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Kang Y, Soehartono NA, Choi JW, Kim KH, Hwang HY, Kim JB, Kim HR, Lee SH, Cho YH. Recent Outcomes of Surgical Redo Aortic Valve Replacement in Prosthetic Valve Failure. Thorac Cardiovasc Surg 2024. [PMID: 38442916 DOI: 10.1055/a-2281-1897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND As redo surgical aortic valve replacement (AVR) is relatively high risk, valve-in-valve transcatheter AVR has emerged as an alternative for failed prostheses. However, the majority of studies are outdated. This study assessed the current clinical outcomes of redo AVR. METHODS AND RESULTS This study enrolled 324 patients who underwent redo AVR due to prosthetic valve failure from 2010 to 2021 in four tertiary centers. The primary outcome was operative mortality. The secondary outcomes were overall survival, cardiac death, and aortic valve-related events. Logistic regression analysis, clustered Cox proportional hazards models, and competing risk analysis were used to evaluate the independent risk factors. Redo AVR was performed in 242 patients without endocarditis and 82 patients with endocarditis. Overall operative mortality was 4.6% (15 deaths). Excluding patients with endocarditis, the operative mortality of redo AVR decreased to 2.5%. Multivariate analyses demonstrated that endocarditis (hazard ratio [HR]: 3.990, p = 0.014), longer cardiopulmonary bypass time (HR: 1.006, p = 0.037), and lower left ventricular ejection fraction (LVEF) (HR: 0.956, p = 0.034) were risk factors of operative mortality. Endocarditis and lower LVEF were independent predictors of overall survival. CONCLUSION The relatively high risk of redo AVR was due to reoperation for prosthetic valve endocarditis. The outcomes of redo AVR for nonendocarditis are excellent. Our findings suggest that patients without endocarditis, especially with acceptable LVEF, can be treated safely with redo AVR.
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Affiliation(s)
- Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nazla Amanda Soehartono
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong Rae Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Hyun Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Heart Stroke Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Shi WY, Malarczyk A, Watson RA, Patel P, Newell P, Awtry J, McGurk S, Kaneko T. Impact of reintervention after index aortic valve replacement on the risk of subsequent mortality. JTCVS OPEN 2023; 16:93-102. [PMID: 38204628 PMCID: PMC10775045 DOI: 10.1016/j.xjon.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/29/2023] [Accepted: 07/25/2023] [Indexed: 01/12/2024]
Abstract
Objectives The use of bioprosthetic aortic valve replacement (AVR) is inherently associated with a risk of structural valve degeneration (SVD) and the need for aortic valve (AV) reintervention. We sought to evaluate whether AV reintervention, in the form of repeat surgical AVR (SAVR) or valve-in-valve transcatheter aortic valve replacement (ViV-TAVR), negatively affects patients' subsequent long-term survival after index SAVR. Methods We identified patients who had undergone bioprosthetic SAVR from 2002 to 2017 at our institution. Median longitudinal follow-up after index SAVR was 7.3 years (10.9 years for those with and 7.2 years for those without AV reintervention), and median follow-up after AV reintervention was 1.9 years. Cox regression analyses using AV reintervention (re-SAVR and ViV-TAVR) as a time-varying covariate were used to determine the impact of reintervention on subsequent survival. Results Of 4167 patients who underwent index SAVR, 139 (3.3%) required AV reintervention for SVD, with re-SAVR being performed in 65 and ViV-TAVR in 74. Median age at the index SAVR was 73 years (interquartile range, 64-79 years), and 2541 (61%) were male. Overall, there were total of 1171 mortalities observed, of which 13 occurred after re-SAVR and 9 after ViV-TAVR. AV reintervention was associated with a greater risk of subsequent mortality compared with those patients who did not require AV reintervention (hazard ratio, 2.53; 95% confidence interval, 1.64-3.88, P < .001). This increased risk of subsequent mortality was more pronounced for those who received their index AVR when <65 years of age (hazard ratio, 5.60; 95% confidence interval, 2.57-12.22, P < .001) versus those ≥65 years (2.06, 1.21-3.52, P = .008). Direct comparison of survival between those who underwent re-SAVR versus ViV-TAVR showed 5-year survival to be comparable (re-SAVR: 74% vs ViV-TAVR: 80%, P = .67). Conclusions Among patients receiving bioprosthetic AVR, an AV reintervention for SVD is associated with an increased risk of subsequent mortality, regardless of re-SAVR or ViV-TAVR, and this risk is greater among younger patients. These findings should be balanced with individual preferences at index AVR in the context of patients' lifetime management of aortic stenosis.
