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Abstract
Cardiogenic shock (CS) is a life-threatening condition characterized by end-organ hypoperfusion and hypoxia primarily due to cardiac dysfunction and low cardiac output. Unfortunately, the mortality and morbidity associated with CS have remained high despite notable advances in heart failure management. Treatment should be carefully guided by hemodynamics assessment. Although inotropes, vasopressors, mechanical circulatory support, and catheter intervention for critical valve lesion are not always recommended, they are helpful in selected patients. Early diagnosis, accurate hemodynamic assessment, and prompt therapeutic intervention are crucial in the management of acute decompensated heart failure with CS.
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Affiliation(s)
- Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe 650-0047, Japan; Department of Clinical Research Support, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe 650-0047, Japan.
| | - Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
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2
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León del Pino MDC, Ruíz Ortiz M, Delgado Ortega M, Sánchez Fernández J, Ferreiro Quero C, Durán Jiménez E, Romero Moreno M, Segura Saint-Gerons J, Ojeda Pineda S, Pan Álvarez-Ossorio M, Mesa Rubio D. Prosthesis-patient mismatch after transcatheter aortic valve replacement: prevalence and medium term prognostic impact. Int J Cardiovasc Imaging 2019; 35:827-836. [DOI: 10.1007/s10554-018-01519-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/24/2018] [Indexed: 01/01/2023]
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3
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Vallabhajosyula S, Patlolla SH, Sandhyavenu H, Vallabhajosyula S, Barsness GW, Dunlay SM, Greason KL, Holmes DR, Eleid MF. Periprocedural Cardiopulmonary Bypass or Venoarterial Extracorporeal Membrane Oxygenation During Transcatheter Aortic Valve Replacement: A Systematic Review. J Am Heart Assoc 2018; 7:JAHA.118.009608. [PMID: 29987125 PMCID: PMC6064861 DOI: 10.1161/jaha.118.009608] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND There are limited data on the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) or cardiopulmonary bypass (CPB) to provide hemodynamic support periprocedurally during transcatheter aortic valve replacement. This study sought to evaluate patients receiving transcatheter aortic valve replacement with concomitant use of CPB/VA-ECMO. METHODS AND RESULTS We systematically reviewed the published literature from 2000 to 2018 for studies evaluating adult patients requiring CPB/VA-ECMO periprocedurally during transcatheter aortic valve replacement. Studies reporting short-term and long-term mortality were included. Given the significant methodological and statistical differences between published studies, meta-analysis of the association of CPB/VA-ECMO with mortality was not performed. Of the 537 studies identified, 9 studies representing 5191 patients met our inclusion criteria. Median ages were between 75 and 87 years with 33% to 75% male patients. Where reported, the Edwards SAPIEN™ transcatheter heart valve was the most frequently used. A total of 203 (3.9%) patients received periprocedural hemodynamic support with CPB/VA-ECMO. Common indications for CPB/VA-ECMO included left ventricular or aortic annular rupture, rapid hemodynamic deterioration, aortic regurgitation, cardiac arrest, and left main coronary artery obstruction. The use of CPB/VA-ECMO was predominantly an emergent strategy and was used for durations of 1 to 2 hours. Short-term mortality (in-hospital and 30-day) was 29.8%, and 1-year mortality was 52.4%. Major complications such as bleeding, vascular injury, tamponade, stroke, and renal failure were noted in 10% to 50% of patients. CONCLUSIONS CPB/VA-ECMO was used in 4% in the early experience of patients undergoing transcatheter aortic valve replacement, most commonly for periprocedural complications. There are limited data on preprocedural planned use of VA-ECMO, and the characteristics of this population remain poorly defined.
