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Matta A, Regueiro A, Urena M, Nombela-Franco L, Riche M, Rodriguez-Gabella T, Amat-Santos I, Chamandi C, Akiki T, Gabani R, Vera-Urquiza R, Lhermusier T, Bouisset F, Carrié D, Campelo-Parada F. Comparison of Paravalvular Leak in SAPIEN 3 and EVOLUT PRO Valves in Transcatheter Aortic Valve Replacement: A Multicenter Registry. Am J Cardiol 2023; 207:114-120. [PMID: 37734300 DOI: 10.1016/j.amjcard.2023.08.098] [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: 06/13/2023] [Revised: 08/09/2023] [Accepted: 08/17/2023] [Indexed: 09/23/2023]
Abstract
Paravalvular leak (PVL), conduction disturbances, and vascular complications remain the most common complications after TAVR. To address these adverse outcomes, the third generation of transcatheter heart valves has been developed. The last generation prosthesis provides an outer pericardial wrap for enhanced sealing and PVL prevention. This study aimed to compare the incidence and severity of PVL and 1-year survival after TAVR using SAPIEN 3 with those using EVOLUT PRO. An observational retrospective analysis was conducted in 1,481 patients who underwent TAVR for symptomatic severe aortic stenosis in 6 different European centers. The primary end point was to assess the frequency and severity of PVL at 30 days after TAVR. The secondary end point was to compare 1-year survival using EVOLUT PRO with that using SAPIEN 3. SAPIEN 3 transcatheter heart valve was implanted in 78.3% of study participants (n = 1,160) whereas EVOLUT PRO was implanted in 21.7% (n = 321). PVL is more commonly observed in patients treated with EVOLUT PRO at prehospital discharge (55.1% vs 37.3%) and at 1-month (51% vs 41.4%) and 1-year (51.3% vs 39.3%) follow-up. This difference mainly concerns low-grade (mild/trace) PVL. The frequency of high-degree (moderate/severe) PVL was almost similar in both groups throughout the study period (5.3% vs 5.8% before hospital discharge, 4% vs 3.1% at 1 month, and 3.2% vs 4.9% at 1 year). No significant difference in survival over 1 year has been observed (hazard ratio 0.73 [0.33 to 1.63], p = 0.442) (Graphical abstract). In conclusion, the detection rate of PVL after TAVR with third-generation heart valves remains high, and there are no major differences between the devices regarding the frequency of significant (moderate/severe) PVL and survival.
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Affiliation(s)
- Anthony Matta
- Department of Cardiology, Hôpital Rangueil, CHU-Toulouse, Toulouse, France; Department of Cardiology, Civilian Hospitals of Colmar, Colmar, France
| | - Ander Regueiro
- Department of Cardiology, Hospital Clinic de Barcelona, Spain
| | - Marina Urena
- Department of Cardiology, Hôpital Bichat, AP-HP, Paris, France
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Maya Riche
- Department of Cardiology, Hôpital Rangueil, CHU-Toulouse, Toulouse, France
| | | | - Ignacio Amat-Santos
- Department of Cardiology, Hospital Clínico Universitario de Valladolid, Spain
| | - Chekrallah Chamandi
- Department of Cardiology, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Tanios Akiki
- Department of Cardiology, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Rami Gabani
- Department of Cardiology, Hospital Clinic de Barcelona, Spain
| | - Rafael Vera-Urquiza
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Thibault Lhermusier
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Frédéric Bouisset
- Department of Cardiology, Hôpital Rangueil, CHU-Toulouse, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Hôpital Rangueil, CHU-Toulouse, Toulouse, France
