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Khan MZ, Brailovsky Y, Vishnevsky O(A, Baqi A, Patel K, Alvarez RJ. Clinical outcome of TAVR vs SAVR in patients with cardiac amyloidosis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:20-25. [DOI: 10.1016/j.carrev.2022.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022]
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2
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Kalogeras K, Jabbour RJ, Ruparelia N, Watson S, Kabir T, Naganuma T, Vavuranakis M, Nakamura S, Malik IS, Mikhail G, Dalby M, Panoulas V. Comparison of warfarin versus DOACs in patients with concomitant indication for oral anticoagulation undergoing TAVI; results from the ATLAS registry. J Thromb Thrombolysis 2019; 50:82-89. [DOI: 10.1007/s11239-019-01968-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Azevedo FS, Correa MG, Paula DHG, Felix ADS, Belém LHJ, Mendes APC, Silva VG, Marques BM, Monteiro AJDO, Weksler C, Colafranceschi AS, Kasal DAB. Transcatheter Aortic Valve Replacement: The Experience of One Brazilian Health Care Center. Braz J Cardiovasc Surg 2018; 33:1-7. [PMID: 29617494 PMCID: PMC5873770 DOI: 10.21470/1678-9741-2017-0117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 09/26/2017] [Indexed: 11/18/2022] Open
Abstract
Objective Transcatheter aortic valve replacement has been an alternative to invasive
treatment for symptomatic severe aortic stenosis in high risk patients. The
primary endpoint was 30-day and 1-year mortality from any cause. Secondary
endpoints were to compare the clinical and echocardiographic variation
pre-and post- transcatheter aortic valve replacement, and the occurrence of
complications throughout a 4-year follow-up period. Methods This prospective cohort, nestled to a multicenter study (Registro Brasileiro
de Implante de Bioprótese por Cateter), describes the experience of a
public tertiary center in transcatheter aortic valve replacement. All
patients who underwent this procedure between October 2011 and February 2016
were included. Results Fifty-eight patients underwent transcatheter aortic valve replacement. The
30-day all-cause mortality was 5.2% (n=3) and after 1 year was 17.2% (n=10).
A significant improvement in New York Heart Association functional
classification was observed when comparing pre-and post- transcatheter
aortic valve replacement (III or IV 84.4% versus 5.8%;
P<0.001). A decline in peak was observed
(P<0.001) and mean (P<0.001)
systolic transaortic gradient. The results of peak and mean post-implant
transaortic gradient were sustained after one year (P=0.29
and P=0.36, respectively). Left ventricular ejection
fraction did not change significantly during follow-up
(P=0.41). The most frequent complications were bleeding
(28.9%), the need for permanent pacemaker (27.6%) and acute renal injury
(20.6%). Conclusion Mortality and complications in this study were consistent with worldwide
experience. Transcatheter aortic valve replacement had positive clinical and
hemodynamic results, when comparing pre-and post-procedure, and the
hemodynamic profile of the prosthesis was sustained throughout
follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Clara Weksler
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brazil
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Haddad A, Arwani R, Altayar O, Sawas T, Murad MH, de Marchena E. Transcatheter aortic valve replacement in patients with pure native aortic valve regurgitation: A systematic review and meta-analysis. Clin Cardiol 2018; 42:159-166. [PMID: 30350358 DOI: 10.1002/clc.23103] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 12/29/2022] Open
Abstract
This systematic review and meta-analysis sought to summarize the available evidence on the use of transcatheter aortic valve replacement (TAVR) in patients with Native Aortic Valve Regurgitation (NAVR) and compare outcomes between first and second generation valves. Owing to the improvements in transcatheter heart valve design and procedural success, TAVR has become increasingly performed in broader aortic valve pathologies. We searched Medline, Embase, Cochrane, and Scopus databases from 2007 to 2018 and performed a systematic review on reports with at least 10 patients with aortic valve regurgitation undergoing TAVR procedure. The main outcome of interest was all-cause mortality at 30 days. A total of 638 patients across 12 studies were included. Mean age ranged from 68 to 84. Society of Thoracic Surgeons score ranged from 5.4% to 13.1% and Logistic EuroSCORE ranged from 18.2% to 33%. The incidence rate of all-cause mortality at 30 days was found to be 11% (95% CI 7%-16%; I2 = 20.86%). All-cause mortality at 30 days for first generation valves had an incidence rate of 15% (95% CI 10%-20%; I2 = 10%) compared to 7% (95% CI 3%-13%; I2 = 37%) in second generation valves with subgroup interaction analysis P = 0.059. Device success incidence rate in second generation valves was 92% (95% CI 83%-99%; I2 = 67%) vs 68% (95% CI 59%-77%; I2 = 53%) in first generation valves with P = 0.001. TAVR appears to be a feasible treatment choice for NAVR patients at high risk for surgical valve replacement. Second generation valves show promising results in terms of short-term outcomes.
