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TAVI imaging: over the echocardiography. Radiol Med 2020; 125:1148-1166. [DOI: 10.1007/s11547-020-01281-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/03/2020] [Indexed: 12/26/2022]
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Pesarini G, Lunardi M, Piccoli A, Gottin L, Prati D, Ferrero V, Scarsini R, Milano A, Forni A, Faggian G, Ribichini F. Effectiveness and Safety of Transcatheter Aortic Valve Implantation in Patients With Pure Aortic Regurgitation and Advanced Heart Failure. Am J Cardiol 2018; 121:642-648. [PMID: 29329825 DOI: 10.1016/j.amjcard.2017.11.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/16/2017] [Accepted: 11/20/2017] [Indexed: 11/25/2022]
Abstract
Results of transcatheter aortic valve implantation (TAVI) for treatment of severe noncalcific isolated aortic regurgitation (AR) complicated by advanced heart failure or cardiogenic shock has been previously reported only in isolated case reports. Current self-expanding transcatheter aortic valves are designed to treat aortic valve stenosis, and have also been implanted in cases of severe AR due to degenerated bioprosthesis and in very few cases of native aortic valves. We report 13 consecutive inoperable patients with noncalcific, pure AR, and advanced heart failure treated with emergency percutaneous transfemoral implantation with self-expandable CoreValves at our institution between July 2012 and September 2017. The immediate and long-term clinical outcome was prospectively assessed according to the Valve Academic Research Consortium-2 criteria for device success and safety. All but 3 patients had previous surgery of the aortic root, including 2 implants of Heart Mate-II left ventricle assist device; none had surgical aortic bioprosthesis at the time of the TAVI. Valve implantation was successful in 12 of 13 patients (92%) and 1 patient required a second unplanned valve procedure within 18 hours. Oversizing the prosthesis by approximately 15% yielded better results with 1 valve. Two patients with left ventricle assist device died within 30 days of TAVI. All patients who survived to hospital discharge had none or just mild residual AR, improved their cardiac function, and survived at long-term without recurrence of clinical events. In conclusion, implanting self-expandable transcatheter valves in patients pure AR in this small study was safe and effective, and represented an important option for inoperable patients with noncalcific severe AR.
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Fioretta ES, Dijkman PE, Emmert MY, Hoerstrup SP. The future of heart valve replacement: recent developments and translational challenges for heart valve tissue engineering. J Tissue Eng Regen Med 2017; 12:e323-e335. [PMID: 27696730 DOI: 10.1002/term.2326] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/25/2016] [Accepted: 09/26/2016] [Indexed: 12/18/2022]
Abstract
Heart valve replacement is often the only solution for patients suffering from valvular heart disease. However, currently available valve replacements require either life-long anticoagulation or are associated with valve degeneration and calcification. Moreover, they are suboptimal for young patients, because they do not adapt to the somatic growth. Tissue-engineering has been proposed as a promising approach to fulfil the urgent need for heart valve replacements with regenerative and growth capacity. This review will start with an overview on the currently available valve substitutes and the techniques for heart valve replacement. The main focus will be on the evolution of and different approaches for heart valve tissue engineering, namely the in vitro, in vivo and in situ approaches. More specifically, several heart valve tissue-engineering studies will be discussed with regard to their shortcomings or successes and their possible suitability for novel minimally invasive implantation techniques. As in situ heart valve tissue engineering based on cell-free functionalized starter materials is considered to be a promising approach for clinical translation, this review will also analyse the techniques used to tune the inflammatory response and cell recruitment upon implantation in order to stir a favourable outcome: controlling the blood-material interface, regulating the cytokine release, and influencing cell adhesion and differentiation. In the last section, the authors provide their opinion about the future developments and the challenges towards clinical translation and adaptation of heart valve tissue engineering for valve replacement. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Emanuela S Fioretta
- Institute for Regenerative Medicine (IREM), University of Zurich, Switzerland
| | - Petra E Dijkman
- Institute for Regenerative Medicine (IREM), University of Zurich, Switzerland
| | - Maximilian Y Emmert
- Institute for Regenerative Medicine (IREM), University of Zurich, Switzerland.,Heart Center Zurich, University Hospital Zurich, Switzerland.,Wyss Translational Center Zurich, Switzerland
| | - Simon P Hoerstrup
- Institute for Regenerative Medicine (IREM), University of Zurich, Switzerland.,Wyss Translational Center Zurich, Switzerland.,Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands
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Hahn RT, Kodali S, Tuzcu EM, Leon MB, Kapadia S, Gopal D, Lerakis S, Lindman BR, Wang Z, Webb J, Thourani VH, Douglas PS. Echocardiographic imaging of procedural complications during balloon-expandable transcatheter aortic valve replacement. JACC Cardiovasc Imaging 2015; 8:288-318. [PMID: 25772835 DOI: 10.1016/j.jcmg.2014.12.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 02/06/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) using a balloon-expandable valve is an accepted alternative to surgical replacement for severe, symptomatic aortic stenosis in high risk or inoperable patients. Intraprocedural transesophageal echocardiography (TEE) offers real-time imaging guidance throughout the procedure and allows for rapid and accurate assessment of complications and procedural results. The value of intraprocedural TEE for TAVR will likely increase in the future as this procedure is performed in lower surgical risk patients, who also have lower risk for general anesthesia, but a greater expectation of optimal results with lower morbidity and mortality. This imaging compendium from the PARTNER (Placement of Aortic Transcatheter Valves) trials is intended to be a comprehensive compilation of intraprocedural complications imaged by intraprocedural TEE and diagnostic tools to anticipate and/or prevent their occurrence.
