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Schulz A, Otton J, Hussain T, Miah T, Schuster A. Clinical Advances in Cardiovascular Computed Tomography: From Present Applications to Promising Developments. Curr Cardiol Rep 2024; 26:1063-1076. [PMID: 39162955 PMCID: PMC11461626 DOI: 10.1007/s11886-024-02110-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE OF THE REVIEW This review aims to provide a profound overview on most recent studies on the clinical significance of Cardiovascular Computed Tomography (CCT) in diagnostic and therapeutic pathways. Herby, this review helps to pave the way for a more extended but yet purposefully use in modern day cardiovascular medicine. RECENT FINDINGS In recent years, new clinical applications of CCT have emerged. Major applications include the assessment of coronary artery disease and structural heart disease, with corresponding recommendations by major guidelines of international societies. While CCT already allows for a rapid and non-invasive diagnosis, technical improvements enable further in-depth assessments using novel imaging parameters with high temporal and spatial resolution. Those developments facilitate diagnostic and therapeutic decision-making as well as improved prognostication. This review determined that recent advancements in both hardware and software components of CCT allow for highly advanced examinations with little radiation exposure. This particularly strengthens its role in preventive care and coronary artery disease. The addition of functional analyses within and beyond coronary artery disease offers solutions in wide-ranging patient populations. Many techniques still require improvement and validation, however, CCT possesses potential to become a "one-stop-shop" examination.
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Affiliation(s)
- Alexander Schulz
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center, Göttingen, Germany
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - James Otton
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Departments of Paediatrics, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Tayaba Miah
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Departments of Paediatrics, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Andreas Schuster
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center, Göttingen, Germany.
- FORUM Cardiology, Rosdorf, Germany.
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Aranaz Murillo A, Ferrer Gracia MC, Dieste Grañena I, Guillén Subirán ME. The importance of MDCT in the evaluation of risk factors before the TAVI procedure and its complications after implantation. RADIOLOGIA 2024; 66:340-352. [PMID: 39089794 DOI: 10.1016/j.rxeng.2023.05.010] [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: 02/27/2023] [Accepted: 05/21/2023] [Indexed: 08/04/2024]
Abstract
Transcatheter aortic valve implantation (TAVI) is the alternative to surgical valve replacement, expanding its indications in the latest guidelines. Multimodal CT (MDCT) is essential in patient selection and detection of complications. Vascular complications are frequent, so it is important to analyse the anatomy of the vessels before the procedure. Regarding annular ruptures and ventricular perforations, the volume and distribution of calcium and the ventricular diameter play an important role. Finally, valve migration is a rare complication that can occur both during and after TAVI. Proper planning of the MDCT procedure reduces the risk of complications and gives the interventional cardiologist security both before and during the procedure.
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Affiliation(s)
- A Aranaz Murillo
- Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - M C Ferrer Gracia
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - I Dieste Grañena
- Servicio de Radiología, Hospital Royo Villanova, Zaragoza, Spain
| | - M E Guillén Subirán
- Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Lopes V, Almeida PC, Moreira N, Ferreira LA, Teixeira R, Donato P, Gonçalves L. Computed tomography imaging in preprocedural planning of transcatheter valvular heart interventions. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1163-1181. [PMID: 38780710 DOI: 10.1007/s10554-024-03140-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
Cardiac Computed Tomography (CCT) has become a reliable imaging modality in cardiology providing robust information on the morphology and structure of the heart with high temporal and isotropic spatial resolution. For the past decade, there has been a paradigm shift in the management of valvular heart disease since previously unfavorable candidates for surgery are now provided with less-invasive interventions. Transcatheter heart valve interventions provide a real alternative to medical and surgical management and are often the only treatment option for valvular heart disease patients. Successful transcatheter valve interventions rely on comprehensive multimodality imaging assessment. CCT is the mainstay imaging technique for preprocedural planning of these interventions. CCT is critical in guiding patient selection, choice of procedural access, device selection, procedural guidance, as well as allowing postprocedural follow-up of complications. This article aims to review the current evidence of the role of CCT in the preprocedural planning of patients undergoing transcatheter valvular interventions.
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Affiliation(s)
- Vanessa Lopes
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal.
| | - Pedro Carvalho Almeida
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Nádia Moreira
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Luís Amaral Ferreira
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Rogério Teixeira
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
| | - Paulo Donato
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Univ Coimbra, Coimbra Institute for Biomedical Imaging and Translation Research (CIBIT), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), Univ Coimbra, Coimbra, Portugal
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Clifford T, Androshchuk V, Rajani R, Weir-McCall JR. Pretranscatheter and Posttranscatheter Valve Planning with Computed Tomography. Radiol Clin North Am 2024; 62:419-434. [PMID: 38553178 DOI: 10.1016/j.rcl.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The range of potential transcatheter solutions to valve disease is increasing, bringing treatment options to those in whom surgery confers prohibitively high risk. As the range of devices and their indications grow, so too will the demand for procedural planning. Computed tomography will continue to enable this growth through the provision of accurate device sizing and procedural risk assessment.
