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de Agustin JA, Pozo Osinalde E, Olmos C, Mahia Casado P, Marcos-Alberca P, Luaces M, Gomez de Diego JJ, Nombela-Franco L, Jimenez-Quevedo P, Tirado-Conte G, Collado Yurrita L, Fernandez-Ortiz A, Perez-Villacastin J. Current Usefulness of Transesophageal Echocardiography in Patients Undergoing Transcatheter Aortic Valve Replacement. J Clin Med 2023; 12:7748. [PMID: 38137816 PMCID: PMC10743683 DOI: 10.3390/jcm12247748] [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: 11/05/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
This review article describes in depth the current usefulness of transesophageal echocardiography in patients who undergo transcatheter aortic valve replacement. Pre-intervention, 3D-transesophageal echocardiography allows us to accurately evaluate the aortic valve morphology and to measure the valve annulus, helping us to choose the appropriate size of the prosthesis, especially useful in cases where the computed tomography is not of adequate quality. Although it is not currently used routinely during the intervention, it remains essential in those cases of greater complexity, such as for patients with greater calcification and bicuspid valve, mechanical mitral prosthesis, and "valve in valve" procedures. Three-dimensional transesophageal echocardiography is the best technique to detect and quantify paravalvular regurgitation, a fundamental aspect to decide whether immediate valve postdilation is needed. It also allows to detect early any immediate complications such as cardiac tamponade, aortic hematoma or dissection, migration of the prosthesis, malfunction of the prosthetic leaflets, or the appearance of segmental contractility disorders due to compromise of the coronary arteries ostium. Transesophageal echocardiography is also very useful in follow-up, to check the proper functioning of the prosthesis and to rule out complications such as thrombosis of the leaflets, endocarditis, or prosthetic degeneration.
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Affiliation(s)
- Jose Alberto de Agustin
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Eduardo Pozo Osinalde
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Carmen Olmos
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Patricia Mahia Casado
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Pedro Marcos-Alberca
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - María Luaces
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Jose Juan Gomez de Diego
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (G.T.-C.); (A.F.-O.); (J.P.-V.)
| | - Pilar Jimenez-Quevedo
- Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (G.T.-C.); (A.F.-O.); (J.P.-V.)
| | - Gabriela Tirado-Conte
- Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (G.T.-C.); (A.F.-O.); (J.P.-V.)
| | | | - Antonio Fernandez-Ortiz
- Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (G.T.-C.); (A.F.-O.); (J.P.-V.)
| | - Julian Perez-Villacastin
- Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (G.T.-C.); (A.F.-O.); (J.P.-V.)
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Deutsch O, Vitanova K, Ruge H, Erlebach M, Krane M, Lange R. Results of new-generation balloon vs. self-expandable transcatheter heart valves for bicuspid aortic valve stenosis. Front Cardiovasc Med 2023; 10:1252163. [PMID: 37727303 PMCID: PMC10505722 DOI: 10.3389/fcvm.2023.1252163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/17/2023] [Indexed: 09/21/2023] Open
Abstract
Background Data comparing new-generation self-expandable (SEV, Evolut R/PRO) vs. balloon-expandable (BEV, SAPIEN 3/3Ultra) transcatheter heart valve replacement (TAVR) in bicuspid aortic valve stenosis (BAV) is limited. Our aim was to compare 30-day results of SEV and BEV implantations in patients with BAV. Methods A total of 2009 patients underwent TAVR between April 2015 and June 2021 at our Centre. From our institutional registry, we identified 106 consecutive patients with BAV who underwent TAVR using SEV and BEV. Results A 106 patients (n = 68 BEV; n = 38 SEV) were included. Mean age was 74.6 ± 8.8 years (BEV) vs.75.3 ± 8.7 years (SEV) (p = 0.670) and Society of Thoracic Surgeons score was 2.6 ± 1.9 (BEV) vs. 2.6 ± 1.6 (SEV) (p = 0.374), respectively. Device landing zone calcium volume (DLZ-CV) was 1168 ± 811 vs. 945 ± 850 mm3 (p = 0.192). Valve Academic Research Consortium (VARC)-3 device success at 30 days was similar (BEV 80.9% vs. SEV 86.8%; p = 0.433). More post-dilatations were performed in SEVs (23.5% BEV vs. 52.6% SEV; p = 0.002). Overall mean gradient at 30 days follow-up was 11.9 ± 4.6 mmHG (BEV) vs. 9.2 ± 3.0 mmHG (SEV) (p = 0.002). A mild-moderate degree of paravalvular leak (PVL) was detected more often in the SEV group (7.4% vs. 13.2%; p = 0.305). A trend towards higher rate of permanent pacemaker implantation was observed in SEV (11.8% vs. 23.7%; p = 0.109). Conclusions Treatment of BAV revealed similar performance using BEV and SEV. In this retrospective cohort study, hemodynamics were more favorable with the SEV, although there was a trend toward more PVL and significantly more post-dilations.
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Affiliation(s)
- Oliver Deutsch
- Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany
| | - Keti Vitanova
- Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany
| | - Hendrik Ruge
- Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany
| | - Magdalena Erlebach
- Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany
| | - Markus Krane
- Department of Surgery, Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, United States
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany
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Henriquez E, Fatima N, Sayabugari R, Nasim MH, Noorayingarath H, Bai K, Garcia A, Habib A, Patel TP, Shaikh F, Razzaq W, Abdin ZU, Gupta I. Transesophageal Echocardiography vs. Transthoracic Echocardiography for Methicillin-Sensitive Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus Endocarditis. Cureus 2023; 15:e39996. [PMID: 37416006 PMCID: PMC10321677 DOI: 10.7759/cureus.39996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
Infective endocarditis is an infection of the inner layers of the heart, seen often in intravenous drug users and patients with valvular lesions or prosthetic heart valves. This entity has high mortality and morbidity. The most common causative microorganism is Staphylococcus aureus. In this comprehensive literature review, we focused on both Staphylococcus aureus infections, i.e., methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) endocarditis, demographics, use of transthoracic echocardiogram and/or transesophageal echocardiogram for diagnostics, and treatments. Although clinical criteria are relevant, transesophageal echocardiogram plays a vital role in establishing and identifying the presence of infective endocarditis and its local complications, with higher sensitivity in patients with prosthetic valves. The antibiotic selection posed a great challenge for clinicians due to antibiotic resistance and the aggressive nature of Staphylococcus aureus. Early diagnosis of infective endocarditis, when suspected, and effective management by a multispecialty team can improve the outcome for the patients.
