1
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Fedorov D, Bauernschmitt R, Grunebaum JP, Bauer S, Sodian R, von Hodenberg E. Interventional versus Surgical Treatment of Degenerated Freestyle Prosthesis. Thorac Cardiovasc Surg 2024; 72:188-196. [PMID: 36858066 DOI: 10.1055/s-0043-1763286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND Bioprosthetic stentless aortic valves may degenerate over time and will require replacement. This study aimed to evaluate early- and mid-term outcomes after isolated surgical redo aortic valve replacement (redo-SAVR) and transcatheter valve-in-valve implantation (TAVI-VIV) for degenerated stentless Freestyle bioprostheses. METHODS We reviewed records of 56 patients at a single center. Overall, 37 patients (66.1%) received TAVI-VIV and 19 (33.9%) received redo-SAVR. RESULTS Thirty-day survival was similar in both groups (100%). One-year survival was comparable between groups (97.3% in TAVI-VIV and 100% in redo-SAVR, p = 1.0). The difference in mid-term survival after adjusting for age and EuroScore II was not significant (p = 0.41). The incidence of pacemaker implantation after TAVI-VIV was higher than after redo-SAVR (19.4% vs. 0%, p = 0.08). CONCLUSION The 30-day and 1-year survival rates after both procedures were outstanding, irrespective of baseline characteristics. Isolated redo-SAVR should be favored in young patients, as the pacemaker implantation rate is lower. TAVI-VIV for degenerated Freestyle prosthesis can be a method of choice in elderly patients and those with high operative risk.
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Affiliation(s)
- Denis Fedorov
- Department of Cardiology, MediClin Herzzentrum Lahr/Baden, Lahr, Germany
| | - Robert Bauernschmitt
- Department of Cardiovascular Surgery, MediClin Herzzentrum Lahr/Baden, Lahr, Germany
- Department of Cardiovascular Surgery, UniversitätsSpital Zürich, Zurich, Switzerland
| | | | - Stefan Bauer
- Department of Cardiovascular Surgery, MediClin Herzzentrum Lahr/Baden, Lahr, Germany
| | - Ralf Sodian
- Department of Cardiovascular Surgery, MediClin Herzzentrum Lahr/Baden, Lahr, Germany
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2
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Gustafson S, Kulkarni A, Galper B, Berry N. Sequential transcatheter aortic and pulmonic valve replacement in bioprosthetic valve dysfunction: a case report. Eur Heart J Case Rep 2023; 7:ytad170. [PMID: 37090755 PMCID: PMC10117369 DOI: 10.1093/ehjcr/ytad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/20/2022] [Accepted: 04/03/2023] [Indexed: 04/25/2023]
Abstract
Background Transcatheter valve replacement is a less invasive alternative to surgical valve replacement and has become increasingly popular. It is often the preferred approach for patients with high surgical risk. In patients with multiple prior sternotomies and multi-valvular failure, sequential transcatheter valve replacements may be a viable option. Case summary We present the case of a 61-year-old-man with two prior sternotomies who underwent sequential transcatheter replacements of the aortic and pulmonic valves for symptomatic aortic and pulmonary stenosis. He was deemed high risk for a repeat sternotomy. The decision to perform sequential transcatheter aortic valve replacement (TAVR) and transcatheter pulmonic valve replacement (TPVR) a month apart was made. Patient underwent valve-in-valve TAVR in a stentless bioprosthetic valve with 29-mm Edwards Sapien 3 followed by TPVR with 26-mm Edwards Sapien 3. He tolerated both procedures well and was asymptomatic at 1-month follow up. Discussion To our knowledge, this is the first reported successful case of sequential TAVR and TPVR with right ventricular outflow tract stenting in a patient with both aortic and pulmonic bioprosthetic valve dysfunction. Our case demonstrates that transcatheter approach to multi-valvular replacements may be a viable option for high-risk surgical patients.
