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Montonati C, Pellegrini D, d'Atri DO, Pellicano M, Briguglia D, Giannini F, De Blasio G, Guagliumi G, Tespili M, Ielasi A. A novel balloon-expandable transcatheter aortic valve bioprosthesis: Myval and Myval Octacor. Expert Rev Cardiovasc Ther 2024; 22:325-337. [PMID: 38970466 DOI: 10.1080/14779072.2024.2375345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/28/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION Over the past two decades, transcatheter aortic valve replacement (TAVR) has expanded its application across all surgical risk levels, including low-risk patients, where, due to longer life expectancy, reducing common pitfalls of TAVR is essential. To address these needs, many technological advancements have been developed. Myval and the new generation Myval Octacor (Meril Life Sciences Pvt. Ltd) are novel balloon-expandable (BE) transcatheter heart valve (THV) systems designed for the treatment of severe aortic stenosis. AREAS COVERED This review aims to illustrate the design features of these novel THVs and the main evidence from available studies. Furthermore, we provide evidence of these THVs' performance in challenging scenarios such as extra-large aortic annuli, bicuspid aortic valves, and valve-in-valve/valve-in-ring procedures. EXPERT OPINION Myval and Myval Octacor have demonstrated comparable early safety and clinical efficacy to the leading contemporary THVs, exhibiting remarkably low rates of moderate to severe paravalvular leak (PVL) and permanent pacemaker implantation (PPI). The wide range of sizes offered by the Myval family may minimize the risk of under-/oversizing, potentially explaining the lower rates of the aforementioned phenomena. Moreover, the presence of both internal skirt and external reinforced cuff may also explain the low rate of moderate to severe PVL.
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Affiliation(s)
- Carolina Montonati
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Dario Pellegrini
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Daniele Oreste d'Atri
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
- Cardiothoracic Department, Università Vita-Salute San Raffaele, Milan, Italy
| | - Mariano Pellicano
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Daniele Briguglia
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Francesco Giannini
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Giuseppe De Blasio
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Giulio Guagliumi
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Maurizio Tespili
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Alfonso Ielasi
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
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van Wely M, Rooijakkers M, Stens N, El Messaoudi S, Somers T, van Garsse L, Thijssen D, Nijveldt R, van Royen N. Paravalvular regurgitation after transcatheter aortic valve replacement: incidence, quantification, and prognostic impact. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae040. [PMID: 39045465 PMCID: PMC11195773 DOI: 10.1093/ehjimp/qyae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/21/2024] [Indexed: 07/25/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) is the standard of care in aortic stenosis with results comparable to surgical aortic valve replacement. However, paravalvular regurgitation (PVR) is more common after TAVR. With the alteration of devices and implantation techniques, the incidence of moderate or more PVR has declined. Mild PVR is still common in around 30% of TAVR patients in low-risk trials. Progression of AS causes myocardial hypertrophy and varying degrees of diastolic dysfunction which may cause heart failure even in combination with small volumes of PVR. Any degree of PVR is associated with an increased risk of overall and cardiovascular mortality. Predictors of PVR are annular eccentricity, severe calcification of the aortic valve, bicuspid aortic valves, and type of prosthesis where balloon-expandable devices are associated with less PVR. PVR is diagnosed using echocardiography, aortic angiogram with or without videodensitometry, haemodynamic parameters, or cardiac magnetic resonance. PVR can be treated using post-dilation, interventional treatment using a vascular plug, or implantation of a second device. Successful post-dilation depends on balloon size which should at least be equal to or >95% of the mean annulus diameter. Implantation of a second device to reduce PVR is successful in ∼90% of cases, either through lengthening of the sealing skirt in case of inadequate position or through further expansion of the index device. Implantation of a vascular plug can successfully reduce PVR and reduce mortality.
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Affiliation(s)
- Marleen van Wely
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Maxim Rooijakkers
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Niels Stens
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Department of Physiology, Radboudumc , Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Saloua El Messaoudi
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Tim Somers
- Department of Cardiothoracic Surgery, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Leen van Garsse
- Department of Cardiothoracic Surgery, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Dick Thijssen
- Department of Physiology, Radboudumc , Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Meredith T, Roy D, Hayward C, Feneley M, Kovacic J, Muller D, Namasivayam M. Strain Assessment in Aortic Stenosis: Pathophysiology and Clinical Utility. J Am Soc Echocardiogr 2024; 37:64-76. [PMID: 37805144 DOI: 10.1016/j.echo.2023.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/09/2023]
Abstract
Contemporary echocardiographic criteria for grading aortic stenosis severity have remained relatively unchanged, despite significant advances in noninvasive imaging techniques over the last 2 decades. More recently, attention has shifted to the ventricular response to aortic stenosis and how this might be quantified. Global longitudinal strain, semiautomatically calculated from standard two-dimensional echocardiographic images, has been the focus of extensive research. Global longitudinal strain is a sensitive marker of subtle hypertrophy-related impairment in left ventricular function and has shown promise as a relatively robust prognostic marker, both independently and when added to severity classification systems. Herein we review the pathophysiological basis underpinning the potential utility of global longitudinal strain in the assessment of aortic stenosis, as well as its potential role in quantifying myocardial recovery and prognostic discrimination following aortic valve replacement.
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Affiliation(s)
- Thomas Meredith
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David Roy
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Hayward
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Feneley
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jason Kovacic
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David Muller
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mayooran Namasivayam
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
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Hameed I, Ahmed A, Kumar A, Li E, Candelario K, Khan S, Kannan A, Latif N, Amabile A, Geirsson A, Williams ML. Mild aortic insufficiency following transcatheter aortic valve replacement: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2023. [PMID: 37172208 DOI: 10.1002/ccd.30674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/08/2023] [Accepted: 04/22/2023] [Indexed: 05/14/2023]
Abstract
BACKGROUND Post-procedural aortic insufficiency (AI) continues to be prevalent following transcatheter aortic valve replacement (TAVR). While several studies have assessed the outcomes of moderate-severe AI following TAVR, the incidence, predictors, and outcomes of mild AI remain unclear. METHODS A systematic literature review was performed to identify studies reporting on mild AI following TAVR. The primary outcome was pooled incidence of post-TAVR mild AI. Secondary outcomes included pooled incidence of mild AI at 30 days and long term. The pooled incidence of midterm mortality in patients with post-TAVR mild AI was also evaluated. The random effect generalized linear mixed-effects model with logit-transformed proportions and Hartung-Knapp adjustment was used to calculate pooled incidence rates. Meta-regression was performed to identify predictors of mild AI. RESULTS The pooled analysis included 19,241 patients undergoing TAVR across 50 studies. The mean age of patients ranged from 73 to 85 years, and female patients ranged from 20.0% to 83.3%. The overall pooled incidence of post-TAVR mild AI was 56.1% (95% confidence interval [CI] 0.31-0.64). The pooled incidence of mild AI at 30 days was 33.7% (95% CI 0.12-0.37). At mean follow-up of 1.15 years, the pooled incidence of mild AI was 37.0% (95% CI 0.16-0.45). The overall pooled incidence of Midterm mortality (mean follow-up 1.22 years) in patients with mild AI was 14.8% (95% CI 0.10-0.25). At meta-regression, none of the explored variables correlated with a difference in mild AI incidence. CONCLUSIONS In published studies to date, 50% of patients undergoing TAVR develop mild AI postoperatively. In 37% of patients, this persists in long term. Though the incidence of AI is likely improving with newer generation TAVR valves, the prevalence and outcomes of mild AI should be closely monitored as TAVR volume and indications expand to younger patients with long life expectancy. The long-term outcomes of mild AI remain unclear. Further dedicated studies on post-TAVR mild AI are needed.
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Affiliation(s)
- Irbaz Hameed
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Adham Ahmed
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Eric Li
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Katherine Candelario
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sumera Khan
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Amudhan Kannan
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nida Latif
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrea Amabile
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arnar Geirsson
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Matthew L Williams
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Gatta F, Haqzad Y, Gradinariu G, Malvindi PG, Khalid Z, Suelo-Calanao RL, Moawad N, Bashir A, Rogers LJ, Lloyd C, Nguyen B, Booth K, Wang L, Al-Attar N, McDowall N, Watkins S, Sayeed R, Baghdadi S, D'Alessio A, Monteagudo-Vela M, Djordjevic J, Goricar M, Hoppe S, Bocking C, Hussain A, Evans B, Arif S, Malkin C, Field M, Sandhu K, Harky A, Torky A, Uddin M, Abdulhakeem M, Kenawy A, Massey J, Cartwright N, Tyson N, Nicou N, Baig K, Jones M, Aljanadi F, Owens CG, Oyebanji T, Doyle J, Spence MS, Brennan PF, Manoharan G, Ramadan T, Ohri S, Loubani M. Redo aortic valve replacement versus valve-in-valve trans-catheter aortic valve implantation: a UK propensity-matched analysis. Monaldi Arch Chest Dis 2023; 94. [PMID: 37074089 DOI: 10.4081/monaldi.2023.2546] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/21/2023] [Indexed: 04/20/2023] Open
Abstract
This study sought to compare the morbidity and mortality of redo aortic valve replacement (redo-AVR) versus valve-in-valve trans-catheter aortic valve implantation (valve-in-valve TAVI) for patients with a failing bioprosthetic valve. A multicenter UK retrospective study of redo-AVR or valve-in-valve TAVI for patients referred for redo aortic valve intervention due to a degenerated aortic bioprosthesis. Propensity score matching was performed for confounding factors. From July 2005 to April 2021, 911 patients underwent redo-AVR and 411 patients underwent valve-in-valve TAVI. There were 125 pairs for analysis after propensity score matching. The mean age was 75.2±8.5 years. In-hospital mortality was 7.2% (n=9) for redo-AVR versus 0 for valve-in-valve TAVI, p=0.002. Surgical patients suffered more post-operative complications, including intra-aortic balloon pump support (p=0.02), early re-operation (p<0.001), arrhythmias (p<0.001), respiratory and neurological complications (p=0.02 and p=0.03) and multi-organ failure (p=0.01). The valve-in-valve TAVI group had a shorter intensive care unit and hospital stay (p<0.001 for both). However, moderate aortic regurgitation at discharge and higher post-procedural gradients were more common after valve-in-valve TAVI (p<0.001 for both). Survival probabilities in patients who were successfully discharged from the hospital were similar after valve-in-valve TAVI and redo-AVR over the 6-year follow-up (log-rank p=0.26). In elderly patients with a degenerated aortic bioprosthesis, valve-in-valve TAVI provides better early outcomes as opposed to redo-AVR, although there was no difference in mid-term survival in patients successfully discharged from the hospital.
