1
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Landi I, Alkhabaz A, Abou Shaar B, Galzerano D, Albert-Brotons D, Tahir M, Eltayeb A, Alenazy A, Arshi F, Limongelli G, Bossone E, Vriz O. Non-atherosclerotic coronary artery disease: an overview of a heterogeneous disease. Coron Artery Dis 2024; 35:333-347. [PMID: 38206797 DOI: 10.1097/mca.0000000000001317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Affiliation(s)
- Irene Landi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Anas Alkhabaz
- Heart Centre, King Faisal Specialist Hospital & Research Centre
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Bader Abou Shaar
- Heart Centre, King Faisal Specialist Hospital & Research Centre
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | - Mohammed Tahir
- Heart Centre, King Faisal Specialist Hospital & Research Centre
| | - Abdulla Eltayeb
- Heart Centre, King Faisal Specialist Hospital & Research Centre
| | - Ali Alenazy
- Heart Centre, King Faisal Specialist Hospital & Research Centre
| | - Fatima Arshi
- Heart Centre, King Faisal Specialist Hospital & Research Centre
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', AORN dei Colli, Monaldi Hospital
| | - Eduardo Bossone
- Department of Cardiology, Azienda Ospedaliera di Rilevanza Nazionale 'A. Cardarelli' Hospital, Naples, Italy
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital & Research Centre
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2
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Iwasaki M, Konishi A, Takahara M, Kohsaka S, Okuda M, Hayashi T, Takamisawa I, Ishii H, Amano T, Shinke T, Ikari Y. Volume-outcome relationship in balloon aortic valvuloplasty: results of a consecutive, patient-level data analysis from a Japanese nationwide multicentre registry (J-SHD). BMJ Open 2023; 13:e073597. [PMID: 37848296 PMCID: PMC10582855 DOI: 10.1136/bmjopen-2023-073597] [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: 03/10/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE Transcatheter balloon aortic valvuloplasty (BAV) remains an important alternative treatment for severe, symptomatic aortic stenosis. With increasing numbers of BAVs being performed, the need for large-scale volume-outcome relationship assessments has become evident. Here, we aimed to explain such relationships by analysing consecutive, patient-level BAV data recorded in a prospective Japanese nationwide multicentre registry. DESIGN Prospective study. SETTING Data of 1920 BAVs performed in 200 Japanese hospitals from January 2015 to December 2019. PARTICIPANTS The mean patient age was 85 years, and 36.9% of procedures involved male patients. METHODS The efficacy of BAV was assessed by reducing the mean transaortic valve gradient after the procedure. We also assessed in-hospital complication rates, including in-hospital death, bleeding, urgent surgery, distal embolism, vessel rupture and contrast-induced nephropathy. Based on the distribution of case volume (median 20, IQR 10-46), we divided the patients into high-volume (≥20) and low-volume (<20) groups. In-hospital complication risk was assessed with adjustment by logistic regression modelling. RESULTS Indications for BAV included palliative/destination (44.2%), bridge to transcatheter aortic valve replacement (34.5%), bridge to surgical aortic valve replacement (7.4%) and salvage (9.7%). Reduction of the mean transaortic valve gradient was similar between the high-volume and low-volume groups (20 mm Hg vs 20 mm Hg, p=0.12). The proportion of in-hospital complications during BAV was 4.2%, and the incidence of complications showed no difference between the high-volume and low-volume groups (4.2% vs 4.1%, p=1.00). Rather than hospital volume, salvage procedure was an independent predictor of in-hospital complications (OR, 4.04; 95% CI, 2.03 to 8.06; p<0.001). CONCLUSION The current study demonstrated that procedural outcomes of BAV were largely independent of its institutional volume.
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Affiliation(s)
- Masamichi Iwasaki
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Akihide Konishi
- Kobe University Hospital Clinical & Translational Research Center, Kobe, Hyogo, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University, Minato-ku, Tokyo, Japan
| | - Masanori Okuda
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Takatoshi Hayashi
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi-gun, Aichi, Japan
| | - Toshiro Shinke
- Division of Cardiology Department of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
| | - Yuji Ikari
- Division of Cardiovascular Medicine, Tokai University Hospital, Hiratsuka, Kanagawa, Japan
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3
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Akuka A, Landes U, Manevich L, Rubinshtein R, Danenberg HD. Coronary Embolism After Transcatheter Aortic Valve Replacement-Case Series and Review of Literature. Am J Cardiol 2023; 205:234-240. [PMID: 37611416 DOI: 10.1016/j.amjcard.2023.07.137] [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: 06/22/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 08/25/2023]
Abstract
Periprocedural systemic embolism is a well-documented complication of transcatheter aortic valve replacement (TAVR). Although the most focus was given to cerebral embolism (which remains unpredictable, difficult to prevent, and a source of increased morbidity and mortality after TAVR), coronary embolism remains less investigated and potentially overlooked. This study provides a case series of 3 patients diagnosed with coronary embolism after TAVR in our institution over a 2-year period (3 of 297 cases, 1%) and a systematic literature review (4 studies; 19 case reports). Overall, coronary embolism associated with TAVR is frequently characterized by proximal vessel occlusion causing ST-elevation myocardial infarction and hemodynamic instability with lower mortality in the acute phase as compared with late coronary embolism. However, it often presents with distal vessel occlusion and minor symptoms that may be overlooked in the periprocedural period. In conclusion, we suggest that TAVR-associated coronary embolism has a much higher prevalence than previously documented. Further studies are warranted to properly assess the prevalence and impact of this phenomenon.
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Affiliation(s)
- Aviram Akuka
- Department of Cardiology, Wolfson Medical Center, Holon, Israel; School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Uri Landes
- Department of Cardiology, Wolfson Medical Center, Holon, Israel; School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Lisa Manevich
- Department of Cardiology, Wolfson Medical Center, Holon, Israel; School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ronen Rubinshtein
- Department of Cardiology, Wolfson Medical Center, Holon, Israel; School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Haim D Danenberg
- Department of Cardiology, Wolfson Medical Center, Holon, Israel; School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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4
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Samaras A, Moysidis DV, Papazoglou AS, Rampidis G, Kampaktsis PN, Kouskouras K, Efthymiadis G, Ziakas A, Fragakis N, Vassilikos V, Giannakoulas G. Diagnostic Puzzles and Cause-Targeted Treatment Strategies in Myocardial Infarction with Non-Obstructive Coronary Arteries: An Updated Review. J Clin Med 2023; 12:6198. [PMID: 37834842 PMCID: PMC10573806 DOI: 10.3390/jcm12196198] [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: 08/21/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a distinct subtype of myocardial infarction (MI), occurring in about 8-10% of spontaneous MI cases referred for coronary angiography. Unlike MI with obstructive coronary artery disease, MINOCA's pathogenesis is more intricate and heterogeneous, involving mechanisms such as coronary thromboembolism, coronary vasospasm, microvascular dysfunction, dissection, or plaque rupture. Diagnosing MINOCA presents challenges and includes invasive and non-invasive strategies aiming to differentiate it from alternative diagnoses and confirm the criteria of elevated cardiac biomarkers, non-obstructive coronary arteries, and the absence of alternate explanations for the acute presentation. Tailored management strategies for MINOCA hinge on identifying the underlying cause of the infarction, necessitating systematic diagnostic approaches. Furthermore, determining the optimal post-MINOCA medication regimen remains uncertain. This review aims to comprehensively address the current state of knowledge, encompassing diagnostic and therapeutic approaches, in the context of MINOCA while also highlighting the evolving landscape and future directions for advancing our understanding and management of this intricate myocardial infarction subtype.
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Affiliation(s)
- Athanasios Samaras
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
- Second Cardiology Department, Hippokration General Hospital of Thessaloniki, 546 42 Thessaloniki, Greece;
| | - Dimitrios V. Moysidis
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
- Third Cardiology Department, Hippokration General Hospital of Thessaloniki, 546 42 Thessaloniki, Greece;
| | - Andreas S. Papazoglou
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
| | - Georgios Rampidis
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
| | - Polydoros N. Kampaktsis
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY 10032, USA;
| | - Konstantinos Kouskouras
- Department of Radiology, AHEPA University General Hospital of Thessaloniki, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Georgios Efthymiadis
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
| | - Nikolaos Fragakis
- Second Cardiology Department, Hippokration General Hospital of Thessaloniki, 546 42 Thessaloniki, Greece;
| | - Vasileios Vassilikos
- Third Cardiology Department, Hippokration General Hospital of Thessaloniki, 546 42 Thessaloniki, Greece;
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
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5
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Samaja GA. Balloon Aortic Valvuloplasty in the Transcatheter Aortic Valve Implantation Era. Heart Int 2023; 17:13-18. [PMID: 37456354 PMCID: PMC10339465 DOI: 10.17925/hi.2023.17.1.13] [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: 04/20/2023] [Accepted: 05/24/2023] [Indexed: 07/18/2023] Open
Abstract
As the population continues to grow, and life expectancy has increased, aortic stenosis (AS) has become the most common valvular disease requiring surgical treatment. The evolution of valve replacement therapies has progressed significantly since 1960. In the last 20 years, transcatheter aortic valve implantation (TAVI) has been a game changer, and has potential to become the standard of care. Despite uncertain prognosis benefits, balloon aortic valvuloplasty (BAV) can be useful in a broad range of patients with AS, as well as being a bridging therapy to valve replacement, or as a destination therapy, besides its role in TAVI procedures. This review describes the contemporary role of BAV in AS treatment, and focuses on technical improvements that reframe BAV as an effective tool in a variety of clinical scenarios. One of these improvements is transradial BAV, either with the conventional approach of BAV or applying the bilateral technique with two balloons.
