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Manasrah N, Sattar Y, Patel N, Kambalapalli S, Duhan S, Pandya KK, Najam M, Alsaud A, AlJaroudi W, Alraies MC. A Propensity-Matched National Analysis of Transcatheter Aortic Valve Implantation Outcome in Patients With Gastrointestinal Bleeding. Am J Cardiol 2023; 205:396-402. [PMID: 37659259 DOI: 10.1016/j.amjcard.2023.07.160] [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: 05/01/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 09/04/2023]
Abstract
Gastrointestinal (GI) bleeding is often observed in severe aortic stenosis, which can be attributed to the presence of arteriovenous malformations and von Willebrand's factor deficiency. GI is one of the most common complications in patients who underwent transcatheter aortic valve implantation (TAVI). The outcome of the TAVI procedure with GI bleeding is unknown. We performed an International Classification of Diseases, Tenth Revision-based national cohort analysis using the national readmission database from 2016 to 2020. We compared cardiovascular outcomes, mortality, and readmission rates of patients with TAVI who developed GI bleeding compared with those who had no GI bleeding. A total of 320,353 hospitalizations with TAVI were identified from the year 2016 to 2020. Patients with TAVI with GI bleeding were 6,193.37 and without GI bleeding were 314,160. The median age of the patients with TAVI with GI or without GI bleeding was 80. GI bleed patients had statistically significantly higher readmission rates at 30, 90, and 180 days and they had higher odds of in-hospital mortality (adjusted odds ratio [aOR] = 6.35; 95% confidence interval [CI]: 5.37 to 7.52; p <0.0001), acute kidney injury (aOR = 5.22; 95% CI:4.75 to 5.74; p <0.0001), stroke (aOR = 2.83; 95% CI 2.05 to 3.91 p:0.0001, postprocedural bleeding (aOR: 1.76; 95% CI: 1.35 to 2.30; p:0.0001), cardiac tamponade (aOR = 2.54; 95% CI 1.86 to 3.49; p <0.0001), use of mechanical circulatory support (aOR: 5.33; 95% CI:4.13 to 6.86; p <0.0001), and heart failure (aOR:1.73; 95%CI: 1.54 to 1.94; p <0.0001). The total cost of hospitalization and length of stay was higher in the GI bleed group. Patients with TAVI with GI bleeding have worse clinical outcomes and higher in-hospital mortality and readmission rates compared with patients with no GI bleeding.
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Affiliation(s)
- Nouraldeen Manasrah
- Department of Internal Medicine, Wayne State University, Detroit Medical Center, Sinai Grace Hospital, Detroit, Michigan
| | - Yasar Sattar
- Department of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Neel Patel
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, Rhode Island
| | - Soumya Kambalapalli
- Department of Internal Medicine, McLaren Regional Medical Center/Michigan State University Flint, Michigan
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, Maryland
| | | | - Maria Najam
- Department of Internal Medicine, University of Texas Rio Grande Valley, Texas
| | - Ali Alsaud
- Department of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Wael AlJaroudi
- Department of Cardiology, Medical College of Georgia at Augusta University, Georgia
| | - M Chadi Alraies
- Department of Cardiology, Wayne State University, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan.
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Adalja D, Zala H, Victor V, Sheth A, Willyard C, Suzuki E, Patel HP, Majmundar M, Vallabhajosyula S, Doshi R. Incidence, Current Guidelines and Management of Gastrointestinal Bleeding after Transcatheter Aortic Valve Replacement: A Systematic Review. Curr Cardiol Rev 2023; 19:e230622206351. [PMID: 35747979 PMCID: PMC10201885 DOI: 10.2174/1573403x18666220623150830] [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: 02/24/2022] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is a significant increase in morbidity and mortality in patients complicated by major bleeding following transcatheter aortic valve replacement (TAVR). It has become more challenging to manage such complications when the patient needs to be on anticoagulation or antiplatelet agent post-procedure to prevent thrombotic/embolic complications. METHODS We systematically reviewed all available randomized controlled trials and observational studies to identify incidence rates of gastrointestinal bleeding post-procedure. After performing a systematic search, a total of 8731 patients from 15 studies (5 RCTs and 10 non-RCTs) were included in this review. RESULTS The average rate of gastrointestinal bleeding during follow-up was 3.0% in randomized controlled trials and 1.9% among observational studies. CONCLUSION Gastrointestinal bleeding has been noted to be higher in the RCTs as compared to observational studies. This review expands knowledge of current guidelines and possible management of patients undergoing TAVR.
