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Late expansion of mechanically expanding transcatheter aortic valves. Cardiovasc Interv Ther 2022; 37:717-724. [PMID: 35129792 DOI: 10.1007/s12928-022-00837-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/13/2022] [Indexed: 11/02/2022]
Abstract
Several studies have demonstrated better hemodynamic stability of mechanically expanding valves following transcatheter aortic valve replacement (TAVR). This study aims to assess the expansion or recoil of transcatheter aortic valves using multidetector computed tomography (MDCT). This was a retrospective study. Among 873 patients who underwent TAVR with balloon-expandable (SAPIEN 3) or mechanically expanding valves (LOTUS) at Keio University Hospital between 2013 and 2020, those who underwent serial MDCT and echocardiographic assessment (pre-procedure, discharge, 6 months, 1 year, and 2 years post-TAVR) as our hospital protocol were included in this analysis (N = 30; LOTUS = 12; SAPIEN 3 = 18). The pre- and post-procedural echocardiographic data and the valve expansion rate evaluated by MDCT were compared between the groups. In LOTUS valves, late-phase expansion was observed on computed tomography (mean expansion rate, 83.8% at discharge and 86.8%, 2 years postoperative, p < 0.001), and a gradual increase in the aortic valve area was observed on echocardiography (aortic valve area: 1.45 cm2 at discharge and 1.51 cm2, 2 years postoperative, p = 0.01). Conversely, in SAPIEN 3, valve expansion was not seen in the late phase (mean expansion rate, 84.5% at discharge and 83.8%, 2 years postoperative) with a decrease in the aortic valve area (1.41 cm2 at discharge and 1.37 cm2, 2 years postoperative, p = 0.04). The expansion of the middle portion of the LOTUS valves was attributed to the increase in the aortic valve area. In conclusion, this study demonstrated the greater late-phase expansion and better valve performance of mechanically expanding valves.
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Ferreira-Neto AN, Rodriguez-Gabella T, Guimaraes L, Freitas-Ferraz A, Bernier M, Figueiredo Guimaraes C, Pasian S, Paradis JM, Delarochellière R, Dumont E, Mohammadi S, Kalavrouziotis D, Côté M, Pibarot P, Rodés-Cabau J. Multimodality evaluation of transcatheter structural valve degeneration at long-term follow-up. ACTA ACUST UNITED AC 2021; 74:247-256. [DOI: 10.1016/j.rec.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/20/2020] [Indexed: 11/24/2022]
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Ferreira-Neto AN, Rodriguez-Gabella T, Guimaraes L, Freitas-Ferraz A, Bernier M, Figueiredo Guimaraes C, Pasian S, Paradis JM, Delarochellière R, Dumont E, Mohammadi S, Kalavrouziotis D, Côté M, Pibarot P, Rodés-Cabau J. Evaluación multimodal de la degeneración estructural de válvulas percutáneas en el seguimiento a largo plazo. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Chiocchi M, Ricci F, Pasqualetto M, D'Errico F, Benelli L, Pugliese L, Cavallo AU, Forcina M, Presicce M, De Stasio V, Di Donna C, Di Tosto F, Spiritigliozzi L, Floris R, Romeo F. Role of computed tomography in transcatheter aortic valve implantation and valve-in-valve implantation: complete review of preprocedural and postprocedural imaging. J Cardiovasc Med (Hagerstown) 2020; 21:182-191. [PMID: 32012138 DOI: 10.2459/jcm.0000000000000899] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
: Since 2002, transcatheter aortic valve implantation (TAVI) has revolutionized the treatment and prognosis of patients with aortic stenosis. A preprocedural assessment of the patient is vital for achieving optimal outcomes from the procedure. Retrospective ECG-gated cardiac computed tomography (CT) today it is the gold-standard imaging technique that provides three-dimensional images of the heart, thus allowing a rapid and complete evaluation of the morphology of the valve, ascending aorta, coronary arteries, peripheral access vessels, and prognostic factors, and also provides preprocedural coplanar fluoroscopic angle prediction to obtain complete assessment of the patient. The most relevant dimension in preprocedural planning of TAVI is the aortic annulus, which can determine the choice of prosthesis size. CT is also essential to identify patients with increased anatomical risk for coronary artery occlusion in Valve in Valve (ViV) procedures.Moreover, CT is very useful in the evaluation of late complications, such as leakage, thrombosis and displacements. At present, CT is the cornerstone imaging modality for the extensive and thorough work-up required for planning and performing each TAVI procedure, to achieve optimal outcomes. Both the CT procedure and analysis should be performed by trained and experienced personnel, with a radiological background and a deep understanding of the TAVI procedure, in close collaboration with the implantation team. An accurate pre-TAVI CT and post-processing for the evaluation of all the points recommended in this review allow a complete planning for the choice of the valve dimensions and type (balloon or self-expandable) and of the best percutaneous access.
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Affiliation(s)
- Marcello Chiocchi
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Francesca Ricci
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Monia Pasqualetto
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | | | - Leonardo Benelli
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Luca Pugliese
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | | | - Marco Forcina
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Matteo Presicce
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | | | - Carlo Di Donna
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Federica Di Tosto
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | | | - Roberto Floris
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Francesco Romeo
- Unit of Cardiology and Interventional Cardiology, University of Rome 'Tor Vergata', Rome, Italy
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Fiori AG, Simonato M, Eyer A, Fonseca JHPD, Gaia DF. Hemodynamic and Imaging Assessment of Transcatheter Aortic Valve Replacement with the Inovare® Proseal using Multislice Computed Tomography. Braz J Cardiovasc Surg 2020; 35:127-133. [PMID: 32369290 PMCID: PMC7199976 DOI: 10.21470/1678-9741-2019-0103] [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] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the hemodynamic performance (i.e., gradients and paravalvular leakage [PVL]) of the new and experimental Braile Inovare® Proseal. Additionally, we aimed to assess pre and postoperatively the aortic annulus and the transcatheter prosthesis using multislice computed tomography (MSCT). Methods Patients were selected by a multidisciplinary heart team and referred for transcatheter aortic valve replacement (TAVR). MSCT was performed before and after surgery. Measurements of the aortic valve and prosthesis were conducted and correlated with the valve gradient and residual PVL. Results Twenty-one patients were selected for the protocol. Patients had a mean age of 79 years and 38% of them were of female sex. The mean EuroSCORE II value was 12.5%±10.8. Mean gradient was reduced from 45.8±11.04 mmHg to 5.59±2.61 mmHg and there were no instances of PVL worse than mild. There were no cases of coronary obstruction or procedural death. Circularity was present in all prostheses evaluated. Circularity indexes for the prostheses were: inflow 0.05±0.03, middle third 0.04±0.02, and outflow 0.04±0.02 (P=0.08). The mean distance between the prosthesis and the left and right coronary ostia were 14.8 mm±3.3 and 17.3 mm±3, respectively. Oversizing was appropriate with a mean of 22.14%±6%. Conclusion Braile Inovare® Proseal transcatheter device has demonstrated low gradients with low rates of PVL. Oversizing by annular measurements was adequate. MSCT was adequate to evaluate device sizing and has demonstrated preserved expansibility and circularity in the evaluated cases.