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Affiliation(s)
- Francesca Gatta
- Department of Cardiology and Cardiothoracic Surgery, Castle Hill Hospital, Hull; Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Yama Haqzad
- Department of Cardiology and Cardiothoracic Surgery, Castle Hill Hospital, Hull.
| | - George Gradinariu
- Department of Cardiology and Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow.
| | | | - Zubair Khalid
- Department of Cardiology and Cardiothoracic Surgery, Castle Hill Hospital, Hull.
| | - Rona L Suelo-Calanao
- Department of Cardiology and Cardiothoracic Surgery, Castle Hill Hospital, Hull.
| | - Nader Moawad
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Aladdin Bashir
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Luke J Rogers
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Clinton Lloyd
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Bao Nguyen
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Karen Booth
- Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle.
| | - Lu Wang
- Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle.
| | - Nawwar Al-Attar
- Department of Cardiology and Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow.
| | - Neil McDowall
- Department of Cardiology and Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow.
| | - Stuart Watkins
- Department of Cardiology and Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow.
| | - Rana Sayeed
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Saleh Baghdadi
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Andrea D'Alessio
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Maria Monteagudo-Vela
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Jasmina Djordjevic
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Matej Goricar
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Solveig Hoppe
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Charlotte Bocking
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Azar Hussain
- Department of Cardiology and Cardiothoracic Surgery, Leeds General Infirmary.
| | - Betsy Evans
- Department of Cardiology and Cardiothoracic Surgery, Leeds General Infirmary.
| | - Salman Arif
- Department of Cardiology and Cardiothoracic Surgery, Leeds General Infirmary.
| | - Christopher Malkin
- Department of Cardiology and Cardiothoracic Surgery, Leeds General Infirmary.
| | - Mark Field
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Kully Sandhu
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Amer Harky
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Ahmed Torky
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Mauin Uddin
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Muhammad Abdulhakeem
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Ayman Kenawy
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - John Massey
- Department of Cardiology and Cardiothoracic Surgery, Northern General Hospital, Sheffield.
| | - Neil Cartwright
- Department of Cardiology and Cardiothoracic Surgery, Northern General Hospital, Sheffield.
| | - Nathan Tyson
- Department of Cardiology and Cardiothoracic Surgery, Nottingham City Hospital.
| | - Niki Nicou
- Department of Cardiology and Cardiothoracic Surgery, Nottingham City Hospital.
| | - Kamran Baig
- Department of Cardiology and Cardiothoracic Surgery, Nottingham City Hospital.
| | - Mark Jones
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Firas Aljanadi
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Colum G Owens
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Tunde Oyebanji
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Joseph Doyle
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Mark S Spence
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Paul F Brennan
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Ganesh Manoharan
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Taha Ramadan
- Department of Cardiology and Cardiothoracic Surgery, Southampton General Hospital.
| | - Sunil Ohri
- Department of Cardiology and Cardiothoracic Surgery, Southampton General Hospital.
| | - Mahmoud Loubani
- Department of Cardiology and Cardiothoracic Surgery, Castle Hill Hospital, Hull.
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Fatehi Hassanabad A, Kealey A, Seal DD, Ahsan MR. A rare delayed complication after TAVR: Acute severe aortic insufficiency. J Card Surg 2022; 37:3925-3927. [PMID: 36073090 DOI: 10.1111/jocs.16866] [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: 02/24/2022] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 11/30/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become the standard of care for managing severe aortic stenosis (AS) in high surgical risk patients. Despite favorable outcomes, TAVR has been associated with complications, such as aortic regurgitation (AR). Post-TAVR aortic insufficiency, which can present at any time after the procedure, manifests as paravalvular leak, central leak, or a combination of the two. Herein, we describe a unique and atypical case of a patient who presented with heart failure and was found to have severe AR in the context of having had TAVR 5 years prior using an Evolut R prosthetic valve.
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Affiliation(s)
| | - Angela Kealey
- Section of Cardiology, Libin Cardiovascular Institute, Calgary, Canada
| | - Douglas D Seal
- Department of Anesthesiology, Cumming School of Medicine, Calgary, Canada
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7
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Istrate M, Dregoesc MI, Bolboacă SD, Botiș C, Ștef A, Bindea DI, Oprea A, Trifan CA, Moț ȘDC, Molnar A, Iancu AC. The effect of the learning curve on paravalvular aortic regurgitation and mid-term mortality in transfemoral transcatheter aortic valve implantation. Echocardiography 2022; 39:204-214. [PMID: 35026044 DOI: 10.1111/echo.15289] [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: 09/16/2021] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Paravalvular aortic regurgitation is an important independent mortality predictor in transcatheter aortic valve implantation (TAVI). Our study evaluated the association between paravalvular aortic regurgitation and mid-term mortality in relation with the learning curve, in patients with severe aortic stenosis who underwent transfemoral TAVI in the first 3 years since the establishment of the program. METHODS Patients with severe aortic stenosis who underwent transfemoral TAVI between 2017 and 2020 were included in the analysis. Paravalvular aortic regurgitation was assessed by transthoracic echocardiography at 48 hours after the procedure. All-cause mortality was evaluated after 30 days and at mid-term follow-up. RESULTS Paravalvular aortic regurgitation ≥grade II was associated with mid-term all-cause mortality (OR 4.4; 95%CI 1.82-11.55; p < 0.001), their prevalence declining after the first 60 cases. Baseline characteristics did not significantly differ in the first 60 patients from the rest of the cohort. Male sex (p = 0.006), advanced age (p = 0.04), coronary artery disease (p = 0.003), or elevated STS Score (p = 0.02) influenced mid-term survival. When adjusting for the presence of these factors, only age (OR 1.1; 95%CI 1.0-1.2), paravalvular aortic regurgitation ≥grade II (OR 3.9; 95%CI 1.3-12.9), and the number of days spent in the intensive care unit (OR 1.4; 95%CI 1.1-1.8) were independent predictors of mid-term all-cause mortality. CONCLUSIONS In a group of patients with severe aortic stenosis who underwent transfemoral TAVI in the first 3 years since the establishment of the program, paravalvular aortic regurgitation ≥grade II was associated with mid-term mortality, both declining after the first 60 cases.
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Affiliation(s)
- Mihnea Istrate
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania
| | - Mihaela I Dregoesc
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania
| | - Sorana D Bolboacă
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Medical Informatics and Biostatistics, Cluj-Napoca, Romania
| | - Cătălin Botiș
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania
| | - Adrian Ștef
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania
| | - Dan I Bindea
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania.,"Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiovascular Surgery, Cluj-Napoca, Romania
| | - Alexandru Oprea
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania.,"Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiovascular Surgery, Cluj-Napoca, Romania
| | - Cătălin A Trifan
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania.,"Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiovascular Surgery, Cluj-Napoca, Romania
| | - Ștefan D C Moț
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania.,The Romanian Academy of Medical Sciences, Bucharest, Romania
| | - Adrian Molnar
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania.,"Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiovascular Surgery, Cluj-Napoca, Romania.,The Romanian Academy of Medical Sciences, Bucharest, Romania
| | - Adrian C Iancu
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania.,"Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania.,The Romanian Academy of Medical Sciences, Bucharest, Romania
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8
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Parikh PB, Romeiser JL, Dhautel B, Mitchell D, Holecek W, Bilfinger T, Poppers J, Bennett-Guerrero E. Predictors and impact of low diastolic blood pressure and widened pulse pressure following transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 39:20-25. [PMID: 34764032 DOI: 10.1016/j.carrev.2021.10.011] [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: 05/16/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The association between post-operative diastolic blood pressure (DBP) and pulse pressure (PP) with outcomes following transcatheter aortic valve replacement (TAVR) remains unclear. We sought to assess the prevalence, predictors, and impact of post-operative DBP and PP on presence of post-procedural aortic insufficiency (AI) and mortality in adults undergoing TAVR. METHODS The study population included 194 patients who underwent TAVR from 2016 to 2017 at an academic tertiary medical center, of which 176 had invasive arterial pressures available postoperatively. Low DBP and widened PP were defined as ≤40 mmHg and ≥80 mmHg respectively on invasive arterial line on post-operative day 1. Clinical outcomes of interest included post-procedural AI and 1-year all-cause mortality. RESULTS Post-operative low DBP and widened PP were noted in 32.4% and 58.5% of the study population. No significant association between post-operative AI and low DBP (p = 0.82) or widened PP (p = 0.32) was noted. There was a trend toward higher rates of mortality in patients with low DBP (19.3% vs 9.2%, p = 0.06) but no difference in mortality in patients with widened PP (10.7% vs 15.1%, p = 0.39) or those with ≥1+ post-procedural AI (16.7% vs 10.7%, p = 0.32). In multivariable analysis, low DBP was associated with a trend toward higher rates of 1-year mortality [odds ratio (OR) 2.43, 95% confidence interval (CI) 0.97-6.11, p = 0.06]. When excluding patients with a post-operative invasive systolic blood pressure < 80 mmHg, low DBP was associated with significantly higher risk-adjusted mortality at 1 year [OR 2.75, 95% CI (1.07-7.07), p = 0.04]. CONCLUSIONS In this contemporary study of adults undergoing TAVR, low DBP and widened PP were widely prevalent post TAVR. Low DBP was associated with a trend toward higher rates of 1-year mortality but not with post-procedural AI.
