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Danenberg HD. Editorial: Procedural echo in TAVR: Mandatory, optional or redundant? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00520-7. [PMID: 38849265 DOI: 10.1016/j.carrev.2024.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024]
Affiliation(s)
- Haim D Danenberg
- Department of Cardiology, E. Wolfson Medical Center, Holon, Israel.
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2
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Hioki H, Yamamoto M, Watanabe Y, Ohno Y, Yashima F, Naganuma T, Tada N, Shirai S, Yamanaka F, Mizutani K, Noguchi M, Izumo M, Takagi K, Asami M, Ueno H, Nishina H, Otsuka T, Hayashida K. Size of Self-Expandable Transcatheter Heart Valve and Mid-Term Adverse Events After Transcatheter Aortic Valve Replacement. Am J Cardiol 2024; 223:156-164. [PMID: 38797196 DOI: 10.1016/j.amjcard.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/19/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024]
Abstract
The hemodynamic performance of self-expandable valves (SEVs) is a preferable choice for small aortic annuli in transcatheter aortic valve replacement (TAVR). However, no data are, so far, available regarding the relation between the size of SEVs and clinical outcomes. This study aimed to evaluate the impact of prosthesis size on adverse events after TAVR using SEVs. We retrospectively analyzed 1,400 patients (23-mm SEV: 13.6%) who underwent TAVR using SEVs at 12 centers. The impact of SEV size on all-cause death and heart failure (HF) after TAVR was evaluated by multivariate Cox regression and propensity score (PS) matching analysis. During the follow-up period (median 511 days), 201 all-cause deaths and 87 HF rehospitalizations were observed. The incidence of all-cause death was comparable between small- (23-mm SEV) and larger-sized (26- or 29-mm SEV) (16.8% vs 13.9%, log-rank p = 0.29). The size of SEV was not associated with a higher incidence of all-cause death (hazard ratio [HR] 1.21, 95% confidence interval [CI] 0.79 to 1.86 in Cox regression; HR 1.31, 95% CI 0.77 to 2.23 in PS matching) and HF after TAVR (subdistribution HR 0.79, 95% CI 0.37 to 1.72 in Cox regression; subdistribution HR 1.00, 95% CI 0.44 to 2.30 in PS matching). The multivariate model including postprocedural prosthesis-patient mismatch showed consistent results. In conclusion, small SEVs had comparable midterm clinical outcomes to larger-sized SEVs, even if the prosthesis-patient mismatch was observed after TAVR.
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Affiliation(s)
- Hirofumi Hioki
- Department of Cardiology, IMS Tokyo Katsushika General Hospital, Tokyo, Japan.
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan; Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Ichikawa Medical Center, Urayasu, Japan
| | - Masaki Izumo
- Department of Cardiology, St; Marianna University, Tokyo, Japan
| | - Kensuke Takagi
- Department of Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan; Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Kentaro Hayashida
- Division of Cardiology, Keio University School of Medicine, Tokyo, Japan
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3
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He A, Wilkins B, Lan NSR, Othman F, Sehly A, Bhat V, Jaltotage B, Dwivedi G, Leipsic J, Ihdayhid AR. Cardiac computed tomography post-transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00109-6. [PMID: 38782668 DOI: 10.1016/j.jcct.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/25/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) is performed to treat aortic stenosis and is increasingly being utilised in the low-to-intermediate-risk population. Currently, attention has shifted towards long-term outcomes, complications and lifelong maintenance of the bioprosthesis. Some patients with TAVR in-situ may develop significant coronary artery disease over time requiring invasive coronary angiography, which may be problematic with the TAVR bioprosthesis in close proximity to the coronary ostia. In addition, younger patients may require a second transcatheter heart valve (THV) to 'replace' their in-situ THV because of gradual structural valve degeneration. Implantation of a second THV carries a risk of coronary obstruction, thereby requiring comprehensive pre-procedural planning. Unlike in the pre-TAVR period, cardiac CT angiography in the post-TAVR period is not well established. However, post-TAVR cardiac CT is being increasingly utilised to evaluate mechanisms for structural valve degeneration and complications, including leaflet thrombosis. Post-TAVR CT is also expected to have a significant role in risk-stratifying and planning future invasive procedures including coronary angiography and valve-in-valve interventions. Overall, there is emerging evidence for post-TAVR CT to be eventually incorporated into long-term TAVR monitoring and lifelong planning.
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Affiliation(s)
- Albert He
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Department of Cardiology, Dunedin Public Hospital, Dunedin, New Zealand
| | - Ben Wilkins
- Department of Cardiology, Dunedin Public Hospital, Dunedin, New Zealand
| | - Nick S R Lan
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Harry Perkins Institute of Medical Research, Perth, Australia; Medical School, University of Western Australia, Perth, Australia
| | - Farrah Othman
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | - Amro Sehly
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | - Vikas Bhat
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | | | - Girish Dwivedi
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Harry Perkins Institute of Medical Research, Perth, Australia; Medical School, University of Western Australia, Perth, Australia
| | - Jonathon Leipsic
- Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Harry Perkins Institute of Medical Research, Perth, Australia; Medical School, Curtin University, Perth, Australia.
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4
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Sakurai Y, Yokoyama Y, Fukuhara S, Takagi H, Kuno T. Complete transcatheter versus surgical approach to aortic stenosis with coronary artery disease: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2024; 167:1305-1313.e9. [PMID: 36150940 DOI: 10.1016/j.jtcvs.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/24/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE This meta-analysis aimed to evaluate outcomes of transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) versus surgical aortic valve replacement (SAVR) with coronary artery bypass grafting (CABG). METHODS The MEDLINE, EMBASE, and Cochrane Library databases were searched through November 2021 to identify studies comparing TAVR + PCI and SAVR + CABG for severe aortic stenosis with concurrent coronary artery disease. Outcomes of interest were all-cause mortality, repeat coronary intervention, rehospitalization, myocardial infarction, and stroke during follow-up, and 30-day periprocedural outcomes. RESULTS Two randomized controlled trials and 6 observational studies including a total of 104,220 patients (TAVR + PCI, n = 5004; SAVR + CABG, n = 99,216) were included. The weighted mean follow-up period was 30.2 months. TAVR + PCI was associated with greater all-cause mortality and coronary reintervention during follow-up period (hazard ratio, 1.35; 95% confidence interval [CI], 1.11-1.65; P = .003, hazard ratio, 4.14; 95% CI, 1.74-9.86; P = .001, respectively), 30-day permanent pacemaker implantation rate (odds ratio [OR], 3.79; 95% CI, 1.61-8.95; P = .002), and periprocedural vascular complications (OR, 6.97; 95% CI, 1.85-26.30; P = .004). In contrast, TAVR + PCI was associated with a lower rate of 30-day acute kidney injury (OR, 0.32; 95% CI, 0.20-0.50; P = .0001). Rehospitalization, myocardial infarction, stroke during follow-up, and other periprocedural outcomes including 30-day mortality were similar in both groups. CONCLUSIONS In patients with severe aortic stenosis and coronary artery disease, TAVR + PCI was associated with greater all-cause mortality at follow-up compared with SAVR + CABG. Heart Team approach to assess TAVR candidacy remains imperative.
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Affiliation(s)
- Yosuke Sakurai
- Department of Surgery, Marshall University Joan Edwards School of Medicine, WVa
| | - Yujiro Yokoyama
- Department of Surgery, St Luke's University Health Network, Pa
| | - Shinichi Fukuhara
- Department of Cardiothoracic Surgery, University of Michigan, Ann Arbor, Mich
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
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5
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Isogai T, Spilias N, Bakhtadze B, Sabbak N, Denby KJ, Layoun H, Agrawal A, Shekhar S, Yun JJ, Puri R, Harb SC, Reed GW, Krishnaswamy A, Kapadia SR. Outcomes and treatment strategy of transcatheter aortic valve replacement with balloon-expandable valve in borderline-size annulus. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00118-0. [PMID: 38641438 DOI: 10.1016/j.carrev.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 03/27/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Candidates for transcatheter aortic valve replacement (TAVR) occasionally have a "borderline-size" aortic annulus between 2 transcatheter heart valve sizes, based on the manufacturer's sizing chart. Data on TAVR outcomes in such patients are limited. METHODS We retrospectively reviewed 1816 patients who underwent transfemoral-TAVR with balloon-expandable valve (BEV) at our institution between 2016 and 2020. We divided patients into borderline and non-borderline groups based on computed tomography-derived annular measurements and compared outcomes. Furthermore, we analyzed procedural characteristics and compared outcomes between the smaller- and larger-valve strategies in patients with borderline-size annulus. RESULTS During a median follow-up of 23.3 months, there was no significant difference between the borderline (n = 310, 17.0 %) and non-borderline (n = 1506) groups in mortality (17.3 % vs. 19.5 %; hazard ratio [HR] = 0.86 [95% CI = 0.62-1.20], p = 0.39), major adverse cardiac/cerebrovascular events (MACCE: death/myocardial infarction/stroke, 21.2 % vs. 21.5 %; HR = 0.97 [0.71-1.32], p = 0.85), paravalvular leak (PVL: mild 21.8 % vs. 20.6 %, p = 0.81; moderate 0 % vs. 1.2 %; p = 0.37), or mean gradient (12.9 ± 5.8 vs. 12.6 ± 5.2 mmHg, p = 0.69) at 1 year. There was no significant difference between the larger-(n = 113) and smaller-valve(n = 197) subgroups in mortality (23.7 % vs. 15.2 %; HR = 1.57 [0.89-2.77], p = 0.12), MACCE (28.1 % vs. 18.4 %; HR = 1.52 [0.91-2.54], p = 0.11), mild PVL (13.3 % vs. 25.9 %; p = 0.12), or mean gradient (12.3 ± 4.5 vs. 13.6 ± 5.3 mmHg, p = 0.16); however, the rate of permanent pacemaker implantation (PPI) was higher in the larger-valve subgroup (15.9 % vs. 2.6 %, p < 0.001). CONCLUSION Borderline-size annulus is not associated with higher risk of adverse outcomes after BEV-TAVR. However, the larger-valve strategy for borderline-size annulus is associated with higher PPI risk, suggesting a greater risk of injury to the conduction system.
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Affiliation(s)
- Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nikolaos Spilias
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Beka Bakhtadze
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nabil Sabbak
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kara J Denby
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James J Yun
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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6
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Awad AK, Ahmed A, Mathew DM, Varghese KS, Mathew SM, Khaja S, Newell PC, Okoh AK, Hirji S. Minimally invasive, surgical, and transcatheter aortic valve replacement: A network meta-analysis. J Cardiol 2024; 83:177-183. [PMID: 37611742 DOI: 10.1016/j.jjcc.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has evolved as an alternative to surgical aortic valve replacement (SAVR). In addition to full-sternotomy (FS), recent reports have shown successful minimally-invasive SAVR approaches, including mini-sternotomy (MS) and mini-thoracotomy (MT). This network-meta-analysis (NMA) seeks to provide an outcomes comparison based on these different modalities (MS, MT, TAVR) compared with FS as a reference arm for the management of aortic valve disease. METHODS A comprehensive literature search was performed to identify studies that compared minimally-invasive SAVR (MS/MT) to conventional FS-SAVR, and/or TAVR. Bayesian NMA was performed using the random effects model. Outcomes were pooled as risk ratios (RR) with their 95 % confidence intervals (CIs). Our primary outcomes included 30-day mortality, stroke, acute kidney injury (AKI), major bleeding, new permanent pacemaker (PPM), and paravalvular leak (PVL). We also assessed long-term mortality at the latest follow-up. RESULTS A total of 27,117 patients (56 studies) were included; 10,397 patients had FS SAVR, 9523 had MS, 5487 had MT, and 1710 had TAVR. Compared to FS, MS was associated with statistically-significantly lower rates of 30-day mortality (RR, 0.76, 95%CI 0.59-0.98), stroke (RR, 0.84, 95%CI 0.72-0.97), AKI (RR, 0.76, 95%CI 0.61-0.94), and long-term mortality (RR 0.84, 95%CI 0.72-0.97) at a weighted mean follow-up duration of 10.4 years, while MT showed statistically-significantly higher rates of 30-day PVL (RR, 3.76, 95%CI 1.31-10.85) and major bleeding (RR 1.45; 95%CI 1.08-1.94). TAVR had statistically significant lower rates of 30-day AKI (RR 0.49, 95%CI 0.31-0.77), but showed statistically-significantly higher PPM (RR 2.50; 95%CI 1.60-3.91) and 30-day PVL (RR 12.85, 95%CI 5.05-32.68) compared to FS. CONCLUSIONS MS was protective against 30-day mortality, stroke, AKI, and long-term mortality compared to FS; TAVR showed higher rates of 30-day PVL and PPM but was protective against AKI. Conversely, MT showed higher rates of 30-day PVL and major bleeding. With the emergence of TAVR, the appropriate benchmarks for SAVR comparison in future trials should be the minimally-invasive SAVR approaches to provide clinical equipoise.
