2
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Ali Z, Sharma P, Mengesha T, Dalmar A, Ammar KA, Allaqaband SQ, O'Hair DP, Khandheria BK, Jain R, Bajwa T. Early clinical and procedural outcomes in large series of 34-mm self-expanding transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 96:940-946. [PMID: 31797524 DOI: 10.1002/ccd.28634] [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: 09/06/2019] [Revised: 10/17/2019] [Accepted: 11/21/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We aimed to evaluate early clinical and procedural outcomes with the 34-mm Evolut R transcatheter aortic valve replacement (TAVR) prosthesis. BACKGROUND The 34-mm Evolut R (Medtronic, Minneapolis, MN) self-expanding TAVR prosthesis was designed to treat patients with larger annuli. METHODS Clinical, demographic, procedural, and echocardiographic data on consecutive patients who underwent TAVR with a 34-mm Evolut R prosthesis at our institution were collected and analyzed. RESULTS One hundred ninety-six patients underwent TAVR with this prosthesis from November 2016 to July 2018, a majority (n = 188, 96%) through transfemoral access and with conscious sedation (n = 182, 93%). Mean age, Society of Thoracic Surgery risk score, and follow-up were 82 ± 8 years, 5.4 ± 5%, and 8.2 ± 5.3 months, respectively. Mean aortic valve (AV) peak velocity was 4.0 ± 0.6 m/s, mean AV gradient was 38 ± 13 mmHg, AV area was 0.79 ± 0.23 cm2 ; calcium score was 3,503 ± 1,970 Agatston units, and perimeter was 85 ± 4.3 mm. Device implantation was successful in all but one patient. Postprocedure mean AV peak velocity, AV mean gradient, and AV area were 1.9 ± 0.4 m/s, 7 ± 3 mmHg, and 2.6 ± 0.7 cm2 , respectively. New pacemaker requirement rate was 16%, and moderate paravalvular leak was present in six patients (3%), which improved to mild in three patients at 6-month follow-up. In-hospital, 30-day, 6-month, and 12-month survival rates were 98%, 96% (hospital discharge), 96% (30-day), 89% (6-month), and 83% (12-month). CONCLUSION These data demonstrate high success and good procedural, echocardiographic, and clinical outcomes of 34-mm Evolut R in patients with large annuli.
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Affiliation(s)
- Zuber Ali
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Payal Sharma
- Department of Internal Medicine, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Tadele Mengesha
- Advocate Aurora Research, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Ahmed Dalmar
- Advocate Aurora Research, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Khawaja Afzal Ammar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Suhail Q Allaqaband
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Daniel P O'Hair
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Tanvir Bajwa
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
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3
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Armijo G, Tang GH, Kooistra N, Ferreira-Neto AN, Toggweiler S, Amat-Santos IJ, Keller LS, Urena M, Ahmad H, Tafur Soto J, Muñoz-Garcia E, Regueiro A, Leenders GE, Tirado-Conte G, Sengupta A, McInerney A, Couture T, Cuevas Herreros O, Rodriguez-Gabella T, Kini A, Ahmed M, Zaid S, Gonzalo N, Nuñez-Gil IJ, Muñoz-Garcia AJ, Jimenez-Quevedo P, Fernández-Ortiz A, Himbert D, Nietlispach F, Stella P, Dangas GD, Escaned J, Macaya C, Rodés-Cabau J, Nombela-Franco L. Third-Generation Balloon and Self-Expandable Valves for Aortic Stenosis in Large and Extra-Large Aortic Annuli From the TAVR-LARGE Registry. Circ Cardiovasc Interv 2020; 13:e009047. [DOI: 10.1161/circinterventions.120.009047] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Currently, 2 third-generation transcatheter valves, 29-mm Sapien-3 and 34-mm Evolut-R (ER), are indicated for large sized aortic annuli. We analyzed short and 1-year performance of these valves in patients with large (area ≥575 mm
2
or perimeter ≥85 mm) and extra-large (≥683 mm
2
or ≥94.2 mm) aortic annuli undergoing transcatheter aortic valve replacement.
Methods:
A total of 833 patients across 12 centers with symptomatic aortic stenosis and large aortic annuli underwent transcatheter aortic valve replacement with 29-mm Sapien-3 (n=640) or 34-mm ER (n=193). Clinical, anatomic, and procedural characteristics were collected, and Valve Academic Research Consortium-2 outcomes were reported.
Results:
Median aortic annulus area and perimeter were 617 mm
2
(591–657) and 89.1 mm (87.0–92.1), respectively (704 mm
2
[689–743] and 96.0 mm [94.5–97.9] in the subgroup of 124 patients with extra-large annuli). Overall device success was 94.3% (Sapien-3, 95.8% and ER, 89.3%;
P
=0.001), with a higher rate of significant paravalvular leak (
P
=0.004), second valve implantation (
P
=0.013), and valve embolization (
P
=0.009) in the ER group. Thirty-day and 1-year mortality was 2.4% and 9.2%, respectively, without differences between groups. Valve hemodynamics were excellent (mean gradient, 8.8±3.6 mm Hg; 3.3% rate of moderate-severe paravalvular leak) in the extra-large annulus, without differences compared with the large annulus group.
