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Mutlu O, Saribay M, Yavuz MM, Salman HE, Al-Nabti ARDMH, Yalcin HC. Material modeling and recent findings in transcatheter aortic valve implantation simulations. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 255:108314. [PMID: 39024970 DOI: 10.1016/j.cmpb.2024.108314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/12/2024] [Accepted: 06/28/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND AND OBJECTIVE Transcatheter aortic valve implantation (TAVI) has significantly transformed the management of aortic valve (AV) diseases, presenting a minimally invasive option compared to traditional surgical valve replacement. Computational simulations of TAVI become more popular and offer a detailed investigation by employing patient-specific models. On the other hand, employing accurate material modeling procedures and applying basic modeling steps are crucial to determining reliable numerical results. Therefore, this review aims to outline the basic modeling approaches for TAVI, focusing on material modeling and geometry extraction, as well as summarizing the important findings from recent computational studies to guide future research in the field. METHODS This paper explains the basic steps and important points in setting up and running TAVI simulations. The material properties of the leaflets, valves, stents, and tissues utilized in TAVI simulations are provided, along with a comprehensive explanation of the geometric extraction methods employed. The differences between the finite element analysis, computational fluid dynamics, and fluid-structure interaction approaches are pointed out and the important aspects of TAVI modeling are described by elucidating the recent computational studies. RESULTS The results of the recent findings on TAVI simulations are summarized to demonstrate its powerful potential. It is observed that the material properties of aortic tissues and components of implanted valves should be modeled realistically to determine accurate results. For patient-specific AV geometries, incorporating calcific deposits on the leaflets is essential for ensuring the accuracy of computational findings. The results of numerical TAVI simulations indicate the significance of the selection of optimal valves and precise deployment within the appropriate anatomical position. These factors collectively contribute to the effective functionality of the implanted valve. CONCLUSIONS Recent studies in the literature have revealed the critical importance of patient-specific modeling, the selection of accurate material models, and bio-prosthetic valve diameters. Additionally, these studies emphasize the necessity of precise positioning of bio-prosthetic valves to achieve optimal performance in TAVI, characterized by an increased effective orifice area and minimal paravalvular leakage.
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Affiliation(s)
- Onur Mutlu
- Qatar University, Biomedical Research Center, Doha, Qatar
| | - Murat Saribay
- Istanbul Bilgi University, Mechanical Engineering Department, Istanbul, Turkey
| | - Mehmet Metin Yavuz
- Middle East Technical University, Mechanical Engineering Department, Ankara, Turkey
| | - Huseyin Enes Salman
- TOBB University of Economics and Technology, Department of Mechanical Engineering, Ankara, Turkey
| | | | - Huseyin Cagatay Yalcin
- Qatar University, Biomedical Research Center, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
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Kılıç R, Güzel T, Aktan A, Demir M, Günlü S, Arslan B, Ertaş F. Comparison of Evolut-R 34 mm Valve and Smaller Evolut-R Valves in Patients Undergoing Transcatheter Aortic Valve Implantation and Determination of Mild Paravalvular Leak Predictors. Anatol J Cardiol 2024:109-117. [PMID: 38221789 PMCID: PMC10837679 DOI: 10.14744/anatoljcardiol.2023.3563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVE The main purpose of this study was to evaluate and compare the in-hospital, 1-month and 1-year post-procedure outcomes of patients treated with Evolut-R 34 mm and Evolut-R 23/26/29 mm devices. Additionally, the study aimed to identify factors that could predict the occurrence of ≥ mild paravalvular leaks (PVL). METHODS Between April 2015 and May 2022, 269 consecutive patients who underwent transcatheter aortic valve implantation (TAVI) with Evolut-R 34 mm (n = 66, 24.5%) and Evolut-R 23/26/29 mm (n = 203, 75.5%) devices in a single center were retrospectively analyzed. RESULTS Patients in the Evolut-R 34 mm group had a lower female sex ratio (16.7% vs. 66.5%, P <.001, respectively), ejection fraction (50.7 ± 10.1% vs. 54.5 ± 9.3%, P =.016, respectively), and mean aortic gradient (7.4 ± 3.3 vs. 9.2 ± 5.0, P =.026, respectively) compared to the Evolut-R 23/26/29 mm group. The groups did not exhibit any statistically significant distinctions with regard to technical success, the need for a permanent pacemaker, occurrences of stroke, major vascular complications, PVL, major adverse cardiovascular and cerebrovascular events, or mortality. Peak velocity was confirmed as a significant predictor of ≥mild PVL in both patient groups in the receiver operating characteristic curve analysis. In logistic regression analysis; In patients with Evolut-R 34 mm valve, pre-TAVI aortic valve peak velocity (odds ratio (OR) = 23.202; P =.019) and calcium volume 800 Hounsfield Units (mm3) (OR = 1.017; P <.001) were independent predictors of ≥mild PVL. CONCLUSION The Evolut-R 34 mm valve has shown comparable in-hospital results with smaller valve sizes. Pre-TAVI aortic valve peak velocity and calcium volume predicted ≥ mild PVL in Evolut-R 34 mm patients.
