201
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Regueiro A, Abdul-Jawad Altisent O, Del Trigo M, Campelo-Parada F, Puri R, Urena M, Philippon F, Rodés-Cabau J. Impact of New-Onset Left Bundle Branch Block and Periprocedural Permanent Pacemaker Implantation on Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2016; 9:e003635. [DOI: 10.1161/circinterventions.115.003635] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/21/2016] [Indexed: 11/16/2022]
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202
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Figulla HR, Webb JG, Lauten A, Feldman T. The transcatheter valve technology pipeline for treatment of adult valvular heart disease. Eur Heart J 2016; 37:2226-39. [PMID: 27161617 DOI: 10.1093/eurheartj/ehw153] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 03/17/2016] [Indexed: 12/17/2022] Open
Abstract
The transcatheter valve technology pipeline has started as simple balloon valvuloplasty for the treatment of stenotic heart valves and evolved since the year 2000 to either repair or replace heart valves percutaneously with multiple devices. In this review, the present technology and its application are illuminated and a glimpse into the near future is dared from a physician's perspective.
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Affiliation(s)
- Hans R Figulla
- Universitätsklinikum Jena, Friedrich Schiller Universität Jena, Jena, Germany
| | - John G Webb
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Lauten
- Charité-Universitaetsmedizin Berlin, Department of Cardiology Berlin, Campus Benjamin Franklin, Germany
| | - Ted Feldman
- Cardiology Division, NorthShore University HealthSystem Evanston, Evanston, USA
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203
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Renilla A, Rubín JM, Morís C. Timing of Pacemaker Implantation After Percutaneous Aortic Valve Replacement. ACTA ACUST UNITED AC 2016; 69:630-1. [PMID: 27129393 DOI: 10.1016/j.rec.2016.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/19/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Alfredo Renilla
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | - José M Rubín
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - César Morís
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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204
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Condado JF, Block PC. Will Transcatheter Aortic Valve Replacement (TAVR) be the Primary Therapy for Aortic Stenosis? CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2016. [DOI: 10.15212/cvia.2016.0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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205
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Ruparelia N, Latib A, Buzzatti N, Giannini F, Figini F, Mangieri A, Regazzoli D, Stella S, Sticchi A, Kawamoto H, Tanaka A, Agricola E, Monaco F, Castiglioni A, Ancona M, Cioni M, Spagnolo P, Chieffo A, Montorfano M, Alfieri O, Colombo A. Long-Term Outcomes After Transcatheter Aortic Valve Implantation from a Single High-Volume Center (The Milan Experience). Am J Cardiol 2016; 117:813-9. [PMID: 26742477 DOI: 10.1016/j.amjcard.2015.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/03/2015] [Accepted: 12/03/2015] [Indexed: 12/20/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is now the treatment of choice for patients with symptomatic aortic stenosis who are inoperable or with high surgical risk. Data with regards to contemporary clinical practice and long-term outcomes are sparse. To evaluate temporal changes in TAVI practice and explore procedural and long-term clinical outcomes of patients in a contemporary "real-world" population, outcomes of 829 patients treated from November 2007 to May 2015, at the San Raffaele Scientific Institute, Milan, Italy, were retrospectively analyzed. Median follow-up was 568 days, with the longest follow-up of 2,677 days. Overall inhospital mortality was 3.5%. During the study period, there was a trend toward treating younger, lower risk patients. Overall mortality rates were 3.5% (30 days), 14% (1 year), 22% (2 years), 29% (3 years), 37% (4 years), 47% (5 years), 53% (6 years), and 72% (7 years). The survival probability at 5 years was significantly higher in patients treated through the transfemoral (TF) route compared to other vascular access sites (log rank p <0.001). Non-TF vascular access and residual paravalvular leak ≥2 (after TAVI) were identified as independent predictors for both all-cause and cardiovascular mortality. No patient required further aortic valve intervention for TAVI prosthesis degeneration. In conclusion, there is a trend toward treating younger, lower-risk patients. Non-TF vascular access approach and ≥2 PVL after TAVI were identified as independent predictors for both overall and cardiovascular mortality with no cases of prosthesis degeneration suggesting acceptable durability.
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206
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Massoullié G, Bordachar P, Ellenbogen KA, Souteyrand G, Jean F, Combaret N, Vorilhon C, Clerfond G, Farhat M, Ritter P, Citron B, Lusson JR, Motreff P, Ploux S, Eschalier R. New-Onset Left Bundle Branch Block Induced by Transcutaneous Aortic Valve Implantation. Am J Cardiol 2016; 117:867-73. [PMID: 26742470 DOI: 10.1016/j.amjcard.2015.12.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/01/2015] [Accepted: 12/01/2015] [Indexed: 11/17/2022]
Abstract
New-onset left bundle branch block (LBBB) is a specific concern of transcutaneous aortic valve implantation (TAVI) given its estimated incidence ranging from 5% to 65%. This high rate of occurrence is dependent on the type of device used (size and shape), implantation methods, and patient co-morbidities. The appearance of an LBBB after TAVI reflects a very proximal lesion of the left bundle branch as it exits the bundle of His. At times transient, its persistence can lead to permanent pacemaker implantation in 15% to 20% of cases, most often for high-degree atrioventricular block. The management of LBBB after TAVI is currently not defined by international societies resulting in individual centers developing their own management strategy. The potential consequences of LBBB are dysrhythmias (atrioventricular block, syncope, and sudden death) and functional (heart failure) complications. Prompt postprocedural recognition and management (permanent pacemaker implantation) of patients prevents the occurrence of potential complications and may constitute the preferred approach in this frail and elderly population despite additional costs and complications of cardiac pacing. Moreover, the expansion of future indications for TAVI necessitates better identification of the predictive factors for the development of LBBB. Indeed, long-term right ventricular pacing may potentially increase the risk of developing heart failure in this population. In conclusion, it is thus imperative to not only develop new aortic prostheses with a less-deleterious impact on the conduction system but also to prescribe appropriate pacing modes in this frail population.