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Affiliation(s)
- Thomas Clifford
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | | | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jonathan R Weir-McCall
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 219, Level 5, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
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van Wely M, Rooijakkers M, Stens N, El Messaoudi S, Somers T, van Garsse L, Thijssen D, Nijveldt R, van Royen N. Paravalvular regurgitation after transcatheter aortic valve replacement: incidence, quantification, and prognostic impact. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae040. [PMID: 39045465 PMCID: PMC11195773 DOI: 10.1093/ehjimp/qyae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/21/2024] [Indexed: 07/25/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) is the standard of care in aortic stenosis with results comparable to surgical aortic valve replacement. However, paravalvular regurgitation (PVR) is more common after TAVR. With the alteration of devices and implantation techniques, the incidence of moderate or more PVR has declined. Mild PVR is still common in around 30% of TAVR patients in low-risk trials. Progression of AS causes myocardial hypertrophy and varying degrees of diastolic dysfunction which may cause heart failure even in combination with small volumes of PVR. Any degree of PVR is associated with an increased risk of overall and cardiovascular mortality. Predictors of PVR are annular eccentricity, severe calcification of the aortic valve, bicuspid aortic valves, and type of prosthesis where balloon-expandable devices are associated with less PVR. PVR is diagnosed using echocardiography, aortic angiogram with or without videodensitometry, haemodynamic parameters, or cardiac magnetic resonance. PVR can be treated using post-dilation, interventional treatment using a vascular plug, or implantation of a second device. Successful post-dilation depends on balloon size which should at least be equal to or >95% of the mean annulus diameter. Implantation of a second device to reduce PVR is successful in ∼90% of cases, either through lengthening of the sealing skirt in case of inadequate position or through further expansion of the index device. Implantation of a vascular plug can successfully reduce PVR and reduce mortality.
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Affiliation(s)
- Marleen van Wely
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Maxim Rooijakkers
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Niels Stens
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Department of Physiology, Radboudumc , Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Saloua El Messaoudi
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Tim Somers
- Department of Cardiothoracic Surgery, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Leen van Garsse
- Department of Cardiothoracic Surgery, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Dick Thijssen
- Department of Physiology, Radboudumc , Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Flores-Umanzor E, Keshvara R, Reza S, Asghar A, Rashidul Anwar M, Cepas-Guillen PL, Osten M, Halankar J, Abrahamyan L, Horlick E. A systematic review of contrast-enhanced computed tomography calcium scoring methodologies and impact of aortic valve calcium burden on TAVI clinical outcomes. J Cardiovasc Comput Tomogr 2023; 17:373-383. [PMID: 37635033 DOI: 10.1016/j.jcct.2023.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/25/2023] [Accepted: 08/19/2023] [Indexed: 08/29/2023]
Abstract
Different methodologies have been used to assess the role of AV calcification (AVC) on TAVI outcomes. This systematic review aims to describe the burden of AVC, synthesize the different methods of calcium score quantification, and evaluate the impact of AVC on outcomes after TAVI. We included studies of TAVI patients who had reported AV calcium scoring by contrast-enhanced multidetector CT and the Agatston method. The impact of calcification on TAVI outcomes without restrictions on follow-up time or outcome type was evaluated. Results were reported descriptively, and a meta-analysis was conducted when feasible. Sixty-eight articles were included, with sample sizes ranging from 23 to 1425 patients. Contrast-enhanced calcium scoring was reported in 30 studies, calcium volume score in 28 studies, and unique scoring methods in two. All studies with calcium volume scores had variable protocols, but most utilized a modified Agatston method with variable attenuation threshold values of 300-850 HU. Eight studies used the Agatston method, with the overall mean AV calcium score in studies published from 2010 to 2012 of 3342.9 AU [95%CI: 3150.4; 3535.4, I2 = 0%]. The overall mean score was lower and heterogenous in studies published from 2014 to 2020 (2658.9 AU [95% CI: 2517.3; 2800.5, I2 = 79%]. Most studies reported a positive association between calcium burden and increased risk of adverse outcomes, including implantation of permanent pacemaker (7/8 studies), paravalvular leak (13/13 studies), and risk of aortic rupture (2/2 studies). AVC quantification methodology with contrast-enhanced CT is still variable. AVC negatively impacts TAVI outcomes independently of the quantification method.
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Affiliation(s)
- Eduardo Flores-Umanzor
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Rajesh Keshvara
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Seleman Reza
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Areeba Asghar
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Mohammed Rashidul Anwar
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Pedro L Cepas-Guillen
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Spain
| | - Mark Osten
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Jaydeep Halankar
- Joint Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network, University of Toronto, ON, Canada
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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Shi J, Li W, Zhang T, Han C, Wang Z, Pei X, Li X, Zhao Z, Wang P, Han J, Chen S. Quantity and location of aortic valve calcification predicts paravalvular leakage after transcatheter aortic valve replacement: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1170979. [PMID: 37293280 PMCID: PMC10244734 DOI: 10.3389/fcvm.2023.1170979] [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: 02/21/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction Transcatheter aortic valve replacement (TAVR) is the first-line treatment for patients with moderate-to-high surgical risk of severe aortic stenosis. Paravalvular leakage (PVL) is a serious complication of TAVR, and aortic valve calcification contributes to the occurrence of PVL. This study aimed to investigate the effect of location and quantity of calcification in the aortic valve complex (AVC) and left ventricular outflow tract (LVOT) on PVL after TAVR. Method We performed a systematic review and meta-analysis to evaluate the effect of quantity and location of aortic valve calcification on PVL after TAVR using observational studies from PubMed and EMBASE databases from inception to February 16, 2022. Results Twenty-four observational studies with 6,846 patients were included in the analysis. A high quantity of calcium was observed in 29.6% of the patients; they showed a higher risk of significant PVL. There was heterogeneity between studies (I2 = 15%). In the subgroup analysis, PVL after TAVR was associated with the quantity of aortic valve calcification, especially those located in the LVOT, valve leaflets, and the device landing zone. A high quantity of calcium was associated with PVL, regardless of expandable types or MDCT thresholds used. However, for valves with sealing skirt, the amount of calcium has no significant effect on the incidence of PVL. Conclusion Our study elucidated the effect of aortic valve calcification on PVL and showed that the quantity and location of aortic valve calcification can help predict PVL. Furthermore, our results provide a reference for the selection of MDCT thresholds before TAVR. We also showed that balloon-expandable valves may not be effective in patients with high calcification, and valves with sealing skirts instead of those without sealing skirts should be applied more to prevent PVL from happening. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=354630, identifier: CRD42022354630.
