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Ali N, Patel PA, Lindsay SJ. Recent developments and controversies in transcatheter aortic valve implantation. Eur J Heart Fail 2018; 20:642-650. [PMID: 29368369 DOI: 10.1002/ejhf.1141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/03/2017] [Accepted: 12/26/2017] [Indexed: 12/19/2022] Open
Abstract
Interventional cardiology has been revolutionised by transcatheter aortic valve implantation (TAVI), which has become established as the benchmark treatment for severe aortic stenosis in patients at high risk for surgical aortic valve replacement (AVR). Increased procedural familiarity and progression in device technology has enabled improvements to be made in complication rates, which have led to a commensurate expansion in the use of TAVI; it is now a viable alternative to AVR in patients at intermediate surgical risk, and has been used in cohorts such as those with bicuspid aortic valves or pure, severe aortic regurgitation. Given the rapid expansion in the use of TAVI, including cohorts of younger patients with fewer co-morbidities, attention must be paid to further reducing remaining complications, such as cardiac tamponade or stroke. To this end, novel techniques and devices have been devised and trialled, with varying levels of success. Furthermore, significant work has gone into refining the technique with exploration of alternative imaging modalities, as well as alternative access routes to provide greater options for patients with challenging vascular anatomy. Whilst significant progress has been made with TAVI, areas of uncertainty remain such as the management of concomitant coronary artery disease and the optimum post-procedure antiplatelet regimen. As such, research in this field continues apace, and is likely to continue as use of TAVI becomes more widespread. This review provides a summary of the existing evidence, as well as an overview of recent developments and contentious issues in the field of TAVI.
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Affiliation(s)
- Noman Ali
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Peysh A Patel
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Steven J Lindsay
- Department of Cardiology, Bradford Royal Infirmary, Bradford, UK
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Alasti M, Rashid H, Rangasamy K, Kotschet E, Adam D, Alison J, Gooley R, Zaman S. Long-term pacemaker dependency and impact of pacing on mortality following transcatheter aortic valve replacement with the LOTUS valve. Catheter Cardiovasc Interv 2018; 92:777-782. [DOI: 10.1002/ccd.27463] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/01/2017] [Accepted: 11/25/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Mohammad Alasti
- Monash Cardiac Rhythm Management Department; MonashHeart, Monash Medical Centre; Melbourne Australia
| | - Hashrul Rashid
- Monash Cardiovascular Research Centre, MonashHeart, Monash Medical Centre and Monash University; Melbourne Australia
| | - Karthikeyan Rangasamy
- Monash Cardiac Rhythm Management Department; MonashHeart, Monash Medical Centre; Melbourne Australia
| | - Emily Kotschet
- Monash Cardiac Rhythm Management Department; MonashHeart, Monash Medical Centre; Melbourne Australia
| | - David Adam
- Monash Cardiac Rhythm Management Department; MonashHeart, Monash Medical Centre; Melbourne Australia
| | - Jeff Alison
- Monash Cardiac Rhythm Management Department; MonashHeart, Monash Medical Centre; Melbourne Australia
| | - Robert Gooley
- Monash Cardiovascular Research Centre, MonashHeart, Monash Medical Centre and Monash University; Melbourne Australia
| | - Sarah Zaman
- Monash Cardiovascular Research Centre, MonashHeart, Monash Medical Centre and Monash University; Melbourne Australia
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354
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Kalich BA, Allender JE, Hollis IB. Medication Management of Patients Undergoing Transcatheter Aortic Valve Replacement. Pharmacotherapy 2017; 38:122-138. [DOI: 10.1002/phar.2056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Bethany A. Kalich
- University of the Incarnate Word Feik School of Pharmacy; San Antonio Texas
- University of Texas Health at San Antonio; San Antonio Texas
| | | | - Ian B. Hollis
- University of North Carolina Hospitals; Chapel Hill North Carolina
- UNC Eshelman School of Pharmacy; Chapel Hill North Carolina
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355
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Siontis GCM, Praz F, Lanz J, Vollenbroich R, Roten L, Stortecky S, Räber L, Windecker S, Pilgrim T. New-onset arrhythmias following transcatheter aortic valve implantation: a systematic review and meta-analysis. Heart 2017; 104:1208-1215. [DOI: 10.1136/heartjnl-2017-312310] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/26/2017] [Accepted: 12/04/2017] [Indexed: 01/27/2023] Open
Abstract
ObjectiveTo evaluate the prevalence and clinical impact of new-onset arrhythmias in patients following transcatheter aortic valve implantation (TAVI).MethodWe systematically identified studies reporting new-onset arrhythmias after TAVI other than atrioventricular conduction disturbances. We summarised monitoring strategies, type and prevalence of arrhythmias and estimated their effect on risk of death or cerebrovascular events by using random-effects meta-analysis. The study is registered withInternational prospective register of systematic reviews (PROSPERO) (CRD42017058053).ResultsSixty-five studies (43 506 patients) reported new-onset arrhythmias following TAVI. The method of arrhythmia detection was specified only in 31 studies (48%). New-onset atrial fibrillation (NOAF) (2641 patients), bradyarrhythmias (182 patients), supraventricular arrhythmias (29 patients), ventricular arrhythmias (28 patients) and non-specified major arrhythmias (855 patients) were reported. In most studies (52 out of 65), new-onset arrhythmia detection was limited to the first month following TAVI. The most frequently documented arrhythmia was NOAF with trend of increasing summary prevalence of 11%, 14%, 14% and 25% during inhospital, 30-day, 1-year and 2-year follow-ups, respectively (P for trend=0.011). Summary prevalence estimates of NOAF at 30-day follow-up differ significantly between studies of prospective and retrospective design (8% and 21%, respectively, P=0.002). New episodes of bradyarrhythmias were documented with a summary crude prevalence of 4% at 1-year follow-up. NOAF increased the risk of death (relative risk 1.61, 95% CI 1.35 to 1.98, I2=47%) and cerebrovascular events (1.79, 95% CI 1.24 to 2.64, I2=0%). No study commented on therapeutic modifications following the detection of new-onset arrhythmias.ConclusionsSystematic identification of new-onset arrhythmias following TAVI may have considerable impact on subsequent therapeutic management and long-term prognosis in this patient population.
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356
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Hengstenberg C, Husser O. A new hope - low permanent pacemaker rates with selfexpanding transcatheter heart valves. EUROINTERVENTION 2017; 13:1255-1257. [PMID: 29260715 DOI: 10.4244/eijv13i11a196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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357
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Predictors of right ventricular pacing and pacemaker dependence in transcatheter aortic valve replacement patients. J Interv Card Electrophysiol 2017; 51:77-86. [DOI: 10.1007/s10840-017-0303-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
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Routh JM, Joseph L, Marthaler BR, Bhave PD. Imaging-based predictors of permanent pacemaker implantation after transcatheter aortic valve replacement. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:81-86. [PMID: 29205396 DOI: 10.1111/pace.13249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 10/23/2017] [Accepted: 11/26/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cardiac conduction abnormalities requiring permanent pacemaker (PPM) implantation are major complications of transcatheter aortic valve replacement (TAVR). We aimed to investigate whether the relationship between prosthetic valve size and cardiac-gated computed tomography (CT)-based aortic root complex measurements can aid in recognizing patients at risk for PPM implantation post-TAVR. METHODS We included 83 of 114 consecutive patients who underwent TAVR with the Edwards Sapien valve (Edwards Lifesciences, Irving, CA, USA) at our institution. We excluded patients with preexisting PPM, patients who required conversion to an open surgical procedure, and patients without CT data. We assessed the significance of various potential predictors of PPM placement post-TAVR. RESULTS Following TAVR, eight patients (9.6%) required PPM. Prosthetic valve to sinus of Valsalva (SOV) index was significantly higher in those patients requiring a PPM post-TAVR (84.1 ± 9.3 vs 76.8 ± 7.1, P = 0.009). CONCLUSIONS The prosthetic valve size to diameter of SOV index was identified as a novel predictor of PPM implantation after TAVR.
