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Vella C, Romano V, Di Maio S, Ancona MB, Castriota F, Vassileva A, Ferri L, Bellini B, Moroni F, Russo F, Ghizzoni G, Gentile D, Palmisano A, Agricola E, Esposito A, Chieffo A, Montorfano M. Valve-in-valve transcatheter aortic valve implantation: The issues behind crossing a bioprosthesis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 62:85-94. [PMID: 38160130 DOI: 10.1016/j.carrev.2023.12.015] [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: 11/10/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
Valve-in-valve transcatheter aortic valve implantation (ViV TAVI) is rapidly arising as a safe and effective alternative to redo-surgery in the treatment of bioprostheses deterioration. While scientific community is currently focusing its attention on the most common limitations related to this procedure, such as the risk of coronary obstruction and patient-prosthesis mismatch, data regarding the first step of a ViV TAVI, the crossing of a degenerated bioprosthesis, are still lacking. The aim of this review is to analyze the available information about bioprosthesis crossing, to show the inherent challenges encountered by interventional cardiologists during valve crossing and to describe the current strategies to perform a correct crossing.
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Affiliation(s)
- Ciro Vella
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Vittorio Romano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvana Di Maio
- Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fausto Castriota
- Interventional Cardiology Unit, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Luca Ferri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Moroni
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Ghizzoni
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Domitilla Gentile
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
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Merdler I, Rogers T, Case BC, Bhogal S, Reddy PK, Ben-Dor I, Zhang C, Satler LF, Weissman G, Waksman R. Aspirin Versus Warfarin after Transcatheter Aortic Valve Replacement in Low-Risk Patients: 2-Year Follow-Up. Am J Cardiol 2023; 206:108-115. [PMID: 37690148 DOI: 10.1016/j.amjcard.2023.08.076] [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: 07/14/2023] [Revised: 08/04/2023] [Accepted: 08/12/2023] [Indexed: 09/12/2023]
Abstract
Subclinical leaflet thrombosis occurs with transcatheter heart valves (THVs) and could be associated with structural valve deterioration. The current guidelines recommend the use of antiplatelet agents after transcatheter aortic valve replacement (TAVR) but not the routine use of oral anticoagulation. Our study examines the effects of short-term warfarin therapy on THV hemodynamics at 24 months after TAVR in low-risk patients. Low-risk patients who underwent TAVR were randomly allocated 1:1 to receive low-dose aspirin (n = 50) or low-dose aspirin plus warfarin (n = 44). After 30 days of treatment, ongoing medication regimens, including anticoagulation, were at the physicians' discretion. Follow-up after a period of 24 months was available for clinical and echocardiographic outcomes. At the 24-month mark, follow-up echocardiography of the randomly allocated patients revealed just 1 additional case of new structural valve deterioration in the aspirin group (compared with the occurrence within 30 days), based on the Valve Academic Research Consortium 3 definitions. There were also no differences in mean pressure gradients (11.5 ± 0.5 mm Hg vs 11.05 ± 4.0 mm Hg, p = 0.6) or peak velocity (2.2 ± 0.5 m/s vs 2.1 ± 0.4 m/s, p = 0.7) between the groups. A composite end point (mortality, stroke, and myocardial infarction) did not show any difference between the groups at long-term follow-up (p = 0.07). In conclusion, in low-risk patients who underwent TAVR, short-term anticoagulation with warfarin did not impact clinical outcomes or THV hemodynamics by echocardiography at 24 months.
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Affiliation(s)
- Ilan Merdler
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC; MedStar Heart & Vascular Institute, MedStar Georgetown University Hospital, Washington, DC
| | - Toby Rogers
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC; MedStar Heart & Vascular Institute, MedStar Georgetown University Hospital, Washington, DC; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Brian C Case
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC; MedStar Heart & Vascular Institute, MedStar Georgetown University Hospital, Washington, DC
| | - Sukhdeep Bhogal
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC; MedStar Heart & Vascular Institute, MedStar Georgetown University Hospital, Washington, DC
| | - Pavan K Reddy
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC; MedStar Heart & Vascular Institute, MedStar Georgetown University Hospital, Washington, DC
| | - Itsik Ben-Dor
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC; MedStar Heart & Vascular Institute, MedStar Georgetown University Hospital, Washington, DC
| | - Cheng Zhang
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC; MedStar Heart & Vascular Institute, MedStar Georgetown University Hospital, Washington, DC
| | - Lowell F Satler
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC; MedStar Heart & Vascular Institute, MedStar Georgetown University Hospital, Washington, DC
| | - Gaby Weissman
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC; MedStar Heart & Vascular Institute, MedStar Georgetown University Hospital, Washington, DC
| | - Ron Waksman
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC; MedStar Heart & Vascular Institute, MedStar Georgetown University Hospital, Washington, DC.
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Should young patients with aortic stenosis undergo transcatheter aortic valve replacement? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:160-161. [DOI: 10.1016/j.carrev.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022]
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