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Seshiah P, Choo J, Garcia S, Kereiakes DJ. Novel Lithotripsy-Assisted Transcatheter Aortic Valve Replacement May Reduce Risk of Aortic Root Rupture. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101111. [PMID: 39129883 PMCID: PMC11307767 DOI: 10.1016/j.jscai.2023.101111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/23/2023] [Accepted: 07/13/2023] [Indexed: 08/13/2024]
Abstract
Background Severe calcific aortic stenosis (AS) can be successfully treated with transcatheter aortic valve replacement (TAVR) using both balloon-expandable valves (BEV) and self-expanding valves. Challenges remain for treatment of AS with TAVR in relation to the severity of calcification involving valve leaflets, aortic annulus, and/or left ventricular outflow tract. Severe calcification presents challenges to TAVR with respect to aortic root/annular rupture and risk for peri-valve leak (PVL). Methods Three separate patients with symptomatic severe AS and severely calcified valves underwent TAVR with BEV. Case 1 underwent TAVR without preceding intravascular lithotripsy (IVL) of the native valve and developed annular rupture requiring surgical rescue. Following this experience, TAVR in 2 subsequent cases was preceded by Shockwave IVL using a novel 12-mm × 30-mm L6 balloon placed across the native valve prior to BEV implantation. Results Following IVL, cases 2 and 3 had uncomplicated TAVR with excellent valve frame expansion, and no significant residual gradient or PVL. Conclusions Severely calcified aortic valves increase the risk of aortic annular rupture and PVL following TAVR. IVL prior to TAVR may enhance leaflet/ annular compliance with the potential to improve the safety and effectiveness of TAVR.
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Affiliation(s)
- Puvi Seshiah
- The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
| | - Joseph Choo
- The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
| | - Santiago Garcia
- The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
| | - Dean J. Kereiakes
- The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
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De Marzo V, Viglino U, Zecchino S, Matos JG, Piredda E, Pigati M, Vercellino M, Crimi G, Balbi M, Seitun S, Porto I. Supra-renal aortic atheroma extent and composition predict acute kidney injury after transcatheter aortic valve replacement: A three-dimensional computed tomography study. Int J Cardiol 2023; 381:8-15. [PMID: 37001646 DOI: 10.1016/j.ijcard.2023.03.053] [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] [Received: 10/14/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE Acute kidney injury (AKI) may complicate transcatheter aortic valve replacement (TAVR) and could be linked to atheroembolization associated with catheter manipulation in the supra-renal (SR) aorta. We sought to determine the impact of SR aortic atheroma burden (SR-AAB) and composition, as well as of the aortic valve calcium score (AV-CS), measured at pre-operative multislice computed tomography (PO-MSCT), on AKI-TAVR. METHODS All TAVR-patients 3 January-2018 to December-2020 were included. A three-dimensional analysis of PO-MSCT was performed, calculating percentage SR-AAB (%SR-AAB) as [(absolute SR-AAB volume)*100/vessel volume]. Types of plaque were defined according to Hounsfield unit (HU) intensity ranges. Calcified plaque was subcategorized into 3 strata: low- (351-700 HU), mid- (701-1000 HU), and high‑calcium (>1000 HU, termed 1 K-plaque). RESULTS The study population included 222 patients [mean age 83.3 ± 5.7 years, 95 (42.8%) males], AKI-TAVR occurred in 67/222 (30.2%). Absolute SR-AAB (41.3 ± 16.4 cm3 vs. 32.5 ± 10.7 cm3,p < 0.001) and %SR-AAB (17.6 ± 5.1% vs. 13.9 ± 4.3%,p < 0.001) were significantly higher in patients developing AKI-TAVR. Patients who developed AKI-TAVR had higher mid‑calcium (6.9 ± 3.8% vs. 4.2 ± 3.5%,p < 0.001) and 1 K-plaque (5.4 ± 3.7% vs. 2.4 ± 2.4%,p < 0.001) with no difference in AV-CS (p = 0.691). Adjusted multivariable logistic regression analysis showed that %SR-AAB [OR (x%increase): 1.12, 95%CI: 1.04-1.22,p = 0.006] and %SR-calcified plaque [OR (x%increase): 5.60, 95%CI: 2.50-13.36,p < 0.001] were associated with AKI-TAVR. Finally, 3-knots spline analyses identified %SR-AAB >15.0% and %SR-calcified plaque >7.0% as optimal thresholds to predict an increased risk of AKI-TAVR. CONCLUSIONS Suprarenal aortic atheroma, when highly calcified, is associated with AKI-TAVR. Perioperative-MSCT assessment of aortic atherosclerosis may help in identification of patients at high-risk for AKI-TAVR, who could benefit from higher peri-operative surveillance.