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Affiliation(s)
- Jared M Routh
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Lee Joseph
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Prashant D Bhave
- Wake Forest University Health Sciences Center, Winston-Salem, NC, USA
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359
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Zukunft der Transkatheter-Aortenklappenimplantation. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-017-0160-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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360
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Toggweiler S, Nissen H, Mogensen B, Cuculi F, Fallesen C, Veien K, Brinkert M, Kobza R, Rück A. Very low pacemaker rate following ACURATE neo transcatheter heart valve implantation. EUROINTERVENTION 2017; 13:1273-1280. [DOI: 10.4244/eij-d-17-00252] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Monteiro C, Ferrari ADL, Caramori PRA, Carvalho LAF, Siqueira DADA, Thiago LEKS, Perin M, Lima VCD, Guérios E, Brito Junior FSD. Permanent Pacing After Transcatheter Aortic Valve Implantation: Incidence, Predictors and Evolution of Left Ventricular Function. Arq Bras Cardiol 2017; 109:550-559. [PMID: 29185614 PMCID: PMC5783436 DOI: 10.5935/abc.20170170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 07/12/2017] [Indexed: 12/21/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is a well-established
procedure; however, atrioventricular block requiring permanent pacemaker
implantation (PPI) is a common complication. Objectives To determine the incidence, predictors and clinical outcomes of PPI after
TAVI, focusing on how PPI affects left ventricular ejection fraction (LVEF)
after TAVI. Methods The Brazilian Multicenter TAVI Registry included 819 patients submitted to
TAVI due to severe aortic stenosis from 22 centers from January/2008 to
January/2015. After exclusions, the predictors of PPI were assessed in 670
patients by use of multivariate regression. Analysis of the ROC curve was
used to measure the ability of the predictors; p < 0.05 was the
significance level adopted. Results Within 30 days from TAVI, 135 patients (20.1%) required PPI. Those patients
were older (82.5 vs. 81.1 years; p = 0.047) and mainly of the male sex
(59.3% vs 45%; p = 0.003). Hospital length of stay was longer in patients
submitted to PPI (mean = 15.7 ± 25.7 vs. 11.8 ± 22.9 days; p
< 0.001), but PPI affected neither all-cause death (26.7% vs. 25.6%; p =
0.80) nor cardiovascular death (14.1% vs. 14.8%; p = 0.84). By use of
multivariate analysis, the previous presence of right bundle-branch block
(RBBB) (OR, 6.19; 3.56-10.75; p ≤ 0.001), the use of
CoreValve® prosthesis (OR, 3.16; 1.74-5.72; p ≤
0.001) and baseline transaortic gradient > 50 mm Hg (OR, 1.86; 1.08-3.2;
p = 0.025) were predictors of PPI. The estimated risk of PPI ranged from 4%,
when none of those predictors was present, to 63%, in the presence of all of
them. The model showed good ability to predict the need for PPI: 0.69
(95%CI: 0.64 - 0.74) in the ROC curve. The substudy of 287 echocardiograms
during the 1-year follow-up showed worse LVEF course in patients submitted
to PPI (p = 0.01). Conclusion BRD prévio, gradiente aórtico médio > 50 mmHg e
CoreValve® são preditores independentes de implante de MPD
pós-TAVI. Ocorreu implante de MPD em aproximadamente 20% dos casos de
TAVI, o que prolongou a internação hospitalar, mas não
afetou a mortalidade. O implante de MPD afetou negativamente a FEVE
pós-TAVI.
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Affiliation(s)
- Cláudio Monteiro
- Centro de Pesquisas Cardiovasculares do Hospital São Lucas da PUCRS, Porto Alegre, RS - Brazil
| | - Andres Di Leoni Ferrari
- Centro de Pesquisas Cardiovasculares do Hospital São Lucas da PUCRS, Porto Alegre, RS - Brazil
| | | | | | | | | | - Marco Perin
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
| | - Valter C de Lima
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS - Brazil
| | - Enio Guérios
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR - Brazil - Brazil
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362
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Sandau KE, Funk M, Auerbach A, Barsness GW, Blum K, Cvach M, Lampert R, May JL, McDaniel GM, Perez MV, Sendelbach S, Sommargren CE, Wang PJ. Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e273-e344. [DOI: 10.1161/cir.0000000000000527] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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363
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Gammie JS, Bartus K, Gackowski A, D'Ambra MN, Szymanski P, Bilewska A, Kusmierczyk M, Kapelak B, Rzucidlo-Resil J, Moat N, Duncan A, Yadev R, Livesey S, Diprose P, Gerosa G, D'Onofrio A, Pitterello D, Denti P, La Canna G, De Bonis M, Alfieri O, Hung J, Kolsut P. Beating-Heart Mitral Valve Repair Using a Novel ePTFE Cordal Implantation Device: A Prospective Trial. J Am Coll Cardiol 2017; 71:25-36. [PMID: 29102688 DOI: 10.1016/j.jacc.2017.10.062] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Conventional mitral valve (MV) operations allow direct anatomic assessment and repair on an arrested heart, but require cardiopulmonary bypass, aortic cross-clamping, sternotomy or thoracotomy, and cardioplegic cardiac arrest, and are associated with significant perioperative disability, and risks of morbidity and mortality. OBJECTIVES This study evaluated safety and performance of a transesophageal echocardiographic-guided device designed to implant artificial expanded polytetrafluoroethylene (ePTFE) cords on mitral leaflets in the beating heart. METHODS In a prospective multicenter study, 30 consecutive patients with severe degenerative mitral regurgitation (MR) were treated with a mitral valve repair system (MVRS) via small left thoracotomy. The primary (30-day) endpoint was successful implantation of cords with MR reduction to moderate or less. RESULTS The primary endpoint was met in 27 of 30 patients (90%). Three patients required conversion to open mitral surgery. There were no deaths, strokes, or permanent pacemaker implantations. At 1 month, MR was mild or less in 89% (24 of 27) and was moderate in 11% (3 of 27). At 6 months, MR was mild or less in 85 % (22 of 26), moderate in 8% (2 of 26), and severe in 8% (2 of 26). Favorable cardiac remodeling at 6 months included decreases in end-diastolic (161 ± 36 ml to 122 ± 30 ml; p < 0.001) and left atrial volumes (106 ± 36 ml to 69 ± 24 ml; p < 0.001). The anterior-posterior mitral annular dimension decreased from 34.7 ± 5.8 mm to 28.2 ± 5.1 mm; p < 0.001 as did the mitral annular area (10.0 ± 2.7 cm2 vs. 6.9 ± 2.0 cm2; p < 0.0001). CONCLUSIONS MVRS ePTFE cordal implantation can reduce the invasiveness and morbidity of conventional MV surgery. The device's safety profile is promising and prospective trials comparing the outcomes of the MVRS to conventional MV repair surgery are warranted. (CE Mark Study for the Harpoon Medical Device [TRACER]; NCT02768870).
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Affiliation(s)
- James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
| | | | | | | | | | | | | | | | | | - Neil Moat
- Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Alison Duncan
- Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Rashmi Yadev
- Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Steve Livesey
- University Hospital Southampton National Health Service Foundation Trust, United Kingdom
| | - Paul Diprose
- University Hospital Southampton National Health Service Foundation Trust, United Kingdom
| | | | | | | | | | | | | | | | - Judy Hung
- Massachusetts General Hospital, Boston, Massachusetts
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Mariathas M, Rawlins J, Curzen N. Transcatheter aortic valve implantation: where are we now? Future Cardiol 2017; 13:551-566. [DOI: 10.2217/fca-2017-0056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) was first used in clinical practice in 2002. Since 2002, there has been a rapid increase in TAVI activity in patients with symptomatic severe aortic stenosis. This has been supported by systematic randomized data comparing TAVI against the gold standard treatment for the last 50 years’ surgical aortic valve replacement. TAVI is now currently a recommended therapeutic intervention in the treatment of severe aortic stenosis patients who are deemed either high risk or inoperable. The indications for TAVI continue to expand. Within this review we will focus on the current guidelines for TAVI, the evidence for it, the complications of TAVI, postprocedure care, the technology available to clinicians now and finally the future perspectives for TAVI.
