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The learning curve in transcatheter aortic valve implantation clinical studies: A systematic review. Int J Technol Assess Health Care 2020; 36:152-161. [DOI: 10.1017/s0266462320000100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BackgroundTranscatheter aortic-valve implantation (TAVI) has become an essential alternative to surgical aortic-valve replacement in the treatment of symptomatic severe aortic stenosis, and this procedure requires technical expertise. The aim of this study was to identify prospective studies on TAVI from the past 10 years, and then to analyze the quality of information reported about the learning curve.Materials and methodsA systematic review of articles published between 2007 and 2017 was performed using PubMed and the EMBASE database. Prospective studies regarding TAVI were included. The quality of information reported about the learning curve was evaluated using the following criteria: mention of the learning curve, the description of a roll-in phase, the involvement of a proctor, and the number of patients suggested to maintain skills.ResultsA total of sixty-eight studies met the selection criteria and were suitable for analysis. The learning curve was addressed in approximately half of the articles (n = 37, 54 percent). However, the roll-in period was mentioned by only eight studies (12 percent) and with very few details. Furthermore, a proctorship was disclosed in three articles (4 percent) whereas twenty-five studies (37 percent) included authors that were proctors for manufacturers of TAVI.ConclusionMany prospective studies on TAVI over the past 10 years mention learning curves as a core component of successful TAVI procedures. However, the quality of information reported about the learning curve is relatively poor, and uniform guidance on how to properly assess the learning curve is still missing.
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Simsek C, Schölzel BE, den Heijer P, Vos J, Meuwissen M, van den Branden B, IJsselmuiden AJJ. The rationale of using cerebral embolic protection devices during transcatheter aortic valve implantation. Neth Heart J 2020; 28:249-252. [PMID: 32152782 PMCID: PMC7190763 DOI: 10.1007/s12471-020-01380-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aortic valve stenosis is one of the most common valvular abnormalities, which can manifest as angina, syncope, dyspnoea and sudden cardiac death. Transcatheter aortic valve implantation (TAVI) has been introduced as an alternative to surgical valve replacement in patients with severe aortic valve stenosis, resulting in less morbidity, shorter time to recovery and similar mortality rates. Progress in this field has reduced complication rates. However, the incidence of peri-procedural stroke remains relatively high (around 4%). To fully utilise the potential of TAVI, cerebral embolic protection devices (CEPD) have been developed and introduced. In this position paper, we aim to summarise the available data on several CEPD.
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Affiliation(s)
- C Simsek
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - B E Schölzel
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - P den Heijer
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - J Vos
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - M Meuwissen
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
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Kochman J, Zbroński K, Kołtowski Ł, Parma R, Ochała A, Huczek Z, Rymuza B, Wilimski R, Dąbrowski M, Witkowski A, Scisło P, Grygier M, Lesiak M, Opolski G. Transcatheter aortic valve implantation in patients with bicuspid aortic valve stenosis utilizing the next-generation fully retrievable and repositionable valve system: mid-term results from a prospective multicentre registry. Clin Res Cardiol 2019; 109:570-580. [PMID: 31478072 PMCID: PMC7182541 DOI: 10.1007/s00392-019-01541-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/22/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the outcomes of transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BiAV) stenosis using a mechanically expanded Lotus™ device. The prior experience with first-generation devices showed disappointing results mainly due to increased prevalence of aortic regurgitation (AR) that exceeded those observed in tricuspid stenosis. METHODS AND RESULTS We collected baseline, in-hospital, 30-day and 2-year follow-up data from a prospective, multicentre registry of patients with BiAV undergoing TAVI using Lotus™ valve. Safety and efficacy endpoints were assessed according to VARC-2 criteria. The study group comprised 24 patients. The mean age was 73.5 years and the mean EuroSCORE 2 was 4.35 ± 2.56%. MDCT analysis revealed Type 1 BiAV in 75% of patients. The mean gradient decreased from 60.1 ± 18.3 to 15 ± 6.4 mm Hg, the AVA increased from 0.6 ± 0.19 to 1.7 ± 0.21 cm2. One in-hospital death was observed secondary to aortic perforation. There was no severe AR and the rate of moderate AR equalled 9% at 30 days (n = 2). Device success was achieved in 83% and the 30-day safety endpoint was 17%. In the 2-year follow-up, the overall mortality was 12.5% and the 2-year composite clinical efficacy endpoint was met in 25% of the patients (n = 6) CONCLUSIONS: The TAVI in selected BiAV patients using the Lotus™ is feasible and characterized by encouraging valve performance and mid-term clinical outcomes.
