, and severe PPM as < 0.65 cm2/m2. All-cause mortality and the Valve Academic Research Consortium 2 (VARC-2) defined composite of clinical efficacy at 1 year were the primary endpoints. Results Finally, 201 patients were included (mean age: 79.6 ±7.4 years, 52% females). The femoral artery served as the delivery route in 79% and most of the prostheses were self-expanding (68%). Any PPM was present in 48 (24%) subjects, and only 7 (3.5%) had severe PPM. Body surface area (BSA) independently predicted any PPM (OR = 16.9, p < 0.001) whereas post-dilation tended to protect against PPM (OR = 0.46, p = 0.09). All-cause mortality was similar in patients with moderate or severe PPM as compared to those with no PPM (14.6% vs. 14.3% vs. 13.1%, respectively, log-rank p = 0.98). Neither moderate (OR = 1.6, 95% CI: 0.8-3.2, p = 0.16) nor severe PPM (OR = 1.67, 95% CI: 0.36-7.7, p = 0.51) had a significant impact on composite endpoint, or its elements, with the exception of transvalvular pressure gradient > 20 mm Hg. Conclusions Severe PPM after TAVI is rare, can be predicted by larger BSA and does not seem to affect mid-term mortality or composite clinical outcome. Larger studies are needed to find different independent predictors of PPM and elucidate its impact in terms of device durability and long-term clinical efficacy.
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230
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Enríquez-Rodríguez E, Amat-Santos IJ, Jiménez-Quevedo P, Martín-Morquecho I, Tirado-Conte G, Pérez-Vizcayno MJ, Gómez de Diego JJ, Arnold R, Aldazábal A, Rojas P, de Agustín A, Del Trigo M, Gutiérrez H, San Román JA, Macaya C, Nombela-Franco L. Comparison of the Hemodynamic Performance of the Balloon-expandable SAPIEN 3 Versus Self-expandable Evolut R Transcatheter Valve: A Case-matched Study. ACTA ACUST UNITED AC 2017; 71:735-742. [PMID: 29191782 DOI: 10.1016/j.rec.2017.10.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 10/06/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES The SAPIEN 3 (S3) valve and the Medtronic Evolut R (EVR) are second-generation transcatheter valves, designed to further reduce the rate of paravalvular aortic regurgitation (AoR). The aim of this study was to compare the 2 devices in terms of valve performance in a case-matched study with independent echocardiographic analysis. METHODS Of a population of 201 patients who underwent transcatheter aortic valve implantation, 144 patients (S3, n = 80; EVR, n = 64) were matched according to aortic annulus diameter and aortic valve calcium score, as assessed by computed tomography. All echocardiographic examinations collected at baseline and at 1- and 6-month follow-up were centrally analyzed. RESULTS The 2 groups were well balanced in baseline clinical and echocardiographic characteristics. The EVR valve showed a better hemodynamic profile as assessed by peak aortic gradient (EVR 13 ± 7 vs S3 20 ± 10mmHg; P<.001), mean aortic gradient (EVR 7 ± 3 vs S3 11 ± 6mmHg; P<.001), and Doppler velocity index (EVR 0.65±0.15 vs S3 0.51±0.16; P<.001). The rate of moderate-severe or any paravalvular (≥ mild) AoR was higher in the EVR group (11% and 50%) than in the S3 group (2.5% and 21%; P <.05, respectively), with a larger number of paravalvular jets (P <.001). CONCLUSIONS In a case-matched cohort of transcatheter aortic valve implantation patients, the S3 valve was associated with a lower rate of paravalvular AoR but also with a higher residual gradient than the EVR system.
