1
|
Mutlu O, Saribay M, Yavuz MM, Salman HE, Al-Nabti ARDMH, Yalcin HC. Material modeling and recent findings in transcatheter aortic valve implantation simulations. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 255:108314. [PMID: 39024970 DOI: 10.1016/j.cmpb.2024.108314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/12/2024] [Accepted: 06/28/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND AND OBJECTIVE Transcatheter aortic valve implantation (TAVI) has significantly transformed the management of aortic valve (AV) diseases, presenting a minimally invasive option compared to traditional surgical valve replacement. Computational simulations of TAVI become more popular and offer a detailed investigation by employing patient-specific models. On the other hand, employing accurate material modeling procedures and applying basic modeling steps are crucial to determining reliable numerical results. Therefore, this review aims to outline the basic modeling approaches for TAVI, focusing on material modeling and geometry extraction, as well as summarizing the important findings from recent computational studies to guide future research in the field. METHODS This paper explains the basic steps and important points in setting up and running TAVI simulations. The material properties of the leaflets, valves, stents, and tissues utilized in TAVI simulations are provided, along with a comprehensive explanation of the geometric extraction methods employed. The differences between the finite element analysis, computational fluid dynamics, and fluid-structure interaction approaches are pointed out and the important aspects of TAVI modeling are described by elucidating the recent computational studies. RESULTS The results of the recent findings on TAVI simulations are summarized to demonstrate its powerful potential. It is observed that the material properties of aortic tissues and components of implanted valves should be modeled realistically to determine accurate results. For patient-specific AV geometries, incorporating calcific deposits on the leaflets is essential for ensuring the accuracy of computational findings. The results of numerical TAVI simulations indicate the significance of the selection of optimal valves and precise deployment within the appropriate anatomical position. These factors collectively contribute to the effective functionality of the implanted valve. CONCLUSIONS Recent studies in the literature have revealed the critical importance of patient-specific modeling, the selection of accurate material models, and bio-prosthetic valve diameters. Additionally, these studies emphasize the necessity of precise positioning of bio-prosthetic valves to achieve optimal performance in TAVI, characterized by an increased effective orifice area and minimal paravalvular leakage.
Collapse
Affiliation(s)
- Onur Mutlu
- Qatar University, Biomedical Research Center, Doha, Qatar
| | - Murat Saribay
- Istanbul Bilgi University, Mechanical Engineering Department, Istanbul, Turkey
| | - Mehmet Metin Yavuz
- Middle East Technical University, Mechanical Engineering Department, Ankara, Turkey
| | - Huseyin Enes Salman
- TOBB University of Economics and Technology, Department of Mechanical Engineering, Ankara, Turkey
| | | | - Huseyin Cagatay Yalcin
- Qatar University, Biomedical Research Center, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
| |
Collapse
|
2
|
Zaheer A, Qiu F, Manoragavan R, Madan M, Sud M, Mamas MA, Wijeysundera HC. Impact of Neighborhood Social Deprivation on Delays to Access for Transcatheter Aortic Valve Replacement: Wait-Times and Clinical Consequences. J Am Heart Assoc 2024; 13:e032450. [PMID: 38879459 PMCID: PMC11255769 DOI: 10.1161/jaha.123.032450] [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: 08/31/2023] [Accepted: 05/24/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has become the standard of care for severe aortic stenosis treatment. Exponential growth in demand has led to prolonged wait times and adverse patient outcomes. Social marginalization may contribute to adverse outcomes. Our objective was to examine the association between different measures of neighborhood-level marginalization and patient outcomes while on the TAVR waiting list. A secondary objective was to understand if sex modifies this relationship. METHODS AND RESULTS We conducted a population-based retrospective cohort study of 11 077 patients in Ontario, Canada, referred to TAVR from April 1, 2018, to March 31, 2022. Primary outcomes were death or hospitalization while on the TAVR wait-list. Using cause-specific Cox proportional hazards models, we evaluated the relationship between neighborhood-level measures of dependency, residential instability, material deprivation, and ethnic and racial concentration with primary outcomes as well as the interaction with sex. After multivariable adjustment, we found a significant relationship between individuals living in the most ethnically and racially concentrated areas (quintile 4 and 5) and mortality (hazard ratio [HR], 0.64 [95% CI, 0.47-0.88] and HR, 0.73 [95% CI, 0.53-1.00], respectively). There was no significant association between material deprivation, dependency, or residential instability with mortality. Women in the highest ethnic or racial concentration quintiles (4 and 5) had significantly lower risks for mortality (HR values of 0.52 and 0.56, respectively) compared with quintile 1. CONCLUSIONS Higher neighborhood ethnic or racial concentration was associated with decreased risk for mortality, particular for women on the TAVR waiting list. Further research is needed to understand the drivers of this relationship.