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Affiliation(s)
| | | | | | | | | | - Shannon M Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Singh V, Mendirichaga R, Inglessis-Azuaje I, Palacios IF, O’Neill WW. The Role of Impella for Hemodynamic Support in Patients With Aortic Stenosis. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:44. [DOI: 10.1007/s11936-018-0644-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Herold J, Herold-Vlanti V, Sherif M, Luani B, Breyer C, Bonaventura K, Braun-Dullaeus R. Analysis of cardiovascular mortality, bleeding, vascular and cerebrovascular events in patients with atrial fibrillation vs. sinus rhythm undergoing transfemoral Transcatheter Aortic Valve Implantation (TAVR). BMC Cardiovasc Disord 2017; 17:298. [PMID: 29262768 PMCID: PMC5738713 DOI: 10.1186/s12872-017-0736-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 12/12/2017] [Indexed: 11/29/2022] Open
Abstract
Background Transcatheter aortic valve replacement (TAVR) has been demonstrated to be an established therapy for high-risk, inoperable patients with severe symptomatic aortic valve stenosis. For patients with moderate surgical risk, TAVR is equivalent to conventional aortic valve surgery. However, atrial fibrillation (AF) is also present in many of these patients, thus requiring post-implantation oral anticoagulation therapy in addition to the inhibition of thrombocyte aggregation, which poses the risk of bleeding complications. The aim of our work was to investigate the influence of AF on mortality and the occurrence of bleeding, vascular and cerebrovascular complications related to TAVR according to the VARC-2 criteria. Methods Two hundred eighty-three patients who underwent TAVR between March 2010 and April 2016 were retrospectively examined. In total, 257 patients who underwent transfemoral access were included in this study. The mean patient age was 81 ± 6 years, 54.1% of the patients were women, and 42.4% had pre-interventional AF. Results Compared to patients with sinus rhythm (SR, n = 148), patients with AF (n = 109) had an almost three-fold higher incidence of major vascular complications (AF 14.7% vs. SR 5.4%, p = 0.016) and life-threatening bleeding (AF 11.9% vs. SR 4.1%, p = 0.028) during the first 30 post-procedural days. However, the rate of cerebrovascular complications (AF 3.7% vs. SR 2.7%, p = 0.726) did not significantly differ between the two groups. Overall mortality was significantly higher in patients with AF during the first month (AF 8.3% vs. SR 2.0%, p = 0.032) and the first year (AF 28.4% vs. SR 15.3%; p = 0.020) following TAVR. Conclusion Patients with AF had significantly more severe bleeding complications after TAVR, which were significantly related to mortality. Future prospective randomized studies must clarify the optimal anticoagulation therapy for patients with AF after TAVR. Trial registration DRKS00011798 on DRKS (Date 17.03.2017).
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Affiliation(s)
- Joerg Herold
- Department of Internal Medicine/Cardiology and Angiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Vasiliki Herold-Vlanti
- Department of Internal Medicine/Cardiology and Angiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Mohammad Sherif
- Department of Internal Medicine/Cardiology and Angiology, University of Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Germany
| | - Blerim Luani
- Department of Internal Medicine/Cardiology and Angiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Christin Breyer
- Department of Internal Medicine/Cardiology and Angiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Klaus Bonaventura
- Department of Internal Medicine/Cardiology and Angiology, Ernst-von-Bergmannstrost Clinic, Charlottenstraße 72, 14467, Potsdam, Germany
| | - Ruediger Braun-Dullaeus
- Department of Internal Medicine/Cardiology and Angiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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Nijenhuis VJ, Bennaghmouch N, Kuijk JPV, Capodanno D, ten Berg JM. Antithrombotic treatment in patients undergoing transcatheter aortic valve implantation (TAVI). Thromb Haemost 2017; 113:674-85. [DOI: 10.1160/th14-10-0821] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/27/2014] [Indexed: 12/31/2022]
Abstract
SummaryTranscatheter aortic valve implantation (TAVI) is an established treatment option for symptomatic patients with severe aortic valvular disease who are not suitable for conventional surgical aortic valve replacement. Despite improving experience and techniques, ischaemic and bleeding complications after TAVI remain prevalent and impair survival in this generally old and comorbid-rich population. Due to changing aetiology of complications over time, antiplatelet and anticoagulant therapy after TAVI should be carefully balanced. Empirically, a dual antiplatelet strategy is generally used after TAVI for patients without an indication for oral anticoagulation (OAC; e. g. atrial fibrillation, mechanical mitral valve prosthesis), including aspirin and a thienopyridine. For patients on OAC, a combination of OAC and aspirin or thienopyridine is generally used. This review shows that current registries are unfit to directly compare antithrombotic regimens. Small exploring studies suggest that additional clopidogrel after TAVI only affects bleeding and not ischemic complications. However, these studies are lack in quality in terms of Cochrane criteria. Currently, three randomised controlled trials are recruiting to gather more knowledge about the effects of clopidogrel after TAVI.