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Affiliation(s)
- Puja B Parikh
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America.
| | - Jamie L Romeiser
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Britney Dhautel
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Duran Mitchell
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - William Holecek
- Department of Surgery, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Thomas Bilfinger
- Department of Surgery, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Jeremy Poppers
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Elliott Bennett-Guerrero
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
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9
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Kanzaki H, Amaki M, Okada A, Takahama H, Izumi C, Anzai T. Influence of Left Ventricular Function on the "Aortic Regurgitation Index" Proposed for the Hemodynamic Assessment of Postprocedural Aortic Regurgitation. Int Heart J 2021; 62:1019-1025. [PMID: 34544972 DOI: 10.1536/ihj.21-028] [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] [Indexed: 11/18/2022]
Abstract
The aortic regurgitation (AR) index, proposed as an objective indicator of postprocedural AR, decreases in proportion to AR severity, besides reportedly providing additional prognostic information. Meanwhile, left ventricular (LV) function has also been considered an essential prognostic factor. This study aimed to clarify whether LV function affected the AR index using cardiac catheterization data.A retrospective study was performed in patients whose LV function was evaluated using a micromanometer-tipped catheter. Patients with grade 2 or higher AR were excluded to explore non-AR factors affecting the AR index value. The AR index was calculated as a ratio of the gradient between the aortic diastolic blood pressure (DBP) and the LV end-diastolic pressure (EDP) to the aortic systolic blood pressure (SBP): AR Index = [ (DBP - LVEDP) / SBP] × 100.A total of 64 patients [age, 62 (interquartile range: 48-70) years; LV ejection fraction, 19% (16%-26%) ] were examined. AR index values ranged from 18.3 to 68.6. Despite having no AR, two patients displayed an AR index < 25, indicating significant AR. Multiple-regression analysis revealed that LV diastolic stiffness (β = -0.750, P < 0.001), LV max dP/dt (β = -0.296, P = 0.006), and heart rate (β = 0.284, P = 0.011) were independent determinants of the AR index value.Patients with impaired LV diastolic function and preserved systolic function had low AR index values. The additional prognostic information of the AR index may be related to LV diastolic function.
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Affiliation(s)
- Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroyuki Takahama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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10
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Acute aortic regurgitation underestimated by transesophageal echocardiography after preparatory balloon aortic valvuloplasty during transcatheter aortic valve implantation for severe aortic stenosis. Cardiovasc Interv Ther 2021; 36:395-397. [PMID: 33792843 DOI: 10.1007/s12928-021-00773-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/29/2020] [Indexed: 10/21/2022]
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11
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Oh JK, Lee SH, Lee SA, Kang DY, Lee S, Kim HJ, Ahn JM, Kim JB, Park DW, Song JM, Choo SJ, Kang DH, Song JK, Park SJ, Kim DH. Prognostic impact of left ventricular mass regression after transcatheter aortic valve replacement in patients with left ventricular hypertrophy. Int J Cardiol 2021; 332:60-66. [PMID: 33781852 DOI: 10.1016/j.ijcard.2021.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/23/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Paravalvular regurgitation (PVR) has been known to be the primary determinant of poor left ventricular (LV) mass regression after transcatheter aortic valve replacement (TAVR). However, the incidence of significant PVR has been reduced considerably as TAVR technology evolved rapidly. This study aimed to investigate the time course and impact of LV mass index (LVMi) regression on long-term clinical outcomes in severe aortic stenosis (AS) patients without significant PVR after TAVR. METHODS Of 412 patients who underwent TAVR, 146 who had LV hypertrophy (LVMi ≥115 g/m2 for men and ≥ 95 g/m2 for women) at baseline and were alive at one year after TAVR were enrolled. The primary outcome was cardiovascular deaths and the impact of LVMi regression on clinical outcomes were examined. The patients with significant PVR were excluded. RESULTS During a median follow-up of 40 months (interquartile range, 26-58 months), 9 (6.2%) cardiovascular deaths, 21 (14.4%) all-cause deaths, and 9 (6.2%) hospitalizations occurred. In the multivariable analysis, the percentage change of LVMi was an independent predictor of cardiovascular deaths (adjusted hazard ratio [HR], 1.03; 95% confidential interval [CI], 1.01-1.05; P = 0.010), and composite outcome of cardiovascular deaths and rehospitalization for heart failure (adjusted HR, 1.02; 95% CI, 1.00-1.04; P = 0.022). Baseline LVMi, eccentric hypertrophy, and TAVR-induced left bundle branch block were independently associated with LVMi regression. CONCLUSIONS In patients with severe AS who received successful TAVR without significant PVR, the degree of LVMi regression is an independent predictor of postoperative outcomes after TAVR.
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Affiliation(s)
- Jin Kyung Oh
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Sun Hack Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Seung-Ah Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sahmin Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Min Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Kwan Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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12
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van Wely M, van der Wulp K, Rooijakkers M, Vart P, Morshuis W, van Royen N, Gehlmann H, Verkroost M, Kievit P, van Garsse L, Geuzebroek G. Aortic Regurgitation Index Ratio Is a Strong Predictor of 1-Year Mortality After Transcatheter Aortic Valve Implantation Using Self-Expanding Devices. Semin Thorac Cardiovasc Surg 2020; 33:923-930. [DOI: 10.1053/j.semtcvs.2020.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 11/11/2022]
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13
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Kampaktsis PN, Subramayam P, Sherifi I, Vavuranakis M, Siasos G, Tousoulis D, Worku B, Minutello RM, Wong SC, Devereux RB. Impact of paravalvular leak on left ventricular remodeling and global longitudinal strain 1 year after transcatheter aortic valve replacement. Future Cardiol 2020; 17:337-345. [PMID: 33590775 DOI: 10.2217/fca-2020-0086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: New mild or persistent moderate paravalvular leak (PVL) is a known predictor of poor outcomes after transcatheter aortic valve replacement (TAVR). Its impact on left ventricular (LV) remodeling and global longitudinal strain (GLS) has not been well studied. Materials & methods: We collected echocardiographic data in 99 TAVR patients. LV remodeling and GLS were compared between patients with and without PVL. Results: Patients without PVL (n = 84) had significant LV ejection fraction, wall thickness and LV mass improvement compared with patients with PVL (n = 15; p < 0.001 for all). Diastolic function worsened in patients with PVL. Baseline GLS improved significantly regardless of PVL (p = 0.016 and p = 0.01, respectively) and was not predictive of LV ejection fraction or LV mass improvement when analyzed in tertiles. Conclusion: PVL impedes reverse LV remodeling but not GLS improvement 1-year after TAVR. Baseline GLS was not a predictor of LV remodeling.
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Affiliation(s)
| | - Pritha Subramayam
- Division of Cardiology, Weill Cornell Medicine/New York Presbyterian, NY 10065, USA
| | - Ines Sherifi
- Division of Cardiology, Weill Cornell Medicine/New York Presbyterian, NY 10065, USA
| | - Manolis Vavuranakis
- 1st Cardiology Department, Hippokrateion Hospital/University of Athens Medical School, Athens, Greece
| | - Gerasimos Siasos
- 1st Cardiology Department, Hippokrateion Hospital/University of Athens Medical School, Athens, Greece
| | - Dimitrios Tousoulis
- 1st Cardiology Department, Hippokrateion Hospital/University of Athens Medical School, Athens, Greece
| | - Berhane Worku
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, NY 10065, USA
| | - Robert M Minutello
- Division of Cardiology, Weill Cornell Medicine/New York Presbyterian, NY 10065, USA
| | - S Chiu Wong
- Division of Cardiology, Weill Cornell Medicine/New York Presbyterian, NY 10065, USA
| | - Richard B Devereux
- Division of Cardiology, Weill Cornell Medicine/New York Presbyterian, NY 10065, USA
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14
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McEvoy E, Wijns W, McGarry P. A thermodynamic transient cross-bridge model for prediction of contractility and remodelling of the ventricle. J Mech Behav Biomed Mater 2020; 113:104074. [PMID: 33189012 DOI: 10.1016/j.jmbbm.2020.104074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 01/20/2020] [Accepted: 08/27/2020] [Indexed: 12/16/2022]
Abstract
Cardiac hypertrophy is an adaption of the heart to a change in cardiovascular loading conditions. The current understanding is that progression may be stress or strain driven, but the multi-scale nature of the cellular remodelling processes have yet to be uncovered. In this study, we develop a model of the contractile left ventricle, with the active cell tension described by a thermodynamically motivated cross-bridge cycling model. Simulation of the transient recruitment of myosin results in correct patterns of ventricular pressure predicted over a cardiac cycle. We investigate how changes in tissue loading and associated deviations in transient force generation can drive restructuring of cellular myofibrils in the heart wall. Our thermodynamic framework predicts in-series sarcomere addition (eccentric remodelling) in response to volume overload, and sarcomere addition in parallel (concentric remodelling) in response to valve and signalling disfunction. This framework provides a significant advance in the current understanding of the fundamental sub-sarcomere level biomechanisms underlying cardiac remodelling. Simulations reveal that pathological tissue loading conditions can significantly alter actin-myosin cross-bridge cycling over the course of the cardiac cycle. The resultant variation in sarcomere stress pushes an imbalance between the internal free energy of the myofibril and that of unbound contractile proteins, initiating remodelling. The link between cross-bridge thermodynamics and myofibril remodelling proposed in this study may significantly advance current understanding of cardiac disease onset.
