301
|
Dvir D, Khan J, Kornowski R, Komatsu I, Chatriwalla A, Mackenson GB, Simonato M, Ribeiro H, Wood D, Leipsic J, Webb J, Mylotte D. Novel strategies in aortic valve-in-valve therapy including bioprosthetic valve fracture and BASILICA. EUROINTERVENTION 2018; 14:AB74-AB82. [DOI: 10.4244/eij-d-18-00667] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
302
|
Eltchaninoff H, Durand E, Cribier A. TAVI durability beyond five years: no alarms, but stay alert. EUROINTERVENTION 2018; 14:e380-e382. [PMID: 30028301 DOI: 10.4244/eijv14i4a67] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hélène Eltchaninoff
- Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, Rouen, France
| | | | | |
Collapse
|
303
|
The paradox between randomized controlled trials and propensity score-matched real-world data: Moving from dissonance to dialog? J Thorac Cardiovasc Surg 2018; 156:1026-1027. [PMID: 30005882 DOI: 10.1016/j.jtcvs.2018.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 11/23/2022]
|
304
|
Wernly B, Zappe AK, Unbehaun A, Sinning JM, Jung C, Kim WK, Fichtlscherer S, Lichtenauer M, Hoppe UC, Alushi B, Beckhoff F, Wewetzer C, Franz M, Kretzschmar D, Navarese E, Landmesser U, Falk V, Lauten A. Transcatheter valve-in-valve implantation (VinV-TAVR) for failed surgical aortic bioprosthetic valves. Clin Res Cardiol 2018; 108:83-92. [DOI: 10.1007/s00392-018-1326-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/26/2018] [Indexed: 12/19/2022]
|
305
|
Voigtländer L, Seiffert M. Expanding TAVI to Low and Intermediate Risk Patients. Front Cardiovasc Med 2018; 5:92. [PMID: 30050909 PMCID: PMC6052659 DOI: 10.3389/fcvm.2018.00092] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/25/2018] [Indexed: 01/16/2023] Open
Abstract
TAVI has become the standard treatment in patients at increased surgical risk and is increasingly being performed in patients at intermediate to low surgical risk. While non-inferiority has been demonstrated in intermediate risk patients, several challenges—particularly with regard to valve durability—need to be addressed before expansion to lower risk and younger patients can be recommended on a broad basis. Current trends, trials results, and remaining challenges are summarized and discussed in the light of updated treatment guidelines.
Collapse
Affiliation(s)
- Lisa Voigtländer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Moritz Seiffert
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,Partner site Hamburg/Kiel/Lübeck, DZHK, German Centre for Cardiovascular Research, Hamburg, Germany
| |
Collapse
|
306
|
Zenses AS, Dahou A, Salaun E, Clavel MA, Rodés-Cabau J, Ong G, Guzzetti E, Côté M, De Larochellière R, Paradis JM, Doyle D, Mohammadi S, Dumont É, Chamandi C, Rodriguez-Gabella T, Rieu R, Pibarot P. Haemodynamic outcomes following aortic valve-in-valve procedure. Open Heart 2018; 5:e000854. [PMID: 30018783 PMCID: PMC6045709 DOI: 10.1136/openhrt-2018-000854] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 05/24/2018] [Accepted: 06/13/2018] [Indexed: 11/23/2022] Open
Abstract
Background and objectives Transcatheter aortic valve-in-valve implantation (ViV) has emerged as a valuable technique to treat failed surgical bioprostheses (BPs) in patients with high risk for redo surgical aortic valve replacement (SAVR). Small BP size (≤21 mm), stenotic pattern of degeneration and pre-existing prosthesis–patient mismatch (PPM) have been associated with worse clinical outcomes after ViV. However, no study has evaluated the actual haemodynamic benefit associated with ViV. This study aims to compare haemodynamic status observed at post-ViV, pre-ViV and early after initial SAVR and to determine the factors associated with worse haemodynamic outcomes following ViV, including the rates of high residual gradient and ‘haemodynamic futility’. Methods Early post-SAVR, pre-ViV and post-ViV echocardiographic data of 79 consecutive patients who underwent aortic ViV at our institution were retrospectively analysed. The primary study endpoint was suboptimal valve haemodynamics (SVH) following ViV defined by the Valve Academic Research Consortium 2 as the presence of high residual aortic mean gradient (≥20 mm Hg) and/or at least moderate aortic regurgitation (AR). Haemodynamic futility of ViV was defined as <10 mm Hg decrease in mean aortic gradient and no improvement in AR compared with pre-ViV. Results SVH was found in 61% of patients (57% high residual gradient, 4% moderate AR) after ViV versus 24% early after SAVR. Pre-existing PPM and BP mode of failure by stenosis were independently associated with the primary endpoint (OR: 2.87; 95% CI 1.08 to 7.65; p=0.035 and OR: 3.02; 95% CI 1.08 to 8.42; p=0.035, respectively) and with the presence of high residual gradient (OR: 4.38; 95% CI 1.55 to 12.37; p=0.005 and OR: 5.37; 95% CI 1.77 to 16.30; p=0.003, respectively) following ViV. Criteria of ViV haemodynamic futility were met in 7.6% overall and more frequently in patients with pre-existing PPM and stenotic BP (18.5%) compared with other patients (2.0%). ViV restored haemodynamic function to early post-SAVR level in only 34% of patients. Conclusion Although ViV was associated with significant haemodynamic improvement compared with pre-ViV in >90% of patients, more than half harboured SVH outcome. Furthermore, only one-third of patients had a restoration of valve haemodynamic function to the early post-SAVR level. Pre-existing PPM and stenosis pattern of BP degeneration were the main factors associated with SVH and haemodynamic futility following ViV. These findings provide strong support for the prevention of PPM at the time of initial SAVR and careful preprocedural patient screening.