Collapse
Affiliation(s)
- Aida Zaheer
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
| | | | - Ragavie Manoragavan
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
| | - Mina Madan
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
- Temerty Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Maneesh Sud
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
- ICESTorontoCanada
- Temerty Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Mamas A. Mamas
- Keele Cardiovascular Research GroupKeele UniversityKeeleUK
| | - Harindra C. Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
- ICESTorontoCanada
- Temerty Faculty of MedicineUniversity of TorontoTorontoCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
| |
Collapse
|
3
|
Ernert C, Kielstein H, Azatyan A, Prantl L, Kehrer A. Extended arc of rotation of Latissimus Dorsi Musculocutaneous Flap providing well-vascularized tissue for reconstruction of complete defects of the sternum: An anatomical study of flap pedicle modification. Clin Hemorheol Microcirc 2024; 86:225-236. [PMID: 37742631 DOI: 10.3233/ch-238115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Deep sternal wound infections (DSWI) following cardiothoracic surgery represent a life quality endangering sequelae and may lead to sternal osteomyelitis. Radical debridement followed by Negative Pressure Wound Therapy (NPWT) may achieve infection control, provide angiogenesis, and improve respiratory function. When stable wound conditions have been established a sustainable plastic surgical flap reconstruction should be undertaken. OBJECTIVE This study analyses a method to simplify defect coverage with a single Latissimus Dorsi Myocutaneous Flap (LDMF). METHODS Preparation of 20 LDMF in ten fresh frozen cadavers was conducted. Surgical steps to increase pedicle length were evaluated. The common surgical preparation of LDMF was compared with additional transection of the Circumflex Scapular Artery (CSA). RESULTS Alteration of the surgical preparation of LDMF by sacrificing the CSA may provide highly valuable well-vascularized muscle tissue above the sensitive area of the Xiphisternum. All defects could be completely reconstructed with a single LDMF. The gain in length of flap tissue in the inferior third of the sternum was 3.86±0.9 cm (range 2.2 to 8 cm). CONCLUSIONS By sacrificing the CSA in harvesting the LDMF a promising gain in length, perfusion and volume may be achieved to cover big sternal defects with a single flap.
Collapse
Affiliation(s)
- Carsten Ernert
- Department of Plastic, Hand and Microsurgery, Ev. Waldkrankenhaus Spandau, Berlin, Germany
| | - Heike Kielstein
- Institute of Anatomy, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Argine Azatyan
- Department of Plastic, Reconstructive and Breast Surgery, Görlitz Hospital, Görlitz, Germany
| | - Lukas Prantl
- Department of Plastic and Reconstructive Surgery, University Medical Center, Regensburg, Germany
| | - Andreas Kehrer
- Department of Plastic and Reconstructive Surgery, University Medical Center, Regensburg, Germany
- Division of Hand and Plastic Surgery, Ingolstadt Hospital, Ingolstadt, Germany
| |
Collapse
|
4
|
Spiliopoulos K, Fludas I, Xanthopoulos A, Magouliotis D, Zotos PA, Salemis NS, Athanasiou T, Schmid FX. New challenges for the surgeon in the modern era of transcatheter aortic valves: Early single center experience of their surgical explantation. Hellenic J Cardiol 2023; 74:77-80. [PMID: 37690523 DOI: 10.1016/j.hjc.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Cardiac Surgery, Helios Klinikum Krefeld, Germany; Department of Cardiothoracic Surgery, University of Thessaly, Larissa, Greece.
| | - Iraklis Fludas
- Department of Anesthesiology and Intensive Care, Helios Klinikum Krefeld, Germany
| | | | | | | | | | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, University of Thessaly, Larissa, Greece
| | | |
Collapse
|
5
|
Miazza J, Vasiloi I, Koechlin L, Gahl B, Santer D, Berdajs D, Nestelberger T, Kaiser C, Eckstein F, Reuthebuch O. Combining Minimally Invasive Direct Coronary Artery Bypass Grafting with Transapical Aortic Valve Implantation-The Next Level Heart Team Approach. J Clin Med 2023; 12:6890. [PMID: 37959355 PMCID: PMC10647604 DOI: 10.3390/jcm12216890] [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: 09/25/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
We present the results of a combined approach for transapical aortic valve replacement and minimally invasive coronary artery bypass grafting (taTAVI-MIDCAB) in patients with combined aortic stenosis and coronary artery disease. BACKGROUND For patients presenting with aortic stenosis and coronary artery disease, a simultaneous procedure addressing both diseases is recommended to reduce operative risk. In high-risk patients with hostile femoral or coronary axis, taTAVI-MIDCAB can be an alternative minimally invasive approach, offering the benefits of left interior mammary artery to left anterior descending coronary artery (LIMA-LAD) grafting. METHODS From 2014 to 2022, 10 patients underwent taTAVI-MIDCAB for combined coronary and severe aortic stenosis in the hybrid operation theater at our institution. We assessed perioperative outcomes and follow-up outcomes. RESULTS The median age was 83 years (81 to 86). The procedure was successfully performed in all patients without conversion to sternotomy. The median length of hospital and intensive care unit stay was 9 days (7 to 16) and 2.5 days (1 to 5), respectively. The median flow over the coronary artery bypass was 31 (22 to 44) mL/min, with a pulsatility index (PI) of 2.4 (2.1 to 3.2). Mild paravalvular leak occurred in 2 patients (10%). There were no neurological events nor acute kidney injury. Pacemaker implantation was required in 1 patient (10%). CONCLUSIONS Simultaneous surgical coronary revascularization and interventional valve implantation in the setting of a hostile femoral and coronary axis appears to be safe and beneficial.
