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Kozarek K, Minhaj MM, Chaney MA, D'Ancona G, Pasic M, Carrel T, Cotter EH. Transcatheter Aortic Valve Replacement for Left Ventricular Assist Device-Induced Aortic Insufficiency. J Cardiothorac Vasc Anesth 2018; 32:1982-1990. [PMID: 29699845 DOI: 10.1053/j.jvca.2018.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Katherine Kozarek
- Department of Anesthesiology, Northwestern Medicine, Feinberg School of Medicine, Chicago, IL
| | - Mohammed M Minhaj
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL.
| | | | - Miralem Pasic
- Department for Cardiovascular Surgery, University Hospital and University of Bern, Bern, Switzerland
| | - Thierry Carrel
- Department for Cardiovascular Surgery, University Hospital and University of Bern, Bern, Switzerland
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Möllmann H, Bestehorn K, Bestehorn M, Papoutsis K, Fleck E, Ertl G, Kuck KH, Hamm C. In-hospital outcome of transcatheter vs. surgical aortic valve replacement in patients with aortic valve stenosis: complete dataset of patients treated in 2013 in Germany. Clin Res Cardiol 2016; 105:553-9. [PMID: 26830097 DOI: 10.1007/s00392-016-0962-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/18/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Transvascular (TV-AVI) or transapical (TA-AVI) aortic valve implantation (TAVI) is a treatment option for patients with aortic stenosis being at high or prohibitive risk for surgical aortic valve implantation (SAVR). Randomized data demonstrated that these subgroups can safely been treated with TAVI. However, a comparison of SAVR and TAVI in intermediate and low-risk patients is missing. Therefore, the aim of the analysis was to compare TAVI and SAVR in all patients who were treated for aortic valve stenosis in Germany throughout 1 year. METHODS The mandatory quality assurance collects data on the in-hospital outcome from all patients (n = 20,340) undergoing either SAVR or TAVI in Germany. In order to compare the different treatment approaches patients were categorized into four risk groups using the logistic EuroScore I (ES). In-hospital mortality and peri- and postprocedural complications were analyzed. RESULTS The in-hospital mortality did not differ between TV-AVI and SAVR in the low risk group (ES <10 %: TV-AVI 2.4 %, SAVR 2.0 %, p = 0.302) and was significantly higher for SAVR in all other risk groups (ES 10-20 %: TV-AVI 3.5 %, SAVR 5.3 %; p = 0.025; ES 20-30 %: TV-AVI 5.5 %, SAVR 12.2 %, p < 0.001; ES >30 %: TV-AVI 6.5 %, SAVR 12.9 %, p = 0.008). TA-AVI had a significantly higher mortality in all risk groups compared to TV-AVI. In comparison to SAVR, TA-AVI had a higher mortality in patients with ES <10, comparable mortality in ES 10-20 %, and lower mortality in patients with an ES >20 %. The overall stroke rate was 2.3 %. It occurred more frequently in patients with an ES <10 % treated with a transapical approach (SAVR 1.8 %, TV-AVI 1.9 %, TA-AVI 3.1 %, p < 0.01). There were no statistically significant differences in all other comparisons. CONCLUSIONS This study demonstrates that TAVI provides excellent outcomes in all risk categories. Compared with SAVR, TV-TAVI yields similar in-hospital mortality among low-risk patients and lower in-hospital mortality among intermediate and high-risk patient populations.
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Affiliation(s)
- Helge Möllmann
- Kerckhoff Heart Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.
