1
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Antony I, Mehari Abraha H, Hameed A, Conway C. A European update on transcatheter aortic valve implantation (TAVI) in the COVID era. J Anat 2022; 242:50-63. [PMID: 36152032 PMCID: PMC9773167 DOI: 10.1111/joa.13740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 12/31/2022] Open
Abstract
Minimally invasive approaches for aortic valve replacement are now at the forefront of pathological aortic valve treatment. New trials show comparability of these devices to existing therapies, not only in high-risk surgical cohorts but also in low-risk and intermediate-risk cohorts. This review provides vital clinical and anatomical background to aortic valvular disease treatment guidelines, while also providing an update on transcatheter aortic valve implantation (TAVI) devices in Europe, their interventional trials and associated complications.
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Affiliation(s)
- Ishan Antony
- School of MedicineRCSI University of Medicine and Health SciencesDublinIreland,Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG)RCSI University of Medicine and Health SciencesDublinIreland
| | - Hyab Mehari Abraha
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG)RCSI University of Medicine and Health SciencesDublinIreland,Trinity Centre for Biomedical Engineering (TCBE)Trinity College DublinDublinIreland
| | - Aamir Hameed
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG)RCSI University of Medicine and Health SciencesDublinIreland,Trinity Centre for Biomedical Engineering (TCBE)Trinity College DublinDublinIreland
| | - Claire Conway
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG)RCSI University of Medicine and Health SciencesDublinIreland,Trinity Centre for Biomedical Engineering (TCBE)Trinity College DublinDublinIreland
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2
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Poulis N, Zaytseva P, Gähwiler EKN, Motta SE, Fioretta ES, Cesarovic N, Falk V, Hoerstrup SP, Emmert MY. Tissue engineered heart valves for transcatheter aortic valve implantation: current state, challenges, and future developments. Expert Rev Cardiovasc Ther 2020; 18:681-696. [DOI: 10.1080/14779072.2020.1792777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Nikolaos Poulis
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Polina Zaytseva
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Eric K. N. Gähwiler
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Sarah E. Motta
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | | | - Nikola Cesarovic
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center of Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Simon P. Hoerstrup
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Maximilian Y. Emmert
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
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3
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Prasitlumkum N, Vutthikraivit W, Thangjui S, Leesutipornchai T, Kewcharoen J, Riangwiwat T, Dworkin J. Epidemiology of infective endocarditis in transcatheter aortic valve replacement: systemic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2020; 21:790-801. [DOI: 10.2459/jcm.0000000000001001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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4
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Bourantas CV, Modolo R, Baumbach A, Søndergaard L, Prendergast BD, Ozkor M, Kennon S, Mathur A, Mullen MJ, Serruys PW. The evolution of device technology in transcatheter aortic valve implantation. EUROINTERVENTION 2019; 14:e1826-e1833. [PMID: 30719977 DOI: 10.4244/eij-d-18-01048] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has rapidly evolved and changed the landscape of structural interventional cardiology. Advances in transcatheter heart valve (THV) prostheses and TAVI-enabling devices have simplified the procedure, reduced the risk of complications, improved short- and long-term outcomes and broadened the applications of TAVI, not only in challenging patients and complex anatomies but also in intermediate-risk or even in low-risk patients, where surgical valve replacement constitutes an effective and well-established therapy. In this review article, we provide an overview of the developments in TAVI devices which have played a vital role in TAVI evolution: we describe the prostheses that failed to reach clinical practice, we present the characteristics of the first valves that were tested in the clinical arena, we summarise the evidence from the first studies that highlighted the potential but also the limitations of TAVI, and we present the advanced next-generation THV prostheses that have an improved performance and safety profile.