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Affiliation(s)
- Jiale Shi
- Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Second Clinical Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wei Li
- Department of Second Clinical Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Basic Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tangshan Zhang
- Department of Vascular Surgery, Jiyang District People's Hospital, Jinan, China
| | - Chengwen Han
- Department of Second Clinical Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Basic Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhengjun Wang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xinhao Pei
- Department of Basic Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xuetao Li
- Department of Second Clinical Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zidong Zhao
- Department of Public Health School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Pengbo Wang
- Department of Public Health School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jingying Han
- Department of Basic Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shiqiao Chen
- Department of Interventional Diagnosis and Treatment, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Leone PP, Scotti A, Ho EC, Assafin M, Doolittle J, Chau M, Slipczuk L, Levitus M, Regazzoli D, Mangieri A, Latib A. Prosthesis Tailoring for Patients Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2023; 12:338. [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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Affiliation(s)
- Pier Pasquale Leone
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Cardiovascular Research Foundation, New York, NY 10019, USA
| | - Edwin C. Ho
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Manaf Assafin
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - James Doolittle
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Mei Chau
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Leandro Slipczuk
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Matthew Levitus
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Farhan S, Stachel G, Desch S, Kurz T, Feistritzer HJ, Hartung P, Eitel I, Nef H, Doerr O, Lauten A, Landmesser U, Sandri M, Holzhey D, Borger M, Ince H, Öner A, Meyer-Saraei R, Wienbergen H, Fach A, Frey N, de Waha-Thiele S, Thiele H. Impact of moderate or severe left ventricular outflow tract calcification on clinical outcomes of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation with self- and balloon-expandable valves: a post hoc analysis from the SOLVE-TAVI trial. EUROINTERVENTION 2022; 18:759-768. [PMID: 35942626 PMCID: PMC11064680 DOI: 10.4244/eij-d-22-00156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/22/2022] [Indexed: 05/04/2024]
Abstract
BACKGROUND Left ventricular outflow tract (LVOT) calcification has been associated with worse outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and may influence the selection of prosthetic valve type. AIMS We aimed to evaluate the impact of LVOT calcification on outcomes after TAVI with a self-expanding valve (SEV) versus a balloon-expandable valve (BEV). METHODS Patients of the SOLVE-TAVI trial, randomised to Edwards SAPIEN 3 or Medtronic Evolut R, were divided according to LVOT calcification into no/mild (≤1 calcium nodule extending <5 mm and covering <10% of the LVOT perimeter) and moderate/severe LVOT calcification groups. The primary endpoint was a composite of death, stroke, moderate/severe paravalvular regurgitation, permanent pacemaker implantation and annulus rupture at 30 days. Additional endpoints included all-cause and cardiovascular mortality at 1 year. RESULTS Out of 416 eligible patients, moderate/severe LVOT calcification was present in 143 (34.4%). Moderate/severe LVOT calcification was associated with significantly longer fluoroscopy time and higher rates of pre- and post-dilation. Regardless of the LVOT calcification group, there was no significant difference in the primary endpoint associated with the valve type (no/mild LVOT calcification group: SEV 25.0% vs BEV 27.0%; hazard ratio [HR] 1.10, 95% confidence interval [95% CI]: 0.68-1.73; p=0.73 and moderate/severe LVOT calcification group: SEV 25.0% vs BEV 19.4%; HR 0.76, 95% CI: 0.38-1.61; p=0.49), no significant interaction between LVOT calcification and valve type (pint=0.29) and no differences between SEV vs BEV within LVOT calcification groups regarding 1-year all-cause and cardiovascular mortality. CONCLUSIONS Moderate/severe LVOT calcification was associated with longer fluoroscopy time and an increased need for pre- and post-dilation, but not with a higher incidence of early and mid-term adverse clinical outcomes, regardless of valve type. (ClinicalTrials.gov: NCT02737150).
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Affiliation(s)
- Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Georg Stachel
- Department of Internal Medicine and Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Steffen Desch
- Department of Internal Medicine and Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
- University Clinic Schleswig-Holstein, Kiel, Germany and University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Campus Lübeck, Lübeck, Germany
| | - Thomas Kurz
- University Clinic Schleswig-Holstein, Kiel, Germany and University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Campus Lübeck, Lübeck, Germany
| | - Hans-Josef Feistritzer
- Department of Internal Medicine and Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Philipp Hartung
- Department of Internal Medicine and Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Ingo Eitel
- University Clinic Schleswig-Holstein, Kiel, Germany and University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Campus Lübeck, Lübeck, Germany
| | - Holger Nef
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Marburg/Gießen, Gießen, Germany
| | - Oliver Doerr
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Marburg/Gießen, Gießen, Germany
| | - Alexander Lauten
- Department of Cardiology and Intensive Care Medicine, Helios Klinikum Erfurt, Erfurt, Germany
| | - Ulf Landmesser
- German Center for Cardiovascular Research (DZHK), Campus Lübeck, Lübeck, Germany
- Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Marcus Sandri
- Department of Internal Medicine and Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - David Holzhey
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Hüseyin Ince
- Medizinische Klinik I im Zentrum fuer Innere Medizin (ZIM), Universitaetsklinikum Rostock, Rostock, Germany
| | - Alper Öner
- Medizinische Klinik I im Zentrum fuer Innere Medizin (ZIM), Universitaetsklinikum Rostock, Rostock, Germany
| | - Roza Meyer-Saraei
- University Clinic Schleswig-Holstein, Kiel, Germany and University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Campus Lübeck, Lübeck, Germany
| | - Harm Wienbergen
- Klinikum Links der Weser, Herzzentrum Bremen, Bremen, Germany
| | - Andreas Fach
