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Cafaro A, Rizzo F, Fischetti D, Quarta L, Mussardo M, Mandurino-Mirizzi A, Tondo A, Ciccone MM, Iacovelli F, Colonna G. Intracoronary Pacing during "Chimney Technique" in Transcatheter Aortic Valve-in-Valve Implantation: An Alternative Temporary Rapid Ventricular Stimulation? J Cardiovasc Dev Dis 2023; 10:341. [PMID: 37623354 PMCID: PMC10455771 DOI: 10.3390/jcdd10080341] [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: 06/13/2023] [Revised: 07/19/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
Temporary rapid ventricular pacing (TRVP) is required during transcatheter aortic valve implantation (TAVI) in order to reduce cardiac output and to facilitate balloon aortic valvuloplasty, prosthesis deployment, and post-deployment balloon dilation. The two most frequently used TRVP techniques are right endocardial (RE)-TRVP and retrograde left endocardial temporary rapid ventricular pacing (RLE)-TRVP. The first one could be responsible for cardiac tamponade, one of the most serious procedural complications during TAVI, while the second one could often be unsuccessful. Intracoronary (IC)-TRVP through a coronary guidewire has been described as a safe and efficient procedure that could avoid such complications. We describe two clinical cases in which IC-TRVP has been effectively used during valve-in-valve TAVI with coronary protection via the "chimney technique", after unsuccessful RLE-TRVP.
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Affiliation(s)
- Alessandro Cafaro
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Francesco Rizzo
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (M.M.C.); (F.I.)
| | - Dionigi Fischetti
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Luca Quarta
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Marco Mussardo
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Alessandro Mandurino-Mirizzi
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Antonio Tondo
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Marco Matteo Ciccone
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (M.M.C.); (F.I.)
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (M.M.C.); (F.I.)
- Division of Cardiology, “SS. Annunziata” Hospital, 74121 Taranto, Italy
| | - Giuseppe Colonna
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
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2
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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.
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Affiliation(s)
| | - Alexandru Achim
- Department of Cardiology, Medizinische Universitätsklinik, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
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3
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Haramati A, Latib A, Lazarus MS. Post-procedural structural heart CT imaging: TAVR, TMVR, and other interventions. Clin Imaging 2023; 101:86-95. [PMID: 37311399 DOI: 10.1016/j.clinimag.2023.05.012] [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: 03/20/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 06/15/2023]
Abstract
Transcatheter valve replacement has experienced substantial growth in the past decade and this technique can now be used for any of the four heart valves. Transcatheter aortic valve replacement (TAVR) has overtaken surgical aortic valve replacement. Transcatheter mitral valve replacement (TMVR) is often performed in pre-existing valves or after prior valve repair, although numerous devices are undergoing trials for replacement of native valves. Transcatheter tricuspid valve replacement (TTVR) is similarly under active development. Lastly, transcatheter pulmonic valve replacement (TPVR) is most often used for revision treatment of congenital heart disease. Given the growth of these techniques, radiologists are increasingly called upon to interpret post-procedural imaging for these patients, particularly with CT. These cases will often arise unexpectedly and require detailed knowledge of potential post-procedural appearances. We review both normal and abnormal post-procedural findings on CT. Certain complications-device migration or embolization, paravalvular leak, or leaflet thrombosis-can occur after replacement of any valve. Other complications are specific to each type of valve, including coronary artery occlusion after TAVR, coronary artery compression after TPVR, or left ventricular outflow tract obstruction after TMVR. Finally, we review access-related complications, which are of particular concern due to the requirement of large-bore catheters for these procedures.
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Affiliation(s)
- Adina Haramati
- Department of Radiology, New York-Presbyterian/Weill Cornell Medicine, 525 East 68(th) Street, New York, NY 10065, United States of America
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210(th) Street, Bronx, NY 10467, United States of America
| | - Matthew S Lazarus
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210(th) Street, Bronx, NY 10467, United States of America.