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York.
| | - Susheel Kodali
- Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | | | - Martin B Leon
- Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | | | | | | | - Brian R Lindman
- Washington University School of Medicine, St. Louis, Missouri
| | - Zuyue Wang
- Medstar Health Research Institute, Washington, DC
| | - John Webb
- University of British Columbia and St. Paul's Hospital, Vancouver, Ontario, Canada
| | | | - Pamela S Douglas
- Division of Cardiovascular Medicine, Duke University Medical Center, and Duke Clinical Research Institute, Durham, North Carolina
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Praz F, Windecker S, Huber C, Carrel T, Wenaweser P. Expanding Indications of Transcatheter Heart Valve Interventions. JACC Cardiovasc Interv 2015; 8:1777-96. [DOI: 10.1016/j.jcin.2015.08.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 01/10/2023]
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6
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Abstract
The advent of transcatheter aortic valve replacement (TAVR) has modified the treatment of severe aortic stenosis (AS). Large randomized trials and multicenter registries have endorsed the efficacy of TAVR in improving outcomes in patients with severe AS who are inoperable or high surgical risk. There has been a noticeable shift in using TAVR in patients with AS who are not at a high surgical risk. Appropriate diagnosis, patient selection, and referral remain cornerstones to achieving optimal outcomes after TAVR or SAVR (surgical aortic valve replacement).
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Affiliation(s)
- Kunal Sarkar
- Department of Cardiology, Policlinico Tor Vergata, University of Rome, Tor Vergata, Viale Oxford 81, Rome 00133, Italy.
| | - Mrinalini Sarkar
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Gian Paolo Ussia
- Department of Cardiology, Policlinico Tor Vergata, University of Rome, Tor Vergata, Viale Oxford 81, Rome 00133, Italy
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Kapadia SR, Leon MB, Makkar RR, Tuzcu EM, Svensson LG, Kodali S, Webb JG, Mack MJ, Douglas PS, Thourani VH, Babaliaros VC, Herrmann HC, Szeto WY, Pichard AD, Williams MR, Fontana GP, Miller DC, Anderson WN, Akin JJ, Davidson MJ, Smith CR. 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 2015; 385:2485-91. [PMID: 25788231 DOI: 10.1016/s0140-6736(15)60290-2] [Citation(s) in RCA: 621] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Based on the early results of the Placement of Aortic Transcatheter Valves (PARTNER) trial, transcatheter aortic valve replacement (TAVR) is an accepted treatment for patients with severe aortic stenosis who are not suitable for surgery. However, little information is available about the late clinical outcomes in such patients. METHODS We did this randomised controlled trial at 21 experienced valve centres in Canada, Germany, and the USA. We enrolled patients with severe symptomatic inoperable aortic stenosis and randomly assigned (1:1) them to transfemoral TAVR or to standard treatment, which often included balloon aortic valvuloplasty. Patients and their treating physicians were not masked to treatment allocation. The randomisation was done centrally, and sites learned of the assignment only after a patient had been screened, consented, and entered into the database. The primary outcome of the trial was all-cause mortality at 1 year in the intention-to-treat population, here we present the prespecified findings after 5 years. This study is registered with ClinicalTrials.gov, number NCT00530894. FINDINGS We screened 3015 patients, of whom 358 were enrolled (mean age 83 years, Society of Thoracic Surgeons Predicted Risk of Mortality 11·7%, 54% female). 179 were assigned to TAVR treatment and 179 were assigned to standard treatment. 20 patients crossed over from the standard treatment group and ten withdrew from study, leaving only six patients at 5 years, of whom five had aortic valve replacement treatment outside of the study. The risk of all-cause mortality at 5 years was 71·8% in the TAVR group versus 93·6% in the standard treatment group (hazard ratio 0·50, 95% CI 0·39-0·65; p<0·0001). At 5 years, 42 (86%) of 49 survivors in the TAVR group had New York Heart Association class 1 or 2 symptoms compared with three (60%) of five in the standard treatment group. Echocardiography after TAVR showed durable haemodynamic benefit (aortic valve area 1·52 cm(2) at 5 years, mean gradient 10·6 mm Hg at 5 years), with no evidence of structural valve deterioration. INTERPRETATION TAVR is more beneficial than standard treatment for treatment of inoperable aortic stenosis. TAVR should be strongly considered for patients who are not surgical candidates for aortic valve replacement to improve their survival and functional status. Appropriate selection of patients will help to maximise the benefit of TAVR and reduce mortality from severe comorbidities. FUNDING Edwards Lifesciences.