- Klinikum Links der Weser, Herzzentrum Bremen, Bremen, Germany
| | - Norbert Frey
- German Center for Cardiovascular Research (DZHK), Campus Lübeck, Lübeck, Germany
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Suzanne de Waha-Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
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10
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Medranda GA, Rogers T, Fuery M, Case BC, Collins EC, Ali SW, Zhang C, Wang JC, Weissman G, Cohen JE, Shults CC, Satler LF, Ben-Dor I, Waksman R. Impact of left ventricular outflow tract calcium on valve geometry in self-expanding transcatheter aortic-valve replacement. Catheter Cardiovasc Interv 2022; 100:404-412. [PMID: 35723247 DOI: 10.1002/ccd.30301] [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: 04/26/2022] [Revised: 05/26/2022] [Accepted: 06/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Evaluate transcatheter heart valve (THV) geometry according to left ventricular outflow tract (LVOT) calcium degree and its impact on hemodynamics and outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) with a contemporary self-expanding THV. BACKGROUND LVOT calcium remains challenging for contemporary THVs. LVOT calcium location and degree may affect THV deployment and impact flow patterns and shear stress, accelerating THV degeneration. METHODS EPROMPT (CoreValve Evolut Pro Prospective Registry; NCT03423459) is a prospective, investigator-initiated, multicenter registry of patients undergoing TAVR using CoreValve Evolut PRO/PRO + THVs. A total of 107 patients were enrolled in EPROMPT's computed tomography (CT) cohort between January 2018 and October 2021. These patients underwent follow-up CT scan 30 days post-TAVR. We analyzed THV geometry and its interaction with the aortic root following deployment using 30-day post-TAVR CT in patients with none/mild versus moderate/severe LVOT calcium. RESULTS Thirty-day THV inflows were less eccentric in the short axis in patients with none/mild versus moderate/severe LVOT calcium (1.16 ± 0.09 vs. 1.21 ± 0.12; p = 0.007). THV became more circular and was similar between both cohorts at the THV waist (1.08 ± 0.06 vs. 1.09 ± 0.11; p = 0.551), leaflet tips (1.03 ± 0.04 vs. 1.05 ± 0.09; p = 0.299), and THV outflow (1.04 ± 2.2 vs. 1.03 ± 2.7; p = 0.143). Thirty-day > mild paravalvular leak was low in both cohorts (1.5% vs. 2.4%; p = 0.724); mean gradients were similar (7.7 ± 3.6 vs. 7.7 ± 3.4 mmHg; p = 0.955). CONCLUSIONS Despite inflow deformities observed in patients with moderate/severe LVOT calcium, Evolut PRO/PRO + conforms to elliptical aortic annuli, maintaining circularity and proper function at the leaflets and outflow, even in patients with moderate/severe LVOT calcium.
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Affiliation(s)
- Giorgio A Medranda
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.,Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael Fuery
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Erin C Collins
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Syed W Ali
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - John C Wang
- Section of Interventional Cardiology, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Gaby Weissman
- Department of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Jeffrey E Cohen
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Christian C Shults
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
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11
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Karout L, Salman R, Ershaid F, Sawaya F, Abi-Ghanem AS. Imaging Modalities Employed in the TAVR Procedure With a Focus on CTA: What the Radiologist Needs to Know. Acad Radiol 2022; 29 Suppl 4:S69-S81. [PMID: 34551883 DOI: 10.1016/j.acra.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES Aortic stenosis (AS) is one of the most common valvular heart disease. Symptomatic AS is associated with a high mortality rate which prompts fast intervention. The introduction of transcatheter aortic valve replacement (TAVR) has drastically improved the outcome of high surgical risk for mortality patients with severe AS. However, this procedure requires the employment of multimodality imaging in the pre-procedural planning, intra-procedural optimization, and post-procedural follow-up stages. This also requires an accurate understanding of the indications, measurements, strength, and limitations of each imaging modality during the different TAVR stages. CONCLUSION In this review, we aim to outline to radiologists the evidence-based approach and indications of different imaging modalities through the pre, peri, and post TAVR stages.
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12
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Medranda GA, Rogers T, Case BC, Ali SW, Zhang C, Wang JC, Weissman G, Satler LF, Ben-Dor I, Waksman R. Impact of Left Ventricular Outflow Tract Calcium on Hemodynamics and Outcomes in Patients After Transcatheter Aortic Valve Implantation With a Contemporary Self-Expanding Valve. Am J Cardiol 2022; 168:128-134. [PMID: 35067347 DOI: 10.1016/j.amjcard.2021.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/01/2022]
Abstract
Left ventricular outflow tract (LVOT) calcium remains a challenge for transcatheter aortic valve implantation (TAVI) and is associated with an increased risk of debris embolization, permanent pacemaker requirement, and annular rupture. We report the results of the (EPROMPT) CoreValve Evolut PRO Prospective Registry, which sought to evaluate the real-world performance of the CoreValve Evolut PRO transcatheter heart valve (THV) according to computed tomography-defined extent of LVOT calcium. The prospective, investigator-initiated, multicenter registry includes patients who underwent TAVI using the CoreValve Evolut PRO/PRO+ THV system. Analyzed patients were dichotomized on the basis of the severity of their LVOT calcium at baseline (none/mild vs moderate/severe). Patients were followed with 30-day clinical assessment and echocardiography. Of the 277 patients included, 177 had computed tomography-defined none/mild LVOT calcium (63.9%), and 100 had moderate/severe LVOT calcium (36.1%). Device success was similar in both cohorts (97.7% vs 95.0%; p = 0.217). Stroke rates were numerically higher in the moderate/severe LVOT calcium cohort (in-hospital and 30 day: 1.7% vs 4.0%; p = 0.240). Patients with none/mild LVOT calcium had higher rates of permanent pacemaker implantation (in-hospital: 21.5% vs 9.0%; p = 0.008 and 30-day: 22.0% vs 12.0%; p = 0.027). At 30 days, there were numerically higher rates of >mild paravalvular leak in patients with moderate/severe LVOT calcium (1.7% vs 4.0%; p = 0.240). Thirty-day mean gradients were similar (7.5 vs 7.6 mm Hg; p = 0.782). In conclusion, patients in the EPROMPT registry receiving the contemporary self-expanding CoreValve Evolut PRO/PRO+ THV demonstrated similar short-term outcomes and hemodynamics across the entire spectrum of LVOT calcium.