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Affiliation(s)
- Gustavo Arturo Samaja
- Interventional Cardiology Department, Policlinico Bancario Buenos Aires, Buenos Aires, Argentina
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6
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Foà A, Canton L, Bodega F, Bergamaschi L, Paolisso P, De Vita A, Villano A, Mattioli AV, Tritto I, Morrone D, Lanza GA, Pizzi C. Myocardial infarction with nonobstructive coronary arteries: from pathophysiology to therapeutic strategies. J Cardiovasc Med (Hagerstown) 2023; 24:e134-e146. [PMID: 37186564 DOI: 10.2459/jcm.0000000000001439] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous group of clinical entities characterized by clinical evidence of acute myocardial infarction (AMI) with normal or near-normal coronary arteries on coronary angiography (stenosis < 50%) and without an over the alternative diagnosis for the acute presentation. Its prevalence ranges from 6% to 11% among all patients with AMI, with a predominance of young, nonwhite females with fewer traditional risks than those with an obstructive coronary artery disease (MI-CAD). MINOCA can be due to either epicardial causes such as rupture or fissuring of unstable nonobstructive atherosclerotic plaque, coronary artery spasm, spontaneous coronary dissection and cardioembolism in-situ or microvascular causes. Besides, also type-2 AMI due to supply-demand mismatch and Takotsubo syndrome must be considered as a possible MINOCA cause. Because of the complex etiology and a limited amount of evidence, there is still some confusion around the management and treatment of these patients. Therefore, the key focus of this condition is to identify the underlying individual mechanisms to achieve patient-specific treatments. Clinical history, electrocardiogram, echocardiography, and coronary angiography represent the first-level diagnostic investigations, but coronary imaging with intravascular ultrasound and optical coherent tomography, coronary physiology testing, and cardiac magnetic resonance imaging offer additional information to understand the underlying cause of MINOCA. Although the prognosis is slightly better compared with MI-CAD patients, MINOCA is not always benign and depends on the etiopathology. This review analyzes all possible pathophysiological mechanisms that could lead to MINOCA and provides the most specific and appropriate therapeutic approach in each scenario.
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Affiliation(s)
- Alberto Foà
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCCS Policlinico St. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna
| | - Lisa Canton
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCCS Policlinico St. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna
| | - Francesca Bodega
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCCS Policlinico St. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna
| | - Luca Bergamaschi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCCS Policlinico St. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna
| | - Pasquale Paolisso
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Antonio De Vita
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome
| | - Angelo Villano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome
| | | | - Isabella Tritto
- Università di Perugia, Dipartimento di Medicina, Sezione di Cardiologia e Fisiopatologia Cardiovascolare, Perugia
| | - Doralisa Morrone
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-Cardiology Division, University Hospital of Pisa, Italy
| | - Gaetano Antonio Lanza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCCS Policlinico St. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna
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7
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Yuzawa-Tsukada N, Kashiwagi Y, Nonoue A, Uno G, Fujii S, Murakami A, Ogawa K, Kawai M, Muto M, Yoshimura M, Miyamoto T. The safety and feasibility of retrograde balloon aortic valvuloplasty using the INOUE-BALLOON with severe aortic stenosis. Heart Vessels 2022; 37:2093-2100. [PMID: 35842560 DOI: 10.1007/s00380-022-02120-0] [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: 11/27/2021] [Accepted: 06/15/2022] [Indexed: 11/04/2022]
Abstract
In the transcatheter aortic valve implantation (TAVI) era, the indications for balloon aortic valvuloplasty (BAV) are increasing. Previously, the INOUE-BALLOON® (IB) was used only for antegrade BAV, but recently, it has also been used for retrograde BAV. However, the safety and feasibility of retrograde BAV using an IB are not fully understood. In this study, we investigated the safety and feasibility of retrograde BAV using an IB in elderly Japanese patients with severe aortic stenosis (AS). We compared 39 cases of retrograde BAV using an IB performed from June 2018 to September 2020 and 34 cases of antegrade BAV using an IB performed from August 2013 to May 2018. The total number of complications was lower in retrograde BAV than in antegrade BAV (p = 0.020). The procedure time was significantly shorter in retrograde BAV than in antegrade BAV (p < 0.001), and the maximum balloon size and number of balloon inflations were smaller in retrograde BAV than in antegrade BAV (p = 0.002 and p < 0.001, respectively). There was no significant difference in the degree of improvement in the aortic valve area or ejection fraction between retrograde and antegrade BAV. In conclusion, the present study showed the safety and feasibility of retrograde BAV using an IB in elderly Japanese patients with severe AS compared with antegrade BAV using an IB.
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Affiliation(s)
- Naoko Yuzawa-Tsukada
- Division of Cardiology, Department of Internal Medicine, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo, 125-8506, Japan. .,Division of Cardiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.
| | - Yusuke Kashiwagi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Nonoue
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.,Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Goki Uno
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.,Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinya Fujii
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.,Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Akimichi Murakami
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan
| | - Kazuo Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Muto
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.,Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Miyamoto
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan
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8
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Dall'Ara G, Grotti S, Guerrieri G, Compagnone M, Spartà D, Galvani M, Tarantino F. Balloon aortic valvuloplasty: current status and future prospects. Expert Rev Cardiovasc Ther 2022; 20:389-402. [PMID: 35514027 DOI: 10.1080/14779072.2022.2074837] [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] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Balloon aortic valvuloplasty (BAV) improves hemodynamic and clinical status of patients with severe aortic stenosis (AS) for a limited period of 6-12 months. However, there is a high number of procedures performed worldwide and an upward trend over the last decades. AREAS COVERED Epidemiology of AS and the advent of transcatheter aortic valve implantation (TAVI) contribute to the extensive referral of patients. The expansion of recommendations for TAVI has occasionally led to financial reimbursement-related problems that do not exist for BAV. BAV is indicated as a bridge to valve replacement, to decision in complex cases, and to extracardiac surgery. BAV may play a role in preparing for TAVI and optimizing procedural results. The minimalist approach and reduced complication rate make it applicable in fragile patients. EXPERT OPINION In the near future, BAV will continue to be a useful asset in managing patients with AS given the multiple indications, broad applicability, safety profile, low cost, and repeatability. Specific studies are necessary to explore technical solutions, stronger indications, the finest technique, and to standardize the procedural result. Pending the development of potential competitive devices, the role that BAV plays will remain closely intertwined with the one played by TAVI.
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Affiliation(s)
| | - Simone Grotti
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | | | | | - Daniela Spartà
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Marcello Galvani
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.,Cardiovascular Research Unit, Myriam Zito Sacco Heart Foundation, Forlì, Italy
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9
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Cortese B, Sanchez-Jimenez E, Ielasi A, Biccirè F, Budassi S, Prati F, Gelpi G. Balloon aortic valvuloplasty review: the revenge during COVID-19 outbreak? Minerva Cardiol Angiol 2022; 70:572-580. [PMID: 35332746 DOI: 10.23736/s2724-5683.22.05997-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aortic stenosis is a highly prevalent cardiac valvular disease in adult population and increases with age. After symptoms onset in severe aortic stenosis, the prognosis begins to decline; however, new studies demonstrate an increased risk of death in patients with moderate disease. Although majority of patients with severe aortic stenosis are treated electively with surgical or transcatheter aortic valve replacement, not all patients are candidates for the interventions. Balloon aortic valvuloplasty can be used successfully as a bridge to definitive treatment or as palliative therapy in patients who are not candidates for either procedure. In this paper, we discuss and justify the current indications and contraindications for balloon aortic valvuloplasty. Additionally, the step-by-step procedure technique and most frequent complications are described. Moreover, we present the safety and feasibility of balloon aortic valvuloplasty in 33 consecutive patients on a waiting list for transcatheter aortic valve replacement at 3 expert Italian centers during the first and second waves of COVID-19, when clinical priorities focused on hospitalized patients with pneumonia. The procedural success in this cohort of patients was achieved in 31 patients (94%). Out of the 33 patients enrolled, 15 underwent TAVR within 5 ± 2 months from the valvuloplasty, and at 6-month follow-up a total of 2 patients died for end-stage heart failure.