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Affiliation(s)
| | - Ameya Kulkarni
- Department of Cardiology, Mid-Atlantic Permanente Medical Group, 8008 Westpark Dr, McLean, VA 22102, USA
| | - Benjamin Galper
- Department of Cardiology, Mid-Atlantic Permanente Medical Group, 8008 Westpark Dr, McLean, VA 22102, USA
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3
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Burgdorf C, Vukadinovikj Momchilovska A, Remppis BA. Outcomes after transcatheter valve-in-valve implantation using a balloon-expandable Edwards Sapien valve in patients with degenerated Freestyle aortic bioprosthesis. Ann Cardiothorac Surg 2021; 10:667-673. [PMID: 34733694 DOI: 10.21037/acs-2021-tviv-fs-43] [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: 03/24/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022]
Abstract
Background Transcatheter aortic valve-in-valve implantation (ViV TAVI) in degenerated Medtronic Freestyle aortic bioprosthesis (FSB) has been reported as being technically challenging. This study sought to evaluate procedural data and outcomes after ViV TAVI using a balloon-expandable Edwards valve in patients with failed FSB. Methods Between August 2014 and December 2020, twenty-seven consecutive patients underwent ViV TAVI for symptomatic FSB failure at our institution using a Sapien XT (n=1) and Sapien 3 (n=26) valve, respectively. Endpoints were defined according to the Valve Academic Research Consortium-2 (VARC-2) criteria and were retrospectively analyzed. Results Mean patient age was 75.7±8.2 years (female n=5, male n=22); Society of Thoracic Surgeons Predicted Risk of Mortality score was 7.3%±6.2%. ViV implantation with correct positioning of the Edwards Sapien valve within the FSB was successful in all cases. Intraprocedural transesophageal echocardiography revealed none/trace paravalvular regurgitation in twenty-five patients (92.6%), mild paravalvular regurgitation was present in two patients (7.4%). Neither of the patients had a mean gradient ≥20.0 mmHg excluding significant patient-prosthesis mismatch. Three early deaths (≤thirty days) occurred resulting in a device success rate of 88.8%. One-year and three-year survival rates for patients alive beyond day thirty after ViV TAVI were 95.8% and 70.0%, respectively. Conclusions ViV TAVI with Edwards Sapien valves lead to acceptable functional results in high-risk patients with degenerated FSB but early complications must be considered particularly during hospital stay.
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Affiliation(s)
- Christof Burgdorf
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Germany
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4
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Kherallah RY, Koneru S, Krajcer Z, Preventza O, Dougherty KG, McCormack ML, Costello BT, Coulter S, Strickman NE, Plana Gomez JC, Mortazavi A, Díez JG, Livesay JJ, Coselli JS, Silva GV. Hemodynamic outcomes after valve-in-valve transcatheter aortic valve replacement: a single-center experience. Ann Cardiothorac Surg 2021; 10:630-640. [PMID: 34733690 DOI: 10.21037/acs-2021-tviv-131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 08/26/2021] [Indexed: 11/06/2022]
Abstract
Background Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) has emerged as a safe, effective alternative to redo aortic valve surgery in high-risk patients with degenerated surgical bioprosthetic valves. However, ViV-TAVR has been associated high postprocedural valvular gradients, compared with TAVR for native-valve aortic stenosis. Methods We performed a retrospective study of all patients who underwent ViV-TAVR for a degenerated aortic valve bioprosthesis between January 1, 2013 and March 31, 2019 at our center. The primary outcome was postprocedural mean aortic valve gradient. Outcomes were compared across surgical valve type (stented versus stentless), surgical valve internal diameter (≤19 versus >19 mm), and transcatheter aortic valve type (self-expanding vs. balloon-expandable). Results Overall, 89 patients underwent ViV-TAVR. Mean age was 69.0±12.6 years, 61% were male, and median Society of Thoracic Surgeons Predicted Risk of Mortality score was 5.4 [interquartile range, 3.2-8.5]. Bioprosthesis mode of failure was stenotic (58% of patients), regurgitant (24%), or mixed (18%). The surgical valve was stented in 75% of patients and stentless in 25%. The surgical valve's internal diameter was ≤19 mm in 45% of cases. A balloon-expandable transcatheter valve was used in 53% of procedures. Baseline aortic valve area and mean gradients were 0.87±0.31 cm2 and 36±18 mmHg, respectively. These improved after ViV-TAVR to 1.38±0.55 cm2 and 18±11 mmHg at a median outpatient follow-up of 331 [67-394] days. Higher postprocedural mean gradients were associated with surgical valves having an internal diameter ≤19 mm (24±13 versus 16±8, P=0.002) and with stented surgical valves (22±11 versus 12±6, P<0.001). Conclusions ViV-TAVR is an effective option for treating degenerated surgical aortic bioprostheses, with acceptable hemodynamic outcomes. Small surgical valves and stented surgical valves are associated with higher postprocedural gradients.
