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Diaz JA, Kobayashi K, Hachinohe D, Horita R, Shitan H. Severe intraprosthetic aortic insufficiency immediately after implantation of a SAPIEN 3 Ultra RESILIA valve with spontaneous resolution: case report. Eur Heart J Case Rep 2024; 8:ytae402. [PMID: 39161715 PMCID: PMC11332268 DOI: 10.1093/ehjcr/ytae402] [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: 02/06/2024] [Revised: 04/11/2024] [Accepted: 07/29/2024] [Indexed: 08/21/2024]
Abstract
Background Aortic insufficiency (AI) is often encountered in transcatheter aortic valve replacement (TAVR) but is only rarely haemodynamically significant. Even more uncommon is the occurrence of intraprosthetic AI that often leads to haemodynamic compromise requiring additional therapeutic intervention. Case summary An 85-year-old female with severe aortic stenosis underwent elective TAVR with a size 23 mm SAPIEN 3 Ultra RESILIA (S3UR) valve. After implantation, the patient developed hypotension. Transthoracic as well as transoesophageal echocardiogram identified significant transvalvular AI. Persistence of AI led the team to consider a TAV-in-TAV strategy. Before a second valve system could be inserted, the patient's blood pressure improved and AI resolved spontaneously. The patient was discharged and recovered with no AI on follow-up imaging studies. Discussion This is the first reported case of significant intraprosthetic AI with the new S3UR in our literature search as of writing. The new S3UR valve has several improvements from previous generations designed to increase valve area and durability as well as decreasing the incidence of paravalvular and intraprosthetic leaks. A stuck leaflet was inferred as the cause of the intraprosthetic AI, and the improved design with excessive expansion may have led to this. Unlike previous case reports, intraprosthetic AI resolved without further intervention likely due to the turbulence of flow releasing the stuck leaflet. Cautious observation prevented the need for a TAV-in-TAV for a rare and possibly catastrophic complication.
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Affiliation(s)
- Juan Armando Diaz
- Cardiovascular Medicine, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, North 49, East 16, 8-1, Higashi Ward, Sapporo 007-0849, Japan
- Makati Medical Center, Makati, Philippines
| | - Ken Kobayashi
- Cardiovascular Medicine, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, North 49, East 16, 8-1, Higashi Ward, Sapporo 007-0849, Japan
| | - Daisuke Hachinohe
- Cardiovascular Medicine, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, North 49, East 16, 8-1, Higashi Ward, Sapporo 007-0849, Japan
| | - Ryo Horita
- Cardiovascular Medicine, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, North 49, East 16, 8-1, Higashi Ward, Sapporo 007-0849, Japan
| | - Hidemasa Shitan
- Cardiovascular Medicine, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, North 49, East 16, 8-1, Higashi Ward, Sapporo 007-0849, Japan
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Afshar AH, Pourafkari L, Nader ND. Periprocedural considerations of transcatheter aortic valve implantation for anesthesiologists. J Cardiovasc Thorac Res 2016; 8:49-55. [PMID: 27489596 PMCID: PMC4970570 DOI: 10.15171/jcvtr.2016.10] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/13/2016] [Indexed: 12/26/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is rapidly gaining popularity as a viable option in the management of patients with symptomatic aortic stenosis (AS) and high risk for open surgical intervention. TAVR soon expanding its indications from "high-risk" group of patients to those with "intermediate-risk". As an anesthesiologist; understanding the procedure and the challenges inherent to it is of utmost importance, in order to implement optimal care for this generally frail population undergoing a rather novel procedure. Cardiac anesthesiologists generally play a pivotal role in the perioperative care of the patients, and therefore they should be fully familiar with the circumstances occurring surrounding the procedure. Along with increasing experience and technical developments for TAVR, the procedure time becomes shorter. Due to this improvement in the procedure time, more and more anesthesiologists feel comfortable in using monitored anesthesia care with moderate sedation for patients undergoing TAVR. A number of complications could arise during the procedure needing rapid diagnoses and occasionally conversion to general anesthesia. This review focuses on the periprocedural anesthetic considerations for TAVR.