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Affiliation(s)
- Bernardo Cortese
- Interventional cardiology department, Clinica Polispecialistica San Carlo, Milano, Italy - .,Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy -
| | - Erick Sanchez-Jimenez
- Interventional cardiology department, Clinica Polispecialistica San Carlo, Milano, Italy
| | - Alfonso Ielasi
- Interventional cardiology department, Istituto Clinico Sant'Ambrogio, Milano, Italy
| | - Flavio Biccirè
- Interventional cardiology department, Ospedale San Giovanni Addolorata, Roma, Italy
| | - Simone Budassi
- Interventional cardiology department, Ospedale San Giovanni Addolorata, Roma, Italy
| | - Francesco Prati
- Interventional cardiology department, Ospedale San Giovanni Addolorata, Roma, Italy
| | - Guido Gelpi
- Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy.,Interventional cardiology department, ASST-Fatebenefratelli-Sacco, Milano, Italy
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10
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Bularga A, Bing R, Shah AS, Adamson PD, Behan M, Newby DE, Flapan A, Uren N, Cruden N. Clinical outcomes following balloon aortic valvuloplasty. Open Heart 2020; 7:openhrt-2020-001330. [PMID: 32907920 PMCID: PMC7481086 DOI: 10.1136/openhrt-2020-001330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/09/2020] [Accepted: 08/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background Balloon aortic valvuloplasty (BAV) remains a treatment option for the selected patients with severe aortic stenosis. We examined clinical outcomes and predictors of prognosis in patients undergoing BAV for severe aortic stenosis. Methods We identified all patients undergoing BAV from January 2010 to March 2018 (n=167) at a single transcatheter aortic valve implantation (TAVI) centre. Patient demographics, investigations, subsequent interventions and clinical outcomes were obtained from electronic health records. Results Patients undergoing BAV were elderly (median age 80, IQR 73–86 years) and half (n=87, 52%) were male. All-cause mortality at 30 days and 12 months was 11% and 43%, respectively. Reduce ejection fraction (EF 30%–50%: HR 1.76, 95% CI 1.05 to 2.94; EF <30%: HR 1.90, 95% CI 1.12 to 3.20) was the only independent predictor at baseline of overall mortality. Median survival was 212 (IQR 54–490) days from the index procedure. Mortality at 1 year was lowest in patients who subsequently underwent TAVI or SAVR but high among those who had no further interventions or those who had a repeat BAV (14%, 19%, 60%, 89% respectively, log-rank p<0.001). Conclusion BAV as a bridge to definitive aortic valve intervention in carefully selected patients offers acceptable outcomes. These contemporary observational findings demonstrate the ongoing potential utility of BAV in the TAVI era.
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Affiliation(s)
- Anda Bularga
- Centre for Cardiovascular Science, University of Edinburgh Division of Health Sciences, Edinburgh, UK
| | - Rong Bing
- Centre for Cardiovascular Science, University of Edinburgh Division of Health Sciences, Edinburgh, UK.,Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Anoop Sv Shah
- Centre for Cardiovascular Science, University of Edinburgh Division of Health Sciences, Edinburgh, UK.,Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Philip D Adamson
- Centre for Cardiovascular Science, University of Edinburgh Division of Health Sciences, Edinburgh, UK.,Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
| | - Miles Behan
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh Division of Health Sciences, Edinburgh, UK.,Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew Flapan
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Neal Uren
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nick Cruden
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
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11
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Mantovani F, Clavel MA, Potenza A, Leuzzi C, Grimaldi T, Vignali L, Navazio A, Guiducci V. Balloon aortic valvuloplasty as a palliative treatment in patients with severe aortic stenosis and limited life expectancy: a single center experience. Aging (Albany NY) 2020; 12:16597-16608. [PMID: 32855363 PMCID: PMC7485726 DOI: 10.18632/aging.103862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022]
Abstract
Whether balloon aortic valvuloplasty (BAV) may provide an effective palliation in symptomatic high-risk patients is uncertain. Therefore, we aimed to evaluate outcomes in symptomatic high-risk patients with severe aortic stenosis (AS), who underwent BAV. All-cause mortality and length of hospitalization for heart failure (HF) up to death or to 1-year follow up were collected after BAV. One hundred thirty-two (132) patients (62% women), mean age 85±7 years, underwent BAV with a substantial reduction of the peak-to-peak aortic gradient from 53±21 to 29±15 mmHg (p<0.001). The median of days of HF hospitalization prior to BAV was 9 (0-19), and decreased after BAV to 0 (0-9), p<0.001. During 1-year follow-up patients with untreated CAD (85, 64%) had a higher mortality compared to patients with insignificant/treated CAD (47, 36%): 1-year survival: 45±7% vs. 66± 7%; p=0.02. After adjustment for STS risk score and severity of residual AS, patients with untreated CAD remained at higher risk of mortality (adjusted HR 1.74 [1.01-2.91]; p=0.04). Thus, in this series of symptomatic high-risk patients, BAV was associated with a significant reduction in aortic valve gradient and hospitalization time for HF post-BAV. In patients with significant CAD, percutaneous intervention might be considered in order to improve survival.
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Affiliation(s)
- Francesca Mantovani
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Cardiology, Reggio Emilia, Italy
| | | | - Antonella Potenza
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Cardiology, Reggio Emilia, Italy
| | - Chiara Leuzzi
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Cardiology, Reggio Emilia, Italy
| | - Teresa Grimaldi
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Cardiology, Reggio Emilia, Italy
| | - Luigi Vignali
- Division of Cardiology, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Alessandro Navazio
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Cardiology, Reggio Emilia, Italy
| | - Vincenzo Guiducci
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Cardiology, Reggio Emilia, Italy
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12
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Dawson L, Huang A, Selkrig L, Shaw JA, Stub D, Walton A, Duffy SJ. Utility of balloon aortic valvuloplasty in the transcatheter aortic valve implantation era. Open Heart 2020; 7:openhrt-2019-001208. [PMID: 32341170 PMCID: PMC7204556 DOI: 10.1136/openhrt-2019-001208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/23/2020] [Accepted: 02/10/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Balloon aortic valvuloplasty (BAV) has seen renewed interest since the advent of transcatheter aortic valve implantation (TAVI). The study aimed to characterise a contemporary BAV cohort and determinants of clinical outcomes. METHODS Patients undergoing BAV at a single tertiary centre were retrospectively reviewed over a 10-year period, and functional and mortality outcomes were reported with up to a 2-year follow-up. RESULTS 224 patients (aged 82.5±8.3 years; 48% female) underwent BAV over the study period. Indications were either destination treatment (39%) or bridge-to-valve replacement (61%)-including bridge-to-decision (29%), symptom relief while on the waitlist (27%), and temporary contraindications to TAVI/aortic valve replacement (AVR) (5%). The mean reduction of aortic mean pressure gradient was 38%. Procedural mortality occurred in 0.5%, stroke in 1.3%, and major bleeding in 0.9%. Twelve-month mortality was 36% overall, and 26% and 50% in the bridging and destination groups, respectively. New York HeartAssociation (NYHA) class improved by ≥1 at 30 days in 50%. Among the bridge-to-TAVI/AVR group, 40% proceeded to TAVI/AVR within 12 months following BAV. In multivariate analysis, active malignancy at baseline (OR: 4.4, 95% CI: 1.3 to 15.1, p=0.02), smoking history (OR: 3.3, 95% CI: 1.3 to 7.9, p<0.01), LVEF ≤30% at baseline (OR: 3.2, 95% CI: 1.3 to 7.6, p<0.01), destination treatment (OR: 2.2, 95% CI: 1.0 to 4.9, p=0.04) were all associated with 12-month mortality. CONCLUSIONS BAV remains a useful procedure with relatively low rates of complications, however, 1-year mortality rates are high. Contemporary indications for BAV include a bridge to definitive valve replacement or destination treatment.
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Affiliation(s)
- Luke Dawson
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alex Huang
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Laura Selkrig
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - James A Shaw
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Antony Walton
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia .,Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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13
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Williams T, Hildick-Smith DJR. Balloon aortic valvuloplasty: indications, patient eligibility, technique and contemporary outcomes. Heart 2020; 106:1102-1110. [PMID: 32444499 DOI: 10.1136/heartjnl-2019-315904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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14
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Saia F. Balloon Aortic Valvuloplasty Today. JACC Cardiovasc Interv 2020; 13:592-593. [DOI: 10.1016/j.jcin.2019.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
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15
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Dall'Ara G, Tumscitz C, Grotti S, Santarelli A, Balducelli M, Tarantino F, Saia F. Contemporary balloon aortic valvuloplasty: Changing indications and refined technique. Catheter Cardiovasc Interv 2020; 97:E1033-E1042. [PMID: 32096927 DOI: 10.1002/ccd.28807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/25/2020] [Accepted: 02/10/2020] [Indexed: 12/19/2022]
Abstract
Even if un to improve long-term prognosis, balloon aortic valvuloplasty (BAV) may be useful in selected patients with symptomatic severe aortic stenosis either as a bridge to surgical or transcatheter valve replacement (aortic valve replacement [AVR] or transcatheter aortic valve implantation [TAVI]) or as a triage strategy for patients with uncertain indications. International guidelines recommend BAV as: a "bridge" to AVR/TAVI, a "trial" in patients with undetermined symptoms, or a "bridge-to-decision" in case of comorbidities. However, in clinical practice, BAV is also used as a palliative measure to improve hemodynamics and quality of life in many patients who are excluded from AVR/TAVI. Finally, BAV is often performed during TAVI to facilitate prosthesis delivery, optimize frame expansion, or for bioprosthetic valve fracture in selected valve-in-valve procedures. Technical innovations, which allow for a mini-invasive approach via transradial access and pacing delivered through the wire, have led to a decrease in complications over time. This review focuses on contemporary BAV with a specific emphasis on new indications, innovative techniques, and specific complex patient subgroups.