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Affiliation(s)
- Grégoire Massoullié
- Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), Clermont-Ferrand, France; Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Kenneth A Ellenbogen
- VCU Pauley Heart Center, Medical College of Virginia/VCU School of Medicine, Richmond, Virginia
| | - Géraud Souteyrand
- Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), Clermont-Ferrand, France; Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Frédéric Jean
- Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), Clermont-Ferrand, France; Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas Combaret
- Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), Clermont-Ferrand, France; Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Charles Vorilhon
- Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), Clermont-Ferrand, France; Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Guillaume Clerfond
- Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), Clermont-Ferrand, France; Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Mehdi Farhat
- Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), Clermont-Ferrand, France; Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Philippe Ritter
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Bernard Citron
- Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), Clermont-Ferrand, France; Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-R Lusson
- Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), Clermont-Ferrand, France; Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pascal Motreff
- Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), Clermont-Ferrand, France; Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sylvain Ploux
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Romain Eschalier
- Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), Clermont-Ferrand, France; Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.
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207
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Young Lee M, Chilakamarri Yeshwant S, Chava S, Lawrence Lustgarten D. Mechanisms of Heart Block after Transcatheter Aortic Valve Replacement - Cardiac Anatomy, Clinical Predictors and Mechanical Factors that Contribute to Permanent Pacemaker Implantation. Arrhythm Electrophysiol Rev 2016; 4:81-5. [PMID: 26835105 DOI: 10.15420/aer.2015.04.02.81] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a valuable, minimally invasive treatment option in patients with symptomatic severe aortic stenosis at prohibitive or increased risk for conventional surgical replacement. Consequently, patients undergoing TAVR are prone to peri-procedural complications including cardiac conduction disturbances, which is the focus of this review. Atrioventricular conduction disturbances and arrhythmias before, during or after TAVR remain a matter of concern for this high-risk group of patients, as they have important consequences on hospital duration, short- and long-term medical management and finally on decisions of device-based treatment strategies (pacemaker or defibrillator implantation). We discuss the mechanisms of atrioventricular disturbances and characterise predisposing factors. Using validated clinical predictors, we discuss strategies to minimise the likelihood of creating permanent high-grade heart block, and identify factors to expedite the decision to implant a permanent pacemaker when the latter is unavoidable. We also discuss optimal pacing strategies to mitigate the possibility of pacing-induced cardiomyopathy.
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208
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Vahanian A, Himbert D. Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2016; 9:385-386. [DOI: 10.1016/j.jcin.2015.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 10/28/2015] [Indexed: 10/22/2022]
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209
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Trastornos de la conducción e implante de marcapasos tras implante de válvula aórtica SAPIEN 3 comparada con la SAPIEN XT. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.06.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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210
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Husser O, Pellegrini C, Kessler T, Burgdorf C, Thaller H, Mayr NP, Kasel AM, Kastrati A, Schunkert H, Hengstenberg C. Predictors of Permanent Pacemaker Implantations and New-Onset Conduction Abnormalities With the SAPIEN 3 Balloon-Expandable Transcatheter Heart Valve. JACC Cardiovasc Interv 2016; 9:244-254. [DOI: 10.1016/j.jcin.2015.09.036] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/17/2015] [Accepted: 09/24/2015] [Indexed: 11/25/2022]
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211
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Management of Coronary Artery Disease and Conduction Abnormalities in Transcatheter Aortic Valve Implantation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:9. [DOI: 10.1007/s11936-015-0432-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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212
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Schernthaner C, Kraus J, Danmayr F, Hammerer M, Schneider J, Hoppe UC, Strohmer B. Short-term pacemaker dependency after transcatheter aortic valve implantation. Wien Klin Wochenschr 2016; 128:198-203. [DOI: 10.1007/s00508-015-0906-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 11/18/2015] [Indexed: 12/14/2022]
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213
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Allahwala UK, Hansen PS, Danson EJ, Straiton N, Sinhal A, Walters DL, Bhindi R. Transcatheter aortic valve implantation: current trends and future directions. Future Cardiol 2015; 12:69-85. [PMID: 26696562 DOI: 10.2217/fca.15.73] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has been increasingly utilized for the treatment of severe symptomatic aortic stenosis in inoperable and high surgical risk patients. Recent advances in valve technology include repositionable scaffolds and smaller delivery systems, as well as improvement in periprocedural imaging. These advances have resulted in reduction of vascular complications, rates of paravalvular aortic regurgitation and periprocedural stroke and improved overall outcomes. Increasingly, TAVI is the preferred treatment for high-risk surgical patients with severe aortic stenosis. Consequently, there is growing interest for the use of TAVI in lower surgical risk patients. Furthermore, the role of TAVI has expanded to include valve-in-valve procedures for the treatment of degenerative bioprosthetic valves and bicuspid aortic valves. Questions remain in regard to the optimal management of concurrent coronary artery disease, strategies to minimize valve leaflet restriction and treatment of conduction abnormalities as well as identifying newer indications for its use.
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Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Peter S Hansen
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Edward J Danson
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Nicola Straiton
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Ajay Sinhal
- Department of Cardiology, Flinders Medical Centre, Adelaide, Australia
| | - Darren L Walters
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
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214
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Simulated Prosthesis Overlay for Patient-Specific Planning of Transcatheter Aortic Valve Implantation Procedures. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:314-22. [PMID: 26575379 DOI: 10.1097/imi.0000000000000198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We tested the hypothesis that simulated three-dimensional prosthesis overlay procedure planning may support valve selection in transcatheter aortic valve implantation (TAVI) procedures. METHODS Preoperative multidimensional computed tomography (MDCT) data sets from 81 consecutive TAVI patients were included in the study. A planning tool was developed, which semiautomatically creates a three-dimensional model of the aortic root from these data. Three-dimensional templates of the commonly used TAVI implants are spatially registered with the patient data and presented as graphic overlay. Fourteen physicians used the tool to perform retrospective planning of TAVI procedures. Results of prosthesis sizing were compared with the prosthesis size used in the actually performed procedure, and the patients were accordingly divided into three groups: those with equal size (concordance with retrospective planning), oversizing (retrospective planning of a smaller prosthesis), and undersizing (retrospective planning of a larger prosthesis). RESULTS In the oversizing group, 85% of the patients had new pacemaker implantation. In the undersizing group, in 66%, at least mild paravalvular leakage was observed (greater than grade 1 in one third of the cases). In 46% of the patients in the equal-size group, neither of these complications was observed. CONCLUSIONS Three-dimensional prosthesis overlay in MDCT-derived patient data for patient-specific planning of TAVI procedures is feasible. It may improve valve selection compared with two-dimensional MDCT planning and thus yield better outcomes.