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Affiliation(s)
- William Y. Shi
- Department of Cardiovascular Surgery, Northwell Health, New York, NY
| | | | - Ryan A. Watson
- Division of Cardiology, Allegheny Health Network, Pittsburgh, Pa
| | - Prem Patel
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Mass
| | - Paige Newell
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Mass
| | - Jake Awtry
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Mass
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Mass
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University in St Louis, St Louis, Mo
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Stolte T, Boeddinghaus J, Allegra G, Leibundgut G, Reuthebuch O, Kaiser C, Müller C, Nestelberger T. Incidence and Outcomes of Valve-in-Valve Transcatheter Aortic Valve Implantation in Failed Bioprosthetic Valves. J Clin Med 2023; 12:5868. [PMID: 37762811 PMCID: PMC10531770 DOI: 10.3390/jcm12185868] [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: 07/05/2023] [Revised: 07/28/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) has become a widely used, comparably efficient and safe alternative to surgical aortic valve replacement (SAVR). Its utilization continues to grow, especially among younger patients. Despite improvements in durability, degeneration and subsequent re-interventions of failed prosthetic valves are still common. Even though valve-in-valve procedures have become more frequent, little is known about the trends over time or about clinical and echocardiographic long-term outcomes. MATERIALS AND METHODS Patients who underwent a valve-in-valve procedure between December 2011 and December 2022 in a large tertiary university hospital were analyzed. Primary outcomes were defined as procedural and device successes as well as event-free survival. Secondary analyses between subsets of patients divided by index valve and date of procedure were performed. RESULTS Among 1407 procedures, 58 (4%) were valve-in-valve interventions, with an increased frequency observed over time. Overall, technical success was achieved in 88% and device success in 85% of patients. Complications were predominantly minor, with similar success rates among TAVR-in-SAVR (TiSAVR) and TAVR-in-TAVR (TiTAVR). Notably, there were significant and lasting improvements in mean echocardiographic gradients at 1 year. Event-free survival was 76% at one month and 69% at one year. CONCLUSIONS Over the last decade, a rising trend of valve-in-valve procedures was observed. Despite an increase in procedures, complications show a contrasting decline with improved technical and device success over time. TiSAVR and TiTAVR showed comparable rates of procedural and device success as well as similar outcomes, highlighting the utility of valve-in-valve procedures in an aging population.
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Affiliation(s)
- Thorald Stolte
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, 8092 Zurich, Switzerland
| | - Jasper Boeddinghaus
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- British Heart Foundation, University Centre for Cardiovascular Science, Usher Institute, University of Edinburgh, Edinburgh EH16 4SS, UK
| | - Giampiero Allegra
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Gregor Leibundgut
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Christoph Kaiser
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Christian Müller
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Thomas Nestelberger
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- British Heart Foundation, University Centre for Cardiovascular Science, Usher Institute, University of Edinburgh, Edinburgh EH16 4SS, UK
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Kalogeropoulos AS, Redwood SR, Allen CJ, Hurrell H, Chehab O, Rajani R, Prendergast B, Patterson T. A 20-year journey in transcatheter aortic valve implantation: Evolution to current eminence. Front Cardiovasc Med 2022; 9:971762. [PMID: 36479570 PMCID: PMC9719928 DOI: 10.3389/fcvm.2022.971762] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/31/2022] [Indexed: 07/26/2023] Open
Abstract
Since the first groundbreaking procedure in 2002, transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis (AS). Through striking developments in pertinent equipment and techniques, TAVI has now become the leading therapeutic strategy for aortic valve replacement in patients with severe symptomatic AS. The procedure streamlining from routine use of conscious sedation to a single arterial access approach, the newly adapted implantation techniques, and the introduction of novel technologies such as intravascular lithotripsy and the refinement of valve-bioprosthesis devices along with the accumulating experience have resulted in a dramatic reduction of complications and have improved associated outcomes that are now considered comparable or even superior to surgical aortic valve replacement (SAVR). These advances have opened the road to the use of TAVI in younger and lower-risk patients and up-to-date data from landmark studies have now established the outstanding efficacy and safety of TAVI in patients with low-surgical risk impelling the most recent ESC guidelines to propose TAVI, as the main therapeutic strategy for patients with AS aged 75 years or older. In this article, we aim to summarize the most recent advances and the current clinical aspects involving the use of TAVI, and we also attempt to highlight impending concerns that need to be further addressed.