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Affiliation(s)
- Eduardo Enríquez-Rodríguez
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Ignacio J Amat-Santos
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Pilar Jiménez-Quevedo
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Irene Martín-Morquecho
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Gabriela Tirado-Conte
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - María José Pérez-Vizcayno
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - José Juan Gómez de Diego
- Departamento de Imagen Cardiaca, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Roman Arnold
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Andrés Aldazábal
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Paol Rojas
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Alberto de Agustín
- Departamento de Imagen Cardiaca, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - María Del Trigo
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Hipólito Gutiérrez
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José A San Román
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Carlos Macaya
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Luis Nombela-Franco
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
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Liao YB, Li YJ, Jun-Li L, Zhao ZG, Wei X, Tsauo JY, Xiong TY, Xu YN, Feng Y, Chen M. Incidence, Predictors and Outcome of Prosthesis-Patient Mismatch after Transcatheter Aortic Valve Replacement: a Systematic Review and Meta-analysis. Sci Rep 2017; 7:15014. [PMID: 29118326 PMCID: PMC5678180 DOI: 10.1038/s41598-017-15396-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/26/2017] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to investigate the incidence, predictors and outcome of prosthesis-patient mismatch (PPM) following transcatheter aortic valve replacement (TAVR). A total of 30 articles incorporating 4,691 patients were identified. The pooled incidences of overall, moderate and severe PPM following TAVR were 33.0%, 25.0% and 11.0% respectively. Medtronic CoreValve (MCV) had lower incidence of overall (32% vs: 40%, P < 0.0001) and moderate (23% vs 32%, P < 0.0001) than Edwards Sapien (ESV). PPM was associated with a younger age, smaller annulus diameter and lower left ventricular ejection fraction in comparison with those patients without PPM. Post-dilation (OR, 0.51, 95% CI, 0.38 to 0.68, p < 0.001) during TAVR would decrease the incidence of PPM. Although PPM was common after TAVR, no significant differences were observed both in short- and mid-term all-cause mortality (30 day: OR: 1.1, 95% CI, 0.70 to 1.73 and 2 year: OR: 1.01, 95% CI, 0.74 to 1.38) between patients with PPM and those without PPM. In conclusion, despite being common after TAVR, the incidence of PPM was lower than that of surgical aortic valve replacement (SAVR) and decreased with the experience accumulating, and PPM was not seen to impact on short- and mid-term survival, regardless of its magnitude.
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Affiliation(s)
- Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yi-Jian Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Li Jun-Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Zhen-Gang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Jiay-Yu Tsauo
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yuan-Ning Xu
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China.
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China.
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Subramaniam K, Nazarnia S. Prosthesis-patient mismatch - what cardiac anesthesiologists need to know? Ann Card Anaesth 2017; 20:234-242. [PMID: 28393786 PMCID: PMC5408531 DOI: 10.4103/aca.aca_9_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Prosthesis-patient Mismatch (PPM) is not uncommon with an incidence reported up to 70% after aortic valve (AV) replacement. Severe forms of PPM are less common (up to 20%); PPM can lead to increased short- and long-term morbidity and mortality. It is important to discriminate PPM from other forms of prosthetic valve dysfunction. Sometimes, prosthetic valve degenerative disease may coexist with PPM. Echocardiography plays an important role in the prevention and diagnosis of PPM. Preemptive strategies to prevent PPM include insertion of newer generation prosthetic valves with better hemodynamic characteristics, stentless prosthesis, aortic root enlargement to insert a larger prosthesis, aortic homograft, and transcutaneous AV implantation. We present an illustrative case and review the literature on PPM pertinent to anesthesiologists.
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233
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Carnero-Alcázar M, Maroto LC, Cobiella-Carnicer J, Vilacosta I, Nombela-Franco L, Alswies A, Villagrán-Medinilla E, Macaya C. Transcatheter versus surgical aortic valve replacement in moderate and high-risk patients: a meta-analysis. Eur J Cardiothorac Surg 2017; 51:644-652. [PMID: 28007879 DOI: 10.1093/ejcts/ezw388] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/26/2016] [Indexed: 01/27/2023] Open
Abstract
Objectives The evidence of the benefits of transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) for patients of high or intermediate surgical risk is not consistent. We performed a meta-analysis to compare major adverse outcomes after TAVR or SAVR. Methods We searched propensity score matched studies or randomized clinical trials comparing the risks of mortality, stroke, major bleeding, acute renal injury, pacemaker implantation, vascular complications and prostheses haemodynamic performance between TAVR and SAVR in patients with moderate or high risk. Combined odds ratios (ORs), relative risk or mean differences with corresponding 95% confidence intervals (CIs) were calculated using a random effects model. Analyses of sensitivity and publication bias were also conducted. Results We included 5 clinical trials and 37 observational studies, enrolling 20 224 patients (TAVR, n = 9099 and SAVR, n = 11 125). The pooled analysis suggested no differences in early (OR = 1.11, 95% CI 0.9-1.39, P = 0.355) or late mortality (relative risk = 0.91, 95% CI 0.78-1.05, P = 0.194). TAVR was associated with a lower risk of major bleeding (OR = 0.42, 95% CI 0.25-0.69, P < 0.001) and acute kidney injury (OR = 0.51, 95% CI 0.34-0.71) but with an increase in the incidence of pacemaker implantation (OR = 2.31, 95% CI 1.73-3.08) and vascular complications (OR = 4.88, 95% CI 2.84-8.39). Residual aortic regurgitation was more frequent after TAVR (OR= 6.83, 95% CI 4.87-9.6). SAVR prostheses were associated with poor trans-prosthetic gradients (mean difference: -2.4 mmHg, 95% CI - 3.27 to - 1.53). Conclusions TAVR and SAVR have similar short and long-term all-cause mortality and risk of stroke among patients of moderate or high surgical risk. TAVR decreases the risk of major bleeding, acute kidney injury and improves haemodynamic performance compared with SAVR but increases the risk of vascular complications, the need for a pacemaker and residual aortic regurgitation.
