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Aktan A, Demir M, Güzel T, Karahan MZ, Aslan B, Kılıç R, Günlü S, Arslan B, Özbek M, Ertaş F. The Effect of Aortic Angulation on Clinical Outcomes of Patients Undergoing Transcatheter Aortic Valve Replacement. Braz J Cardiovasc Surg 2024; 39:e20220436. [PMID: 38426701 PMCID: PMC10903524 DOI: 10.21470/1678-9741-2022-0436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 08/21/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION The aim of this study was to assess the impact of aortic angulation (AA) on periprocedural and in-hospital complications as well as mortality of patients undergoing Evolut™ R valve implantation. METHODS A retrospective study was conducted on 264 patients who underwent transfemoral-approach transcatheter aortic valve replacement with self-expandable valve at our hospital between August 2015 and August 2022. These patients underwent multislice computer tomography scans to evaluate AA. Transcatheter aortic valve replacement endpoints, device success, and clinical events were assessed according to the definitions provided by the Valve Academic Research Consortium-3. Cumulative events included paravalvular leak, permanent pacemaker implantation, new-onset stroke, and in-hospital mortality. Patients were divided into two groups, AA ≤ 48° and AA > 48°, based on the mean AA measurement (48.3±8.8) on multislice computer tomography. RESULTS Multivariable logistic regression analysis was performed to identify predictors of cumulative events, utilizing variables with a P-value < 0.2 obtained from univariable logistic regression analysis, including AA, age, hypertension, chronic renal failure, and heart failure. AA (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 0.89-3.38, P=0.104), age (OR: 1.04, 95% CI: 0.99-1.10, P=0.099), hypertension (OR: 1.66, 95% CI: 0.82-3.33, P=0.155), chronic renal failure (OR: 1.82, 95% CI: 0.92-3.61, P=0.084), and heart failure (OR: 0.57, 95% CI: 0.27-1.21, P=0.145) were not found to be significantly associated with cumulative events in the multivariable logistic regression analysis. CONCLUSION This study demonstrated that increased AA does not have a significant impact on intraprocedural and periprocedural complications of patients with new generation self-expandable valves implanted.
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Affiliation(s)
- Adem Aktan
- Department of Cardiology, Mardin Training and Research Hospital,
Mardin, Turkey
| | - Muhammed Demir
- Department of Cardiology, Faculty of Medicine, Dicle University,
Diyarbakır, Turkey
| | - Tuncay Güzel
- Department of Cardiology, Health Science University, Gazi
Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | | | - Burhan Aslan
- Department of Cardiology, Health Science University, Gazi
Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Raif Kılıç
- Department of Cardiology, Diyarlife Hospital, Diyarbakır,
Turkey
| | - Serhat Günlü
- Department of Cardiology, Dağkapı State Hospital,
Diyarbakır, Turkey
| | - Bayram Arslan
- Department of Cardiology, Ergani State Hospital, Diyarbakır,
Turkey
| | - Mehmet Özbek
- Department of Cardiology, Faculty of Medicine, Dicle University,
Diyarbakır, Turkey
| | - Faruk Ertaş
- Department of Cardiology, Faculty of Medicine, Dicle University,
Diyarbakır, Turkey
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Xiong TY, Ali WB, Feng Y, Hayashida K, Jilaihawi H, Latib A, Lee MKY, Leon MB, Makkar RR, Modine T, Naber C, Peng Y, Piazza N, Reardon MJ, Redwood S, Seth A, Sondergaard L, Tay E, Tchetche D, Yin WH, Chen M, Prendergast B, Mylotte D. Transcatheter aortic valve implantation in patients with bicuspid valve morphology: a roadmap towards standardization. Nat Rev Cardiol 2023; 20:52-67. [PMID: 35726019 DOI: 10.1038/s41569-022-00734-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 02/08/2023]
Abstract
Indications for transcatheter aortic valve implantation (TAVI) have expanded in many countries to include patients with aortic stenosis who are at low surgical risk, and a similar expansion to this cohort is anticipated elsewhere in the world, together with an increase in the proportion of patients with bicuspid aortic valve (BAV) morphology as the age of the patients being treated decreases. To date, patients with BAV have been excluded from major randomized trials of TAVI owing to anatomical considerations. As a consequence, BAV has been a relative contraindication to the use of TAVI in international guidelines. Although clinical experience and observational data are accumulating, BAV presents numerous anatomical challenges for successful TAVI, despite advances in device design. Furthermore, in those with BAV, substantial geographical variation exists in patient characteristics, clinical approach and procedural strategy. Therefore, in this Roadmap article, we summarize the existing evidence and provide consensus recommendations from an international group of experts on the application of TAVI in patients with BAV in advance of the anticipated growth in the use of this procedure in this challenging cohort of patients.