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Affiliation(s)
- Eoin McEvoy
- Biomedical Engineering, National University of Ireland, Galway, Ireland
| | - William Wijns
- The Lambe Institute for Translational Medicine, University Hospital, Galway, Ireland
| | - Patrick McGarry
- Biomedical Engineering, National University of Ireland, Galway, Ireland.
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15
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Kurt IH, Şen Ö, Kuçükosmanoğlu M, Salkın FÖ, Urgun ÖD, Şahin Ş, Çolak S, Kılıç S. The Influence of Aortic Pulse Wave Velocity on Short-Term Functional Capacity in Patients with Mild Paravalvular Regurgitation Following Transcatheter Aortic Valve Implantation. Braz J Cardiovasc Surg 2020; 35:504-511. [PMID: 32864931 PMCID: PMC7454626 DOI: 10.21470/1678-9741-2019-0454] [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] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Recently, the clinical significance of mild paravalvular aortic regurgitation (PAR) has been evaluated and suggested that it can be predictor of clinical outcomes. In our study, we aimed to investigate the interaction of aortic pulse wave velocity (PWV) and mild PAR and their effects on the functional status of patients after transcatheter aortic valve implantation (TAVI). METHODS A total of 109 consecutive patients with symptomatic severe aortic stenosis were enrolled prospectively. After TAVI procedure, they were divided in to three groups according to PAR and PWV measurements. Patients without PAR were defined as the NonePAR group (n=60), patients with mild PAR and normal PWV were defined as the MildPAR-nPWV group (n=23), and patients with mild PAR and high PWV were defined as the MildPAR-hPWV group (n=26). RESULTS Compared with other groups, the MildPAR-hPWV group was older (P<0.001), hypertensive (P=0.015), and had a higher pulse pressure (P=0.018). In addition to PWV, this group had lower aortic regurgitation index (ARI) (P=0.010) and higher rate of New York Heart Association (NYHA) class II (at least) patients (P<0.001) in 30-day follow-up period. On multivariate regression analysis, the MildPARhPWV group (odds ratio=1.364, 95% confidence interval 1.221-1.843; P=0.011) as well as N-terminal-pro-brain natriuretic peptide levels and ARI were independently related with 30-day functional NYHA classification. However, NonePAR or MildPAR-nPWV group was not an independent predictor of early functional status. CONCLUSION It was concluded that high PWV may adversely affect early functional status in patients with mild PAR in contrast to normal values following TAVI.
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Affiliation(s)
- Ibrahim Halil Kurt
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Ömer Şen
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Mehmet Kuçükosmanoğlu
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Fatma Özge Salkın
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Örsan Deniz Urgun
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Şeyda Şahin
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Salih Çolak
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Salih Kılıç
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
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16
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Anantha-Narayanan M, Kandasamy VV, Reddy YN, Megaly M, Baskaran J, Pershad A, Suri RM, Garcia S. Low-Risk Transcatheter Versus Surgical Aortic Valve Replacement - An Updated Meta-Analysis of Randomized Controlled Trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:441-452. [PMID: 31678116 DOI: 10.1016/j.carrev.2019.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To perform a meta-analysis including all available randomized controlled trials (RCTs) to date comparing transcatheter aortic valve replacement (TAVR) to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS) and low surgical risk. BACKGROUND Current guidelines recommend SAVR for patients with severe symptomatic AS and low surgical risk. A few RCTs have evaluated TAVR in low surgical risk patients but equipoise exists related to TAVR valve durability, paravalvular leak (PVL) and role of TAVR in younger, low surgical risk patients. METHODS Five databases were analyzed from January-2000 to March-2019 for RCTs comparing SAVR to TAVR in low-risk severe AS patients. RESULTS Four RCTs on low-risk TAVR patients with 2887 patients were included. Mean follow-up was ~24.1 ± 24 months. Early mortality was lower with TAVR compared to SAVR (RR: 0.44, 95% CI: 0.20-0.95, P = 0.038) whereas long-term mortality was similar (RR: 0.67, 95% CI: 0.39-1.14, P = 0.141). Both early and long-term stroke rates were similar. TAVR was associated with lower risk of atrial fibrillation, major bleeding, acute kidney injury (AKI) and rehospitalization, but higher rates of permanent pacemaker implantation (PPM) and moderate or severe PVL. There was no difference in major vascular complications, myocardial infarction, endocarditis, aortic valve gradients and valve area at follow-up. CONCLUSIONS In low-risk patients with severe AS, TAVR has a lower early mortality compared to SAVR with no difference in long-term mortality. Although complication rates varied between TAVR and SAVR, our study findings suggest that transfemoral-TAVR is an appropriate treatment option for severe symptomatic AS in patients with low surgical risk.
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Affiliation(s)
| | | | | | | | - Janani Baskaran
- CHI Health Creighton University Medical Center, United States of America
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17
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Aalaei-Andabili SH, Bavry AA. Left Ventricular Diastolic Dysfunction and Transcatheter Aortic Valve Replacement Outcomes: A Review. Cardiol Ther 2019; 8:21-28. [PMID: 30847743 PMCID: PMC6525224 DOI: 10.1007/s40119-019-0134-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Indexed: 12/23/2022] Open
Abstract
Aortic stenosis (AS) is the most common valvular disease that can lead to increased afterload, left ventricular (LV) remodeling, and myocardial fibrosis. We reviewed the literature addressing the impact of transcatheter aortic valve replacement (TAVR) on LV remodeling and patients' outcomes by elimination of AS-related high afterload. TAVR reduces afterload and improves LV remodeling recovery. However, myocardial fibrosis may not completely reverse after the TAVR. The LV diastolic dysfunction (LVDD) induced by AS is an independent predictor of post-TAVR mortality, and mortality increases with severity of LVDD. The impact of diastolic dysfunction on patient outcomes emerges at 30 days but continues to persist during mid-term follow-up. Based on severity of the baseline LVDD, some patients may tolerate post-TAVR aortic regurgitation (AR), but even minimal post-TAVR AR in patients with severe baseline LVDD can have an additive negative impact on survival. It is crucial to consider TAVR prior to development of advanced LVDD. Appropriate device selection and deployment technique are important in improvement of TAVR outcomes via elimination of AR.
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Affiliation(s)
| | - Anthony A Bavry
- Department of Medicine, University of Florida, Gainesville, FL, USA.
- North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.
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18
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Abstract
Transcatheter aortic valve replacement (TAVR) is a safe and effective therapy for aortic valve replacement in patients ineligible for or at high risk for surgery. However, outcomes after TAVR based on an individual's sex remain to be fully elucidated. We searched PUBMED and EMBASE using the keywords: "transcatheter aortic valve replacement," "transcatheter aortic valve implantation," "sex differences," "gender," "sex characteristics" and collected information on baseline features, procedural characteristics, and postprocedural outcomes in women. Inclusion/exclusion resulted in 23 publications. Women had less preexisting comorbidities than men. Most studies reported better survival in women (range of hazard ratio [95% CI] = 0.27 [0.09-0.84] to 0.91 [0.75-1.10]). At 30 days, women also had more vascular complications (6-20% vs 2-14%) and higher bleeding rates (10-44% vs 8-25%). Stroke rates were similar at 30 days (women, 1-7%; men, 1-5%). This literature review showed better survival in women than men after TAVR. However, women had more vascular complications and bleeding; stroke rates were similar. These findings may partly be explained by fewer baseline comorbidities in women. These results should be interpreted with caution as most measures only include unadjusted percentages.
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19
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TAVR with mechanically expandable prostheses: Is balloon aortic valvuloplasty really necessary? Int J Cardiol 2017; 246:37-40. [DOI: 10.1016/j.ijcard.2017.03.115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/22/2017] [Accepted: 03/24/2017] [Indexed: 11/17/2022]
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20
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Kampaktsis PN, Kokkinidis DG, Wong SC, Vavuranakis M, Skubas NJ, Devereux RB. The role and clinical implications of diastolic dysfunction in aortic stenosis. Heart 2017; 103:1481-1487. [PMID: 28684437 DOI: 10.1136/heartjnl-2017-311506] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 04/19/2017] [Indexed: 12/19/2022] Open
Abstract
Diastolic dysfunction in aortic stenosis results primarily from left ventricular hypertrophy and myocardial fibrosis due to chronically elevated left ventricular systolic pressure. Currently, diastolic dysfunction does not have an explicit clinical role in management of patients with aortic stenosis. Studies have shown that improvement in diastolic dysfunction follows left ventricular remodelling after aortic valve replacement and that it occurs gradually or incompletely. Retrospective studies suggest that advanced grades of diastolic dysfunction at baseline are associated with increased mortality and adverse events even after aortic valve replacement. Recent studies have also associated myocardial fibrosis, a hallmark of diastolic dysfunction, with worse outcomes. In addition, these results were independent of the degree of aortic stenosis or valve replacement. Indirect evidence of the role of diastolic dysfunction in aortic stenosis also comes from paradoxical low-flow, low-gradient aortic stenosis, where disproportionate left ventricular hypertrophy leads to underfilling of the left ventricle, low-flow state and is associated with worse prognosis. Lastly, a limited number of studies suggest that worse diastolic dysfunction at baseline is detrimental in patients who develop aortic regurgitation after transcatheteraortic valve replacement, due to superimposition of volume overload on a stiff left ventricle. Current major limitations in our understanding of the prognostic role of diastolic dysfunction are the lack of universally accepted classification schemes, its dependence on dynamic loading conditions and the lack of larger prospective studies.