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215
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Husser O, Kessler T, Burgdorf C, Templin C, Pellegrini C, Schneider S, Kasel AM, Kastrati A, Schunkert H, Hengstenberg C. Conduction Abnormalities and Pacemaker Implantations After SAPIEN 3 Vs SAPIEN XT Prosthesis Aortic Valve Implantation. ACTA ACUST UNITED AC 2015; 69:141-8. [PMID: 26542175 DOI: 10.1016/j.rec.2015.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/24/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Transcatheter aortic valve implantation is increasingly used in patients with aortic stenosis. Post-procedural intraventricular conduction abnormalities and permanent pacemaker implantations remain a serious concern. Recently, the Edwards SAPIEN 3 prosthesis has replaced the SAPIEN XT. We sought to determine the incidences of new-onset intraventricular conduction abnormalities and permanent pacemaker implantations by comparing the 2 devices. METHODS We analyzed the last consecutive 103 patients undergoing transcatheter aortic valve implantation with SAPIEN XT before SAPIEN 3 was used in the next 105 patients. To analyze permanent pacemaker implantations and new-onset intraventricular conduction abnormalities, patients with these conditions at baseline were excluded. Electrocardiograms were recorded at baseline, after the procedure, and before discharge. RESULTS SAPIEN 3 was associated with higher device success (100% vs 92%; P=.005) and less paravalvular leakage (0% vs 7%; P<.001). The incidence of permanent pacemaker implantations was 12.6% (23 of 183) with no difference between the 2 groups (SAPIEN 3: 12.5% [12 of 96] vs SAPIEN XT: 12.6% [11 of 87]; P=.99). SAPIEN 3 was associated with a higher rate of new-onset intraventricular conduction abnormalities (49% vs 27%; P=.007) due to a higher rate of fascicular blocks (17% vs 5%; P=.021). There was no statistically significant difference in transient (29% [20 of 69] vs persistent 19% [12 of 64]; P=.168) left bundle branch blocks (28% [19 of 69] vs 17% [11 of 64]; P=.154) when SAPIEN 3 was compared with SAPIEN XT. CONCLUSIONS We found a trend toward a higher rate of new-onset intraventricular conduction abnormalities with SAPIEN 3 compared with SAPIEN XT, although this did not result in a higher permanent pacemaker implantation rate.
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Affiliation(s)
- Oliver Husser
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
| | - Thorsten Kessler
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christof Burgdorf
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christian Templin
- Universitäres Herzzentrum, Universitätsspital Zürich, Zurich, Switzerland
| | - Costanza Pellegrini
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Simon Schneider
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Albert Markus Kasel
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian Hengstenberg
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Partner Site Munich Heart Alliance, Munich, Germany
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216
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Moreno R, Calvo L, Sánchez-Recalde A, Galeote G, Jiménez-Valero S, López T, Plaza I, González-Davia R, Ramírez U, Mesa JM, Moreno-Gomez I, López-Sendón JL. Short- and long-term need for permanent pacemaker after transcatheter implantation of the Edwards Sapien aortic valve prosthesis. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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217
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Moreno R, Calvo L, Sánchez-Recalde A, Galeote G, Jiménez-Valero S, López T, Plaza I, González-Davia R, Ramírez U, Mesa JM, Moreno-Gomez I, López-Sendón JL. Short- and long-term need for permanent pacemaker after transcatheter implantation of the Edwards Sapien aortic valve prosthesis. Rev Port Cardiol 2015; 34:665-72. [DOI: 10.1016/j.repc.2015.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/06/2015] [Accepted: 05/09/2015] [Indexed: 11/29/2022] Open
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218
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Hamid T, Choudhury TR, Anderson SG, Hashmi I, Chowdhary S, Hesketh Roberts D, Fraser DG, Hasan R, Mahadevan VS, Levy R. Does the CHA2DS2-Vasc score predict procedural and short-term outcomes in patients undergoing transcatheter aortic valve implantation? Open Heart 2015; 2:e000170. [PMID: 26512326 PMCID: PMC4620233 DOI: 10.1136/openhrt-2014-000170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/12/2014] [Accepted: 11/26/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is associated with periprocedural and postprocedural morbidity and mortality. Currently, there is a paucity of risk stratification models for potential TAVI candidates. We employed the CHA2DS2-Vasc score to quantify the risk of 30-day mortality and morbidity in patients undergoing TAVI. METHODS AND RESULTS A retrospective analysis of registry data for consecutive patients undergoing TAVI at 3 tertiary centres in Northwest England between 2008 and 2013. The CHA2DS2-Vasc score and its modification-the R2CHA2DS2-Vasc score, which includes pre-existing renal impairment and pre-existing conduction abnormality (right bundle branch block/left bundle branch block, RBBB/LBBB)-were calculated for all patients. A total of 313 patients with a mean age of 80 (79.1-80.8) years underwent TAVI. The implanted devices were either the CoreValve or the Edwards-SAPIEN prosthesis. The 30-day mortality was 14.3% in those with a CHA2DS2-Vasc score ≥6, whereas it was only 6.2% in those with a score <6 (p=0.04). Using the R2-CHA2DS2-Vasc score, the difference was more pronounced with a 30-day mortality of 22.6% in those patients with an R2-CHA2DS2-Vasc score ≥7 compared to 6.0% in those with a R2-CHA2DS2-Vasc score <7 (p=0.001). In multivariable Cox regression analyses, there was a significant and independent relationship between the CHA2DS2-Vasc score (hazard ratio (HR)= 2.71, (1.01 to 7.31); p<0.05) and the modified R2CHA2DS2-Vasc score (HR=4.27 (1.51 to 12.07); p=0.006) with 30-day mortality. CONCLUSIONS Our study demonstrates the potential use of the CHA2DS2-Vasc or the R2CHA2DS2-Vasc score to quantify the risk of mortality in patients undergoing TAVI. This could have significant implications in terms of clinical as well as patients' decision-making.