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Affiliation(s)
- R Yazan Kherallah
- Division of Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Srikanth Koneru
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, TX, USA
| | - Kathryn G Dougherty
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Melissa L McCormack
- Division of Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Briana T Costello
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | | | - Neil E Strickman
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Juan Carlos Plana Gomez
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ali Mortazavi
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Jose G Díez
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - James J Livesay
- Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, TX, USA
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, TX, USA
| | - Guilherme V Silva
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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5
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Khazaal J, Ragagni M, Parker J, Timek T, Murphy E, Heiser J, Willekes C. Freestyle Aortic Bioprostheses in Patients 60 Years old and Younger. Semin Thorac Cardiovasc Surg 2021; 34:870-877. [PMID: 34380081 DOI: 10.1053/j.semtcvs.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 11/11/2022]
Abstract
Evaluate outcomes of the Freestyle stentless aortic bioprosthesis in patients 60 years old and younger. All patients, 60 years old and younger, between January 1, 1998 to December 31, 2015 who underwent implantation of a Freestyle aortic valve at a single institution were reviewed. Medical records and telephone interviews were utilized for data collection. 515 patients were identified with an average age of 51.3 years. Mean follow up was 11.1 years. 225 full root replacements and 290 subcoronary implants were performed. Overall survival, including patients with concomitant procedures, at 15 years was 63.7% (95% CI 58.3-68.5). Isolated subcoronary implants (58%,167/290) had a 15-year survival of 71.6% (95% CI 62.6-78.7) vs 78.4% (95% CI 69.7, 84.9) for isolated root replacements (63%,141/225) which was not statistically significant (P = 0.397). No significant difference in operative SVD at 15 years occurred between full root replacements 37.6% (95% CI 27.2-50.2) vs subcoronary implants 39.4% (95% CI31.1, 49.0). 110 patients required reoperation solely for intrinsic SVD. 93% (102/110) failed due to aortic insufficiency. Of reoperative interventions for SVD, 37% (41/110) of patients required urgent reoperation and 4.5% (5/110) required emergent reoperation. Pseudoaneurysms developed in six of the full root replacements. Freestyle aortic valves have a high rate of acute failure requiring urgent or emergent reintervention in patients 60 years old and younger. This has led our group to shift practice away from their implantation.
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Affiliation(s)
- Jawad Khazaal
- College of Human Medicine, Michigan State University, Grand Rapids
| | - Mary Ragagni
- Department of Cardiovascular Research, Spectrum Health, Grand Rapids
| | - Jessica Parker
- Office of Research and Education, Spectrum Health, Grand Rapids
| | - Tomasz Timek
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids
| | - Edward Murphy
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids
| | - John Heiser
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids
| | - Charles Willekes
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids.