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Affiliation(s)
| | - Carlo Tumscitz
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Simone Grotti
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | | | - Marco Balducelli
- Cardiology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
| | | | - Francesco Saia
- Cardiology Unit, Policlinico S.Orsola-Malpighi University Hospital, Bologna, Italy
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16
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Sex-Specific Predictors of Mortality Following Balloon Aortic Valvuloplasty. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:945-948. [DOI: 10.1016/j.carrev.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/16/2018] [Accepted: 01/02/2019] [Indexed: 11/20/2022]
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17
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Broyd CJ, Panoulas V, Mattar W, Akhtar M, Shekarchi-Khanghahi E, Ioannou A, Raja SG, Mason M, Rahman-Haley S, Skondras E, Dalby M, Luscher TF, Kabir T. Effect of Aortic Valve Calcium Quantity on Outcome After Balloon Aortic Valvuloplasty for Severe Aortic Stenosis. Am J Cardiol 2018; 122:1036-1041. [PMID: 30086876 DOI: 10.1016/j.amjcard.2018.05.048] [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: 03/14/2018] [Revised: 05/23/2018] [Accepted: 05/30/2018] [Indexed: 11/28/2022]
Abstract
Balloon aortic valvuloplasty has a role in a select group of patients with severe aortic stenosis. Identifying those appropriate patients who will benefit most is key. Given previous evidence demonstrating that histologically the intervention involves a physical disrupting of the cusp's calcium we hypothesized that the quantity of calcium seen at CT will influence outcome. We examined our cohort of patients who had undergone balloon aortic valvuloplasty and CT-quantified aortic valve calcium (AVC) between July 2011 and April 2014. All patients underwent echocardiography pre- and post-procedure and for those patients managed medically, again at 6 months. A potential predictive AVC value for mortality was calculated using Youden's index. A total of 240 aortic valvuloplasties were performed in 206 patients (male = 124). Valvuloplasty caused a significant (pre 0.63 ± 0.21 vs post 0.77 ± 0.27 cm2, p <0.01, n = 240), but temporary (post 0.80 ± 0.27 vs 6 months: 0.64 ± 0.18 cm2, p <0.01, n = 88) increase in valve area. Those patients with a non-severe AVC (<1853.5 AU) had a larger increase in valve area after valvuloplasty compared with those with more calcium (0.10 [95% confidence interval {CI} 0.05 to 0.10] vs 0.15 [95%CI 0.10 to 0.22] cm2, p = 0.049). Multivariate analysis revealed severe AVC (Hazard ratio 2.79, 95% CI 1.18 to 6.63, p = 0.02) along with pulmonary artery pressure post-valvuloplasty (Hazard ratio 1.02, 95% CI 1.00 to 1.03, p = 0.03) to be predictive of survival. In conclusion, in patients with severe aortic stenosis the degree of AVC impacts on the success of valvuloplasty.
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Affiliation(s)
- Christopher J Broyd
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom.
| | - Vasileios Panoulas
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom; Imperial College London
| | - Wala Mattar
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
| | - Mohammed Akhtar
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
| | - Eliana Shekarchi-Khanghahi
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
| | - Adam Ioannou
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
| | - Shahzad G Raja
- Department of Cardiac Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
| | - Mark Mason
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
| | - Shelley Rahman-Haley
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
| | - Evangelos Skondras
- Department of Imaging, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
| | - Miles Dalby
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom; Imperial College London
| | - Thomas F Luscher
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom; Imperial College London
| | - Tito Kabir
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
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18
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Attisano T, Silverio A, Stabile E, Briguori C, Tuccillo B, Scotto Di Uccio F, Di Lorenzo E, Tesorio T, Giordano A, Calabrò P, Cappelli Bigazzi M, Golino P, Scherillo M, Vigorito F, Quaranta G, Esposito G, Mauro C, Musumeci G, Tarantini G, Galasso G. Safety and feasibility of balloon aortic valvuloplasty in non-TAVI centers: The “BAV for life” experience. Catheter Cardiovasc Interv 2018; 93:E63-E70. [DOI: 10.1002/ccd.27820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/10/2018] [Accepted: 07/22/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Tiziana Attisano
- Interventional Cardiology Unit, Cardiovascular and Thoracic Department; San Giovanni di Dio e Ruggi d'Aragona University Hospital; Salerno Italy
| | - Angelo Silverio
- Interventional Cardiology Unit, Cardiovascular and Thoracic Department; San Giovanni di Dio e Ruggi d'Aragona University Hospital; Salerno Italy
| | - Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences; Università Federico II; Naples Italy
| | - Carlo Briguori
- Interventional Cardiology Unit; Clinica Mediterranea; Naples Italy
| | | | | | | | - Tullio Tesorio
- Interventional Cardiology Service; Casa di Cura Montevergine; Mercogliano Avellino Italy
| | - Arturo Giordano
- Interventional Cardiology Unit; Clinica Pineta Grande; Castelvolturno Caserta Italy
| | - Paolo Calabrò
- Department of Cardiothoracic and Respiratory Sciences; University of Campania "Luigi Vanvitelli"; Naples Italy
| | | | - Paolo Golino
- Cardiology-CCU Unit; A.O.R.N. dei Colli; Naples Italy
| | | | - Francesco Vigorito
- Interventional Cardiology Unit, Cardiovascular and Thoracic Department; San Giovanni di Dio e Ruggi d'Aragona University Hospital; Salerno Italy
| | | | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences; Università Federico II; Naples Italy
| | - Ciro Mauro
- Cardiovascular Department; Antonio Cardarelli Hospital; Naples Italy
| | | | - Giuseppe Tarantini
- Department of Cardiac; Thoracic and Vascular sciences, University of Padua; Padua Italy
| | - Gennaro Galasso
- Interventional Cardiology Unit, Cardiovascular and Thoracic Department; San Giovanni di Dio e Ruggi d'Aragona University Hospital; Salerno Italy
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Shilova AS, Gilyarova EM, Andreev DA, Shchekochikhin DY, Novikova NA, Gilyarov MY. EMBOLIC MYOCARDIAL INFARCTION. EXPERIENCE IN DIAGNOSIS AND MANAGEMENT. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2018. [DOI: 10.20996/1819-6446-2018-14-3-361-369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acute myocardial infarction (AMI) is one of the main causes of morbidity and mortality, both in the Russian Federation and around the world. Approximately, in up to 10% of patients with clinical diagnostic features of AMI, early angiography does not reveal an occluded vessel or possibly any evidence of coronary artery disease. These patients constitute an intriguing subgroup referred to as “Myocardial Infarction with Non-Obstructive Coronary Arteries” (MINOCA). MINOCA is a collective concept that unites many different pathologies, which determines the essential heterogeneity of the etiological factors. Coronary artery embolism is recognized as an important non-atherosclerotic cause of AMI. In turn, the most common underlying disease in those with coronary embolism is the atrial fibrillation. The advantages of reperfusion strategy and cardioprotective therapy in the treatment of obstructive arteriosclerosis are well studied, widely presented in the literature and supported by a strong evidence base, while the issues of diagnosis and treatment of patients with MINOCA are currently widely discussed We present two clinical cases of embolic myocardial infarction in patients with atrial fibrillation, diagnosed in our clinic in 2017.
