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Rimskaya EM, Mironova NA, Sokolov SF, Golitsyn SP. [Left bundle branch block - dilated cardiomyopathy - heart failure: common links in the closed pathogenetic chain]. KARDIOLOGIIA 2023; 63:68-76. [PMID: 36880146 DOI: 10.18087/cardio.2023.2.n1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/23/2021] [Indexed: 03/08/2023]
Abstract
This review summarizes the available information on the epidemiology and prognosis of patients with left bundle branch block (LBBB), morphological alterations of the myocardium both resulting in and ensuing LBBB, cardiac biomechanics in LBBB, and possibilities of its correction.
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Affiliation(s)
- E M Rimskaya
- Chazov National Medical Research Center of Cardiology
| | - N A Mironova
- Chazov National Medical Research Center of Cardiology
| | - S F Sokolov
- Chazov National Medical Research Center of Cardiology
| | - S P Golitsyn
- Chazov National Medical Research Center of Cardiology
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2
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Lee KH, Yagishita A, Ohno Y, Sakai T, Sakai K, Miyamoto J, Horinouchi H, Sakama S, Kamioka N, Murakami T, Ayabe K, Amino M, Yoshioka K, Ikari Y. Late-onset atrioventricular block after transcatheter aortic valve replacement. Heart Rhythm O2 2022; 2:607-613. [PMID: 34988505 PMCID: PMC8703188 DOI: 10.1016/j.hroo.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Conduction disturbances leading to permanent pacemaker implantation (PPI) rarely occur late after transcatheter aortic valve replacement (TAVR). The clinical features of this phenomenon and its association with periprocedural conduction disturbances remain uncertain. Objectives We aimed to determine the incidence and characteristics of late-onset atrioventricular block (AVB) after TAVR. Methods This single-center study included 246 patients undergoing TAVR. Late-onset AVB was defined as AVB ≥1 month after the TAVR. Results Periprocedural AVB (periAVB) occurred in 43 patients (17%). Patients with periAVB had a higher rate of right bundle branch block (47% vs 7%, P < .0001). Of the 43 patients with periAVB, 15 underwent PPI (35%) at a median duration of 6 days, whereas 1 of the remaining 203 patients without periAVB underwent PPI within 1 month (0.5%). During a median follow-up duration of 365 days, late-onset AVB occurred in 10 of 230 patients without PPI within 1 month (4%) at a median duration of 76 days. All 10 patients presented transient periprocedural atrioventricular conduction disturbances, including 8 patients with periAVB (80%), all of whom recovered within 1 month, and 9 patients underwent self-expanding valve implantation (90%). The mortality rate in patients with PPI within 1 month was higher than in those without, although the difference was not statistically significant (hazard ratio 2.68, 95% confidence interval 0.97–9.05, log-rank P = .09). Conclusion Late-onset AVB occurred in a minority of patients undergoing TAVR. Greater vigilance is warranted, particularly in patients with transient conduction disturbances during the periprocedural period following self-expanding valve implantation.
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Affiliation(s)
| | - Atsuhiko Yagishita
- Address reprint requests and correspondence: Dr Atsuhiko Yagishita, Department of Cardiology, Tokai University, Shimokasuya 143, Isehara, Kanagawa, Japan.
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Bayer AS, Chambers HF. Prosthetic Valve Endocarditis Diagnosis and Management- New Paradigm Shift Narratives. Clin Infect Dis 2021; 72:1687-1692. [PMID: 33458755 DOI: 10.1093/cid/ciab036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Indexed: 12/12/2022] Open
Abstract
Prosthetic valve endocarditis (PVE) is a major infectious disease problem due to the increasing numbers of patients undergoing valve replacement surgery. PVE can present diagnostic difficulties echocardiographically, especially when complicating transvascular placement techniques. Moreover, outbreaks of unusual PVE pathogens, such as Mycobacterium chimaera, have presented major diagnostic and therapeutic dilemmas.
