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Poletti E, Amat-Santos I, Criscione E, Popolo Rubbio A, García-Gómez M, Orzalkiewicz M, Pan M, Sisinni A, Squillace M, Del Blanco BG, Bruno F, Panoulas V, Pracon R, De Backer O, Taramasso M, Costa G, Barbanti M, Van Mieghem NM, Regazzoli D, Mangieri A, Scotti A, Latib A, Saia F, Bedogni F, Testa L. Performance of balloon-expandable transcatheter bioprostheses in inoperable patients with pure aortic regurgitation of a native valve: The BE-PANTHEON international project. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00630-4. [PMID: 39198100 DOI: 10.1016/j.carrev.2024.08.007] [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: 06/12/2024] [Revised: 07/19/2024] [Accepted: 08/14/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND The off-label utilization of transcatheter heart valve (THV) devices for the treatment of inoperable or high-surgical risk patients with pure native aortic valve regurgitation (NAVR) has demonstrated suboptimal outcomes, both with self- and balloon-expandable (BE) devices. The aim of this study is to compare the use of different BE scaffolds in treating pure NAVR. METHODS Consecutive patients with pure severe NAVR who were deemed to be at high-risk and were treated with last-generation BE-THVs among seventeen Centers in Europe and US. Technical and device success rates were the primary objectives. RESULTS Between February 2018 and July 2023, among 144 patients, 41 (28 %) received a MyVal device and 103 (72 %) were treated with a Sapien THV. Patients treated with a MyVal THV had an extra-large annulus more frequently compared to the Sapien group (49%vs.20 %, p < 0.001). Technical and device success rates were 90 % and 81 %, respectively, p > 0.1. The rate of THV migration/embolization (MyVal 4.9%vs. Sapien 11 %, p = 0.4) and second valve needed (4.9%vs.7.8 %, p = 0.7) were numerically lower in the MyVal group, whereas the rate of at least moderate paravalvular leak (15%vs.7.8 %, p = 0.2) and permanent pacemaker implantation (25%vs.18 %, p = 0.16) were numerically higher in the Myval group. CONCLUSIONS Off-label use of BE devices for pure NAVR represents a potential alternative in high-risk patients in the absence of dedicated devices. However, BE in NAVR is associated with suboptimal outcomes. The availability of larger THV sizes may introduce transcatheter aortic valve replacement as an effective treatment for patients traditionally deemed unsuitable. NON-STANDARD ABBREVIATIONS AND ACRONYMS AR = aortic regurgitation, BE = balloon-expandable, NAVR = native aortic valve regurgitation, PM = pacemaker, TAVR = transcatheter aortic valve replacement, THV = transcatheter heart valve, TVEM = transcatheter valve embolization and migration, VARC-3 = Valve Academic Research Consortium 3.
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Affiliation(s)
- Enrico Poletti
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Ignacio Amat-Santos
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Enrico Criscione
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Popolo Rubbio
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Mario García-Gómez
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Mateusz Orzalkiewicz
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Manuel Pan
- Department of Cardiology, Hospital Universitario Reina Sofía, University of Córdoba, IMIBIC - CIBERCV, Spain
| | - Antonio Sisinni
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Mattia Squillace
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Francesco Bruno
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland
| | - Vasileios Panoulas
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland; Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, United Kingdom of Great Britain and Northern Ireland
| | - Radoslaw Pracon
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland
| | - Ole De Backer
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Giuliano Costa
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria Policlinico G. Rodolico - San Marco, University of Catania, Catania, Italy
| | | | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Francesco Saia
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Francesco Bedogni
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luca Testa
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy.
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Farjat-Pasos JI, Kalavrouziotis D, Beaudoin J, Paradis JM. Simultaneous Transcatheter Aortic and Mitral Native Valve Replacement: A Step-by-Step Procedural Approach. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2024; 8:100295. [PMID: 39100586 PMCID: PMC11294837 DOI: 10.1016/j.shj.2024.100295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/17/2024] [Accepted: 02/01/2024] [Indexed: 08/06/2024]
Abstract
Multivalvular heart disease (MVHD) is present in one-third of patients with valvular heart disease (VHD). Compared to single VHD patients, these patients have a more significant hemodynamic impact and are often left under medical treatment. Most importantly, when undergoing multiple valve interventions, they show worse rates of heart failure and mortality. The guidelines-supported interventions in patients with MVHD in combined aortic regurgitation and mitral stenosis include percutaneous mitral balloon commissurotomy, open mitral commissurotomy, or surgical mitral valve replacement followed by transcatheter or surgical aortic valve replacement, trying to minimize the increased mortality risk of double-valve replacement. Simultaneous transcatheter valve replacement (STVR) for native MVHD is still off-label and not yet considered in clinical guidelines since the evidence of its results is limited to a few cases reported worldwide. However, fully percutaneous transfemoral STVR seems promising for MVHD patients thanks to its minimal invasiveness, the continuous improvement of the transcatheter heart valve devices, the likely shorter length of stay and the fastest recovery. To our knowledge, this is the first case ever reported of fully percutaneous STVR for native MVHD in aortic regurgitation and mitral stenosis. Deep understanding of both pathologies and their interactions, not only from a pathological point of view but from the procedural planning and procedural steps point of view is mandatory. Hereby we present the specific STVR procedural planning considerations, a step-by-step guide on how to perform an aortic and mitral STVR and its critical considerations, as well as the procedural and follow-up results.
