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Kawamura A, Maeda K, Shimamura K, Yamashita K, Mukai T, Nakamura D, Mizote I, Sakata Y, Miyagawa S. Coronary access after repeat transcatheter aortic valve replacement in patients of small body size: A simulation study. J Thorac Cardiovasc Surg 2024; 168:76-85.e8. [PMID: 36604286 DOI: 10.1016/j.jtcvs.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/05/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Coronary artery access after repeat transcatheter aortic valve replacement (TAV-in-TAV) is reportedly more difficult because leaflet displacement of the first transcatheter heart valve (THV) impairs coronary cannulation; however, its effects in small patients are unknown. This study aimed to simulate coronary accessibility after TAV-in-TAV in patients of small body size. METHODS We retrospectively analyzed computed tomography scans after initial THV implantation and classified patients by THV and coronary artery location, valve-to-aorta distance, and valve-to-coronary distance. Risks were compared between the SAPIEN and CoreValve/Evolut series, among THV generations, and between bicuspid and tricuspid aortic valves in the CoreValve/Evolut series. RESULTS A total of 254 patients (SAPIEN series, n = 164; CoreValve/Evolut series, n = 90) were enrolled. The average body surface area of the patients was 1.44 m2. Patients were classified as "feasible" (26%), "theoretically feasible with low risk" (19.7%), "theoretically feasible with high risk" (8.7%), or "unfeasible" (45.8%). The "unfeasible" rate was significantly higher in the CoreValve/Evolut series than in the SAPIEN series (78.9% vs 26.2%; P < .001). A significantly higher "unfeasible" rate was identified in the current model of SAPIEN (SAPIEN, 8.3%; SAPIENXT, 1.8%; SAPIEN3, 48.2%; P < .001), but not in the CoreValve/Evolut series (CoreValve, 83.3%; Evolut R, 80.0%; Evolut PRO, 71.4%; P = .587). Patients with a bicuspid aortic valve had a lower "unfeasible" rate compared to those with a tricuspid aortic valve (60.0% vs 86.2%; P = .014). CONCLUSIONS Patients of small body size may have a high probability of "unfeasible" coronary access after TAV-in-TAV, especially when treated with current high-frame devices, suggesting the need for careful strategic planning for initial THV implantation.
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Affiliation(s)
- Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichi Maeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kizuku Yamashita
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Mukai
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Nakamura
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Isamu Mizote
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Yang L, Chen S, Zhang X, Zhang Y, Zhou D, Pan W, Ge J. Comparisons of noncoronary sinus pivot implantation (NCPI) and conventional method for transcatheter aortic valve replacement with self-expanding valve in pure aortic regurgitation (PAR). Catheter Cardiovasc Interv 2024; 103:1093-1100. [PMID: 38690931 DOI: 10.1002/ccd.31064] [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] [Received: 12/15/2023] [Revised: 03/05/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND As compared to treatment of aortic stenosis (AS), transcatheter aortic valve replacement (TAVR) using the commercially available valves to treat pure aortic regurgitation (PAR) has a lower device success rate and higher complication rates. AIMS The study compared the acute results between TAVR using a novel noncoronary sinus pivot implantation (NCPI) method and that using the conventional method, aiming to explore a more optimized and effective operation method for TAVR in PAR. METHODS PAR patients who underwent TAVR with self-expanding valves in our center from September 2021 to September 2023 were enrolled were divided into the NCPI (group A, N = 16) and conventional method (group B, N = 39) groups. We analyzed the pre-operative evaluation parameters and procedural and postoperative data of the two subgroups. RESULTS The total patients' mean age was 71.2 ± 8.7 years and most were male (61.8%), with a mean Society of Thoracic Surgeons score of 3.4 ± 1.9%. The device success rate of groups A and B was 100% and 71.8%, respectively. In group B, 48.7% had major adverse cardiac events (MACE); 46.2% patients had permanent pacemaker implantation or valve in valve implantation. None had MACE in group A. The noncoronary sinus implantation depth in NCPI was -1.1 + 1.0 and 4.2 + 3.7 mm in groups A and B (p < 0.001), respectively. CONCLUSIONS TAVR with a self-expanding valve using the NCPI method had a higher procedure success rate and dramatically low complications than that using the conventional method in PAR patients.
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Affiliation(s)
- Lifan Yang
- Department of Cardiology, Zhongshan Hospital, Fudan University Minhang Meilong, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shasha Chen
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaochun Zhang
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuan Zhang
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daxin Zhou
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenzhi Pan
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junbo Ge
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
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Kikuchi S, Minamimoto Y, Matsushita K, Cho T, Terasaka K, Hanajima Y, Nakahashi H, Gohbara M, Kimura Y, Yasuda S, Okada K, Matsuzawa Y, Iwahashi N, Kosuge M, Ebina T, Morel O, Ohlmann P, Uchida K, Hibi K. Impact of New-Onset Right Bundle-Branch Block After Transcatheter Aortic Valve Replacement on Permanent Pacemaker Implantation. J Am Heart Assoc 2024; 13:e032777. [PMID: 38639357 PMCID: PMC11179913 DOI: 10.1161/jaha.123.032777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND A delayed and recurrent complete atrioventricular block (CAVB) is a life-threatening complication of transcatheter aortic valve replacement (TAVR). Post-TAVR evaluation may be important in predicting delayed and recurrent CAVB requiring permanent pacemaker implantation (PPI). The impact of new-onset right bundle-branch block (RBBB) after TAVR on PPI remains unknown. METHODS AND RESULTS In total, 407 patients with aortic stenosis who underwent TAVR were included in this analysis. Intraprocedural CAVB was defined as CAVB that occurred during TAVR. A 12-lead ECG was evaluated at baseline, immediately after TAVR, on postoperative days 1 and 5, and according to the need to identify new-onset bundle-branch block (BBB) and CAVB after TAVR. Forty patients (9.8%) required PPI, 17 patients (4.2%) had persistent intraprocedural CAVB, and 23 (5.7%) had delayed or recurrent CAVB after TAVR. The rates of no new-onset BBB, new-onset left BBB, and new-onset RBBB were 65.1%, 26.8%, and 4.7%, respectively. Compared with patients without new-onset BBB and those with new-onset left BBB, the rate of PPI was higher in patients with new-onset RBBB (3.4% versus 5.6% versus 44.4%, P<0.0001). On post-TAVR evaluation in patients without persistent intraprocedural CAVB, the multivariate logistic regression analysis showed that new-onset RBBB was a statistically significant predictor of PPI compared with no new-onset BBB (odds ratio [OR], 18.0 [95% CI, 5.94-54.4]) in addition to the use of a self-expanding valve (OR, 2.97 [95% CI, 1.09-8.10]). CONCLUSIONS Patients with new-onset RBBB after TAVR are at high risk for PPI.
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Affiliation(s)
- Shinnosuke Kikuchi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yugo Minamimoto
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Kensuke Matsushita
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Tomoki Cho
- Cardiovascular CenterYokohama City University Medical CenterYokohamaJapan
| | - Kengo Terasaka
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yohei Hanajima
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Hidefumi Nakahashi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Masaomi Gohbara
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yuichiro Kimura
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Shota Yasuda
- Cardiovascular CenterYokohama City University Medical CenterYokohamaJapan
| | - Kozo Okada
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yasushi Matsuzawa
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Noriaki Iwahashi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Masami Kosuge
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Toshiaki Ebina
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Olivier Morel
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier UniversitaireStrasbourgFrance
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier UniversitaireStrasbourgFrance
| | - Keiji Uchida
- Cardiovascular CenterYokohama City University Medical CenterYokohamaJapan
| | - Kiyoshi Hibi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
- Department of CardiologyYokohama City University Graduate School of MedicineYokohamaJapan
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Gorla R, Oliva OA, Arzuffi L, Milani V, Saitta S, Squillace M, Poletti E, Tusa M, Votta E, Brambilla N, Testa L, Bedogni F, Sturla F. Angulation and curvature of aortic landing zone affect implantation depth in transcatheter aortic valve implantation. Sci Rep 2024; 14:10409. [PMID: 38710782 DOI: 10.1038/s41598-024-61084-5] [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: 12/04/2023] [Accepted: 04/30/2024] [Indexed: 05/08/2024] Open
Abstract
In transcatheter aortic valve implantation (TAVI), final device position may be affected by device interaction with the whole aortic landing zone (LZ) extending to ascending aorta. We investigated the impact of aortic LZ curvature and angulation on TAVI implantation depth, comparing short-frame balloon-expanding (BE) and long-frame self-expanding (SE) devices. Patients (n = 202) treated with BE or SE devices were matched based on one-to-one propensity score. Primary endpoint was the mismatch between the intended (HPre) and the final (HPost) implantation depth. LZ curvature and angulation were calculated based on the aortic centerline trajectory available from pre-TAVI computed tomography. Total LZ curvature ( k L Z , t o t ) and LZ angulation distal to aortic annulus ( α L Z , D i s t a l ) were greater in the SE compared to the BE group (P < 0.001 for both). In the BE group, HPost was significantly higher than HPre at both cusps (P < 0.001). In the SE group, HPost was significantly deeper than HPre only at the left coronary cusp (P = 0.013). At multivariate analysis, α L Z , D i s t a l was the only independent predictor (OR = 1.11, P = 0.002) of deeper final implantation depth with a cut-off value of 17.8°. Aortic LZ curvature and angulation significantly affected final TAVI implantation depth, especially in high stent-frame SE devices reporting, upon complete release, deeper implantation depth with respect to the intended one.
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Affiliation(s)
- Riccardo Gorla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, P.Zza Edmondo Malan 2, 20097, San Donato Milanese, Milan, Italy.
| | - Omar A Oliva
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, P.Zza Edmondo Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Luca Arzuffi
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, P.Zza Edmondo Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Valentina Milani
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Simone Saitta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Mattia Squillace
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, P.Zza Edmondo Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Enrico Poletti
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, P.Zza Edmondo Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Maurizio Tusa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, P.Zza Edmondo Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Nedy Brambilla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, P.Zza Edmondo Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, P.Zza Edmondo Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, P.Zza Edmondo Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Francesco Sturla
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Tiago C, Dias Vaz M, Marques A, Barata M, Braga JP, Boa A, Carvalho AF. Intraoperative Corticosteroids and Pacemaker Implantation After Transcatheter Aortic Valve Replacement. Cureus 2024; 16:e56824. [PMID: 38654777 PMCID: PMC11037441 DOI: 10.7759/cureus.56824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis. However, conduction disturbances leading to pacemaker implantation remain a common complication, increasing morbidity and mortality in these patients. Hence, measures to lower its incidence should be taken, and corticosteroid therapy could be effective by reducing inflammation caused by direct mechanical trauma to the conduction system. METHODS A retrospective cohort study was conducted at the Centro Hospitalar de Vila Nova de Gaia/Espinho, analyzing the medical records of patients with native severe aortic stenosis who underwent transfemoral TAVR in 2022. The Chi-square test was used to compare the rate of pacemaker implantation in patients who received corticosteroids with patients who didn't. The statistical significance was considered for a p-value <0.05. RESULTS A total of 341 patients were included in this study. Monitored anesthesia care was the preferred anesthetic technique (99.1%). Sixty-three point three percent (63.3%) of patients received corticosteroids at the beginning of the procedure. Corticosteroid administration did not significantly affect the incidence of permanent pacemaker implantation (p=0.277), vascular complications on the access site (p=0.765), or in-hospital mortality (p=0.909). Male gender, 1st-degree atrioventricular block, and right branch block were the only identified predictors of permanent pacemaker implantation after transfemoral TAVR (p=0.041 <0.001 and <0.001, respectively). CONCLUSION Corticosteroid administration at the beginning of TAVR doesn't seem to influence the incidence of permanent pacemaker implantation, which can suggest that other factors play a more important role in the development of conduction disturbances leading to pacemaker implantation.
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Affiliation(s)
- Catarina Tiago
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - Marta Dias Vaz
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - Ana Marques
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - Melanie Barata
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - José Pedro Braga
- Cardiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - Ana Boa
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - Ana Filipa Carvalho
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
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Datta R, Bharadwaj P, Keshavamurthy G, Guleria VS, Kj R, Abbot AK. Transcatheter aortic valve implantation using coplanar and cuspal overlap techniques in Indian patients. Indian Heart J 2024; 76:36-43. [PMID: 38218314 PMCID: PMC10943560 DOI: 10.1016/j.ihj.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] [Received: 04/27/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Transcatheter Aortic Valve Implantation (TAVI) techniques gradually evolved since 2002 and have undergone various refinements. Achieving optimal implantation depth has become crucial for good long term outcome. High implantation decreases the likelihood of conduction disturbances. Conventionally TAVI valve is positioned in a tricusp coplanar (CON) fluoroscopic projection however it does not ensure a optimal implantation. In an attempt to attain higher implantation(3 mm) and decrease rate of permanent pacemaker, cuspal overlap technique (COT) view has been developed. There is scarcity of Indian literature comparing TAVI deployment using coplanar and cuspal overlap techniques. METHODS We included 111 patients who underwent TAVR with a self-expanding Core Valve Evolut R (Medtronic, Minneapolis, Minnesota), between January 2017 to September 2022 at our centre.Transcatheter Heart Valves (THV) were implanted using the traditional coplanar in 55 patients, while in 56 patients valves were implanted using the COT. RESULTS Baseline characteristics including electrocardiographic findings were comparable in both groups. In all patients Evolut R or Evolut PRO valves were used. Procedure was done in conscious sedation in 90.9 % of patients in CON and 96.4 % in COT group. Predilatation and postdilatation was used in 38.8 % vs 33.9 % and 27 % vs 32 % in CON and COT groups respectively. 90 day PPI rate was less in COT group (7.3 % CON vs 3.5 % COP). Majority of patients who received permanent pacemaker implantation (PPI) had baseline ECG abnormality (RBBB in 50 %, LBBB in 16 %, Grade 1 AV block 16 %). Mean time of post procedure PPI was 5.6 days in COT group and 7.3 days in CON group. New onset LBBB was also less in COT group (21 % CON vs 12.5 % COT).There were 3.6 % intraprocedural deaths in CON group and 1.8 % in COT group. Depth of deployed valve was 4.8 ± 2.34 mm in COT and 6.6 ± 2.11 mm in CON group. Valve deployment time was more in COT group(10.40 CON vs 14.34 min COT). Average valve recapture rate was 2.58 in COP and 2.11 in CON. Stroke rate was more in COT group(3.6 % CON vs 7.14 % COT). Pericardial effusions were also more in COT group. All cause mortality at 3 months was 10.9 % in CON group and 5.3 % in COT. CONCLUSION In this study we achieved lower rates of PPI and new onset LBBB using COT technique in Indian patients using self-expandable prostheses. However valve deployment time, stroke rate and pericardial effusion were seen more in COT group. All cause mortality was low in cuspal overlap technique.