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20
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Impact of chronic kidney disease on mortality in adults undergoing balloon aortic valvuloplasty. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:448-451. [DOI: 10.1016/j.carrev.2017.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/21/2017] [Accepted: 10/23/2017] [Indexed: 11/20/2022]
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21
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Is Predilation Necessary to Help the Lotus Bloom? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:77. [PMID: 29496116 DOI: 10.1016/j.carrev.2018.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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22
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Raphael CE, Heit JA, Reeder GS, Bois MC, Maleszewski JJ, Tilbury RT, Holmes DR. Coronary Embolus. JACC Cardiovasc Interv 2018; 11:172-180. [DOI: 10.1016/j.jcin.2017.08.057] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/03/2017] [Accepted: 08/08/2017] [Indexed: 10/18/2022]
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23
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Arsalan M, Khan S, Golman J, Szerlip M, Mahoney C, Herbert M, Brown D, Mack M, Holper EM. Balloon aortic valvuloplasty to improve candidacy of patients evaluated for transcatheter aortic valve replacement. J Interv Cardiol 2017; 31:68-73. [PMID: 29285803 DOI: 10.1111/joic.12476] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/19/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Evaluate the role of balloon aortic valvuloplasty (BAV) in improving candidacy of patients for transcatheter aortic valve replacement (TAVR). BACKGROUND Patients who are not candidates for TAVR may undergo BAV to improve functional and clinical status. METHODS 117 inoperable or high-risk patients with critical aortic stenosis underwent BAV as a bridge-to-decision for TAVR. Frailty measures including gait speed, serum albumin, hand grip, activities of daily living (ADL); and NYHA functional class before and after BAV were compared. RESULTS Mean age was 81.6 ± 8.5 years and the mean Society of Thoracic Surgeons predicted risk of mortality was 9.57 ± 5.51, with 19/117 (16.2%) patients non-ambulatory. There was no significant change in mean GS post-BAV, but all non-ambulatory patients completed GS testing at follow-up. Albumin and hand grip did not change after BAV, but there was a significant improvement in mean ADL score (4.85 ± 1.41 baseline to 5.20 ± 1.17, P = 0.021). The number of patients with Class IV congestive heart failure (CHF) was significantly lower post BAV (71/117 [60.7%] baseline versus 18/117 [15.4%], P = 0.008). 78/117 (66.7%) of patients were referred to definitive valve therapy after BAV. CONCLUSIONS When evaluating frailty measures post BAV, we saw no significant improvement in mean GS, however, we observed a significant improvement in non-ambulatory patients and ADL scores. We also describe improved Class IV CHF symptoms. With this improved health status, the majority of patients underwent subsequent valve therapy, demonstrating that BAV may improve candidacy of patients for TAVR.
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Affiliation(s)
| | | | | | | | | | | | - David Brown
- The Heart Hospital Baylor Plano, Plano, Texas
| | | | - Elizabeth M Holper
- Baylor Research Institute, Plano, Texas.,The Heart Hospital Baylor Plano, Plano, Texas
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24
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Ford TJ, Nguyen K, Brassil J, Kushwaha V, Friedman D, Allan R, Pitney M, Jepson N. Balloon Aortic Valvuloplasty in the Transcatheter Valve Era: Single Centre Indications and Early Safety Data in a High Risk Population. Heart Lung Circ 2017; 27:595-600. [PMID: 28688833 DOI: 10.1016/j.hlc.2017.05.128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/20/2017] [Accepted: 05/09/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The introduction of transcatheter aortic valve implantation (TAVI) has generated a renewed interest in the techniques available to treat high-risk patients with severe aortic stenosis (AS). We report our single centre experience with balloon aortic valvuloplasty (BAV) focussing on indications, procedural success and 30-day outcomes. METHODS We retrospectively reviewed all patients that underwent BAV procedures at our institution between August 2012 and August 2014. Procedural success and complications were adjudicated according to VARC-2 criteria. RESULTS Fifty-one consecutive adult patients with severe symptomatic AS underwent a total of 55 BAV procedures. The patients had a mean age of 88±5.7 years and all had extensive comorbidities with a high surgical risk (mean logistic EuroSCORE of 25.22%±14.5%). Indications for BAV included palliation of symptoms n=42 (76%); bridge to definitive valve replacement (n=6, 11%); and evaluation of response (n=6, 11%). The procedure was completed in all patients with no intraprocedural deaths (within 24hours) and low 30-day mortality at 3.9% (n=2). Minor vascular complications occurred in 11.8% (n=6), whilst permanent pacemaker implantation was required in 5.8% (n=3). There were no cases of myocardial infarction, stroke, tamponade, severe aortic regurgitation or major vascular complications during 30-day follow-up. CONCLUSIONS Balloon aortic valvuloplasty may be performed safely and effectively with high procedural success and low 30-day complications, even in a very high-risk and elderly cohort of patients in whom the role of TAVI is uncertain or inappropriate.
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Affiliation(s)
- Thomas J Ford
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Katherine Nguyen
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Joseph Brassil
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Virag Kushwaha
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Daniel Friedman
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Roger Allan
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Mark Pitney
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Nigel Jepson
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia.
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Sandhu K, Krishnamoorthy S, Afif A, Nolan J, Gunning MG. Balloon aortic valvuloplasty in contemporary practice. J Interv Cardiol 2017; 30:212-216. [DOI: 10.1111/joic.12384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/23/2017] [Accepted: 03/29/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kully Sandhu
- Royal Stoke University Hospital; University Hospital of North Midlands; Stoke on Trent Staffordshire United Kingdom
| | | | - Ashari Afif
- Royal Stoke University Hospital; University Hospital of North Midlands; Stoke on Trent Staffordshire United Kingdom
| | - James Nolan
- Royal Stoke University Hospital; University Hospital of North Midlands; Stoke on Trent Staffordshire United Kingdom
| | - Mark G. Gunning
- Royal Stoke University Hospital; University Hospital of North Midlands; Stoke on Trent Staffordshire United Kingdom
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26
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Alkhouli M, Zack CJ, Sarraf M, Bashir R, Nishimura RA, Eleid MF, Nkomo VT, Sandhu GS, Gulati R, Greason KL, Holmes DR, Rihal CS. Morbidity and Mortality Associated With Balloon Aortic Valvuloplasty. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004481. [DOI: 10.1161/circinterventions.116.004481] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 03/15/2017] [Indexed: 11/16/2022]
Abstract
Background—
The introduction of transcatheter aortic valve replacement (TAVR) led to renewed interest in balloon aortic valvuloplasty (BAV). We sought to assess contemporary trends in BAV utilization and their outcomes.
Methods and Results—
The Nationwide Inpatient Sample was used to identify patients who underwent BAV between 2004 and 2013. In-hospital morbidity and mortality, and predictors of death after BAV were assessed. Outcomes of propensity-matched groups of patients undergoing elective BAV or TAVR were evaluated. BAV utilization increased from 707 cases in 2004 to 3715 cases in 2013 (national estimates). Procedural and in-hospital mortality were 1.4% and 8.5%, respectively. Vascular complications occurred in 7.0% of cases, blood transfusion in 17.5%, clinical stroke in 1.8%, and pacemaker implantation in 3.0%. The strongest predictors of in-hospital death were cardiogenic shock (odds ratio, 6.01; 95% confidence interval, 4.19–8.61;
P
<0.001), need for left ventricular assist device (odds ratio, 3.48; 95% confidence interval, 2.25–5.36;
P
<0.001), coagulopathy (odds ratio, 2.19; 95% confidence interval, 1.51–3.18;
P
<0.001), and low institutional volume of BAV (odds ratio, 1.58; 95% confidence interval, 1.06–2.37;
P
=0.03). In propensity-matched patients undergoing elective BAV or TAVR, rates of in-hospital mortality (2.9% versus 3.5%;
P
=0.60), clinical stroke (1.6% versus 3.1%;
P
=0.10), and vascular complications (8.2% versus 10.9%;
P
=0.14) were similar. However, BAV was associated with lower rates of pacemaker implantation (2.9% versus 8.0%;
P
<0.001) and blood transfusion (12.8% versus 22.9%;
P
<0.001).
Conclusions—
In a contemporary national registry, BAV is associated with significant morbidity and mortality that are similar to TAVR. With the substantial increase in BAV utilization and the continuous improvement in TAVR outcomes, these data have important implications to aid clinicians in the selection of appropriate BAV candidates.
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Affiliation(s)
- Mohamad Alkhouli
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Chad J. Zack
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Mohammad Sarraf
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Riyaz Bashir
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Rick A. Nishimura
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Mackram F. Eleid
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Vuyisile T. Nkomo
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Gurpreet S. Sandhu
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Rajiv Gulati
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Kevin L. Greason
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - David R. Holmes
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Charanjit S. Rihal
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
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Hosokawa S, Hiasa Y, Seno A, Yasuoka T, Izumi T, Ogura R. Predictors of early restenosis after intracardiac echocardiography guided antegrade balloon aortic valvuloplasty in high-risk or inoperable patients. Cardiovasc Interv Ther 2017; 33:109-115. [PMID: 28108953 DOI: 10.1007/s12928-016-0451-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022]
Abstract
Antegrade balloon aortic valvuloplasty (BAV) may be more effective than retrograde BAV. However, early restenosis is found inconstantly within three months after BAV. To evaluate the factor of ER after intracardiac echocardiogram (ICE) guided Antegrade BAV, fifty patients with severe aortic stenosis (AS) underwent BAV procedures with ICE. ER was defined as mean aortic valve pressure gradient (PG) >40 mmHg. During one-year follow-up period, 6 patients died and 2 patients underwent aortic valve replacement. ER was present in 13 patients (26%) at three months after BAV. Procedural, clinical, and hemodynamic data were collected. The mean age of the patient population was 85.4 ± 7.6 years; the mean STS score and EuroSCORE were 7.8 ± 1.1 and 14.6 ± 4.1, respectively. The mean aortic valve PG decreased from 63.4 ± 19.8 to 28.5 ± 10.1 mmHg (p < 0.0001). Baseline characteristics were similar between the two groups. There is no significant difference of mean aortic valve PG immediate after BAV(ER; 29 ± 8.8 mmHg, nonER; 21 ± 6.1 mmHg, p = ns). Univariate analysis showed patients with ER group had significantly higher rate of left ventricular hypertrophy, pulmonary hypertension, and high mean aortic valve PG at admission. Multivariate analysis revealed high mean aortic valve PG at admission as independent predictors of ER. Antegrade BAV may be effective for severe AS. Left ventricular hypertrophy, pulmonary hypertension and high mean PG were predictor of early restenosis. Early intervention should be considered for these patients.