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Affiliation(s)
| | - Luis Carlos Maroto
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Isidre Vilacosta
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Ali Alswies
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Carlos Macaya
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
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Ochiai T, Saito S, Yamanaka F, Shishido K, Tanaka Y, Yamabe T, Shirai S, Tada N, Araki M, Naganuma T, Watanabe Y, Yamamoto M, Hayashida K. Renin–angiotensin system blockade therapy after transcatheter aortic valve implantation. Heart 2017; 104:644-651. [DOI: 10.1136/heartjnl-2017-311738] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 01/29/2023] Open
Abstract
ObjectiveThe persistence of left ventricular (LV) hypertrophy is associated with poor clinical outcomes after transcatheter aortic valve implantation (TAVI) for aortic stenosis. However, the optimal medical therapy after TAVI remains unknown. We investigated the effect of renin−angiotensin system (RAS) blockade therapy on LV hypertrophy and mortality in patients undergoing TAVI.MethodsBetween October 2013 and April 2016, 1215 patients undergoing TAVI were prospectively enrolled in the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI registry. This cohort was stratified according to the postoperative usage of RAS blockade therapy with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs). Patients with at least two prescriptions dispensed 180 days apart after TAVI and at least a 6-month follow-up constituted the RAS blockade group (n=371), while those not prescribed any ACE inhibitors or ARBs after TAVI were included in the no RAS blockade group (n=189).ResultsAt 6 months postoperatively, the RAS blockade group had significantly greater LV mass index regression than the no RAS blockade group (−9±24% vs −2±25%, p=0.024). Kaplan-Meier analysis revealed a significantly lower cumulative 2-year mortality in the RAS blockade than that in the no RAS blockade group (7.5% vs 12.5%; log-rank test, p=0.031). After adjusting for confounding factors, RAS blockade therapy was associated with significantly lower all-cause mortality (HR, 0.45; 95% CI 0.22 to 0.91; p=0.025).ConclusionsPostoperative RAS blockade therapy is associated with greater LV mass index regression and reduced all-cause mortality. These data need to be confirmed by a prospective randomised controlled outcome trial.
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235
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Short-Term Outcome and Hemodynamic Performance of Next-Generation Self-Expanding Versus Balloon-Expandable Transcatheter Aortic Valves in Patients With Small Aortic Annulus. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005013. [DOI: 10.1161/circinterventions.117.005013] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 08/22/2017] [Indexed: 01/30/2023]
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236
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Al-Hawwas M, Marmagkiolis K, Mehta JL. The Impact of Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement on Left Ventricular Remodeling. Am J Cardiol 2017; 120:1198-1202. [PMID: 28823482 DOI: 10.1016/j.amjcard.2017.06.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/01/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) appears to be equivalent to surgical aortic valve replacement (SAVR) with regard to clinical end points in high-risk and intermediate risk patients. Major landmark trials, such as Placement of Aortic Transcatheter Valves (PARTNER) trials 1 and 2 and US CoreValve show similar hemodynamic responses and left ventricular remodeling after both procedures. Real-life nonrandomized studies, however, suggest that TAVI may result in a somewhat better hemodynamic response and, therefore, a more favorable left ventricular remodeling than after SAVR for the first few years of follow-up. Further, there are fewer cases of prosthesis patient mismatch and more cases of paravalvular leak and conduction system abnormalities that affect the left ventricular remodeling process with TAVI than with SAVR. Overall, TAVI may be considered superior to SAVR in high-risk patients whose clinical outcome depends on a favorable remodeling process.