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Affiliation(s)
- Elvis Henriquez
- Internal Medicine, University of Medical Sciences, Las Tunas, CUB
| | - Neha Fatima
- Internal Medicine, Lisie Hospital, Kochi, IND
| | | | | | | | - Karoona Bai
- Internal Medicine, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | | | - Ayesha Habib
- Internal Medicine, Punjab Medical College, Faisalabad, PAK
| | | | - Fouziya Shaikh
- Internal Medicine, Krishna Institute of Medical Sciences, Karad, IND
| | - Waleed Razzaq
- Internal Medicine, Services Hospital Lahore, Lahore, PAK
| | - Zain U Abdin
- Medicine, District Head Quarters Hospital, Faisalabad, PAK
| | - Ishita Gupta
- Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, IND
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4
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Inoue M, Shimizu M, Okamoto H, Mizuno T, Shimizu S, Imashuku Y, Kitagawa H. An Unexpected Free-Floating Aortic Valve Leaflet Avulsion in the Left Atrium on Transesophageal Echocardiography During Transcatheter Aortic Valve Implantation Under Extracorporeal Membrane Oxygenation. CASE (PHILADELPHIA, PA.) 2023; 7:129-133. [PMID: 37123634 PMCID: PMC10147544 DOI: 10.1016/j.case.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Aortic valve leaflet avulsion is a rare complication during TAVI. Avulsed leaflet traveled to the LA with ECMO flow and migrated to the aorta. TEE aided in timely management and helped complete the transcatheter intervention.
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Affiliation(s)
- Motoi Inoue
- Department of Anesthesiology, Shiga University of Medical Science, Shiga, Japan
- Correspondence: Motoi Inoue, MD, Department of Anesthesiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
| | - Morihiro Shimizu
- Department of Anesthesiology, Shiga University of Medical Science, Shiga, Japan
| | - Hiroki Okamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Takayoshi Mizuno
- Department of Anesthesiology, Shiga University of Medical Science, Shiga, Japan
| | - Satoshi Shimizu
- Department of Anesthesiology, Shiga University of Medical Science, Shiga, Japan
| | - Yasuhiko Imashuku
- Department of Anesthesiology, Shiga University of Medical Science, Shiga, Japan
| | - Hirotoshi Kitagawa
- Department of Anesthesiology, Shiga University of Medical Science, Shiga, Japan
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5
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Savvoulidis P, Moody WE, Steeds R, Ludman PF, Bradley JR, Singh A, Lawton E, Nadir MA, Doshi SN. A time-efficient protocol for transthoracic echocardiography during transfemoral transcatheter aortic valve implantation: early identification and effective management of intraprocedural complications. Echo Res Pract 2022; 9:3. [PMID: 35974389 PMCID: PMC9382780 DOI: 10.1186/s44156-022-00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/28/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractTransfemoral transcatheter aortic valve implantation (TAVI) under conscious sedation is the most widely used method of implantation. Echocardiography is used to detect complications and to assess the implantation result. The aim of this paper is to provide a time-efficient protocol when transthoracic echocardiography (TTE) is used to guide TAVI procedures.
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6
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Ro R, Lerakis S. Imaging for Planning and Guidance for Structural Heart Interventions. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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7
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Michel JM, Frangieh AH, Giacoppo D, Alvarez-Covarrubias HA, Pellegrini C, Rheude T, Deutsch O, Mayr NP, Rumpf PM, Stähli BE, Kastrati A, Schunkert H, Xhepa E, Joner M, Kasel AM. Safety and efficacy of minimalist transcatheter aortic valve implantation using a new-generation balloon-expandable transcatheter heart valve in bicuspid and tricuspid aortic valves. Clin Res Cardiol 2021; 110:1993-2006. [PMID: 34505192 DOI: 10.1007/s00392-021-01935-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/30/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Bicuspid aortic valve may be associated with increased complications during transcatheter aortic valve implantation (TAVI). AIMS Compare balloon-expandable transcatheter heart valve (THV) safety and efficacy in severe tricuspid (TAV) and bicuspid (BAV) aortic stenosis. METHODS Transfemoral TAVI was performed in 743 patients (Jan 2014-June 2019) using the SAPIEN 3 THV. Aortic valve morphology was determined using computed tomography. Valve Academic Research Consortium-2 (VARC-2) derived safety and efficacy endpoints at 1 year were evaluated. RESULTS BAV patients (n = 78), were younger (77 [72, 81] vs. 81 [78, 85] years, p < 0.001) with lower surgical risk (EuroSCORE II 2.96% vs. 4.51% p < 0.001). Bicuspid valves were more calcified (BAV 1308mm3, TAV 848mm3 p < 0.001) with more asymmetric calcification (BAV 63/78 (81%), TAV 239/665 (36%), p < 0.001). Device success (BAV 94%, TAV 90%, p = 0.45) and major vascular complications (BAV 6%, TAV 9%, p = 0.66) were comparable. At 1 year, there was a trend toward lower combined all-cause mortality and rehospitalization for congestive heart failure in BAV patients (BAV 7%, TAV 13%, p = 0.08) with significantly lower all-cause mortality in this cohort (BAV 1%, TAV 9%, p = 0.020). VARC-2 time-related valve safety (BAV 22%, TAV 20%, p = 0.60) was comparable; however, bioprosthetic valve thrombosis remained more common in BAV patients (BAV 7%, TAV 2%, p = 0.010, Hazard ratio 3.57 [95% confidence interval 1.26, 10.10]). After propensity score matching, only bioprosthetic valve thrombosis remained significantly different. CONCLUSIONS Safety and efficacy of the SAPIEN 3 balloon-expandable THV in BAV is comparable with TAV. Higher rates of bioprosthetic valve thrombosis require further investigation.