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Philipsen TE, Collas VM, Rodrigus IE, Salgado RA, Paelinck BP, Vrints CM, Bosmans JM. Brachiocephalic artery access in transcatheter aortic valve implantation: a valuable alternative: 3-year institutional experience. Interact Cardiovasc Thorac Surg 2015; 21:734-40. [DOI: 10.1093/icvts/ivv262] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 08/18/2015] [Indexed: 12/14/2022] Open
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Assessment of Single-Bolus Contrast Administration Technique Using Hybrid Dual-Source ECG-Gated Thoracic and Dual-Source Non–ECG-Gated High-Pitch Abdominopelvic CT Acquisitions for Procedural Planning Before Transcatheter Aortic Valve Replacement. J Comput Assist Tomogr 2015; 39:207-12. [DOI: 10.1097/rct.0000000000000194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bao B, Saito N, Watanabe S, Tokushige A, Yamamoto E, Kawase Y, Kimura T, Inoue K. A novel device for antegrade percutaneous balloon aortic valvuloplasty: feasibility of the looped Inoue balloon technique in swine model. Catheter Cardiovasc Interv 2013; 82:E564-8. [PMID: 23460405 DOI: 10.1002/ccd.24908] [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: 11/09/2012] [Revised: 02/13/2013] [Accepted: 02/26/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The study aimed to assess the feasibility of a novel device and technique for antegrade percutaneous balloon aortic valvuloplasty (BAV) in a swine model. BACKGROUND BAV is currently being applied more frequently compared to the past with the advent of transcatheter aortic valve replacement. Although the antegrade BAV approach offers several advantages over the retrograde approach, the antegrade approach is technically more complicated and demanding. METHODS We developed a novel balloon catheter and a technique to simplify the antegrade BAV. The balloon catheter was designed to make a loop in left atrium by inserting two different sized stylets. The balloon catheter was easily dropped into the left ventricle via the mitral valve while maintaining the loop. The balloon catheter was advanced to the ascending aorta by holding the two stylets. Then, the balloon was inflated. We named the technique as the looped Inoue balloon technique. The feasibility of the looped Inoue balloon technique was assessed in a healthy swine with a body weight of 40 kg by four independent operators. Every operator conducted the procedure twice. RESULTS The procedural success rate was 100% in all operators. The average procedure time was 170 ± 35 sec. No procedure related complications were noted. CONCLUSIONS The study results indicate that the antegrade BAV using the looped Inoue balloon technique is feasible and may simplify the antegrade approach.
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Affiliation(s)
- Bingyuan Bao
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Bohula May EA, Faxon D. Transcatheter aortic valve replacement: History and current status. Trends Cardiovasc Med 2013; 23:172-8. [DOI: 10.1016/j.tcm.2012.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 11/12/2012] [Accepted: 11/13/2012] [Indexed: 11/28/2022]
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Abstract
While transcatheter aortic valve replacement is considered a viable alternative to traditional surgery for patients with critical aortic stenosis, it is still a cardiac surgical procedure with a steep learning curve. Space consideration is a key aspect of the procedure's success. A TAVR program requires the commitment from and investment of institutional resources, the outfitting of an appropriate procedure room, and meticulous training of a multidisciplinary TAVR team. Careful integration of the various imaging modalities, medical specialties, and equipment is necessary to ensure the safety and efficacy of the procedure and to treat complications that may arise.
