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Nardi G, De Backer O, Saia F, Sondergaard L, Ristalli F, Meucci F, Stolcova M, Mattesini A, Demola P, Wang X, Al Jabri A, Palmerini T, Bruno AG, Ielasi A, Van Belle E, Berti S, Di Mario C. Peripheral intravascular lithotripsy for transcatheter aortic valve implantation: a multicentre observational study. EUROINTERVENTION 2022; 17:e1397-e1406. [PMID: 34734559 PMCID: PMC9896402 DOI: 10.4244/eij-d-21-00581] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The presence of severe calcific atherosclerosis at the iliofemoral axis may preclude transcatheter aortic valve implantation (TAVI) by the transfemoral (TF) approach. Intravascular lithotripsy (IVL) is a novel technology that fractures intimal/medial calcium and increases vessel compliance allowing TF TAVI in selected patients with peripheral artery disease (PAD). AIMS The aim of this study was to report on the safety and efficacy of IVL-assisted TF TAVI in an all-comers population. METHODS Clinical, imaging and procedural data on all consecutive patients treated by IVL-assisted TF TAVI in six high-volume European centres (2018-2020) were collected in this prospective, real-world, multicentre registry. RESULTS IVL-assisted TF TAVI was performed in 108 patients, increasing from 2.4% to 6.5% of all TAVI from 2018 to 2020, respectively. The target lesion was most often localised at the common and/or external iliac artery (93.5% of cases; average TL-MLD 4.6±0.9 mm with 318 degrees of calcium arc). Transfemoral aortic valve delivery was successful in 100% of cases; final procedural success in 98.2% (two conversions to cardiac open surgery for annular rupture and valve migration). Complications of the IVL-treated segments consisted of 1 perforation and 3 major dissections requiring stent implantation (2 covered stents and 2 BMS). Access-site-related complications included 3 major bleedings. Three in-hospital deaths were recorded (2.8%, 1 failed surgical conversion after annular rupture, 1 cardiac arrest after initial valvuloplasty, 1 late hyperkalaemia in renal dysfunction). CONCLUSIONS IVL-assisted TF TAVI proved to be a safe and effective approach, which helps to expand the indications for TF TAVI in patients with severe calcific PAD. However, these patients continue to have a higher-than-average incidence of periprocedural complications.
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Affiliation(s)
- Giulia Nardi
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Francesco Saia
- Interventional Cardiology Unit, Cardio-Thoracic Vascular Department, University Hospital of Bologna, Policlinico Sant’Orsola-Malpighi, Bologna, Italy
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Francesca Ristalli
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Francesco Meucci
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Miroslava Stolcova
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Pierluigi Demola
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Xi Wang
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Tullio Palmerini
- Interventional Cardiology Unit, Cardio-Thoracic Vascular Department, University Hospital of Bologna, Policlinico Sant’Orsola-Malpighi, Bologna, Italy
| | - Antonio Giulio Bruno
- Interventional Cardiology Unit, Cardio-Thoracic Vascular Department, University Hospital of Bologna, Policlinico Sant’Orsola-Malpighi, Bologna, Italy
| | - Alfonso Ielasi
- Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, Lille, France
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Khanji MY, Ricci F, Galusko V, Sekar B, Chahal CAA, Ceriello L, Gallina S, Kennon S, Awad WI, Ionescu A. Management of aortic stenosis: a systematic review of clinical practice guidelines and recommendations. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:340-353. [PMID: 33751049 DOI: 10.1093/ehjqcco/qcab016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023]
Abstract
Multiple guidelines exist for the management of aortic stenosis (AS). We systematically reviewed current guidelines and recommendations, developed by national or international medical organizations, on management of AS to aid clinical decision-making. Publications in MEDLINE and EMBASE between 1 June 2010 and 15 January 2021 were identified. Additionally, the International Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations were searched. Two reviewers independently screened titles and abstracts. Two reviewers assessed rigour of guideline development and extracted the recommendations. Of the seven guidelines and recommendations retrieved, five showed considerable rigour of development. Those rigourously developed, agreed on the definition of severe AS and diverse haemodynamic phenotypes, indications and contraindications for intervention in symptomatic severe AS, surveillance intervals in asymptomatic severe AS, and the importance of multidisciplinary teams (MDTs) and shared decision-making. Discrepancies exist in age and surgical risk cut-offs for recommending surgical aortic valve replacement (SAVR) vs. transcatheter aortic valve implantation (TAVI), the use of biomarkers and complementary multimodality imaging for decision-making in asymptomatic patients and surveillance intervals for non-severe AS. Contemporary guidelines for AS management agree on the importance of MDT involvement and shared decision-making for individualized treatment and unanimously indicate valve replacement in severe, symptomatic AS. Discrepancies exist in thresholds for age and procedural risk used in choosing between SAVR and TAVI, role of biomarkers and complementary imaging modalities to define AS severity and risk of progression in asymptomatic patients.