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Affiliation(s)
- Mark Mariathas
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - John Rawlins
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
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365
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Tummala R, Banerjee K, Sankaramangalam K, Mick S, Krishnaswamy A, White J, Fares M, Mehta A, Popovic Z, Svensson LG, Kapadia SR. Clinical and procedural outcomes with the SAPIEN 3 versus the SAPIEN XT prosthetic valves in transcatheter aortic valve replacement: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2017; 92:E149-E158. [DOI: 10.1002/ccd.27398] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/10/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Ramyashree Tummala
- Department of Internal Medicine; St. Vincent Charity Medical Center, An Affiliate of Case Western Reserve University; Cleveland Ohio
| | - Kinjal Banerjee
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | | | - Stephanie Mick
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | | | - Jonathon White
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | - Maan Fares
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | - Anand Mehta
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | - Zoran Popovic
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
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Carnero-Alcázar M, Maroto LC, Cobiella-Carnicer J, Vilacosta I, Nombela-Franco L, Alswies A, Villagrán-Medinilla E, Macaya C. Transcatheter versus surgical aortic valve replacement in moderate and high-risk patients: a meta-analysis. Eur J Cardiothorac Surg 2017; 51:644-652. [PMID: 28007879 DOI: 10.1093/ejcts/ezw388] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/26/2016] [Indexed: 01/27/2023] Open
Abstract
Objectives The evidence of the benefits of transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) for patients of high or intermediate surgical risk is not consistent. We performed a meta-analysis to compare major adverse outcomes after TAVR or SAVR. Methods We searched propensity score matched studies or randomized clinical trials comparing the risks of mortality, stroke, major bleeding, acute renal injury, pacemaker implantation, vascular complications and prostheses haemodynamic performance between TAVR and SAVR in patients with moderate or high risk. Combined odds ratios (ORs), relative risk or mean differences with corresponding 95% confidence intervals (CIs) were calculated using a random effects model. Analyses of sensitivity and publication bias were also conducted. Results We included 5 clinical trials and 37 observational studies, enrolling 20 224 patients (TAVR, n = 9099 and SAVR, n = 11 125). The pooled analysis suggested no differences in early (OR = 1.11, 95% CI 0.9-1.39, P = 0.355) or late mortality (relative risk = 0.91, 95% CI 0.78-1.05, P = 0.194). TAVR was associated with a lower risk of major bleeding (OR = 0.42, 95% CI 0.25-0.69, P < 0.001) and acute kidney injury (OR = 0.51, 95% CI 0.34-0.71) but with an increase in the incidence of pacemaker implantation (OR = 2.31, 95% CI 1.73-3.08) and vascular complications (OR = 4.88, 95% CI 2.84-8.39). Residual aortic regurgitation was more frequent after TAVR (OR= 6.83, 95% CI 4.87-9.6). SAVR prostheses were associated with poor trans-prosthetic gradients (mean difference: -2.4 mmHg, 95% CI - 3.27 to - 1.53). Conclusions TAVR and SAVR have similar short and long-term all-cause mortality and risk of stroke among patients of moderate or high surgical risk. TAVR decreases the risk of major bleeding, acute kidney injury and improves haemodynamic performance compared with SAVR but increases the risk of vascular complications, the need for a pacemaker and residual aortic regurgitation.
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Affiliation(s)
| | - Luis Carlos Maroto
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Isidre Vilacosta
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Ali Alswies
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Carlos Macaya
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
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367
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Xu B, Mottram PM, Lockwood S, Meredith IT. Imaging Guidance for Transcatheter Aortic Valve Replacement: Is Transoesophageal Echocardiography the Gold Standard? Heart Lung Circ 2017; 26:1036-1050. [DOI: 10.1016/j.hlc.2017.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/16/2016] [Accepted: 02/15/2017] [Indexed: 12/21/2022]
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Predictors of permanent pacemaker implantation after transfemoral aortic valve implantation with the Lotus valve. Am Heart J 2017; 192:57-63. [PMID: 28938964 DOI: 10.1016/j.ahj.2017.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 07/12/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Permanent pacemaker implantation (PPMI) after transcatheter aortic valve implantation is of high clinical relevance, but PPMI rates differ widely between valve types. Although the Lotus valve can be repositioned, reported rates for PPMI are high. The predictors of PPMI after Lotus valve implantation have not been defined yet. METHODS We analyzed the impact of preexisting conduction disturbances, depth of implantation, oversizing, and amount of calcification on PPMI in 216 patients with severe symptomatic aortic stenosis underdoing Lotus valve implantation. RESULTS PPMI was required in 39.8% of patients. Patients with need for PPMI compared with patients without need for PPMI had more often the following criteria: male gender (P=.035); preprocedural right bundle-branch block (RBBB) (16.3% vs 0, P<.001); atrioventricular (AV) block first degree (26.7% vs 10.1%, P=.004); higher calcium volume of the left coronary cusp (63.1±87.5 mm3 vs 42.8±49.3 mm3, P=.05); and deeper valve implantation at right coronary (P=.011), noncoronary (P=.026), and left coronary (P=.012) position. Oversizing in relation to annulus and left ventricular outflow tract did not have an impact on need for PPMI. By multiple regression analysis, preprocedural AV block first degree (P=.005), RBBB (P<.001), and depth of implantation (P=.006) were independent risk factors for need of PPMI. CONCLUSIONS In patients with severe aortic stenosis receiving transfemoral Lotus valve, preexisting AV block first degree, RBBB, and implantation depth are independent predictors of PPMI, highlighting the importance of careful valve positioning.
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Auffret V, Puri R, Urena M, Chamandi C, Rodriguez-Gabella T, Philippon F, Rodés-Cabau J. Conduction Disturbances After Transcatheter Aortic Valve Replacement. Circulation 2017; 136:1049-1069. [DOI: 10.1161/circulationaha.117.028352] [Citation(s) in RCA: 302] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a well-accepted option for treating patients with aortic stenosis at intermediate to high or prohibitive surgical risk. TAVR-related conduction disturbances, mainly new-onset left bundle-branch block and advanced atrioventricular block requiring permanent pacemaker implantation, remain the most common complication of this procedure. Furthermore, improvements in TAVR technology, akin to the increasing experience of operators/centers, have translated to a major reduction in periprocedural complications, yet the incidence of conduction disturbances has remained relatively high, with perhaps an increasing trend over time. Several factors have been associated with a heightened risk of conduction disturbances and permanent pacemaker implantation after TAVR, with prior right bundle-branch block and transcatheter valve type and implantation depth being the most commonly reported. New-onset left bundle-branch block and the need for permanent pacemaker implantation may have a significant detrimental association with patients’ prognosis. Consequently, strategies intended to reduce the risk and to improve the management of such complications are of paramount importance, particularly in an era when TAVR expansion toward treating lower-risk patients is considered inevitable. In this article, we review the available evidence on the incidence, predictive factors, and clinical association of conduction disturbances after TAVR and propose a strategy for the management of these complications.
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Affiliation(s)
- Vincent Auffret
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Rishi Puri
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Marina Urena
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Chekrallah Chamandi
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Tania Rodriguez-Gabella
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - François Philippon
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Josep Rodés-Cabau
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
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371
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Arora S, Vavalle JP. Transcatheter aortic valve replacement in intermediate and low risk patients-clinical evidence. Ann Cardiothorac Surg 2017; 6:493-497. [PMID: 29062744 DOI: 10.21037/acs.2017.07.01] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The encouraging results of the PARTNER 2 (Placement of AoRtic TraNscathetER Valves 2) trial led to the approval of transcatheter aortic valve replacement (TAVR) in intermediate-surgical-risk patients. Recently, the SURTAVI (SUrgical Replacement and Transcatheter Aortic Valve Implantation) investigators demonstrated the feasibility of TAVR with self-expanding valves in intermediate-risk patients. The focus has now shifted to clinical trials comparing TAVR to surgery in low-surgical-risk populations with a goal to expand TAVR to all-risk patients. However, low-surgical-risk patients continue to be acceptable candidates for surgical aortic valve replacement, with proven outcomes over many decades. Although new data has emerged showing feasibility of TAVR in young patients with bicuspid valves, with newer generation TAVR valves there will be minimal tolerance for adverse outcomes in the low risk category. To expand the reach of TAVR into low-surgical-risk patients, important questions about valve durability, leaflet thrombosis, higher rates of paravalvular leak and permanent pacemakers (PPM) will need to be addressed. However, as TAVR technology continues to evolve, it seems to be just a matter of time before TAVR establishes itself as a modality for aortic valve replacement regardless of surgical risk.
