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Hodgson DMD, Elkhateeb O, Gainer R, Hirsch G, Koilpillai C, Aliter H. Structural valve deterioration of bioprosthesis in the aortic position: A single-center experience. J Card Surg 2022; 37:4285-4292. [PMID: 36259749 DOI: 10.1111/jocs.17044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/06/2022] [Accepted: 08/14/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Aortic valve replacement (AVR) is one of the most common open-heart surgical procedures. The durability of the tissue valve in the aortic position is crucial in AVR and transcatheter AVR. We reviewed structural valve deterioration using echocardiographic follow-up in three types of surgical aortic tissue valves. METHODS A retrospective analysis was conducted where hemodynamic deterioration was evaluated and compared using transthoracic echocardiography, including pressure gradients and effective orifice area. Kaplan-Meier analyses were used to summarize the time to failure. RESULTS The study included 133 Trifecta, 156 Epic, and 321 Magna Ease valves. Seventy-six percent (1941/2551) of patients had to be excluded due to insufficient echo data. Through univariate analysis, 34% (216/610) of valves met deterioration criteria after 24 months. Unadjusted survival curves showed a significant difference between valves (p ≤ .001), with a longer mean time to deterioration for the Magna Ease versus Trifecta and Epic of 68.9 versus 50.1 and 38.2 months, respectively. A Cox proportional hazard analysis found worse hazard ratios of 1.69 (p ≤ .04) and 2.4 (p ≤ .01) for Trifecta versus Magna and Epic versus Trifecta, respectively. CONCLUSION All three valve types demonstrated structural valve deterioration on echocardiographic follow-up with significant differences in rate. The Magna Ease appeared to have the highest durability, and the Epic the lowest. Further investigation is warranted to confirm the results in a larger multicenter study.
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Affiliation(s)
| | - Osama Elkhateeb
- Department of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ryan Gainer
- Department of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gregory Hirsch
- Department of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chris Koilpillai
- Department of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hashem Aliter
- Department of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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2
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Watson RA, Vishnevsky A, Dikdan S, Marcantuono R, Decaro M, Goldhammer J, Entwistle JWC, Ruggiero N, Mehrotra P. Orifice areas of balloon-expandable transcatheter heart valves: a three-dimensional transesophageal echocardiography study. J Am Soc Echocardiogr 2021; 35:460-468. [PMID: 34954049 DOI: 10.1016/j.echo.2021.12.009] [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: 03/20/2021] [Revised: 10/21/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Accurate expected effective orifice area (EOA) values for balloon-expandable (BE) transcatheter heart valves (THV) are crucial for preventing patient prosthesis mismatch (PPM) and assessment of THV function. Currently published reference EOAs, however, are based on transthoracic echocardiography (TTE) which may be subject to left ventricular outflow tract diameter underestimation and/or suboptimal THV Doppler interrogation. The objective of this study was to establish reference EOA values for BE THVs based on Doppler and three-dimensional (3D) transesophageal echocardiography (TEE). METHODS We retrospectively reviewed 212 intra-procedural TEEs performed during BE THV implantation with optimal post-implant Doppler and 3D imaging. We compared continuity equation-derived EOAs to geometric orifice areas by 3D-planimetry (GOA3D). Performance indices (i.e., EOA normalized to valve size) and PPM rates were determined. TTE-based EOAs performed within 30 days were also calculated in a subset of 170 patients. RESULTS The average EOA for all BE THV valves (77% Sapien 3) was 2.3 cm2 ± 0.5, while the average EOA was 1.6 ± 0.2 cm2 for 20 mm, 2.0 ± 0.2 cm2 for 23 mm, 2.5 ± 0.3 cm2 for 26 mm and 3.0 ± 0.3 cm2 for 29 mm THV size (p<0.001). Bland-Altman analysis demonstrated very good agreement between EOA and GOA3D (bias -0.04 ± 0.15 cm2). There was a strong correlation between annular area and TEE-based EOA (R=0.84) and GOA3D (R=0.87). The mean performance index was 47 ± 5% and was similar for all THV sizes (p=0.21). EOAs based on TTE were smaller compared to TEE, while the correlation with annular area (R=0.67) and agreement with GOA3D (bias -0.26 ± 0.43 cm2) was not as strong. The overall PPM rate was 2% in the TEE cohort and 12% in the TTE cohort. CONCLUSIONS Effective orifice areas for BE THVs based on intra-procedural Doppler and 3D-TEE suggest that previously published TTE-based reference values for EOA are underestimated while PPM rates may be overestimated. Our findings have important clinical implications for pre-implant decision making and for the evaluation of THV hemodynamics and function during follow-up.