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Affiliation(s)
- Polydoros N Kampaktsis
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA.,Society of Junior Doctors, Athens, Greece
| | - Damianos G Kokkinidis
- Society of Junior Doctors, Athens, Greece.,Division of Cardiology, Denver VA Medical Center and University of Colorado, Denver, Colorado, USA
| | - Shing-Chiu Wong
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
| | - Manolis Vavuranakis
- National Kapodistrian University of Athens, 1st Cardiology Clinic, Athens, Greece
| | - Nikolaos J Skubas
- Department of Anesthesiology, New York Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Richard B Devereux
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
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21
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Left ventricular outflow tract rupture during transcatheter aortic valve implantation: anatomic evidence of the vulnerable area. Cardiovasc Pathol 2017; 29:7-10. [DOI: 10.1016/j.carpath.2017.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/18/2017] [Accepted: 03/23/2017] [Indexed: 11/22/2022] Open
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22
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Kaneko H, Hoelschermann F, Schau T, Tambor G, Neuss M, Butter C. Different impact of aortic regurgitation assessed by aortic root angiography after transcatheter aortic valve implantation according to baseline left ventricular ejection fraction and N-terminal pro-B-type natriuretic peptide. Cardiovasc Interv Ther 2017; 33:232-238. [DOI: 10.1007/s12928-017-0473-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 05/22/2017] [Indexed: 11/28/2022]
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23
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Tateishi H, Abdelghani M, Cavalcante R, Miyazaki Y, Campos C, Collet C, Slots T, Leite R, Mangione J, Abizaid A, Soliman O, Spitzer E, Onuma Y, Serruys P, Lemos P, de Brito F. The interaction of de novo and pre-existing aortic regurgitation after TAVI: insights from a new quantitative aortographic technique. EUROINTERVENTION 2017; 13:60-68. [DOI: 10.4244/eij-d-16-00647] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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24
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Korhonen M, Parkkonen J, Hedman M, Muuronen A, Onatsu J, Mustonen P, Vanninen R, Taina M. Morphological features of the left atrial appendage in consecutive coronary computed tomography angiography patients with and without atrial fibrillation. PLoS One 2017; 12:e0173703. [PMID: 28288200 PMCID: PMC5348027 DOI: 10.1371/journal.pone.0173703] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/25/2017] [Indexed: 01/01/2023] Open
Abstract
The majority of intracardiac thrombi form in the left atrial appendage (LAA). Enlargement of this structure, together with certain morphological features, may indicate a predisposition to the formation of thrombi and subsequent cardioembolic stroke. Thus far, studies on LAA morphology have largely focused on those patients with atrial fibrillation (AF). Taking a different approach, we investigated the variation in LAA morphology in a consecutive patient population with and without AF. We evaluated 808 consecutive patients (529 females; mean age 52.5±9.9 years) who underwent coronary artery computed tomography angiography (CCTA), the majority of whom (749) had no history of AF. We assessed the length, lobe number, and morphological classification of their LAAs. Demographic data and medical histories were collated from medical records and then correlated with LAA morphology. The proportions of each of the four morphological classes of LAA for the overall vs. non-AF population were: WindSock, 62.3/61.5%; Cactus, 18.6/18.8%; ChickenWing, 10.0/10.0%; and CauliFlower, 9.2/9.6%. Age (p<0.001; r = 0.156) and female gender (p<0.001) were both found to be associated with an increased body surface area (BSA)-related LAA length. Male patients were more likely to manifest multi-lobed (p = 0.003) LAAs, and overweight patients with a greater number of multi-lobed LAA morphological classes (p = 0.010). No associations with morphological LAA features could be found for patients with diabetes, hypertension, or dyslipidemia. Nor did the size of the left atrium exhibit any correlation with BSA-related LAA length. In the overall and non-AF populations, aging and female gender were associated with longer BSA-indexed LAAs.
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Affiliation(s)
- Miika Korhonen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- * E-mail:
| | - Johannes Parkkonen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Marja Hedman
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Muuronen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha Onatsu
- Neuro Center, Kuopio University Hospital, Kuopio, Finland
| | - Pirjo Mustonen
- Department of Cardiology, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikko Taina
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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25
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Aortic Regurgitation Generates a Kinematic Obstruction Which Hinders Left Ventricular Filling. Ann Biomed Eng 2017; 45:1305-1314. [PMID: 28091966 DOI: 10.1007/s10439-017-1790-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
An incompetent aortic valve (AV) results in aortic regurgitation (AR), where retrograde flow of blood into the left ventricle (LV) is observed. In this work, we parametrically characterized the detailed changes in intra-ventricular flow during diastole as a result of AR in a physiological in vitro left-heart simulator (LHS). The loss of energy within the LV as the level of AR increased was also assessed. The validated LHS consisted of an optically-clear, flexible wall LV and a modular AV holder. Two-component, planar, digital particle image velocimetry was used to visualize and quantify intra-ventricular flow. A large coherent vortical structure which engulfed the whole LV was observed under control conditions. In the cases with AR, the regurgitant jet was observed to generate a "kinematic obstruction" between the mitral valve and the LV apex, preventing the trans-mitral jet from generating a coherent vortical structure. The regurgitant jet was also observed to impinge on the inferolateral wall of the LV. Energy dissipation rate (EDR) for no, trace, mild, and moderate AR were found to be 1.15, 2.26, 3.56, and 5.99 W/m3, respectively. This study has, for the first time, performed an in vitro characterization of intra-ventricular flow in the presence of AR. Mechanistically, the formation of a "kinematic obstruction" appears to be the cause of the increased EDR (a metric quantifiable in vivo) during AR. EDR increases non-linearly with AR fraction and could potentially be used as a metric to grade severity of AR and develop clinical interventional timing strategies for patients.
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26
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Naber CK, Pyxaras SA, Ince H, Frambach P, Colombo A, Butter C, Gatto F, Hink U, Nickenig G, Bruschi G, Brueren G, Tchétché D, Den Heijer P, Schillinger W, Scholtz S, Van der Heyden J, Lefèvre T, Gilard M, Kuck KH, Schofer J, Divchev D, Baumgartner H, Asch F, Wagner D, Latib A, De Marco F, Kische S. A multicentre European registry to evaluate the Direct Flow Medical transcatheter aortic valve system for the treatment of patients with severe aortic stenosis. EUROINTERVENTION 2016; 12:e1413-e1419. [PMID: 27934611 DOI: 10.4244/eij-d-15-00511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Our aim was to assess the clinical outcomes of the Direct Flow Medical Transcatheter Aortic Valve System (DFM-TAVS), when used in routine clinical practice. METHODS AND RESULTS This is a prospective, open-label, multicentre, post-market registry of patients treated with DFM-TAVS according to approved commercial indications. Echocardiographic and angiographic data were evaluated by an independent core laboratory and adverse events were adjudicated and classified according to VARC-2 criteria by an independent clinical events committee. The primary endpoint was freedom from all-cause mortality at 30 days post procedure. Secondary endpoints included procedural, early safety and efficacy endpoints at 30 days. Two hundred and fifty patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) with the DFM-TAVS were enrolled in 21 European centres. The primary endpoint, freedom from all-cause mortality at 30 days, was met in 98% (245/250) of patients. Device success was 83.8%. Moderate or severe aortic regurgitation was reported in 3% of patients, and none/trace regurgitation in 73% of patients. Post-procedural permanent pacemaker implantation was performed in 30 patients (12.0%). CONCLUSIONS The DFM-TAVS was associated with good short-term outcomes in this real-world registry. The low pacemaker and aortic regurgitation rates confirm the advantages of this next-generation transcatheter heart valve (THV).
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Affiliation(s)
- Christoph K Naber
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Essen, Germany
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27
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Goncalves A, Nyman C, Okada DR, Singh A, Swanson J, Cheezum M, Steigner M, Di Carli M, Solomon S, Shah PB, Bhatt DL, Shook D, Blankstein R. Transthoracic Echocardiography to Assess Aortic Regurgitation after TAVR: A Comparison with Periprocedural Transesophageal Echocardiography. Cardiology 2016; 137:1-8. [DOI: 10.1159/000452617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/27/2016] [Indexed: 11/19/2022]
Abstract
Background: We aimed to compare periprocedural transesophageal echocardiography (TEE) with postprocedural transthoracic echocardiography (TTE) for the diagnosis of aortic regurgitation (AR). Methods and Results: TEE and TTE images of 163 transcatheter aortic valve replacement (TAVR) patients (mean age 81 ± 8 years; 56% men) were reviewed separately and blinded to each other as well as to all clinical data. The median time between TEE during TAVR (TEE/TAVR) and TTE was 4 days (IQR 2-10 days). After TAVR, 48% of the patients had at least trace AR by TEE, 56% by angiography and 67% by TTE. The majority of AR was paravalvular (78%). More patients were classified with mild-to-moderate AR by TTE than by TEE (44 vs. 22%, p < 0.01). When examining the 46 patients with AR by TTE which was not at TEE/TAVR, both systolic and diastolic blood pressure (SBP and DBP) were significantly higher during TTE than during TEE (mean ΔSBP = 9 ± 4 mm Hg and mean ΔDBP = 6 ± 2 mm Hg, p < 0.01 for both). No differences in BP between TEE and TTE were found among patients with no AR or among those who had AR in both studies. At a median follow-up of 185 days (IQR 39-424 days), the overall mortality was 17%, but this was not associated with the presence of AR on TTE or TEE. Conclusions: Patients' hemodynamic conditions may result in underdiagnosis of paravalvular regurgitation in periprocedural TEE. Our findings suggest that a postprocedural evaluation for AR by TTE could serve as a reasonable alternative to TEE for the evaluation of AR.
