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Eckel C, Kim WK, Sötemann D, Grothusen C, Tiyerili V, Dohmen G, Renker M, Charitos EI, Hamm CW, Choi YH, Elsässer A, Möllmann H, Blumenstein J. ACURATE neo2 Versus SAPIEN 3 Ultra Transcatheter Heart Valve in Severe Aortic Valve Calcification: A Propensity-Matched Analysis. Circ Cardiovasc Interv 2024; 17:e013608. [PMID: 38529637 DOI: 10.1161/circinterventions.123.013608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/08/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Comparative data on transcatheter self-expanding ACURATE neo2 (NEO2) and balloon-expandable SAPIEN 3 Ultra prostheses in technically challenging anatomy of severe aortic valve calcified aortic annuli are scarce. METHODS A total of 1987 patients with severe native aortic stenosis treated with the self-expanding NEO2 (n=1457) or balloon-expandable SAPIEN 3 Ultra (n=530) from January 2017 to April 2023 were evaluated. The primary end point was procedural outcome according to the Valve Academic Research Consortium 3 definitions. Propensity matching defined 219 pairs with severe calcification (calcium density cutoff, 758 AU/cm2) of the native aortic valve. RESULTS Technical success (90.4% versus 91.8%; risk difference, 1.4% [95% CI, -4.4 to -7.2]; P=0.737) and device success at 30 days (80.8% versus 75.8%; risk difference, -5.0% [95% CI, -13.2 to 3.1]; P=0.246) were comparable between NEO2 and SAPIEN 3 Ultra. The rate of severe prosthesis-patient mismatch (1.1% versus 10.1%; risk difference, 10.0% [95% CI, 4.0-13.9]; P<0.001) and mean transvalvular gradient ≥20 mm Hg (2.8% versus 14.3%; risk difference, 11.5% [95% CI, 5.8-17.1]; P<0.001) was lower with NEO2. The rate of more-than-mild paravalvular leakage or valve-in-valve due to paravalvular leakage was significantly higher (6.2% versus 0.0%; risk difference, 6.2% [95% CI, -10.1 to -2.7]; P=0.002), and there was a tendency for a higher rate of device embolization or migration (1.8% versus 0.0%; risk difference, -1.8% [95% CI, -4.1 to 0.4]; P=0.123) with NEO2. Multivarate regression revealed no independent impact of transcatheter heart valve selection on device success (odds ratio, 0.93 [95% CI, 0.48-1.77]; P=0.817). CONCLUSIONS In patients with severely calcified annuli, supraannular implantation of NEO2 showed hemodynamic advantages. Nevertheless, NEO2 was associated with a higher incidence of relevant paravalvular leakage and a numerically higher rate of device embolization than SAPIEN 3 Ultra in this particular patient group.
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Affiliation(s)
- Clemens Eckel
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany (C.E., D.S., C.G., V.T., H.M., J.B.)
- Department of Cardiology, University of Oldenburg, Germany (C.E., A.E., J.B.)
| | - Won-Keun Kim
- Departments of Cardiology (W.-K.K., M.R.), Kerckhoff Heart Center, Bad Nauheim, Germany
- Cardiac Surgery (W.-K.K., M.R., E.I.C., Y.-H.C.), Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Dagmar Sötemann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany (C.E., D.S., C.G., V.T., H.M., J.B.)
| | - Christina Grothusen
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany (C.E., D.S., C.G., V.T., H.M., J.B.)
- Department of Cardiac Surgery, University of Kiel, Germany (C.G.)
| | - Vedat Tiyerili
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany (C.E., D.S., C.G., V.T., H.M., J.B.)
| | - Guido Dohmen
- Department of Cardiac Surgery, St. Johannes Hospital, Dortmund, Germany (G.D.)
| | - Matthias Renker
- Departments of Cardiology (W.-K.K., M.R.), Kerckhoff Heart Center, Bad Nauheim, Germany
- Cardiac Surgery (W.-K.K., M.R., E.I.C., Y.-H.C.), Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Efstratios I Charitos
- Cardiac Surgery (W.-K.K., M.R., E.I.C., Y.-H.C.), Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Christian W Hamm
- Department of Cardiology, University of Giessen, Germany (C.W.H.)
- German Center for Cardiovascular Research, Partner Site RheinMain, Bad Nauheim, Germany (C.W.H.)
| | - Yeong-Hoon Choi
- Cardiac Surgery (W.-K.K., M.R., E.I.C., Y.-H.C.), Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Albrecht Elsässer
- Department of Cardiology, University of Oldenburg, Germany (C.E., A.E., J.B.)
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany (C.E., D.S., C.G., V.T., H.M., J.B.)
| | - Johannes Blumenstein
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany (C.E., D.S., C.G., V.T., H.M., J.B.)
- Department of Cardiology, University of Oldenburg, Germany (C.E., A.E., J.B.)
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Yao YJ, Zhao ZG, Wang X, Peng Y, Wei JF, He S, Li YJ, He JJ, Zhu ZK, Feng Y, Chen M. Snaring Self-Expanding Devices to Facilitate Transcatheter Aortic Valve Replacement in Patients with Complex Aortic Anatomies. J Clin Med 2023; 12:5067. [PMID: 37568469 PMCID: PMC10420027 DOI: 10.3390/jcm12155067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
The snare-assisted technique has been described to facilitate transcatheter aortic valve replacement (TAVR) delivery system advancement in complex aortic anatomies. However, the evidence is limited to case reports. To evaluate the safety profile of the snare-facilitated approach and its impact on self-expanding (SE) TAVR outcomes, we collected consecutive patients who underwent transfemoral SE-TAVR for aortic stenosis, using propensity score matching (PSM) separately in tricuspid and type-0 and type-1 bicuspid aortic valve morphology between the snare and non-snare groups. In 766 patients, despite the snare group having significantly larger annulus angulation and maximal ascending aortic diameter, both groups achieved comparable 30-day device success rates, regardless of first-generation or new-generation valve use. After PSM, the snare group had a significantly lower new permanent pacemaker implantation rate among 193 type-0 patients (3.3% vs. 18.3%, p = 0.01). The ipsilateral group used new-generation valves less frequently (23.0% vs. 75.4%, p < 0.001), but there were no significant inter-group differences in procedure-related events, except for a lower incidence of PVL ≥ mild in the ipsilateral group (14.9% vs. 32.3%, p = 0.01). In conclusion, the snare-assisted technique appears useful in SE-TAVR with angulated aortic root anatomy, and the benefits were comparable between ipsilateral and contralateral snare techniques.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.-J.Y.); (Y.P.); (J.-F.W.); (S.H.); (Y.-J.L.); (J.-J.H.); (Z.-K.Z.)
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.-J.Y.); (Y.P.); (J.-F.W.); (S.H.); (Y.-J.L.); (J.-J.H.); (Z.-K.Z.)