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Affiliation(s)
- Andreas S. Kalogeropoulos
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Cardiology, MITERA General Hospital, Hygeia Healthcare Group, Athens, Greece
| | - Simon R. Redwood
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Christopher J. Allen
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Harriet Hurrell
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Omar Chehab
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Bernard Prendergast
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Tiffany Patterson
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
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5
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van Nieuwkerk AC, Santos RB, Fernandez-Nofrerias E, Tchétché D, de Brito FS, Barbanti M, Kornowski R, Latib A, D'Onofrio A, Ribichini F, Mainar V, Dumonteil N, Baan J, Abizaid A, Sartori S, D'Errigo P, Tarantini G, Lunardi M, Orvin K, Pagnesi M, Larraya GL, Ghattas A, Dangas G, Mehran R, Delewi R. Outcomes in Valve-in-Valve Transcatheter Aortic Valve Implantation. Am J Cardiol 2022; 172:81-89. [PMID: 35351288 DOI: 10.1016/j.amjcard.2022.02.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Abstract
The use of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is increasing, but studies evaluating clinical outcomes in these patients are scarce. Also, there are limited data to guide the choice of valve type in ViV-TAVI. Therefore, this CENTER-study evaluated clinical outcomes in patients with ViV-TAVI compared to patients with native valve TAVI (NV-TAVI). In addition, we compared outcomes in patients with ViV-TAVI treated with self-expandable versus balloon-expandable valves. A total of 256 patients with ViV-TAVI and 11333 patients with NV-TAVI were matched 1:2 using propensity score matching, resulting in 256 patients with ViV-TAVI and 512 patients with NV-TAVI. Mean age was 81±7 years, 58% were female, and the Society of Thoracic Surgeons Predicted Risk of Mortality was 6.3% (4.0% to 12.8%). Mortality rates were comparable between ViV-TAVI and NV-TAVI patients at 30 days (4.1% vs 5.9%, p = 0.30) and 1 year (14.2% vs 17.3%, p = 0.34). Stroke rates were also similar at 30 days (2.8% vs 1.8%, p = 0.38) and 1 year (4.9% vs 4.3%, p = 0.74). Permanent pacemakers were less frequently implanted in patients with ViV-TAVI (8.8% vs 15.0%, relative risk 0.59, 95% confidence interval [CI] 0.37 to 0.92, p = 0.02). Patients with ViV-TAVI were treated with self-expandable valves (n = 162) and balloon-expandable valves (n = 94). Thirty-day major bleeding was less frequent in patients with self-expandable valves (3% vs 13%, odds ratio 5.12, 95% CI 1.42 to 18.52, p = 0.01). Thirty-day mortality was numerically lower in patients with self-expandable valves (3% vs 7%, odds ratio 3.35, 95% CI 0.77 to 14.51, p = 0.11). In conclusion, ViV-TAVI seems a safe and effective treatment for failing bioprosthetic valves with low mortality and stroke rates comparable to NV-TAVI for both valve types.
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Affiliation(s)
- Astrid C van Nieuwkerk
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands
| | - Raquel B Santos
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands; Department of Cardiology, Centro Hospitalar Universitário do Porto, Serviço Cardiologia, Porto, Portugal
| | | | | | - Fabio S de Brito
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Marco Barbanti
- Division of Cardiology, Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, New York; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | | | - Jan Baan
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands
| | - Alexandre Abizaid
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paola D'Errigo
- National Centre for Global Health - Istituto Superiore di Sanità, Rome, Italy
| | | | - Mattia Lunardi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Katia Orvin
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Matteo Pagnesi
- Department of Medical and Surgical specialties, Institute of Cardiology, ASST Spedali Civili, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | | | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ronak Delewi
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands.
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6
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Basman C, Pirelli L, Singh VP, Reimers CD, Hemli J, Brinster DR, Patel NC, Scheinerman SJ, Kliger CA. Lifetime management for aortic stenosis: Planning for future therapies. J Cardiol 2022; 80:185-189. [PMID: 35016808 DOI: 10.1016/j.jjcc.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
A shift to lifetime management has gained more focus with the approval of low-risk transcatheter aortic valve replacement (TAVR). This paper is therefore focused on the different approaches for lifetime management. Herein we discuss the procedural safety, durability, performance, and future options for each lifetime management strategy. In younger patients that elect to undergo surgical aortic valve replacement (SAVR), options for bioprosthetic failure are TAV-in-SAV or redo SAVR. Among patients that undergo TAVR, options for valve failure include TAVR explant with SAVR or TAV-in-TAV. Additionally, there are patients who may require a third valvular intervention. The initial therapy may limit re-intervention options down the road. This review discusses how options for future therapies affect the decision of SAVR vs TAVR in younger patients.