| | - Kurt Bestehorn
- Institut für klinische Pharmakologie, TU Dresden, Dresden, Germany
| | - Maike Bestehorn
- Institut für klinische Pharmakologie, TU Dresden, Dresden, Germany
| | - Konstantinos Papoutsis
- Deutsche Gesellschaft für Kardiologie, Herz- und Kreislaufforschung, Düsseldorf, Germany
| | - Eckart Fleck
- Deutsche Gesellschaft für Kardiologie, Herz- und Kreislaufforschung, Düsseldorf, Germany
| | - Georg Ertl
- Department of Internal Medicine I, Cardiology, University Hospital Würzburg, Würzburg, Germany
| | | | - Christian Hamm
- Kerckhoff Heart Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
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Gülker JE, Schott P, Katoh M, Bufe A. Case report: Cerebral stentretreiver thrombectomy of an embolized valve fragment after valve in valve TAVI. Clin Res Cardiol 2015; 105:372-5. [DOI: 10.1007/s00392-015-0935-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/22/2015] [Indexed: 12/20/2022]
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Bijuklic K, Hansen L, Witt J, Schofer J. Successful transfemoral Edwards SAPIEN 3 valve in valve implantation in a patient with a degenerated aortic bioprosthesis associated with severe paravalvular aortic regurgitation. Clin Res Cardiol 2014; 104:92-3. [PMID: 25227426 DOI: 10.1007/s00392-014-0760-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 09/04/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Klaudija Bijuklic
- Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Hamburg, Germany,
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Geis NA, Chorianopoulos E, Kallenbach K, André F, Pleger ST, Karck M, Katus HA, Bekeredjian R. Feasibility of sheathless transfemoral aortic valve implantation in patients with small access vessel diameters. Clin Res Cardiol 2014; 103:775-80. [PMID: 24748131 DOI: 10.1007/s00392-014-0713-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/04/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We intended to show feasibility of sheathless transfemoral aortic valve implantation in patients with small access vessel diameters. BACKGROUND Transcatheter aortic valve implantation (TAVI) has emerged as a valid treatment option in patients with aortic valve stenosis who are poor candidates for surgical aortic valve replacement. Few patients, who cannot undergo transfemoral or transsubclavian aortic valve implantation due to small access vessel diameters, are not suitable for transapical or direct aortic valve implantation, either. METHODS In more than 700 transcatheter aortic valve implantations since 2008 we identified 17 patients who had to be excluded from transfemoral valve implantation due to vessel diameters <6 mm and who were no candidates for transapical or direct aortic implantation. We performed CoreValve™ implantations in these patients without the required 18F sheath to cross the vessels despite their small size (4.6-5.9 mm). RESULTS Sixteen sheathless implantations were successful. In all 17 patients, bleeding during the procedure due to the smaller delivery catheter was minimal. Sixteen patients had a successful access site closure at the end of the procedure. CONCLUSIONS Sheathless implantation of a self-expanding aortic valve can be safely considered in selected patients with access vessel diameters below 6 mm, if transapical or direct aortic implantation is not suitable.
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Affiliation(s)
- Nicolas A Geis
- Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Haussig S, Schuler G, Linke A. Worldwide TAVI registries: what have we learned? Clin Res Cardiol 2014; 103:603-12. [PMID: 24648061 DOI: 10.1007/s00392-014-0698-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 03/03/2014] [Indexed: 01/27/2023]
Abstract
With a rapidly aging society, the number of patients with cardiovascular disease-in particular aortic stenosis-is progressively increasing. Although conventional aortic valve replacement remains the only treatment known to improve prognosis and symptoms in symptomatic patients with aortic stenosis, about one-third are still withhold from the life-saving therapy. Based on the compelling evidence of the randomized Placement of Aortic transcatheter valves (PARTNER) A and B cohort, TAVI is now considered standard of care for extreme risk and inoperable patients and is an alternative to surgery for high-risk patients with symptomatic aortic stenosis. However, these patients were super-selected, which does not reflect a clinical real-world situation. TAVI registries represent a real-world scenario, and therefore provide the evidence for the treatment of high-risk patients (regarding comorbidities and anatomical factors) in daily clinical life. The review will focus on the recently published Edwards SAPIEN, Medtronic CoreValve and mixed (national) registries with the focus on short- and midterm outcome. These registries suggest that the growing experience of the operators with regard to patient selection, prevention, recognition and treatment of procedural complications together with the developments in valve design will improve the short-term results of TAVI. However, randomized trials in intermediate risk patients and data on long-term valve durability are a prerequisite before indications can be expanded to younger and lower risk patient population.