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28
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Keeble TR, Khokhar A, Akhtar MM, Mathur A, Weerackody R, Kennon S. Percutaneous balloon aortic valvuloplasty in the era of transcatheter aortic valve implantation: a narrative review. Open Heart 2016; 3:e000421. [PMID: 28008354 PMCID: PMC5174794 DOI: 10.1136/openhrt-2016-000421] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 08/19/2016] [Accepted: 08/30/2016] [Indexed: 01/15/2023] Open
Abstract
The role of percutaneous balloon aortic valvuloplasty (BAV) in the management of severe symptomatic aortic stenosis has come under the spotlight following the development of the transcatheter aortic valve implantation (TAVI) technique. Previous indications for BAV were limited to symptom palliation and as a bridge to definitive therapy for patients undergoing conventional surgical aortic valve replacement (AVR). In the TAVI era, BAV may also be undertaken to assess the ‘therapeutic response’ of a reduction in aortic gradient in borderline patients often with multiple comorbidities, to assess symptomatic improvement prior to consideration of definitive TAVI intervention. This narrative review aims to update the reader on the current indications and practical techniques involved in undertaking a BAV procedure. In addition, a summary of the haemodynamic and clinical outcomes, as well as the frequently encountered procedural complications is presented for BAV procedures conducted during both the pre-TAVI and post-TAVI era.
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Affiliation(s)
- Thomas R Keeble
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, UK; Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK
| | - Arif Khokhar
- Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK; Department of Cardiology, Royal Brompton & Harefield NHS Trust, London, UK
| | - Mohammed Majid Akhtar
- Department of Cardiology , Barts' Heart Centre, St. Bartholomews' Hospital , London , UK
| | - Anthony Mathur
- Department of Cardiology , Barts' Heart Centre, St. Bartholomews' Hospital , London , UK
| | - Roshan Weerackody
- Department of Cardiology , Barts' Heart Centre, St. Bartholomews' Hospital , London , UK
| | - Simon Kennon
- Department of Cardiology , Barts' Heart Centre, St. Bartholomews' Hospital , London , UK
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29
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Abdelghani M, Ren B, Spitzer E, Tateishi H, Jonker H, Geleijnse ML, Tijssen JG, de Winter RJ, Serruys PWJC, Soliman OII. A granular approach to improve reproducibility of the echocardiographic assessment of paravalvular regurgitation after TAVI. Int J Cardiovasc Imaging 2016; 32:1519-27. [PMID: 27464964 PMCID: PMC5021735 DOI: 10.1007/s10554-016-0947-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 07/19/2016] [Indexed: 11/28/2022]
Abstract
Paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) is challenging to quantitate. Transthoracic echocardiography (TTE) is the main tool used for the assessment of PVL but is modestly reproducible. We sought to develop a reproducible echocardiographic approach to assess PVL in the post-TAVI setting. Four observers independently analyzed eleven parameters of PVL severity in 50 pre-discharge TTE studies performed after TAVI. The parameters included color-Doppler parameters [jet circumferential extent (CE) and planimetered vena contracta area in the short-axis view and jet breadth and qualitative features in the long-axis views], continuous-wave Doppler parameters [jet velocity time integral (VTI) and pressure half time (PHT)], quantitative Doppler parameters (regurgitation volume and fraction and effective regurgitant orifice area), aortic diastolic flow reversal and valve stent eccentricity. Intraclass correlation coefficient (ICC) and coefficient of variation (CV) for numerical parameters and kappa coefficient (κ) for categorical parameters were calculated for inter- and intra-observer comparisons. Inter-observer ICC was highest and CV lowest for CE (0.88 and 0.36), jet origin breadth (0.82 and 0.39), jet qualitative features in long-axis views (0.87 and 0.26), jet VTI (0.87 and 0.04) and PHT (0.73 and 0.10). Similar results were found in intra-observer comparisons. A 2-step granular approach combining the most reproducible parameters was used to grade PVL by the four observers. Inter-observer agreement was achieved in 86 % of cases (κ = 0.79). Combining color Doppler and continuous wave Doppler parameters in a granular algorithm yields excellent reproducibility of PVL assessment by TTE.
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Affiliation(s)
- Mohammad Abdelghani
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ben Ren
- Cardialysis Clinical Trials Management and Core Laboratories, Westblaak 98, Rotterdam, 3012KM, The Netherlands.,Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Ernest Spitzer
- Cardialysis Clinical Trials Management and Core Laboratories, Westblaak 98, Rotterdam, 3012KM, The Netherlands
| | - Hiroki Tateishi
- Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Hans Jonker
- Cardialysis Clinical Trials Management and Core Laboratories, Westblaak 98, Rotterdam, 3012KM, The Netherlands
| | - Marcel L Geleijnse
- Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Jan G Tijssen
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick W J C Serruys
- The International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Osama I I Soliman
- Cardialysis Clinical Trials Management and Core Laboratories, Westblaak 98, Rotterdam, 3012KM, The Netherlands. .,Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands.
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30
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Abdelghani M, Tateishi H, Spitzer E, Tijssen JG, de Winter RJ, Soliman OII, Hahn RT, Serruys PW. Echocardiographic and angiographic assessment of paravalvular regurgitation after TAVI: optimizing inter-technique reproducibility. Eur Heart J Cardiovasc Imaging 2016; 17:852-60. [DOI: 10.1093/ehjci/jew083] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/30/2016] [Indexed: 02/05/2023] Open
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31
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Kampaktsis PN, Bang CN, Chiu Wong S, Skubas NJ, Singh H, Voudris K, Baduashvili A, Pastella K, Swaminathan RV, Kaple RK, Minutello RM, Feldman DN, Kim L, Hriljac I, Lin F, Bergman GS, Salemi A, Devereux RB. Prognostic Importance of Diastolic Dysfunction in Relation to Post Procedural Aortic Insufficiency in Patients Undergoing Transcatheter Aortic Valve Replacement. Catheter Cardiovasc Interv 2016; 89:445-451. [PMID: 27218599 DOI: 10.1002/ccd.26582] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 04/21/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We sought to examine whether baseline diastolic dysfunction (DD) is associated with increased mortality in patients who develop aortic insufficiency (AI) after transcatheter aortic valve replacement (TAVR). BACKGROUND Significant post-TAVR AI is associated with increased mortality, likely secondary to adverse hemodynamics secondary to volume overload and decreased LV compliance from chronic pressure overload. However, the effect of baseline DD on outcomes of patients with post-TAVR AI has not been studied. METHODS A total of 195 patients undergoing TAVR were included in the study. Patients with moderate-to-severe mitral stenosis, prior mitral valve replacement or atrial fibrillation were excluded. DD was classified at baseline by a 2-step approach as recommended by the American Society of Echocardiography while AI was evaluated 30 days post-TAVR. Follow up data up to 2 years post-TAVR was used in survival analysis. RESULTS Patients with severe baseline DD who developed ≥mild post-TAVR AI had increased mortality compared to all other patients (HR = 3.89, CI: 1.76-8.6, P = 0.001), which remained significant after adjusting for post-TAVR AI, pre-TAVR AI, baseline mitral regurgitation, ejection fraction, pulmonary artery pressure, creatinine clearance and history of stroke. CONCLUSIONS Even mild post-TAVR AI may have a negative impact on outcomes of patients with underlying severe DD. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Polydoros N Kampaktsis
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Department of Internal Medicine, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York
| | - Casper N Bang
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Department of Cardiology, Copenhagen University Hospital Roskilde, Roskilde, Denmark
| | - S Chiu Wong
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Nikolaos J Skubas
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Anesthesiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Harsimran Singh
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Konstantinos Voudris
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York
| | - Amiran Baduashvili
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Department of Internal Medicine, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York
| | - Kalliopi Pastella
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York
| | - Rajesh V Swaminathan
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Ryan K Kaple
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Robert M Minutello
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Dmitriy N Feldman
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Luke Kim
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Ingrid Hriljac
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Fay Lin
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Geoffrey S Bergman
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Arash Salemi
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiothoracic Surgery, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Richard B Devereux
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
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32
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Höllriegel R, Woitek F, Stativa R, Mangner N, Haußig S, Fuernau G, Holzhey D, Mohr FW, Schuler GC, Linke A. Hemodynamic Assessment of Aortic Regurgitation After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2016; 9:1061-8. [DOI: 10.1016/j.jcin.2016.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/18/2015] [Accepted: 02/11/2016] [Indexed: 10/21/2022]
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33
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Okafor I, Raghav V, Midha P, Kumar G, Yoganathan A. The hemodynamic effects of acute aortic regurgitation into a stiffened left ventricle resulting from chronic aortic stenosis. Am J Physiol Heart Circ Physiol 2016; 310:H1801-7. [PMID: 27106040 DOI: 10.1152/ajpheart.00161.2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/18/2016] [Indexed: 11/22/2022]
Abstract
Acute aortic regurgitation (AR) post-chronic aortic stenosis is a prevalent phenomenon occurring in patients who undergo transcatheter aortic valve replacement (TAVR) surgery. The objective of this work was to characterize the effects of left ventricular diastolic stiffness (LVDS) and AR severity on LV performance. Three LVDS models were inserted into a physiological left heart simulator. AR severity was parametrically varied through four levels (ranging from trace to moderate) and compared with a competent aortic valve. Hemodynamic metrics such as average diastolic pressures (DP) and reduction in transmitral flow were measured. AR index was calculated as a function of AR severity and LVDS, and the work required to make up for lost volume due to AR was estimated. In the presence of trace AR, higher LVDS had up to a threefold reduction in transmitral flow (13% compared with 3.5%) and a significant increase in DP (2-fold). The AR index ranged from ∼42 to 16 (no AR to moderate AR), with stiffer LVs having lower values. To compensate for lost volume due to AR, the low, medium, and high LVDS models were found to require 5.1, 5.5, and 6.6 times more work, respectively. This work shows that the LVDS has a significant effect on the LV performance in the presence of AR. Therefore, the LVDS of potential TAVR patients should be assessed to gain an initial indication of their ability to tolerate post-procedural AR.
