201
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Kostyunin A, Mukhamadiyarov R, Glushkova T, Bogdanov L, Shishkova D, Osyaev N, Ovcharenko E, Kutikhin A. Ultrastructural Pathology of Atherosclerosis, Calcific Aortic Valve Disease, and Bioprosthetic Heart Valve Degeneration: Commonalities and Differences. Int J Mol Sci 2020; 21:E7434. [PMID: 33050133 PMCID: PMC7587971 DOI: 10.3390/ijms21207434] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 01/24/2023] Open
Abstract
Atherosclerosis, calcific aortic valve disease (CAVD), and bioprosthetic heart valve degeneration (alternatively termed structural valve deterioration, SVD) represent three diseases affecting distinct components of the circulatory system and their substitutes, yet sharing multiple risk factors and commonly leading to the extraskeletal calcification. Whereas the histopathology of the mentioned disorders is well-described, their ultrastructural pathology is largely obscure due to the lack of appropriate investigation techniques. Employing an original method for sample preparation and the electron microscopy visualisation of calcified cardiovascular tissues, here we revisited the ultrastructural features of lipid retention, macrophage infiltration, intraplaque/intraleaflet haemorrhage, and calcification which are common or unique for the indicated types of cardiovascular disease. Atherosclerotic plaques were notable for the massive accumulation of lipids in the extracellular matrix (ECM), abundant macrophage content, and pronounced neovascularisation associated with blood leakage and calcium deposition. In contrast, CAVD and SVD generally did not require vasculo- or angiogenesis to occur, instead relying on fatigue-induced ECM degradation and the concurrent migration of immune cells. Unlike native tissues, bioprosthetic heart valves contained numerous specialised macrophages and were not capable of the regeneration that underscores ECM integrity as a pivotal factor for SVD prevention. While atherosclerosis, CAVD, and SVD show similar pathogenesis patterns, these disorders demonstrate considerable ultrastructural differences.
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Affiliation(s)
| | | | | | | | | | | | | | - Anton Kutikhin
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (A.K.); (R.M.); (T.G.); (L.B.); (D.S.); (N.O.); (E.O.)
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202
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Durko AP, Pibarot P, Atluri P, Bapat V, Cameron DE, Casselman FP, Chen EP, Dahle G, Elefteriades JA, Lancellotti P, Prager RL, Rosenhek R, Speir A, Stijnen M, Tasca G, Yoganathan A, Walther T, De Paulis R. Essential information on surgical heart valve characteristics for optimal valve prosthesis selection: expert consensus document from the European Association for Cardio-Thoracic Surgery (EACTS)–The Society of Thoracic Surgeons (STS)–American Association for Thoracic Surgery (AATS) Valve Labelling Task Force. Eur J Cardiothorac Surg 2020; 59:54-64. [DOI: 10.1093/ejcts/ezaa263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/26/2020] [Accepted: 04/08/2020] [Indexed: 01/17/2023] Open
Abstract
Abstract
Comprehensive information on the characteristics of surgical heart valves (SHVs) is essential for optimal valve selection. Such information is also important in assessing SHV function after valve replacement. Despite the existing regulatory framework for SHV sizing and labelling, this information is challenging to obtain in a uniform manner for various SHVs. To ensure that clinicians are adequately informed, the European Association for Cardio-Thoracic Surgery (EACTS), The Society of Thoracic Surgeons (STS) and American Association for Thoracic Surgery (AATS) set up a Task Force comprised of cardiac surgeons, cardiologists, engineers, regulatory bodies, representatives of the International Organization for Standardization and major valve manufacturers. Previously, the EACTS–STS–AATS Valve Labelling Task Force identified the most important problems around SHV sizing and labelling. This Expert Consensus Document formulates recommendations for providing SHV physical dimensions, intended implant position and haemodynamic performance in a transparent, uniform manner. Furthermore, the Task Force advocates for the introduction and use of a standardized chart to assess the probability of prosthesis–patient mismatch and calls valve manufacturers to provide essential information required for SHV choice on standardized Valve Charts, uniformly for all SHV models.
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Affiliation(s)
- Andras P Durko
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Laval University, Quebec, QC, Canada
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Vinayak Bapat
- Department of Cardiovascular Surgery, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Duke E Cameron
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Filip P.A Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Gry Dahle
- Department of Cardiothoracic and Thoracic surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - John A Elefteriades
- Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology, University of Liège Hospital, Liège, Belgium
| | - Richard L Prager
- Department of Cardiac Surgery, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Raphael Rosenhek
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Alan Speir
- Department of Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, VA, USA
| | | | - Giordano Tasca
- Cardiac Surgery Unit, Heart Health Center, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ajit Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory School of Medicine, Atlanta, GA, USA
| | - Thomas Walther
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University, Frankfurt, Germany
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203
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Belhaj Soulami R, Anselmi A, Tomasi J, Verhoye JP. Late surgical explantation of a transcatheter heart valve in a patient with a porcelain aorta. Eur J Cardiothorac Surg 2020; 55:1008-1011. [PMID: 30289474 DOI: 10.1093/ejcts/ezy327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/22/2018] [Accepted: 08/30/2018] [Indexed: 01/16/2023] Open
Abstract
Structural valve deterioration is a well-studied phenomenon in bioprosthetic heart valves. Conversely, structural valve deterioration after transcatheter aortic valve implantation is not as well-elucidated. Therefore, late surgical explantation after transcatheter aortic valve implantation is an infrequent procedure, and thus, surgical findings and management of such cases remain unclear, particularly in patients previously labelled as 'inoperable' or at 'high risk'. Herein, we report the case of a late surgical explantation of a transcatheter heart valve (THV) 7 years after its implantation in a patient with a porcelain aorta and periprosthetic regurgitation.
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Affiliation(s)
- Réda Belhaj Soulami
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Amedeo Anselmi
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Jacques Tomasi
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Jean-Philippe Verhoye
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
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204
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Pibarot P, Ternacle J, Jaber WA, Salaun E, Dahou A, Asch FM, Weissman NJ, Rodriguez L, Xu K, Annabi MS, Guzzetti E, Beaudoin J, Bernier M, Leipsic J, Blanke P, Clavel MA, Rogers E, Alu MC, Douglas PS, Makkar R, Miller DC, Kapadia SR, Mack MJ, Webb JG, Kodali SK, Smith CR, Herrmann HC, Thourani VH, Leon MB, Hahn RT. Structural Deterioration of Transcatheter Versus Surgical Aortic Valve Bioprostheses in the PARTNER-2 Trial. J Am Coll Cardiol 2020; 76:1830-1843. [DOI: 10.1016/j.jacc.2020.08.049] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023]
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205
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Percy ED, Harloff M, Hirji S, Malarczyk A, Cherkasky O, Yazdchi F, McGurk S, Shekar P, Kaneko T. Subclinical Structural Valve Degeneration in Young Patients With Bioprosthetic Aortic Valves. Ann Thorac Surg 2020; 111:1486-1493. [PMID: 32979371 DOI: 10.1016/j.athoracsur.2020.07.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/21/2020] [Accepted: 07/10/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bioprosthetic structural valve degeneration (SVD) has previously been a clinical diagnosis, but subclinical changes have been increasingly recognized in transcatheter valves. The significance of subclinical SVD after surgical aortic valve replacement (SAVR), however, is not well understood. The purpose of this study was to characterize the incidence and outcomes of subclinical SVD in young patients after SAVR. METHODS Patients aged ≤65 years who underwent bioprosthetic SAVR between January 2002 and June 2018 at a single institution were included. Endocarditis cases and those with in-hospital mortality were excluded. All available longitudinal postoperative echocardiograms were reviewed. Subclinical SVD was defined as an increase in mean transvalvular gradient of at least 10 mm Hg and/or new onset of mild intraprosthetic regurgitation or increase by at least 1 grade, compared with baseline postoperative echocardiogram. RESULTS Overall, 822 unique SAVR cases were included. Over the study period, 356 (43.3%) patients developed subclinical SVD. Only 21.5% of those with subclinical SVD progressed to clinical SVD or to repeat aortic valve procedures. In those with progression, the first signs of SVD occurred significantly earlier than in those whose changes remained stable (11 months vs 23 months; P = .036). Anticoagulation did not impact the development or progression of subclinical SVD. There was no difference in long-term survival for those who did or did not develop subclinical SVD. CONCLUSIONS Subclinical SVD occurred in a large proportion of young patients undergoing bioprosthetic SAVR. Despite its high prevalence, subclinical SVD was not associated with decreased survival or repeat procedures.
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Affiliation(s)
- Edward D Percy
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Morgan Harloff
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexandra Malarczyk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Olena Cherkasky
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Farhang Yazdchi
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Prem Shekar
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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206
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Simonato M, Dvir D. The Ten Commandments of Aortic Valve-in-Valve. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:397-405. [PMID: 32955362 DOI: 10.1177/1556984520951874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Matheus Simonato
- 28105 Escola Paulista de Medicina Universidade Federal de São Paulo, Brazil
| | - Danny Dvir
- 26743 Jesselson Integrated Heart Centre, ShaareZedek Medical Center, Hebrew University, Jerusalem, Israel.,Division of Cardiology, University of Washington, Seattle, WA, USA
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207
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Kostyunin AE, Yuzhalin AE, Rezvova MA, Ovcharenko EA, Glushkova TV, Kutikhin AG. Degeneration of Bioprosthetic Heart Valves: Update 2020. J Am Heart Assoc 2020; 9:e018506. [PMID: 32954917 PMCID: PMC7792365 DOI: 10.1161/jaha.120.018506] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The implantation of bioprosthetic heart valves (BHVs) is increasingly becoming the treatment of choice in patients requiring heart valve replacement surgery. Unlike mechanical heart valves, BHVs are less thrombogenic and exhibit superior hemodynamic properties. However, BHVs are prone to structural valve degeneration (SVD), an unavoidable condition limiting graft durability. Mechanisms underlying SVD are incompletely understood, and early concepts suggesting the purely degenerative nature of this process are now considered oversimplified. Recent studies implicate the host immune response as a major modality of SVD pathogenesis, manifested by a combination of processes phenocopying the long‐term transplant rejection, atherosclerosis, and calcification of native aortic valves. In this review, we summarize and critically analyze relevant studies on (1) SVD triggers and pathogenesis, (2) current approaches to protect BHVs from calcification, (3) obtaining low immunogenic BHV tissue from genetically modified animals, and (4) potential strategies for SVD prevention in the clinical setting.
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Affiliation(s)
- Alexander E Kostyunin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Arseniy E Yuzhalin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation.,Department of Molecular and Cellular Oncology The University of Texas MD Anderson Cancer Center Houston TX
| | - Maria A Rezvova
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Evgeniy A Ovcharenko
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Tatiana V Glushkova
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Anton G Kutikhin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
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208
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Valve-in-Valve Transcatheter Aortic Valve Replacement: A Review of Procedural Details, Safety, and Clinical Implications. Cardiol Rev 2020; 28:291-294. [DOI: 10.1097/crd.0000000000000318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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209
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Mirsadraee S, Sellers S, Duncan A, Hamadanchi A, Gorog DA. Bioprosthetic valve thrombosis and degeneration following transcatheter aortic valve implantation (TAVI). Clin Radiol 2020; 76:73.e39-73.e47. [PMID: 32919757 DOI: 10.1016/j.crad.2020.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
Bioprosthetic valve thrombosis (BPVT) is a recognised complication of prosthetic aortic valves and can be found in up to 13% of patients after transcatheter implantation. The mechanism of BPVT is not well known, abnormal flow conditions in the new and native sinuses and lack of functional endothelialisation are suspected causes. BPVT may result in valve dysfunction, possibly related to degeneration, and recurrence of patient symptoms, or remain subclinical. BPVT is best diagnosed at multiphase gated computed tomography (CT) angiography as the presence of reduced leaflet motion (RELM) and hypoattenuating aortic leaflet thickening (HALT). Although CT is used to exclude BPVT in symptomatic patients and those with increased valve gradients, the value of screening and prophylactic anticoagulation is debatable.