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Affiliation(s)
- Raif Kılıç
- Department of Cardiology, Çermik State Hospital, Diyarbakır, Türkiye
| | - Tuncay Güzel
- Department of Cardiology, Health Science University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Türkiye
| | - Adem Aktan
- Department of Cardiology, Mardin Training and Research Hospital, Mardin, Türkiye
| | - Muhammed Demir
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Türkiye
| | - Serhat Günlü
- Department of Cardiology, Mardin Artuklu University Faculty of Medicine, Mardin, Türkiye
| | - Bayram Arslan
- Department of Cardiology, Ergani State Hospital, Diyarbakır, Türkiye
| | - Faruk Ertaş
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Türkiye
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Bartos PV, Molnar B, Herold Z, Dekany G, Piroth Z, Horvath G, Ahres A, Heesch CM, Czobor NR, Satish S, Pinter T, Fontos G, Andreka P. Short- and Medium-Term Outcomes Comparison of Native- and Valve-in-Valve TAVI Procedures. Rev Cardiovasc Med 2023; 24:255. [PMID: 39076381 PMCID: PMC11270067 DOI: 10.31083/j.rcm2409255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/01/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2024] Open
Abstract
Background In high-risk patients with degenerated aortic bioprostheses, valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as a less invasive alternative to surgical valve replacement. To compare outcomes of ViV and native valve (NV) TAVI procedures. Methods 34 aortic ViV-TAVI performed between 2012 and 2022 using self-expanding valves, were included in this retrospective analysis. Propensity score matching (1:2 ratio, 19 criteria) was used to select a comparison NV-TAVI group from a database of 1206 TAVI procedures. Clinical and echocardiographic endpoints, short- and long-term all-cause mortality (ACM) and cardiovascular mortality (CVM) data were obtained. Subgroup analyses were completed according to the true internal diameter, dividing patients into a small ( ≤ 19 mm) valve group (SVG) and a large ( > 19 mm) valve group (LVG). Results Clinical outcomes of ViV- and NV-TAVI were comparable, including device success [88.2% vs. 91.1%, p = 0.727], major adverse cardiovascular and cerebrovascular events [5.8% vs. 5.8%, p = 1.000], hemodialysis need [5.8% vs. 2.9%, p = 0.599], pacemaker need [2.9% vs. 11.7%, p = 0.265], major vascular complications [2.9% vs. 1.4%, p = 1.000], life-threatening or major bleeding [2.9% vs. 1.4%, p = 1.000] and in-hospital mortality [8.8% vs. 5.9%, p = 0.556]. There was a significant difference in the immediate post-intervention mean residual aortic valve gradient (MAVG) [14.6 ± 8.5 mm Hg vs. 6.4 ± 4.5 mm Hg, p < 0.0001], which persisted at 1 year [p = 0.0002]. There were no differences in 12- or 30-month ACM [11.8% vs. 8.8%, p = 0.588; 23.5% vs. 27.9%, p = 0.948], and CVM [11.8% vs. 7.3%, p = 0.441; 23.5% vs. 16.2%, p = 0.239]. Lastly, there was no difference in CVM at 1 year and 30 months [11.1% vs. 12.5%, p = 0.889; 22.2% vs. 25.0%, p = 0.742]. Conclusions Analyzing a limited group (n = 34) of ViV-TAVI procedures out of 1206 TAVIs done at a single institution, ViV-TAVI appeared to be an acceptable approach in patients not deemed appropriate candidates for redo valve replacement surgery. Clinical outcomes of ViV-TAVI were comparable to TAVI for native valve stenosis.
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Affiliation(s)
- Peter V. Bartos
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Balazs Molnar
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Zoltan Herold
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary
| | - Gabor Dekany
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Zsolt Piroth
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Gergely Horvath
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Abdelkrim Ahres
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Christian M Heesch
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
- Department of Interventional Cardiology, Florida Heart Clinic, Hallandale Beach, FL 33009, USA
| | - Nikoletta R. Czobor
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Sai Satish
- Department of Interventional Cardiology, Apollo Hospital, 600006 Chennai, India
| | - Tunde Pinter
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Geza Fontos
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Peter Andreka
- Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
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Bei E, Voudris V, Kalogeras K, Oikonomou E, Iakovou I, Kosmas I, Kalantzis C, Vavuranakis MA, Pantelidis P, Lazaros G, Tousoulis D, Tsioufis C, Vavuranakis M. Impact of Evolution of Self-Expandable Aortic Valve Design: Peri-Operative and Short-Term Outcomes. J Clin Med 2023; 12:jcm12051739. [PMID: 36902526 PMCID: PMC10003529 DOI: 10.3390/jcm12051739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
A few data exist on the differences of implantable aortic valve bio-prostheses. We investigate three generations of self-expandable aortic valves in terms of the outcomes. Patients undergoing transcatheter aortic valve implantation (TAVI) were allocated into three groups according to the valve type: group A (CoreValveTM), group B (EvolutTMR) and group C (EvolutTMPRO). The implantation depth, device success, electrocardiographic parameters, need for permanent pacemaker (PPM), and paravalvular leak (PVL) were assessed. In the study, 129 patients were included. The final implantation depth did not differ among the groups (p = 0.07). CoreValveTM presented greater upward jump of the valve at release (2.88 ± 2.33 mm vs. 1.48 ± 1.09 mm and 1.71 ± 1.35 mm, for groups A, B, and C, respectively, p = 0.011). The device success (at least 98% for all groups, p = 1.00) and PVL rates (67% vs. 58%, vs. 60% for groups A, B, and C, respectively, p = 0.64) did not differ. PPM implantation within 24 h (33% vs. 19% vs. 7% for groups A, B, and C, respectively, p = 0.006) and until discharge (group A: 38% vs. group B: 19% and group C: 9%, p = 0.005) was lower in the newer generation valves. Newer generation valves present better device positioning, more predictable deployment, and fewer rates of PPM implantation. No significant difference in PVL was observed.
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Affiliation(s)
- Evangelia Bei
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Vasileios Voudris
- Interventional Department of Cardiology, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Konstantinos Kalogeras
- Third Department of Cardiology, Sotiria General Hospital for Chest Diseases, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Evangelos Oikonomou
- Third Department of Cardiology, Sotiria General Hospital for Chest Diseases, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-210-776-3492
| | - Ioannis Iakovou
- Interventional Department of Cardiology, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Ilias Kosmas
- Interventional Department of Cardiology, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Charalampos Kalantzis
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Michael-Andrew Vavuranakis
- Third Department of Cardiology, Sotiria General Hospital for Chest Diseases, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Panteleimon Pantelidis
- Third Department of Cardiology, Sotiria General Hospital for Chest Diseases, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George Lazaros
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Constantinos Tsioufis
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Manolis Vavuranakis
- Third Department of Cardiology, Sotiria General Hospital for Chest Diseases, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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5
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Leone PP, Scotti A, Ho EC, Assafin M, Doolittle J, Chau M, Slipczuk L, Levitus M, Regazzoli D, Mangieri A, Latib A. Prosthesis Tailoring for Patients Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2023; 12:338. [PMID: 36615141 PMCID: PMC9821207 DOI: 10.3390/jcm12010338] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has risen over the past 20 years as a safe and effective alternative to surgical aortic valve replacement for treatment of severe aortic stenosis, and is now a well-established and recommended treatment option in suitable patients irrespective of predicted risk of mortality after surgery. Studies of numerous devices, either newly developed or reiterations of previous prostheses, have been accruing. We hereby review TAVI devices, with a focus on commercially available options, and aim to present a guide for prosthesis tailoring according to patient-related anatomical and clinical factors that may favor particular designs.