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Affiliation(s)
- Apoana Gomes Fiori
- Universidade Federal de São Paulo Escola Paulista de Medicina Division of Cardiac Surgery São Paulo Brazil Division of Cardiac Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Matheus Simonato
- Universidade Federal de São Paulo Escola Paulista de Medicina Division of Cardiac Surgery São Paulo Brazil Division of Cardiac Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alfredo Eyer
- Universidade Federal de São Paulo Escola Paulista de Medicina Department of Radiology São Paulo Brazil Department of Radiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - José Honório Palma da Fonseca
- Universidade Federal de São Paulo Escola Paulista de Medicina Division of Cardiac Surgery São Paulo Brazil Division of Cardiac Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Diego Felipe Gaia
- Universidade Federal de São Paulo Escola Paulista de Medicina Division of Cardiac Surgery São Paulo Brazil Division of Cardiac Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Faure ME, Suchá D, Schwartz FR, Symersky P, Bogers AJJC, Gaca JG, Koweek LM, de Heer LM, Budde RPJ. Surgically implanted aortic valve bioprostheses deform after implantation: insights from computed tomography. Eur Radiol 2020; 30:2651-2657. [PMID: 32002643 DOI: 10.1007/s00330-019-06634-6] [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] [Received: 08/06/2019] [Revised: 11/28/2019] [Accepted: 12/13/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Little is known about the prevalence and degree of deformation of surgically implanted aortic biological valve prostheses (bio-sAVRs). We assessed bio-sAVR deformation using multidetector-row computed tomography (MDCT). METHODS Three imaging databases were searched for patients with MDCT performed after bio-sAVR implantation. Minimal and maximal valve ring diameters were obtained in systole and/or diastole, depending on the acquired cardiac phase(s). The eccentricity index (EI) was calculated as a measure of deformation as (1 - (minimal diameter/maximal diameter)) × 100%. EI of < 5% was considered none or trivial deformation, 5-10% mild deformation, and > 10% non-circular. Indications for MDCT and implanted valve type were retrieved. RESULTS One hundred fifty-two scans of bio-sAVRs were included. One hundred seventeen measurements were performed in systole and 35 in diastole. None or trivial deformation (EI < 5%) was seen in 67/152 (44%) of patients. Mild deformation (EI 5-10%) was seen in 59/152 (39%) and non-circularity was found in 26/152 (17%) of cases. Overall, median EI was 5.5% (IQR 3.4-7.8). In 77 patients, both systolic and diastolic measurements were performed from the same scan. For these scans, the median EI was 6.5% (IQR 3.4-10.2) in systole and 5.1% (IQR3.1-7.6) in diastole, with a significant difference between both groups (p = 0.006). CONCLUSIONS Surgically implanted aortic biological valve prostheses show mild deformation in 39% of cases and were considered non-circular in 17% of studied valves. KEY POINTS • Deformation of surgically implanted aortic valve bioprostheses (bio-sAVRs) can be adequately assessed using MDCT. • Bio-sAVRs show at least mild deformation (eccentricity index > 5%) in 56% of studied cases and were considered non-circular (eccentricity index > 10%) in 17% of studied valves. • The higher deformity rate found in bio-sAVRs with (suspected) valve pathology could suggest that geometric deformity may play a role in leaflet malformation and thrombus formation similar to that of transcatheter heart valves.
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Affiliation(s)
- Marguerite E Faure
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Po Box 2040, 3000, CA, Rotterdam, The Netherlands. .,Department of Radiology, AZ Monica, Antwerp, Belgium.
| | - Dominika Suchá
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Fides R Schwartz
- Department of Radiology, Duke University Medical Center, Durham, USA
| | - Petr Symersky
- Department of Cardiothoracic Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jeffrey G Gaca
- Department of Cardiothoracic Surgery, Duke University Medical Center, Durham, USA
| | - Lynne M Koweek
- Department of Radiology, Duke University Medical Center, Durham, USA
| | - Linda M de Heer
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Po Box 2040, 3000, CA, Rotterdam, The Netherlands
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Jafar R, Labrosse MR, Weaver JD, Retta SM, Wu C, Duraiswamy N. A Computational Study on Deformed Bioprosthetic Valve Geometries: Clinically Relevant Valve Performance Metrics. J Biomech Eng 2020; 142:011003. [PMID: 31314893 PMCID: PMC10464846 DOI: 10.1115/1.4044235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Indexed: 11/08/2022]
Abstract
Transcatheter aortic valves (TAV) are symmetrically designed, but they are often not deployed inside cylindrical conduits with circular cross-sectional areas. Many TAV patients have heavily calcified aortic valves, which often result in deformed prosthesis geometries after deployment. We investigated the effects of deformed valve annulus configurations on a surgical bioprosthetic valve as a model for TAV. We studied valve leaflet motions, stresses and strains, and analog hydrodynamic measures (using geometric methods), via finite element (FE) modeling. Two categories of annular deformations were created to approximate clinical observations: (1) noncircular annulus with valve area conserved, and (2) under-expansion (reduced area) compared to circular annulus. We found that under-expansion had more impact on increasing stenosis (with geometric orifice area metrics) than noncircularity, and that noncircularity had more impact on increasing regurgitation (with regurgitation orifice area metrics) than under-expansion. We found durability predictors (stress/strain) to be the highest in the commissure regions of noncircular configurations such as EllipMajor (noncircular and under-expansion areas). Other clinically relevant performance aspects such as leaflet kinematics and coaptation were also investigated with the noncircular configurations. This study provides a framework for choosing the most challenging TAV deformations for acute and long-term valve performance in the design and testing phase of device development.
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Affiliation(s)
- Reza Jafar
- Cardiovascular Mechanics Laboratory, Department of Mechanical Engineering, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Michel R Labrosse
- Cardiovascular Mechanics Laboratory, Department of Mechanical Engineering, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Jason D Weaver
- Division of Applied Mechanics (DAM), Office of Science and Engineering Laboratories (OSEL), Center for Devices and Radiological Health (CDRH), Food and Drug Administration (FDA), Silver Spring, MD 20993
| | - Stephen M Retta
- Office of Product Evaluation and Quality (OPEQ), Center for Devices and Radiological Health (CDRH), Food and Drug Administration (FDA), Silver Spring, MD 20993
| | - Changfu Wu
- Office of Product Evaluation and Quality (OPEQ), Center for Devices and Radiological Health (CDRH), Food and Drug Administration (FDA), Silver Spring, MD 20993
| | - Nandini Duraiswamy
- Division of Applied Mechanics (DAM), Office of Science and Engineering Laboratories (OSEL), Center for Devices and Radiological Health (CDRH), Food and Drug Administration (FDA), 10903 New Hampshire Avenue, WO62, #2206, Silver Spring, MD 20993
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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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Lehner A, Dashkalova T, Ulrich S, Fernandez Rodriguez S, Mandilaras G, Jakob A, Dalla-Pozza R, Fischer M, Schneider H, Tarusinov G, Kampmann C, Hofbeck M, Dähnert I, Kanaan M, Haas NA. Intermediate outcomes of transcatheter pulmonary valve replacement with the Edwards Sapien 3 valve - German experience. Expert Rev Med Devices 2019; 16:829-834. [PMID: 31432698 DOI: 10.1080/17434440.2019.1653180] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: After encouraging results with the Edwards Sapien and XT valves, this study aimed to review procedural data and early outcomes for the Sapien 3 valves for transcatheter pulmonary valve replacement (TPVR). Methods: We performed a multicenter, retrospective analysis of cases who underwent a Sapien 3 TPVR between 2015 and 2017 in 7 centers in Germany with a follow-up of up to 2 years. Results: 56 patients could be enrolled (weight 58,5 ± 25,0 kg; 53% Tetralogy of Fallot, 45% native RVOT). Most procedures were two-stage procedures (82,1%) with 100% prestenting. Valve sizes were 20 mm (n = 1), 23 mm (n = 15), 26 mm (n = 27), 29 mm (n = 13). Procedural success rate was 96.4%. Two patients underwent surgical valve implantation after balloon rupture during TPVR. Follow-up data were available up to 24-month post TPVR. The rate of patients with ? moderate and severe pulmonary regurgitation decreased to 0% after TPVR, peak systolic gradient decreased from 24,2 (SD±20,9) mmHg to 7,1 mmHg (SD±5,0). There were no endocarditis, severe tricuspid valve impairment or stent fractures. Conclusions: With the Edwards Sapien 3 valve, the patient pool for TPVR can be substantially extended. Continued data collection is necessary to verify long-term results.