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Affiliation(s)
- Mohammed Y Khanji
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK.,Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.,NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London EC1A 7BE, UK
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, "G.d'Annunzio" University, 66100 Chieti, Italy.,Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 205 02 Malmö, Sweden.,Department of Cardiology, Casa di Cura Villa Serena, 65013 Città Sant'Angelo, Pescara, Italy
| | - Victor Galusko
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Baskar Sekar
- Department of Cardiology, Morriston Cardiac Regional Centre, Swansea Bay Health Board, Heol Maes Eglwys, Swansea SA6 6NL, UK
| | - C Anwar A Chahal
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.,Department of Cardiology, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Laura Ceriello
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, "G.d'Annunzio" University, 66100 Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, "G.d'Annunzio" University, 66100 Chieti, Italy
| | - Simon Kennon
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Wael I Awad
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Adrian Ionescu
- Department of Cardiology, Morriston Cardiac Regional Centre, Swansea Bay Health Board, Heol Maes Eglwys, Swansea SA6 6NL, UK
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Paone G, Grubb KJ. Commentary: Surgical or transapical aortic valve replacement? Does the answer matter if you are asking the wrong question? J Thorac Cardiovasc Surg 2020; 162:1712-1713. [PMID: 32312537 DOI: 10.1016/j.jtcvs.2020.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Gaetano Paone
- Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Ga.
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Ga
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Nechwatal RM, Bestehorn K, Leuschner F, Hagendorff A, Guha M, Schlitt A. [Postacute care after transcatheter aortic valve implantation (TAVI)]. Herz 2020; 46:41-47. [PMID: 32313970 DOI: 10.1007/s00059-020-04915-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 07/30/2019] [Accepted: 03/19/2020] [Indexed: 11/26/2022]
Abstract
With increasing age valvular heart disease is among the most frequent diseases of the heart. Relevant valvular disease impairs not only the long-term prognosis but also physical resilience, activities of daily living and the quality of life. In cases of middle to high-grade symptomatic cardiac defects, valve replacement or valve reconstruction is still the surgical procedure of choice; however, in recent years the transcatheter percutaneous aortic valve replacement (TAVI) procedure has become more prominent for the most frequent defect, aortic valve stenosis. This article provides an overview of the aftercare and rehabilitation of patients following a TAVI intervention.
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Affiliation(s)
- Robert Michael Nechwatal
- Rehaklinik Heidelberg-Königstuhl, Fachklinik für Herz‑, Kreislauf‑, Gefäß‑, Lungen- und Bronchialerkrankungen, Kohlhof 6, 69117, Heidelberg, Deutschland.