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Affiliation(s)
- Craig Basman
- Department of Cardiology and Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY, USA; Department of Cardiology, Northern Westchester Hospital/Northwell Health, Mount Kisco, NY, USA.
| | - Luigi Pirelli
- Department of Cardiology and Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY, USA
| | - Varinder P Singh
- Department of Cardiology and Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY, USA; Department of Cardiology, Northern Westchester Hospital/Northwell Health, Mount Kisco, NY, USA
| | - Carl D Reimers
- Department of Cardiology, Northern Westchester Hospital/Northwell Health, Mount Kisco, NY, USA
| | - Jonathan Hemli
- Department of Cardiology and Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY, USA
| | - Derek R Brinster
- Department of Cardiology and Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY, USA
| | - Nirav C Patel
- Department of Cardiology and Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY, USA
| | - S Jacob Scheinerman
- Department of Cardiology and Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY, USA
| | - Chad A Kliger
- Department of Cardiology and Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY, USA
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7
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White A, Nguyen Q, Hong Y, Moon M, Wang S, Wang W. Rapid Deployment Valves Are Advantageous in the Redo Setting: A Single-Centre Retrospective Study. CJC Open 2021; 4:299-304. [PMID: 35386134 PMCID: PMC8978054 DOI: 10.1016/j.cjco.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022] Open
Abstract
Background The spectrum on how to manage aortic valve disease continues to widen. The purpose of this study is to add further clarification to the role of rapid deployment valves (RDVs) by comparing their outcomes with traditional sutured valves (TSVs) in the reoperative aortic valve replacement (AVR) setting. Methods This study was a retrospective review of all patients undergoing a second surgical reoperation for aortic valve disease. Patients were categorized into 2 groups: RDV and TSV. Cox proportional hazards regression models were used to determine the association between exposures of interest and the primary and secondary outcomes, after adjusting for all the baseline characteristics. The primary outcome was major adverse cardiovascular events (MACE) within 3 years, which was the composite of all-cause death, readmission for myocardial infarct, readmission for stroke, and readmission for heart failure. Results A total of 307 patients made up the study population from 2010 to 2019. Of those, 254 patients received TSV, and 53 patients received RDV. RDV patients were significantly older than TSV patients by 10 years, on average. Shorter cardiopulmonary bypass (CPB) times were found with the RDV group. There was no significant difference in the primary outcome of MACE within 3 years. Conclusions This single-centre large cohort study of patients with reoperative AVR found that RDVs facilitate smoother operations by saving 1 hour of cross-clamp time and CPB time. Furthermore, RDVs have comparable outcomes with TSVs, despite the significantly older patient population.
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8
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Tugaoen Z, Nguyen P, Arora S, Vavalle J. The selection of transcatheter heart valves in transcatheter aortic valve replacement. Trends Cardiovasc Med 2021; 32:513-522. [PMID: 34634481 DOI: 10.1016/j.tcm.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
Transcatheter heart valve technology has rapidly progressed since initial approval in the United States. There are currently two widely available transcatheter heart valve delivery systems approved in the US; however limited data exist on optimal device selection for various patient populations. This review explores the characteristics of currently approved transcatheter heart valve systems and scenarios where one valve system may be favored over others. We provide a simplified decision tree for selecting the optimal transcatheter valve system for specific patient-centered characteristics.
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Affiliation(s)
- Zachary Tugaoen
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Peter Nguyen
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States
| | - Sameer Arora
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States
| | - John Vavalle
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States.
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9
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Qi SS, Kelly RF, Bianco R, Schoen FJ. Increased utilization of bioprosthetic aortic valve technology:Trends, drivers, controversies and future directions. Expert Rev Cardiovasc Ther 2021; 19:537-546. [PMID: 33928833 DOI: 10.1080/14779072.2021.1924676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Bioprosthetic valves (BPV) implanted surgically or by transcatheter valve implantation (TAVI) comprise an overwhelming majority of substitute aortic valves implanted worldwide.Areas Covered: Prominent drivers of this trend are: 1) BPV patients have generally better outcomes than those with a mechanical valve, and remain largely free of anticoagulation and its consequences; 2) BPV durability has improved over the years; and 3) the expanding use of TAVI and valve-in-valve (VIV) procedures permitting interventional management of structural valve degeneration (SVD). Nevertheless, key controversies exist: 1) optimal anticoagulation regimens for surgical and TAVI BPVs; 2) the incidence, mechanisms and mitigation strategies for SVD; 3) the use of VIV for treatment of SVD, and 4) valve selection recommendations for difficult cohorts, (e.g. patients 50-70 years, patients <50, childbearing age women). This communication reviews trends in and drivers of BPV utilization, current controversies, and future directions affecting BPV use.Expert Opinion: Long-term data are needed in several areas related to aortic BPV use, including anticoagulation/antiplatelet therapy, especially following TAVI. TAVI and especially VIV durability and optimal use warrant will benefit greatly from long-term data. Certain populations may benefit from such high-quality data on multi-year outcomes, particularly younger patients.
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Affiliation(s)
- Steven S Qi
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Rosemary F Kelly
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Richard Bianco
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Frederick J Schoen
- Professor of Pathology and Health Sciences and Technology, Harvard Medical School, Executive Vice Chairman, Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
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