Collapse
Affiliation(s)
- Jules Miazza
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (D.S.)
| | - Ion Vasiloi
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (D.S.)
| | - Luca Koechlin
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (D.S.)
| | - Brigitta Gahl
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (D.S.)
| | - David Santer
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (D.S.)
| | - Denis Berdajs
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (D.S.)
| | - Thomas Nestelberger
- Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Friedrich Eckstein
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (D.S.)
| | - Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (D.S.)
| |
Collapse
|
6
|
Gherasie FA, Achim A. TAVR Interventions and Coronary Access: How to Prevent Coronary Occlusion. Life (Basel) 2023; 13:1605. [PMID: 37511980 PMCID: PMC10381891 DOI: 10.3390/life13071605] [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: 06/19/2023] [Revised: 07/06/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Due to technological advancements during the past 20 years, transcatheter aortic valve replacements (TAVRs) have significantly improved the treatment of symptomatic and severe aortic stenosis, significantly improving patient outcomes. The continuous evolution of transcatheter valve models, refined imaging planning for enhanced accuracy, and the growing expertise of technicians have collectively contributed to increased safety and procedural success over time. These notable advancements have expanded the scope of TAVR to include patients with lower risk profiles as it has consistently demonstrated more favorable outcomes than surgical aortic valve replacement (SAVR). As the field progresses, coronary angiography is anticipated to become increasingly prevalent among patients who have previously undergone TAVR, particularly in younger cohorts. It is worth noting that aortic stenosis is often associated with coronary artery disease. While the task of re-accessing coronary artery access following TAVR is challenging, it is generally feasible. In the context of valve-in-valve procedures, several crucial factors must be carefully considered to optimize coronary re-access. To obtain successful coronary re-access, it is essential to align the prosthesis with the native coronary ostia. As part of preventive measures, strategies have been developed to safeguard against coronary obstruction during TAVR. One such approach involves placing wires and non-deployed coronary balloons or scaffolds inside an at-risk coronary artery, a procedure known as chimney stenting. Additionally, the bioprosthetic or native aortic scallops intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) procedure offers an effective and safer alternative to prevent coronary artery obstructions. The key objective of our study was to evaluate the techniques and procedures employed to achieve commissural alignment in TAVR, as well as to assess the efficacy and measure the impact on coronary re-access in valve-in-valve procedures.
Collapse
Affiliation(s)
| | - Alexandru Achim
- Department of Cardiology, Medizinische Universitätsklinik, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| |
Collapse
|
7
|
Tahir AM, Mutlu O, Bensaali F, Ward R, Ghareeb AN, Helmy SMHA, Othman KT, Al-Hashemi MA, Abujalala S, Chowdhury MEH, Alnabti ARDMH, Yalcin HC. Latest Developments in Adapting Deep Learning for Assessing TAVR Procedures and Outcomes. J Clin Med 2023; 12:4774. [PMID: 37510889 PMCID: PMC10381346 DOI: 10.3390/jcm12144774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 07/30/2023] Open
Abstract
Aortic valve defects are among the most prevalent clinical conditions. A severely damaged or non-functioning aortic valve is commonly replaced with a bioprosthetic heart valve (BHV) via the transcatheter aortic valve replacement (TAVR) procedure. Accurate pre-operative planning is crucial for a successful TAVR outcome. Assessment of computational fluid dynamics (CFD), finite element analysis (FEA), and fluid-solid interaction (FSI) analysis offer a solution that has been increasingly utilized to evaluate BHV mechanics and dynamics. However, the high computational costs and the complex operation of computational modeling hinder its application. Recent advancements in the deep learning (DL) domain can offer a real-time surrogate that can render hemodynamic parameters in a few seconds, thus guiding clinicians to select the optimal treatment option. Herein, we provide a comprehensive review of classical computational modeling approaches, medical imaging, and DL approaches for planning and outcome assessment of TAVR. Particularly, we focus on DL approaches in previous studies, highlighting the utilized datasets, deployed DL models, and achieved results. We emphasize the critical challenges and recommend several future directions for innovative researchers to tackle. Finally, an end-to-end smart DL framework is outlined for real-time assessment and recommendation of the best BHV design for TAVR. Ultimately, deploying such a framework in future studies will support clinicians in minimizing risks during TAVR therapy planning and will help in improving patient care.