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Affiliation(s)
| | - Martin B Leon
- Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Raj R Makkar
- Cedars Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Susheel Kodali
- Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | | | | | - Pamela S Douglas
- Duke Clinical Research Institute/Duke University Medical Center, Durham, NC, USA
| | | | | | | | | | | | | | | | - D Craig Miller
- Stanford University School of Medicine, Department of Cardiovascular Surgery, Falk CV Research Center, Stanford, CA, USA
| | | | | | | | - Craig R Smith
- Columbia University Medical Center/New York Presbyterian Presbyterian Hospital, New York, NY, USA
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Gilmanov DS, Solinas M, Kallushi E, Gasbarri T, Bianchi G, Farneti PA, Glauber M. Sutureless aortic valve replacement for aortic incompetence. J Card Surg 2015; 30:391-5. [PMID: 25765903 DOI: 10.1111/jocs.12531] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Sutureless prostheses for surgical aortic valve replacement (AVR) are usually used in degenerative calcified aortic stenosis. Less is known on the application of sutureless prostheses for pure aortic incompetence. METHODS Between 2011 and 2014, 442 patients were operated on with the Perceval aortic sutureless valve implant. We identified 11 patients (10 female, mean age 70.5) who underwent sutureless AVR for pure aortic incompetence (off-label use). Three patients had a left ventricle ejection fraction of 30% or less. Mean logistic EuroSCORE was 15.2 (range 2.2-45.2). In five patients associated mitral procedures (three [60%] repair and two [40%] replacement) were performed. Four procedures were performed through a minimally invasive approach (three right minithoracotomies and one partial sternotomy). RESULTS Mean cardiopulmonary bypass time was 130.2 min and aortic cross clamp time was 82.2 min. Mean implanted prosthesis size was 24.5 ± 1.3 (median 25) mm (insignificant correlation with preoperative aortic valve annulus measurement by transthoracic echocardiography: 21.6 ± 1.5 [median 21] mm, Pearson's r = 0.373, p = 0.259). One patient died on 24th day after AVR associated with aortic arch replacement and hypothermic circulatory arrest (10 years after correction for type A aortic dissection). No residual para- or intravalvular leakage was present on discharge and 12-month follow-up. No migration of the prosthesis occurred. CONCLUSION Sutureless AVR is an option in selected patients with aortic incompetence. Preoperative aortic annulus measurement by echocardiography has poor predictive value for estimation of prosthetic valve size.
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Affiliation(s)
- Daniyar Sh Gilmanov
- Adult Cardiac Surgery Department, G. Monasterio Tuscany Foundation - G. Pasquinucci Heart Hospital, Massa, Italy
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Ussia GP, Sarkar K, Cammalleri V, Marchei M, Muscoli S, De Vico P, Rubino D, De Persis F, Macrini M, Romeo F. Clinical results with the 31 mm CoreValveª in large aortic annuli: the importance of implantation technique. EUROINTERVENTION 2015; 10:e1-8. [DOI: 10.4244/eijv10i9a182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Putrino AL, Best M, Yong G. Improved quality of life two-years post Transcatheter Aortic Valve Replacement for a regurgitant aortic homograft. Heart Lung Circ 2014; 24:e51-5. [PMID: 25529837 DOI: 10.1016/j.hlc.2014.11.001] [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: 10/08/2014] [Revised: 10/28/2014] [Accepted: 11/01/2014] [Indexed: 11/25/2022]
Abstract
The limited durability of prosthetic cardiac valves together with an aging population will present ongoing management challenges. This paper describes the case of an 82 year-old male with symptomatic severe regurgitation in an aortic homograft which remains successfully treated with Transcatheter Aortic Valve Replacement (TAVR) at two-year follow-up.
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Affiliation(s)
- Anthony L Putrino
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Matthew Best
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Gerald Yong
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia.