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Affiliation(s)
| | - Leili Pourafkari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ; Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA
| | - Nader D Nader
- Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA
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Hahn RT, Kodali S, Tuzcu EM, Leon MB, Kapadia S, Gopal D, Lerakis S, Lindman BR, Wang Z, Webb J, Thourani VH, Douglas PS. Echocardiographic imaging of procedural complications during balloon-expandable transcatheter aortic valve replacement. JACC Cardiovasc Imaging 2015; 8:288-318. [PMID: 25772835 DOI: 10.1016/j.jcmg.2014.12.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 02/06/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) using a balloon-expandable valve is an accepted alternative to surgical replacement for severe, symptomatic aortic stenosis in high risk or inoperable patients. Intraprocedural transesophageal echocardiography (TEE) offers real-time imaging guidance throughout the procedure and allows for rapid and accurate assessment of complications and procedural results. The value of intraprocedural TEE for TAVR will likely increase in the future as this procedure is performed in lower surgical risk patients, who also have lower risk for general anesthesia, but a greater expectation of optimal results with lower morbidity and mortality. This imaging compendium from the PARTNER (Placement of Aortic Transcatheter Valves) trials is intended to be a comprehensive compilation of intraprocedural complications imaged by intraprocedural TEE and diagnostic tools to anticipate and/or prevent their occurrence.
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York.
| | - Susheel Kodali
- Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | | | - Martin B Leon
- Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | | | | | | | - Brian R Lindman
- Washington University School of Medicine, St. Louis, Missouri
| | - Zuyue Wang
- Medstar Health Research Institute, Washington, DC
| | - John Webb
- University of British Columbia and St. Paul's Hospital, Vancouver, Ontario, Canada
| | | | - Pamela S Douglas
- Division of Cardiovascular Medicine, Duke University Medical Center, and Duke Clinical Research Institute, Durham, North Carolina
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Feltes G, Núñez-Gil IJ. Practical update on imaging and transcatheter aortic valve implantation. World J Cardiol 2015; 7:178-186. [PMID: 25914787 PMCID: PMC4404373 DOI: 10.4330/wjc.v7.i4.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/26/2014] [Accepted: 02/02/2015] [Indexed: 02/06/2023] Open
Abstract
After very rapid advances in the development of the technique and devices, transcatheter aortic valve implantation (named TAVI or TAVR), is today a reality that is here to stay. It has become the minimally-invasive treatment option for high-risk and non-surgical patients with severe symptomatic aortic stenosis. Requiring the participation of a multidisciplinary team for its implementation, cardiac imaging plays an important role. From pre-assessment to determine the suitability of the patient, the access site, the type of device, to the guidance during the procedure, and ultimately the long term monitoring of the patient. Correct selection of the patient and device, correct placement of the stent-valve and early detection of complications are of paramount importance for procedural success and for patient outcome. Each technique has advantages and disadvantages, being the cardiologist who will determine the best approach according to the type of patient and the expertise of the center in each one of them. This article summarizes the last contributions of the most common used imaging techniques, in each step of the procedure.