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Affiliation(s)
- S Mirsadraee
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK; National Heart & Lung Institute, Imperial College, London, UK.
| | - S Sellers
- Department of Radiology & Centre for Heart Lung Innovation, University of British Columbia & St Paul's Hospital, Vancouver, Canada
| | - A Duncan
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - A Hamadanchi
- Department of Cardiology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - D A Gorog
- National Heart & Lung Institute, Imperial College, London, UK; Department of Postgraduate Medicine, University of Hertfordshire, Hertfordshire, UK
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210
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Brown RA, Reid AB, Turaga M, Huang AL, Maggiore PL, Sellers SL, Kiritchkov L, Tarazi SC, Blanke P, Leipsic JA. Subclinical Leaflet Thrombosis Post Transcatheter Aortic Valve Replacement – An Update for 2020. STRUCTURAL HEART 2020. [DOI: 10.1080/24748706.2020.1805534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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211
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Frasca A, Xue Y, Kossar AP, Keeney S, Rock C, Zakharchenko A, Streeter M, Gorman RC, Grau JB, George I, Bavaria JE, Krieger A, Spiegel DA, Levy RJ, Ferrari G. Glycation and Serum Albumin Infiltration Contribute to the Structural Degeneration of Bioprosthetic Heart Valves. JACC Basic Transl Sci 2020; 5:755-766. [PMID: 32875167 PMCID: PMC7452200 DOI: 10.1016/j.jacbts.2020.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 12/31/2022]
Abstract
Two novel and interacting mechanisms contributing to BHV SVD are reported: glycation and serum albumin infiltration. Glycation product formation and serum albumin deposition were observed in 45 clinical BHV explanted due to SVD as well as BHV tissue subcutaneously implanted in rats. In vitro exposure to glycation and serum albumin elicited collagen network misalignment similar to that seen in clinical and rat explant BHV tissue. Glycation was sufficient to impair BHV hydrodynamic function in ISO-5840-compliant pulse duplication testing and concomitant serum albumin infiltration exacerbated these effects.
Valvular heart diseases are associated with significant cardiovascular morbidity and mortality, and often require surgical and/or percutaneous repair or replacement. Valve replacement is limited to mechanical and biological prostheses, the latter of which circumvent the need for lifelong anticoagulation but are subject to structural valve degeneration (SVD) and failure. Although calcification is heavily studied, noncalcific SVD, which represent roughly 30% of BHV failures, is relatively underinvestigated. This original work establishes 2 novel and interacting mechanisms—glycation and serum albumin incorporation—that occur in clinical valves and are sufficient to induce hallmarks of structural degeneration as well as functional deterioration.
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Key Words
- AGE, advanced glycation end product
- BHV, bioprosthetic heart valve
- BP, bovine pericardium
- CML, N-carboxymethyl-lysine
- EOA, effective orifice area
- HSA, human serum albumin
- IHC, immunohistochemistry
- PBS, phosphate-buffered saline
- SAVR, surgical aortic valve replacement
- SHG, second harmonic generation
- SVD, structural valve degeneration
- TAVR, transcatheter aortic valve replacement
- advanced glycation end products
- aortic valve disease
- biomaterial
- bioprosthetic heart valve
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Affiliation(s)
- Antonio Frasca
- Department of Surgery, Columbia University, New York, New York
| | - Yingfei Xue
- Department of Surgery, Columbia University, New York, New York
| | | | - Samuel Keeney
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher Rock
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Andrey Zakharchenko
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew Streeter
- Department of Chemistry, Yale University, New Haven, Connecticut
| | - Robert C Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Juan B Grau
- Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Isaac George
- Department of Surgery, Columbia University, New York, New York
| | - Joseph E Bavaria
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Abba Krieger
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David A Spiegel
- Department of Chemistry, Yale University, New Haven, Connecticut
| | - Robert J Levy
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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212
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Schussler O, Lila N, Grau J, Ruel M, Lecarpentier Y, Carpentier A. Possible Link Between the ABO Blood Group of Bioprosthesis Recipients and Specific Types of Structural Degeneration. J Am Heart Assoc 2020; 9:e015909. [PMID: 32698708 PMCID: PMC7792238 DOI: 10.1161/jaha.119.015909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Pigs/bovines share common antigens with humans: α-Gal, present in all pigs/bovines close to the human B-antigen; and AH-histo-blood-group antigen, identical to human AH-antigen and present only in some animals. We investigate the possible impact of patients' ABO blood group on bioprosthesis structural valve degeneration (SVD) through calcification/pannus/tears/perforations for patients ≤60 years at implantation. Methods and Results This was a single-center study (Paris, France) that included all degenerative bioprostheses explanted between 1985 and 1998, mostly porcine bioprostheses (Carpentier-Edwards second/third porcine bioprostheses) and some bovine bioprostheses. For the period 1998 to 2014, only porcine bioprostheses with longevity ≥13 years were included (total follow-up ≥29 years). Except for blood groups, important predictive factors for SVD were prospectively collected (age at implantation/longevity/number/site/sex/SVD types) and analyzed using logistic regression. All variables were available for 500 explanted porcine bioprostheses. By multivariate analyses, the A group was associated with an increased risk of: tears (odds ratio[OR], 1.61; P=0.026); pannus (OR, 1.5; P=0.054), pannus with tears (OR, 1.73; P=0.037), and tendency for lower risk of: calcifications (OR, 0.63; P=0.087) or isolated calcification (OR, 0.67; P=0.17). A-antigen was associated with lower risk of perforations (OR 0.56; P=0.087). B-group patients had an increased risk of: perforations (OR, 1.73; P=0.043); having a pannus that was calcified (OR, 3.0, P=0.025). B-antigen was associated with a propensity for calcifications in general (OR, 1.34; P=0.25). Conclusions Patient's ABO blood group is associated with specific SVD types. We hypothesize that carbohydrate antigens, which may or may not be common to patient and animal bioprosthetic tissue, will determine a patient's specific immunoreactivity with respect to xenograft tissue and thus bioprosthesis outcome in terms of SVD.
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Affiliation(s)
- Olivier Schussler
- Deparments of Cardiovascular Surgery and Cardiovascular Research Laboratory Geneva University Hospitals and Faculty of Medicine Geneva Switzerland.,Service de Chirurgie Thoracique Hôpitaux Universitaire de StrasbourgParis University Paris France
| | - Nermine Lila
- Biosurgical Research Lab (Carpentier Foundation) APHPGeorges PompidouEuropean Georges Pompidou Hospital Paris France
| | - Juan Grau
- Department of Epidemiology Ottawa Heart InstituteUniversity of Ottawa Ontario Canada
| | - Marc Ruel
- Department of Epidemiology Ottawa Heart InstituteUniversity of Ottawa Ontario Canada
| | - Yves Lecarpentier
- Centre de Recherche Clinique Grand Hôpital de l'Est Francilien (GHEF) Meaux France
| | - Alain Carpentier
- Biosurgical Research Lab (Carpentier Foundation) APHPGeorges PompidouEuropean Georges Pompidou Hospital Paris France.,Division of Cardiac Surgery and Research Laboratory European HospitalEuropean Georges Pompidou Hospital Paris France
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213
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Duncan A, Quarto C, Davies S. Midterm Degeneration of Transcatheter Heart Valve Device following Valve-in-Valve Transcatheter Aortic Valve Replacement Requiring Repeat Transcatheter Aortic Valve Replacement. CASE 2020; 4:291-298. [PMID: 32875198 PMCID: PMC7451866 DOI: 10.1016/j.case.2020.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
ViV-TAVR is an alternative to redo-SAVR in patients with a degenerate surgical bioprosthesis. Optimal TAVR device positioning is crucial in determining procedural durability. TAVR-in-TAVR can be performed to treat a degenerated ViV-TAVR device. Coronary obstruction, limited coronary access, and device thrombosis may occur.
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214
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Tam DY, Wijeysundera HC, Naimark D, Gaudino M, Webb JG, Cohen DJ, Fremes SE. Impact of Transcatheter Aortic Valve Durability on Life Expectancy in Low-Risk Patients With Severe Aortic Stenosis. Circulation 2020; 142:354-364. [DOI: 10.1161/circulationaha.119.044559] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Recent clinical trial results showed that transcatheter aortic valve replacement (TAVR) is noninferior and may be superior to surgical aortic valve replacement (SAVR) for mortality, stroke, and rehospitalization. However, the impact of transcatheter valve durability remains uncertain.
Methods:
Discrete event simulation was used to model hypothetical scenarios of TAVR versus SAVR durability in which TAVR failure times were varied to determine the impact of TAVR valve durability on life expectancy in a cohort of low-risk patients similar to those in recent trials. Discrete event simulation modeling was used to estimate the tradeoff between a less invasive procedure with unknown valve durability (TAVR) and that of a more invasive procedure with known durability (SAVR). Standardized differences were calculated, and a difference >0.10 was considered clinically significant. In the base-case analysis, patients with structural valve deterioration requiring reoperation were assumed to undergo a valve-in-valve TAVR procedure. A sensitivity analysis was conducted to determine the impact of TAVR valve durability on life expectancy in younger age groups (40, 50, and 60 years).
Results:
Our cohort consisted of patients with aortic stenosis at low surgical risk with a mean age of 73.4±5.9 years. In the base-case scenario, the standardized difference in life expectancy was <0.10 between TAVR and SAVR until transcatheter valve prosthesis failure time was 70% shorter than that of surgical prostheses. At a transcatheter valve failure time <30% compared with surgical valves, SAVR was the preferred option. In younger patients, life expectancy was reduced when TAVR durability was 30%, 40%, and 50% shorter than that of surgical valves in 40-, 50-, and 60-year-old patients, respectively.
Conclusions:
According to our simulation models, the durability of TAVR valves must be 70% shorter than that of surgical valves to result in reduced life expectancy in patients with demographics similar to those of recent trials. However, in younger patients, this threshold for TAVR valve durability was substantially higher. These findings suggest that durability concerns should not influence the initial treatment decision concerning TAVR versus SAVR in older low-risk patients on the basis of current evidence supporting TAVR valve durability. However, in younger low-risk patients, valve durability must be weighed against other patient factors such as life expectancy.
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Affiliation(s)
- Derrick Y. Tam
- Division of Cardiac Surgery, Departments of Surgery (D.Y.T., S.E.F.), University of Toronto, ON, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Institute of Health Policy, Management and Evaluation (D.Y.T., H.C.W., D.N., S.E.F.), University of Toronto, ON, Canada
| | - Harindra C. Wijeysundera
- Medicine (H.C.W.), University of Toronto, ON, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Institute of Health Policy, Management and Evaluation (D.Y.T., H.C.W., D.N., S.E.F.), University of Toronto, ON, Canada
- ICES, Toronto, ON, Canada (H.C.W.)
| | - David Naimark
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Institute of Health Policy, Management and Evaluation (D.Y.T., H.C.W., D.N., S.E.F.), University of Toronto, ON, Canada
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York (M.G.)
| | - John G. Webb
- Center for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (J.G.W.)
| | | | - Stephen E. Fremes
- Division of Cardiac Surgery, Departments of Surgery (D.Y.T., S.E.F.), University of Toronto, ON, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Institute of Health Policy, Management and Evaluation (D.Y.T., H.C.W., D.N., S.E.F.), University of Toronto, ON, Canada
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215
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Raschpichler MC, Woitek F, Chakravarty T, Flint N, Yoon SH, Mangner N, Patel CG, Singh C, Kashif M, Kiefer P, Holzhey D, Linke A, Stachel G, Thiele H, Borger MA, Makkar RR. Valve-in-Valve for Degenerated Transcatheter Aortic Valve Replacement Versus Valve-in-Valve for Degenerated Surgical Aortic Bioprostheses: A 3-Center Comparison of Hemodynamic and 1-Year Outcome. J Am Heart Assoc 2020; 9:e013973. [PMID: 32646262 PMCID: PMC7660709 DOI: 10.1161/jaha.119.013973] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background As transcatheter aortic valve replacement (TAVR) is expected to progress into younger patient populations, valve‐in‐TAVR (ViTAVR) may become a frequent consideration. Data on ViTAVR, however, are limited. This study investigated the outcome of ViTAVR in comparison to valve in surgical aortic valve replacement (ViSAVR), because ViSAVR is an established procedure for higher‐risk patients requiring repeated aortic valve intervention. Methods and Results Clinical and procedural data of patients who underwent ViTAVR at 3 sites in the United States and Germany were retrospectively compared with data of patients who underwent ViSAVR at Cedars‐Sinai Medical Center, according to Valve Academic Research Consortium‐2 criteria. A total of 99 consecutive patients, 52.5% women, with a median Society of Thoracic Surgeons score of 7.2 were identified. Seventy‐four patients (74.7%) underwent ViSAVR, and 25 patients (25.3%) underwent ViTAVR. Balloon‐expandable devices were used in 72.7%. ViSAVR patients presented with smaller index devices (21.0 versus 26.0 mm median true internal diameter; P<0.001). Significantly better postprocedural hemodynamics (median prosthesis mean gradient, 12.5 [interquartile range, 8.8–16.2] versus 16.0 [interquartile range, 13.0–20.5] mm Hg; P=0.045) were observed for ViTAVR compared with the ViSAVR. Device success, however, was not different (79.2% and 66.2% for ViTAVR and ViSAVR, respectively; P=0.35), as were rates of permanent pacemaker implantation (16.7% versus 5.4%; P=0.1). One‐year‐mortality was 9.4% and 13.4% for ViTAVR and ViSAVR, respectively (log‐rank P=0.38). Conclusions Compared with ViSAVR, ViTAVR provides acceptable outcomes, with slightly better hemodynamics, similar device success rates, and similar 1‐year mortality.