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4
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Prandi FR, Niv Granot Y, Margonato D, Belli M, Illuminato F, Vinayak M, Barillà F, Romeo F, Tang GHL, Sharma S, Kini A, Lerakis S. Coronary Obstruction during Valve-in-Valve Transcatheter Aortic Valve Replacement: Pre-Procedural Risk Evaluation, Intra-Procedural Monitoring, and Follow-Up. J Cardiovasc Dev Dis 2023; 10:jcdd10050187. [PMID: 37233154 DOI: 10.3390/jcdd10050187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is emerging as an effective treatment for patients with symptomatically failing bioprosthetic valves and a high prohibitive surgical risk; a longer life expectancy has led to a higher demand for these valve reinterventions due to the increased possibilities of outliving the bioprosthetic valve's durability. Coronary obstruction is the most feared complication of valve-in-valve (ViV) TAVR; it is a rare but life-threatening complication and occurs most frequently at the left coronary artery ostium. Accurate pre-procedural planning, mainly based on cardiac computed tomography, is crucial to determining the feasibility of a ViV TAVR and to assessing the anticipated risk of a coronary obstruction and the eventual need for coronary protection measures. Intraprocedurally, the aortic root and a selective coronary angiography are useful for evaluating the anatomic relationship between the aortic valve and coronary ostia; transesophageal echocardiographic real-time monitoring of the coronary flow with a color Doppler and pulsed-wave Doppler is a valuable tool that allows for a determination of real-time coronary patency and the detection of asymptomatic coronary obstructions. Because of the risk of developing a delayed coronary obstruction, the close postprocedural monitoring of patients at a high risk of developing coronary obstructions is advisable. CT simulations of ViV TAVR, 3D printing models, and fusion imaging represent the future directions that may help provide a personalized lifetime strategy and tailored approach for each patient, potentially minimizing complications and improving outcomes.
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Affiliation(s)
- Francesca Romana Prandi
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Yoav Niv Granot
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Davide Margonato
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Martina Belli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Federica Illuminato
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Manish Vinayak
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Francesco Barillà
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Francesco Romeo
- Faculty of Medicine, Unicamillus-Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Samin Sharma
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Annapoorna Kini
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Stamatios Lerakis
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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5
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Alomari I, Burstein S, Premyodhin N, Tooker M, Williams S, Abudayyeh I. Novel technique for high-risk coronary protection during implantation of transcatheter aortic valve implants. Future Cardiol 2023; 19:77-85. [PMID: 37078426 DOI: 10.2217/fca-2022-0046] [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: 04/21/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has become increasingly common as the indications expanded to include valve-in-valve (ViV) applications and a wider patient population with lower surgical risk. Intra-operative coronary arterial occlusion remains a significant source of morbidity, particularly in ViV applications or cases with high-risk anatomy. We present a novel technique for coronary artery protection utilizing a guide extension catheter to secure coronary access during valve deployment and a ViV case demonstration in a patient with prior surgical aortic valve replacement.
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Affiliation(s)
- Ihab Alomari
- University of California Irvine, 101 The City Dr S, Orange, CA 92868, USA
- Good Samaritan Medical Center, 1225 Wilshire Blvd, Los Angeles, CA 90017, USA
| | - Steven Burstein
- Good Samaritan Medical Center, 1225 Wilshire Blvd, Los Angeles, CA 90017, USA
| | - Ned Premyodhin
- University of California Irvine, 101 The City Dr S, Orange, CA 92868, USA
| | - Megan Tooker
- Loma Linda University, 11234 Anderson St, Loma Linda, CA 92354, USA
| | - Shammah Williams
- Loma Linda University, 11234 Anderson St, Loma Linda, CA 92354, USA
| | - Islam Abudayyeh
- Veterans Affairs Loma Linda Healthcare System, 11201 Benton St, Loma Linda, CA 92357, USA
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6
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Tully A, Tom S, Xie J, O'Brian C, Gleason P, Grubb KJ. Evolving computed tomography angiography for aortic valve replacement: Optimizing transcatheter and surgical therapies. J Card Surg 2022; 37:4124-4132. [PMID: 36168827 DOI: 10.1111/jocs.16977] [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: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 01/06/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis and pre-procedure planning relies heavily on advanced imaging. Multidetector computed tomography angiography, the "TAVR CT," facilitates essential planning steps of measuring the aortic root for valve sizing and feasibility and assessment of potential access vessels, making it the guideline gold standard in preprocedural TAVR work up. This Impact of Advanced Imaging Techniques on Cardiac Surgery article will examine the development of TAVR CT, illustrate the current impact and utility, and highlight potential areas of future growth. Clinicians who keep informed of these changes and can become proficient with TAVR CT analyses will offer patients the most optimal results and fuel future therapeutic growth.