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11
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Transcatheter Valve-in-Valve Implantation: A Systematic Review of Literature. Heart Lung Circ 2014; 23:1020-8. [DOI: 10.1016/j.hlc.2014.06.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 02/24/2014] [Accepted: 06/03/2014] [Indexed: 11/23/2022]
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12
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Quality metrics in cardiac catheterization for congenital heart disease: Utility of 30-day mortality. Catheter Cardiovasc Interv 2014; 85:104-10. [DOI: 10.1002/ccd.25683] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 08/13/2014] [Accepted: 09/19/2014] [Indexed: 11/07/2022]
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13
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Testa L, Latib A, Rossi ML, De Marco F, De Carlo M, Fiorina C, Oreglia J, Petronio AS, Ettori F, De Servi S, Klugmann S, Ussia GP, Tamburino C, Panisi P, Brambilla N, Colombo A, Presbitero P, Bedogni F. CoreValve implantation for severe aortic regurgitation: a multicentre registry. EUROINTERVENTION 2014; 10:739-45. [DOI: 10.4244/eijv10i6a127] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Roy D, Sharma R, Brecker SJD. Native aortic valve regurgitation: transcatheter therapeutic options. EUROINTERVENTION 2014; 9 Suppl:S55-62. [PMID: 24025959 DOI: 10.4244/eijv9ssa11] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an acceptable treatment for patients with aortic stenosis but remains contraindicated for patients with native aortic valve regurgitation (NAVR). It is well established that patients with severe NAVR and symptoms have a poor prognosis if left untreated and that they should be offered surgical aortic valve replacement. There are patients with NAVR and at high surgical risk for whom conventional surgical aortic valve replacement may be unsuitable. Until recently there has been limited experience in the treatment of these patients with TAVI but outcomes from isolated case reports and small registries are encouraging. Of interest are certain new TAVI devices with design features which may make them better suited to the treatment of NAVR patients.
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Affiliation(s)
- David Roy
- Department of Cardiology, St George's Healthcare NHS Trust, London, United Kingdom
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Barbanti M, Ye J, Pasupati S, El-Gamel A, Webb JG. The Helio transcatheter aortic dock for patients with aortic regurgitation. EUROINTERVENTION 2014; 9 Suppl:S91-4. [PMID: 24025967 DOI: 10.4244/eijv9ssa17] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Marco Barbanti
- St. Paul's Hospital, University of British Columbia, Vancouver, Canada
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Sarkar K, Speciale G, Ussia GP. Core valve implant failure in the presence of mechanical mitral prosthesis: Importance of assessing left ventricular outflow tract. Catheter Cardiovasc Interv 2014; 85:920-4. [DOI: 10.1002/ccd.25376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/20/2013] [Accepted: 12/23/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Kunal Sarkar
- Department of Cardiology; Policlinico Tor Vergata, University of Rome; Tor Vergata, Viale Oxford, 81 00133 Rome Italy
| | - Giulio Speciale
- Department of Cardiovascular Sciences; Campus Bio-Medico University of Rome; Via Alvaro del Portillo 200 00128 Rome Italy
| | - Gian Paolo Ussia
- Department of Cardiology; Policlinico Tor Vergata, University of Rome; Tor Vergata, Viale Oxford, 81 00133 Rome Italy
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Schlingloff F, Schäfer U, Frerker C, Schmoeckel M, Bader R. Transcatheter aortic valve implantation of a second-generation valve for pure aortic regurgitation: procedural outcome, haemodynamic data and follow-up. Interact Cardiovasc Thorac Surg 2014; 19:388-93. [DOI: 10.1093/icvts/ivu155] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pesarini G, Bedogni F, Ribichini F. "Valve in valve" implantation of two self-expandable transcatheter aortic valves in a patient with aortic root aneurysm and massive aortic regurgitation: "a new TAVI option". Catheter Cardiovasc Interv 2014; 83:836-40. [PMID: 24038951 DOI: 10.1002/ccd.25194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 08/12/2013] [Accepted: 09/08/2013] [Indexed: 11/08/2022]
Abstract
Catheter-based treatment of aortic regurgitation (AR) often proves challenging especially due to associated anatomical difficulties. Here, we present a case of CoreValve implantation with a novel use of the valve-in-valve technique to effectively treat severe AR in a patient with repeated cardiac surgery and aneurismatic prosthetic ascending aorta.
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Affiliation(s)
- Gabriele Pesarini
- Department of Medicine, University of Verona Medical School, Verona, Italy
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Schlingloff F, Frerker C, Schäfer U, Bader R. Transapical aortic valve (JenaValve) implantation for severe aortic insufficiency and aortic aneurysm. J Thorac Cardiovasc Surg 2013; 146:e40-1. [PMID: 23856206 DOI: 10.1016/j.jtcvs.2013.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/14/2013] [Accepted: 05/23/2013] [Indexed: 11/28/2022]
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