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Yang YX, Liu XM, Fu Y, Li C, Wang HJ, Xu L, Xia K, Zhang ZY, Zhong JC, Chen ML, Su PX, Wang LF. Comparisons of different new-generation transcatheter aortic valve implantation devices for patients with severe aortic stenosis: a systematic review and network meta-analysis. Int J Surg 2023; 109:2414-2426. [PMID: 37161443 PMCID: PMC10442113 DOI: 10.1097/js9.0000000000000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Whether there are differences among the new-generation transcatheter aortic valve implantation (TAVI) devices for patients with aortic stenosis remains unclear. The aim of the study was to compare the efficiency and safety of different new-generation TAVI devices for patients with aortic stenosis. MATERIALS AND METHODS A comprehensive search of PubMed, Embase and Web of Science from their inception to 1 February 2022. Randomized clinical trials and observational studies that compared two or more different TAVI devices were enroled. Pairwise meta-analysis and frequentist network meta-analysis were conducted to pool the outcome estimates of interest. RESULTS A total of 79 studies were finally included. According to the surface under the cumulative ranking, the top two ranked valves for lower rates of events were as follows: direct flow medical (DFM) (4.6%) and Lotus (48.8%) for lower rate of device success; Sapien 3 (16.8%) and DFM (19.7%) for lower mortality; DFM (8.6%) and Sapien 3 (25.5%) for lower rates of stroke; Evolut (27.6%) and DFM (35.8%) for lower rates of major and life-threatening bleeding; Portico (22.6%) and Sapien 3 (41.9%) for lower rates of acute kidney injury; Acurate (8.6%) and DFM (13.2%) for lower rates of permanent pacemaker implantation; Lotus (0.3%) and Sapien 3 (22.7%) for lower rates of paravalvular leak; Evolut (1.4%) and Portico (29.1%) for lower rates of mean aortic valve gradients. CONCLUSIONS The findings of the present study suggested that the device success rates were comparable among these new-generation valves except for DFM. After excluding DFM, Sapien 3 might be the best effective for decreased mortality and stroke; Lotus might be the best effective for decreased paravalvular leak; Evolut might be the best effective for decreased major and life-threatening bleeding and mean aortic valve gradients; Acurate and Portico might be the best effective for decreased permanent pacemaker implantation and acute kidney injury, respectively.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Pi-Xiong Su
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Chaoyang District, Beijing, China
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Eckel CE, Kim WK, Grothusen C, Tiyerili V, Elsässer A, Sötemann D, Schlüter J, Choi YH, Charitos EI, Renker M, Hamm CW, Dohmen G, Möllmann H, Blumenstein J. Comparison of the New-Generation Self-Expanding NAVITOR Transcatheter Heart Valve with Its Predecessor, the PORTICO, in Severe Native Aortic Valve Stenosis. J Clin Med 2023; 12:3999. [PMID: 37373693 DOI: 10.3390/jcm12123999] [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: 04/28/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Third-generation transcatheter heart valves (THVs) are designed to improve outcomes. Data on the new intra-annular self-expanding NAVITOR are scarce. AIMS The aim of this analysis was to compare outcomes between the PORTICO and the NAVITOR systems. METHODS Data from 782 patients with severe native aortic stenosis treated with PORTICO (n = 645) or NAVITOR (n = 137) from 05/2012 to 09/2022 were evaluated. The clinical and hemodynamic outcomes of 276 patients (PORTICO, n = 139; NAVITOR, n = 137) were evaluated according to VARC-3 recommendations. RESULTS Rates of postprocedural more-than-mild paravalvular leakage (PVL) were significantly lower for NAVITOR than for PORTICO (7.2% vs. 1.5%, p = 0.041). In addition, severe bleeding rates (27.3% vs. 13.1%, p = 0.005) and major vascular complications (5.8% vs. 0.7%, p = 0.036) were lower in the NAVITOR group. The mean gradients (7 vs. 8 mmHg, p = 0.121) and calculated aortic valve areas (1.90 cm2 vs. 1.99 cm2, p = 0.235) were comparable. Rates of PPI were similarly high in both groups (15.3 vs. 21.6, p = 0.299). CONCLUSIONS The NAVITOR demonstrated favorable in-hospital procedural outcome data, with lower rates of relevant PVL, major vascular complications, and severe bleeding than its predecessor the PORTICO and preserved favorable hemodynamic outcomes.
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Affiliation(s)
- Clemens Enno Eckel
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
| | - Won-Keun Kim
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | - Christina Grothusen
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiac and Vascular Surgery, University of Kiel, 24098 Kiel, Germany
| | - Vedat Tiyerili
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Albrecht Elsässer
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
| | - Dagmar Sötemann
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Judith Schlüter
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | | | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Bad Nauheim, Germany
| | - Christian W Hamm
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Bad Nauheim, Germany
- Department of Cardiology, University of Giessen, 35390 Giessen, Germany
| | - Guido Dohmen
- Department of Cardiac Surgery, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Johannes Blumenstein
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
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Eckel C, Blumenstein J, Grothusen C, Tiyerili V, Elsässer A, Dohmen G, Zeckzer A, Gaede L, Choi YH, Charitos EI, Hamm CW, Kim WK, Möllmann H, Renker M. Procedural Outcomes of a Self-Expanding Transcatheter Heart Valve in Patients with Porcelain Aorta. J Clin Med 2023; 12:jcm12030945. [PMID: 36769593 PMCID: PMC9917710 DOI: 10.3390/jcm12030945] [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: 12/16/2022] [Revised: 01/07/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Severe calcification of the ascending aorta increases the peri-operative risk for neurological complications in patients with severe aortic stenosis. Transcatheter aortic valve implantation (TAVI) seems to be an optimal treatment option in these patients. However, the impact of the extent of aortic calcification on procedural and neurological outcomes during TAVI is unclear. METHODS Data from 3010 patients with severe native aortic valve stenosis treated with ACURATE neo/neo2 from May 2012 to July 2022 were evaluated and matched by 2-to-1 nearest-neighbor matching to identify one patient with porcelain aorta (PA) (n = 492) compared with two patients without PA (n = 984). PA was additionally subdivided into circumferential (classic PA) (n = 89; 3.0%) and non-circumferential (partial PA) (n = 403; 13.4%) calcification. We compared outcomes according to VARC-3 criteria among patients with and without PA and identified predictors for occurrence of stroke in the overall population. RESULTS Technical success (88.5% vs. 87.4%, p = 0.589) and device success at 30 days (82.3% vs. 81.5%, p = 0.755) after transcatheter ACURATE neo/neo2 implantation according to VARC-3 definition was high and did not differ between non-calcified aortas or PA. The rate of in-hospital complications according to VARC-3-definitions was low in both groups. Rates of all stroke (3.2% (n = 31) vs. 2.6% (n = 13), p = 0.705) or transitory ischemic attacks (1.1% vs. 1.2%, p = 1.000) did not differ significantly. Thirty-day all-cause mortality did not differ (3.0% vs. 3.2%, RR 1.1; p = 0.775). Overall device migration/embolization (OR 5.0 [2.10;11.87]), severe bleeding (OR 1.79 [1.11;2.89]), and major structural cardiac complications (OR 3.37 [1.32;8.57]) were identified as independent predictors for in-hospital stroke in a multivariate analysis after implantation of ACURATE neo/neo2. CONCLUSION A porcelain aorta does not increase the risk of neurological complications after transfemoral ACURATE neo/neo2 implantation. Based on these findings, transfemoral ACURATE neo/neo2 implantation is safe in these particularly vulnerable patients.
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Affiliation(s)
- Clemens Eckel
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
| | - Johannes Blumenstein
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
- Correspondence: ; Tel.: +49-(0)231-1843-35100
| | - Christina Grothusen
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, 24118 Kiel, Germany
| | - Vedat Tiyerili
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiology, University of Bonn, 53113 Bonn, Germany
| | - Albrecht Elsässer
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
| | - Guido Dohmen
- Department of Cardiac Surgery, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Anna Zeckzer
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Luise Gaede
- Department of Cardiology, University Hospital of Erlangen, 91054 Erlangen, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | | | - Christian W. Hamm
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
- Department of Cardiology, Justus-Liebig University of Giessen, 35390 Giessen, Germany
| | - Won-Keun Kim
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
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Eckel C, Sötemann D, Kim WK, Grothusen C, Tiyerili V, Dohmen G, Renker M, Charitos E, Hamm CW, Choi YH, Möllmann H, Blumenstein J. Procedural Outcomes of a Self-Expanding Transcatheter Heart Valve in Small Annuli. J Clin Med 2022; 11:jcm11185313. [PMID: 36142960 PMCID: PMC9502952 DOI: 10.3390/jcm11185313] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Self-expanding transcatheter valves (THV) seem superior to balloon-expanding valves in regard to the incidence of prosthesis-patient mismatch (PPM). Data on the occurrence of PPM with the ACURATE neo/neo2 system as a representative of self-expanding prostheses in very small annuli, even below the applicable instructions for use (IFU), are scarce. METHODS Data from 654 patients with severe native aortic stenosis treated with the smallest size ACURATE neo/neo2 valve (size S, 23 mm) at two German high-volume centers from 06/2012 to 12/2021 were evaluated. We compared clinical and hemodynamic outcomes among patients with implantation in adherence to the recommended sizing (on-label n = 529) and below the recommended sizing range (off-label n = 125) and identified predictors for PPM in the overall population. BMI-adjusted PPM was defined according to VARC-3 recommendations. RESULTS Post-procedure, the mean gradient (10.0 mmHg vs. 9.0 mmHg, p = 0.834) and the rate of paravalvular leakage (PVL) ≥ moderate (3.2% vs. 2.8%, p = 0.770) were similar between on-label and off-label implantations. The rate of moderate to severe PPM (24%) was comparably low in ACURATE neo/neo2 S, with a very low proportion of severe PPM whether implanted off- or on-label (4.9% vs. 3.8%, p = 0.552). Thirty-day all-cause mortality was higher among patients with off-label implantations (6.5% vs. 2.3%, p = 0.036). In the subgroup of these patients, no device-related deaths occurred, and cardiac causes did not differ (each 5). Besides small annulus area and high BMI, a multivariate analysis identified a greater cover index (OR 3.26), deep implantation (OR 2.25) and severe calcification (OR 2.07) as independent predictors of PPM. CONCLUSIONS The ACURATE neo/neo2 S subgroup shows a convincing hemodynamic outcome according to low mean gradient even outside the previous IFUs without a relevant increase in the rate of PVL or PPM. In addition to known factors such as annulus area and BMI, potential predictors for PPM are severe annulus calcification and implantation depth. Nevertheless, the ACURATE neo/neo2 system seems to be a reliable option in patients with very small annuli.