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Affiliation(s)
- Andrew Tully
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA.,Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
| | - Stephanie Tom
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA.,Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Joe Xie
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Colin O'Brian
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Patrick Gleason
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA.,Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
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7
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Ahmad Y, Oakley L, Yoon S, Kaewkes D, Chakravarty T, Patel C, Palmerini T, Bruno AG, Saia F, Testa L, Bedogni F, Chieffo A, Montorfano M, Bartorelli AL, Porto I, Grube E, Nickenig G, Sinning JM, De Carlo M, Petronio AS, Barbanti M, Tamburino C, Iadanza A, Burzotta F, Trani C, Fraccaro C, Tarantini G, Aranzulla TC, Musumeci G, Stefanini GG, Taramasso M, Kim HS, Codner P, Kornowski R, Pelliccia F, Vignali L, Makkar RR. Transcatheter Aortic Valve Replacement in Patients at High Risk of Coronary Obstruction. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100347. [PMID: 39131939 PMCID: PMC11307859 DOI: 10.1016/j.jscai.2022.100347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/11/2022] [Accepted: 04/17/2022] [Indexed: 08/13/2024]
Abstract
Background Coronary obstruction following transcatheter aortic valve replacement (TAVR) is a life-threatening complication. For patients at elevated risk, it is not known how valve choice is influenced by clinical and anatomic factors and how outcomes differ between valve platforms. For patients at high risk of coronary obstruction, we sought to describe the anatomical and clinical characteristics of patients treated with both balloon-expandable (BE) and self-expanding (SE) valves. Methods This was a multicenter international registry of patients undergoing TAVR who are considered to be at high risk of coronary obstruction and receiving pre-emptive coronary protection. Results A total of 236 patients were included. Patients receiving SE valves were more likely to undergo valve-in-valve procedures and also had smaller sinuses of Valsalva and valve-to-coronary distance. Three-year cardiac mortality was 21.6% with SE vs 3.7% with BE valves. This was primarily driven by increased rates of definite or probable coronary occlusion, which occurred in 12.1% of patients with SE valves vs 2.1% in patients with BE valves. Conclusions In patients undergoing TAVR with coronary protection, those treated with SE valves had increased rates of clinical and anatomic features that increase the risk of coronary obstruction. These include an increased frequency of valve-in-valve procedures, smaller sinuses of Valsalva, and smaller valve-to-coronary distances. These patients were observed to have increased cardiac mortality compared with patients treated with BE valves, but this is likely due to their higher risk clinical and anatomic phenotypes rather than as a function of the valve type itself.
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Affiliation(s)
- Yousif Ahmad
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Luke Oakley
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sunghan Yoon
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Danon Kaewkes
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tarun Chakravarty
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chinar Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tullio Palmerini
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Antonio G. Bruno
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Francesco Saia
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Luca Testa
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Francesco Bedogni
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Italo Porto
- Cardiovascular Unit, Department of Internal Medicine and Specialties and IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Eberhard Grube
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | | | | | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Francesco Burzotta
- Department of Cardiology, Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Trani
- Department of Cardiology, Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | | | | | | | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | | | - Luigi Vignali
- UO Cardiologia, Azienda Ospedaliero–Universitaria di Parma, Parma, Italy
| | - Raj R. Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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8
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Aurigemma C, Burzotta F, Vergallo R, Farina P, Romagnoli E, Cangemi S, Bianchini F, Nesta M, Bruno P, D'Amario D, Leone AM, Trani C. Transcatether Aortic Valve Implantation to Treat Degenerated Surgical Bioprosthesis: Focus on the Specific Procedural Challenges. Front Cardiovasc Med 2022; 9:895477. [PMID: 35711347 PMCID: PMC9194080 DOI: 10.3389/fcvm.2022.895477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Actually transcatheter aortic valve implantation within failed surgically bioprosthetic valves (VIV-TAVI) is an established procedure in patients at high risk for repeat surgical aortic valve intervention. Although less invasive than surgical reintervention, VIV-TAVI procedure offers potential challenges, such as higher rates of prosthesis-patient mismatch and coronary obstruction. Thus, optimal procedural planning plays an important role to minimize the risk of procedure complications. In this review, we describe the key points of a VIV-TAVI procedure to optimize outcomes and reduce the risk of procedure complications.