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Affiliation(s)
- Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | | | - Martin B Leon
- Columbia University Medical Center, New York, NY, USA
| | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Thomas Modine
- Department of Heart Valve Therapy, CHU Bordeaux, Bordeaux, France.,IHU Lyric, Bordeaux-, Pessac, France.,Shanghai Jiaotong University, Shanghai, China
| | - Christoph Naber
- Department of Cardiology, Klinikum Wilhelmshaven, Wilhelmshaven, Germany
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Nicolo Piazza
- Division of Cardiology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, TX, USA
| | - Simon Redwood
- Department of Cardiology, St Thomas' Hospital, London, UK
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi, India
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Edgar Tay
- National University Heart Center, National University of Singapore, Singapore, Singapore
| | - Didier Tchetche
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Wei-Hsian Yin
- Heart Center, ChengHsin General Hospital, Taipei, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Bernard Prendergast
- Department of Cardiology, St Thomas' Hospital, London, UK. .,Cleveland Clinic London, London, UK.
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, National University of Ireland, Galway, Ireland.
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Kawsara A, Raybuck B. Snare and track (SNACK) technique: a novel approach for successful placement of an intracardiac echocardiogram catheter in the left atrium: a case report. Eur Heart J Case Rep 2022; 6:ytac365. [PMID: 36111074 PMCID: PMC9470155 DOI: 10.1093/ehjcr/ytac365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/11/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Placing an intracardiac echocardiogram (ICE) catheter in the left atrium allows for excellent visualization of the left atrial appendage to guide left atrial (LA) appendage occlusion (LAAO). Nonetheless, it requires a separate septal puncture or a unique set of skills to navigate the ICE through a previously prepared septal puncture, which can be challenging.
Case summary
This report describes a novel method to insert an ICE in the left atrium through a single septal puncture utilizing a snare technique. A 76-year-old male underwent LAAO by ICE guidance. After obtaining a standard atrial septal puncture, we were unable to advance the ICE into the left atrium. Therefore, we used a loop snare to grasp the ICE catheter-tip in the right atrium and direct it into the left atrium via the prepared septal puncture by tracking a pigtail wire that we routinely place as part of the procedure. Afterward, the left atrial appendage was successfully occluded with a Watchman device (Boston Scientific, Galway, Ireland), and the patient was discharged home without complications.
Discussion
The described technique could be a helpful tool for ICE placement to the left atrium in a controlled fashion, especially when challenging anatomy is encountered.
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Affiliation(s)
- Akram Kawsara
- Department of Medicine, Division of Cardiology, West Virginia University , 1 Medical Center Dr, Morgantown, WV 26505 , USA
| | - Bryan Raybuck
- Department of Medicine, Division of Cardiology, West Virginia University , 1 Medical Center Dr, Morgantown, WV 26505 , USA
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Frumkin D, Pietron M, Kind A, Brand A, Knebel F, Laule M, Leistner DM, Landmesser U, Krackhardt F, Sherif M, Sündermann SH, Grubitzsch H, Lembcke A, Niehues SM, Stangl K, Dreger H. Valve embolization during transcatheter aortic valve implantation: Incidence, risk factors and follow-up by computed tomography. Front Cardiovasc Med 2022; 9:928740. [PMID: 35935663 PMCID: PMC9355668 DOI: 10.3389/fcvm.2022.928740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background In most cases of transcatheter valve embolization and migration (TVEM), the embolized valve remains in the aorta after implantation of a second valve into the aortic root. There is little data on potential late complications such as valve thrombosis or aortic wall alterations by embolized valves. Aims The aim of this study was to analyze the incidence of TVEM in a large cohort of patients undergoing transcatheter aortic valve implantation (TAVI) and to examine embolized valves by computed tomography (CT) late after TAVI. Methods The patient database of our center was screened for cases of TVEM between July 2009 and July 2021. To identify risk factors, TVEM cases were compared to a cohort of 200 consecutive TAVI cases. Out of 35 surviving TVEM patients, ten patients underwent follow-up by echocardiography and CT. Results 54 TVEM occurred in 3757 TAVI procedures, 46 cases were managed percutaneously. Horizontal aorta (odds ratio [OR] 7.51, 95% confidence interval [CI] 3.4–16.6, p < 0.001), implantation of a self-expanding valve (OR 4.63, 95% CI 2.2–9.7, p < 0.01) and a left ventricular ejection fraction < 40% (OR 2.94, 95% CI 1.1–7.3, p = 0.016) were identified as risk factors for TVEM. CT scans were performed on average 26.3 months after TAVI (range 2–84 months) and detected hypoattenuated leaflet thickening (HALT) in two patients as well as parts of the stent frame protruding into the aortic wall in three patients. Conclusion TVEM represents a rare complication of TAVI. Follow up-CT detected no pathological findings requiring intervention.