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Affiliation(s)
- Tahir Hamid
- Manchester Royal Infirmary, Central Manchester University NHS Foundation Trust , Manchester , UK ; University Hospital of South Manchester NHS Foundation Trust , Wythenshawe , UK
| | - Tawfiq R Choudhury
- Manchester Royal Infirmary, Central Manchester University NHS Foundation Trust , Manchester , UK
| | - Simon G Anderson
- Manchester Royal Infirmary, Central Manchester University NHS Foundation Trust , Manchester , UK ; Institute of Cardiovascular Sciences, University of Manchester , Manchester , UK
| | - Izhar Hashmi
- Blackpool Teaching Hospitals NHS Foundation Trust , Blackpool , UK
| | - Saqib Chowdhary
- University Hospital of South Manchester NHS Foundation Trust , Wythenshawe , UK
| | | | - Douglas G Fraser
- Manchester Royal Infirmary, Central Manchester University NHS Foundation Trust , Manchester , UK
| | - Ragheb Hasan
- Manchester Royal Infirmary, Central Manchester University NHS Foundation Trust , Manchester , UK
| | - Vaikom S Mahadevan
- Manchester Royal Infirmary, Central Manchester University NHS Foundation Trust , Manchester , UK
| | - Richard Levy
- University Hospital of South Manchester NHS Foundation Trust , Wythenshawe , UK
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Urena M, Rodés-Cabau J. Managing heart block after transcatheter aortic valve implantation: from monitoring to device selection and pacemaker indications. EUROINTERVENTION 2015; 11 Suppl W:W101-5. [DOI: 10.4244/eijv11swa30] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sündermann SH, Gessat M, Maier W, Kempfert J, Frauenfelder T, Nguyen TDL, Maisano F, Falk V. Simulated Prosthesis Overlay for Patient-Specific Planning of Transcatheter Aortic Valve Implantation Procedures. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Simon H. Sündermann
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Michael Gessat
- Computer Vision Laboratory, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Willibald Maier
- Division of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Thomas Frauenfelder
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Thi D. L. Nguyen
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Maisano
- Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
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Dizon JM, Nazif TM, Hess PL, Biviano A, Garan H, Douglas PS, Kapadia S, Babaliaros V, Herrmann HC, Szeto WY, Jilaihawi H, Fearon WF, Tuzcu EM, Pichard AD, Makkar R, Williams M, Hahn RT, Xu K, Smith CR, Leon MB, Kodali SK. Chronic pacing and adverse outcomes after transcatheter aortic valve implantation. Heart 2015; 101:1665-71. [DOI: 10.1136/heartjnl-2015-307666] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 07/14/2015] [Indexed: 11/04/2022] Open
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Abstract
The advent of transcatheter aortic valve replacement (TAVR) has modified the treatment of severe aortic stenosis (AS). Large randomized trials and multicenter registries have endorsed the efficacy of TAVR in improving outcomes in patients with severe AS who are inoperable or high surgical risk. There has been a noticeable shift in using TAVR in patients with AS who are not at a high surgical risk. Appropriate diagnosis, patient selection, and referral remain cornerstones to achieving optimal outcomes after TAVR or SAVR (surgical aortic valve replacement).
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Affiliation(s)
- Kunal Sarkar
- Department of Cardiology, Policlinico Tor Vergata, University of Rome, Tor Vergata, Viale Oxford 81, Rome 00133, Italy.
| | - Mrinalini Sarkar
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Gian Paolo Ussia
- Department of Cardiology, Policlinico Tor Vergata, University of Rome, Tor Vergata, Viale Oxford 81, Rome 00133, Italy
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223
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Agarwal S, Parashar A, Kumbhani DJ, Svensson LG, Krishnaswamy A, Tuzcu EM, Kapadia SR. Comparative meta-analysis of balloon-expandable and self-expandable valves for transcatheter aortic valve replacement. Int J Cardiol 2015; 197:87-97. [PMID: 26117654 DOI: 10.1016/j.ijcard.2015.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/06/2015] [Accepted: 06/12/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Balloon-expandable valves (BEVs) and self-expandable valves (SEVs) are two major types of valves utilized for transcatheter aortic valve replacement (TAVR). We conducted a meta-analysis of available studies to compare the safety and efficacy of these two valve types. METHODS Medline search was conducted using standard search terms to determine eligible studies. Primary outcomes of the meta-analysis included death and stroke at 30days and 1year. Pooled estimates of procedural outcomes were also compared between the valve types. Analysis was performed for entire cohort and separately for patients undergoing transfemoral TAVR (TF-TAVR). RESULTS Analysis of entire cohort revealed similar 30-day mortality in the SEV and BEV cohorts. There was no significant difference in the incidence of stroke at 30days between the two study groups. Both pooled comparisons demonstrated a significant heterogeneity with I(2)>50%, necessitating the use of random effect modeling. We observed a significantly higher incidence of new pacemaker implantation, aortic regurgitation≥2+ at 30days, valve embolization, and need for >1 valve following SEV implantation compared with BEV implantation. Analysis of TF-TAVR cohort showed higher 30day [IRR (95% CI): 1.34 (1.19-1.52)] but a similar 1-year mortality [IRR (95% CI): 1.07 (0.96-1.19)] for SEV compared to BEV implantation. CONCLUSION Compared to BEV implantation, SEV implantation was associated with a similar risk of mortality and stroke at 30-day and 1-year follow-up duration. Analysis of the TF-TAVR cohort revealed a significantly higher mortality at 30days among patients undergoing SEV implantation, compared with BEV implantation. In addition, there was a significantly higher incidence of other adverse events noted above, following SEV implantation, compared with BEV implantation.