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Affiliation(s)
- Devina Adalja
- Department of Internal Medicine, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Harshvardhan Zala
- Department of Clinical Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Varun Victor
- Department of Internal Medicine, Canton Medical Education Foundation, Canton, OH, USA
| | - Aakash Sheth
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Charles Willyard
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA
| | - Emi Suzuki
- Department of Pediatrics, UCSF- Fresno, Fresno, CA, USA
| | - Harsh P. Patel
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, IL, USA
| | - Monil Majmundar
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | | | - Rajkumar Doshi
- Department of Cardiology, St Joseph's University Medical Center, Paterson, NJ, USA
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Efficacy and safety outcomes in novel oral anticoagulants versus vitamin-K antagonist on post-TAVI patients: a meta-analysis. BMC Cardiovasc Disord 2020; 20:307. [PMID: 32586273 PMCID: PMC7318737 DOI: 10.1186/s12872-020-01582-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/10/2020] [Indexed: 12/29/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) has been a favored option for the patient who suffered from symptomatic aortic stenosis. However, the efficacy and safety outcomes in novel oral anticoagulants (NOACs) versus Vitamin-K antagonist (VKA) for post-TAVI patients are still controversial. This meta-analysis aims at comparing the clinical outcome and safety of NOACs and VKA in the patients after receiving TAVI. Method We searched literature articles in all reachable databases, and observational study as well as randomized controlled trial would be included in order to perform a comprehensive analysis. All-cause mortality, major or life-threatening bleeding, disabling or nondisabling stroke were main pooled outcome measures. Subgroup analysis and meta-regression were adopted to explore heterogeneity. Assessment of bias was performed under the suggestion of Cochrane’s Collaboration Tool. Results We collected 3841 non-duplicate citations from PubMed, Embase, Cochrane and ClinicalTrials.gov, and eventually 7 studies were included for this meta-analysis. As a result, VKA showed priority against NOACs in the field of anti-thromboembolism (4435 participants, RR:1.44, 95% CI: 1.05 to 1.99, I2 = 0%, P = 0.02). Conclusion With corroborative analysis of severe complications, VKA is shown to be more protective on post-TAVI patients in disabling or nondisabling stroke scenario but not in mortality or bleeding event.
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NOAC monotherapy in patients with concomitant indications for oral anticoagulation undergoing transcatheter aortic valve implantation. Clin Res Cardiol 2018; 107:799-806. [DOI: 10.1007/s00392-018-1247-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/09/2018] [Indexed: 12/13/2022]
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Geis NA, Kiriakou C, Chorianopoulos E, Pleger ST, Katus HA, Bekeredjian R. Feasibility and safety of vitamin K antagonist monotherapy in atrial fibrillation patients undergoing transcatheter aortic valve implantation. EUROINTERVENTION 2018; 12:2058-2066. [PMID: 28433958 DOI: 10.4244/eij-d-15-00259] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to assess the efficacy and safety of vitamin K antagonist (VKA) monotherapy in atrial fibrillation (AF) patients undergoing transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS In 735 TAVIs since 2008 we identified 167 patients suffering from concomitant AF who received either VKA monotherapy (n=77), VKA plus single antiplatelet therapy (SAPT, n=41) or a triple anticoagulation regimen (n=49). Thromboembolic as well as bleeding complications were analysed for six months after TAVI. Only one minor bleeding and no thromboembolic events occurred after VKA therapy had been initiated post TAVI. Compared to patients being treated with additional either single or dual antiplatelet therapy, the incidence of major/life-threatening bleeding complications was significantly lower in the VKA mono group (0/77 [VKA mono] vs. 3/41 [VKA+SAPT; p=0.04] vs. 4/49 [triple anticoagulation; p=0.02]). Analysis of a combined endpoint of post-procedural death, stroke, embolism and major bleeding revealed a significant superiority of VKA monotherapy compared to VKA plus SAPT or DAPT, respectively (5/77 vs. 9/41 [p=0.02] vs. 14/49 [p=0.002]). CONCLUSIONS VKA therapy without additional antiplatelet treatment is effective and safe in AF patients undergoing TAVI.