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Affiliation(s)
- David Frumkin
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Malte Pietron
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Kind
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Brand
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Medizinische Klinik für Kardiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Knebel
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Sana Klinikum Lichtenberg, Berlin, Germany
| | - Michael Laule
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - David M. Leistner
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Medizinische Klinik für Kardiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Ulf Landmesser
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Medizinische Klinik für Kardiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Krackhardt
- Medizinische Klinik mit Schwerpunkt Kardiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Mohammad Sherif
- Medizinische Klinik mit Schwerpunkt Kardiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Simon H. Sündermann
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Klinik für kardiovaskuläre Chirurgie, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Herko Grubitzsch
- Klinik für kardiovaskuläre Chirurgie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Lembcke
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan M. Niehues
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Karl Stangl
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Henryk Dreger
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- *Correspondence: Henryk Dreger,
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Perrin N, Ibrahim R, Dürrleman N, Basmadjian A, Leroux L, Demers P, Modine T, Ben Ali W. Bicuspid Aortic Valve Stenosis: From Pathophysiological Mechanism, Imaging Diagnosis, to Clinical Treatment Methods. Front Cardiovasc Med 2022; 8:798949. [PMID: 35211518 PMCID: PMC8860891 DOI: 10.3389/fcvm.2021.798949] [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: 10/20/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Bicuspid aortic valve (BAV) is the most frequent congenital anomaly and has a natural evolution toward aortic regurgitation or stenosis due to the asymmetrical valve function associated with an evolutive ascending aortopathy. Several BAV classifications exist describing the presence and number of raphe, amount and location of calcium, and the symmetry of the functional cusps. The impact of BAV morphology on transcatheter aortic valve implantation (TAVI) outcomes still remains little investigated. Pivotal randomized trials comparing TAVI with surgery have excluded BAV until yet. However, data from registries and observational studies including highly selected patients have shown promising results of TAVI in BAV. With this review, we aimed at describing anatomical and pathophysiological characteristics of BAV, discussing the main aspects to assess diagnostic imaging modalities, and giving an overview of TAVI outcomes and technical considerations specific to BAV morphology.
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Affiliation(s)
- Nils Perrin
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
| | - Réda Ibrahim
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Nicolas Dürrleman
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Arsène Basmadjian
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Lionel Leroux
- Service Médico-Chirurgical, Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
| | - Philippe Demers
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Thomas Modine
- Service Médico-Chirurgical, Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
| | - Walid Ben Ali
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
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Zhou D, Chen J, Fan J, Yidilisi A, Dai H, Xu Y, Zhu G, Guo Y, Wang J, Liu X. Self‐expanding transcatheter aortic valve replacement in patients with extremely horizontal aortas. Catheter Cardiovasc Interv 2022; 99 Suppl 1:1432-1439. [PMID: 35094487 DOI: 10.1002/ccd.30094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Dao Zhou
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Jun Chen
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Jiaqi Fan
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Abuduwufuer Yidilisi
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Hanyi Dai
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Yeming Xu
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Gangjie Zhu
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Yuchao Guo
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Jian'an Wang
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Xianbao Liu
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
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7
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D’Ancona G, Kische S, El-Mawardy M, Dißmann M, Heinze H, Zohlnhöfer-Momm D, Gürer H, Ince H. Aortic annulus angulation does not attenuate procedural success of transcatheter aortic valve replacement using a novel self-expanding bioprosthesis. Heart Vessels 2019; 34:1969-1975. [DOI: 10.1007/s00380-019-01436-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/15/2019] [Indexed: 10/26/2022]
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Correlation Between Aortic Angulation and Outcomes of Transcatheter Aortic Valve Replacement With New-Generation Valves. Curr Probl Cardiol 2019; 46:100415. [PMID: 30975449 DOI: 10.1016/j.cpcardiol.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/09/2019] [Indexed: 02/07/2023]
Abstract
The aim of this study was to assess the correlation of aortic angulation (AA) on immediate postprocedural and long-term outcomes following transcatheter aortic valve replacement (TAVR) with new-generation valves. There is limited and conflicting data on the impact of AA on short- and long-term outcomes in patients undergoing TAVR. Available studies to date were done with first-generation valves. We assessed 179 patients who underwent TAVR with either a balloon-expandable or self-expandable valve at our institute from May 2014 to June 2017 and had multislice computed tomography scans available for AA evaluation. All included patients received a second- or third-generation valve. TAVR endpoints, device success, and adverse events were defined according to the Valve Academic Research Consortium-2 criteria. The mean AA of the study population was 49.05 ± 10.07. Patients were divided into 2 groups: AA <49 and AA ≥49, and then further subdivided by valve type. There were no difference in mean age, The Society for Thoracic Surgery (STS) score, or race distribution between the AA <49 and AA ≥49 groups. The preimplantation balloon valvuloplasty rate was higher in patients with AA ≥ 49 compared to patients with AA <49, (70% vs 55.1%, P = 0.04). There was no difference in re-hospitalization, pacemaker implantation, postprocedural aortic regurgitation or mortality between patients with AA <49 and AA ≥49 irrespective of valve type (P < 0.05). AA does not significantly affect short- or long-term outcomes in patients who undergo TAVR with new-generation balloon-expandable or self-expandable valves.