Collapse
Affiliation(s)
- Anas M Tahir
- Electrical and Computer Engineering Department, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Biomedical Research Center, Qatar University, Doha 2713, Qatar
| | - Onur Mutlu
- Biomedical Research Center, Qatar University, Doha 2713, Qatar
| | - Faycal Bensaali
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
| | - Rabab Ward
- Electrical and Computer Engineering Department, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Abdel Naser Ghareeb
- Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar
- Faculty of Medicine, Al Azhar University, Cairo 11884, Egypt
| | - Sherif M H A Helmy
- Noninvasive Cardiology Section, Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar
| | | | - Mohammed A Al-Hashemi
- Noninvasive Cardiology Section, Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar
| | | | | | | | - Huseyin C Yalcin
- Biomedical Research Center, Qatar University, Doha 2713, Qatar
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar
| |
Collapse
|
8
|
Webb JG, Sathananthan J, Wood DA. The Perfect Valve. JACC Cardiovasc Interv 2023; 16:1636-1639. [PMID: 37438030 DOI: 10.1016/j.jcin.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 07/14/2023]
Affiliation(s)
- John G Webb
- Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada.
| | - Janar Sathananthan
- Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada
| |
Collapse
|
9
|
Cormican DS. Judgment Reserved: The Evolving Development of Cerebral Embolic Protection Devices in Transcutaneous Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2023; 37:195-197. [PMID: 36460562 DOI: 10.1053/j.jvca.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Daniel S Cormican
- Division of Cardiothoracic Anesthesiology, Division of Surgical Critical Care, Anesthesiology Institute, Allegheny Health Network, Pittsburgh, PA.
| |
Collapse
|
10
|
Tayama E, Saku K, Anegawa T, Oryoji A, Negoto S. Prosthetic cardiac valves: history and review of cardiac prostheses clinically available in Japan. Surg Today 2022; 52:521-531. [PMID: 34435247 DOI: 10.1007/s00595-021-02361-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/10/2021] [Indexed: 10/20/2022]
Abstract
Recently developed prosthetic valves are reliable and essential for the treatment of valvular heart disease. The mechanical valve evolved remarkably following the introduction of pyrolite carbon material, which enabled the creation of a bileaflet form incorporated with a pivot mechanism. The improved durability of the biological valve is attributed mainly to the development of a tissue fixation process and anti-calcification treatments. However, optimal antithrombogenicity and durability have not yet been achieved for either prosthetic valve type. To select the most suitable prosthetic valve for each individual patient from among the many clinically available prosthetic valves, it is necessary to have a thorough understanding of the characteristics of each valve.
Collapse
Affiliation(s)
- Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan.
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Tomoyuki Anegawa
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Atsunobu Oryoji
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Shinya Negoto
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| |
Collapse
|
11
|
Zito A, Princi G, Lombardi M, D'Amario D, Vergallo R, Aurigemma C, Romagnoli E, Pelargonio G, Bruno P, Trani C, Burzotta F, Crea F. Long-term clinical impact of permanent pacemaker implantation in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis. Europace 2022; 24:1127-1136. [PMID: 35138367 PMCID: PMC9460982 DOI: 10.1093/europace/euac008] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/27/2022] [Indexed: 11/12/2022] Open
Abstract
Aims The aims of this study is to assess by an updated meta-analysis the clinical outcomes related to permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) at long-term (≥12 months) follow-up (LTF). Methods and results A comprehensive literature research was performed on PubMed and EMBASE. The primary endpoint was all-cause death. Secondary endpoints were rehospitalization for heart failure, stroke, and myocardial infarction. A subgroup analysis was performed according to the Society of Thoracic Surgeon—Predicted Risk of Mortality (STS-PROM) score. This study is registered with PROSPERO (CRD42021243301). A total of 51 069 patients undergoing TAVI from 31 observational studies were included. The mean duration of follow-up was 22 months. At LTF, PPI post-TAVI was associated with a higher risk of all-cause death [risk ratio (RR) 1.18, 95% confidence interval (CI) 1.10–1.25; P < 0.001] and rehospitalization for heart failure (RR 1.32, 95% CI 1.13–1.52; P < 0.001). In contrast, the risks of stroke and myocardial infarction were not affected. Among the 20 studies that reported procedural risk, the association between PPI and all-cause death risk at LTF was statistically significant only in studies enrolling patients with high STS-PROM score (RR 1.25, 95% CI 1.12–1.40), although there was a similar tendency of the results in those at medium and low risk. Conclusion Patients necessitating PPI after TAVI have a higher long-term risk of all-cause death and rehospitalization for heart failure as compared to those who do not receive PPI.