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Affiliation(s)
- Janusz Kochman
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1a, PL, 02-097, Warsaw, Poland
| | - Karol Zbroński
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1a, PL, 02-097, Warsaw, Poland.
| | - Łukasz Kołtowski
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1a, PL, 02-097, Warsaw, Poland
| | | | | | - Zenon Huczek
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1a, PL, 02-097, Warsaw, Poland
| | - Bartosz Rymuza
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1a, PL, 02-097, Warsaw, Poland
| | - Radosław Wilimski
- Department of Cardiac Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Dąbrowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Piotr Scisło
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1a, PL, 02-097, Warsaw, Poland
| | - Marek Grygier
- Department of Cardiology, Poznan University of Medical Science, Poznan, Poland
| | - Maciej Lesiak
- Department of Cardiology, Poznan University of Medical Science, Poznan, Poland
| | - Grzegorz Opolski
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1a, PL, 02-097, Warsaw, Poland
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Tabata N, Sinning JM, Kaikita K, Tsujita K, Nickenig G, Werner N. Current status and future perspective of structural heart disease intervention. J Cardiol 2019; 74:1-12. [DOI: 10.1016/j.jjcc.2019.02.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
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Takagi H, Hari Y, Nakashima K, Kuno T, Ando T. Network meta-analysis of new-generation valves for transcatheter aortic valve implantation. Heart Vessels 2019; 34:1984-1992. [PMID: 31144096 DOI: 10.1007/s00380-019-01442-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/24/2019] [Indexed: 11/29/2022]
Abstract
To comprehensively compare and rank new-generation valves (NGVs) for transcatheter aortic valve implantation, we performed a network meta-analysis (NMA) of all eligible comparative studies. MEDLINE and EMBASE were searched through September 2018. We included all studies comparing 4 NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3) and an early generation valve (CoreValve) as the reference transcatheter heart valve (THV) each other and reporting at least one of postprocedural incidence of all-cause death, ≥ moderate aortic regurgitation (AR), and new permanent pacemaker implantation (PMI). To compare different THVs, a random-effects restricted-maximum-likelihood NMA based on a frequentist framework for indirect and mixed comparisons was used. Using surface under the cumulative ranking curve (SUCRA), the relative ranking probability of each THV was estimated and the hierarchy of competing THVs was obtained. We identified 29 eligible studies enrolling a total of 17,817 patients. In accordance with the estimated SUCRA probability, SAPIEN 3 was the best effective for a reduction in death (80.6%) and the second best for decreased ≥ moderate AR (74.4%) and PMI (74.1%) compared with the other THVs. Lotus was ranked the best for a reduction in ≥ moderate AR (94.5%;), whereas the worst for decreased PMI (1.2%) and the second worst for a reduction in mortality (38.6%). ACURATE was the best for decreased PMI (99.2%) and the second best for a reduction in mortality (77.9%). As a whole, SAPIEN 3 may be the best effective NGV among the 4 examined NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3).
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka, 411-8611, Japan. .,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Yosuke Hari
- Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka, 411-8611, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kouki Nakashima
- Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka, 411-8611, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Toshiki Kuno
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Tomo Ando
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
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Conzelmann LO, Würth A, Balthasar V, Neuber C, Tzamalis P, Gonska BD, Schmitt C, Mehlhorn U, Schymik G. Transcatheter aortic valve implantation in severe calcified annulus using the Lotus valve system: Increased incidence of fatal major vascular complications. Catheter Cardiovasc Interv 2019; 95:E21-E29. [PMID: 31115146 DOI: 10.1002/ccd.28339] [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: 11/15/2018] [Accepted: 05/02/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study reports the outcome of a highly selected transcatheter aortic valve implantation (TAVI) population. BACKGROUND In patients with aortic valve stenosis and severe calcification of the left ventricular outflow tract and/or the annulus, the Boston Scientific Lotus valve provided a low paravalvular leakage rate omitting the risk of annular rupture. METHODS Until now more than 3,600 TAVI procedures were performed at our institution. Between 8/2015 and 2/2017, 634 TAVI procedures were performed, of which 80 TAVI patients with severe calcifications consecutively received the Lotus valve. Valve Academic Research Consortium (VARC)-2 criteria of these procedures were prospectively documented in our institutional TAVI registry. One year follow-up for the Lotus treated patients was completed. RESULTS Mean age was 82.0 ± 5.5 years. Device success was 95.0%. Conversion was required in two cases (2.5%). New permanent pacemaker implantation rate was 33.3%. Vascular complications occurred more frequent in comparison to non-Lotus treated patients (13.8 vs. 8.1%; p < .05): five minor and six major vascular complications (6.3 and 7.5%), including four fatal aortic injuries (three acute aortic dissections type A, one rupture of the aortic arch). Seventy-two-hour and 30-day mortality rates were also higher in Lotus patients (6.3 and 12.5% vs. 0.3 and 2.5%; each p < .05). One-year mortality in Lotus patients was 22.5%. CONCLUSIONS In TAVI procedures with the Lotus valve occurrence of vascular complications including lethal aortic injuries and mortality rates were considerably high. Furthermore, in every TAVI procedure careful examination of the aorta should be mandatory and be a part of planning it.
