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Moscoso J, Rojas P, Baltodano R, Cachicatari A, Quiroz J, Velarde K, Levano G, Pimentel C. Simultaneous onset of acute myocardial infarction, bicuspid aortic stenosis, and cardiac transthyretin amyloidosis-A clinically complex confluence. Echocardiography 2024; 41:e15733. [PMID: 38284668 DOI: 10.1111/echo.15733] [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: 12/09/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/30/2024] Open
Abstract
The coexistence of bicuspid aortic valve disease and coronary artery disease is well-established, but the identification of cardiac amyloidosis in this population has surged with advancing imaging techniques, introducing complexities in patient management. This case report emphasizes the pivotal role of multimodality imaging in accurately diagnosing three concurrent pathologies.
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Affiliation(s)
- Josh Moscoso
- Department of Cardiology, Guillermo Almenara Hospital, Lima, Perú
| | - Paol Rojas
- Department of Cardiology, Guillermo Almenara Hospital, Lima, Perú
| | | | | | - Jose Quiroz
- Department of Cardiology, Guillermo Almenara Hospital, Lima, Perú
| | - Kevin Velarde
- Department of Cardiology, Guillermo Almenara Hospital, Lima, Perú
| | - Gerald Levano
- Department of Cardiology, Guillermo Almenara Hospital, Lima, Perú
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Zheng HJ, Cheng YB, Lin DQ, Yan CJ, Yu SJ, He P, Li J, Cheng W. Effect of transcatheter aortic valve replacement on ascending aorta dilatation rate in patients with tricuspid and bicuspid aortic stenosis. IJC HEART & VASCULATURE 2023; 49:101313. [PMID: 38107428 PMCID: PMC10724657 DOI: 10.1016/j.ijcha.2023.101313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/07/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
Objectives The aim of the present study was to assess the differences between BAV and TAV patients with chronic moderate to severe or severe AS regarding presentation, incidence of TAVR, survival, ascending aorta diameter and dilatation rate before and after TAVR. Methods The study included 667 consecutive patients with chronic moderate to severe or severe AS from January 2012 and December 2022. Outcomes included all-cause mortality, incidence of TAVR, and ascending aorta diameter and dilatation rate. Results There were 185 BAV-AS and 482 TAV-AS patients, and BAV-AS patients were younger (67 vs 78 years, P = 0.027). Total follow-up was 4.5 years (IQR: 2.7-8.9 years), 290 patients underwent TAVR, and 165 patients died. The 8-year TAVR incidence was higher in BAV-AS (55% ± 4%) vs TAV-AS (41% ± 5%; P = 0.02). The 8-year survival was higher in BAV-AS (85% ± 6%) vs TAV-AS (71% ± 6%; P < 0.0001) and became insignificant after age adjustment (P = 0.33). The dilatation rate of ascending aorta was significantly faster in BAV-AS patients compared with TAV-AS patients before TAVR. However, the ascending aorta dilatation rate for BAV-AS and TAV-AS patients was not significantly different after TAVR. Conclusions Compared with TAV-AS, BAV-AS patients were younger and underwent TAVR more frequently, resulting in a considerable survival advantage. After TAVR, ascending aorta dilatation rates were similar in BAV-AS and TAV-AS patients, suggesting an important role of hemodynamics on ascending aorta dilatation in BAV-AS.
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Affiliation(s)
| | | | - De-Qing Lin
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chao-Jun Yan
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - San-Jiu Yu
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ping He
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jun Li
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Wei Cheng
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Yeats BB, Sivakumar SK, Samaee M, Polsani V, Yadav PK, Thourani VH, Sellers S, Sathananthan J, Dasi LP. Calcium Fracture and Device Over Expansion in Transcatheter Aortic Valve Replacement for Bicuspid Aortic Valves. Ann Biomed Eng 2023; 51:2172-2181. [PMID: 37219698 DOI: 10.1007/s10439-023-03246-6] [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: 01/05/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve disease (BAV) has potential risks of under expansion and non-circularity which may compromise long-term durability. This study aims to investigate calcium fracture and balloon over expansion in balloon-expandable TAVs on the stent deformation with the aid of simulation. BAV patients treated with the SAPIEN 3 Ultra with pre- and post-TAVR CTs were analyzed (n = 8). Simulations of the stent deployment were performed (1) with baseline simulation allowing calcium fracture, (2) without allowable calcium fracture and (3) with balloon over expansion (1 mm larger diameter). When compared to post CT, baseline simulations had minimal error in expansion (2.5% waist difference) and circularity (3.0% waist aspect ratio difference). When compared to baseline, calcium fracture had insignificant impact on the expansion (- 0.5% average waist difference) and circularity (- 1.6% average waist aspect ratio difference). Over expansion had significantly larger expansion compared to baseline (15.4% average waist difference) but had insignificant impact on the circularity (- 0.5% waist aspect ratio difference). We conclude that stent deformation can be predicted with minimal error, calcium fracture has small differences on the final stent deformation except in extreme calcified cases, and balloon over expansion expands the waist closer to nominal values.
