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Kawamura A, Maeda K, Shimamura K, Yamashita K, Mukai T, Nakamura D, Mizote I, Sakata Y, Miyagawa S. Coronary access after repeat transcatheter aortic valve replacement in patients of small body size: A simulation study. J Thorac Cardiovasc Surg 2024; 168:76-85.e8. [PMID: 36604286 DOI: 10.1016/j.jtcvs.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/05/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Coronary artery access after repeat transcatheter aortic valve replacement (TAV-in-TAV) is reportedly more difficult because leaflet displacement of the first transcatheter heart valve (THV) impairs coronary cannulation; however, its effects in small patients are unknown. This study aimed to simulate coronary accessibility after TAV-in-TAV in patients of small body size. METHODS We retrospectively analyzed computed tomography scans after initial THV implantation and classified patients by THV and coronary artery location, valve-to-aorta distance, and valve-to-coronary distance. Risks were compared between the SAPIEN and CoreValve/Evolut series, among THV generations, and between bicuspid and tricuspid aortic valves in the CoreValve/Evolut series. RESULTS A total of 254 patients (SAPIEN series, n = 164; CoreValve/Evolut series, n = 90) were enrolled. The average body surface area of the patients was 1.44 m2. Patients were classified as "feasible" (26%), "theoretically feasible with low risk" (19.7%), "theoretically feasible with high risk" (8.7%), or "unfeasible" (45.8%). The "unfeasible" rate was significantly higher in the CoreValve/Evolut series than in the SAPIEN series (78.9% vs 26.2%; P < .001). A significantly higher "unfeasible" rate was identified in the current model of SAPIEN (SAPIEN, 8.3%; SAPIENXT, 1.8%; SAPIEN3, 48.2%; P < .001), but not in the CoreValve/Evolut series (CoreValve, 83.3%; Evolut R, 80.0%; Evolut PRO, 71.4%; P = .587). Patients with a bicuspid aortic valve had a lower "unfeasible" rate compared to those with a tricuspid aortic valve (60.0% vs 86.2%; P = .014). CONCLUSIONS Patients of small body size may have a high probability of "unfeasible" coronary access after TAV-in-TAV, especially when treated with current high-frame devices, suggesting the need for careful strategic planning for initial THV implantation.
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Affiliation(s)
- Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichi Maeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kizuku Yamashita
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Mukai
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Nakamura
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Isamu Mizote
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Lisi C, Catapano F, Brilli F, Scialò V, Corghi E, Figliozzi S, Cozzi OF, Monti L, Stefanini GG, Francone M. CT imaging post-TAVI: Murphy's first law in action-preparing to recognize the unexpected. Insights Imaging 2024; 15:157. [PMID: 38900378 PMCID: PMC11189851 DOI: 10.1186/s13244-024-01729-1] [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: 01/26/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Transfemoral aortic valve implantation (TAVI) has been long considered the standard of therapy for high-risk patients with severe aortic-stenosis and is now effectively employed in place of surgical aortic valve replacement also in intermediate-risk patients. The potential lasting consequences of minor complications, which might have limited impact on elderly patients, could be more noteworthy in the longer term when occurring in younger individuals. That's why a greater focus on early diagnosis, correct management, and prevention of post-procedural complications is key to achieve satisfactory results. ECG-triggered multidetector computed tomography angiography (CTA) is the mainstay imaging modality for pre-procedural planning of TAVI and is also used for post-interventional early detection of both acute and long-term complications. CTA allows detailed morphological analysis of the valve and its movement throughout the entire cardiac cycle. Moreover, stent position, coronary artery branches, and integrity of the aortic root can be precisely evaluated. Imaging reliability implies the correct technical setting of the computed tomography scan, knowledge of valve type, normal post-interventional findings, and awareness of classic and life-threatening complications after a TAVI procedure. This educational review discusses the main post-procedural complications of TAVI with a specific imaging focus, trying to clearly describe the technical aspects of CTA Imaging in post-TAVI and its clinical applications and challenges, with a final focus on future perspectives and emerging technologies. CRITICAL RELEVANCE STATEMENT: This review undertakes an analysis of the role computed tomography angiography (CTA) plays in the assessment of post-TAVI complications. Highlighting the educational issues related to the topic, empowers radiologists to refine their clinical approach, contributing to enhanced patient care. KEY POINTS: Prompt recognition of TAVI complications, ranging from value issues to death, is crucial. Adherence to recommended scanning protocols, and the optimization of tailored protocols, is essential. CTA is central in the diagnosis of TAVI complications and functions as a gatekeeper to treatment.
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Affiliation(s)
- Costanza Lisi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Federica Catapano
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy.
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy.
| | - Federica Brilli
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Vincenzo Scialò
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Eleonora Corghi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Stefano Figliozzi
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Ottavia Francesca Cozzi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Lorenzo Monti
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Giulio Giuseppe Stefanini
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
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Beneduce A, Khokhar AA, Curio J, Giannini F, Zlahoda-Huzior A, Grant D, Lynch L, Zakrzewski P, Kim WK, Maisano F, de Backer O, Dudek D. Impact of leaflet splitting on coronary access after redo-TAVI for degenerated supra-annular self-expanding platforms. EUROINTERVENTION 2024; 20:e770-e780. [PMID: 38887883 PMCID: PMC11163438 DOI: 10.4244/eij-d-24-00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/20/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Coronary access (CA) is a major concern in redo-transcatheter aortic valve implantation (TAVI) for failing supra-annular self-expanding transcatheter aortic valves (TAVs). AIMS This ex vivo study evaluated the benefit of leaflet splitting (LS) on subsequent CA after redo-TAVI in anatomies deemed at high risk of unfeasible CA. METHODS Ex vivo, patient-specific models were printed three-dimensionally. Index TAVI was performed using ACURATE neo2 or Evolut PRO (TAV-1) at the standard implant depth and with different degrees of commissural misalignment (CMA). Redo-TAVI was performed using the balloon-expandable SAPIEN 3 Ultra (TAV-2) at different implant depths with commissural alignment. Selective CA was attempted for each configuration before and after LS in a pulsatile flow simulator. The leaflet splay area was assessed on the bench. RESULTS In matched comparisons of 128 coronary cannulations across 64 redo-TAVI configurations, the overall feasibility of CA significantly increased after LS (60.9% vs 18.7%; p<0.001). The effect of LS varied according to the sinotubular junction height, TAV-1 design, TAV-1 CMA, and TAV-2 implant depth, given TAV-2 alignment. LS enabled CA for up to CMA 45° with the ACURATE neo2 TAV-1 and up to CMA 30° with the Evolut PRO TAV-1. The combination of LS and a low TAV-2 implant provided the highest feasibility of CA after redo-TAVI. The leaflet splay area ranged from 25.60 mm2 to 37.86 mm2 depending on the TAV-1 platform and TAV-2 implant depth. CONCLUSIONS In high-risk anatomies, LS significantly improves CA feasibility after redo-TAVI for degenerated supra-annular self-expanding platforms. Decisions on redo-TAVI feasibility should be carefully individualised, taking into account the expected benefit of LS on CA for each scenario.
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Affiliation(s)
| | - Arif A Khokhar
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Clinical Research Center Intercard, Kraków, Poland
| | - Jonathan Curio
- Department of Cardiology, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | | | - Adriana Zlahoda-Huzior
- Clinical Research Center Intercard, Kraków, Poland
- Department of Measurement and Electronics, AGH University of Science and Technology, Kraków, Poland
| | - Daire Grant
- Boston Scientific Corporation, Marlborough, MA, USA
| | - Lisa Lynch
- Boston Scientific Corporation, Marlborough, MA, USA
| | | | | | - Francesco Maisano
- Heart Valve Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ole de Backer
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dariusz Dudek
- Digital Medicine & Robotics Center, Jagiellonian University Medical College, Kraków, Poland
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
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Oks D, Reza S, Vázquez M, Houzeaux G, Kovarovic B, Samaniego C, Bluestein D. Effect of Sinotubular Junction Size on TAVR Leaflet Thrombosis: A Fluid-Structure Interaction Analysis. Ann Biomed Eng 2024; 52:719-733. [PMID: 38097896 DOI: 10.1007/s10439-023-03419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/03/2023] [Indexed: 12/26/2023]
Abstract
TAVR has emerged as a standard approach for treating severe aortic stenosis patients. However, it is associated with several clinical complications, including subclinical leaflet thrombosis characterized by Hypoattenuated Leaflet Thickening (HALT). A rigorous analysis of TAVR device thrombogenicity considering anatomical variations is essential for estimating this risk. Clinicians use the Sinotubular Junction (STJ) diameter for TAVR sizing, but there is a paucity of research on its influence on TAVR devices thrombogenicity. A Medtronic Evolut® TAVR device was deployed in three patient models with varying STJ diameters (26, 30, and 34 mm) to evaluate its impact on post-deployment hemodynamics and thrombogenicity, employing a novel computational framework combining prosthesis deployment and fluid-structure interaction analysis. The 30 mm STJ patient case exhibited the best hemodynamic performance: 5.94 mmHg mean transvalvular pressure gradient (TPG), 2.64 cm2 mean geometric orifice area (GOA), and the lowest mean residence time (TR)-indicating a reduced thrombogenic risk; 26 mm STJ exhibited a 10 % reduction in GOA and a 35% increase in mean TPG compared to the 30 mm STJ; 34 mm STJ depicted hemodynamics comparable to the 30 mm STJ, but with a 6% increase in TR and elevated platelet stress accumulation. A smaller STJ size impairs adequate expansion of the TAVR stent, which may lead to suboptimal hemodynamic performance. Conversely, a larger STJ size marginally enhances the hemodynamic performance but increases the risk of TAVR leaflet thrombosis. Such analysis can aid pre-procedural planning and minimize the risk of TAVR leaflet thrombosis.
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Affiliation(s)
- David Oks
- Barcelona Supercomputing Center, Computer Applications in Science and Engineering, Barcelona, Spain
| | - Symon Reza
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8084, USA
| | - Mariano Vázquez
- Barcelona Supercomputing Center, Computer Applications in Science and Engineering, Barcelona, Spain
- ELEM Biotech SL, Barcelona, Spain
| | - Guillaume Houzeaux
- Barcelona Supercomputing Center, Computer Applications in Science and Engineering, Barcelona, Spain
| | - Brandon Kovarovic
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8084, USA
| | - Cristóbal Samaniego
- Barcelona Supercomputing Center, Computer Applications in Science and Engineering, Barcelona, Spain
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8084, USA.