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Affiliation(s)
- Nicolas A Geis
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
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Stanger DE, Abdulla AH, Wong FT, Alipour S, Bressler BL, Wood DA, Webb JG. Upper gastrointestinal bleeding following transcatheter aortic valve replacement: A retrospective analysis. Catheter Cardiovasc Interv 2016; 90:E53-E61. [PMID: 27392808 DOI: 10.1002/ccd.26650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 05/09/2016] [Accepted: 06/04/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The aim of this study was to identify the incidence of upper gastrointestinal bleeding (UGIB) in the postprocedural period following transcatheter aortic valve replacement (TAVR). BACKGROUND As TAVR moves into intermediate- and low-risk patients, it has become increasingly important to understand its extracardiac complications. The patient population undergoing TAVR have clinical and demographic characteristics that place them at significant risk of UGIB. Practical aspects of TAVR, including use of antithrombotic therapy, further increase risk of UGIB. METHODS A retrospective single-center evaluation of 841 patients who underwent TAVR between January 2005 and August 2014 was performed in conjunction with analysis of referral patterns to the gastroenterology service for UGIB at the same site. RESULTS The overall risk of UGIB following TAVR was found to be 2.0% (n = 17/841). Additionally, the risk of UGIB in patients receiving triple antithrombotic therapy was found to be 10-fold greater than patients not receiving triple antithrombotic therapy (11.8% vs 1.0%). Endoscopy findings demonstrated five high-risk esophageal lesions including erosive esophageal ulcers, visible vessels at the GE junction, erosions at distal esophagus, and an actively bleeding esophageal ring that had been intubated through by the transesophageal echocardiography (TEE) probe. CONCLUSIONS This large cohort study demonstrates that TAVR is associated with a moderate risk of severe UGIB. The results of this study suggest that patients on triple antithrombotic therapy are at highest risk for severe UGIB. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Dylan E Stanger
- Division of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alym H Abdulla
- Division of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frank T Wong
- Division of Gastroenterology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sina Alipour
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian L Bressler
- Division of Gastroenterology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Koenig F, Lee JS, Akra B, Hollweck T, Wintermantel E, Hagl C, Thierfelder N. Is Transcatheter Aortic Valve Implantation of Living Tissue-Engineered Valves Feasible? An In Vitro Evaluation Utilizing a Decellularized and Reseeded Biohybrid Valve. Artif Organs 2016; 40:727-37. [PMID: 27187768 DOI: 10.1111/aor.12683] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 11/23/2015] [Indexed: 01/08/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is a fast-growing, exciting field of invasive therapy. During the last years many innovations significantly improved this technique. However, the prostheses are still associated with drawbacks. The aim of this study was to create cell-seeded biohybrid aortic valves (BAVs) as an ideal implant by combination of assets of biological and artificial materials. Furthermore, the influence of TAVI procedure on tissue-engineered BAV was investigated. BAV (n=6) were designed with decellularized homograft cusps and polyurethane walls. They were seeded with fibroblasts and endothelial cells isolated from saphenous veins. Consecutively, BAV were conditioned under low pulsatile flow (500 mL/min) for 5 days in a specialized bioreactor. After conditioning, TAVI-simulation was performed. The procedure was concluded with re-perfusion of the BAV for 2 days at an increased pulsatile flow (1100 mL/min). Functionality was assessed by video-documentation. Samples were taken after each processing step and evaluated by scanning electron microscopy (SEM), immunohistochemical staining (IHC), and Live/Dead-assays. The designed BAV were fully functioning and displayed physiologic behavior. After cell seeding, static cultivation and first conditioning, confluent cell layers were observed in SEM. Additionally, IHC indicated the presence of endothelial cells and fibroblasts. A significant construction of extracellular matrix was detected after the conditioning phase. However, a large number of lethal cells were observed after crimping by Live/Dead staining. Analysis revealed that the cells while still being present directly after crimping were removed in subsequent perfusion. Extensive regions of damaged cell-layers were detected by SEM-analysis substantiating these findings. Furthermore, increased ICAM expression was detected after re-perfusion as manifestation of inflammatory reaction. The approach to generate biohybrid valves is promising. However, damages inflicted during the crimping process seem not to be immediately detectable. Due to severe impacts on seeded cells, the strategy of living TE valves for TAVI should be reconsidered.