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Affiliation(s)
- Arnold S Bayer
- The Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Henry F Chambers
- The Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco School of Medicine, San Francisco, California, USA
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Vicent L, Fernández‐Cordón C, Nombela‐Franco L, Escobar‐Robledo LA, Ayesta A, Ariza Solé A, Gómez‐Doblas JJ, Bernal E, Tirado‐Conte G, Cobiella J, González‐Saldivar H, López‐Otero D, Díez‐Villanueva P, Sarnago F, Armario X, Bayés‐de-Luna A, Martínez‐Sellés M. Baseline ECG and Prognosis After Transcatheter Aortic Valve Implantation: The Role of Interatrial Block. J Am Heart Assoc 2020; 9:e017624. [PMID: 33140688 PMCID: PMC7763710 DOI: 10.1161/jaha.120.017624] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/25/2020] [Indexed: 01/03/2023]
Abstract
Background The clinical significance of conduction disturbances after transcatheter aortic valve implantation has been described; however, little is known about the influence of baseline ECGs in the prognosis of these patients. Our aim was to study the influence of baseline ECG parameters, including interatrial block (IAB), in the prognosis of patients treated with transcatheter aortic valve implantation. Methods and Results The BIT (Baseline Interatrial Block and Transcatheter Aortic Valve Implantation) registry included 2527 patients with aortic stenosis treated with transcatheter aortic valve implantation. A centralized analysis of baseline ECGs was performed. Patients were divided into 4 groups: normal P wave duration (<120 ms); partial IAB (P wave duration ≥120 ms, positive in the inferior leads); advanced IAB (P wave duration ≥120 ms, biphasic [+/-] morphology in the inferior leads); and nonsinus rhythm (atrial fibrillation/flutter and paced rhythm). The mean age of patients was 82.6±9.8 years and 1397 (55.3%) were women. A total of 960 patients (38.0%) had a normal P wave, 582 (23.0%) had partial IAB, 300 (11.9%) had advanced IAB, and 685 (27.1%) presented with nonsinus rhythm. Mean follow-up duration was 465±171 days. Advanced IAB was the only independent predictor of all-cause mortality (hazard ratio [HR], 1.48; 95% CI, 1.10-1.98 [P=0.010]) and of the composite end point (death/stroke/new atrial fibrillation) (HR, 1.51; 95% CI, 1.17-1.94 [P=0.001]). Conclusions Baseline ECG characteristics influence the prognosis of patients with aortic stenosis treated with transcatheter aortic valve implantation. Advanced IAB is present in about an eighth of patients and is associated with all-cause death and the composite end point of death, stroke, and new atrial fibrillation during follow-up.
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Affiliation(s)
- Lourdes Vicent
- Department of CardiologyHospital General Universitario Gregorio MarañónCIBERCVMadridSpain
- Department of CardiologyHospital General Universitario 12 de OctubreCIBERCVMadridSpain
| | - Clara Fernández‐Cordón
- Department of CardiologyHospital General Universitario Gregorio MarañónCIBERCVMadridSpain
| | | | - Luis Alberto Escobar‐Robledo
- Department of CardiologyHospital de la Santa Creu i Sant Pau. Fundación Investigación Cardiovascular. Programa‐ICCC CardiovascularInstitut de Recerca del Hospital de la Santa Creu I Sant PauIIB‐Sant Pau Barcelona, SpainBarcelonaSpain
| | - Ana Ayesta
- Department of CardiologyHospital Universitario Central de AsturiasOviedoAsturiasSpain
| | - Albert Ariza Solé
- Department of CardiologyBellvitge University Hospital. L’Hospitalet de LlobregatBarcelonaSpain
| | | | - Eva Bernal
- Department of CardiologyHospital Universitari Germans Trias i Pujol BadalonaBarcelonaSpain
| | | | - Javier Cobiella
- Cardiovascular InstituteHospital Clinico San Carlos, IdISSCMadridSpain
| | - Hugo González‐Saldivar
- Department of CardiologyHospital General Universitario Gregorio MarañónCIBERCVMadridSpain
| | - Diego López‐Otero
- Department of CardiologyHospital Cínico UniversitarioSantiago de CompostelaSpain
| | | | - Fernando Sarnago
- Department of CardiologyHospital General Universitario 12 de OctubreCIBERCVMadridSpain
| | - Xavier Armario
- Department of CardiologyHospital de la Santa Creu i Sant Pau. Fundación Investigación Cardiovascular. Programa‐ICCC CardiovascularInstitut de Recerca del Hospital de la Santa Creu I Sant PauIIB‐Sant Pau Barcelona, SpainBarcelonaSpain
| | - Antonio Bayés‐de-Luna
- Department of CardiologyHospital de la Santa Creu i Sant Pau. Fundación Investigación Cardiovascular. Programa‐ICCC CardiovascularInstitut de Recerca del Hospital de la Santa Creu I Sant PauIIB‐Sant Pau Barcelona, SpainBarcelonaSpain
| | - Manuel Martínez‐Sellés
- Department of CardiologyHospital General Universitario Gregorio MarañónCIBERCVMadridSpain
- Universidad EuropeaUniversidad ComplutenseMadridSpain
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Ruile P, Pache G, Minners J, Hein M, Neumann FJ, Breitbart P. Fusion imaging of pre- and post-procedural computed tomography angiography in transcatheter aortic valve implantation patients: evaluation of prosthesis position and its influence on new conduction disturbances. Eur Heart J Cardiovasc Imaging 2020; 20:781-788. [PMID: 30544215 DOI: 10.1093/ehjci/jey195] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/23/2018] [Accepted: 11/15/2018] [Indexed: 02/03/2023] Open
Abstract
AIMS The purpose of this study was to evaluate prosthesis position by fusion of pre- and post-transcatheter aortic valve implantation (TAVI) computed tomography angiography (CTA) images and to investigate its influence on the occurrence of new conduction disturbances (CD). METHODS AND RESULTS We performed CTA fusion imaging in 120 TAVI patients (Edwards Sapien 3) on a standard image post-processing workstation to obtain a 3D reconstruction of the transcatheter heart valve (THV) position within the native annulus region. Optimal implantation depth of the THV was defined according to the manufacturers recommendations as 70-80% of the prosthesis above (aortic) and 20-30% below (ventricular) the native annulus plane. Pre- and post-interventional electrocardiograms (ECGs) were assessed for the development of new CD. THV position was found to be within, above, or below the prespecified margins in 32 patients (27%), 71 patients (59%), and 17 patients (14%), respectively. Interobserver reliability was high for fusion measurements [e.g. median THV position 0.983, 95% confidence interval (CI): 0.935-0.996]. Patients with low stent position were significantly more likely to develop new CD compared with patients with optimal or high stent position (P = 0.039). Independent predictors of CD in multivariate analysis were low THV position [odds ratio (CI): 1.362 (1.093-1.698), P = 0.006] and calcification of the device landing zone [odds ratio (CI): 1.149 (1.024-1.289), P = 0.018]. CONCLUSION Fusion imaging of pre- and post-TAVI-CTA allows for the exact evaluation of THV position in relation to the native annulus plane. A low THV position as assessed by fusion imaging is associated with the development of new CD post-TAVI.