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Affiliation(s)
- Ikechukwu Okafor
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Vrishank Raghav
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Prem Midha
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Gautam Kumar
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia; and Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Ajit Yoganathan
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Georgia; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia;
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34
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Abdelghani M, Soliman OI, Schultz C, Vahanian A, Serruys PW. Adjudicating paravalvular leaks of transcatheter aortic valves: a critical appraisal. Eur Heart J 2016; 37:2627-44. [DOI: 10.1093/eurheartj/ehw115] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 03/01/2016] [Indexed: 12/18/2022] Open
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35
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Abdelghani M, Serruys PW. Transcatheter Aortic Valve Implantation in Lower-Risk Patients With Aortic Stenosis. Circ Cardiovasc Interv 2016; 9:e002944. [DOI: 10.1161/circinterventions.115.002944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/04/2016] [Indexed: 01/01/2023]
Abstract
Transcatheter aortic valve implantation underwent progressive improvements until it became the default therapy for inoperable patients, and a recommended therapy in high-risk operable patients with symptomatic severe aortic stenosis. In the lower-risk patient strata, a currently costly therapy that still has important complications with questionable durability is competing with the established effective and still-improving surgical replacement. This report tries to weigh the clinical evidence, the recent technical improvements, the durability, and the cost-effectiveness claims supporting the adoption of transcatheter aortic valve implantation in intermediate-low risk patients. The importance of appropriate patients’ risk stratification and a more comprehensive approach to estimate that risk are also emphasized in the present report.
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Affiliation(s)
- Mohammad Abdelghani
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (M.A.); and International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Patrick W. Serruys
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (M.A.); and International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
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Naber CK, Pyxaras SA, Ince H, Latib A, Frambach P, den Heijer P, Wagner D, Butter C, Colombo A, Kische S. Real-world multicentre experience with the Direct Flow Medical® repositionable and retrievable transcatheter aortic valve implantation system for the treatment of high-risk patients with severe aortic stenosis. EUROINTERVENTION 2016; 11:e1314-20. [DOI: 10.4244/eijv11i11a254] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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37
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Stundl A, Rademacher MC, Descoups C, Weber M, Sedaghat A, Grube M, Hammerstingl C, Mellert F, Vasa-Nicotera M, Welz A, Grube E, Werner N, Nickenig G, Sinning JM. Balloon post-dilation and valve-in-valve implantation for the reduction of paravalvular leakage with use of the self-expanding CoreValve prosthesis. EUROINTERVENTION 2016; 11:1140-7. [DOI: 10.4244/eijy15m11_04] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rigamonti F, Montecucco F. Potential useful prognostic parameters after transcatheter aortic valve implantation: editorial. Eur J Clin Invest 2016; 46:101-3. [PMID: 26584146 DOI: 10.1111/eci.12569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/12/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Fabio Rigamonti
- Division of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
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Dall'Ara G, Saia F, Moretti C, Marrozzini C, Taglieri N, Bordoni B, Chiarabelli M, Ciuca C, Rapezzi C, Marzocchi A. Incidence, treatment, and outcome of acute aortic valve regurgitation complicating percutaneous balloon aortic valvuloplasty. Catheter Cardiovasc Interv 2015; 89:E145-E152. [DOI: 10.1002/ccd.26378] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/03/2015] [Accepted: 11/27/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Gianni Dall'Ara
- Policlinico S. Orsola-Malpighi; Cardiology Unit, University of Bologna; Bologna Italy
- Dottorato Di Ricerca XXX° Ciclo, Scienze Cardio-Nefro-Toraciche; University of Bologna; Bologna Italy
| | - Francesco Saia
- Policlinico S. Orsola-Malpighi; Cardiology Unit, University of Bologna; Bologna Italy
| | - Carolina Moretti
- Policlinico S. Orsola-Malpighi; Cardiology Unit, University of Bologna; Bologna Italy
| | - Cinzia Marrozzini
- Policlinico S. Orsola-Malpighi; Cardiology Unit, University of Bologna; Bologna Italy
| | - Nevio Taglieri
- Policlinico S. Orsola-Malpighi; Cardiology Unit, University of Bologna; Bologna Italy
| | - Barbara Bordoni
- Policlinico S. Orsola-Malpighi; Cardiology Unit, University of Bologna; Bologna Italy
| | - Matteo Chiarabelli
- Policlinico S. Orsola-Malpighi; Cardiology Unit, University of Bologna; Bologna Italy
| | - Cristina Ciuca
- Policlinico S. Orsola-Malpighi; Cardiology Unit, University of Bologna; Bologna Italy
| | - Claudio Rapezzi
- Policlinico S. Orsola-Malpighi; Cardiology Unit, University of Bologna; Bologna Italy
| | - Antonio Marzocchi
- Policlinico S. Orsola-Malpighi; Cardiology Unit, University of Bologna; Bologna Italy
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Halkin A, Steinvil A, Aviram G, Biner S, Banai S, Keren G, Finkelstein A, Topilsky Y. Aortic regurgitation following transcatheter aortic valve replacement: Impact of preprocedural left ventricular diastolic filling patterns on late clinical outcomes. Catheter Cardiovasc Interv 2015; 87:1156-63. [DOI: 10.1002/ccd.26298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/15/2015] [Accepted: 10/02/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Amir Halkin
- Department of Cardiology, Tel Aviv Medical Center and the Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Arie Steinvil
- Department of Cardiology, Tel Aviv Medical Center and the Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Galit Aviram
- Department of Radiology, Tel Aviv Medical Center and the Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Simon Biner
- Department of Cardiology, Tel Aviv Medical Center and the Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Medical Center and the Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Gad Keren
- Department of Cardiology, Tel Aviv Medical Center and the Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Ariel Finkelstein
- Department of Cardiology, Tel Aviv Medical Center and the Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Medical Center and the Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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41
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Di Martino LFM, Vletter WB, Ren B, Schultz C, Van Mieghem NM, Soliman OII, Di Biase M, de Jaegere PP, Geleijnse ML. Prediction of paravalvular leakage after transcatheter aortic valve implantation. Int J Cardiovasc Imaging 2015; 31:1461-8. [PMID: 26187523 PMCID: PMC4572040 DOI: 10.1007/s10554-015-0703-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/06/2015] [Indexed: 01/10/2023]
Abstract
Significant paravalvular leakage (PVL) after transcatheter aortic valve implantation (TAVI) is related to patient mortality. Predicting the development of PVL has focused on computed tomography (CT) derived variables but literature targeting CoreValve devices is limited, controversial, and did not make use of standardized echocardiographic methods. The study included 164 consecutive patients with severe aortic stenosis that underwent TAVI with a Medtronic CoreValve system©, with available pre-TAVI CT and pre-discharge transthoracic echocardiography. The predictive value for significant PVL of the CT-derived Agatston score, aortic annulus size and eccentricity, and “cover index” was assessed, according to both echocardiographic Valve Academic Research Consortium (VARC) criteria and angiographic Sellers criteria. Univariate predictors for more than mild PVL were the maximal diameter of the aortic annulus size (for both angiographic and echocardiographic assessment of PVL), cover index (for echocardiographic assessment of PVL only), and Agatston score (for both angiographic and echocardiographic assessment of PVL). The aortic annulus eccentricity index was not predicting PVL. At multivariate analysis, Agatston score was the only independent predictor for both angiographic and echocardiographic assessment of PVL. Agatston score is the only independent predictor of PVL regardless of the used imaging technique for the definition of PVL.