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Affiliation(s)
- Christos V Bourantas
- Department of Cardiology, Barts Heart Center, Barts Health NHS Trust, London, United Kingdom
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5
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Overtchouk P, Modine T. A comparison of alternative access routes for transcatheter aortic valve implantation. Expert Rev Cardiovasc Ther 2018; 16:749-756. [DOI: 10.1080/14779072.2018.1524295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Pavel Overtchouk
- Interventional Cardiology and Cardiovascular Surgery Centre Hospitalier Regional, Universitaire de Lille (CHRU de Lille), Lille, France
| | - Thomas Modine
- Interventional Cardiology and Cardiovascular Surgery Centre Hospitalier Regional, Universitaire de Lille (CHRU de Lille), Lille, France
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6
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Abstract
Transcatheter aortic valve implantation (TAVI) is currently performed through an alternative access in 15% of patients. The transapical access is progressively being abandoned as a result of its invasiveness and poor outcomes. Existing data does not allow TAVI operators to favour one access over another - between transcarotid, trans-subclavian and transaortic - because all have specific strengths and weaknesses. The percutaneous trans-subclavian access might become the main surgery-free alternative access, although further research is needed regarding its safety. Moreover, the difficult learning curve might compromise its adoption. The transcaval access is at an experimental stage and requires the development of dedicated cavo-aortic crossing techniques and closure devices.
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Affiliation(s)
- Pavel Overtchouk
- Centre Hospitalier Regional et Universitaire de Lille Lille, France
| | - Thomas Modine
- Centre Hospitalier Regional et Universitaire de Lille Lille, France
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7
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Auffret V, Puri R, Urena M, Chamandi C, Rodriguez-Gabella T, Philippon F, Rodés-Cabau J. Conduction Disturbances After Transcatheter Aortic Valve Replacement. Circulation 2017; 136:1049-1069. [DOI: 10.1161/circulationaha.117.028352] [Citation(s) in RCA: 302] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a well-accepted option for treating patients with aortic stenosis at intermediate to high or prohibitive surgical risk. TAVR-related conduction disturbances, mainly new-onset left bundle-branch block and advanced atrioventricular block requiring permanent pacemaker implantation, remain the most common complication of this procedure. Furthermore, improvements in TAVR technology, akin to the increasing experience of operators/centers, have translated to a major reduction in periprocedural complications, yet the incidence of conduction disturbances has remained relatively high, with perhaps an increasing trend over time. Several factors have been associated with a heightened risk of conduction disturbances and permanent pacemaker implantation after TAVR, with prior right bundle-branch block and transcatheter valve type and implantation depth being the most commonly reported. New-onset left bundle-branch block and the need for permanent pacemaker implantation may have a significant detrimental association with patients’ prognosis. Consequently, strategies intended to reduce the risk and to improve the management of such complications are of paramount importance, particularly in an era when TAVR expansion toward treating lower-risk patients is considered inevitable. In this article, we review the available evidence on the incidence, predictive factors, and clinical association of conduction disturbances after TAVR and propose a strategy for the management of these complications.
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Affiliation(s)
- Vincent Auffret
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Rishi Puri
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Marina Urena
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Chekrallah Chamandi
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Tania Rodriguez-Gabella
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - François Philippon
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Josep Rodés-Cabau
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
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8
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Transapical transcatheter aortic valve implantation using the J-Valve system: A 1-year follow-up study. J Thorac Cardiovasc Surg 2017; 154:46-55. [DOI: 10.1016/j.jtcvs.2017.03.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 02/06/2017] [Accepted: 03/13/2017] [Indexed: 11/23/2022]
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9
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Gomes B, Katus HA, Bekeredjian R. Repositionable self-expanding aortic bioprosthesis. Expert Rev Med Devices 2017; 14:565-576. [PMID: 28571486 DOI: 10.1080/17434440.2017.1338136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Transcatheter aortic valve implantation/replacement (TAVI or TAVR) has been established as a first line therapy in patients with symptomatic severe aortic stenosis (AS) at high or prohibitive surgical risk and as an alternative in elderly patients with intermediate surgical risk. Since its first-in-human procedure in 2002, the past 15-years have shown rapid developments in TAVI technology with the introduction and further improvement of new transcatheter heart valves (THV). Areas covered: There are currently several THV systems available, based on balloon-expandable, self-expandable or other technologies. Some of these are repositionable and retrievable even after partial or full deployment, potentially reducing the risk of malpositioning. The aim of this review is to describe such repositionable self-expandable THV systems. Expert commentary: Repositionability potentially represents a crucial step towards higher safety and efficacy of TAVI. It is unclear if full self-expandability or a combination of self and mechanical expansion will be more advantageous.