Conclusions:
In patients with large and extra-large aortic annuli, transcatheter aortic valve replacement using 29-mm Sapien-3 and 34-mm ER is safe and feasible. Observed differences in clinical outcomes and hemodynamic performance may guide valve choice in this cohort of patients undergoing transcatheter aortic valve replacement.
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Affiliation(s)
- Germán Armijo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Gilbert H.L. Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY (G.H.L.T., A.S.)
| | - Nynke Kooistra
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands (N.K., G.E.L., P.S.)
| | - Alfredo Nunes Ferreira-Neto
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.N.F.-N., T.C., J.R.-C.)
| | - Stefan Toggweiler
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Switzerland (S.T.)
| | - Ignacio J. Amat-Santos
- Department of Cardiology, Instituto de Ciencias del Corazón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Spain (I.J.A.-S., T.R.-G.)
| | - Lukas S. Keller
- Department of Cardiology, University Heart Centre Zurich, Switzerland (L.S.K., O.C.H.)
| | - Marina Urena
- Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, France (M.U., D.H.)
| | - Hasan Ahmad
- Division of Cardiology, Westchester Medical Center, Valhalla, New York, NY (H.A., S.Z.)
| | - Jose Tafur Soto
- Department of Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, LA (J.T.S., M.A.)
| | - Erika Muñoz-Garcia
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Malaga, Spain (E.M.-G., A.J.M.-G.)
| | - Ander Regueiro
- Department of Cardiology, Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, IDIBAPS, Spain (A.R.)
| | - Geert E. Leenders
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands (N.K., G.E.L., P.S.)
| | - Gabriela Tirado-Conte
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Aditya Sengupta
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY (G.H.L.T., A.S.)
| | - Angela McInerney
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Thomas Couture
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.N.F.-N., T.C., J.R.-C.)
| | - Oscar Cuevas Herreros
- Department of Cardiology, University Heart Centre Zurich, Switzerland (L.S.K., O.C.H.)
| | - Tania Rodriguez-Gabella
- Department of Cardiology, Instituto de Ciencias del Corazón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Spain (I.J.A.-S., T.R.-G.)
| | - Annapoorna Kini
- Division of Cardiology, Mount Sinai Medical Center, New York, NY (A.K., G.D.D.)
| | - Mohammed Ahmed
- Department of Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, LA (J.T.S., M.A.)
| | - Syed Zaid
- Division of Cardiology, Westchester Medical Center, Valhalla, New York, NY (H.A., S.Z.)
| | - Nieves Gonzalo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Ivan J. Nuñez-Gil
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Antonio J. Muñoz-Garcia
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Malaga, Spain (E.M.-G., A.J.M.-G.)
| | - Pilar Jimenez-Quevedo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Antonio Fernández-Ortiz
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Dominique Himbert
- Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, France (M.U., D.H.)
| | - Fabian Nietlispach
- Department of Cardiology, Universitz Hospital Zurich and Hirslanden Klinik Im Park, Zurich, Switzerland (F.N.)
| | - Pieter Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands (N.K., G.E.L., P.S.)
| | - George D. Dangas
- Division of Cardiology, Mount Sinai Medical Center, New York, NY (A.K., G.D.D.)
| | - Javier Escaned
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Carlos Macaya
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.N.F.-N., T.C., J.R.-C.)
| | - Luis Nombela-Franco
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
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5
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Koifman E, Patel N, Weissman G, Kiramijyan S, Didier R, Torguson R, Kumar S, Tavil-Shatelyan A, Ben-Dor I, Satler LF, Pichard AD, Waksman R. Outcome of implantation of a second self-expanding valve for the treatment of residual significant aortic regurgitation. Catheter Cardiovasc Interv 2017; 90:673-679. [PMID: 28296039 DOI: 10.1002/ccd.26960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 09/20/2016] [Accepted: 12/22/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Residual aortic regurgitation (AR) following transcatheter aortic valve replacement (TAVR) is associated with adverse outcome. We sought to evaluate the efficacy and safety of second CoreValve (CV) implantation to treat residual AR following the initial CV deployment. METHODS AND RESULTS TAVR patients treated with a second CV due to moderate and above residual AR were compared to single device implantation. Valvular function parameters were compared at baseline, post procedure, and 30 days. Among 172 CV TAVR patients, 11 required a second device (6%) due to significant residual AR. The main differences between the groups were higher rates of low ejection fraction in patients with 2 CV implanted and higher annular diameter (27 [29-25] vs. 25 [26-24] mm, P = 0.03), requiring a larger device. Although two patients in the two CV group had high initial implantation, low implantation was similar between the groups. A second CV achieved adequate reduction in residual AR in six patients (55%), while an additional four patients had moderate residual AR. Only one remained with moderate to severe AR after 30 days follow-up. There were no cases of peri-procedural stroke or mortality. CONCLUSIONS Second implantation of self-expanding valve can successfully reduce residual significant AR following initial CV implantation and should be considered as therapeutic option for this population. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Edward Koifman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Nirav Patel
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Gaby Weissman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Sarkis Kiramijyan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Romain Didier
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Sandeep Kumar
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Arpi Tavil-Shatelyan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Augusto D Pichard
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
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