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Affiliation(s)
- Neal Kleiman
- Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, Texas, USA
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Giordana F, Capriolo M, Frea S, Marra WG, Giorgi M, Bergamasco L, Omedè PL, Sheiban I, D'Amico M, Bovolo V, Salizzoni S, La Torre M, Rinaldi M, Marra S, Gaita F, Morello M. Impact of TAVI on Mitral Regurgitation: A Prospective Echocardiographic Study. Echocardiography 2012. [DOI: 10.1111/echo.12050] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Francesca Giordana
- Medical Sciences Department; San Giovanni Battista “Molinette” Hospital; University of Torino; Italy
| | - Michele Capriolo
- Medical Sciences Department; San Giovanni Battista “Molinette” Hospital; University of Torino; Italy
| | - Simone Frea
- Medical Sciences Department; San Giovanni Battista “Molinette” Hospital; University of Torino; Italy
| | - Walter Grosso Marra
- Medical Sciences Department; San Giovanni Battista “Molinette” Hospital; University of Torino; Italy
| | - Mauro Giorgi
- Medical Sciences Department; San Giovanni Battista “Molinette” Hospital; University of Torino; Italy
| | | | - Pier Luigi Omedè
- Medical Sciences Department; San Giovanni Battista “Molinette” Hospital; University of Torino; Italy
| | - Imad Sheiban
- Medical Sciences Department; San Giovanni Battista “Molinette” Hospital; University of Torino; Italy
| | - Maurizio D'Amico
- Medical Sciences Department; San Giovanni Battista “Molinette” Hospital; University of Torino; Italy
| | - Virginia Bovolo
- Medical Sciences Department; San Giovanni Battista “Molinette” Hospital; University of Torino; Italy
| | - Stefano Salizzoni
- Division of Cardiac-Surgery; San Giovanni Battista “Molinette” Hospital; University of Torino; Italy
| | - Michele La Torre
- Division of Cardiac-Surgery; San Giovanni Battista “Molinette” Hospital; University of Torino; Italy
| | - Mauro Rinaldi
- Division of Cardiac-Surgery; San Giovanni Battista “Molinette” Hospital; University of Torino; Italy
| | - Sebastiano Marra
- Medical Sciences Department; San Giovanni Battista “Molinette” Hospital; University of Torino; Italy
| | - Fiorenzo Gaita
- Medical Sciences Department; San Giovanni Battista “Molinette” Hospital; University of Torino; Italy
| | - Mara Morello
- Medical Sciences Department; San Giovanni Battista “Molinette” Hospital; University of Torino; Italy
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Dvir D, Sagie A, Porat E, Assali A, Shapira Y, Vaknin-Assa H, Shafir G, Bental T, Nevzorov R, Battler A, Kornowski R. Clinical profile and outcome of patients with severe aortic stenosis at high surgical risk: Single-center prospective evaluation according to treatment assignment. Catheter Cardiovasc Interv 2012; 81:871-81. [DOI: 10.1002/ccd.24623] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 08/19/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Danny Dvir
- Department of Cardiology; Rabin Medical Center; Petach Tikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv; Israel
| | - Alexander Sagie
- Department of Cardiology; Rabin Medical Center; Petach Tikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv; Israel
| | - Eyal Porat
- Department of Cadiothoracic Surgery; Rabin Medical Center; Petach Tikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv; Israel
| | - Abid Assali
- Department of Cardiology; Rabin Medical Center; Petach Tikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv; Israel
| | - Yaron Shapira
- Department of Cardiology; Rabin Medical Center; Petach Tikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv; Israel
| | - Hana Vaknin-Assa
- Department of Cardiology; Rabin Medical Center; Petach Tikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv; Israel
| | - Gideon Shafir
- Department of Radiology; Rabin Medical Center; Petach Tikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv; Israel
| | - Tamir Bental
- Department of Cardiology; Rabin Medical Center; Petach Tikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv; Israel
| | - Roman Nevzorov
- Department of Cardiology; Rabin Medical Center; Petach Tikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv; Israel
| | - Alexander Battler
- Department of Cardiology; Rabin Medical Center; Petach Tikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv; Israel
| | - Ran Kornowski
- Department of Cardiology; Rabin Medical Center; Petach Tikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv; Israel
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