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Kisacik H, Tok D, Balci KG, Demirkan B, Karakurt M, Açar B, Karabulut Ö, Erbay I, Balci MM. Evaluation of Acquired Thrombocytopenia According to the Balloon-Expandable Versus Self-Expandable Valves in Patients Undergoing Transcatheter Aortic Valve Replacement. Angiology 2020; 72:290-294. [PMID: 32873055 DOI: 10.1177/0003319720953048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In patients with severe aortic stenosis, the data about the incidence of acquired thrombocytopenia according to the use of balloon-expandable or self-expandable valves are limited. We investigated the relationship between the post-transcatheter aortic valve replacement (TAVR) thrombocytopenia and the balloon-expandable or self-expandable valves. A total of 127 consecutive patients who underwent TAVR were retrospectively analyzed. Among the study population, 61 (48%) patients underwent TAVR with the balloon-expandable valve and the 66 (52%) patients with the self-expandable valve. Procedural success did not differ between the groups (P = .575). The access site complications and in-hospital mortality were the same across the groups (P = .225 and P = .466). However, paravalvular (PV) leaks were significantly higher in the self-expandable valve group (P = .007). Among all, 65 patients experienced thrombocytopenia, which was more frequent in the self-expandable valve group (63.6 vs 37.7%, P = .005). In multivariate analyses, admission platelet count, PV leak, and self-expandable valve deployment were the predictors of thrombocytopenia (P = .001, P = .002, and P = .021, respectively). The present study showed a higher incidence of acquired thrombocytopenia in the self-expandable valve group. Although the procedural success was similar between the groups, postprocedural PV leaks were more common in the self-expandable valve group.
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Affiliation(s)
| | - Derya Tok
- 536164Ankara City Hospital, Ankara, Turkey
| | | | | | | | - Burak Açar
- 52980Kocaeli University Medical Faculty, Kocaeli, Turkey
| | | | - Ilke Erbay
- 536164Ankara City Hospital, Ankara, Turkey
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Giannini C, Petronio AS, Mehilli J, Sartori S, Chandrasekhar J, Faggioni M, Lefèvre T, Presbitero P, Capranzano P, Tchetche D, Iadanza A, Sardella G, Van Mieghem NM, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail GW, Ferrer MC, Naber C, Kievit P, Sorrentino S, Morice MC, Chieffo A, Mehran R. Edwards SAPIEN Versus Medtronic Aortic Bioprosthesis in Women Undergoing Transcatheter Aortic Valve Implantation (from the Win-TAVI Registry). Am J Cardiol 2020; 125:441-448. [PMID: 31813530 DOI: 10.1016/j.amjcard.2019.10.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/28/2019] [Indexed: 11/27/2022]
Abstract
We sought to analyze outcomes of women receiving balloon-expandable valves (BEV) or self-expanding valves (SEV) in contemporary transcatheter aortic valve implantation (TAVI). WIN TAVI (Women's INternational Transcatheter Aortic Valve Implantation) is the first all-female TAVI registry to study the safety and performance of TAVI in women. We compared women treated with BEV (n = 408, 46.9%) versus those treated with SEV (n = 461, 53.1%). The primary efficacy end point was the Valve Academic Research Consortium-2 (VARC-2) composite of 1-year all-cause death, stroke, myocardial infarction, hospitalization for valve-related symptoms or heart failure or valve-related dysfunction. Women receiving SEV had higher surgical risk scores, higher rate of previous stroke and pulmonary hypertension whereas women receiving BEV were more frequently denied surgical valve replacement due to frailty. BEV patients were less likely to require post-dilation and had significantly lower rates of residual aortic regurgitation grade ≥2 (9.8% vs 4.7%, p = 0.007). At 1 year, the crude incidence and adjusted risk of the primary VARC-2 efficacy end point was similar between groups (17.1% with SEV and 14.3% with BEV, p = 0.25; hazards ratio 1.09, 95% confidence interval 0.68 to 1.75). Conversely the crude rate and adjusted risk of new pacemaker implantation was higher with SEV than BEV (15% vs 8.6%, p = 0.001; hazards ratio 1.97, 95% confidence interval 1.13 to 3.43). A subanalysis on new generation valves showed no difference in the need for pacemaker implantation between the 2 devices (10.1% vs 8.0%, p = 0.56). In conclusion, in contemporary TAVI, SEV are used more frequently in women with greater co-morbidities. While there were no differences in unadjusted and adjusted risk of 1-year primary efficacy end point between the valve types, there was a greater need for permanent pacemakers after SEV implantation.