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Affiliation(s)
- Breandan B Yeats
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 387 Technology Cir NW, Atlanta, GA, 30313, USA
| | - Sri Krishna Sivakumar
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 387 Technology Cir NW, Atlanta, GA, 30313, USA
| | - Milad Samaee
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 387 Technology Cir NW, Atlanta, GA, 30313, USA
| | - Venkateshwar Polsani
- Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Pradeep K Yadav
- Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Stephanie Sellers
- Cardiovascular Translational Lab, Centre for Heart Lung Innovation & Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada
| | - Janarthanan Sathananthan
- Cardiovascular Translational Lab, Centre for Heart Lung Innovation & Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada
| | - Lakshmi P Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 387 Technology Cir NW, Atlanta, GA, 30313, USA.
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Mukai T, Kumamaru H, Kohsaka S, Mizote I, Nakamura D, Matsuhiro Y, Maeda K, Shimamura K, Sakata Y. One-year outcome of transcatheter aortic valve replacement for bicuspid aortic valve stenosis: a report from the Japanese Nationwide registry (J-TVT registry). Cardiovasc Interv Ther 2023; 38:414-423. [PMID: 37278956 PMCID: PMC10485111 DOI: 10.1007/s12928-023-00933-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/05/2023] [Indexed: 06/07/2023]
Abstract
The outcome of transcatheter aortic valve replacement (TAVR) for patients with bicuspid aortic valve (BAV) remains unclear, particularly among Asian patients that are known to have different valvular morphology and lower body habitus. This study investigated patient characteristics, procedural and 1-year outcome of TAVR for BAV within national TAVR registry in Japan. The patient-level data were extracted from the J-TVT (Japanese Transcatheter Valvular Therapy) registry between August 2013 and December 2018; overall, there were 423 patients (2.5%) with BAV and 16,802 patients with tricuspid aortic valve (TAV). At baseline, patients with BAV were younger and had less arteriosclerotic comorbidities. There was no statistically significant difference between BAV and TAV groups in conversion to surgery (0.5% vs. 1.1%, p = 0.34) and 30-day mortality (0.5% vs. 1.3%, p = 0.18). Cumulative all-cause survival and survival from major adverse events were analyzed. Cox proportional hazard regression model was used to estimate the hazard ratio. All-cause mortality and major adverse event rate at 1 year were comparable between the two groups. Relative hazard for all-cause mortality for BAV compared to TAV was 1.01 (0.70-1.45; p = 0.96), and for major adverse event was 0.94 (0.69-1.27; p = 0.67). From the Japanese nationwide TAVR registry, procedural and 1-year outcome of TAVR in BAV was as favorable as TAVR in TAV.
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Affiliation(s)
- Takashi Mukai
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University, Tokyo, Japan
| | - Isamu Mizote
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Daisuke Nakamura
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yutaka Matsuhiro
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Koichi Maeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Zhu Z, Xiong T, Chen M. Comparison of patients with bicuspid and tricuspid aortic valve in transcatheter aortic valve implantation. Expert Rev Med Devices 2023; 20:209-220. [PMID: 36815427 DOI: 10.1080/17434440.2023.2184686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has emerged as a safe and effective alternative to surgery for aortic stenosis (AS). However, there are still differences in the procedural process and outcome of bicuspid aortic valve (BAV) treated with TAVI compared with tricuspid aortic valve. AREAS COVERED This review paper aims to summarize the main characteristics and clinical evidence of TAVI in patients with bicuspid and tricuspid aortic valves and compare the outcomes of TAVI procedure. EXPERT OPINION The use of TAVI in patients with BAV has shown similar clinical outcomes compared with tricuspid aortic valve. The efficacy of TAVI for challenging BAV anatomies remains a concern due to the lack of randomized trials. Detailed preprocedural planning is of great importance in low-surgical-risk BAV patients. A better understanding of which subtypes of BAV anatomy are at greater risk for adverse outcomes can potentially benefit the selection of TAVI or open-heart surgery in low surgical risk AS patients.