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13
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Pontone G, Rossi A, Guglielmo M, Dweck MR, Gaemperli O, Nieman K, Pugliese F, Maurovich-Horvat P, Gimelli A, Cosyns B, Achenbach S. Clinical applications of cardiac computed tomography: a consensus paper of the European Association of Cardiovascular Imaging-part II. Eur Heart J Cardiovasc Imaging 2022; 23:e136-e161. [PMID: 35175348 PMCID: PMC8944330 DOI: 10.1093/ehjci/jeab292] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/28/2021] [Indexed: 11/12/2022] Open
Abstract
Cardiac computed tomography (CT) was initially developed as a non-invasive diagnostic tool to detect and quantify coronary stenosis. Thanks to the rapid technological development, cardiac CT has become a comprehensive imaging modality which offers anatomical and functional information to guide patient management. This is the second of two complementary documents endorsed by the European Association of Cardiovascular Imaging aiming to give updated indications on the appropriate use of cardiac CT in different clinical scenarios. In this article, emerging CT technologies and biomarkers, such as CT-derived fractional flow reserve, perfusion imaging, and pericoronary adipose tissue attenuation, are described. In addition, the role of cardiac CT in the evaluation of atherosclerotic plaque, cardiomyopathies, structural heart disease, and congenital heart disease is revised.
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Affiliation(s)
- Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Marco Guglielmo
- Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Marc R Dweck
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Koen Nieman
- Department of Radiology and Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Francesca Pugliese
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Alessia Gimelli
- Fondazione CNR/Regione Toscana “Gabriele Monasterio”, Pisa, Italy
| | - Bernard Cosyns
- Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, Brussel, Belgium
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University of Erlangen, Erlangen, Germany
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14
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Sá MP, Van den Eynde J, Malin JH, Torregrossa G, Sicouri S, Ramlawi B. Impact of left ventricle outflow tract calcification on the outcomes of transcatheter aortic valve implantation: A study‐level meta‐analysis. J Card Surg 2022; 37:1379-1390. [DOI: 10.1111/jocs.16306] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/29/2021] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center Main Line Health Wynnewood Pennsylvania USA
- Department of Cardiothoracic Surgery Research Lankenau Institute for Medical Research Wynnewood Pennsylvania USA
| | - Jef Van den Eynde
- Department of Cardiovascular Sciences KU Leuven Leuven Belgium
- Helen B. Taussig Heart Center The Johns Hopkins Hospital and School of Medicine Baltimore Maryland USA
| | - John H. Malin
- Philadelphia College of Osteopathic Medicine Bala Cynwyd Pennsylvania USA
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center Main Line Health Wynnewood Pennsylvania USA
- Department of Cardiothoracic Surgery Research Lankenau Institute for Medical Research Wynnewood Pennsylvania USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research Lankenau Institute for Medical Research Wynnewood Pennsylvania USA
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center Main Line Health Wynnewood Pennsylvania USA
- Department of Cardiothoracic Surgery Research Lankenau Institute for Medical Research Wynnewood Pennsylvania USA
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15
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McInerney A, Vera-Urquiza R, Tirado-Conte G, Marroquin L, Jimenez-Quevedo P, Nuñez-Gil I, Pozo E, Gonzalo N, de Agustín JA, Escaned J, Fernández-Ortiz A, Macaya C, Nombela-Franco L. Pre-dilation and Post-dilation in Transcatheter Aortic Valve Replacement: Indications, Benefits and Risks. Interv Cardiol 2021; 16:e28. [PMID: 34721667 PMCID: PMC8532006 DOI: 10.15420/icr.2020.35] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/17/2021] [Indexed: 12/12/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is an established treatment for patients with symptomatic severe aortic stenosis. In recent years, an emphasis has been placed on simplification of the procedure. Balloon predilation was initially considered a mandatory step to cross and prepare the stenotic aortic valve, but several studies demonstrated the feasibility of performing TAVR without balloon valvuloplasty. Balloon postdilation of the implanted valve is sometimes required to optimise results, although many patients do not require this step. Contemporary consensus advocates an individualised approach to TAVR procedures and so balloon pre- and post-dilation are performed selectively. This review aims to outline the advantages and disadvantages of balloon pre- and post-dilation and to identify the scenarios in which they are required during TAVR procedures.
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Affiliation(s)
- Angela McInerney
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | | | | | - Luis Marroquin
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | | | - Iván Nuñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | - Eduardo Pozo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | - Nieves Gonzalo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | | | - Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | | | - Carlos Macaya
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
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16
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Pighi M, Giovannini D, Scarsini R, Piazza N. Diagnostic Work-Up of the Aortic Patient: An Integrated Approach toward the Best Therapeutic Option. J Clin Med 2021; 10:5120. [PMID: 34768640 PMCID: PMC8584438 DOI: 10.3390/jcm10215120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 01/09/2023] Open
Abstract
Aortic stenosis (AS) is the most common valvular heart disease. In the last decade, transcatheter aortic valve implantation (TAVI) has become the standard of care for symptomatic patients at high surgical risk. Recently, indications to TAVI have also been extended to the low surgical risk and intermediate surgical risk populations. Consequently, in this setting, some aspects acquire greater relevance: surgical risk evaluation, clinical assessment, multimodality imaging of the valve, and management of coronary artery disease. Moreover, future issues such as coronary artery re-access and valve-in-valve interventions should be considered in the valve selection process. This review aims to summarize the principal aspects of a multidimensional (multidisciplinary) and comprehensive preprocedural work-up. The Heart Team is at the center of the decision-making process of the management of aortic valve disease and bears responsibility for offering each patient a tailored approach based on an individual evaluation of technical aspects together with the risks and benefits of each modality. Considering the progressive expansion in TAVI indication and technological progress, the role of a work-up and multidisciplinary Heart Team will be even more relevant.