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Affiliation(s)
- Vincenzo De Marzo
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy
| | - Umberto Viglino
- Radiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Zecchino
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy
| | - Joao Gavina Matos
- Radiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Piredda
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy
| | - Maria Pigati
- Radiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Vercellino
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy
| | - Gabriele Crimi
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy
| | - Manrico Balbi
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy; Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Seitun
- Radiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Italo Porto
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy; Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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Johal G, Jonnala V, Pourafkari L, Sedghi S, Jafarsis S, Fernandez S, Iyer V, Nader ND. Energy loss index as a predictor of all-cause mortality after transcatheter aortic valve replacement: A long-term follow-up. Echocardiography 2023; 40:327-334. [PMID: 36859692 DOI: 10.1111/echo.15545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/21/2023] [Accepted: 02/06/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND As transcatheter aortic valve replacement (TAVR) procedures become more widely available, there is a growing need to monitor and evaluate postoperative outcomes accurately. The energy loss index (ELI) of the ascending aorta has been commonly used to examine the agreement between the echocardiographic and Gorlin measurement of the aortic valve area. OBJECTIVES This project aims to demonstrate a link between ELI values and mortality following implanted TAVR valves and determine an ELI cutoff value associated with post-TAVR events. METHOD We retrospectively reviewed patients undergoing TAVR from 2012 to 2017. We calculated ELI values for patients immediately postoperative after a TAVR procedure. Using Receiver-Operator Characteristic and Cox Regression analyses, we identified a cutoff value to distinguish between "High ELI" (≥ 1.34) and "Low ELI" (< 1.34) patients. RESULTS This study showed low ELI (hazard ratio, 2.30; 95% confidence interval 1.57-3.36, p < .001) as representative of patients with a high risk of mortality post-TAVR. Additionally, post-TAVR, ejection fraction increased by 3.6% (p < .001), and the aortic valve effective orifice area increased by 1.41 cm squared (p < .001) while the mean transvalvular gradient decreased by 32.8 mmHg (p < .001) and the peak transvalvular gradient decreased by 49.0 mmHg (p < .001). CONCLUSION ELI is an additional prognostic factor that should be considered during risk assessment before TAVR. This study shows that patients with Low ELI had decreased cumulative survival post-TAVR. These patients almost had a fivefold increased risk of death following TAVR.
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Affiliation(s)
- Gurkaran Johal
- Department of Anaesthesiology, University at Buffalo, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Vinesh Jonnala
- Department of Medicine, Rutgers University Newark, New Jersey, USA
| | - Leili Pourafkari
- Department of Anaesthesiology, University at Buffalo, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Cardiac Imaging, The Lundquist Institute, Harbor-UCLA, Medical Center, Torrance, California, USA
| | - Siavash Sedghi
- Department of Anaesthesiology, University at Buffalo, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Samira Jafarsis
- Department of Anaesthesiology, University at Buffalo, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Department of Medicine, Division of Cardiology, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Stanley Fernandez
- Department of Medicine, Division of Cardiology, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Vijay Iyer
- Department of Medicine, Division of Cardiology, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Nader D Nader