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Affiliation(s)
- Fabian Koenig
- Department of Cardiac Surgery, Laboratory for Tissue Engineering, Grosshadern Medical Centre, Ludwig Maximilians University, Munich.,Department of Medical Engineering, Technical University Munich, Garching, Germany
| | - Jang-Sun Lee
- Department of Cardiac Surgery, Laboratory for Tissue Engineering, Grosshadern Medical Centre, Ludwig Maximilians University, Munich
| | - Bassil Akra
- Department of Cardiac Surgery, Laboratory for Tissue Engineering, Grosshadern Medical Centre, Ludwig Maximilians University, Munich
| | - Trixi Hollweck
- Department of Cardiac Surgery, Laboratory for Tissue Engineering, Grosshadern Medical Centre, Ludwig Maximilians University, Munich
| | - Erich Wintermantel
- Department of Medical Engineering, Technical University Munich, Garching, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Laboratory for Tissue Engineering, Grosshadern Medical Centre, Ludwig Maximilians University, Munich
| | - Nikolaus Thierfelder
- Department of Cardiac Surgery, Laboratory for Tissue Engineering, Grosshadern Medical Centre, Ludwig Maximilians University, Munich
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Antithrombotic therapy in patients undergoing TAVI with concurrent atrial fibrillation. One center experience. J Thromb Thrombolysis 2016; 40:193-7. [PMID: 25863809 DOI: 10.1007/s11239-015-1210-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Aim of the present study was to record the antithrombotic approach in AF and non-AF patients undergoing TAVI, and to compare the efficiency of the used regimens combination. Antithrombotic approach of patients undergoing TAVI remains a challenging dispute. It becomes even more complex when need for anticoagulant treatment is required due to concurrent atrial fibrillation. Consecutive patients with severe symptomatic aortic stenosis treated with TAVI, were retrospectively studied. All patients were divided into two groups, matched to age, depending on the existence of atrial fibrillation. The primary end-point was the composite of MACE, while the secondary end-point was the occurrence of major bleeding at follow-up. A total of 80 patients were included in the study. Out of them, 20 patients (80.2 ± 5.4 years) suffered from concurrent atrial fibrillation. This group was matched with 20 patients (80.6 ± 3.7 years) with no need for anticoagulation. AF-group patients were treated with clopidogrel plus acenocoumarol for 3 months. Following that, acetylsalicylic acid plus acenocoumarol were prescribed. Non-AF patients were treated with 3 months clopidogrel plus acetylsalicylic acid followed by single acetylsalicylic acid medication. No statistical significant differences in MACE between AF and non-AF group were identified (p = 0.705, phi coefficient = 0.06) (mean follow-up 23.4 ± 14 months). Similarly, there was no statistical significant difference for bleedings among the AF and non-AF patient group (p = 0.658, phi coefficient = 0.14). In patients undergoing TAVI with CoreValve, with concurrent AF, treatment with clopidogrel plus acenocoumarol for 3 months, followed by acetylsalicylic acid plus acenocoumarol, seems safe and effective enough in long-term follow-up.
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Spangenberg T, Budde U, Schewel D, Frerker C, Thielsen T, Kuck KH, Schäfer U. Treatment of acquired von Willebrand syndrome in aortic stenosis with transcatheter aortic valve replacement. JACC Cardiovasc Interv 2016; 8:692-700. [PMID: 25946442 DOI: 10.1016/j.jcin.2015.02.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/02/2015] [Accepted: 02/27/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study sought to investigate the prevalence of abnormal von Willebrand multimers (AbM) in patients undergoing transcatheter aortic valve replacement (TAVR) and the impact of TAVR on the underlying factor variances. BACKGROUND An association between the acquired von Willebrand syndrome (aVWS) and valvular aortic stenosis (AS) has been established in the past and surgical aortic valve replacement (SAVR) shown to lead to factor recovery. Prevalence and course of AbM in patients treated with TAVR though has not yet been described comprehensively. METHODS Ninety-five consecutive patients underwent TAVR at our institution. Hemostaseologic testing was performed before and up to 1 week after TAVR. Transvalvular and right heart hemodynamics as well as bleeding episodes were recorded and analyzed with descriptive statistics. RESULTS Baseline prevalence of AbM was 42% with an average high-molecular-weight multimer (HMWM) count of 16.2 ± 3.3%. Pressure gradients correlated significantly with the extent of HMWM deficiency (r = -0.63 [p < 0.0001]). Following valve implantation, HMWM increased proportional to the drop in mean pressure gradient and normalized in most of the patients. However, residual aortic regurgitation/leakage led to inferior HMWM recovery but prosthesis-patient mismatch (PPM) was rare and left HMWM uninfluenced. We saw no association of transfusion with AbM and 1-year mortality was unaffected by AbM. CONCLUSIONS AbM in patients with AS undergoing TAVR is frequent. However, TAVR is capable of correcting AbM and therefore possibly aVWS in patients with AS. As opposed to SAVR, bleeding and transfusion requirement in TAVR patients was not associated with severe HMWM deficiency; PPM was rare and HMWM were uninfluenced by the procedure. Aortic regurgitation after TAVR adversely influenced HMWM recovery.