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Affiliation(s)
- Clemens Eckel
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
| | - Dagmar Sötemann
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | | | - Vedat Tiyerili
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Guido Dohmen
- Department of Cardiac Surgery, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | - Efstratios Charitos
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | - Christian W. Hamm
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Johannes Blumenstein
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
- Department of Internal Medicine, St. Johannes Hospital, Johannesstraße 9-13, 44139 Dortmund, Germany
- Correspondence: ; Tel.: +49-(0)231-1843-35100
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Blumenstein J, Eckel C, Husser O, Kim WK, Renker M, Choi YH, Hamm CW, Al-Terki H, Sötemann D, Körbi L, Tiyerili V, Grothusen C, Gaede L, Dohmen G, Möllmann H. Multi-Center Comparison of Two Self-Expanding Transcatheter Heart Valves: A Propensity Matched Analysis. J Clin Med 2022; 11:jcm11144228. [PMID: 35887990 PMCID: PMC9318122 DOI: 10.3390/jcm11144228] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 02/01/2023] Open
Abstract
Background: During the last years, several transcatheter aortic heart valves entered the clinical market and are commercially available. The prostheses differ regarding several technical and functional aspects. However, little is known regarding head-to-head comparative data of the ACURATE neo and the PORTICO valve prostheses. Objectives: The aim of this study was to compare two self-expanding transcatheter aortic heart valves (THV), the ACURATE neo and the PORTICO, with regard to in-hospital and 30-day outcomes, as well as early device failures. Methods: A total of 1591 consecutive patients with severe native aortic valve stenosis from two centers were included in the analyses and matched by 1:1 nearest neighbor matching to identify one patient treated with PORTICO (n = 344) for each patient treated with ACURATE neo (n = 344). Results: In-hospital complications were comparable between both valves, including any kind of stroke (ACURATE neo = 3.5% vs. PORTICO = 3.8%; p = 1.0), major vascular complications (ACURATE neo = 4.5% vs. PORTICO = 5.4%; p = 0.99) or life-threatening bleeding (ACURATE neo = 1% vs. PORTICO = 2%; p = 0.68). The rate of device failure defined by the VARC-2 criteria were comparable, including elevated gradients and moderate-to-severe paravalvular leakage (ACURATE neo = 7.3% vs. PORTICO = 7.6%; p = 1.0). However, the need for permanent pacemaker implantation (PPI) was significantly more frequent after the use of PORTICO THV (9.5% vs. 18.7%; p = 0.002). Conclusions: In this two-center case-matched comparison, short-term clinical and hemodynamic outcomes showed comparable results between PORTICO and ACURATE neo prostheses. However, PORTICO was associated with a significant higher incidence of PPI.
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Affiliation(s)
- Johannes Blumenstein
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
- Medical School, Carl von Ossietzky University, 26111 Oldenburg, Germany
- Correspondence: ; Tel.: +49-(0)231-1843-35100; Fax: +49-(0)231-35900
| | - Clemens Eckel
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
- Medical School, Carl von Ossietzky University, 26111 Oldenburg, Germany
| | - Oliver Husser
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany; (W.-K.K.); (M.R.); (C.W.H.)
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany;
- Department of Cardiology, Justus-Liebig University of Giessen, 35390 Giessen, Germany
| | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany; (W.-K.K.); (M.R.); (C.W.H.)
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany;
| | - Christian W. Hamm
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany; (W.-K.K.); (M.R.); (C.W.H.)
- Department of Cardiology, Justus-Liebig University of Giessen, 35390 Giessen, Germany
| | - Hani Al-Terki
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
| | - Dagmar Sötemann
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
| | - Leon Körbi
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
| | - Vedat Tiyerili
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
| | - Christina Grothusen
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
| | - Luise Gaede
- Department of Medicine 2-Cardiology and Angiology, Friedrich-Alexander University, 91054 Erlangen, Germany;
| | - Guido Dohmen
- Department of Cardiothoracic Surgery, St.-Johannes-Hospital, 11137 Dortmund, Germany;
| | - Helge Möllmann
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
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8
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Werner N, Renker M, Dörr O, Bauer T, Nef H, Choi YH, Hamm CW, Zahn R, Kim WK. Anatomical suitability and off-label use of contemporary transcatheter heart valves. Int J Cardiol 2021; 350:96-103. [PMID: 34979147 DOI: 10.1016/j.ijcard.2021.12.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite excellent procedural results in a broad clinical population, certain anatomical or clinical conditions are still challenging for transcatheter aortic valve replacement (TAVI). Whether the adherence to the instructions for use (IFU) or the use of a clinically suitable device is a prerequisite for procedural success has not been well characterized. AIMS The anatomical and clinical suitability of new-generation transcatheter heart valves (THV) was evaluated in an all-comers population (n = 540) at a high-volume center. METHODS Conformity with anatomical IFU criteria was evaluated in each implanted THV. In addition, the suitability of the implanted THV was verified in each case according to clinical and anatomical criteria, which had been previously defined according to the results of an international survey including 20 renowned TAVI operators. Furthermore, criteria of clinical suitability and adherence to IFU of each THV were applied to the overall cohort to analyze the proportion of patients in whom the use of the respective THV would have been judged to be unsuitable or off-label. RESULTS An off-label use of THV based on anatomical considerations was found in 20% of all procedures, whereas the implantation of a THV deemed to be clinically unsuitable was noted in 16.3% of all procedures. Clinical suitability and conformity with IFU were present to a varying extent across the THV systems. Neither clinical suitability, nor conformity with IFU were associated with device failure or periprocedural mortality. On multivariable analysis, aortic tortuosity, mean transaortic gradient and ascending aorta diameter were identified as independent predictors of device failure (VARC-3). CONCLUSIONS Off-label TAVI and the use of clinically unsuitable THVs were common, but did not affect procedural outcomes. The variety of clinical and anatomical coverage of the different THV systems emphasizes the importance of an individualized THV selection.
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Affiliation(s)
- Nicolas Werner
- Sana Klinikum Offenbach, Department of Cardiology, Offenbach, Germany
| | - Matthias Renker
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Oliver Dörr
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Justus-Liebig University of Giessen and Marburg, Department of Cardiology, Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Timm Bauer
- Sana Klinikum Offenbach, Department of Cardiology, Offenbach, Germany; Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Holger Nef
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Justus-Liebig University of Giessen and Marburg, Department of Cardiology, Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Yeong-Hoon Choi
- Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Christian W Hamm
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Justus-Liebig University of Giessen and Marburg, Department of Cardiology, Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Ralf Zahn
- Herzzentrum Ludwigshafen, Department of Cardiology, Ludwigshafen, Germany
| | - Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; Justus-Liebig University of Giessen and Marburg, Department of Cardiology, Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany.
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9
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Saltiel A, Rabinovich Y, Rubinstein C, Atamna O, Finkelstein A, Sheick-Yousif B. A novel endovascular treatment for transcatheter aortic valve embolization. J Vasc Surg Cases Innov Tech 2021; 7:755-758. [PMID: 34805651 PMCID: PMC8585581 DOI: 10.1016/j.jvscit.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/14/2021] [Indexed: 11/25/2022] Open
Abstract
In the present report, we have described the case of an 82-year-old obese man who had required transcatheter aortic valve replacement to treat severe symptomatic aortic stenosis. During implantation, the balloon-mounted valve became dislodged and embolized to the ascending aorta. A second valve was successfully implanted after several failed attempts to reposition the first one into the aortic annulus. The dislodged valve became further embolized and landed in the distal descending aorta, partially obstructing the splanchnic, renal, and lower extremity blood flow. It was rotated with flexible forceps and permanently secured in the distal thoracic aorta using a thoracic endoprosthesis, rendering it harmless.
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10
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In-hospital outcomes of self-expanding and balloon-expandable transcatheter heart valves in Germany. Clin Res Cardiol 2021; 110:1977-1982. [PMID: 34546428 PMCID: PMC8639556 DOI: 10.1007/s00392-021-01928-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
Introduction The effect of valve type on outcomes in transfemoral transcatheter aortic valve replacement (TF-TAVR) has recently been subject of debate. We investigate outcomes of patients treated with balloon-expanding (BE) vs. self-expanding (SE) valves in in a cohort of all these procedures performed in Germany in 2018. Methods All patients receiving TF-TAVR with either BE (N = 9,882) or SE (N = 7,413) valves in Germany in 2018 were identified. In-hospital outcomes were analyzed for the endpoints in-hospital mortality, major bleeding, stroke, acute kidney injury, postoperative delirium, permanent pacemaker implantation, mechanical ventilation > 48 h, length of hospital stay, and reimbursement. Since patients were not randomized to the two treatment options, logistic or linear regression models were used with 22 baseline patient characteristics and center-specific variables as potential confounders. As a sensitivity analysis, the same confounding factors were taken into account using the propensity score methods (inverse probability of treatment weighting). Results Baseline characteristics differed substantially, with higher EuroSCORE (p < 0.001), age (p < 0.001) and rate of female sex (p < 0.001) in SE treated patients. After risk adjustment, no marked differences in outcomes were found for in-hospital mortality [risk adjusted odds ratio (aOR) for SE instead of BE 0.94 (96% CI 0.76;1.17), p = 0.617] major bleeding [aOR 0.91 (0.73;1.14), p = 0.400], stroke [aOR 1.13 (0.88;1.46), p = 0.347], acute kidney injury [OR 0.97 (0.85;1.10), p = 0.621], postoperative delirium [aOR 1.09 (0.96;1.24), p = 0.184], mechanical ventilation > 48 h [aOR 0.98 (0.77;1.25), p = 0.893], length of hospital stay (risk adjusted difference in days of hospitalization (SE instead of BE): − 0.05 [− 0.34;0.25], p = 0.762) and reimbursement [risk adjusted difference in reimbursement (SE instead of BE): − €72 (− €291;€147), p = 0.519)] There is, however, an increased risk of PPI for SE valves (aOR 1.27 [1.15;1.41], p < 0.001). Similar results were found after application of propensity score adjustment. Conclusions We find broadly equivalent outcomes in contemporary TF-TAVR procedures, regardless of the valve type used. Incidence of major complications is very low for both types of valve. Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01928-6.