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Affiliation(s)
- Stephan Haussig
- Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany
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FAERBER GLORIA, SCHLEGER SIMONE, DIAB MAHMOUD, BREUER MARTIN, FIGULLA HANSR, EICHINGER WALTERB, DOENST TORSTEN. Valve-in-Valve Transcatheter Aortic Valve Implantation: The New Playground for Prosthesis-Patient Mismatch. J Interv Cardiol 2014; 27:287-92. [DOI: 10.1111/joic.12108] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- GLORIA FAERBER
- Department of Cardiothoracic Surgery; Jena University Hospital; Friedrich Schiller University; Jena Germany
| | - SIMONE SCHLEGER
- Department of Cardiac Surgery; Hospital Bogenhausen; Munich Germany
| | - MAHMOUD DIAB
- Department of Cardiothoracic Surgery; Jena University Hospital; Friedrich Schiller University; Jena Germany
| | - MARTIN BREUER
- Department of Cardiothoracic Surgery; Jena University Hospital; Friedrich Schiller University; Jena Germany
| | - HANS R. FIGULLA
- Department of Cardiology; Angiology and Pulmonology; Jena University Hospital; Friedrich Schiller University; Jena Germany
| | | | - TORSTEN DOENST
- Department of Cardiothoracic Surgery; Jena University Hospital; Friedrich Schiller University; Jena Germany
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Fernández D, Cevallos J, Brugaletta S, Martín-Yuste V, Freixa X, Andrea R, Falces C, Regueiro-Cueva A, Masotti M, Sabaté M. Percutaneous transcatheter aortic valve implantation: present and future perspective. Expert Rev Med Devices 2014; 10:185-99. [DOI: 10.1586/erd.12.78] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Diemert P, Lange P, Greif M, Seiffert M, Conradi L, Massberg S, Blankenberg S, Reichenspurner H, Hagl C, Schmitz C, Schröfel H, Treede H, Schymik G, Kupatt C. Edwards Sapien XT valve placement as treatment option for aortic regurgitation after transfemoral CoreValve implantation: a multicenter experience. Clin Res Cardiol 2013; 103:183-90. [DOI: 10.1007/s00392-013-0632-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 11/05/2013] [Indexed: 11/27/2022]
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Claiborne TE, Slepian MJ, Hossainy S, Bluestein D. Polymeric trileaflet prosthetic heart valves: evolution and path to clinical reality. Expert Rev Med Devices 2013; 9:577-94. [PMID: 23249154 DOI: 10.1586/erd.12.51] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Present prosthetic heart valves, while hemodynamically effective, remain limited by progressive structural deterioration of tissue valves or the burden of chronic anticoagulation for mechanical valves. An idealized valve prosthesis would eliminate these limitations. Polymeric heart valves (PHVs), fabricated from advanced polymeric materials, offer the potential of durability and hemocompatibility. Unfortunately, the clinical realization of PHVs to date has been hampered by findings of in vivo calcification, degradation and thrombosis. Here, the authors review the evolution of PHVs, evaluate the state of the art of this technology and propose a pathway towards clinical reality. In particular, the authors discuss the development of a novel aortic PHV that may be deployed via transcatheter implantation, as well as its optimization via device thrombogenicity emulation.
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Affiliation(s)
- Thomas E Claiborne
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
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Abstract
Transcatheter valve implantation or repair has been a very promising approach for the treatment of valvular heart diseases since transcatheter aortic valve implantation (TAVI) was successfully performed in 2002. Great achievements have been made in this field (especially TAVI and transcatheter mitral valve repair--MitraClip system) in recent years. Evidence from clinical trials or registry studies has proved that transcatheter valve treatment for valvular heart diseases is safe and effective in surgical high-risk or inoperable patients. As the evidence accumulates, transcatheter valve treatment might be an alterative surgery for younger patients with surgically low or intermediate risk valvular heart diseases in the near future. In this paper, the updates on transcatheter valve treatment are reviewed.
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Affiliation(s)
- Xian-bao Liu
- Cardiovascular Key Lab of Zhejiang Province, Department of Cardiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
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Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. J Am Coll Cardiol 2013; 61:837-48. [PMID: 23428216 DOI: 10.1016/j.jacc.2012.10.049] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 09/18/2012] [Accepted: 10/16/2012] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The study sought to contrast risk profiles and compare outcomes of patients with severe aortic stenosis (AS) and coronary artery disease (CAD) who underwent aortic valve replacement (AVR) and coronary artery bypass grafting (AS+CABG) with those of patients with isolated AS who underwent AVR alone. BACKGROUND In patients with severe AS, CAD is often an incidental finding with underappreciated survival implications. METHODS From October 1991 to July 2010, 2,286 patients underwent AVR+CABG and 1,637 AVR alone. A propensity score was developed and used for matched comparisons of outcomes (1,082 patient pairs). Analyses of long-term mortality were performed for each group, then combined to identify common and unique risk factors. RESULTS Patients with AS+CAD versus isolated AS were older, more symptomatic, and more likely to be hypertensive, and had lower ejection fraction and greater arteriosclerotic burden but less severe AS. Hospital morbidity and long-term survival were poorer (43% vs. 59% at 10 years). Both groups shared many mortality risk factors; however, early risk among AS+CAD patients reflected effects of CAD; late risk reflected diastolic left ventricular dysfunction expressed as ventricular hypertrophy and left atrial enlargement. Patients with isolated AS and few comorbidities had the best outcome, those with CAD without myocardial damage had intermediate outcome equivalent to propensity-matched isolated AS patients, and those with CAD, myocardial damage, and advanced comorbidities had the worst outcome. CONCLUSIONS Cardiovascular risk factors and comorbidities must be considered in managing patients with severe AS. Patients with severe AS and CAD risk factors should undergo early diagnostics and AVR+CABG before ischemic myocardial damage occurs.
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Safety and efficacy of the subclavian access route for TAVI in cases of missing transfemoral access. Clin Res Cardiol 2013; 102:627-36. [DOI: 10.1007/s00392-013-0575-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 04/25/2013] [Indexed: 11/30/2022]
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