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Affiliation(s)
- Bruna Gomes
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
| | - Hugo A Katus
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
| | - Raffi Bekeredjian
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
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10
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Greason KL. Rikki-Tikki-Tavi for aortic regurgitation. J Thorac Cardiovasc Surg 2017; 154:56-57. [PMID: 28438324 DOI: 10.1016/j.jtcvs.2017.03.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Kevin L Greason
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minn.
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11
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Metaxa S, Ioannou A, Missouris CG. Transcatheter aortic valve implantation: new hope in the management of valvular heart disease. Postgrad Med J 2017; 93:280-288. [PMID: 28104807 DOI: 10.1136/postgradmedj-2016-134554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/19/2016] [Accepted: 12/29/2016] [Indexed: 12/17/2022]
Abstract
Severe calcific aortic stenosis is relatively common, and unless treated with valve replacement it carries an adverse prognosis. A large number of patients, however, are denied surgery due to their advanced age or coexistent medical conditions that increase perioperative cardiovascular risks. Transcatheter aortic valve implantation (TAVI), a technique in which a bioprosthetic valve is inserted via a catheter and implanted within the diseased native aortic valve, is a new therapeutic modality for treatment of older patients with severe symptomatic aortic stenosis and other comorbidities, who have an inherently high surgical risk. This review will provide an overview of the pivotal trials in the development of TAVI; while also investigating important complications and limitations of the procedure and evaluating how new valves are being designed and clinically evaluated, with the ultimate goal of reducing potential complications and expanding the use of TAVI to lower-risk patient cohorts.
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Affiliation(s)
| | | | - Constantinos G Missouris
- Frimley Health NHS Foundation Trust, London, UK.,University of Cyprus Medical School, Nicosia, Cyprus
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12
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Siqueira DA, Abizaid AA. New Aortic Valve Technologies. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Alexandre A.C. Abizaid
- Dante Pazzanese Institute of Cardiology; São Paulo Brazil
- Hospital do Coração-Associação do Sanatório Sírio (HCor); São Paulo Brazil
- Hospital Israelita Albert Einstein; São Paulo Brazil
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13
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Sündermann SH, Holzhey D, Bleiziffer S, Treede H, Jacobs S, Falk V. Second-generation transapical valves: the Medtronic Engager system. Multimed Man Cardiothorac Surg 2016; 2014:mmu001. [PMID: 24568935 DOI: 10.1093/mmcts/mmu001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The Medtronic Engager aortic valve system is a second-generation transcatheter aortic valve implantation bioprosthesis combined with a delivery system designed for over-the-wire transapical implantation of the valve. The self-expandable stent has control arms to be placed into the native aortic sinuses to achieve correct positioning of the bioprosthesis in a predefined height. The purpose of the lower skirt is to reduce paravalvular leakage. A three-leaflet, bovine pericardium valve is mounted on the stent. The implantation is facilitated by the control arms and rotational positioning of the commissural posts. A multicentre feasibility study showed promising results. The results from the following European pivotal trial led to CE mark approval in 2013. Here, we describe technical details of the device and its implantation technique and highlight special steps of the procedure.