Collapse
Affiliation(s)
- Anne-Sophie Zenses
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada.,IFSTTAR, LBA UMR_T24, Aix-Marseille Univ, Marseille, France
| | - Abdellaziz Dahou
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Erwan Salaun
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | | | | | - Géraldine Ong
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | | | - Mélanie Côté
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | | | | | - Daniel Doyle
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Éric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | | | | | - Régis Rieu
- IFSTTAR, LBA UMR_T24, Aix-Marseille Univ, Marseille, France
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| |
Collapse
|
307
|
Atkins BZ, Aldea GS. “Drilling Down” on Structural Valve Deterioration. J Am Coll Cardiol 2018; 72:586. [DOI: 10.1016/j.jacc.2018.04.080] [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: 04/25/2018] [Accepted: 04/25/2018] [Indexed: 10/28/2022]
|
308
|
Xuan Y, Dvir D, Wang Z, Mizoguchi T, Ye J, Guccione JM, Ge L, Tseng EE. Stent and leaflet stresses in 26-mm, third-generation, balloon-expandable transcatheter aortic valve. J Thorac Cardiovasc Surg 2018; 157:528-536. [PMID: 30041923 DOI: 10.1016/j.jtcvs.2018.04.115] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 04/12/2018] [Accepted: 04/23/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Transcatheter aortic valve replacement has proven successful in treating intermediate-risk, high-risk, and inoperable patients with severe aortic stenosis. Third-generation, balloon-expandable transcatheter aortic valves were developed with an outer sealing skirt to reduce paravalvular leakage. As transcatheter aortic valve replacement use expands, long-term durability questions remain. Valve design influences durability, where regions of increased leaflet stress are vulnerable to early degeneration. However, third-generation transcatheter aortic valve stresses are unknown. Our goals were to determine the stent and leaflet stresses of third-generation, balloon-expandable transcatheter aortic valves. METHODS The commercial 26-mm Edwards SAPIEN 3 valve (Edwards Lifesciences, Inc, Irvine, Calif) underwent high-resolution micro-computed tomography scanning to develop a precise 3-dimensional geometric mesh of the stent and valve. Leaflet material properties were obtained from surgical bioprostheses, and stent material properties were based on cobalt-chromium. Simulations of systemic pressure loading were performed, and stress was calculated using finite element analyses. RESULTS At diastole, maximum and minimum principal stresses on transcatheter aortic valve leaflets were 2.7 MPa and -0.47 MPa, respectively. Peak leaflet stresses were observed at upper leaflet commissures, at their connection to the stent. Maximum and minimum principal stresses for the stent were 38.2 MPa and -44.4 MPa, respectively, at 80 mm Hg and were located just below the commissural stent. CONCLUSIONS Stress analysis of the 26-mm SAPIEN 3 valve using exact geometry from high-resolution scans demonstrated that peak stresses for both transcatheter aortic valve stent and leaflets were present at commissural tips where leaflets were attached. These regions would be most likely to initiate degeneration. The Dacron skirt had minimal effect on stresses on leaflets and stent.