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Affiliation(s)
- Michele Pighi
- Division of Cardiology, Department of Medicine, McGill University Health Center, Montreal, QC H4A 3J1, Canada;
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (D.G.); (R.S.)
| | - Davide Giovannini
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (D.G.); (R.S.)
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (D.G.); (R.S.)
| | - Nicolo Piazza
- Division of Cardiology, Department of Medicine, McGill University Health Center, Montreal, QC H4A 3J1, Canada;
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17
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Grodecki K, Tamarappoo BK, Huczek Z, Jedrzejczyk S, Cadet S, Kwiecinski J, Rymuza B, Parma R, Olasinska-Wisniewska A, Fijalkowska J, Protasiewicz M, Walczak A, Nowak A, Gocol R, Slomka PJ, Reczuch K, Jagielak D, Grygier M, Wojakowski W, Filipiak KJ, Dey D. Non-calcific aortic tissue quantified from computed tomography angiography improves diagnosis and prognostication of patients referred for transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2021; 22:626-635. [PMID: 33247903 DOI: 10.1093/ehjci/jeaa304] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/22/2020] [Indexed: 12/31/2022] Open
Abstract
AIMS We aimed to investigate the role of aortic valve tissue composition from quantitative cardiac computed tomography angiography (CTA) in patients with severe aortic stenosis (AS) for the differentiation of disease subtypes and prognostication after transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS Our study included 447 consecutive AS patients from six high-volume centres reporting to a prospective nationwide registry of TAVI procedures (POL-TAVI), who underwent cardiac CTA before TAVI, and 224 matched controls with normal aortic valves. Components of aortic valve tissue were identified using semi-automated software as calcific and non-calcific. Volumes of each tissue component and composition [(tissue component volume/total tissue volume) × 100%] were quantified. Relationship of aortic valve composition with clinical outcomes post-TAVI was evaluated using Valve Academic Research Consortium (VARC)-2 definitions.High-gradient (HG) AS patients had significantly higher aortic tissue volume compared to low-flow low-gradient (LFLG)-AS (1672.7 vs. 1395.3 mm3, P < 0.001) as well as controls (509.9 mm3, P < 0.001), but increased non-calcific tissue was observed in LFLG compared to HG patients (1063.6 vs. 860.2 mm3, P < 0.001). Predictive value of aortic valve calcium score [area under the curve (AUC) 0.989, 95% confidence interval (CI): 0.981-0.996] for severe AS was improved after addition of non-calcific tissue volume (AUC 0.995, 95% CI: 0.991-0.999, P = 0.011). In the multivariable analysis of clinical and quantitative computed tomography parameters of aortic valve tissue, non-calcific tissue volume [odds ratio (OR) 5.2, 95% CI 1.8-15.4, P = 0.003] and history of stroke (OR 2.6, 95% CI 1.1-6.5, P = 0.037) were independent predictors of 30-day major adverse cardiovascular event (MACE). CONCLUSION Quantitative CTA assessment of aortic valve tissue volume and composition can improve detection of severe AS, differentiation between HG and LFLG-AS in patients referred for TAVI as well as prediction of 30-day MACEs post-TAVI, over the current clinical standard.
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Affiliation(s)
- Kajetan Grodecki
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute,116N Robertson Blvd, Suite 400, Los Angeles, CA 90048, USA.,1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | | | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Szymon Jedrzejczyk
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Sebastien Cadet
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute,116N Robertson Blvd, Suite 400, Los Angeles, CA 90048, USA
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42 04-628 Warsaw, Poland
| | - Bartosz Rymuza
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Radoslaw Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland
| | - Anna Olasinska-Wisniewska
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Długa 1/2, 61-848 Poznan, Poland
| | - Jadwiga Fijalkowska
- 2nd Department of Radiology, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-214 - Gdansk, Poland
| | - Marcin Protasiewicz
- Department of Cardiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Andrzej Walczak
- Department of Cardiac Surgery, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland
| | - Adrianna Nowak
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland
| | - Radoslaw Gocol
- Department of Cardiac Surgery, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland
| | - Piotr J Slomka
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute,116N Robertson Blvd, Suite 400, Los Angeles, CA 90048, USA
| | - Krzysztof Reczuch
- Department of Cardiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Dariusz Jagielak
- Department of Cardiac Surgery, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-214 - Gdansk, Poland
| | - Marek Grygier
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2, 61-848 Poznan, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland
| | - Krzysztof J Filipiak
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Damini Dey
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute,116N Robertson Blvd, Suite 400, Los Angeles, CA 90048, USA
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18
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Mahon C, Davies A, Gambaro A, Musella F, Costa AL, Panoulas V, Nicol E, Duncan A, Davies S, Mirsadraee S. Association of individual aortic leaflet calcification on paravalvular regurgitation and conduction abnormalities with self-expanding trans-catheter aortic valve insertion. Quant Imaging Med Surg 2021; 11:1970-1982. [PMID: 33936979 DOI: 10.21037/qims-20-1122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Complication rates of paravalvular aortic regurgitation (PVR) and permanent pacemaker insertion remain high in patients undergoing trans-catheter aortic valve insertion for severe aortic stenosis. The spatial distribution of calcium between individual aortic valve leaflets, and its potential role in these complications is gaining interest. We aimed to assess the accuracy of individual aortic valve leaflet calcium quantification, and to determine its effect on the frequency of these complications. Methods This was a retrospective study of 251 patients who underwent trans-catheter aortic valve insertion using the Evolut RTM valve. The off-line Terarecon software platform was used for Agatston scoring the short axis views. Results There was a correlation between the sum of the individual leaflet and the total aortic valve calcium score. There was a univariate association between an increase [per 100 Agatston unit (AU)] in both right coronary leaflet (RCL) and left coronary leaflet (LCL) calcium with the risk of PVR. There was an association between an increase in LCL calcium score (per 100 AU) and need for post-implantation balloon aortic valvuloplasty (BAV). There was no association between individual leaflet calcification on the risk of permanent pacemaker insertion. Conclusions This study supports the idea that a quantifiable and reproducible method of individual valve leaflet calcification score may serve as an independent risk factor for paravalvular regurgitation, beyond visual assessment of asymmetry. However, the same may not be true of spatial calcium distribution and permanent pacemaker implantation (PPI).