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Affiliation(s)
- Pier Pasquale Leone
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Cardiovascular Research Foundation, New York, NY 10019, USA
| | - Edwin C. Ho
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Manaf Assafin
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - James Doolittle
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Mei Chau
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Leandro Slipczuk
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Matthew Levitus
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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6
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Ro R, Lerakis S. Imaging for Planning and Guidance for Structural Heart Interventions. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Santangelo G, Ielasi A, Pellicano M, Latib A, Tespili M, Donatelli F. An Update on New Generation Transcatheter Aortic Valves and Delivery Systems. J Clin Med 2022; 11:jcm11030499. [PMID: 35159952 PMCID: PMC8837046 DOI: 10.3390/jcm11030499] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/30/2021] [Accepted: 01/15/2022] [Indexed: 12/15/2022] Open
Abstract
Over the last 15 years, the management of aortic valve disease has been changed by transcatheter aortic valve replacement, which has become the standard of care across the entire spectrum of surgical risk. As a result of continuous evolution of this technique, several next-generation transcatheter heart valves (THVs) have been developed to minimize procedural complications and improve patient outcomes. This review aims to provide an update on the new generation THVs and delivery systems.
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Affiliation(s)
- Gloria Santangelo
- San Paolo Hospital, Division of Cardiology, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy;
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, Via Faravelli 16, 20149 Milan, Italy; (M.P.); (M.T.)
- Correspondence:
| | - Mariano Pellicano
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, Via Faravelli 16, 20149 Milan, Italy; (M.P.); (M.T.)
| | - Azeem Latib
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 210th Street, Bronx, NY 10467, USA;
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, Via Faravelli 16, 20149 Milan, Italy; (M.P.); (M.T.)
| | - Francesco Donatelli
- Department of Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, University of Milan, Via Faravelli 16, 20149 Milan, Italy;
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6554163. [DOI: 10.1093/ejcts/ezac158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/14/2022] Open
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Valvo R, Costa G, Tamburino C, Barbanti M. Coronary artery cannulation after transcatheter aortic valve implantation. EUROINTERVENTION 2021; 17:835-847. [PMID: 34796879 PMCID: PMC9724942 DOI: 10.4244/eij-d-21-00158] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has revolutionised the treatment of severe, symptomatic aortic stenosis and it is now a proven and effective alternative to surgery for patients regardless of preoperative risk stratification. Nevertheless, the consequent expansion towards younger patients with longer life expectancy focuses attention on long-term considerations. In particular, although the prevalence of coronary artery disease has been shown to decrease with the lowering of estimated risk stratification, the chance of requirement of future coronary interventions after TAVI increases dramatically as a function of patients' life expectancy. To date, however, only a few studies have investigated the feasibility and reproducibility of coronary artery cannulation after TAVI. Different conditions related mainly to aortic root anatomy and specific transcatheter aortic valve (TAV) designs and deployment have been associated with impaired coronary access after TAVI. In the present review, we will examine the conditions that may make coronary access after TAVI more challenging or even impossible.
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Affiliation(s)
- Roberto Valvo
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico - San Marco”, Via Santa Sofia 78, 95123 Catania, Italy
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Tugaoen Z, Nguyen P, Arora S, Vavalle J. The selection of transcatheter heart valves in transcatheter aortic valve replacement. Trends Cardiovasc Med 2021; 32:513-522. [PMID: 34634481 DOI: 10.1016/j.tcm.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
Transcatheter heart valve technology has rapidly progressed since initial approval in the United States. There are currently two widely available transcatheter heart valve delivery systems approved in the US; however limited data exist on optimal device selection for various patient populations. This review explores the characteristics of currently approved transcatheter heart valve systems and scenarios where one valve system may be favored over others. We provide a simplified decision tree for selecting the optimal transcatheter valve system for specific patient-centered characteristics.
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Affiliation(s)
- Zachary Tugaoen
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Peter Nguyen
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States
| | - Sameer Arora
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States
| | - John Vavalle
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States.
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11
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Hughes E, Grossman PM. Transcatheter Aortic Valve Replacement with a Self-Expanding Prosthesis. Interv Cardiol Clin 2021; 10:441-453. [PMID: 34593108 DOI: 10.1016/j.iccl.2021.06.004] [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: 11/26/2022]
Abstract
The self-expanding transcatheter heart valve (Medtronic Cardiovascular Corevalve and Evolut) is a supra-annular, trileafet porcine pericardial valves on a diamond lattice nickel-titanium alloy frame. The TAVR device has undergone significant improvements in design and procedural techniques to further increase safety, efficacy, and durability since they it was first released. Unique design characteristics, as well as patient and procedural factors, favor self-expanding over balloon-expandable prostheses in certain situations. The self-expanding transcatheter heart valve has proven to be an excellent option for severe aortic stenosis patients with any level of surgical risk and preliminary data suggest a comparable durability to surgical tissue valves.
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Affiliation(s)
- Erinn Hughes
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Frankel Cardiovascular Center, 1500 East Medical Center Drive, SPC 5869, Ann Arbor, MI 48109-5869, USA
| | - Paul Michael Grossman
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Frankel Cardiovascular Center, 1500 East Medical Center Drive, SPC 5869, Ann Arbor, MI 48109-5869, USA.
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12
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Dallan LAP, Forrest JK, Reardon MJ, Szeto WY, George I, Kodali S, Kleiman NS, Yakubov SJ, Grubb KJ, Liu F, Baeza C, Attizzani GF. Transcatheter Aortic Valve Replacement With Self-Expandable Supra-Annular Valves for Degenerated Surgical Bioprostheses: Insights From Transcatheter Valve Therapy Registry. J Am Heart Assoc 2021; 10:e021871. [PMID: 34514840 PMCID: PMC8649494 DOI: 10.1161/jaha.121.021871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transcatheter aortic valve replacement with supra‐annular transcatheter heart valves has been adopted in patients with degenerated surgical aortic valves. The next generation self‐expanding Evolut PRO valve has not been evaluated in patients with surgical valve failure. Methods and Results Patients undergoing transcatheter aortic valve replacement in degenerated surgical aortic valve procedures using the Evolut R or Evolut PRO transcatheter heart valves in the Society of Thoracic Surgeons and American College of Cardiology Transcatheter Valve Therapy Registry between April 2015 and June 2019 were evaluated. Transcatheter valve performance was evaluated by clinical site echocardiography. In‐hospital, 30‐day, and 1‐year clinical outcomes were based on the Society of Thoracic Surgeons‐American College of Cardiology‐Transcatheter Valve Therapy registry definitions. Transcatheter aortic valve replacement in degenerated surgical aortic valve was performed in 5897 patients (5061 [85.8%] patients received the Evolut R valve and 836 [14.2%] received the Evolut PRO valve). Thirty‐day transcatheter heart valves hemodynamic performance was excellent in both groups (mean gradient: Evolut PRO: 13.8±7.5 mm Hg; Evolut R: 14.5±8.1 mm Hg), while paravalvular regurgitation was significantly different between valve types (P=0.02). Clinical events were low at 30 days (Evolut PRO: for the all‐cause mortality, 2.8%, any stroke was 1.8%, new pacemaker implantation, 3.0%: Evolut R:all‐cause mortality, 2.5%, any stroke was 2.2%, new pacemaker implantation, 5.3%) and 1 year (Evolut PRO: all‐cause mortality, 9.2%; any stroke, 3.1%; Evolut R: all‐cause mortality, 9.8%; any stroke, 2.9%). Conclusions Transcatheter aortic valve replacement in degenerated surgical aortic valve with self‐expandable supra‐annular transcatheter heart valves is associated with excellent clinical outcomes and valve hemodynamics. Additional reductions in residual paravalvular regurgitation were obtained with the next generation Evolut PRO.