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Affiliation(s)
- Jonathan M Michel
- German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Antonio H Frangieh
- German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Cardiology, Hôtel-Dieu de France University Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Daniele Giacoppo
- German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Cardiology, Alto Vicentino Hospital, Santorso, Italy.,Department of Cardiac-Thoracic-Vascular Sciences, University of Padua, Padua, Italy.,Cardiovascular Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Hector A Alvarez-Covarrubias
- German Heart Centre Munich, Technical University Munich, Munich, Germany.,Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - Tobias Rheude
- German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Oliver Deutsch
- German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - N Patrick Mayr
- German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - P Moritz Rumpf
- German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Adnan Kastrati
- German Heart Centre Munich, Technical University Munich, Munich, Germany.,Deutsches Zentrum Für Herz- Und Kreislauf-Forschung (DZHK) E.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- German Heart Centre Munich, Technical University Munich, Munich, Germany.,Deutsches Zentrum Für Herz- Und Kreislauf-Forschung (DZHK) E.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Erion Xhepa
- German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Michael Joner
- German Heart Centre Munich, Technical University Munich, Munich, Germany.,Deutsches Zentrum Für Herz- Und Kreislauf-Forschung (DZHK) E.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - A Markus Kasel
- German Heart Centre Munich, Technical University Munich, Munich, Germany. .,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
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8
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Chen M, Michel J, Kasel AM. Application of Balloon-Expandable Transcatheter Heart Valve in Bicuspid Aortic Valve. JACC. ASIA 2021; 1:147-161. [PMID: 36338163 PMCID: PMC9627836 DOI: 10.1016/j.jacasi.2021.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 06/16/2023]
Abstract
Bicuspid aortic valve (BAV) remains challenging in transcatheter aortic valve replacement (TAVR) because of unfavorable anatomy. New-generation balloon-expandable valve (BEV) appears to be a valid alternative to surgery, especially in some Asian countries with a higher prevalence of BAV. This tutorial review summarizes current thinking about how to plan and implant BEV in BAVs using versatile techniques. First, the authors depict the main morphological characteristics of BAVs and their effects on the TAVR procedure. Next, the authors provide preprocedural analysis on sizing, obtaining the optimal deployment projection, and how to simplify valve-crossing. Finally, the authors provide step-by-step guidance on how to deploy the BEVs with evolved iterations in terms of specific anatomies, calcified annulus, and giant annulus.
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Key Words
- AV, aortic valve
- BAV, bicuspid aortic valve
- BEV, balloon-expandable valve
- MDCT, multidetector computed tomography
- ODP, optimal deployment projection
- PVL, paravalvular leak
- SEV, self-expanding valve
- TAV, tricuspid aortic valve
- TAVR, transcatheter aortic valve replacement
- THV, transcatheter heart valve
- aortic stenosis
- balloon-expandable valve
- bicuspid aortic valve
- transcatheter aortic valve replacement
- transcatheter heart valve
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Affiliation(s)
- Mi Chen
- Department of Cardiac Surgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jonathan Michel
- Department of Cardiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Albert Markus Kasel
- Department of Cardiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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9
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Pospishil L, Nampi RG, Neuburger PJ. Contemporary Practice of Echocardiography in Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2021; 36:4-7. [PMID: 34366216 DOI: 10.1053/j.jvca.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Liliya Pospishil
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Robert G Nampi
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY.
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10
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Bodart LE, Ciske BR, Le J, Reilly NM, Deaño RC, Ewer SM, Tipnis P, Rahko PS, Wagner MG, Raval AN, Speidel MA. Technical and clinical study of x-ray-based surface echo probe tracking using an attached fiducial apparatus. Med Phys 2021; 48:2528-2542. [PMID: 33608930 DOI: 10.1002/mp.14790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Several types of structural heart intervention (SHI) use information from multiple imaging modalities to complete an interventional task. For example, in transcatheter aortic valve replacement (TAVR), placement and deployment of a bioprosthetic aortic valve in the aorta is primarily guided by x-ray fluoroscopy (XRF), and echocardiography provides visualization of cardiac anatomy and blood flow. However, simultaneous interpretation of independent x-ray and echo displays remains a challenge for the interventionalist. The purpose of this work was to develop a novel echo/x-ray co-registration solution in which volumetric transthoracic echo (TTE) is transformed to the x-ray coordinate system by tracking the three-dimensional (3D) pose of a probe fiducial attachment from its appearance in two-dimensional (2D) x-ray images. METHODS A fiducial attachment for a commercial TTE probe consisting of rings of high-contrast ball bearings was designed and fabricated. The 3D pose (position and orientation) of the fiducial attachment is estimated from a 2D x-ray image using an algorithm in which a virtual point cloud model of the attachment is iteratively rotated, translated, and forward-projected onto the image until the average sum-of-squares of grayscale values at the projected points is minimized. Fiducial registration error (FRE) and target registration error (TRE) of this approach were evaluated in phantom studies using TAVR-relevant gantry orientations and four standard acoustic windows for the TTE probe. A patient study was conducted to assess the clinical suitability of the fiducial attachment prototype during TTE imaging of patients undergoing SHI. TTE image quality for the task of guiding a transcatheter procedure was evaluated in a reviewer study. RESULTS The 3D FRE ranged from 0.32 ± 0.03 mm (mean ± SD) to 1.31 ± 0.05 mm, depending on C-arm orientation and probe acoustic window. The 3D TRE ranged from 1.06 ± 0.03 mm to 2.42 ± 0.06 mm. Fiducial pose estimation was stable when >75% of the fiducial markers were visible in the x-ray image. A panel of reviewers graded the presentation of heart valves in TTE images from 48 SHI patients. While valve presentation did not differ significantly between acoustic windows (P > 0.05), the mitral valve did achieve a significantly higher image quality compared to the aortic and tricuspid valves (P < 0.001). Overall, reviewers perceived sufficient image quality in 76.5% of images of the mitral valve, 54.9% of images of the aortic valve, and 48.6% of images of the tricuspid valve. CONCLUSIONS Fiducial-based tracking of a commercial TTE probe is compatible with clinical SHI workflows and yields 3D target registration error of less than 2.5 mm for a variety of x-ray gantry geometries and echo probe acoustic windows. Although TTE image quality with respect to target valve anatomy was sufficient for the majority of cases examined, prescreening of patients for sufficient TTE quality would be helpful.