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Affiliation(s)
| | - Alexander Würth
- Medical Clinic III - Department of Cardiology, ViDia Clinics, Sankt Vincentius Hospital Karlsruhe, Karlsruhe, Germany
| | | | | | - Panagiotis Tzamalis
- Medical Clinic IV - Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Bernd-Dieter Gonska
- Medical Clinic III - Department of Cardiology, ViDia Clinics, Sankt Vincentius Hospital Karlsruhe, Karlsruhe, Germany
| | - Claus Schmitt
- Medical Clinic IV - Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Uwe Mehlhorn
- HELIOS Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany
| | - Gerhard Schymik
- Medical Clinic IV - Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
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Berntorp K, Koul S, Nozohoor S, Harnek J, Bjursten H, Götberg M. Single-center evaluation of a next generation fully repositionable and retrievable transcatheter aortic valve replacement. BMC Cardiovasc Disord 2019; 19:44. [PMID: 30808296 PMCID: PMC6390309 DOI: 10.1186/s12872-019-1021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The mechanically expandable Lotus Valve System is a fully repositionable and retrievable valve with an adaptive seal to minimize paravalvular leak (PVL). The aim of this study was to evaluate the short- and long-term safety and efficacy of the new device with focus on a new implantation technique to reduce the need for a permanent pacemaker (PPM) post procedure. METHODS We performed a prospective single-center, non-randomized evaluation of the Lotus Valve System. The first 100 consecutive Lotus Valve implantations were included in the analysis. Outcome was assessed according to VARC2-criteria. Postoperative pacemaker rates were assessed using the national pacemaker registry and electronic medical records. Mortality at 30 days and 12 months were acquired from the national population registry. RESULTS Mean age was 82.7 ± 5.6 years, mean Euroscore I was 25.3 ± 14.5%, mean STS-score was 6.5 ± 4.1% and mean aortic valve area was 0.6 ± 0.1 cm2. There were no cases of valve embolization, ectopic valve deployment or additional valve implantation. Device success according to the VARC2-criteria was 97%. The 30-day mortality rate was 3%. Two deaths occurred due to stroke and one due to a ventricular rupture. Major stroke rate was 2% and major vascular complication rate was 2%. The 12-month mortality rate was 14%. At discharge 87% of patients had no/trace PVL, 12% had mild PVL and one patient had a moderate PVL. A total of 13% received a new PPM post valve implantation. Among patients who did not have a PPM before the procedure, the PPM rate was 15.3%. CONCLUSIONS This single-center evaluation of the Lotus Valve System demonstrated a good clinical outcome with a low mortality, in a high-risk population. Introduction of a new implantation technique resulted in lower PPM rates than previously reported without negatively affecting PVL. TRIAL REGISTRATION Current Controlled Trials ISRCTN14952278 , retrospectively registered 06/11/2017.
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Affiliation(s)
- Karolina Berntorp
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, 221-85, Lund, SE, Sweden.
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, 221-85, Lund, SE, Sweden
| | - Shahab Nozohoor
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, 221-85, Lund, SE, Sweden
| | - Jan Harnek
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, 221-85, Lund, SE, Sweden
| | - Henrik Bjursten
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, 221-85, Lund, SE, Sweden
| | - Matthias Götberg
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, 221-85, Lund, SE, Sweden
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9
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Musa TA, Uddin A, Loveday C, Dobson LE, Igra M, Richards F, Swoboda PP, Singh A, Garg P, Foley JRJ, Fent GJ, Goddard AJP, Malkin C, Plein S, Blackman DJ, McCann GP, Greenwood JP. Silent cerebral infarction and cognitive function following TAVI: an observational two-centre UK comparison of the first-generation CoreValve and second-generation Lotus valve. BMJ Open 2019; 9:e022329. [PMID: 30670503 PMCID: PMC6347912 DOI: 10.1136/bmjopen-2018-022329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To compare the incidence of silent cerebral infarction and impact on cognitive function following transcatheter aortic valve implantation (TAVI) with the first-generation CoreValve (Medtronic, Minneapolis, Minnesota, USA) and second-generation Lotus valve (Boston Scientific, Natick Massachusetts, USA). DESIGN A prospective observational study comprising a 1.5 T cerebral MRI scan, performed preoperatively and immediately following TAVI, and neurocognitive assessments performed at baseline, 30 days and 1 year follow-up. SETTING University hospitals of Leeds and Leicester, UK. PATIENTS 66 (80.6±8.0 years, 47% male) patients with high-risk severe symptomatic aortic stenosis recruited between April 2012 and May 2015. MAIN OUTCOME MEASURES Incidence of new cerebral microinfarction and objective decline in neurocognitive performance. RESULTS All underwent cerebral MRI at baseline and immediately following TAVI, and 49 (25 Lotus, 24 CoreValve) completed neurocognitive assessments at baseline, 30 days and 1 year. There was a significantly greater incidence of new cerebral microinfarction observed following the Lotus TAVI (23 (79%) vs 22 (59%), p=0.025) with a greater number of new infarcts per patient (median 3.5 (IQR 7.0) vs 2.0 (IQR 3.0), p=0.002). The mean volume of infarcted cerebral tissue per patient was equivalent following the two prostheses (p=0.166). More patients suffered new anterior (14 (48%) vs 2 (5%), p=0.001) and vertebrobasilar (15 (52%) vs 7 (19%), p=0.005) lesions following Lotus. Lotus was associated with a decline in verbal memory and psychomotor speed at 30 days. However, performance longitudinally at 1 year was preserved in all neurocognitive domains. CONCLUSIONS There was a higher incidence of silent cerebral microinfarction and a greater number of lesions per patient following Lotus compared with CoreValve. However, there was no objective decline in neurocognitive function discernible at 1 year following TAVI with either prosthesis.
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Affiliation(s)
- Tarique Al Musa
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Catherine Loveday
- Cognitive Science Research Unit, University of Westminster, London, UK
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Mark Igra
- Interventional Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Fiona Richards
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, University of Leicester, Leicester, UK
- National Institute of Health Research (NIHR) Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - James R J Foley
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Graham J Fent
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Anthony J P Goddard
- Interventional Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Christopher Malkin
- Interventional Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Interventional Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Daniel J Blackman
- Interventional Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Gerald P McCann
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, University of Leicester, Leicester, UK
- National Institute of Health Research (NIHR) Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Interventional Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center, New York Presbyterian Hospital.