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Affiliation(s)
- Ryan A Watson
- Division of Cardiology, Thomas Jefferson University Hospital, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA
| | - Alec Vishnevsky
- Division of Cardiology, Thomas Jefferson University Hospital, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA
| | - Sean Dikdan
- Division of Cardiology, Thomas Jefferson University Hospital, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA
| | - Rebecca Marcantuono
- Division of Cardiology, Thomas Jefferson University Hospital, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA
| | - Mark Decaro
- Division of Cardiology, Thomas Jefferson University Hospital, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA
| | - Jordan Goldhammer
- Department of Anesthesiology, Thomas Jefferson University Hospital, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA
| | - John W C Entwistle
- Division of Cardiothoracic Surgery, Thomas Jefferson University Hospital, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA
| | - Nicholas Ruggiero
- Division of Cardiology, Thomas Jefferson University Hospital, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA
| | - Praveen Mehrotra
- Division of Cardiology, Thomas Jefferson University Hospital, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA.
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Essential information on surgical heart valve characteristics for optimal valve prosthesis selection: Expert consensus document from the European Association for Cardio-Thoracic Surgery (EACTS)-The Society of Thoracic Surgeons (STS)-American Association for Thoracic Surgery (AATS) Valve Labelling Task Force. J Thorac Cardiovasc Surg 2020; 161:545-558. [PMID: 33070936 DOI: 10.1016/j.jtcvs.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Comprehensive information on the characteristics of surgical heart valves (SHVs) is essential for optimal valve selection. Such information is also important in assessing SHV function after valve replacement. Despite the existing regulatory framework for SHV sizing and labelling, this information is challenging to obtain in a uniform manner for various SHVs. To ensure that clinicians are adequately informed, the European Association for Cardio-Thoracic Surgery (EACTS), The Society of Thoracic Surgeons (STS) and American Association for Thoracic Surgery (AATS) set up a Task Force comprised of cardiac surgeons, cardiologists, engineers, regulatory bodies, representatives of the International Organization for Standardization and major valve manufacturers. Previously, the EACTS-STS-AATS Valve Labelling Task Force identified the most important problems around SHV sizing and labelling. This Expert Consensus Document formulates recommendations for providing SHV physical dimensions, intended implant position and hemodynamic performance in a transparent, uniform manner. Furthermore, the Task Force advocates for the introduction and use of a standardized chart to assess the probability of prosthesis-patient mismatch and calls valve manufacturers to provide essential information required for SHV choice on standardized Valve Charts, uniformly for all SHV models.
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Durko AP, Pibarot P, Atluri P, Bapat V, Cameron DE, Casselman FPA, Chen EP, Dahle G, Elefteriades JA, Lancellotti P, Prager RL, Rosenhek R, Speir A, Stijnen M, Tasca G, Yoganathan A, Walther T, De Paulis R. Essential Information on Surgical Heart Valve Characteristics for Optimal Valve Prosthesis Selection: Expert Consensus Document From the European Association for Cardio-Thoracic Surgery (EACTS)-The Society of Thoracic Surgeons (STS)-American Association for Thoracic Surgery (AATS) Valve Labelling Task Force. Ann Thorac Surg 2020; 111:314-326. [PMID: 33036738 DOI: 10.1016/j.athoracsur.2020.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 10/23/2022]
Abstract
Comprehensive information on the characteristics of surgical heart valves (SHVs) is essential for optimal valve selection. Such information is also important in assessing SHV function after valve replacement. Despite the existing regulatory framework for SHV sizing and labelling, this information is challenging to obtain in a uniform manner for various SHVs. To ensure that clinicians are adequately informed, the European Association for Cardio-Thoracic Surgery (EACTS), The Society of Thoracic Surgeons (STS) and American Association for Thoracic Surgery (AATS) set up a Task Force comprised of cardiac surgeons, cardiologists, engineers, regulatory bodies, representatives of the International Organization for Standardization and major valve manufacturers. Previously, the EACTS-STS-AATS Valve Labelling Task Force identified the most important problems around SHV sizing and labelling. This Expert Consensus Document formulates recommendations for providing SHV physical dimensions, intended implant position and hemodynamic performance in a transparent, uniform manner. Furthermore, the Task Force advocates for the introduction and use of a standardized chart to assess the probability of prosthesis-patient mismatch and calls valve manufacturers to provide essential information required for SHV choice on standardized Valve Charts, uniformly for all SHV models.