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Affiliation(s)
- Luis Augusto P Dallan
- Department of Cardiovascular Medicine Harrington Heart and Vascular InstituteUniversity Hospitals Cleveland Medical Center Cleveland OH
| | - John K Forrest
- Departments of Internal Medicine (Cardiology) and Surgery (Cardiac Surgery) Yale University School of Medicine New Haven CT
| | - Michael J Reardon
- Department of Cardiothoracic Surgery Methodist DeBakey Heart and Vascular CenterHouston Methodist Houston TX
| | - Wilson Y Szeto
- University of Pennsylvania School of Medicine Philadelphia PA
| | - Isaac George
- Departments of Cardiology and Cardiac Surgery Columbia University-New York Presbyterian New York NY
| | - Susheel Kodali
- Departments of Cardiology and Cardiac Surgery Columbia University-New York Presbyterian New York NY
| | - Neal S Kleiman
- Department of Cardiothoracic Surgery Methodist DeBakey Heart and Vascular CenterHouston Methodist Houston TX
| | - Steven J Yakubov
- Departments of Cardiac Surgery and Interventional Cardiology Riverside Methodist HospitalOhioHealth Columbus OH
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery Emory University School of Medicine Atlanta GA
| | - Fang Liu
- Statistical Services MedtronicMounds View MN
| | - Cristian Baeza
- Department of Cardiovascular Medicine Harrington Heart and Vascular InstituteUniversity Hospitals Cleveland Medical Center Cleveland OH
| | - Guilherme F Attizzani
- Department of Cardiovascular Medicine Harrington Heart and Vascular InstituteUniversity Hospitals Cleveland Medical Center Cleveland OH
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Alvarado T, Rivero F, Diego G, García-Guimaraes M, Salamanca J, Díez-Villanueva P, Cuesta J, Antuña P, Jiménez-Borreguero J, Alfonso F. Transcatheter aortic valve replacement using the new Evolut-Pro system: a prospective comparison with the Evolut-R device. J Thorac Dis 2021; 13:4023-4032. [PMID: 34422332 PMCID: PMC8339791 DOI: 10.21037/jtd-20-2409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 05/12/2021] [Indexed: 11/25/2022]
Abstract
Background Evolut Pro (EVP) is a novel self-expandable aortic valve. This prosthesis consists of an external porcine pericardial wrap designed to reduce paravalvular leak (PVL), maintaining the benefits of its predecessor, the Evolut R (EVR). The aim was to compare the functional and clinical results in the short and medium term of the new EVP with the EVR system. Methods Consecutive patients receiving either the EVR (n=50) or the EVP (n=33) from June 2015 to October 2018 were compared. Baseline characteristics, cardiovascular imaging, procedural outcomes, short and mid-term follow-up outcomes were prospectively collected and assessed. Results Residual mild PVL was common and comparable in the two groups (EVR 79% vs. EVP 70%; P=0.4). In the EVR group, the presence of PVL was directly related to prosthesis size, but this correlation was not observed in the EVP group. Conduction abnormalities were more prevalent with the EVP, but these did not translate into a higher need of permanent pacemaker implantation. Vascular and bleeding complications were infrequent in both groups. At mid-term clinical follow-up (median survival time: EVR 11±0.3 months, EVP 12±0.2 months), the 1-year rate of adverse events was similar (EVR: 24%, EVP: 33%; P=0.3). Conclusions Both protheses are effective for the treatment of severe aortic stenosis with excellent results at mid-term clinical follow up. The EVP remains associated with a significant rate of residual mild PVL that appears to be similar to that observed with EVR.
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Affiliation(s)
- Teresa Alvarado
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Guillermo Diego
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Jorge Salamanca
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Javier Cuesta
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Paula Antuña
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
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Rahman F, Resar JR. TAVI Beyond 3 Years: Durability and Predictors for Survival. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:417-425. [PMID: 34182824 DOI: 10.1177/15569845211017558] [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: 11/16/2022]
Abstract
The use of transcatheter aortic valve implantation (TAVI) has greatly increased over the past 2 decades and now has overtaken surgical aortic valve replacement. We have limited data regarding the long-term durability of TAVI and the predictors of survival. Calcification, inflammation, fibrous tissue deposition, and mechanical stress are important in the structural deterioration of surgical bioprosthetic valves and likely contribute to TAVI durability. However, TAVI has several differences to surgical valve replacement such as valve preparation, valve to native anatomy interaction, and valve sizing which all likely contribute to durability and long-term survival. Most procedures have been performed on older patients and therefore long-term follow-up studies have noted mortality of approximately 50% at 5 years and 75% by 7 years. Current data are limited by the high mortality of patients who have received TAVI often as a result of age, frailty, and other competing comorbidities. TAVI as compared with surgical valve replacement is associated with several differences including higher conduction abnormalities (i.e., need for pacemakers) and paravalvular leak, both of which may affect long-term morbidity and mortality. In this review, we discuss the current status of our knowledge and identify areas that require further investigation.