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9
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Kong WK, Delgado V, Bax JJ. Bicuspid Aortic Valve. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.005987. [DOI: 10.1161/circimaging.117.005987] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/26/2017] [Indexed: 01/06/2023]
Affiliation(s)
- William K.F. Kong
- From the Department of Cardiology, Leiden University Medical Center, The Netherlands (W.K.F.K., V.D., J.J.B.); and Department of Cardiology, National University Heart Center, National University Health System, Singapore (W.K.F.K.)
| | - Victoria Delgado
- From the Department of Cardiology, Leiden University Medical Center, The Netherlands (W.K.F.K., V.D., J.J.B.); and Department of Cardiology, National University Heart Center, National University Health System, Singapore (W.K.F.K.)
| | - Jeroen J. Bax
- From the Department of Cardiology, Leiden University Medical Center, The Netherlands (W.K.F.K., V.D., J.J.B.); and Department of Cardiology, National University Heart Center, National University Health System, Singapore (W.K.F.K.)
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Linke A, Chandrasekhar J, Sartori S, Lefevre T, van Belle E, Schaefer U, Tchetche D, Sardella G, Webb J, Colombo A, Windecker S, Vogel B, Farhan S, Sorrentino S, Sharma M, Snyder C, Asgar A, Dumonteil N, Tamburino C, Hink U, Violini R, Stella P, Bernstein D, Deliargyris E, Hengstenberg C, Baber U, Mehran R, Anthopoulos P, Dangas G. Effect of valve design and anticoagulation strategy on 30-day clinical outcomes in transcatheter aortic valve replacement: Results from the BRAVO 3 randomized trial. Catheter Cardiovasc Interv 2017; 90:1016-1026. [DOI: 10.1002/ccd.27154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/30/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Axel Linke
- Department of Internal Medicine/Cardiology; University of Leipzig, Heart Centre; Germany
| | - Jaya Chandrasekhar
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Samantha Sartori
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Thierry Lefevre
- Division of Cardiology; Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé; Massy France
| | - Eric van Belle
- Department of Cardiology and INSERM UMR 1011; University Hospital, and CHRU Lille; Lille France
| | - Ulrich Schaefer
- Division of Cardiologyy; University Heart Center; Hamburg Germany
- Division of Cardiologyy; Asklepios Clinics St. Georg; Hamburg Germany
| | | | | | - John Webb
- Division of Cardiologyy; St. Paul's Hospital; Vancouver British Columbia Canada
| | | | | | - Birgit Vogel
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Serdar Farhan
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Sabato Sorrentino
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Madhav Sharma
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Clayton Snyder
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Anita Asgar
- Division of Cardiology; Montreal Heart Institute; Montreal Canada
| | | | | | - Ulrich Hink
- Cardiology Department; Johannes Gutenberg University Hospital; Mainz Germany
| | - Roberto Violini
- Division of Cardiology; Azienda Ospedaliera San Camillo-Forlanini di Roma; Italy
| | - Pieter Stella
- Division of Cardiology; University Medical Center Utrecht; The Netherlands
| | - Debra Bernstein
- Division of Cardiology; The Medicines Company; Parsippany New Jersey
| | | | - Christian Hengstenberg
- Division of Cardiology; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance; Munich Germany
- Division of Cardiologyy; Deutsches Herzzentrum München, Technische Universität München; Munich Germany
| | - Usman Baber
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Roxana Mehran
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | | | - George Dangas
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
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Safety and Efficacy of Self-Expanding TAVR in Patients With Aortoventricular Angulation. JACC Cardiovasc Imaging 2016; 9:973-81. [DOI: 10.1016/j.jcmg.2016.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/13/2016] [Accepted: 06/15/2016] [Indexed: 11/19/2022]
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12