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Affiliation(s)
- Julio I. Farjat-Pasos
- Department of Structural Interventional Cardiology, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Dimitri Kalavrouziotis
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Jonathan Beaudoin
- Department of Echocardiography, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Jean-Michel Paradis
- Department of Structural Interventional Cardiology, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
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Santos LDM, Luz LS, Bastos VL, Barcelos TA, Abreu FAA, Beck LC, Darnasser MJAH, Cruz FDA, Matos LCV, Carvalho WB. Case Report: Transcatheter aortic valve implantation using balloon-expandable bioprosthesis in patients with severe pure aortic regurgitation on noncalcified native valves: a series of cases. Front Cardiovasc Med 2024; 11:1365181. [PMID: 38737717 PMCID: PMC11088235 DOI: 10.3389/fcvm.2024.1365181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/01/2024] [Indexed: 05/14/2024] Open
Abstract
Background For individuals with pure aortic regurgitation (AR), transcatheter aortic valve implantation (TAVI) is cautiously recommended only for those with a high or prohibitive surgical risk. We aimed to describe the results of a case series of transcatheter implantation of a balloon-expandable aortic valve bioprosthesis (BEV) for the treatment of noncalcified native valve AR. Methods From February 2022-November 2022, we performed TAVI in patients with severe pure AR. Cases were indicated on the basis of symptoms, high/prohibitive surgical risk, or patient refusal of conventional treatment. Results Five patients underwent successful TAVI. The mean age was 81.9 ± 6.6 years, 3 (60%) female and 5 (100%) in NYHA class III or IV. The baseline echocardiogram showed an ejection fraction of 49.0 ± 10.6% and left ventricular end-systolic diameter 28.5 ± 4.7 mm/m². The average area of the aortic annulus was 529.1 ± 47.0mm² and the area oversizing index was 17.6 ± 1.2%. In the 30-day follow-up, there were no cases of prosthesis embolization, annulus rupture, stroke, acute myocardial infarction, acute renal failure, hemorrhagic complication or death. One patient required a permanent pacemaker and another had a minor vascular complication. The clinical follow-up were 19.8 months (16.7-21.8). During this period, all patients remained alive and in NYHA class I or II. One of the patients developed a moderate paravalvular leak. Conclusion TAVI with a BEV proved to be safe and effective in this small case series of patients with noncalcified native valve AR in a follow-up longer than 1 year.
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Affiliation(s)
- Luciano de Moura Santos
- Department of Interventional Cardiology, Hospital Santa Lucia Sul, Brasilia, Brazil
- Department of Interventional Cardiology, Hospital Santa Lucia Norte, Brasilia, Brazil
| | - Larissa Santos Luz
- Department of Interventional Cardiology, Hospital Santa Lucia Sul, Brasilia, Brazil
| | | | | | | | - Leonardo Cogo Beck
- Department of Interventional Cardiology, Hospital Santa Lucia Sul, Brasilia, Brazil
- Department of Interventional Cardiology, Hospital Santa Lucia Norte, Brasilia, Brazil
| | - Mohammed Jamal Aldin Hilal Darnasser
- Department of Interventional Cardiology, Hospital Santa Lucia Sul, Brasilia, Brazil
- Department of Interventional Cardiology, Hospital Santa Lucia Norte, Brasilia, Brazil
| | | | - Luis Carlos Vieira Matos
- Department of Interventional Cardiology, Hospital Santa Lucia Sul, Brasilia, Brazil
- Department of Interventional Cardiology, Hospital Santa Lucia Norte, Brasilia, Brazil
| | - Wenderval Borges Carvalho
- Department of Interventional Cardiology, Hospital Santa Lucia Sul, Brasilia, Brazil
- Department of Interventional Cardiology, Hospital Santa Lucia Norte, Brasilia, Brazil