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Affiliation(s)
- Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Gregor Pache
- Section of Cardiovascular Radiology, Department of Radiology, University of Freiburg, Hugstetterstr. 55, Freiburg, Germany
| | - Jan Minners
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Philipp Breitbart
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, Bad Krozingen, Germany
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Breitbart P, Pache G, Minners J, Hein M, Schröfel H, Neumann FJ, Ruile P. Predictors for low TAVI-prosthesis position assessed by fusion imaging of pre- and post-procedural CT angiography. Clin Res Cardiol 2020; 110:93-101. [PMID: 32399896 PMCID: PMC7806565 DOI: 10.1007/s00392-020-01654-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022]
Abstract
Background Low prosthesis position after transcatheter aortic valve implantation (TAVI) is associated with higher rates of new onset conduction disturbances and permanent pacemaker implantations. Purpose of this study was to investigate possible predictors of a low prosthesis position of the SAPIEN 3 (Edwards Lifesciences, Irvine, California, USA) valve type using fusion imaging of pre- and post-procedural computed tomography angiography (CTA). Methods CTA fusion imaging was performed in 120 TAVI-patients with 3D-reconstruction of the transcatheter heart valve (THV) position within the device landing zone. A low implantation position was defined according to the manufacturer’s recommendations as > 30% of the prosthesis below the native annulus plane. Results A low THV position was found in 17 patients (14%). Patients with low THV position had less calcification of the annulus region and a smaller annulus size compared to patients with a normal or high THV position (P = 0.003 and 0.041, respectively). The only independent predictor of a low THV position in multivariate logistic regression analysis was the extent of calcification of the cusp region (odds ratio [CI] 0.842 [0.727–0.976], P = 0.022). Conclusions Fusion imaging of pre-and post-procedural CTA identified reduced calcification of the cusp region as an independent predictor of a low THV position of the SAPIEN 3. This should be considered when planning the TAVI procedure. Graphic abstract Correlation of cusp region calcification and prosthesis position after TAVI ![]()
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Affiliation(s)
- Philipp Breitbart
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany.
| | - Gregor Pache
- Radiology Hegau Bodensee, Practice for Diagnostic Radiology, Singen, Germany
| | - Jan Minners
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Manuel Hein
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Holger Schröfel
- Division of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Philipp Ruile
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
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Subramani S, Arora L, Krishnan S, Hanada S, Sharma A, Ramakrishna H. Analysis of Conduction Abnormalities and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2020; 34:1082-1093. [DOI: 10.1053/j.jvca.2019.07.132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 12/31/2022]
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Infective endocarditis post-transcatheter aortic valve implantation (TAVI), microbiological profile and clinical outcomes: A systematic review. PLoS One 2020; 15:e0225077. [PMID: 31951610 PMCID: PMC6968844 DOI: 10.1371/journal.pone.0225077] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/27/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The data on infective endocarditis after transcatheter aortic valve implantation (TAVI) is scarce and limited to case reports and case series in the literature. It is the need of the hour to analyze the available data on post-TAVI infective endocarditis from the available literature. The objectives of this systematic review were to evaluate the incidence of infective endocarditis after transcatheter aortic valve implantation, its microbiological profile and clinical outcomes. It will help us to improve the antibiotic prophylaxis strategies and treatment options for infective endocarditis in the context of TAVI. METHODS EMBASE, Medline and the CENTRAL trials registry of the Cochrane Collaboration were searched for articles on infective endocarditis in post-TAVI patients till October 2018. Eleven articles were included in the systematic review. The outcomes assessed werethe incidence of infective endocarditis, its microbiological profile andclinical outcomes including major adverse cardiac event (MACE), net adverse clinical event (NACE), surgical intervention and valve-in-valve procedure. RESULTS The incidence of infective endocarditis varied from 0%-14.3% in the included studies, the mean was3.25%. The average duration of follow-up was 474 days (1.3 years). Enterococci were the most common causative organism isolated from 25.9% of cases followed by Staphylococcus aureus (16.1%) and coagulase-negative Staphylococcus species (14.7%). The mean in-hospital mortality and mortality at follow-up was 29.5% and 29.9%, respectively. The cumulative incidence of heart failure, stroke and major bleeding were 37.1%, 5.3% and 11.3%,respectively. Only a single study by Martinez-Selles et al. reported arrhythmias in 20% cases. The septic shock occurred in 10% and 27.7% post-TAVI infective endocarditis patients according to 2 studies. The surgical intervention and valve-in-valve procedure were reported in 11.4% and 6.4% cases, respectively. CONCLUSION The incidence of post-TAVI infective endocarditis is low being 3.25% but it is associated with high mortality and complications. The most common complication is heart failure with a cumulative incidence of 37.1%. Enterococciare the most common causative organism isolated from 25.9% of cases followed by Staphylococcus aureus in 16.1% of cases. Appropriate measures should be taken to prevent infective endocarditis in post-TAVI patients including adequate antibiotics prophylaxis directed specifically against these organisms. STUDY REGISTRATION PROSPERO registration number CRD42018115943.