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Affiliation(s)
- Faisal Rahman
- 1501 Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jon R Resar
- 1501 Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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15
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Predictors and Outcome Impact of Mitral Regurgitation in Transcatheter Aortic Valve Replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 32:35-40. [PMID: 33436346 DOI: 10.1016/j.carrev.2020.12.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND/PURPOSE Several studies have reported that mitral regurgitation (MR) can improve following transcatheter aortic valve replacement (TAVR) alone using earlier-generation valves. The purpose of this study was to determine the predictors and short-term outcome impact of MR in patients undergoing TAVR using all generation valves across all risk groups. METHODS/MATERIALS In this retrospective, study from 2012 to 2020, we reviewed data on 1822 low-, intermediate-, and high-risk patients who underwent TAVR. Included were 1266 patients with baseline MR who underwent transfemoral TAVR. Our primary outcome was persistence or worsening of baseline MR post-TAVR. Additional endpoints included an inpatient composite (intensive care unit length of stay >24 h, post-TAVR length of stay >2 days, and inpatient death), 30-day composite (30-day death or readmission), and 1-year composite (1-year death or readmission). RESULTS Of the 1266 patients included, 665 had significant baseline MR (≥moderate), which improved in 79.4% of patients (n=528). Female patients, those with lower body mass indices, and those with higher right ventricular systolic pressures were more likely to have persistence or worsening of baseline MR. Patients whose baseline MR persisted or worsened, had higher rates (80.3% vs. 77.3%, p=0.0019) of our inpatient composite, higher rates (15.3% vs. 10.0%, p=0.0389) of our 30-day composite, and higher rates (36.7% vs. 26.8%, p=0.0107) of our 1-year composite when compared to patients whose baseline MR improved post-TAVR. CONCLUSIONS Our study identifies clinical characteristics, which help identify patients who may require closer post-procedural follow-up and warrant possible staged mitral valve intervention post-TAVR across all risk groups.
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16
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Claessen BE, Tang GHL, Kini AS, Sharma SK. Considerations for Optimal Device Selection in Transcatheter Aortic Valve Replacement: A Review. JAMA Cardiol 2020; 6:102-112. [PMID: 32902569 DOI: 10.1001/jamacardio.2020.3682] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Aortic valve stenosis (AS) is the most common manifestation of acquired valvular heart disease in developed countries. Several large-scale randomized clinical trials investigating the entire spectrum of patients with severe symptomatic AS from low to prohibitive risk have established transcatheter aortic valve replacement (TAVR) as a safe and effective alternative to surgical aortic valve replacement. Observations There are currently only 3 types of TAVR devices commercially available in the US, but several other valve types are undergoing clinical trials in the US. Because of fundamental differences in engineering features, each TAVR device type has specific strengths and limitations. This review aims to provide an overview of design features and clinical outcomes of various TAVR devices that are either commercially available or undergoing clinical investigation. Conclusions and Relevance Given the lack of large-scale head-to-head comparisons of various TAVR devices and the rapid development of new device iterations, there is insufficient evidence to claim superiority of one device type over another. Nonetheless, as each TAVR device has unique design characteristics, certain patient-related and anatomy-related factors may slightly favor one or several particular designs.
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Affiliation(s)
- Bimmer E Claessen
- Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York.,Division of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna S Kini
- Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K Sharma
- Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
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Meta-analysis Comparing Outcomes of Self-Expanding Versus Balloon-Expandable Valves for Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 128:202-209. [PMID: 32534734 DOI: 10.1016/j.amjcard.2020.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 01/08/2023]
Abstract
There are two commercially available transcatheter heart valve systems: balloon expandable valves (BEV) and self-expanding valves (SEV). However, there is a paucity of randomized trials comparing both systems. Electronic databases (Medline, the Cochrane Library, Web of Science, and clinicaltrials.gov) and major conference proceedings were searched for randomized trials of patients with symptomatic severe aortic stenosis and received transcatheter aortic valve implantation (TAVI) with a SEV or BEV or surgical aortic valve replacement. The main efficacy outcomes were all-cause mortality and stroke at the longest available follow-up. The main analysis was performed using a random-effects network meta-analysis complemented by several subgroup and sensitivity analyses. Ten trials with 9,439 patients (mostly undergoing transfemoral TAVI) were included. At a median of 27 months, there was no difference between BEV and SEV valves in terms of all-cause mortality (odds ratio [OR] 1.05, 95% confidence interval [CI] 0.79 to 1.42). The incidence of any stroke was higher with BEV (OR 1.51, 95% CI 1.01 to 2.26), but there was no difference in the incidence of disabling stroke. At 30-days, BEV valves were associated with lower incidence of new permanent pacemaker placement (OR 0.50, 95% CI 0.32 to 0.79) and moderate/severe paravalvular regurgitation (OR 0.39, 95% CI 0.22 to 0.68). In conclusion, in patients with severe symptomatic aortic stenosis undergoing transfemoral TAVI, SEV and BEV were associated with similar all-cause mortality. BEV were associated with a higher incidence of any stroke driven by nondisabling strokes, but lower incidence of new permanent pacemaker placement and moderate/severe paravalvular regurgitation compared with SEV.
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Abstract
Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to treat symptomatic severe aortic stenosis. The patient populations that have been shown to benefit from this procedure continue to grow with time. Techniques and technology in TAVR persistently advance with a continued trend toward improved outcomes for patients. In this review, we highlight the advances in vascular access, TAVR valve design, progress in reducing procedural complications, and emerging evidence in the field.
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Affiliation(s)
- Morgan H Randall
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Anthony A Bavry
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA.
- North Florida/South Georgia, Veterans Health System, Gainesville, FL, USA.
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Jiang T, Hasan SM, Faluk M, Patel J. Evolution of Transcatheter Aortic Valve Replacement | Review of Literature. Curr Probl Cardiol 2020; 46:100600. [PMID: 32522375 DOI: 10.1016/j.cpcardiol.2020.100600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 11/18/2022]
Abstract
Aortic valve stenosis is the most common primary valvular heart disease leading to either surgical or transcatheter valve replacement in the United States with its prevalence on the rise due to the elderly population. Over the recent years, the rise of transcatheter aortic valve replacement has been exponential due to technologic developments and randomized control trials. In this review article, we aim to review current literature on transcatheter aortic valve replacements.
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Abstract
Degenerative aortic stenosis is the most common valvular disease worldwide; however, its physiopathology remains poorly understood. Although, developments in prevention of this disease have remained relatively stagnant, the last decade has brought about innovative treatment options incorporating different percutaneous and surgical approaches. These advances have allowed physicians to offer relief to high-risk patients, previously deemed nonsurgical. Increasingly, there is a shift toward offering percutaneous valve replacement to moderate and low-risk patients with aortic stenosis. Enthusiasm for a new treatment option must always be tempered by caution; as defining appropriate patient selection is essential to achieve optimal outcomes.