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Affiliation(s)
- Sameer Arora
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - John P Vavalle
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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372
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Dumonteil N, Meredith I, Blackman D, Tchétché D, Hildick-Smith D, Spence M, Walters D, Harnek J, Worthley S, Rioufol G, Lefèvre T, Modine T, Van Mieghem N, Houle V, Allocco D, Dawkins K. Insights into the need for permanent pacemaker following implantation of the repositionable LOTUS valve for transcatheter aortic valve replacement in 250 patients: results from the REPRISE II trial with extended cohort. EUROINTERVENTION 2017; 13:796-803. [DOI: 10.4244/eij-d-16-01025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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373
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374
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Raelson CA, Gabriels J, Ruan J, Ip JE, Thomas G, Liu CF, Cheung JW, Lerman BB, Patel A, Markowitz SM. Recovery of atrioventricular conduction in patients with heart block after transcatheter aortic valve replacement. J Cardiovasc Electrophysiol 2017; 28:1196-1202. [PMID: 28677917 DOI: 10.1111/jce.13291] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/13/2017] [Accepted: 06/23/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recovery of conduction has been demonstrated in >50% of patients who receive pacemakers (PPMs) for high-degree atrioventricular block (HD-AVB) after transcatheter aortic valve replacement (TAVR). Little information is available about the time course of conduction recovery in these patients and if any features predict early recovery of conduction. METHODS A retrospective review was performed of patients who underwent TAVR with balloon and self-expanding valves who required PPMs for HD-AVB. Serial PPM interrogations were analyzed to detect recovery of AV conduction. Analysis was performed to identify predictors and timing of conduction recovery. RESULTS Of a total population of 578 patients, 54 (9%) received PPMs for HD-AVB. In multivariate analysis, predictors of HD-AVB requiring a PPM included age (P = 0.014), right bundle branch block (OR 7.33 [3.64-14.8], P < 0.0001), atrial fibrillation (OR 2.16 [1.16-4.05], P = 0.016), and self-expanding valves (OR 4.19 [2.20-7.97], P < 0.0001). Of the 54 patients who received PPMs, 38 had follow-up sufficient to evaluate AV conduction recovery. Of these, 23 (61%) showed recovery of AV nodal conduction; 20 had already recovered by their first interrogation, a median of 22 days (IQR 14-31) post-PPM placement. There were no statistically significant predictors of AV nodal conduction recovery, including type of valve implanted. CONCLUSIONS A majority of patients who receive PPMs for HD-AVB after TAVR recover AV conduction during follow-up, and in most patients conduction recovery occurs within weeks. These findings imply that programming to minimize ventricular pacing may be beneficial in a majority of these patients.
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Affiliation(s)
- Colin A Raelson
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | | | | | - James E Ip
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - George Thomas
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Christopher F Liu
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Bruce B Lerman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | | | - Steven M Markowitz
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
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375
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Auffret V, Webb JG, Eltchaninoff H, Muñoz-García AJ, Himbert D, Tamburino C, Nombela-Franco L, Nietlispach F, Morís C, Ruel M, Dager AE, Serra V, Cheema AN, Amat-Santos IJ, de Brito FS, Lemos PA, Abizaid A, Sarmento-Leite R, Dumont E, Barbanti M, Durand E, Alonso Briales JH, Vahanian A, Bouleti C, Immè S, Maisano F, del Valle R, Benitez LM, García del Blanco B, Puri R, Philippon F, Urena M, Rodés-Cabau J. Clinical Impact of Baseline Right Bundle Branch Block in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2017; 10:1564-1574. [DOI: 10.1016/j.jcin.2017.05.030] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/01/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
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376
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Abstract
Nearly 20 years have passed from the concept to clinical development of percutaneous aortic valve replacement, starting from an idea considered "stupid" of Professor Alain Cribier in Rouen. After a first phase of compassionate implantation, large randomized trials PARTNER and COREVALVE US have allowed TAVI to impose itself in the European and American recommendations in patients inoperable or considered with high surgical risk. Next European recommendations on the management of valvular heart diseases expected in 2017 should take into account the positive results observed in intermediate risk patients in the PARTNER 2 and SURTAVI studies, recently adopted in the US recommendations. Randomized trials in "all coming" patients are already on their way, and the future of TAVI is to be the reference treatment for a vast majority of patients with aortic stenosis.
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377
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Abstract
Patients with inoperable, high-risk, and intermediate-risk aortic stenosis can now be treated with transcatheter aortic valve replacement. Centers for Medicare and Medicaid Services and the Food and Drug Administration selectively choose centers based on experience and require a collaborative, multidisciplinary team approach in the treatment and decision making for these patients. The work-up has been streamlined. Gated multislice computed tomography angiogram has emerged as the gold standard for assessment of valve anatomy and sizing of the transcatheter heart valve. Assessment of risk has evolved to include a more comprehensive functional and frailty evaluation. Long term-results are needed before the expansion of transcatheter aortic valve replacement into the low-risk category.
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Affiliation(s)
- John H Braxton
- Structural Heart Services, Marshfield Clinic, Saint Joseph Hospital, 1000 North Oak Avenue, Section 2C2, Marshfield, WI 54449, USA.
| | - Kelly S Rasmussen
- Structural Heart Services, Department of Cardiology, Marshfield Clinic, Saint Joseph Hospital, 1000 North Oak Avenue, Section 2C2, Marshfield, WI 54449, USA
| | - Milind S Shah
- Structural Heart Services, Section of Cardiology, Marshfield Clinic, Saint Joseph Hospital, 1000 North Oak Avenue, Section 2C2, Marshfield, WI 54449, USA
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378
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Choo SJ. Expanding the applications of transcatheter aortic valve replacement: Wave of the future, or not so fast? J Thorac Cardiovasc Surg 2017; 154:818-819. [PMID: 28676185 DOI: 10.1016/j.jtcvs.2017.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/18/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Suk Jung Choo
- Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Republic of Korea.
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379
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Franzone A, Windecker S. The Conundrum of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005514. [DOI: 10.1161/circinterventions.117.005514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anna Franzone
- From the Department of Cardiology, Bern University Hospital, University of Bern, Switzerland
| | - Stephan Windecker
- From the Department of Cardiology, Bern University Hospital, University of Bern, Switzerland
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380
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A single center's experience with pacemaker implantation after the Cox maze procedure for atrial fibrillation. J Thorac Cardiovasc Surg 2017; 154:139-146.e1. [DOI: 10.1016/j.jtcvs.2016.12.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 11/15/2016] [Accepted: 12/12/2016] [Indexed: 11/24/2022]
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381
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Biviano AB, Nazif T, Dizon J, Garan H, Abrams M, Fleitman J, Hassan D, Kapadia S, Babaliaros V, Xu K, Rodes-Cabau J, Szeto WY, Fearon WF, Dvir D, Dewey T, Williams M, Kindsvater S, Mack MJ, Webb JG, Craig Miller D, Smith CR, Leon MB, Kodali S. Atrial Fibrillation is Associated with Increased Pacemaker Implantation Rates in the Placement of AoRTic Transcatheter Valve (PARTNER) Trial. J Atr Fibrillation 2017; 10:1494. [PMID: 29250217 DOI: 10.4022/jafib.1494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/02/2016] [Accepted: 05/06/2017] [Indexed: 01/13/2023]
Abstract
Atrial fibrillation (AF) is associated with worse outcomes in many cardiovascular diseases. There are few data examining pacemaker implantation rates and indications in patients with AF who undergo transcatheter aortic valve replacement (TAVR). To examine the impact of AF on the incidence of and indications for pacemakers in patients undergoing TAVR, we evaluated data of 1723 patients without pre-existing pacemakers who underwent TAVR in the Placement of AoRTic TraNscathetER Valve (PARTNER) trial. Permanent pacemaker implantation rates and indications were compared in groups based on baseline and discharge heart rhythm: sinus rhythm (SR) vs. AF. 1211 patients manifested SR at baseline/SR at discharge (SR/SR), 105 SR baseline/AF discharge (SR/AF), and 407 AF baseline/AF discharge (AF/AF). Patients who developed and were discharged with AF (SR/AF) had the highest rates of pacemaker implantation at 30 days (13.7% SR/AF vs. 5.4% SR/SR, p=0.0008 and 5.9% AF/AF, p=0.008) and 1 year (17.7% SR/AF vs. 7.1% SR/SR, p=0.0002 and 8.1% AF/AF, p=0.0034). Conversion from SR to AF by discharge was an independent predictor of increased pacemaker implantation at 30 days (HR 2.19 vs. SR/SR, 95% CI 1.23-3.93, p=0.008) and 1 year (HR 1.91 vs. SR/SR, 95% CI 1.33-3.80). Pacemaker indications differed between groups, with relatively more implanted in the AF groups for sick sinus syndrome (SSS) versus AV block. In conclusion, conversion to AF is an independent predictor of permanent pacemaker implantation in TAVR patients. Indications differ depending on heart rhythm, with patients in AF manifesting clinically significant tachy-brady syndrome versus AV block.