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237
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Bagur R, Pibarot P, Otto CM. Importance of the valve durability-life expectancy ratio in selection of a prosthetic aortic valve. Heart 2017; 103:1756-1759. [DOI: 10.1136/heartjnl-2017-312348] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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238
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Pislaru SV, Nkomo VT. Hybrid Imaging to Assess Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement: In Search of Validation. JACC Cardiovasc Interv 2017; 10:1588-1590. [PMID: 28734890 DOI: 10.1016/j.jcin.2017.06.017] [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: 06/08/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Sorin V Pislaru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
| | - Vuyisile T Nkomo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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239
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Meucci F, Stefàno P, Di Mario C. Unlike for PCI, for TAVR smaller is better. Int J Cardiol 2017; 240:157-158. [PMID: 28606675 DOI: 10.1016/j.ijcard.2017.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Francesco Meucci
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Pierluigi Stefàno
- Cardiovascular Surgery, University Hospital Careggi, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy.
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240
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CT-Defined Prosthesis–Patient Mismatch Downgrades Frequency and Severity, and Demonstrates No Association With Adverse Outcomes After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2017; 10:1578-1587. [DOI: 10.1016/j.jcin.2017.05.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 12/21/2022]
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241
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Saybolt MD, Fiorilli PN, Gertz ZM, Herrmann HC. Low-Flow Severe Aortic Stenosis. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.004838. [DOI: 10.1161/circinterventions.117.004838] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/03/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Matthew D. Saybolt
- From the Departments of Medicine of the University of Pennsylvania, Philadelphia (M.D.S., P.N.F., H.C.H.) and Virginia Commonwealth University, Richmond (Z.M.G.)
| | - Paul N. Fiorilli
- From the Departments of Medicine of the University of Pennsylvania, Philadelphia (M.D.S., P.N.F., H.C.H.) and Virginia Commonwealth University, Richmond (Z.M.G.)
| | - Zachary M. Gertz
- From the Departments of Medicine of the University of Pennsylvania, Philadelphia (M.D.S., P.N.F., H.C.H.) and Virginia Commonwealth University, Richmond (Z.M.G.)
| | - Howard C. Herrmann
- From the Departments of Medicine of the University of Pennsylvania, Philadelphia (M.D.S., P.N.F., H.C.H.) and Virginia Commonwealth University, Richmond (Z.M.G.)
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242
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Airhart S, Medvedev I, Dean LS. Relative prosthesis-patient mismatch after transcatheter aortic valve replacement: The impact of morbid obesity. Catheter Cardiovasc Interv 2017; 90:341-345. [PMID: 27566959 DOI: 10.1002/ccd.26721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 05/10/2016] [Accepted: 07/27/2016] [Indexed: 11/06/2022]
Abstract
Prosthesis-patient mismatch (PPM) is defined as a small effective orifice area (EOA) of a normally functioning prosthetic valve in relation to patient body size. Even moderate impediment to forward flow has been associated with an increase in all-cause mortality. We report an unusual cause of PPM where a transcatheter implantation of a large EOA valve in an aortic position results in relative PPM in a patient with morbid obesity. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Sophia Airhart
- Division of Cardiology of the University of Washington School of Medicine, Seattle, WA
| | - Ivan Medvedev
- Division of Cardiology of the University of Washington School of Medicine, Seattle, WA
| | - Larry S Dean
- Division of Cardiology of the University of Washington School of Medicine, Seattle, WA
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243