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Rational and design of the Baseline Interatrial block and Transcatheter aortic valve implantation (BIT) registry. J Electrocardiol 2019; 57:100-103. [PMID: 31629098 DOI: 10.1016/j.jelectrocard.2019.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Aortic stenosis (AS) is currently the most frequent heart valve disease. Symptomatic severe AS has a poor prognosis and transcatheter aortic valve implantation (TAVI) is becoming the therapy of choice in these patients. Changes in the conduction tissue after the procedure constitute one of the main limitations of TAVI, with a frequent need for a definitive pacemaker. Interatrial block (IAB) is defined as a prolonged P-wave duration and is related with atrial fibrosis. The presence of IAB could be a marker of conduction tissue abnormalities at other levels. No study has specifically analyzed the role of IAB as a predictor of the need for permanent pacemaker in patients with AS undergoing TAVI. METHODS The Baseline Interatrial block and Transcatheter aortic valve implantation (BIT) registry will be performed in approximately 3000 patients with severe AS treated with TAVI. A centralized analysis of baseline ECGs will study the presence and type of IAB and other ECG data (rhythm, P-wave duration, PR and QRS intervals/intraventricular conduction disorders). Clinical follow-up will be carried out by local researchers. The primary endpoint will be the requirement of permanent pacemaker during post-TAVI hospitalization. As secondary objectives, the incidence of new onset AF, stroke, or mortality during follow-up will be analyzed. Secondary endpoints will include the incidence of new onset AF, stroke, or mortality during follow-up. CONCLUSION The BIT registry will study, for the first time, the influence of previous IAB in the need of permanent pacemaker after TAVI: This large registry will also provide information regarding the association of this and other ECG parameters with prognosis.
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Frank D, Abdel-Wahab M, Gilard M, Digne F, Souteyrand G, Caussin C, Collart F, Letocart V, Wöhrle J, Kuhn C, Hovorka T, Baumgartner H. Characteristics and outcomes of patients ≤ 75 years who underwent transcatheter aortic valve implantation: insights from the SOURCE 3 Registry. Clin Res Cardiol 2018; 108:763-771. [PMID: 30552511 DOI: 10.1007/s00392-018-1404-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 12/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current trials and registries of transcatheter valve implantation (TAVI) mostly include patients older than 75 years. Little is known about younger patients who undergo this treatment. We investigated comorbidities among patients < 75 years old who underwent TAVI in the SAPIEN 3™ European post-approval SOURCE 3 Registry, and analysed outcomes at 30 days and 1 year. METHODS AND RESULTS Three age groups of patients were analysed for outcomes and characteristics: < 75 (n = 235), 75-80 (n = 391) and ≥ 80 years (n = 1320). Overall, the mean age was 81.6 ± 6.7 years; transfemoral access was used in 87.1% of patients treated with SAPIEN 3 transcatheter heart valves. The mean logistic EuroSCORE increased according to age group (12.6%, 17.3% and 19.7%, respectively, p < 0.001). Younger patients had a higher incidence of comorbidities, particularly those not included in surgical risk score assessment tools, e.g., severe liver disease, previous radiation therapy, and porcelain aorta. Mortality rates were similar between age groups at 30 days (1.7%, 2.0% and 2.3%, respectively, p = 0.79) and 1 year (14.2%, 9.3% and 13.3%, respectively, p = 0.08). However, sudden cardiac death rates were higher in the < 75 years age group compared with the ≥ 85 years age group (20.7% vs. 4.8%, p = 0.010). CONCLUSIONS In current TAVI practice, patients younger than 75 years are a minority (12%). Despite younger age and lower surgical risk scores, this cohort was characterized by comorbidities not accounted for by traditional surgical risk scores. More data are needed for this age group to guide the appropriate decision between surgery and TAVI. CLINICALTRIAL. GOV NUMBER NCT02698956.
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Affiliation(s)
- Derk Frank
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Str. 3, Building 6, 24105, Kiel, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Kiel/Hamburg/Lübeck, Kiel, Germany.