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Affiliation(s)
- Angelo B Biviano
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Tamim Nazif
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Jose Dizon
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Hasan Garan
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Mark Abrams
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Jessica Fleitman
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Dua Hassan
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | | | | | - Ke Xu
- Cardiovascular Research Foundation, New York, NY
| | - Josep Rodes-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Wilson Y Szeto
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Danny Dvir
- St. Paul's Hospital, Vancouver, BC, Canada
| | - Todd Dewey
- HCA Medical City Dallas Hospital, Dallas, TX
| | | | | | | | | | | | - Craig R Smith
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Martin B Leon
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY.,Cardiovascular Research Foundation, New York, NY
| | - Susheel Kodali
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
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382
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Wechselberger S, Piorkowski C, Pohl M. Current rare indications and future directions for implantable loop recorders. Herzschrittmacherther Elektrophysiol 2017; 27:366-370. [PMID: 27873022 DOI: 10.1007/s00399-016-0475-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The scope of application for implantable loop recorders has shifted away from the evaluation of unclear palpitations and syncope episodes to more complex conditions. This article focuses on rare indications of growing importance such as rhythm monitoring after ablation of atrial fibrillation or after cryptogenic stroke. Furthermore, forthcoming applications in various clinical settings are described, e. g., arrhythmia detection after myocardial infarction, after catheter-based valve interventions, in heart failure, and in cardiomyopathies. Enhancement of the capabilities of implantable loop recorders could broaden their fields of use.
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Affiliation(s)
- Simon Wechselberger
- Steinbeis Research Center on Electrophysiology and Cardiac Devices, Fetscherstraße 111, 01307, Dresden, Germany
| | - Christopher Piorkowski
- Steinbeis Research Center on Electrophysiology and Cardiac Devices, Fetscherstraße 111, 01307, Dresden, Germany.
- Department of Invasive Electrophysiology, Technical University of Dresden, Heart Center, University Hospital, Fetscherstraße 76, 01307, Dresden, Germany.
| | - Matthias Pohl
- Steinbeis Research Center on Electrophysiology and Cardiac Devices, Fetscherstraße 111, 01307, Dresden, Germany
- Department of Invasive Electrophysiology, Technical University of Dresden, Heart Center, University Hospital, Fetscherstraße 76, 01307, Dresden, Germany
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383
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Falk V, Wöhrle J, Hildick-Smith D, Bleiziffer S, Blackman DJ, Abdel-Wahab M, Gerckens U, Linke A, Ince H, Wenaweser P, Allocco DJ, Dawkins KD, Van Mieghem NM. Safety and efficacy of a repositionable and fully retrievable aortic valve used in routine clinical practice: the RESPOND Study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx297] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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384
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Becker M, Blangy H, Folliguet T, Villemin T, Freysz L, Luc A, Maureira P, Popovic B, Olivier A, Sadoul N. Incidence, indications and predicting factors of permanent pacemaker implantation after transcatheter aortic valve implantation: A retrospective study. Arch Cardiovasc Dis 2017. [PMID: 28647466 DOI: 10.1016/j.acvd.2017.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND As the number of transcatheter aortic valve implantation (TAVI) procedures is constantly increasing, it is important to consider common complications, such as pacemaker (PM) implantation, and their specific risk factors. AIMS Echocardiographic, computed tomography and electrocardiographic data were analysed to determine the predicting factors, if any, associated with PM implantation. METHODS This retrospective study included patients referred to Nancy University Hospital for a TAVI procedure from January 2013 to December 2015. Both Medtronic CoreValve and Edwards SAPIEN valves were implanted. Patients with preprocedurally implanted PMs and/or referred from another institution were excluded. RESULTS Of 208 TAVI patients, 23 had a pre-existing PM and were excluded. A new PM was required in 38 patients (20.5%). Pre-existing right bundle branch block (RBBB), the use of the Medtronic CoreValve and large prostheses were identified as predictors of PM implantation (P=0.0361, P=0.0004 and P=0.0019, respectively). Using logistic regression, predictors of PM implantation included first-degree atrioventricular block (odds ratio 3.7, 95% confidence interval 1.5-9.1; P=0.0054) and large aortic annulus diameter in echocardiography (odds ratio 1.2, 95% confidence interval 1-1.4; P=0.0447), with a threshold of 24.1mm. For the combination of preTAVI PR duration >220ms and QRS duration >120ms, the positive predictive value for PM implantation reached 80%. CONCLUSION Use of the Medtronic CoreValve, RBBB and first-degree atrioventricular block are major risk factors for post-TAVI PM implantation. In addition, large aortic annulus and large valvular prosthesis are independent risk factors for PM implantation. The combination of preTAVI prolonged PR interval and increased QRS duration could be used as a marker for periprocedural PM implantation.
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Affiliation(s)
- Mathieu Becker
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France
| | - Hugues Blangy
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France
| | - Thierry Folliguet
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France; Université de Lorraine, 54000 Nancy, France
| | - Thibault Villemin
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France; Université de Lorraine, 54000 Nancy, France
| | - Luc Freysz
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France
| | - Amandine Luc
- ESPRI-Biobase unit, PARC, university hospital of Nancy, 54511 Vandœuvre-lès-Nancy, France
| | - Pablo Maureira
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France; Université de Lorraine, 54000 Nancy, France
| | - Batric Popovic
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France
| | - Arnaud Olivier
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France; Université de Lorraine, 54000 Nancy, France
| | - Nicolas Sadoul
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France; Université de Lorraine, 54000 Nancy, France.
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385
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Campelo-Parada F, Nombela-Franco L, Urena M, Regueiro A, Jiménez-Quevedo P, Del Trigo M, Chamandi C, Rodríguez-Gabella T, Auffret V, Abdul-Jawad Altisent O, DeLarochellière R, Paradis JM, Dumont E, Philippon F, Pérez-Castellano N, Puri R, Macaya C, Rodés-Cabau J. Timing of Onset and Outcome of New Conduction Abnormalities Following Transcatheter Aortic Valve Implantation: Role of Balloon Aortic Valvuloplasty. ACTA ACUST UNITED AC 2017; 71:162-169. [PMID: 28566243 DOI: 10.1016/j.rec.2017.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Little is known about the timing of onset and outcome of conduction abnormalities (CA) following balloon-expandable transcatheter aortic valve implantation. The aim of this study was to examine the timing of CA and determine the impact of balloon aortic valvuloplasty (BAV) on the persistence of these abnormalities. METHODS A total of 347 patients were included. Of these, 75 had a continuous electrocardiogram recording and a 6-lead electrocardiogram at each step of the procedure. RESULTS In the transcatheter aortic valve implantation population undergoing continuous electrocardiogram monitoring, new-onset left bundle branch block (LBBB) or third-degree atrioventricular block occurred in 48 (64%) and 16 (21.3%) patients, with 51.5% of CA occurring before valve implantation. Left bundle branch block persisted more frequently at hospital discharge (53.8 vs 22.7%; P=.028) and at 1-month follow-up (38.5 vs 13.6%; P=.054) when occurring before valve implantation. Balloon aortic valvuloplasty prior to valve implantation was used in 264 (76.1%) patients, and 78 (22.5%) had persistent LBBB or complete atrioventricular block requiring pacemaker implantation. Persistent LBBB or unresolved atrioventricular block at 1 month occurred more frequently in the BAV group (76.1 vs 47.6%; P=.021), and the use of BAV was associated with a lack of CA resolution (OR, 3.5; 95%CI, 1.17-10.43; P=.021). CONCLUSIONS In patients undergoing a balloon-expandable transcatheter aortic valve implantation, more than half of CA occurred before valve implantation. Early occurrence of CA was associated with a higher rate of persistence at 1-month follow-up. The use of BAV was associated with an increased risk of CA persistence.
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Affiliation(s)
| | | | - Marina Urena
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Canada; Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, Paris, France
| | - Ander Regueiro
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Canada
| | | | - María Del Trigo
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Canada
| | - Chekrallah Chamandi
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Canada
| | | | - Vincent Auffret
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Canada
| | | | | | - Jean-Michel Paradis
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Canada
| | - Eric Dumont
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Canada
| | - François Philippon
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Canada
| | | | - Rishi Puri
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Canada
| | - Carlos Macaya
- Departamento de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Canada.
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386
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Amrane H, Porta F, Van Boven AV, Kappetein AP, Head SJ. A meta-analysis on clinical outcomes after transaortic transcatheter aortic valve implantation by the Heart Team. EUROINTERVENTION 2017; 13:e168-e176. [PMID: 28374676 DOI: 10.4244/eij-d-16-00103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to perform a meta-analysis on transaortic (TAo) transcatheter aortic valve implantation (TAVI) in order to gain more insight into the safety and efficacy of the approach in addition to the data available from selected centres with small numbers of patients. METHODS AND RESULTS PubMed and EMBASE were searched on 31 August 2016. The search yielded 251 studies, of which 16 with 1,907 patients were included in the meta-analysis. All were observational, single-arm studies. The rate of conversion to sternotomy was 3.2% (95% CI: 2.3-3.5%; I2=0) among nine studies. Device success among 10 studies was 91% (95% CI: 86.7-94.0%; I2=25.5). Major vascular complications occurred at a rate of 3.1% (95% CI: 1.6-6.0%; I2=60.8). Moderate or severe paravalvular leakage/aortic valve regurgitation (PVL/AR) was reported to be 6.7% (95% CI: 4.3-10.1%; I2=58.9). Permanent pacemaker implantation was required in 11.7% (95% CI: 9.2-14.8%; I2=26.5) of patients. Pooled 30-day post-TAVI complication rates were 9.9% (95% CI: 8.6-11.3%; I2=0) for mortality, 3.7% (95% CI: 2.4-5.6%; I2=28.7) for all stroke, and 1.0% for myocardial infarction (95% CI: 0.5-1.7%; I2=0). The Valve Academic Research Consortium-2 (VARC-2) composite safety endpoint occurred at a pooled rate of 16.7% (95% CI: 10.6-25.3%; I2=58.7). CONCLUSIONS In this meta-analysis of observational studies, transaortic TAVI appears to be a safe procedure with low complication rates.