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Affiliation(s)
- Zhongkai Zhu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Tianyuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Fan J, Chen J, Wang L, Dai H, Guo Y, Jiang J, Hu P, Lin X, Li C, Liu X, Wang J. Feasibility and safety of next-day discharge following transcatheter bicuspid aortic valve replacement. IJC HEART & VASCULATURE 2022; 42:101101. [PMID: 35937949 PMCID: PMC9350863 DOI: 10.1016/j.ijcha.2022.101101] [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: 05/02/2022] [Revised: 07/09/2022] [Accepted: 07/27/2022] [Indexed: 11/22/2022]
Abstract
Background Decreased length of stay in the index hospitalization is a tendency in transcatheter aortic valve replacement (TAVR) era. In this study, we aim to evaluate the feasibility and safety of next-day discharge (NDD) in bicuspid aortic valve (BAV) patients following TAVR. Methods The study analyzed patients who received TAVR in 2019 to 2022. Thirty-day mortality and readmission rate were compared between BAV and tricuspid aortic valve (TAV) patients. Results The proportion of NDD was similar between the BAV and TAV group (45.3 % vs 41.3 %, p = 0.487). In NDD patients, the lower age (72.0 [67.0, 77.0] yrs vs 74.0 [70.0, 80.0] yrs, p = 0.011) and STS score (2.33 [1.56, 3.54] % vs 3.82 [2.38, 5.70] %, p < 0.001) were observed in the BAV group. The NDD BAV patients had higher proportion of post-dilatation (74.3 % vs 50.7 %, p = 0.003) when compared with the TAV patients. The NDD patients was safe with no death both in BAV and TAV patients at 30-day follow-up. Moreover, the readmission rate was comparable between BAV and TAV patients who discharged on the next day after TAVR (8.1 % vs 14.0 %, p = 0.397). Conclusions NDD after TAVR was feasible and safe in both BAV and TAV patients. The younger BAV patients with fast recovery deserve the next-day discharge after TAVR.
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Affiliation(s)
- Jiaqi Fan
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jun Chen
- Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Lihan Wang
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Hanyi Dai
- Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Yuchao Guo
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jubo Jiang
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Po Hu
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xinping Lin
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Cheng Li
- Department of Nursing, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Corresponding authors at: Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
| | - Jian'an Wang
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Corresponding authors at: Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
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Esmailie F, Razavi A, Yeats B, Sivakumar SK, Chen H, Samaee M, Shah IA, Veneziani A, Yadav P, Thourani VH, Dasi LP. Biomechanics of Transcatheter Aortic Valve Replacement Complications and Computational Predictive Modeling. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100032. [PMID: 37273734 PMCID: PMC10236878 DOI: 10.1016/j.shj.2022.100032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/09/2021] [Accepted: 11/03/2021] [Indexed: 06/06/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is a rapidly growing field enabling replacement of diseased aortic valves without the need for open heart surgery. However, due to the nature of the procedure and nonremoval of the diseased tissue, there are rates of complications ranging from tissue rupture and coronary obstruction to paravalvular leak, valve thrombosis, and permanent pacemaker implantation. In recent years, computational modeling has shown a great deal of promise in its capabilities to understand the biomechanical implications of TAVR as well as help preoperatively predict risks inherent to device-patient-specific anatomy biomechanical interaction. This includes intricate replication of stent and leaflet designs and tested and validated simulated deployments with structural and fluid mechanical simulations. This review outlines current biomechanical understanding of device-related complications from TAVR and related predictive strategies using computational modeling. An outlook on future modeling strategies highlighting reduced order modeling which could significantly reduce the high time and cost that are required for computational prediction of TAVR outcomes is presented in this review paper. A summary of current commercial/in-development software is presented in the final section.
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Affiliation(s)
- Fateme Esmailie
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Atefeh Razavi
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Breandan Yeats
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sri Krishna Sivakumar
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Huang Chen
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Milad Samaee
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Imran A. Shah
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alessandro Veneziani
- Department of Mathematics, Department of Computer Science, Emory University, Atlanta, Georgia, USA
| | - Pradeep Yadav
- Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Lakshmi Prasad Dasi
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
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