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Aktan A, Demir M, Güzel T, Karahan MZ, Aslan B, Kılıç R, Günlü S, Arslan B, Özbek M, Ertaş F. The Effect of Aortic Angulation on Clinical Outcomes of Patients Undergoing Transcatheter Aortic Valve Replacement. Braz J Cardiovasc Surg 2024; 39:e20220436. [PMID: 38426701 PMCID: PMC10903524 DOI: 10.21470/1678-9741-2022-0436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 08/21/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION The aim of this study was to assess the impact of aortic angulation (AA) on periprocedural and in-hospital complications as well as mortality of patients undergoing Evolut™ R valve implantation. METHODS A retrospective study was conducted on 264 patients who underwent transfemoral-approach transcatheter aortic valve replacement with self-expandable valve at our hospital between August 2015 and August 2022. These patients underwent multislice computer tomography scans to evaluate AA. Transcatheter aortic valve replacement endpoints, device success, and clinical events were assessed according to the definitions provided by the Valve Academic Research Consortium-3. Cumulative events included paravalvular leak, permanent pacemaker implantation, new-onset stroke, and in-hospital mortality. Patients were divided into two groups, AA ≤ 48° and AA > 48°, based on the mean AA measurement (48.3±8.8) on multislice computer tomography. RESULTS Multivariable logistic regression analysis was performed to identify predictors of cumulative events, utilizing variables with a P-value < 0.2 obtained from univariable logistic regression analysis, including AA, age, hypertension, chronic renal failure, and heart failure. AA (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 0.89-3.38, P=0.104), age (OR: 1.04, 95% CI: 0.99-1.10, P=0.099), hypertension (OR: 1.66, 95% CI: 0.82-3.33, P=0.155), chronic renal failure (OR: 1.82, 95% CI: 0.92-3.61, P=0.084), and heart failure (OR: 0.57, 95% CI: 0.27-1.21, P=0.145) were not found to be significantly associated with cumulative events in the multivariable logistic regression analysis. CONCLUSION This study demonstrated that increased AA does not have a significant impact on intraprocedural and periprocedural complications of patients with new generation self-expandable valves implanted.
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Affiliation(s)
- Adem Aktan
- Department of Cardiology, Mardin Training and Research Hospital,
Mardin, Turkey
| | - Muhammed Demir
- Department of Cardiology, Faculty of Medicine, Dicle University,
Diyarbakır, Turkey
| | - Tuncay Güzel
- Department of Cardiology, Health Science University, Gazi
Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | | | - Burhan Aslan
- Department of Cardiology, Health Science University, Gazi
Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Raif Kılıç
- Department of Cardiology, Diyarlife Hospital, Diyarbakır,
Turkey
| | - Serhat Günlü
- Department of Cardiology, Dağkapı State Hospital,
Diyarbakır, Turkey
| | - Bayram Arslan
- Department of Cardiology, Ergani State Hospital, Diyarbakır,
Turkey
| | - Mehmet Özbek
- Department of Cardiology, Faculty of Medicine, Dicle University,
Diyarbakır, Turkey
| | - Faruk Ertaş
- Department of Cardiology, Faculty of Medicine, Dicle University,
Diyarbakır, Turkey
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Kulkarni A, Arafat M, Hou L, Liang S, Kassotis J. Racial Disparity Among Patients Undergoing Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Replacement in the United States. Angiology 2023; 74:812-821. [PMID: 36426842 DOI: 10.1177/00033197221137025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive alternative to surgical aortic valve replacement (SAVR). However, racial disparities in the utilization of TAVR persist. This meta-analysis attempts to determine whether the prevalence of adverse outcomes (procedure-related complications) represent barriers to the use of TAVR among African Americans (AA). The TAVR cohort consisted of 89.6% Caucasian (C) and 4.7% AA, while the SAVR cohort included 86.9% C and 6.4% AA. The utilization rate (UR) of TAVR was 1.48 and .35 among C and AA, respectively, while the UR of SAVR was 1.44 and .48 among C and AA, respectively. Following TAVR, for AA the odds ratio (OR) was greater for stroke (OR = 1.22, P = .02) and transient ischemic attack (TIA) (OR = 1.57, P < .001) and lower for undergoing the insertion of a permanent pacemaker (OR = .81, P < .001). While there was a significant difference between C and AA in TAVR and SAVR utilization, outcomes between groups following TAVR are comparable; therefore, adverse outcomes do not appear to be a barrier to the use of TAVR among eligible AA.