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Affiliation(s)
- Lindsay E Bodart
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA
| | - Benjamin R Ciske
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Jonathan Le
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Nicole M Reilly
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Roderick C Deaño
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Steven M Ewer
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Parag Tipnis
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Peter S Rahko
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Martin G Wagner
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA
| | - Amish N Raval
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin - Madison, Madison, WI, USA
| | - Michael A Speidel
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA.,Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
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11
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Michel JM, Hashorva D, Kretschmer A, Alvarez-Covarrubias HA, Mayr NP, Pellegrini C, Rheude T, Frangieh AH, Giacoppo D, Kastrati A, Schunkert H, Xhepa E, Joner M, Kasel AM. Evaluation of a Low-Dose Radiation Protocol During Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 139:71-78. [PMID: 33190811 DOI: 10.1016/j.amjcard.2020.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
We aimed to evaluate the efficacy and safety of a low-dose imaging protocol to reduce intraprocedural radiation during transcatheter aortic valve implantation (TAVI). Observational analysis: 802 transfemoral TAVI patients receiving balloon-expandable devices ≥23 mm at a high-volume centre. After propensity score matching, a standard-dose group (SD, n = 333) treated between January 2014 and February 2016 was compared with a low-dose group (LD, n = 333) treated between August 2017 and March 2019 after departmental uptake of a low-dose imaging protocol (reduced field size, high table height, use of "fluoro save," 3.75 frames/second acquisition, increased filtering). Primary end point was dose-area product (DAP). Secondary safety end points were VARC-2 device success and a composite of in-hospital complications. The LD protocol was associated with lower DAP (4.64 [2.93, 8.42] vs 22.73 [12.31, 34.58] Gy⋅cm2, p <0.001) and fluoroscopy time (10.4 [8.1, 13.9] vs 11.5 [9.1, 15.3] minutes, p = 0.001). Contrast use was higher in the LD group (LD 110 [94, 130] vs SD 100 [80, 135] milliliters, p = 0.042). Device success (LD 88.3% vs SD 91.3%, p = 0.25), and the composite end point (LD 8.1% vs SD 11.4%, p = 0.19) were similar. In multivariate analysis, the low-dose protocol was associated with a 19.8 Gy⋅cm2 reduction in procedural DAP (p <0.001). In conclusion, compared with standard imaging, a low-dose protocol for TAVI significantly reduced radiation dose without compromising outcomes.
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12
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Veulemans V, Afzal S, Papadopoulos G, Maier O, Kelm M, Zeus T, Hellhammer K. TAVR-related echocardiographic assessment - status quo, challenges and perspectives. Acta Cardiol 2020; 75:275-285. [PMID: 30856056 DOI: 10.1080/00015385.2019.1579979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is an emerging and a well-established procedure for high-risk and inoperable patients worldwide. Recent studies revealed furthermore that TAVR is equal or even superior to surgical valve replacement in intermediate risk patients. Therefore, a successful procedure is not only dependent on precise preprocedural patient selection but also on careful intraprocedural multimodal imaging guidance and adequate postprocedural follow-up. Up to date, 2D/3D transthoracic and/or transoesophageal echocardiography is an easy and goal-oriented tool for periprocedural TAVR-assessment regarding annulus measurements, cardiac function and concomitant valve diseases. Further procedural success is directly related to prevention of severe early and late complications. Thus, a careful intra- and postprocedural echocardiographic guidance is crucial to evaluate prosthetic function, position and its haemodynamic implication and changes in the integrity of the left ventricle during intra- and postprocedural management. We explored the role of echocardiography for pre-, intra- and postprocedural TAVR-assessment, illustrated by cases and possible algorithms, in a comprehensive literature review. Furthermore, we describe the role of fusion imaging, that is, real-time fusion of transoesophageal echocardiography and fluoroscopy (EchoNavigator Release System® I and II) during TAVR.
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Affiliation(s)
- Verena Veulemans
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Duesseldorf, Düsseldorf, Germany
| | - Shazia Afzal
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Duesseldorf, Düsseldorf, Germany
| | - Georgios Papadopoulos
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Duesseldorf, Düsseldorf, Germany
| | - Oliver Maier
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Duesseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Duesseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Duesseldorf, Düsseldorf, Germany
| | - Katharina Hellhammer
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Duesseldorf, Düsseldorf, Germany
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13
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Tan W, Aboulhosn J. Echocardiographic guidance of interventions in adults with congenital heart defects. Cardiovasc Diagn Ther 2019; 9:S346-S359. [PMID: 31737541 DOI: 10.21037/cdt.2018.09.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiac catheterization procedures have revolutionized the treatment of adults with congenital heart disease over the past six decades. Patients who previously would have required open heart surgery for various conditions can now undergo percutaneous cardiac catheter-based procedures to close intracardiac shunts, relieve obstructive valvular lesions, stent stenotic vessels, or even replace and repair dysfunctional valves. As the complexity of percutaneous cardiac catheterization procedures has increased, so has the use of echocardiography for interventional guidance in adults with congenital heart disease. Transthoracic, transesophageal, intracardiac, and three-dimensional echocardiography have all become part and parcel of the catheterization laboratory experience. In this review, we aim to describe the different echocardiographic techniques and their role in various cardiac catheterization interventions specific to adults with congenital heart disease.