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11
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Musa TA, Uddin A, Dobson LE, Swoboda PP, Garg P, Foley JRJ, Malkin C, Plein S, Blackman DJ, Greenwood JP. Cardiovascular magnetic resonance assessment of 1st generation CoreValve and 2nd generation Lotus valves. J Interv Cardiol 2018; 31:391-399. [PMID: 29696693 DOI: 10.1111/joic.12512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/01/2018] [Accepted: 03/20/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES We sought to compare using serial CMR, the quantity of AR and associated valve hemodynamics, following the first-generation CoreValve (Medtronic, Minneapolis, MN) and the second-generation Lotus valve (Boston Scientific, Natick, MA). BACKGROUND Aortic regurgitation (AR) following Transcatheter Aortic Valve Replacement (TAVR) confers a worse prognosis and can be accurately quantified using cardiovascular magnetic resonance (CMR). Second generation valves have been specifically designed to reduce paravalvular AR and improve clinical outcomes. METHODS Fifty-one patients (79.0 ± 7.7 years, 57% male) were recruited and imaged at three time points: immediately pre- and post-TAVR, and at 6 months. RESULTS CMR-derived AR fraction immediately post-TAVR was greater in the CoreValve compared to Lotus group (11.7 ± 8.4 vs. 4.3 ± 3.4%, P = 0.001), as was the frequency of ≥moderate AR (9/24 (37.5%) versus 0/27, P < 0.001). However, at 6 months AR fraction had improved significantly in the CoreValve group such that the two valve designs were comparable (6.4 ± 5.0 vs 5.6 ± 5.3%, P = 0.623), with no patient in either group having ≥moderate AR. The residual peak pressure gradient immediately following TAVR was significantly lower with CoreValve compared to Lotus (14.1 ± 5.6 vs 25.4 ± 11.6 mmHg, P = 0.001), but again by 6 months the two valve designs were comparable (16.5 ± 9.4 vs 19.7 ± 10.5 mmHg, P = 0.332). There was no difference in the degree of LV reverse remodeling between the two valves at 6 months. CONCLUSION Immediately post-TAVR, there was significantly less AR but a higher residual peak pressure gradient with the Lotus valve compared to CoreValve. However, at 6 months both devices had comparable valve hemodynamics and LV reverse remodeling.
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Affiliation(s)
- Tarique Al Musa
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - James R J Foley
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Daniel J Blackman
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
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12
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Transcatheter heart valve for aortic valve implantation: republication of the article published in the Japanese Journal of Artificial Organs. J Artif Organs 2018; 21:125-131. [PMID: 29426997 DOI: 10.1007/s10047-017-1015-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
This review was created based on a translation of the Japanese review first reported in the Japanese Journal of Artificial Organs in 2015 (vol. 44, no. 3, pp. 136-140), with some modifications.
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13
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Pellegrini C, Hengstenberg C, Husser O. The Lotus dilemma-respond to paravalvular leakage, but not answering pacemaker implantations? J Thorac Dis 2017; 9:2804-2807. [PMID: 29221244 DOI: 10.21037/jtd.2017.08.64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Costanza Pellegrini
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christian Hengstenberg
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Deutsches Zentrum für Herz-und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Oliver Husser
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Rashid HN, McCormick LM, Talman AH, Ihdayhid AR, Nerlekar N, Amiruddin AS, Cameron J, Nasis A, Meredith IT, Gooley RP. Effect of aorto-ventricular angulation on procedural success in transcatheter aortic valve replacements with the Lotus Valve system. Catheter Cardiovasc Interv 2017; 91:1365-1370. [PMID: 29210168 DOI: 10.1002/ccd.27378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/03/2017] [Accepted: 09/16/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the effect of aorto-ventricular angulation (AA) on procedural success with the Lotus Valve system. BACKGROUND AA, the angulation of the aortic valve basal plane, may affect the deployment of transcatheter aortic valve replacements (TAVRs). The Lotus Valve system is fully repositionable and delivered on a pre-shaped catheter which may alter the impact of AA on its deployment. The effect of AA on procedural and clinical outcomes with the Lotus valve is unreported. METHODS Consecutive patients who underwent transfemoral TAVR with the Lotus Valve system were analyzed. AA was determined on pre-procedural multi-detector computed tomography imaging. Device success, procedural characteristics, and clinical events were assessed according to Valve Academic Research Consortium-2 (VARC2) definitions. RESULTS One hundred sixty-five patients were analyzed (48% male, mean age 84 years). The mean AA was 47.8 degrees. Patients were, therefore, divided into low AA (AA < 48°) or high AA (AA ≥ 48°). Baseline characteristics were similar in both cohorts. Device success and procedural outcomes were also similar including procedure time, contrast dose, and need to reposition. There was no difference in degree of moderate or greater para-valvular regurgitation (PVR) (0% vs. 3%, P = 0.09). Clinical outcomes of death, stroke, myocardial infarction, and other major VARC2 endpoints were similar. CONCLUSION AA did not affect device success or clinical outcome with the Lotus Valve system. The Lotus' unique design features may have mitigated the impact of AA by improving the accuracy, ease of valve positioning, and reducing PVR.