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Affiliation(s)
- Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Adham Ahmed
- City University of New York School of Medicine, New York, NY, USA
| | - Dave M Mathew
- City University of New York School of Medicine, New York, NY, USA
| | | | - Serena M Mathew
- City University of New York School of Medicine, New York, NY, USA
| | - Sofia Khaja
- City University of New York School of Medicine, New York, NY, USA
| | - Paige C Newell
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Sameer Hirji
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Hegeman RRMJJ, van Ginkel DJ, Laengle S, Timmers L, Rensing BJWM, de Kroon TL, Sonker U, Kelder JC, Mach M, Andreas M, Swaans MJ, Ten Berg JM, Klein P. Preoperative computed tomography-imaging with patient-specific computer simulation in transcatheter aortic valve implantation: Design and rationale of the GUIDE-TAVI trial. Am Heart J 2024; 269:158-166. [PMID: 38163616 DOI: 10.1016/j.ahj.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/28/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is an established treatment option for patients with severe aortic valve stenosis, but is still associated with relatively high rates of pacemaker implantation and paravalvular regurgitation. Routine preoperative computed tomography (CT) combined with patient-specific computer modelling can predict the interaction between the TAVI device and the patient's unique anatomy, allowing physicians to assess the risk for paravalvular regurgitation and conduction disorders in advance to the procedure. The aim of this trial is to assess potential improvement in the procedural outcome of TAVI by applying CT-based patient-specific computer simulations in patients with suitable anatomy for TAVI. METHODS The GUIDE-TAVI trial is an international multicenter randomized controlled trial including patients accepted for TAVI by the Heart Team. Patients enrolled in the study will be randomized into 2 arms of each 227 patients. In patients randomized to the use of FEops HEARTGuide (FHG), patient-specific computer simulation with FHG is performed in addition to routine preoperative CT imaging and results of the FHG are available to the operator(s) prior to the scheduled intervention. In patients randomized to no use of FHG, only routine preoperative CT imaging is performed. The primary objective is to evaluate whether the use of FHG will reduce the incidence of mild to severe PVR, according to the Valve Academic Research Consortium 3. Secondary endpoints include the incidence of new conduction disorders requiring permanent pacemaker implantation, the difference between preoperative and final selected valve size, the difference between target and final implantation depth, change of preoperative decision, failure to implant valve, early safety composite endpoint and quality of life. CONCLUSIONS The GUIDE-TAVI trial is the first multicenter randomized controlled trial to evaluate the value of 3-dimensional computer simulations in addition to standard preprocedural planning in TAVI procedures.
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Affiliation(s)
- Romy R M J J Hegeman
- Department of Cardiothoracic Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands; Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands.
| | - Dirk-Jan van Ginkel
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Severin Laengle
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Leo Timmers
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Benno J W M Rensing
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Thomas L de Kroon
- Department of Cardiothoracic Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Uday Sonker
- Department of Cardiothoracic Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Johannes C Kelder
- Department of Epidemiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Markus Mach
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria; Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Andreas
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin J Swaans
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Jurriën M Ten Berg
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands; Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
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8
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Malhotra G, Cole CMW, Cox SV, Ross JDW, Dooris M, Moore PT, Chong AA, Dahiya A, Korver K, Hayman SM, Camuglia AC. Third-Generation Transcatheter Aortic Heart Valve with Reverse Parachute Sealing Cuff in Patients with Aortic Valve Disease. Heart Lung Circ 2024; 33:324-331. [PMID: 38184427 DOI: 10.1016/j.hlc.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/18/2023] [Accepted: 11/08/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND The Navitor (Abbott Inc, IL, USA) transcatheter heart valve is a novel third-generation self-expanding bioprosthesis with specific features to mitigate paravalvular regurgitation (PVR). Owing to its novelty, there is a paucity of data on its application in clinical practice. METHODS Consecutive cohort analysis of the use of the Navitor system in an as-treated clinical setting at a quaternary heart hospital. RESULTS Sixty consecutive non-clinical trial patients treated with Navitor were identified. All patients underwent a successful procedure. The mean age was 79.3 years (±SD 7.82), 56.67% (n=34) were female, and the mean STS score was 4.87 (±SD 5.70). At 30 days post-procedure, all patients were alive with no readmissions for heart failure. One patient had a major vascular complication (1.7%). Four patients (7.14% of patients without a pre-existing pacemaker) received a new permanent pacemaker. Two patients (3.4%) had a non-disabling stroke. PVR at 30 days was trivial or none in 75% of patients, and no patient had worse than mild PVR. CONCLUSIONS The Navitor system in this as-treated cohort was associated with favourable clinical, haemodynamic, and safety outcomes.
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Affiliation(s)
- Ganeev Malhotra
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Chris M W Cole
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Stephen V Cox
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Jordan D W Ross
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Mark Dooris
- University of Queensland, Brisbane, QLD, Australia; Mater Hospital and Health Service, Brisbane, QLD, Australia
| | - Peter T Moore
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Adrian A Chong
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia; Mater Hospital and Health Service, Brisbane, QLD, Australia
| | - Arun Dahiya
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Kellee Korver
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Sam M Hayman
- University of Queensland, Brisbane, QLD, Australia; Mater Hospital and Health Service, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Anthony C Camuglia
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia; Mater Hospital and Health Service, Brisbane, QLD, Australia.
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9
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Sanz Sánchez J, Regazzoli D, Barbanti M, Fiorina C, Adamo M, Angelillis M, De Carlo M, Bellini B, Montorfano M, Mangieri A, Bruschi G, Merlanti B, Agnifili ML, Testa L, Ferrara E, Musto C, Colombo A, Tamburino C, Reimers B. Impact of balloon post-dilation on valve durability and long-term clinical outcomes after self-expanding transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2024; 103:209-218. [PMID: 37957842 DOI: 10.1002/ccd.30907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/10/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Balloon post-dilation (BPD) is a widely adopted strategy to optimize acute results of TAVI, with a positive impact on both paravalvular leak and mean gradients. On the other hand, the inflation of the balloon inside prosthetic leaflets may damage them increasing the risk of structural valve deterioration (SVD). Furthermore, the impact of BPD on long-term clinical outcomes and valve hemodynamics is yet unknown. AIMS To evaluate the impact of BPD on valve durability and long-term clinical outcomes in patients undergoing self-expanding transcatheter valve implantation (TAVI). METHODS Echocardiographic and clinical data from the ClinicalService (a nation-based data repository and medical care project) were analyzed. Patients were divided into two groups, those who underwent BPD after TAVI and those who did not. Coprimary endpoints were all-cause death and SVD. Cumulative incidence functions for SVD were estimated. RESULTS Among 1835 patients included in the study, 417 (22.7%) underwent BPD and 1418 (77.3%) did not undergo BPD. No statistically significant differences at 6-year follow-up were found between groups in terms of all-cause mortality (HR: 1.05, 95% CI: 0.9-1.22; p = 0.557) and SVD (2.1% vs. 1.4%, p = 0.381). In addition, BPD did not predispose to higher risk of cardiovascular death, myocardial infarction, valve thrombosis, and endocarditis at 6-year follow-up. CONCLUSIONS BPD following TAVI with a self-expanding prosthesis does not seem to be associated with an increased risk of adverse clinical outcomes or SVD at 6-year follow-up.
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Affiliation(s)
- Jorge Sanz Sánchez
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy
- Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | | | - Claudia Fiorina
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Cividi di Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Cividi di Brescia, Brescia, Italy
| | - Marco Angelillis
- Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Marco De Carlo
- Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Giuseppe Bruschi
- Department of Cardiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Bruno Merlanti
- Department of Cardiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Luca Testa
- IRCCS Policlinico S. Donato, Milan, Italy
| | - Erica Ferrara
- Cardiologia Interventistica, Asst Ovest Milanese Legnano Hospital, Legnano, Italy
| | - Carmine Musto
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
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Urzua Fresno CM, Ocazionez D, Groves DW, Vargas D. Computed Tomography of Transcatheter Aortic Valve Replacement-Related Complications. Semin Roentgenol 2024; 59:112-120. [PMID: 38388090 DOI: 10.1053/j.ro.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/22/2023] [Accepted: 11/25/2023] [Indexed: 02/24/2024]
Affiliation(s)
| | - Daniel Ocazionez
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston-McGovern Medical School, Houston, TX
| | - Daniel W Groves
- Departments of Medicine and Radiology, University of Colorado, Aurora, CO
| | - Daniel Vargas
- Department of Radiology, University of Colorado, Aurora, CO.
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11
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Costa G, Saia F, Pilgrim T, Abdel-Wahab M, Garot P, Sammartino S, Gandolfo C, Branca L, Latib A, Amat-Santos I, Mylotte D, De Marco F, De Backer O, Nombela Franco L, Akodad M, Ribichini FL, Bedogni F, Mazzapicchi A, Tomii D, Laforgia P, Cannata S, Fiorina C, Scotti A, Fezzi S, Criscione E, Poletti E, Mazzucca M, Lunardi M, Mainardi A, Andreaggi S, Quagliana A, Montarello NJ, Hennessey B, Mon-Noboa M, Meier D, Adamo M, Sgroi C, Reddavid CM, Strazzieri O, Crescenzia Motta S, Frittitta V, Dipietro E, Comis A, Melfa C, Calì M, Laterra G, Thiele H, Webb JG, Sondergaard L, Tamburino C, Barbanti M. One-year clinical outcomes of transcatheter aortic valve implantation with the latest iteration of self-expanding or balloonexpandable devices: insights from the OPERA-TAVI registry. EUROINTERVENTION 2024; 20:95-103. [PMID: 37982161 PMCID: PMC10758986 DOI: 10.4244/eij-d-23-00720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/09/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Midterm comparative analyses of the latest iterations of the most used Evolut and SAPIEN platforms for transcatheter aortic valve implantation (TAVI) are lacking. AIMS We aimed to compare 1-year clinical outcomes of TAVI patients receiving Evolut PRO/PRO+ (PRO) or SAPIEN 3 Ultra (ULTRA) devices in current real-world practice. METHODS Among patients enrolled in the OPERA-TAVI registry, patients with complete 1-year follow-up were considered for the purpose of this analysis. One-to-one propensity score matching was used to compare TAVI patients receiving PRO or ULTRA devices. The primary endpoint was a composite of 1-year all-cause death, disabling stroke and rehospitalisation for heart failure. Five prespecified subgroups of patients were considered according to leaflet and left ventricular outflow tract calcifications, annulus dimensions and angulation, and leaflet morphology. RESULTS Among a total of 1,897 patients, 587 matched pairs of patients with similar clinical and anatomical characteristics were compared. The primary composite endpoint did not differ between patients receiving PRO or ULTRA devices (Kaplan-Meier [KM] estimates 14.0% vs 11.9%; log-rank p=0.27). Patients receiving PRO devices had higher rates of 1-year disabling stroke (KM estimates 2.6% vs 0.4%; log-rank p=0.001), predominantly occurring within 30 days after TAVI (1.4% vs 0.0%; p=0.004). Outcomes were consistent across all the prespecified subsets of anatomical scenarios (all pinteraction>0.10). CONCLUSIONS One-year clinical outcomes of patients undergoing transfemoral TAVI and receiving PRO or ULTRA devices in the current clinical practice were similar, but PRO patients had higher rates of disabling stroke. Outcomes did not differ across the different anatomical subsets of the aortic root.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Francesco Saia
- Cardiovascular Department, Policlinico S. Orsola, University of Bologna, Bologna, Italy
| | - Thomas Pilgrim
- Bern University Hospital, Inselspital, Bern, Switzerland
| | | | - Philippe Garot
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Sofia Sammartino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Caterina Gandolfo
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | | | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ignacio Amat-Santos
- Division of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Darren Mylotte
- Department of Cardiology, University Hospital, University of Galway, Ireland
| | - Federico De Marco
- Interventional Cardiology Department, IRCSS Centro Cardiologico Monzino, Milan, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Luis Nombela Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Mariama Akodad
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Francesco Bedogni
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Daijiro Tomii
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - Pietro Laforgia
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Stefano Cannata
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | | | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Simone Fezzi
- Department of Cardiology, University Hospital, University of Galway, Ireland
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Enrico Poletti
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Mattia Mazzucca
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Stefano Andreaggi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Angelo Quagliana
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicholas J Montarello
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Breda Hennessey
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Matias Mon-Noboa
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - David Meier
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Orazio Strazzieri
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Valentina Frittitta
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Elena Dipietro
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Alessandro Comis
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Chiara Melfa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Mariachiara Calì
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Abbott Vascular, Santa Clara, CA, USA
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
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Bansari RB, Saveeta F, Payal F. Comment on "Incidence, Causes, Correlates, and Outcome of Bioprosthetic Valve Dysfunction and Failure Following Transcatheter Aortic Valve Implantation". Curr Probl Cardiol 2023; 48:101966. [PMID: 37473947 DOI: 10.1016/j.cpcardiol.2023.101966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Raveena Bai Bansari
- Internal medicine department, Peoples University of Medical and Health Sciences for Women, Nawabshah, Pakistan
| | - Fnu Saveeta
- Internal medicine department, Peoples University of Medical and Health Sciences for Women, Nawabshah, Pakistan.
| | - Fnu Payal
- Internal medicine department, Ghulam Muhammad mahar medical college sukkur, Sukkur, Pakistan
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13
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Mack MJ, Leon MB, Thourani VH, Pibarot P, Hahn RT, Genereux P, Kodali SK, Kapadia SR, Cohen DJ, Pocock SJ, Lu M, White R, Szerlip M, Ternacle J, Malaisrie SC, Herrmann HC, Szeto WY, Russo MJ, Babaliaros V, Smith CR, Blanke P, Webb JG, Makkar R. Transcatheter Aortic-Valve Replacement in Low-Risk Patients at Five Years. N Engl J Med 2023; 389:1949-1960. [PMID: 37874020 DOI: 10.1056/nejmoa2307447] [Citation(s) in RCA: 67] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND A previous analysis in this trial showed that among patients with severe, symptomatic aortic stenosis who were at low surgical risk, the rate of the composite end point of death, stroke, or rehospitalization at 1 year was significantly lower with transcatheter aortic-valve replacement (TAVR) than with surgical aortic-valve replacement. Longer-term outcomes are unknown. METHODS We randomly assigned patients with severe, symptomatic aortic stenosis and low surgical risk to undergo either TAVR or surgery. The first primary end point was a composite of death, stroke, or rehospitalization related to the valve, the procedure, or heart failure. The second primary end point was a hierarchical composite that included death, disabling stroke, nondisabling stroke, and the number of rehospitalization days, analyzed with the use of a win ratio analysis. Clinical, echocardiographic, and health-status outcomes were assessed through 5 years. RESULTS A total of 1000 patients underwent randomization: 503 patients were assigned to undergo TAVR, and 497 to undergo surgery. A component of the first primary end point occurred in 111 of 496 patients in the TAVR group and in 117 of 454 patients in the surgery group (Kaplan-Meier estimates, 22.8% in the TAVR group and 27.2% in the surgery group; difference, -4.3 percentage points; 95% confidence interval [CI], -9.9 to 1.3; P = 0.07). The win ratio for the second primary end point was 1.17 (95% CI, 0.90 to 1.51; P = 0.25). The Kaplan-Meier estimates for the components of the first primary end point were as follows: death, 10.0% in the TAVR group and 8.2% in the surgery group; stroke, 5.8% and 6.4%, respectively; and rehospitalization, 13.7% and 17.4%. The hemodynamic performance of the valve, assessed according to the mean (±SD) valve gradient, was 12.8±6.5 mm Hg in the TAVR group and 11.7±5.6 mm Hg in the surgery group. Bioprosthetic-valve failure occurred in 3.3% of the patients in the TAVR group and in 3.8% of those in the surgery group. CONCLUSIONS Among low-risk patients with severe, symptomatic aortic stenosis who underwent TAVR or surgery, there was no significant between-group difference in the two primary composite outcomes. (Funded by Edwards Lifesciences; PARTNER 3 ClinicalTrials.gov number, NCT02675114.).