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Affiliation(s)
- Rajat Datta
- Department of Cardiology, AHRR, Delhi, India.
| | | | | | | | - Ratheesh Kj
- Department of Cardiology, AHRR, Delhi, India.
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Persia-Paulino YR, Almendarez Lacayo M, Alperi A, Hernández-Vaquero D, Fernández Asensio R, Cuevas Pérez J, Adeba A, Flórez P, Vigil-Escalera M, Álvarez Velasco R, Renilla A, Del Valle Fernández R, Antuña P, Morís de la Tassa C, Avanzas P, Pascual I. Self-expanding TAVI using the cusp overlap technique versus the traditional technique: electrocardiogram changes and 1-year cardiovascular outcomes. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:29-38. [PMID: 37437882 DOI: 10.1016/j.rec.2023.04.008] [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: 01/20/2023] [Accepted: 04/18/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Transcatheter aortic valve implantation (TAVI) using the cusp overlap technique (COT) has shown a lower pacemaker implantation rate at 30 days. The objective of this study was to compare electrocardiogram changes and clinical outcomes between COT and the traditional technique (TT) at 1 year of follow-up. METHODS Observational, retrospective, nonrandomized study of consecutive patients undergoing TAVI between January 2015 and January 2021. Patients were matched using a propensity score and the TT was compared with COT. The primary endpoints were electrocardiogram changes and a combined endpoint including pacemaker implantation, hospitalization, or cardiovascular death at 1 year. RESULTS We included 254 patients. After propensity score matching, 184 patients (92 per group) remained. There were no statistically significant differences in baseline characteristics. At 1 year, COT patients showed a significant reduction in new onset left bundle branch block (49% vs 27%, P=.002) and less P wave (13.1±21.0 msec vs 5.47±12.5 msec; P=.003) and QRS prolongation (29.77±27.0 msec vs 16.38±25.4 msec, P <.001). COT was associated with a significant reduction in the occurrence of the primary endpoint (SHR, 0.39 [IC95%, 0.21-0.76]; P=.005). CONCLUSIONS At 1 year of follow-up, COT reduced the incidence of new onset left bundle branch block and diminished QRS and P wave widening compared with the TT. COT was also associated with a statistically significant reduction in the occurrence of the combined primary cardiovascular endpoint.
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Affiliation(s)
- Yván R Persia-Paulino
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Marcel Almendarez Lacayo
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | - Alberto Alperi
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | - Daniel Hernández-Vaquero
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | | | - Javier Cuevas Pérez
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Antonio Adeba
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Pablo Flórez
- Servicio de Cardiología, Hospital Valle del Nalón, Langreo, Asturias, Spain
| | - María Vigil-Escalera
- Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Rut Álvarez Velasco
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | - Alfredo Renilla
- Servicio de Cardiología, Hospital Vital Álvarez-Buylla, Mieres, Asturias, Spain
| | | | - Paula Antuña
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - César Morís de la Tassa
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
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Pagnesi M, Kim WK, Baggio S, Scotti A, Barbanti M, De Marco F, Adamo M, Eitan A, Estévez-Loureiro R, Conradi L, Toggweiler S, Mylotte D, Veulemans V, Søndergaard L, Wolf A, Giannini F, Maffeo D, Pilgrim T, Montorfano M, Zweiker D, Ferlini M, Kornowski R, Hildick-Smith D, Taramasso M, Abizaid A, Schofer J, Sinning JM, Van Mieghem NM, Wöhrle J, Khogali S, Van der Heyden JAS, Wood DA, Ielasi A, MacCarthy P, Brugaletta S, Hamm CW, Costa G, Testa L, Massussi M, Alarcón R, Schäfer U, Brunner S, Reimers B, Lunardi M, Zeus T, Vanhaverbeke M, Naber CK, Di Ienno L, Buono A, Windecker S, Schmidt A, Lanzillo G, Vaknin-Assa H, Arunothayaraj S, Saccocci M, Siqueira D, Brinkmann C, Sedaghat A, Ziviello F, Seeger J, Rottbauer W, Brouwer J, Buysschaert I, Jelisejevas J, Bharucha A, Regueiro A, Metra M, Colombo A, Latib A, Mangieri A. Incidence, Predictors, and Prognostic Impact of New Permanent Pacemaker Implantation After TAVR With Self-Expanding Valves. JACC Cardiovasc Interv 2023; 16:2004-2017. [PMID: 37480891 DOI: 10.1016/j.jcin.2023.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/23/2023] [Accepted: 05/08/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES The authors sought to evaluate the incidence, predictors, and outcomes of new permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) with contemporary self-expanding valves (SEV). BACKGROUND Need for PPI is frequent post-TAVR, but conflicting data exist on new-generation SEV and on the prognostic impact of PPI. METHODS This study included 3,211 patients enrolled in the multicenter NEOPRO (A Multicenter Comparison of Acurate NEO Versus Evolut PRO Transcatheter Heart Valves) and NEOPRO-2 (A Multicenter Comparison of ACURATE NEO2 Versus Evolut PRO/PRO+ Transcatheter Heart Valves 2) registries (January 2012 to December 2021) who underwent transfemoral TAVR with SEV. Implanted transcatheter heart valves (THV) were Acurate neo (n = 1,090), Acurate neo2 (n = 665), Evolut PRO (n = 1,312), and Evolut PRO+ (n = 144). Incidence and predictors of new PPI and 1-year outcomes were evaluated. RESULTS New PPI was needed in 362 patients (11.3%) within 30 days after TAVR (8.8%, 7.7%, 15.2%, and 10.4%, respectively, after Acurate neo, Acurate neo2, Evolut PRO, and Evolut PRO+). Independent predictors of new PPI were Society of Thoracic Surgeons Predicted Risk of Mortality score, baseline right bundle branch block and depth of THV implantation, both in patients treated with Acurate neo/neo2 and in those treated with Evolut PRO/PRO+. Predischarge reduction in ejection fraction (EF) was more frequent in patients requiring PPI (P = 0.014). New PPI was associated with higher 1-year mortality (16.9% vs 10.8%; adjusted HR: 1.66; 95% CI: 1.13-2.43; P = 0.010), particularly in patients with baseline EF <40% (P for interaction = 0.049). CONCLUSIONS New PPI was frequently needed after TAVR with SEV (11.3%) and was associated with higher 1-year mortality, particularly in patients with EF <40%. Baseline right bundle branch block and depth of THV implantation independently predicted the need of PPI.
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Affiliation(s)
- Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Sara Baggio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Amnon Eitan
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Rodrigo Estévez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
| | - Stefan Toggweiler
- Heart Center Lucerne, Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospitals, Galway, Ireland
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Lars Søndergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alexander Wolf
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Essen, Germany
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - David Zweiker
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - David Hildick-Smith
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | | | | | - Joachim Schofer
- Department for Percutaneous Treatment of Structural Heart Disease, Albertinen Heart Center, Hamburg, Germany; MVZ Department Structural Heart Disease, Asklepios St. Georg Clinic, Hamburg, Germany
| | - Jan-Malte Sinning
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jochen Wöhrle
- Department of Cardiology and Intensive Care, Medical Campus Lake Constance, Friedrichshafen, Germany
| | - Saib Khogali
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Jan A S Van der Heyden
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands; Interventional Cardiology Unit, AZ Sint-Jan Hospital, Bruges, Belgium
| | - David A Wood
- Centre for Heart Valve and Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Salvatore Brugaletta
- Clinic Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Christian W Hamm
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Giuliano Costa
- Department of Cardiology, C.A.S.T. Policlinico G. Rodolico, Catania, Italy
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Mauro Massussi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Robert Alarcón
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Ulrich Schäfer
- Department of Internal Medicine, Marienkrankenhaus, Hamburg, Germany
| | - Stephanie Brunner
- Heart Center Lucerne, Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Mattia Lunardi
- Department of Cardiology, Galway University Hospitals, Galway, Ireland
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoph K Naber
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Essen, Germany
| | - Luca Di Ienno
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Andrea Buono
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Albrecht Schmidt
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Giuseppe Lanzillo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | | | - Matteo Saccocci
- Cardiac Surgery Unit, Fondazione Poliambulanza, Brescia, Italy
| | | | - Christina Brinkmann
- MVZ Department Structural Heart Disease, Asklepios St. Georg Clinic, Hamburg, Germany
| | - Alexander Sedaghat
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Francesca Ziviello
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Julia Seeger
- Department of Cardiology and Intensive Care, Medical Campus Lake Constance, Friedrichshafen, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Jorn Brouwer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Ian Buysschaert
- Interventional Cardiology Unit, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Julius Jelisejevas
- Centre for Heart Valve and Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Apurva Bharucha
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Ander Regueiro
- Clinic Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
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9
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Li Y, Lei R, Zhou J, Wang J, Zhang H. Lower incidence of new-onset severe conduction disturbances after transcatheter aortic valve implantation with bicuspid aortic valve in patients with no baseline conduction abnormality: a cross-sectional investigation in a single center in China. Front Cardiovasc Med 2023; 10:1176984. [PMID: 37441707 PMCID: PMC10333533 DOI: 10.3389/fcvm.2023.1176984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Abstract
Background With technological advancements, the incidence of most transcatheter aortic valve implantation (TAVI)-related complications, with the exception of conduction disturbances, has decreased. Bicuspid aortic valve (BAV) is also no longer considered a contraindication to TAVI; however, the effect of BAV on postoperative conduction disturbances after TAVI is unknown. Methods We collected information on patients who met the indications for TAVI and successfully underwent TAVI at our center between January 2018 and January 2021. Patients with preoperative pacemaker implantation status or conduction disturbances (atrioventricular block, bundle branch block, and intraventricular block) were excluded. Based on imaging data, the patients were categorized into the BAV group and the tricuspid aortic valve (TAV) group. The incidence of new perioperative conduction disturbances was compared between the two groups. Results A total of 187 patients were included in this study, 64 (34.2%) of whom had BAV. The incidence of third-degree block in the BAV group was 1.6%, which was lower than that (13.0%) in the TAV group (P < 0.05). Multivariate logistic regression results showed that the risk of third-degree conduction disturbances was 15-fold smaller in the BAV group than that in the TAV group [relative risk (RR) = 0.067, 95% CI = 0.008-0.596, P < 0.05]. The risk of other blocks in the BAV group was about half of that in the TAV group (RR = 0.498, 95% CI = 0.240-1.032); however, the difference was not statistically significant (P > 0.05). Conclusion The present study found that patients with BAV had a lower rate of third-degree conduction disturbances after TAVI than patients with TAV.
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Affiliation(s)
- Yuehuan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ruobing Lei
- Chevidence Lab Child & Adolescent Health, Department of Pediatric Research Institute, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Jiawei Zhou
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haibo Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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10
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Wienemann H, Maier O, Beyer M, Portratz M, Tanaka T, Mauri V, Ernst A, Waldschmidt L, Kuhn E, Bleiziffer S, Wilde N, Schaefer A, Zeus T, Baldus S, Zimmer S, Veulemans V, Rudolph TK, Adam M. Cusp overlap versus standard three-cusp technique for self-expanding Evolut transcatheter aortic valves. EUROINTERVENTION 2023; 19:e176-e187. [PMID: 37013922 PMCID: PMC10240731 DOI: 10.4244/eij-d-22-01030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/14/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Reducing rates of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) is important for achieving the best procedural outcomes. The cusp overlap technique (COT) implements procedural steps including an overlap angulation of the right and left coronary cusp to mitigate this complication. AIMS We investigated the incidence of PPI and complication rates following the COT compared to the standard three-cusp implantation technique (3CT) in an all-comers cohort. METHODS A total of 2,209 patients underwent TAVI with the self-expanding Evolut platform from January 2016 to April 2022 at five sites. Baseline, procedural and in-hospital outcome characteristics were compared for both techniques before and after one-to-one propensity score matching. RESULTS A total of 1,151 patients were implanted using the 3CT and 1,058 using the COT. At discharge, the rates of PPI (17.0 vs 12.3%; p=0.002) and moderate/severe paravalvular regurgitation (4.6% vs 2.4%; p=0.006) were significantly reduced with the COT compared with 3CT within the unmatched cohort. Overall procedural success and complication rates were similar; major bleeding was less common in the COT group (7.0% vs 4.6%; p=0.020). These results remained consistent after propensity score matching. In multivariable logistic regression analysis, right bundle branch block (odds ratio [OR] 7.19, 95% confidence interval [CI]: 5.18-10.0; p<0.001) and diabetes mellitus (OR 1.38, 95% CI: 1.05-1.80; p=0.021) emerged as predictors of PPI, whereas the COT (OR 0.63, 95% CI: 0.49-0.82; p<0.001) was protective. CONCLUSIONS The introduction of the COT was associated with a significant and relevant reduction of PPI and paravalvular regurgitation rates without an increase in complication rates.