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Affiliation(s)
- Hashrul N Rashid
- MonashHEART, Monash Health, Melbourne, Australia.,Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Liam M McCormick
- MonashHEART, Monash Health, Melbourne, Australia.,Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | | | - Abdul R Ihdayhid
- MonashHEART, Monash Health, Melbourne, Australia.,Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Nitesh Nerlekar
- MonashHEART, Monash Health, Melbourne, Australia.,Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | | | - James Cameron
- MonashHEART, Monash Health, Melbourne, Australia.,Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Arthur Nasis
- MonashHEART, Monash Health, Melbourne, Australia.,Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Ian T Meredith
- MonashHEART, Monash Health, Melbourne, Australia.,Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Robert P Gooley
- MonashHEART, Monash Health, Melbourne, Australia.,Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
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15
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Predictors of permanent pacemaker implantation after transfemoral aortic valve implantation with the Lotus valve. Am Heart J 2017; 192:57-63. [PMID: 28938964 DOI: 10.1016/j.ahj.2017.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 07/12/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Permanent pacemaker implantation (PPMI) after transcatheter aortic valve implantation is of high clinical relevance, but PPMI rates differ widely between valve types. Although the Lotus valve can be repositioned, reported rates for PPMI are high. The predictors of PPMI after Lotus valve implantation have not been defined yet. METHODS We analyzed the impact of preexisting conduction disturbances, depth of implantation, oversizing, and amount of calcification on PPMI in 216 patients with severe symptomatic aortic stenosis underdoing Lotus valve implantation. RESULTS PPMI was required in 39.8% of patients. Patients with need for PPMI compared with patients without need for PPMI had more often the following criteria: male gender (P=.035); preprocedural right bundle-branch block (RBBB) (16.3% vs 0, P<.001); atrioventricular (AV) block first degree (26.7% vs 10.1%, P=.004); higher calcium volume of the left coronary cusp (63.1±87.5 mm3 vs 42.8±49.3 mm3, P=.05); and deeper valve implantation at right coronary (P=.011), noncoronary (P=.026), and left coronary (P=.012) position. Oversizing in relation to annulus and left ventricular outflow tract did not have an impact on need for PPMI. By multiple regression analysis, preprocedural AV block first degree (P=.005), RBBB (P<.001), and depth of implantation (P=.006) were independent risk factors for need of PPMI. CONCLUSIONS In patients with severe aortic stenosis receiving transfemoral Lotus valve, preexisting AV block first degree, RBBB, and implantation depth are independent predictors of PPMI, highlighting the importance of careful valve positioning.
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16
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Auffret V, Puri R, Urena M, Chamandi C, Rodriguez-Gabella T, Philippon F, Rodés-Cabau J. Conduction Disturbances After Transcatheter Aortic Valve Replacement. Circulation 2017; 136:1049-1069. [DOI: 10.1161/circulationaha.117.028352] [Citation(s) in RCA: 302] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a well-accepted option for treating patients with aortic stenosis at intermediate to high or prohibitive surgical risk. TAVR-related conduction disturbances, mainly new-onset left bundle-branch block and advanced atrioventricular block requiring permanent pacemaker implantation, remain the most common complication of this procedure. Furthermore, improvements in TAVR technology, akin to the increasing experience of operators/centers, have translated to a major reduction in periprocedural complications, yet the incidence of conduction disturbances has remained relatively high, with perhaps an increasing trend over time. Several factors have been associated with a heightened risk of conduction disturbances and permanent pacemaker implantation after TAVR, with prior right bundle-branch block and transcatheter valve type and implantation depth being the most commonly reported. New-onset left bundle-branch block and the need for permanent pacemaker implantation may have a significant detrimental association with patients’ prognosis. Consequently, strategies intended to reduce the risk and to improve the management of such complications are of paramount importance, particularly in an era when TAVR expansion toward treating lower-risk patients is considered inevitable. In this article, we review the available evidence on the incidence, predictive factors, and clinical association of conduction disturbances after TAVR and propose a strategy for the management of these complications.
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Affiliation(s)
- Vincent Auffret
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Rishi Puri
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Marina Urena
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Chekrallah Chamandi
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Tania Rodriguez-Gabella
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - François Philippon
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Josep Rodés-Cabau
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
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17
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Bagur R, Choudhury T, Mamas MA. Transcatheter aortic valve implantation with the repositionable and fully retrievable Lotus Valve System TM. J Thorac Dis 2017; 9:2798-2803. [PMID: 29221243 DOI: 10.21037/jtd.2017.08.78] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rodrigo Bagur
- Division of Cardiology, London Health Sciences Centre, Departments of Medicine and Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
| | - Tawfiq Choudhury
- Division of Cardiology, London Health Sciences Centre, Departments of Medicine and Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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18
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Wöhrle J, Gonska B, Rodewald C, Seeger J, Scharnbeck D, Rottbauer W. Transfemoral aortic valve implantation with the repositionable Lotus valve for treatment of patients with symptomatic severe aortic stenosis: results from a single-centre experience. EUROINTERVENTION 2017; 12:760-7. [PMID: 27542789 DOI: 10.4244/eijv12i6a124] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the study was to evaluate the procedural and 30-day results for the repositionable Lotus valve in patients undergoing transfemoral aortic valve implantation in a single-centre experience. METHODS AND RESULTS We prospectively enrolled 110 patients with severe symptomatic aortic stenosis (NCT02162069). All procedures were performed without general anaesthesia by the transfemoral approach. Patients were followed for 30 days. Patients received the 23 mm (n=20), 25 mm (n=43) or 27 mm (n=47) Lotus device. Mean oversizing in relation to annulus or left ventricular outflow tract (LVOT) did not differ among groups. There was no residual moderate or severe aortic regurgitation. The rate of mild aortic regurgitation was low at 9.1%. There was no valve embolisation, no need for a second valve and no conversion to surgery. The need for a new pacemaker implantation due to complete (third degree) or type II (Mobitz) second degree atrioventricular block was 24.1%, excluding patients with previously implanted devices. Within 30 days the rates of all-cause mortality and stroke were low. CONCLUSIONS In patients with severe aortic stenosis, transfemoral TAVI with the repositionable Lotus valve was associated with a high rate of device success, no moderate or severe residual aortic regurgitation, low rates of major vascular complications and mortality within 30 days.