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Webb JG, Mack MJ, White JM, Dvir D, Blanke P, Herrmann HC, Leipsic J, Kodali SK, Makkar R, Miller DC, Pibarot P, Pichard A, Satler LF, Svensson L, Alu MC, Suri RM, Leon MB. Transcatheter Aortic Valve Implantation Within Degenerated Aortic Surgical Bioprostheses: PARTNER 2 Valve-in-Valve Registry. J Am Coll Cardiol 2017; 69:2253-2262. [PMID: 28473128 DOI: 10.1016/j.jacc.2017.02.057] [Citation(s) in RCA: 240] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/28/2017] [Accepted: 02/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early experience with transcatheter aortic valve replacement (TAVR) within failed bioprosthetic surgical aortic valves has shown that valve-in-valve (VIV) TAVR is a feasible therapeutic option with acceptable acute procedural results. OBJECTIVES The authors examined 30-day and 1-year outcomes in a large cohort of high-risk patients undergoing VIV TAVR. METHODS Patients with symptomatic degeneration of surgical aortic bioprostheses at high risk (≥50% major morbidity or mortality) for reoperative surgery were prospectively enrolled in the multicenter PARTNER (Placement of Aortic Transcatheter Valves) 2 VIV trial and continued access registries. RESULTS Valve-in-valve procedures were performed in 365 patients (96 initial registry, 269 continued access patients). Mean age was 78.9 ± 10.2 years, and mean Society of Thoracic Surgeons score was 9.1 ± 4.7%. At 30 days, all-cause mortality was 2.7%, stroke was 2.7%, major vascular complication was 4.1%, conversion to surgery was 0.6%, coronary occlusion was 0.8%, and new pacemaker insertion was 1.9%. One-year all-cause mortality was 12.4%. Mortality fell from the initial registry to the subsequent continued access registry, both at 30 days (8.2% vs. 0.7%, respectively; p = 0.0001) and at 1 year (19.7% vs. 9.8%, respectively; p = 0.006). At 1 year, mean gradient was 17.6 mm Hg, and effective orifice area was 1.16 cm2, with greater than mild paravalvular regurgitation of 1.9%. Left ventricular ejection fraction increased (50.6% to 54.2%), and mass index decreased (135.7 to 117.6 g/m2), with reductions in both mitral (34.9% vs. 12.7%) and tricuspid (31.8% vs. 21.2%) moderate or severe regurgitation (all p < 0.0001). Kansas City Cardiomyopathy Questionnaire score increased (mean: 43.1 to 77.0) and 6-min walk test distance results increased (mean: 163.6 to 252.3 m; both p < 0.0001). CONCLUSIONS In high-risk patients, TAVR for bioprosthetic aortic valve failure is associated with relatively low mortality and complication rates, improved hemodynamics, and excellent functional and quality-of-life outcomes at 1 year. (The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves [PARTNER II]; NCT01314313).
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Affiliation(s)
- John G Webb
- Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor Scott and White Health, Plano, Texas
| | - Jonathon M White
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Danny Dvir
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Howard C Herrmann
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathon Leipsic
- Department of Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Susheel K Kodali
- Structural Heart and Valve Center, Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Raj Makkar
- Heart Institute, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - D Craig Miller
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Philippe Pibarot
- Department of Medicine, Laval University, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Augusto Pichard
- Division of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC
| | - Lowell F Satler
- Division of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC
| | - Lars Svensson
- Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Maria C Alu
- Structural Heart and Valve Center, Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Rakesh M Suri
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Martin B Leon
- Structural Heart and Valve Center, Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center, New York, New York
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Abstract
Patients with inoperable, high-risk, and intermediate-risk aortic stenosis can now be treated with transcatheter aortic valve replacement. Centers for Medicare and Medicaid Services and the Food and Drug Administration selectively choose centers based on experience and require a collaborative, multidisciplinary team approach in the treatment and decision making for these patients. The work-up has been streamlined. Gated multislice computed tomography angiogram has emerged as the gold standard for assessment of valve anatomy and sizing of the transcatheter heart valve. Assessment of risk has evolved to include a more comprehensive functional and frailty evaluation. Long term-results are needed before the expansion of transcatheter aortic valve replacement into the low-risk category.