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Affiliation(s)
- Weiyi Tan
- University of California, Los Angeles, USA
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14
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Zoghbi WA, Asch FM, Bruce C, Gillam LD, Grayburn PA, Hahn RT, Inglessis I, Islam AM, Lerakis S, Little SH, Siegel RJ, Skubas N, Slesnick TC, Stewart WJ, Thavendiranathan P, Weissman NJ, Yasukochi S, Zimmerman KG. Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement. J Am Soc Echocardiogr 2019; 32:431-475. [DOI: 10.1016/j.echo.2019.01.003] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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15
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Marino M, Lilie CJ, Culp WC, Schepel SR, Tippett JC. The Evolution of Echocardiographic Type and Anesthetic Technique for Transcatheter Aortic Valve Replacement at a High-Volume Transcatheter Aortic Valve Replacement Center. J Cardiothorac Vasc Anesth 2019; 33:29-35. [DOI: 10.1053/j.jvca.2018.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Indexed: 11/11/2022]
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16
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Intracardiac Echocardiography in Structural Heart Disease Interventions. JACC Cardiovasc Interv 2018; 11:2133-2147. [DOI: 10.1016/j.jcin.2018.06.056] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/17/2018] [Accepted: 06/05/2018] [Indexed: 01/17/2023]
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17
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Ong G, Annabi MS, Clavel MA, Guzzetti E, Salaun E, Toubal O, Dahou A, Pibarot P. Paravalvular Regurgitation After Transcatheter Aortic Valve Replacement: Is the Problem Solved? Interv Cardiol Clin 2018; 7:445-458. [PMID: 30274611 DOI: 10.1016/j.iccl.2018.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Paravalvular regurgitation is a frequent complication after transcatheter aortic valve replacement and its association with worse outcomes depends on the degree of its severity. Despite substantial improvement in transcatheter heart valve design, sizing and implantation technique, moderate or severe paravalvular regurgitation still occurs in 2% to 7% of patients and is associated with a more than 2-fold increase in mortality. This review provides a state-of-the-art approach to (i) paravalvular regurgitation prevention by optimizing patient selection, valve sizing, and positioning and (ii) the detection, quantitation and management of paravalvular regurgitation during and after valve implantation.
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Affiliation(s)
- Géraldine Ong
- Department of Medicine, Laval University, Institut de cardiologie et de pneumologie de Québec/ Laval Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Mohammed-Salah Annabi
- Department of Medicine, Laval University, Institut de cardiologie et de pneumologie de Québec/ Laval Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Marie-Annick Clavel
- Department of Medicine, Laval University, Institut de cardiologie et de pneumologie de Québec/ Laval Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Ezequiel Guzzetti
- Department of Medicine, Laval University, Institut de cardiologie et de pneumologie de Québec/ Laval Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Erwan Salaun
- Department of Medicine, Laval University, Institut de cardiologie et de pneumologie de Québec/ Laval Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Oumhani Toubal
- Department of Medicine, Laval University, Institut de cardiologie et de pneumologie de Québec/ Laval Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Abdellaziz Dahou
- Department of Medicine, Laval University, Institut de cardiologie et de pneumologie de Québec/ Laval Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Philippe Pibarot
- Department of Medicine, Laval University, Institut de cardiologie et de pneumologie de Québec/ Laval Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada.
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18
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Fiorilli PN, Anwaruddin S, Zhou E, Shah R. Catheterization Laboratory: Structural Heart Disease, Devices, and Transcatheter Aortic Valve Replacement. Anesthesiol Clin 2018; 35:627-639. [PMID: 29101953 DOI: 10.1016/j.anclin.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The cardiac catheterization laboratory is advancing medicine by performing procedures on patients who would usually require sternotomy and cardiopulmonary bypass. These procedures are done percutaneously, allowing them to be performed on patients considered inoperable. Patients have compromised cardiovascular function or advanced age. An anesthesiologist is essential for these procedures in case of hemodynamic compromise. Interventionalists are becoming more familiar with transcatheter aortic valve replacement and the device has become smaller, both contributing to less complications. Left atrial occlusion and the endovascular edge-to-edge mitral valve repair devices were approved. Although these devices require general anesthesia, an invasive surgery and cardiopulmonary bypass machine are not necessary for deployment.
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Affiliation(s)
- Paul N Fiorilli
- Interventional Cardiology, Cardiovascular Division, Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Saif Anwaruddin
- Transcatheter Valve Program, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Elizabeth Zhou
- Adult Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Ronak Shah
- Adult Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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19
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Fernando RJ, Garner C, Slaughter TF. A Review of the 2017 American Society of Echocardiography Guidelines for Evaluation of Aortic Stenosis: Considerations for Perioperative Echocardiography. J Cardiothorac Vasc Anesth 2018; 32:1800-1814. [PMID: 29735221 DOI: 10.1053/j.jvca.2018.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC.
| | - Chandrika Garner
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | - Thomas F Slaughter
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
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20
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Mahmood F, Matyal R, Mahmood F, Sheu RD, Feng R, Khabbaz KR. Intraoperative Echocardiographic Assessment of Prosthetic Valves: A Practical Approach. J Cardiothorac Vasc Anesth 2018; 32:823-837. [DOI: 10.1053/j.jvca.2017.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 12/30/2022]
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21
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Hahn RT, Nicoara A, Kapadia S, Svensson L, Martin R. Echocardiographic Imaging for Transcatheter Aortic Valve Replacement. J Am Soc Echocardiogr 2018; 31:405-433. [DOI: 10.1016/j.echo.2017.10.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Indexed: 02/06/2023]
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22
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Arjoon R, Brogan A, Sugeng L. Interventional Echocardiography: Field of Advanced Imaging to Support Structural Heart Interventions. US CARDIOLOGY REVIEW 2018. [DOI: 10.15420/usc.2017:16:1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Multimodality imaging, particularly echocardiography, is paramount in planning and guiding structural heart disease interventions. Transesophageal echocardiography remains unique in its ability to provide real-time 2D and 3D imaging of valvular heart disease and anatomic cardiac defects, which directly impacts the strategy and outcome of these procedures. This review summarizes the role of transesophageal echocardiography in patients undergoing the most common structural heart disease interventions.