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Affiliation(s)
- Simon H Sündermann
- Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
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14
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Wiegerinck EMA, Van Kesteren F, Van Mourik MS, Vis MM, Baan J. An up-to-date overview of the most recent transcatheter implantable aortic valve prostheses. Expert Rev Med Devices 2016; 13:31-45. [PMID: 26567756 DOI: 10.1586/17434440.2016.1120665] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the past decade transcatheter aortic valve implantation (TAVI) has evolved towards the routine therapy for high-risk patients with severe aortic valve stenosis. Technical refinements in TAVI are rapidly evolving with a simultaneous expansion of the number of available devices. This review will present an overview of the current status of development of TAVI-prostheses; describes the technical features and applicability of each device and the clinical data available.
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Affiliation(s)
- Esther M A Wiegerinck
- a Heart Center, Academic Medical Center , University of Amsterdam , Amsterdam , the Netherlands
| | - Floortje Van Kesteren
- a Heart Center, Academic Medical Center , University of Amsterdam , Amsterdam , the Netherlands
| | - Martijn S Van Mourik
- a Heart Center, Academic Medical Center , University of Amsterdam , Amsterdam , the Netherlands
| | - Marije M Vis
- a Heart Center, Academic Medical Center , University of Amsterdam , Amsterdam , the Netherlands
| | - Jan Baan
- a Heart Center, Academic Medical Center , University of Amsterdam , Amsterdam , the Netherlands
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15
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Doss M, Walther T. Transcatheter/Hybrid Aortic Valves in the Young. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2016; 19:68-74. [PMID: 27060047 DOI: 10.1053/j.pcsu.2015.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/08/2015] [Indexed: 06/05/2023]
Abstract
Transcatheter aortic valve implantation (T-AVI) has been established as an alternative to conventional aortic valve replacement. The number of procedures is steadily rising and has reached comparable implant rates to conventional aortic valve replacement. The success of T-AVI is easily explained by their true minimally invasive nature, ease of use, and excellent hemodynamics. Whilst their use was initially limited to high-risk patients, current trends show that more and more intermediate-risk patients are now treated with theses prostheses. The question arises whether children would also benefit from this type of procedure. Percutaneous transcatheter pulmonary valve replacement is already becoming an important adjunct in the treatment of older children with failing right ventricular outflow tract conduits. Recently, several valve-in-valve procedures have been performed using T-AVI in failing bioprosthetic valves in young patients. There has also been a report of successful transcatheter neoaortic valve replacements in young patients after Fontan palliation. As an alternative to transcatheter valves, so called hybrid or sutureless rapid deployment aortic valves have recently been introduced into clinical practice. Although this concept is old, the current generation of these prostheses has been redesigned based on modern experiences with transcatheter valves. Current outcomes demonstrate that aortic valve replacement with sutureless valves could be a promising option for aortic stenosis, by facilitating minimally invasive surgery and minimizing cardiopulmonary bypass and cross clamping time. Therefore, the sutureless valve could prove to be an important alternative to conventional bioprosthetic aortic valve replacement in children too. In the current review, we provide an overview of the different types of transcatheter and sutureless aortic valve substitutes, discuss their advantages and short comings, and outline their clinical performance and potential benefits in a young patient population.
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Affiliation(s)
- Mirko Doss
- Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim, Germany.