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Affiliation(s)
- Andras P Durko
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vinayak Bapat
- Department of Cardiovascular Surgery, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Duke E Cameron
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Filip P A Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Gry Dahle
- Department of Cardiothoracic and Thoracic Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - John A Elefteriades
- Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology, University of Liège Hospital, Liège, Belgium
| | - Richard L Prager
- Department of Cardiac Surgery, University of Michigan Hospital, Ann Arbor, Michigan
| | - Raphael Rosenhek
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Alan Speir
- Department of Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Giordano Tasca
- Cardiac Surgery Unit, Heart Health Center, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ajit Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory School of Medicine, Atlanta, Georgia
| | - Thomas Walther
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University, Frankfurt, Germany
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5
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Durko AP, Pibarot P, Atluri P, Bapat V, Cameron DE, Casselman FP, Chen EP, Dahle G, Elefteriades JA, Lancellotti P, Prager RL, Rosenhek R, Speir A, Stijnen M, Tasca G, Yoganathan A, Walther T, De Paulis R. Essential information on surgical heart valve characteristics for optimal valve prosthesis selection: expert consensus document from the European Association for Cardio-Thoracic Surgery (EACTS)–The Society of Thoracic Surgeons (STS)–American Association for Thoracic Surgery (AATS) Valve Labelling Task Force. Eur J Cardiothorac Surg 2020; 59:54-64. [DOI: 10.1093/ejcts/ezaa263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/26/2020] [Accepted: 04/08/2020] [Indexed: 01/17/2023] Open
Abstract
Abstract
Comprehensive information on the characteristics of surgical heart valves (SHVs) is essential for optimal valve selection. Such information is also important in assessing SHV function after valve replacement. Despite the existing regulatory framework for SHV sizing and labelling, this information is challenging to obtain in a uniform manner for various SHVs. To ensure that clinicians are adequately informed, the European Association for Cardio-Thoracic Surgery (EACTS), The Society of Thoracic Surgeons (STS) and American Association for Thoracic Surgery (AATS) set up a Task Force comprised of cardiac surgeons, cardiologists, engineers, regulatory bodies, representatives of the International Organization for Standardization and major valve manufacturers. Previously, the EACTS–STS–AATS Valve Labelling Task Force identified the most important problems around SHV sizing and labelling. This Expert Consensus Document formulates recommendations for providing SHV physical dimensions, intended implant position and haemodynamic performance in a transparent, uniform manner. Furthermore, the Task Force advocates for the introduction and use of a standardized chart to assess the probability of prosthesis–patient mismatch and calls valve manufacturers to provide essential information required for SHV choice on standardized Valve Charts, uniformly for all SHV models.