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Affiliation(s)
- Anja Lehner
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Tsvetina Dashkalova
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Sarah Ulrich
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Silvia Fernandez Rodriguez
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Guido Mandilaras
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Andre Jakob
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Robert Dalla-Pozza
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Marcus Fischer
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Heike Schneider
- Department for Pediatric Cardiology and Intensive Care, Heart Center Goettingen, Georg-August-University Goettingen , Goettingen , Germany
| | - Gleb Tarusinov
- Department for Pediatric Cardiology, Heart Center Duisburg , Duisburg , Germany
| | - Christoph Kampmann
- Department for Pediatric Cardiology, University Medical Center Mainz , Mainz , Germany
| | - Michael Hofbeck
- Department for Pediatric Cardiology, University Hospital Tuebingen , Tuebingen , Germany
| | - Ingo Dähnert
- Department for Pediatric Cardiology, Heart Center Leipzig , Leipzig , Germany
| | - Majed Kanaan
- Center for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum , Bad Oeynhausen , Germany
| | - Nikolaus A Haas
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
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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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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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Morgan GJ, Sadeghi S, Salem MM, Wilson N, Kay J, Rothman A, Galindo A, Martin MH, Gray R, Ross M, Aboulhosn JA, Levi DS. SAPIEN valve for percutaneous transcatheter pulmonary valve replacement without “pre‐stenting”: A multi‐institutional experience. Catheter Cardiovasc Interv 2018; 93:324-329. [DOI: 10.1002/ccd.27932] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/30/2018] [Accepted: 09/23/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Gareth J. Morgan
- Division of Pediatric CardiologyChildren's Hospital of Colorado Aurora Colorado
- Division of CardiologyUniversity of Colorado Aurora Colorado
| | - Soraya Sadeghi
- Department of Pediatrics, Division of CardiologyUCLA Mattel Children's Hospital Los Angeles California
| | - Moris M. Salem
- Department of Pediatrics, Division of CardiologyKaiser Permanente Los Angeles California
| | - Neil Wilson
- Division of Pediatric CardiologyChildren's Hospital of Colorado Aurora Colorado
| | - Joseph Kay
- Division of CardiologyUniversity of Colorado Aurora Colorado
| | - Abraham Rothman
- Division of Pediatric CardiologyChildren's Heart Center of Nevada Las Vegas Nevada
| | - Alvaro Galindo
- Division of Pediatric CardiologyChildren's Heart Center of Nevada Las Vegas Nevada
| | - Mary Hunt Martin
- Division of Pediatric CardiologyPrimary Children's Hospital Salt Lake City Utah
| | - Robert Gray
- Division of Pediatric CardiologyPrimary Children's Hospital Salt Lake City Utah
| | - Michael Ross
- Division of Pediatric CardiologyChildren's Hospital of Colorado Aurora Colorado
| | - Jamil A. Aboulhosn
- Department of Medicine, Ahmanson Adult Congenital Heart Disease CenterDavid Geffen School of Medicine at UCLA Los Angeles California
| | - Daniel Steven Levi
- Department of Pediatrics, Division of CardiologyUCLA Mattel Children's Hospital Los Angeles California
- Department of Medicine, Ahmanson Adult Congenital Heart Disease CenterDavid Geffen School of Medicine at UCLA Los Angeles California
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Hansson NC, Leipsic J, Pugliese F, Andersen HR, Rossi A, Simonato M, Jensen KT, Christiansen EH, Terkelsen CJ, Blanke P, Tang M, Krusell LR, Klaaborg KE, Terp K, Kennon S, Dvir D, Bøtker HE, Webb J, Nørgaard BL. Aortic valve and left ventricular outflow tract calcium volume and distribution in transcatheter aortic valve replacement: Influence on the risk of significant paravalvular regurgitation. J Cardiovasc Comput Tomogr 2018. [DOI: 10.1016/j.jcct.2018.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wagner MG, Hatt CR, Dunkerley DAP, Bodart LE, Raval AN, Speidel MA. A dynamic model-based approach to motion and deformation tracking of prosthetic valves from biplane x-ray images. Med Phys 2018; 45:2583-2594. [PMID: 29659023 PMCID: PMC6205814 DOI: 10.1002/mp.12913] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 04/02/2018] [Accepted: 04/02/2018] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure in which a prosthetic heart valve is placed and expanded within a defective aortic valve. The device placement is commonly performed using two-dimensional (2D) fluoroscopic imaging. Within this work, we propose a novel technique to track the motion and deformation of the prosthetic valve in three dimensions based on biplane fluoroscopic image sequences. METHODS The tracking approach uses a parameterized point cloud model of the valve stent which can undergo rigid three-dimensional (3D) transformation and different modes of expansion. Rigid elements of the model are individually rotated and translated in three dimensions to approximate the motions of the stent. Tracking is performed using an iterative 2D-3D registration procedure which estimates the model parameters by minimizing the mean-squared image values at the positions of the forward-projected model points. Additionally, an initialization technique is proposed, which locates clusters of salient features to determine the initial position and orientation of the model. RESULTS The proposed algorithms were evaluated based on simulations using a digital 4D CT phantom as well as experimentally acquired images of a prosthetic valve inside a chest phantom with anatomical background features. The target registration error was 0.12 ± 0.04 mm in the simulations and 0.64 ± 0.09 mm in the experimental data. CONCLUSIONS The proposed algorithm could be used to generate 3D visualization of the prosthetic valve from two projections. In combination with soft-tissue sensitive-imaging techniques like transesophageal echocardiography, this technique could enable 3D image guidance during TAVR procedures.