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Affiliation(s)
- Hendrik Wienemann
- Clinic III for Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Oliver Maier
- Department of Cardiology, Pneumology, and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Martin Beyer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Max Portratz
- Clinic for General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Tetsu Tanaka
- Clinic II for Internal Medicine, University Hospital Bonn, Bonn, Germany
| | - Victor Mauri
- Clinic III for Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Angela Ernst
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Lara Waldschmidt
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Elmar Kuhn
- Department of Cardiovascular Surgery, University Hospital Cologne, Cologne, Germany
| | - Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Nihal Wilde
- Clinic II for Internal Medicine, University Hospital Bonn, Bonn, Germany
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Tobias Zeus
- Department of Cardiology, Pneumology, and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Clinic III for Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Sebastian Zimmer
- Clinic II for Internal Medicine, University Hospital Bonn, Bonn, Germany
| | - Verena Veulemans
- Department of Cardiology, Pneumology, and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tanja Katharina Rudolph
- Clinic for General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Matti Adam
- Clinic III for Internal Medicine, University Hospital Cologne, Cologne, Germany
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11
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Krasivskyi I, Djordjevic I, Ivanov B, Gerfer S, Suhr L, Avgeridou S, Sabashnikov A, Kuhn E, Rahmanian P, Mader N, Eghbalzadeh K, Wahlers T. High Incidence of Transient Permanent Pacemaker Rate After Rapid Deployment Valve Replacement: Insights of a 9-Year Single-Centre Experience. Heart Lung Circ 2022; 31:1658-1665. [PMID: 36155721 DOI: 10.1016/j.hlc.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/01/2022] [Accepted: 08/06/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The incidence of new permanent pacemaker implantation (PPI) after rapid deployment aortic valve replacement (RDAVR) remains debated. Expertise in this field has significantly increased over the last decade. This study aimed to investigate the need for PPI following implantation of a rapid deployment (RD) valve. METHODS Analysis of n=372 patients who underwent Edwards INTUITY (Edwards Lifesciences, Irvine, CA, USA) (n=251) and Perceval (Sorin/LivaNova Group, Saluggia, Italy) (n=121) valve replacement at the current institution between May 2012 and August 2018 was performed. Coronary artery bypass graft procedures were additionally performed in patients with coronary artery disease. Baseline, preoperative and postoperative outcomes were examined regarding correctness and completeness of the procedure. Statistical analysis was performed using SPSS Version 23.0.0 (IBM Corp, Armonk, NY, USA). RESULTS A total of 372 patients (aged 75±6.3 yrs) with a high grade of aortic valve stenosis underwent either Edwards INTUITY (67%) or Perceval (33%) valve replacement. Seventy-six (76) patients (20%) presented with preoperative conduction disorders. Sixty (60) patients (16%) underwent PPI, which in most cases was performed during the first month after the initial operation. Follow-up was performed up to 9 years, presenting a persistent pacemaker dependency rate of 50% among all patients who underwent PPI. Twenty (20) (40%) PPI recipients showed no dependency on pacemaker, while 10 (10%) required temporary pacemaker support. Mean length of ICU stay was 4±5.1 days and in-hospital stay was 8.2±7.6 days. CONCLUSIONS The incidence of PPI after RD valve implantation still remains high compared with conventional aortic valve replacement. However, this study shows that this phenomenon appears to be transient in a significant proportion of the patients undergoing RD valve replacement. These findings might contribute to the scientific discussion and should be taken into consideration for the indication of RD valve replacement.
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Affiliation(s)
- Ihor Krasivskyi
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany.
| | - Ilija Djordjevic
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Borko Ivanov
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Stephen Gerfer
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Laura Suhr
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Soi Avgeridou
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Anton Sabashnikov
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Elmar Kuhn
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Parwis Rahmanian
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Navid Mader
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Kaveh Eghbalzadeh
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Thorsten Wahlers
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
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12
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Hioki H, Watanabe Y, Kozuma K, Ryuzaki T, Goto S, Inohara T, Katsumata Y, Tsunaki T, Kawahata R, Kobayashi T, Asami M, Otsuka T, Yamamoto M, Hayashida K. Validation of reliability and predictivity of membrane septum length measurements for pacemaker need after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2022; 100:868-876. [PMID: 36073020 DOI: 10.1002/ccd.30377] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/27/2022] [Accepted: 08/16/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the inter methodological agreement of membrane septum (MS) length measurement and additive value for risk stratification of new pacemaker implantation (PMI) over the established predictors after transcatheter aortic valve replacement (TAVR). BACKGROUND Recent studies have suggested MS length and implantation depth (ID) as predictors for PMI after TAVR. However, the measurement of MS length is neither uniform nor validated in different cohort. METHODS We retrospectively analyzed patients who underwent TAVR at five centers. The MS length was measured by two previously proposed methods (coronal and annular view method). Predictive ability of risk factors, including MS length and ID, for new PMI within 30 days after TAVR were evaluated. RESULTS Among 754 patients of study population, 31 patients (4.1%) required new PMI within 30 days of TAVR. There was a weak correlation (ρ = 0.47) and a poor agreement between the two methods. The ID and the difference between MS length and ID (ΔMSID), were independent predictors for new PMI, whereas MS length alone was not. Further, for predicting new PMI after TAVR, discrimination performance was not significantly improved when MS length was added to the model with ID alone (integrated discrimination improvement = 0, p= 0.99; continuous net-reclassification improvement = 0.10, p= 0.62). CONCLUSIONS External validity and predictive accuracy of MS length for PMI after TAVR were not sufficient to provide better risk stratification over the established predictors in our cohort. Moreover, the ID and ΔMSID, but not MS length alone, are predictive of future PMI after TAVR.
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Affiliation(s)
- Hirofumi Hioki
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Ken Kozuma
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Toshinobu Ryuzaki
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shinichi Goto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.,Department of Medicine, One Brave Idea and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, USA
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Tatsuya Tsunaki
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | | | | | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan.,Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.,Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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13
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Maier O, Piayda K, Binnebößel S, Berisha N, Afzal S, Polzin A, Klein K, Westenfeld R, Horn P, Jung C, Kelm M, Veulemans V, Zeus T. Real-world experience with the cusp-overlap deployment technique in transcatheter aortic valve replacement: A propensity-matched analysis. Front Cardiovasc Med 2022; 9:847568. [PMID: 36119734 PMCID: PMC9471948 DOI: 10.3389/fcvm.2022.847568] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background The implantation depth (ID) is a critical condition for optimal hemodynamic and clinical outcomes in transcatheter aortic valve replacement (TAVR). The recently recommended cusp-overlap technique (COT) offers optimized fluoroscopic projections facilitating a precise ID. This single-center observational study aimed to investigate short-term clinical performance, safety, and efficacy outcomes in patients undergoing TAVR with self-expandable prostheses and application of COT in a real-world setting. Materials and methods From September 2020 to April 2021, a total of 170 patients underwent TAVR with self-expandable devices and the application of COT, while 589 patients were treated from January 2016 to August 2020 with a conventional three-cusp coplanar view approach. The final ID and 30-day outcomes were compared after 1:1 propensity score matching, resulting in 150 patients in both cohorts. Results The mean ID was significantly reduced in the COT cohort (−4.2 ± 2.7 vs. −4.9 ± 2.3 mm; p = 0.007) with an improvement of ID symmetry of less than 2 mm difference below the annular plane (47.3 vs. 57.3%; p = 0.083). The rate of new permanent pacemaker implantation (PPI) following TAVR was effectively reduced (8.0 vs. 16.8%; p = 0.028). While the fluoroscopy time decreased (18.4 ± 7.6 vs. 19.8 ± 7.6 min; p = 0.023), the dose area product increased in the COT group (4951 ± 3662 vs. 3875 ± 2775 Gy × cm2; p = 0.005). Patients implanted with COT had a shorter length of in-hospital stay (8.4 ± 4.0 vs. 10.3 ± 6.7 days; p = 0.007). Conclusion Transcatheter aortic valve replacement using the cusp-overlap deployment technique is associated with an optimized implantation depth, leading to fewer permanent conduction disturbances. However, our in-depth analysis showed for the first time an increase of radiation dose due to extreme angulations of the gantry to obtain the cusp-overlap view.
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Affiliation(s)
- Oliver Maier
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Kerstin Piayda
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany
| | - Stephan Binnebößel
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Nora Berisha
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Shazia Afzal
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Amin Polzin
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Kathrin Klein
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Verena Veulemans
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- *Correspondence: Verena Veulemans,
| | - Tobias Zeus
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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14
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Laricchia A, Cereda A, Lucreziotti S, Sticchi A, Regazzoli D, Reimers B, Colombo A, Latib A, Mangieri A. Expanding our horizons for the use of transcatheter self-expanding valves: what does the future hold? Expert Rev Cardiovasc Ther 2022; 20:497-501. [PMID: 35673979 DOI: 10.1080/14779072.2022.2085688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) is an established alternative to aortic valve surgery in patient with severe aortic valve stenosis. As interventionalists are pushing towards treatment of patients with lower risk profile with a wide range of anatomies, contemporary transcatheter heart valves (THV) should offer an excellent performance in terms of residual gradient, rate of pacemaker and perivalvular leak. AREAS COVERED Self-expandable (SE) valve offer a valid alternative to balloon-expandable (BE) valves, nevertheless comparative trials suggest a better outcome of patients treated with BE over SE platforms. New generation SE valves offer an excellent outcome in terms of procedural safety, however implementations in valve design and performance are required to reach the BE valves performance. EXPERT COMMENTARY in the near future, new devices should be able to obtain optimal results with a negligible rate of complications. Developments in the design of the delivery system together with refinements in valve technology are desirable to achieve results which are comparable to surgical aortic valve replacement.
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Affiliation(s)
| | - Alberto Cereda
- Cardiovascular department, ASST Santi Paolo Carlo, Milano, Italy
| | | | - Alessandro Sticchi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
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15
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Barati S, Fatouraee N, Nabaei M, Petrini L, Migliavacca F, Luraghi G, Matas JFR. Patient-specific multi-scale design optimization of transcatheter aortic valve stents. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106912. [PMID: 35640391 DOI: 10.1016/j.cmpb.2022.106912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/09/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Transcatheter aortic valve implantation (TAVI) has become the standard treatment for a wide range of patients with aortic stenosis. Although some of the TAVI post-operative complications are addressed in newer designs, other complications and lack of long-term and durability data on the performance of these prostheses are limiting this procedure from becoming the standard for heart valve replacements. The design optimization of these devices with the finite element and optimization techniques can help increase their performance quality and reduce the risk of malfunctioning. Most performance metrics of these prostheses are morphology-dependent, and the design and the selection of the device before implantation should be planned for each individual patient. METHODS In this study, a patient-specific aortic root geometry was utilized for the crimping and implantation simulation of 50 stent samples. The results of simulations were then evaluated and used for developing regression models. The strut width and thickness, the number of cells and patterns, the size of stent cells, and the diameter profile of the stent were optimized with two sets of optimization processes. The objective functions included the maximum crimping strain, radial strength, anchorage area, and the eccentricity of the stent. RESULTS The optimization process was successful in finding optimal models with up to 40% decrease in the maximum crimping strain, 261% increase in the radial strength, 67% reduction in the eccentricity, and about an eightfold increase in the anchorage area compared to the reference device. CONCLUSIONS The stents with larger distal diameters perform better in the selected objective functions. They provide better anchorage in the aortic root resulting in a smaller gap between the device and the surrounding tissue and smaller contact pressure. This framework can be used in designing patient-specific stents and improving the performance of these devices and the outcome of the implantation process.
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Affiliation(s)
- Sara Barati
- Biological Fluid Dynamics Research Laboratory, Biomedical Engineering Department, Amirkabir University of Technology, 350 Hafez Ave, Tehran, Iran
| | - Nasser Fatouraee
- Biological Fluid Dynamics Research Laboratory, Biomedical Engineering Department, Amirkabir University of Technology, 350 Hafez Ave, Tehran, Iran.
| | - Malikeh Nabaei
- Biological Fluid Dynamics Research Laboratory, Biomedical Engineering Department, Amirkabir University of Technology, 350 Hafez Ave, Tehran, Iran
| | - Lorenza Petrini
- Department of Civil and Environmental Engineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| | - Giulia Luraghi
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy.
| | - Josè Felix Rodriguez Matas
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy.