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Affiliation(s)
- Hafid Amrane
- Department of Cardiothoracic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, the Netherlands
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387
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Badenco N, Chong-Nguyen C, Maupain C, Himbert C, Duthoit G, Waintraub X, Chastre T, Gandjbakhch E, Hidden-Lucet F, Le Prince P, Collet JP, Frank R. Respective role of surface electrocardiogram and His bundle recordings to assess the risk of atrioventricular block after transcatheter aortic valve replacement. Int J Cardiol 2017; 236:216-220. [DOI: 10.1016/j.ijcard.2017.02.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/11/2017] [Accepted: 02/06/2017] [Indexed: 11/16/2022]
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388
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Giannini C, De Carlo M, Tamburino C, Ettori F, Latib AM, Bedogni F, Bruschi G, Presbitero P, Poli A, Fabbiocchi F, Violini R, Trani C, Giudice P, Barbanti M, Adamo M, Colombo P, Benincasa S, Agnifili M, Petronio AS. Transcathether aortic valve implantation with the new repositionable self-expandable Evolut R versus CoreValve system: A case-matched comparison. Int J Cardiol 2017; 243:126-131. [PMID: 28595747 DOI: 10.1016/j.ijcard.2017.05.095] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 04/05/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite promising results following transcatheter aortic valve implantation (TAVI), several relevant challenges still remain. To overcome these issues, new generation devices have been developed. The purpose of the present study was to determine whether TAVI with the new self-expanding repositionable Evolut R offers potential benefits compared to the preceding CoreValve, using propensity matching. METHODS Between June 2007 and November 2015, 2148 consecutive patients undergoing TAVI either CoreValve (n=1846) or Evolut R (n=302) were prospectively included in the Italian TAVI ClinicalService® project. For the purpose of our analysis 211 patients treated with the Evolut R were matched to 211 patients treated with the CoreValve. An independent core laboratory reviewed all angiographic procedural data and an independent clinical events committee adjudicated all events. RESULTS Patients treated with Evolut R experienced higher 1-year overall survival (log rank test p=0.045) and a significantly lower incidence of major vascular access complications, bleeding events and acute kidney injury compared to patients treated with the CoreValve. Recapture manoeuvres to optimize valve deployment were performed 44 times, allowing a less implantation depth for the Evolut R. As a consequence, the rate of more than mild paravalvular leak and new permanent pacemaker was lower in patients receiving the Evolut R. CONCLUSION In this matched comparison of high surgical risk patients undergoing TAVI, the use of Evolut R was associated with a significant survival benefit at 1year compared with the CoreValve. This was driven by lower incidence of periprocedural complications and higher rates of correct anatomic positioning.
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Affiliation(s)
| | | | | | | | | | | | - Giuseppe Bruschi
- "De Gasperis" Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy
| | | | | | | | | | - Carlo Trani
- Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Pietro Giudice
- Giovanni Di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - Marco Barbanti
- Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Paola Colombo
- "De Gasperis" Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy
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389
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Kim WK, Liebetrau C, Renker M, Rolf A, Van Linden A, Arsalan M, Husser O, Möllmann H, Hamm C, Walther T. Transfemoral aortic valve implantation using a self-expanding transcatheter heart valve without pre-dilation. Int J Cardiol 2017; 243:156-160. [PMID: 28579166 DOI: 10.1016/j.ijcard.2017.05.092] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/12/2017] [Accepted: 05/23/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the present study was to investigate whether transfemoral implantation of the Acurate neo transcatheter heart valve without pre-dilation is feasible. METHODS Between December 2014 and December 2016, 294 patients were treated with the Acurate neo prosthesis at our center. Of these, 72 cases were performed without pre-dilation. The decision to omit pre-dilation was at the discretion of the operator, preferably in the case of mild to moderate aortic valve calcification (AVC). Propensity matching (1:1) resulted in 48 cases in each group. Main outcomes of interest were device success according to VARC-2 criteria, residual aortic regurgitation (AR) ≥ 2°, and rate of post-dilation. RESULTS Median [IQR] age in patients without pre-dilation was 82.7 years [78.6–85.6], STS score was 4.6% [3.4–6.1], and AVC-score was 1436 AU [1043–1682] with mild and moderate AVC in 63.9% and 36.1% of cases, respectively. Device success was achieved in 94.4% of cases, post-dilation was necessary in 26.4%, and one (1.4%) patient had moderate AR. In the matched population, there were no differences regarding device success, rate of AR ≥ 2°, need for post-dilation, and post-procedural mean gradient, but the group without pre-dilation had shorter procedure (34.0 min [27.0–38.8] vs. 43.0 min [34.3–52.0]; p < 0.001) and fluoroscopy times (7.4 min [5.7–9.0] vs. 9.9 min [7.9–13.5]; p < 0.001). CONCLUSION In select patients with mild to moderate AVC, transfemoral implantation of the Acurate neo without pre-dilation is feasible and safe. This allows for a straightforward procedure that may be performed without rapid pacing in the majority of cases.
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Affiliation(s)
- Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Rhein Main, Frankfurt am Main, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany.
| | - Christoph Liebetrau
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany
| | - Matthias Renker
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
| | - Andreas Rolf
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany
| | - Arnaud Van Linden
- Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | - Mani Arsalan
- Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | - Oliver Husser
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Helge Möllmann
- St. Johannes Hospital, Department of Cardiology, Dortmund, Germany
| | - Christian Hamm
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany
| | - Thomas Walther
- Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany
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390
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Nijenhuis V, Van Dijk V, Chaldoupi S, Balt J, Ten Berg J. Severe conduction defects requiring permanent pacemaker implantation in patients with a new-onset left bundle branch block after transcatheter aortic valve implantation. Europace 2017; 19:1015-1021. [DOI: 10.1093/europace/euw174] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/15/2016] [Indexed: 11/13/2022] Open
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391
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Wenaweser P, Stortecky S, Schütz T, Praz F, Gloekler S, Windecker S, Elsässer A. Transcatheter aortic valve implantation with the NVT Allegra transcatheter heart valve system: first-in-human experience with a novel self-expanding transcatheter heart valve. EUROINTERVENTION 2017; 12:71-7. [PMID: 27173865 DOI: 10.4244/eijv12i1a13] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to demonstrate the feasibility and investigate the safety of a novel, self-expanding trans-catheter heart valve in a selected patient population with severe aortic stenosis. METHODS AND RESULTS Between January and September 2013, a total of 21 patients with symptomatic severe aortic stenosis were eligible for transcatheter aortic valve implantation (TAVI) with the self-expanding NVT Allegra bioprosthesis (New Valve Technology, Hechingen, Germany) at two cardiovascular centres. Patients were elderly (age 83.8±4 years), predominantly female (95.2%), and all were considered to be at prohibitive risk for surgical aortic valve replacement (logistic EuroSCORE 30.4±11%). Procedural and device success was achieved in 95.2% and 85.7%, respectively. Echocardiographic assessment at discharge showed favourable haemodynamic results with a reduction of the mean transvalvular aortic gradient from 48.0±21 mmHg to 8.9±3 mmHg. In the majority of patients (90.5%), none or trace aortic regurgitation was recorded. Permanent pacemaker implantation was required in 23.8% of patients within the first 30 days of follow-up. Apart from one procedural death, no other serious adverse events were observed during the periprocedural period. TAVI with the NVT Allegra system was highly effective in alleviating symptoms and reducing NYHA functional class at 30-day follow-up. CONCLUSIONS The first-in-human experience with the NVT Allegra transcatheter heart valve prosthesis was associated with a high rate of procedural success. Furthermore, the NVT Allegra bioprosthesis was able to achieve favourable haemodynamic results and effectively alleviate symptoms at 30-day follow-up. The larger, multicentre NAUTILUS study will provide further information on the safety and efficacy of this novel, second-generation transcatheter aortic bioprosthesis.