- Department of Anaesthesiology, University at Buffalo, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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Patel PP, El Sabbagh A, Johnson PW, Suliman R, Salwa N, Morales-Lara AC, Pollak P, Yamani M, Parikh P, Sonavane SK, Landolfo C, Alkhouli MA, Eleid MF, Guerrero M, Fortuin FD, Sweeney J, Noseworthy PA, Carter RE, Adedinsewo D. Sex Differences in the Impact of Aortic Valve Calcium Score on Mortality After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Imaging 2022; 15:e014034. [PMID: 35920157 PMCID: PMC9397521 DOI: 10.1161/circimaging.122.014034] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is now an approved alternative to surgical aortic valve replacement for the treatment of severe aortic stenosis. As the clinical adoption of TAVR expands, it remains important to identify predictors of mortality after TAVR. We aimed to evaluate the impact of sex differences in aortic valve calcium score (AVCS) on long-term mortality following TAVR in a large patient sample. METHODS We included consecutive patients who successfully underwent TAVR for treatment of severe native aortic valve stenosis from June 2010 to May 2021 across all US Mayo Clinic sites with follow-up through July 2021. AVCS values were obtained from preoperative computed tomography of the chest. Additional clinical data were abstracted from medical records. Kaplan-Meier curves and Cox-proportional hazard regression models were employed to evaluate the effect of AVCS on long-term mortality. RESULTS A total of 2543 patients were evaluated in the final analysis. Forty-one percent were women, median age was 82 years (Q1: 76, Q3: 86), 18.4% received a permanent pacemaker following TAVR, and 88.5% received a balloon expandable valve. We demonstrate an increase in mortality risk with higher AVCS after multivariable adjustment (P<0.001). When stratified by sex, every 500-unit increase in AVCS was associated with a 7% increase in mortality risk among women (adjusted hazard ratio, 1.07 [95% CI, 1.02-1.12]) but not in men. CONCLUSIONS We demonstrate a notable sex difference in the association between AVCS and long-term mortality in a large TAVR patient sample. This study highlights the potential value of AVCS in preprocedural risk stratification, specifically among women undergoing TAVR. Additional studies are needed to validate this finding.
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Affiliation(s)
| | | | - Patrick W. Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Rayan Suliman
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Najiyah Salwa
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Peter Pollak
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Mohamad Yamani
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Pragnesh Parikh
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Carolyn Landolfo
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | | | | | - Mayra Guerrero
- Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - John Sweeney
- Division of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ
| | | | - Rickey E. Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
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Foley M, Hall K, Howard JP, Ahmad Y, Gandhi M, Mahboobani S, Okafor J, Rahman H, Hadjiloizou N, Ruparelia N, Mikhail G, Malik I, Kanaganayagam G, Sutaria N, Rana B, Ariff B, Barden E, Anderson J, Afoke J, Petraco R, Al-Lamee R, Sen S. Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100349. [PMID: 35992189 PMCID: PMC9337994 DOI: 10.1016/j.jscai.2022.100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/04/2022] [Accepted: 04/18/2022] [Indexed: 01/09/2023]
Abstract
Background Transcatheter aortic valve replacement (TAVR) is the treatment of choice for patients with severe aortic stenosis who are at a moderate or higher surgical risk. Stroke is a recognised and serious complication of TAVR, and it is important to identify patients at higher stroke risk. This study aims to discover if aortic valve calcium score calculated from pre-TAVR computed tomography is associated with acute stroke in TAVR patients. Methods We conducted a retrospective, observational cohort study of 433 consecutive patients undergoing TAVR between January 2017 and December 2019 at the Hammersmith Hospital. Results This cohort had a median age of 83 years (interquartile range, 78-87), and 52.7% were male. Fifty-two patients (12.0%) had a history of previous stroke or transient ischemic attack. Median aortic valve calcium score was 2145 (interquartile range, 1427-3247) Agatston units. Twenty-two patients had a stroke up to the time of discharge (5.1%). In a logistic regression model, aortic valve calcium score was significantly associated with acute stroke (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.01-1.53; P = .02). Acute stroke was also significantly associated with peripheral arterial disease (OR, 4.32; 95% CI, 1.65-10.65; P = .0018) and a longer procedure time (OR, 1.01; 95% CI, 1.00-1.02; P = .0006). Conclusions Aortic valve calcium score from pre-TAVR computed tomography is an independent risk factor for acute stroke in the TAVR population. This is an additional clinical value of the pre-TAVR aortic valve calcium score and should be considered when discussing periprocedural stroke risk.