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Affiliation(s)
- Tobias Spangenberg
- Division of Cardiology, Asklepios Klinik St. Georg Hospital, Hamburg, Germany.
| | - Ulrich Budde
- Medilys Laborgesellschaft mbH, Hemostaseology, Hamburg, Germany
| | - Dimitry Schewel
- Division of Cardiology, Asklepios Klinik St. Georg Hospital, Hamburg, Germany
| | - Christian Frerker
- Division of Cardiology, Asklepios Klinik St. Georg Hospital, Hamburg, Germany
| | - Thomas Thielsen
- Division of Cardiology, Asklepios Klinik St. Georg Hospital, Hamburg, Germany
| | - Karl-Heinz Kuck
- Division of Cardiology, Asklepios Klinik St. Georg Hospital, Hamburg, Germany
| | - Ulrich Schäfer
- Division of Cardiology, Asklepios Klinik St. Georg Hospital, Hamburg, Germany; Division of Cardiology, University Heart Center Eppendorf, Hamburg, Germany
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Egron S, Kütting M, Marzelle J, Becquemin JP, Schmitz-Rode T, Steinseifer U. What can be done for cerebral embolic protection in TAVI? Analysis in the light of 10 years' experience with protected carotid artery stenting. Expert Rev Med Devices 2016; 13:15-29. [PMID: 26567610 DOI: 10.1586/17434440.2015.1120666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the last 30 years, development of minimally invasive percutaneous procedures to treat cardiovascular defects has been thriving. Although these techniques present obvious advantages, like avoiding cardiopulmonary bypass, the passage of catheter systems and the deployment of devices in the blood circulation can cause particle embolization that may result in stroke. In carotid artery stenting, cerebral embolic protection devices (CEPD) such as filtering membranes have been available for already 10 years. In transcatheter aortic valve implantation (TAVI), the development of CEPD is starting and three membrane-based devices are in clinical trials. There are controversial discussions about the efficacy of CEPD in TAVI. The experience with CEPD in carotid artery stenting can help to understand some of the technical issues and shortcomings of current devices and thereby ultimately reduce cerebral complication risks during TAVI procedures.
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Affiliation(s)
- Sandrine Egron
- a Department of Cardiovascular Engineering , Institute of Applied Medical Engineering AME, Helmholtz Institute , Aachen , Germany
| | - Maximilian Kütting
- a Department of Cardiovascular Engineering , Institute of Applied Medical Engineering AME, Helmholtz Institute , Aachen , Germany
| | - Jean Marzelle
- b Department of Vascular Surgery , Henri Mondor Hospital , Créteil , France
| | | | - Thomas Schmitz-Rode
- a Department of Cardiovascular Engineering , Institute of Applied Medical Engineering AME, Helmholtz Institute , Aachen , Germany
| | - Ulrich Steinseifer
- a Department of Cardiovascular Engineering , Institute of Applied Medical Engineering AME, Helmholtz Institute , Aachen , Germany
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Sterling LH, Windle SB, Filion KB, Eisenberg MJ. Pharmacological management strategies for stroke prevention following transcatheter aortic valve replacement: A systematic review. Int J Cardiol 2015; 191:303-11. [DOI: 10.1016/j.ijcard.2015.04.226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 04/01/2015] [Accepted: 04/29/2015] [Indexed: 11/30/2022]
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Gandhi S, Schwalm JDR, Velianou JL, Natarajan MK, Farkouh ME. Comparison of Dual-antiplatelet Therapy to Mono-antiplatelet Therapy After Transcatheter Aortic Valve Implantation: Systematic Review and Meta-analysis. Can J Cardiol 2015; 31:775-84. [DOI: 10.1016/j.cjca.2015.01.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 01/15/2015] [Accepted: 01/19/2015] [Indexed: 11/24/2022] Open
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Dual Versus Single Antiplatelet Therapy in Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-analysis. Heart Lung Circ 2015; 24:185-92. [DOI: 10.1016/j.hlc.2014.07.058] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 07/11/2014] [Indexed: 11/18/2022]