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He C, Xiao L, Liu J. Safety and efficacy of self-expandable Evolut R vs. balloon-expandable Sapien 3 valves for transcatheter aortic valve implantation: A systematic review and meta-analysis. Exp Ther Med 2019; 18:3893-3904. [PMID: 31602250 PMCID: PMC6777306 DOI: 10.3892/etm.2019.8000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/09/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to systematically search literature and conduct a meta-analysis comparing the clinical efficacy and safety of Evolut R and Sapien 3 valves for transcatheter aortic valve implantation (TAVI). The PubMed, Biomed Central, Scopus, Cochrane library and Google scholar databases were searched for articles published up to June, 2019. A total of 5 studies were included. In total, 795 patients underwent TAVI with Evolut R, while 665 patients received the Sapien 3 valve in the included studies. Overall device success with Evolut R was 95.7% and with Sapien 3 was 94.2%. Pooled data indicated no significant differences between the 2 valves (OR, 1.12; 95% CI, 0.66–1.89; P=0.68; I2=0%). No significant differences were observed in the incidence of none to mild paravalvular leakage between the 2 groups (OR, 1.71; 95% CI, 0.83–3.54; P=0.14; I2=0%). Both mean [random; mean difference (MD) = −3.96; 95% CI, −4.61 to −3.31; P<0.00001, I2=0%] and peak (random; MD = −6.85; 95% CI, −8.22 to −5.48; P<0.00001, I2=0%) aortic valve gradients were significantly lower with Evolut R. No significant differences were observed in the 30-day mortality (OR, 1.32; 95% CI, 0.45–3.87; P=0.62; I2=0%) or 30-day stroke outcomes (OR, 0.76; 95% CI, 0.32–1.81; P=0.54; I2=0%) between the 2 devices. On the whole, the findings of this study indicate that Evolut R and Sapien 3 valves may be comparable in terms of device success and short-term complications. The differences between the 2 devices for post-operative moderate to severe paravalvular leak and permanent pacemaker implantation remain unclear. There is thus a need for a large multi-center randomized controlled trial to provide stronger evidence on this subject.
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Affiliation(s)
- Chenglin He
- Department of Cardiovascular Medicine, Hanchuan People's Hospital, Hanchuan, Hubei 431600, P.R. China
| | - Lang Xiao
- Department of Haematology, Hanchuan Hospital of Traditional Chinese Medicine, Hanchuan, Hubei 431600, P.R. China
| | - Junli Liu
- Department of Critical Care Medicine, Hanchuan People's Hospital, Hanchuan, Hubei 431600, P.R. China
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5
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Alfadhli J, Jeraq M, Singh V, Martinez C. Updates on transcatheter aortic valve replacement: Techniques, complications, outcome, and prognosis. J Saudi Heart Assoc 2018; 30:340-348. [PMID: 30108426 PMCID: PMC6090012 DOI: 10.1016/j.jsha.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/10/2018] [Accepted: 07/21/2018] [Indexed: 11/25/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) initially emerged as a therapeutic option for high-risk patients with severe aortic stenosis. Advancement in technologies since the first era of TAVRs, experience from previous obstacles, and lessons learned from complications have allowed the evolution of this procedure to the current state. This review focuses on the updates on the most current devices, complications, and outcomes of TAVR.