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Affiliation(s)
- Michael Foley
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Kerry Hall
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - James P. Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Yousif Ahmad
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Manisha Gandhi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Samir Mahboobani
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Joseph Okafor
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Haseeb Rahman
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nearchos Hadjiloizou
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neil Ruparelia
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ghada Mikhail
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Iqbal Malik
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Gajen Kanaganayagam
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nilesh Sutaria
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Bushra Rana
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ben Ariff
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Edward Barden
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jonathan Anderson
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jonathan Afoke
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ricardo Petraco
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
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Moscarella E, Mangieri A, Giannini F, Tchetchè D, Kim WK, Sinning JM, Landes U, Kornowski R, De Backer O, Nickenig G, De Biase C, Søndergaard L, De Marco F, Bedogni F, Ancona M, Montorfano M, Regazzoli D, Stefanini G, Toggweiler S, Tamburino C, Immè S, Tarantini G, Sievert H, Schäfer U, Kempfert J, Wöehrle J, Latib A, Calabrò P, Medda M, Tespili M, Colombo A, Ielasi A. Annular size and interaction with trans-catheter aortic valves for treatment of severe bicuspid aortic valve stenosis: Insights from the BEAT registry. Int J Cardiol 2021; 349:31-38. [PMID: 34843819 DOI: 10.1016/j.ijcard.2021.11.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/15/2021] [Accepted: 11/24/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is safe and feasible in patients with bicuspid aortic valve (BAV), but whether annular size may influence TAVR results in BAV patients remains unclear. We aimed at evaluating the impact of aortic annular size on procedural and clinical outcomes of BAV patients undergoing TAVR, as well as potential interactions between annular dimension and trans-catheter heart valve (THV) type (balloon-expandable (BEV) vs. self-expanding (SEV). METHODS BEAT is a multicenter registry of consecutive BAV stenosis undergoing TAVR. For this sub-study patients were classified according to annular dimension in small-annulus (area < 400 mm2 or perimeter <72 mm), medium-annulus (area ≥ 400 and < 575 mm2, perimeter ≥72 mm and< 85 mm), large-annulus (area ≥ 575 mm2 or perimeter ≥85 mm). Primary endpoint was Valve Academic Research Consortium-2 (VARC-2) device success. RESULTS 45(15.5%) patients had small, 132(45.3%) medium, and 114(39.2%) large annuli. Compared with other groups, patients with large annuli were more frequently male, younger, with higher body mass index, larger aortic valve area, higher rate of moderate-severe calcification, lower mean trans-aortic valve gradient and lower left ventricular ejection fraction. In large-annuli SEVs were associated with a lower VARC-2 device success (75.9% vs. 90.6%, p = 0.049) driven by a higher rate of paravalvular valvular leak (PVL) compared to BEVs (20.7% vs. 1.2%, p < 0.001). However, no differences in clinical outcomes were observed according to annular size nor THV type. CONCLUSIONS TAVR in BAV patients is feasible irrespective of annular size. However in patients with large aortic annulus SEVs were associated with a significantly higher rate of PVLs compared to BEVs.
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Affiliation(s)
- Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Francesco Giannini
- Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
| | | | - Uri Landes
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ole De Backer
- The Heart Center-Rigshospitalet, Copenhagen, Denmark
| | - Georg Nickenig
- Cardiology Department, University Hospital Bonn, Bonn, Germany
| | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | | | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | | | - Corrado Tamburino
- Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy
| | | | | | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, United Kingdom
| | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, NY, United States of America; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Massimo Medda
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Antonio Colombo
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France; EMO GVM Centro Cuore Columbus, Milan, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy.
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7
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Chevance V, Valter R, Nouri MR, Sifaoui I, Moussafeur A, Lepeule R, Bergoend E, Mule S, Tacher V, Huguet R, Folliguet T, Canoui-Poitrine F, Lim P, Deux JF. Should We Quantify Valvular Calcifications on Cardiac CT in Patients with Infective Endocarditis? J Clin Med 2021; 10:4458. [PMID: 34640477 PMCID: PMC8509527 DOI: 10.3390/jcm10194458] [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: 09/06/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Evaluate the impact of valvular calcifications measured on cardiac computed tomography (CCT) in patients with infective endocarditis (IE). METHODS Seventy patients with native IE (36 aortic IE, 31 mitral IE, 3 bivalvular IE) were included and explored with CCT between January 2016 and April 2018. Mitral and aortic valvular calcium score (VCS) were measured on unenhanced calcium scoring images, and correlated with clinical, surgical data, and 1-year death rate. RESULTS VCS of patients with mitral IE and no peripheral embolism was higher than those with peripheral embolism (868 (25-1725) vs. 6 (0-95), p < 0.05). Patients with high calcified mitral IE (mitral VCS > 100; n = 15) had a lower rate of surgery (40.0% vs.78.9%; p = 0.03) and a higher 1-year-death risk (53.3% vs. 10.5%, p = 0.04; OR = 8.5 (2.75-16.40) than patients with low mitral VCS (n = 19). Patients with aortic IE and high aortic calcifications (aortic VCS > 100; n = 18) present more frequently atypical bacteria on blood cultures (33.3% vs. 4.8%; p = 0.03) than patients with low aortic VCS (n = 21). CONCLUSION The amount of valvular calcifications on CT was associated with embolism risk, rate of surgery and 1-year risk of death in patients with mitral IE, and germ's type in aortic IE raising the question of their systematic quantification in native IE.