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Affiliation(s)
- Michael J Mack
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Martin B Leon
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Vinod H Thourani
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Philippe Pibarot
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Rebecca T Hahn
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Philippe Genereux
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Susheel K Kodali
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Samir R Kapadia
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - David J Cohen
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Stuart J Pocock
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Michael Lu
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Roseann White
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Molly Szerlip
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Julien Ternacle
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - S Chris Malaisrie
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Howard C Herrmann
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Wilson Y Szeto
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Mark J Russo
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Vasilis Babaliaros
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Craig R Smith
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Philipp Blanke
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - John G Webb
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Raj Makkar
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
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14
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Nguyen D, Marwick T, Moodie M, Gao L. Early offering transcatheter aortic valve replacement to patients with moderate aortic stenosis: quantifying costs and benefits - a Markov model-based simulation study. BMJ Open 2023; 13:e073254. [PMID: 37993164 PMCID: PMC10668295 DOI: 10.1136/bmjopen-2023-073254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE Aortic stenosis (AS) is one of the most common acquired cardiac valvular diseases. The success of transcatheter aortic valve implantation (TAVI) for severe AS has led to increasing interest in its use to earlier disease-moderate AS (MAS). DESIGN Model-based study using a Markov microsimulation technique to evaluate the long-term costs and benefits associated with 'early' TAVI. Key data inputs were sourced from the international literature and costs were obtained from Australian sources. SETTING Australian health care system perspective. PARTICIPANTS 10 000 hypothetical MAS patients with or without left ventricular diastolic dysfunction or impaired left ventricular ejection fraction. INTERVENTION Comparing early TAVI to medical management over a life time horizon for MAS patients aged >65 years. We evaluated the cost-effectiveness of offering early TAVI in five scenarios (10%, 25%, 50%, 75% and 90% take-up rates). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure is quality-adjusted life years (QALY) gained and the incremental cost-utility ratio (ICUR). Secondary outcomes are life-years gained and the number of heart failure case avoided. RESULTS Offering early TAVI for MAS patients resulted in both higher healthcare costs and greater benefits (an increase of 3.02 QALYs or 3.99 life-years) per person treated. The ICUR was around $A10 867 and $A11 926 per QALY gained for all five scenarios, with the total cost of early TAVI to the healthcare system being anticipated to be up to $A3.66 billion. Sensitivity analyses indicated a 100% probability of being cost-effective with a willingness to pay threshold of $A50 000/QALY. The benefits remained, even with assumptions of high levels of repeat valve replacement after TAVI. CONCLUSION While ongoing randomised controlled trials will define the benefit of TAVI to MAS patients, these results suggest that this intervention is likely to be cost-effective.
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Affiliation(s)
- Dieu Nguyen
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Tom Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Lan Gao
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University Faculty of Health, Geelong, Victoria, Australia
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15
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Flores-Umanzor E, Keshvara R, Reza S, Asghar A, Rashidul Anwar M, Cepas-Guillen PL, Osten M, Halankar J, Abrahamyan L, Horlick E. A systematic review of contrast-enhanced computed tomography calcium scoring methodologies and impact of aortic valve calcium burden on TAVI clinical outcomes. J Cardiovasc Comput Tomogr 2023; 17:373-383. [PMID: 37635033 DOI: 10.1016/j.jcct.2023.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/25/2023] [Accepted: 08/19/2023] [Indexed: 08/29/2023]
Abstract
Different methodologies have been used to assess the role of AV calcification (AVC) on TAVI outcomes. This systematic review aims to describe the burden of AVC, synthesize the different methods of calcium score quantification, and evaluate the impact of AVC on outcomes after TAVI. We included studies of TAVI patients who had reported AV calcium scoring by contrast-enhanced multidetector CT and the Agatston method. The impact of calcification on TAVI outcomes without restrictions on follow-up time or outcome type was evaluated. Results were reported descriptively, and a meta-analysis was conducted when feasible. Sixty-eight articles were included, with sample sizes ranging from 23 to 1425 patients. Contrast-enhanced calcium scoring was reported in 30 studies, calcium volume score in 28 studies, and unique scoring methods in two. All studies with calcium volume scores had variable protocols, but most utilized a modified Agatston method with variable attenuation threshold values of 300-850 HU. Eight studies used the Agatston method, with the overall mean AV calcium score in studies published from 2010 to 2012 of 3342.9 AU [95%CI: 3150.4; 3535.4, I2 = 0%]. The overall mean score was lower and heterogenous in studies published from 2014 to 2020 (2658.9 AU [95% CI: 2517.3; 2800.5, I2 = 79%]. Most studies reported a positive association between calcium burden and increased risk of adverse outcomes, including implantation of permanent pacemaker (7/8 studies), paravalvular leak (13/13 studies), and risk of aortic rupture (2/2 studies). AVC quantification methodology with contrast-enhanced CT is still variable. AVC negatively impacts TAVI outcomes independently of the quantification method.
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Affiliation(s)
- Eduardo Flores-Umanzor
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Rajesh Keshvara
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Seleman Reza
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Areeba Asghar
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Mohammed Rashidul Anwar
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Pedro L Cepas-Guillen
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Spain
| | - Mark Osten
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Jaydeep Halankar
- Joint Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network, University of Toronto, ON, Canada
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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16
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Mesnier J, Ternacle J, Cheema AN, Campelo-Parada F, Urena M, Veiga-Fernandez G, Nombela-Franco L, Munoz-Garcia AJ, Vilalta V, Regueiro A, Del Val D, Asmarats L, Del Trigo M, Serra V, Bonnet G, Jonveaux M, Rezaei E, Matta A, Himbert D, de la Torre Hernandez JM, Tirado-Conte G, Fernandez-Nofrerias E, Vidal P, Alfonso F, Gutierrez-Alonso L, Oteo JF, Belahnech Y, Mohammadi S, Philippon F, Modine T, Rodés-Cabau J. Cardiac Death After Transcatheter Aortic Valve Replacement With Contemporary Devices. JACC Cardiovasc Interv 2023; 16:2277-2290. [PMID: 37758382 DOI: 10.1016/j.jcin.2023.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/14/2023] [Accepted: 07/09/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The burden of cardiac death after transcatheter aortic valve replacement (TAVR), particularly from advanced heart failure (HF) and sudden cardiac death (SCD), remains largely unknown. OBJECTIVES This study sought to evaluate the incidence and predictors of SCD and HF-related death in TAVR recipients treated with newer-generation devices. METHODS This study included a total of 5,421 consecutive patients who underwent TAVR with newer-generation devices using balloon (75.7%) or self-expandable (24.3%) valves. RESULTS After a median follow-up of 2 (IQR: 1-3) years, 976 (18.0%) patients had died, 50.8% from cardiovascular causes. Advanced HF and SCD accounted for 11.6% and 7.5% of deaths, respectively. Independent predictors of HF-related death were atrial fibrillation (HR: 2.17; 95% CI: 1.47-3.22; P < 0.001), prior pacemaker (HR: 1.79; 95% CI: 1.10-2.92; P = 0.01), reduced left ventricular ejection fraction (HR: 1.08 per 5% decrease; 95% CI: 1.01-1.14; P = 0.02), transthoracic approach (HR: 2.50; 95% CI: 1.37-4.55; P = 0.003), and new-onset persistent left bundle branch block (HR: 1.85; 95% CI: 1.14-3.02; P = 0.01). Two baseline characteristics (diabetes, HR: 1.81; 95% CI: 1.13-2.89; P = 0.01; and chronic kidney disease, HR: 1.72; 95% CI: 1.02-2.90; P = 0.04) and 3 procedural findings (valve in valve, HR: 2.17; 95% CI: 1.01-4.64; P = 0.04; transarterial nontransfemoral approach, HR: 2.23; 95% CI: 1.23-4.48; P = 0.01; and periprocedural ventricular arrhythmia, HR: 7.19; 95% CI: 2.61-19.76; P < 0.001) were associated with an increased risk of SCD after TAVR. CONCLUSIONS Advanced HF and SCD accounted for a fifth of deaths after TAVR in contemporary practice. Potentially treatable factors leading to increased risk of HF deaths and SCD were identified, such as arrhythmia/dyssynchrony factors for HF and valve-in-valve TAVR or periprocedural ventricular arrhythmias for SCD.
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Affiliation(s)
- Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Julien Ternacle
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Asim N Cheema
- Southlake Regional Health Centre, St. Michael's Hospital Toronto, Newmarket, Ontario, Canada
| | | | - Marina Urena
- Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
| | - Antonio J Munoz-Garcia
- Hospital Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Málaga, Spain
| | - Victoria Vilalta
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ander Regueiro
- Cardiology Department, Instituto Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - David Del Val
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa, CIBER-CV, Madrid, Spain
| | - Lluis Asmarats
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Del Trigo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Vicenç Serra
- Vall d'Hebron Research Institute, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Guillaume Bonnet
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Melchior Jonveaux
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Effat Rezaei
- Southlake Regional Health Centre, St. Michael's Hospital Toronto, Newmarket, Ontario, Canada
| | | | - Dominique Himbert
- Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Gabriela Tirado-Conte
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
| | | | - Pablo Vidal
- Cardiology Department, Instituto Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa, CIBER-CV, Madrid, Spain
| | | | - Juan Francisco Oteo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Yassin Belahnech
- Vall d'Hebron Research Institute, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Thomas Modine
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Cardiology Department, Instituto Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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17
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Jakulla RS, Gunta SP, Huded CP. Heart Failure after Aortic Valve Replacement: Incidence, Risk Factors, and Implications. J Clin Med 2023; 12:6048. [PMID: 37762989 PMCID: PMC10531882 DOI: 10.3390/jcm12186048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Severe aortic stenosis (AS) carries a poor prognosis with the onset of heart failure (HF) symptoms, and surgical or transcatheter aortic valve replacement (AVR) is its only definitive treatment. The management of AS has seen a paradigm shift with the adoption of transcatheter aortic valve replacement (TAVR), allowing for the treatment of AS in patients who would not otherwise be candidates for surgical AVR. Despite improving long-term survival after TAVR in recent years, residual HF symptoms and HF hospitalization are common and are associated with an increased mortality and a poor health status. This review article summarizes the incidence and risk factors for HF after AVR. Strategies for preventing and better managing HF after AVR are necessary to improve outcomes in this patient population. Extensive research is underway to assess whether earlier timing for AVR, prior to the development of severe symptomatic AS and associated extra-valvular cardiac damage, can improve post-AVR patient outcomes.
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Affiliation(s)
- Roopesh Sai Jakulla
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64110, USA
| | - Satya Preetham Gunta
- Department of Cardiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Chetan P. Huded
- Department of Cardiology, University of Missouri-Kansas City, Kansas City, MO 64110, USA
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18
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Juarez-Casso FM, Crestanello JA. The Evolving Role of Surgical Aortic Valve Replacement in the Era of Transcatheter Valvular Procedures. J Clin Med 2023; 12:5299. [PMID: 37629341 PMCID: PMC10455383 DOI: 10.3390/jcm12165299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
Surgical aortic valve replacement (SAVR) has long been the standard treatment for severe symptomatic aortic stenosis (AS). However, transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive alternative; it was initially intended for high-risk patients and has now expanded its use to patients of all risk groups. While TAVR has demonstrated promising outcomes in diverse patient populations, uncertainties persist regarding its long-term durability and potential complications, raising the issue of the ideal lifetime management strategy for patients with AS. Therefore, SAVR continues to play an important role in clinical practice, particularly in younger patients with longer life expectancies, those with complex aortic anatomy who are unsuitable for TAVR, and those requiring concomitant surgical procedures. The choice between TAVR and SAVR warrants personalized decision-making, considering patient characteristics, comorbidities, anatomical considerations, and overall life expectancy. A multidisciplinary approach involving an experienced heart team is crucial in the preoperative evaluation process. In this review, we aimed to explore the current role of surgical management in addressing aortic valve stenosis amidst the expanding utilization of less invasive transcatheter procedures.