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Sanchez-Luna JP, Martín P, Dager AE, Charry PD, Beltrán JR, Sánchez-Recalde Á, Giannini F, Gómez-Menchero A, Pan M, Ielasi A, Monastyrski A, Barbanti M, Fernandez-Avilés F, Ancona MB, Mussayev A, De Brahi JP, Lamelas P, Sánchez-Pérez A, García Puerta M, Ortiz M, Gonzalez-Gutiérrez JC, Marengo G, Gómez J, Gonzalez-Bartol E, Stepanenko A, Gomez-Salvador I, San Román JA, Amat-Santos IJ. Clinical outcomes of TAVI with the Myval balloon-expandable valve for non-calcified aortic regurgitation. EUROINTERVENTION 2023; 19:580-588. [PMID: 37565470 PMCID: PMC10500190 DOI: 10.4244/eij-d-23-00344] [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: 05/02/2023] [Accepted: 06/20/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) in non-calcified aortic regurgitation (NCAR) is an off-label procedure. The balloon-expandable Myval includes extra-large sizes (30.5 mm and 32 mm) of interest in this setting. AIMS We aimed to evaluate the safety and feasibility of Myval in NCAR. METHODS This was an international, multicentre, observational study that enrolled all consecutive patients with symptomatic severe NCAR undergoing TAVR with the Myval device. The images were centrally analysed. RESULTS A total of 113 patients were recruited, 64.6% were men, the mean age was 78.4±7.5 years, and the Society of Thoracic Surgeons score was 2.7±1.7%. Aortic root dilatation was present in 59.3% of patients, 7.1% were bicuspid, and the mean annular area was 638.6±106.0 mm2. The annular area was beyond the recommended range for extra-large sizes in 2.6% of cases, and additional volume was added in 92% (median 4 cc, up to 9 cc). The extra-large sizes were used in 95 patients (84.1%), and the mean oversizing was 17.9±11.0%. The technical success rate was 94.7%; the rate of residual ≥moderate aortic regurgitation was 8.9%, and the pacemaker rate was 22.2%. There were no cases of annular rupture, cardiac tamponade, or aortic dissection, but in 4 patients (3.5%) valve embolisation occurred (1 antegrade and 3 ventricular), all in cases with a tapered left ventricle outflow tract (p=0.007). Thirty-day and 1-year mortality were 5.3% and 9.7%, respectively. Technical success was associated with better survival (97.1% vs 72.7%; p=0.012), and valve embolisation was the main determinant of mortality (p=0.047). CONCLUSIONS Myval is a feasible and safe option for selected non-operable patients with NCAR and demonstrated good midterm outcomes and lack of impact of oversizing on device durability.
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Affiliation(s)
| | - Pedro Martín
- Cardiology Department, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas, Gran Canaria, Spain
| | - Antonio E Dager
- Cardiology Department, Angiografía de Occidente Hospital, Cali, Colombia
| | - Pablo D Charry
- Cardiology Department, Clínica Medilaser, Neiva, Colombia
| | - Javier R Beltrán
- Cardiology Department, Los Comuneros Hospital Universitario de Bucaramanga, Bucaramanga, Colombia
| | | | | | | | - Manuel Pan
- Cardiology Department, Hospital Reina Sofía, Cordoba, Spain and University of Cordoba (IMIBIC), Cordoba, Spain
| | - Alfonso Ielasi
- Cardiology Department, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Andrea Monastyrski
- Cardiology Department, Hospital Universitario Val d'Hebron, Barcelona, Spain
| | - Marco Barbanti
- Cardiology Department, Policlinico-Vittorio Emanuele Hospital, Catania, Italy
| | | | | | - Abdurashid Mussayev
- Cardiology Department, National Research Cardiac Surgery Center, Astana, Kazakhstan
| | - Juan Pablo De Brahi
- Cardiology Department, Sanatorio de La Trinidad Mitre, Buenos Aires, Argentina
| | - Pablo Lamelas
- Cardiology Department, Instituto Cardiovascular, Buenos Aires, Argentina
| | - Andrés Sánchez-Pérez
- Cardiology Department, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas, Gran Canaria, Spain
| | | | - Miguel Ortiz
- Cardiology Department, Angiografía de Occidente Hospital, Cali, Colombia
| | | | - Giorgio Marengo
- Cardiology Department, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Javier Gómez
- Cardiology Department, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | | | - Alexander Stepanenko
- Cardiology Department, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Itziar Gomez-Salvador
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Madrid, Spain
| | - J Alberto San Román
- Cardiology Department, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Madrid, Spain
| | - Ignacio J Amat-Santos
- Cardiology Department, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Madrid, Spain
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