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Scotten LN, Siegel R. Thrombogenic potential of transcatheter aortic valve implantation with trivial paravalvular leakage. ANNALS OF TRANSLATIONAL MEDICINE 2014; 2:43. [PMID: 25333018 DOI: 10.3978/j.issn.2305-5839.2014.05.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 05/16/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Significant paravalvular leakage after transcatheter aortic valve implantation (TAVI) correlates with increased morbidity and mortality, but adverse consequences of trivial paravalvular leakage have stimulated few investigations. Using a unique method distinctly different from other diagnostic approaches, we previously reported elevated backflow velocities of short duration (transients) in mechanical valve closure. In this study, similar transients were found in a transcatheter valve paravalvular leakage avatar. METHODS Paravalvular leakage rate (zero to 58 mL/second) and aortic valve incompetence (volumetric back flow/forward flow; zero to 32%) were made adjustable using a mock transcatheter aortic valve device and tested in quasi-steady and pulsatile flow test systems. Projected dynamic valve area (PDVA) from the back illuminated mock transcatheter aortic valve device was measured and regional backflow velocities were derived by dividing volumetric flow rate by the PDVA over the open and closing valve phase and the total closed valve area derived from backflow leakage. RESULTS Aortic incompetence from 1-32% generated negative backflow transients from 8 to 267 meters/second, a range not dissimilar to that measured in mechanical valves with zero paravalvular leakage. Optimal paravalvular leakage was identified; not too small generating high backflow transients, not too large considering volume overload and cardiac energy loss caused by defective valve behavior and fluid motion. CONCLUSIONS Thrombogenic potential of transcatheter aortic valves with trivial aortic incompetence and high magnitude regional backflow velocity transients was comparable to mechanical valves. This may have relevance to stroke rate, asymptomatic microembolic episodes and indications for anticoagulation therapy after transcatheter valve insertion.
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Affiliation(s)
- Lawrence N Scotten
- 1 ViVitro Systems Inc. (VSI), Victoria, B.C., Canada ; 2 90 Garibaldi Street, Lake Oswego, OR, USA
| | - Rolland Siegel
- 1 ViVitro Systems Inc. (VSI), Victoria, B.C., Canada ; 2 90 Garibaldi Street, Lake Oswego, OR, USA
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Bernelli C, Chieffo A, Montorfano M, Maisano F, Giustino G, Buchanan GL, Chan J, Costopoulos C, Latib A, Figini F, De Meo E, Giannini F, Covello RD, Gerli C, Franco A, Agricola E, Spagnolo P, Cioni M, Alfieri O, Camici PG, Colombo A. Usefulness of Baseline Activated Clotting Time–Guided Heparin Administration in Reducing Bleeding Events During Transfemoral Transcatheter Aortic Valve Implantation. JACC Cardiovasc Interv 2014; 7:140-151. [DOI: 10.1016/j.jcin.2013.10.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/20/2013] [Accepted: 10/24/2013] [Indexed: 10/25/2022]
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Pharmacodynamic effect of clopidogrel in patients undergoing transcatheter aortic valve implantation. BIOMED RESEARCH INTERNATIONAL 2013; 2013:386074. [PMID: 23956980 PMCID: PMC3728551 DOI: 10.1155/2013/386074] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 06/25/2013] [Indexed: 11/17/2022]
Abstract
The aim of this study was to analyze periprocedural and mid-term effect of clopidogrel on platelet function using the VerifyNow P2Y12 point-of-care assay in patients undergoing TAVI. Platelet reactivity was measured at the beginning of the procedure after 300 mg clopidogrel bolus administration and during the follow-up (at 1 month after the procedure) in 52 patients undergoing TAVI using the Medtronic CoreValve prosthesis (Medtronic CoreValve). A cutoff value of 240 PRU was used to identify nonresponders to clopidogrel treatment with high residual platelet reactivity (HRPR). Baseline HRPR was identified in 80% of patients and in 72% of patients during 6-month follow-up. There was no significant difference in the pharmacodynamic effects of clopidogrel on platelet reactivity from baseline to 6-months follow-up (297 ± 57 vs. 275 ± 62; P = 0.058). Ischemic event occurred only in 3 patients (5.8%) from the study group. In conclusion, majority of patients undergoing TAVI had high residual platelet reactivity after pretreatment with 300 mg of clopidogrel and during the 6-month follow-up at dual antiplatelet treatment. The noneffectiveness of clopidogrel in the TAVI population raises the question of the routine use of dual antiplatelet treatment in this setting.
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