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Koshy AN, Tang GHL, Khera S, Vinayak M, Berdan M, Gudibendi S, Hooda A, Safi L, Lerakis S, Dangas GD, Sharma SK, Kini AS, Krishnamoorthy P. Redo-TAVR Feasibility After SAPIEN 3 Stratified by Implant Depth and Commissural Alignment: A CT Simulation Study. Circ Cardiovasc Interv 2024; 17:e013766. [PMID: 38502723 DOI: 10.1161/circinterventions.123.013766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/02/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Redo-transcatheter aortic valve replacement (TAVR) can pin the index transcatheter heart valve leaflets open leading to sinus sequestration and restricting coronary access. The impact of initial implant depth and commissural alignment on redo-TAVR feasibility is unclear. We sought to determine the feasibility of redo-TAVR and coronary access after SAPIEN 3 (S3) TAVR stratified by implant depth and commissural alignment. METHODS Consecutive patients with native valve aortic stenosis were evaluated using multidetector computed tomography. S3 TAVR simulations were done at 3 implant depths, sizing per manufacturer recommendation and assuming nominal expansion in all cases. Redo-TAVR was deemed unfeasible based on valve-to-sinotubular junction distance and valve-to-sinus height <2 mm, while the neoskirt plane of the S3 transcatheter heart valve estimated coronary access feasibility. RESULTS Overall, 1900 patients (mean age, 80.2±8 years; STS-PROM [Society of Thoracic Surgeons Predicted Risk of Operative Mortality], 3.4%) were included. Redo-TAVR feasibility reduced significantly at shallower initial S3 implant depths (2.3% at 80:20 versus 27.5% at 100:0, P<0.001). Larger S3 sizes reduced redo-TAVR feasibility, but only in patients with a 100:0 implant (P<0.001). Commissural alignment would render redo-TAVR feasible in all patients, assuming the utilization of leaflet modification techniques to reduce the neoskirt height. Coronary access following TAV-in-TAV was affected by both index S3 implant depth and size. CONCLUSIONS This study highlights the critical impact of implant depth, commissural alignment, and transcatheter heart valve size in predicting redo-TAVR feasibility. These findings highlight the necessity for individualized preprocedural planning, considering both immediate results and long-term prospects for reintervention as TAVR is increasingly utilized in younger patients with aortic stenosis.
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Affiliation(s)
- Anoop N Koshy
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
- Department of Cardiology, The Royal Melbourne Hospital, Australia (A.N.K.)
- Department of Cardiology and The University of Melbourne, Austin Health, Australia (A.N.K.)
| | - Gilbert H L Tang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York (G.H.L.T., M.B., S.G.)
| | - Sahil Khera
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
| | - Manish Vinayak
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
| | - Megan Berdan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York (G.H.L.T., M.B., S.G.)
| | - Sneha Gudibendi
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York (G.H.L.T., M.B., S.G.)
| | - Amit Hooda
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
| | - Lucy Safi
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
| | - Stamatios Lerakis
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
| | - Annapoorna S Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
| | - Parasuram Krishnamoorthy
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
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Vinayak M, Leone PP, Tanner R, Dhulipala V, Camaj A, Makhija RRK, Hooda A, Kini AS, Sharma SK, Khera S. Transcatheter Aortic Valve Replacement: Current Status and Future Indications. J Clin Med 2024; 13:373. [PMID: 38256506 PMCID: PMC10817053 DOI: 10.3390/jcm13020373] [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: 12/12/2023] [Revised: 12/31/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
In the past two decades, transcatheter aortic valve replacement (TAVR) has transformed the management of aortic stenosis and has become the standard of care regardless of surgical risk levels. Advances in transcatheter valve design across newer generations, improved imaging, greater operator expertise, and technical enhancements have collectively contributed to increased safety and a decline in procedural complications over this timeframe. The application of TAVR has progressively expanded to include younger patients with lower risks, who have longer life expectancies. This article offers an up-to-date review of the latest innovations in transcatheter delivery systems, devices, and its possible future indications.
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Affiliation(s)
- Manish Vinayak
- Mount Sinai Heart, Mount Sinai Hospital, New York, NY 10029, USA; (P.P.L.); (R.T.); (V.D.); (A.C.); (R.R.K.M.); (A.H.); (A.S.K.); (S.K.S.)
| | | | | | | | | | | | | | | | | | - Sahil Khera
- Mount Sinai Heart, Mount Sinai Hospital, New York, NY 10029, USA; (P.P.L.); (R.T.); (V.D.); (A.C.); (R.R.K.M.); (A.H.); (A.S.K.); (S.K.S.)
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Zivkovic M, Tomovic S, Busic I, Zivic K, Vukcevic V, Wojakowski W, Binder RK, Banovic M. Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement. Curr Probl Cardiol 2024; 49:102016. [PMID: 37544628 DOI: 10.1016/j.cpcardiol.2023.102016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
Extending the indication of transcatheter aortic valve replacement (TAVR) to younger and lower-risk patients naturally results in longer life expectancy and survival rates after the intervention. The longer life expectancy of these patients leads to an increased possibility of future acute coronary events, necessitating the development of effective and appropriate treatment strategies. Acute coronary syndromes (ACS) in patients with previous TAVR procedures present with modified clinical characteristics when compared to the non-TAVR population. In populations with prior TAVR procedures, plaque rupture remains the main cause of ACS. However, unlike the non-TAVR population, there is an increased frequency of nonatherotrombotic mechanisms, like emboli and mechanical obstruction of coronary ostia by valve components. The main observation related to the treatment of ACS TAVR patients is the significantly lower percentage of patients undergoing invasive management. Furthermore, ACS in TAVR patients is associated with poor prognosis, higher long-term mortality rates, and higher incidence of MACE. It is surprising that considering this significant and increasingly recognized issue, there are only a few studies that have investigated ACS after TAVR. The scope of the present review is to address available data about ACS following TAVR, focusing on incidence, timing, mechanism, and causes. We also examined current knowledge regarding optimal invasive treatment and analyzed short and long-term clinical outcomes.
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Affiliation(s)
- Milorad Zivkovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sara Tomovic
- Belgrade Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivan Busic
- Belgrade Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Katarina Zivic
- Belgrade Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Vladan Vukcevic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia; Belgrade Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Ronald K Binder
- Department of Internal Medicine II, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Marko Banovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia; Belgrade Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia.
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Liu X, Wang Y, Sheng Y, Han Y, Jing Q, Wang G, Liang Z, Li Y, Wang B, Xu K, Yang L, Mintz GS. Neo-Commissural Alignment by Withdrawing and Readvancing the Delivery System during Transcatheter Aortic Valve Replacement with Self-Expanding Prosthesis. J Interv Cardiol 2023; 2023:1060481. [PMID: 38116127 PMCID: PMC10728361 DOI: 10.1155/2023/1060481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/20/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023] Open
Abstract
Objective To investigate the feasibility of obtaining neo-commissural alignment by withdrawing and readvancing the delivery system during transcatheter aortic valve replacement (TAVR) with self-expanding prosthesis. Methods TAVR was performed in five patients with severe aortic valve stenosis by the femoral approach. The delivery catheter was withdrawn and readvanced with the opposite orientation when the Venus-A plus transcatheter heart valve (THV) centre marker was found to be overlapped with or close to the left marker at the aortic annulus level on the fluoroscopic image at the projection of the right and left coronary cusps superimposing. Neo-commissural alignment was evaluated by comparing the aortic computed tomography before TAVR with it after TAVR. Results The THV centre marker was overlapped with or close to the right marker at the aortic annulus level on the fluoroscopic image at the projection of the right and left coronary cusps superimposed in all the present five patients after withdrawing and readvancing the delivery system. The commissural angle deviation before vs. post TAVR was 12.3° ± 7.0°. Three of five patients had neo-commissural alignment. Two of the five patients had mild neo-commissural misalignment. Conclusions It is possible to obtain the neo-commissural alignment by controlling delivery catheter insertion orientation using the markers on the inflow of the Venus-A plus valve.
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Affiliation(s)
- Xian Liu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Yingdong Wang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Yuhe Sheng
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Quanmin Jing
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Geng Wang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Zhenyang Liang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Yang Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Bin Wang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Kai Xu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Li Yang
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, China
| | - Gary S. Mintz
- Cardiovascular Research Foundation, New York, NY, USA
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9
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Oks D, Reza S, Vázquez M, Houzeaux G, Kovarovic B, Samaniego C, Bluestein D. Effect of Sinotubular Junction Size on TAVR Leaflet Thrombosis: A Fluid-structure Interaction Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.13.23298476. [PMID: 38014278 PMCID: PMC10680880 DOI: 10.1101/2023.11.13.23298476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Purpose TAVR has emerged as a standard approach for treating severe aortic stenosis patients. However, it is associated with several clinical complications, including subclinical leaflet thrombosis characterized by Hypoattenuated Leaflet Thickening (HALT). A rigorous analysis of TAVR device thrombogenicity considering anatomical variations is essential for estimating this risk. Clinicians use the Sinotubular Junction (STJ) diameter for TAVR sizing, but there is a paucity of research on its influence on TAVR devices thrombogenicity. Methods A Medtronic Evolut® TAVR device was deployed in three patient models with varying STJ diameters (26, 30, and 34mm) to evaluate its impact on post-deployment hemodynamics and thrombogenicity, employing a novel computational framework combining prosthesis deployment and fluid- structure interaction analysis. Results The 30 mm STJ patient case exhibited the best hemodynamic performance: 5.94 mmHg mean transvalvular pressure gradient (TPG), 2.64 cm 2 mean geometric orifice area (GOA), and the lowest mean residence time (T R ) - indicating a reduced thrombogenic risk; 26 mm STJ exhibited a 10 % reduction in GOA and a 35% increase in mean TPG compared to the 30 mm STJ; 34 mm STJ depicted hemodynamics comparable to the 30 mm STJ, but with a 6% increase in T R and elevated platelet stress accumulation. Conclusion A smaller STJ size impairs adequate expansion of the TAVR stent, which may lead to suboptimal hemodynamic performance. Conversely, a larger STJ size marginally enhances the hemodynamic performance but increases the risk of TAVR leaflet thrombosis. Such analysis can aid pre- procedural planning and minimize the risk of TAVR leaflet thrombosis.