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Affiliation(s)
- Martin G. Wagner
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWIUSA
- Department of RadiologyUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Charles R. Hatt
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWIUSA
| | | | - Lindsay E. Bodart
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Amish N. Raval
- Department of MedicineUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Michael A. Speidel
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWIUSA
- Department of MedicineUniversity of Wisconsin‐MadisonMadisonWIUSA
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Rodríguez-Olivares R, El Faquir N, Rahhab Z, van Gils L, Ren B, Sakhi R, Geleijnse ML, van Domburg R, de Jaegere PPT, Zamorano Gómez JL, Van Mieghem NM. Impact of device-host interaction on paravalvular aortic regurgitation with different transcatheter heart valves. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:126-132. [PMID: 29779973 DOI: 10.1016/j.carrev.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/18/2018] [Accepted: 05/01/2018] [Indexed: 10/16/2022]
Abstract
AIMS We sought to evaluate the interaction of different aortic root phenotypes with self-expanding (SEV), balloon-expandable (BEV) and mechanically expanded (MEV) and the impact on significant aortic regurgitation. METHODS AND RESULTS We included 392 patients with a SEV (N = 205), BEV (N = 107) or MEV (N = 80). Aortic annulus eccentricity index and calcification were measured by multi-slice CT scan. Paravalvular aortic regurgitation was assessed by contrast aortography (primary analysis) and transthoracic echocardiography (secondary analysis). In mildly calcified roots paravalvular regurgitation incidence was similar for all transcatheter heart valves (SEV 8.4%; BEV 9.1%; MEV 2.0% p = 0.27). Conversely, in heavily calcified roots paravalvular regurgitation incidence was significantly higher with SEV (SEV 45.9%; BEV 0.0%; MEV 0.0% p < 0.001). When paravalvular regurgitation was assessed by TTE, the overall findings were similar although elliptic aortic roots were associated with more paravalvular regurgitation with SEV (20.5% vs. BEV 4.5% vs. MEV 3.2%; p = 0.009). CONCLUSIONS In heavily calcified aortic roots, significant paravalvular aortic regurgitation is more frequent with SEV than with BEV or MEV, but similar in mildly calcified ones. These findings may support patient-tailored transcatheter heart valve selection. CLASSIFICATIONS Aortic stenosis; multislice computed tomography; transcatheter aortic valve replacement; paravalvular aortic regurgitation. CONDENSED ABSTRACT We sought to evaluate the interaction of different aortic root phenotypes with self-expanding (SEV), balloon-expandable (BEV) and mechanically expanded (MEV) and the impact on significant aortic regurgitation. We included 392 patients with a SEV (N = 205), BEV (N = 107) or MEV (N = 80). Aortic annulus eccentricity index and calcification were measured by multi-slice CT scan. Paravalvular aortic regurgitation was assessed by contrast aortography and transthoracic echocardiography. We found that in heavily calcified aortic roots, significant paravalvular aortic regurgitation is more frequent with SEV than with BEV or MEV, but similar in mildly calcified ones.
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Affiliation(s)
- Ramón Rodríguez-Olivares
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands; Department of Cardiology, Ramón y Cajal University Hospital. Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Spain
| | - Nahid El Faquir
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Zouhair Rahhab
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Lennart van Gils
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Ben Ren
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Rafi Sakhi
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Marcel L Geleijnse
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Ron van Domburg
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | | | - Jose L Zamorano Gómez
- Department of Cardiology, Ramón y Cajal University Hospital. Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Spain
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16
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El Faquir N, Ren B, Faure M, de Ronde M, Geeve P, Maugenest AM, Kardys I, Geleijnse ML, de Jaegere PP, Budde RPJ, Van Mieghem NM. Long-Term Structural Integrity and Durability of the Medtronic CoreValve System After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Imaging 2017; 11:781-783. [PMID: 29153578 DOI: 10.1016/j.jcmg.2017.08.019] [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: 04/24/2017] [Revised: 07/13/2017] [Accepted: 08/03/2017] [Indexed: 11/26/2022]
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Almeida JG, Ferreira SM, Fonseca P, Dias T, Guerreiro C, Barbosa A, Teixeira P, Carvalho M, Ferreira W, Ferreira ND, Braga P, Ribeiro J, Ribeiro VG. Comparison of self-expanding and balloon-expandable transcatheter aortic valves morphology and association with paravalvular regurgitation: Evaluation using multidetector computed tomography. Catheter Cardiovasc Interv 2017; 92:533-541. [PMID: 29105953 DOI: 10.1002/ccd.27401] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/06/2017] [Accepted: 10/12/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Compare final morphology of self-expanding and balloon-expandable prosthesis and association with paravalvular regurgitation (PVR). BACKGROUND PVR after transcatheter aortic valve replacement (TAVR) remains a frequent complication. A better understanding of the prosthesis geometry may be important to improve selection of the best device for each case and possibly reduce the rates of PVR. METHODS Retrospective study including patients consecutively submitted to transcatheter aortic valve replacement: August/2007-October/2016. Three months after the procedure a multidetector computed tomography (MDCT) was performed to assess prosthesis geometry: dimensions, eccentricity, and expansion. RESULTS A total of 147 individuals were included (mean age of 78.8 ± 6.7 and 50.3% males), 57% treated with a self-expanding prosthesis. On the postprocedure MDCT, the self-expanding group had higher eccentricity index (15.0 vs. 7.1%, p < .001) and lower expansion (68.3 vs. 82.8%, p < .001). In that group, the volume of calcium of landing zone had a significant correlation with eccentricity index and under-expansion. Patients with ≥mild PVR presented higher eccentricity (12.6 vs. 7.9%, p < .001) and lower expansion (68 vs. 75%, p = .012). Eccentricity index and landing zone calcium volume were independent predictors of PVR. CONCLUSIONS Self-expanding prosthesis have greater eccentricity and under-expansion. Calcium burden exerts more influence in the final morphology of that type of valve. Calcification and eccentricity are associated with the development of PVR. These factors should be considered in the selection of the most appropriate type of prosthesis for each scenario.
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Affiliation(s)
- João G Almeida
- Department of Cardiology, Gaia/Espinho Hospital Center, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
| | - Sara M Ferreira
- Department of Cardiology, Divino Espirito Santo Hospital, Ponta Delgada, Portugal
| | - Paulo Fonseca
- Department of Cardiology, Gaia/Espinho Hospital Center, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
| | - Tiago Dias
- Department of Cardiology, Gaia/Espinho Hospital Center, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
| | - Cláudio Guerreiro
- Department of Cardiology, Gaia/Espinho Hospital Center, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
| | - Ana Barbosa
- Department of Cardiology, Gaia/Espinho Hospital Center, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
| | - Pedro Teixeira
- Department of Cardiology, Gaia/Espinho Hospital Center, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
| | - Mónica Carvalho
- Department of Cardiology, Gaia/Espinho Hospital Center, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
| | - Wilson Ferreira
- Department of Cardiology, Gaia/Espinho Hospital Center, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
| | - Nuno D Ferreira
- Department of Cardiology, Gaia/Espinho Hospital Center, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
| | - Pedro Braga
- Department of Cardiology, Gaia/Espinho Hospital Center, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
| | - José Ribeiro
- Department of Cardiology, Gaia/Espinho Hospital Center, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
| | - Vasco G Ribeiro
- Department of Cardiology, Gaia/Espinho Hospital Center, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
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18
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George I, Guglielmetti LC, Bettinger N, Moss A, Wang C, Kheysin N, Hahn R, Kodali S, Leon M, Bapat V, Borger MA, Williams M, Smith C, Khalique OK. Aortic Valve Annular Sizing: Intraoperative Assessment Versus Preoperative Multidetector Computed Tomography. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005968. [PMID: 28487320 DOI: 10.1161/circimaging.116.005968] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/09/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Appropriate valve sizing is critical in aortic valve replacement. We hypothesized that direct intraoperative valve sizing results in smaller aortic annular diameters compared with sizing based on systolic-phase multidetector computerized tomographic (MDCT) imaging. METHODS AND RESULTS We retrospectively analyzed 78 patients undergoing surgical aortic valve replacement for severe aortic stenosis between 2012 and 2014 at our institution. Preoperative MDCT measurements of the aortic annulus served as basis for assignment to a theoretical surgical valve size, which was then (1) compared to the implanted valve size and (2) to a theoretical transcatheter aortic valve replacement valve size. To quantify the resulting differences, geometric orifice areas (GOA) were calculated. MDCT-based sizing produced the same valve size for n=34 patients (group CT-same), a larger valve with a 25% increased GOA in n=32 patients (group CT-Lg) and a smaller GOA by 22% in n=12 patients (group CT-Sm). On the basis of MDCT measurements, 41% of valves implanted were undersized. The comparison of intraoperative implanted to a theoretical transcatheter aortic valve replacement valve size resulted in GOAs 25% larger for patients in group CT-same, 40.6% larger in group CT-Lg and 14.6% larger in group CT-Sm. CONCLUSIONS Preoperative MDCT measurements differ substantially from direct intraoperative assessment of the aortic annulus. Implanted surgical aortic valve replacement valves were smaller relative to MDCT-based sizing in 41% of patients, and the potential GOA was between 25% and 40.6% larger if patients had undergone transcatheter aortic valve replacement.