| | | | | | - Franck Digne
- Centre Cardiologique du Nord, Saint-Denis, France
| | | | | | | | | | - Jochen Wöhrle
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Christian Kuhn
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Str. 3, Building 6, 24105, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Kiel/Hamburg/Lübeck, Kiel, Germany
| | - Tomas Hovorka
- Statistics, Edwards Lifesciences, Prague, Czech Republic
| | - Helmut Baumgartner
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
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Ball TN, Vasudevan A, Mi Ko J, Assar MD, McCullough PA, Stoler RC. Analysis of electrocardiographic intervals before and after transcatheter aortic valve implantation to predict the need for permanent pacing. Proc (Bayl Univ Med Cent) 2018; 31:407-413. [PMID: 30948968 DOI: 10.1080/08998280.2018.1471884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/23/2018] [Accepted: 04/30/2018] [Indexed: 10/28/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is growing in utilization in the USA, and atrioventricular heart block is a common complication of the procedure. In patients with conduction system changes following TAVI, there are no clear guidelines for permanent pacing, leading to difficult clinical decisions on how long to leave temporary transvenous pacemakers in place. The aim of our study was to determine whether changes in electrocardiogram characteristics could predict the need for permanent pacing. A retrospective analysis was conducted of 209 consecutive TAVI patients seen from January 2012 to December 2015 at Baylor Heart and Vascular Hospital, Dallas. The baseline characteristics were similar between those who received a permanent pacemaker (PPM) within 7 days of the procedure (21.1%) and those who did not (78.9%); of those who did receive a PPM, 79.5% were implanted for complete heart block. The median (range) percentage change in the sum of QRS and PR was significantly higher in those who received a PPM (20.2%) than those who did not (7.1%) (P = 0.004). Using the percentage change in the sum of QRS and PR to predict PPM, the area under the curve was found to be 0.69. The optimal cutpoint was found to be 18.9% (sensitivity = 0.63, specificity = 0.73). Our study suggests that delay in the conduction system immediately following TAVI predicts the need for permanent pacing.
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Affiliation(s)
- Timothy N Ball
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Baylor Heart and Vascular Institute, and Baylor Jack and Jane Hamilton Heart and Vascular HospitalDallas Texas
| | - Anupama Vasudevan
- Baylor Scott & White Research InstituteDallas Texas.,Division of Cardiology, Texas A&M Health Science Center College of Medicine, Dallas CampusDallas Texas
| | - Jong Mi Ko
- Baylor Scott & White Research InstituteDallas Texas
| | - Manish D Assar
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Baylor Heart and Vascular Institute, and Baylor Jack and Jane Hamilton Heart and Vascular HospitalDallas Texas
| | - Peter A McCullough
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Baylor Heart and Vascular Institute, and Baylor Jack and Jane Hamilton Heart and Vascular HospitalDallas Texas.,Division of Cardiology, Texas A&M Health Science Center College of Medicine, Dallas CampusDallas Texas
| | - Robert C Stoler
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Baylor Heart and Vascular Institute, and Baylor Jack and Jane Hamilton Heart and Vascular HospitalDallas Texas.,Division of Cardiology, Texas A&M Health Science Center College of Medicine, Dallas CampusDallas Texas
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Conduction abnormalities after transcatheter aortic valve implantation. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2018; 15:105-112. [PMID: 29434632 PMCID: PMC5803544 DOI: 10.11909/j.issn.1671-5411.2018.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In the last few years, transcatheter aortic valve implantation (TAVI) has become an alternative procedure in patients with severe aortic stenosis and high risk for surgical aortic replacement. Due to the anatomic correlation between aortic valve structure and conduction system of the heart, one of the most common complications after TAVI is conduction system disturbances which including bundle branch block, complete heart block and need for permanent pacemaker implantation. Although these disturbances are usually not lethal, they may have a great influence on patients' state and long term-survival. Several risk factors for conduction disturbances have been identified which including age, anatomy of the heart, periprocedural factors, type of implanted valve, preexisting abnormalities and comorbidities. As this technique becomes more familiar to physicians, patients should be carefully screened for risk factors for the development of conduction abnormalities after TAVI in order to provide effective prevention and proper treatment.
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Hung CL, Lai YJ, Chi PC, Chen LC, Tseng YM, Kuo JY, Lin CI, Chen YC, Lin SJ, Yeh HI. Dose-related ethanol intake, Cx43 and Nav1.5 remodeling: Exploring insights of altered ventricular conduction and QRS fragmentation in excessive alcohol users. J Mol Cell Cardiol 2017; 114:150-160. [PMID: 29097069 DOI: 10.1016/j.yjmcc.2017.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/05/2017] [Accepted: 10/27/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chronic, excessive ethanol intake has been linked with various electrical instabilities, conduction disturbances, and even sudden cardiac death, but the underlying cause for the latter is insufficiently delineated. METHODS We studied surface electrocardiography (ECG) in a community-dwelling cohort with moderate-to-heavy daily alcohol intake (grouped as >90g/day, ≤90g/day, and nonintake). RESULTS Compared with nonintake, heavier alcohol users showed markedly widened QRS duration and higher prevalence of QRS fragmentation (64.3%, 50.9%, and 33.7%, respectively, χ2 12.0, both p<0.05) on surface ECG across the 3 groups. These findings were successfully recapitulated in 14-week-old C57BL/6 mice that were chronically given a 4% or 6% alcohol diet and showed dose-related slower action potential upstroke, reduced resting membrane potential, and disorganized or decreased intraventricular conduction (all p<0.05). Immunodetection further revealed increased ventricular collagen I depots with Cx43 downregulation and remodeling, together with clustered and diminished membrane Nav1.5 distribution. Administration of Cx43 blocker (heptanol) and Nav1.5 inhibitor (tetrodotoxin) in the mice each attenuated the suppression ventricular conduction compared with nonintake mice (p<0.05). CONCLUSIONS Chronic excessive alcohol ingestion is associated with dose-related phenotypic intraventricular conduction disturbances and QRS fragmentation that can be recapitulated in mice. The mechanisms may involve suppressed gap junction and sodium channel functions, together with enhanced cardiac fibrosis that may contribute to arrhythmogenesis.