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Affiliation(s)
- John H Braxton
- Structural Heart Services, Marshfield Clinic, Saint Joseph Hospital, 1000 North Oak Avenue, Section 2C2, Marshfield, WI 54449, USA.
| | - Kelly S Rasmussen
- Structural Heart Services, Department of Cardiology, Marshfield Clinic, Saint Joseph Hospital, 1000 North Oak Avenue, Section 2C2, Marshfield, WI 54449, USA
| | - Milind S Shah
- Structural Heart Services, Section of Cardiology, Marshfield Clinic, Saint Joseph Hospital, 1000 North Oak Avenue, Section 2C2, Marshfield, WI 54449, USA
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245
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Foroutan F, Guyatt GH, Otto CM, Siemieniuk RA, Schandelmaier S, Agoritsas T, Vandvik PO, Bhagra S, Bagur R. Structural valve deterioration after transcatheter aortic valve implantation. Heart 2017; 103:1899-1905. [DOI: 10.1136/heartjnl-2017-311329] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/17/2017] [Accepted: 05/03/2017] [Indexed: 11/03/2022] Open
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246
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A meta-analysis of effects of transcatheter versus surgical aortic valve replacement on left ventricular ejection fraction and mass. Int J Cardiol 2017; 238:31-36. [DOI: 10.1016/j.ijcard.2017.03.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 03/21/2017] [Accepted: 03/24/2017] [Indexed: 11/19/2022]
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247
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Early Hemodynamic Results in Patients with Small Aortic Annulus after Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:254-258. [DOI: 10.1097/imi.0000000000000380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective Patients with a small aortic annulus (≤21 mm) have an increased risk of patient-prosthesis mismatch after valve replacement. The aim of this study was to compare the early hemodynamic performance of the balloon-expandable transaortic valve implantation Edwards system (SAPIEN) and the sutureless Perceval prostheses. Methods Fifty patients underwent transcatheter aortic valve implantation, and 113 patients underwent sutureless aortic valve replacement. Mean ± SD aortic annulus diameter was 19.7 ± 1 mm, with no significant difference between groups. SAPIEN valve size was 23 mm in 40 patients (80%) and 26 mm in 10 patients (20%). Perceval valve size was small in 45 patients (40%), medium in 62 patients (55%), and large in 6 patients (5%). Transthoracic Doppler echocardiographic images were collected at baseline and before discharge. Results There were no significant difference in predischarge effective orifice area (SAPIEN: 1.5 ± 0.5 cm2 and Perceval: 1.48 ± 0.34 cm2, P = 0.58) and indexed effective orifice areas (SAPIEN: 0.93 ± 0.32 cm2/m2 and Perceval: 0.88 ± 0.22 cm2/m2, P = 0.42). Predischarge mean ± SD transaortic gradient was lower with the SAPIEN than with Perceval valves (12 ± 6 and 17 ± 6 mm Hg, respectively, P < 0.001). Rates of moderate and severe prosthesis-patient mismatch were similar (SAPIEN: 44% and 10% and Perceval: 50% and 14%, P = 0.53 and 0.75, respectively). There were no moderate-severe paravalvular leaks. Conclusions Although indexed effective orifice areas were similar, transcatheter aortic valve implantation with the balloon-expandable SAPIEN system yielded lower predischarge transaortic mean gradients than the surgically implanted Perceval, in patients with a small annulus.
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Olivier Dionne P, Poulin F, Bouchard D, Généreux P, Ibrahim R, Cartier R, Lamarche Y, Demers P. Early Hemodynamic Results in Patients with Small Aortic Annulus after Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Pierre Olivier Dionne
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC Canada
| | - Frédéric Poulin
- Department of Cardiology, Hôpital Sacré-Coeur de Montréal, Montreal, QC Canada
| | - Denis Bouchard
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC Canada
| | - Philippe Généreux
- Department of Cardiology, Hôpital Sacré-Coeur de Montréal, Montreal, QC Canada
| | - Reda Ibrahim
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC Canada
| | - Raymond Cartier
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC Canada
| | - Yoan Lamarche
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC Canada
| | - Philippe Demers
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC Canada
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Lindman BR, Otto CM, Douglas PS, Hahn RT, Elmariah S, Weissman NJ, Stewart WJ, Ayele GM, Zhang F, Zajarias A, Maniar HS, Jilaihawi H, Blackstone E, Chinnakondepalli KM, Tuzcu EM, Leon MB, Pibarot P. Blood Pressure and Arterial Load After Transcatheter Aortic Valve Replacement for Aortic Stenosis. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.006308. [DOI: 10.1161/circimaging.116.006308] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/15/2017] [Indexed: 11/16/2022]
Abstract
Background—
After aortic valve replacement, left ventricular afterload is often characterized by the residual valve obstruction. Our objective was to determine whether higher systemic arterial afterload—as reflected in blood pressure, pulsatile and resistive load—is associated with adverse clinical outcomes after transcatheter aortic valve replacement (TAVR).