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10
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Faroux L, Villecourt A, Metz D. The Management of Coronary Artery Disease in TAVR Patients. J Clin Med 2023; 12:7126. [PMID: 38002738 PMCID: PMC10672348 DOI: 10.3390/jcm12227126] [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: 09/07/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
About half of the transcatheter aortic valve replacement (TAVR) recipients exhibit some degree of coronary artery disease (CAD), and controversial results have been reported regarding the impact of the presence and severity of CAD on clinical outcomes post-TAVR. In addition to coronary angiography, promising data has been recently reported on the use of both cardiac computed tomography angiography and the functional invasive assessment of coronary lesions whether by FFR or iFR in the work-up pre-TAVR. Despite mitigated available data, percutaneous revascularization of significant coronary lesions has been the routine strategy in TAVR candidates with CAD. Additionally, scarce data exists on the incidence, characteristics and management of coronary events post-TAVR, and increasing interest exists on the potential coronary access challenges in patients requiring coronary angiography/intervention post-TAVR. This review provides an updated overview of the knowledge of CAD in TAVR recipients, focusing on its prevalence, clinical impact, pre- and post-procedural evaluation and management.
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Affiliation(s)
- Laurent Faroux
- Cardiology Department, Reims University Hospital, 51100 Reims, France
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11
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Zaid S, Bapat VN, Sathananthan J, Landes U, De Backer O, Tarantini G, Grubb KJ, Kaneko T, Khalique OK, Jilaihawi H, Fukui M, Madhavan M, Cangut B, Harrington K, Thourani VH, Makkar RR, Leon MB, Mack MJ, Tang GHL. Challenges and Future Directions in Redo Aortic Valve Reintervention After Transcatheter Aortic Valve Replacement Failure. Circ Cardiovasc Interv 2023; 16:e012966. [PMID: 37988437 DOI: 10.1161/circinterventions.123.012966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is increasingly being performed in younger and lower surgical risk patients. Reintervention for failed transcatheter heart valves will likely increase in the future as younger patients are expected to outlive the initial bioprosthesis. While redo-TAVR has emerged as an attractive and less invasive alternative to surgical explantation (TAVR-explant) to treat transcatheter heart valve failure, it may not be feasible in all patients due to the risk of coronary obstruction and impaired coronary access. Conversely, TAVR-explant can be offered to most patients who are surgical candidates, but the reported outcomes have shown high mortality and morbidity. This review provides the latest evidence, current challenges, and future directions on redo-TAVR and TAVR-explant for transcatheter heart valve failure, to guide aortic valve reintervention and facilitate patients' lifetime management of aortic stenosis.
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Affiliation(s)
- Syed Zaid
- Division of Cardiology, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX (S.Z.)
| | - Vinayak N Bapat
- Cardiothoracic Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (V.N.B., M.F.)
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.S.)
| | - Uri Landes
- Department of Cardiology, Edith Wolfson Medical Center, Tel-Aviv University, Holon, Israel (U.L.)
| | - Ole De Backer
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark (O.D.B.)
| | | | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (K.J.G.)
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (T.K.)
| | - Omar K Khalique
- DeMatteis Cardiovascular Institute; Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY (O.K.K.)
| | - Hasan Jilaihawi
- Division of Cardiology, Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, CA (H.J., R.R.M.)
| | - Miho Fukui
- Cardiothoracic Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (V.N.B., M.F.)
| | - Mahesh Madhavan
- Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY (M.M, M.B.L.)
| | - Busra Cangut
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY (B.C., G.H.L.T.)
| | - Katherine Harrington
- Department of Cardiothoracic Surgery, Baylor, Scott and White the Heart Hospital, Plano, TX (K.H., M.J.M.)
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA (V.H.T.)
| | - Raj R Makkar
- Division of Cardiology, Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, CA (H.J., R.R.M.)
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY (M.M, M.B.L.)
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor, Scott and White the Heart Hospital, Plano, TX (K.H., M.J.M.)
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY (B.C., G.H.L.T.)
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12
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Sadat N, Lojenburg JH, Scharfschwerdt M, Fujta B, Ensminger S. Impact of different in vitro models on functional performance of the self-expanding transcatheter heart valve. Eur J Cardiothorac Surg 2023; 64:ezad333. [PMID: 37773993 DOI: 10.1093/ejcts/ezad333] [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: 05/04/2023] [Revised: 08/23/2023] [Accepted: 09/28/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVES Transcatheter heart valves (THVs) are investigated according to International Organization for Standardization requirements using in vitro heart simulators to evaluate hydrodynamic performance. In contrast to surgical valves, a THV's performance heavily depends on the configuration and shape of the aortic anulus. In International Organization for Standardization regulations, there is no detailed definition for the construction of a compartment in which a THV has to be tested. Therefore, the aim of this in vitro study was to compare different in vitro models for functional testing of THVs. METHODS Porcine aortic conduits (23-mm diameter) were implanted in Dacron prostheses and calcified with double-distilled water and calcification buffer at 37°C over 83 million cycles in a Hi-Cycler (durability testing) mimicking nearly 3 patient-years. Hydrodynamic testing of Evolut PRO 26 mm was performed within 3 models (plexiglass, native conduit and calcified conduit; all 23-mm diameter) at a frequency of 64 bpm and different stroke volumes (55-105 ml). RESULTS Calcified conduits showed significantly higher mean pressure gradients (MPG) and lower effective orifice areas (EOA) in comparison to native conduits (without THV; P < 0.001). EOA and MPG of Evolut PRO differed depending on the model tested. Calcified conduits resulted in the lowest EOA and highest MPG of the THV compared to plexiglass and the native conduit. Full expansion of the THV was least impaired in the native conduit, while lowest geometric orifice area, lowest minimal internal diameter and highest pin-wheeling index of Evolut PRO were seen in the calcified conduit. CONCLUSIONS Full expansion and functional performance of the Evolut PRO THV depends on the configuration of the testing compartment in an in vitro setting.
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Affiliation(s)
- Najla Sadat
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Luebeck, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Germany
| | - John Habakuk Lojenburg
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Buntaro Fujta
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Luebeck, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Luebeck, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Germany
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13
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Higami H, Saito H, Endo H, Matsuo H, Tsuchikane E. A case report of virtual reality-guided percutaneous coronary intervention for anomalous origin of right coronary artery chronic total occlusion. Eur Heart J Case Rep 2023; 7:ytad507. [PMID: 37900664 PMCID: PMC10606233 DOI: 10.1093/ehjcr/ytad507] [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: 03/23/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 10/31/2023]
Abstract
Background Engagement of the guiding catheter (GC) for the coronary artery is sometimes difficult, depending on the patient's anatomy. The most suitable GC before percutaneous coronary intervention (PCI) in individual cases has not been determined yet. Case summary An 81-year-old woman who had a right coronary artery chronic total occlusion had difficulty to engage the catheter for the right coronary artery in the first examination. Virtual reality (VR)-guided GC simulation before PCI using cardiac computed tomography (CT) could overcome the difficulty of GC engagement for the coronary artery and achieve procedure success. Discussion VR-guided GC simulation has the potential to solve the catheter approach difficulty for any cardiovascular intervention.
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Affiliation(s)
- Hirooki Higami
- Department of Cardiovascular Medicine, Gifu Heart Center, 4-14-4 Yabutaminami, Gifu city, Gifu 500-8384, Japan
| | - Hiroki Saito
- Department of Cardiovascular Medicine, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Hideaki Endo
- Department of Cardiovascular Medicine, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, 4-14-4 Yabutaminami, Gifu city, Gifu 500-8384, Japan
| | - Etsuo Tsuchikane
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
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14
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Kane J, Kearney KE, Lombardi WL, Azzalini L. Electrocautery-assisted re-entry to resolve bilateral aorto-ostial chronic total occlusions due to leaflet obstruction following transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2023; 102:489-494. [PMID: 37471714 DOI: 10.1002/ccd.30781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/26/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Abstract
Coronary artery obstruction is a rare but life-threatening complication of transcatheter aortic valve replacement (TAVR). While urgent percutaneous coronary intervention has been described in cases of acute occlusion, little is known about the interventional management of obstruction once it has occurred in the chronic setting. We describe a case in which electrocautery-assisted re-entry was successfully utilized to manage the right coronary artery and left main chronic total occlusion due to leaflet-induced coronary artery obstruction after TAVR.
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Affiliation(s)
- Jesse Kane
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Kathleen E Kearney
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - William L Lombardi
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Lorenzo Azzalini
- Division of Cardiology, University of Washington, Seattle, Washington, USA
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15
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Konami Y, Sakamoto T, Suzuyama H, Horio E, Yamaguchi J. Commissural alignment in the Evolut TAVR procedure: conventional versus hat marker-guided shaft rotation methods. ASIAINTERVENTION 2023; 9:156-165. [PMID: 37736211 PMCID: PMC10507608 DOI: 10.4244/aij-d-23-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/20/2023] [Indexed: 09/23/2023]
Abstract
Background Coronary cannulation after TAVR is sometimes difficult due to an overlap between native and neo-commissures, especially in Evolut devices with a supra-annular position. The Evolut C-tab corresponds to a neo-commissure, and the hat marker is in a fixed position. Therefore, the orientation of the hat marker can be adjusted to minimise overlaps. Aims We investigated whether the HAt marker-guided SHaft rotation method (HASH, stylised as the #rotation method) is effective in facilitating coronary artery access after transcatheter aortic valve replacement (TAVR) with an Evolut system. Methods We retrospectively analysed 95 patients who underwent electrocardiogram-gated cardiac computed tomography after TAVR. In the #rotation method, the hat marker of the delivery catheter was adjusted to face the greater curvature of the descending thoracic aorta in the left anterior oblique view. Its orientation was maintained while the system passed through the aortic arch. Results In total, 60 and 35 patients underwent TAVR with the #rotation and non-#rotation methods, respectively. A ±15° angle between the native and neo-commissures was more frequent in the #rotation group (p=0.001). Favourable angles and appropriate frame orientation for access to the left coronary artery were significantly more frequent in the #rotation group than in the non-#rotation group (p<0.001 and p=0.001). Although the #rotation method showed a higher rate of favourable angles and frames in the right coronary artery, statistically significant differences were not found. Conclusions The #rotation method is useful for improving commissural post alignment in TAVR with Evolut devices, especially in the ostium of the left coronary artery.