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Affiliation(s)
- Isaac George
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.).
| | - Laura C Guglielmetti
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Nicolas Bettinger
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Andrew Moss
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Catherine Wang
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Nathan Kheysin
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Rebecca Hahn
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Susheel Kodali
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Martin Leon
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Vinayak Bapat
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Michael A Borger
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Mathew Williams
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Craig Smith
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Omar K Khalique
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
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19
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Harrison JK, Hughes GC, Reardon MJ, Stoler R, Grayburn P, Hebeler R, Liu D, Chang Y, Popma JJ. Balloon Post-Dilation Following Implantation of a Self-Expanding Transcatheter Aortic Valve Bioprosthesis. JACC Cardiovasc Interv 2017; 10:168-175. [DOI: 10.1016/j.jcin.2016.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 10/13/2016] [Accepted: 11/03/2016] [Indexed: 12/17/2022]
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20
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Maeno Y, Abramowitz Y, Yoon SH, Jilaihawi H, Raul S, Israr S, Miyasaka M, Kawamori H, Kazuno Y, Rami T, Takahashi N, Mangat G, Kashif M, Chakravarty T, Nakamura M, Cheng W, Makkar RR. Transcatheter Aortic Valve Replacement With Different Valve Types in Elliptic Aortic Annuli. Circ J 2017; 81:1036-1042. [DOI: 10.1253/circj.cj-16-1240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | - Sharma Raul
- Cedars-Sinai Medical Center, Heart Institute
| | | | | | | | | | - Tanya Rami
- Cedars-Sinai Medical Center, Heart Institute
| | | | | | | | | | | | - Wen Cheng
- Cedars-Sinai Medical Center, Heart Institute
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21
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Xuan Y, Krishnan K, Ye J, Dvir D, Guccione JM, Ge L, Tseng EE. Stent and leaflet stresses in a 26-mm first-generation balloon-expandable transcatheter aortic valve. J Thorac Cardiovasc Surg 2016; 153:1065-1073. [PMID: 28108064 DOI: 10.1016/j.jtcvs.2016.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 11/25/2016] [Accepted: 12/05/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Transcatheter aortic valve replacement is established therapy for high-risk and inoperable patients with severe aortic stenosis, but questions remain regarding long-term durability. Valve design influences durability. Increased leaflet stresses in surgical bioprostheses have been correlated with degeneration; however, transcatheter valve leaflet stresses are unknown. From 2007 to 2014, a majority of US patients received first-generation balloon-expandable transcatheter valves. Our goal was to determine stent and leaflet stresses in this valve design using finite element analyses. METHODS A 26-mm Sapien Transcatheter Heart Valve (Edwards Lifesciences, Inc, Irvine, Calif) underwent high-resolution microcomputed tomography scanning to develop precise 3-dimensional geometry of the leaflets, the stent, and the polyethylene terephthalate elements. The stent was modeled using 3-dimensional elements and the leaflets were modeled using shell elements. Stent material properties were based on stainless steel, whereas those for leaflets were obtained from surgical bioprostheses. Noncylindrical Sapien valve geometry was also simulated. Pressure loading to 80 mm Hg and 120 mm Hg was performed using ABAQUS finite element software (Dassault Systèmes, Waltham, Mass). RESULTS At 80 mm Hg, maximum principal stresses on Sapien leaflets were 1.31 megaspascals (MPa). Peak leaflet stress was observed at commissural tips where leaflets connected to the stent. Maximum principal stresses for the stent were 188.91 MPa and located at stent tips where leaflet commissures were attached. Noncylindrical geometry increased peak principal leaflet stresses by 16%. CONCLUSIONS Using exact geometry from high-resolution scans, the 26-mm Sapien Transcatheter Heart Valve showed that peak stresses for both stent and leaflets were present at commissural tips where leaflets were attached. These regions would be prone to leaflet degeneration. Understanding stresses in first-generation transcatheter valves allows comparison to future designs for relative durability.
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Affiliation(s)
- Yue Xuan
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, Calif
| | - Kapil Krishnan
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, Calif
| | - Jian Ye
- Division of Cardiovascular Surgery, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Danny Dvir
- Division of Cardiology, University of Washington, Seattle, Wash
| | - Julius M Guccione
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, Calif
| | - Liang Ge
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, Calif
| | - Elaine E Tseng
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, Calif.
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22
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Yashima F, Yamamoto M, Watanabe Y, Takagi K, Yamada Y, Inohara T, Yanagisawa R, Tanaka M, Arai T, Shimizu H, Jinzaki M, Kozuma K, Fukuda K, Suzuki T, Hayashida K. Impact of underfilling and overfilling in balloon-expandable transcatheter aortic valve implantation assessed by multidetector computed tomography: Insights from the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) registry. Int J Cardiol 2016; 222:738-744. [DOI: 10.1016/j.ijcard.2016.07.218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
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23
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Martin C, Sun W. Transcatheter Valve Underexpansion Limits Leaflet Durability: Implications for Valve-in-Valve Procedures. Ann Biomed Eng 2016; 45:394-404. [PMID: 27734178 DOI: 10.1007/s10439-016-1738-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 09/16/2016] [Indexed: 11/25/2022]
Abstract
Transcatheter aortic valve (TAV) implantation within a failed bioprosthetic valve is a growing trend for high-risk patients. The non-compliant stent of the previous prosthesis may prevent full expansion of the TAV, which has been shown to distort the leaflet configuration, and has been hypothesized to adversely affect durability. In this study, TAV leaflet fatigue damage under cyclic pressurization in the setting of stent underexpansion by 0 (fully expanded), 1, 2 and 3 mm was simulated using finite element analysis to test this hypothesis. In the 2 and 3 mm underexpanded devices, the TAV leaflets exhibited severe pin-wheeling during valve closure, which increased leaflet stresses dramatically, and resulted in accelerated fatigue damage of the leaflets. The leaflet fatigue damage in the 1 mm underexpanded case was similar to that in the fully expanded case. Clinically a range of 10-15% underexpansion is generally considered acceptable; however, it was observed in this study that ≥2 mm (≥9.1%) underexpansion, will significantly impact device durability. Further study is necessary to determine the impact of various deployment conditions, i.e. non-uniform and non-circular deployments and different implantation heights, on differing TAV devices, but it is clear that the normal TAV leaflet configuration must be preserved in order to preserve durability.
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Affiliation(s)
- Caitlin Martin
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Room 206, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Room 206, 387 Technology Circle, Atlanta, GA, 30313-2412, USA.