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Affiliation(s)
- Shikhar Agarwal
- Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Akhil Parashar
- Department of Internal Medicine, Cleveland Clinic, United States
| | - Dharam J Kumbhani
- Interventional Cardiology, UT Southwestern Medical Center, United States
| | - Lars G Svensson
- Department of Cardiovascular Surgery, Cleveland Clinic, United States
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - E Murat Tuzcu
- Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
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Jochheim D, Zadrozny M, Theiss H, Baquet M, Maimer-Rodrigues F, Bauer A, Lange P, Greif M, Kupatt C, Hausleiter J, Hagl C, Massberg S, Mehilli J. Aortic regurgitation with second versus third-generation balloon-expandable prostheses in patients undergoing transcatheter aortic valve implantation. EUROINTERVENTION 2015; 11:214-20. [DOI: 10.4244/eijv11i2a40] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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225
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Wöhrle J, Gonska B, Rodewald C, Trepte U, Koch S, Scharnbeck D, Seeger J, Markovic S, Rottbauer W. Transfemoral aortic valve implantation with the repositionable Lotus valve compared with the balloon-expandable Edwards Sapien 3 valve. Int J Cardiol 2015; 195:171-5. [PMID: 26043152 DOI: 10.1016/j.ijcard.2015.05.139] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 05/21/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The rate of paravalvular aortic insufficiency (AI) with transcatheter aortic valve implantation (TAVI) with first generation devices was higher compared with surgical replacement. Residual AI after TAVI has been linked to an increased mortality rate. We compared two second generation TAVI devices - the repositionable Lotus valve with the balloon-expandable Edwards Sapien 3 valve - regarding procedural and 30 day outcome. METHODS AND RESULTS In 78 patients with severe aortic stenosis undergoing transfemoral TAVI we evaluated post-procedural paravalvular AI, device success and early safety according to VARC criteria. Valve size was based on a 256-multislice computed tomography. Patients were followed for 30 days. The Lotus valve (N = 26) and the Edwards Sapien 3 valve (N = 52) were implanted under fluoroscopic guidance. Baseline characteristics were similar between groups. Perimeter derived annulus diameter did not differ with 25.7 ± 1.6mm for Lotus and 25.2 ± 2.1mm for Edwards Sapien 3 patients. After TAVI aortography and transthoracic echocardiography revealed no moderate or severe AI. The rate of mild AI was 12% for Lotus and 15% for Edwards Sapien 3 (p = 0.62). There were no deaths, stroke, annulus rupture or coronary obstruction. Device success was 96% and 98% (p = 0.61), early safety according to VARC 11.5% in both groups (p = 1.0) and the need for pacemaker implantation 27% and 4% (p < 0.003), respectively. CONCLUSIONS TAVI with second-generation devices was associated with no moderate or severe AI and a low rate of mild AI. Device success was high for Lotus and Edwards Sapien 3 while the need for permanent pacemaker was significantly higher with the Lotus valve.
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Affiliation(s)
- Jochen Wöhrle
- Dept. of Internal Medicine II - Cardiology, University of Ulm, Ulm, Germany.
| | - Birgid Gonska
- Dept. of Internal Medicine II - Cardiology, University of Ulm, Ulm, Germany
| | - Christoph Rodewald
- Dept. of Internal Medicine II - Cardiology, University of Ulm, Ulm, Germany
| | - Ulrike Trepte
- Dept. of Internal Medicine II - Cardiology, University of Ulm, Ulm, Germany
| | - Sabrina Koch
- Dept. of Internal Medicine II - Cardiology, University of Ulm, Ulm, Germany
| | - Dominik Scharnbeck
- Dept. of Internal Medicine II - Cardiology, University of Ulm, Ulm, Germany
| | - Julia Seeger
- Dept. of Internal Medicine II - Cardiology, University of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Dept. of Internal Medicine II - Cardiology, University of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Dept. of Internal Medicine II - Cardiology, University of Ulm, Ulm, Germany
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Barón-Esquivias G, Manito N, López Díaz J, Martín Santana A, García Pinilla JM, Gómez Doblas JJ, Gómez Bueno M, Barrios Alonso V, Lambert JL. Actualización 2014 en cardiología clínica, cardiología geriátrica e insuficiencia cardiaca y trasplante. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Chen C, Zhao ZG, Liao YB, Peng Y, Meng QT, Chai H, Li Q, Luo XL, Liu W, Zhang C, Chen M, Huang DJ. Impact of renal dysfunction on mid-term outcome after transcatheter aortic valve implantation: a systematic review and meta-analysis. PLoS One 2015; 10:e0119817. [PMID: 25793780 PMCID: PMC4368625 DOI: 10.1371/journal.pone.0119817] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/16/2015] [Indexed: 02/05/2023] Open
Abstract
Background There is conflicting evidence regarding the impact of preexisting renal dysfunction (RD) on mid-term outcomes after transcatheter aortic valve implantation (TAVI) in patients with symptomatic aortic stenosis (AS). Methods and results Forty-seven articles representing 32,131 patients with AS undergoing a TAVI procedure were included in this systematic review and meta-analysis. Pooled analyses were performed with both univariate and multivariate models, using a fixed or random effects method when appropriate. Compared with patients with normal renal function, mid-term mortality was significantly higher in patients with preexisting RD, as defined by the author (univariate hazard ratio [HR]: 1.69; 95% confidence interval [CI]: 1.50–1.90; multivariate HR: 1.47; 95% CI: 1.17–1.84), baseline estimated glomerular filtration rate (eGFR) (univariate HR: 1.65; 95% CI: 1.47–1.86; multivariate HR: 1.46; 95% CI: 1.24–1.71), and serum creatinine (univariate HR: 1.69; 95% CI: 1.48–1.92; multivariate HR: 1.65; 95% CI: 1.36–1.99). Advanced stage of chronic kidney disease (CKD stage 3–5) was strongly related to bleeding (univariate HR in CKD stage 3: 1.30, 95% CI: 1.13–1.49; in CKD stage 4: 1.30, 95% CI: 1.04–1.62), acute kidney injure (AKI) (univariate HR in CKD stage 3: 1.28, 95% CI: 1.03–1.59; in CKD stage 4: 2.27, 95% CI: 1.74–2.96), stroke (univariate HR in CKD stage 4: 3.37, 95% CI: 1.52–7.46), and mid-term mortality (univariate HR in CKD stage 3: 1.57, 95% CI: 1.26–1.95; in CKD stage 4: 2.77, 95% CI: 2.06–3.72; in CKD stage 5: 2.64, 95% CI: 1.91–3.65) compared with CKD stage 1+2. Patients with CKD stage 4 had a higher incidence of AKI (univariate HR: 1.70, 95% CI: 1.34–2.16) and all-cause death (univariate HR: 1.60, 95% CI: 1.28–1.99) compared with those with CKD stage 3. A per unit decrease in serum creatinine was also associated with a higher mortality at mid-term follow-up (univariate HR: 1.24, 95% CI: 1.18–1.30; multivariate HR: 1.19, 95% CI: 1.08–1.30). Conclusions Preexisting RD was associated with increased mid-term mortality after TAVI. Patients with CKD stage 4 had significantly higher incidences of peri-procedural complications and a poorer prognosis, a finding that should be factored into the clinical decision-making process regarding these patients.