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Affiliation(s)
- Alice Le Huu
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, & The Texas Heart Institute, Houston, TX, USA
| | - Dominique Shum-Tim
- Division of Cardiac Surgery & Surgical Research, Department of Surgery, McGill University, Montreal, QC, Canada
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21
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Anderson RD, Gargus N, Randall MH. Editorial: The use of Fascia iliaca Block with Minimal Conscious Sedation in Transcatheter Aortic Valve Replacement: Advances in TAVR Anesthesia. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:602-603. [PMID: 32201210 DOI: 10.1016/j.carrev.2020.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 11/19/2022]
Affiliation(s)
- R David Anderson
- University of Florida, Division of Cardiovascular Medicine, 1329 SW 16th St., PO Box 100288, Gainesville, FL 32608, United States of America.
| | - Nathan Gargus
- University of Florida, Division of Cardiovascular Medicine, 1329 SW 16th St., PO Box 100288, Gainesville, FL 32608, United States of America
| | - Morgan H Randall
- University of Florida, Division of Cardiovascular Medicine, 1329 SW 16th St., PO Box 100288, Gainesville, FL 32608, United States of America
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Transcatheter Aortic Valve Implantation in Patients With Severe, Symptomatic Aortic Valve Stenosis at Intermediate Surgical Risk: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2020; 20:1-121. [PMID: 32194880 PMCID: PMC7080451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Surgical aortic valve replacement (SAVR) is the conventional treatment in patients at low or intermediate surgical risk. Transcatheter aortic valve implantation (TAVI) is a less invasive procedure, originally developed as an alternative for patients at high or prohibitive surgical risk. METHODS We conducted a health technology assessment of TAVI versus SAVR in patients with severe, symptomatic aortic valve stenosis at intermediate surgical risk, which included an evaluation of effectiveness, safety, cost-effectiveness, budget impact, and patient preferences and values. We performed a literature search to retrieve systematic reviews and selected one that was relevant to our research question. We complemented the systematic review with a literature search to identify randomized controlled trials published after the review. Applicable, previously published cost-effectiveness analyses were available, so we did not conduct a primary economic evaluation. We analyzed the net budget impact of publicly funding TAVI in people at intermediate surgical risk in Ontario. To contextualize the potential value of TAVI for people at intermediate surgical risk, we spoke with people who had aortic valve stenosis and their families. RESULTS We identified two randomized controlled trials; they found that in patients with severe, symptomatic aortic valve stenosis, TAVI was noninferior to SAVR with respect to the composite endpoint of all-cause mortality or disabling stroke within 2 years of follow-up (GRADE: High). However, compared with SAVR, TAVI had a higher risk of some complications and a lower risk of others. Device-related costs for TAVI (approximately $23,000) are much higher than for SAVR (approximately $6,000). Based on two published cost-effectiveness analyses conducted from the perspective of the Ontario Ministry of Health, TAVI was more expensive and, on average, more effective (i.e., it produced more quality-adjusted life-years) than SAVR. The incremental cost-effectiveness ratios showed that TAVI may be cost-effective, but the probability of TAVI being cost-effective versus SAVR was less than 60% at a willingness-to-pay value of $100,000 per quality-adjusted life-year. The net budget impact of publicly funding TAVI in Ontario would be about $2 million to $3 million each year for the next 5 years. This cost may be reduced if people receiving TAVI have a shorter hospital stay (≤ 3 days). We interviewed 13 people who had lived experience with aortic valve stenosis. People who had undergone TAVI reported reduced physical and psychological effects and a shorter recovery time. Patients and caregivers living in remote or northern regions reported lower out-of-pocket costs with TAVI because the length of hospital stay was reduced. People said that TAVI increased their quality of life in the short-term immediately after the procedure. CONCLUSIONS In people with severe, symptomatic aortic valve stenosis at intermediate surgical risk, TAVI was similar to SAVR with respect to the composite endpoint of all-cause mortality or disabling stroke. However, the two treatments had different patterns of complications. The study authors also noted that longer follow-up is needed to assess the durability of the TAVI valve. Compared with SAVR, TAVI may provide good value for money, but publicly funding TAVI in Ontario would result in additional costs over the next 5 years. People with aortic valve stenosis who had undergone TAVI appreciated its less invasive nature and reported a substantial reduction in physical and psychological effects after the procedure, improving their quality of life.
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Kalogeras K, Ruparelia N, Kabir T, Jabbour R, Naganuma T, Vavuranakis M, Nakamura S, Wang B, Sen S, Hadjiloizou N, Malik IS, Mikhail G, Dalby M, Panoulas V. Comparison of the self-expanding Evolut-PRO transcatheter aortic valve to its predecessor Evolut-R in the real world multicenter ATLAS registry. Int J Cardiol 2020; 310:120-125. [PMID: 32139239 DOI: 10.1016/j.ijcard.2020.02.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/16/2020] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Evolut PRO self-expanding transcatheter aortic valve has been designed to feature an outer pericardial wrap that aims to reduce paravalvular regurgitation (PVR) rates. Medium-term clinical outcomes, compared to its predecessor Evolut R, in a real-world setting, have not been investigated. The aim of the present study was to compare the two valves with regards to peri-procedural complications, early outcomes and mid-term survival. METHODS Consecutive patients, undergoing TAVI with either the Evolut PRO or Evolut R device, from the multicenter ATLAS registry were retrospectively studied. Outcomes studied included periprocedural complications, PVR at discharge, need for new pacemaker implantation and Kaplan-Meier estimated 1-year all-cause mortality. RESULTS Analysis included 673 patients (498 treated with Evolut R and 175 treated with Evolut PRO). At least moderate PVR was numerically lower amongst patients treated with Evolut PRO (7.4% vs 3.8% for Evolut R and Evolut PRO respectively, p = .108). Rates of new permanent pacemaker (PPM) implantation (21.1% vs. 11.9%, p = .023), and bail-out valve-in-valve (2.4% vs. 0%, p = .049) were significantly lower amongst the Evolut PRO group. No differences were demonstrated regarding bleeding, stroke or acute kidney injury. One-year Kaplan-Meier estimated survival was similar between groups (93% for Evolut R vs. 91.2% for Evolut PRO, plog-rank = 0.806). CONCLUSIONS The Evolut PRO self-expanding valve demonstrates similar mid-term survival rates and numerically, yet not significant, lower incidence of PVR compared to its predecessor. Interestingly this new generation valve is associated with a significantly reduced rate for new PPM implantation. Future studies are required to confirm this finding.