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim, Germany
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16
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Zhu D, Chen Y, Guo Y, Hu J, Zhang J, Wei X, Tang H, Shi Y. Transapical transcatheter aortic valve implantation using a new second-generation TAVI system - J-Valve™ for high-risk patients with aortic valve diseases: Initial results with 90-day follow-up. Int J Cardiol 2015. [PMID: 26197402 DOI: 10.1016/j.ijcard.2015.07.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To evaluate the safety and efficacy of transcatheter aortic valve implantation (TAVI) for patients with aortic stenosis (AS) or pure/dominant aortic regurgitation (AR) using the J-Valve™ system. METHODS Twenty patients with isolated aortic valve disease (11 with pure/dominant AR and 9 with AS) at high risk for open-heart surgery were enrolled in this study. The mean Logistic Euro-SCORE I was 27.2±8.2% (mean age 74.5±4.7years). Four sizes of prosthesis were used for annular size up to 21 mm (n=1), 23mm (n=2), 25mm (n=10) and 27mm (n=7). Clinical and echocardiographic evaluations were performed at baseline, post-procedure and follow-up. The primary endpoint was all-cause mortality. Secondary endpoints were procedural success, major adverse events as well as echocardiographic performance. RESULTS TAVI with the J-Valve™ device was successfully performed in 19 patients (95%). Conversion to surgical valve replacement was necessary in one patient due to prosthesis embolization. No mortality occurred during 90 days follow-up. Pacemaker implantation for new onset conduction disorders was necessary in one patient (5%). For patient with severe AS, post-procedure TAVI resulted in favorable reduction of mean transvalvular gradients (55.3±8.5 vs. 16.4±13.3 mmHg, P<0.01). Mean transvalvular gradient was also favorable in AR patients after valve implantation (6.9±1mmHg). The majority of patients had none or trivial paravalvular regurgitation (17/19) while none had moderate or severe paravalvular regurgitation. CONCLUSION Trans-apical TAVI using the J-Valve™ prosthesis is potentially an effective treatment option for patients with AS or pure/dominant AR at high risk for open-heart surgery.
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Affiliation(s)
- Da Zhu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yucheng Chen
- Department of Cardiology, West China hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yingqiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
| | - Jia Hu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Ji Zhang
- JC Medical Inc. Redwood City, CA, USA
| | - Xin Wei
- Department of Cardiology, West China hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Hong Tang
- Department of Cardiology, West China hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yingkang Shi
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
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17
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Schlotter F, Haussig S, Schuler G, Linke A. Valve-in-valve Medtronic CoreValve implantation into a degenerated transapical Ventor Embracer aortic valve bioprosthesis. Clin Res Cardiol 2015; 104:908-10. [PMID: 26130221 DOI: 10.1007/s00392-015-0886-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Florian Schlotter
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, 04289, Leipzig, Germany
| | - Stephan Haussig
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, 04289, Leipzig, Germany
| | - Gerhard Schuler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, 04289, Leipzig, Germany
| | - Axel Linke
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, 04289, Leipzig, Germany.
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18
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Van Linden A, Doss M, Arsalan M, Kim WK, Walther T. Transcatheter aortic valve implantation--update and evidence. MINIM INVASIV THER 2015; 24:255-63. [PMID: 25966964 DOI: 10.3109/13645706.2015.1047852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Transcatheter aortic valve implantation (T-AVI) has become the standard of care for high-risk patients suffering from severe aortic valve stenosis. More than 60,000 implants have been performed to date. While the first-generation T-AVI devices had some specific issues, the advancements in these first-generation devices and the development of second-generation devices significantly reduced the incidence of peri-procedural complications. The two major access routes are the transfemoral (TF) and the transapical (TA) approach. Both approaches have their advantages and should be considered equal alternatives for finding the best treatment option for the individual patient. Currently there are discussions about extending the indication to patients with lower risk profiles. However, there is no real evidence to justify an expansion, as results of surgical aortic valve replacement in low and intermediate risk patients are excellent.