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Affiliation(s)
- Matthias C Raschpichler
- Cedars-Sinai Smidt Heart Institute Los Angeles CA.,University Clinic of Cardiac Surgery Heart Center Leipzig Leipzig Germany
| | - Felix Woitek
- Department of Cardiology Dresden University Hospital Dresden Germany
| | | | - Nir Flint
- Cedars-Sinai Smidt Heart Institute Los Angeles CA.,Department of Cardiology Tel-Aviv Sourasky Medical Center Sackler Faculty of Medicine Tel-Aviv University Tel-Aviv Israel
| | | | - Norman Mangner
- Department of Cardiology Dresden University Hospital Dresden Germany
| | | | | | | | - Philip Kiefer
- University Clinic of Cardiac Surgery Heart Center Leipzig Leipzig Germany
| | - David Holzhey
- University Clinic of Cardiac Surgery Heart Center Leipzig Leipzig Germany
| | - Axel Linke
- Department of Cardiology Dresden University Hospital Dresden Germany
| | - Georg Stachel
- Department of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig Germany
| | - Michael A Borger
- University Clinic of Cardiac Surgery Heart Center Leipzig Leipzig Germany
| | - Raj R Makkar
- Cedars-Sinai Smidt Heart Institute Los Angeles CA
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216
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Stefanelli G, Pirro F, Smorto V, Bellisario A, Chiurlia E, Weltert L. Stentless Pericarbon Freedom Versus Stented Perimount Aortic Bioprosthesis: Propensity-Matched Long-Term Follow-Up. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:440-448. [PMID: 32628077 DOI: 10.1177/1556984520929778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Stentless aortic valves have shown superior hemodynamic performance and faster left ventricular mass regression compared to stented bioprostheses. Yet, controversies exist concerning the durability of stentless valves. This case-matched study compared short- and long-term clinical outcomes of stentless LivaNova-Sorin Pericarbon Freedom™ (SPF) and stented Carpentier-Edwards Perimount (CEP) aortic prostheses. METHODS From 2003 through 2006, 134 consecutive patients received aortic valve replacement with SPF at our institution. This cohort was matched, according to 20 preoperative clinical parameters, with a control group of 390 patients who received CEP prosthesis during the same time. The resulting 55 + 55 matched patients were analyzed for perioperative results and long-term clinical outcomes. RESULTS Early mortality was 0% for both groups. Lower transvalvular gradients were found in the SPF group (10.6 ± 2.9 versus 15.7 ± 3.1 mmHg, P < 0.001). Overall late mortality (mean follow-up: 10.03 years) was similar for both groups (50.1% versus 42.8%, P = 0.96). Freedom from structural valve degeneration (SVD) at 13 years was similar for both groups (SPF = 92.3%, CEP = 73.9%, P = 0.06). Freedom from aortic valve reinterventions did not differ (SPF = 92.3%, CEP = 93.5%, P = 0.55). Gradients at 13-year follow-up remained significantly lower in SPF group (10.0 ± 4.5 versus 16.2 ± 9.5 mmHg, P < 0.001). Incidence of acute bacterial endocarditis (ABE) and major adverse cardiovascular and cerebrovascular events (MACCE) was similar. CONCLUSIONS SPF and CEP demonstrated comparable long-term outcomes related to late mortality, SVD, aortic valve reinterventions, and incidence of ABE and MACCE. Superior hemodynamic performance of SPF over time can make this valve a suitable choice in patients with small aortic root and large body surface area.
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Affiliation(s)
- Guglielmo Stefanelli
- 18614 Department of Cardiology and Cardiac Surgery, Hesperia Hospital, Modena, Italy
| | - Fabrizio Pirro
- 18614 Department of Cardiology and Cardiac Surgery, Hesperia Hospital, Modena, Italy
| | - Vincenzo Smorto
- 18614 Department of Cardiology and Cardiac Surgery, Hesperia Hospital, Modena, Italy
| | - Alessandro Bellisario
- European Hospital, Rome, Italy.,Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Emilio Chiurlia
- 18614 Department of Cardiology and Cardiac Surgery, Hesperia Hospital, Modena, Italy
| | - Luca Weltert
- European Hospital, Rome, Italy.,Saint Camillus International University of Health and Medical Sciences, Rome, Italy
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217
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Solinas M, Bianchi G, Chiaramonti F, Margaryan R, Kallushi E, Gasbarri T, Santarelli F, Murzi M, Farneti P, Leone A, Simeoni S, Varone E, Marchi F, Glauber M, Concistrè G. Right anterior mini-thoracotomy and sutureless valves: the perfect marriage. Ann Cardiothorac Surg 2020; 9:305-313. [PMID: 32832412 DOI: 10.21037/acs-2019-surd-172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background A minimally invasive approach (MIA) reduces mortality and morbidity in patients referred for aortic valve replacement (AVR). Sutureless technology facilitates a MIA. We describe our experience with the sutureless Perceval (LivaNova, Italy) aortic bioprosthesis through a right anterior mini-thoracotomy (RAMT) approach. Methods Between March 2011 and October 2019, 1,049 patients underwent AVR with Perceval bioprosthesis. Five hundred and three patients (48%) were operated through a RAMT approach in the second intercostal space. Considering only isolated AVR (881), 98% of patients were operated with MIA, and Perceval in RAMT approach was performed in 57% of these patients. Eight patients (1.6%) had previously undergone cardiac surgery. The prosthesis sizes implanted were: S (n=91), M (n=154), L (n=218) and XL (n=40). Concomitant procedures were mitral valve surgery (n=6), tricuspid valve repair (n=1), mitral valve repair and tricuspid valve repair (n=1) and miectomy (n=2). Mean age was 78±4 years (range, 65-89 years), 317 patients were female (63%) and EuroSCORE II was 5.9%±8.4%. Results The 30-day mortality was 0.8% (4/503). Cardiopulmonary bypass (CPB) and aortic cross-clamp times were 81.6±30.8 and 50.3±24.5 minutes respectively for stand-alone procedures. In two patients, early moderate paravalvular leakage appeared as a result of incomplete expansion of the sutureless valve due to oversizing of the bioprosthesis, requiring reoperations at two and nine postoperative days with sutured aortic bioprosthesis implantation. Permanent pacemaker implantation within the first thirty days was necessary in 26 (5.2%) patients. At the mean follow-up of 4.6 years (range, 1 month to 8.6 years), survival was 96%, freedom from reoperation was 99.2%, and mean transvalvular pressure gradient was 11.9±4.3 mmHg. Conclusions AVR with the Perceval bioprosthesis in a RAMT approach is a safe and feasible procedure associated with low mortality and excellent hemodynamic performance. Sutureless technology facilitates a RAMT approach.
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Affiliation(s)
- Marco Solinas
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Giacomo Bianchi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Francesca Chiaramonti
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Rafik Margaryan
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Enkel Kallushi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Tommaso Gasbarri
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Filippo Santarelli
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Michele Murzi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Pierandrea Farneti
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Alessandro Leone
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Simone Simeoni
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Egidio Varone
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Federica Marchi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Mattia Glauber
- Department of Minimally-Invasive Cardiac Surgery, Istituto Clinico Sant' Ambrogio, Milan, Italy
| | - Giovanni Concistrè
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
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218
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Bleiziffer S, Simonato M, Webb JG, Rodés-Cabau J, Pibarot P, Kornowski R, Windecker S, Erlebach M, Duncan A, Seiffert M, Unbehaun A, Frerker C, Conzelmann L, Wijeysundera H, Kim WK, Montorfano M, Latib A, Tchetche D, Allali A, Abdel-Wahab M, Orvin K, Stortecky S, Nissen H, Holzamer A, Urena M, Testa L, Agrifoglio M, Whisenant B, Sathananthan J, Napodano M, Landi A, Fiorina C, Zittermann A, Veulemans V, Sinning JM, Saia F, Brecker S, Presbitero P, De Backer O, Søndergaard L, Bruschi G, Franco LN, Petronio AS, Barbanti M, Cerillo A, Spargias K, Schofer J, Cohen M, Muñoz-Garcia A, Finkelstein A, Adam M, Serra V, Teles RC, Champagnac D, Iadanza A, Chodor P, Eggebrecht H, Welsh R, Caixeta A, Salizzoni S, Dager A, Auffret V, Cheema A, Ubben T, Ancona M, Rudolph T, Gummert J, Tseng E, Noble S, Bunc M, Roberts D, Kass M, Gupta A, Leon MB, Dvir D. Long-term outcomes after transcatheter aortic valve implantation in failed bioprosthetic valves. Eur Heart J 2020; 41:2731-2742. [DOI: 10.1093/eurheartj/ehaa544] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/09/2020] [Accepted: 06/22/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There are no data on long-term outcomes after aortic ViV. Our aim was to perform a large-scale assessment of long-term survival and reintervention after aortic ViV.
Methods and results
A total of 1006 aortic ViV procedures performed more than 5 years ago [mean age 77.7 ± 9.7 years; 58.8% male; median STS-PROM score 7.3% (4.2–12.0)] were included in the analysis. Patients were treated with Medtronic self-expandable valves (CoreValve/Evolut, Medtronic Inc., Minneapolis, MN, USA) (n = 523, 52.0%), Edwards balloon-expandable valves (EBEV, SAPIEN/SAPIEN XT/SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) (n = 435, 43.2%), and other devices (n = 48, 4.8%). Survival was lower at 8 years in patients with small-failed bioprostheses [internal diameter (ID) ≤ 20 mm] compared with those with large-failed bioprostheses (ID > 20 mm) (33.2% vs. 40.5%, P = 0.01). Independent correlates for mortality included smaller-failed bioprosthetic valves [hazard ratio (HR) 1.07 (95% confidence interval (CI) 1.02–1.13)], age [HR 1.21 (95% CI 1.01–1.45)], and non-transfemoral access [HR 1.43 (95% CI 1.11–1.84)]. There were 40 reinterventions after ViV. Independent correlates for all-cause reintervention included pre-existing severe prosthesis–patient mismatch [subhazard ratio (SHR) 4.34 (95% CI 1.31–14.39)], device malposition [SHR 3.75 (95% CI 1.36–10.35)], EBEV [SHR 3.34 (95% CI 1.26–8.85)], and age [SHR 0.59 (95% CI 0.44–0.78)].
Conclusions
The size of the original failed valve may influence long-term mortality, and the type of the transcatheter valve may influence the need for reintervention after aortic ViV.