Collapse
Affiliation(s)
- Andrea Zito
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
| | - Marco Lombardi
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
12
|
Williams DF, Bezuidenhout D, de Villiers J, Human P, Zilla P. Long-Term Stability and Biocompatibility of Pericardial Bioprosthetic Heart Valves. Front Cardiovasc Med 2021; 8:728577. [PMID: 34589529 PMCID: PMC8473620 DOI: 10.3389/fcvm.2021.728577] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/19/2021] [Indexed: 01/15/2023] Open
Abstract
The use of bioprostheses for heart valve therapy has gradually evolved over several decades and both surgical and transcatheter devices are now highly successful. The rapid expansion of the transcatheter concept has clearly placed a significant onus on the need for improved production methods, particularly the pre-treatment of bovine pericardium. Two of the difficulties associated with the biocompatibility of bioprosthetic valves are the possibilities of immune responses and calcification, which have led to either catastrophic failure or slow dystrophic changes. These have been addressed by evolutionary trends in cross-linking and decellularization techniques and, over the last two decades, the improvements have resulted in somewhat greater durability. However, as the need to consider the use of bioprosthetic valves in younger patients has become an important clinical and sociological issue, the requirement for even greater longevity and safety is now paramount. This is especially true with respect to potential therapies for young people who are afflicted by rheumatic heart disease, mostly in low- to middle-income countries, for whom no clinically acceptable and cost-effective treatments currently exist. To extend longevity to this new level, it has been necessary to evaluate the mechanisms of pericardium biocompatibility, with special emphasis on the interplay between cross-linking, decellularization and anti-immunogenicity processes. These mechanisms are reviewed in this paper. On the basis of a better understanding of these mechanisms, a few alternative treatment protocols have been developed in the last few years. The most promising protocol here is based on a carefully designed combination of phases of tissue-protective decellularization with a finely-titrated cross-linking sequence. Such refined protocols offer considerable potential in the progress toward superior longevity of pericardial heart valves and introduce a scientific dimension beyond the largely disappointing 'anti-calcification' treatments of past decades.
Collapse
Affiliation(s)
- David F. Williams
- Strait Access Technologies Ltd. Pty., Cape Town, South Africa
- Wake Forest Institute of Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Deon Bezuidenhout
- Strait Access Technologies Ltd. Pty., Cape Town, South Africa
- Cardiovascular Research Unit, Cape Heart Institute, University of Cape Town, Cape Town, South Africa
| | | | - Paul Human
- Christiaan Barnard Department of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Peter Zilla
- Strait Access Technologies Ltd. Pty., Cape Town, South Africa
- Cardiovascular Research Unit, Cape Heart Institute, University of Cape Town, Cape Town, South Africa
- Christiaan Barnard Department of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
13
|
Medranda GA, Rogers T, Ali SW, Zhang C, Shea C, Sciandra KA, Case BC, Forrestal BJ, Sutton JA, McFadden EP, Malla P, Gordon P, Ehsan A, Wilson SR, Levitt R, Parikh P, Bilfinger T, Torguson R, Asch FM, Weissman G, Ben-Dor I, Shults CC, Garcia-Garcia HM, Satler LF, Waksman R. Prosthetic valve endocarditis after transcatheter aortic valve replacement in low-risk patients. Catheter Cardiovasc Interv 2021; 99:896-903. [PMID: 34505737 DOI: 10.1002/ccd.29943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/06/2021] [Accepted: 08/27/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We sought to report details of the incidence, organisms, clinical course, and outcomes of prosthetic valve endocarditis (PVE) after transcatheter aortic valve replacement (TAVR) in low-risk patients. BACKGROUND PVE remains a rare but devastating complication of aortic valve replacement. Data regarding PVE after TAVR in low-risk patients are lacking. METHODS We performed a detailed review of all patients in the low-risk TAVR trials who underwent TAVR from 2016 to 2020 and were adjudicated to have definitive PVE by the independent Clinical Events Committee. RESULTS We analyzed 396 low-risk patients who underwent TAVR (including 72 with bicuspid valves). PVE occurred in 11 patients at a median 379 days (210, 528) from TAVR. The incidence within the first 30 days was 0%; days 31-365, 1.5%; and after day 365, 2.8%. The most common organism identified was Streptococcus (n = 4/11). Early PVE (≤ 365 days) occurred in five patients, of whom three demonstrated evidence of embolic stroke and two underwent surgical aortic valve re-intervention. Late PVE (> 365 days) occurred in six patients, of whom thee demonstrated evidence of embolic stroke and only one underwent surgical aortic valve re-intervention. Of the six patients with evidence of embolic stroke, two died, two were discharged to rehabilitation, and two were discharged home with home care. CONCLUSIONS PVE was infrequent following TAVR in low-risk patients but was associated with substantial morbidity and mortality. Embolic stroke complicated the majority of PVE cases, contributing to worse outcomes in these patients. Efforts must be undertaken to minimize PVE in TAVR.