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Affiliation(s)
| | - Juan A. Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA;
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19
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Okumus N, Abraham S, Puri R, Tang WHW. Aortic Valve Disease, Transcatheter Aortic Valve Replacement, and the Heart Failure Patient: A State-of-the-Art Review. JACC. HEART FAILURE 2023; 11:1070-1083. [PMID: 37611989 DOI: 10.1016/j.jchf.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 08/25/2023]
Abstract
Concomitant aortic stenosis (AS) in heart failure (HF) is associated with high rates of mortality and morbidity. Current guidelines recommend aortic valve replacement in patients with severe symptomatic AS and asymptomatic AS with left ventricular ejection fraction <50% and during other cardiac surgeries. Transcatheter aortic valve replacement (TAVR) has now allowed for the treatment of severe AS in previously inoperable or high-surgical-risk patients. Leveraging multimodality imaging techniques is increasingly recognized for reinforcing the rationale for intervening early, thus mitigating the risk of ongoing progression to advanced HF. There are increasing data in favor of TAVR in diverse clinical scenarios, particularly asymptomatic AS and moderate AS. Limited information is, however, available regarding the advantages of HF medical therapy before and after intervention. This review aims to comprehensively examine the phenotypes of AS in the context of HF progression, while exploring the evolving role of TAVR in specific populations.
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Affiliation(s)
- Nazli Okumus
- Allegheny General Hospital Cardiovascular Institute, Pittsburgh, Pennsylvania, USA
| | - Sonu Abraham
- Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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20
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Haramati A, Latib A, Lazarus MS. Post-procedural structural heart CT imaging: TAVR, TMVR, and other interventions. Clin Imaging 2023; 101:86-95. [PMID: 37311399 DOI: 10.1016/j.clinimag.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 06/15/2023]
Abstract
Transcatheter valve replacement has experienced substantial growth in the past decade and this technique can now be used for any of the four heart valves. Transcatheter aortic valve replacement (TAVR) has overtaken surgical aortic valve replacement. Transcatheter mitral valve replacement (TMVR) is often performed in pre-existing valves or after prior valve repair, although numerous devices are undergoing trials for replacement of native valves. Transcatheter tricuspid valve replacement (TTVR) is similarly under active development. Lastly, transcatheter pulmonic valve replacement (TPVR) is most often used for revision treatment of congenital heart disease. Given the growth of these techniques, radiologists are increasingly called upon to interpret post-procedural imaging for these patients, particularly with CT. These cases will often arise unexpectedly and require detailed knowledge of potential post-procedural appearances. We review both normal and abnormal post-procedural findings on CT. Certain complications-device migration or embolization, paravalvular leak, or leaflet thrombosis-can occur after replacement of any valve. Other complications are specific to each type of valve, including coronary artery occlusion after TAVR, coronary artery compression after TPVR, or left ventricular outflow tract obstruction after TMVR. Finally, we review access-related complications, which are of particular concern due to the requirement of large-bore catheters for these procedures.
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Affiliation(s)
- Adina Haramati
- Department of Radiology, New York-Presbyterian/Weill Cornell Medicine, 525 East 68(th) Street, New York, NY 10065, United States of America
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210(th) Street, Bronx, NY 10467, United States of America
| | - Matthew S Lazarus
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210(th) Street, Bronx, NY 10467, United States of America.
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21
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Shi J, Li W, Zhang T, Han C, Wang Z, Pei X, Li X, Zhao Z, Wang P, Han J, Chen S. Quantity and location of aortic valve calcification predicts paravalvular leakage after transcatheter aortic valve replacement: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1170979. [PMID: 37293280 PMCID: PMC10244734 DOI: 10.3389/fcvm.2023.1170979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction Transcatheter aortic valve replacement (TAVR) is the first-line treatment for patients with moderate-to-high surgical risk of severe aortic stenosis. Paravalvular leakage (PVL) is a serious complication of TAVR, and aortic valve calcification contributes to the occurrence of PVL. This study aimed to investigate the effect of location and quantity of calcification in the aortic valve complex (AVC) and left ventricular outflow tract (LVOT) on PVL after TAVR. Method We performed a systematic review and meta-analysis to evaluate the effect of quantity and location of aortic valve calcification on PVL after TAVR using observational studies from PubMed and EMBASE databases from inception to February 16, 2022. Results Twenty-four observational studies with 6,846 patients were included in the analysis. A high quantity of calcium was observed in 29.6% of the patients; they showed a higher risk of significant PVL. There was heterogeneity between studies (I2 = 15%). In the subgroup analysis, PVL after TAVR was associated with the quantity of aortic valve calcification, especially those located in the LVOT, valve leaflets, and the device landing zone. A high quantity of calcium was associated with PVL, regardless of expandable types or MDCT thresholds used. However, for valves with sealing skirt, the amount of calcium has no significant effect on the incidence of PVL. Conclusion Our study elucidated the effect of aortic valve calcification on PVL and showed that the quantity and location of aortic valve calcification can help predict PVL. Furthermore, our results provide a reference for the selection of MDCT thresholds before TAVR. We also showed that balloon-expandable valves may not be effective in patients with high calcification, and valves with sealing skirts instead of those without sealing skirts should be applied more to prevent PVL from happening. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=354630, identifier: CRD42022354630.
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Affiliation(s)
- Jiale Shi
- Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Second Clinical Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wei Li
- Department of Second Clinical Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Basic Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tangshan Zhang
- Department of Vascular Surgery, Jiyang District People's Hospital, Jinan, China
| | - Chengwen Han
- Department of Second Clinical Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Basic Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhengjun Wang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xinhao Pei
- Department of Basic Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xuetao Li
- Department of Second Clinical Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zidong Zhao
- Department of Public Health School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Pengbo Wang
- Department of Public Health School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jingying Han
- Department of Basic Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shiqiao Chen
- Department of Interventional Diagnosis and Treatment, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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22
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Huang X, Zhang G, Zhou X, Yang X. A review of numerical simulation in transcatheter aortic valve replacement decision optimization. Clin Biomech (Bristol, Avon) 2023; 106:106003. [PMID: 37245279 DOI: 10.1016/j.clinbiomech.2023.106003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Recent trials indicated a further expansion of clinical indication of transcatheter aortic valve replacement to younger and low-risk patients. Factors related to longer-term complications are becoming more important for use in these patients. Accumulating evidence indicates that numerical simulation plays a significant role in improving the outcome of transcatheter aortic valve replacement. Understanding mechanical features' magnitude, pattern, and duration is a topic of ongoing relevance. METHODS We searched the PubMed database using keywords such as "transcatheter aortic valve replacement" and "numerical simulation" and reviewed and summarized relevant literature. FINDINGS This review integrated recently published evidence into three subtopics: 1) prediction of transcatheter aortic valve replacement outcomes through numerical simulation, 2) implications for surgeons, and 3) trends in transcatheter aortic valve replacement numerical simulation. INTERPRETATIONS Our study offers a comprehensive overview of the utilization of numerical simulation in the context of transcatheter aortic valve replacement, and highlights the advantages, potential challenges from a clinical standpoint. The convergence of medicine and engineering plays a pivotal role in enhancing the outcomes of transcatheter aortic valve replacement. Numerical simulation has provided evidence of potential utility for tailored treatments.
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Affiliation(s)
- Xuan Huang
- Department of Cardiovascular Surgery, West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China; Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China
| | - Guangming Zhang
- Center for Computational Systems Medicine, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Xiaobo Zhou
- Center for Computational Systems Medicine, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Xiaoyan Yang
- Department of Cardiovascular Surgery, West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China; Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China.
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23
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Trongtorsak A, Thangjui S, Adhikari P, Shrestha B, Kewcharoen J, Navaravong L, Kanjanauthai S, Attanasio S, Saudye HA. Gender Disparities after Transcatheter Aortic Valve Replacement with Newer Generation Transcatheter Heart Valves: A Systematic Review and Meta-Analysis. Med Sci (Basel) 2023; 11:medsci11020033. [PMID: 37218985 DOI: 10.3390/medsci11020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
Previous studies have demonstrated gender disparities in mortality and vascular complications after transcatheter aortic valve replacement (TAVR) with early generation transcatheter heart valves (THVs). It is unclear, however, whether gender-related differences persist with the newer generation THVs. We aim to assess gender disparities after TAVR with newer generation THVs. The MEDLINE and Embase databases were thoroughly searched from inception to April 2023 to identify studies that reported gender-specific outcomes after TAVR with newer generation THVs (Sapien 3, Corevalve Evolut R, and Evolut Pro). The outcomes of interest included 30-day mortality, 1-year mortality, and vascular complications. In total, 5 studies (4 databases) with a total of 47,933 patients (21,073 females and 26,860 males) were included. Ninety-six percent received TAVR via the transfemoral approach. The females had higher 30-day mortality rates (odds ratio (OR) = 1.53, 95% confidence interval (CI) 1.31-1.79, p-value (p) < 0.001) and vascular complications (OR = 1.43, 95% CI 1.23-1.65, p < 0.001). However, one-year mortality was similar between the two groups (OR = 0.78, 95% CI 0.61-1.00, p = 0.28). The female gender continues to be associated with higher 30-day mortality rates and vascular complications after TAVR with newer generation transcatheter heart valves, while there was no difference in 1-year mortality between the genders. More data is needed to explore the causes and whether we can improve TAVR outcomes in females.
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Affiliation(s)
- Angkawipa Trongtorsak
- Ascension Saint Francis Hospital, Internal Medicine Residency Program, Evanston, IL 60202, USA
| | - Sittinun Thangjui
- Bassett Healthcare Network, Internal Medicine Residency Program, New York, NY 13326, USA
| | - Pabitra Adhikari
- Ascension Saint Francis Hospital, Internal Medicine Residency Program, Evanston, IL 60202, USA
| | - Biraj Shrestha
- Reading Hospital-Tower Health, Internal Medicine Residency Program, West Reading, PA 19611, USA
| | - Jakrin Kewcharoen
- Division of Cardiovascular Medicine, Loma Linda University Health, Loma Linda, CA 92350, USA
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
| | - Somsupha Kanjanauthai
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Steve Attanasio
- Rush University Medical Center, Division of Cardiovascular Medicine, Chicago, IL 60612, USA
| | - Hammad A Saudye
- Ascension Saint Francis Hospital, Division of Cardiovascular Medicine, Evanston, IL 60202, USA
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24
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Avvedimento M, Angellotti D, Ilardi F, Leone A, Scalamogna M, Catiello DS, Manzo R, Mariani A, Molaro MI, Simonetti F, Spaccarotella CAM, Piccolo R, Esposito G, Franzone A. Acute advanced aortic stenosis. Heart Fail Rev 2023:10.1007/s10741-023-10312-7. [PMID: 37083966 PMCID: PMC10403405 DOI: 10.1007/s10741-023-10312-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 04/22/2023]
Abstract
Acute decompensation often represents the onset of symptoms associated with severe degenerative aortic stenosis (AS) and usually complicates the clinical course of the disease with a dismal impact on survival and quality of life. Several factors may derange the faint balance between left ventricular preload and afterload and precipitate the occurrence of symptoms and signs of acute heart failure (HF). A standardized approach for the management of this condition is currently lacking. Medical therapy finds very limited application in this setting, as drugs usually indicated for the control of acute HF might worsen hemodynamics in the presence of AS. Urgent aortic valve replacement is usually performed by transcatheter than surgical approach whereas, over the last decades, percutaneous balloon valvuloplasty gained renewed space as bridge to definitive therapy. This review focuses on the pathophysiological aspects of acute advanced AS and summarizes current evidence on its management.
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Affiliation(s)
- Marisa Avvedimento
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Domenico Angellotti
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Maria Scalamogna
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Domenico Simone Catiello
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Andrea Mariani
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Maddalena Immobile Molaro
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Fiorenzo Simonetti
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | | | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy.
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25
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Yokoyama H, Sugiyama Y, Miyashita H, Jalanko M, Ochiai T, Shishido K, Yamanaka F, Vähäsilta T, Saito S, Laine M, Moriyama N. Impact of Mild Paravalvular Regurgitation on Long-Term Clinical Outcomes After Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 191:14-22. [PMID: 36623409 DOI: 10.1016/j.amjcard.2022.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/26/2022] [Accepted: 12/04/2022] [Indexed: 01/09/2023]
Abstract
The impact of mild paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) remains controversial. We evaluated the impact of mild PVR after TAVI on long-term clinical outcomes. We included patients who underwent TAVI for severe symptomatic aortic stenosis between December 2008 and June 2019 at 2 international centers and compared all-cause death between the group with mild PVR (group 1) and the group with none or trace PVR (group 2). PVR was categorized using a 3-class grading scheme, and patients with PVR ≧ moderate and those who were lost to follow-up were excluded. This retrospective analysis included 1,404 patients (mean age 81.7 ± 6.5 years, 58.0% women). Three hundred fifty eight patients (25.5%) were classified into group 1 and 1,046 patients (74.5%) into group 2. At baseline, group 1 was older and had a lower body mass index, worse co-morbidities, and more severe aortic stenosis. To account for these differences, propensity score matching was performed, resulting in 332 matched pairs. Within these matched groups, during a mean follow-up of 3.2 years, group 1 had a significantly lower survival rate at 5 years (group 1: 62.0% vs group 2: 68.0%, log-rank p = 0.029, hazard ratio: 1.41 [95% confidence interval: 1.04 to 1.91]). In the matched cohort, patients with mild PVR had a significant 1.4-fold increased risk of mortality at 5 years after TAVI compared with those with none or trace PVR. Further studies with more patients are needed to evaluate the impact of longer-term outcomes.