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Affiliation(s)
- Sabine Bleiziffer
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Matheus Simonato
- Division of Cardiac Surgery, Escola Paulista de Medicina - Universidade Federal de São Paulo, R. Botucatu, 740, São Paulo - SP, 04023-062, Brazil
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada
| | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 1050 Avenue de la Médecine Local 4211 Ferdinand Vandry Pavillon, Québec, QC G1V 0A6, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 1050 Avenue de la Médecine Local 4211 Ferdinand Vandry Pavillon, Québec, QC G1V 0A6, Canada
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital in Petach Tikva & Faculty of Medicine at Tel Aviv University, 39 Jabotinski St., Petah Tikva 49100
| | - Stephan Windecker
- Universitätsklinik für Kardiologie, Inselspital Bern, Freiburgstrasse 15 3010 Bern, Switzerland
| | - Magdalena Erlebach
- Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München, Lazarettstraße 36, 80636 München, Germany
| | - Alison Duncan
- Department of Echocardiography, The Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - Moritz Seiffert
- Universitäres Herz- und Gefäßzentrum, Universitätsklinikum Hamburg-Eppendorf, Villa Garbrecht, Martinistraße 52, 20251 Hamburg, Germany
| | - Axel Unbehaun
- Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Augustenburger Platz 1 13353 Berlin, Germany
| | - Christian Frerker
- Klinik III für Innere Medizin, Uniklinik Köln, Köln, Kerpener Str. 62, 50937 Köln, Germany
| | - Lars Conzelmann
- Helios Klinik für Herzchirurgie Karlsruhe, Helios Karlsruhe, Franz-Lust-Straße 30, 76185 Karlsruhe, Germany
| | - Harindra Wijeysundera
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave. Toronto, ON M4N 3M5 Canada
| | - Won-Keun Kim
- Abteilung für Kardiologie, Kerckhoff-Klinik, Benekestr. 2 - 8, 61231 Bad Nauheim, Germany
| | - Matteo Montorfano
- Unità Operativa di Cardiologia Interventistica ed Emodinamica, I.R.C.C.S. Ospedale San Raffaele, Via Olgettina n. 60, 20132 Milan, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, 111 East 210th Street Bronx, NY 10467-2401, USA
| | - Didier Tchetche
- Division of Cardiology, Clinique Pasteur, 45 avenue de Lombez BP 27617 31076 Toulouse Cedex 3, France
| | - Abdelhakim Allali
- Klinik für Kardiologie & Angiologie, Segeberger Kliniken, Am Kurpark 1, 23795 Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Abteilung für Strukturelle Herzerkrankungen, Universitätsklinikum Leipzig, Strümpellstraße 39 04289 Leipzig, Germany
| | - Katia Orvin
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital in Petach Tikva & Faculty of Medicine at Tel Aviv University, 39 Jabotinski St., Petah Tikva 49100
| | - Stefan Stortecky
- Universitätsklinik für Kardiologie, Inselspital Bern, Freiburgstrasse 15 3010 Bern, Switzerland
| | - Henrik Nissen
- Department of Cardiology, Odense Universitetshospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Andreas Holzamer
- Herz-, Thorax- und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Marina Urena
- Department of Cardiology, Hôpital Bichat-Claude-Bernard, 46 Rue Henri Huchard, 75018 Paris, France
| | - Luca Testa
- Department of Cardiology, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Italy
| | - Marco Agrifoglio
- Sezione di Malattie dell’Apparato Cardiovascolare, Centro Cardiologico Monzino, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Brian Whisenant
- Intermountain Heart Institute, Intermountain Healthcare, 5169 Cottonwood St #520, Murray, UT 84107, USA
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada
| | - Massimo Napodano
- Dipartimento di Scienze Cardiologiche Toraciche e Vascolari, Università degli Studi di Padova, Via Giustiniani, 2 - 35128 Padova, Italy
| | - Antonio Landi
- Dipartimento di Scienze Cardiologiche Toraciche e Vascolari, Università degli Studi di Padova, Via Giustiniani, 2 - 35128 Padova, Italy
| | - Claudia Fiorina
- Emodinamica, Spedali Civili di Brescia, Piazzale Spedali Civili, 125123 Brescia, Italy
| | - Armin Zittermann
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Verena Veulemans
- Klinik für Kardiologie, Pneumologie & Angiologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Jan-Malte Sinning
- Herzzentrum Bonn, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Francesco Saia
- Laboratorio di Emodinamica dell'Istituto di Cardiologia, Università degli Studi di Bologna, Policlinico S.Orsola-Malpighi, Via Giuseppe Massarenti, 9, 40138 Bologna, Italy
| | - Stephen Brecker
- Structural Heart Disease Clinic, Department of Cardiology, St. George's University Hospitals, Blackshaw Rd, Tooting, London SW17 0QT, UK
| | - Patrizia Presbitero
- Cardiologia clinica e interventistica, Cardio Center, Humanitas, Via Manzoni 56, 20089 Rozzano, Milano, Italy
| | - Ole De Backer
- Hjertemedicinsk Klinik, Center for Hjerte-, Kar-, Lunge- og Infektionssygdomme, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lars Søndergaard
- Hjertemedicinsk Klinik, Center for Hjerte-, Kar-, Lunge- og Infektionssygdomme, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Giuseppe Bruschi
- Cardiochirurgia, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3 - 20162 Milan, Italy
| | - Luis Nombela Franco
- Servicio de Cardiología, Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
| | - Anna Sonia Petronio
- Sezione Dipartimentale di Emodinamica, Università di Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Marco Barbanti
- Malattie dell'apparato cardiovascolare, Università degli Studi di Catania, Via Santa Maria del Rosario, 9 (1° piano) 95131 - Catania, Italy
| | - Alfredo Cerillo
- Cardiochirurgia, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3 - 50134 Firenze, Italy
| | - Konstantinos Spargias
- Transcatheter Heart Valves Department, Hygeia Hospital, Athens, Erithrou Stavrou 4, Marousi 151 23, Greece
| | - Joachim Schofer
- Innere Medizin und Kardiologie, Medizinisches Versorgungszentrum, Wördemanns Weg 25-27 22527 Hamburg Germany
| | - Mauricio Cohen
- The Elaine and Sydney Sussman Cardiac Catheterization Laboratories, Cardiovascular Division, University of Miami Miller School of Medicine, 1400 NW 12th Ave, Miami, FL 33136, USA
| | - Antonio Muñoz-Garcia
- Unidad de Hemodinámica, Hospital Universitario Virgen de la Victoria, Campus de Teatinos, S/N, 29010 Málaga, Spain
| | - Ariel Finkelstein
- Division of Cardiology, Tel-Aviv Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel
| | - Matti Adam
- Klinik III für Innere Medizin, Uniklinik Köln, Köln, Kerpener Str. 62, 50937 Köln, Germany
| | - Vicenç Serra
- Servicio de Cardiología, Hospital Vall d’Hebron, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - Rui Campante Teles
- Divisão de Cardiologia, Hospital de Santa Cruz, Lisboa, Av. Prof. Dr. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Didier Champagnac
- Cardiologie Interventionnelle, Cardiologie Tonkin, 158 Rue Léon Blum 69100 Villeurbanne, France
| | - Alessandro Iadanza
- Emodinamica, Azienda Ospedaliera Universitaria Senese, Viale Mario Bracci, 16, 53100 Siena, Italy
| | - Piotr Chodor
- Department of Cardiology, Silesian Center for Heart Disease, Marii Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Holger Eggebrecht
- Interventionelle Kardiologie, Cardioangiologisches Centrum Bethanien, Im Prüfling 23, 60389 Frankfurt am Main, Germany
| | - Robert Welsh
- Mazankowski Alberta Heart Institute, University of Alberta, 11220 83 Ave NW, Edmonton, AB T6G 2B7, Canada
| | - Adriano Caixeta
- Divisão de Cardiologia, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - Morumbi, São Paulo - SP, 05653-010, Brazil
| | - Stefano Salizzoni
- Dipartimento Cardiovascolare e Toracico, Città della Salute e della Scienza - "Molinette" Hospital, Corso Bramante, 88, 10126 Torino, Italy
| | - Antonio Dager
- Cardiología, Clinica de Occidente, Cl. 18 Nte. #5-34 Cali, Valle del Cauca, Colombia
| | - Vincent Auffret
- Cardiologie et maladies vasculaires, Centre Hospitalier Universitaire de Rennes, 2 Rue Henri le Guilloux, 35000 Rennes, France
| | - Asim Cheema
- Interventional Cardiology, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada
| | - Timm Ubben
- Herz-, Gefäß- und Diabeteszentrum, Asklepios Klinik St. Georg, Lohmühlenstraße 5, 20099 Hamburg, Germany
| | - Marco Ancona
- Unità Operativa di Cardiologia Interventistica ed Emodinamica, I.R.C.C.S. Ospedale San Raffaele, Via Olgettina n. 60, 20132 Milan, Italy
| | - Tanja Rudolph
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Jan Gummert
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Elaine Tseng
- Division of Adult Cardiothoracic Surgery, University of California San Francisco, 4150 Clement St, (112) San Francisco, CA 9412,USA
| | - Stephane Noble
- Unité de cardiologie structurelle, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4 1205 Genève, Switzerland
| | - Matjaz Bunc
- Interventional Cardiology, Ljubljana University Medical Centre, Zaloška cesta 7, 1000 Ljubljana, Slovenia
| | - David Roberts
- Division of Cardiology, Blackpool Teaching Hospitals, Whinney Heys Rd, Blackpool FY3 8NR,UK
| | - Malek Kass
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, 409 Tache Ave, Winnipeg, MB R2H 2A6, Canada
| | - Anuj Gupta
- Cardiac Catheterization Laboratory, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201, USA
| | - Martin B Leon
- Center for Interventional Vascular Therapy, Columbia University Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Danny Dvir
- Division of Cardiology, University of Washington, 1959 NE Pacific Street, C502-A, PO Box 356422, Seattle, WA 98195, USA
- Jesselson Integrated Heart Center, Shaare Zedek Medical Centre, Hebrew University, Shmu'el Bait St 12, Jerusalem, 9103102, Israel
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219
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Le Bars F, Tomasi J, Belhaj Soulami R, Colas F, Anselmi A, Verhoye JP. Long-term follow-up of the Shelhigh™ superstentless bioprosthesis aortic valve and valved conduit in a monocentric experience. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:776-783. [PMID: 32558524 DOI: 10.23736/s0021-9509.20.11219-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Shelhigh™ SuperStentless (Shelhigh, INC., Union, NJ, USA) is a stentless aortic valve bioprosthesis and aortic root valved conduit. In 2007, this device was recalled by FDA due to malfunction, and subsequently reintegrated by BioIntegral Surgical™ Few data are available over late durability of this device. We performed a long-term follow-up of Shelhigh™ devices implanted at our center. METHODS Between 2002 and 2007, 44 patients underwent aortic valve replacement with a Shelhigh™ device (40 aortic valve bioprosthesis and 4 valved conduit). We performed a clinical and echocardiographic follow-up (9.2 years±4.3). Standardized definitions of valve-related events were adopted. RESULTS At discharge, maximum and mean aortic gradients averaged 36.1±11.3 and 21.0±6.8 mmHg, respectively. The 30-days mortality was 2.3%. Over the follow-up period, 29 patients died (65.9%); 2 deaths were valve related. Overall survival at 1, 5 and 10 years was 97.7%, 85.8% and 54% respectively. At last echocardiography, average transvalvular gradients had remained globally stable in the population (33.6±12 and 20.4±10.5 mmHg). Eight (19%) structural valve deterioration (SVD) events were reported. Two (5%) non-structural valve dysfunction (NSVD) events occurred (periprosthetic leak). Two (5%) infectious endocarditis events and two (5%) valve thromboses were also deplored. Three (7%) patients required re-operation (2 due to SVD and 1 due to endocarditis). CONCLUSIONS The immediate hemodynamic performance of the Shelhigh™ aortic bioprostheses was unexpectedly suboptimal. Despite this, hemodynamic performance remained stable over time. Patients survival at follow-up was satisfactory, however, continued surveillance is necessary.
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Affiliation(s)
- Florent Le Bars
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Jacques Tomasi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Reda Belhaj Soulami
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Fabrice Colas
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France -
| | - Jean-Philippe Verhoye
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
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220
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Ler A, Ying YJ, Sazzad F, Choong AMTL, Kofidis T. Structural durability of early-generation Transcatheter aortic valve replacement valves compared with surgical aortic valve replacement valves in heart valve surgery: a systematic review and meta-analysis. J Cardiothorac Surg 2020; 15:127. [PMID: 32513222 PMCID: PMC7278207 DOI: 10.1186/s13019-020-01170-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background The current treatment for aortic stenosis includes open surgical aortic valve replacement (SAVR) as well as endovascular transcatheter aortic valve replacement (TAVR). This study aims to compare the 1-year, 2–3 year and 5-year structural durability of TAVR valves with that of SAVR valves. Method A systematic literature search was conducted in July 2019 on Medline (via PubMed), Embase and Cochrane electronic databases according to the PRISMA guidelines. Results Thirteen randomized controlled trials were included. From the meta-analysis, we observed higher rates of 1-year (OR: 7.65, CI: 4.57 to 12.79, p < 0.00001), 2–3-year (OR: 13.49, CI: 5.66 to 32.16, p < 0.00001) and 5-year paravalvular regurgitation (OR: 14.51, CI: 4.47 to 47.09, p < 0.00001) associated with the TAVR valves than the SAVR valves. There were also higher rates of 1-year (OR: 5.00, CI: 3.27 to 7.67, p < 0.00001), 2–3-year (OR: 8.14, CI: 3.58 to 18.50, p < 0.00001) and 5-year moderate or severe aortic regurgitation (MD: 14.65, CI: 4.55 to 47.19, p < 0.00001), and higher rates of 1-year (OR: 3.55, CI: 1.86 to 6.77, p = 0.0001), 2–3-year (OR: 3.55, CI: 1.86 to 6.77, p = 0.0001) and 5-year reintervention (OR: 3.55, CI: 1.22 to 10.38, p = 0.02) in the TAVR valves as compared to SAVR valves. Conclusion TAVR valves appear to be more susceptible to structural valve deterioration and thus potentially less structurally durable than SAVR valves, given that they may be associated with higher rates of moderate or severe aortic regurgitation, paravalvular regurgitation and reintervention in the 1-year-, 2–3 year, and 5-year period.