Methods and Results—
Total, pulsatile, and resistive arterial load were measured in 2141 patients with severe aortic stenosis treated with TAVR in the PARTNER I trial (Placement of Aortic Transcatheter Valve) who had systolic blood pressure (SBP) and an echocardiogram obtained 30 days after TAVR. The primary end point was 30-day to 1-year all-cause mortality. Lower SBP at 30 days after TAVR was associated with higher mortality (20.0% for SBP 100–129 mm Hg versus 12.0% for SBP 130–170 mm Hg;
P
<0.001). This association remained significant after adjustment, was consistent across subgroups, and confirmed in sensitivity analyses. In adjusted models that included SBP, higher total and pulsatile arterial load were associated with increased mortality (
P
<0.001 for all), but resistive load was not. Patients with low 30-day SBP and high pulsatile load had a 3-fold higher mortality than those with high 30-day SBP and low pulsatile load (26.1% versus 8.1%; hazard ratio, 3.62; 95% confidence interval, 2.36–5.55).
Conclusions—
Even after relief of valve obstruction in patients with aortic stenosis, there is an independent association between post-TAVR blood pressure, systemic arterial load, and mortality. Blood pressure goals in patients with a history of aortic stenosis may need to be redefined. Increased pulsatile arterial load, rather than blood pressure, may be a target for adjunctive medical therapy to improve outcomes after TAVR.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00530894
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Affiliation(s)
- Brian R. Lindman
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Catherine M. Otto
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Pamela S. Douglas
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Rebecca T. Hahn
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Sammy Elmariah
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Neil J. Weissman
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - William J. Stewart
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Girma M. Ayele
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Feifan Zhang
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Alan Zajarias
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Hersh S. Maniar
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Hasan Jilaihawi
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Eugene Blackstone
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Khaja M. Chinnakondepalli
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - E. Murat Tuzcu
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Martin B. Leon
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Philippe Pibarot
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
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George I, Guglielmetti LC, Bettinger N, Moss A, Wang C, Kheysin N, Hahn R, Kodali S, Leon M, Bapat V, Borger MA, Williams M, Smith C, Khalique OK. Aortic Valve Annular Sizing: Intraoperative Assessment Versus Preoperative Multidetector Computed Tomography. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005968. [PMID: 28487320 DOI: 10.1161/circimaging.116.005968] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/09/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Appropriate valve sizing is critical in aortic valve replacement. We hypothesized that direct intraoperative valve sizing results in smaller aortic annular diameters compared with sizing based on systolic-phase multidetector computerized tomographic (MDCT) imaging. METHODS AND RESULTS We retrospectively analyzed 78 patients undergoing surgical aortic valve replacement for severe aortic stenosis between 2012 and 2014 at our institution. Preoperative MDCT measurements of the aortic annulus served as basis for assignment to a theoretical surgical valve size, which was then (1) compared to the implanted valve size and (2) to a theoretical transcatheter aortic valve replacement valve size. To quantify the resulting differences, geometric orifice areas (GOA) were calculated. MDCT-based sizing produced the same valve size for n=34 patients (group CT-same), a larger valve with a 25% increased GOA in n=32 patients (group CT-Lg) and a smaller GOA by 22% in n=12 patients (group CT-Sm). On the basis of MDCT measurements, 41% of valves implanted were undersized. The comparison of intraoperative implanted to a theoretical transcatheter aortic valve replacement valve size resulted in GOAs 25% larger for patients in group CT-same, 40.6% larger in group CT-Lg and 14.6% larger in group CT-Sm. CONCLUSIONS Preoperative MDCT measurements differ substantially from direct intraoperative assessment of the aortic annulus. Implanted surgical aortic valve replacement valves were smaller relative to MDCT-based sizing in 41% of patients, and the potential GOA was between 25% and 40.6% larger if patients had undergone transcatheter aortic valve replacement.
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Affiliation(s)
- Isaac George
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.).
| | - Laura C Guglielmetti
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Nicolas Bettinger
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Andrew Moss
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Catherine Wang
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Nathan Kheysin
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Rebecca Hahn
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Susheel Kodali
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Martin Leon
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Vinayak Bapat
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Michael A Borger
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Mathew Williams
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Craig Smith
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Omar K Khalique
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
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