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Affiliation(s)
- Jochen Wöhrle
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
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19
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Rashid HN, Gooley R, McCormick L, Zaman S, Ramkumar S, Jackson D, Amiruddin A, Nasis A, Cameron J, Meredith IT. Safety and efficacy of valve repositioning during transcatheter aortic valve replacement with the Lotus Valve System. J Cardiol 2017; 70:55-61. [PMID: 27890512 DOI: 10.1016/j.jjcc.2016.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/14/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
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20
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Giannini C, De Carlo M, Tamburino C, Ettori F, Latib AM, Bedogni F, Bruschi G, Presbitero P, Poli A, Fabbiocchi F, Violini R, Trani C, Giudice P, Barbanti M, Adamo M, Colombo P, Benincasa S, Agnifili M, Petronio AS. Transcathether aortic valve implantation with the new repositionable self-expandable Evolut R versus CoreValve system: A case-matched comparison. Int J Cardiol 2017; 243:126-131. [PMID: 28595747 DOI: 10.1016/j.ijcard.2017.05.095] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 04/05/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite promising results following transcatheter aortic valve implantation (TAVI), several relevant challenges still remain. To overcome these issues, new generation devices have been developed. The purpose of the present study was to determine whether TAVI with the new self-expanding repositionable Evolut R offers potential benefits compared to the preceding CoreValve, using propensity matching. METHODS Between June 2007 and November 2015, 2148 consecutive patients undergoing TAVI either CoreValve (n=1846) or Evolut R (n=302) were prospectively included in the Italian TAVI ClinicalService® project. For the purpose of our analysis 211 patients treated with the Evolut R were matched to 211 patients treated with the CoreValve. An independent core laboratory reviewed all angiographic procedural data and an independent clinical events committee adjudicated all events. RESULTS Patients treated with Evolut R experienced higher 1-year overall survival (log rank test p=0.045) and a significantly lower incidence of major vascular access complications, bleeding events and acute kidney injury compared to patients treated with the CoreValve. Recapture manoeuvres to optimize valve deployment were performed 44 times, allowing a less implantation depth for the Evolut R. As a consequence, the rate of more than mild paravalvular leak and new permanent pacemaker was lower in patients receiving the Evolut R. CONCLUSION In this matched comparison of high surgical risk patients undergoing TAVI, the use of Evolut R was associated with a significant survival benefit at 1year compared with the CoreValve. This was driven by lower incidence of periprocedural complications and higher rates of correct anatomic positioning.
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Affiliation(s)
| | | | | | | | | | | | - Giuseppe Bruschi
- "De Gasperis" Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy
| | | | | | | | | | - Carlo Trani
- Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Pietro Giudice
- Giovanni Di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - Marco Barbanti
- Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Paola Colombo
- "De Gasperis" Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy
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21
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Kilic T, Yilmaz I. Transcatheter aortic valve implantation: a revolution in the therapy of elderly and high-risk patients with severe aortic stenosis. J Geriatr Cardiol 2017; 14:204-217. [PMID: 28408919 PMCID: PMC5387215 DOI: 10.11909/j.issn.1671-5411.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/01/2017] [Accepted: 03/12/2017] [Indexed: 12/18/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) represents a real revolution in the field of interventional cardiology for the treatment of elderly or high-risk surgical patients with severe symptomatic aortic valve stenosis. Today, TAVI seems to play a key and a reliable role in the treatment of intermediate and maybe low-risk patients with severe aortic stenosis. TAVI has also evolved from a complex and hazardous procedure into an effective and safe therapy by the development of new generation devices. This article aims to review the background and future of TAVI, clinical trials and registries with old and new generation TAVI devices and to focus on some open issues related to post-procedural outcomes.