Collapse
Affiliation(s)
- Giorgio A Medranda
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.,Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Syed W Ali
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Corey Shea
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Kathryn A Sciandra
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Joseph A Sutton
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | | | - Prerna Malla
- Department of Neurology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Paul Gordon
- Division of Cardiology, Lifespan Cardiovascular Institute, Providence, Rhode Island, USA
| | - Afshin Ehsan
- Division of Cardiothoracic Surgery, Lifespan Cardiovascular Institute, Providence, Rhode Island, USA
| | - Sean R Wilson
- Department of Medicine, Valley Hospital, Ridgewood, New Jersey, USA
| | - Robert Levitt
- Department of Cardiology, Henrico Doctors' Hospital, Richmond, Virginia, USA
| | - Puja Parikh
- Department of Medicine, Stony Brook Hospital, Stony Brook, New York, USA
| | - Thomas Bilfinger
- Department of Surgery, Stony Brook Hospital, Stony Brook, New York, USA
| | - Rebecca Torguson
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Federico M Asch
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Gaby Weissman
- Department of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Christian C Shults
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| |
Collapse
|
14
|
Transcatheter Aortic Valve Implantation in Younger Patients: A New Challenge. MEDICINA-LITHUANIA 2021; 57:medicina57090883. [PMID: 34577806 PMCID: PMC8466138 DOI: 10.3390/medicina57090883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022]
Abstract
The number of aortic stenosis patients in Western countries is increasing, along with better life conditions and expectancies. Presently, the volume of percutaneous transcatheter aortic valve implantations (TAVIs) is incessantly increasing, and has already overcome the surgical replacement procedure volume. According to the literature, TAVI is a feasible procedure even among low surgical risk patients, and American guidelines have extended the indications for TAVI, including shifting patient evaluations from high/low STS scores to old/young patients, a "paradigm shift" of aortic stenosis evaluation. As a result, low-risk young (<75 years-old) population management could be the next challenge in cardiology. To manage the life conditions of a 65 year old patient affected by aortic stenosis who is undergoing TAVI, one of the most crucial issue will be bioprosthesis durability and the appropriate intervention to make in cases of valve dysfunction or failure.
Collapse
|
15
|
Zervides C, Nohra O, Hunduma G, Thomas NW, Samia R. 2006 to 2019 Story; percutaneously implantable aortic valve prototypes. J Cardiothorac Surg 2021; 16:223. [PMID: 34362403 PMCID: PMC8348870 DOI: 10.1186/s13019-021-01597-6] [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: 06/06/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
Aims A review was conducted on the composition, advantages and limitations of available aortic valve prototypes to create an ideal valve for percutaneous implantation. Patients Patients with multiple comorbidities who cannot withstand the risks of open cardiac surgery. Methodology The search was performed using online databases and textbooks. Articles were excluded based on specific criterion. Results Ten prototypes created between 2006 and 2019 were found and reviewed. The prototypes had a set of advantages and limitations with their characteristics coinciding at times. Conclusions The ideal percutaneously implantable aortic valve should have minimum coaptation height, zero folds in the leaflets, minimum valve height, minimum leaflet flexion and three leaflets. It can be composed of biological or synthetic material, as long as it provides minimal risk of thrombosis. However, more studies are needed to ensure other ideal parameters.
Collapse
Affiliation(s)
- Constantinos Zervides
- University of Nicosia Medical School, University of Nicosia, 21 Ilia Papakyriakou, 2414, Engomi, Nicosia, Cyprus.
| | - Ornella Nohra
- University of Nicosia Medical School, University of Nicosia, 21 Ilia Papakyriakou, 2414, Engomi, Nicosia, Cyprus
| | - Gabriel Hunduma
- University of Nicosia Medical School, University of Nicosia, 21 Ilia Papakyriakou, 2414, Engomi, Nicosia, Cyprus
| | - Neil Wild Thomas
- University of Nicosia Medical School, University of Nicosia, 21 Ilia Papakyriakou, 2414, Engomi, Nicosia, Cyprus
| | - Ramy Samia
- University of Nicosia Medical School, University of Nicosia, 21 Ilia Papakyriakou, 2414, Engomi, Nicosia, Cyprus
| |
Collapse
|
16
|
Bäz L, Puscholt M, Lasch C, Diab M, Möbius-Winkler S, Schulze PC, Dannberg G, Franz M. Delayed Improvement of Depression and Anxiety after Transcatheter Aortic Valve Implantation (TAVI) in Stages of Extended Extra-Valvular Cardiac Damage. J Clin Med 2021; 10:jcm10081579. [PMID: 33918058 PMCID: PMC8070529 DOI: 10.3390/jcm10081579] [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: 02/11/2021] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Depression and anxiety are frequently occurring and likely to be linked to the severity of cardiac diseases like aortic stenosis (AS). This seems to be of interest since a staging classification of extra-valvular cardiac damage in AS has been introduced and shown to be of prognostic relevance. Objective: The current study aimed to investigate the frequency of depression and anxiety in association to staging and their dynamics after transcatheter aortic valve implantation (TAVI). Methods: A total number of 224 AS patients undergoing TAVI were classified according to the 2017 staging classification into stage 0 to 4 and further dichotomized into group A (stage 0 to 2) and B (stage 3 and 4). Using the Hospital Anxiety and Depression Scale (HADS-D), patients were assigned to depressive versus non-depressive or anxious versus non-anxious per staging group respectively, and analyzed at baseline, 6 weeks, 6 months and 12 months after TAVI. Results: After dichotomization, 158 patients (70.5%) were assigned to group A and 66 patients (29.5%) to group B. The part showing pathologic values for depression was 25.4% (57/224 patients) in the entire collective, 26.6% (42/158 patients) in group A and 22.7% (15/66 patients) in group B (p = n.s.). The proportion showing pathologic values for anxiety was 26.8% (60/224 patients) in the entire collective and did not differ between group A (24.7%, 39/158 patients) and B (31.8%, 21/66 patients) (p = n.s.). In patients revealing pathologic values for depression or anxiety prior to TAVI, there were significant and stable improvements over time observable already in short-term (6 weeks) follow-up in group A, and likewise, but later, in long-term (6/12 months) follow-up in group B. Conclusions: Although of proven prognostic relevance, higher stages of extra-valvular cardiac damage are not associated with higher rates of pre-existing depression or anxiety. The TAVI procedure resulted in a persisting reduction of depression and anxiety in patients showing pathologic values at baseline. Notably, these improvements are timely delayed in higher stages.