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Affiliation(s)
- Yutaka Konami
- Division of Cardiology, Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan
- Department of Cardiology, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Hiroto Suzuyama
- Division of Cardiology, Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Eiji Horio
- Division of Cardiology, Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
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Silva G, Silva M, Guerreiro C, Sampaio F, Pires-Morais G, Santos L, Melica B, Rodrigues A, Braga P, Fontes-Carvalho R. Coronary angiography and percutaneous coronary intervention after transcatheter aortic valve replacement: Feasibility in clinical practice. Rev Port Cardiol 2023; 42:749-756. [PMID: 36958581 DOI: 10.1016/j.repc.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/08/2022] [Accepted: 10/15/2022] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE Coronary artery disease is highly prevalent among patients with severe aortic stenosis who undergo transcatheter aortic valve replacement (TAVR). As indications for TAVR are now expanding to younger and lower-risk patients, the need for coronary angiography (CA) and percutaneous coronary intervention (PCI) during their lifetime is expected to increase. The objective of our study was to assess the need for CA and the feasibility of re-engaging the coronary ostia after TAVR. METHODS We performed a retrospective analysis of 853 consecutive patients undergoing TAVR between August 2007 and December 2020. Patients who needed CA after TAVR were selected. The primary endpoint was the rate of successful coronary ostia cannulation after TAVR. RESULTS Of a total of 31 CAs in 28 patients (3.5% of 810 patients analyzed: 57% male, age 77.8±7.0 years) performed after TAVR, 28 (90%) met the primary endpoint and in three cannulation was semi-selective. All failed selective coronary ostia cannulations occurred in patients with a self-expanding valve. Sixteen (52%) also had indication for PCI, which was successfully performed in all. The main indication for CA was non-ST-elevation acute coronary syndrome (35%, n=11). Two cases of primary PCI occurred without delay. There were no complications reported during or after the procedure. CONCLUSION Although CA was rarely needed in patients after TAVR, selective diagnostic CA was possible in the overwhelming majority of patients. PCI was performed successfully in all cases, without complications.
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Affiliation(s)
- Gualter Silva
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
| | - Mariana Silva
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Cláudio Guerreiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Francisco Sampaio
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Gustavo Pires-Morais
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Lino Santos
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Bruno Melica
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Alberto Rodrigues
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Pedro Braga
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
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Agricola E, Ancona F, Bartel T, Brochet E, Dweck M, Faletra F, Lancellotti P, Mahmoud-Elsayed H, Marsan NA, Maurovich-Hovart P, Monaghan M, Pontone G, Sade LE, Swaans M, Von Bardeleben RS, Wunderlich N, Zamorano JL, Popescu BA, Cosyns B, Donal E. Multimodality imaging for patient selection, procedural guidance, and follow-up of transcatheter interventions for structural heart disease: a consensus document of the EACVI Task Force on Interventional Cardiovascular Imaging: part 1: access routes, transcatheter aortic valve implantation, and transcatheter mitral valve interventions. Eur Heart J Cardiovasc Imaging 2023; 24:e209-e268. [PMID: 37283275 DOI: 10.1093/ehjci/jead096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 06/08/2023] Open
Abstract
Transcatheter therapies for the treatment of structural heart diseases (SHD) have expanded dramatically over the last years, thanks to the developments and improvements of devices and imaging techniques, along with the increasing expertise of operators. Imaging, in particular echocardiography, is pivotal during patient selection, procedural monitoring, and follow-up. The imaging assessment of patients undergoing transcatheter interventions places demands on imagers that differ from those of the routine evaluation of patients with SHD, and there is a need for specific expertise for those working in the cath lab. In the context of the current rapid developments and growing use of SHD therapies, this document intends to update the previous consensus document and address new advancements in interventional imaging for access routes and treatment of patients with aortic stenosis and regurgitation, and mitral stenosis and regurgitation.
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Affiliation(s)
- Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
- Vita-Salute San Raffaele University, via Olgettina 58, Milan 20132, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
| | - Thomas Bartel
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, 26th Street, Dubai, United Arab Emirates
| | - Eric Brochet
- Cardiology Department, Hopital Bichat, 46 rue Huchard, Paris 75018, France
| | - Marc Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Francesco Faletra
- Senior SHD Consultant Istituto Cardiocentro Via Tesserete 48, CH-6900 Lugano, Switzerland
- Senior Imaging Consultant ISMETT UPCM Hospital, Discesa dei Giudici, 4, 90133 Palermo, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, Domaine Universitaire du Sart Tilman, Liège B4000, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | | | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Leyla Elif Sade
- University of Pittsburgh-Heart & Vascular Institute UPMC, 200 Lothrop St Ste E354.2, Pıttsburgh, PA 15213, USA
- Cardiology Department, Baskent University, Ankara, Turkey
| | - Martin Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Nina Wunderlich
- Asklepios Klinik Langen Röntgenstrasse 20, Langen 63225, Germany
| | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila' -Euroecolab, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania
| | - Bernard Cosyns
- Cardiology Department, Centrum voor Hart en Vaatziekten (CHVZ), Universitair ziekenhuis Brussel, Brussels, Belgium
| | - Erwan Donal
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Universite´ de Rennes-1, Rennes, France
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Paz Rios LH, Salazar Adum JP, Barriga Guzman RC, Levisay JP, Ricciardi MJ. A Case of Valve-in-Valve-in-Valve for Severe Aortic Regurgitation: Is Lifetime Management Upon Us? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53S:S180-S183. [PMID: 35527219 DOI: 10.1016/j.carrev.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The incremental use of transcatheter aortic valve replacement will inexorably lead to structural valve deterioration and the need for both a second and third valvular interventions, raising the question of feasibility. CASE SUMMARY We present the case of a 76-year-old man that presented with cardiogenic shock refractory to inotropic support. His workup revealed severe bioprosthetic aortic regurgitation 5 years after undergoing transcatheter aortic valve-in-valve implantation. After confirming anatomical suitability with multimodality imaging, he underwent uncomplicated valve-in-valve-in-valve (ViViV) implantation of a 23 mm Edwards S3 Ultra valve with rapid clinical improvement. CONCLUSIONS Whether in the form of stenosis or severe regurgitation as in our patient, ViViV is feasible. Careful preprocedural planning and confirmation of anatomical suitability with multimodality imaging are key for success and safety.
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Affiliation(s)
- Luis H Paz Rios
- Corrigan Minehan Heart Center, Massachusetts General Hospital, United States of America
| | - Juan Pablo Salazar Adum
- Cardiovascular Division, Department of Medicine, NorthShore University Health System, Evanston, IL, United States of America
| | | | - Justin P Levisay
- Cardiovascular Division, Department of Medicine, NorthShore University Health System, Evanston, IL, United States of America
| | - Mark J Ricciardi
- Cardiovascular Division, Department of Medicine, NorthShore University Health System, Evanston, IL, United States of America.
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19
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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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20
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Belur AD, Solankhi N, Sharma R. Management of coronary artery disease in patients with aortic stenosis in the era of transcatheter aortic valve replacement. Front Cardiovasc Med 2023; 10:1139360. [PMID: 37408653 PMCID: PMC10318168 DOI: 10.3389/fcvm.2023.1139360] [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: 01/06/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Aortic stenosis (AS) is a common valve disorder among the elderly, and these patients frequently have concomitant coronary artery disease (CAD). Risk factors for calcific AS are similar to those for CAD. Historically, the treatment of these conditions involved simultaneous surgical replacement of the aortic valve (AV) with coronary artery bypass grafting. Since the advancement of transcatheter AV therapies, there have been tremendous advancements in the safety, efficacy, and feasibility of this procedure with expanding indications. This has led to a paradigm shift in our approach to the patient with AS and concomitant CAD. Data regarding the management of CAD in patients with AS are largely limited to single-center studies or retrospective analyses. This article aims to review available literature around the management of CAD in patients with AS and assist in the current understanding in approaches toward management.
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Affiliation(s)
- Agastya D. Belur
- Cardiovascular Disease Fellowship Program, University of Louisville School of Medicine, Louisville, KY, United States
| | - Naresh Solankhi
- Jewish Hospital Cardiology, University of Louisville Jewish Hospital, Louisville, KY, United States
| | - Ravi Sharma
- Jewish Hospital Cardiology, University of Louisville Jewish Hospital, Louisville, KY, United States
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21
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Tarantini G, Tang G, Nai Fovino L, Blackman D, Van Mieghem NM, Kim WK, Karam N, Carrilho-Ferreira P, Fournier S, Pręgowski J, Fraccaro C, Vincent F, Campante Teles R, Mylotte D, Wong I, Bieliauskas G, Czerny M, Bonaros N, Parolari A, Dudek D, Tchetche D, Eltchaninoff H, de Backer O, Stefanini G, Sondergaard L. Management of coronary artery disease in patients undergoing transcatheter aortic valve implantation. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions in collaboration with the ESC Working Group on Cardiovascular Surgery. EUROINTERVENTION 2023; 19:37-52. [PMID: 36811935 PMCID: PMC10174192 DOI: 10.4244/eij-d-22-00958] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/19/2023] [Indexed: 02/24/2023]
Abstract
Significant coronary artery disease (CAD) is a frequent finding in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), and the management of these two conditions becomes of particular importance with the extension of the procedure to younger and lower-risk patients. Yet, the preprocedural diagnostic evaluation and the indications for treatment of significant CAD in TAVI candidates remain a matter of debate. In this clinical consensus statement, a group of experts from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the European Society of Cardiology (ESC) Working Group on Cardiovascular Surgery aims to review the available evidence on the topic and proposes a rationale for the diagnostic evaluation and indications for percutaneous revascularisation of CAD in patients with severe aortic stenosis undergoing transcatheter treatment. Moreover, it also focuses on commissural alignment of transcatheter heart valves and coronary re-access after TAVI and redo-TAVI.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gilbert Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Daniel Blackman
- Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | | | | | - Nicole Karam
- Department of Cardiology, Hôpital Européen Georges-Pompidou, Paris, France
| | - Pedro Carrilho-Ferreira
- Serviço de Cardiologia, Hospital de Santa Maria, CHULN, and Centro de Cardiologia da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | | | | | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Flavien Vincent
- Division of Cardiology, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | | | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Ivan Wong
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gintautas Bieliauskas
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Martin Czerny
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Alessandro Parolari
- Department of Biomedical Sciences for Health, University of Milano, Milan, Italy and University Cardiac Surgery, Policlinico San Donato IRCCS, Milan, Italy
| | - Darius Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy
| | | | | | - Ole de Backer
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Lars Sondergaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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22
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Meduri CU, Rück A, Linder R, Verouhis D, Settergren M, Sorajja A, Daher D, Saleh N. Commissural Alignment With ACURATE neo2 Valve in an Unselected Population. JACC Cardiovasc Interv 2023; 16:670-677. [PMID: 36990556 DOI: 10.1016/j.jcin.2023.01.018] [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: 08/31/2022] [Revised: 12/08/2022] [Accepted: 01/10/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Commissural alignment has become an important topic in transcatheter aortic valve replacement (TAVR) because it may improve coronary access, facilitate future valve procedures, and possibly improve valve durability. The efficacy of commissural alignment with ACURATE neo2 has not yet been shown in a large population. OBJECTIVES The authors sought to determine the feasibility and success of attempting commissural alignment in an unselected TAVR population treated with the ACURATE neo2 prosthetic heart valve. METHODS A total of 170 consecutive patients underwent TAVR with a dedicated implantation technique to align the TAVR valve to the native valve. Using right-left overlap and 3-cusp views, valve orientation was adjusted by rotation of the unexpanded valve at the level of the aortic root. Effectiveness was assessed postprocedure as the degree of misalignment determined by analyzing fluoroscopic valve orientation to corresponding cusp orientation on preprocedural computed tomography. Safety endpoints included mortality, stroke/transient ischemic attack, and additional complications through 30 days. RESULTS Of 170 patients, 167 (98.2%) could be analyzed for alignment, and all 170, for safety outcomes. Most patients (97%) had successful alignment (≤ mild misalignment), with 80% with commissural alignment, while the degrees of misalignment were 17% mild, 1.2% moderate, 1.8% severe. CONCLUSIONS In this large evaluation of a commissural alignment technique, alignment was achieved in nearly all patients without safety concerns or impact to procedure duration. Commissural alignment appears effective and safe across all patients with this novel technique.