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6
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Vukadinovikj A, Baumgártner E, Bohmann K, Härter D, Wimmer-Greinecker G, Burgdorf C. Transcatheter valve-in-valve implantation versus surgical redo aortic root replacement in patients with degenerated freestyle aortic bioprosthesis. Catheter Cardiovasc Interv 2021; 97:1472-1478. [PMID: 33522093 DOI: 10.1002/ccd.29507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 11/03/2020] [Accepted: 01/17/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Transcatheter aortic valve-in-valve implantation (ViV TAVI) represents a new treatment option for patients with degenerated aortic bioprosthesis. Comparative data to redo surgical aortic valve replacement (redo SAVR) are limited. OBJECTIVE We investigated feasibility and outcome of ViV TAVI versus redo SAVR in patients with symptomatic degenerated Medtronic Freestyle aortic bioprosthesis (FSB). METHODS Between January 2002 and February 2020, 25 patients with failed FSB underwent ViV TAVI and 10 patients with failed FSB underwent redo SAVR. Endpoints were defined according to the Valve Academic Research Consortium-2 (VARC-2) criteria. RESULTS Age and logistic EuroSCORE II were higher in patients with ViV TAVI (75.4 ± 1.7 vs. 62.9 ± 5.1 years, p = .019; 11.5 ± 1.6 vs. 5.6 ± 5.6%, p = .007). Valve implantation was successful in all cases. Mean transvalvular pressure gradients were significantly lower in patients with redo SAVR than ViV TAVI (7.6 ± 1.0 vs. 10.3 ± 0.8 mmHg, p = .037). Aortic valve regurgitation was absent in 91% and 100% of patients with ViV TAVI and redo SAVR, respectively. Thirty-day mortality rates were 12% in the ViV TAVI cohort versus 0% in the redo SAVR cohort (p = .542). Within the first year after hospital discharge, one patient after ViV TAVI had redo surgical intervention. CONCLUSIONS ViV TAVI and redo SAVR lead to excellent functional results in patients with degenerated FSB. Post-procedural early complications must be considered particularly in patients with ViV TAVI because of higher clinical risk profiles.
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Affiliation(s)
| | - Eva Baumgártner
- Klinik für Herz-Thorax-Chirurgie, Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Germany
| | - Katja Bohmann
- Klinik für Herz-Thorax-Chirurgie, Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Germany
| | - Denise Härter
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Germany
| | | | - Christof Burgdorf
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Germany
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7
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Schneider AW, Hazekamp MG, Versteegh MIM, de Weger A, Holman ER, Klautz RJM, Bruggemans EF, Braun J. Reinterventions after freestyle stentless aortic valve replacement: an assessment of procedural risks. Eur J Cardiothorac Surg 2020; 56:1117-1123. [PMID: 31424504 PMCID: PMC6911150 DOI: 10.1093/ejcts/ezz222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 07/04/2019] [Accepted: 07/10/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, LUMC, Leiden, Netherlands
| | | | - Arend de Weger
- Department of Cardiothoracic Surgery, LUMC, Leiden, Netherlands
| | | | | | | | - Jerry Braun
- Department of Cardiothoracic Surgery, LUMC, Leiden, Netherlands
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8
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Pascual I, Almendárez M, Álvarez Velasco R, Adeba A, Hernández-Vaquero D, Lorca R, Díaz R, Alperi A, Cubero-Gallego H, Rozado J, Morís C, Avanzas P. Long term follow up of percutaneous treatment for degenerated Mitroflow prosthesis with self-expanding transcatheter aortic valve implantation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:955. [PMID: 32953755 PMCID: PMC7475412 DOI: 10.21037/atm.2020.02.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The durability of aortic valve bioprosthesis and the structural valve deterioration (SVD) are could be treated with valve-in-valve (VIV) transcatheter aortic valve implantation (TAVI). This technique has been proven to be a feasible procedure with good results in selected patients. The aim of this work was to assess the long-term results of this TAVI with an autoexpandable valve in patients with failed Mitroflow (MF) bioprosthetic aortic valves. Methods Single center, observational and prospective study that included 65 consecutive patients with symptomatic failed MF bioprosthetic aortic valve, treated with VIV-TAVI. The primary endpoints were clinical long-term events including all-cause mortality, cardiovascular mortality, re-hospitalization due to heart failure, stroke/transient ischemic attack (TIA) and endocarditis. Secondary endpoints were the absence of SVD or patient-prosthesis mismatch (PPM) and valve hemodynamics analysis at follow-up. Results Between March 2012 to July 2019, 65 symptomatic patients (age 80.4±5.9 years) with degenerated MF valves (numbers 19: 27.7%; 21: 38.5%; 23: 21.5%; 25: 12.3%) underwent CoreValve (n=11) or Evolut R (n=54) implantation (23, 26 and 29 mm sizes). The STS predicted risk of mortality was 6.39%±5.62%. The primary combined endpoint occurred in 32.3% of the cases. A total of 13 patients (20%) died during follow-up, but 4 (7.3%) from cardiovascular causes. Two patients were reported of having a stroke/TIA and 5 readmissions for cardiovascular causes were reported (2 of them within the first 30 days). Twenty-five patients (38.5%) presented PPM during follow-up, being PPM severe in 15 (23.1%). Conclusions Self-expanding TAVI for degenerated MF bioprosthesis has favourable long-term outcomes. It is a good option in order to avoid the risks of redo surgery in selected patients.