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Affiliation(s)
- Abha Kulkarni
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Mohammod Arafat
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Linle Hou
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Shiochee Liang
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - John Kassotis
- Department of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Zhou D, Chen J, Fan J, Yidilisi A, Dai H, Xu Y, Zhu G, Guo Y, Wang J, Liu X. Self‐expanding transcatheter aortic valve replacement in patients with extremely horizontal aortas. Catheter Cardiovasc Interv 2022; 99 Suppl 1:1432-1439. [PMID: 35094487 DOI: 10.1002/ccd.30094] [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: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Dao Zhou
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Jun Chen
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Jiaqi Fan
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Abuduwufuer Yidilisi
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Hanyi Dai
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Yeming Xu
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Gangjie Zhu
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Yuchao Guo
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Jian'an Wang
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Xianbao Liu
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
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Medranda GA, Musallam A, Zhang C, Rappaport H, Gallino PE, Case BC, Satler LF, Ben-Dor I, Rogers T, Waksman R. The Impact of Aortic Angulation on Contemporary Transcatheter Aortic Valve Replacement Outcomes. JACC Cardiovasc Interv 2021; 14:1209-1215. [PMID: 34112456 DOI: 10.1016/j.jcin.2021.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of this study was to investigate whether the degree of aortic angulation (AA) affects outcomes after transcatheter aortic valve replacement (TAVR) using newer-generation transcatheter heart valves (THVs). BACKGROUND AA ≥48° has been reported to adversely influence accurate THV deployment, procedural success, fluoroscopy time, and paravalvular leak (PVL) in patients undergoing TAVR with early generation self-expanding (SE) THVs. METHODS A retrospective observational study was conducted among 841 patients across all risk strata who underwent transfemoral TAVR using the balloon-expandable (BE) SAPIEN 3 or the SE CoreValve Evolut PRO from 2015 to 2020. The previously published cutoff of 48° was used to analyze procedural success and in-hospital outcomes according to THV type. Receiver-operating characteristic analysis was performed to investigate the impact of AA on an in-hospital composite outcome (need for >1 THV, more than mild PVL, new permanent pacemaker implantation, stroke, and death). RESULTS AA ≥48° did not influence outcomes in patients with BE THVs. Additionally, AA ≥48° did not influence procedural success (99.1% vs. 99.1%; p = 0.980), number of THVs used (1.02 vs. 1.04; p = 0.484), rates of more than mild PVL (0.4% vs. 0%; p = 0.486), new permanent pacemaker implantation (11.8% vs. 17.1%; p = 0.178), in-hospital stroke (3.9% vs. 1.8%; p = 0.298), or in-hospital death (0.4% vs. 0.9%; p = 0.980) in patients with SE THVs. Receiver-operating characteristic analysis demonstrated similar outcomes irrespective of AA, with areas under the curve of 0.5525 for SE THVs and 0.5115 for BE THVs. CONCLUSIONS AA no longer plays a role with new-generation BE or SE THVs in contemporary TAVR practice. AA ≥48° did not affect procedural success or in-hospital outcomes and should no longer be a consideration when determining THV selection.