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16
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Pascual I, Almendárez M, Avanzas P, Álvarez R, Arboine LA, del Valle R, Hernández-Vaquero D, Alfonso F, Morís C. La técnica de superposición de cúspides en TAVI con dispositivo autoexpandible optimiza la profundidad del implante y reduce la necesidad de marcapasos permanente. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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17
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Pascual I, Almendárez M, Avanzas P, Álvarez R, Arboine LA, Del Valle R, Hernández-Vaquero D, Alfonso F, Morís C. Cusp-overlapping TAVI technique with a self-expanding device optimizes implantation depth and reduces permanent pacemaker requirement. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:412-420. [PMID: 34226165 DOI: 10.1016/j.rec.2021.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/20/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES This study aimed to determine the safety and efficacy of modifying the classic implantation technique for aortic transcatheter heart valve (THV) implantation to a cusp-overlap-projection (COP) technique to achieve a higher implantation depth and to reduce the burden of new permanent pacemaker implantation (PPMI) at 30 days. Aortic self-expanding THV carries an elevated risk for PPMI. A higher implantation depth minimizes the damage in the conduction system and may reduce PPMI rates. METHODS From March 2017, 226 patients were consecutively included: 113 patients were treated using the COP implantation technique compared with the previous 113 consecutive patients treated using the classic technique. In all patients, implantation depth was assessed by 3 methods (noncoronary cusp to the THV, mean of the noncoronary cusp and the left coronary cusp to the THV, and the deepest edge from the left coronary cusp and the noncoronary cusp to the THV). RESULTS The COP group had a lower implantation depth than the group treated with the classic technique (4.8 mm± 2.2 vs 5.7 mm± 3.1; P=.011; 5.8 mm± 3.1 vs 6.5 mm± 2.4; P=.095; 7.1 mm± 2.8 vs 7.4 mm±3.2; P=.392). Forty patients (17.7%) required a new PPMI after the 30-day follow-up but this requirement was significantly lower in the COP group (12.4% vs 23%, P=.036). The COP implantation technique consistently protected against the main event (OR, 0.45; 95%CI, 0.21-0.97; P=.043), with similar procedural success rates and complications. CONCLUSIONS The COP implantation technique is a simple modification of the implantation protocol and provides a higher implantation depth of self-expanding-THV with lower conduction disturbances and PPMI rates.
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Affiliation(s)
- Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación del Principado de Asturias, Oviedo, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Marcel Almendárez
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación del Principado de Asturias, Oviedo, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación del Principado de Asturias, Oviedo, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain.
| | - Rut Álvarez
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luis A Arboine
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Raquel Del Valle
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Daniel Hernández-Vaquero
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación del Principado de Asturias, Oviedo, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Fernando Alfonso
- Departamento de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - César Morís
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación del Principado de Asturias, Oviedo, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain
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18
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Piayda K, Bauer T, Beckmann A, Bekeredjian R, Bleiziffer S, Ensminger S, Frerker C, Möllmann H, Walther T, Balaban Ü, Herrmann E, Hamm C, Beyersdorf F, Lichtenberg A, Zeus T, Mehdiani A. Procedural Results of Patients Undergoing Transcatheter Aortic Valve Implantation With Aortic Annuli Diameter ≥26 mm: insights from the German Aortic Valve Registry. Am J Cardiol 2022; 164:111-117. [PMID: 34844737 DOI: 10.1016/j.amjcard.2021.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
Patients presenting with severe aortic stenosis and large aortic annuli are challenging to treat because of the size limitations of available transcatheter heart valves. In this study, we aimed to determine clinical and hemodynamic outcomes in patients presenting with large aortic annuli who underwent transcatheter aortic valve implantation (TAVI). Patients from the German Aortic Valve Registry who underwent TAVI either with the Edwards Sapien (ES) or Medtronic CoreValve (MCV) systems from 2011 to 2017 were included. They were further stratified into a large (aortic annulus diameter 26 to 29 mm for ES; 26 to 30 mm for MCV) and extra-large (aortic annulus diameter >29 mm for ES; >30 mm for MCV) group and analyzed using propensity score adjustment. Extra-large was set beyond the sizing limitations according to the manufacturer's instructions for use. Patients in the large (n = 5,628) and extra-large (n = 509) groups were predominantly male (large: 92.6% vs extra-large: 91.9%). The 30-day mortality was comparable (large: 3.9% vs extra-large: 5.0%, p = 0.458). Procedure duration (large: 78.9 minutes ± 0.82 vs extra-large: 86.4 minutes ± 1.9, p <0.001) was longer in the extra-large group. Likewise, vascular complications (large: 6.2% vs extra-large: 12%, p = 0.002) and the need for a permanent pacemaker implantation (large: 18.8% vs extra-large: 26.0%, p = 0.027) were more often present in the extra-large group. Aortic regurgitation ≥II after valve implantation was numerically higher (large: 3.0% vs extra-large: 5.3%, p = 0.082) in patients with extra-large anatomy. In conclusion, patients with large and extra-large aortic annulus diameters who underwent TAVI have comparable 30-day mortality. Beyond the recommended annulus range, there is a higher risk for vascular complications and permanent pacemaker implantation.
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Affiliation(s)
- Kerstin Piayda
- Division of Cardiology, Pulmonology and Vascular Medicine
| | - Timm Bauer
- Department of Cardiology, General Internal Medicine, Intensive Care, Sana Clinic Offenbach, Offenbach, Germany
| | - Andreas Beckmann
- German Society for Thoracic and Cardiovascular Surgery, Berlin, Germany
| | - Raffi Bekeredjian
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Sabine Bleiziffer
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany; German Center for Cardiovascular Research, Berlin, Germany
| | - Stephan Ensminger
- Department of Cardiac Surgery, University of Lübeck, Lübeck, Germany
| | - Christian Frerker
- Department of Cardiology, Vascular Medicine and Intensive Care, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research DZHK, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Helge Möllmann
- Department of Internal Medicine I, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | - Thomas Walther
- Department of Cardiothoracic Surgery, University Hospital Frankfurt, Frankfurt, Germany; German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main, Frankfurt, Germany
| | - Ümniye Balaban
- German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main, Frankfurt, Germany; Institute of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt, Frankfurt, Germany
| | - Eva Herrmann
- German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main, Frankfurt, Germany; Institute of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt, Frankfurt, Germany
| | - Christian Hamm
- Department of Cardiology, Kerckhoff Klinik Bad Nauheim, Bad Nauheim, Germany
| | | | - Artur Lichtenberg
- Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine.
| | - Arash Mehdiani
- Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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19
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Kim WK, Renker M, Doerr O, Hofmann S, Nef H, Choi YH, Hamm CW. Impact of implantation depth on outcomes of new-generation balloon-expandable transcatheter heart valves. Clin Res Cardiol 2021; 110:1983-1992. [PMID: 34476559 DOI: 10.1007/s00392-021-01932-w] [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: 07/04/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little is known about the impact of the ID on outcomes and device success using balloon-expandable devices. This study sought to analyze the impact of implantation depth (ID) on procedural outcomes. METHODS In consecutive patients (n = 969) undergoing transfemoral TAVR with new-generation balloon-expandable prostheses, the mean ID (IDMean) was determined by aortography and categorized into low, correct, and high device position. Outcomes of interest were device success (VARC-2), paravalvular regurgitation (PVR) ≥ moderate, severe prosthesis-patient mismatch (PPM), permanent pacemaker implantation (PPI), and the composite of the three latter outcome measures (COMPPPP). RESULTS IDMean was greater among patients with PPI (median 4.0 [interquartile range 2.0; 4.0] vs. 3.5 [1.5; 5.5] mm; p = 0.002), severe PPM (3.5 [1.5; 5.0] vs. 4.0 [2.0; 6.0] mm; p = 0.028), and COMPPPP (4.0 [2.0; 6.0] vs. 3.0 [1.5; 5.5] mm; p < 0.001) when compared with the respective groups without these complications. There was no significant association between IDMean and device success or PVR ≥ moderate. Categorization into low (7.3%), correct (90.7%), and high (2.0%) device position showed significant discrimination with an increase of severe PPM, PPI, and COMPPPP with lower position, whereas device success was not significantly affected by position. Only PVR ≥ moderate showed an asymmetric distribution with highest rates in the high and low position group, which was non-significant. However, among patients without correct position the rate of device success was 45.6%. CONCLUSIONS A higher device position was associated with improved outcomes. Malpositioning without functional impairment should not be classified as device failure. The odds ratio of IDMean was calculated by univariate logistic regression for each outcome variable, showing that with higher values of IDMean (i.e., low implantation depth), the risk of severe PPM, PPI, and COMPPPP increases. The bar charts under the heading "Position category" denote the frequency of each outcome measure across patients with high, correct, and low device position. The p values are derived from chi-squared test.
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Affiliation(s)
- Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, 61231, Bad Nauheim, Germany. .,Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany. .,Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany. .,German Centre for Cardiovascular Research (DZHK), Rhine-Main Affiliate, Frankfurt am Main, Germany.
| | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, 61231, Bad Nauheim, Germany.,Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Oliver Doerr
- Department of Cardiology, Kerckhoff Heart Center, 61231, Bad Nauheim, Germany.,Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany.,German Centre for Cardiovascular Research (DZHK), Rhine-Main Affiliate, Frankfurt am Main, Germany
| | - Simon Hofmann
- Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Holger Nef
- Department of Cardiology, Kerckhoff Heart Center, 61231, Bad Nauheim, Germany.,Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany.,German Centre for Cardiovascular Research (DZHK), Rhine-Main Affiliate, Frankfurt am Main, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research (DZHK), Rhine-Main Affiliate, Frankfurt am Main, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart Center, 61231, Bad Nauheim, Germany.,Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany.,German Centre for Cardiovascular Research (DZHK), Rhine-Main Affiliate, Frankfurt am Main, Germany
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20
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Ko TY, Kao HL, Liu YJ, Yeh CF, Huang CC, Chen YH, Hung CS, Chan CY, Lin LC, Chen YS, Lin MS. Impact of conduction disturbances on left ventricular mass regression and geometry change following transcatheter aortic valve replacement. Sci Rep 2021; 11:16778. [PMID: 34408241 PMCID: PMC8373860 DOI: 10.1038/s41598-021-96297-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open
Abstract
Our study aimed to compare the difference of LV mass regression and remodeling in regard of conduction disturbances (CD) following transcatheter aortic valve replacement (TAVR). A prospective analysis of 152 consecutive TAVR patients was performed. 53 patients (34.9%) had CD following TAVR, including 30 (19.7%) permanent pacemaker implantation and 23 (15.2%) new left bundle branch block. In 123 patients with 1-year follow-up, significant improvement of LV ejection fraction (LVEF) (baseline vs 12-month: 65.1 ± 13.2 vs 68.7 ± 9.1, P = 0.017) and reduced LV end-systolic volume (LVESV) (39.8 ± 25.8 vs 34.3 ± 17.1, P = 0.011) was found in non-CD group (N = 85), but not in CD group (N = 38). Both groups had significant decrease in LV mass index (baseline vs 12-month: 148.6 ± 36.9 vs. 136.4 ± 34.7 in CD group, p = 0.023; 153.0 ± 50.5 vs. 125.6 ± 35.1 in non-CD group, p < 0.0001). In 46 patients with 3-year follow-up, only non-CD patients (N = 28) had statistically significant decrease in LV mass index (Baseline vs 36-month: 180.8 ± 58.8 vs 129.8 ± 39.1, p = 0.0001). Our study showed the improvement of LV systolic function, reduced LVESV and LV mass regression at 1 year could be observed in patients without CD after TAVR. Sustained LV mass regression within 3-year was found only in patients without CD.
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Affiliation(s)
- Tsung-Yu Ko
- Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, Medical College, National Taiwan University, Taipei, Taiwan
| | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Ying-Ju Liu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Fan Yeh
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Ching-Chang Huang
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Chih-Yang Chan
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Lung-Chun Lin
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
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21
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Ravaux JM, Di Mauro M, Vernooy K, Kats S, Mariani S, Ronco D, Actis Dato G, Simons J, Hof AWV, Maessen JG, Lorusso R. Permanent pacemaker implantation following transcatheter aortic valve implantation using self-expandable, balloon-expandable, or mechanically expandable devices: a network meta-analysis. Europace 2021; 23:1998-2009. [PMID: 34379760 DOI: 10.1093/europace/euab209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/17/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Permanent pacemaker implantation (PPI) still limits the expansion of indications for transcatheter aortic valve implantation (TAVI). Comparison between different systems remains scarce. We aimed to determine the impact of the device type used on post-TAVI PPI. METHODS AND RESULTS A systematic literature review was performed to identify studies reporting the use of balloon-expandable valve (BEV), self-expandable valve (SEV), and mechanically expandable valve (MEV) and post-TAVI PPI. A network meta-analysis was used to compare TAVI mechanisms (Analysis A) and transcatheter heart valves (Analysis B) with respect to post-TAVI PPI. Analysis A included 40 181 patients with a pooled PPI rate of 19.2% in BEV, 24.7% in SEV, and 34.8% in MEV. Balloon-expandable valve showed lower risk compared to either SEV or MEV and SEV demonstrated lower risk for PPI than MEV. Implantation of BEV was associated with 39% and 62% lower PPI rate with respect to SEV and MEV. Implantation of SEV was associated with 38% lower PPI rate with respect to MEV. Analysis B included 36.143 patients with the lowest pooled PPI rate of 9.6% for Acurate Neo or others, and the highest pooled PPI rate of 34.3% for Lotus. CoreValve, Evolut Portico, and Lotus influenced significantly PPI rate, while Sapien group did not. CONCLUSION Implantation of BEV and also SEV were associated with lower post-TAVI PPI rate, while MEV were associated with higher post-TAVI PPI. Patient tailored-approach including devices characteristics may help to reduce post-TAVI PPI and to allow TAVI to take the leap towards extension of use in younger patients. PROSPERO NUMBER CRD42021238671.