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Affiliation(s)
- Chi Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Zhen-Gang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Qing-Tao Meng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Hua Chai
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Qiao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xiao-Lin Luo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Wei Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Chen Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
- * E-mail:
| | - De-Jia Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
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Walther T, Hamm CW, Schuler G, Berkowitsch A, Kötting J, Mangner N, Mudra H, Beckmann A, Cremer J, Welz A, Lange R, Kuck KH, Mohr FW, Möllmann H. Perioperative Results and Complications in 15,964 Transcatheter Aortic Valve Replacements: Prospective Data From the GARY Registry. J Am Coll Cardiol 2015; 65:2173-80. [PMID: 25787198 DOI: 10.1016/j.jacc.2015.03.034] [Citation(s) in RCA: 303] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 03/06/2015] [Accepted: 03/06/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has evolved into a routine procedure with good outcomes in high-risk patients. OBJECTIVES TAVR complication rates were evaluated based on prospective data from the German Aortic Valve Registry (GARY). METHODS From 2011 to 2013, a total of 15,964 TAVR procedures were registered. We evaluated the total cohort for severe vital complications (SVCs), including the following: death on the day of intervention, conversion to sternotomy, low cardiac output that required mechanical support, aortic dissection, and annular rupture; technical complications of the procedures (TCOs), such as repositioning or retrieval of the valve prosthesis and embolization of the prosthesis; and other complications. RESULTS Mean patient age was 81 ± 6 years, 54% of the patients were women, the median logistic Euroscore I was 18.3, the German aortic valve score was 5.6, and the Society of Thoracic Surgeons score was 5.0. Overall in-hospital mortality was 5.2%, whereas SVCs occurred in 5.0% of the population. Independent predictors for SVCs were female sex, pre-operative New York Heart Association functional class IV, ejection fraction <30%, pre-operative intravenous inotropes, arterial vascular disease, and higher degree of calcifications. TCOs occurred in 4.7% of patients and decreased significantly from 2011 to 2013. An emergency sternotomy was performed in 1.3% of the patients; however, multivariate analysis did not identify any predictors for conversion to sternotomy. CONCLUSIONS The all-comers GARY registry revealed good outcomes after TAVR and a regression in complications. Survival of approximately 60% of patients who experienced SVCs or who required sternotomy underlines the need for heart team-led indication, intervention, and follow-up care of TAVR patients.
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Affiliation(s)
- Thomas Walther
- Kerckhoff Herzzentrum, Abteilung Herzchirurgie, Bad Nauheim, Germany.
| | - Christian W Hamm
- Kerckhoff Herzzentrum, Abteilung Kardiologie, Bad Nauheim, Germany
| | - Gerhard Schuler
- Herzzentrum Leipzig, Abteilung Kardiologie, Leipzig, Germany
| | | | | | - Norman Mangner
- Herzzentrum Leipzig, Abteilung Kardiologie, Leipzig, Germany
| | - Harald Mudra
- Städtisches Klinikum Munich, Klinikum Neuperlach, Department of Cardiology/Pneumology, Munich, Germany
| | - Andreas Beckmann
- Deutsche Gesellschaft für Thorax-, Herz-, und Gefässchirurgie, Berlin, Germany
| | - Jochen Cremer
- Universität Kiel, Abteilung für Herzchirurgie, Kiel, Germany
| | - Armin Welz
- Universität Bonn, Abteilung Herzchirurgie, Bonn, Germany
| | - Rüdiger Lange
- Deutsches Herzzentrum München, Abteilung Herzchirurgie, München, Germany
| | - Karl-Heinz Kuck
- St. Georg Krankenhaus, Abteilung Kardiologie, Hamburg, Germany
| | | | - Helge Möllmann
- Kerckhoff Herzzentrum, Abteilung Kardiologie, Bad Nauheim, Germany
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Barón-Esquivias G, Manito N, López Díaz J, Martín Santana A, García Pinilla JM, Gómez Doblas JJ, Gómez Bueno M, Barrios Alonso V, Lambert JL. Update for 2014 on clinical cardiology, geriatric cardiology, and heart failure and transplantation. ACTA ACUST UNITED AC 2015; 68:317-23. [PMID: 25758161 DOI: 10.1016/j.rec.2014.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/11/2014] [Indexed: 11/19/2022]
Abstract
In the present article, we review publications from the previous year in the following 3 areas: clinical cardiology, geriatric cardiology, and heart failure and transplantation. Among the new developments in clinical cardiology are several contributions from Spanish groups on tricuspid and aortic regurgitation, developments in atrial fibrillation, syncope, and the clinical characteristics of heart disease, as well as various studies on familial heart disease and chronic ischemic heart disease. In geriatric cardiology, the most relevant studies published in 2014 involve heart failure, degenerative aortic stenosis, and data on atrial fibrillation in the geriatric population. In heart failure and transplantation, the most noteworthy developments concern the importance of multidisciplinary units and patients with preserved systolic function. Other notable publications were those related to iron deficiency, new drugs, and new devices and biomarkers. Finally, we review studies on acute heart failure and transplantation, such as inotropic drugs and ventricular assist devices.