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Affiliation(s)
- Chung-Lieh Hung
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Division of Cardiology, Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Jun Lai
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Ching Chi
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Division of Cardiology, Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Chia Chen
- Department of Mechanical Engineering, National Taiwan University, Taipei, Taiwan
| | - Ya-Ming Tseng
- Division of Cardiology, Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Yuan Kuo
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Division of Cardiology, Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-I Lin
- Institute of Physiology, National Defense Medical Center, Taipei, Taiwan; Department of Biophysics, National Defense Medical Center, Taipei, Taiwan
| | - Yao-Chang Chen
- Biomedical Engineering, National Defense Medical Center, Taipei, Taiwan
| | - Shing-Jong Lin
- Institute of Clinical Medicine, and, Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Hung-I Yeh
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Division of Cardiology, Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan.
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Bapat V, Frank D, Cocchieri R, Jagielak D, Bonaros N, Aiello M, Lapeze J, Laine M, Chocron S, Muir D, Eichinger W, Thielmann M, Labrousse L, Rein KA, Verhoye JP, Gerosa G, Baumbach H, Bramlage P, Deutsch C, Thoenes M, Romano M. Transcatheter Aortic Valve Replacement Using Transaortic Access: Experience From the Multicenter, Multinational, Prospective ROUTE Registry. JACC Cardiovasc Interv 2017; 9:1815-22. [PMID: 27609256 DOI: 10.1016/j.jcin.2016.06.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/08/2016] [Accepted: 06/20/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The Registry of the Utilization of the TAo-TAVR approach using the Edwards SAPIEN Valve (ROUTE) was established to assess the effectiveness and safety of the use of transaortic (TAo) access for transcatheter aortic valve replacement (TAVR) procedures (NCT01991431). BACKGROUND TAVR represents an alternative to surgical valve replacement in high-risk patients. Whereas the transfemoral access route is used commonly as the first-line approach, transapical access is an option for patients not suitable for transfemoral treatment mainly due to anatomic conditions. TAo-TAVR has been shown to be a viable alternative surgical access route; however, only limited data on its effectiveness and safety has been published. METHODS ROUTE is a multicenter, international, prospective, observational registry; data were collected from 18 centers across Europe starting in February 2013. Patients having severe calcific aortic stenosis were documented if they were scheduled to undergo TAo-TAVR using an Edwards SAPIEN XT or a SAPIEN 3 valve. The primary endpoint was 30-day mortality. Secondary endpoints were intraprocedural or in hospital and 30-day complication rates. RESULTS A total of 301 patients with a mean age of 81.7 ± 5.9 years and an Society of Thoracic Surgeons score of 9.0 ± 7.6% were included. Valve success was documented in 96.7%. The 30-day mortality was 6.1% (18/293) (procedure-related mortality: 3.1%; 9 of 293). The Valve Academic Research Consortium-2 defined complications included myocardial infarction (1.0%), stroke (1.0%), transient ischemic attack (0.3%), major vascular complications (3.4%), life-threatening bleeding (3.4%), and acute kidney injury (9.5%). In 3.3% of patients, paravalvular regurgitation was classified as moderate or severe (10 of 300). Twenty-six patients (8.8%) required permanent pacemaker implantation. CONCLUSIONS TAo access for TAVR seems to be a safe alternative to the transapical procedure.
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Affiliation(s)
| | - Derk Frank
- Department of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Germany
| | - Ricardo Cocchieri
- Heart Center, Academic Medical Center, University of Amsterdam, Netherlands
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Poland
| | - Nikolaos Bonaros
- University Hospital for Cardiac Surgery, Medical University Innsbruck, Austria
| | - Marco Aiello
- Department of Cardiothoracic Surgery, Foundation IRCCS Policlinico S. Matteo, Pavia University School of Medicine, Pavia, Italy
| | - Joel Lapeze
- Department of Cardiovascular Surgery, Hospital Louis Pradel, Lyon, France
| | - Mika Laine
- Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Sidney Chocron
- Cardiothoracic Surgery, Hospital Jean Minjoz, University Hospital of Besancon, France
| | - Douglas Muir
- Cardiothoracic Division, James Cook Hospital, Middlesbrough, United Kingdom
| | - Walter Eichinger
- Department of Cardiothoracic Surgery, Klinikum Bogenhausen, Munich, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Hospital Essen, Germany
| | - Louis Labrousse
- Department of Cardiovascular Surgery, CHU Hospital of Bordeaux, France
| | - Kjell Arne Rein
- Department of Cardiothoracic Surgery, Rikshospital Oslo, Norway
| | | | - Gino Gerosa
- Department of Cardiac Surgery, University of Padova, Italy
| | - Hardy Baumbach
- Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus Stuttgart, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Martin Thoenes
- Edwards Lifesciences, Medical Affairs/Professional Education, Nyon, Switzerland
| | - Mauro Romano
- Institut Hospitalier Jacques Cartier, Massy, France
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Martínez-Sellés M, Ariza-Solé A, Vidán MT, Formiga F. [Cardiogeriatrics: What do the current guidelines say about the elderly patient?]. Rev Esp Geriatr Gerontol 2017; 52:115-118. [PMID: 28222942 DOI: 10.1016/j.regg.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 12/12/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España; Universidad Europea, Madrid, España
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital de Bellvitge, IDIBELL, L'Hospitalet de Llobregat (Barcelona), España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España. CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES)
| | - Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, IDIBELL, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España.