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Affiliation(s)
- Konstantinos Kalogeras
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Foundation Trust, London, UK; 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Neil Ruparelia
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Tito Kabir
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Foundation Trust, London, UK
| | - Richard Jabbour
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Manolis Vavuranakis
- 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece; 3(rd) Department of Cardiology, Sotiria Hospital, National & Kapodistrian University of Athens, Greece
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Brian Wang
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Sayan Sen
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Nearchos Hadjiloizou
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
| | - Iqbal S Malik
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Ghada Mikhail
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Miles Dalby
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Foundation Trust, London, UK; Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
| | - Vasileios Panoulas
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Foundation Trust, London, UK; Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
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Erdem A, Zencirci AE, Ozden K, Terzi S. Transfemoral aortic valve implantation in the case of pre-existing mitral prosthesis and pure aortic regurgitation: A case report. World J Clin Cases 2019. [DOI: 10.12998/wjcc.v7.i21.3532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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25
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Erdem A, Esen Zencirci A, Ozden K, Terzi S. Transfemoral aortic valve implantation in the case of pre-existing mitral prosthesis and pure aortic regurgitation: A case report. World J Clin Cases 2019; 7:3549-3552. [PMID: 31750336 PMCID: PMC6854404 DOI: 10.12998/wjcc.v7.i21.3549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is recommended in patients with severe aortic stenosis who have high surgical risk. However, in the pre-existing mechanical mitral valve prosthesis and natural pure aortic regurgitation, TAVR is relatively contraindicated. In this report, we described one case of TAVR with native aortic regurgitation in the presence of mechanical mitral valve prosthesis.
CASE SUMMARY A 64-year-old man with a medical history of mitral valve replacement had severe dyspnea and was symptomatic even at rest for 3 mo. His echocardiography showed severe native pure aortic regurgitation. His euroscore was 15. A TAVR procedure with an evolut R was planned. A 34 mm evolut R was placed by transesophageal echocardiography. The mitral prosthesis was functioning normally, and mild-moderate paravalvular leakage was evident by transesophageal echocardiography. The patient recovered without any complication. At 1 mo follow up, the patient was well, and no paravalvular leakage was noted.
CONCLUSION TAVR for pure aortic regurgitation in the presence of prosthetic mitral valve can be a safe procedure.
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Affiliation(s)
- Aysun Erdem
- Department of Cardiology, Dr Siyami Ersek Thoracic and Heart Surgery Education and Research Hospital, Istanbul 34710, Turkey
| | - Aycan Esen Zencirci
- Department of Cardiology, Dr Siyami Ersek Thoracic and Heart Surgery Education and Research Hospital, Istanbul 34710, Turkey
| | - Kivilcim Ozden
- Department of Cardiology, Dr Siyami Ersek Thoracic and Heart Surgery Education and Research Hospital, Istanbul 34710, Turkey
| | - Sait Terzi
- Department of Cardiology, Dr Siyami Ersek Thoracic and Heart Surgery Education and Research Hospital, Istanbul 34710, Turkey
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Luraghi G, Migliavacca F, García-González A, Chiastra C, Rossi A, Cao D, Stefanini G, Rodriguez Matas JF. On the Modeling of Patient-Specific Transcatheter Aortic Valve Replacement: A Fluid-Structure Interaction Approach. Cardiovasc Eng Technol 2019; 10:437-455. [PMID: 31309527 DOI: 10.1007/s13239-019-00427-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/04/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Transcatheter aortic valve replacement (TAVR) is a minimally invasive treatment for high-risk patients with aortic diseases. Despite its increasing use, many influential factors are still to be understood and require continuous investigation. The best numerical approach capable of reproducing both the valves mechanics and the hemodynamics is the fluid-structure interaction (FSI) modeling. The aim of this work is the development of a patient-specific FSI methodology able to model the implantation phase as well as the valve working conditions during cardiac cycles. METHODS The patient-specific domain, which included the aortic root, native valve and calcifications, was reconstructed from CT images, while the CAD model of the device, metallic frame and pericardium, was drawn from literature data. Ventricular and aortic pressure waveforms, derived from the patient's data, were used as boundary conditions. The proposed method was applied to two real clinical cases, which presented different outcomes in terms of paravalvular leakage (PVL), the main complication after TAVR. RESULTS The results confirmed the clinical prognosis of mild and moderate PVL with coherent values of regurgitant volume and effective regurgitant orifice area. Moreover, the final release configuration of the device and the velocity field were compared with postoperative CT scans and Doppler traces showing a good qualitative and quantitative matching. CONCLUSION In conclusion, the development of realistic and accurate FSI patient-specific models can be used as a support for clinical decisions before the implantation.
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Affiliation(s)
- Giulia Luraghi
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Piazza L. da Vinci 32, 20133, Milan, Italy.
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Alberto García-González
- Laboratori de Càlcul Numèric (LaCàN), E.T.S. de Ingenieros de Caminos, Canales y Puertos, Universitat Politècnica de Catalunya (UPC), Jordi Girona 1-3, 08034, Barcelona, Spain
| | - Claudio Chiastra
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Piazza L. da Vinci 32, 20133, Milan, Italy.,PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Alexia Rossi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Davide Cao
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Jose Felix Rodriguez Matas
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Piazza L. da Vinci 32, 20133, Milan, Italy
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Power D, Schäfer U, Guedeney P, Claessen BE, Sartori S, Sorrentino S, Lefèvre T, Kupatt C, Tchetche D, Dumonteil N, Webb JG, Colombo A, Windecker S, Ten Berg JM, Hildick-Smith D, Boekstegers P, Linke A, Tron C, Van Belle E, Asgar AW, Jeger R, Sardella G, Hink U, Husser O, Grube E, Lechthaler I, Wijngaard P, Anthopoulos P, Deliargyris EN, Bernstein D, Hengstenberg C, Mehran R, Dangas GD. Impact of percutaneous closure device type on vascular and bleeding complications after TAVR: A post hoc analysis from the BRAVO-3 randomized trial. Catheter Cardiovasc Interv 2019; 93:1374-1381. [PMID: 31116908 DOI: 10.1002/ccd.28295] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/04/2019] [Accepted: 04/06/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVE Prostar XL (PS) and ProGlide (PG) are common vascular closure devices (VCD) used in TAVR via transfemoral vascular approach. The impact of these VCD on vascular and bleeding complications remains unclear. METHODS The BRAVO-3 trial randomized 802 patients undergoing transfemoral TAVR. We stratified patients according to type of VCD used and examined the 30-day incidence of major or minor vascular complications, major bleeding (BARC ≥3b), AKI and major adverse cardiac and cerebrovascular events (MACCE; death, myocardial infarction or stroke). RESULTS A total of 746 (93%) patients were treated with either PS (n = 352, 47%) or PG (n = 394, 53%) VCD, without significant differences in successful deployment rate (PS 322 [91.2%] vs. PG 373 [94.2%] respectively, p = .20). PG was associated with a significantly lower incidence of major or minor vascular complications, compared to PS (adjusted OR: 0.54; 95% CI: 0.37-0.80; p < .01). Rates of acute kidney injury were also lower with the PG device. There was no significant difference between bleeding, MACCE, and death. CONCLUSIONS Compared to PS, the PG VCD was associated with a lower rate of major or minor vascular complications and lower rates of AKI after transfemoral TAVR.