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Affiliation(s)
- Justine M Ravaux
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Michele Di Mauro
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
| | - Suzanne Kats
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Silvia Mariani
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Daniele Ronco
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.,Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giulia Actis Dato
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Jorik Simons
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Arnoud W Van't Hof
- Department of Cardiology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jos G Maessen
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Roberto Lorusso
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
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22
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Gorla R, Casenghi M, Finotello A, De Marco F, Morganti S, Regazzoli D, Bianchi G, Acerbi E, Popolo Rubbio A, Brambilla N, Testa L, Castriota F, Auricchio F, Reimers B, Bedogni F. Outcome of transcatheter aortic valve replacement in bicuspid aortic valve stenosis with new-generation devices. Interact Cardiovasc Thorac Surg 2021; 32:20-28. [PMID: 33201993 DOI: 10.1093/icvts/ivaa231] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/05/2020] [Accepted: 09/03/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To compare device success and paravalvular leak rates of 3 new-generation transcatheter aortic valve replacement devices in patients with bicuspid aortic valve stenosis and to test their biomechanical performance in a computer-based simulation model of aortic root with increasing ellipticity. METHODS This retrospective multicentre study included 56 bicuspid aortic valve patients undergoing transcatheter aortic valve replacement with new-generation devices: Lotus/Lotus Edge (N = 15; 27%), Evolut-R (N = 20; 36%) and ACURATE neo (N = 21; 37%). Three virtual simulation models of aortic root with increasing index of eccentricity (0-0.25-0.5) were implemented. Stress distribution, stent-root contact area and paravalvular orifice area were computed. RESULTS Device success was achieved in 43/56 patients (77%) with comparable rates among Lotus (87%), Evolut-R (60%) and ACURATE neo (86%; P = 0.085). Moderate paravalvular leak rate was significantly lower in the Lotus group as compared to Evolut-R group (0% vs 30%; P = 0.027) and comparable to the ACURATE neo group (0% vs 10%; P = 0.33). By index of eccentricity = 0.5, Lotus showed a uniform and symmetric pattern of stress distribution with absent paravalvular orifice area, ACURATE neo showed a mild asymmetry with small paravalvular orifice area (1.1 mm2), whereas a severely asymmetric pattern was evident with Evolut-R, resulting in a large paravalvular orifice area (12.0 mm2). CONCLUSIONS Transcatheter aortic valve replacement in bicuspid aortic valve patients with new-generation devices showed comparable device success rates. Lotus showed moderate paravalvular leak rate comparable to that of ACURATE neo and significantly lower than Evolut-R. On simulation, Lotus and ACURATE neo showed optimal adaptability to elliptic anatomies as compared to Evolut-R.
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Affiliation(s)
- Riccardo Gorla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Matteo Casenghi
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alice Finotello
- Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Simone Morganti
- Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Damiano Regazzoli
- Department of Clinical and Interventional Cardiology, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Giovanni Bianchi
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Elena Acerbi
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Antonio Popolo Rubbio
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Nedy Brambilla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Fausto Castriota
- Department of Clinical and Interventional Cardiology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Bernhard Reimers
- Department of Clinical and Interventional Cardiology, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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23
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Bernhard B, Okuno T, Cicovic A, Stortecky S, Reichlin T, Lanz J, Praz F, Windecker S, Pilgrim T. Systemic corticosteroid exposure and atrioventricular conductance delays after transcatheter aortic valve implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:1-6. [PMID: 34238680 DOI: 10.1016/j.carrev.2021.06.127] [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: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atrioventricular conduction delays (AVCD) are common after transcatheter aortic valve implantation (TAVI) and frequently require implantation of a permanent pacemaker (PPM). Autopsy studies demonstrated the role of ischemia, inflammation, and oedema in the pathogenesis of AVCD. Corticosteroids (CS) reduce inflammation and oedema and hence might lead to a lower rate of AVCD. METHODS Based on a prospective single-center registry, we performed a propensity score (PS) matched analysis of subjects treated with or without systemic CS (>2.5 mg prednisolone-equivalent per day) at the time of TAVI. The primary endpoint was a composite of PPM-implantation and new-onset left bundle branch block (LBBB) within 30 days after TAVI. RESULTS Among 2213 consecutive patients undergoing TAVI (51.5% female, mean age 82.1 ± 6.1 years) 89 patients were treated with systemic CS, of which 87 were included in the PS matched analysis. At 30 days, rates of the composite of PPM and LBBB were comparable between patients with versus without CS both in the overall cohort (33.7% versus 33.0%, p = 0.89) and the PS matched cohort (34.5% versus 40.2%, p = 0.443). There were no differences in a composite of major or minor vascular complications and major or life-threatening bleeding events between patients with versus without CS in the overall cohort (34.8% versus 26.6%, p = 0.088) or the PS matched cohort (33.3% versus 33.3%, p ≥ 0.999). CONCLUSION In this exploratory study, intake of systemic CS among patients undergoing TAVI was not associated with differences in rates of AVCD, vascular complications, or bleeding events after TAVI.
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Affiliation(s)
- Benedikt Bernhard
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Aleksandar Cicovic
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
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24
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Nicolas J, Guedeney P, Claessen BE, Mehilli J, Petronio AS, Sartori S, Lefèvre T, Presbitero P, Capranzano P, Iadanza A, Cao D, Chiarito M, Goel R, Roumeliotis A, Chandiramani R, Chen S, Sardella G, Van Mieghem NM, Sorrentino S, Meliga E, Tchétché D, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail GW, Ferrer-Gracia MC, Naber C, Kievit PC, Baber U, Sharma SK, Morice MC, Dangas GD, Chandrasekhar J, Chieffo A, Mehran R. Incidence, predictors and clinical impact of permanent pacemaker insertion in women following transcatheter aortic valve implantation: Insights from a prospective multinational registry. Catheter Cardiovasc Interv 2021; 98:E908-E917. [PMID: 34117817 DOI: 10.1002/ccd.29807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 02/03/2021] [Accepted: 06/05/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To describe the incidence, predictors, and clinical impact of permanent pacemaker insertion (PPI) following transcatheter aortic valve replacement (TAVR) in women. BACKGROUND Data on pacemaker insertion complicating TAVR in women are scarce. METHODS The Women's International Transcatheter Aortic Valve implantation (WIN-TAVI) is a prospective registry evaluating the safety and efficacy of TAVR in women. We included patients without preprocedural pacemakers and divided them into two groups: (1) PPI and (2) no-PPI. We identified PPI predictors using logistic regression and studied its clinical impact on the Valve Academic Research Consortium (VARC)-2 efficacy and safety endpoints. RESULTS Out of 1019 patients, 922 were included in the analysis. Post-TAVR PPI occurred in 132 (14.3%) patients. Clinical and procedural characteristics were similar in both groups. Pre-existing right bundle branch block (RBBB) was associated with a high risk of post-TAVR PPI (OR 3.62, 95% CI 1.85-7.06, p < 0.001), while implantation of balloon-expandable prosthesis was associated with a lower risk (OR 0.47, 95% CI 0.30-0.74, p < 0.001). Post-TAVR PPI prolonged in-hospital stay by a median of 2 days (11 [9-16] days in PPI vs. 9 [7-14] days in no-PPI, p = 0.005), yet risks of VARC-2 efficacy and safety endpoints at 1 year were similar in both groups (adj HR 0.95, 95% CI 0.60-1.52, p = 0.84 and adj HR 1.22, 95% CI 0.83-1.79, p = 0.31, respectively). CONCLUSION Pacemaker implantation following TAVR is frequent among women and is associated with pre-existing RBBB and valve type. PPI prolongs hospital stay, albeit without any significant impact on 1-year outcomes.
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Affiliation(s)
- Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paul Guedeney
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Cardiology, Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Bimmer E Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julinda Mehilli
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University and German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | | | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thierry Lefèvre
- Department of Cardiology, Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | | | | | - Alessandro Iadanza
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ridhima Goel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anastasios Roumeliotis
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rishi Chandiramani
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Siyan Chen
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gennaro Sardella
- Department of Cardiology, Policlinico Umberto I,"Sapienza" University of Rome, Rome, Italy
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Sabato Sorrentino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emanuele Meliga
- Department of Cardiology, Mauriziano Umberto I Hospital, Turin, Italy
| | - Didier Tchétché
- Department of Cardiology, Groupe CardioVasculaire Interventional, Clinique Pasteur, Toulouse, France
| | - Nicolas Dumonteil
- Department of Cardiology, Groupe CardioVasculaire Interventional, Clinique Pasteur, Toulouse, France
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Daniela Trabattoni
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Ghada W Mikhail
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | | | - Christoph Naber
- Department of Cardiology, Contilia Heart and Vascular Centre, Essen, Germany
| | - Peter C Kievit
- Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marie-Claude Morice
- Department of Cardiology, Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jaya Chandrasekhar
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alaide Chieffo
- Department of Cardiology, IRCCS San Raffael Hospital, Segrate, Italy
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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25
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Ravaux JM, Di Mauro M, Vernooy K, Van't Hof AW, Veenstra L, Kats S, Maessen JG, Lorusso R. One-year pacing dependency after pacemaker implantation in patients undergoing transcatheter aortic valve implantation: Systematic review and meta-analysis. JTCVS OPEN 2021; 6:41-55.e15. [PMID: 36003550 PMCID: PMC9390410 DOI: 10.1016/j.xjon.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 12/04/2022]
Abstract
Objectives Atrioventricular conductions disturbances, requiring permanent pacemaker implantation (PPI), represent a potential complication after transcatheter aortic valve implantation (TAVI), However, little is known about the pacemaker dependency after PPI in this patient setting. This systematic review analyses the incidence of PPI, the short-term (1-year) pacing dependency, and predictors for such a state after TAVI. Methods We performed a systematic search in PUBMED, EMBASE, and MEDLINE to identify potentially relevant literature investigating PPI requirement and dependency after TAVI. Study data, patients, and procedural characteristics were extracted. Odds ratio (OR) with 95% confidence intervals were extracted. Results Data from 23 studies were obtained that included 18,610 patients. The crude incidence of PPI after TAVI was 17% (range, 8.8%-32%). PPI occurred at a median time of 3.2 days (range, 0-30 days). Pacing dependency at 1-year was 47.5% (range, 7%-89%). Self-expandable prosthesis (pooled OR was 2.14 [1.15-3.96]) and baseline right bundle branch block (pooled OR was 2.01 [1.06-3.83]) showed 2-fold greater risk to maintain PPI dependency at 1 year after TAVI. Conclusions Although PPI represents a rather frequent event after TAVI, conduction disorders have a temporary nature in almost 50% of the cases with recovery and stabilization after discharge. Preoperative conduction abnormality and type of TAVI are associated with higher PPI dependency at short term.
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Affiliation(s)
- Justine M. Ravaux
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Address for reprints: Justine M. Ravaux, MD, Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.
| | - Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | - Arnoud W. Van't Hof
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Leo Veenstra
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Suzanne Kats
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Jos G. Maessen
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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26
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Breitbart P, Minners J, Hein M, Schröfel H, Neumann FJ, Ruile P. Implantation depth and its influence on complications after TAVI with self-expanding valves. Int J Cardiovasc Imaging 2021; 37:3081-3092. [PMID: 33988801 PMCID: PMC8494692 DOI: 10.1007/s10554-021-02275-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022]
Abstract
Prior studies in patients with transcatheter aortic valve implantation (TAVI) demonstrated an influence of transcatheter heart valve (THV) position on the occurrence of new conductions disturbances (CD) and paravalvular leakage (PVL) post TAVI in balloon-expandable valves (BEV). Purpose of this study was to investigate the THV implantation depth and its influence on the occurrence of CD and PVL in self-expanding valves (SEV). We performed fusion imaging of pre- and post-procedural computed tomography angiography in 104 TAVI-patients (all with Evolut R) to receive a 3-D reconstruction of the THV within the native annulus region. The THV length below the native annulus was measured for assessment of implantation depth. Electrocardiograms pre-discharge were assessed for conduction disturbances (CD), PVL was determined in transthoracic echocardiography. The mean implantation depth of the THV in the whole cohort was 4.3 ± 3.0 mm. Using the best cut-off of ≥ 4 mm in receiver operating characteristic curve analysis (sensitivity 83.3%, specificity 60.0%) patients with lower THV position developed more new CD after TAVI (68.2 vs. 23.7%, P < 0.001). A deep THV position was identified as the only predictor for new CD after TAVI (odds ratio [CI] 1.312[1.119–1.539], P = 0.001). The implantation depth showed no influence on the grade of PVL (r = 0.052, P = 0.598). In patients with TAVI using the Evolut R SEV, a lower THV positioning (≥ 4 mm length below annulus) was a predictor for new conduction disturbances. In contrast, implantation depth was not associated with the extent of PVL.