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Affiliation(s)
| | - Andreas Rück
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden. https://twitter.com/AndreasRck2
| | - Rickard Linder
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - Dinos Verouhis
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - Magnus Settergren
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - Amalin Sorajja
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - Daniel Daher
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - Nawzad Saleh
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
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23
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Beaupré F, Garot P. 3 Ways to Mitigate the Risk of Transcatheter Heart Valve Underexpansion and Dysfunction in Valve-in-Valve TAVR. JACC Cardiovasc Interv 2023; 16:527-529. [PMID: 36922037 DOI: 10.1016/j.jcin.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Frédéric Beaupré
- ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay-Santé, Massy, France.
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24
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Ogami T, Kliner DE, Toma C, Sanon S, Smith AJC, Serna-Gallegos D, Wang Y, Makani A, Doshi N, Brown JA, Yousef S, Sultan I. Acute Coronary Syndrome After Transcatheter Aortic Valve Implantation (Results from Over 40,000 Patients). Am J Cardiol 2023; 193:126-132. [PMID: 36905688 DOI: 10.1016/j.amjcard.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/28/2023] [Accepted: 02/06/2023] [Indexed: 03/13/2023]
Abstract
Acute coronary syndrome (ACS) encompasses a broad category of presentations from unstable angina to ST-elevation myocardial infarctions. Most patients undergo coronary angiography upon presentation for diagnosis and treatment. However, the ACS management strategy after transcatheter aortic valve implantation (TAVI) may be complicated because of challenging coronary access. The National Readmission Database was reviewed to identify all patients who were readmitted with ACS within 90 days after TAVI between 2012 and 2018. Their outcomes were described between patients who were readmitted with ACS (ACS group) and without (non-ACS group). A total of 44,653 patients were readmitted within 90 days after TAVI. Among them, 1,416 patients (3.2%) were readmitted with ACS. The ACS group had a higher prevalence of men, diabetes, hypertension, congestive heart failure, peripheral vascular disease, and a history of percutaneous coronary intervention (PCI). In the ACS group, 101 patients (7.1%) developed cardiogenic shock, whereas 120 patients (8.5%) developed ventricular arrhythmias. Overall, 141 patients (9.9%) in the ACS group died during readmissions (vs 3.0% in the non-ACS group, p <0.001). Among the ACS group, PCI was performed in 33 (5.9%), whereas coronary bypass grafting was performed in 12 (0.82%). The factors associated with ACS readmission included a history of diabetes, congestive heart failure, chronic kidney disease, and PCI, and nonelective TAVI. Coronary artery bypass grafting was an independent factor related to in-hospital mortality during ACS readmission (odds ratio 11.9, 95% confidence interval 2.18 to 65.4, p = 0.004), whereas PCI was not (odds ratio 0.19, 95% confidence interval 0.03 to 1.44, p = 0.11). In conclusion, patients readmitted with ACS have significantly higher mortality compared with those readmitted without ACS. History of PCI is an independent factor associated with ACS after TAVI.
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Affiliation(s)
- Takuya Ogami
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - Dustin E Kliner
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - Catalin Toma
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - Saurabh Sanon
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - Anson J Conrad Smith
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania; Department of Cardiothoracic Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yisi Wang
- Department of Cardiothoracic Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amber Makani
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - Nandini Doshi
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania; Department of Cardiothoracic Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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25
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Quagliana A, Montarello NJ, Willemen Y, Bække PS, Jørgensen TH, De Backer O, Sondergaard L. Commissural Alignment and Coronary Access after Transcatheter Aortic Valve Replacement. J Clin Med 2023; 12:jcm12062136. [PMID: 36983139 PMCID: PMC10056242 DOI: 10.3390/jcm12062136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVR) is the first therapeutic option for elderly patients with severe symptomatic aortic stenosis, and indications are steadily expanding to younger patients and subjects with lower surgical risk and longer life expectancy. Commissural alignment between native and transcatheter valves facilitates coronary access after TAVR and is thus considered a procedural goal, allowing long-term management of coronary artery disease. Moreover, commissural alignment may potentially have a positive impact on transvalvular hemodynamic and valve durability. This review focus on technical hints to achieve commissural alignment and current evidence for different transcatheter aortic valves.
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Affiliation(s)
- Angelo Quagliana
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
- Cardiocentro Ticino Institute—EOC, Universita’della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Nicholas J. Montarello
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Yannick Willemen
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Pernille S. Bække
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Troels H. Jørgensen
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
- Correspondence:
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26
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Prosthesis Tailoring for Patients Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2023; 12:jcm12010338. [PMID: 36615141 PMCID: PMC9821207 DOI: 10.3390/jcm12010338] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has risen over the past 20 years as a safe and effective alternative to surgical aortic valve replacement for treatment of severe aortic stenosis, and is now a well-established and recommended treatment option in suitable patients irrespective of predicted risk of mortality after surgery. Studies of numerous devices, either newly developed or reiterations of previous prostheses, have been accruing. We hereby review TAVI devices, with a focus on commercially available options, and aim to present a guide for prosthesis tailoring according to patient-related anatomical and clinical factors that may favor particular designs.
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27
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Tarantini G, Fabris T, Nai Fovino L, Cardaioli F, Pergola V, Montonati C, Rodinò G, Cabrelle G, Massussi M, Scotti A, Zuccarelli V, Sciarretta T, Masiero G, Gregori D, Napodano M, Fraccaro C, Continisio S, Iliceto S. Definition of trAnscatheter heart Valve orIeNtation in biCuspId aortic valve: The DA VINCI pilot study. Front Cardiovasc Med 2022; 9:1056496. [PMID: 36578836 PMCID: PMC9790995 DOI: 10.3389/fcvm.2022.1056496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives To assess the impact of conventional transcatheter heart valve (THV) commissural alignment techniques on THV/coronary overlap and coronary access (CA) after transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV). Background Specific Evolut Pro/Pro + and Acurate Neo2 THV orientations are associated with reduced neo-commissural overlap with coronary ostia in tricuspid aortic anatomy. Whether standard orientation techniques are effective also in the setting of BAV anatomy has not been studied. Methods The DA VINCI (Definition of trAnscatheter aortic Valve orIeNtation in biCuspId aortic valve) pilot study is a prospective registry enrolling consecutive patients with severe BAV stenosis undergoing TAVR with last generation supra-annular tall-frame THVs implanted with a cusp overlap view-based commissural alignment. Patients underwent pre- and post-TAVR computed tomography (CT) and coronary angiography. The study endpoint was the rate of favorable THV/coronary overlap, defined as an angle > 40° between the THV commissural post and coronary ostia. Other endpoints were the rates of successful THV alignment with respect to the raphe and of selective CA after TAVR. Moreover, different virtual THV alignment models were tested to identify which one would produce the lower degree of THV/coronary overlap. Results Thirty-four patients with type 1 BAV with right-left raphe undergoing TAVR (23 with Evolut Pro/Pro + and 11 with Acurate Neo2) were included. At pre-TAVR CT, moderate/severe cusp asymmetry was found in 50% of patients, severe coronary ostia eccentricity was observed in 47.1% for the RCA vs. 8.8% for the LCA (P < 0.007). Correct TVH orientation was achieved in 29 cases. At post-TAVR CT, optimal THV alignment/mild misalignment to the raphe was observed in 86.2%, but a moderate/severe overlap with the coronaries was seen in 13.7% for the RCA and 44.8% for the LCA (P = 0.019). After TAVR, selective RCA cannulation was possible in 82.8% vs. 75.9% for the LCA (P = 0.74), while combined selective CA of both coronaries was possible in less than two-thirds of the patients. Virtual THV alignment in the coronary ostia overlap view assuming a hypothetical circular THV expansion would produce an optimal THV/coronary overlap in almost 90% of cases. Conclusion Given cusp asymmetry and coronary ostia eccentricity of BAV combined with potential THV asymmetrical expansion, conventional commissural alignment techniques are associated with higher rates of THV misalignment and of moderate/severe neo-commissure overlap with the coronary ostia as compared to tricuspid aortic stenosis, resulting in lower rates of selective CA after TAVR. A modified THV orientation technique based on the coronary ostia overlap view might be preferable in BAV patients.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy,*Correspondence: Giuseppe Tarantini,
| | - Tommaso Fabris
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Valeria Pergola
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Carolina Montonati
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giulio Rodinò
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giulio Cabrelle
- Department of Medicine—DIMED, University of Padua, Padua, Italy
| | - Mauro Massussi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy,Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy,Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Vittorio Zuccarelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Tommaso Sciarretta
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, University of Padua, Padua, Italy
| | - Massimo Napodano
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Saverio Continisio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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28
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Guedeney P, Collet JP. [How to select the best device using pre-TAVR CT scan]. Ann Cardiol Angeiol (Paris) 2022; 71:407-412. [PMID: 36273953 DOI: 10.1016/j.ancard.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 09/23/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Transcatheter aortic valve replacement or TAVR has become the gold standard for the treatment of symptomatic and severe aortic valve stenosis in elderly patients. Although the role of computed tomography imaging was initially limited to the determination of the optimal vascular approach, it has progressively matured to become the pilar of TAVR work-up while being standardized by consensus conferences. The list of evaluated elements includes aortic annulus diameter, the optimal projection curve, the number of aortic leaflets, the severity and localization of calcifications, coronary ostial height, membranous septum length and aortic angulation. The proper and cautious evaluation of these elements may help evaluating the risk for the main periprocedural complications such as coronary obstruction, annular rupture, permanent pacemaker implantation or procedural failure and selecting the optimal transcatheter heart valve and its size, according to the patient's specific anatomy. In this review, we detail how the evaluation of these parameters may impact the selection of the transcatheter heart valve.