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Surkova E, Badano LP, Bellu R, Aruta P, Sambugaro F, Romeo G, Migliore F, Muraru D. Left bundle branch block: from cardiac mechanics to clinical and diagnostic challenges. Europace 2017; 19:1251-1271. [DOI: 10.1093/europace/eux061] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/14/2017] [Indexed: 12/15/2022] Open
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Gonska B, Seeger J, Keßler M, von Keil A, Rottbauer W, Wöhrle J. Predictors for permanent pacemaker implantation in patients undergoing transfemoral aortic valve implantation with the Edwards Sapien 3 valve. Clin Res Cardiol 2017; 106:590-597. [DOI: 10.1007/s00392-017-1093-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/17/2017] [Indexed: 11/24/2022]
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Sokalskis V, Muraru D, Fraccaro C, Napodano M, D'Onofrio A, Tarantini G, Badano LP. Echocardiographic follow-up after transcatheter aortic valve replacement. Echocardiography 2017; 34:267-278. [PMID: 28052455 DOI: 10.1111/echo.13443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The use of transcatheter aortic valve replacement (TAVR) for high-risk patients with aortic stenosis has rapidly increased during the past years. Accordingly, more and more patients are referred for a follow-up echocardiographic study after TAVR. However, the echocardiographic evaluation of patients who underwent TAVR places specific demands on echocardiographers. Furthermore, TAVR may be associated with new types of complications, which are frequently unrecognized or underestimated due to lack of familiarity with the normal and pathological appearance of TAVR. Therefore, this review summarizes the echocardiographic parameters describing the structural and functional status of bioprostheses used in TAVR, procedures taking into account their peculiar hemodynamics. We also describe the strengths and the limitations of echocardiography and of other imaging modalities in detecting long-term complications of TAVR (eg, infective endocarditis, thrombosis). The aim of this review was to serve as a guide for a structured echocardiographic follow-up of TAVR patients, as well as for the echocardiographic diagnosis of the procedure-associated complications.
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Affiliation(s)
- Vladislavs Sokalskis
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy.,University Heart Center Hamburg, Hamburg, Germany
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
| | - Massimo Napodano
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
| | - Augusto D'Onofrio
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
| | - Luigi Paolo Badano
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
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Conduction disturbances after transcatheter aortic valve implantation procedures - predictors and management. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:203-11. [PMID: 27625682 PMCID: PMC5011535 DOI: 10.5114/aic.2016.61640] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 06/29/2016] [Indexed: 12/02/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become a safe and efficient alternative to cardiac surgery in patients with severe aortic stenosis. In many countries the number of performed TAVI procedures equals the number of surgical implantations. Indications for TAVI are becoming more liberal, allowing a wider spectrum of patients to benefit from the advantages of transcatheter therapy. Due to its invasive nature, TAVI is associated with some complications such as conduction disturbances. Although these disturbances are usually not lethal, they have a great influence on patients’ state and long term-survival. The most relevant and common are His’ bundle branch blocks, atrioventricular blocks, and need for permanent pacemaker implantation. With the frequency at 10% to even 50%, conduction abnormalities are among the most important TAVI-related adverse events. Risk factors for conduction disturbances include age, anatomy of the heart, periprocedural factors, type of implanted valve, and comorbidities. Severity of occurring complications varies; therefore selection of a proper treatment approach is required. Considered as the most effective management, permanent pacemaker implantation turned out to negatively influence both recovery and survival. Moreover, there is no expert consensus on use of resynchronization therapy after TAVI. In this paper, the authors present a comprehensive analysis of the most common conduction disturbances accompanying TAVI, factors related to their occurrence, and treatment approach.
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Hulman M, Bena M, Artemiou P, Gasparovic I, Hudec V. Transaortic approach for transcatheter aortic valve replacement with other concomitant cardiac procedures in high-risk patients. J Card Surg 2016; 31:493-7. [PMID: 27388782 DOI: 10.1111/jocs.12796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The transaortic (TAo) approach has been proposed as an alternative to the transapical approach and can be used in concomitant procedures. We use the TAo transcatheter aortic valve replacement (TAVR) with other simultaneous cardiac procedures in high-risk patients who needed surgical management. MATERIALS AND METHODS Between September 2013 and September 2015, nine consecutive high-risk patients with severe aortic valve stenosis (AR) and combined tricuspid valve disease or coronary artery disease were treated with TAo TAVR and simultaneous tricuspid valve repair or coronary artery bypass grafting. RESULTS Mean postoperative pressure gradient at discharge was 13.4 ± 3.2 mmHg and AR grade >2/4 was observed in one case (11.1%). New pacemaker implantation was required in one case (11.1%). Device success was achieved in 88.9% (n = 8), 30-day mortality was in 11.1% (n = 1), and intermediate mortality was in 33.3% (n = 3). CONCLUSION TAo-TAVR approach offers definitive treatment to high-risk patients with coexisting complex cardiac lesions. Despite the relatively high 30-day and intermediate mortality, it is an option for selected high-risk patients.