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Affiliation(s)
- Cristina Aurigemma
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rocco Vergallo
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Farina
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Cangemi
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Bianchini
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marialisa Nesta
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piergiorgio Bruno
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico D'Amario
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Maria Leone
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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9
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1 Year Outcome of Chimney Snorkel Stunting Technique in Our TAVR Cohort. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Joshi U, Duvvuri P, Barzallo M, Mungee S. Acute Ostial Right Coronary Artery Occlusion During Valve Deployment of Transcatheter Aortic Valve Replacement Leading to Acute Right Ventricular Failure: A Perfect Storm and Successful Navigation. Cureus 2020; 12:e12373. [PMID: 33527054 PMCID: PMC7844881 DOI: 10.7759/cureus.12373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute coronary obstruction is a relatively rare complication of transcatheter aortic valve replacement (TAVR). Left coronary ostial obstruction is much more common compared to right coronary occlusion due to its relatively lower ostial height from the aortic annulus. We present a case of acute ostial right coronary occlusion immediately upon deployment of a 29-mm Sapien 3 transcatheter aortic valve. The acute right coronary ostial occlusion manifested with ventricular fibrillation, acute right ventricular failure, and right-sided cardiogenic shock. The patient, after undergoing an initial unsuccessful attempt at percutaneous revascularization, was placed on veno-arterial extracorporeal membrane oxygenation (VA-ECMO). This was later transitioned to percutaneous right atrial to pulmonary artery right ventricular support, which led to subsequent recovery.
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11
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Arshi A, Yakubov SJ, Stiver KL, Sanchez CE. Overcoming the transcatheter aortic valve replacement Achilles heel: coronary re-access. Ann Cardiothorac Surg 2020; 9:468-477. [PMID: 33312904 PMCID: PMC7724072 DOI: 10.21037/acs-2020-av-38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/09/2020] [Indexed: 01/30/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for the treatment of symptomatic severe aortic stenosis (AS). Coronary artery disease (CAD) is common in patients with severe AS. As the indications for TAVR extend to lower risk patients with longer life expectancy and as CAD is a progressive condition, coronary angiography will become increasingly common in patients who have had a previous TAVR. Coronary artery re-access after TAVR may be challenging but is possible in most cases. Commissural alignment of the prosthesis with the native coronary ostia plays an important role in successful coronary re-access. Coronary artery obstruction is a potentially devastating complication of TAVR, particularly in valve-in-valve procedures. In the present keynote lecture, we review techniques used to mitigate the risk of coronary obstruction, as well as catheter selection and strategies for selective coronary artery engagement for specific transcatheter aortic valve (TAV) bioprostheses.
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Affiliation(s)
- Arash Arshi
- OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Kevin L Stiver
- OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
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Use of Patient-Specific 3-Dimensional Printed Models for Planning a Valve-in-Valve Transcatheter Aortic Valve Replacement and Educating Health Personnel, Patients, and Families. Ochsner J 2020; 21:93-98. [PMID: 33828432 PMCID: PMC7993438 DOI: 10.31486/toj.19.0106] [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] [Indexed: 11/18/2022] Open
Abstract
Background: Aortic stenosis is a common disease of the elderly. Valve replacement with open surgery is the preferred therapy for many patients with low surgical risk. Bioprosthetic valve failure occurs in up to 66% of patients and has a worse prognosis when the mechanism of failure is stenosis compared to regurgitation. Case Report: An 80-year-old female with a medical history of surgical aortic valve replacement, diabetes, chronic back pain, coronary artery disease, and hypertension was referred to the interventional cardiology clinic for heart failure symptoms. A bioprosthetic valve placement that was small for the patient's size (effective orifice area/body surface area 0.75 cm2/m2) resulted in symptomatic improvement that lasted for 7 years. The patient underwent an aortic valve-in-valve transcatheter valve replacement with excellent outcomes. Preoperative planning involved a patient-specific 3-dimensional printed patient model. Conclusion: In patients at high surgical risk, transcatheter aortic valve replacement is a fundamental pillar of treatment. However, valve-in-valve procedures have specific anatomic challenges, such as the risk of coronary artery obstruction and the limitation of valve expansion inside a rigid bioprosthetic valve frame. In those difficult cases, interventional cardiologists must make precise decisions regarding the approach. Three-dimensional models can be printed with the patient's specific measurements. This approach represents truly personalized medicine and can serve as a tool for procedural planning, education of the health personnel involved in the case, and patient and family engagement.