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11
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Mach M, Szalkiewicz P, Poschner T, Hasan W, Andreas M, Winkler B, Hasimbegovic E, Steinkellner T, Strouhal A, Adlbrecht C, Delle-Karth G, Grabenwöger M. The use of semi-compliant versus non-compliant balloon systems for predilatation during the implantation of self-expandable transcatheter aortic valves: Data from the VIenna CardioThOracic Aortic Valve RegistrY (VICTORY). Eur J Clin Invest 2021; 51:e13570. [PMID: 33954997 PMCID: PMC8459263 DOI: 10.1111/eci.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/11/2021] [Accepted: 04/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to evaluate the differences in outcome arising from the use of semi-compliant (SCB) versus non-compliant balloon (NCB) systems for predilatation during self-expanding transcatheter aortic valve replacement (TAVR). METHODS 251 TAVR procedures with the implantation of self-expanding valves after predilatation were analyzed. SCB systems were used in 166 and NCB systems in 85 patients. The primary endpoint was defined as device success, a composite endpoint comprising the absence of procedural mortality, correct valve positioning, adequate valve performance and the absence of more than a mild paravalvular leak. The secondary endpoints were chosen in accordance with the valve academic research consortium (VARC-2) endpoint definitions. RESULTS No significant differences were observed with regard to procedural device success between the SCB- and NCB cohort (SCB: 142 [85.5%%] vs. NCB: 77 [90.6%]; P = .257). There was a notable difference between the rates of conversion to open surgery and the postdilatation rate, both of which were higher for the NCB group (SCB: 1 [0.6%] vs. NCB: 4 [5.1%]; P = .042; SCB: 30 [18.1%] vs. NCB: 34 [40%]; P < .001). In a multivariate logistic regression analysis, the use of semi-compliant balloon systems for predilatation was associated with a lower risk for postdilatation (OR: 0.296; 95% CI: 0.149-0.588) and conversion to open surgery (OR: 0.205; 95% CI: 0.085-0.493; P = .001) but not for device success. CONCLUSION While the balloon compliance did not affect the procedural mortality, device success or the rate of paravalvular leakage, the use of semi-compliant balloons for predilatation during TAVR should be investigated in larger randomized trials in the light of the lower rates of postdilatation and conversion to open surgery compared to their non-compliant counterparts.
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Affiliation(s)
- Markus Mach
- Department of Cardiac Surgery, Medical University of Vienna - Vienna General Hospital, Vienna, Austria.,Heart Team Vienna, Department of Cardio-Vascular Surgery, Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria
| | - Philipp Szalkiewicz
- Department of Cardiac Surgery, Medical University of Vienna - Vienna General Hospital, Vienna, Austria.,Heart Team Vienna, Department of Cardio-Vascular Surgery, Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria
| | - Thomas Poschner
- Department of Cardiac Surgery, Medical University of Vienna - Vienna General Hospital, Vienna, Austria
| | - Waseem Hasan
- Faculty of Medicine, Imperial College London, London, UK
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna - Vienna General Hospital, Vienna, Austria
| | - Bernhard Winkler
- Heart Team Vienna, Department of Cardio-Vascular Surgery, Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria
| | - Ena Hasimbegovic
- Department of Cardiac Surgery, Medical University of Vienna - Vienna General Hospital, Vienna, Austria.,Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna - Vienna General Hospital, Vienna, Austria
| | - Theresia Steinkellner
- Division of Anatomy, Center of Anatomy and Cell Biology, Medical University of Vienna - Vienna General Hospital, Vienna, Austria
| | - Andreas Strouhal
- Department of Cardiology, Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Vienna, Austria
| | - Christopher Adlbrecht
- Department of Cardiology, Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Vienna, Austria.,Imed19-privat, private clinical research center, Vienna, Austria
| | - Georg Delle-Karth
- Department of Cardiology, Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Vienna, Austria
| | - Martin Grabenwöger
- Heart Team Vienna, Department of Cardio-Vascular Surgery, Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria.,Medical faculty, Sigmund Freud University, Vienna, Austria
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12
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Ravaux JM, Di Mauro M, Vernooy K, Kats S, Mariani S, Ronco D, Actis Dato G, Simons J, Hof AWV, Maessen JG, Lorusso R. Permanent pacemaker implantation following transcatheter aortic valve implantation using self-expandable, balloon-expandable, or mechanically expandable devices: a network meta-analysis. Europace 2021; 23:1998-2009. [PMID: 34379760 DOI: 10.1093/europace/euab209] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/17/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Permanent pacemaker implantation (PPI) still limits the expansion of indications for transcatheter aortic valve implantation (TAVI). Comparison between different systems remains scarce. We aimed to determine the impact of the device type used on post-TAVI PPI. METHODS AND RESULTS A systematic literature review was performed to identify studies reporting the use of balloon-expandable valve (BEV), self-expandable valve (SEV), and mechanically expandable valve (MEV) and post-TAVI PPI. A network meta-analysis was used to compare TAVI mechanisms (Analysis A) and transcatheter heart valves (Analysis B) with respect to post-TAVI PPI. Analysis A included 40 181 patients with a pooled PPI rate of 19.2% in BEV, 24.7% in SEV, and 34.8% in MEV. Balloon-expandable valve showed lower risk compared to either SEV or MEV and SEV demonstrated lower risk for PPI than MEV. Implantation of BEV was associated with 39% and 62% lower PPI rate with respect to SEV and MEV. Implantation of SEV was associated with 38% lower PPI rate with respect to MEV. Analysis B included 36.143 patients with the lowest pooled PPI rate of 9.6% for Acurate Neo or others, and the highest pooled PPI rate of 34.3% for Lotus. CoreValve, Evolut Portico, and Lotus influenced significantly PPI rate, while Sapien group did not. CONCLUSION Implantation of BEV and also SEV were associated with lower post-TAVI PPI rate, while MEV were associated with higher post-TAVI PPI. Patient tailored-approach including devices characteristics may help to reduce post-TAVI PPI and to allow TAVI to take the leap towards extension of use in younger patients. PROSPERO NUMBER CRD42021238671.
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Affiliation(s)
- Justine M Ravaux
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Michele Di Mauro
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
| | - Suzanne Kats
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Silvia Mariani
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Daniele Ronco
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.,Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giulia Actis Dato
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Jorik Simons
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Arnoud W Van't Hof
- Department of Cardiology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jos G Maessen
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Roberto Lorusso
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
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13
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Mahon C, Davies A, Gambaro A, Musella F, Costa AL, Panoulas V, Nicol E, Duncan A, Davies S, Mirsadraee S. Association of individual aortic leaflet calcification on paravalvular regurgitation and conduction abnormalities with self-expanding trans-catheter aortic valve insertion. Quant Imaging Med Surg 2021; 11:1970-1982. [PMID: 33936979 DOI: 10.21037/qims-20-1122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Complication rates of paravalvular aortic regurgitation (PVR) and permanent pacemaker insertion remain high in patients undergoing trans-catheter aortic valve insertion for severe aortic stenosis. The spatial distribution of calcium between individual aortic valve leaflets, and its potential role in these complications is gaining interest. We aimed to assess the accuracy of individual aortic valve leaflet calcium quantification, and to determine its effect on the frequency of these complications. Methods This was a retrospective study of 251 patients who underwent trans-catheter aortic valve insertion using the Evolut RTM valve. The off-line Terarecon software platform was used for Agatston scoring the short axis views. Results There was a correlation between the sum of the individual leaflet and the total aortic valve calcium score. There was a univariate association between an increase [per 100 Agatston unit (AU)] in both right coronary leaflet (RCL) and left coronary leaflet (LCL) calcium with the risk of PVR. There was an association between an increase in LCL calcium score (per 100 AU) and need for post-implantation balloon aortic valvuloplasty (BAV). There was no association between individual leaflet calcification on the risk of permanent pacemaker insertion. Conclusions This study supports the idea that a quantifiable and reproducible method of individual valve leaflet calcification score may serve as an independent risk factor for paravalvular regurgitation, beyond visual assessment of asymmetry. However, the same may not be true of spatial calcium distribution and permanent pacemaker implantation (PPI).