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Abramowitz Y, Maeno Y, Chakravarty T, Kazuno Y, Takahashi N, Kawamori H, Mangat G, Cheng W, Jilaihawi H, Makkar RR. Aortic Angulation Attenuates Procedural Success Following Self-Expandable But Not Balloon-Expandable TAVR. JACC Cardiovasc Imaging 2016; 9:964-72. [PMID: 27424244 DOI: 10.1016/j.jcmg.2016.02.030] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/03/2016] [Accepted: 02/26/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of increased aortic angulation (AA) on acute procedural success following transcatheter aortic valve replacement (TAVR). BACKGROUND The degree of angulation between the aorta and the heart can make accurate positioning of the bioprosthesis during TAVR more demanding, particularly in instances of an extremely angulated or horizontal aortic root. Nonetheless, there are limited data on the impact of AA on the acute success of TAVR. METHODS We assessed 582 patients who underwent TAVR at our institute and had contrast computed tomography available for AA evaluation. TAVR endpoints, device success, and adverse events were considered according to the Valve Academic Research Consortium-2 definitions. RESULTS The mean angulation of the aorta was 47.3 ± 8.7°. Patients were therefore divided into 2 groups: AA <48° and AA ≥48°. AA in the 480 patients who underwent balloon-expandable (BE) TAVR did not influence acute procedural success or short-term clinical outcome. In contrast, increased AA among the 102 patients who underwent self-expandable (SE) TAVR was found to significantly attenuate procedural success (area under the curve: 0.73; 95% confidence interval: 0.61 to 0.85; p = 0.008). The numerical cutoff for AA with the highest sum of sensitivity and specificity for device success was ≥48° (sensitivity 85%, specificity 61%). Moreover, patients whose AA was ≥48° were also associated with an increased need for a second valve and post-dilation, had increased fluoroscopy time and increased valve embolization, and had increased post-procedural paravalvular regurgitation greater than or equal to mild following SE TAVR. Major complications at 30 days, including mortality were similar between AA groups. Six-month mortality was also similar between both AA groups. CONCLUSIONS Increased aortic root angulation adversely influences acute procedural success following SE but not BE TAVR. Because of these data, BE valves may be preferred when evaluating patients with high AA before TAVR.
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Affiliation(s)
| | - Yoshio Maeno
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | - Yoshio Kazuno
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | | | | | - Wen Cheng
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | - Raj R Makkar
- Cedars-Sinai Heart Institute, Los Angeles, California.
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Çöllüoğlu İT, Ergene AO, Barış N, Kozan Ö. Transcatheter aortic valve implantation with either Edwards SAPIEN valve and core valve in patients with horizontal aorta. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2016. [DOI: 10.1016/j.ijcac.2016.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kim IS, Ko YG, Shin S, Shim JY, Lee S, Chang BC, Shim JK, Kwak YR, Hong MK. The First Case of Successful Transcatheter Aortic Valve Implantation Using CoreValve in Korea. Korean Circ J 2012; 42:788-91. [PMID: 23236334 PMCID: PMC3518716 DOI: 10.4070/kcj.2012.42.11.788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/05/2012] [Accepted: 05/07/2012] [Indexed: 11/11/2022] Open
Abstract
Surgical replacement of the aortic valve is the standard therapy for severe aortic valve stenosis. However, it is generally associated with increased mortality and morbidities in older individuals. Transcatheter aortic valve implantation (TAVI) is a less invasive procedure and has shown similar clinical outcomes as surgical treatment in elderly patients at high risk for conventional surgery. In this report, we describe the first case of TAVI using a CoreValve in Korea. An 84-year-old man with symptomatic severe aortic valve stenosis was successfully treated by transfemoral TAVI. The patient was discharged without any significant complications and remained free of adverse clinical event for a follow-up duration of 6 months.
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Affiliation(s)
- In-Soo Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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Current world literature. Curr Opin Cardiol 2012; 27:682-95. [PMID: 23075824 DOI: 10.1097/hco.0b013e32835a0ad8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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