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Hein R, Abdel-Wahab M, Sievert H, Kuck KH, Voehringer M, Hambrecht R, Sack S, Hauptmann KE, Senges J, Zahn R, Mudra H. Outcome of patients after emergency conversion from transcatheter aortic valve implantation to surgery. EUROINTERVENTION 2014; 9:446-51. [PMID: 23965349 DOI: 10.4244/eijv9i4a73] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS To evaluate: 1) the causes of emergency conversion from transcatheter aortic valve implantation (TAVI) to surgery, 2) procedural settings, and 3) short-term outcome of converted patients. METHODS AND RESULTS The prospective German TAVI registry was used to identify patients who underwent bail-out surgery during TAVI. Additionally, standardised questionnaires were developed and used to assess more detailed periprocedural and postprocedural data. Emergency conversion from TAVI to open cardiac surgery was required in 24 of 1,975 patients (1.2%). Primary conversion causes were aorto-valvular complications (i.e., aortic annulus rupture, aortic perforation, or thoracic aortic dissection). This was followed by prosthesis embolisation, myocardial perforation, severe aortic regurgitation, and coronary obstructions. The mean time interval between abortions of TAVI to surgery was 19 minutes (SD ± 17 min, range 5-80 min). Four of 24 patients (16.7%) died during the initial surgery, seven of 24 (29.2%) within the first 72 hours and the 30-day mortality was 45.8%. The highest mortality was observed in patients with aortic perforation or dissection (4/5, 80%). Mortality rates for other entities were: prosthesis embolisation 40% (2/5), myocardial perforation 50% (2/4), annulus rupture 67% (2/3), severe aortic regurgitation 33% (1/3), and coronary impairment 0% (0/3). CONCLUSIONS Emergency conversion from TAVI to surgery is a rare event carrying a mortality of around 45% after 30 days. Outcome of converted patients with prior injury of aortic, aorto-valvular, or myocardial tissue during TAVI was poor, whereas patients with severe aortic regurgitation and those with coronary complications had a more favourable outcome after 30 days. Collected procedural and outcome data demand on-site cardiac surgery as a prerequisite for TAVI and constant process optimisation efforts regarding such emergency scenarios.
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Affiliation(s)
- Ralph Hein
- Städtisches Klinikum München GmbH, Klinikum Neuperlach, Department of Cardiology, Munich, Germany
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Witkowski A, Jastrzebski J, Dabrowski M, Chmielak Z. Second transcatheter aortic valve implantation for treatment of suboptimal function of previously implanted prosthesis: review of the literature. J Interv Cardiol 2014; 27:300-7. [PMID: 24731263 DOI: 10.1111/joic.12120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To systematically review reported cases of second transcatheter aortic valve deployment within a previously implanted prosthesis (TAV-in-TAV). BACKGROUND TAV-in-TAV deployment is one of the rescue strategies undertaken due to an unsuccessful or suboptimal transcatheter aortic valve implantation (TAVI) result. Currently, there are no clear indications for second valve implantation and outcomes of patients with 2 prostheses deployed remain poorly known. METHODS The MEDLINE and PubMed databases were searched for cases of TAV-in-TAV implantations of aortic valve. RESULTS Forty-three articles reporting on TAV-in-TAV deployment were included in the review. The most frequently observed indication for second valve implantation was aortic regurgitation (AR) occurring shortly after TAVI. There was a strong dominance of paravalvular over intravalvular AR, with prosthesis malposition being the main underlying cause of TAVI failure (81% of all identified cases). Perioperative echocardiographic images are crucial in identifying causes of failure and helpful in optimal rescue strategy selection. Success rate of TAV-in-TAV implantation varies from 90% to 100% with mortality rate of 0-14.3% at 30 days. Despite similar aortic valve function in follow-up, TAV-in-TAV may be an independent predictor of increased cardiovascular mortality. CONCLUSIONS TAV-in-TAV implantation is feasible and results in favorable short- and mid-term outcomes in patients with acute failure of TAVI without recourse to open-heart surgery. Further studies are needed to establish algorithm of the management of unsuccessful or suboptimal implantation results.