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Affiliation(s)
- Hiroaki Yokoyama
- Department of Cardiology & Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Yoichi Sugiyama
- Department of Cardiology & Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan; Heart and Lung Center, Helsinki University Central Hospital, Helsinki University, Helsinki, Finland
| | - Hirokazu Miyashita
- Department of Cardiology & Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Mikko Jalanko
- Heart and Lung Center, Helsinki University Central Hospital, Helsinki University, Helsinki, Finland
| | - Tomoki Ochiai
- Department of Cardiology & Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Koki Shishido
- Department of Cardiology & Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Futoshi Yamanaka
- Department of Cardiology & Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Tommi Vähäsilta
- Heart and Lung Center, Helsinki University Central Hospital, Helsinki University, Helsinki, Finland
| | - Shigeru Saito
- Department of Cardiology & Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Mika Laine
- Heart and Lung Center, Helsinki University Central Hospital, Helsinki University, Helsinki, Finland
| | - Noriaki Moriyama
- Department of Cardiology & Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan.
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26
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Conzelmann L, Grotherr P, Dapeng L, Würth A, Widder J, Jacobshagen C, Mehlhorn U. Valve-Related Complications in TAVI Leading to Emergent Cardiac Surgery. Thorac Cardiovasc Surg 2023; 71:107-117. [PMID: 36446625 DOI: 10.1055/s-0042-1758073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is now a standard procedure for the treatment of symptomatic aortic valve stenosis in many patients. In Germany, according to the annual reports from the German Institute for Quality Assurance and Transparency in Healthcare (Institut für Qualitätssicherung und Transparenz im Gesundheitswesen), the rate of serious intraprocedural complications, such as valve malpositioning or embolization, coronary obstruction, aortic dissection, annular rupture, pericardial tamponade, or severe aortic regurgitation requiring emergency cardiac surgery has decreased markedly in recent years from more than 5.5% in 2012 to 2.0% in 2019. However, with increased use, the total number of adverse events remains about 500 per year, about 100 of which require conversion to sternotomy. These, sometimes, fatal events can occur at any time and are still challenging. Therefore, the interdisciplinary TAVI heart team should be prepared and aware of possible rescue strategies.
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Affiliation(s)
- Lars Conzelmann
- Department of Cardiac Surgery, HELIOS Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany
| | - Philipp Grotherr
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Lu Dapeng
- Department of Cardiology, Intensive Care Medicine and Angiology, Vincentius-Diakonissen Hospital Karlsruhe, Karlsruhe, Germany
| | - Alexander Würth
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Julian Widder
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Claudius Jacobshagen
- Department of Cardiology, Intensive Care Medicine and Angiology, Vincentius-Diakonissen Hospital Karlsruhe, Karlsruhe, Germany
| | - Uwe Mehlhorn
- Department of Cardiac Surgery, HELIOS Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany
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27
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Martinez J, Alperi A, Silva I, Pascual I, Ledesma D, Alvarez R, Almendarez M, Avanzas P, del Valle R, Moris C. Leaving obstacles aside: Antegrade paravalvular leakage closure after transcatheter aortic valve replacement. Clin Case Rep 2023; 11:e6971. [PMID: 36860724 PMCID: PMC9969761 DOI: 10.1002/ccr3.6971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/05/2023] [Indexed: 03/03/2023] Open
Abstract
Paravalvular leakage (PVL) is yet a potential and serious complication after transcatheter aortic valve replacement. Percutaneous PVL closure may be the treatment of choice upon failure of balloon postdilation in patients with excessive surgical risk. If the retrograde approach fails, an antegrade strategy might provide the solution.
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Affiliation(s)
| | - Alberto Alperi
- Hospital Universitario Central de AsturiasOviedoSpain,Instituto de Investigación Sanitaria del Principado de Asturias, ISPAOviedoSpain
| | - Iria Silva
- Hospital Universitario Central de AsturiasOviedoSpain
| | - Isaac Pascual
- Hospital Universitario Central de AsturiasOviedoSpain,Instituto de Investigación Sanitaria del Principado de Asturias, ISPAOviedoSpain,University of OviedoOviedoSpain
| | - David Ledesma
- Hospital Universitario Central de AsturiasOviedoSpain
| | - Rut Alvarez
- Hospital Universitario Central de AsturiasOviedoSpain
| | | | - Pablo Avanzas
- Hospital Universitario Central de AsturiasOviedoSpain,Instituto de Investigación Sanitaria del Principado de Asturias, ISPAOviedoSpain,University of OviedoOviedoSpain
| | - Raquel del Valle
- Hospital Universitario Central de AsturiasOviedoSpain,Instituto de Investigación Sanitaria del Principado de Asturias, ISPAOviedoSpain
| | - Cesar Moris
- Hospital Universitario Central de AsturiasOviedoSpain,Instituto de Investigación Sanitaria del Principado de Asturias, ISPAOviedoSpain,University of OviedoOviedoSpain
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28
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Sattar Y, Prakash P, Almas T, Mir T, Titus A, Ahmad S, Khan MS, Aggarwal A, Ullah W, Alhharbi A, Kakouros N, Alraies MC, Qureshi WT. Cardiovascular Outcomes of Older versus Newer Generation Transcatheter Aortic Valve Replacement Recipients: A Systematic Review & Meta-analysis. Curr Probl Cardiol 2023; 48:101467. [PMID: 36272548 DOI: 10.1016/j.cpcardiol.2022.101467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023]
Abstract
Newer generation transcatheter heart valves (THV) are presumed to yield better clinical efficacy and postprocedural complication profile as compared to transcatheter aortic valve replacement (TAVR) using older generation THVs. The real impact of newer generation valves on TAVR outcomes is not well known. Studies comparing older and newer generation THVs were identified from online databases including PubMed, EMBASE, Cochrane, and ClinicalTrials.gov from inception until August 2020. The primary outcome of the study was to compare mortality. Secondary outcomes included cerebrovascular events, myocardial infarction, major vascular complications, major bleeding, acute kidney injury, paravalvular leak, and post-procedural pacemaker implantation. Statistical analysis was performed using the Mantel-Haenszel random effect model with an odds ratio (OR), 95% confidence interval (CI), and p-value significance ≤0.05. A total of 14 studies were included with a combined patient population of 5697 patients (older generation n=1996; newer generation n=3701). Newer generation valves showed statistically significant results favoring lower major vascular complications (OR=2.05; 95% CI, 1.33-3.18; P = 0.00), major bleeding (OR=1.99; 95% CI, 1.35-2.93; P = 0.00), acute kidney injury (OR=1.71; 95% CI, 1.13-2.59; P = 0.01), paravalvular leak (OR=2.41; 95% CI, 1.11-5.28; P = 0.03) and mortality (OR=1.50; 95% CI, 1.10-2.06; P = 0.01) as compared to older generation valves. Cerebrovascular events, myocardial infarction, and pacemaker placement rates were found to be similar between older and newer generation valves. TAVR outcomes using newer generation valves are superior to those of older generation valves in terms of major vascular complications, acute kidney injury, paravalvular leak, and mortality.
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Affiliation(s)
- Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, WV
| | - Preeya Prakash
- Department of Internal Medicine, Detroit Medical center, Wayne State University, Detroit, MI
| | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tanveer Mir
- Department of Internal Medicine, Detroit Medical center, Wayne State University, Detroit, MI
| | - Anoop Titus
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Saad Ahmad
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai - Elmhurst Hospital, Queens, NY
| | | | - Ankita Aggarwal
- Department of Internal Medicine, Ascension providence Rochester
| | - Waqas Ullah
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA
| | - Anas Alhharbi
- Department of Cardiology, West Virginia University, Morgantown, WV
| | - Nikolaos Kakouros
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA
| | - M Chadi Alraies
- Department of Interventional Cardiology, Detroit Medical Center, DMC Heart Hospital, Detroit, MI
| | - Waqas T Qureshi
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA.
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29
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Dowling C, Gooley R, McCormick L, Sharma RP, Yeung AC, Fearon WF, Dargan J, Khan F, Firoozi S, Brecker SJ. Ongoing experience with patient-specific computer simulation of transcatheter aortic valve replacement in bicuspid aortic valve. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 51:31-37. [PMID: 36740551 DOI: 10.1016/j.carrev.2023.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/23/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is increasingly being used to treat younger, lower-risk patients with bicuspid aortic valve (BAV). Patient-specific computer simulation may identify patients at risk for developing paravalvular regurgitation (PVR) and major conduction disturbance. Only limited prospective experience of this technology exist. We wished to describe our ongoing experience with patient-specific computer simulation. METHODS Patients who were referred for consideration of TAVR with a self-expanding transcatheter heart valve (THV) and had BAV identified on pre-procedural cardiac computed tomography imaging underwent patient-specific computer simulation. The computer simulations were reviewed by the Heart Team and used to guide surgical or transcatheter treatment approaches and to aid in THV sizing and positioning. Clinical outcomes were recorded. RESULTS Between May 2019 and May 2021, 16 patients with BAV were referred for consideration of TAVR with a self-expanding THV. Sievers Type 1 morphology was present in 15 patients and Type 0 in the remaining patient. Two patients were predicted to develop moderate-to-severe PVR with a TAVR procedure and these patients underwent successful surgical aortic valve replacement. In the remaining 14 patients, computer simulation was used to optimize THV sizing and positioning to minimise PVR and conduction disturbance. One patient with a low valve implantation depth developed moderate PVR and this complication was correctly predicted by the computer simulations. No patient required insertion of a new permanent pacemaker. CONCLUSION Patient-specific computer simulation may be used to guide the most appropriate treatment modality for patients with BAV. The usage of computer simulation to guide THV sizing and positioning was associated with favourable clinical outcomes.
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Affiliation(s)
- Cameron Dowling
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Robert Gooley
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Liam McCormick
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Rahul P Sharma
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - James Dargan
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Faisal Khan
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
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30
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Aigner P, Sella Bart E, Panfili S, Körner T, Mach M, Andreas M, Königshofer M, Saitta S, Redaelli A, Schmid A, Moscato F. Quantification of paravalvular leaks associated with TAVI implants using 4D MRI in an aortic root phantom made possible by the use of 3D printing. Front Cardiovasc Med 2023; 10:1083300. [PMID: 36742071 PMCID: PMC9894656 DOI: 10.3389/fcvm.2023.1083300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/02/2023] [Indexed: 01/21/2023] Open
Abstract
Introduction Transcatheter aortic valve implantation (TAVI) has become an alternative to surgical replacement of the aortic valve elderly patients. However, TAVI patients may suffer from paravalvular leaks (PVL). Detecting and grading is usually done by echocardiography, but is limited by resolution, 2D visualization and operator dependency. 4D flow magnetic resonance imaging (MRI) is a promising alternative, which did not reach clinical application in TAVI patients. The aim of this study was applying 3D printing technologies in order to evaluate flow patterns and hemodynamics of PVLs following TAVI, exploiting 4D flow MRI and standard ultrasound. Materials and methods An MR-compatible, anatomically left ventricle, aortic root, and ascending aorta model was fabricated by combining 3D-printed parts and various soft silicone materials to match physiological characteristics. An Abbott Portico™ valve was used in continuous antegrade flow (12-22 l/min), retrograde flow with varying transvalvular pressures (60-110 mmHg), and physiological pulsatile hemodynamics (aortic pressure: 120/80 mmHg, cardiac output: 5 l/min) Time-resolved MR measurements were performed above and below the TAVI stent and compared with color Doppler ultrasound measurements in exactly the same setup. Results The continuous antegrade flow measurements from MRI largely agreed with the flowmeter measurements, and a maximum error of only 7% was observed. In the retrograde configuration, visualization of the paravalvular leaks was possible from the MR measurements, but flow was overestimated by up to 33%. The 4D MRI measurement in the pulsatile setup revealed a single main PVL, which was also confirmed by the color Doppler measurements, and velocities were similar (2.0 m/s vs. 1.7 m/s). Discussion 4D MRI techniques were used to qualitatively assess flow in a patient-specific, MR-compatible and flexible model, which only became possible through the use of 3D printing techniques. Flow patterns in the ascending aorta, identification and quantification of PVLs was possible and the location and extent of PVLs were confirmed by ultrasound measurements. The 4D MRI flow technique allowed evaluation of flow patterns in the ascending aorta and the left ventricle below the TAVI stent with good results in identifying PVLs, demonstrating its capabilities over ultrasound by providing the ability to visualize the paravalvular jets in three dimensions at however, additional expenditure of time and money.