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24
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Gunning PS, Saikrishnan N, Yoganathan AP, McNamara LM. Total ellipse of the heart valve: the impact of eccentric stent distortion on the regional dynamic deformation of pericardial tissue leaflets of a transcatheter aortic valve replacement. J R Soc Interface 2016; 12:20150737. [PMID: 26674192 DOI: 10.1098/rsif.2015.0737] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Transcatheter aortic valve replacements (TAVRs) are a percutaneous alternative to surgical aortic valve replacements and are used to treat patients with aortic valve stenosis. This minimally invasive procedure relies on expansion of the TAVR stent to radially displace calcified aortic valve leaflets against the aortic root wall. However, these calcium deposits can impede the expansion of the device causing distortion of the valve stent and pericardial tissue leaflets. The objective of this study was to elucidate the impact of eccentric TAVR stent distortion on the dynamic deformation of the tissue leaflets of the prosthesis in vitro. Dual-camera stereophotogrammetry was used to measure the regional variation in strain in a leaflet of a TAVR deployed in nominal circular and eccentric (eccentricity index = 28%) orifices, representative of deployed TAVRs in vivo. It was observed that (i) eccentric stent distortion caused incorrect coaptation of the leaflets at peak diastole resulting in a 'peel-back' leaflet geometry that was not present in the circular valve and (ii) adverse bending of the leaflet, arising in the eccentric valve at peak diastole, caused significantly higher commissure strains compared with the circular valve in both normotensive and hypertensive pressure conditions (normotension: eccentric = 13.76 ± 2.04% versus circular = 11.77 ± 1.61%, p = 0.0014, hypertension: eccentric = 15.07 ± 1.13% versus circular = 13.56 ± 0.87%, p = 0.0042). This study reveals that eccentric distortion of a TAVR stent can have a considerable impact on dynamic leaflet deformation, inducing deleterious bending of the leaflet and increasing commissures strains, which might expedite leaflet structural failure compared to leaflets in a circular deployed valve.
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Affiliation(s)
- Paul S Gunning
- Biomechanics Research Centre, Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Republic of Ireland
| | - Neelakantan Saikrishnan
- Cardiovascular Fluid Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Ajit P Yoganathan
- Cardiovascular Fluid Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Laoise M McNamara
- Biomechanics Research Centre, Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Republic of Ireland
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Leipsic JA. President's Page. J Cardiovasc Comput Tomogr 2016; 10:193-4. [PMID: 26837234 DOI: 10.1016/j.jcct.2016.01.010] [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: 11/29/2022]
Affiliation(s)
- Jonathon A Leipsic
- Canada Research Chair, Advanced Cardiac Imaging and Vice Chairman of Radiology, University of British Columbia, Canada.
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Bapat V, Chambers D. In vitro evaluation of valve-in-valve combinations using a SAPIEN XT valve implanted within PERIMOUNT and Magna Ease pericardial bioprostheses. EUROINTERVENTION 2016; 11:e1291-301. [DOI: 10.4244/eijv11i11a251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Shibayama K, Mihara H, Jilaihawi H, Berdejo J, Harada K, Itabashi Y, Siegel R, Makkar RR, Shiota T. 3D Assessment of Features Associated With Transvalvular Aortic Regurgitation After TAVR. JACC Cardiovasc Imaging 2016; 9:114-23. [DOI: 10.1016/j.jcmg.2015.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/13/2015] [Accepted: 05/13/2015] [Indexed: 12/01/2022]
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Transcatheter Aortic Valve Implantation – Yesterday, Today and Tomorrow. Heart Lung Circ 2015; 24:1149-61. [DOI: 10.1016/j.hlc.2015.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 07/21/2015] [Accepted: 07/27/2015] [Indexed: 11/19/2022]
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Hamm CW, Arsalan M, Mack MJ. The future of transcatheter aortic valve implantation. Eur Heart J 2015; 37:803-10. [PMID: 26578195 DOI: 10.1093/eurheartj/ehv574] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/05/2015] [Indexed: 11/13/2022] Open
Abstract
Since the introduction of transcatheter aortic valve implantation (TAVI) into clinical practice, the treatment of aortic stenosis has changed dramatically. In the past, medical therapy with or without balloon aortic valvuloplasty was the only option for inoperable patients. More recently, TAVI has become the treatment of choice for these patients and the preferred alternative for high-risk operable patients. Surgical aortic valve replacement (SAVR) currently remains the gold standard for patients at low or intermediate operative risk. As randomized trials have demonstrated comparable results between TAVI and SAVR in the high-risk population, there is now a clear trend towards performing TAVI even in intermediate-risk patients while awaiting the results of randomized trials in that population. Nevertheless, there are still questions regarding TAVI involving paravalvular leak (PVL), stroke, pacemaker requirements, and durability that remain to be more definitively answered before TAVI can routinely be performed in a broader, lower risk population. Improvements in patient selection, imaging, and second and third generation devices have decreased the incidence of PVLs and vascular complications that followed the earliest TAVI procedures, but the rates of perioperative stroke and permanent pacemaker implantation must still be addressed. Furthermore, the long-term durability of TAVI devices and a role for post-procedure antithrombotic management remain unanswered. Until these questions are more clearly answered, it is the Heart Team's task to determine the optimal treatment for each patient based on risk scores, frailty metrics, comorbidities, patient preference, and potential for improvement in quality of life.
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Affiliation(s)
- Christian W Hamm
- Department of Medical Clinic I, University of Giessen, Klinikstr. 33, Gießen 35392, Germany Department Cardiac Surgery, Kerckhoff Heart Center, Benekestrasse 2-8, Bad Nauheim 61231, Germany
| | - Mani Arsalan
- Department Cardiac Surgery, Kerckhoff Heart Center, Benekestrasse 2-8, Bad Nauheim 61231, Germany The Heart Hospital Baylor Plano, 1100 Allied Drive, Plano, TX 75093, USA
| | - Michael J Mack
- Cardiovascular Surgery, Baylor Health Care System, Dallas, TX, USA
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Tan JS, Leipsic J, Perlman G, Stub D, Dvir D, Hansson NC, Norgaard BL, Blanke P, Cheung A, Ye J, Thompson CR, Moss RR, Lauck S, Wood D, Webb J. A Strategy of Underexpansion and Ad Hoc Post-Dilation of Balloon-Expandable Transcatheter Aortic Valves in Patients at Risk of Annular Injury. JACC Cardiovasc Interv 2015; 8:1727-32. [DOI: 10.1016/j.jcin.2015.08.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/03/2015] [Accepted: 08/03/2015] [Indexed: 10/22/2022]
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Hansson NC, Nørgaard BL, Barbanti M, Nielsen NE, Yang TH, Tamburino C, Dvir D, Jilaihawi H, Blanke P, Makkar RR, Latib A, Colombo A, Tarantini G, Raju R, Wood D, Andersen HR, Ribeiro HB, Kapadia S, Min J, Feuchtner G, Gurvitch R, Alqoofi F, Pelletier M, Ussia GP, Napodano M, Sandoli de Brito F, Kodali S, Pache G, Canovas SJ, Berger A, Murphy D, Svensson LG, Rodés-Cabau J, Leon MB, Webb JG, Leipsic J. The impact of calcium volume and distribution in aortic root injury related to balloon-expandable transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 2015; 9:382-92. [DOI: 10.1016/j.jcct.2015.04.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/24/2015] [Accepted: 04/04/2015] [Indexed: 10/23/2022]