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Affiliation(s)
- Adam Witkowski
- Interventional Cardiology and Angiology Department, Institute of Cardiology, Warsaw, Poland
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Pagnotta P, Ferrante G, Presbitero P. Rescue “valve in valve” implantation after late onset corevalve cusp rupture leading to acute massive aortic insufficiency. Catheter Cardiovasc Interv 2013; 83:E283-6. [DOI: 10.1002/ccd.23155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 03/19/2011] [Indexed: 11/10/2022]
Affiliation(s)
- Paolo Pagnotta
- Department of Interventional Cardiology; Istituto Clinico Humanitas IRCCS, Rozzano; Milan Italy
| | - Giuseppe Ferrante
- Department of Interventional Cardiology; Istituto Clinico Humanitas IRCCS, Rozzano; Milan Italy
| | - Patrizia Presbitero
- Department of Interventional Cardiology; Istituto Clinico Humanitas IRCCS, Rozzano; Milan Italy
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MSCT guided sizing of the Edwards Sapien XT TAVI device: Impact of different degrees of oversizing on clinical outcome. Int J Cardiol 2013; 168:2658-64. [DOI: 10.1016/j.ijcard.2013.03.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 02/11/2013] [Accepted: 03/17/2013] [Indexed: 11/22/2022]
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Noble S, Cikirikcioglu M, Roffi M. Massive aortic regurgitation following paravalvular balloon valvuloplasty of an Edwards SAPIEN valve treated by emergent CoreValve implantation: never cross a transcatheter aortic valve without a pigtail. Catheter Cardiovasc Interv 2013; 82:E609-12. [PMID: 23460365 DOI: 10.1002/ccd.24906] [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: 11/27/2012] [Accepted: 02/26/2013] [Indexed: 11/08/2022]
Abstract
A 72-year-old patient, with a history of coronary artery bypass and aorto-bifemoral graft, was diagnosed with a symptomatic severe aortic valve stenosis in the presence of moderately decreased left ventricular function. The Heart team decision was to implant an Edwards SAPIEN XT 26 mm valve by transapical approach, therefore avoiding access through the aorto-bifemoral graft. At the end of the procedure, grades 2-3 aortic regurgitation was observed. Since each run of rapid pacing ended in ventricular fibrillation, it was decided to treat the aortic regurgitation conservatively with the option of post-dilation in a second procedure if hemodynamic deterioration was observed. Six days later balloon valvuloplasty was performed because of heart failure requiring endotracheal intubation. Despite transesophageal echocardiography guidance the balloon was inadvertently advanced through the paravalvular space. As a consequence, balloon valvuloplasty was complicated by massive aortic regurgitation and severe hemodynamic instability which was resolved after emergency transfemoral implantation of a CoreValve. Without any further complications, the patient was discharged eight days later.
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Affiliation(s)
- Stéphane Noble
- Department of Medical Specialties, Université de Genève, Geneva, Switzerland
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Dvir D, Barbash IM, Ben-Dor I, Torguson R, Badr S, Minha S, Pendyala LK, Loh JP, Pichard AD, Waksman R. Paravalvular regurgitation after transcatheter aortic valve replacement: Diagnosis, clinical outcome, preventive and therapeutic strategies. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:174-81. [DOI: 10.1016/j.carrev.2013.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 02/22/2013] [Indexed: 10/26/2022]
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Zahn R, Schiele R, Zeymer U, Bauer T, Lehmann A, Cornelius B, Sack FU. Occlusion of the left main stem: a rare, but life-threatening complication of transcatheter aortic valve implantation with the Medtronic CoreValve™ prosthesis. Clin Res Cardiol 2013; 102:323-6. [DOI: 10.1007/s00392-013-0538-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 01/15/2013] [Indexed: 01/03/2023]
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12