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Affiliation(s)
- Ciara Mahon
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Allan Davies
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Alessia Gambaro
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Ana Luisa Costa
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Edward Nicol
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Alison Duncan
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Simon Davies
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
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14
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Kim WK, Bhumimuang K, Renker M, Fischer-Rasokat U, Möllmann H, Walther T, Choi YH, Nef H, Hamm CW. Determinants of paravalvular leakage following transcatheter aortic valve replacement in patients with bicuspid and tricuspid aortic stenosis. Eur Heart J Cardiovasc Imaging 2021:jeab011. [PMID: 33582771 DOI: 10.1093/ehjci/jeab011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/14/2021] [Indexed: 12/26/2022] Open
Abstract
AIMS Paravalvular leakage (PVL) after transcatheter aortic valve replacement (TAVR) is a common complication in patients with bicuspid aortic valve (BAV). However, predictors and mechanisms of PVL are not well understood in this subset. The aim of this study was to analyse determinants and mechanisms of PVL in BAV and tricuspid aortic valve (TAV). METHODS AND RESULTS Of the 2394 consecutive patients undergoing transfemoral TAVR using new-generation valves at our centre, we identified 242 cases with BAV. To adjust for baseline differences, we performed 3 : 1 propensity score matching (TAVPS n = 726). We analysed the aortic root anatomy and calcification as well as the number, circumferential distribution, and predilection sites of PVL using pre-procedural multidetector computed tomography and post-TAVR echocardiography. In the matched cohort, the incidence of PVL ≥mild (BAV 51.9% vs. TAVPS 51.7%; P = 0.955) and PVL ≥moderate (BAV 5.0% vs. TAVPS 3.7%; P = 0.393), the circumferential distribution, and independent predictors were similar between BAV and TAVPS. Both the presence of peri-annular calcium chunks or LVOT calcification were highly associated with PVL in BAV and TAVPS patients, whereas in BAV patients neither the presence of a calcium bridge nor the volume of its calcification was related to PVL. Notably, the spatial localization of these lesions did not necessarily match the circumferential leak position. CONCLUSION The incidence, circumferential distribution, predilection sites, and predictors of PVL were similar in matched population of BAV and TAVPS patients undergoing transfemoral TAVR using new-generation devices. These novel findings suggest a common underlying mechanism of PVL in both entities.
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Affiliation(s)
- Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8 61231 Bad Nauheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Frankfurt am Main, Germany
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
- Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
| | - Kid Bhumimuang
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8 61231 Bad Nauheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Frankfurt am Main, Germany
| | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8 61231 Bad Nauheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Frankfurt am Main, Germany
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | - Ulrich Fischer-Rasokat
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8 61231 Bad Nauheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Frankfurt am Main, Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Johann-Wolfgang-Goethe University, Frankfurt, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | - Holger Nef
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8 61231 Bad Nauheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Frankfurt am Main, Germany
- Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8 61231 Bad Nauheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Frankfurt am Main, Germany
- Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
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15
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Geng X, Xu ZQ, Tu CZ, Peng J, Jin X, Ye L, Zhang AY, Gu YQ, Feng ZG. Hydrogel Complex Electrospun Scaffolds and Their Multiple Functions in In Situ Vascular Tissue Engineering. ACS APPLIED BIO MATERIALS 2021; 4:2373-2384. [DOI: 10.1021/acsabm.0c01225] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Xue Geng
- School of Materials Science & Engineering, Beijing Institution of Technology, Beijing 100081, China
- Beijing Key Laboratory of Construction Tailorable Advanced Functional Materials and Green Applications, Beijing 100081, China
| | - Ze-Qin Xu
- Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Cheng-Zhao Tu
- School of Materials Science & Engineering, Beijing Institution of Technology, Beijing 100081, China
| | - Jia Peng
- School of Materials Science & Engineering, Beijing Institution of Technology, Beijing 100081, China
| | - Xin Jin
- School of Materials Science & Engineering, Beijing Institution of Technology, Beijing 100081, China
| | - Lin Ye
- School of Materials Science & Engineering, Beijing Institution of Technology, Beijing 100081, China
- Beijing Key Laboratory of Construction Tailorable Advanced Functional Materials and Green Applications, Beijing 100081, China
| | - Ai-Ying Zhang
- School of Materials Science & Engineering, Beijing Institution of Technology, Beijing 100081, China
- Beijing Key Laboratory of Construction Tailorable Advanced Functional Materials and Green Applications, Beijing 100081, China
| | - Yong-Quan Gu
- Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Zeng-Guo Feng
- School of Materials Science & Engineering, Beijing Institution of Technology, Beijing 100081, China
- Beijing Key Laboratory of Construction Tailorable Advanced Functional Materials and Green Applications, Beijing 100081, China
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16
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Reifart J, Liebetrau C, Weferling M, Dörr O, Renker M, Bhumimuang K, Liakopoulos O, Choi YH, Nef H, Hamm CW, Kim WK. Single versus double use of a suture-based closure device for transfemoral aortic valve implantation. Int J Cardiol 2021; 331:183-188. [PMID: 33529662 DOI: 10.1016/j.ijcard.2021.01.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/11/2021] [Accepted: 01/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The most common method of percutaneous closure in transfemoral transcatheter aortic valve implantation (TAVI) employs two obtusely oriented ProGlide devices. The aim of this study was to assess the feasibility and safety of using a single ProGlide system for primary access site closure in comparison with the double ProGlide approach in an all-comers TAVI population. METHODS Between March 2016 and December 2018, a total of 1105 patients underwent transfemoral TAVI for severe aortic stenosis at our center. Application of two ProGlide systems was standard until April 2017 (n = 432), whereas thereafter a single ProGlide system was used (n = 663). A 1:1 propensity score matching was performed to adjust for baseline differences between the two groups, resulting in 327 matched cases. Primary outcomes of interest were main access site-related vascular complications. RESULTS The mean number of ProGlide devices used per patient was 1.03 (SD 0.2) in the single-ProGlide group versus 2.01 (SD 0.14) in the double-ProGlide group. An additional vascular closure device was required to obtain full hemostasis in 23.2% versus 9.5% of patients (p < 0.001) in the two groups, respectively. Technical success of ProGlide usage was similar (94.3% versus 92.1%, p = 0.163). In the matched cohorts, the rates of main access site-related major vascular complications were similar (4.0% vs. 6.4%, p = 0.217). CONCLUSION The single-ProGlide technique is feasible, with rates of technical success similar to those of the double-ProGlide technique. Use of this method did not lead to more frequent access site-related complications but was more cost effective than the double-ProGlide approach.
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Affiliation(s)
- Joerg Reifart
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany.
| | - Christoph Liebetrau
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany
| | - Maren Weferling
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany
| | - Oliver Dörr
- Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany
| | - Matthias Renker
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany
| | - Kid Bhumimuang
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
| | - Oliver Liakopoulos
- Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | - Yeong-Hoon Choi
- Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | - Holger Nef
- Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany
| | - Christian W Hamm
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany
| | - Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany
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17
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Ohya M, Fuku Y, Shimamoto T, Kadota K. Delayed Valsalva obstruction after transcatheter self-expandable aortic valve implantation: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 33634230 PMCID: PMC7891291 DOI: 10.1093/ehjcr/ytaa443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/07/2020] [Accepted: 10/17/2020] [Indexed: 12/05/2022]
Abstract
Background Delayed coronary obstruction after transcatheter aortic valve implantation has been reported to occur more commonly after self-expandable aortic valve implantation than balloon-expandable valve. Case summary An 86-year-old woman treated by transcatheter self-expandable aortic valve implantation had acute coronary syndrome 3 months after the procedure. Emergent coronary angiography showed decreased blood flow in the left coronary artery. Balloon angioplasty between the valve frame and the left coronary cusp was performed, and her ischaemia resolved. Contrast-enhanced computed tomography showed a commissural post of the supra-annular valve overlying the left coronary cusp, and serial computed tomography showed the valve frame expanding over time. She received coronary bypass grafting using saphenous vein grafts for the left anterior descending and left circumflex arteries. Four months after surgery for the left anterior descending artery, the patient had recurrent chest pain, and computed tomography showed a graft occlusion in the left anterior descending artery. Shortly afterwards, she died of sudden cardiac arrest. Discussion In this report, we describe delayed Valsalva obstruction after transcatheter self-expandable aortic valve implantation, which can be detectable by serial computed tomography. The sealing of a coronary cusp by a commissural post of the valve may be one of the causes of delayed coronary ischaemia after transcatheter self-expandable aortic valve implantation.