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Maleki H, Shahriari S, Labrosse M, Rodés-Cabau J, Pibarot P, Kadem L. Effect of Aortic Annulus Size and Prosthesis Oversizing on the Hemodynamics and Leaflet Bending Stress of Transcatheter Valves: An In Vitro Study. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.03.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Muller B, Ghawi H, Heitschmidt MG, Fogg L, Hibbeln J, Hijazi ZM, Kenny D. Medium-term CT evaluation of stent geometry, integrity, and valve function of the Edwards SAPIEN transcatheter heart valve in the pulmonary position. Catheter Cardiovasc Interv 2015; 87:E97-103. [DOI: 10.1002/ccd.26074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/23/2015] [Indexed: 01/28/2023]
Affiliation(s)
- Brieann Muller
- Rush Center for Congenital and Structural Heart Disease; Rush University Medical Center; Chicago Illinois
| | - Hani Ghawi
- Rush Center for Congenital and Structural Heart Disease; Rush University Medical Center; Chicago Illinois
| | - Mary G. Heitschmidt
- Rush Center for Congenital and Structural Heart Disease; Rush University Medical Center; Chicago Illinois
| | - Louis Fogg
- Rush Center for Congenital and Structural Heart Disease; Rush University Medical Center; Chicago Illinois
| | - John Hibbeln
- Rush Center for Congenital and Structural Heart Disease; Rush University Medical Center; Chicago Illinois
| | - Ziyad M. Hijazi
- Rush Center for Congenital and Structural Heart Disease; Rush University Medical Center; Chicago Illinois
| | - Damien Kenny
- Rush Center for Congenital and Structural Heart Disease; Rush University Medical Center; Chicago Illinois
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Schuhbaeck A, Weingartner C, Arnold M, Schmid J, Pflederer T, Marwan M, Rixe J, Nef H, Schneider C, Lell M, Uder M, Ensminger S, Feyrer R, Weyand M, Achenbach S. Aortic annulus eccentricity before and after transcatheter aortic valve implantation: Comparison of balloon-expandable and self-expanding prostheses. Eur J Radiol 2015; 84:1242-8. [DOI: 10.1016/j.ejrad.2015.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 03/09/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
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Assessment of the Geometric Interaction Between the Lotus Transcatheter Aortic Valve Prosthesis and the Native Ventricular Aortic Interface by 320-Multidetector Computed Tomography. JACC Cardiovasc Interv 2015; 8:740-9. [DOI: 10.1016/j.jcin.2015.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 02/23/2015] [Accepted: 03/03/2015] [Indexed: 11/20/2022]
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Watanabe Y, Chevalier B, Hayashida K, Leong T, Bouvier E, Arai T, Farge A, Hovasse T, Garot P, Cormier B, Morice MC, Lefèvre T. Comparison of multislice computed tomography findings between bicuspid and tricuspid aortic valves before and after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2015; 86:323-30. [DOI: 10.1002/ccd.25830] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 01/03/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Yusuke Watanabe
- Division of Cardiology; Department of Internal Medicine; Teikyo University School of Medicine; Tokyo Japan
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Massy France
| | - Bernard Chevalier
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Massy France
| | - Kentaro Hayashida
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Tora Leong
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Massy France
| | - Erik Bouvier
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Massy France
| | - Takahide Arai
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Massy France
| | - Arnaud Farge
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Massy France
| | - Thomas Hovasse
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Massy France
| | - Philippe Garot
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Massy France
| | - Bertrand Cormier
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Massy France
| | - Marie-Claude Morice
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Massy France
| | - Thierry Lefèvre
- Department of Cardiology and Cardiovascular Surgery; Institut Cardiovasculaire Paris Sud; Massy France
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Finite Element Analysis of Transcatheter Aortic Valve Implantation in the Presence of Aortic Leaflet Calcifications. BIOMEDICAL TECHNOLOGY 2015. [DOI: 10.1007/978-3-319-10981-7_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Salgado RA, Budde RPJ, Leiner T, Shivalkar B, Van Herck PL, Op de Beeck BJ, Vrints C, Buijsrogge MP, Stella PR, Rodrigus I, Bosmans J, Parizel PM. Transcatheter Aortic Valve Replacement: Postoperative CT Findings of Sapien and CoreValve Transcatheter Heart Valves. Radiographics 2014; 34:1517-36. [DOI: 10.1148/rg.346130149] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bax JJ, Delgado V, Bapat V, Baumgartner H, Collet JP, Erbel R, Hamm C, Kappetein AP, Leipsic J, Leon MB, MacCarthy P, Piazza N, Pibarot P, Roberts WC, Rodés-Cabau J, Serruys PW, Thomas M, Vahanian A, Webb J, Zamorano JL, Windecker S. Open issues in transcatheter aortic valve implantation. Part 2: procedural issues and outcomes after transcatheter aortic valve implantation. Eur Heart J 2014; 35:2639-54. [DOI: 10.1093/eurheartj/ehu257] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Binder RK, Webb JG, Toggweiler S, Freeman M, Barbanti M, Willson AB, Alhassan D, Hague CJ, Wood DA, Leipsic J. Impact of post-implant SAPIEN XT geometry and position on conduction disturbances, hemodynamic performance, and paravalvular regurgitation. JACC Cardiovasc Interv 2014; 6:462-8. [PMID: 23702010 DOI: 10.1016/j.jcin.2012.12.128] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 11/30/2012] [Accepted: 12/21/2012] [Indexed: 01/29/2023]
Abstract
OBJECTIVES This report sought to study the impact of the balloon-expandable SAPIEN XT (Edwards Lifesciences, Irvine, California) transcatheter heart valve (THV) stent frame geometry and position on outcomes of transcatheter aortic valve replacement (TAVR). BACKGROUND Post-implant THV geometry and position might impact atrioventricular conduction, hemodynamic performance, and annular sealing. METHODS Eighty-nine consecutive patients who underwent TAVR with a Sapien XT THV had pre- and post-implant multidetector computed tomography, transthoracic echocardiography, and electrocardiograms performed to assess THV stent geometry, atrioventricular conduction, and hemodynamic performance. RESULTS The THV Circularity (THV eccentricity <10% [eccentricity = minimum stent diameter/maximum stent diameter]) and under-expansion (THV area/nominal THV area <90%) were present in 97.8% (2 of 89) and 0%, respectively. Low THV implantation was associated with new left bundle branch block and complete heart block (3.4 ± 2.0 mm vs. 5.5 ± 2.9 mm, p = 0.01) and with the need for permanent pacemaker implantation (3.5 ± 2.0 mm vs. 7.1 ± 2.5 mm, p = 0.001). In contrast, labeled THV size and THV area oversizing was not associated with atrioventricular conduction disturbances. The relation between inflow stent frame area and annular area was related to paravalvular regurgitation (p = 0.025). Labeled prosthesis size but not prosthesis expansion or eccentricity was related to valve gradient (p = 0.005) and effective orifice area (p < 0.001). CONCLUSIONS Low implantation depth of balloon-expandable THVs is associated with clinically significant new conduction disturbances and permanent pacemaker implantation. Importantly, annular area oversizing was not associated with these complications.