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Affiliation(s)
- Abdullah Haddad
- Division of Cardiology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania. Harvard T.H Chan School of Public Health, Boston, Massachusetts
| | - Remy Arwani
- Ain Shams University-Faculty of Medicine, Cairo, Egypt
| | - Osama Altayar
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Tarek Sawas
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Eduardo de Marchena
- Division of Cardiology, University of Miami-Miller School of Medicine, Miami, Florida
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Real‐world comparison of the new 34 mm self‐expandable transcatheter aortic prosthesis Evolut R to its 31 mm core valve predecessor. Catheter Cardiovasc Interv 2018; 93:685-691. [DOI: 10.1002/ccd.27862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/02/2018] [Accepted: 08/12/2018] [Indexed: 11/07/2022]
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Yousef A, Hibbert B, Feder J, Bernick J, Russo J, MacDonald Z, Glover C, Dick A, Boodhwani M, Lam BK, Ruel M, Labinaz M, Burwash IG. A novel echocardiographic hemodynamic index for predicting outcome of aortic stenosis patients following transcatheter aortic valve replacement. PLoS One 2018; 13:e0195641. [PMID: 29698407 PMCID: PMC5919479 DOI: 10.1371/journal.pone.0195641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/26/2018] [Indexed: 11/29/2022] Open
Abstract
Objective Transcatheter aortic valve replacement (TAVR) reduces left ventricular (LV) afterload and improves prognosis in aortic stenosis (AS) patients. However, LV afterload consists of both valvular and arterial loads, and the benefits of TAVR may be attenuated if the arterial load dominates. We proposed a new hemodynamic index, the Relative Valve Load (RVL), a ratio of mean gradient (MG) and valvuloarterial impedance (Zva), to describe the relative contribution of the valvular load to the global LV load, and examined whether RVL predicted patient outcome following TAVR. Methods A total of 258 patients with symptomatic severe AS (indexed aortic valve area (AVA)<0.6cm2/m2, AR≤2+) underwent successful TAVR at the University of Ottawa Heart Institute and had clinical follow-up to 1-year post-TAVR. Pre-TAVR MG, AVA, percent stroke work loss (%SWL), Zva and RVL were measured by echocardiography. The primary endpoint was all cause mortality at 1-year post TAVR. Results There were 53 deaths (20.5%) at 1-year. RVL≤7.95ml/m2 had a sensitivity of 60.4% and specificity of 75.1% for identifying all cause mortality at 1-year post-TAVR and provided better specificity than MG<40 mmHg, AVA>0.75cm2, %SWL≤25% and Zva>5mmHg/ml/m2 despite equivalent or better sensitivity. In multivariable Cox analysis, RVL≤7.95ml/m2 was an independent predictor of all cause mortality (HR 3.2, CI 1.8–5.9; p<0.0001). RVL≤7.95ml/m2 was predictive of all cause mortality in both low flow and normal flow severe AS. Conclusions RVL is a strong predictor of all-cause mortality in severe AS patients undergoing TAVR. A pre-procedural RVL≤7.95ml/m2 identifies AS patients at increased risk of death despite TAVR and may assist with decision making on the benefits of TAVR.