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Affiliation(s)
- Michal Hulman
- Medical Faculty of the Slovak Health University, Clinic of Cardiac Surgery, National Institute for Cardiovascular Diseases, Bratislava, Slovakia
| | - Martin Bena
- Medical Faculty of the Slovak Health University, Clinic of Cardiac Surgery, National Institute for Cardiovascular Diseases, Bratislava, Slovakia
| | - Panagiotis Artemiou
- Medical Faculty of the Slovak Health University, Clinic of Cardiac Surgery, National Institute for Cardiovascular Diseases, Bratislava, Slovakia
| | - Ivo Gasparovic
- Medical Faculty of the Slovak Health University, Clinic of Cardiac Surgery, National Institute for Cardiovascular Diseases, Bratislava, Slovakia
| | - Vladan Hudec
- Medical Faculty of the Slovak Health University, Clinic of Cardiac Surgery, National Institute for Cardiovascular Diseases, Bratislava, Slovakia
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Martínez-Sellés M, Bouza E, Díez-Villanueva P, Valerio M, Fariñas MC, Muñoz-García AJ, Ruiz-Morales J, Gálvez-Acebal J, Antorrena I, de la Hera Galarza JM, Navas E, Muñoz P. Incidence and clinical impact of infective endocarditis after transcatheter aortic valve implantation. EUROINTERVENTION 2016; 11:1180-7. [DOI: 10.4244/eijy15m02_05] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Comorbidity and intervention in octogenarians with severe symptomatic aortic stenosis. Int J Cardiol 2015; 189:61-6. [DOI: 10.1016/j.ijcard.2015.04.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 02/01/2015] [Accepted: 04/02/2015] [Indexed: 11/18/2022]
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Impact of left ventricular conduction defect with or without need for permanent right ventricular pacing on functional and clinical recovery after TAVR. Clin Res Cardiol 2015; 104:964-74. [DOI: 10.1007/s00392-015-0865-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
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Van Linden A, Doss M, Arsalan M, Kim WK, Walther T. Transcatheter aortic valve implantation--update and evidence. MINIM INVASIV THER 2015; 24:255-63. [PMID: 25966964 DOI: 10.3109/13645706.2015.1047852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Transcatheter aortic valve implantation (T-AVI) has become the standard of care for high-risk patients suffering from severe aortic valve stenosis. More than 60,000 implants have been performed to date. While the first-generation T-AVI devices had some specific issues, the advancements in these first-generation devices and the development of second-generation devices significantly reduced the incidence of peri-procedural complications. The two major access routes are the transfemoral (TF) and the transapical (TA) approach. Both approaches have their advantages and should be considered equal alternatives for finding the best treatment option for the individual patient. Currently there are discussions about extending the indication to patients with lower risk profiles. However, there is no real evidence to justify an expansion, as results of surgical aortic valve replacement in low and intermediate risk patients are excellent.
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Affiliation(s)
- Arnaud Van Linden
- a 1 Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany
| | - Mirko Doss
- a 1 Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany
| | - Mani Arsalan
- a 1 Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany
| | - Won Keun Kim
- a 1 Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany.,b 2 Department of Cardiology, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany
| | - Thomas Walther
- a 1 Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany
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2014 update on interventional cardiology. ACTA ACUST UNITED AC 2015; 68:324-30. [PMID: 25749393 DOI: 10.1016/j.rec.2014.12.009] [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: 11/30/2014] [Accepted: 12/15/2014] [Indexed: 11/22/2022]
Abstract
This article reviews the most relevant publications and studies in the field of interventional cardiology in 2014. In the area of coronary interventional procedures, integrated treatment of acute coronary syndrome continues to be the subject of numerous studies that evaluate different devices and pharmacological and mechanical strategies that can be used without increasing the risk of hemorrhage or the need for reintervention. Certain anatomical substrates continue to generate a considerable number of publications, both on the outcomes with different stents and on the use of specific techniques. Bioabsorbable drug-eluting stents are used in increasingly complex lesions with promising results. The development of interventional procedures for structural heart disease continues to advance, with new evidence on percutaneously placed aortic valve prostheses, the outcome of percutaneous mitral valve repair, and the safety and efficacy of left atrial appendage occlusion. Finally, renal denervation has generated one of the major debates of the year.
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Kuck KH, Eggebrecht H, Figulla H, Haude M, Katus H, Möllmann H, Naber C, Schunkert H, Thiele H, Hamm C. Qualitätskriterien zur Durchführung der transvaskulären Aortenklappenimplantation (TAVI). KARDIOLOGE 2014. [DOI: 10.1007/s12181-014-0622-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Clinical impact of a new left bundle branch block following TAVI implantation: 1-year results of the TAVIK cohort. Clin Res Cardiol 2014; 104:351-62. [DOI: 10.1007/s00392-014-0791-2] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/06/2014] [Indexed: 12/15/2022]
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