Collapse
Affiliation(s)
- Yue Xuan
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, Calif
| | - Danny Dvir
- Division of Cardiology, University of Washington, Seattle, Wash
| | - Zhongjie Wang
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, Calif
| | - Trek Mizoguchi
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, Calif
| | - Jian Ye
- Division of Cardiovascular Surgery, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Julius M Guccione
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, Calif
| | - Liang Ge
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, Calif
| | - Elaine E Tseng
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, Calif.
| |
Collapse
|
309
|
Salaun E, Clavel MA, Rodés-Cabau J, Pibarot P. Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation. Heart 2018; 104:1323-1332. [DOI: 10.1136/heartjnl-2017-311582] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/02/2018] [Accepted: 03/06/2018] [Indexed: 02/02/2023] Open
Abstract
The main limitation of bioprosthetic valves is their limited durability, which exposes the patient to the risk of aortic valve reintervention. Transcatheter aortic valve implantation (TAVI) is considered a reasonable alternative to surgical aortic valve replacement (SAVR) in patients with intermediate or high surgical risk. TAVI is now rapidly expanding towards the lower risk populations. Although the results of midterm durability of the transcatheter bioprostheses are encouraging, their long-term durability remains largely unknown. The objective of this review article is to present the definition, mechanisms, incidence, outcome and management of structural valve deterioration of aortic bioprostheses with specific emphasis on TAVI. The structural valve deterioration can be categorised into three stages: stage 1: morphological abnormalities (fibrocalcific remodelling and tear) of bioprosthesis valve leaflets without hemodynamic valve deterioration; stage 2: morphological abnormalities and moderate hemodynamic deterioration (increase in gradient and/or new onset of transvalvular regurgitation); and stage 3: morphological abnormalities and severe hemodynamic deterioration. Several specifics inherent to the TAVI including valve oversizing, manipulation, delivery, positioning and deployment may cause injuries to the valve leaflets and increase leaflet mechanical stress, which may limit the long-term durability of transcatheter bioprostheses. The selection of the type of aortic valve replacement and bioprosthesis should thus take into account the ratio between the demonstrated durability of the bioprostheses versus the life expectancy of the patient. Pending the publication of robust data on long-term durability of transcatheter bioprostheses, it appears reasonable to select SAVR with a bioprosthesis model that has well-established long-term durability in patients with low surgical risk and long life expectancy.
Collapse
|
310
|
Cahill TJ, Chen M, Hayashida K, Latib A, Modine T, Piazza N, Redwood S, Søndergaard L, Prendergast BD. Transcatheter aortic valve implantation: current status and future perspectives. Eur Heart J 2018; 39:2625-2634. [PMID: 29718148 DOI: 10.1093/eurheartj/ehy244] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/08/2018] [Indexed: 02/05/2023] Open
Affiliation(s)
- T J Cahill
- Oxford Heart Centre, Oxford University Hospitals, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - M Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue St, Chengdu, China
| | - K Hayashida
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - A Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
| | - T Modine
- Service de Chirurgie Cardio-Vasculaire, Hôpital Cardiologique, CHRU de Lille, 2 Avenue Oscar Lambret, Lille, France
| | - N Piazza
- Department of Interventional Cardiology, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Quebec, Canada
| | - S Redwood
- Department of Cardiology, St Thomas’ Hospital, Westminster Bridge Rd, London, UK
| | - L Søndergaard
- Heart Center, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
| | - B D Prendergast
- Department of Cardiology, St Thomas’ Hospital, Westminster Bridge Rd, London, UK
| |
Collapse
|
311
|
Aldea GS, Dvir D. Exuberance meets harsh realities in the bioprosthetic tissue valve era. J Thorac Cardiovasc Surg 2018; 155:e145-e146. [PMID: 29482848 DOI: 10.1016/j.jtcvs.2018.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
| | - Danny Dvir
- Division of Cardiology, University of Washington, Seattle, Wash
| |
Collapse
|
312
|
Abstract
TAVI has become the standard treatment in patients at increased surgical risk and is increasingly being performed in patients at intermediate to low surgical risk. While non-inferiority has been demonstrated in intermediate risk patients, several challenges-particularly with regard to valve durability-need to be addressed before expansion to lower risk and younger patients can be recommended on a broad basis. Current trends, trials results, and remaining challenges are summarized and discussed in the light of updated treatment guidelines.
Collapse
Affiliation(s)
- Lisa Voigtländer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Moritz Seiffert
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- Partner site Hamburg/Kiel/Lübeck, DZHK, German Centre for Cardiovascular Research, Hamburg, Germany
| |
Collapse
|