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23
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Role of Echocardiography in Transcatheter Aortic Valve Implantation. Echocardiography 2018. [DOI: 10.1007/978-3-319-71617-6_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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24
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Tang GH, Kaneko T. Assessing Implant Depth Using Aortography in Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:129-132. [DOI: 10.1016/j.jcin.2017.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/07/2017] [Indexed: 11/27/2022]
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25
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Chourdakis E, Koniari I, Kounis NG, Velissaris D, Koutsogiannis N, Tsigkas G, Hauptmann KE, Sontag B, Hahalis G. The role of echocardiography and CT angiography in transcatheter aortic valve implantation patients. J Geriatr Cardiol 2018; 15:86-94. [PMID: 29434630 PMCID: PMC5803542 DOI: 10.11909/j.issn.1671-5411.2018.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/06/2018] [Accepted: 01/13/2018] [Indexed: 12/13/2022] Open
Abstract
The transcatheter aortic valve implantation (TAVI) consist an alternative treatment in patients with severe aortic stenosis. Multimodality imaging using transthoracic echocardiography (TTE) or transesophageal echocardiography (TOE) and multislice CT (MSCT) constitute cornerstone techniques for the pre-operative management, peri-procedural guidance, follow up and recognition of possible transcatheter valve related complications. CT angiography is much more accurate regarding the total definition of aortic annulus diameter and circumferential area. Two-dimensional (2D) echocardiography, underestimates the aortic valve annulus diameter compared to 3D imaging techniques (MSCT, MRI and 3D TOE). Three-dimensional TOE imaging provides measurements of the aortic valve annulus similar to those delivered by MSCT. The pre-procedural MSCT constitutes the gold standard modality minimizing the presence of paravalvular aortic regurgitation, one of the most frequent complications. TOE/TTE and MSCT performance could predict the possibility of pacemaker implantation post-procedural. The presence of a new transient or persisting MR can be assessed well by TOE. Both TTE and TOE, consist initially the basic examination for post TAVI evaluation. In case of transcatheter heart valve failure, the MSCT could be used as additional imaging technique.
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Affiliation(s)
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of Patras, Rion, Patras, Greece
| | - Nicholas G Kounis
- Department of Cardiology, University Hospital of Patras, Rion, Patras, Greece
| | - Dimitrios Velissaris
- Department of Internal Medicine, University Hospital of Patras, Rion, Patras, Greece
| | | | - Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, Rion, Patras, Greece
| | | | - Bruno Sontag
- Krankenhaus der Barmherzigen Brüder Trier, Germany
| | - George Hahalis
- Department of Cardiology, University Hospital of Patras, Rion, Patras, Greece
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26
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Casset C, Jankowski A, Bertrand B, Saunier C, Piliero N, Rodiere M, Ferretti G, Quesada JL, Broisat A, Riou L, Fagret D, Ghezzi C, Vanzetto G, Barone-Rochette G. Evaluation of Imaging Strategy to Optimize and Improve Outcome of Transcatheter Aortic Valvular Implantation. Am J Cardiol 2017; 120:1633-1638. [PMID: 28864319 DOI: 10.1016/j.amjcard.2017.07.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 07/08/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
Abstract
Cardiac computed tomography (CT) provides additional information with ultrasound in the transcatheter heart valve (THV) size selection. However, the influence of these incremental data on outcomes has not been evaluated in a randomized study. A single-center prospective, randomized, and open study was performed. Patients referred for transfemoral transcatheter aortic valve implantation with a balloon-expandable endoprothesis were included. THV size selection was performed using either transthoracic and transesophageal echocardiography data (control group) or ultrasound and CT results (CT group). The primary composite end point included the occurrence of stroke, major vascular complications, and moderate or severe paravalvular aortic regurgitation (PAR) at 1 year. Fifty patients (n = 25 in the control and CT groups) were enrolled. The primary composite end point occurred in 40% and 8% of patients from the control and CT groups, respectively (p = 0.008). The Kaplan-Meier analysis revealed a pejorative association with not performing the CT (p = 0.007). A decrease in the occurrence of PAR was observed in the CT group compared with the control group (PAR 28% vs 4%, p = 0.04; major vascular complications 12% vs 4%, p = 0.6; all-cause death 16% vs. 4%, p = 0.34; no stroke). In conclusion, the use of cardiac CT in addition to ultrasound data in THV size selection reduced the long-term occurrence of cardiovascular events.
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Khoche S, Ramsingh D, Maus T. The Year in Perioperative Echocardiography: Selected Highlights From 2016. J Cardiothorac Vasc Anesth 2017; 31:1554-1561. [DOI: 10.1053/j.jvca.2017.04.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Indexed: 01/15/2023]
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28
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Basman C, Parmar YJ, Kronzon I. Intracardiac Echocardiography for Structural Heart and Electrophysiological Interventions. Curr Cardiol Rep 2017; 19:102. [PMID: 28879526 DOI: 10.1007/s11886-017-0902-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW With an increasing number of interventional procedures performed for structural heart disease and cardiac arrhythmias each year, echocardiographic guidance is necessary for safe and efficient results. The purpose of this review article is to overview the principles of intracardiac echocardiography (ICE) and describes the peri-interventional role of ICE in a variety of structural heart disease and electrophysiological interventions. RECENT FINDINGS Both transthoracic (TTE) and transesophageal echocardiography have limitations. ICE provides the advantage of imaging from within the heart, providing shorter image distances and higher resolution. ICE may be performed without sedation and avoids esophageal intubation as with transesophageal echocardiography (TEE). Limitations of ICE include the need for additional venous access with possibility of vascular complications, potentially higher costs, and a learning curve for new operators. Data supports the use of ICE in guiding device closure of interatrial shunts, transseptal puncture, and electrophysiologic procedures. This paper reviews the more recent reports that ICE may be used for primary guidance or as a supplement to TEE in patients undergoing left atrial appendage (LAA) closure, interatrial shunt closure, transaortic valve implantation (TAVI), percutaneous mitral valve repair (PMVR), paravalvular leak (PVL) closure, aortic interventions, transcatheter pulmonary valve replacement (tPVR), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) closure. ICE imaging technology will continue to expand and help improve structural heart and electrophysiology interventions.
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Affiliation(s)
- Craig Basman
- Department of Cardiovascular Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, USA
| | - Yuvrajsinh J Parmar
- Department of Cardiovascular Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, USA
| | - Itzhak Kronzon
- Department of Cardiovascular Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, USA.