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Dvir D, Lavi I, Eltchaninoff H, Himbert D, Almagor Y, Descoutures F, Vahanian A, Tron C, Cribier A, Kornowski R. Multicenter evaluation of Edwards SAPIEN positioning during transcatheter aortic valve implantation with correlates for device movement during final deployment. JACC Cardiovasc Interv 2012; 5:563-570. [PMID: 22625196 DOI: 10.1016/j.jcin.2012.03.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/27/2012] [Accepted: 03/02/2012] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This study sought to evaluate the exact location of Edwards SAPIEN (Edwards Lifesciences, Irvine, California) devices in different stages of implantation and to quantify possible operator-independent device movement during final deployment. BACKGROUND Accurate device positioning during transcatheter aortic valve implantation is crucial in order to achieve optimal results. METHODS This multicenter study consisted of 68 procedures with reliable pacemaker capture. Device positions were assessed using fluoroscopic images and the C-THV system (Paieon Medical, Rosh Ha'Ayin, Israel). RESULTS The location after implantation was significantly higher than in the final stage of rapid pacing: 16.7 ± 16.3% of device height below the plane of the lower sinus border versus 32.6 ± 13.8%, p < 0.0001. Operator-independent device-center upper movement during final deployment was 2 ± 1.43 mm, range: -1.3 to 4.6 mm. Device movement was asymmetrical, occurring more in the lower part of the device than in its upper part (3.2 ± 1.4 mm vs. 0.75 ± 1.5 mm, p < 0.001), resulting in device shortening. Multivariate analysis revealed that moderate and severe aortic valve calcification had 49% higher upward movement than mild calcification (p = 0.03), and aortic sinus volume was negatively correlated with movement size (r = -0.35, p = 0.005). This movement was independent of device version (SAPIEN vs. SAPIEN XT), procedural access (transfemoral vs. transapical), and interventricular septum width. CONCLUSIONS The final Edwards SAPIEN position is mostly aortic in relation to the lower sinus border. There is an operator-independent upward movement of the device center during the final stage of implantation. Anticipated upward movement of the device should influence its positioning before final deployment.
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Affiliation(s)
- Danny Dvir
- Department of Cardiology, Institute of Interventional Cardiology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ifat Lavi
- Department of Cardiology, Institute of Interventional Cardiology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hélène Eltchaninoff
- Department of Cardiology, Charles Nicolle Hospital, University of Rouen, Rouen, France
| | | | - Yaron Almagor
- Department of Cardiology, Sha'are Zedek Medical Center, Jerusalem, Israel
| | | | - Alec Vahanian
- Department of Cardiology, Hôpital Bichat, Paris, France
| | - Christophe Tron
- Department of Cardiology, Charles Nicolle Hospital, University of Rouen, Rouen, France
| | - Alain Cribier
- Department of Cardiology, Charles Nicolle Hospital, University of Rouen, Rouen, France
| | - Ran Kornowski
- Department of Cardiology, Institute of Interventional Cardiology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Bloomfield GS, Gillam LD, Hahn RT, Kapadia S, Leipsic J, Lerakis S, Tuzcu M, Douglas PS. A practical guide to multimodality imaging of transcatheter aortic valve replacement. JACC Cardiovasc Imaging 2012; 5:441-55. [PMID: 22498335 DOI: 10.1016/j.jcmg.2011.12.013] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 11/27/2011] [Accepted: 12/13/2011] [Indexed: 12/31/2022]
Abstract
The advent of transcatheter aortic valve replacement (TAVR) is one of the most widely anticipated advances in the care of patients with severe aortic stenosis. This procedure is unique in many ways, one of which is the need for a multimodality imaging team-based approach throughout the continuum of the care of TAVR patients. Pre-procedural planning, intra-procedural implantation optimization, and long-term follow-up of patients undergoing TAVR require the expert use of various imaging modalities, each of which has its own strengths and limitations. Divided into 3 sections (pre-procedural, intraprocedural, and long-term follow-up), this review offers a single source for expert opinion and evidence-based guidance on how to incorporate the various modalities at each step in the care of a TAVR patient. Although much has been learned in the short span of time since TAVR was introduced, recommendations are offered for clinically relevant research that will lead to refinement of best practice strategies for incorporating multimodality imaging into TAVR patient care.