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Affiliation(s)
- Shinobu Hosokawa
- Division of Cardiology, Tokushima Red Cross Hospital, Irinokuchi103, Komatsushima-cho, Komatsushima, 773-8502, Japan.
| | - Yoshikazu Hiasa
- Division of Cardiology, Tokushima Red Cross Hospital, Irinokuchi103, Komatsushima-cho, Komatsushima, 773-8502, Japan
| | - Akiho Seno
- Division of Cardiology, Tokushima Red Cross Hospital, Irinokuchi103, Komatsushima-cho, Komatsushima, 773-8502, Japan
| | - Tatuo Yasuoka
- Division of Cardiology, Tokushima Red Cross Hospital, Irinokuchi103, Komatsushima-cho, Komatsushima, 773-8502, Japan
| | - Tomoko Izumi
- Division of Cardiology, Tokushima Red Cross Hospital, Irinokuchi103, Komatsushima-cho, Komatsushima, 773-8502, Japan
| | - Riyo Ogura
- Division of Cardiology, Tokushima Red Cross Hospital, Irinokuchi103, Komatsushima-cho, Komatsushima, 773-8502, Japan
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28
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Kennon S, Archbold A. Expert Opinion: Guidelines for the Management of Patients with Aortic Stenosis Undergoing Non-cardiac Surgery: Out of Date and Overly Prescriptive. Interv Cardiol 2017; 12:133-136. [PMID: 29588742 DOI: 10.15420/icr.2017:20:2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Patients with severe aortic stenosis who require non-cardiac surgery present a difficult clinical problem. The most recent clinical practice guidelines from the American College of Cardiology/American Heart Association and the European Society of Cardiology for the perioperative cardiovascular assessment and management of patients undergoing noncardiac surgery were both published in 2014. These guidelines are reviewed in the light of recently published randomised controlled trial data regarding the efficacy of transcatheter aortic valve implantation to treat aortic stenosis.
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Affiliation(s)
- Simon Kennon
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
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29
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Keeble TR, Khokhar A, Akhtar MM, Mathur A, Weerackody R, Kennon S. Percutaneous balloon aortic valvuloplasty in the era of transcatheter aortic valve implantation: a narrative review. Open Heart 2016; 3:e000421. [PMID: 28008354 PMCID: PMC5174794 DOI: 10.1136/openhrt-2016-000421] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 08/19/2016] [Accepted: 08/30/2016] [Indexed: 01/15/2023] Open
Abstract
The role of percutaneous balloon aortic valvuloplasty (BAV) in the management of severe symptomatic aortic stenosis has come under the spotlight following the development of the transcatheter aortic valve implantation (TAVI) technique. Previous indications for BAV were limited to symptom palliation and as a bridge to definitive therapy for patients undergoing conventional surgical aortic valve replacement (AVR). In the TAVI era, BAV may also be undertaken to assess the ‘therapeutic response’ of a reduction in aortic gradient in borderline patients often with multiple comorbidities, to assess symptomatic improvement prior to consideration of definitive TAVI intervention. This narrative review aims to update the reader on the current indications and practical techniques involved in undertaking a BAV procedure. In addition, a summary of the haemodynamic and clinical outcomes, as well as the frequently encountered procedural complications is presented for BAV procedures conducted during both the pre-TAVI and post-TAVI era.
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Affiliation(s)
- Thomas R Keeble
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, UK; Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK
| | - Arif Khokhar
- Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK; Department of Cardiology, Royal Brompton & Harefield NHS Trust, London, UK
| | - Mohammed Majid Akhtar
- Department of Cardiology , Barts' Heart Centre, St. Bartholomews' Hospital , London , UK
| | - Anthony Mathur
- Department of Cardiology , Barts' Heart Centre, St. Bartholomews' Hospital , London , UK
| | - Roshan Weerackody
- Department of Cardiology , Barts' Heart Centre, St. Bartholomews' Hospital , London , UK
| | - Simon Kennon
- Department of Cardiology , Barts' Heart Centre, St. Bartholomews' Hospital , London , UK
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30
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Tron C, Bizios A, Durand E, Bouhzam N, Bettinger N, Eltchaninoff H. La valvuloplastie percutanée en urgence : quels patients, quels résultats ? Presse Med 2016; 45:898-902. [PMID: 27374262 DOI: 10.1016/j.lpm.2016.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/30/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Christophe Tron
- CHU de Rouen, hôpital Charles-Nicolle, service de cardiologie, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
| | - Anna Bizios
- CHU de Rouen, hôpital Charles-Nicolle, service de cardiologie, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - Eric Durand
- CHU de Rouen, hôpital Charles-Nicolle, service de cardiologie, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - Najime Bouhzam
- CHU de Rouen, hôpital Charles-Nicolle, service de cardiologie, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - Nicolas Bettinger
- CHU de Rouen, hôpital Charles-Nicolle, service de cardiologie, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - Hélène Eltchaninoff
- CHU de Rouen, hôpital Charles-Nicolle, service de cardiologie, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France
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31
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Pasipoularides A. Calcific Aortic Valve Disease: Part 2-Morphomechanical Abnormalities, Gene Reexpression, and Gender Effects on Ventricular Hypertrophy and Its Reversibility. J Cardiovasc Transl Res 2016; 9:374-99. [PMID: 27184804 PMCID: PMC4992466 DOI: 10.1007/s12265-016-9695-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/03/2016] [Indexed: 02/07/2023]
Abstract
In part 1, we considered cytomolecular mechanisms underlying calcific aortic valve disease (CAVD), hemodynamics, and adaptive feedbacks controlling pathological left ventricular hypertrophy provoked by ensuing aortic valvular stenosis (AVS). In part 2, we survey diverse signal transduction pathways that precede cellular/molecular mechanisms controlling hypertrophic gene expression by activation of specific transcription factors that induce sarcomere replication in-parallel. Such signaling pathways represent potential targets for therapeutic intervention and prevention of decompensation/failure. Hypertrophy provoking signals, in the form of dynamic stresses and ligand/effector molecules that bind to specific receptors to initiate the hypertrophy, are transcribed across the sarcolemma by several second messengers. They comprise intricate feedback mechanisms involving gene network cascades, specific signaling molecules encompassing G protein-coupled receptors and mechanotransducers, and myocardial stresses. Future multidisciplinary studies will characterize the adaptive/maladaptive nature of the AVS-induced hypertrophy, its gender- and individual patient-dependent peculiarities, and its response to surgical/medical interventions. They will herald more effective, precision medicine treatments.
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Affiliation(s)
- Ares Pasipoularides
- Duke University School of Medicine, Durham, NC, USA.
- Duke/NSF Research Center for Emerging Cardiovascular Technologies, Duke University, Durham, NC, 27710, USA.
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32
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Liang KW, Yu CL, Lee WL, Wang KY, Chang Y. Consecutive Sessions of Rescue Balloon Aortic Valvuloplasty for Critical Aortic Valve Stenosis Followed by Successful Bridging to Trans-Catheter Aortic Valve Implantation. ACTA CARDIOLOGICA SINICA 2016; 31:168-71. [PMID: 27122866 DOI: 10.6515/acs20140821c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED Percutaneous balloon aortic valvuloplasty (BAV) was a rare procedure in catheterization laboratories because of its limited prognostic impact. The recent advent of transcatheter aortic valve implantation (TAVI) has led to a resurgence of BAV, opening the way to a new indication as a bridge to TAVI. Herein, we reported an 83-year-old man with critical aortic valve stenosis and pulmonary edema, who strongly declined surgical aortic valve replacement. He also lacked financial support or insurance reimbursement for TAVI. He received BAV for relief of syncope, pulmonary edema and impending respiratory failure 4 times within 4 years and was successfully bridged to TAVI after receiving charity aid funding from the hospital. KEY WORDS Aortic valve stenosis; Balloon aortic valvuloplasty (BAV); Transcatheter aortic valve implantation (TAVI).