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Affiliation(s)
- Peter Wenaweser
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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392
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Gonska B, Seeger J, Keßler M, von Keil A, Rottbauer W, Wöhrle J. Predictors for permanent pacemaker implantation in patients undergoing transfemoral aortic valve implantation with the Edwards Sapien 3 valve. Clin Res Cardiol 2017; 106:590-597. [DOI: 10.1007/s00392-017-1093-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/17/2017] [Indexed: 11/24/2022]
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393
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van Gils L, Tchetche D, Lhermusier T, Abawi M, Dumonteil N, Rodriguez Olivares R, Molina-Martin de Nicolas J, Stella PR, Carrié D, De Jaegere PP, Van Mieghem NM. Transcatheter Heart Valve Selection and Permanent Pacemaker Implantation in Patients With Pre-Existent Right Bundle Branch Block. J Am Heart Assoc 2017; 6:JAHA.116.005028. [PMID: 28258051 PMCID: PMC5524025 DOI: 10.1161/jaha.116.005028] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Right bundle branch block is an established predictor for new conduction disturbances and need for a permanent pacemaker (PPM) after transcatheter aortic valve replacement. The aim of the study was to evaluate the absolute rates of transcatheter aortic valve replacement related PPM implantations in patients with pre‐existent right bundle branch block and categorize for different transcatheter heart valves. Methods and Results We pooled data on 306 transcatheter aortic valve replacement patients from 4 high‐volume centers in Europe and selected those with right bundle branch block at baseline without a previously implanted PPM. Logistic regression was used to evaluate whether PPM rate differed among transcatheter heart valves after adjustment for confounders. Mean age was 83±7 years and 63% were male. Median Society of Thoracic Surgeons score was 6.3 (interquartile range, 4.1–10.2). The following transcatheter valve designs were used: Medtronic CoreValve (n=130; Medtronic, Minneapolis, MN); Edwards Sapien XT (ES‐XT; n=124) and Edwards Sapien 3 (ES‐3; n=32; Edwards Lifesciences, Irvine, CA); and Boston Scientific Lotus (n=20; Boston Scientific Corporation, Marlborough, MA). Overall permanent pacemaker implantation rate post‐transcatheter aortic valve replacement was 41%, and per valve design: 75% with Lotus, 46% with CoreValve, 32% with ES‐XT, and 34% with ES‐3. The indication for PPM implantation was total atrioventricular block in 98% of the cases. Lotus was associated with a higher PPM rate than all other valves. PPM rate did not differ between ES‐XT and ES‐3. Ventricular paced rhythm at 30‐day and 1‐year follow‐up was present in 81% at 89%, respectively. Conclusions Right bundle branch block at baseline is associated with a high incidence of PPM implantation for all transcatheter heart valves. PPM rate was highest for Lotus and lowest for ES‐XT and ES‐3. Pacemaker dependency remained high during follow‐up.
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Affiliation(s)
| | | | | | - Masieh Abawi
- University Medical Center Utrecht, Utrecht, The Netherlands
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394
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Kilic T, Yilmaz I. Transcatheter aortic valve implantation: a revolution in the therapy of elderly and high-risk patients with severe aortic stenosis. J Geriatr Cardiol 2017; 14:204-217. [PMID: 28408919 PMCID: PMC5387215 DOI: 10.11909/j.issn.1671-5411.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/01/2017] [Accepted: 03/12/2017] [Indexed: 12/18/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) represents a real revolution in the field of interventional cardiology for the treatment of elderly or high-risk surgical patients with severe symptomatic aortic valve stenosis. Today, TAVI seems to play a key and a reliable role in the treatment of intermediate and maybe low-risk patients with severe aortic stenosis. TAVI has also evolved from a complex and hazardous procedure into an effective and safe therapy by the development of new generation devices. This article aims to review the background and future of TAVI, clinical trials and registries with old and new generation TAVI devices and to focus on some open issues related to post-procedural outcomes.
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Affiliation(s)
- Teoman Kilic
- Invasive Cardiology Research and Application Unit, Department of Cardiology, Kocaeli University, Kocaeli, Turkey
| | - Irem Yilmaz
- Department of Cardiology, Kocaeli University, Kocaeli, Turkey
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395
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Landes U, Barsheshet A, Finkelstein A, Guetta V, Assali A, Halkin A, Vaknin‐Assa H, Segev A, Bental T, Ben‐Shoshan J, Barbash IM, Kornowski R. Temporal trends in transcatheter aortic valve implantation, 2008-2014: patient characteristics, procedural issues, and clinical outcome. Clin Cardiol 2017; 40:82-88. [PMID: 27783882 PMCID: PMC6490360 DOI: 10.1002/clc.22632] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND About a decade past the first transcatheter aortic valve implantation (TAVI), data are limited regarding temporal trends accompanying its evolution from novel technology to mainstream therapy. We evaluated these trends in a large multicenter TAVI registry. HYPOTHESIS TAVI is changing and improving with time. METHODS Patients who underwent TAVI between January 2008 and December 2014 at 3 high-volume Israeli centers were divided into 5 time quintiles according to procedure date. Outcomes were analyzed and reported according to Valve Academic Research Consortium-2. RESULTS A total of 1285 patients were studied (43% male; mean age, 83 ± 3 years; mean Society of Thoracic Surgeons [STS] score, 5.5 ± 3.6). Over time, there was a shift toward treating patients at lower STS score, increased use of conscious sedation and transfemoral approach, and decreased use of balloon predilatation. The balloon-expandable to self-expandable valve utilization ratio decreased, the valve-in-valve experience increased from 4% to 17% of all TAVI volume, and length of hospital stay was halved (P = 0.006). Kaplan-Meier survival curves showed gradual decrease in mortality risk (P = 0.031), but there was no significant 1-year mortality decrease by multivariable analysis. Each year increment was associated with an adjusted 20%, 15%, and 12% decrease in new pacemaker obligation (P = 0.004), new pacemaker obligation or left bundle branch block (P = 0.008), and in-hospital infections (P = 0.082), respectively. CONCLUSIONS Temporal trends accompanying TAVI evolution include its utilization in lower-risk patients, procedural simplification, improved overall survival, decreased pacemaker obligation, and shorter hospital stay.
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Affiliation(s)
- Uri Landes
- Department of Cardiology, Beilinson HospitalRabin Medical CenterPetah TikvaIsrael
| | - Alon Barsheshet
- Department of Cardiology, Beilinson HospitalRabin Medical CenterPetah TikvaIsrael
| | | | - Victor Guetta
- Leviev Heart Center, Sheba Medical CenterRamat GanIsrael
- Sackler Faculty of Medicine, Tel Aviv UniversityIsrael
| | - Abid Assali
- Department of Cardiology, Beilinson HospitalRabin Medical CenterPetah TikvaIsrael
| | - Amir Halkin
- Department of CardiologyTel Aviv Medical CenterIsrael
| | - Hanna Vaknin‐Assa
- Department of Cardiology, Beilinson HospitalRabin Medical CenterPetah TikvaIsrael
| | - Amit Segev
- Leviev Heart Center, Sheba Medical CenterRamat GanIsrael
- Sackler Faculty of Medicine, Tel Aviv UniversityIsrael
| | - Tamir Bental
- Department of Cardiology, Beilinson HospitalRabin Medical CenterPetah TikvaIsrael
| | | | - Israel M. Barbash
- Leviev Heart Center, Sheba Medical CenterRamat GanIsrael
- Sackler Faculty of Medicine, Tel Aviv UniversityIsrael
| | - Ran Kornowski
- Department of Cardiology, Beilinson HospitalRabin Medical CenterPetah TikvaIsrael
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396
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Arora S, Misenheimer JA, Ramaraj R. Transcatheter Aortic Valve Replacement: Comprehensive Review and Present Status. Tex Heart Inst J 2017; 44:29-38. [PMID: 28265210 DOI: 10.14503/thij-16-5852] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Aortic stenosis is the most common valvular heart disease in the developed world. About 7% of the population over age 65 years suffers from degenerative aortic stenosis. The prognosis of patients with symptomatic severe aortic stenosis is dismal without valve replacement. Even though the American College of Cardiology recommends aortic valve replacement to treat this condition as a class I recommendation, approximately one third of these patients over the age of 75 years are not referred for surgery. Typically, this is from concern about prohibitive surgical risk associated with patient frailty, comorbidities, age, and severe left ventricular dysfunction. The advent in France of transcatheter aortic valve replacement has raised the hope in the United States for an alternative, less invasive treatment for aortic stenosis. Two recent trials-the Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve (Partner) and the CoreValve US Pivotal-have established transcatheter aortic valve replacement as the preferred approach in patients who are at high or prohibitive surgical risk. The more recently published Partner 2 trial has shown the feasibility of transcatheter aortic valve replacement in intermediate-surgical-risk patients as well. With a profile that promises easier use and better valve performance and delivery, newer-generation valves have shown their potential for further improvement in safety profile and overall outcomes. We review the history and status of this topic.