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Affiliation(s)
- Gonzalo Barón-Esquivias
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain.
| | - Nicolás Manito
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Javier López Díaz
- Servicio de Insuficiencia Cardiaca y Trasplante Cardiaco, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain
| | - Antonio Martín Santana
- Servicio de Cardiología, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, Spain
| | | | - Juan José Gómez Doblas
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Manuel Gómez Bueno
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - José Luis Lambert
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo Asturias, Spain
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Möllmann H, Kim WK, Kempfert J, Walther T, Hamm C. Complications of transcatheter aortic valve implantation (TAVI): how to avoid and treat them. Heart 2015; 101:900-8. [DOI: 10.1136/heartjnl-2013-304708] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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231
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Urena M, Rodés-Cabau J. Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2015; 8:70-3. [DOI: 10.1016/j.jcin.2014.09.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/24/2014] [Indexed: 01/05/2023]
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Nazif TM, Dizon J, Hahn RT, Xu K, Babaliaros V, Douglas PS, El-Chami MF, Herrmann HC, Mack M, Makkar RR, Miller DC, Pichard A, Tuzcu EM, Szeto WY, Webb JG, Moses JW, Smith CR, Williams MR, Leon MB, Kodali SK. Predictors and Clinical Outcomes of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2015; 8:60-9. [DOI: 10.1016/j.jcin.2014.07.022] [Citation(s) in RCA: 388] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/24/2014] [Accepted: 07/31/2014] [Indexed: 11/27/2022]
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Weber M, Sinning JM, Hammerstingl C, Werner N, Grube E, Nickenig G. Permanent Pacemaker Implantation after TAVR - Predictors and Impact on Outcomes. Interv Cardiol 2015; 10:98-102. [PMID: 29588683 DOI: 10.15420/icr.2015.10.2.98] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The number of patients undergoing transcatheter aortic valve replacement (TAVR) worldwide is increasing steadily. Atrioventricular conduction disturbances, with or without the need for permanent pacemaker (PPM) implantation, are one of the most common adverse events after TAVR. Among transcatheter heart valves (THV), rates of conduction abnormalities vary from less than 10 % to more than 50 %. Depending on the reported data referred to, historical data showed that up to one-third of the patients required implantation of a PPM following TAVR. Although generally considered as a minor complication, PPM may have a profound impact on prognosis and quality of life after TAVR. Current data support the hypothesis that conduction abnormalities leading to pacemaker dependency result from mechanical compression of the conduction system by the prosthesis stent frame and individual predisposing conduction defects such as right bundle-branch block (RBBB). With several large randomised trials and registry studies having been published recently and second generation THV having been introduced, the debate about predictors for pacemaker implantation and their impact on outcome after TAVR is still ongoing.
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Affiliation(s)
- Marcel Weber
- University of Bonn, Department of Internal Medicine II, Cardiology, Pulmonology and Angiology, Germany
| | - Jan-Malte Sinning
- University of Bonn, Department of Internal Medicine II, Cardiology, Pulmonology and Angiology, Germany
| | - Christoph Hammerstingl
- University of Bonn, Department of Internal Medicine II, Cardiology, Pulmonology and Angiology, Germany
| | - Nikos Werner
- University of Bonn, Department of Internal Medicine II, Cardiology, Pulmonology and Angiology, Germany
| | - Eberhard Grube
- University of Bonn, Department of Internal Medicine II, Cardiology, Pulmonology and Angiology, Germany
| | - Georg Nickenig
- University of Bonn, Department of Internal Medicine II, Cardiology, Pulmonology and Angiology, Germany
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van der Boon RM, Houthuizen P, Urena M, Poels TT, van Mieghem NM, Brueren GR, Altintas S, Nuis RJ, Serruys PW, van Garsse LA, van Domburg RT, Cabau JR, de Jaegere PP, Prinzen FW. Trends in the occurrence of new conduction abnormalities after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2014; 85:E144-52. [DOI: 10.1002/ccd.25765] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/30/2014] [Indexed: 01/29/2023]
Affiliation(s)
| | - Patrick Houthuizen
- Catharina Hospital; Eindhoven The Netherlands
- Cardiovascular Research Institute Maastricht; Maastricht The Netherlands
| | - Marina Urena
- Quebec Heart & Lung Institute, Laval University; Quebec City Canada
| | - Thomas T. Poels
- Maastricht University Medical Center; Maastricht The Netherlands
| | | | | | - Sibel Altintas
- Maastricht University Medical Center; Maastricht The Netherlands
| | | | | | | | | | | | | | - Frits W. Prinzen
- Cardiovascular Research Institute Maastricht; Maastricht The Netherlands
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Poels TT, Houthuizen P, Van Garsse LA, Soliman Hamad MA, Maessen JG, Prinzen FW, Van Straten AH. Frequency and prognosis of new bundle branch block induced by surgical aortic valve replacement. Eur J Cardiothorac Surg 2014; 47:e47-53. [DOI: 10.1093/ejcts/ezu435] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tarsia G, Smaldone C, Viceconte NG, Osanna RA, Santillo V, Cuda C, Polosa D, Costantino MF, Del Prete G, Pittella G, Scarano E, Cappiello P, Di Natale M, Sisto F, Marraudino N, Lisanti P. Lower cardiovascular mortality with Medtronic CoreValve versus Edwards SAPIEN in patients with aortic valve stenosis undergoing transcatheter aortic valve implantation. Int J Cardiol 2014; 177:520-2. [DOI: 10.1016/j.ijcard.2014.08.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 08/15/2014] [Indexed: 11/30/2022]