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Affiliation(s)
- Ciara Mahon
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Allan Davies
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Alessia Gambaro
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Ana Luisa Costa
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Edward Nicol
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Alison Duncan
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Simon Davies
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
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19
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Morris MF, Sugurmaran R, Kirschner M, Verma D, Bhalla V, Caskey M, Byrne T. Multi-modality imaging and operative findings of a post-TAVR ventricular septal defect. J Cardiovasc Comput Tomogr 2021; 15:e92-e93. [PMID: 33583751 DOI: 10.1016/j.jcct.2021.01.004] [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: 11/24/2020] [Revised: 01/22/2021] [Accepted: 01/31/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Michael F Morris
- Cardiovascular Institute, Banner University Medical Center - Phoenix, United States.
| | | | | | - Divya Verma
- Cardiovascular Institute, Banner University Medical Center - Phoenix, United States
| | - Vikas Bhalla
- Cardiovascular Institute, Banner University Medical Center - Phoenix, United States
| | | | - Timothy Byrne
- Cardiovascular Institute, Banner University Medical Center - Phoenix, United States; Abrazo Arizona Heart Hospital, United States
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20
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Anwaruddin S, Herrmann HC. Who should get surgical aortic valve replacement in the era of transcatheter aortic valve replacement?-interventional cardiology perspective. Ann Cardiothorac Surg 2020; 9:490-492. [PMID: 33312907 DOI: 10.21037/acs-2020-av-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Saif Anwaruddin
- Department of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Howard C Herrmann
- Department of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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21
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Luraghi G, Matas JFR, Beretta M, Chiozzi N, Iannetti L, Migliavacca F. The impact of calcification patterns in transcatheter aortic valve performance: a fluid-structure interaction analysis. Comput Methods Biomech Biomed Engin 2020; 24:375-383. [PMID: 32924580 DOI: 10.1080/10255842.2020.1817409] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) strongly depends on the calcification patterns, which may lead to a malapposition of the stented valve and complication onsets in terms of structure kinematics and paravalvular leakage (PVL). From one anatomical-resembling model of the aortic root, six configurations with different calcific deposits were built. TAVR fluid-structure interaction simulations predicted different outcomes for the different calcifications patterns in terms of the final valve configuration in the implantation site and the PVL estimations. In particular models with deposits along the cups coaptation resulted in mild PVL, while those with deposits along the attachment line in moderate PVL.
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Affiliation(s)
- Giulia Luraghi
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Jose Felix Rodriguez Matas
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Marta Beretta
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Nicole Chiozzi
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | | | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
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22
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Piayda K, Hellhammer K, Veulemans V, Afzal S, Heidari H, Wimmer AC, Al Juburi M, Antoch G, Kelm M, Zeus T. Performance of the CoreValve Evolut R and PRO in Severely Calcified Anatomy: A Propensity Score Matched Analysis. Heart Lung Circ 2020; 29:1847-1855. [PMID: 32646637 DOI: 10.1016/j.hlc.2020.05.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 05/02/2020] [Accepted: 05/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The CoreValve Evolut R and PRO (Medtronic, Minneapolis, MN, USA) are among the newest-generation of self-expandable transcatheter aortic valve replacement (TAVR) devices and show excellent results. Treating patients with severely calcified (SC) native aortic valve anatomy may be challenging because of the increased risk of periprocedural complications. This study investigated the performance of Evolut R and PRO in this special patient subset. METHODS Patients who underwent TAVR with the CoreValve Evolut R or PRO (n=381) from September 2015 to March 2018 were divided by aortic valve calcification extent. Patients with SC aortic valve anatomy (n=98; men, >2,062 and women, >1,377 Agatston units) were compared with those with non-severely calcified (NCS) aortic valve anatomy after 1:2 propensity score matching. Outcomes were evaluated according to the updated valve academic research consortium criteria. RESULTS Patients with SC anatomy were older (83 years vs 80 years, p<0.001) and had a smaller aortic valve area (0.63 cm2 vs 0.70 cm2, p=0.028). Pre-dilatation was more often performed (30.6% vs 15.8%, p=0.003) and a permanent pacemaker implantation was more often necessary (32.9% vs 8.8%, p<0.001) in the SC group. None/mild aortic regurgitation (AR) was evenly distributed (SC, 96.9% vs NCS, 99.5%, p=0.109); moderate AR was present in 3.1% of SC patients and in 0.5% of NSC patients. Severe AR was not observed. CONCLUSION The CoreValve Evolut R and PRO showed good clinical safety profiles and excellent haemodynamic results in patients with SC anatomy and who more often required permanent pacemaker implantation.