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Affiliation(s)
- Ashlynn Ler
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, 9th Floor, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.,School of Medicine, National University of Ireland, Galway, Ireland
| | - Yeo Jie Ying
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, 9th Floor, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.,School of Medicine, Queen's University Belfast, Belfast, UK
| | - Faizus Sazzad
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, 9th Floor, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge Road, Singapore.,National University Health System (NUHS), 5 Lower Kent Ridge Road, Kent Ridge Road, 119228, Singapore
| | - Andrew M T L Choong
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, 9th Floor, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge Road, Singapore.,Cardiovascular Research Institute, MD6, 14 Medical Drive, National University of Singapore, Singapore, 117599, Singapore.,National University Health System (NUHS), 5 Lower Kent Ridge Road, Kent Ridge Road, 119228, Singapore
| | - Theo Kofidis
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, 9th Floor, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge Road, Singapore. .,Cardiovascular Research Institute, MD6, 14 Medical Drive, National University of Singapore, Singapore, 117599, Singapore. .,National University Health System (NUHS), 5 Lower Kent Ridge Road, Kent Ridge Road, 119228, Singapore.
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221
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Xuan Y, Dvir D, Wang Z, Ye J, Guccione JM, Ge L, Tseng EE. Stent and leaflet stresses across generations of balloon-expandable transcatheter aortic valves. Interact Cardiovasc Thorac Surg 2020; 30:879-886. [PMID: 32248231 PMCID: PMC7248644 DOI: 10.1093/icvts/ivaa037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 01/10/2020] [Accepted: 02/04/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve replacement (TAVR) is established therapy for severe aortic stenosis patients with intermediate-, high- and prohibitive-risk for surgery. A significant challenge when expanding TAVR to low-risk and younger patients is the unknown long-term durability. High leaflet stresses have been associated with surgical bioprosthetic valve degeneration. In this study, we examined the impact of changes in valve design across 3 generations of same-sized TAVR devices on stent and leaflet stresses. METHODS The 26-mm Edwards SAPIEN, 23, 26 and 29 mm SAPIEN XT (XT) and 26 mm SAPIEN 3 (S3) (n = 1 each) underwent micro-computed tomography (micro-CT) scanning. Dynamic finite element computational simulations of 23-26 mm SAPIEN, 23-29 mm XT and 23-29 mm S3 were performed with physiological loading and micro-CT or scaled geometries. RESULTS Peak stresses were concentrated in the commissure area and along the bottom of the suture, representing areas most likely to develop structural valve degeneration across TAVR generations. Latest-generation S3 showed greatest 99th percentile principal stress on commissural leaflets for 26 and 29 mm, and increased stresses over XT for 23 mm. Percentage of higher stress areas within the leaflets steadily increased across generations, 3.8%, 3.9% and 5.7%, respectively, for 26 mm SAPIEN, XT and S3 with similar trend for 29-mm valves. CONCLUSIONS Using computational simulations based on high-fidelity modelling of balloon-expandable TAVRs, our study demonstrated that maximum stress areas existed in similar leaflet locations across SAPIEN generations, while the latest model S3 had the highest magnitude for both 26- and 29-mm valves. S3 also had the largest area of higher stresses than other generations, which would be prone to degeneration. Our study coupled with future long-term clinical outcomes >10 years will provide insight on biomechanics of TAVR degeneration.
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Affiliation(s)
- Yue Xuan
- Division of Cardiothoracic Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Danny Dvir
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Zhongjie Wang
- Division of Cardiothoracic Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Jian Ye
- Department of Surgery, St Paul’s Hospital, Vancouver, BC, Canada
| | - Julius M Guccione
- Division of Cardiothoracic Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Liang Ge
- Division of Cardiothoracic Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Elaine E Tseng
- Division of Cardiothoracic Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA
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222
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Meuris B, Borger MA, Bourguignon T, Siepe M, Grabenwöger M, Laufer G, Binder K, Polvani G, Stefano P, Coscioni E, van Leeuwen W, Demers P, Dagenais F, Canovas S, Theron A, Langanay T, Roussel JC, Wendler O, Mariscalco G, Pessotto R, Botta B, Bramlage P, de Paulis R. Durability of bioprosthetic aortic valves in patients under the age of 60 years - rationale and design of the international INDURE registry. J Cardiothorac Surg 2020; 15:119. [PMID: 32460798 PMCID: PMC7251702 DOI: 10.1186/s13019-020-01155-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an ever-growing number of patients requiring aortic valve replacement (AVR). Limited data is available on the long-term outcomes and structural integrity of bioprosthetic valves in younger patients undergoing surgical AVR. METHODS The INSPIRIS RESILIA Durability Registry (INDURE) is a prospective, open-label, multicentre, international registry with a follow-up of 5 years to assess clinical outcomes of patients younger than 60 years who undergo surgical AVR using the INSPIRIS RESILIA aortic valve. INDURE will be conducted across 20-22 sites in Europe and Canada and intends to enrol minimum of 400 patients. Patients will be included if they are scheduled to undergo AVR with or without concomitant root replacement and/or coronary bypass surgery. The primary objectives are to 1) determine VARC-2 defined time-related valve safety at one-year (depicted as freedom from events) and 2) determine freedom from stage 3 structural valve degeneration (SVD) presenting as morphological abnormalities and severe haemodynamic valve degeneration at 5 years. Secondary objectives include the assessment of the haemodynamic performance of the valve, all stages of SVD, potential valve-in-valve procedures, clinical outcomes (in terms of New York Heart Association [NYHA] function class and freedom from valve-related rehospitalisation) and change in patient quality-of-life. DISCUSSION INDURE is a prospective, multicentre registry in Europe and Canada, which will provide much needed data on the long-term performance of bioprosthetic valves in general and the INSPIRIS RESILIA valve in particular. The data may help to gather a deeper understanding of the longevity of bioprosthetic valves and may expand the use of bioprosthetic valves in patients under the age of 60 years. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03666741 (registration received September, 12th, 2018).
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Affiliation(s)
- Bart Meuris
- Cardiac Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | | | | | - Matthias Siepe
- Heart Center University of Freiburg, Freiburg and Bad Krozingen, Germany
| | | | | | - Konrad Binder
- Heart Center University St. Pölten, St. Pölten, Austria
| | | | | | - Enrico Coscioni
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | | | | | | | - Sergio Canovas
- Hospital University Virgen de la Arrixaca, Murcia, Spain
| | | | | | | | - Olaf Wendler
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | - Beate Botta
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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223
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Chakravarty T, Patel A, Kapadia S, Raschpichler M, Smalling RW, Szeto WY, Abramowitz Y, Cheng W, Douglas PS, Hahn RT, Herrmann HC, Kereiakes D, Svensson L, Yoon SH, Babaliaros VC, Kodali S, Thourani VH, Alu MC, Liu Y, McAndrew T, Mack M, Leon MB, Makkar RR. Anticoagulation After Surgical or Transcatheter Bioprosthetic Aortic Valve Replacement. J Am Coll Cardiol 2020; 74:1190-1200. [PMID: 31466616 DOI: 10.1016/j.jacc.2019.06.058] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is paucity of evidence on the impact of anticoagulation (AC) after bioprosthetic aortic valve replacement (AVR) on valve hemodynamics and clinical outcomes. OBJECTIVES The study aimed to assess the impact of AC after bioprosthetic AVR on valve hemodynamics and clinical outcomes. METHODS Data on antiplatelet and antithrombotic therapy were collected. Echocardiograms were performed at 30 days and 1 year post-AVR. Linear regression model and propensity-score adjusted cox proportional model were used to assess the impact of AC on valve hemodynamics and clinical outcomes, respectively. RESULTS A total of 4,832 patients undergoing bioprosthetic AVR (transcatheter aortic valve replacement [TAVR], n = 3,889 and surgical AVR [SAVR], n = 943) in the pooled cohort of PARTNER2 (Placement of Aortic Transcatheter Valves) randomized trials and nonrandomized registries were studied. Following adjustment for valve size, annular diameter, atrial fibrillation, and ejection fraction at the time of assessment of hemodynamics, there was no significant difference in aortic valve mean gradients or aortic valve areas between patients discharged on AC vs. those not discharged on AC, for either TAVR or SAVR cohorts. A significantly greater proportion of patients not discharged on AC had an increase in mean gradient >10 mm Hg from 30 days to 1 year, compared with those discharged on AC (2.3% vs. 1.1%, p = 0.03). There was no independent association between AC after TAVR and adverse outcomes (death, p = 0.15; rehospitalization, p = 0.16), whereas AC after SAVR was associated with significantly fewer strokes (hazard ratio [HR]: 0.17; 95% confidence interval [CI]: 0.05-0.60; p = 0.006). CONCLUSIONS In the short term, early AC after bioprosthetic AVR did not result in adverse clinical events, did not significantly affect aortic valve hemodynamics (aortic valve gradients or area), and was associated with decreased rates of stroke after SAVR (but not after TAVR). Whether early AC after bioprosthetic AVR has impact on long-term outcomes remains to be determined. (Placement of AoRTic TraNscathetER Valves [PARTNERII A]; NCT01314313).
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Affiliation(s)
- Tarun Chakravarty
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Akshar Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | | | | | - Yigal Abramowitz
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Wen Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Pamela S Douglas
- Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina
| | - Rebecca T Hahn
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | | | | | | | - Sung-Han Yoon
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Susheel Kodali
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Vinod H Thourani
- Medstar Heart & Vascular Institute, Washington Hospital Center, Washington, DC
| | - Maria C Alu
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Yangbo Liu
- Cardiovascular Research Foundation, New York, New York
| | | | | | - Martin B Leon
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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224
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Pibarot P, Salaun E, Dahou A, Avenatti E, Guzzetti E, Annabi MS, Toubal O, Bernier M, Beaudoin J, Ong G, Ternacle J, Krapf L, Thourani VH, Makkar R, Kodali SK, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Leipsic J, Blanke P, Williams MR, McCabe JM, Brown DL, Babaliaros V, Goldman S, Szeto WY, Généreux P, Pershad A, Alu MC, Xu K, Rogers E, Webb JG, Smith CR, Mack MJ, Leon MB, Hahn RT. Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients. Circulation 2020; 141:1527-1537. [DOI: 10.1161/circulationaha.119.044574] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background:
This study aimed to compare echocardiographic findings in low-risk patients with severe aortic stenosis after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR).
Methods:
The PARTNER 3 trial (Placement of Aortic Transcatheter Valves) randomized 1000 patients with severe aortic stenosis and low surgical risk to undergo either transfemoral TAVR with the balloon-expandable SAPIEN 3 valve or SAVR. Transthoracic echocardiograms obtained at baseline and at 30 days and 1 year after the procedure were analyzed by a consortium of 2 echocardiography core laboratories.
Results:
The percentage of moderate or severe aortic regurgitation (AR) was low and not statistically different between the TAVR and SAVR groups at 30 days (0.8% versus 0.2%;
P
=0.38). Mild AR was more frequent after TAVR than SAVR at 30 days (28.8% versus 4.2%;
P
<0.001). At 1 year, mean transvalvular gradient (13.7±5.6 versus 11.6±5.0 mm Hg;
P
=0.12) and aortic valve area (1.72±0.37 versus 1.76±0.42 cm
2
;
P
=0.12) were similar in TAVR and SAVR. The percentage of severe prosthesis–patient mismatch at 30 days was low and similar between TAVR and SAVR (4.6 versus 6.3%;
P
=0.30). Valvulo-arterial impedance (Z
va
), which reflects total left ventricular hemodynamic burden, was lower with TAVR than SAVR at 1 year (3.7±0.8 versus 3.9±0.9 mm Hg/mL/m
2
;
P
<0.001). Tricuspid annulus plane systolic excursion decreased and the percentage of moderate or severe tricuspid regurgitation increased from baseline to 1 year in SAVR but remained unchanged in TAVR. Irrespective of treatment arm, high Z
va
and low tricuspid annulus plane systolic excursion, but not moderate to severe AR or severe prosthesis–patient mismatch, were associated with increased risk of the composite end point of mortality, stroke, and rehospitalization at 1 year.