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Affiliation(s)
- Philipp Breitbart
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany.
| | - Jan Minners
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Manuel Hein
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Holger Schröfel
- Division of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Philipp Ruile
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
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27
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Gorla R, De Marco F, Garatti A, Bianchi G, Acerbi E, Oliva OA, Arneri A, Brambilla N, Testa L, Agnifili ML, Tusa M, Bedogni F. In-hospital outcomes and predictors of paravalvular leak and deep implantation with the Evolut-R 34 mm device: A comparison with smaller Evolut-R sizes. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:19-26. [PMID: 33933374 DOI: 10.1016/j.carrev.2021.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/06/2021] [Accepted: 03/30/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare in-hospital outcome of Evolut-R 34 mm vs. smaller Evolut-R devices and to identify predictors of paravalvular leak (PVL) and deep implantation specific for Evolut-R 34 mm. METHODS This single-center retrospective study included 359 consecutive patients undergoing transcatheter aortic valve replacement (TAVR) with Evolut-R 34 mm (N = 84,23.4%) and Evolut-R 23/26/29 mm (N = 275,76.6%) between 2016 and 2019. RESULTS Patients in Evolut-R 34 mm group were more frequently males, had lower STS score, ejection fraction, and mean aortic gradient compared to the Evolut-R 23/26/29 mm group. Horizontal aorta and large LVOT were more frequent findings in the Evolut-R 34 mm group, whereas calcium volume was comparable among the groups. During TAVR, mean implantation depth and contrast volume were greater in the Evolut-R 34 mm group, compared to the Evolut 23/26/29 mm group. Post-procedurally, 30-day mortality, ≥moderate PVL, device success and pacemaker implantation (PM) rates were comparable between groups. Among independent predictors of ≥moderate PVL, calcium volume (OR:1.04; p < 0.001) was predictive with different thresholds in both groups, whereas aortic angulation (OR:1.40; p = 0.005) was predictive only in Evolut-R 34 mm group at a cutoff of 60° (AUC:0.73; p = 0.043). Body weight (OR:1.03; p = 0.027), left ventricular outflow tract (LVOT) diameter (OR:1.34; p = 0.001), and mean aortic gradient (OR:0.96; p = 0.006) were independent predictors of deep implantation (mean depth ≥ 6 mm), with LVOT>27 mm being predictive specifically for Evolut-R 34 mm (AUC:0.66; p = 0.024). CONCLUSIONS TAVR with Evolut-R 34 mm and Evolut-R 23/26/29 mm showed comparable in-hospital outcome. Aortic angulation >60° and LVOT >27 mm were predictive respectively of ≥moderate PVL and deep implantation specifically in Evolut-R 34 mm patients.
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Affiliation(s)
- Riccardo Gorla
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Federico De Marco
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Andrea Garatti
- Cardiac Surgery Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giovanni Bianchi
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Elena Acerbi
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Omar Alessandro Oliva
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Nedy Brambilla
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luca Testa
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Mauro Luca Agnifili
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Maurizio Tusa
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Bedogni
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Sandhu A, Tzou WS. A Disruptive Technology: Determining Need for Permanent Pacing After TAVR. Curr Cardiol Rep 2021; 23:53. [PMID: 33871728 DOI: 10.1007/s11886-021-01481-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW Transcatheter aortic valve replacement (TAVR) has changed the paradigm for management of severe aortic stenosis. Despite evolution of TAVR over the past 2 decades, conduction system disturbances remain a concern post-TAVR. In this review, we describe (1) permanent pacemaker (PP) implant rates associated with TAVR, (2) risk factors predicting need for PP therapy post-TAVR, (3) management of perioperative conduction abnormalities, and (4) novel areas of research. RECENT FINDINGS Conduction disturbances remain a common issue post-TAVR, in particular, left bundle branch block (LBBB). Though newer data describes resolution of a significant fraction of these disturbances over time, rates of pacemaker therapy remain high despite improvements in valve technology and procedural technique. Recent consensus statements and guideline documents are important first steps in standardizing an approach to post-TAVR conduction disturbances. New areas of research show promise in both prediction and treatment of conduction disturbances post-TAVR.
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Affiliation(s)
- Amneet Sandhu
- Division of Cardiology, Cardiac Electrophysiology Section, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, 80045, USA.,Division of Cardiology, Denver VA Medical Center, Denver, CO, USA
| | - Wendy S Tzou
- Division of Cardiology, Cardiac Electrophysiology Section, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, 80045, USA.
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29
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Ito N, Zen K, Kuwabara K, Matoba S. Recapture failure in transcatheter aortic valve replacement with CoreValve Evolut R. Catheter Cardiovasc Interv 2021; 98:E486-E489. [PMID: 33645905 DOI: 10.1002/ccd.29580] [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: 11/20/2020] [Revised: 01/20/2021] [Accepted: 02/13/2021] [Indexed: 11/11/2022]
Abstract
Self-expanding prostheses for transcatheter aortic valve replacement (TAVR), which can be recaptured, provide us the option of repositioning for a more accurate placement. We report a very rare case in which the recapture of CoreValve Evolut R (Medtronic, Minneapolis, Minnesota) to correct the implantation depth during the deployment could not be achieved. We planned TAVR with a 23 mm Evolut R prosthesis for a 92-year-old female with severe aortic stenosis and tightly bent thoracic aorta. During the first deployment attempt, the implantation depth was greater than we expected at 2/3 deployment. They tried to recapture and reposition the prosthesis, but the prosthesis was not re-sheathed into the capsule of the delivery system. The prosthesis could not be recaptured despite a repeat attempt, and they were forced to deploy the device as it was. The prosthesis was deployed very carefully and implanted successfully without a pop-up into the ascending aorta. At a later date, this situation was replicated in vitro and was found that the distal segment of the capsule became deformed, increasing the resistance to rotating the grip handle.
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Affiliation(s)
- Nobuyasu Ito
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kensuke Kuwabara
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Cardiovascular Medicine, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Chen S, Chau KH, Nazif TM. The incidence and impact of cardiac conduction disturbances after transcatheter aortic valve replacement. Ann Cardiothorac Surg 2020; 9:452-467. [PMID: 33312903 PMCID: PMC7724062 DOI: 10.21037/acs-2020-av-23] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/21/2020] [Indexed: 12/29/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has developed into an established therapy for patients with severe aortic stenosis (AS) across the spectrum of surgical risk. Despite improvements in transcatheter heart valve (THV) technologies and procedural techniques, cardiac conduction disturbances, including high degree atrioventricular block (AVB) requiring permanent pacemaker (PPM) implantation and new-onset left bundle branch block (LBBB), remain frequent complications. TAVR-related conduction disturbances occur due to injury to the conduction system from interactions with interventional equipment and the transcatheter valve stent frame. Risk factors for post-TAVR conduction disturbances have been identified and include clinical characteristics, baseline electrocardiogram findings (right bundle branch block), anatomic factors, and potentially modifiable procedural factors (type of transcatheter valve, depth of implantation, over-sizing). New-onset LBBB and PPM implantation after TAVR have been shown to be associated with adverse long-term clinical outcomes, including mortality and heart failure hospitalization. These clinical consequences are likely to be of increasing importance as TAVR is utilized in younger and lower risk population. This review provides an updated overview of the literature regarding the incidence, predictors, and clinical outcomes of TAVR-related conduction disturbances, as well as proposed strategies for the management of this frequent clinical challenge.
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Affiliation(s)
- Shmuel Chen
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Katherine H Chau
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Tamim M Nazif
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
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31
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Barbanti M, Costa G, Picci A, Criscione E, Reddavid C, Valvo R, Todaro D, Deste W, Condorelli A, Scalia M, Licciardello A, Politi G, De Luca G, Strazzieri O, Motta S, Garretto V, Veroux P, Giaquinta A, Giuffrida A, Sgroi C, Leon MB, Webb JG, Tamburino C. Coronary Cannulation After Transcatheter Aortic Valve Replacement: The RE-ACCESS Study. JACC Cardiovasc Interv 2020; 13:2542-2555. [PMID: 33069648 DOI: 10.1016/j.jcin.2020.07.006] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aims of this study were to investigate the feasibility of coronary ostia cannulation after transcatheter aortic valve replacement (TAVR) and to assess potential predictors of coronary access impairment. BACKGROUND Certain data concerning the feasibility and reproducibility of coronary cannulation after TAVR are lacking. METHODS RE-ACCESS (Reobtain Coronary Ostia Cannulation Beyond Transcatheter Aortic Valve Stent) was an investigator-driven, single-center, prospective, registry-based study that enrolled consecutive patients undergoing TAVR using all commercially available devices. All patients underwent coronary angiography before and after TAVR. The primary endpoint was the rate of unsuccessful coronary ostia cannulation after TAVR. Secondary endpoints were the identification of factors associated with the inability to selectively cannulate coronary ostia after TAVR. RESULTS Among 300 patients enrolled in the RE-ACCESS study from December 2018 to January 2020, a total of 23 cases (7.7%) of unsuccessful coronary cannulation after TAVR were documented. This issue occurred in 22 of 23 cases with the use of Evolut R/PRO transcatheter aortic valves (TAVs) (17.9% vs. 0.4%; p < 0.01). In multivariate analysis, the use of Evolut R/PRO TAVs (odds ratio [OR]: 29.6; 95% confidence interval [CI]: 2.6 to 335.0; p < 0.01), the TAV-sinus of Valsalva relation (OR: 1.1 per 1-mm increase; 95% CI: 1.0 to 1.2; p < 0.01), and the mean TAV implantation depth (OR: 1.7 per 1-mm decrease; 95% CI: 1.3 to 2.3; p < 0.01) were found to be independent predictors of unsuccessful coronary cannulation after TAVR. A model combining these factors was demonstrated to predict with very high accuracy the risk for unsuccessful coronary cannulation after TAVR (area under the curve: 0.94; p < 0.01). CONCLUSIONS Unsuccessful coronary cannulation following TAVR was observed in 7.7% of patients and occurred almost exclusively in those receiving Evolut TAVs. The combination of Evolut TAV, a higher TAV-sinus of Valsalva relation, and implantation depth predicts with high accuracy the risk for unsuccessful coronary cannulation after TAVR. (Reobtain Coronary Ostia Cannulation Beyond Transcatheter Aortic Valve Stent [RE-ACCESS]; NCT04026204).
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Affiliation(s)
- Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy.
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Andrea Picci
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Enrico Criscione
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Claudia Reddavid
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Denise Todaro
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Wanda Deste
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | | | - Matteo Scalia
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | | | - Giorgia Politi
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Giuseppe De Luca
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Orazio Strazzieri
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Silvia Motta
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Valeria Garretto
- Division of Radiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Pierfrancesco Veroux
- Division of Vascular Surgery, A.O.U. Policlinico-San Marco, University of Catania, Catania, Italy
| | - Alessia Giaquinta
- Division of Vascular Surgery, A.O.U. Policlinico-San Marco, University of Catania, Catania, Italy
| | - Angelo Giuffrida
- Division of Cardiac Surgery, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Martin B Leon
- Cardiology Department, NewYork-Presbyterian/Columbia University Medical Center, New York, New York
| | - John G Webb
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy
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Laricchia A, Khokhar AA, Gallo F, Giannini F, Colombo A, Latib A, Mangieri A. Transcatheter aortic valve replacement: potential use in lower-risk aortic stenosis. Expert Rev Cardiovasc Ther 2020; 18:723-731. [PMID: 33021849 DOI: 10.1080/14779072.2020.1833717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The widespread use of transcatheter aortic valve implantation (TAVI) is expanding to low-risk patients. Nevertheless, a low clinical risk does not always correspond to a low procedural risk for the percutaneous approach. AREAS COVERED The initial trials on TAVI in low-risk populations had encouraging results, showing non-inferiority in comparison to surgical aortic valve replacement (SAVR). However, the low-risk definition is based on risk score calculators developed for the surgical setting and not including other specific features that are more relevant to TAVI and can affect procedural outcomes. For example, the presence of bicuspid aortic valves, high calcific burden, low coronary height or conduction disturbances is all potentially associated with suboptimal results or even procedural complications. In addition, the lack of longer follow-up prevents us to draw conclusions about long-term outcomes, including data about valve durability and coronary re-access. EXPERT OPINION Although current evidence suggest similar results for TAVI and SAVR in low-risk populations, there are some technical and procedural limitations that still need to be addressed in order to close the gap between TAVI and surgery. Optimal, lasting results with a low rate of procedural complications are highly expected in low-risk, otherwise healthy subjects, with potential for longevity.
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Affiliation(s)
- Alessandra Laricchia
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Arif A Khokhar
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Francesco Gallo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Francesco Giannini
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Antonio Colombo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center , Bronx, NY, USA
| | - Antonio Mangieri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
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Attizzani GF, Dallan LAP, Markowitz A, Yakubov SJ, Deeb GM, Reardon MJ, Forrest JK, Mangi AA, Huang J, Popma JJ. Impact of Repositioning on Outcomes Following Transcatheter Aortic Valve Replacement With a Self-Expandable Valve. JACC Cardiovasc Interv 2020; 13:1816-1824. [PMID: 32763073 DOI: 10.1016/j.jcin.2020.04.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study sought to compare outcomes following transcatheter aortic valve replacement when valve repositioning was performed (repositioned group) versus procedures without repositioning (nonrepositioned group). BACKGROUND The Evolut R and Evolut PRO valves were designed to allow repositioning during deployment, yet the effect of repositioning on clinical outcomes remains unclear. METHODS Patients implanted with the Evolut R or PRO valve from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial continued access study and the Evolut Low Risk Trial between June 2016 and November 2018 were combined. Baseline multidetector computed tomography data were analyzed for the Evolut Low Risk Trial patients. The primary outcomes were the rate of all-cause mortality and the rate of disabling stroke 30 days. Secondary outcomes were per Valve Academic Research Consortium-2. RESULTS The Evolut R or PRO valve was implanted in 946 patients, and repositioning was performed in 318 (33.6%). Compared with patients in the nonrepositioned group, patients in the repositioned group had lower Society of Thoracic Surgeons score (2.3 ± 1.3% vs. 2.6 ± 1.4%; p < 0.001) and fewer prior percutaneous coronary interventions (11.9% vs. 19.7%; p = 0.003). There were no differences in baseline multidetector computed tomography parameters between groups. There were no differences in the primary outcome of death (0.3% vs. 0.3%; p = 0.99) or disabling stroke (0.3% vs. 0.5%; p = 0.71) at 30 days or 1 year (1.9% vs. 2.9%; p = 0.44; and 0.8% vs. 0.9%%; p = 0.79, respectively). CONCLUSIONS The utilization of the repositioning feature of the Evolut valves was safe, and no differences in death or disabling stroke were observed at 30 days or 1 year between groups. (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients; NCT02701283; Safety and Efficacy Study of the Medtronic CoreValve® System In the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement [SURTAVI]; NCT01586910).