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Affiliation(s)
- Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital, 1-11 Miwa, Kurashiki 710-8602, Japan
| | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, 1-11 Miwa, Kurashiki 710-8602, Japan
| | - Takeshi Shimamoto
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-11 Miwa, Kurashiki 710-8602, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, 1-11 Miwa, Kurashiki 710-8602, Japan
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18
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Abdelghani M, Mankerious N, Landt M, Toelg R, Abdel-Wahab M, Richardt G. Transcatheter Aortic Valve Implantation With the Third Generation Balloon-Expandable Bioprosthesis in Patients With Severe Landing Zone Calcium. Am J Cardiol 2020; 125:931-940. [PMID: 31959428 DOI: 10.1016/j.amjcard.2019.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 01/16/2023]
Abstract
Device success of earlier generation balloon-expandable transcatheter heart valves (BE-THV) is lower in patients with severe landing zone calcium (LZC). We sought to explore the impact of LZC on the outcome of transcatheter aortic valve implantation (TAVI) with the next generation Edwards Sapien 3 BE-THV. In the present study, severe LZC was defined as severe aortic valve cusp calcium (AVC) and/or left ventricular outflow tract calcium (LVOTC) on computed tomography. Patients who underwent TAVI for pure/predominant aortic regurgitation, bicuspid aortic valve disease, or failed bioprosthetic valve were excluded. Out of 350 patients who underwent TAVI with the Edwards Sapien 3 (age 80.7 ± 6.1, female: 45.1%, Society of Thoracic Surgeons score: 4.9 ± 3.8, transfemoral: 97.4%), 106 (30.3%) had severe LZC; 78 severe AVC (22.3%) and 49 severe LVOTC (14.0%). Severe LZC was associated with lower device success (96.2% vs 100%, p = 0.008) driven by more prosthetic valve regurgitation (PVR, p = 0.008). On multivariable analysis, PVR was associated with severe LVOTC (odds ratio [95% confidence interval] 2.130 [1.092 to 4.158]) but not with severe AVC (1.529 [0.835 to 2.800]). Balloon predilatation (BPreD) was performed in 42.5% of patients with severe LZC (vs 19.3% in nonsevere LZC; p <0.001) and was associated with prolonged procedural time (p = 0.001) and higher irradiation exposure (p = 0.027). Device success (p = 0.311), major procedural complications (p = 0.132), 30-day safety end point (p = 0.815), and PVR (p = 0.684) were not significantly different between patients with severe LZC who underwent BPreD versus direct TAVI. In conclusion, device success of the third generation BE-THV is lower in severe LZC driven by more PVR, especially in patients with severe LVOTC. In those patients, BPreD prolonged the procedure without improving THV performance.
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19
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Krapf S, von Scheidt W, Thilo C. Periprocedural embolisation of a Sapien 3 TAVI prosthesis: failure and success. Clin Res Cardiol 2019; 109:649-651. [PMID: 31784902 DOI: 10.1007/s00392-019-01573-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/11/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Stephan Krapf
- Department of Cardiac and Thoracic Surgery, University Hospital Augsburg, Herzzentrum Augsburg-Schwaben, Augsburg, Germany
| | - Wolfgang von Scheidt
- Department of Cardiology, I. Medizinische Klinik, Universitätsklinikum Augsburg, Herzzentrum Augsburg-Schwaben, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Christian Thilo
- Department of Cardiology, I. Medizinische Klinik, Universitätsklinikum Augsburg, Herzzentrum Augsburg-Schwaben, Stenglinstr. 2, 86156, Augsburg, Germany.
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20
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Ueno G, Ohno N, Toma M, Kobayashi T, Maeda T, Kato O, Yoshizawa K, Miyamoto T, Fujiwara K. Successful recovery from transcatheter aortic valve embolization by thoracic endovascular stent-graft repair. Gen Thorac Cardiovasc Surg 2019; 68:851-854. [PMID: 31625083 DOI: 10.1007/s11748-019-01225-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 09/26/2019] [Indexed: 11/25/2022]
Abstract
We report a case of an 84-year-old Japanese female patient with transcatheter valve embolization treated with thoracic endovascular stenting. She was diagnosed with severe aortic stenosis and referred to our hospital. Transapical transcatheter aortic valve implantation (TA-TAVI) was selected because she had multiple comorbidities and peripheral vascular disease. During TA-TAVI, the transcatheter valve (TV) came loose and lodged in the distal aortic arch. The TV was floating and unstable, thereby affecting her hemodynamics. After a second TV was placed in the appropriate position with no trouble, we tried fixing the TV using a thoracic endovascular stent-graft. The procedure was successful, and the patient recovered well. The cause of embolization seemed to be associated with a relatively mild calcification of the native aortic valve. Although this complication is rare, several recovery procedures should be prepared.
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Affiliation(s)
- Go Ueno
- Department of Cardiovascular Surgery, Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan.
| | - Masanao Toma
- Department of Cardiology, Amagasaki General Medical Center, Amagasaki, Japan
| | - Taishi Kobayashi
- Department of Cardiology, Amagasaki General Medical Center, Amagasaki, Japan
| | - Toshi Maeda
- Department of Cardiovascular Surgery, Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Otohime Kato
- Department of Cardiovascular Surgery, Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Kosuke Yoshizawa
- Department of Cardiovascular Surgery, Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Tadashi Miyamoto
- Department of Cardiology, Amagasaki General Medical Center, Amagasaki, Japan
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21
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Challenges of recognizing bicuspid aortic valve in elderly patients undergoing TAVR. Int J Cardiovasc Imaging 2019; 36:251-256. [DOI: 10.1007/s10554-019-01704-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/17/2019] [Indexed: 12/17/2022]
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22
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Lower mortality in an all-comers aortic stenosis population treated with TAVI in comparison to SAVR. Clin Res Cardiol 2019; 109:611-615. [DOI: 10.1007/s00392-019-01548-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
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23
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Kim WK, Renker M, Rolf A, Fischer-Rasokat U, Wiedemeyer J, Doss M, Möllmann H, Walther T, Nef H, Hamm CW, Liebetrau C. Annular versus supra-annular sizing for TAVI in bicuspid aortic valve stenosis. EUROINTERVENTION 2019; 15:e231-e238. [DOI: 10.4244/eij-d-19-00236] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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24
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Asami M, Pilgrim T, Stortecky S, Heg D, Roost E, Windecker S, Hunziker L. Impact of valvular resistance on aortic regurgitation after transcatheter aortic valve replacement according to the type of prosthesis. Clin Res Cardiol 2019; 108:1343-1353. [PMID: 30929034 DOI: 10.1007/s00392-019-01469-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/22/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The impact of aortic valvular resistance (VR) on the degree of post-transcatheter aortic valve replacement (TAVR) aortic regurgitation (AR) remains unclear. The objective of the study was to investigate the relationship between VR and paravalvular AR after TAVR. METHODS Between August 2007 and December 2015, 708 TAVR patients had sufficient data to calculate VR before the intervention and were eligible for the present analysis. The patient population was dichotomized according to VR. The association between VR and post-TAVR AR was separately assessed by prosthesis type. RESULTS Among patients with low VR (LVR; < 238 dynes/cm5), 176 (49.7%) patients were treated with balloon-expandable (BE) valves and 178 (51.3%) patients with self-expandable (SE) transcatheter valves. Among patients with high VR (HVR ≥ 238), 147 (41.5%) and 207 (68.5%) patients received BE and SE, respectively. Baseline characteristics were similar in both groups irrespective of the type of valve. Patients with HVR had a 2.5-fold risk of ≥ moderate post-TAVR AR compared to patients with LVR. Both, HVR (HRadj 2.45, 95% CI 1.33-4.51) and the use of SE (HRadj 3.11, 95% CI 1.66-5.82), emerged as independent predictors of ≥ moderate post-TAVR AR. Moderate or greater post-AR was consistently predicted in patients treated with SE (HRadj 2.42, 95% CI 1.22-4.80) irrespective of the level of VR. CONCLUSIONS HVR is associated with a nearly 2.5-fold increased risk of moderate or greater post-TAVR AR and is an independent predictor of post-TAVR AR.
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Affiliation(s)
- Masahiko Asami
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland
| | - Dik Heg
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Eva Roost
- Department of Cardiac Surgery, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland.