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Affiliation(s)
- Philipp Aigner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria,Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria,*Correspondence: Philipp Aigner,
| | - Eleonora Sella Bart
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria,Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Sebastiano Panfili
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria,Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Tito Körner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Markus Mach
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Markus Königshofer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Simone Saitta
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alberto Redaelli
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Albrecht Schmid
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Francesco Moscato
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria,Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria,Austrian Cluster for Tissue Regeneration, Vienna, Austria
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31
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Gupta R, Mahmoudi E, Behnoush AH, Khalaji A, Malik AH, Sood A, Bandyopadhyay D, Zaid S, Goel A, Sreenivasan J, Patel C, Vyas AV, Lavie CJ, Patel NC. Effect of BMI on patients undergoing transcatheter aortic valve implantation: A systematic review and meta-analysis. Prog Cardiovasc Dis 2023:S0033-0620(22)00158-X. [PMID: 36657654 DOI: 10.1016/j.pcad.2022.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 12/26/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND The relationship of body mass index (BMI) and an "obesity paradox" with cardiovascular risk prediction is controversial. This systematic review and meta-analysis aims to compare the associations of different BMI ranges on transcatheter aortic valve implantation (TAVI) outcomes. METHODS International databases, including PubMed, the Web of Science, and the Cochrane Library, were systematically searched for observational and randomized controlled trial studies investigating TAVI outcomes in any of the four BMI categories: underweight, normal weight, overweight, and obese with one of the predefined outcomes. Primary outcomes were in-hospital, 30-day, and long-term all-cause mortality. Random-effects meta-analysis was performed to calculate the odds ratio (OR) or standardized mean differences (SMD) with 95% confidence interval (CI) for each paired comparison between two of the BMI categories. RESULTS A total of 38 studies were included in our analysis, investigating 99,829 patients undergoing TAVI. There was a trend toward higher comorbidities such as hypertension, diabetes, and dyslipidemia in overweight patients and individuals with obesity. Compared with normal-weight, patients with obesity had a lower rate of 30-day mortality (OR 0.42, 95% CI 0.25-0.72, p < 0.01), paravalvular aortic regurgitation (OR 0.63, 95% CI 0.44-0.91, p = 0.01), 1-year mortality (OR 0.48, 95% CI 0.24-0.96, p = 0.04), and long-term mortality (OR 0.69, 95% CI 0.51-0.94, p = 0.02). However, acute kidney injury (OR 1.16, 95% CI 1.04-1.30, p = 0.01) and permanent pacemaker implantation (OR 1.25, 95% CI 1.05-1.50, p = 0.01) odds were higher in patients with obesity. Noteworthy, major vascular complications were significantly higher in underweight patients in comparison with normal weight cases (OR 1.62, 95% CI 1.07-2.46, p = 0.02). In terms of left ventricular ejection fraction (LVEF), patients with obesity had higher post-operative LVEF compared to normal-weight individuals (SMD 0.12, 95% CI 0.02-0.22, p = 0.02). CONCLUSION Our results suggest the presence of the "obesity paradox" in TAVI outcomes with higher BMI ranges being associated with lower short- and long-term mortality. BMI can be utilized for risk prediction of patients undergoing TAVI.
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Affiliation(s)
- Rahul Gupta
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA.
| | - Elham Mahmoudi
- Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Behnoush
- Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Khalaji
- Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran
| | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Aayushi Sood
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | - Dhrubajyoti Bandyopadhyay
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Syed Zaid
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
| | - Akshay Goel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
| | - Jayakumar Sreenivasan
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Chirdeep Patel
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Apurva V Vyas
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Nainesh C Patel
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA
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32
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Sa YK, Hwang BH, Chung WB, Lee KY, Lee J, Kang D, Ko YG, Yu CW, Kim J, Choi SH, Bae JW, Chae IH, Choi YS, Park CS, Yoo KD, Jeon DS, Kim HS, Chung WS, Chang K. Real-World Comparison of Transcatheter Versus Surgical Aortic Valve Replacement in the Era of Current-Generation Devices. J Clin Med 2023; 12:jcm12020571. [PMID: 36675500 PMCID: PMC9864945 DOI: 10.3390/jcm12020571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/13/2023] Open
Abstract
Few studies have reported comparisons of out-of-hospital clinical outcomes after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS) in the era of current-generation valves that reflect the real-world situation. Data on patients with severe AS aged 65 years or older who underwent TAVR or SAVR between 2015 and 2018 were obtained from the National Health Insurance Service in Korea and clinical event rate was analyzed. The primary endpoint was all-cause death at 1 year. The cohort included a total of 4623 patients over 65 years of age, of whom 1269 (27.4%) were treated with TAVR. After 1:1 propensity score matching, 2120 patients were included in the study. TAVR was associated with reduced 1-year mortality (hazard ratio (HR): 0.55; 95% confidence interval (CI): 0.42−0.70; p < 0.001). There was no difference between the groups in the incidence of ischemic stroke (HR: 0.72, 95% CI: 0.43−1.20; p = 0.21) and intracranial hemorrhage (HR: 1.10; p = 0.74). Permanent pacemaker insertion was observed more frequently in the TAVR cohort (9.4% vs. 2.5%, HR: 3.95, 95% CI: 2.57−6.09; p < 0.001), whereas repeat procedures were rare in both treatments (0.5% vs. 0.3%, p = 0.499). In the nation-wide real-world data analysis, TAVR with current-generation devices showed significantly lower 1-year mortality compared to SAVR in severe AS patients.
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Affiliation(s)
- Young Kyoung Sa
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Woo-Baek Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kwan Yong Lee
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jungkuk Lee
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul 05545, Republic of Korea
| | - Dongwoo Kang
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul 05545, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University, Seoul 03722, Republic of Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University, Seoul 02841, Republic of Korea
| | - Juhan Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University, Gwangju 61469, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University, Seongnam 13620, Republic of Korea
| | - Yun-Seok Choi
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Chul Soo Park
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Ki Dong Yoo
- Division of Cardiology, Department of Internal Medicine, St. Vincent Hospital, The Catholic University of Korea, Suwon 65091, Republic of Korea
| | - Doo Soo Jeon
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon 06591, Republic of Korea
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University, Seoul 03080, Republic of Korea
| | - Wook-Sung Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Correspondence:
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Ueyama HA, Gleason PT, Babaliaros VC, Greenbaum AB. Transcatheter Mitral Valve Replacement in Failed Bioprosthetic Valve, Ring, and Mitral Annular Calcification Associated Mitral Valve Disease Using Balloon Expandable Transcatheter Heart Valve. Methodist Debakey Cardiovasc J 2023; 19:37-49. [PMID: 37213881 PMCID: PMC10198232 DOI: 10.14797/mdcvj.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/10/2023] [Indexed: 05/23/2023] Open
Abstract
Transcatheter mitral valve replacement (TMVR) using the SAPIEN platform has been performed in failed bioprosthetic valves (valve-in-valve), surgical annuloplasty rings (valve-in-ring), and native valves with mitral annular calcification (MAC) (valve-in-MAC). Experience over the past decade has identified important challenges and solutions to improve clinical outcomes. In this review, we discuss the indication, trend in utilization, unique challenges, procedural planning, and clinical outcomes of valve-in-valve, valve-in-ring, and valve-in-MAC TMVR.
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Affiliation(s)
- Hiroki A. Ueyama
- Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, US
| | - Patrick T. Gleason
- Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, US
| | - Vasilis C. Babaliaros
- Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, US
| | - Adam B. Greenbaum
- Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, US
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Baman JR, Medhekar AN, Malaisrie SC, McCarthy P, Davidson CJ, Bonow RO. Management Challenges in Patients Younger Than 65 Years With Severe Aortic Valve Disease. JAMA Cardiol 2022; 8:281-289. [PMID: 36542365 DOI: 10.1001/jamacardio.2022.4770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ImportanceThe management of aortic valve disease, including aortic stenosis and aortic regurgitation (AR), in younger adult patients (age &lt;65 years) is complex, and the optimal strategy is often unclear, contingent on multiple anatomic and holistic factors.ObservationsTraditional surgical approaches carry significant considerations, including compulsory lifelong anticoagulation for patients who receive a mechanical aortic valve replacement (AVR) and the risk of structural valvular deterioration and need for subsequent valve intervention in those who receive a bioprosthetic AVR. These factors are magnified in young adults who are considering pregnancy, for whom issues of anticoagulation and valve longevity are heightened. The Ross procedure has emerged as a promising alternative; however, its adoption is limited to highly specialized centers. Valve repair is an option for selected patients with AR. These treatment options offer varying degrees of durability and are associated with different risks and complications, especially for younger adult patients. Patient-centered care from a multidisciplinary valve team allows for discussion of the optimal timing of intervention and the advantages and disadvantages of the various treatment options.Conclusions and RelevanceThe management of severe aortic valve disease in adults younger than 65 years is complex, and there are numerous considerations with each management decision. While mechanical AVR and bioprosthetic AVR have historically been the standards of care, other options are emerging for selected patients but are not yet generalizable beyond specialized surgical centers. A detailed discussion by members of the multidisciplinary heart team and the patient is an integral part of the shared decision-making process.
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Affiliation(s)
- Jayson R. Baman
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ankit N. Medhekar
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - S. Chris Malaisrie
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patrick McCarthy
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles J. Davidson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert O. Bonow
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Editor, JAMA Cardiology
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Isogai T, Agrawal A, Shekhar S, Spilias N, Hodges K, Yun JJ, Puri R, Reed GW, Krishnaswamy A, Kapadia SR. One-year clinical and echocardiographic outcomes of transcatheter aortic valve replacement with SAPIEN 3 Ultra versus SAPIEN 3. Catheter Cardiovasc Interv 2022; 101:417-430. [PMID: 36511393 DOI: 10.1002/ccd.30515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The newest-generation balloon-expandable valve, SAPIEN 3 Ultra (S3U), is expected to function well with the enhanced sealing skirt compared with SAPIEN 3 (S3). However, current literature on the comparison between these two valves is limited to short-term follow-ups. Therefore, we aimed to evaluate the 1-year outcomes and echocardiographic changes of S3U compared with S3. METHODS We retrospectively identified patients who underwent transfemoral-transcatheter aortic valve replacement with S3U or S3 (20/23/26 mm) at our institution in 2018-2020. Outcomes were 1-year clinical events and echocardiographic parameters, and were compared between S3U and S3 after adjustment with inverse probability of treatment weighting. RESULTS The S3U and S3 groups included 297 (25.7%) and 858 (74.3%) patients, respectively. There were no significant differences between the two groups in clinical events (death 5.8% vs. 5.5%, hazard ratio [HR] 1.07, 95% confidence interval [CI] 0.81-1.90; death or heart failure hospitalization 10.3% vs. 10.1%, HR 1.04, 95% CI 0.67-1.62). The S3U group had a lower prevalence of mild paravalvular leakage (PVL) (13.7% vs. 22.3%, p = 0.044), with similar moderate PVL (0.7% vs. 1.2%, p > 0.99). No significant differences were observed in aortic valve mean gradient and Doppler velocity index at 1 year. However, the S3U group had a larger increase in mean gradient from implantation to 1 year (median +4.70 vs. +1.63 mmHg, p < 0.001). CONCLUSIONS S3U and S3 carried similarly favorable clinical event risks. Nonetheless, S3U was associated with less frequent mild PVL but a larger increase in transprosthetic gradient. Further studies are needed to determine the prognostic impact of these hemodynamic differences.
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Affiliation(s)
- Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nikolaos Spilias
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin Hodges
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - James J Yun
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Impact of Paravalvular Leak on Outcomes After Transcatheter Aortic Valve Implantation: Meta-Analysis of Kaplan-Meier-derived Individual Patient Data. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Annamalai SK, Koethe BC, Simsolo E, Huang D, Connors A, Resor CD, Weintraub AR, Pandian NG, Downey BC, Patel AR, Wessler BS. Left ventricular stroke volume index following transcatheter aortic valve replacement is an early predictor of 1-year survival. Clin Cardiol 2022; 46:76-83. [PMID: 36273422 PMCID: PMC9849436 DOI: 10.1002/clc.23937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/22/2022] [Accepted: 10/03/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Adverse cardiac events are common following transcatheter aortic valve replacement (TAVR). Our aim was to investigate the low left ventricular stroke volume index (LVSVI) 30 days after TAVR as an early echocardiographic marker of survival. HYPOTHESIS Steady-state (30-day) LVSVI after TAVR is associated with 1-year mortality. METHODS A single-center retrospective analysis of all patients undergoing TAVR from 2017 to 2019. Baseline and 30-day post-TAVR echocardiographic LVSVI were calculated. Patients were stratified by pre-TAVR transaortic gradient, surgical risk, and change in transvalvular flow following TAVR. RESULTS This analysis focuses on 238 patients treated with TAVR. The 1-year mortality rate was 9% and 124 (52%) patients had normal flow post-TAVR. Of those with pre-TAVR low flow, 67% of patients did not normalize LVSVI at 30 days. The 30-day normal flow was associated with lower 1-year mortality when compared to low flow (4% vs. 14%, p = .007). This association remained significant after adjusting for known predictors of risk (adjusted odds ratio [OR] of 3.45, 95% confidence interval: 1.02-11.63 [per 1 ml/m2 decrease], p = .046). Normalized transvalvular flow following TAVR was associated with reduced mortality (8%) when compared to those with persistent (15%) or new-onset low flow (12%) (p = .01). CONCLUSIONS LVSVI at 30 days following TAVR is an early echocardiographic predictor of 1-year mortality and identifies patients with worse intermediate outcomes. More work is needed to understand if this short-term imaging marker might represent a novel therapeutic target.