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Affiliation(s)
- Guilherme F Attizzani
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Luis Augusto P Dallan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Alan Markowitz
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Steven J Yakubov
- Department of Interventional Cardiology, OhioHealth Riverside Methodist, Columbus, Ohio
| | - G Michael Deeb
- Departments of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor, Michigan
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - John K Forrest
- Departments of Internal Medicine (Cardiology) and Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Abeel A Mangi
- Departments of Internal Medicine (Cardiology) and Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Jian Huang
- Department of Biostatistics, Medtronic Statistical Services, Minneapolis, Minnesota
| | - Jeffrey J Popma
- Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Manuel AM, Almeida J, Guerreiro C, Dias T, Barbosa A, Teixeira P, Ribeiro J, Dias A, Caeiro D, Fonseca M, Teixeira M, Oliveira M, Gonçalves H, Primo J, Rodrigues A, Gama V, Braga P, Fontes-Carvalho R. The effects of transcatheter aortic valve implantation on cardiac electrical properties. Rev Port Cardiol 2020; 39:431-440. [DOI: 10.1016/j.repc.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 12/31/2019] [Accepted: 02/22/2020] [Indexed: 11/26/2022] Open
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35
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Manuel AM, Almeida J, Guerreiro C, Dias T, Barbosa A, Teixeira P, Ribeiro J, Dias A, Caeiro D, Fonseca M, Teixeira M, Oliveira M, Gonçalves H, Primo J, Rodrigues A, Gama V, Braga P, Fontes-Carvalho R. The effects of transcatheter aortic valve implantation on cardiac electrical properties. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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A validated computational framework to predict outcomes in TAVI. Sci Rep 2020; 10:9906. [PMID: 32555300 PMCID: PMC7303192 DOI: 10.1038/s41598-020-66899-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/28/2020] [Indexed: 11/08/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) still presents complications: paravalvular leakage (PVL) and onset of conduction abnormalities leading to permanent pacemaker implantation. Our aim was testing a validated patient-specific computational framework for prediction of TAVI outcomes and possible complications. Twenty-eight TAVI patients (14 SapienXT and 14 CoreValve) were retrospectively selected. Pre-procedural CT images were post-processed to create 3D patient-specific implantation sites. The procedures were simulated with finite element analysis. Simulations' results were compared against post-procedural clinical fluoroscopy and echocardiography images. The computational model was in good agreement with clinical findings: the overall stent diameter difference was 2.6% and PVL was correctly identified with a post-processing algorithm in 83% of cases. Strains in the implantation site were studied to assess the risk of conduction system disturbance and were found highest in the patient who required pacemaker implantation. This study suggests that computational tool could support safe planning and broadening of TAVI.
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37
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Gorla R, De Marco F, Garatti A, Bianchi G, Popolo Rubbio A, Acerbi E, Casenghi M, Spagnolo P, Brambilla N, Testa L, Agnifili ML, Tusa M, Bedogni F. Impact of aortic angle on transcatheter aortic valve implantation outcome with
Evolut‐R
, Portico, and
Acurate‐NEO. Catheter Cardiovasc Interv 2020; 97:E135-E145. [DOI: 10.1002/ccd.28957] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/05/2020] [Accepted: 04/25/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Riccardo Gorla
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Federico De Marco
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Andrea Garatti
- Cardiac Surgery Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Giovanni Bianchi
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Antonio Popolo Rubbio
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Elena Acerbi
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Matteo Casenghi
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Pietro Spagnolo
- Radiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Nedy Brambilla
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Luca Testa
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Mauro L. Agnifili
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Maurizio Tusa
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Francesco Bedogni
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
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Caballero A, Mao W, McKay R, Sun W. The Impact of Self-Expandable Transcatheter Aortic Valve Replacement on Concomitant Functional Mitral Regurgitation: A Comprehensive Engineering Analysis. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2020; 4:179-191. [PMID: 33728393 DOI: 10.1080/24748706.2020.1740365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Mitral regurgitation (MR) is present in a large proportion of patients who undergo transcatheter aortic valve replacement (TAVR). However, existing clinical data on the impact of TAVR on early post-procedural MR severity are contradictory. Using a comprehensive computational engineering methodology, this study aimed to evaluate quantitatively the structural and hemodynamic impact of TAVR on aortic-mitral continuity and MR severity in a rigorously developed and validated patient-specific left heart (LH) computer model with aortic stenosis and concomitant functional MR. Methods TAVR procedure was virtually simulated using a self-expandable valve (SEV) at three implantation heights. Pre- and post-TAVR LH dynamics as well as intra-operative biomechanics were analyzed. Results No significant differences in early MR improvement (<10%) were noted at the three implantation depths when compared to the pre-TAVR state. The high deployment model resulted in the highest stress in the native aortic leaflets, lowest stent-tissue contact force, highest aortic-mitral angle, and highest MR reduction for this patient case. When comparing SEV vs. balloon-expandable valve (BEV) performance at an optimal implantation height, the SEV gave a higher regurgitant volume ⋅ than the pre-TAVR model (40.49 vs 37.59 ml), while the BEV model gave the lowest regurgitant volume (33.84 vs 37.59 ml). Conclusions Contact force, aortic-mitral angle, and valve annuli compression were identified as possible mechanistic parameters that may suggest avenues for acute MR improvement. Albeit a single patient parametric study, it is our hope that such detailed engineering analysis could shed some light into the underlying biomechanical mechanisms of TAVR impact on MR.
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Affiliation(s)
- Andrés Caballero
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Wenbin Mao
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Raymond McKay
- Division of Cardiology, The Hartford Hospital, Hartford, Connecticut, USA
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
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Mas-Peiro S, Fichtlscherer S, Walther C, Vasa-Nicotera M. Current issues in transcatheter aortic valve replacement. J Thorac Dis 2020; 12:1665-1680. [PMID: 32395310 PMCID: PMC7212163 DOI: 10.21037/jtd.2020.01.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aortic stenosis is the most common valvular disease worldwide. With transcatheter aortic valve replacement (TAVR) being increasingly expanded to lower-risk populations, several challenging issues remain to be solved. The present review aims at discussing modern approaches to such issues as well as the current status of TAVR. TAVR has undergone several developments in the recent years: an increased use of transfemoral access, the development of prostheses in order to adapt to challenging anatomies, improved delivery systems with repositioning features, and outer skirts aiming at reducing paravalvular leak. The indication of TAVR is increasingly being expanded to patients with lower surgical risk. The main clinical trials supporting such expansion are reviewed and the latest data on low-risk patients are discussed. A number of challenges need still to be addressed and are also reviewed in this paper: the need for updated international guidelines including the latest evidence; a reduction of main complications such as permanent pacemaker implantation, paravalvular leak, and stroke (and its potential prevention by using anti-embolic protection devices); the appropriate role of TAVR in patients with concomitant cardiac ischemic disease; and durability of bio-prosthetic implanted valves. Finally, the future perspectives for TAVR use and next device developments are discussed.
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Affiliation(s)
- Silvia Mas-Peiro
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Claudia Walther
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
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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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41
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Coeman M, Kayaert P, Philipsen T, Calle S, Gheeraert P, Gevaert S, Czapla J, Timmers L, Van Heuverswyn F, De Pooter J. Different dynamics of new-onset electrocardiographic changes after balloon- and self-expandable transcatheter aortic valve replacement: Implications for prolonged heart rhythm monitoring. J Electrocardiol 2020; 59:68-73. [DOI: 10.1016/j.jelectrocard.2020.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/27/2019] [Accepted: 01/14/2020] [Indexed: 12/21/2022]
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Gozdek M, Ratajczak J, Arndt A, Zieliński K, Pasierski M, Matteucci M, Fina D, Jiritano F, Meani P, Raffa GM, Malvindi PG, Pilato M, Paparella D, Słomka A, Landes U, Kornowski R, Kubica J, Lorusso R, Suwalski P, Kowalewski M. Transcatheter aortic valve replacement with Lotus and Sapien 3 prosthetic valves: a systematic review and meta-analysis. J Thorac Dis 2020; 12:893-906. [PMID: 32274157 PMCID: PMC7139024 DOI: 10.21037/jtd.2019.12.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Frequent occurrence of paravalvular leak (PVL) after transcatheter aortic valve replacement (TAVR) was the main concern with early-generation devices and focused technological improvements. Current systematic review and meta-analysis sought to compare outcomes of TAVR for severe native valve stenosis with next-generation devices: Lotus and Sapien 3. Methods Electronic databases were screened for studies comparing outcomes of TAVR with Lotus and Sapien 3. In a random-effects meta-analysis, the pooled incidence rates of procedural, clinical and functional outcomes according to VARC-2 definitions were assessed. Results Eleven observational studies including 2,836 patients (Lotus N=862 vs. Sapien 3 N=1,974) met inclusion criteria. No differences were observed regarding composite endpoints—device success and early safety. Similarly, 30-day mortality, major vascular complications, acute kidney injury and serious bleeding events were similar with both devices. Lotus valve demonstrated 35% reduction of the risk for mild PVL: risk ratio (RR) 0.65, 95% confidence interval (CI): 0.49–0.85, P=0.002; but there were no statistical differences with regard to moderate/severe PVL (RR 0.56, 95% CI: 0.18–1.77, P=0.320). Lotus valves produced significantly higher mean transaortic gradients: mean difference (MD) 0.88 mmHg, 95% CI, 0.24–1.53 mmHg, P=0.007; however, without translation into higher rate of prosthesis-patient mismatch (RR 1.10, 95% CI: 0.82–1.47, P=0.540). As compared to Sapien 3, Lotus device placement was associated with significantly higher rate of permanent pacemaker implantation (RR 2.30, 95% CI: 1.95–2.71, P<0.00001) and cerebrovascular events (RR 1.76, 95% CI: 1.03–2.99, P=0.040). Conclusions Lotus valve, as compared with Sapien 3, was associated with lower risk for PVL but higher risk for permanent pacemaker implantation and cerebrovascular events.
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Affiliation(s)
- Mirosław Gozdek
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Jakub Ratajczak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Adam Arndt
- Department of Anesthesiology and Intensive Therapy, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - Michał Pasierski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Matteo Matteucci
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Dario Fina
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Cardiovascular Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Federica Jiritano
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Paolo Meani
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Department of Intensive Care Unit, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | | | - Michele Pilato
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Domenico Paparella
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK.,Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy
| | - Artur Słomka
- Department of Pathophysiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Uri Landes
- Department of Cardiology, Institute of Interventional Cardiology, Rabin Medical Center, Petach Tikva and Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Institute of Interventional Cardiology, Rabin Medical Center, Petach Tikva and Tel Aviv University, Tel Aviv, Israel
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Piotr Suwalski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Mariusz Kowalewski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
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Ojeda S, Hidalgo F, Romero M, Mazuelos F, Suárez de Lezo J, Martín E, Lostalo A, Luque A, González R, Fernández A, López-Aguilera J, Segura J, Guerrero N, Pan M. Impact of the repositionable Evolut R CoreValve system on the need for a permanent pacemaker after transcatheter aortic valve implantation in patients with severe aortic stenosis. Catheter Cardiovasc Interv 2020; 95:783-790. [PMID: 31062927 DOI: 10.1002/ccd.28327] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/15/2019] [Accepted: 04/21/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To compare the incidence of permanent pacemaker implantation (PPI) with the CoreValve and Evolut R prostheses, to evaluate the implantation depth with both types of prostheses, and to study factors predicting the need for PPI. BACKGROUND The Evolut R CoreValve can be recaptured and repositioned during deployment, allowing a more precise implantation. METHODS A total of 208 patients treated with CoreValve and 137 patients treated with Evolut R were analyzed. The depth of the prosthesis in the LVOT was measured by angiography in the annular perpendicular view projection after deploymen in all patients. RESULTS Baseline conduction abnormalities were comparable between the groups (85/208, 40.9% vs. 53/137, 38.7%; p = 0.69). The mean prosthesis depth was 10.3 ± 8.6 mm in the CoreValve group and 5.5 ± 2.7 mm in the Evolut R group; p < 0.0001. Conduction disturbances after valve implantation were more frequent with the CoreValve (new-onset left bundle branch block: 93, 44.7% vs. 16, 11.7%; p < 0.05, first-degree atrioventricular block: 23, 11.1% vs. 5, 3.6%; p < 0.05). In addition, the incidence of PPI was significantly lower with Evolut R (45, 21.6% vs. 15, 10.9%; p = 0.01). The predictors of the need for PPI were the mean depth of the prosthesis (OR: 1.13, 95% CI: 1.06-1.21; p < 0.0001) and prior right bundle branch block (OR 10.22, 95% CI: 4.62-22.63; p < 0.0001). CONCLUSIONS The recapturable capability of the Evolut R system allowed for higher and precise valve implantation. This fact had an impact on the reduction in the need for PPI.