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Affiliation(s)
- Gerald S Bloomfield
- Division of Cardiovascular Medicine, Duke University Medical Center, and Duke Clinical Research Institute, Durham, North Carolina 27715, USA
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Gotzmann M, Lindstaedt M, Mügge A. From pressure overload to volume overload: aortic regurgitation after transcatheter aortic valve implantation. Am Heart J 2012; 163:903-11. [PMID: 22709742 DOI: 10.1016/j.ahj.2012.03.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 03/21/2012] [Indexed: 10/28/2022]
Abstract
Severe aortic valve stenosis is a common valvular heart disease that is characterized by left ventricular (LV) pressure overload. A lasting effect of pressure overload is LV remodeling, accompanied by concentric hypertrophy and increased myocardial stiffness. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement for patients with severe symptomatic aortic valve stenosis and high surgical risk. Although TAVI has favorable hemodynamic performance, aortic valve regurgitation (AR) is the most frequent complication because of the specific technique used for implantation of transcatheter valves. During implantation, the calcified native valve is pushed aside, and the prosthesis usually achieves only an incomplete prosthesis apposition. As a consequence, the reported prevalence of moderate and severe AR after TAVI is 6% to 21%, which is considerably higher than that after a surgical valve replacement. Although mild AR probably has minor hemodynamic effects, even moderate AR might result in serious consequences. In moderate and severe AR after TAVI, a normal-sized LV with increased myocardial stiffness has been exposed to volume overload. Because the noncompliant LV is unable to raise end-diastolic volume, the end-diastolic pressure increases, and the forward stroke volume decreases. In recent years, an increasing number of patients have successfully undergone TAVI. Despite encouraging overall results, a substantial number of patients receive neither symptomatic nor prognostic benefits from TAVI. Aortic valve regurgitation has been considered a potential contributor to morbidity and mortality after TAVI. Therefore, various strategies and improvements in valve designs are mandatory to reduce the prevalence of AR after TAVI.
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Patel PA, Fassl J, Thompson A, Augoustides JGT. Transcatheter aortic valve replacement--part 3: the central role of perioperative transesophageal echocardiography. J Cardiothorac Vasc Anesth 2012; 26:698-710. [PMID: 22578977 DOI: 10.1053/j.jvca.2012.03.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Prakash A Patel
- Cardiothoracic and Vascular Section, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA
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Interventional options for severe aortic regurgitation after transcatheter aortic valve implantation: balloons, snares, valve-in-valve. Clin Res Cardiol 2012; 101:503-7. [DOI: 10.1007/s00392-012-0434-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 02/20/2012] [Indexed: 11/26/2022]
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Akin I, Kische S, Schneider H, Liebold A, Ortak J, Bänsch D, Rehders TC, Thiele O, Schneider R, Kundt G, Krenz H, Chatterjee T, Nienaber CA, Ince H. Surface and intracardiac ECG for discriminating conduction disorders after CoreValve implantation. Clin Res Cardiol 2011; 101:357-64. [PMID: 22179507 PMCID: PMC3326231 DOI: 10.1007/s00392-011-0400-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 12/07/2011] [Indexed: 11/30/2022]
Abstract
Background Transcatheter aortic valve implantation (TAVI) has been developed to minimize operative morbidity and mortality in high-risk symptomatic patients unfit for open surgery. With the proximity of the aortic valve annulus to the conduction system there is, however, an unknown risk of conduction disturbances necessitating monitoring and often cardiac pacing. Materials and methods We enrolled 50 consecutive patients from January 2007 to 2008 in our prospective evaluation of conduction disturbances measured by surface and intracardiac ECG recordings. Baseline parameters, procedural characteristics as well as twelve-lead surface ECG and intracardiac conduction times were revealed pre-interventionally, after TAVI and at 7-day follow-up. Results TAVI was performed successfully in all patients. During 7 days of follow-up the rate for first-degree AV block raised from 14% at baseline to 44% at day 7 (p < 0.001), while rates for type II second- and third-degree were 0 versus 8% (p < 0.001) and 0 versus 12% (p < 0.001), respectively. Similarly, the prevalence of new left bundle branch block (LBBB) rose from 2 to 54% (p < 0.001). Intracardiac measurements revealed a prolongation of both AH and HV interval from 123.7 ± 41.6 to 136.6 ± 40.5 ms (p < 0.001) and from 54.8 ± 11.7 to 71.4 ± 20.0 ms (p < 0.001), respectively. Pacemaker implantation at a mean follow-up of 4.8 ± 1.2 days was subsequently performed in 23 patients (46%) due to complete AV block (12%) and type II second-degree AV block (8%) while another 13 patients (26%) received a pacemaker for the combination of new LBBB with marked HV prolongation. The high rate of first-degree AV block was primarily driven by an increase in HV interval. Conclusion Cardiac conduction disturbances were common in the early experience with CoreValve implantation necessitating close surveillance for at least 1 week.