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Affiliation(s)
- Jarrah Alfadhli
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USAUSA
- Corresponding author at: Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Mohammed Jeraq
- Department of General Surgery, University of Miami Miller School of Medicine, Miami, FL, USAUSA
| | - Vikas Singh
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USAUSA
| | - Claudia Martinez
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USAUSA
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Gilbert ON, Choi CH, Franzil JL, Caughey M, Qureshi W, Stacey RB, Pu M, Applegate RJ, Gandhi SK, Zhao DXM. Comparison of paravalvular aortic leak characteristics in the Medtronic CoreValve versus Edwards Sapien Valve: Paravalvular aortic leak characteristics. Catheter Cardiovasc Interv 2018; 92:972-980. [DOI: 10.1002/ccd.27643] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/02/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Olivia N. Gilbert
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem North Carolina
| | - Charles H. Choi
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem North Carolina
| | - Jodie L. Franzil
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem North Carolina
| | - Melissa Caughey
- Division of Cardiology, Department of Medicine; University of North Carolina Medical Center; Chapel Hill North Carolina
| | - Waqas Qureshi
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem North Carolina
| | - R. Brandon Stacey
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem North Carolina
| | - Min Pu
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem North Carolina
| | - Robert J. Applegate
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem North Carolina
| | - Sanjay K. Gandhi
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem North Carolina
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D'Ascenzo F, Benedetto U, Bianco M, Conrotto F, Moretti C, D'Onofrio A, Agrifoglio M, Colombo A, Ribichini F, Tarantini G, D'Amico M, Salizzoni S, Rinaldi M. Which is the best antiaggregant or anticoagulant therapy after TAVI? A propensity-matched analysis from the ITER registry. The management of DAPT after TAVI. EUROINTERVENTION 2017; 13:e1392-e1400. [PMID: 28870875 DOI: 10.4244/eij-d-17-00198] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The safety and efficacy of single vs. dual antiplatelet therapy (DAPT) in patients undergoing TAVI remain to be addressed. The aim of our study was to evaluate the usefulness of a DAPT compared to a single platelet therapy in patients undergoing TAVI with a balloon-expandable prosthesis. METHODS AND RESULTS All consecutive patients enrolled in the ITER registry were included. Patients undergoing TAVI discharged with aspirin alone were compared to those taking DAPT before and after selection using propensity score with matching. Subgroup analysis was performed for those on OAT. Prosthetic heart valve dysfunction at follow-up was the primary endpoint, whereas all-cause death, cardiovascular death, bleedings, vascular complications and cerebrovascular accidents were the secondary ones. From 1,364 patients, after propensity score with matching, 605 were selected for each group (aspirin alone vs. DAPT). At 30 days, rates of VARC mortality were lower in patients with aspirin alone (1.5% vs. 4.1%, p=0.003), mainly driven by a reduction of major vascular complications (5.3% vs. 10.7%, p<0.001) and of major bleedings (6.6% vs. 11.5%, p<0.001), without a difference in prosthetic heart valve dysfunction after 45±14 months (2.8% vs. 3.0%, p=0.50). These results were confirmed on multivariable analysis. CONCLUSIONS After TAVI with a balloon-expandable prosthesis, aspirin alone does not increase the risk of prosthetic valve dysfunction, and reduces the risk of periprocedural complications and of 30-day all-cause death.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy
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Kilic T, Yilmaz I. Transcatheter aortic valve implantation: a revolution in the therapy of elderly and high-risk patients with severe aortic stenosis. J Geriatr Cardiol 2017; 14:204-217. [PMID: 28408919 PMCID: PMC5387215 DOI: 10.11909/j.issn.1671-5411.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/01/2017] [Accepted: 03/12/2017] [Indexed: 12/18/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) represents a real revolution in the field of interventional cardiology for the treatment of elderly or high-risk surgical patients with severe symptomatic aortic valve stenosis. Today, TAVI seems to play a key and a reliable role in the treatment of intermediate and maybe low-risk patients with severe aortic stenosis. TAVI has also evolved from a complex and hazardous procedure into an effective and safe therapy by the development of new generation devices. This article aims to review the background and future of TAVI, clinical trials and registries with old and new generation TAVI devices and to focus on some open issues related to post-procedural outcomes.