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Affiliation(s)
- Giorgio A Medranda
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA. https://twitter.com/GiorgioMedranda
| | - Anees Musallam
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hank Rappaport
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Paige E Gallino
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA. https://twitter.com/BCase07
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA. https://twitter.com/DorBen
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
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Kaneko U, Hachinohe D, Kobayashi K, Shitan H, Mitsube K, Furugen A, Kawamura T, Koshima R, Fujita T. Evolut Self-Expanding Transcatheter Aortic Valve Replacement in Patients with Extremely Horizontal Aorta (Aortic Root Angle ≥ 70°). Int Heart J 2020; 61:1059-1069. [PMID: 32921666 DOI: 10.1536/ihj.20-120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Because of its rigidity and non-steerability, the presence of a horizontal aortic root poses a major anatomical issue during transcatheter aortic valve replacement (TAVR) with Evolut self-expanding valve. Previous studies have elucidated the difficulties of coaxial implantation of the self-expanding valve in patients with horizontal aorta, often resulting in increased complications and a lower device success rate. To date, most patients with extremely horizontal aorta (aortic root angle ≥ 70°) have been excluded from major TAVR clinical trials. Therefore, available data on TAVR with Evolut in this challenging anatomy are limited, and standardized treatment strategies and clinical results remain unknown. Herein, we report a clinical case series of TAVR with Evolut in extremely horizontal aorta. Among seven patients (aged 80-92 years; STS score, 12.6% ± 7.9%) who underwent TAVR with Evolut system, aortic root angle ranged from 71° to 83° (mean, 75.1°± 4.5°). All patients achieved device success with dedicated strategies and were clinically stable at 3-month follow-up. None of the patients had more than mild paravalvular leakage (PVL) at any point during follow-up.Complications in three patients included complete atrioventricular block requiring a permanent pacemaker implantation, cerebral infarction because of atrial fibrillation 3 days after TAVR, and cardiac tamponade requiring pericardiocentesis. In this case series, Evolut self-expanding TAVR in extremely horizontal aorta was effective and feasible with a high device success rate. Based on anatomical features, some dedicated strategies majorly contribute to the success of this procedure. Large-scale multicenter studies are required to confirm our findings.
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Affiliation(s)
- Umihiko Kaneko
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Daisuke Hachinohe
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Ken Kobayashi
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Hidemasa Shitan
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Keijiro Mitsube
- Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Azusa Furugen
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Takeshi Kawamura
- Department of Anesthesiology, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Ryuji Koshima
- Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Tsutomu Fujita
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
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Veulemans V, Maier O, Bosbach G, Polzin A, Piayda K, Afzal S, Jung C, Westenfeld R, Kelm M, Zeus T. Novel insights on outcome in horizontal aorta with self‐expandable new‐generation transcatheter aortic valve replacement devices. Catheter Cardiovasc Interv 2020; 96:1511-1519. [DOI: 10.1002/ccd.28961] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/13/2020] [Accepted: 04/26/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine Heinrich Heine University, Medical Faculty Düsseldorf Germany
| | - Oliver Maier
- Division of Cardiology, Pulmonology and Vascular Medicine Heinrich Heine University, Medical Faculty Düsseldorf Germany
| | - Georg Bosbach
- Division of Cardiology, Pulmonology and Vascular Medicine Heinrich Heine University, Medical Faculty Düsseldorf Germany
| | - Amin Polzin
- Division of Cardiology, Pulmonology and Vascular Medicine Heinrich Heine University, Medical Faculty Düsseldorf Germany
| | - Kerstin Piayda
- Division of Cardiology, Pulmonology and Vascular Medicine Heinrich Heine University, Medical Faculty Düsseldorf Germany
| | - Shazia Afzal
- Division of Cardiology, Pulmonology and Vascular Medicine Heinrich Heine University, Medical Faculty Düsseldorf Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine Heinrich Heine University, Medical Faculty Düsseldorf Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine Heinrich Heine University, Medical Faculty Düsseldorf Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine Heinrich Heine University, Medical Faculty Düsseldorf Germany
- CARID (Cardiovascular Research Institute Düsseldorf) Heinrich Heine University, Medical Faculty, Düsseldorf Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine Heinrich Heine University, Medical Faculty Düsseldorf Germany
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