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Affiliation(s)
- Andras P Durko
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Laval University, Quebec, QC, Canada
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Vinayak Bapat
- Department of Cardiovascular Surgery, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Duke E Cameron
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Filip P.A Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Gry Dahle
- Department of Cardiothoracic and Thoracic surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - John A Elefteriades
- Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology, University of Liège Hospital, Liège, Belgium
| | - Richard L Prager
- Department of Cardiac Surgery, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Raphael Rosenhek
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Alan Speir
- Department of Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, VA, USA
| | | | - Giordano Tasca
- Cardiac Surgery Unit, Heart Health Center, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ajit Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory School of Medicine, Atlanta, GA, USA
| | - Thomas Walther
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University, Frankfurt, Germany
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Külling M, Külling J, Wyss C, Hürlimann D, Reho I, Salzberg S, Bühler I, Noll G, Grünenfelder J, Corti R, Biaggi P. Effective orifice area and hemodynamic performance of the transcatheter Edwards Sapien 3 prosthesis: short-term and 1-year follow-up. Eur Heart J Cardiovasc Imaging 2018; 19:23-30. [PMID: 28065915 DOI: 10.1093/ehjci/jew301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 11/16/2017] [Indexed: 12/12/2022] Open
Abstract
Aims The Edwards Sapien 3 heart valve prosthesis (S3) is commonly used for transcatheter aortic valve implantation (TAVI) and is available in three sizes. To date no data has been published on the effective orifice area (EOA) and the hemodynamic performance of the three different S3 sizes. The aim of this study was to measure the size-specific EOA and hemodynamic performance of the S3 in short-term and 1-year follow-up. Methods and results One hundred and thirteen consecutive patients treated by TAVI with a S3 prosthesis at the Heart Clinic Zurich between May 2014 and July 2015 were included. Clinical data were extracted from the Swiss TAVI registry. The EOA was calculated using Doppler echocardiography (peri-interventionally and at discharge) and by 3D-biplane transoesophageal echocardiography (peri-interventionally). Mean transvalvular gradients (dPmean) were additionally calculated with Doppler echocardiography at 30 days and 1 year. Results were analysed separately for the 23 mm (n = 42; 37%), 26 mm (n = 46; 41%), and 29 mm (n = 25; 22%) prostheses. At discharge, the EOAs were 1.6 ± 0.2 cm2 (23 mm S3), 2.0 ± 0.2 cm2 (26 mm S3), and 2.7 ± 0.2 cm2 (29 mm S3), p < 0.001. The dPmeans at discharge were 10.9 ± 6.0 mmHg (23 mm S3), 10.4 ± 3.5 mmHg (26 mm S3), and 8.9 ± 2.8 mmHg (29 mm S3), p = 0.235, and did not significantly change over time within any of the S3 sizes. Conclusions Post-TAVI, the EOAs of the three different S3 prosthesis sizes differ significantly, the transvalvular gradients, however, are comparable. Mean transvalvular gradients remain stable over time and document good prosthesis function after 1 year.
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Affiliation(s)
- Mischa Külling
- University of Zurich, Faculty of Medicine, Rämistrasse 71, 8006 Zurich, Switzerland
| | - Jeremy Külling
- Swiss Federal Institute of Technology (ETH), Department of Statistics, Rämistrasse 101, 8092 Zurich, Switzerland
| | - Christophe Wyss
- Heart Clinic Zurich, Hirslanden, Witellikerstrasse 40, 8032 Zurich, Switzerland
| | - David Hürlimann
- Heart Clinic Zurich, Hirslanden, Witellikerstrasse 40, 8032 Zurich, Switzerland
| | - Ivano Reho
- Heart Clinic Zurich, Hirslanden, Witellikerstrasse 40, 8032 Zurich, Switzerland
| | - Sacha Salzberg
- Heart Clinic Zurich, Hirslanden, Witellikerstrasse 40, 8032 Zurich, Switzerland
| | - Ines Bühler
- Heart Clinic Zurich, Hirslanden, Witellikerstrasse 40, 8032 Zurich, Switzerland
| | - Georg Noll
- Heart Clinic Zurich, Hirslanden, Witellikerstrasse 40, 8032 Zurich, Switzerland
| | - Jürg Grünenfelder
- Heart Clinic Zurich, Hirslanden, Witellikerstrasse 40, 8032 Zurich, Switzerland
| | - Roberto Corti
- Heart Clinic Zurich, Hirslanden, Witellikerstrasse 40, 8032 Zurich, Switzerland
| | - Patric Biaggi
- Heart Clinic Zurich, Hirslanden, Witellikerstrasse 40, 8032 Zurich, Switzerland
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