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Affiliation(s)
- Virgile Chevance
- AP-HP, Hopital Henri Mondor, Service de Radiologie, IMRB, F-94010 Créteil, France; (M.R.N.); (I.S.); (S.M.); (V.T.); (J.-F.D.)
| | - Remi Valter
- AP-HP, Hopital Henri Mondor, Service de Santé Publique, IMRB, F-94010 Créteil, France; (R.V.); (F.C.-P.)
| | - Mohamed Refaat Nouri
- AP-HP, Hopital Henri Mondor, Service de Radiologie, IMRB, F-94010 Créteil, France; (M.R.N.); (I.S.); (S.M.); (V.T.); (J.-F.D.)
| | - Islem Sifaoui
- AP-HP, Hopital Henri Mondor, Service de Radiologie, IMRB, F-94010 Créteil, France; (M.R.N.); (I.S.); (S.M.); (V.T.); (J.-F.D.)
| | - Amina Moussafeur
- AP-HP, Hopital Henri Mondor, Service de Cardiologie, IMRB, F-94010 Créteil, France; (A.M.); (R.H.); (P.L.)
| | - Raphael Lepeule
- AP-HP, Hopital Henri Mondor, Département de Prévention, Diagnostic et Traitement des Infections, IMRB, F-94010 Créteil, France;
| | - Eric Bergoend
- Service de Chirurgie Cardiaque Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, F-94010 Créteil, France; (E.B.); (T.F.)
| | - Sebastien Mule
- AP-HP, Hopital Henri Mondor, Service de Radiologie, IMRB, F-94010 Créteil, France; (M.R.N.); (I.S.); (S.M.); (V.T.); (J.-F.D.)
| | - Vania Tacher
- AP-HP, Hopital Henri Mondor, Service de Radiologie, IMRB, F-94010 Créteil, France; (M.R.N.); (I.S.); (S.M.); (V.T.); (J.-F.D.)
- Unité INSERM U955 Team 18, IMRB, F-94010 Creteil, France
| | - Raphaelle Huguet
- AP-HP, Hopital Henri Mondor, Service de Cardiologie, IMRB, F-94010 Créteil, France; (A.M.); (R.H.); (P.L.)
| | - Thierry Folliguet
- Service de Chirurgie Cardiaque Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, F-94010 Créteil, France; (E.B.); (T.F.)
- Unité INSERM U955 Team 18, IMRB, F-94010 Creteil, France
| | - Florence Canoui-Poitrine
- AP-HP, Hopital Henri Mondor, Service de Santé Publique, IMRB, F-94010 Créteil, France; (R.V.); (F.C.-P.)
- Unité INSERM U955 Team 18, IMRB, F-94010 Creteil, France
- Clinical Epidemiology and Ageing Unit, Institute Mondor de Recherche Biomédicale, Paris-Est University, F-94000 Créteil, France
| | - Pascal Lim
- AP-HP, Hopital Henri Mondor, Service de Cardiologie, IMRB, F-94010 Créteil, France; (A.M.); (R.H.); (P.L.)
- Unité INSERM U955 Team 18, IMRB, F-94010 Creteil, France
| | - Jean-François Deux
- AP-HP, Hopital Henri Mondor, Service de Radiologie, IMRB, F-94010 Créteil, France; (M.R.N.); (I.S.); (S.M.); (V.T.); (J.-F.D.)