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Frangieh AH, Ott I, Michel J, Shivaraju A, Joner M, Mayr NP, Hengstenberg C, Husser O, Pellegrini C, Schunkert H, Kastrati A, Kasel AM. Standardized Minimalistic Transfemoral Transcatheter Aortic Valve Replacement (TAVR) Using the SAPIEN 3 Device: Stepwise Description, Feasibility, and Safety from a Large Consecutive Single-Center Single-Operator Cohort. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2017. [DOI: 10.1080/24748706.2017.1358832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Antonio H. Frangieh
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Ilka Ott
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Jonathan Michel
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Anupama Shivaraju
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - N. Patrick Mayr
- Deutsches Herzzentrum Mänchen, Institut für Anästhesiologie, Technische Universität München, Munich, Germany
| | - Christian Hengstenberg
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, 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
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Costanza Pellegrini
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, 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
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, 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
| | - Albert Markus Kasel
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
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30
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Paravalvular Regurgitation after Transcatheter Aortic Valve Replacement: Comparing Transthoracic versus Transesophageal Echocardiographic Guidance. J Am Soc Echocardiogr 2017; 30:533-540. [PMID: 28391002 DOI: 10.1016/j.echo.2017.02.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is increasingly being performed in cardiac catheterization laboratories using transthoracic echocardiography (TTE) to guide valve deployment. The risk of paravalvular regurgitation (PVR) remains a concern. METHODS We retrospectively reviewed 454 consecutive patients (mean age, 82 ± 8; 58% male) who underwent transfemoral TAVR at Emory Healthcare from 2007 to 2014. Two hundred thirty-four patients underwent TAVR in the cardiac catheterization laboratory with TTE guidance (TTE-TAVR; mean Society of Thoracic Surgeons score, 10%), while 220 patients underwent the procedure in the hybrid operating room with transesophageal echocardiography (TEE) guidance (TEE-TAVR; mean Society of Thoracic Surgeons score, 11%). All patients received an Edwards valve (SAPIEN 55%, SAPIEN-XT 45%). Clinical and procedural characteristics, echocardiographic parameters, and incidence of PVR were compared. RESULTS The incidence of at least mild PVR at discharge was comparable between TTE-TAVR and TEE-TAVR (33% vs 38%, respectively; P = .326) and did not differ when stratified by valve type. However, in the TTE-TAVR group, there was a higher incidence of second valve implantation (7% vs 2%; P = .026) and postdilation (38% vs 17%; P < .001) during the procedure. Although not independently associated with PVR at discharge (odds ratio = 1.12; 95% CI, 0.69-1.79), TTE-TAVR was associated with PVR-related events: the combined outcome of mild PVR at discharge, intraprocedural postdilation, and second valve insertion (odds ratio = 1.58; 95% CI, 1.01-2.46). There were no significant differences in PVR at 30 days, 6 months, and 1 year between the two groups. CONCLUSIONS TTE-TAVR in a high-risk group of patients was associated with increased incidence of intraprocedure PVR-related events, although it was not associated with higher rates of PVR at follow-up. Multicenter randomized trials are required to confirm the cost-effectiveness and safety of TTE-TAVR.
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31
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Abstract
Transcatheter aortic valve replacement (TAVR) has become a widely accepted therapeutic option for patients with severe, symptomatic aortic stenosis at intermediate, high, or extreme risk for conventional surgery as determined through a heart team approach. Two valve prostheses are currently available and the Food and Drug Administration (FDA) approved in the United States for TAVR: the self-expandable Medtronic CoreValve (Medtronic, Inc., Minneapolis, MN, USA) and the balloon-expandable Edwards Sapien Valve (Edwards Lifesciences, Irvine CA, USA). The preoperative evaluation for TAVR includes transthoracic echocardiography (TTE) for the diagnosis of aortic stenosis. Cardiac computed tomography (CTA) has become the imaging modality of choice for annular sizing. Aortic root dimensions and coronary ostia height, and the degree of annular and left ventricular outflow tract calcification are also assessed to estimate the risk of coronary obstruction, annular rupture, and postoperative aortic regurgitation. Finally, CTA is essential to determine the adequacy of the peripheral vasculature for a transfemoral approach. Intraoperatively, fluoroscopy is mandatory for valve positioning, whereas the use of TTE or transesophageal echocardiography (TEE) varies by center. TTE is used for postoperative surveillance of valve function.
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Affiliation(s)
- Arash Salemi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Berhane M Worku
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA.,Departmemt of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
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Bergmann T, Sengupta PP, Narula J. Is TAVR Ready for the Global Aging Population? Glob Heart 2017; 12:291-299. [PMID: 28433492 DOI: 10.1016/j.gheart.2017.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/24/2017] [Accepted: 02/14/2017] [Indexed: 11/26/2022] Open
Abstract
The emergence of the global pandemic of chronic diseases necessitates critical assessment of interventions that can be targeted at both the individual and population levels. Among cardiovascular diseases, the increasing prevalence of valvular heart diseases such as aortic stenosis parallels the rising burden of atherosclerotic cardiovascular diseases. As an alternative to surgical aortic valve replacement, technological innovation has allowed development of minimally invasive transcatheter aortic valve replacement (TAVR). This review examines whether TAVR can be applicable in low-resource regions across the world. Although revolutionary, TAVR is currently complex and requires a "Heart Team" approach for optimized patient care. We propose the emergence of telemedicine networks, newer valve designs that allow implementation of minimal approaches, and the use of minimal numbers of specialists for adapting TAVR to settings where surgical backup is not available. With efforts to reduce resource utilization, these alternate strategies have the potential to affect implementation of TAVR globally.