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Affiliation(s)
- Kae-Woei Liang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; Cardiovascular Research Center, Department of Medicine
| | - Chu-Leng Yu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; Department of Surgery, National Yang Ming University School of Medicine, Taipei
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; Cardiovascular Research Center, Department of Medicine
| | - Kuo-Yang Wang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; Cardiovascular Research Center, Department of Medicine; ; Department of Medicine, Chung Shan Medical University; ; Department of Medicine, China Medical University, Taichung, Taiwan
| | - Yen Chang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; Department of Surgery, National Yang Ming University School of Medicine, Taipei
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Shimada Y, Ito K, Yano K, Tanaka C, Nakashoji T, Tonomura D, Takehara K, Kino N, Yoshida M, Kurotobi T, Tsuchida T, Fukumoto H. Real-time transesophageal echocardiography facilitates antegrade balloon aortic valvuloplasty. Cardiovasc Diagn Ther 2016; 6:172-9. [PMID: 27054107 DOI: 10.21037/cdt.2015.10.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report two cases of severe aortic stenosis (AS) where antegrade balloon aortic valvuloplasty (BAV) was performed under real-time transesophageal echocardiography (TEE) guidance. Real-time TEE can provide useful information for evaluating the aortic valve response to valvuloplasty during the procedure. It was led with the intentional wire-bias technique in order to compress the severely calcified leaflet, and consequently allowed the balloon to reach the largest possible size and achieve full expansion of the aortic annulus.
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Affiliation(s)
- Yoshihisa Shimada
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Kazato Ito
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Kentaro Yano
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Chiharu Tanaka
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | | | - Daisuke Tonomura
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Kosuke Takehara
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Naoto Kino
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Masataka Yoshida
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Toshiya Kurotobi
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Takao Tsuchida
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Hitoshi Fukumoto
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
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34
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Indications and Utility of Percutaneous Balloon Aortic Valvuloplasty in Older Adults. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0144-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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35
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Kamperidis V, Hadjimiltiades S, Mouratoglou S, Ziakas A, Sianos G, Sarafidou A, Ventoulis I, Kazinakis G, Giannakoulas G, Efthimiadis G, Parcharidis G, Karvounis H. Aortic balloon valvuloplasty before transcatheter valve replacement in high-risk patients with aortic stenosis. Herz 2015; 41:144-50. [DOI: 10.1007/s00059-015-4353-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/27/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
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36
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Yanagisawa H, Saito N, Imai M, Minakata K, Fujita T, Watanabe S, Watanabe H, Yamazaki K, Toyota T, Taniguchi T, Tazaki J, Shizuta S, Daijo H, Sakata R, Kimura T. Successful balloon aortic valvuloplasty as a bridge therapy to transcatheter aortic valve implantation during the proctoring period. J Cardiol Cases 2015; 12:113-116. [PMID: 30546571 DOI: 10.1016/j.jccase.2015.05.006] [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: 03/02/2015] [Revised: 04/25/2015] [Accepted: 05/16/2015] [Indexed: 10/23/2022] Open
Abstract
In Japan, transcatheter aortic valve implantation (TAVI) with Edwards-SAPIEN XT valve (Edwards Lifesciences Inc., Irvine, CA, USA) started in October 2013. All institutions should undergo a training period to perform TAVI independently. Balloon aortic valvuloplasty (BAV) as a bridge to TAVI during the training period should be performed with caution to avoid severe aortic regurgitation (AR) because bailout TAVI is not possible. We present a case in which BAV was successfully performed as a bridge to TAVI during the training period. The patient was an 85-year-old man with medically uncontrollable congestive heart failure due to severe aortic valve stenosis. The aortic valve area was 0.60 cm2 with a left ventricular ejection fraction of 20%. TAVI was considered a safe but high-risk strategy owing to the unstable hemodynamic condition. We chose BAV as a bridge therapy to TAVI. The aortic annulus diameter was 25.3 mm on computed tomography scans. We chose a 20-mm balloon catheter to avoid BAV-induced AR. Transfemoral TAVI was performed successfully 16 days after BAV using a 26-mm SAPIEN XT valve. The postoperative course was uneventful. The case demonstrated BAV as a bridge therapy to TAVI can be safely and effectively performed during the training period. <Learning objective: All institutions should undergo a training period to start transcatheter aortic valve implantation (TAVI). Balloon aortic valvuloplasty (BAV) during the training period should be performed with caution. The present case suggests that BAV as a bridge therapy to TAVI can be safely performed during the training period. An accurate measurement of aortic annulus diameter and the use of an undersized balloon catheter might reduce the risk of BAV-related aortic regurgitation.>.
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Affiliation(s)
- Hiromu Yanagisawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naritatsu Saito
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masao Imai
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Minakata
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takanari Fujita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shin Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuhiro Yamazaki
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiaki Toyota
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Daijo
- Department of Anesthesiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryuzo Sakata
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Costopoulos C, Sutaria N, Ariff B, Fertleman M, Malik I, Mikhail GW. Balloon aortic valvuloplasty as a treatment option in the era of transcatheter aortic valve implantation. Expert Rev Cardiovasc Ther 2015; 13:457-60. [PMID: 25865236 DOI: 10.1586/14779072.2015.1036742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aortic valve stenosis is the commonest encountered valvular pathology and a frequent cause of morbidity and mortality in cases of severe stenosis. Definitive treatment has traditionally been offered in the form of surgical aortic valve replacement in patients with an acceptable surgical risk and more recently with the less invasive transcatheter aortic valve implantation (TAVI) in those where surgery is not a viable option. Prior to the introduction of TAVI, inoperable patients were treated medically and where appropriate with balloon aortic valvuloplasty, a procedure which although effective only provided short-term relief and was associated with high complication rates especially during its infancy. Here we discuss whether balloon aortic valvuloplasty continues to have a role in contemporary clinical practice in an era where significant advances have been achieved in the fields of surgical aortic valve replacement, TAVI and postoperative care.
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Affiliation(s)
- Charis Costopoulos
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
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Van Belle E, Rauch A, Vincentelli A, Jeanpierre E, Legendre P, Juthier F, Hurt C, Banfi C, Rousse N, Godier A, Caron C, Elkalioubie A, Corseaux D, Dupont A, Zawadzki C, Delhaye C, Mouquet F, Schurtz G, Deplanque D, Chinetti G, Staels B, Goudemand J, Jude B, Lenting PJ, Susen S. Von Willebrand factor as a biological sensor of blood flow to monitor percutaneous aortic valve interventions. Circ Res 2015; 116:1193-201. [PMID: 25670067 DOI: 10.1161/circresaha.116.305046] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
RATIONALE Percutaneous aortic valve procedures are a major breakthrough in the management of patients with aortic stenosis. Residual gradient and residual aortic regurgitation are major predictors of midterm and long-term outcome after percutaneous aortic valve procedures. We hypothesized that (1) induction/recovery of high molecular weight (HMW) multimers of von Willebrand factor defect could be instantaneous after acute changes in blood flow, (2) a bedside point-of-care assay (platelet function analyzer-closure time adenine DI-phosphate [PFA-CADP]), reflecting HMW multimers changes, could be used to monitor in real-time percutaneous aortic valve procedures. OBJECTIVE To investigate the time course of HMW multimers changes in models and patients with instantaneous induction/reversal of pathological high shear and its related bedside assessment. METHODS AND RESULTS We investigated the time course of the induction/recovery of HMW multimers defects under instantaneous changes in shear stress in an aortic stenosis rabbit model and in patients undergoing implantation of a continuous flow left ventricular assist device. We further investigated the recovery of HMW multimers and monitored these changes with PFA-CADP in aortic stenosis patients undergoing transcatheter aortic valve implantation or balloon valvuloplasty. Experiments in the aortic stenosis rabbit model and in left ventricular assist device patients demonstrated that induction/recovery of HMW multimers occurs within 5 minutes. Transcatheter aortic valve implantation patients experienced an acute decrease in shear stress and a recovery of HMW multimers within minutes of implantation which was sustained overtime. In patients with residual high shear or with residual aortic regurgitation, no recovery of HMW multimers was observed. PFA-CADP profiles mimicked HMW multimers recovery both in transcatheter aortic valve implantation patients without aortic regurgitation (correction) and transcatheter aortic valve implantation patients with aortic regurgitation or balloon valvuloplasty patients (no correction). CONCLUSIONS These results demonstrate that variations in von Willebrand factor multimeric pattern are highly dynamic, occurring within minutes after changes in blood flow. It also demonstrates that PFA-CADP can evaluate in real time the results of transcatheter aortic valve procedures.
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Affiliation(s)
- Eric Van Belle
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Antoine Rauch
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - André Vincentelli
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Emmanuelle Jeanpierre
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Paulette Legendre
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Francis Juthier
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Christopher Hurt
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Carlo Banfi
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Natacha Rousse
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Anne Godier
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Claudine Caron
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Ahmed Elkalioubie
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Delphine Corseaux
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Annabelle Dupont
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Christophe Zawadzki
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Cédric Delhaye
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Frédéric Mouquet
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Guillaume Schurtz
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Dominique Deplanque
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Giulia Chinetti
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Bart Staels
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Jenny Goudemand
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Brigitte Jude
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Peter J Lenting
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.)
| | - Sophie Susen
- From the Department of Cardiology, Lille University Hospital, Lille, France (E.V.B., A.V., F.J., C.H., C.B., N.R., C.D., G.S., D.D.); INSERM UMR 1011, Univ Lille 2, Institut Pasteur de Lille, EGID, Lille, France (E.V.B., A.R., A.V., E.J., F.J., C.B., N.R., C.C., A.E., D.C., A.D., C.Z., G.C., B.S., J.G., B.J., S.S.); Department of Hematology, Transfusion Lille University Hospital, Lille, France (A.R., E.J., C.C., A.E., C.Z., F.M., J.G., B.J., S.S.); INSERM U1176 and UMR_S1176, Univ Paris-Sud, Le Kremlin Bicêtre, France (P.L., P.J.L.); and INSERM UMR 1140, Paris, France (A.G.).