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Transcatheter aortic valve replacement for severe symptomatic aortic stenosis using a repositionable valve system: 30-day primary endpoint results from the REPRISE II study. J Am Coll Cardiol 2014; 64:1339-48. [PMID: 25257635 DOI: 10.1016/j.jacc.2014.05.067] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/07/2014] [Accepted: 05/13/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement provides results comparable to those of surgery in patients at high surgical risk, but complications can impact long-term outcomes. The Lotus valve, designed to improve upon earlier devices, is fully repositionable and retrievable, with a unique seal to minimize paravalvular regurgitation (PVR). OBJECTIVES The prospective, single-arm, multicenter REPRISE II study (REpositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of Lotus Valve System: Evaluation of Safety and Performance) evaluated the transcatheter valve system for treatment of severe symptomatic calcific aortic valve stenosis. METHODS Patients (n = 120; aortic annulus 19 to 27 mm) considered by a multidisciplinary heart team to be at high surgical risk received the valve transfemorally. The primary device performance endpoint, 30-day mean pressure gradient, was assessed by an independent echocardiographic core laboratory and compared with a pre-specified performance goal. The primary safety endpoint was 30-day mortality. Secondary endpoints included safety/effectiveness metrics per Valve Academic Research Consortium criteria. RESULTS Mean age was 84.4 years, 57% of the patients were female, and 76% were New York Heart Association functional class III/IV. Mean aortic valve area was 0.7 ± 0.2 cm(2). The valve was successfully implanted in all patients, with no cases of valve embolization, ectopic valve deployment, or additional valve implantation. All repositioning (n = 26) and retrieval (n = 6) attempts were successful; 34 patients (28.6%) received a permanent pacemaker. The primary device performance endpoint was met, because the mean gradient improved from 46.4 ± 15.0 mm Hg to 11.5 ± 5.2 mm Hg. At 30 days, the mortality rate was 4.2%, and the rate of disabling stroke was 1.7%; 1 (1.0%) patient had moderate PVR, whereas none had severe PVR. CONCLUSIONS REPRISE II demonstrates the safety and effectiveness of the Lotus valve in patients with severe aortic stenosis who are at high surgical risk. The valve could be positioned successfully with minimal PVR. (REPRISE II: REpositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of Lotus™ Valve System - Evaluation of Safety and Performance; NCT01627691).
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Abdel-Wahab M, El-Mawardy M, Richardt G. Update on transcatheter aortic valve replacement. Trends Cardiovasc Med 2014; 25:154-61. [PMID: 25453986 DOI: 10.1016/j.tcm.2014.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 10/03/2014] [Accepted: 10/04/2014] [Indexed: 11/25/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is currently the treatment modality of choice for patients with symptomatic severe aortic stenosis who are inoperable or at high risk for surgical aortic valve replacement. TAVR has shown a clear mortality benefit compared to conservative treatment in inoperable patients and is at least non-inferior to surgical aortic valve replacement in high-risk operable patients. Through improvements in pre-procedural imaging, refinement in valve technologies, increasing operator and team experience, and continuous valuable research, TAVR has developed rapidly in the past few years and is expected to further boost in the near future. In this review, we highlight the current status of TAVR, summarize recent updates, and discuss briefly the future expectations of this rapidly evolving technology.
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Affiliation(s)
- Mohamed Abdel-Wahab
- Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, Bad Segeberg 23795, Germany.
| | - Mohamed El-Mawardy
- Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, Bad Segeberg 23795, Germany
| | - Gert Richardt
- Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, Bad Segeberg 23795, Germany
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Sorajja P, Pedersen W. Next-Generation Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2014; 64:1349-51. [DOI: 10.1016/j.jacc.2014.06.1187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/17/2014] [Indexed: 12/01/2022]
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Predictors of permanent pacemaker requirement after transcatheter aortic valve implantation: Insights from a Brazilian Registry. Int J Cardiol 2014; 175:248-52. [DOI: 10.1016/j.ijcard.2014.05.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/28/2014] [Accepted: 05/11/2014] [Indexed: 11/18/2022]
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Clinical significance of conduction disturbances after aortic valve intervention: current evidence. Clin Res Cardiol 2014; 104:1-12. [DOI: 10.1007/s00392-014-0739-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/24/2014] [Indexed: 12/16/2022]
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Mortality in patients requiring pacemaker implantation following transcatheter aortic valve replacement: Insights from a systematic review and meta-analysis. Int J Cardiol 2014; 174:207-8. [DOI: 10.1016/j.ijcard.2014.03.200] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
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Transcatheter aortic valve implantation-induced left bundle branch block: causes and consequences. J Cardiovasc Transl Res 2014; 7:395-405. [PMID: 24800873 DOI: 10.1007/s12265-014-9560-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an alternative treatment option for patients with severe aortic valve stenosis who do not qualify for surgical aortic valve replacement (AVR). Besides its proven clinical benefits, one of the complications of TAVI is the creation of conduction abnormalities, like left bundle branch block (LBBB). New LBBB occurs between 7 and 65% of cases, numbers that differ considerably between devices. In this review, we discuss the possible causes and the clinical significance of TAVI-induced LBBB. Several device- and procedural-related factors seem responsible for the development of LBBB, of which depth of implantation and balloon-annulus diameter ratio are the most important ones. TAVI-induced LBBB negatively affects cardiac function and hospitalization, but its impact on mortality is subject of debate. Future research and registries should implement strict diagnostic criteria for LBBB together with recording of its timing and persistence.
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