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Affiliation(s)
- Paul Guedeney
- Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), 47 boulevard de l'hôpital, 75013, Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), 47 boulevard de l'hôpital, 75013, Paris, France.
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29
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Feasibility of selective coronary angiography and percutaneous coronary intervention following self-expanding transcatheter aortic valve replacement: a systematic review and meta-analysis. Coron Artery Dis 2022; 33:678-681. [DOI: 10.1097/mca.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Personalised Treatment in Aortic Stenosis: A Patient-Tailored Transcatheter Aortic Valve Implantation Approach. J Cardiovasc Dev Dis 2022; 9:jcdd9110407. [PMID: 36421942 PMCID: PMC9694505 DOI: 10.3390/jcdd9110407] [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] [Received: 10/19/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVI) has become a game changer in the management of severe aortic stenosis shifting the concept from inoperable or high-risk patients to intermediate or low surgical-risk individuals. Among devices available nowadays, there is no clear evidence that one device is better than the other or that one device is suitable for all patients. The selection of the optimal TAVI valve for every patient represents a challenging process for clinicians, given a large number of currently available devices. Consequently, understanding the advantages and disadvantages of each valve and personalising the valve selection based on patient-specific clinical and anatomical characteristics is paramount. This review article aims to both analyse the available devices in the presence of specific clinical and anatomic features and offer guidance to select the most suitable valve for a given patient.
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Khokhar AA, Ponticelli F, Zlahoda-Huzior A, Zakrzewski P, Mikhail G, Dudek D, Giannini F. Coronary access techniques following ACURATE neo2 implantation in surgical bioprosthesis. EUROINTERVENTION 2022; 18:820-821. [PMID: 35708304 PMCID: PMC9725048 DOI: 10.4244/eij-d-22-00149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Arif A Khokhar
- Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Digital Innovations & Robotics Hub, Krakow, Poland
| | | | - Adriana Zlahoda-Huzior
- Digital Innovations & Robotics Hub, Krakow, Poland
- Department of Measurement & Electronics, AGH University of Science & Technology, Krakow, Poland
| | | | - Ghada Mikhail
- Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dariusz Dudek
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
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Russo G, Tang GHL, Sangiorgi G, Pedicino D, Enriquez-Sarano M, Maisano F, Taramasso M. Lifetime Management of Aortic Stenosis: Transcatheter Versus Surgical Treatment for Young and Low-Risk Patients. Circ Cardiovasc Interv 2022; 15:915-927. [PMID: 36378737 DOI: 10.1161/circinterventions.122.012388] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transcatheter aortic valve replacement is now indicated across all risk categories of patients with symptomatic severe aortic stenosis and has been proposed as first line option for the majority of patients >74 years old. However, median age of patients enrolled in the transcatheter aortic valve replacement low-risk trials is 74 years and transcatheter aortic valve replacement has never been systematically investigated in young low risk patients. Although the long-term data in surgical aortic valve replacement in young patients (age <75) are well known, such data remain lacking in transcatheter aortic valve replacement. In the absence of clear guideline recommendations in patients with challenging anatomies (eg, hostile calcium, bicuspid), it is important to know the potential advantages and disadvantages of each treatment and to consider how they might integrate with each other in the lifetime management of such patients. In this review, we discuss current outstanding issues on the management of severe aortic stenosis from a lifetime management perspective, particularly in terms of initial intervention and future reinterventions.
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Affiliation(s)
- Giulio Russo
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome (G.R., G.S.)
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York (G.H.L.T.)
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome (G.R., G.S.)
| | - Daniela Pedicino
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italia (D.P.).,Università Cattolica del Sacro Cuore, Roma, Italia (D.P.)
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Liu VY, Pawar A, Weissman JS, Kim DH. Clinical outcomes of cardiovascular procedures in older patients with dementia. J Am Geriatr Soc 2022; 70:3315-3317. [PMID: 35770876 PMCID: PMC9669092 DOI: 10.1111/jgs.17936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Victor Y. Liu
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ajinkya Pawar
- Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Joel S. Weissman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Dae Hyun Kim
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA
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Khokhar AA, Giannini F, Zlahoda‐Huzior A, Mikhail G, Dudek D. Coronary access after ACURATE neo2 implantation for valve-in-valve TAVR: Insights from ex vivo simulations. Catheter Cardiovasc Interv 2022; 100:662-666. [PMID: 36116020 PMCID: PMC9826017 DOI: 10.1002/ccd.30367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/10/2022] [Accepted: 08/04/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Arif A. Khokhar
- Department of CardiologyImperial College Healthcare NHS TrustLondonUK
- Digital Innovations & Robotics HubKrakowPoland
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & ResearchMaria Cecilia HospitalCotignolaItaly
| | - Adriana Zlahoda‐Huzior
- Digital Innovations & Robotics HubKrakowPoland
- Department of Measurement and ElectronicsAGH University of Science and TechnologyKrakowPoland
| | - Ghada Mikhail
- Department of CardiologyImperial College Healthcare NHS TrustLondonUK
| | - Dariusz Dudek
- Interventional Cardiology Unit, GVM Care & ResearchMaria Cecilia HospitalCotignolaItaly
- Institute of CardiologyJagiellonian University Medical CollegeKrakowPoland
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Saji M, Highchi R, Iguchi N, Takamisawa I, Shimizu J, Shimokawa T, Nanasato M, Takayama M, Isobe M. Combination Use of Inoue-Balloon and Self-Expandable Transcatheter Valves in Managing Aortic Stenosis Not Amenable to Balloon-Expandable Valves. Int Heart J 2022; 63:843-851. [DOI: 10.1536/ihj.22-220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Mike Saji
- Department of Cardiology, Sakakibara Heart Institute
| | | | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute
| | | | - Jun Shimizu
- Department of Anesthesiology, Sakakibara Heart Institute
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
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Khokhar AA, Ponticelli F, Zlahoda-Huzior A, Chandra K, Ruggiero R, Toselli M, Gallo F, Cereda A, Sticchi A, Laricchia A, Regazzoli D, Mangieri A, Reimers B, Biscaglia S, Tumscitz C, Campo G, Mikhail GW, Kim WK, Colombo A, Dudek D, Giannini F. Coronary access following ACURATE neo implantation for transcatheter aortic valve-in-valve implantation: Ex vivo analysis in patient-specific anatomies. Front Cardiovasc Med 2022; 9:902564. [PMID: 36187005 PMCID: PMC9515364 DOI: 10.3389/fcvm.2022.902564] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Coronary access after transcatheter aortic valve implantation (TAVI) with supra-annular self-expandable valves may be challenging or un-feasible. There is little data concerning coronary access following transcatheter aortic valve-in-valve implantation (ViV-TAVI) for degenerated surgical bioprosthesis. Aims To evaluate the feasibility and challenge of coronary access after ViV-TAVI with the supra-annular self-expandable ACURATE neo valve. Materials and methods Sixteen patients underwent ViV-TAVI with the ACURATE neo valve. Post-procedural computed tomography (CT) was used to create 3D-printed life-sized patient-specific models for bench-testing of coronary cannulation. Primary endpoint was feasibility of diagnostic angiography and PCI. Secondary endpoints included incidence of challenging cannulation for both diagnostic catheters (DC) and guiding catheters (GC). The association between challenging cannulations with aortic and transcatheter/surgical valve geometry was evaluated using pre and post-procedural CT scans. Results Diagnostic angiography and PCI were feasible for 97 and 95% of models respectively. All non-feasible procedures occurred in ostia that underwent prophylactic “chimney” stenting. DC cannulation was challenging in 17% of models and was associated with a narrower SoV width (30 vs. 35 mm, p < 0.01), STJ width (28 vs. 32 mm, p < 0.05) and shorter STJ height (15 vs. 17 mm, p < 0.05). GC cannulation was challenging in 23% of models and was associated with narrower STJ width (28 vs. 32 mm, p < 0.05), smaller transcatheter-to-coronary distance (5 vs. 9.2 mm, p < 0.05) and a worse coronary-commissural overlap angle (14.3° vs. 25.6o, p < 0.01). Advanced techniques to achieve GC cannulation were required in 22/64 (34%) of cases. Conclusion In this exploratory bench analysis, diagnostic angiography and PCI was feasible in almost all cases following ViV-TAVI with the ACURATE neo valve. Prophylactic coronary stenting, higher implantation, narrower aortic sinus dimensions and commissural misalignment were associated with an increased challenge of coronary cannulation.