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Affiliation(s)
- Arnaud Van Linden
- a 1 Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany
| | - Mirko Doss
- a 1 Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany
| | - Mani Arsalan
- a 1 Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany
| | - Won Keun Kim
- a 1 Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany.,b 2 Department of Cardiology, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany
| | - Thomas Walther
- a 1 Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany
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Cheng J, Chen M, Zhu D, Zhang J, Hu J, Guo Y. Successful trans-apical aortic valve implantation for a high risk patient with aortic stenosis using a new second-generation TAVI device - J-Valve system. J Cardiothorac Surg 2015; 10:5. [PMID: 25595419 PMCID: PMC4299398 DOI: 10.1186/s13019-015-0207-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/07/2015] [Indexed: 02/07/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has evolved as a routine procedure to treat selected high-risk patients with severe aortic stenosis. The new J-Valve™ prosthesis is designed for antegrade transapical implantation, it is characterized by a porcine aortic prosthesis attaching to a self-expandable Nitinol stent. The key feature of the device are three U-shape anatomically oriented devices - “graspers” which could facilitate intuitive ‘self-positioning’ valve implantation. Hereby, we report a successful case of trans-apical TAVI in an elderly high-risk patient with severe aortic stenosis using J-Valve™ system.
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Affiliation(s)
- Jiahan Cheng
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China. .,West china school of Clinical Medicine, Sichuan University, Chengdu, China.
| | - Miao Chen
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
| | - Da Zhu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
| | - Ji Zhang
- JC Medical Inc., Florida, CA, USA.
| | - Jia Hu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
| | - Yingqiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
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Kheradvar A, Groves EM, Goergen CJ, Alavi SH, Tranquillo R, Simmons CA, Dasi LP, Grande-Allen KJ, Mofrad MRK, Falahatpisheh A, Griffith B, Baaijens F, Little SH, Canic S. Emerging Trends in Heart Valve Engineering: Part II. Novel and Standard Technologies for Aortic Valve Replacement. Ann Biomed Eng 2014; 43:844-57. [DOI: 10.1007/s10439-014-1191-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
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Kindzelski BA, Li M, Mazilu D, Hunt T, Horvath KA. Real-time magnetic resonance-guided aortic valve replacement using Engager valve. Ann Thorac Surg 2014; 98:2194-9. [PMID: 25468087 DOI: 10.1016/j.athoracsur.2014.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/03/2014] [Accepted: 09/09/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE New-generation stented bioprostheses coupled with better imaging modalities are expanding the clinical utility of transcatheter aortic valve replacement (TAVR). This study aimed at evaluating the feasibility of real-time cardiovascular magnetic resonance (rtCMR) -guided TAVR using the Medtronic Engager aortic valve system in a preclinical model. DESCRIPTION The Engager delivery device was slightly modified to make it CMR-compatible. Ten Yucatan swine underwent rtCMR-guided transapical TAVR. Postplacement phase-contrast and first-pass perfusion CMR sequences were used to evaluate for aortic regurgitation and myocardial perfusion, respectively. EVALUATION Real-time CMR provided excellent visualization of cardiac anatomy during TAVR. Nine of 10 animals had proper valve placement in the aortic annulus as determined by CMR and confirmed by necropsy inspection. Postplacement phase-contrast scans confirmed no intravalvular or paravalvular leaks. Perfusion scans demonstrated sufficient coronary flow. Roentgenographs confirmed proper placement of the prostheses. CONCLUSIONS The Engager valve can be implanted transapically under rtCMR guidance with a modified, CMR-compatible delivery device in a preclinical model. Cardiovascular magnetic resonance allowed for accurate preplacement evaluation, real-time guidance, and postplacement functional assessment.