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Affiliation(s)
- Kerstin Piayda
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Katharina Hellhammer
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Verena Veulemans
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Shazia Afzal
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Houtan Heidari
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Anna Christina Wimmer
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Maryam Al Juburi
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany
| | - Tobias Zeus
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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Abdelghani M, Mankerious N, Landt M, Toelg R, Abdel-Wahab M, Richardt G. Transcatheter Aortic Valve Implantation With the Third Generation Balloon-Expandable Bioprosthesis in Patients With Severe Landing Zone Calcium. Am J Cardiol 2020; 125:931-940. [PMID: 31959428 DOI: 10.1016/j.amjcard.2019.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 01/16/2023]
Abstract
Device success of earlier generation balloon-expandable transcatheter heart valves (BE-THV) is lower in patients with severe landing zone calcium (LZC). We sought to explore the impact of LZC on the outcome of transcatheter aortic valve implantation (TAVI) with the next generation Edwards Sapien 3 BE-THV. In the present study, severe LZC was defined as severe aortic valve cusp calcium (AVC) and/or left ventricular outflow tract calcium (LVOTC) on computed tomography. Patients who underwent TAVI for pure/predominant aortic regurgitation, bicuspid aortic valve disease, or failed bioprosthetic valve were excluded. Out of 350 patients who underwent TAVI with the Edwards Sapien 3 (age 80.7 ± 6.1, female: 45.1%, Society of Thoracic Surgeons score: 4.9 ± 3.8, transfemoral: 97.4%), 106 (30.3%) had severe LZC; 78 severe AVC (22.3%) and 49 severe LVOTC (14.0%). Severe LZC was associated with lower device success (96.2% vs 100%, p = 0.008) driven by more prosthetic valve regurgitation (PVR, p = 0.008). On multivariable analysis, PVR was associated with severe LVOTC (odds ratio [95% confidence interval] 2.130 [1.092 to 4.158]) but not with severe AVC (1.529 [0.835 to 2.800]). Balloon predilatation (BPreD) was performed in 42.5% of patients with severe LZC (vs 19.3% in nonsevere LZC; p <0.001) and was associated with prolonged procedural time (p = 0.001) and higher irradiation exposure (p = 0.027). Device success (p = 0.311), major procedural complications (p = 0.132), 30-day safety end point (p = 0.815), and PVR (p = 0.684) were not significantly different between patients with severe LZC who underwent BPreD versus direct TAVI. In conclusion, device success of the third generation BE-THV is lower in severe LZC driven by more PVR, especially in patients with severe LVOTC. In those patients, BPreD prolonged the procedure without improving THV performance.
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Navigating the “Optimal Implantation Depth” With a Self-Expandable TAVR Device in Daily Clinical Practice. JACC Cardiovasc Interv 2020; 13:679-688. [DOI: 10.1016/j.jcin.2019.07.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/02/2019] [Accepted: 07/30/2019] [Indexed: 12/19/2022]
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Yucel-Finn A, Nicol E, Leipsic JA, Weir-McCall JR. CT in planning transcatheter aortic valve implantation procedures and risk assessment. Clin Radiol 2019; 76:73.e1-73.e19. [PMID: 31883615 DOI: 10.1016/j.crad.2019.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/13/2019] [Indexed: 12/31/2022]
Abstract
For surgical aortic valve replacement, the Society of Thoracic Surgeons score (STSS) is the reference standard for the prediction of operative risk. In transcatheter aortic valve implantation (TAVI) though, where the procedure itself is minimally invasive, the traditional risk assessment is supplemented by CTA. Through a consistent approach to the acquisition of high-quality images and the standardised reporting of annular measurements and adverse root and vascular features, patients at risk of complications can be identified. In turn, this may allow for a personalised procedural approach and treatment strategies devised to potentially reduce or mitigate this risk. This article provides a systematic and standardised approach to pre-procedural work-up with computed tomography angiography (CTA) and explores the current state of evidence and future areas of development in this rapidly developing field.
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Affiliation(s)
| | - E Nicol
- Royal Brompton Hospital, London, UK
| | - J A Leipsic
- St Paul's Hospital, Vancouver, British Columbia, Canada
| | - J R Weir-McCall
- Royal Papworth Hospital, Cambridge, UK; University of Cambridge School of Clinical Medicine, Cambridge, UK.
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26
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Ng VG, Hahn RT, Nazif TM. Planning for Success: Pre-procedural Evaluation for Transcatheter Aortic Valve Replacement. Cardiol Clin 2019; 38:103-113. [PMID: 31753169 DOI: 10.1016/j.ccl.2019.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Vivian G Ng
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY 10032, USA
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY 10032, USA
| | - Tamim M Nazif
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY 10032, USA.
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27
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Blanke P, Weir-McCall JR, Achenbach S, Delgado V, Hausleiter J, Jilaihawi H, Marwan M, Norgaard BL, Piazza N, Schoenhagen P, Leipsic JA. Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI) / transcatheter aortic valve replacement (TAVR): An expert consensus document of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2019; 13:1-20. [DOI: 10.1016/j.jcct.2018.11.008] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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28
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Blanke P, Weir-McCall JR, Achenbach S, Delgado V, Hausleiter J, Jilaihawi H, Marwan M, Nørgaard BL, Piazza N, Schoenhagen P, Leipsic JA. Computed Tomography Imaging in the Context of Transcatheter Aortic Valve Implantation (TAVI)/Transcatheter Aortic Valve Replacement (TAVR). JACC Cardiovasc Imaging 2019; 12:1-24. [DOI: 10.1016/j.jcmg.2018.12.003] [Citation(s) in RCA: 192] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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29
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Al’Aref SJ, Mrsic Z, Feuchtner G, Min JK, Villines TC. The Journal of Cardiovascular Computed Tomography year in review - 2018. J Cardiovasc Comput Tomogr 2018; 12:529-538. [DOI: 10.1016/j.jcct.2018.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/18/2018] [Indexed: 12/24/2022]
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30
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Pollari F, Kališnik JM, Fischlein T, Pfeiffer S. Aortic calcification and the risk for paravalvular regurgitation after TAVI: The importance of focusing on reliable outcomes and appropriate variables. J Cardiovasc Comput Tomogr 2018; 12:e15. [PMID: 29759896 DOI: 10.1016/j.jcct.2018.05.001] [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: 03/26/2018] [Accepted: 05/03/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Francesco Pollari
- Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg - Paracelsus Medical University, Nuremberg, Germany; PhD Program in Angio-Cardio-Thoracic Pathophysiology and Imaging, Sapienza University of Rome, Rome, Italy.
| | - Jurij M Kališnik
- Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg - Paracelsus Medical University, Nuremberg, Germany
| | - Theodor Fischlein
- Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg - Paracelsus Medical University, Nuremberg, Germany
| | - Steffen Pfeiffer
- Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg - Paracelsus Medical University, Nuremberg, Germany
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