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Affiliation(s)
- Luigi F M Di Martino
- From the Department of Cardiology, Ospedali Riuniti, Università degli studi di Foggia, Foggia, Italy
| | - Wim B Vletter
- From the Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Ben Ren
- From the Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Carl Schultz
- From the Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- From the Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Osama I I Soliman
- From the Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. .,From the Cardialysis Cardiovascular Core Laboratory, Rotterdam, The Netherlands.
| | - Matteo Di Biase
- From the Department of Cardiology, Ospedali Riuniti, Università degli studi di Foggia, Foggia, Italy
| | - Peter P de Jaegere
- From the Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Marcel L Geleijnse
- From the Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
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Miyazaki S, Agricola E, Panoulas VF, Slavich M, Giustino G, Miyazaki T, Figini F, Latib A, Chieffo A, Montorfano M, Margonato A, Maisano F, Alfieri O, Colombo A. Influence of baseline ejection fraction on the prognostic value of paravalvular leak after transcatheter aortic valve implantation. Int J Cardiol 2015; 190:277-81. [DOI: 10.1016/j.ijcard.2015.04.190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/23/2015] [Indexed: 01/10/2023]
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Sundh F, Simlund J, Harrison JK, Hughes GC, Vavalle J, Maynard C, Strauss DG, Wagner GS, Ugander M. Incidence of strict versus nonstrict left bundle branch block after transcatheter aortic valve replacement. Am Heart J 2015; 169:438-44. [PMID: 25728735 DOI: 10.1016/j.ahj.2014.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Up to one-third of patients diagnosed with left bundle branch block (LBBB) by conventional electrocardiographic (ECG) criteria are misdiagnosed. Strict LBBB shows decreased left ventricular pumping efficiency compared with nonstrict LBBB. However, no previous study has evaluated the frequency of strict LBBB after transcatheter aortic valve replacement (TAVR). The aim of this study was to determine the incidence of developing strict versus nonstrict LBBB after TAVR and test the hypothesis that preprocedure QRS duration does not predict strict LBBB but predicts development of nonstrict LBBB. METHODS All patients receiving TAVR between 4/2011 and 2/2013 (n = 71) with no preexisting bundle branch block or permanent pacemaker were included. Twelve-lead ECGs were acquired preprocedure and both 1-day and 1-month postprocedure. All ECGs were classified as strict LBBB, nonstrict LBBB, or no LBBB. RESULTS Sixty-eight patients had ECGs eligible for final analysis. On postprocedure day 1, 25 (37%) of 68 patients developed strict LBBB, and 2 patients (3%) developed nonstrict LBBB. At 1-month follow-up, the 2 patients diagnosed with nonstrict LBBB had resolved to normal, and 5 (20%) of 25 patients with strict LBBB had resolved to normal. Preprocedure QRS duration did not predict strict LBBB (P = .51). Because of the low incidence of nonstrict LBBB, QRS duration as a predictor of nonstrict LBBB could not be tested. CONCLUSIONS Almost all patients who developed evidence of LBBB after TAVR met the new strict criteria, indicating probable procedural injury to the left bundle branch. Preprocedural QRS duration did not predict the development of strict LBBB.
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Caballero L, Saura D, García-Lara J, Oliva MJ, Pinar E, González-Carrillo J, García-Navarro M, Espinosa MD, Valdés M, de la Morena G. Influence of aortic regurgitation after TAVI on left ventricular filling pattern. Eur J Clin Invest 2015; 45:18-26. [PMID: 25402558 DOI: 10.1111/eci.12374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 11/10/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Paravalvular aortic regurgitation after transcatheter aortic valve implantation is associated with a hemodynamic deterioration and a poor outcome. We aim to determine the early hemodynamic effect of paravalvular aortic regurgitation in relation with the change in the left ventricle filling pattern and to assess their clinical outcome. MATERIAL AND METHODS Eighty-two consecutive patients referred for transcatheter aortic valve implantation were included. Patients were classified according to the change in the left ventricular filling pattern, and significant paravalvular aortic regurgitation (grade ≥ 2) was reported. Follow-up and incidence of death and hospitalization for heart failure were reported. RESULTS Sixteen patients (19·5%) presented a worsening of left ventricular filling pattern. The incidence of significant paravalvular aortic regurgitation was higher in the group with a worsening of left ventricular filling pattern (56·3% vs. 19·7%; P = 0·009). In the multivariate analysis, the only variable significantly associated with the worsening of left ventricular filling pattern was the significant paravalvular aortic regurgitation (OR 4·84; 95% CI 1·23 - 19·1; P = 0·024). During the follow-up (642·5 days), there was a higher incidence of the endpoint of death or hospitalization for heart failure in the group with a worsening of left ventricular filling pattern (62·5% vs. 31·8%; P = 0·042) and a lower event-free survival rate (long rank test = 0·013). CONCLUSIONS The presence of a significant paravalvular aortic regurgitation is associated with a worsening in parameters of diastolic function. This finding should alert the cardiologist as patients with a worsening of left ventricular filling pattern present a higher incidence of paravalvular aortic regurgitation and a less favourable outcome.
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Affiliation(s)
- Luis Caballero
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
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45
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Sutureless Aortic Valve Replacement: A Canadian Multicentre Study. Can J Cardiol 2015; 31:63-8. [DOI: 10.1016/j.cjca.2014.10.030] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 11/19/2022] Open
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Transcatheter aortic valve replacement for severe symptomatic aortic stenosis using a repositionable valve system: 30-day primary endpoint results from the REPRISE II study. J Am Coll Cardiol 2014; 64:1339-48. [PMID: 25257635 DOI: 10.1016/j.jacc.2014.05.067] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/07/2014] [Accepted: 05/13/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement provides results comparable to those of surgery in patients at high surgical risk, but complications can impact long-term outcomes. The Lotus valve, designed to improve upon earlier devices, is fully repositionable and retrievable, with a unique seal to minimize paravalvular regurgitation (PVR). OBJECTIVES The prospective, single-arm, multicenter REPRISE II study (REpositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of Lotus Valve System: Evaluation of Safety and Performance) evaluated the transcatheter valve system for treatment of severe symptomatic calcific aortic valve stenosis. METHODS Patients (n = 120; aortic annulus 19 to 27 mm) considered by a multidisciplinary heart team to be at high surgical risk received the valve transfemorally. The primary device performance endpoint, 30-day mean pressure gradient, was assessed by an independent echocardiographic core laboratory and compared with a pre-specified performance goal. The primary safety endpoint was 30-day mortality. Secondary endpoints included safety/effectiveness metrics per Valve Academic Research Consortium criteria. RESULTS Mean age was 84.4 years, 57% of the patients were female, and 76% were New York Heart Association functional class III/IV. Mean aortic valve area was 0.7 ± 0.2 cm(2). The valve was successfully implanted in all patients, with no cases of valve embolization, ectopic valve deployment, or additional valve implantation. All repositioning (n = 26) and retrieval (n = 6) attempts were successful; 34 patients (28.6%) received a permanent pacemaker. The primary device performance endpoint was met, because the mean gradient improved from 46.4 ± 15.0 mm Hg to 11.5 ± 5.2 mm Hg. At 30 days, the mortality rate was 4.2%, and the rate of disabling stroke was 1.7%; 1 (1.0%) patient had moderate PVR, whereas none had severe PVR. CONCLUSIONS REPRISE II demonstrates the safety and effectiveness of the Lotus valve in patients with severe aortic stenosis who are at high surgical risk. The valve could be positioned successfully with minimal PVR. (REPRISE II: REpositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of Lotus™ Valve System - Evaluation of Safety and Performance; NCT01627691).
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Recovery of Left Ventricular Mechanics after Transcatheter Aortic Valve Implantation: Effects of Baseline Ventricular Function and Postprocedural Aortic Regurgitation. J Am Soc Echocardiogr 2014; 27:1133-42. [DOI: 10.1016/j.echo.2014.07.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Indexed: 11/15/2022]
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Kodama H, Shi C, Kojima M, Ikeda S, Arai F, Takahashi I, Negoro M, Fukuda T. Catheter manipulation training system based on quantitative measurement of catheter insertion and rotation. Adv Robot 2014. [DOI: 10.1080/01691864.2014.941005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gotzmann M, Czauderna A, Hehnen T, Aweimer A, Lind A, Kloppe A, Bösche L, Mügge A, Ewers A. Three-year outcomes after transcatheter aortic valve implantation with the CoreValve prosthesis. Am J Cardiol 2014; 114:606-11. [PMID: 24998088 DOI: 10.1016/j.amjcard.2014.05.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 05/13/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
Abstract
There is little known about the long-term results of the CoreValve prosthesis. The aim of this study was to assess the 3-year clinical and hemodynamic outcomes of the CoreValve prosthesis. One hundred fifty consecutive patients with severe aortic stenosis successfully underwent transcatheter aortic valve implantation (TAVI) with the CoreValve prosthesis. The primary study end point was death from any cause after TAVI. The secondary end points were defined as (1) cardiovascular death and (2) prosthesis-related mortality and morbidity. At 1 to 3 years, all-cause mortality rates were 25%, 32%, and 41%, respectively, and cardiovascular mortality rates were 14%, 21%, and 27%, respectively. Before TAVI, 95% of patients were in New York Heart Association class III or IV. Of the surviving patients, rates of New York Heart Association class III or IV at 1 to 3 years were 33%, 39%, and 38%, respectively. There was an annual decrease of the valve area of approximately 0.1 cm². Aortic restenosis occurred in 2 patients. Moderate or severe aortic regurgitation (AR) occurred in 15% of patients immediately after TAVI. Twenty patients (13%) had a slight worsening of AR within 3 years. New severe AR did not occur. The incidence of prosthesis-related endocarditis was 0.66% per year. Overall, 7 patients (incidence of 1.5% per year) had a clinically relevant problem of the prosthesis. In conclusion, TAVI with the CoreValve prosthesis had favorable effects on symptoms and outcomes even after 3 years. These results are clouded by side effects, such as AR and prosthesis-related mortality and morbidity.
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Citro R, Attisano T, Vigorito F, Cavallo AU, Vitale G, Coccia M, Santoro G, Giudice P. Combined percutaneous closure of paravalvular leaks and intraprosthetic regurgitation after transcatheter aortic valve implantation. Int J Cardiol 2014; 175:e48-51. [DOI: 10.1016/j.ijcard.2014.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 05/12/2014] [Indexed: 11/28/2022]
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