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Affiliation(s)
- Bogdan A Kindzelski
- Cardiothoracic Surgery Research Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Ming Li
- Cardiothoracic Surgery Research Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Dumitru Mazilu
- Cardiothoracic Surgery Research Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Timothy Hunt
- Cardiothoracic Surgery Research Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Keith A Horvath
- Cardiothoracic Surgery Research Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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Huber C, Wenaweser P, Windecker S, Carrel T. Transapical transcatheter aortic valve implantation using the second-generation self-expanding Symetis ACURATE TA valve. Multimed Man Cardiothorac Surg 2014; 2014:mmu017. [PMID: 25298363 DOI: 10.1093/mmcts/mmu017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Transapical transcatheter aortic valve implantation (TA-TAVI) is the recognized first choice surgical TAVI access. Expansion of this well-established treatment modality with subsequent broader patient inclusion has accelerated development of second-generation TA-TAVI devices. The Swiss ACURATE TA Symetis valve allows for excellent anatomical positioning, resulting in a very low incidence of paravalvular leaks. The self-expanding stent features an hourglass shape to wedge the native aortic valve annulus. A specially designed delivery system facilitates controlled release aided by tactile operator feedback. The ACURATE TA valve made of three native porcine non-coronary leaflets has received CE approval in September 2011. Since then, this valve is the third most frequently implanted TAVI device with over 1200 implants in Europe and South America. Results from the Symetis ACURATE TA™ Valve Implantation ('SAVI') Registry showed a procedural success rate of 98.0% and a survival rate of 93.2% at 30 days. This presentation provides technical considerations and detailed procedural aspects of device implantation.
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Affiliation(s)
- Christoph Huber
- Clinic for Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland
| | - Peter Wenaweser
- Clinic for Cardiology, University Hospital Berne, Berne, Switzerland
| | - Stephan Windecker
- Clinic for Cardiology, University Hospital Berne, Berne, Switzerland
| | - Thierry Carrel
- Clinic for Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland
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Conrotto F, D'Ascenzo F, Francesca G, Colaci C, Sacciatella P, Biondi-Zoccai G, Moretti C, D'Amico M, Gaita F, Marra S. Impact of access on TAVI procedural and midterm follow-up: a meta-analysis of 13 studies and 10,468 patients. J Interv Cardiol 2014; 27:500-8. [PMID: 25196312 DOI: 10.1111/joic.12141] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) may be performed using the transfemoral (TF) or transapical (TA) approach in most patients with aortic stenosis. The impact of access choice on peri-procedural and midterm results remains to be defined. METHODS Medline and Cochrane Library were searched for articles describing differences in baseline, peri-procedural, and midterm outcomes among patients undergoing TF or TA TAVI. The primary end-point was all-cause mortality after at least 1-year follow-up, while secondary end-points were 30 days mortality and in-hospital complications (bleeding and cerebrovascular events). The independent impact of access choice was evaluated with pooled analysis using a random-effect model. RESULTS Thirteen studies with 10,468 patients were included. TF was the most exploited strategy (69.5% vs. 30.5%). After adjusting for confounding variables, 30-day and midterm follow-up mortality (median 365 days, range 222-400) were lower in TF patients with a pooled adjusted odds ratio of 0.81 (0.68-0.97 I(2) 99%) and 0.85 (0.80-0.90 I(2) 96%), respectively. Regarding periprocedural outcomes, TF reduced risk of bleedings and strokes (OR of 0.74 [0.66-0.82 I(2) 95%] and 0.91 [0.83-0.99] I(2) 86%, respectively). CONCLUSIONS The TF approach reduces mortality in TAVI patients, due to lower rates of periprocedural bleedings and strokes.
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Affiliation(s)
- Federico Conrotto
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
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Schlingloff F, Schäfer U, Frerker C, Schmoeckel M, Bader R. Transcatheter aortic valve implantation of a second-generation valve for pure aortic regurgitation: procedural outcome, haemodynamic data and follow-up. Interact Cardiovasc Thorac Surg 2014; 19:388-93. [DOI: 10.1093/icvts/ivu155] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Seiffert M, Conradi L, Kloth B, Koschyk D, Schirmer J, Schnabel RB, Blankenberg S, Reichenspurner H, Diemert P, Treede H. Single-centre experience with next-generation devices for transapical aortic valve implantation†. Eur J Cardiothorac Surg 2014; 47:39-45; discussion 45. [DOI: 10.1093/ejcts/ezu041] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tam DY, Chu MWA. Paravalvular leak after transcatheter aortic valve implantation: trading one disease for another? Expert Rev Cardiovasc Ther 2014; 12:407-11. [DOI: 10.1586/14779072.2014.885380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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