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Affiliation(s)
- Ronald K Binder
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Litmanovich DE, Ghersin E, Burke DA, Popma J, Shahrzad M, Bankier AA. Imaging in Transcatheter Aortic Valve Replacement (TAVR): role of the radiologist. Insights Imaging 2014; 5:123-45. [PMID: 24443171 PMCID: PMC3948900 DOI: 10.1007/s13244-013-0301-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 10/18/2013] [Accepted: 11/14/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is a novel technique developed in the last decade to treat severe aortic stenosis in patients who are non-surgical candidates because of multiple comorbidities. METHODS Since the technique is performed using a transvascular approach, pre-procedural assessment of the aortic valve apparatus, ascending aorta and vascular access is of paramount importance for both appropriate patient selection and correct device selection. This assessment is performed by a multi-disciplinary team with radiology being an integral and important part. RESULTS Among imaging modalities, there is growing scientific evidence supporting the crucial role of MDCT in the assessment of the aortic valve apparatus, suitability of the iliofemoral or alternative pathway, and determination of appropriate coaxial angles. MDCT also plays an important role in post-procedure imaging in the assessment of valve integrity and position. CONCLUSION This review outlines the principal aspects of TAVR, the multidisciplinary approach and utilisation of different imaging modalities, as well as a step-by-step approach to MDCT acquisition protocols, reconstruction techniques, pre-procedure measurements and post-procedure assessment. TEACHING POINTS • TAVR is a new technique to treat severe aortic stenosis in high-risk and nonsurgical candidates. • MDCT assessment of the aortic annulus is important for appropriate patient and device selection. • Multidisciplinary approach is required for patient selection, procedure planning and performance. • MDCT is required for assessment of the aortic root, iliofemoral or alternative vascular pathway.
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Affiliation(s)
- Diana E Litmanovich
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave-Shapiro 4, Boston, MA, 02215, USA,
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Katsanos S, Ewe SH, Debonnaire P, van der Kley F, de Weger A, Palmen M, Scholte AJ, Schalij MJ, Bax JJ, Marsan NA, Delgado V. Multidetector row computed tomography parameters associated with paravalvular regurgitation after transcatheter aortic valve implantation. Am J Cardiol 2013; 112:1800-6. [PMID: 24035163 DOI: 10.1016/j.amjcard.2013.07.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
Abstract
Multidetector row computed tomographic (MDCT) assessment of aortic annulus dimensions and frame position and deployment have been associated with paravalvular aortic regurgitation (PAVR) after transcatheter aortic valve implantation (TAVI). The present evaluation investigated the (pre- and postprocedure) MDCT associates of PAVR ≥2+. In total, 123 patients referred for TAVI underwent clinical evaluation, transthoracic echocardiography, and pre- and post-TAVI MDCT. Pre-TAVI MDCT measurements of the aortic annular dimensions and post-TAVI MDCT evaluation of the position and deployment of the prosthesis in the native annulus were performed. At 1-month follow-up, PAVR ≥2+ was observed in 25 patients (20%). The difference between the MDCT-derived maximum aortic annulus and the nominal diameters of the implanted prosthesis (odds ratio 1.912, p = 0.002) and shallow position of the frame in the left ventricular outflow tract (<2 mm) (odds ratio 4.865, p = 0.017) were independently related to significant PAVR. A maximum annulus diameter ≥2 mm larger than the nominal frame diameter had 72% sensitivity and 61% specificity to predict PAVR. In conclusion, in patients undergoing TAVI, ≥2-mm difference between maximum aortic annulus and nominal prosthesis diameters and depth of the frame into the left ventricular outflow tract of <2 mm are independently associated with PAVR ≥2+.
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A Review of JACC Journal Articles on the Topic of Interventional Cardiology: 2011–2012. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Transcatheter aortic valve replacement with a new self-expanding transcatheter heart valve and motorized delivery system. JACC Cardiovasc Interv 2013; 6:301-7. [PMID: 23517843 DOI: 10.1016/j.jcin.2013.01.129] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 01/04/2013] [Accepted: 01/15/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to demonstrate feasibility and short- and midterm clinical outcomes with a new self-expanding transcatheter heart valve and motorized delivery system. BACKGROUND Refining transcatheter aortic valve replacement with newly designed bioprostheses and delivery systems is anticipated to facilitate the procedure, reduce the risk of complications, improve outcomes, and widen applicability. METHODS The CENTERA valve (Edwards Lifesciences, Irvine, California) was implanted in 15 patients with symptomatic severe aortic stenosis via femoral or axillary arterial percutaneous access. Patients underwent transesophageal echocardiography during and transthoracic echocardiography and multidetector computed tomography before and after valve implantation. Clinical and echocardiographic follow-up was obtained at 30 days and for the initial 10 patients after 1 year. RESULTS All 15 device implants were successful. Aortic valve area increased from 0.7 ± 0.1 cm(2) to 1.6 ± 0.4 cm(2) post-procedure (p < 0.01) and 1.8 ± 0.3 cm(2) at 1 year. Mean transaortic gradient decreased from 36.3 ± 14.2 mm Hg to 10.6 ± 5.4 mm Hg post-procedure (p < 0.001) and 10.8 ± 4.1 mm Hg at 1 year. Paravalvular aortic regurgitation at 30-day follow-up was none/trivial in 3 (23%), mild in 9 (69%), and moderate in 1 (8%) patient. Four patients (27%) received a new permanent pacemaker. Survival was 87% at 30 days and 80% at 1 year. All surviving patients were in New York Heart Association functional class I (25%) or II (75%) at 1 year. CONCLUSIONS Transcatheter aortic valve replacement with the CENTERA transcatheter heart valve and motorized delivery system is feasible and can lead to good short- and midterm clinical and hemodynamic outcomes.
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Demkow M, Rużyłło W, Biernacka EK, Kalińczuk Ł, Spiewak M, Kowalski M, Sitkowska E, Kuśmierczyk M, Różanski J, Banaś S, Chmielak Z, Hoffman P. Percutaneous Edwards SAPIEN(™) valve implantation for significant pulmonary regurgitation after previous surgical repair with a right ventricular outflow patch. Catheter Cardiovasc Interv 2013; 83:474-81. [PMID: 23804542 DOI: 10.1002/ccd.25096] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 09/17/2013] [Accepted: 06/16/2013] [Indexed: 11/05/2022]
Abstract
BACKGROUND Current indications for percutaneous pulmonary valve implantation (PPVI) are limited to patients who had their outflow tracts repaired with the use of a "full" condui-homograft. Patients after a patch repair are believed to have an unfavorable anatomy for PPVI. OBJECTIVES To evaluate a novel use of Edwards SAPIEN(TM) valve for percutaneous treatment of moderate and severe pulmonary regurgitation after tetralogy of Fallot (TF) repair with a right ventricular outflow (RVOT) patch. METHODS PPVI was intended in 10 patients (age 21-39 years, 2 ♂) with regurgitant fraction of 30-59%, measured by cardiac magnetic resonance imaging (CMRI) 16-30 years after repair with a RVOT patch. Balloon test-inflations were used for definitive measurements and location of the landing site for the valve. All RVOTs were prestented. RESULTS Successful valve implantation was achieved in nine patients. In one patient a bare-metal stent used for prestenting embolized into pulmonary artery. A 26-mm valve was implanted in seven and a 23-mm in two patients. CMRI at 1-2 month follow-up (n = 8) demonstrated both, sustained relief of pulmonary incompetence (regurgitant fraction = 0-14%) and significant decrease of the right ventricular end-diastolic volume indexes (from 169.9 ± 43.8 to 140.0 ± 40.3 ml/m(2) , P < 0.001). At that follow-up no adverse event occurred. No stent fractures were observed. CONCLUSIONS We report the first case series of patients with significant PR after a RVOT patch repair, successfully treated with a percutaneous Edwards SAPIEN(TM) valve implantation. The procedure is technically feasible and may be offered to patients with the outflow tracts larger than those limited by the Melody(®) system available currently.
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Affiliation(s)
- Marcin Demkow
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, 04-628 Warszawa, Alpejska 42, Poland
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Dixon SR, Safian RD. The Year in Interventional Cardiology. J Am Coll Cardiol 2013; 61:1637-52. [DOI: 10.1016/j.jacc.2013.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 01/16/2013] [Indexed: 02/07/2023]
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