Collapse
Affiliation(s)
- Laura Bäz
- Department of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.B.); (M.P.); (C.L.); (S.M.-W.); (P.C.S.); (G.D.)
| | - Marisa Puscholt
- Department of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.B.); (M.P.); (C.L.); (S.M.-W.); (P.C.S.); (G.D.)
| | - Claudia Lasch
- Department of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.B.); (M.P.); (C.L.); (S.M.-W.); (P.C.S.); (G.D.)
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany;
| | - Sven Möbius-Winkler
- Department of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.B.); (M.P.); (C.L.); (S.M.-W.); (P.C.S.); (G.D.)
| | - P. Christian Schulze
- Department of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.B.); (M.P.); (C.L.); (S.M.-W.); (P.C.S.); (G.D.)
| | - Gudrun Dannberg
- Department of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.B.); (M.P.); (C.L.); (S.M.-W.); (P.C.S.); (G.D.)
| | - Marcus Franz
- Department of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.B.); (M.P.); (C.L.); (S.M.-W.); (P.C.S.); (G.D.)
- Correspondence: ; Tel.: +49-(3641)-9324127; Fax: +49-(3641)-0324102
| |
Collapse
|
17
|
Haase D, Bäz L, Bekfani T, Neugebauer S, Kiehntopf M, Möbius-Winkler S, Franz M, Schulze PC. Metabolomic profiling of patients with high gradient aortic stenosis undergoing transcatheter aortic valve replacement. Clin Res Cardiol 2020; 110:399-410. [PMID: 33057764 PMCID: PMC7907030 DOI: 10.1007/s00392-020-01754-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022]
Abstract
Aim Aim of our study was to evaluate metabolic changes in patients with aortic stenosis (AS) before and after transcatheter aortic valve replacement (TAVR) and to assess whether this procedure reverses metabolomic alterations. Methods 188 plasma metabolites of 30 patients with severe high-gradient aortic valve stenosis (pre-TAVR and 6 weeks post-TAVR) as well as 20 healthy controls (HC) were quantified by liquid chromatography tandem mass spectrometry. Significantly altered metabolites were then correlated to an extensive patient database of clinical parameters at the time of measurement. Results Out of the determined metabolites, 26.6% (n = 50) were significantly altered in patients with AS pre-TAVR compared to HC. In detail, 5/40 acylcarnitines as well as 10/42 amino acids and biogenic amines were mainly increased in AS, whereas 29/90 glycerophospholipids and 6/15 sphingomyelins were mainly reduced. In the post-TAVR group, 10.1% (n = 19) of metabolites showed significant differences when compared to pre-TAVR. Moreover, we found nine metabolites revealing reversible concentration levels. Correlation with clinically important parameters revealed strong correlations between sphingomyelins and cholesterol (r = 0.847), acylcarnitines and brain natriuretic peptide (r = 0.664) and showed correlation of acylcarnitine with an improvement of left ventricular (LV) ejection fraction (r = − 0.513) and phosphatidylcholines with an improvement of LV mass (r = − 0.637). Conclusion Metabolic profiling identified significant and reversible changes in circulating metabolites of patients with AS. The correlation of circulating metabolites with clinical parameters supports the use of these data to identify novel diagnostic as well as prognostic markers for disease screening, pathophysiological studies as well as patient surveillance. Electronic supplementary material The online version of this article (10.1007/s00392-020-01754-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Daniela Haase
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Laura Bäz
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Tarek Bekfani
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Sophie Neugebauer
- Department of Clinical Chemistry and Laboratory Diagnostics, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Michael Kiehntopf
- Department of Clinical Chemistry and Laboratory Diagnostics, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Sven Möbius-Winkler
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Marcus Franz
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - P Christian Schulze
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany.