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Affiliation(s)
- David Power
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York City, New York
| | - Ulrich Schäfer
- Division of Cardiology, University Heart Center, Hamburg, Germany
| | - Paul Guedeney
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York City, New York
| | - Bimmer E Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York City, New York
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York City, New York
| | - Sabato Sorrentino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York City, New York
| | - Thierry Lefèvre
- Department of Cardiology, Hôpital Privé Jacques Cartier, Massy, France
| | | | - Didier Tchetche
- Department of Cardiology, Clinique Pasteur Toulouse, Toulouse, France
| | | | - John G Webb
- Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy
| | | | - Jurriën M Ten Berg
- Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - David Hildick-Smith
- Department of Interventional Cardiology, Sussex Cardiac Center, Brighton, UK
| | | | | | - Christophe Tron
- Department of Cardiology, Rouen University Hospital, Rouen, France
| | - Eric Van Belle
- Department of Cardiology and INSERM UMR 1011, CHU Lille, Lille, France
| | - Anita W Asgar
- Institute de Cardiologie de Montréal, Montreal, Quebec, Canada
| | - Raban Jeger
- Cardiology, University Hospital Basel, University of Basel, Switzerland
| | | | - Ulrich Hink
- Department of Cardiology, Universitätsmedizin Mainz, Mainz, Germany
| | | | | | | | | | | | | | - Debra Bernstein
- Science and Strategy Consulting Group, Basking Ridge, New Jersey
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York City, New York
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York City, New York
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Correlation Between Aortic Angulation and Outcomes of Transcatheter Aortic Valve Replacement With New-Generation Valves. Curr Probl Cardiol 2019; 46:100415. [PMID: 30975449 DOI: 10.1016/j.cpcardiol.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/09/2019] [Indexed: 02/07/2023]
Abstract
The aim of this study was to assess the correlation of aortic angulation (AA) on immediate postprocedural and long-term outcomes following transcatheter aortic valve replacement (TAVR) with new-generation valves. There is limited and conflicting data on the impact of AA on short- and long-term outcomes in patients undergoing TAVR. Available studies to date were done with first-generation valves. We assessed 179 patients who underwent TAVR with either a balloon-expandable or self-expandable valve at our institute from May 2014 to June 2017 and had multislice computed tomography scans available for AA evaluation. All included patients received a second- or third-generation valve. TAVR endpoints, device success, and adverse events were defined according to the Valve Academic Research Consortium-2 criteria. The mean AA of the study population was 49.05 ± 10.07. Patients were divided into 2 groups: AA <49 and AA ≥49, and then further subdivided by valve type. There were no difference in mean age, The Society for Thoracic Surgery (STS) score, or race distribution between the AA <49 and AA ≥49 groups. The preimplantation balloon valvuloplasty rate was higher in patients with AA ≥ 49 compared to patients with AA <49, (70% vs 55.1%, P = 0.04). There was no difference in re-hospitalization, pacemaker implantation, postprocedural aortic regurgitation or mortality between patients with AA <49 and AA ≥49 irrespective of valve type (P < 0.05). AA does not significantly affect short- or long-term outcomes in patients who undergo TAVR with new-generation balloon-expandable or self-expandable valves.
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Dvir D. Newer Generation Transcatheter Heart Valve Devices: Moving FORWARD. JACC Cardiovasc Interv 2018; 11:2335-2336. [PMID: 30466833 DOI: 10.1016/j.jcin.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Danny Dvir
- University of Washington, Seattle, Washington.
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Abdelghani M, Allali A, Kaur J, Hemetsberger R, Mehilli J, Neumann F, Frerker C, Kurz T, El‐Mawardy M, Richardt G, Abdel‐Wahab M. Impact of prosthesis‐iteration evolution and sizing practice on the incidence of prosthesis–patient mismatch after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2018; 93:971-979. [DOI: 10.1002/ccd.27977] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/15/2018] [Accepted: 10/23/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Mohammad Abdelghani
- The Heart Center, Segeberger Kliniken Bad Segeberg Germany
- Cardiology Department, The Academic Medical CenterUniversity of Amsterdam Amsterdam The Netherlands
| | | | | | | | - Julinda Mehilli
- Munich University CenterLudwig‐Maximilians University Munich Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance Munich Germany
| | | | | | - Thomas Kurz
- Cardiology DepartmentLübeck University Hospital Lübeck Germany
| | | | - Gert Richardt
- The Heart Center, Segeberger Kliniken Bad Segeberg Germany
| | - Mohamed Abdel‐Wahab
- The Heart Center, Segeberger Kliniken Bad Segeberg Germany
- Cardiology DepartmentHeart Center Leipzig, University Hospital Leipzig Germany
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Real‐world comparison of the new 34 mm self‐expandable transcatheter aortic prosthesis Evolut R to its 31 mm core valve predecessor. Catheter Cardiovasc Interv 2018; 93:685-691. [DOI: 10.1002/ccd.27862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/02/2018] [Accepted: 08/12/2018] [Indexed: 11/07/2022]
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32
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Naqvi TZ. Echocardiography in transcatheter aortic (Core)Valve implantation: Part 2-Transesophageal echocardiography. Echocardiography 2018; 35:1020-1041. [DOI: 10.1111/echo.14034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Tasneem Z. Naqvi
- Department of Cardiology; Echocardiography Laboratory; Mayo Clinic; Scottsdale AZ USA
- University of Southern California; Los Angeles CA USA
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33
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Naqvi TZ. Echocardiography in transcatheter aortic valve implantation-Part 1-Transthoracic echocardiography. Echocardiography 2018; 35:1005-1019. [DOI: 10.1111/echo.13799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Tasneem Z. Naqvi
- Echocardiographic Laboratory; Department of Cardiology; Mayo Clinic; Scottsdale AZ USA
- Division of Cardiology; University of Southern California; Los Angeles CA USA
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