Conclusions:
In patients with severe aortic stenosis and low surgical risk, TAVR with the SAPIEN 3 valve was associated with similar percentage of moderate or severe AR compared with SAVR but higher percentage of mild AR. Transprosthetic gradients, valve areas, percentage of severe prosthesis–patient mismatch, and left ventricular mass regression were similar in TAVR and SAVR. SAVR was associated with significant deterioration of right ventricular systolic function and greater tricuspid regurgitation, which persisted at 1 year. High Z
va
and low tricuspid annulus plane systolic excursion were associated with worse outcome at 1 year whereas AR and severe prosthesis–patient mismatch were not.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02675114.
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Affiliation(s)
- Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Erwan Salaun
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Abdellaziz Dahou
- Cardiovascular Research Foundation, New York, NY (A.D., E.A., M.C.A., M.B.L., R.T.H.)
| | - Eleonora Avenatti
- Cardiovascular Research Foundation, New York, NY (A.D., E.A., M.C.A., M.B.L., R.T.H.)
| | - Ezequiel Guzzetti
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Mohamed-Salah Annabi
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Oumhani Toubal
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Mathieu Bernier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Jonathan Beaudoin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Géraldine Ong
- St Michael’s Hospital, University of Toronto, Canada (G.O.)
| | - Julien Ternacle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Laura Krapf
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Atlanta, GA (V.H.T.)
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, CA (R.M.)
| | - Susheel K. Kodali
- Columbia University Irving Medical Center/New York–Presbyterian Hospital, New York (S.K.K., M.C.A., C.R.S., M.B.L., R.T.H.)
| | - Mark Russo
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (M.R.)
| | | | - S. Chris Malaisrie
- Feinberg School of Medicine, Northwestern University, Chicago, IL (S.C.M.)
| | | | | | - Philipp Blanke
- St Paul’s Hospital, Vancouver, Canada (J.L., P.B., J.G.W.)
| | | | | | - David L. Brown
- Baylor Scott & White Healthcare, Plano, TX (D.L.B., M.J.M.)
| | | | | | | | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.)
| | | | - Maria C. Alu
- Cardiovascular Research Foundation, New York, NY (A.D., E.A., M.C.A., M.B.L., R.T.H.)
- Columbia University Irving Medical Center/New York–Presbyterian Hospital, New York (S.K.K., M.C.A., C.R.S., M.B.L., R.T.H.)
| | - Ke Xu
- Edwards Lifesciences, Irvine, CA (K.X., E.R.)
| | - Erin Rogers
- Edwards Lifesciences, Irvine, CA (K.X., E.R.)
| | - John G. Webb
- St Paul’s Hospital, Vancouver, Canada (J.L., P.B., J.G.W.)
| | - Craig R. Smith
- Columbia University Irving Medical Center/New York–Presbyterian Hospital, New York (S.K.K., M.C.A., C.R.S., M.B.L., R.T.H.)
| | | | - Martin B. Leon
- Cardiovascular Research Foundation, New York, NY (A.D., E.A., M.C.A., M.B.L., R.T.H.)
- Columbia University Irving Medical Center/New York–Presbyterian Hospital, New York (S.K.K., M.C.A., C.R.S., M.B.L., R.T.H.)
| | - Rebecca T. Hahn
- Cardiovascular Research Foundation, New York, NY (A.D., E.A., M.C.A., M.B.L., R.T.H.)
- Columbia University Irving Medical Center/New York–Presbyterian Hospital, New York (S.K.K., M.C.A., C.R.S., M.B.L., R.T.H.)
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225
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Hosoba S, Mori M, Goto Y, Fukumoto Y, Shimura T, Yamamoto M. Hypo-attenuated leaflet thickening in surgically-implanted mitral bioprosthesis. J Cardiothorac Surg 2020; 15:74. [PMID: 32381038 PMCID: PMC7206689 DOI: 10.1186/s13019-020-01120-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022] Open
Abstract
Background Hypo-attenuated leaflet thickening (HALT) in bioprosthetic aortic valve has been studied, but its equivalent in bioprosthetic mitral valve (bMV) remains uncharacterized. We sought to identify the prevalence, hemodynamic characteristics, and significance of anticoagulation therapy in bMV HALT. Methods A single-center cross-sectional study of 53 consecutive patients who underwent mitral valve replacement (MVR) with bMV between 2007 and 2017 was conducted. Cardiac-gated contrasted CT scans were obtained. Anticoagulant and antiplatelet therapy use were ascertained at the time of hospital discharge and CT scanning. Patient characteristics, postoperative stroke, and hemodynamic profile by echocardiogram were obtained to descriptively characterize the prevalence and characteristics associated with bMV HALT. Results Three patients (5.7%) were found to have a HALT on bMV. The mean time from index MVR to CT scan was 3.4 ± 0.8 years in HALT cohort and 3.4 ± 2.7 years in non-HALT cohort. Fifty patients (94.3%) were discharged on warfarin, and 37 patients (69.8%) were on warfarin at the time of CT scans. One patient with HALT was on therapeutic warfarin at the time of the CT scan that identified HALT. All three patients were asymptomatic at the time of CT scan. In patients with HALT, mean transmitral pressure gradient were 8, 5, and 2.7 mmHg, all with trivial or mild mitral regurgitation. Conclusions In this study, the prevalence of HALT was low at 5.7%, all presenting without symptoms. One patient presented with HALT while on therapeutic oral anticoagulation, which may suggest thrombotic etiology may not adequately explain HALT.
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Affiliation(s)
- Soh Hosoba
- Division of Cardiovascular Surgery, Toyohashi Heart Center, 21 Gofuntori, Oyamacho, Toyohashi, Aichi, 4418530, Japan.
| | - Makoto Mori
- Section of Cardiac Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Yoshihiro Goto
- Division of Cardiovascular Surgery, Toyohashi Heart Center, 21 Gofuntori, Oyamacho, Toyohashi, Aichi, 4418530, Japan
| | - Yuichiro Fukumoto
- Division of Cardiovascular Surgery, Toyohashi Heart Center, 21 Gofuntori, Oyamacho, Toyohashi, Aichi, 4418530, Japan
| | - Tetsuro Shimura
- Division of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
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226
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Pibarot P, Mazer CD, Verma S. Should Bioprosthetic Aortic Valves Be Routinely Anticoagulated?: Insights From PARTNER and Beyond. J Am Coll Cardiol 2020; 74:1201-1204. [PMID: 31466617 DOI: 10.1016/j.jacc.2019.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Quebec, Canada.
| | - C David Mazer
- Department of Anesthesia, Li Ka Shing Knowledge Institute of St. Michael's Hospital, and Departments of Anesthesia and Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Departments of Surgery, and Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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227
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Kumar A, Reardon MJ, Lahorra JA, Reed GW, Kapadia SR, Kalra A. Low risk transcatheter aortic valve replacement: taking the plunge and embracing a paradigm shift. Future Cardiol 2020; 16:143-146. [DOI: 10.2217/fca-2019-0084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Anirudh Kumar
- Heart & Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Michael J Reardon
- Department of Cardiovascular Surgery, The Methodist Hospital, Houston, TX 77030, USA
| | - Joseph A Lahorra
- Heart & Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
- Heart & Vascular Center, Cleveland Clinic Akron General, Akron, OH 44307, USA
| | - Grant W Reed
- Heart & Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Samir R Kapadia
- Heart & Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Ankur Kalra
- Heart & Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
- Heart & Vascular Center, Cleveland Clinic Akron General, Akron, OH 44307, USA
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228
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Ochi A, Cheng K, Zhao B, Hardikar AA, Negishi K. Patient Risk Factors for Bioprosthetic Aortic Valve Degeneration: A Systematic Review and Meta-Analysis. Heart Lung Circ 2020; 29:668-678. [DOI: 10.1016/j.hlc.2019.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/22/2019] [Indexed: 11/26/2022]
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229
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Webb JG, Murdoch DJ, Alu MC, Cheung A, Crowley A, Dvir D, Herrmann HC, Kodali SK, Leipsic J, Miller DC, Pibarot P, Suri RM, Wood D, Leon MB, Mack MJ. 3-Year Outcomes After Valve-in-Valve Transcatheter Aortic Valve Replacement for Degenerated Bioprostheses: The PARTNER 2 Registry. J Am Coll Cardiol 2020; 73:2647-2655. [PMID: 31146808 DOI: 10.1016/j.jacc.2019.03.483] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/05/2019] [Accepted: 03/05/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) for degenerated surgical bioprosthetic aortic valves is associated with favorable early outcomes. However, little is known about the durability and longer-term outcomes associated with this therapy. OBJECTIVES The aim of this study was to examine late outcomes after valve-in-valve 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 valve-in-valve and continued access registries. Three-year clinical and echocardiographic follow-up was obtained. RESULTS Valve-in-valve procedures were performed in 365 patients. The mean age was 78.9 ± 10.2 years, and the mean Society of Thoracic Surgeons score was 9.1 ± 4.7%. At 3 years, the overall Kaplan-Meier estimate of all-cause mortality was 32.7%. Aortic valve re-replacement was required in 1.9%. Mean transaortic gradient was 35.0 mm Hg at baseline, decreasing to 17.8 mm Hg at 30-day follow-up and 16.6 mm Hg at 3-year follow-up. Baseline effective orifice area was 0.93 cm2, increasing to 1.13 and 1.15 cm2 at 30 days and 3 years, respectively. Moderate to severe aortic regurgitation was reduced from 45.1% at pre-TAVR baseline to 2.5% at 3 years. Importantly, moderate or severe mitral and tricuspid regurgitation also decreased (33.7% vs. 8.6% [p < 0.0001] and 29.7% vs. 18.8% [p = 0.002], respectively). Baseline left ventricular ejection fraction was 50.7%, increasing to 54.7% at 3 years (p < 0.0001), while left ventricular mass index was 136.4 g/m2, decreasing to 109.1 g/m2 at 3 years (p < 0.0001). New York Heart Association functional class improved, with 90.4% in class III or IV at baseline and 14.1% at 3 years (p < 0.0001), and Kansas City Cardiomyopathy Questionnaire overall score increased (43.1 to 73.1; p < 0.0001). CONCLUSIONS At 3-year follow-up, TAVR for bioprosthetic aortic valve failure was associated with favorable survival, sustained improved hemodynamic status, and excellent functional and quality-of-life outcomes. (The PARTNER II Trial: Placement of Aortic Transcatheter Valves II - PARTNER II - Nested Registry 3/Valve-in-Valve [PII NR3/ViV]; NCT03225001).
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Affiliation(s)
- John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada.
| | - Dale J Murdoch
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Maria C Alu
- Columbia University Medical Center, New York, New York
| | - Anson Cheung
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Aaron Crowley
- Cardiovascular Research Foundation, New York, New York
| | - Danny Dvir
- University of Washington, Seattle, Washington
| | | | | | | | | | | | - Rakesh M Suri
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - David Wood
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Martin B Leon
- Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York
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230
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Fiori AG, Simonato M, Eyer A, Fonseca JHPD, Gaia DF. Hemodynamic and Imaging Assessment of Transcatheter Aortic Valve Replacement with the Inovare® Proseal using Multislice Computed Tomography. Braz J Cardiovasc Surg 2020; 35:127-133. [PMID: 32369290 PMCID: PMC7199976 DOI: 10.21470/1678-9741-2019-0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the hemodynamic performance (i.e., gradients and paravalvular leakage [PVL]) of the new and experimental Braile Inovare® Proseal. Additionally, we aimed to assess pre and postoperatively the aortic annulus and the transcatheter prosthesis using multislice computed tomography (MSCT). Methods Patients were selected by a multidisciplinary heart team and referred for transcatheter aortic valve replacement (TAVR). MSCT was performed before and after surgery. Measurements of the aortic valve and prosthesis were conducted and correlated with the valve gradient and residual PVL. Results Twenty-one patients were selected for the protocol. Patients had a mean age of 79 years and 38% of them were of female sex. The mean EuroSCORE II value was 12.5%±10.8. Mean gradient was reduced from 45.8±11.04 mmHg to 5.59±2.61 mmHg and there were no instances of PVL worse than mild. There were no cases of coronary obstruction or procedural death. Circularity was present in all prostheses evaluated. Circularity indexes for the prostheses were: inflow 0.05±0.03, middle third 0.04±0.02, and outflow 0.04±0.02 (P=0.08). The mean distance between the prosthesis and the left and right coronary ostia were 14.8 mm±3.3 and 17.3 mm±3, respectively. Oversizing was appropriate with a mean of 22.14%±6%. Conclusion Braile Inovare® Proseal transcatheter device has demonstrated low gradients with low rates of PVL. Oversizing by annular measurements was adequate. MSCT was adequate to evaluate device sizing and has demonstrated preserved expansibility and circularity in the evaluated cases.