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Affiliation(s)
- I Akin
- Heart Center Rostock, Department of Internal Medicine I, Rostock School of Medicine, University Hospital Rostock, Rostock, Germany
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Raffa GM, Malvindi PG, Settepani F, Ornaghi D, Basciu A, Cappai A, Tarelli G. Aortic Valve Replacement for Paraprosthetic Leak After Transcatheter Implantation. J Card Surg 2011; 27:47-51. [DOI: 10.1111/j.1540-8191.2011.01351.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Young E, Chen JF, Dong O, Gao S, Massiello A, Fukamachi K. Transcatheter Heart Valve With Variable Geometric Configuration: In Vitro Evaluation. Artif Organs 2011; 35:1151-9. [DOI: 10.1111/j.1525-1594.2011.01331.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Current World Literature. Curr Opin Anaesthesiol 2011; 24:463-5. [DOI: 10.1097/aco.0b013e3283499d5a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Takagi K, Latib A, Al-Lamee R, Mussardo M, Montorfano M, Maisano F, Godino C, Chieffo A, Alfieri O, Colombo A. Predictors of moderate-to-severe paravalvular aortic regurgitation immediately after CoreValve implantation and the impact of postdilatation. Catheter Cardiovasc Interv 2011; 78:432-43. [PMID: 21793168 DOI: 10.1002/ccd.23003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 01/16/2011] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the predictors of moderate-to-severe aortic regurgitation (AR≥2+) after CoreValve implantation and evaluate the feasibility and safety of postdilatation in reducing the degree of AR. BACKGROUND Although transcatheter aortic valve implantation is an alternative treatment for high surgical risk patients with severe aortic stenosis, post-implantation paravalvular AR remains a complication. METHODS From July 2008 to July 2010, we enrolled 79 consecutive patients with severe aortic stenosis who underwent CoreValve implantation. RESULTS On univariable analysis, the predictors of AR≥2+ immediately after CoreValve implantation were: larger annulus size, low implantation, prosthesis mismatch, chronic renal insufficiency, a history of heart failure, and peripheral vascular disease. On multivariable analysis, the independent predictors of AR≥2+ were: larger annulus diameter (OR 1.78, 95%CI 1.25-2.55; P = 0.002), low implantation (OR 3.67, 95%CI 1.01-13.35, P = 0.05), and peripheral vascular disease (OR 3.54, 95%CI 1.19-10.56, P = 0.02). Post-CoreValve implantation, AR ≥ 2 was seen in 40.5% (32/79). Twenty-one patients underwent postdilatation with improvement in AR grade in the majority (17/21). Of the four patients who did not respond to postdilatation, two underwent valve-in-valve implantation. In one patient, the valve was pulled more proximally by the snare technique. The remaining 10 patients were treated conservatively. CONCLUSION The appropriate strategy for treating patients with AR≥2+ depends on the causes and severity of AR post-TAVI. This study suggests that we should carefully select the size of CoreValve prosthesis to prevent prosthesis mismatch, especially when implanted in larger annulus sizes. For valves implanted in the appropriate position, postdilatation appears effective in reducing the degree of AR.