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Affiliation(s)
- Teoman Kilic
- Invasive Cardiology Research and Application Unit, Department of Cardiology, Kocaeli University, Kocaeli, Turkey
| | - Irem Yilmaz
- Department of Cardiology, Kocaeli University, Kocaeli, Turkey
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Abstract
PURPOSE OF REVIEW Transcatheter aortic valve replacement (TAVR) has been effective in prohibitive/high-risk patients. Expansion toward intermediate or even low-risk patients has been proposed. A review of recent developments will help understand current trends and issues. RECENT FINDINGS The 5-year results from the PARTNER I trial and 2-year results of the CoreValve US Pivotal Trial, together with national registries, confirmed the long-term efficacy and durability of TAVR. Studies including PARTNER II, ADVANCE, and The German Aortic Valve Registry showed short-to mid-term success in intermediate-risk patients. Comparison of balloon-expandable and self-expanding valves in the CHOICE trial associated specific outcome differences with specific valve types, suggesting a more customized approach in valve selection. Short-term results of newer-generation valves have demonstrated excellent safety and efficacy with improved designs. Studies on TAVR-specific complications, such as conduction block and arrhythmia, paravalvular aortic regurgitation, and stroke, have renewed ideas about their prognosis, treatment, and prevention. Conscious sedation percutaneous TAVR has become more popular, with excellent outcomes and improved cost savings. SUMMARY TAVR has been accepted as an effective treatment even for intermediate-risk patients. This article aims to review the most recent results and essential issues.
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Fraccaro C, Tarantini G, Rosato S, Tellaroli P, D'Errigo P, Tamburino C, Onorati F, Ranucci M, Barbanti M, Grossi C, Santoro G, Santini F, Covello RD, Fusco D, Seccareccia F. Early and Midterm Outcome of Propensity-Matched Intermediate-Risk Patients Aged ≥80 Years With Aortic Stenosis Undergoing Surgical or Transcatheter Aortic Valve Replacement (from the Italian Multicenter OBSERVANT Study). Am J Cardiol 2016; 117:1494-501. [PMID: 26993427 DOI: 10.1016/j.amjcard.2016.02.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
The aim of this study was to analyze procedural and postprocedural outcomes of patients aged ≥80 years treated by transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) as enrolled in the OBservational Study of Effectiveness of SAVR-TAVR procedures for severe Aortic steNosis Treatment (OBSERVANT) Study. TAVI is offered to patients with aortic stenosis judged inoperable or at high surgical risk. Nevertheless, it is common clinical practice to treat elderly (≥80 years) patients by TAVI regardless of surgical risk for traditional SAVR. OBSERVANT is a multicenter, observational, prospective cohort study that enrolled patients with symptomatic severe aortic stenosis who underwent SAVR or TAVI from December 2010 to June 2012 in 93 Italian participating hospitals. Information on demographic characteristics, health status before intervention, therapeutic approach, and intraprocedural and 30-day outcomes was collected. An administrative follow-up was set up to collect data on midterm to long-term outcomes. We reviewed baseline and procedural data of patients aged ≥80 years, looking for different early and late outcome after TAVI or SAVR. Patients treated by TAVI were sicker than SAVR because of higher rate of co-morbidities, advanced illness, frailty, and Logistic EuroSCORE. After propensity matching, early and midterm mortality were comparable between the 2 groups. However, patients treated by TAVI had higher rate of vascular complications (6.0% vs 0.5%; p <0.0001), permanent pacemaker implantation (13.4% vs 3.7%; p <0.0001), and paravalvular leak (8.9% vs 2.4%; p <0.0001). Patients who underwent SAVR had more frequent bleedings needing transfusion (63.2% vs 34.5%; p <0.0001) and acute kidney injury (9.6% vs 3.9%; p = 0.0010). In conclusion, patients aged ≥80 years treated by TAVI or SAVR had similar early and midterm mortality.
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11
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Htun NM, Webb JG. Evaluation of the Edwards SAPIEN 3 Transcatheter Valve For Aortic Stenosis. Expert Rev Med Devices 2016; 13:225-32. [DOI: 10.1586/17434440.2016.1149288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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