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Affiliation(s)
- Apoana Gomes Fiori
- Universidade Federal de São Paulo Escola Paulista de Medicina Division of Cardiac Surgery São Paulo Brazil Division of Cardiac Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Matheus Simonato
- Universidade Federal de São Paulo Escola Paulista de Medicina Division of Cardiac Surgery São Paulo Brazil Division of Cardiac Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alfredo Eyer
- Universidade Federal de São Paulo Escola Paulista de Medicina Department of Radiology São Paulo Brazil Department of Radiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - José Honório Palma da Fonseca
- Universidade Federal de São Paulo Escola Paulista de Medicina Division of Cardiac Surgery São Paulo Brazil Division of Cardiac Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Diego Felipe Gaia
- Universidade Federal de São Paulo Escola Paulista de Medicina Division of Cardiac Surgery São Paulo Brazil Division of Cardiac Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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231
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Al-Abdouh A, Upadhrasta S, Fashanu O, Elias H, Zhao D, Hasan RK, Michos ED. Transcatheter Aortic Valve Replacement in Low-Risk Patients: A Meta-Analysis of Randomized Controlled Trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:461-466. [DOI: 10.1016/j.carrev.2019.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/08/2019] [Accepted: 08/12/2019] [Indexed: 12/19/2022]
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232
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Landes U, Webb JG, De Backer O, Sondergaard L, Abdel-Wahab M, Crusius L, Kim WK, Hamm C, Buzzatti N, Montorfano M, Ludwig S, Schofer N, Voigtlaender L, Guerrero M, El Sabbagh A, Rodés-Cabau J, Guimaraes L, Kornowski R, Codner P, Okuno T, Pilgrim T, Fiorina C, Colombo A, Mangieri A, Eltchaninoff H, Nombela-Franco L, Van Wiechen MP, Van Mieghem NM, Tchétché D, Schoels WH, Kullmer M, Tamburino C, Sinning JM, Al-Kassou B, Perlman GY, Danenberg H, Ielasi A, Fraccaro C, Tarantini G, De Marco F, Witberg G, Redwood SR, Lisko JC, Babaliaros VC, Laine M, Nerla R, Castriota F, Finkelstein A, Loewenstein I, Eitan A, Jaffe R, Ruile P, Neumann FJ, Piazza N, Alosaimi H, Sievert H, Sievert K, Russo M, Andreas M, Bunc M, Latib A, Govdfrey R, Hildick-Smith D, Sathananthan J, Hensey M, Alkhodair A, Blanke P, Leipsic J, Wood DA, Nazif TM, Kodali S, Leon MB, Barbanti M. Repeat Transcatheter Aortic Valve Replacement for Transcatheter Prosthesis Dysfunction. J Am Coll Cardiol 2020; 75:1882-1893. [DOI: 10.1016/j.jacc.2020.02.051] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/15/2020] [Accepted: 02/14/2020] [Indexed: 01/01/2023]
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233
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Commentary: The future of a former valve: Inspiring, resilient, or both? J Thorac Cardiovasc Surg 2020; 162:1487-1488. [PMID: 32199658 DOI: 10.1016/j.jtcvs.2020.02.055] [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: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 11/20/2022]
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234
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Vallabhaneni S, Matka M, Olenchock S, Sarnoski C, Longo S, Shirani J. Commissural fusion as etiology of bioprosthetic mitral stenosis in a patient with rheumatic heart disease. Echocardiography 2020; 37:637-640. [PMID: 32181512 DOI: 10.1111/echo.14634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/20/2020] [Accepted: 03/01/2020] [Indexed: 11/28/2022] Open
Abstract
We report commissural fusion as a unique morphologic etiology of early bioprosthetic mitral valve failure in a woman with a history of rheumatic mitral stenosis. She had undergone mitral valve replacement with a 25-mm Edwards Magna Ease bovine pericardial bioprosthesis 3 years earlier and presented with progressive dyspnea. Transesophageal echocardiography revealed severe bioprosthetic stenosis due to commissural fusion. She underwent percutaneous valve-in-valve implantation with a 26-mm Edwards Sapien 3 prosthesis. Marked symptomatic improvement was noted postprocedurally. We speculate that commissural fusion may be a unique pathologic feature of failing bioprosthetic valves in patients with prior rheumatic mitral valve disease.
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Affiliation(s)
| | - Marsel Matka
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Stephen Olenchock
- Department of Cardiothoracic Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Christopher Sarnoski
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Santo Longo
- Department of Pathology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Jamshid Shirani
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
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235
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Ali N, Malkin CJ, Cunnington MS, Lederman RJ, Blackman DJ. Untreatable Severe Structural Degeneration of a Transcatheter Aortic Heart Valve. JACC Case Rep 2020; 2:347-351. [PMID: 34291227 PMCID: PMC8290901 DOI: 10.1016/j.jaccas.2020.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
Abstract
We describe a patient who presented with heart failure 7 years post-transcatheter aortic valve implantation (TAVI) as a result of severe structural valve degeneration. Anatomic challenges, combined with the type of transcatheter heart valve used initially, meant that TAVI-in-TAVI risked obstructing the coronary arteries, even if preceded by bioprosthetic aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction. The patient was treated with balloon aortic valvuloplasty.
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Affiliation(s)
- Noman Ali
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | | | | | | | - Daniel J. Blackman
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
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236
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Fukuhara S, Shiomi S, Yang B, Kim K, Bolling SF, Haft J, Tang P, Pagani F, Prager RL, Chetcuti S, Grossman PM, Patel HJ, Deeb GM. Early Structural Valve Degeneration of Trifecta Bioprosthesis. Ann Thorac Surg 2020; 109:720-727. [DOI: 10.1016/j.athoracsur.2019.06.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/02/2019] [Accepted: 06/10/2019] [Indexed: 12/15/2022]
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237
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Walker S, Dittfeld C, Jakob A, Schönfelder J, König U, Tugtekin SM. Sterilization and Cross-Linking Combined with Ultraviolet Irradiation and Low-Energy Electron Irradiation Procedure: New Perspectives for Bovine Pericardial Implants in Cardiac Surgery. Thorac Cardiovasc Surg 2020; 70:33-42. [PMID: 32114687 DOI: 10.1055/s-0040-1705100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Bovine pericardium is the major natural source of patches and aortic valve substitutes in cardiac repair procedures. However, long-term tissue durability and biocompatibility issues lead to degeneration (e.g., calcification) that requires reoperation. Tissue preparation strategies, including glutaraldehyde fixation, are reasons for the deterioration of pericardial tissues. We describe a pretreatment procedure involving sterilization and cross-linking combined with ultraviolet (UV) irradiation and low-energy electron irradiation (SULEEI). This innovative, glutaraldehyde-free protocol improves the mechanical aspects and biocompatibility of porcine pericardium patches. METHODS We adopted the SULEEI protocol, which combines decellularization, sterilization, and cross-linking, along with UV irradiation and low-energy electron irradiation, to pretreat bovine pericardium. Biomechanics, such as ultimate tensile strength and elasticity, were investigated by comparing SULEEI-treated tissue with glutaraldehyde-fixed analogues, clinical patch materials, and an aortic valve substitute. Histomorphological and cellular aspects were investigated by histology, DNA content analysis, and degradability. RESULTS Mechanical parameters, including ultimate tensile strength, elasticity (Young's modulus), and suture retention strength, were similar for SULEEI-treated and clinically applied bovine pericardium. The SULEEI-treated tissues showed well-preserved histoarchitecture that resembled all pericardial tissues investigated. Fiber density did not differ significantly. DNA content after the SULEEI procedure was reduced to less than 10% of the original tissue material, and more than 50% of the SULEEI-treated pericardium was digested by collagenase. CONCLUSION The SULEEI procedure represents a new treatment protocol for the preparation of patches and aortic valve prostheses from bovine pericardial tissue. The avoidance of glutaraldehyde fixation may lessen the tissue degeneration processes in cardiac repair patches and valve prostheses.
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Affiliation(s)
- Simona Walker
- Department of Medical and Biotechnological Applications, Fraunhofer Institute for Organic Electronics, Electron Beam and Plasma Technology, Dresden, Germany
| | - Claudia Dittfeld
- Department of Cardiac Surgery, Faculty of Medicine Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Aline Jakob
- Department of Cardiac Surgery, Faculty of Medicine Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Jessy Schönfelder
- Department of Medical and Biotechnological Applications, Fraunhofer Institute for Organic Electronics, Electron Beam and Plasma Technology, Dresden, Germany
| | - Ulla König
- Department of Medical and Biotechnological Applications, Fraunhofer Institute for Organic Electronics, Electron Beam and Plasma Technology, Dresden, Germany
| | - Sems-Malte Tugtekin
- Department of Cardiac Surgery, Faculty of Medicine Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
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Fauvel C, Capoulade R, Durand E, Béziau DM, Schott JJ, Le Tourneau T, Eltchaninoff H. Durability of transcatheter aortic valve implantation: A translational review. Arch Cardiovasc Dis 2020; 113:209-221. [PMID: 32113816 DOI: 10.1016/j.acvd.2019.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 10/24/2022]
Abstract
Until recently, transcatheter aortic valve implantation was restricted to high-risk and inoperable patients. The updated 2017 European Society of Cardiology Guidelines has widened the indication to include intermediate-risk patients, based on two recently published trials (PARTNER 2 and SURTAVI). Moreover, two other recent trials (PARTNER 3 and EVOLUT LOW RISK) have demonstrated similar results with transcatheter aortic valve implantation in low-risk patients. Thus, extension of transcatheter aortic valve implantation to younger patients, who are currently treated by surgical aortic valve replacement, raises the crucial question of bioprosthesis durability. In this translational review, we propose to produce a state-of-the-art overview of the durability of transcatheter aortic valve implantation by integrating knowledge of the basic science of bioprosthesis degeneration (pathophysiology and biomarkers). After summarising the new definition of structural valve deterioration, we will present what is known about the pathophysiology of aortic stenosis and bioprosthesis degeneration. Next, we will consider how to identify a population at risk of early degeneration, and how basic science with the help of biomarkers could identify and predict structural valve deterioration. Finally, we will present data on the differences in durability of transcatheter aortic valve implantation compared with surgical aortic valve replacement.
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Affiliation(s)
- Charles Fauvel
- Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France
| | - Romain Capoulade
- L'institut du Thorax, INSERM 1087, CNRS, CHU de Nantes, Université de Nantes, 44007 Nantes, France
| | - Eric Durand
- Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France; Normandie université, UNIROUEN, INSERM U1096, 76000 Rouen, France
| | - Delphine M Béziau
- Normandie Université, UNIROUEN, INSERM U1096, Rouen University Hospital, Department of Cardiology, FHU REMOD-VHF, 76000 Rouen, France
| | - Jean-Jacques Schott
- L'institut du Thorax, INSERM 1087, CNRS, CHU de Nantes, Université de Nantes, 44007 Nantes, France
| | - Thierry Le Tourneau
- L'institut du Thorax, INSERM 1087, CNRS, CHU de Nantes, Université de Nantes, 44007 Nantes, France
| | - Hélène Eltchaninoff
- Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France; Normandie université, UNIROUEN, INSERM U1096, 76000 Rouen, France.