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Affiliation(s)
- Soledad Ojeda
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Francisco Hidalgo
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Miguel Romero
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Francisco Mazuelos
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Javier Suárez de Lezo
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Ernesto Martín
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Adrián Lostalo
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Aurora Luque
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Rafael González
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Ana Fernández
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - José López-Aguilera
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - José Segura
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Noelia Guerrero
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Manuel Pan
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
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Ghosh RP, Marom G, Bianchi M, D'souza K, Zietak W, Bluestein D. Numerical evaluation of transcatheter aortic valve performance during heart beating and its post-deployment fluid-structure interaction analysis. Biomech Model Mechanobiol 2020; 19:1725-1740. [PMID: 32095912 DOI: 10.1007/s10237-020-01304-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/02/2020] [Indexed: 01/11/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that provides an effective alternative to open-heart surgical valve replacement for treating advanced calcific aortic valve disease patients. However, complications, such as valve durability, device migration, paravalvular leakage (PVL), and thrombogenicity may lead to increased overall post-TAVR morbidity and mortality. A series of numerical studies involving a self-expandable TAVR valve were performed to evaluate these complications. Structural studies were performed with finite element (FE) analysis, followed by computational fluid dynamics (CFD) simulations, and fluid-structure interaction (FSI) analysis. The FE analysis was utilized to study the effect of TAVR valve implantation depth on valve anchorage in the Living Heart Human Model, which is capable of simulating beating heart during repeated cardiac cycles. The TAVR deployment cases where no valve migration was observed were then used to calculate the post-deployment thrombogenic potential via CFD simulations. FSI analysis followed to further assess the post-deployment TAVR hemodynamic performance for different implantation depths. The deployed valves PVL, geometric and effective orifice areas, and the leaflets structural and flow stress magnitudes were compared to determine the device optimal landing zone. The combined structural and hemodynamic analysis indicated that with the TAVR valve deployed at an aft ventricle position an optimal performance was achieved in the specific anatomy studied. Given the TAVR's rapid expansion to younger lower-risk patients, the comprehensive numerical methodology proposed here can potentially be used as a predictive tool for both procedural planning and valve design optimization to minimize the reported complications.
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Affiliation(s)
- Ram P Ghosh
- Department of Biomedical Engineering, Health Sciences Center T08-050, Stony Brook University, Stony Brook, NY, 11794-8084, USA
| | - Gil Marom
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Matteo Bianchi
- Department of Biomedical Engineering, Health Sciences Center T08-050, Stony Brook University, Stony Brook, NY, 11794-8084, USA
| | - Karl D'souza
- Dassault Systèmes SIMULIA Corp, Johnston, RI, 02919, USA
| | - Wojtek Zietak
- Capvidia NV, Research Park Haasrode, Technologielaan 3, 3001, Leuven, Belgium
| | - Danny Bluestein
- Department of Biomedical Engineering, Health Sciences Center T08-050, Stony Brook University, Stony Brook, NY, 11794-8084, USA.
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Giannini C, Petronio AS, Mehilli J, Sartori S, Chandrasekhar J, Faggioni M, Lefèvre T, Presbitero P, Capranzano P, Tchetche D, Iadanza A, Sardella G, Van Mieghem NM, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail GW, Ferrer MC, Naber C, Kievit P, Sorrentino S, Morice MC, Chieffo A, Mehran R. Edwards SAPIEN Versus Medtronic Aortic Bioprosthesis in Women Undergoing Transcatheter Aortic Valve Implantation (from the Win-TAVI Registry). Am J Cardiol 2020; 125:441-448. [PMID: 31813530 DOI: 10.1016/j.amjcard.2019.10.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/28/2019] [Indexed: 11/27/2022]
Abstract
We sought to analyze outcomes of women receiving balloon-expandable valves (BEV) or self-expanding valves (SEV) in contemporary transcatheter aortic valve implantation (TAVI). WIN TAVI (Women's INternational Transcatheter Aortic Valve Implantation) is the first all-female TAVI registry to study the safety and performance of TAVI in women. We compared women treated with BEV (n = 408, 46.9%) versus those treated with SEV (n = 461, 53.1%). The primary efficacy end point was the Valve Academic Research Consortium-2 (VARC-2) composite of 1-year all-cause death, stroke, myocardial infarction, hospitalization for valve-related symptoms or heart failure or valve-related dysfunction. Women receiving SEV had higher surgical risk scores, higher rate of previous stroke and pulmonary hypertension whereas women receiving BEV were more frequently denied surgical valve replacement due to frailty. BEV patients were less likely to require post-dilation and had significantly lower rates of residual aortic regurgitation grade ≥2 (9.8% vs 4.7%, p = 0.007). At 1 year, the crude incidence and adjusted risk of the primary VARC-2 efficacy end point was similar between groups (17.1% with SEV and 14.3% with BEV, p = 0.25; hazards ratio 1.09, 95% confidence interval 0.68 to 1.75). Conversely the crude rate and adjusted risk of new pacemaker implantation was higher with SEV than BEV (15% vs 8.6%, p = 0.001; hazards ratio 1.97, 95% confidence interval 1.13 to 3.43). A subanalysis on new generation valves showed no difference in the need for pacemaker implantation between the 2 devices (10.1% vs 8.0%, p = 0.56). In conclusion, in contemporary TAVI, SEV are used more frequently in women with greater co-morbidities. While there were no differences in unadjusted and adjusted risk of 1-year primary efficacy end point between the valve types, there was a greater need for permanent pacemakers after SEV implantation.
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Should All Low-risk Patients Now Be Considered for TAVR? Operative Risk, Clinical, and Anatomic Considerations. Curr Cardiol Rep 2019; 21:161. [PMID: 31781976 DOI: 10.1007/s11886-019-1250-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This article reviews the current data on TAVR in low-risk patients with severe, symptomatic aortic stenosis, highlights the results of the recently published Medtronic Low Risk Randomized Study and PARTNER 3 trials, and describes specific clinical, anatomic, and procedural considerations regarding the optimal treatment choice in this population. RECENT FINDINGS In low-risk patients, the Medtronic Low Risk Randomized Study demonstrated TAVR to be non-inferior to surgery with respect to the composite endpoint of death or disabling stroke while PARTNER 3 trial proved TAVR to be superior to surgery with regard to the composite endpoint of death, stroke, or rehospitalization. Recent trials demonstrate the safety and efficacy of TAVR in low-risk patients and have led to an FDA indication for the use of TAVR in these patients. However, the lack of long-term data on the rate of transcatheter valve deterioration in the younger population, higher incidence of paravalvular leak and pacemaker implantation following TAVR, along with certain intrinsic anatomic factors remain potential challenges to generalize TAVR in all low surgical risk patients. We describe specific clinical, anatomic, and procedural considerations regarding the optimal treatment choice for low-risk patients with severe, symptomatic AS.
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Du F, Zhu Q, Jiang J, Chen H, Liu X, Wang J. Incidence and Predictors of Permanent Pacemaker Implantation in Patients Who Underwent Transcatheter Aortic Valve Replacement: Observation of a Chinese Population. Cardiology 2019; 145:27-34. [DOI: 10.1159/000502792] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/18/2019] [Indexed: 11/19/2022]
Abstract
Aims: Permanent pacemaker (PPM) implantation is one of the most common complications after transcatheter aortic valve replacement (TAVR). We studied the incidence of PPM implantation and identified the predictors in patients who underwent TAVR in a Chinese population. Methods and Results: A total of 256 patients who underwent TAVR with self-expandable valves were included. The incidence of PPM implantation in our study population was 14.8%. In patients who received PPM implantation, the proportion of bicuspid aortic valve (BAV) patients was much lower compared to tricuspid aortic valve (TAV) patients (18.4 vs. 81.6%, p < 0.05). Patients with BAV were associated with a significantly lower PPM implantation rate and shallower implantation depth compared to patients with TAV (6.4 vs. 21.7% and 4.2 ± 4.4 vs. 6.2 ± 5.0 mm, respectively, p < 0.05 for both). In the multivariable logistic regression analysis, prior right bundle branch block (RBBB; OR 8.3, 95% CI 2.2–32.1, p < 0.05), implantation depth (OR 1.3, 95% CI 1.1–1.5, p = 0.01), and TAV (OR 4.7, 95% CI 1.5–14.4, p < 0.05) were independent predictors of PPM implantation after TAVR. There was no difference in 30-day and 1-year all-cause mortality between the 2 groups. Conclusions: The incidence of PPM implantation in patients with self-expandable valves after TAVR was 14.8% in our cohort study. Independent predictors of PPM implantation included prior RBBB, TAV, and implantation depth at the noncoronary sinus side. TAVR in BAV with a supra-annular structure-based sizing strategy might decrease the risk of PPM implantation.
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Hellhammer K, Piayda K, Afzal S, Veulemans V, Hennig I, Makosch M, Polzin A, Kelm M, Zeus T. Micro-dislodgement during transcatheter aortic valve implantation with a contemporary self-expandable prosthesis. PLoS One 2019; 14:e0224815. [PMID: 31697759 PMCID: PMC6837455 DOI: 10.1371/journal.pone.0224815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/22/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives To evaluate the incidence, risk factors and the clinical outcome of micro-dislodgement (MD) with a contemporary self-expandable prosthesis during transcatheter aortic valve implantation. Methods MD was defined as movement of the prosthesis of at least 1.5 mm upwards or downwards from its position directly before release compared to its final position. Patients were grouped according to the occurrence (+MD) or absence (-MD) of MD. Baseline characteristics, imaging data and outcome parameters were retrospectively analyzed. Results We identified 258 eligible patients. MD occurred in 31.8% (n = 82) of cases with a mean magnitude of 2.8 mm ± 2.2 in relation to the left coronary cusp and 3.0 mm ± 2.1 to the non-coronary cusp. Clinical and hemodynamic outcomes were similar in both groups with consistency over a follow-up period of three months. A larger aortic valve area (AVA) (-MD vs. +MD: 0.6 cm2 ± 0.3 vs. 0.7cm2 ± 0.2; p = 0.014), was the only independent risk factor for the occurrence of MD in a multivariate regression analysis (OR 5.3; 95% CI: 1.1–24.9; p = 0.036). Conclusions MD occurred in nearly one third of patients and did not affect clinical and hemodynamic outcome. A larger AVA seems to be a potential risk factor for MD.
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Affiliation(s)
- Katharina Hellhammer
- University Hospital Düsseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Kerstin Piayda
- University Hospital Düsseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Shazia Afzal
- University Hospital Düsseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Verena Veulemans
- University Hospital Düsseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Inga Hennig
- University Hospital Düsseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Matthias Makosch
- University Hospital Düsseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Amin Polzin
- University Hospital Düsseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Malte Kelm
- University Hospital Düsseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany
| | - Tobias Zeus
- University Hospital Düsseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
- * E-mail:
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Patient-Specific Computer Simulation of Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Morphology. Circ Cardiovasc Imaging 2019; 12:e009178. [DOI: 10.1161/circimaging.119.009178] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
A patient-specific computer simulation of transcatheter aortic valve replacement (TAVR) in tricuspid aortic valve has been developed, which can predict paravalvular regurgitation and conduction disturbance. We wished to validate a patient-specific computer simulation of TAVR in bicuspid aortic valve and to determine whether patient-specific transcatheter heart valve (THV) sizing and positioning might improve clinical outcomes.
Methods:
A retrospective study was performed on TAVR in bicuspid aortic valve patients that had both pre- and postprocedural computed tomography imaging. Preprocedural computed tomography imaging was used to create finite element models of the aortic root. Finite element analysis and computational fluid dynamics was performed. The simulation output was compared with postprocedural computed tomography imaging, cineangiography, echocardiography, and electrocardiograms. For each patient, multiple simulations were performed, to identify an optimal THV size and position for the patient’s specific anatomic characteristics.
Results:
A total of 37 patients were included in the study. The simulations accurately predicted the THV frame deformation (minimum-diameter intraclass correlation coefficient, 0.84; maximum-diameter intraclass correlation coefficient, 0.88; perimeter intraclass correlation coefficient, 0.91; area intraclass correlation coefficient, 0.91), more than mild paravalvular regurgitation (area under the receiver operating characteristic curve, 0.86) and major conduction abnormalities (new left bundle branch block or high-degree atrioventricular block; area under the receiver operating characteristic curve, 0.88). When compared with the implanted THV size and implant depth, optimal patient-specific THV sizing and positioning reduced simulation-predicted paravalvular regurgitation and markers of conduction disturbance.
Conclusions:
Patient-specific computer simulation of TAVR in bicuspid aortic valve may predict the development of important clinical outcomes, such as paravalvular regurgitation and conduction abnormalities. Patient-specific THV sizing and positioning may improve clinical outcomes of TAVR in bicuspid aortic valve.
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Vollenbroich R, Wenaweser P, Macht A, Stortecky S, Praz F, Rothenbühler M, Roost E, Hunziker L, Räber L, Windecker S, Pilgrim T. Long-term outcomes with balloon-expandable and self-expandable prostheses in patients undergoing transfemoral transcatheter aortic valve implantation for severe aortic stenosis. Int J Cardiol 2019; 290:45-51. [DOI: 10.1016/j.ijcard.2019.03.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/09/2019] [Accepted: 03/24/2019] [Indexed: 01/05/2023]
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