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Affiliation(s)
| | | | - Eli Simsolo
- The CardioVascular CenterTufts Medical CenterBostonMassachusettsUSA
| | - Dou Huang
- Department of MedicineTufts Medical CenterBostonMassachusettsUSA
| | - Ann Connors
- The CardioVascular CenterTufts Medical CenterBostonMassachusettsUSA
| | - Charles D. Resor
- The CardioVascular CenterTufts Medical CenterBostonMassachusettsUSA
| | | | | | - Brian C. Downey
- The CardioVascular CenterTufts Medical CenterBostonMassachusettsUSA
| | - Ayan R. Patel
- The CardioVascular CenterTufts Medical CenterBostonMassachusettsUSA
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Farhan S, Stachel G, Desch S, Kurz T, Feistritzer HJ, Hartung P, Eitel I, Nef H, Doerr O, Lauten A, Landmesser U, Sandri M, Holzhey D, Borger M, Ince H, Öner A, Meyer-Saraei R, Wienbergen H, Fach A, Frey N, de Waha-Thiele S, Thiele H. Impact of moderate or severe left ventricular outflow tract calcification on clinical outcomes of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation with self- and balloon-expandable valves: a post hoc analysis from the SOLVE-TAVI trial. EUROINTERVENTION 2022; 18:759-768. [PMID: 35942626 PMCID: PMC11064680 DOI: 10.4244/eij-d-22-00156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/22/2022] [Indexed: 05/04/2024]
Abstract
BACKGROUND Left ventricular outflow tract (LVOT) calcification has been associated with worse outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and may influence the selection of prosthetic valve type. AIMS We aimed to evaluate the impact of LVOT calcification on outcomes after TAVI with a self-expanding valve (SEV) versus a balloon-expandable valve (BEV). METHODS Patients of the SOLVE-TAVI trial, randomised to Edwards SAPIEN 3 or Medtronic Evolut R, were divided according to LVOT calcification into no/mild (≤1 calcium nodule extending <5 mm and covering <10% of the LVOT perimeter) and moderate/severe LVOT calcification groups. The primary endpoint was a composite of death, stroke, moderate/severe paravalvular regurgitation, permanent pacemaker implantation and annulus rupture at 30 days. Additional endpoints included all-cause and cardiovascular mortality at 1 year. RESULTS Out of 416 eligible patients, moderate/severe LVOT calcification was present in 143 (34.4%). Moderate/severe LVOT calcification was associated with significantly longer fluoroscopy time and higher rates of pre- and post-dilation. Regardless of the LVOT calcification group, there was no significant difference in the primary endpoint associated with the valve type (no/mild LVOT calcification group: SEV 25.0% vs BEV 27.0%; hazard ratio [HR] 1.10, 95% confidence interval [95% CI]: 0.68-1.73; p=0.73 and moderate/severe LVOT calcification group: SEV 25.0% vs BEV 19.4%; HR 0.76, 95% CI: 0.38-1.61; p=0.49), no significant interaction between LVOT calcification and valve type (pint=0.29) and no differences between SEV vs BEV within LVOT calcification groups regarding 1-year all-cause and cardiovascular mortality. CONCLUSIONS Moderate/severe LVOT calcification was associated with longer fluoroscopy time and an increased need for pre- and post-dilation, but not with a higher incidence of early and mid-term adverse clinical outcomes, regardless of valve type. (ClinicalTrials.gov: NCT02737150).
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Affiliation(s)
- Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Georg Stachel
- Department of Internal Medicine and Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Steffen Desch
- Department of Internal Medicine and Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
- University Clinic Schleswig-Holstein, Kiel, Germany and University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Campus Lübeck, Lübeck, Germany
| | - Thomas Kurz
- University Clinic Schleswig-Holstein, Kiel, Germany and University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Campus Lübeck, Lübeck, Germany
| | - Hans-Josef Feistritzer
- Department of Internal Medicine and Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Philipp Hartung
- Department of Internal Medicine and Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Ingo Eitel
- University Clinic Schleswig-Holstein, Kiel, Germany and University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Campus Lübeck, Lübeck, Germany
| | - Holger Nef
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Marburg/Gießen, Gießen, Germany
| | - Oliver Doerr
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Marburg/Gießen, Gießen, Germany
| | - Alexander Lauten
- Department of Cardiology and Intensive Care Medicine, Helios Klinikum Erfurt, Erfurt, Germany
| | - Ulf Landmesser
- German Center for Cardiovascular Research (DZHK), Campus Lübeck, Lübeck, Germany
- Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Marcus Sandri
- Department of Internal Medicine and Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - David Holzhey
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Hüseyin Ince
- Medizinische Klinik I im Zentrum fuer Innere Medizin (ZIM), Universitaetsklinikum Rostock, Rostock, Germany
| | - Alper Öner
- Medizinische Klinik I im Zentrum fuer Innere Medizin (ZIM), Universitaetsklinikum Rostock, Rostock, Germany
| | - Roza Meyer-Saraei
- University Clinic Schleswig-Holstein, Kiel, Germany and University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Campus Lübeck, Lübeck, Germany
| | - Harm Wienbergen
- Klinikum Links der Weser, Herzzentrum Bremen, Bremen, Germany
| | - Andreas Fach
- Klinikum Links der Weser, Herzzentrum Bremen, Bremen, Germany
| | - Norbert Frey
- German Center for Cardiovascular Research (DZHK), Campus Lübeck, Lübeck, Germany
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Suzanne de Waha-Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
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Bhushan S, Huang X, Li Y, He S, Mao L, Hong W, Xiao Z. Paravalvular Leak After Transcatheter Aortic Valve Implantation Its Incidence, Diagnosis, Clinical Implications, Prevention, Management, and Future Perspectives: A Review Article. Curr Probl Cardiol 2022; 47:100957. [DOI: https:/doi.org/10.1016/j.cpcardiol.2021.100957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Helmy T, Kumar S, Khan AA, Raza A, Smart S, Bailey SR. Review of Prosthetic Paravalvular Leaks: Diagnosis and Management. Curr Cardiol Rep 2022; 24:1287-1297. [PMID: 36152141 DOI: 10.1007/s11886-022-01744-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Paravalvular leak (PVL) is a relatively uncommon complication associated with prosthetic valve implantation. PVL can occasionally lead to serious adverse consequences such as congestive heart failure, infective endocarditis, and hemolytic anemia. Surgical re-operation carries a high mortality risk. RECENT FINDINGS Transcatheter closure therapy provides a viable alternative for the treatment of this disorder with reasonable procedural and clinical success. The recent advent of hybrid imaging modalities has increased procedural success. This article summarizes the pathophysiology, clinical characteristics, and treatment modalities surroundings prosthetic paravalvular leak.
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Affiliation(s)
- Tarek Helmy
- Division of Cardiovascular Medicine, Louisiana State University School of Medicine, Shreveport, LA, USA.
| | - Sundeep Kumar
- Division of Cardiovascular Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Abdul A Khan
- Division of Cardiovascular Medicine, Louisiana State University School of Medicine, Shreveport, LA, USA
| | - Ali Raza
- Division of Cardiovascular Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Steven Smart
- Division of Cardiovascular Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Steven R Bailey
- Division of Cardiovascular Medicine, Louisiana State University School of Medicine, Shreveport, LA, USA
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Abd Elmaksoud TR. Incidence, Outcomes and Predictors of Aortic Regurgitation After Transcatheter Aortic Valve Replacement in Al Azhar University Hospitals and National Heart Institute, Egypt. JOURNAL OF CARDIOLOGY AND CARDIOVASCULAR RESEARCH 2022. [DOI: 10.37191/mapsci-jccr-3(3)-065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background: Aortic regurgitation (AR), which has ill-defined predictors and an unknown long-term influence on outcomes, is a significant transcatheter aortic valve replacement (TAVR) constraint.
Objective: this research aimed to assess the prevalence, identify predictors, and evaluate the outcomes of aortic regurgitation following trans catheter aortic valve implantation (TAVI).
1. To calculate the prevalence of aortic regurgitation in elderly patients receiving trans catheter aortic valve implantation who have severe symptomatic aortic stenosis.
2. To determine aortic regurgitation risk factors after trans catheter aortic valve implantation.
Methods: From November 2017 to November 2020, this prospective observational study was done in the National Heart Institute on severe aortic valve stenosis patients above 65 years who were candidates for aortic valve replacement from the outpatient department.
Results: LVEF significantly improved. Compared to before TAVI (55.08 ± 9.71), LVEF elevated to 58.9 ± 8.8 (P<0.001). Twenty-five patients (83.3%) showed class III/IV, four patients (13.3%) showed class II, and one patient (3.3%) showed class I before TAVI. While after TAVI, three patients (10%) only showed NYHA class III/IV, six patients (20 %) in class II, and 21 patients (70%) improved to be in class I. The left ventricular mass index mean was 158 ±32.37 before TAVI and 133.50 ±21.96 after TAVI (p<0.001). Compared to before TAVI (0.75 ± 0.2), mean aortic valve area was improved to 2.0 ± 0.2 following TAVI (P<0.001). A significant reduction in the mean pressure gradient from 47 ± 11.08 mmHg across the native valve prior to TAVI to 10.28 ± 3.21 mmHg across the prosthetic valve following TAVI (P <0.001).
Expert commentary: The clinical and results of TAVR devices were clearly outlined in literature study. The study showed a high incidence of pacemaker implantation with Core valve and aortic regurgitation. This information strongly supports the need for a randomized trial with sufficient power to compare the most recent self-expandable valve generation to balloon expandable valves. In the 2019 PARTNER 3 prospective randomized trial, it was discovered that, when compared to surgical management, low-risk patients (defined as STS 4%) had a lower risk of the composite outcome of stroke, death, and rehospitalization at 1 year. Additionally, it was shown that TAVR had a lower risk of stroke and required less time in the hospital (3 days as opposed to 7, P0.001) than surgery [1]. In addition, despite an elevated permanent pacemaker implantation rate, the 2019 Medtronic Evolut Transcatheter Aortic Valve Replacement revealed no inferiority for composite all-cause stroke and death, as well as a statistically significant decrease in the rates of life-threatening bleeding, acute kidney injury and atrial fibrillation, compared with SAVR at 30 days following the procedure [2].
Conclusion: According to the study in high-risk patients with severe symptomatic aortic stenosis, TAVI is alternative, viable, safe, and successful therapy compared to traditional open-heart surgery.
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Panagides V, Mesnier J, Nuche J, Delarochellière R, Paradis JM, Kalavrouziotis D, Dumont E, Mohammadi S, Rodes-Cabau J. From the Evolut Pro to the Evolut FX self-expanding transcatheter aortic valve replacement systems: current status and future perspectives. Expert Rev Med Devices 2022; 19:561-569. [PMID: 36005274 DOI: 10.1080/17434440.2022.2113386] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Since the initial experience with the CoreValve (Medtronic, Minneapolis, Minnesota), there have been continuous iterations of this valve system in order to improve procedural success and reduce periprocedural complications. The Evolut Pro, Pro+, and FX are the latest generations of this transcatheter heart valve (THV). AREAS COVERED This review paper aims to analyze the main characteristics and clinical evidence about the Evolut Pro THV and summarize the main iterations of the newer generation Evolut FX valve system. EXPERT OPINION The Evolut Pro system has been associated with good clinical outcomes and excellent valve hemodynamic performance including reduced rates of paravalvular leaks. Technical enhancements to improve valve positioning, orientation, and vascular access have been implemented in the newer generation Evolut FX system.
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Affiliation(s)
- Vassili Panagides
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Jules Mesnier
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Jorge Nuche
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Robert Delarochellière
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Jean-Michel Paradis
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Dimitri Kalavrouziotis
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Eric Dumont
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Siamak Mohammadi
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Josep Rodes-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
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Zahid S, Din MTU, Khan MZ, Rai D, Ullah W, Sanchez-Nadales A, Elkhapery A, Khan MU, Goldsweig AM, Singla A, Fonarrow G, Balla S. Trends, Predictors, and Outcomes of 30-Day Readmission With Heart Failure After Transcatheter Aortic Valve Replacement: Insights From the US Nationwide Readmission Database. J Am Heart Assoc 2022; 11:e024890. [PMID: 35929464 PMCID: PMC9496292 DOI: 10.1161/jaha.121.024890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data on trends, predictors, and outcomes of heart failure (HF) readmissions after transcatheter aortic valve replacement (TAVR) remain limited. Moreover, the relationship between hospital TAVR discharge volume and HF readmission outcomes has not been established. METHODS AND RESULTS The Nationwide Readmission Database was used to identify 30‐day readmissions for HF after TAVR from October 1, 2015, to November 30, 2018, using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) codes. A total of 167 345 weighted discharges following TAVR were identified. The all‐cause readmission rate within 30 days of discharge was 11.4% (19 016). Of all the causes of 30‐day rehospitalizations, HF comprised 31.4% (5962) of all causes. The 30‐day readmission rate for HF did not show a significant decline during the study period (Ptrend=0.06); however, all‐cause readmission rates decreased significantly (Ptrend=0.03). HF readmissions were comparable between high‐ and low‐volume TAVR centers. Charlson Comorbidity Index >8, length of stay >4 days during the index hospitalization, chronic obstructive pulmonary disease, atrial fibrillation, chronic HF, preexisting pacemaker, complete heart block during index hospitalization, paravalvular regurgitation, chronic kidney disease, and end‐stage renal disease were independent predictors of 30‐day HF readmission after TAVR. HF readmissions were associated with higher mortality rates when compared with non‐HF readmissions (4.9% versus 3.3%; P<0.01). Each HF readmission within 30 days was associated with an average increased cost of $13 000 more than for each non‐HF readmission. CONCLUSIONS During the study period from 2015 to 2018, 30‐day HF readmissions after TAVR remained steady despite all‐cause readmissions decreasing significantly. All‐cause readmission mortality and HF readmission mortality also showed a nonsignificant downtrend. HF readmissions were comparable across low‐, medium‐, and high‐volume TAVR centers. HF readmission was associated with increased mortality and resource use attributed to the increased costs of care compared with non‐HF readmission. Further studies are needed to identify strategies to decrease the burden of HF readmissions and related mortality after TAVR.