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25
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Pellegrini C, Rheude T, Trenkwalder T, Mayr NP, Michel J, Kastrati A, Schunkert H, Kasel AM, Joner M, Hengstenberg C, Husser O. One-year clinical outcome with a novel self-expanding transcatheter heart valve. Catheter Cardiovasc Interv 2019; 94:783-792. [PMID: 30801906 PMCID: PMC6899934 DOI: 10.1002/ccd.28144] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/08/2019] [Accepted: 01/28/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate 1-year outcome using the ACURATE neo (Symetis S.A., a Boston Scientific Company, Ecublens, Switzerland) according to the updated Valve Academic Research Consortium (VARC-2) with emphasis on the composite endpoints "clinical efficacy after 30 days" and "time-related valve safety". BACKGROUND Initial reports on the clinical performance of patients treated with the ACURATE neo are promising; however, information regarding one-year outcome is scarce, especially with regard to the composite endpoints proposed by the VARC-2. METHODS One hundred and fifty one consecutive patients undergoing transfemoral transcatheter aortic valve replacement (TAVR) with the ACURATE neo for severe aortic valve stenosis were enrolled. Data were prospectively collected and event rates during follow-up were calculated as the Kaplan-Meier estimates. RESULTS Mean age was 81.1 ± 5.9 years and 49.7% (75/151) were female with a median logistic EuroScore of 13.8% [8.2-20.5]. Device success was achieved in 88.1% (133/151) and procedure related mortality was 0.7% (1/151). At one-year, all-cause mortality was 3.3% (5/151), while permanent pacemaker implantation occurred in 12.7% (19/151) of patients. The "clinical efficacy after 30 days" was observed in 24.8% (37/151), where the main contributor was symptom worsening in 14.8% (22/151) of cases. "Time-related valve safety" occurred in 22.0% (33/151) with structural valve deterioration as main contributor in 10.7% (16/151) of cases. CONCLUSIONS Using the ACURATE neo, we found a favorable safety profile with low all-cause mortality at 1 year. The reported VARC-2 defined composite endpoints at 1 year reveal low rates of "clinical efficacy after 30 days" and "time-related valve safety".
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Affiliation(s)
- Costanza Pellegrini
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Teresa Trenkwalder
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - N Patrick Mayr
- Institut für Anästhesiologie, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Jonathan Michel
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Adnan Kastrati
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Albert M Kasel
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian Hengstenberg
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Oliver Husser
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Department of Internal Medicine I, Cardiology, St. Johannes-Hospital, Dortmund, Germany
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26
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Niepmann ST, Steffen E, Zietzer A, Adam M, Nordsiek J, Gyamfi-Poku I, Piayda K, Sinning JM, Baldus S, Kelm M, Nickenig G, Zimmer S, Quast C. Graded murine wire-induced aortic valve stenosis model mimics human functional and morphological disease phenotype. Clin Res Cardiol 2019; 108:847-856. [PMID: 30767058 DOI: 10.1007/s00392-019-01413-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/14/2019] [Indexed: 11/30/2022]
Abstract
Aortic valve stenosis (AS) is the most common valve disease requiring therapeutic intervention. Even though the incidence of AS has been continuously rising and AS is associated with significant morbidity and mortality, to date, no medical treatments have been identified that can modify disease progression. This unmet medical need is likely attributed to an incomplete understanding of the molecular mechanism driving disease development. To investigate the pathophysiology leading to AS, reliable and reproducible animal models that mimic human pathophysiology are needed. We have tested and expanded the protocols of a wire-injury induced AS mouse model. For this model, coronary wires were used to apply shear stress to the aortic valve cusps with increasing intensity. These protocols allowed distinction of mild, moderate and severe wire-injury. Upon moderate or severe injury, AS developed with a significant increase in aortic valve peak blood flow velocity. While moderate injury promoted solitary AS, severe-injury induced mixed aortic valve disease with concomitant mild to moderate aortic regurgitation. The changes in aortic valve function were reflected by dilation and hypertrophy of the left ventricle, as well as a decreased left ventricular ejection fraction. Histological analysis revealed the classic hallmarks of human disease with aortic valve thickening, increased macrophage infiltration, fibrosis and calcification. This new mouse model of AS promotes functional and morphological changes similar to moderate and severe human AS. It can be used to investigate the pathomechanisms contributing to AS development and to test novel therapeutic strategies.
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Affiliation(s)
- Sven Thomas Niepmann
- Heart Center Bonn, Clinic for Internal Medicine II, University Hospital Bonn, Bonn, Germany.
| | - Eva Steffen
- Heart Center Bonn, Clinic for Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Andreas Zietzer
- Heart Center Bonn, Clinic for Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Matti Adam
- Clinic for Cardiology, University Hospital Cologne, Cologne, Germany
| | - Julia Nordsiek
- Heart Center Bonn, Clinic for Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Isabella Gyamfi-Poku
- Cardiovascular Research Laboratory, Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Kerstin Piayda
- Cardiovascular Research Laboratory, Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Jan-Malte Sinning
- Heart Center Bonn, Clinic for Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Stephan Baldus
- Clinic for Cardiology, University Hospital Cologne, Cologne, Germany
| | - Malte Kelm
- Cardiovascular Research Laboratory, Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,CARID, Cardiovascular Research Institute Düsseldorf, Düsseldorf, Germany
| | - Georg Nickenig
- Heart Center Bonn, Clinic for Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Clinic for Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Christine Quast
- Cardiovascular Research Laboratory, Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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27
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Wernly B, Eder S, Navarese EP, Kretzschmar D, Franz M, Alushi B, Beckhoff F, Jung C, Lichtenauer M, Datz C, Schulze PC, Landmesser U, Hoppe UC, Falk V, Lauten A. Transcatheter aortic valve replacement for pure aortic valve regurgitation: "on-label" versus "off-label" use of TAVR devices. Clin Res Cardiol 2019; 108:921-930. [PMID: 30737532 DOI: 10.1007/s00392-019-01422-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 01/24/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) has become the mainstay of treatment for aortic stenosis in patients with high surgical risk. Pure aortic regurgitation (PAR) is considered a relative contraindication for TAVR; however, TAVR is increasingly performed in PAR patients with unfavorable risk profile. Herein, we aim to summarize available data on TAVR for PAR with special emphasis on "on-label" versus "off-label" TAVR devices. METHODS AND RESULTS Pubmed was searched for studies of patients undergoing TAVR for PAR. Primary outcome was 30 day-mortality. Pooled estimated event rates were calculated. Twelve studies including a total of 640 patients were identified until December 2017. Among these, 208 (33%) patients were treated with devices with CE-mark approval for PAR ("on-label"; JenaValve and J valve). Overall, the procedural success rate was 89.9% (95% CI 81.1-96.1%; I2 80%). Major bleeding was reported in 6.4% (95% CI 2.9-10.8%; I2 48%). All-cause mortality at 30 days was 10.4% (95% CI 7.1-14.2%; I2 20%). Stroke occurred in 2.2% (95% CI 0.9-3.9%; I2 0%). A permanent pacemaker was required in 10.7% (95% CI 7.3-14.6%; I2 23%). At 30 days after TAVR, ≥ moderate AR post-interventional was observed in 11.5% (95% CI 2.9-23.6%; I2 90%). In the "on-label"-group, success rate was 93.0% (95% CI 85.9-98.1%; I2 52%). 30-day-mortality was 9.1% (95% CI 3.7-16.0%; I2 36%). More than trace AR was present in 2.8% (95% CI 0.1-7.6%; I2 0%). Compared to first-generation devices, second-generation devices were associated with significantly lower 30-day-mortality (r = - 0.10; p = 0.02), and significantly higher procedural success rates (r = 0.28; p < 0.001). Compared to other second-generation devices, the use of J valve or JenaValve was not associated with altered mortality (r = 0.04; p = 0.50), rates of > trace residual AR (r = - 0.05; p = 0.65) but with a significantly higher procedural success (r = 0.15; p = 0.042). CONCLUSION Based on this summary of available observational data TAVR for PAR is feasible and safe in patients deemed inoperable. First-generation TAVR devices are associated with inferior outcome and should be avoided. The "on-label" use of PAR-certified TAVR devices is associated with a significantly higher procedural success rate and might be favorable compared to other second-generation devices.
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Affiliation(s)
- Bernhard Wernly
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Sarah Eder
- Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of Paracelsus Medical University Salzburg, Oberndorf, Austria
| | - Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Falls Church, VA, USA.,SIRIO MEDICINE Network, Evidence-Based Section, Falls Church, VA, USA.,Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Daniel Kretzschmar
- Department of Cardiology, Clinic of Internal Medicine I, Universitaetsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Marcus Franz
- Department of Cardiology, Clinic of Internal Medicine I, Universitaetsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Brunilda Alushi
- Department of Cardiology, University Heart Center Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Site Berlin, Berlin, Germany
| | - Frederik Beckhoff
- Department of Cardiology, University Heart Center Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Site Berlin, Berlin, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Düsseldorf, Germany
| | - Michael Lichtenauer
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Christian Datz
- Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of Paracelsus Medical University Salzburg, Oberndorf, Austria
| | - Paul Christian Schulze
- Department of Cardiology, Clinic of Internal Medicine I, Universitaetsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Ulf Landmesser
- Department of Cardiology, University Heart Center Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Uta C Hoppe
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charite Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Alexander Lauten
- Department of Cardiology, University Heart Center Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany. .,German Center for Cardiovascular Research (DZHK), Site Berlin, Berlin, Germany.