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Affiliation(s)
- Teoman Kilic
- Invasive Cardiology Research and Application Unit, Department of Cardiology, Kocaeli University, Kocaeli, Turkey
| | - Irem Yilmaz
- Department of Cardiology, Kocaeli University, Kocaeli, Turkey
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22
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Dobson LE, Musa TA, Uddin A, Fairbairn TA, Bebb OJ, Swoboda PP, Haaf P, Foley J, Garg P, Fent GJ, Malkin CJ, Blackman DJ, Plein S, Greenwood JP. The impact of trans-catheter aortic valve replacement induced left-bundle branch block on cardiac reverse remodeling. J Cardiovasc Magn Reson 2017; 19:22. [PMID: 28222749 PMCID: PMC5320804 DOI: 10.1186/s12968-017-0335-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/02/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Left bundle branch block (LBBB) is common following trans-catheter aortic valve replacement (TAVR) and has been linked to increased mortality, although whether this is related to less favourable cardiac reverse remodeling is unclear. The aim of the study was to investigate the impact of TAVR induced LBBB on cardiac reverse remodeling. METHODS 48 patients undergoing TAVR for severe aortic stenosis were evaluated. 24 patients with new LBBB (LBBB-T) following TAVR were matched with 24 patients with a narrow post-procedure QRS (nQRS). Patients underwent cardiovascular magnetic resonance (CMR) prior to and 6 m post-TAVR. Measured cardiac reverse remodeling parameters included left ventricular (LV) size, ejection fraction (LVEF) and global longitudinal strain (GLS). Inter- and intra-ventricular dyssynchrony were determined using time to peak radial strain derived from CMR Feature Tracking. RESULTS In the LBBB-T group there was an increase in QRS duration from 96 ± 14 to 151 ± 12 ms (P < 0.001) leading to inter- and intra-ventricular dyssynchrony (inter: LBBB-T 130 ± 73 vs nQRS 23 ± 86 ms, p < 0.001; intra: LBBB-T 118 ± 103 vs. nQRS 13 ± 106 ms, p = 0.001). Change in indexed LV end-systolic volume (LVESVi), LVEF and GLS was significantly different between the two groups (LVESVi: nQRS -7.9 ± 14.0 vs. LBBB-T -0.6 ± 10.2 ml/m2, p = 0.02, LVEF: nQRS +4.6 ± 7.8 vs LBBB-T -2.1 ± 6.9%, p = 0.002; GLS: nQRS -2.1 ± 3.6 vs. LBBB-T +0.2 ± 3.2%, p = 0.024). There was a significant correlation between change in QRS and change in LVEF (r = -0.434, p = 0.002) and between change in QRS and change in GLS (r = 0.462, p = 0.001). Post-procedure QRS duration was an independent predictor of change in LVEF and GLS at 6 months. CONCLUSION TAVR-induced LBBB is associated with less favourable cardiac reverse remodeling at medium term follow up. In view of this, every effort should be made to prevent TAVR-induced LBBB, especially as TAVR is now being extended to a younger, lower risk population.
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Affiliation(s)
- Laura E. Dobson
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Tarique A. Musa
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Timothy A. Fairbairn
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Owen J. Bebb
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Peter P. Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Philip Haaf
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - James Foley
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Graham J. Fent
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | | | - Daniel J. Blackman
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
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23
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Barbanti M, Gulino S, Costa G, Tamburino C. Pathophysiology, incidence and predictors of conduction disturbances during Transcatheter Aortic Valve Implantation. Expert Rev Med Devices 2017; 14:135-147. [PMID: 28092726 DOI: 10.1080/17434440.2017.1282819] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Over the past decade, transcatheter aortic valve implantation (TAVI) has evolved rapidly toward an extremely reproducible, safe and effective procedure, with a marked reduction of its related complications. However, the occurrence of conduction disturbances and the need for permanent pacemaker implantation (PPI) after TAVI remains a concern. Areas covered: In this article review, we will go through the mechanisms involved in conduction disturbances after TAVI, and we will discuss the key aspects of pathophysiology, incidence and predictors of conduction disturbances following Transcatheter Aortic Valve Implantation. The evaluation of patient's valve anatomy and the selection of the most appropriate prosthesis have been proposed as a valuable options to reduce the incidence of conductions disturbances. Moreover, in recent times, a great number of new TAVI devices, so-called 'second-generation devices', have been introduced to address the limitations of the first-generation devices, including conduction disturbance, with scarce results. Expert commentary: Conduction disturbances after TAVI are increasingly recognized as an important issue in TAVI complications. Further characterization of the procedural- and patient-related factors that contribute to the development of conduction abnormalities will help to improve prosthesis designs and patient selection, making TAVI even more safer.