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Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Developed in collaboration with the American College of Surgeons, American Society of Anesthesiologists, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Vascular Medicine Endorsed by the Society of Hospital Medicine. J Nucl Cardiol 2015; 22:162-215. [PMID: 25523415 DOI: 10.1007/s12350-014-0025-z] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 2014; 64:e77-137. [PMID: 25091544 DOI: 10.1016/j.jacc.2014.07.944] [Citation(s) in RCA: 813] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Nwaejike N, Mills K, Stables R, Field M. Balloon aortic valvuloplasty as a bridge to aortic valve surgery for severe aortic stenosis. Interact Cardiovasc Thorac Surg 2014; 20:429-35. [DOI: 10.1093/icvts/ivu398] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: Executive Summary. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.945] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Hui DS, Shavelle DM, Cunningham MJ, Matthews RV, Starnes VA. Contemporary use of balloon aortic valvuloplasty in the era of transcatheter aortic valve implantation. Tex Heart Inst J 2014; 41:469-76. [PMID: 25425977 DOI: 10.14503/thij-13-3757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The development of transcatheter aortic valve implantation (TAVI) has increased the use of balloon aortic valvuloplasty (BAV) in treating aortic stenosis. We evaluated our use of BAV in an academic tertiary referral center with a developing TAVI program. We reviewed 69 consecutive stand-alone BAV procedures that were performed in 62 patients (mean age, 77 ± 10 yr; 62% men; baseline mean New York Heart Association functional class, 3 ± 1) from January 2009 through December 2012. Enrollment for the CoreValve(®) clinical trial began in January 2011. We divided the study cohort into 2 distinct periods, defined as pre-TAVI (2009-2010) and TAVI (2011-2012). We reviewed clinical, hemodynamic, and follow-up data, calculating each BAV procedure as a separate case. Stand-alone BAV use increased 145% from the pre-TAVI period to the TAVI period. The mean aortic gradient reduction was 13 ± 10 mmHg. Patients were successfully bridged as intended to cardiac or noncardiac surgery in 100% of instances and to TAVI in 60%. Five patients stabilized with BAV subsequently underwent surgical aortic valve replacement with no operative deaths. The overall in-hospital mortality rate (17.4%) was highest in emergent patients (61%). The implementation of a TAVI program was associated with a significant change in BAV volumes and indications. Balloon aortic valvuloplasty can successfully bridge patients to surgery or TAVI, although least successfully in patients nearer death. As TAVI expands to more centers and higher-risk patient groups, BAV might become integral to collaborative treatment decisions by surgeons and interventional cardiologists.
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Direct transcatheter aortic valve implantation - one-year outcome of a case control study. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 10:250-7. [PMID: 25489318 PMCID: PMC4252322 DOI: 10.5114/pwki.2014.46766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 06/05/2014] [Accepted: 06/10/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Transaortic valve implantation (TAVI) has a well-established position in the treatment of high-risk and inoperable patients with severe aortic stenosis (AS). The TAVI protocol requires a pre-dilatation for native valve preparation. AIM To assess the safety and feasibility of TAVI without pre-dilatation and to compare it with the procedure with pre-dilatation. MATERIAL AND METHODS Out of 101 TAVI patients, in 10 the procedure was performed without balloon predilatation, and 8 patients were included in the analysis. The procedural, echocardiographic, and clinical outcomes were compared with a case control matched cohort (1: 2 ratio). A 12-month follow-up was done in all cases. RESULTS The procedure was successfully completed in all patients in the study group (SG), but there was one procedural failure in the control group (CG). All patients received a CoreValve (Medtronic) bioprosthesis. There was a significant immediate decrease in transvalvular gradients (TG) in both study arms after the procedure (SG: mean TG: from 46.0 ±14.0 mm Hg to 10.0 ±4.8 mm Hg, p < 0.001; CG: mean TG: from 55.9 ±12.0 mm Hg to 9.9 ±2.9 mm Hg, p < 0.001). A marked increase in the effective orifice areas was observed in both cohorts (SG: 1.63 ±0.13 cm(2) and CG: 1.67 ±0.25 cm(2), p = 0.75). The periprocedural complication rate was equally distributed in both arms. The 12-month all-cause mortality was 12.5% in both groups. CONCLUSIONS The direct TAVI approach seams to be safe and feasible. The clinical and echocardiographic results are not different from those achieved in patients treated with standard TAVI protocol with pre-dilatation.
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Pre-dilatation of severely stenotic aortic valves using angioplasty balloons prior to balloon aortic valvuloplasty. Catheter Cardiovasc Interv 2014. [DOI: 10.1002/ccd.25253] [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: 11/07/2022]
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Panayiotides IM, Nikolaides E. Transcatheter Aortic Valve Implantation (TAVI): Is it Time for This Intervention to be Applied in a Lower Risk Population? CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2014; 8:93-102. [PMID: 25452701 PMCID: PMC4234280 DOI: 10.4137/cmc.s19217] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 09/24/2014] [Accepted: 10/03/2014] [Indexed: 12/13/2022]
Abstract
Patients with severe aortic stenosis are sometimes not candidates for conventional open heart surgery because of severe deconditioning, excessive risk factors, and multiple comorbidities. Transcatheter aortic valve implantation (TAVI) is a relatively recent intervention, which was initially addressed to individuals with severe symptomatic aortic stenosis at substantial or prohibitive surgical risk. Despite the documented beneficial effects of this therapeutic intervention in certain carefully selected individuals, it has not yet been applied to lower risk patients. This is a review of the current literature and accumulated clinical data of this rapidly evolving invasive procedure in an attempt to resolve whether it can now be applied to a wider portion of patients with aortic stenosis.
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Affiliation(s)
- Ioannis M Panayiotides
- Cardiologist in private practice, affiliated with Nicosia General Hospital, Cardiology Department, Nicosia, Cyprus
| | - Evagoras Nikolaides
- Director of Cardiology Department, Nicosia General Hospital, Nicosia, Cyprus
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Pan XB, Zhang FW, Hu SS, Liu ZG, Ma K, Pang KJ, Yan FX, Wang X, Ou-Yang WB, Wang Y, Li SJ. Hybrid balloon valvuloplasty through the ascending aorta via median sternotomy in infants with severe congenital valvular aortic stenosis: feasibility of a new method†. Eur J Cardiothorac Surg 2014; 47:1003-5. [PMID: 25228746 DOI: 10.1093/ejcts/ezu362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/15/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To evaluate a novel hybrid balloon valvuloplasty procedure for severe congenital valvular aortic stenosis in low-weight infants, performed through the ascending aorta via median sternotomy. METHODS Eighteen infants (<90 days of age) with severe congenital aortic stenosis were included in this study. Hybrid balloon valvuloplasty procedures were performed in a hybrid operating room. Patients were followed up at 3 months, 6 months, 1 year and then annually following the procedure. RESULTS The hybrid balloon valvuloplasty procedure was successful in all patients. Eight patients were successfully rescued from left ventricular systolic dysfunction by cardiac compression under direct vision. The aortic valve pressure gradient decreased from 80.3 ± 20.8 mmHg preoperatively to 16.0 ± 3.6 mmHg immediately postoperatively (P < 0.001). None of the patients developed significant aortic insufficiency. The fluoroscopy time was 6.2 ± 2.9 min. Intraoperative blood transfusions and pacing were not required. The patients were all alive and healthy at the end of the follow-up period (mean 21.3 months; range 3-41 months), and the aortic valve pressure gradient remained low (21.7 ± 5.3 mmHg). Reintervention was not required in any of the patients. CONCLUSIONS Hybrid balloon valvuloplasty through the ascending aorta via median sternotomy is an effective and safe procedure for infants with severe congenital aortic stenosis.
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Affiliation(s)
- Xiang-Bin Pan
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng-Wen Zhang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sheng-Shou Hu
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhen-Guo Liu
- Davis Heart and Lung Research Institute, The Ohio State University Medical Center, Columbus, OH, USA
| | - Kai Ma
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kun-Jing Pang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fu-Xia Yan
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Wang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Bin Ou-Yang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Wang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shou-Jun Li
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Affiliation(s)
- Catherine M Otto
- From the Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle (C.M.O.); and the Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom (B.P.)
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Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:2215-45. [PMID: 25085962 DOI: 10.1161/cir.0000000000000105] [Citation(s) in RCA: 468] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:e278-333. [PMID: 25085961 DOI: 10.1161/cir.0000000000000106] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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