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Affiliation(s)
- Salman Zahid
- Department of Medicine Rochester General Hospital Rochester NY
| | | | - Muhammad Zia Khan
- Division of Cardiology West Virginia University Heart & Vascular Institute Morgantown WV
| | - Devesh Rai
- Department of Medicine Rochester General Hospital Rochester NY
| | - Waqas Ullah
- Department of Cardiovascular Medicine Jefferson University Hospitals Philadelphia PA
| | | | - Ahmed Elkhapery
- Department of Medicine Rochester General Hospital Rochester NY
| | - Muhammad Usman Khan
- Division of Cardiology West Virginia University Heart & Vascular Institute Morgantown WV
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine University of Nebraska Medical Center Omaha NE
| | | | - Greg Fonarrow
- Division of Cardiovascular Medicine University of California Los Angeles Los Angeles CA
| | - Sudarshan Balla
- Division of Cardiology West Virginia University Heart & Vascular Institute Morgantown WV
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Xie CM, Yao YT. The current practice of transcatheter aortic valve replacement in China. J Card Surg 2022; 37:3168-3177. [PMID: 35924996 DOI: 10.1111/jocs.16815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/29/2022] [Accepted: 06/19/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The purpose of this study is to summarize the current practice and experience of transcatheter aortic valve replacement in China. METHODS The relevant articles were identified through computerized searches of the CNKI, WANFANG, VIP, and PubMed databases through February 1, 2022, using the search terms: "transcatheter aortic valve replacement," "transcatheter aortic valve implantation," "China." RESULTS The database searches identified 22 articles, 2092 patients, 57.65% were male, with a mean age of 74.2 ± 6.0 years, 71.51% of patients were classified by New York Heart Association as class Ⅲ/Ⅳ, Society of Thoracic Surgeons score 8.4 ± 4.1, mean left ventricular ejection fraction 52.8 ± 14.2%, mean transvalvular aortic pressure gradient 59.9 ± 18.9 mmHg. The overall procedural success rate was 97.85%, and 2.15% of patients were converted to sternotomy, mainly due to transcatheter aortic bioprosthesis dislocation. The most common vascular access approach was transfemoral (1071 patients, 51.20%). General anesthesia (48.90%) was the commonly used anesthesia technique. The incidence of postprocedural complications was as follows: permanent pacemaker implantation (10.47%), bleeding events (8.60%), mild paravalvular leakage (17.73%), moderate and severe paravalvular leakage (4.16%), vascular complications (3.30%), stroke (1.43%), respectively. The overall periprocedural period and postprocedural 30-day mortality was 2.72%. CONCLUSIONS Among patients undergoing transcatheter aortic valve replacement in China, device implantation success was achieved in 97.85% of cases. The most common vascular access approach was transfemoral. General anesthesia was the most commonly used anesthetic technique. Paravalvular leakage (458 patients, 21.89%) was the most common complication.
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Affiliation(s)
- Chun-Mei Xie
- Department of Anesthesiology, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China
| | - Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Okuno T, Demirel C, Tomii D, Erdoes G, Heg D, Lanz J, Praz F, Zbinden R, Reineke D, Räber L, Stortecky S, Windecker S, Pilgrim T. Risk and Timing of Noncardiac Surgery After Transcatheter Aortic Valve Implantation. JAMA Netw Open 2022; 5:e2220689. [PMID: 35797045 PMCID: PMC9264039 DOI: 10.1001/jamanetworkopen.2022.20689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Noncardiac surgery after transcatheter aortic valve implantation (TAVI) is a clinical challenge with concerns about safety and optimal management. OBJECTIVES To evaluate perioperative risk of adverse events associated with noncardiac surgery after TAVI by timing of surgery, type of surgery, and TAVI valve performance. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using data from a prospective TAVI registry of patients at the tertiary care University Hospital in Bern, Switzerland. All patients undergoing noncardiac surgery after TAVI were identified. Data were analyzed from November through December 2021. EXPOSURES Timing, clinical urgency, and risk category of noncardiac surgery were assessed among patients who had undergone TAVI and subsequent noncardiac surgery. MAIN OUTCOMES AND MEASURES A composite of death, stroke, myocardial infarction, and major or life-threatening bleeding within 30 days after noncardiac surgery. RESULTS Among 2238 patients undergoing TAVI between 2013 and 2020, 300 patients (mean [SD] age, 81.8 [6.6] years; 144 [48.0%] women) underwent elective (160 patients) or urgent (140 patients) noncardiac surgery after TAVI and were included in the analysis. Of these individuals, 63 patients (21.0%) had noncardiac surgery within 30 days of TAVI. Procedures were categorized into low-risk (21 patients), intermediate-risk (190 patients), and high-risk (89 patients) surgery. Composite end points occurred within 30 days of surgery among 58 patients (Kaplan-Meier estimate, 19.7%; 95% CI, 15.6%-24.7%). There were no significant differences in baseline demographics between patients with the 30-day composite end point and 242 patients without this end point, including mean (SD) age (81.3 [7.1] years vs 81.9 [6.5] years; P = .28) and sex (25 [43.1%] women vs 119 [49.2%] women; P = .37). Timing (ie, ≤30 days from TAVI to noncardiac surgery), urgency, and risk category of surgery were not associated with increased risk of the end point. Moderate or severe prosthesis-patient mismatch (adjusted hazard ratio [aHR], 2.33; 95% CI, 1.37-3.95; P = .002) and moderate or severe paravalvular regurgitation (aHR, 3.61; 95% CI 1.25-10.41; P = .02) were independently associated with increased risk of the end point. CONCLUSIONS AND RELEVANCE These findings suggest that noncardiac surgery may be performed early after successful TAVI. Suboptimal device performance, such as prosthesis-patient mismatch and paravalvular regurgitation, was associated with increased risk of adverse outcomes after noncardiac surgery.
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Affiliation(s)
- Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Caglayan Demirel
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Daijiro Tomii
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Gabor Erdoes
- Department of Anesthesiology and Pain Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Dik Heg
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Rainer Zbinden
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiovascular Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
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Transcatheter Aortic Valve Implantation with ACURATE neo: Results from the PROGRESS PVL Registry. J Interv Cardiol 2022; 2022:9138403. [PMID: 35832535 PMCID: PMC9252754 DOI: 10.1155/2022/9138403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/18/2022] [Accepted: 05/03/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives The PROGRESS PVL registry evaluated transcatheter aortic valve implantation (TAVI) in patients treated with ACURATE neo, a supra-annular self-expanding bioprosthetic aortic valve. Background While clinical outcomes with TAVI are comparable with those achieved with surgery, residual aortic regurgitation (AR) and paravalvular leak (PVL) are common complications. The ACURATE neo valve has a pericardial sealing skirt designed to minimize PVL. Methods The primary endpoint was the rate of total AR over time, as assessed by a core echocardiographic laboratory. The study enrolled 500 patients (mean age: 81.8 ± 5.1 years; 61% female; mean baseline STS score: 6.0 ± 4.5%) from 22 centers in Europe and Canada; 498 patients were treated with ACURATE neo. Results The rate of ≥ moderate AR was 4.6% at discharge and 3.1% at 12 months; the rate of ≥ moderate PVL was 4.6% at discharge and 2.6% at 12 months. Paired analyses showed significant improvement in overall PVL between discharge and 12 months (P < 0.001); 64.6% of patients had no change in PVL grade, 24.9% improved, and 10.5% worsened. Patients also exhibited significant improvement in transvalvular gradient (P < 0.001) and effective orifice area (P=0.01). The mortality rate was 2.2% at 30 days and 11.3% at 12 months. The permanent pacemaker implantation (PPI) rate was 10.2% at 30 days and 12.2% at 12 months. Conclusions Results from PROGRESS PVL support the sustained safety and performance of TAVI with the ACURATE neo valve, showing excellent valve hemodynamics, good clinical outcomes, and significant interindividual improvement in PVL from discharge to 12-month follow-up.
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Hemodynamics of self-expanding versus balloon-expandable transcatheter heart valves in relation to native aortic annulus anatomy. Clin Res Cardiol 2022; 111:1336-1347. [PMID: 35704088 DOI: 10.1007/s00392-022-02046-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/23/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study aimed to compare hemodynamic characteristics of different self-expanding (SE) and balloon-expandable (BE) transcatheter heart valves (THV) in relation to native aortic annulus anatomy. BACKGROUND A patient centered THV selection becomes increasingly important as indications for transcatheter aortic valve replacement (TAVR) are extended towards lower risk populations. METHODS Hemodynamic parameters including mean gradient (MG), effective orifice area (EOA), Doppler velocity index (DVI), degree of paravalvular regurgitation (PVR) and patient-prosthesis mismatch (PPM) were compared by valve type, label size and in relation to quintiles of native aortic annulus area. RESULTS 2609 patients were treated at 3 centers in Germany with SAPIEN 3 (n = 1146), ACURATE Neo (n = 649), Evolut R (n = 546) or Evolut Pro (n = 268) THV. SE THVs provided superior hemodynamics in terms of larger EOA, higher DVI and lower MG compared to BE THV, especially in patients with small aortic annuli. Severe PPM was less frequent in SE treated patients. The rate of PVR ≥ moderate was comparable for SE and BE devices in smaller annular dimensions, but remarkably lower for BE TAVR in large aortic annular dimensions (> 547.64 mm2) (2% BE THV vs. > 10% for SE THV; p < 0.001). CONCLUSIONS Patients with small aortic annular dimensions may benefit hemodynamically from SE THV. With increasing annulus size, BE THV may have advantages since PVR ≥ moderate occurs less frequently.
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Kananathan S, Perera LA, Mohanarajan M, Sherif M, Harky A. The management of paravalvular leaks post aortic valve replacement. J Card Surg 2022; 37:2786-2798. [PMID: 35695718 DOI: 10.1111/jocs.16672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Paravalvular leak (PVL) is uncommon but can lead to severe complications after surgical or transcatheter aortic valve implantation. Conditions associated with PVLs such as heart failure, hemolysis, and infective endocarditis can lead to catastrophic results if not treated promptly; the therapeutic goals differ according to the presentation. It is vital that PVLs are diagnosed early using various imaging modalities. Different approaches have been studied in managing PVLs; there is an increased interest in the transcatheter aortic valve closure procedure as it is minimally invasive and decreases the occurrence of further reinterventions. AIM To discuss the classification of PVLs, diagnostic approaches, and available management options. METHOD A literature review was performed using 28 studies. RESULTS This review evaluated the relationship between the time of diagnosis, management of PVL and the resulting outcomes. DISCUSSION Patients with PVL should be assessed through a multidisciplinary team approach and a patient-selective plan should be in place. CONCLUSION Open surgical intervention is reserved for complex cases where minimally invasive techniques cannot be utilized.
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Affiliation(s)
- Shalini Kananathan
- Dnipro Medical Institute of Traditional and Non-Traditional Medicine, Dnipro, Ukraine
| | | | - Maneeshaa Mohanarajan
- Dnipro Medical Institute of Traditional and Non-Traditional Medicine, Dnipro, Ukraine
| | - Mohamed Sherif
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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van Nieuwkerk AC, Santos RB, Fernandez-Nofrerias E, Tchétché D, de Brito FS, Barbanti M, Kornowski R, Latib A, D'Onofrio A, Ribichini F, Mainar V, Dumonteil N, Baan J, Abizaid A, Sartori S, D'Errigo P, Tarantini G, Lunardi M, Orvin K, Pagnesi M, Larraya GL, Ghattas A, Dangas G, Mehran R, Delewi R. Outcomes in Valve-in-Valve Transcatheter Aortic Valve Implantation. Am J Cardiol 2022; 172:81-89. [PMID: 35351288 DOI: 10.1016/j.amjcard.2022.02.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Abstract
The use of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is increasing, but studies evaluating clinical outcomes in these patients are scarce. Also, there are limited data to guide the choice of valve type in ViV-TAVI. Therefore, this CENTER-study evaluated clinical outcomes in patients with ViV-TAVI compared to patients with native valve TAVI (NV-TAVI). In addition, we compared outcomes in patients with ViV-TAVI treated with self-expandable versus balloon-expandable valves. A total of 256 patients with ViV-TAVI and 11333 patients with NV-TAVI were matched 1:2 using propensity score matching, resulting in 256 patients with ViV-TAVI and 512 patients with NV-TAVI. Mean age was 81±7 years, 58% were female, and the Society of Thoracic Surgeons Predicted Risk of Mortality was 6.3% (4.0% to 12.8%). Mortality rates were comparable between ViV-TAVI and NV-TAVI patients at 30 days (4.1% vs 5.9%, p = 0.30) and 1 year (14.2% vs 17.3%, p = 0.34). Stroke rates were also similar at 30 days (2.8% vs 1.8%, p = 0.38) and 1 year (4.9% vs 4.3%, p = 0.74). Permanent pacemakers were less frequently implanted in patients with ViV-TAVI (8.8% vs 15.0%, relative risk 0.59, 95% confidence interval [CI] 0.37 to 0.92, p = 0.02). Patients with ViV-TAVI were treated with self-expandable valves (n = 162) and balloon-expandable valves (n = 94). Thirty-day major bleeding was less frequent in patients with self-expandable valves (3% vs 13%, odds ratio 5.12, 95% CI 1.42 to 18.52, p = 0.01). Thirty-day mortality was numerically lower in patients with self-expandable valves (3% vs 7%, odds ratio 3.35, 95% CI 0.77 to 14.51, p = 0.11). In conclusion, ViV-TAVI seems a safe and effective treatment for failing bioprosthetic valves with low mortality and stroke rates comparable to NV-TAVI for both valve types.
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Affiliation(s)
- Astrid C van Nieuwkerk
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands
| | - Raquel B Santos
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands; Department of Cardiology, Centro Hospitalar Universitário do Porto, Serviço Cardiologia, Porto, Portugal
| | | | | | - Fabio S de Brito
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Marco Barbanti
- Division of Cardiology, Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, New York; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | | | - Jan Baan
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands
| | - Alexandre Abizaid
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paola D'Errigo
- National Centre for Global Health - Istituto Superiore di Sanità, Rome, Italy
| | | | - Mattia Lunardi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Katia Orvin
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Matteo Pagnesi
- Department of Medical and Surgical specialties, Institute of Cardiology, ASST Spedali Civili, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | | | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ronak Delewi
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands.
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50
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Rouleau SG, Brady WJ, Koyfman A, Long B. Transcatheter aortic valve replacement complications: A narrative review for emergency clinicians. Am J Emerg Med 2022; 56:77-86. [DOI: 10.1016/j.ajem.2022.03.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/11/2022] [Accepted: 03/20/2022] [Indexed: 02/07/2023] Open
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