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Affiliation(s)
- Travis Bergmann
- Cardiac Ultrasound Research and Core Lab, Department of Medicine, Mount Sinai's Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Partho P Sengupta
- Cardiac Ultrasound Research and Core Lab, Department of Medicine, Mount Sinai's Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA.
| | - Jagat Narula
- Cardiac Ultrasound Research and Core Lab, Department of Medicine, Mount Sinai's Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
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Parikh A, Lerakis S. Imaging for Planning and Guidance for Structural Heart Interventions. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ankit Parikh
- Emory University School of Medicine; Atlanta GA USA
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Abdelghani M, Tateishi H, Spitzer E, Tijssen JG, de Winter RJ, Soliman OII, Hahn RT, Serruys PW. Echocardiographic and angiographic assessment of paravalvular regurgitation after TAVI: optimizing inter-technique reproducibility. Eur Heart J Cardiovasc Imaging 2016; 17:852-60. [DOI: 10.1093/ehjci/jew083] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/30/2016] [Indexed: 02/05/2023] Open
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Hatt CR, Speidel MA, Raval AN. Real-time pose estimation of devices from x-ray images: Application to x-ray/echo registration for cardiac interventions. Med Image Anal 2016; 34:101-108. [PMID: 27179366 DOI: 10.1016/j.media.2016.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/08/2016] [Accepted: 04/23/2016] [Indexed: 11/18/2022]
Abstract
In recent years, registration between x-ray fluoroscopy (XRF) and transesophageal echocardiography (TEE) has been rapidly developed, validated, and translated to the clinic as a tool for advanced image guidance of structural heart interventions. This technology relies on accurate pose-estimation of the TEE probe via standard 2D/3D registration methods. It has been shown that latencies caused by slow registrations can result in errors during untracked frames, and a real-time ( > 15 hz) tracking algorithm is needed to minimize these errors. This paper presents two novel similarity metrics designed for accurate, robust, and extremely fast pose-estimation of devices from XRF images: Direct Splat Correlation (DSC) and Patch Gradient Correlation (PGC). Both metrics were implemented in CUDA C, and validated on simulated and clinical datasets against prior methods presented in the literature. It was shown that by combining DSC and PGC in a hybrid method (HYB), target registration errors comparable to previously reported methods were achieved, but at much higher speeds and lower failure rates. In simulated datasets, the proposed HYB method achieved a median projected target registration error (pTRE) of 0.33 mm and a mean registration frame-rate of 12.1 hz, while previously published methods produced median pTREs greater than 1.5 mm and mean registration frame-rates less than 4 hz. In clinical datasets, the HYB method achieved a median pTRE of 1.1 mm and a mean registration frame-rate of 20.5 hz, while previously published methods produced median pTREs greater than 1.3 mm and mean registration frame-rates less than 12 hz. The proposed hybrid method also had much lower failure rates than previously published methods.
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Affiliation(s)
- Charles R Hatt
- University of Wisconsin - Madison, Department of Medical Physics, 1111 Highland Ave, Rm 1005 Madison, WI, 53705, United States.
| | - Michael A Speidel
- University of Wisconsin - Madison, Department of Medical Physics, United States
| | - Amish N Raval
- University of Wisconsin - Madison, School of Medicine and Public Health, Division of Cardiovascular Medicine, United States
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Sinning JM, Stundl A, Pingel S, Weber M, Sedaghat A, Hammerstingl C, Vasa-Nicotera M, Mellert F, Schiller W, Kovac J, Welz A, Grube E, Werner N, Nickenig G. Pre-Procedural Hemodynamic Status Improves the Discriminatory Value of the Aortic Regurgitation Index in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2016; 9:700-11. [DOI: 10.1016/j.jcin.2015.12.271] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/07/2015] [Accepted: 12/17/2015] [Indexed: 11/29/2022]
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Neuburger PJ, Saric M, Huang C, Williams MR. A Practical Approach to Managing Transcatheter Aortic Valve Replacement With Sedation. Semin Cardiothorac Vasc Anesth 2016; 20:147-57. [DOI: 10.1177/1089253215625111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transcatheter aortic valve replacement is increasingly performed as a minimally invasive treatment option for aortic valve disease. The typical anesthetic management for this procedure was traditionally similar to surgical aortic valve replacement and involved general anesthesia and transesophageal echocardiography. In this review, we discuss the technological advances in transcatheter valve systems that have improved outcomes and allow for use of sedation instead of general anesthesia. We describe an anesthetic protocol that avoids general anesthesia and utilizes transthoracic echocardiography for procedural guidance.
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Affiliation(s)
| | | | - Conan Huang
- NYU Langone Medical Center, New York, NY, USA
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Bartel T, Edris A, Velik-Salchner C, Müller S. Intracardiac echocardiography for guidance of transcatheter aortic valve implantation under monitored sedation: a solution to a dilemma? Eur Heart J Cardiovasc Imaging 2015; 17:1-8. [PMID: 26497737 DOI: 10.1093/ehjci/jev280] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/20/2015] [Indexed: 12/17/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has been established as a valuable alternative to surgical aortic valve replacement in patients deemed to have high or prohibitive perioperative risk. However, there are several technical constraints and procedural risks inherent to TAVI. These risks include annulus rupture, ventricular perforation, aortic dissection, coronary occlusion, and dislodgement or migration of the valve prosthesis to the aorta or the left ventricle (LV). Other complications may be related to inappropriate valve deployment and subsequent paravalvular leak. Most complications cannot be detected at an early stage without echocardiographic guidance. Although not addressed by current guidelines, some European centres have advocated a 'minimalist' approach with exclusively fluoroscopic and angiographic guidance. Transoesophageal echocardiography (TEE), including real-time three-dimensional (RT-3D) imaging, has been established as a standard approach for peri-interventional guidance of TAVI. However, TEE monitoring almost always necessitates general anaesthesia and endotracheal intubation. A potential alternative to TEE is intracardiac echocardiography (ICE) that may provide a solution to a common dilemma: the most important advantage of ICE being the compatibility with monitored anaesthesia care without endotracheal intubation. Other advantages of ICE include uninterrupted monitoring, no fluoroscopic interference, and precise Doppler-based assessment of pulmonary artery pressures. Limitations of ICE include the need for additional venous access, the learning curve associated with a new device, and potentially increased cost.
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Affiliation(s)
- Thomas Bartel
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, PO Box 112412, Abu Dhabi, United Arab Emirates
| | - Ahmad Edris
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, PO Box 112412, Abu Dhabi, United Arab Emirates
| | | | - Silvana Müller
- Division of Cardiology, Department of Internal Medicine III, Innsbruck Medical University, Innsbruck, Austria
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