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Abstract
PURPOSE OF REVIEW Bioprosthetic valves are now used for the majority of surgical aortic valve replacements and for all transcatheter aortic valve replacements. However, bioprostheses are subject to structural valve deterioration (SVD) and have, therefore limited durability. RECENT FINDINGS Clinical, imaging, and circulating biomarkers may help to predict or indicate the presence of bioprosthetic valve SVD. The most important biomarkers of SVD includes: patient-related clinical biomarkers, such as diabetes and renal failure; valve-related biomarkers, such as absence of antimineralization process and severe prosthesis-patient mismatch; imaging biomarkers: the presence of valve leaflet mineralization on multidetector computed tomography or sodium fluoride uptake on positron emission tomography; and circulating biomarkers including: increased levels of HOMA index, ApoB/ApoA-I ratio, PCSK9, Lp-PLA2, phosphocalcic product. The assessment of these biomarkers may help to enhance risk stratification for SVD following AVR and may contribute to open novel pharmacotherapeutic avenues for the prevention of SVD. SUMMARY SVD may affect all bioprostheses after aortic valve replacement, and is the main cause of bioprosthetic valve failure and reintervention during the follow-up. Comprehensive assessment of clinical, imaging, and circulating biomarkers associated with earlier SVD could help strengthen the follow-up in high-risk patients and provide novel pharmacologic therapeutic strategies.
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240
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Braghiroli J, Kapoor K, Thielhelm TP, Ferreira T, Cohen MG. Transcatheter aortic valve replacement in low risk patients: a review of PARTNER 3 and Evolut low risk trials. Cardiovasc Diagn Ther 2020; 10:59-71. [PMID: 32175228 DOI: 10.21037/cdt.2019.09.12] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a mainstay in treatment for patients with severe aortic stenosis who are considered high-risk surgical candidates. The use of TAVR in low-risk patients with severe aortic stenosis is being explored as an alternative to surgical aortic valve replacement (SAVR). Recent results from the Medtronic Evolut Low Risk trial and the Placement of Aortic Transcatheter Valves (PARTNER) 3 trial shed light on the use of TAVR in low-risk surgical candidates. The Evolut Low Risk trial compared TAVR with a self-expanding supra-annular bioprosthesis to SAVR in 1468 patients with severe aortic stenosis who were low surgical risk. Patients with a mean age of 74 and a mean Society of Thoracic Surgeons (STS) risk score of 1.9% were randomized to either TAVR or SAVR groups. Using the composite end point of death or disabling stroke at 24 months, the study found an incidence of 5.3% in the TAVR arm and 6.7% in the surgical arm. The Evolut Low Risk trial thus concluded that TAVR was statistically noninferior but not superior to SAVR (difference, -1.4 percentage points; 95% Bayesian credible interval for the difference, -4.9 to 2.1; posterior probability of noninferiority, >0.999). The PARTNER 3 trial assigned 1,000 patients with severe aortic stenosis and low surgical risk to either TAVR with transfemoral placement of balloon expandable valve or SAVR. Patients with a mean age of 73 and a mean STS score of 1.9% were randomized to either TAVR or SAVR groups. With respect to the primary endpoint of composite death from any cause, stroke, or rehospitalization, the study found an occurrence of 8.5% in TAVR and 15.1% in SAVR, confirming both noninferiority and superiority in the TAVR group [absolute difference, -6.6 percentage points; 95% confidence interval (CI), -10.8 to -2.5; P<0.001 for noninferiority; hazard ratio, 0.54; 95% CI, 0.37 to 0.79; P=0.001 for superiority]. Both the Evolut low risk trial and the PARTNER 3 trial provide evidence that the use of TAVR extends beyond the scope of high and intermediate risk surgical patients and is at the very least equivalent to SAVR in the treatment low-risk surgical candidates when using a transfemoral approach in patients without bicuspid aortic valves. In this article we provide an extensive review on the Evolute low risk and PARTNER 3 trials, including a discussion on clinically relevant outcomes.
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Affiliation(s)
- Joao Braghiroli
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Kunal Kapoor
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Torin P Thielhelm
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Tanira Ferreira
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Mauricio G Cohen
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
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Rheude T, Pellegrini C, Cassese S, Wiebe J, Wagner S, Trenkwalder T, Alvarez H, Mayr NP, Hengstenberg C, Schunkert H, Kastrati A, Husser O, Joner M. Predictors of haemodynamic structural valve deterioration following transcatheter aortic valve implantation with latest-generation balloon-expandable valves. EUROINTERVENTION 2020; 15:1233-1239. [DOI: 10.4244/eij-d-19-00710] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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242
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Capodanno D, Søndergaard L. How to Define Durability of Transcatheter and Surgical Bioprosthetic Aortic Valves. JACC Cardiovasc Interv 2020; 13:257-260. [DOI: 10.1016/j.jcin.2019.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/16/2019] [Accepted: 06/20/2019] [Indexed: 10/25/2022]
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243
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Butchart EG, Chambers J, Borer JS, Grunkemeier G, Yoganathan A. Long-Term Durability of Transcatheter Valves. JACC Cardiovasc Interv 2020; 13:253-256. [DOI: 10.1016/j.jcin.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/25/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
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244
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Bax JJ, Delgado V, Hahn RT, Leipsic J, Min JK, Grayburn P, Sondergaard L, Yoon SH, Windecker S. Transcatheter Aortic Valve Replacement. JACC Cardiovasc Imaging 2020; 13:124-139. [DOI: 10.1016/j.jcmg.2018.10.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 01/14/2023]
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Abstract
Introduction: Valve durability represents a main concern, as the target population for transcatheter aortic valve implantation (TAVI) evolves to include lower risk and younger patients who are likely to survive for a number of years after the procedure.Areas covered: The purpose of this review article is to provide an overview of potential mechanisms and rates of structural valve deterioration (SVD) of transcatheter bioprostheses.Expert opinion: Recently the standardized definitions of SVD proposed by European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) have permitted for the first time, an objective evaluation of existing and novel TAVI prostheses, and to compare their longevity versus surgical bioprostheses. Although the results of midterm durability of the transcatheter bioprostheses are encouraging, our knowledge concerning the clinical outcomes of TAVI beyond 5 years is still limited. Evidence of longer-term durability is mandatory before replacing surgery with TAVI, particularly in younger and lower-risk patients.
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Affiliation(s)
- Anna Sonia Petronio
- Cardio Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Cristina Giannini
- Cardio Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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246
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Duncan A, Mirsadraee S, Quarto C, Davies S. Transcatheter aortic valve implantation 10 years after valve‐in‐valve transcatheter aortic valve implantation for failing aortic valve homograft root replacement. Catheter Cardiovasc Interv 2019; 96:228-235. [DOI: 10.1002/ccd.28658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/12/2019] [Accepted: 12/07/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Alison Duncan
- Heart DivisionRoyal Brompton Hospital London United Kingdom
| | | | - Cesare Quarto
- Heart DivisionRoyal Brompton Hospital London United Kingdom
| | - Simon Davies
- Heart DivisionRoyal Brompton Hospital London United Kingdom
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Zareian R, Tseng JC, Fraser R, Meganck J, Kilduff M, Sarraf M, Dvir D, Kheradvar A. Effect of stent crimping on calcification of transcatheter aortic valves. Interact Cardiovasc Thorac Surg 2019; 29:64-73. [PMID: 30793744 DOI: 10.1093/icvts/ivz024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 12/26/2018] [Accepted: 12/27/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Although many challenges related to the acute implantation of transcatheter aortic valves have been resolved, durability and early degeneration are currently the main concerns. Recent reports indicate the potential for early valve degeneration and calcification. However, only little is known about the underlying mechanisms behind the early degeneration of these valves. The goal of this study was to test whether stent crimping increases the risk for early calcification. METHODS Stented valves that were crimped at 18-Fr and 14-Fr catheter and uncrimped controls were exposed to a standard calcifying solution for 50 million cycles in an accelerated wear test system. Subsequently, the leaflets of the valves were imaged by microcomputed tomography (micro-CT) followed by histochemical staining and microscopic analyses to quantify calcification and other changes in the leaflets' characteristics. RESULTS Heavily calcified regions were found over the stent-crimped leaflets compared to uncrimped controls, particularly around the stent's struts. Micro-CT studies measured the total volume of calcification in the uncrimped valves as 77.31 ± 1.63 mm3 vs 95.32 ± 5.20 mm3 in 18-Fr and 110.01 ± 8.33 mm3 in 14-Fr stent-crimped valves, respectively. These results were congruent with the increase in leaflet thickness measured by CT scans (0.44 ± 0.07 mm in uncrimped valves vs 0.69 ± 0.15 mm and 0.75 ± 0.09 mm in 18-Fr and 14-Fr stent-crimped valves, respectively). Histological studies confirmed the micro-CT results, denoting that the percentage of calcification in uncrimped leaflets at the valve's posts was 5.34 ± 3.97 compared to 19.97 ± 6.18 and 27.64 ± 13.17 in the 18-Fr and 14-Fr stent-crimped leaflets, respectively. CONCLUSIONS This study concludes that stent-crimping damage is associated with a higher level of passive leaflet calcification, which may contribute to early valve degeneration.
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Affiliation(s)
- Ramin Zareian
- The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California Irvine, Irvine, CA, USA
| | | | | | | | | | - Mohammad Sarraf
- Cardiovascular Division, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Danny Dvir
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Arash Kheradvar
- The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California Irvine, Irvine, CA, USA
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248
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Valvo R, Criscione E, Reddavid C, Barbanti M. Early detection of transcatheter heart valve dysfunction. Expert Rev Cardiovasc Ther 2019; 17:863-872. [PMID: 31829050 DOI: 10.1080/14779072.2019.1703673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: Transcatheter aortic valve implantation therapy is spreading rapidly, representing the standard of care in inoperable and high-risk patients, and a valid alternative in intermediate- and low-risk patients with severe symptomatic aortic stenosis. In this subset, the development and validation of noninvasive, quantitative, in vivo imaging modality, to monitor possible valve dysfunction is mandatory, in order to plan timely therapeutic interventions before the onset of symptoms.Areas covered: The implantation of transcatheter heart valves (THV) is increasing rapidly. As a consequence, THV dysfunction will become a major cause of cardiovascular morbidity after TAVI. Emergency repeat aortic valve replacement surgery is associated with a high rate of mortality compared with elective repeat surgery. In this context, early detection of THV dysfunction is therefore highly desirable. The review aims to examine the different diagnostic method to early detect THV dysfunction.Expert opinion: Most promising innovations in the diagnosis of early detection of THV dysfunction are evaluated, and the future outlook is explored. Waiting for upcoming evidence about the utility of CT, CMR, and PET on early detection of THV dysfunction, tailoring echocardiogram follow-up based on patients' characteristics is the desirable approach.
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Affiliation(s)
- Roberto Valvo
- A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Enrico Criscione
- A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Claudia Reddavid
- A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Marco Barbanti
- A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
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Moschovas A, Safarov R, Sandhaus T, Tkebuchava S, Schenkl C, Kirov H, Färber G, Doenst T. Literaturübersicht 2018 zur Herzklappenchirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2019. [DOI: 10.1007/s00398-019-00332-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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250
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Orvin K, Zekry SB, Morelli O, Barabash IM, Segev A, Danenberg H, Assali A, Guetta V, Assa HV, Zeniou V, Lotan C, Sagie A, Gilon D, Feinberg MS, Shapira Y, Kornowski R. Long-Term Functional and Structural Durability of Bioprosthetic Valves Placed in the Aortic Valve Position via Percutaneous Rout in Israel. Am J Cardiol 2019; 124:1748-1756. [PMID: 31629462 DOI: 10.1016/j.amjcard.2019.08.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
There is limited organized "real life" data regarding the long-term structural and functional durability of transcatheter aortic valve implants, a topic of major importance. We assessed the 5-year structural and functional integrity outcomes following trans-catheter aortic valve implantation (TAVI) with both self-expandable and balloon-expandable prosthetic valve devices. This study included 450 consecutive patients who underwent TAVI for severe symptomatic aortic stenosis (AS) between September 2008 and December 2011. Data were acquired from a multicenter Israeli registry and the median follow up time was 5.6 years. In 184 patients (40.9%) who survived 5 years, prostheses displayed sustained hemodynamic performance, with average peak and mean aortic valve gradients of 16.2 ± 8.9 and 9.2 ± 6.6 mm Hg, respectively. Late structural valve deterioration was found in 22 (12.3%) patients. Of these, 16 (8.9%) experienced valve deterioration and 6 (3.3%) experienced valve failure. Among the 6 patients with bioprosthetic valve failure, only 3 underwent re-interventions. Bioprosthetic valve dysfunction occurred more frequently in patients with small valves (23 mm) and high peak and mean transvalvular gradients at baseline. In conclusion, a relatively low rate of valve deterioration or failure was noted in our long-term follow-up study after TAVI procedures with both the catheter-based self-expandable and balloon-expandable prosthetic valves.
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