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Solomonica A, Choudhury T, Bagur R. Newer-generation of Edwards transcatheter aortic valve systems: SAPIEN 3, Centera, and SAPIEN 3 Ultra. Expert Rev Med Devices 2018; 16:81-87. [DOI: 10.1080/17434440.2019.1555465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Rodrigo Bagur
- London Health Sciences Centre, London, Canada
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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29
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Incidence and impact of prosthesis–patient mismatch following transcatheter aortic valve implantation. Clin Res Cardiol 2018; 108:660-668. [DOI: 10.1007/s00392-018-1394-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 11/15/2018] [Indexed: 12/28/2022]
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30
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Rheude T, Blumenstein J, Möllmann H, Husser O. Spotlight on the SAPIEN 3 transcatheter heart valve. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:353-360. [PMID: 30319292 PMCID: PMC6171512 DOI: 10.2147/mder.s143897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is increasingly performed in patients with severe aortic stenosis. The efficacy and safety have been demonstrated in large randomized trials in patients with high- or intermediate operative risk. With latest-generation transcatheter heart valve (THV) systems, growing operator experience and improved patient selection, clinical outcome has significantly improved with a decline of TAVI-related complications. In this review, the Edwards SAPIEN 3 THV is discussed in terms of technology, procedural advances and complication trends and future developments.
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Affiliation(s)
- Tobias Rheude
- Department of Cardiovascular Diseases, German Heart Centre, Technical University Munich, Munich, Germany
| | | | - Helge Möllmann
- Department of Cardiology, St.-Johannes-Hospital, Dortmund, Germany,
| | - Oliver Husser
- Department of Cardiology, St.-Johannes-Hospital, Dortmund, Germany,
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31
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A combination of rare complications 3 years after a dual-chamber pacemaker implantation. Clin Res Cardiol 2018; 108:465-467. [PMID: 30259106 DOI: 10.1007/s00392-018-1375-3] [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: 05/28/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
Late perforation of the atrial wall after pacemaker implantation frequently remains asymptomatic but may cause chest pain, dyspnea or syncope. Perforation can also lead to rarer complications such as hemoptysis and pneumopericardium. We present the case of a patient who developed progressive hemoptysis 3 years after a dual-chamber pacemaker implantation. Pacemaker interrogation showed stable impedance of the right atrial lead and stable pacing threshold values. CT revealed perforation of the right atrial wall by the RA-lead with consecutive pneumopericardium and diffuse lung bleeding of the right middle lobe. The patient was hemodynamically stable at all times. The right atrial lead was transvenously extracted and replaced without any further complications.
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32
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Invasive hemodynamics and cardiac biomarkers to predict outcomes after percutaneous edge-to-edge mitral valve repair in patients with severe heart failure. Clin Res Cardiol 2018; 108:375-387. [PMID: 30191296 DOI: 10.1007/s00392-018-1365-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/30/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Percutaneous mitral valve repair (PMVR) via MitraClip implantation is a therapeutic option for high-risk or non-surgical candidates with severe mitral regurgitation (MR) and advanced stages of heart failure (HF). However, these patients have a high mortality despite PMVR, and predictors for outcomes are not well established. Here, we evaluated invasive hemodynamics, echocardiography parameters, and biomarkers to predict outcomes after PMVR in severe HF patients. METHODS Patients with reduced ejection fraction (EF) and severe and moderate-to-severe MR undergoing PMVR at our centre between September 2009 and January 2016 were analysed retrospectively. Inclusion criteria were: left ventricular EF < 45%, preoperative right heart catheterization, successful MitraClip deployment ("technical success"), and follow-up for at least 1 year after the procedure. Data from preoperative right heart catheterization, echocardiography, and biomarkers were assessed. Primary endpoint was all-cause mortality at 1 year after PMVR. We performed univariate and multivariate Cox regression analyses and generated a risk score to predict outcomes. RESULTS Of 174 patients with PMVR and severe HF, 79.9% had functional MR. Mean EF was 25% (17.2; 30.7) and advanced New York Heart Association functional class was prevalent (class II: 13%; class III: 70%; and class IV: 17%). The cumulative incidences of all-cause death were 6.9% and 17.8% at 30 days and 1 year, respectively. In the Cox multivariate model, high-sensitive troponin T [hsTnT; hazard ratio (HR) 1.01; confidence interval (CI) 1.01-1.02; p < 0.0001] and mixed venous O2-saturation (HR 0.92; CI 0.89-0.96; p < 0.0001) were found to significantly and independently predict outcomes. A simple risk score including these two parameters was sufficient to discriminate between low- and high-risk patients (HR 7.22; CI 3.4-15.5; p < 0.001). CONCLUSION In a cohort of patients with severe HF undergoing PMVR, patients with elevated hsTnT and reduced mixed venous O2-saturation carried the worst prognosis. A simple risk score including these two parameters may improve patient selection and outcomes after PMVR.
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Kim WK, Möllmann H, Liebetrau C, Renker M, Rolf A, Simon P, Van Linden A, Arsalan M, Doss M, Hamm CW, Walther T. The ACURATE neo Transcatheter Heart Valve. JACC Cardiovasc Interv 2018; 11:1721-1729. [DOI: 10.1016/j.jcin.2018.04.039] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/11/2018] [Accepted: 04/17/2018] [Indexed: 01/29/2023]
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34
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Wernly B, Zappe AK, Unbehaun A, Sinning JM, Jung C, Kim WK, Fichtlscherer S, Lichtenauer M, Hoppe UC, Alushi B, Beckhoff F, Wewetzer C, Franz M, Kretzschmar D, Navarese E, Landmesser U, Falk V, Lauten A. Transcatheter valve-in-valve implantation (VinV-TAVR) for failed surgical aortic bioprosthetic valves. Clin Res Cardiol 2018; 108:83-92. [DOI: 10.1007/s00392-018-1326-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/26/2018] [Indexed: 12/19/2022]
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Kim WK, Hengstenberg C, Hilker M, Kerber S, Schäfer U, Rudolph T, Linke A, Franz N, Kuntze T, Nef H, Kappert U, Zembala MO, Toggweiler S, Walther T, Möllmann H. The SAVI-TF Registry. JACC Cardiovasc Interv 2018; 11:1368-1374. [DOI: 10.1016/j.jcin.2018.03.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 10/28/2022]
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Heart Valve Disease Awareness Survey 2017: what did we achieve since 2015? Clin Res Cardiol 2018; 108:61-67. [PMID: 29943272 DOI: 10.1007/s00392-018-1312-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/20/2018] [Indexed: 12/26/2022]
Abstract
AIMS The 2015 Heart Valve Disease Awareness Survey showed a low knowledge and awareness about heart valve disease in the general population despite its high prevalence and morbidity. The 2017 survey was conducted to re-evaluate concern and knowledge about heart valve disease after 2 years of rapidly increasing patient numbers presenting with heart valve disease. METHODS AND RESULTS A total of 12,820 people aged 60 years or older in 11 European countries took part in the survey. While the number of people concerned most about heart valve disease increased significantly (2015:1.7% vs. 2017:2.1%; p < 0.001), it is still very low compared to cancer (28.8%) or Alzheimer's disease (20.9%). More people claim to be familiar with heart valve disease in general (2015: 17.1% vs. 2017: 20.0%; p < 0.001) and the majority claims to know of at least one therapy for heart valve disease (61.9%). Nevertheless, only 3.8% could correctly identify aortic stenosis (AS), which is significantly less than in 2015 (7.2%; p < 0.001). As before, the majority of the respondents claimed to rarely or never undergo a stethoscope check from their general practitioner (2015: 54.2% vs. 2017: 50.6%, p < 0.001); nevertheless, a positive trend can be seen. People wish heart valve disease to be part of regular checks by the general practitioners. CONCLUSION The general population's knowledge of heart valve disease in general slightly increased over the last 2 years. However, detailed understanding of aortic stenosis and its treatment options is still low, as is the level of concern shown for heart valve disease. Nevertheless, the general population cites heart valve disease as a condition they wish to be checked for regularly.
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37
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Late migration of Edwards SAPIEN 3 transcatheter heart valves: mechanisms and transcatheter treatment options for a rare phenomenon. Clin Res Cardiol 2018; 107:1183-1186. [DOI: 10.1007/s00392-018-1301-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 06/11/2018] [Indexed: 10/14/2022]
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Author's reply. J Cardiol 2018; 71:598. [DOI: 10.1016/j.jjcc.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/08/2017] [Indexed: 11/21/2022]
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39
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Predictors of paravalvular regurgitation and permanent pacemaker implantation after TAVR with a next-generation self-expanding device. Clin Res Cardiol 2018; 107:688-697. [DOI: 10.1007/s00392-018-1235-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
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40
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Patient-specific registration of 3D CT angiography (CTA) with X-ray fluoroscopy for image fusion during transcatheter aortic valve implantation (TAVI) increases performance of the procedure. Clin Res Cardiol 2018; 107:507-516. [DOI: 10.1007/s00392-018-1212-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/01/2018] [Indexed: 12/14/2022]
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