| | - Kurt Bestehorn
- Institut für Klinische Pharmakologie, TU Dresden, Dresden, Deutschland
| | - Florian Leuschner
- Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Manju Guha
- Reha-Klinik am Sendesaal, Bremen, Deutschland
| | - Axel Schlitt
- Abteilung für Kardiologie und Diabetologie, Paracelsus-Harz-Klinik Bad Suderode, Quedlinburg, Deutschland
- Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
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Trends in vascular complications and associated treatment strategies following transfemoral transcatheter aortic valve replacement. J Vasc Surg 2020; 72:1313-1324.e5. [PMID: 32169358 DOI: 10.1016/j.jvs.2020.01.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 01/17/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Vascular complications (VC) and bleeding complications impact morbidity and mortality after transfemoral transcatheter aortic valve replacement (TF-TAVR). Few contemporary studies have detailed these complications, associated treatment strategies, or clinical outcomes. We examined the incidence, predictors, treatment strategies, and outcomes of VCs in a multicenter cohort of patients undergoing TF-TAVR. METHODS We performed a retrospective registry and chart review of all nonclinical trial TF-TAVR patients from seven centers within a five-state hospital system from 2012 to 2016. Bleeding and VC were recorded as defined by the Valve Academic Research Consortium recommendations. Procedural and 30-day outcomes and 1-year mortality were compared between patients with no, minor, or major VC. Multivariable logistic and Cox regressions were used to identify predictors of major VC and mortality, respectively. RESULTS Over the study period, 1573 patients underwent TF-TAVR, with 96 (6.1%) experiencing a major VC and 77 (4.9%) experiencing a minor VC. The majority of VCs were access site related (74.2%), occurred intraoperatively (52.6%), and required interventional treatment (73.2%). The site, timing, and treatment method of VCs did not significantly change over the study period. Patients with VCs had a greater need for blood transfusion, longer postoperative length of stay, higher rates of cardiac events, increased vascular-related 30-day readmission, and higher 30-day mortality. Female sex (odds ratio [OR], 3.00; 95% CI, 1.91-4.72) and prior percutaneous coronary intervention (OR, 2.14 ; 95% CI, 1.38-3.31) were the strongest predictors of major VC. VCs modestly decreased over the study period: every 90-day increase in surgery date decreased the odds of major VC by 6% (95% CI, 1%-10%). Patients with major VCs had worse 1-year survival (OR, 79%; 95% CI, 69%-86%) compared with patients with minor VCs (OR, 92%; 95% CI, 82%-96%) or no VCs (OR, 88%; 95% CI, 87%-90%; P = .002). However, for patients who survived more than 30 days, the 1-year survival did not differ between groups For patients who survived more than 30 days, male sex (hazard ratio, 1.84; 95% CI, 1.30-2.60) and the logit of STS mortality risk score (hazard ratio, 1.98; 95% CI, 1.48-2.65) were the strongest predictors of mortality. After adjusting for other factors, minor and major VC were not predictors of 1-year mortality for patients who survived more than 30 days. CONCLUSIONS In our contemporary cohort, VCs after TF-TAVR have modestly decreased in recent years, but continue to impact perioperative outcomes. Patient selection, consideration of alternative access routes, and prompt recognition and treatment of VCs are critical elements in optimizing early clinical outcomes after TF-TAVR.
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Pour-Ghaz I, Raja J, Bayoumi M, Manolukas T, Khouzam RN, Ibebuogu UN. Transcatheter aortic valve replacement with a focus on transcarotid: a review of the current literature. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:420. [PMID: 31660319 DOI: 10.21037/atm.2019.07.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Valve replacement in high-risk patients with severe aortic stenosis has undergone a huge paradigm shift in the recent years in terms of procedural details and vascular access site for patients who have poor peripheral access. Carotid artery is one of the more promising access sites which has been proven to provide a good alternative site with comparable outcomes to transfemoral approach. In this manuscript, we will provide a review of the current literature on transaortic, transapical, transaxillary and transcarotid approaches to transcatheter aortic valve replacement (TAVR) while focusing on the transcarotid approach.
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Affiliation(s)
- Issa Pour-Ghaz
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joel Raja
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mahmoud Bayoumi
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Theodore Manolukas
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rami N Khouzam
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Uzoma N Ibebuogu
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Kim C, Hong MK. Aortic Stenosis and Transcatheter Aortic Valve Implantation: Current Status and Future Directions in Korea. Korean Circ J 2019; 49:283-297. [PMID: 30895756 PMCID: PMC6428950 DOI: 10.4070/kcj.2019.0044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/11/2019] [Indexed: 01/11/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has been accepted as one of primary options for treatment of symptomatic severe aortic stenosis. Although TAVI has been predominantly used for patients at high risk or with old age who were not considered optimal candidates for surgical aortic valve replacement (SAVR), its indication is now expanding toward low risk profile and younger age. Many clinical trials are now ongoing to test the possibility of TAVI for use in patients even with uncharted indications who are not eligible for SAVR in current guidelines but may benefit from valve replacement. Current issues including periprocedural safety, long-term adverse events, hemodynamics and durability associated with TAVI should be also solved for expanding use of TAVI. The review presents current status and future directions of TAVI and discusses perspectives in Korea.
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Affiliation(s)
- Choongki Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Myeong Ki Hong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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