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Affiliation(s)
- Arif A. Khokhar
- Department of Cardiology, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
- Digital Innovations and Robotics Hub, Kraków, Poland
- *Correspondence: Arif A. Khokhar,
| | - Francesco Ponticelli
- Gruppo Villa Maria (GVM) Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Adriana Zlahoda-Huzior
- Department of Measurement and Electronics, Akademia Gorniczo-Hutnicza (AGH) University of Science and Technology, Kraków, Poland
| | - Kailash Chandra
- Gruppo Villa Maria (GVM) Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Rossella Ruggiero
- Gruppo Villa Maria (GVM) Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Marco Toselli
- Gruppo Villa Maria (GVM) Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Gallo
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science, Ospedale dell’Angelo, Venice, Italy
| | - Alberto Cereda
- Department of Cardiology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alessandro Sticchi
- Invasive Cardiology Unit, Humanitas Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | | | - Damiano Regazzoli
- Invasive Cardiology Unit, Humanitas Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Antonio Mangieri
- Invasive Cardiology Unit, Humanitas Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Bernhard Reimers
- Invasive Cardiology Unit, Humanitas Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Simone Biscaglia
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Carlo Tumscitz
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Ghada W. Mikhail
- Department of Cardiology, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Antonio Colombo
- Invasive Cardiology Unit, Humanitas Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Dariusz Dudek
- Gruppo Villa Maria (GVM) Care and Research, Maria Cecilia Hospital, Cotignola, Italy
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Francesco Giannini
- Gruppo Villa Maria (GVM) Care and Research, Maria Cecilia Hospital, Cotignola, Italy
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Tang GHL, Amat-Santos IJ, De Backer O, Avvedimento M, Redondo A, Barbanti M, Costa G, Tchétché D, Eltchaninoff H, Kim WK, Zaid S, Tarantini G, Søndergaard L. Rationale, Definitions, Techniques, and Outcomes of Commissural Alignment in TAVR: From the ALIGN-TAVR Consortium. JACC Cardiovasc Interv 2022; 15:1497-1518. [PMID: 35926918 DOI: 10.1016/j.jcin.2022.06.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 10/16/2022]
Abstract
Given the expanding indications of transcatheter aortic valve replacement (TAVR) in younger patients with longer life expectancies, the ability to perform postprocedural coronary access represents a priority in their lifetime management. A growing body of evidence suggests that commissural (and perhaps coronary) alignment in TAVR impacts coronary access and valve hemodynamics as well as coronary flow and access after redo-TAVR. Recent studies have provided modified delivery system insertion and rotation techniques to obtain commissural alignment with available transcatheter heart valve devices. Moreover, patient-specific preprocedural planning and postprocedural imaging tools have been developed to facilitate and evaluate commissural alignment. Future efforts should aim to refine transcatheter heart valve and delivery system designs to make neocommissural alignment easier and more reproducible. The aim of this review is to present an in-depth insight of commissural alignment in TAVR, including its rationale, standardized definitions, technical steps, outcomes, and future directions.
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Affiliation(s)
- Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA.
| | | | - Ole De Backer
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Alfredo Redondo
- CIRBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Department of Cardiology, Hospital Clinico Universitario de Santiago de Compostela, A Coruna, Spain
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | | | | | | | - Syed Zaid
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Lars Søndergaard
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Meier D, Akodad M, Chatfield AG, Lutter G, Puehler T, Søndergaard L, Wood DA, Webb JG, Sellers SL, Sathananthan J. Impact of Commissural Misalignment on Hydrodynamic Function Following Valve-in-Valve Intervention With the ACURATE neo. JACC Cardiovasc Interv 2022; 15:1532-1539. [DOI: 10.1016/j.jcin.2022.05.034] [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: 03/22/2022] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 10/17/2022]
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Meier D, Akodad M, Landes U, Barlow AM, Chatfield AG, Lai A, Tzimas G, Tang GH, Puehler T, Lutter G, Leipsic JA, Søndergaard L, Wood DA, Webb JG, Sellers SL, Sathananthan J. Coronary Access Following Redo TAVR. JACC Cardiovasc Interv 2022; 15:1519-1531. [DOI: 10.1016/j.jcin.2022.05.005] [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: 03/02/2022] [Revised: 04/18/2022] [Accepted: 05/03/2022] [Indexed: 10/17/2022]
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Chiarito M, Spirito A, Nicolas J, Selberg A, Stefanini G, Colombo A, Reimers B, Kini A, Sharma SK, Dangas GD, Mehran R. Evolving Devices and Material in Transcatheter Aortic Valve Replacement: What to Use and for Whom. J Clin Med 2022; 11:jcm11154445. [PMID: 35956061 PMCID: PMC9369546 DOI: 10.3390/jcm11154445] [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] [Received: 06/05/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, providing a viable alternative to surgical aortic valve replacement (SAVR) for patients deemed to be at prohibitive surgical risk, but also for selected patients at intermediate or low surgical risk. Nonetheless, there still exist uncertainties regarding the optimal management of patients undergoing TAVR. The selection of the optimal bioprosthetic valve for each patient represents one of the most challenging dilemmas for clinicians, given the large number of currently available devices. Limited follow-up data from landmark clinical trials comparing TAVR with SAVR, coupled with the typically elderly and frail population of patients undergoing TAVR, has led to inconclusive data on valve durability. Recommendations about the use of one device over another in given each patient’s clinical and procedural characteristics are largely based on expert consensus. This review aims to evaluate the available evidence on the performance of different devices in the presence of specific clinical and anatomic features, with a focus on patient, procedural, and device features that have demonstrated a relevant impact on the risk of poor hemodynamic valve performance and adverse clinical events.
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Affiliation(s)
- Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; (M.C.); (J.N.); (A.S.); (A.S.); (A.K.); (S.K.S.); (G.D.D.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy; (G.S.); (A.C.); (B.R.)
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; (M.C.); (J.N.); (A.S.); (A.S.); (A.K.); (S.K.S.); (G.D.D.)
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; (M.C.); (J.N.); (A.S.); (A.S.); (A.K.); (S.K.S.); (G.D.D.)
| | - Alexandra Selberg
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; (M.C.); (J.N.); (A.S.); (A.S.); (A.K.); (S.K.S.); (G.D.D.)
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy; (G.S.); (A.C.); (B.R.)
- Istituti di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy; (G.S.); (A.C.); (B.R.)
- Istituti di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy; (G.S.); (A.C.); (B.R.)
- Istituti di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; (M.C.); (J.N.); (A.S.); (A.S.); (A.K.); (S.K.S.); (G.D.D.)
| | - Samin K. Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; (M.C.); (J.N.); (A.S.); (A.S.); (A.K.); (S.K.S.); (G.D.D.)
| | - George D. Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; (M.C.); (J.N.); (A.S.); (A.S.); (A.K.); (S.K.S.); (G.D.D.)
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; (M.C.); (J.N.); (A.S.); (A.S.); (A.K.); (S.K.S.); (G.D.D.)
- Correspondence: ; Tel.: +1-(212)-659-9649; Fax: +1-(646)-537-8547
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Chen F, Jia K, Li Y, Xiong T, Wang X, Zhu Z, Ou Y, Li X, Wei X, Zhao Z, Li Q, He S, Wei J, Peng Y, Feng Y, Chen M. Coronary access after transcatheter aortic valve replacement in bicuspid versus tricuspid aortic stenosis. EUROINTERVENTION 2022; 18:203-212. [PMID: 35236643 PMCID: PMC9912966 DOI: 10.4244/eij-d-21-00970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND It is unknown whether there are differences in coronary access after transcatheter aortic valve replacement (TAVR) between bicuspid and tricuspid anatomy. AIMS Our aim was to investigate coronary access after TAVR using a self-expanding transcatheter heart valve (THV) in bicuspid versus tricuspid aortic valves (BAV vs TAV), based on CT simulation. METHODS A total of 86 type 0 BAV, 70 type 1 BAV, and 132 TAV patients were included. If the coronary ostium faced the sealed parts of the THV or the tilted-up native leaflet (NL), this was defined as THV- or NL-related challenging coronary access, respectively. If coaxial engagement was not allowed due to interference from the unwrapped frame, THV-related complex coronary access was defined. RESULTS The incidence of THV-related challenging coronary access was 21.2% for the left coronary artery (LCA) and 17.7% for the right coronary artery (RCA), and type 0 BAV patients encountered fewer THV-related challenging LCA access than their TAV counterparts (OR 0.42, 95% CI: 0.20-0.89). NL-related challenging coronary access was observed in 3.1% for LCA and 1.4% for RCA, and THV-related complex coronary access was identified in 5.9% for LCA and 17.0% for RCA; however, no significant differences were found among groups. The proportion of optimal fluoroscopic viewing angles suitable for guiding LCA engagement was similar among groups (64.0% vs 70.0% vs 62.1%), but those suitable for guiding RCA engagement were significantly higher in the type 0 BAV group (31.4% vs 4.3% vs 9.1%). CONCLUSIONS Coronary access may be challenging or complex in a significant proportion of both BAV and TAV patients after TAVR. Type 0 BAV anatomy may be more favourable for post-TAVR coronary access.
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Affiliation(s)
- Fei Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kaiyu Jia
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yijian Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Tianyuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongkai Zhu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanweixiang Ou
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhengang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Sen He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiafu Wei
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu 610041, PR China
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Tang GHL, Zaid S. Commissural (Mis)Alignment in TAVR and Hemodynamic Impact: More Questions Raised Than Answered. JACC Cardiovasc Interv 2022; 15:1137-1139. [PMID: 35680193 DOI: 10.1016/j.jcin.2022.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA.
| | - Syed Zaid
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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Evolving Indications of Transcatheter Aortic Valve Replacement—Where Are We Now, and Where Are We Going. J Clin Med 2022; 11:jcm11113090. [PMID: 35683476 PMCID: PMC9180932 DOI: 10.3390/jcm11113090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/04/2022] [Accepted: 05/27/2022] [Indexed: 01/14/2023] Open
Abstract
Indications for transcatheter aortic valve replacement (TAVR) have steadily increased over the last decade since the first trials including inoperable or very high risk patients. Thus, TAVR is now the most common treatment of aortic valve stenosis in elderly patients (vs. surgical aortic valve replacement -SAVR-). In this review, we summarize the current indications of TAVR and explore future directions in which TAVR indications can expand.