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Laricchia A, Khokhar AA, Gallo F, Giannini F, Colombo A, Latib A, Mangieri A. Transcatheter aortic valve replacement: potential use in lower-risk aortic stenosis. Expert Rev Cardiovasc Ther 2020; 18:723-731. [PMID: 33021849 DOI: 10.1080/14779072.2020.1833717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The widespread use of transcatheter aortic valve implantation (TAVI) is expanding to low-risk patients. Nevertheless, a low clinical risk does not always correspond to a low procedural risk for the percutaneous approach. AREAS COVERED The initial trials on TAVI in low-risk populations had encouraging results, showing non-inferiority in comparison to surgical aortic valve replacement (SAVR). However, the low-risk definition is based on risk score calculators developed for the surgical setting and not including other specific features that are more relevant to TAVI and can affect procedural outcomes. For example, the presence of bicuspid aortic valves, high calcific burden, low coronary height or conduction disturbances is all potentially associated with suboptimal results or even procedural complications. In addition, the lack of longer follow-up prevents us to draw conclusions about long-term outcomes, including data about valve durability and coronary re-access. EXPERT OPINION Although current evidence suggest similar results for TAVI and SAVR in low-risk populations, there are some technical and procedural limitations that still need to be addressed in order to close the gap between TAVI and surgery. Optimal, lasting results with a low rate of procedural complications are highly expected in low-risk, otherwise healthy subjects, with potential for longevity.
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Affiliation(s)
- Alessandra Laricchia
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Arif A Khokhar
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Francesco Gallo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Francesco Giannini
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Antonio Colombo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center , Bronx, NY, USA
| | - Antonio Mangieri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
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Guide Extension-Assisted Stent Implantation at Ostial Right Coronary Artery Creating Stent Tunnel During Transcatheter Aortic Valve Replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:50-53. [PMID: 32473909 DOI: 10.1016/j.carrev.2020.04.022] [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: 03/19/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
Coronary artery occlusion is an uncommon but life-threatening complication of transcatheter aortic valve replacement (TAVR). Both low coronary artery height and externally mounted stented bioprosthesis present an increased risk for coronary artery occlusion, and various prevention strategies have been recommended. We present an 86-year-old woman with failed surgical bioprosthesis, concomitant obstructive ostial right coronary artery (RCA) lesion, and low coronary ostial heights who underwent simultaneous TAVR and percutaneous coronary intervention of ostial RCA. Due to suprannular valve expansion after post-dilation, the RCA ostium was compromised, and a novel stent tunnel was created under the native leaflets towards the left coronary sinus to maintain RCA perfusion.
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Valvo R, Costa G, Barbanti M. How to Avoid Coronary Occlusion During TAVR Valve-in-Valve Procedures. Front Cardiovasc Med 2019; 6:168. [PMID: 31803761 PMCID: PMC6877473 DOI: 10.3389/fcvm.2019.00168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/04/2019] [Indexed: 11/22/2022] Open
Abstract
Transcatheter aortic valve-in-valve replacement has been recently reported as a less-invasive alternative to re-do surgery in patients with bioprosthetic valve failure. Although procedural success is achieved in the great majority of patients, this therapy is associated with several potential complications, and coronary occlusion is one of the most feared. This is a rare event, but it is associated with an extremely poor prognosis. In this review, the mechanisms, the identification of patients at high risk, the primary prevention strategies, and treatment of coronary occlusion will be discussed.
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Affiliation(s)
- Roberto Valvo
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
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Nejjari M, Cacoub L, Digne F. [Management of non-rhythmic complications of TAVI procedures]. Ann Cardiol Angeiol (Paris) 2019; 68:439-442. [PMID: 31676032 DOI: 10.1016/j.ancard.2019.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 12/20/2022]
Abstract
Transcatheter aortic valve (TAVI) is the treatment of choice in patients with severe symptomatic aortic stenosis at high surgical risk. Recent data have also shown favorable results in patients considered to have an intermediate operative risk, which broadens the application of this new technology. Despite its success, the TAVI procedure has been associated with life-threatening complications. Advances in preoperative screening and patient selection have reduced the incidence of these complications. When these complications occur, early recognition and rapid management are essential. The purpose of this review is to describe non-rhythmic mechanical complications attributable to TAVI procedures with their predictive factors, how to prevent and manage them.
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Affiliation(s)
- M Nejjari
- Département d'hémodynamique, centre cardiologique du Nord, 32, rue des Moulins-Gémeaux, 93200 Saint-Denis, France.
| | - L Cacoub
- Département d'hémodynamique, centre cardiologique du Nord, 32, rue des Moulins-Gémeaux, 93200 Saint-Denis, France
| | - F Digne
- Département d'hémodynamique, centre cardiologique du Nord, 32, rue des Moulins-Gémeaux, 93200 Saint-Denis, France
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Dhamija Y, Kalra A, Puri R. Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement. JACC Case Rep 2019; 1:319-321. [PMID: 34316816 PMCID: PMC8288806 DOI: 10.1016/j.jaccas.2019.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Ankur Kalra
- Cleveland Clinic Akron General, Akron, Ohio
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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