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Affiliation(s)
- Altayyeb Yousef
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Joshua Feder
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jordan Bernick
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Juan Russo
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Zachary MacDonald
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher Glover
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alexander Dick
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Buu-Khanh Lam
- Division of Cardiac Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian G. Burwash
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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Yousef A, MacDonald Z, Simard T, Russo JJ, Feder J, Froeschl MV, Dick A, Glover C, Burwash IG, Latib A, Rodés-Cabau J, Labinaz M, Hibbert B. Transcatheter Aortic Valve Implantation (TAVI) for Native Aortic Valve Regurgitation - A Systematic Review. Circ J 2017; 82:895-902. [PMID: 29311499 DOI: 10.1253/circj.cj-17-0672] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has become the standard of care for management of high-risk patients with aortic stenosis. Limited data is available regarding the performance of TAVI in patients with native aortic valve regurgitation (NAVR).Methods and Results:We performed a systematic review from 2002 to 2016. The primary outcome was device success as per VARC-2 criteria. Secondary endpoints included procedural complications, and 30-day and 1-year mortality rates. A total of 175 patients were included from 31 studies. Device success was reported in 86.3% of patients - with device failure driven by moderate aortic regurgitation (AR ≥3+) and/or need for a second device. Procedural complications were rare, with no procedural deaths, myocardial infarctions or annular ruptures reported. Procedural safety was acceptable with a low 30-day incidence of stroke (1.5%). The 30-day and 1-year overall mortality rates were 9.6% and 20.0% (cardiovascular death, 3.8% and 10.1%, respectively). Patients receiving 2nd-generation valves demonstrated similar safety profiles with greater device success compared with 1st-generation valves (96.2% vs. 78.4%). This was driven by the higher incidence of second-valve implantation (23.4% vs. 1.7%) and significant paravalvular leak (8.3% vs. 0.0%). CONCLUSIONS TAVI demonstrates acceptable safety and efficacy in high-risk patients with severe NAVR. Second-generation valves may afford a similar safety profile with improved device success. Dedicated studies are needed to definitively establish the efficacy of TAVI in this population.
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Affiliation(s)
- Altayyeb Yousef
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute
| | - Zachary MacDonald
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute
| | - Trevor Simard
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute.,Department of Cellular and Molecular Medicine, University of Ottawa
| | - Juan J Russo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute
| | - Joshua Feder
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute
| | - Michael V Froeschl
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute
| | - Alexander Dick
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute
| | - Christopher Glover
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute
| | - Ian G Burwash
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute
| | | | - Marino Labinaz
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute.,Department of Cellular and Molecular Medicine, University of Ottawa
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Sud M, Tam DY, Wijeysundera HC. The Economics of Transcatheter Valve Interventions. Can J Cardiol 2017; 33:1091-1098. [DOI: 10.1016/j.cjca.2017.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 10/19/2022] Open
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Barker CM, Reardon MJ. Should TAVR Replace Surgery for Aortic Stenosis in Low- to Intermediate-Risk Patients? Can J Cardiol 2017; 33:1124-1128. [DOI: 10.1016/j.cjca.2017.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/23/2017] [Accepted: 06/23/2017] [Indexed: 11/16/2022] Open
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Successful Transcatheter Aortic Valve Implantation of a Low-Profile Last-Generation Aortic Bioprosthesis in a Patient With Coarctation of the Aorta. Can J Cardiol 2016; 32:1575.e5-1575.e7. [DOI: 10.1016/j.cjca.2016.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 01/17/2016] [Accepted: 01/18/2016] [Indexed: 11/20/2022] Open
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