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Keller LS, Panagides V, Mesnier J, Nuche J, Rodés-Cabau J. Percutaneous Coronary Intervention Pre-TAVR: Current State of the Evidence. Curr Cardiol Rep 2022; 24:1011-1020. [PMID: 35622221 DOI: 10.1007/s11886-022-01717-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW This review intends to give an up-to-date overview of the current state of evidence in the treatment of coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR), focusing on percutaneous coronary interventions (PCI) pre-TAVR. RECENT FINDINGS The recently published ACTIVATION trial is the 1st randomized trial comparing coronary revascularization (PCI) versus medical treatment in patients with significant CAD undergoing TAVR. With the caveat of several major limitations of the trial, the results of this study raised the question about the appropriateness of the common practice to routinely revascularize coronary stenosis before TAVR. Aortic valve stenosis is the most common valvular heart disease among the elderly and it often co-occurs with CAD. TAVR is increasingly considered an alternative to surgical aortic valve replacement not only in the elderly population but also in younger and lower-risk patients. The impact of co-existing CAD on clinical outcomes as well as the optimal timing of PCI in TAVR candidates is still unclear and the subject of ongoing randomized trials. Meanwhile, it is common practice in many centers to routinely perform invasive coronary angiography and PCI for significant coronary disease as part of the TAVR workup. While computed tomography angiography has emerged as a possible alternative to the invasive coronary angiography in patients with low pre-test probability for CAD, the value of functional invasive assessment of coronary lesions in the pre-TAVR setting has still to be clarified. Also, there is an increasing interest in the clinical relevance and optimal management of the potentially challenging coronary access post-TAVR, requiring further research.
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Affiliation(s)
- Lukas S Keller
- Québec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Vassili Panagides
- Québec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Jules Mesnier
- Québec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Jorge Nuche
- Québec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Josep Rodés-Cabau
- Québec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, Québec, G1V 4G5, Canada.
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Alexis SL, Sengupta A, Zaid S, Tang GH. Self‐Expanding Transcatheter Aortic Valve Replacement and Cerebral Embolic Protection. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Webb JG, Blanke P, Meier D, Sathananthan J, Lauck S, Chatfield AG, Jelijevas J, Wood DA, Akodad M. TAVI in 2022: Remaining issues and future direction. Arch Cardiovasc Dis 2022; 115:235-242. [DOI: 10.1016/j.acvd.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022]
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Appa H, Park K, Bezuidenhout D, van Breda B, de Jongh B, de Villiers J, Chacko R, Scherman J, Ofoegbu C, Swanevelder J, Cousins M, Human P, Smith R, Vogt F, Podesser BK, Schmitz C, Conradi L, Treede H, Schröfel H, Fischlein T, Grabenwöger M, Luo X, Coombes H, Matskeplishvili S, Williams DF, Zilla P. The Technological Basis of a Balloon-Expandable TAVR System: Non-occlusive Deployment, Anchorage in the Absence of Calcification and Polymer Leaflets. Front Cardiovasc Med 2022; 9:791949. [PMID: 35310972 PMCID: PMC8928444 DOI: 10.3389/fcvm.2022.791949] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/18/2022] [Indexed: 12/14/2022] Open
Abstract
Leaflet durability and costs restrict contemporary trans-catheter aortic valve replacement (TAVR) largely to elderly patients in affluent countries. TAVR that are easily deployable, avoid secondary procedures and are also suitable for younger patients and non-calcific aortic regurgitation (AR) would significantly expand their global reach. Recognizing the reduced need for post-implantation pacemakers in balloon-expandable (BE) TAVR and the recent advances with potentially superior leaflet materials, a trans-catheter BE-system was developed that allows tactile, non-occlusive deployment without rapid pacing, direct attachment of both bioprosthetic and polymer leaflets onto a shape-stabilized scallop and anchorage achieved by plastic deformation even in the absence of calcification. Three sizes were developed from nickel-cobalt-chromium MP35N alloy tubes: Small/23 mm, Medium/26 mm and Large/29 mm. Crimp-diameters of valves with both bioprosthetic (sandwich-crosslinked decellularized pericardium) and polymer leaflets (triblock polyurethane combining siloxane and carbonate segments) match those of modern clinically used BE TAVR. Balloon expansion favors the wing-structures of the stent thereby creating supra-annular anchors whose diameter exceeds the outer diameter at the waist level by a quarter. In the pulse duplicator, polymer and bioprosthetic TAVR showed equivalent fluid dynamics with excellent EOA, pressure gradients and regurgitation volumes. Post-deployment fatigue resistance surpassed ISO requirements. The radial force of the helical deployment balloon at different filling pressures resulted in a fully developed anchorage profile of the valves from two thirds of their maximum deployment diameter onwards. By combining a unique balloon-expandable TAVR system that also caters for non-calcific AR with polymer leaflets, a powerful, potentially disruptive technology for heart valve disease has been incorporated into a TAVR that addresses global needs. While fulfilling key prerequisites for expanding the scope of TAVR to the vast number of patients of low- to middle income countries living with rheumatic heart disease the system may eventually also bring hope to patients of high-income countries presently excluded from TAVR for being too young.
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Affiliation(s)
- Harish Appa
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Kenneth Park
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Deon Bezuidenhout
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
| | - Braden van Breda
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Bruce de Jongh
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Jandré de Villiers
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Reno Chacko
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Jacques Scherman
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
- Chris Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Chima Ofoegbu
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
- Chris Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Justiaan Swanevelder
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Michael Cousins
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Paul Human
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
- Chris Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Robin Smith
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Ferdinand Vogt
- Deparment of Cardiac Surgery, Artemed Clinic Munich South, Munich, Germany
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Bruno K. Podesser
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Christoph Schmitz
- Auto Tissue Berlin, Berlin, Germany
- Department of Cardiac Surgery, University of Munich, Munich, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Hendrik Treede
- Department of Cardiac and Vascular Surgery, University Hospital, Mainz, Germany
| | - Holger Schröfel
- Department of Cardiovascular Surgery, University Heart Center, Freiburg, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Vienna North Hospital, Vienna, Austria
| | - Xinjin Luo
- Department of Cardiac Sugery, Fu Wai Hospital, Peking Union Medical College, Beijing, China
| | - Heather Coombes
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | | | - David F. Williams
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
- Wake Forest Institute of Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Peter Zilla
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
- Chris Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
- Cape Heart Centre, University of Cape Town, Cape Town, South Africa
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Samaee M, Hatoum H, Biersmith M, Yeats B, Gooden SC, Thourani VH, Hahn RT, Lilly S, Yoganathan A, Dasi LP. Gradient and pressure recovery of a self-expandable transcatheter aortic valve depends on ascending aorta size: In vitro study. JTCVS OPEN 2022; 9:28-38. [PMID: 36003461 PMCID: PMC9390729 DOI: 10.1016/j.xjon.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022]
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Ramlawi B, Deeb GM, Yakubov SJ, Markowitz AH, Hughes GC, Kiaii RB, Huang J, Kleiman NS, Reardon MJ. Mechanisms of death in low risk patients after transcatheter or surgical aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 42:1-5. [DOI: 10.1016/j.carrev.2022.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/26/2021] [Accepted: 03/25/2022] [Indexed: 11/03/2022]
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Akodad M, Sellers S, Landes U, Meier D, Tang GHL, Gada H, Rogers T, Caskey M, Rutkin B, Puri R, Rovin J, Leipsic J, Sondergaard L, Grubb KJ, Gleason P, Garde K, Tadros H, Teodoru S, Wood DA, Webb JG, Sathananthan J. Balloon-Expandable Valve for Treatment of Evolut Valve Failure: Implications on Neoskirt Height and Leaflet Overhang. JACC Cardiovasc Interv 2022; 15:368-377. [PMID: 35210043 DOI: 10.1016/j.jcin.2021.12.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/26/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study sought to determine the degree of Evolut (Medtronic) leaflet pinning, diameter expansion, leaflet overhang, and performance at different implant depths of the balloon-expandable Sapien 3 (S3, Edwards Lifesciences LLC) transcatheter heart valve (THV) within the Evolut THV. BACKGROUND Preservation of coronary access and flow is a major factor when considering the treatment of failed Evolut THVs. METHODS An in vitro study was performed with 20-, 23-, 26-, and 29-mm S3 THVs deployed within 23-, 26-, 29-, and 34-mm Evolut R THVs, respectively. The S3 outflow was positioned at various depths at node 4, 5, and 6 of the Evolut R. Neoskirt height, leaflet overhang, performance, and Evolut R valve housing diameter expansion were assessed under physiological conditions as per ISO 5840-3 standard. RESULTS The neoskirt height for the Evolut R was shorter when the S3 outflow was positioned at node 4 compared with node 6 (node 4 height for 23 mm = 16.3 mm, 26 mm = 17.1 mm, 29 mm = 18.3 mm, and 34 mm = 19.9 mm vs node 6 height for 23 mm = 23.9 mm, 26 mm = 23.4 mm, 29 mm = 24.7 mm, and 34 mm = 27 mm Evolut R). All configurations exhibited acceptable hydrodynamic performance irrespective of the degree of leaflet overhang, except the 29-mm S3 implanted in 34-mm Evolut R at node 4 (regurgitant fraction >20%). The valve housing radius of the index Evolut R increased when the S3 was implanted, with the increase ranging from 0 to 2.5 mm. CONCLUSIONS Placement of the S3 at a lower implant position within an index Evolut R reduces the neoskirt height with no significant compromise to S3 valve function despite a higher degree of leaflet overhang. Low S3 implantation may facilitate future coronary access after redo transcatheter aortic valve replacement.
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Affiliation(s)
- Mariama Akodad
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - Stephanie Sellers
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - Uri Landes
- Edith Wolfson Medical Center, Holon, Israel; Tel-Aviv University, Tel-Aviv, Israel
| | - David Meier
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Hemal Gada
- Department of Cardiothoracic Surgery, Pinnacle Health, Harrisburg, Pennsylvania, USA
| | - Toby Rogers
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Michael Caskey
- Department of Cardiovascular Surgery, Abrazo Arizona Heart Hospital, Phoenix, Arizona, USA
| | - Bruce Rutkin
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joshua Rovin
- Department of Cardiovascular and Thoracic Surgery, Morton Plant Hospital, BayCare Health System, Clearwater, Florida, USA
| | - Jonathon Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - Lars Sondergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patrick Gleason
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Kshitija Garde
- Research and Development, Structural Heart & Aortic, Medtronic, Santa Ana, California, USA
| | - Hatem Tadros
- Research and Development, Structural Heart & Aortic, Medtronic, Santa Ana, California, USA
| | - Sebastian Teodoru
- Research and Development, Structural Heart & Aortic, Medtronic, Santa Ana, California, USA
| | - David A Wood
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada.
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