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397
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Barbanti M, Gulino S, Costa G, Tamburino C. Pathophysiology, incidence and predictors of conduction disturbances during Transcatheter Aortic Valve Implantation. Expert Rev Med Devices 2017; 14:135-147. [PMID: 28092726 DOI: 10.1080/17434440.2017.1282819] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Over the past decade, transcatheter aortic valve implantation (TAVI) has evolved rapidly toward an extremely reproducible, safe and effective procedure, with a marked reduction of its related complications. However, the occurrence of conduction disturbances and the need for permanent pacemaker implantation (PPI) after TAVI remains a concern. Areas covered: In this article review, we will go through the mechanisms involved in conduction disturbances after TAVI, and we will discuss the key aspects of pathophysiology, incidence and predictors of conduction disturbances following Transcatheter Aortic Valve Implantation. The evaluation of patient's valve anatomy and the selection of the most appropriate prosthesis have been proposed as a valuable options to reduce the incidence of conductions disturbances. Moreover, in recent times, a great number of new TAVI devices, so-called 'second-generation devices', have been introduced to address the limitations of the first-generation devices, including conduction disturbance, with scarce results. Expert commentary: Conduction disturbances after TAVI are increasingly recognized as an important issue in TAVI complications. Further characterization of the procedural- and patient-related factors that contribute to the development of conduction abnormalities will help to improve prosthesis designs and patient selection, making TAVI even more safer.
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Affiliation(s)
- Marco Barbanti
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Simona Gulino
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Giuliano Costa
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Corrado Tamburino
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
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398
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Metaxa S, Ioannou A, Missouris CG. Transcatheter aortic valve implantation: new hope in the management of valvular heart disease. Postgrad Med J 2017; 93:280-288. [PMID: 28104807 DOI: 10.1136/postgradmedj-2016-134554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/19/2016] [Accepted: 12/29/2016] [Indexed: 12/17/2022]
Abstract
Severe calcific aortic stenosis is relatively common, and unless treated with valve replacement it carries an adverse prognosis. A large number of patients, however, are denied surgery due to their advanced age or coexistent medical conditions that increase perioperative cardiovascular risks. Transcatheter aortic valve implantation (TAVI), a technique in which a bioprosthetic valve is inserted via a catheter and implanted within the diseased native aortic valve, is a new therapeutic modality for treatment of older patients with severe symptomatic aortic stenosis and other comorbidities, who have an inherently high surgical risk. This review will provide an overview of the pivotal trials in the development of TAVI; while also investigating important complications and limitations of the procedure and evaluating how new valves are being designed and clinically evaluated, with the ultimate goal of reducing potential complications and expanding the use of TAVI to lower-risk patient cohorts.
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Affiliation(s)
| | | | - Constantinos G Missouris
- Frimley Health NHS Foundation Trust, London, UK.,University of Cyprus Medical School, Nicosia, Cyprus
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399
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Bjursten H, Nozohoor S, Johansson M, Zindovic I, Appel CF, Sjögren J, Dencker M, Olivecrona G, Harnek J, Koul S, Feldman T, Reardon MJ, Götberg M. The safety of introducing a new generation TAVR device: one departments experience from introducing a second generation repositionable TAVR. BMC Cardiovasc Disord 2017; 17:25. [PMID: 28086805 PMCID: PMC5237269 DOI: 10.1186/s12872-016-0466-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/29/2016] [Indexed: 11/10/2022] Open
Abstract
Background In the evolving field of transcatheter aortic valve replacements a new generation of valves have been introduced to clinical practice. With the complexity of the TAVR procedure and the unique aspects of each TAVR device, there is a perceived risk that changing or adding a new valve in a department could lead to a worse outcome for patients, especially during the learning phase. The objective was to study the safety aspect of introducing a second generation repositionable transcatheter valve (Boston Scientific Lotus valve besides Edwards Sapien valve) in a department. Methods In a retrospective study, 53 patients receiving the Lotus system, and 47 patients receiving the Sapien system over a period of three years were compared for short-term outcome according to VARC-2 definitions and 1-year survival. Results Outcome in terms VARC-2 criteria for early safety and clinical efficacy, stroke rate, and survival at 30 days and at 1 year were similar. The Lotus valve had less paravalvular leakage, where 90% had none or trace aortic insufficiency as compared to only 48% for the Sapien system. Conclusions Introduction of a new generation valve can be done with early device success and safety, and without jeopardizing the outcome for patients up to one year. We found no adverse effects by changing valve type and observed improved outcome in terms of lower PVL-rates. Both existing and new centers starting a TAVR program can benefit from the use of a new generation device.
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Affiliation(s)
- Henrik Bjursten
- Department of Cardiothoracic Surgery, and Cardiology, Institute of Clinical Sciences, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden.
| | - Shahab Nozohoor
- Department of Cardiothoracic Surgery, and Cardiology, Institute of Clinical Sciences, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden
| | - Malin Johansson
- Department of Cardiothoracic Surgery, and Cardiology, Institute of Clinical Sciences, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden
| | - Igor Zindovic
- Department of Cardiothoracic Surgery, and Cardiology, Institute of Clinical Sciences, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden
| | - Carl-Fredrik Appel
- Department of Cardiothoracic Surgery, and Cardiology, Institute of Clinical Sciences, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden
| | - Johan Sjögren
- Department of Cardiothoracic Surgery, and Cardiology, Institute of Clinical Sciences, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden
| | - Magnus Dencker
- Department of Clinical Physiology, and Cardiology, Institute of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Göran Olivecrona
- Department of Cardiothoracic Surgery, and Cardiology, Institute of Clinical Sciences, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden
| | - Jan Harnek
- Department of Cardiothoracic Surgery, and Cardiology, Institute of Clinical Sciences, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden
| | - Sasha Koul
- Department of Cardiothoracic Surgery, and Cardiology, Institute of Clinical Sciences, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden
| | - Ted Feldman
- Cardiology Division, Evanston Hospital, Evanston, IL, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Matthias Götberg
- Department of Cardiothoracic Surgery, and Cardiology, Institute of Clinical Sciences, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden
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Rahmani B, Tzamtzis S, Sheridan R, Mullen MJ, Yap J, Seifalian AM, Burriesci G. In Vitro Hydrodynamic Assessment of a New Transcatheter Heart Valve Concept (the TRISKELE). J Cardiovasc Transl Res 2016; 10:104-115. [PMID: 28028692 PMCID: PMC5437138 DOI: 10.1007/s12265-016-9722-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/21/2016] [Indexed: 11/01/2022]
Abstract
This study presents the in vitro hydrodynamic assessment of the TRISKELE, a new system suitable for transcatheter aortic valve implantation (TAVI), aiming to mitigate the procedural challenges experienced with current technologies. The TRISKELE valve comprises three polymeric leaflet and an adaptive sealing cuff, supported by a novel fully retrievable self-expanding nitinol wire frame. Valve prototypes were manufactured in three sizes of 23, 26, and 29 mm by automated dip-coating of a biostable polymer, and tested in a hydrodynamic bench setup in mock aortic roots of 21, 23, 25, and 27 mm annulus, and compared to two reference valves suitable for equivalent implantation ranges: Edwards SAPIEN XT and Medtronic CoreValve. The TRISKELE valves demonstrated a global hydrodynamic performance comparable or superior to the controls with significant reduction in paravalvular leakage. The TRISKELE valve exhibits enhanced anchoring and improved sealing. The valve is currently under preclinical investigation.
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Affiliation(s)
- Benyamin Rahmani
- Cardiovascular Engineering Laboratory, UCL Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Spyros Tzamtzis
- Cardiovascular Engineering Laboratory, UCL Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Rose Sheridan
- Cardiovascular Engineering Laboratory, UCL Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Michael J Mullen
- Barts Health NHS Trust, University College London Hospital, London, UK
| | - John Yap
- Barts Health NHS Trust, University College London Hospital, London, UK
| | | | - Gaetano Burriesci
- Cardiovascular Engineering Laboratory, UCL Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK. .,Ri.MED Foundation, Bioengineering Group, Palermo, Italy.
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