| |
Collapse
|
18
|
Hernandez-Vaquero D. Structural heart disease: the revolution. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:954. [PMID: 32953754 PMCID: PMC7475406 DOI: 10.21037/atm.2020.01.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel Hernandez-Vaquero
- Department of Cardiac Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Department of Phisiology, University of Oviedo, Oviedo, Spain
| |
Collapse
|
19
|
Gonzálvez-García A, Jiménez-Valero S, Jurado-Román A, Galeote G, Moreno R. Transcatheter Aortic Valve Implantation During COVID-19 Pandemic: The Device Also Matters. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 26:66-67. [PMID: 32921594 PMCID: PMC7834872 DOI: 10.1016/j.carrev.2020.08.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/27/2020] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Alfonso Jurado-Román
- Unit of Interventional Cardiology, Hospital La Paz, IdiPAZ, CIBER-CV, Madrid, Spain
| | - Guillermo Galeote
- Unit of Interventional Cardiology, Hospital La Paz, IdiPAZ, CIBER-CV, Madrid, Spain
| | - Raúl Moreno
- Unit of Interventional Cardiology, Hospital La Paz, IdiPAZ, CIBER-CV, Madrid, Spain.
| |
Collapse
|
20
|
Wiktorowicz A, Wit A, Dziewierz A, Rzeszutko L, Dudek D, Kleczynski P. Calcium Pattern Assessment in Patients with Severe Aortic Stenosis Via the Chou's 5-Steps Rule. Curr Pharm Des 2020; 25:3769-3775. [PMID: 31566130 DOI: 10.2174/1381612825666190930101258] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Progression of aortic valve calcifications (AVC) leads to aortic valve stenosis (AS). Importantly, the AVC degree has a great impact on AS progression, treatment selection and outcomes. Methods of AVC assessment do not provide accurate quantitative evaluation and analysis of calcium distribution and deposition in a repetitive manner. OBJECTIVE We aim to prepare a reliable tool for detailed AVC pattern analysis with quantitative parameters. METHODS We analyzed computed tomography (CT) scans of fifty patients with severe AS using a dedicated software based on MATLAB version R2017a (MathWorks, Natick, MA, USA) and ImageJ version 1.51 (NIH, USA) with the BoneJ plugin version 1.4.2 with a self-developed algorithm. RESULTS We listed unique parameters describing AVC and prepared 3D AVC models with color pointed calcium layer thickness in the stenotic aortic valve. These parameters were derived from CT-images in a semi-automated and repeatable manner. They were divided into morphometric, topological and textural parameters and may yield crucial information about the anatomy of the stenotic aortic valve. CONCLUSION In our study, we were able to obtain and define quantitative parameters for calcium assessment of the degenerated aortic valves. Whether the defined parameters are able to predict potential long-term outcomes after treatment, requires further investigation.
Collapse
Affiliation(s)
- Agata Wiktorowicz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Kopernika St. 17, Krakow, Poland
| | - Adrian Wit
- Faculty of Physics and Applied Computer Science, University of Science and Technology, Mickiewicza Ave. 30, 30-059 Krakow, Poland
| | - Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Kopernika St. 17, Krakow, Poland
| | - Lukasz Rzeszutko
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Kopernika St. 17, Krakow, Poland
| | - Dariusz Dudek
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Kopernika St. 17, Krakow, Poland
| | - Pawel Kleczynski
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Kopernika St. 17, Krakow, Poland
| |
Collapse
|
21
|
Mas-Peiro S, Fichtlscherer S, Walther C, Vasa-Nicotera M. Current issues in transcatheter aortic valve replacement. J Thorac Dis 2020; 12:1665-1680. [PMID: 32395310 PMCID: PMC7212163 DOI: 10.21037/jtd.2020.01.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aortic stenosis is the most common valvular disease worldwide. With transcatheter aortic valve replacement (TAVR) being increasingly expanded to lower-risk populations, several challenging issues remain to be solved. The present review aims at discussing modern approaches to such issues as well as the current status of TAVR. TAVR has undergone several developments in the recent years: an increased use of transfemoral access, the development of prostheses in order to adapt to challenging anatomies, improved delivery systems with repositioning features, and outer skirts aiming at reducing paravalvular leak. The indication of TAVR is increasingly being expanded to patients with lower surgical risk. The main clinical trials supporting such expansion are reviewed and the latest data on low-risk patients are discussed. A number of challenges need still to be addressed and are also reviewed in this paper: the need for updated international guidelines including the latest evidence; a reduction of main complications such as permanent pacemaker implantation, paravalvular leak, and stroke (and its potential prevention by using anti-embolic protection devices); the appropriate role of TAVR in patients with concomitant cardiac ischemic disease; and durability of bio-prosthetic implanted valves. Finally, the future perspectives for TAVR use and next device developments are discussed.
Collapse
Affiliation(s)
- Silvia Mas-Peiro
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Claudia Walther
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| |
Collapse
|