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Affiliation(s)
- Kensuke Takagi
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
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Azadani AN, Tseng EE. Transcatheter valve-in-valve implantation for failing bioprosthetic valves. Future Cardiol 2011; 6:811-31. [PMID: 21142638 DOI: 10.2217/fca.10.106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Transcatheter valve implantation is becoming an alternative to conventional surgical valve replacement in patients at high surgical risk. While experience and acceptance with transcatheter techniques increased rapidly, transcatheter valve implantation within failing bioprostheses has emerged as a new concept (valve-in-valve implantation). Currently, the majority of prostheses implanted in patients are bioprosthetic valves that are expected to degenerate over time. Valve-in-valve implantation provides great utility in high-operative-risk patients since the mortality risk for reoperation can be significantly higher than for first-time isolated valve replacement. Although two current devices are CE Mark approved in Europe for implantation within native valves, off-label clinical implementation of valve-in-valve have been described in numerous case reports. In this article, we provide an overview of transcatheter valve implantation in failing bioprostheses with an emphasis on the aortic position.
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Affiliation(s)
- Ali N Azadani
- Division of Cardiothoracic Surgery, University of California at San Francisco (UCSF) Medical Center, San Francisco, CA, USA.
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Di Mario C, Alfieri O, Iung B, Serruys P. Transcatheter valves and interventional cardiology. EUROINTERVENTION 2011; 6:673-7. [DOI: 10.4244/eijv6i6a114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zahn R, Gerckens U, Grube E, Linke A, Sievert H, Eggebrecht H, Hambrecht R, Sack S, Hauptmann KE, Richardt G, Figulla HR, Senges J. Transcatheter aortic valve implantation: first results from a multi-centre real-world registry. Eur Heart J 2010; 32:198-204. [PMID: 20864486 DOI: 10.1093/eurheartj/ehq339] [Citation(s) in RCA: 449] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS Treatment of elderly symptomatic patients with severe aortic stenosis and co-morbidities is challenging. Transcatheter aortic valve interventions [balloon valvuloplasty and transcatheter aortic valve implantation (TAVI)] are evolving as alternative treatment options to surgical valve replacement. We report the first results of the prospective multi-centre German Transcatheter Aortic Valve Interventions-Registry. METHODS AND RESULTS Between January 2009 and December 2009, a total of 697 patients (81.4 ± 6.3 years, 44.2% males, and logistic EuroScore 20.5 ± 13.2%) underwent TAVI. Pre-operative aortic valve area was 0.6 ± 0.2 cm² with a mean transvalvular gradient of 48.7 ± 17.2 mmHg. Transcatheter aortic valve implantation was performed percutaneously in the majority of patients [666 (95.6%)]. Only 31 (4.4%) procedures were done surgically: 26 (3.7%) transapically and 5 (0.7%) transaortically. The Medtronic CoreValve™ prosthesis was used in 84.4%, whereas the Sapien Edwards™ prosthesis was used in the remaining cases. Technical success was achieved in 98.4% with a post-operative mean transaortic pressure gradient of 5.4 ± 6.2 mmHg. Any residual aortic regurgitation was observed in 72.4% of patients, with a significant aortic insufficiency (≥Grade III) in only 16 patients (2.3%). Complications included pericardial tamponade in 1.8% and stroke in 2.8% of patients. Permanent pacemaker implantation after TAVI became necessary in 39.3% of patients. In-hospital death rate was 8.2%, and the 30-day death rate 12.4%. CONCLUSION In this real-world registry of high-risk patients with aortic stenosis, TAVI had a high success rate and was associated with moderate in-hospital complications. However, careful patient selection and continued hospital selection seem crucial to maintain these results.
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Affiliation(s)
- Ralf Zahn
- Abteilung für Kardiologie, Herzzentrum Ludwigshafen, Bremserstrasse 79, Ludwigshafen, Germany.
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Zahn R, Schiele R, Kilkowski C, Klein B, Zeymer U, Werling C, Lehmann A, Layer G, Saggau W. There are two sides to everything: two case reports on sequelae of rescue interventions to treat complications of transcatheter aortic valve implantation of the Medtronic CoreValve prosthesis. Clin Res Cardiol 2010; 99:579-85. [PMID: 20405133 DOI: 10.1007/s00392-010-0166-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 04/07/2010] [Indexed: 11/29/2022]
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