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Affiliation(s)
- Marco Barbanti
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Simona Gulino
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Giuliano Costa
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Corrado Tamburino
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
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Soliman OII, El Faquir N, Ren B, Spitzer E, van Gils L, Jonker H, Geleijnse ML, van Es GA, Tijssen JG, van Mieghem NM, de Jaegere PPT. Comparison of valve performance of the mechanically expanding Lotus and the balloon-expanded SAPIEN3 transcatheter heart valves: an observational study with independent core laboratory analysis. Eur Heart J Cardiovasc Imaging 2017; 19:157-167. [DOI: 10.1093/ehjci/jew280] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/14/2016] [Indexed: 12/24/2022] Open
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25
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Zaman S, McCormick L, Gooley R, Rashid H, Ramkumar S, Jackson D, Hui S, Meredith IT. Incidence and predictors of permanent pacemaker implantation following treatment with the repositionable Lotus™ transcatheter aortic valve. Catheter Cardiovasc Interv 2016; 90:147-154. [DOI: 10.1002/ccd.26857] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/12/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Sarah Zaman
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), School of Clinical Sciences; Monash University
- Cardiovascular Division; Monash Heart, Monash Medical Centre; Melbourne Victoria Australia
| | - Liam McCormick
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), School of Clinical Sciences; Monash University
- Cardiovascular Division; Monash Heart, Monash Medical Centre; Melbourne Victoria Australia
| | - Robert Gooley
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), School of Clinical Sciences; Monash University
- Cardiovascular Division; Monash Heart, Monash Medical Centre; Melbourne Victoria Australia
| | - Hashrul Rashid
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), School of Clinical Sciences; Monash University
| | - Satish Ramkumar
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), School of Clinical Sciences; Monash University
| | - Damon Jackson
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), School of Clinical Sciences; Monash University
| | - Samuel Hui
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), School of Clinical Sciences; Monash University
| | - Ian T. Meredith
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), School of Clinical Sciences; Monash University
- Cardiovascular Division; Monash Heart, Monash Medical Centre; Melbourne Victoria Australia
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Bagur R, Teefy PJ, Kiaii B, Diamantouros P, Chu MW. First North American experience with the transfemoral ACURATE-neo
TM
self-expanding transcatheter aortic bioprosthesis. Catheter Cardiovasc Interv 2016; 90:130-138. [DOI: 10.1002/ccd.26802] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 09/05/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Rodrigo Bagur
- Division of Interventional Cardiology; University Hospital, London Health Sciences Centre, Western University, London; Ontario Canada
| | - Patrick J. Teefy
- Division of Interventional Cardiology; University Hospital, London Health Sciences Centre, Western University, London; Ontario Canada
| | - Bob Kiaii
- Division of Cardiac Surgery; University Hospital, London Health Sciences Centre, Western University, London; Ontario Canada
| | - Pantelis Diamantouros
- Division of Interventional Cardiology; University Hospital, London Health Sciences Centre, Western University, London; Ontario Canada
| | - Michael W.A. Chu
- Division of Cardiac Surgery; University Hospital, London Health Sciences Centre, Western University, London; Ontario Canada
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Eksik A, Yildirim A, Gul M, Aslan S, Tosu AR, Surgit O, Cakmak HA, Satilmisoglu MH, Akkaya E, Bakir I. Comparison of Edwards Sapien XT versus Lotus Valve Devices in Terms of Electrophysiological Study Parameters in Patients Undergoing TAVI. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1132-1140. [PMID: 27418419 DOI: 10.1111/pace.12917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/16/2016] [Accepted: 07/08/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The purpose of this study is to assess the electrocardiographic and electrophysiological parameters of conduction abnormalities in patients undergoing transcatheter aortic valve implantation (TAVI) due to severe aortic valve stenosis. METHODS The study included 55 patients who underwent TAVI using either the Boston Scientific Lotus (n:25) (Boston Scientific, Natick, MA, USA) or Edwards Sapien XT (n:30) (Edwards Lifesciences, Irvine, CA, USA) prostheses. An electrophysiological study (EPS) was performed in the catheterization room immediately before the initial balloon valvuloplasty and immediately after prosthesis implantation. RESULTS QRS duration and His-bundle to His-ventricle (HV) intervals, which were similar between the two groups before the procedure, were found to be significantly higher in the Lotus valve group postprocedure. Permanent pacemakers (PPMs) were required more frequently in the Lotus group than in the Sapien XT group at discharge (24.0% vs 6.7%, P = 0.07). With the exception of a higher prevalence of paravalvular leakage (P < 0.001) in patients undergoing Sapien XT implantation, other clinical outcomes were similar between the two groups. Multiple regression analysis revealed that baseline atrioventricular (AV) conduction disorders and HV intervals after the procedure were independently associated with PPM implantation after TAVI. CONCLUSION In this first study comparing the findings of EPS and electrocardiography, the impact of the Lotus valve on AV conduction systems was greater than that of the Sapien XT. However, the need for PPM was higher in the Lotus valve than in the Sapien XT. PPM requirement is related to valve design; it may decrease with reduced frame height and metal burden in novel valve systems.
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Affiliation(s)
- Abdurrahman Eksik
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Aydin Yildirim
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Gul
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Serkan Aslan
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Aydin Rodi Tosu
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Surgit
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | | | - Muhammet Hulusi Satilmisoglu
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Emre Akkaya
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ihsan Bakir
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Chan AW, Wong D, Charania J. Transcatheter Aortic Valve Replacement in Bicuspid Aortic Stenosis Using Lotus Valve System. Catheter Cardiovasc Interv 2016; 90:157-163. [DOI: 10.1002/ccd.26506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/23/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Albert W. Chan
- Cardiac Service, Royal Columbian Hospital; New Westminster British Columbia, Canada
| | - Daniel Wong
- Cardiac Service, Royal Columbian Hospital; New Westminster British Columbia, Canada
| | - Jahangir Charania
- Cardiac Service, Royal Columbian Hospital; New Westminster British Columbia, Canada
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Harjai KJ, Grines CL, Leon MB. Transcatheter Aortic Valve Replacement: 2015 in Review. J Interv Cardiol 2016; 29:27-46. [DOI: 10.1111/joic.12274] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Kishore J. Harjai
- Geisinger Clinic; Pearsall Heart Hospital; Wilkes-Barre Pennsylvania
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Urena M, Rodés-Cabau J. Managing heart block after transcatheter aortic valve implantation: from monitoring to device selection and pacemaker indications. EUROINTERVENTION 2015; 11 Suppl W:W101-5. [DOI: 10.4244/eijv11swa30] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abdel-Wahab M, Jose J, Richardt G. Transfemoral TAVI devices: design overview and clinical outcomes. EUROINTERVENTION 2015; 11 Suppl W:W114-8. [DOI: 10.4244/eijv11swa33] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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