- Unité INSERM U955 Team 18, IMRB, F-94010 Creteil, France
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8
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Myasoedova VA, Di Minno A, Songia P, Massaiu I, Alfieri V, Valerio V, Moschetta D, Andreini D, Alamanni F, Pepi M, Trabattoni D, Poggio P. Sex-specific differences in age-related aortic valve calcium load: A systematic review and meta-analysis. Ageing Res Rev 2020; 61:101077. [PMID: 32334093 DOI: 10.1016/j.arr.2020.101077] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 11/28/2022]
Abstract
Aging of the aortic valve, characterized by leaflet thickening and loss of extensibility, leads to progressive changes in valve function. These age-related mechanisms have not been evaluated yet in sex-specific calcific aortic valve stenosis (CAVS) onset and progression. Recent studies reported the association between high aortic valve calcification (AVC) load and male gender in patients with CAVS while women present faster progression than men. To evaluate these age- and sex-specific differences, we performed a systematic review and meta-analysis with meta-regression. A systematic search related to AVC measured by computed tomography and gender-specific differences was conducted according to PRISMA guidelines. Seven studies, enrolling 1859 men and 1055 women, were included in the quantitative synthesis. We found a significant difference between men and women both in AVC load and density. AVC load mean difference (MD), between men and women, was 1131 ± 243 AU (p < 0.0001; I2: 96.5 %, p < 0.001), while AVC density MD was 159 ± 20 AU/cm2 (p < 0.0001) without heterogeneity among the studies (I2: 23.5, p = 0.3). Meta-regression analyses showed that AVC load MD positively correlated with age and other cardiovascular risk factors such as diabetes, hypertension, and coronary artery disease presence. Our meta-analysis shows a significant association of incremental AVC load with male gender, regardless of the individual anatomical characteristics and the cardiovascular risk factors. Further studies are needed: i) to clarify if there are different sex-related pathophysiological processes driving the development and the progression of age-related CAVS, and ii) to determine if a sex-specific therapeutic strategy should be applied for CAVS treatment and/or prevention.
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Affiliation(s)
| | - Alessandro Di Minno
- Università deli Studi di Napoli Federico II, Dipartimento di Farmacia, Napoli, Italy
| | | | | | | | - Vincenza Valerio
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Università deli Studi di Napoli Federico II, Dipartimento di Medicina Clinica e Chirurgia, Napoli, Italy
| | - Donato Moschetta
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Università degli Studi di Milano, Dipartimento di Scienze Farmacologiche e Biomolecolari, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Università degli Studi di Milano, Dipartimento di Scienze Cliniche e di Comunità, Milan, Italy
| | - Francesco Alamanni
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Università degli Studi di Milano, Dipartimento di Scienze Cliniche e di Comunità, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Paolo Poggio
- Centro Cardiologico Monzino IRCCS, Milan, Italy.
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9
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Milhorini Pio S, Bax J, Delgado V. How valvular calcification can affect the outcomes of transcatheter aortic valve implantation. Expert Rev Med Devices 2020; 17:773-784. [PMID: 32597265 DOI: 10.1080/17434440.2020.1789456] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction In transcatheter aortic valve implantation (TAVI), assessment of aortic valve calcification is not as standardized as aortic annulus measurement. Aortic valve calcification is important for stable anchoring of the prosthesis to the aortic annulus. However, excessive aortic valve calcification is related to procedural complications. Areas covered This review covers the methods to assess aortic valve calcification and the implications of aortic valve calcium burden for TAVI outcomes. We performed a systematic review of the literature in Pubmed and secondary sources. Furthermore, future perspectives on how to integrate aortic valve calcification assessment in the management of patients with aortic stenosis is discussed. Expert opinion Thorough assessment of the aortic valve and aortic root components including aortic valve calcification is key in the planning of TAVI. Aortic valve calcification load, location and extension are important contributors to paravalvular regurgitation. Asymmetric calcification burden with greater calcification of the left-coronary cusp related to higher need of permanent pacemaker implantation. Patients with moderate and severe left ventricular outflow tract/subannular calcification are more susceptible to aortic annular rupture. Periprocedural dislodgement of calcium form cusps and commissures is one of the main reasons of coronary artery ostial occlusion during transcatheter aortic valve implantation. Abbreviations Ao, aorta; LA, left atrium; LAA, left atrial appendage; LV, left ventricle; LVOT, left ventricular outflow tract; THV, transcatheter heart valve.
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Affiliation(s)
- Stephan Milhorini Pio
- Department of Cardiology, Leiden University Medical Center , Leiden, The Netherlands
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center , Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center , Leiden, The Netherlands
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