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Affiliation(s)
- Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Functional Biology Department, University of Oviedo, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Marcel Almendárez
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Rut Álvarez Velasco
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Antonio Adeba
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Daniel Hernández-Vaquero
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Functional Biology Department, University of Oviedo, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Rebeca Lorca
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Rocío Díaz
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Alberto Alperi
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain
| | - Héctor Cubero-Gallego
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Jose Rozado
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - César Morís
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain.,Medicine Department, University of Oviedo, Asturias, Spain
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain.,Medicine Department, University of Oviedo, Asturias, Spain
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9
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Mahmoud AN, Gad MM, Elgendy IY, Mahmoud AA, Taha Y, Elgendy AY, Ahuja KR, Saad AM, Simonato M, McCabe JM, Reisman M, Kapadia SR, Dvir D. Systematic review and meta-analysis of valve-in-valve transcatheter aortic valve replacement in patients with failed bioprosthetic aortic valves. EUROINTERVENTION 2020; 16:539-548. [DOI: 10.4244/eij-d-19-00928] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Lee HA, Chou AH, Wu VCC, Chen DY, Lee HF, Lee KT, Chu PH, Cheng YT, Chang SH, Chen SW. Balloon-expandable versus self-expanding transcatheter aortic valve replacement for bioprosthetic dysfunction: A systematic review and meta-analysis. PLoS One 2020; 15:e0233894. [PMID: 32479546 PMCID: PMC7263630 DOI: 10.1371/journal.pone.0233894] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/14/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve-in-valve (VIV) procedure is a safe alternative to conventional reoperation for bioprosthetic dysfunction. Balloon-expandable valve (BEV) and self-expanding valve (SEV) are the 2 major types of devices used. Evidence regarding the comparison of the 2 valves remains scarce. METHODS A systematic review and meta-analysis was conducted to compare the outcomes of BEV and SEV in transcatheter VIV for aortic bioprostheses dysfunction. A computerized search of Medline, PubMed, Embase, and Cochrane databases was performed. English-language journal articles reporting SEV or BEV outcomes of at least 10 patients were included. RESULTS In total, 27 studies were included, with 2,269 and 1,671 patients in the BEV and SEV groups, respectively. Rates of 30-day mortality and stroke did not differ significantly between the 2 groups. However, BEV was associated with significantly lower rates of postprocedural permanent pacemaker implantation (3.8% vs. 12%; P < 0.001). Regarding echocardiographic parameters, SEV was associated with larger postprocedural effective orifice area at 30 days (1.53 cm2 vs. 1.23 cm2; P < 0.001) and 1 year (1.55 cm2 vs. 1.22 cm2; P < 0.001). CONCLUSIONS For patients who underwent transcatheter aortic VIV, SEV was associated with larger postprocedural effective orifice area but higher rates of permanent pacemaker implantation. These findings provide valuable information for optimizing device selection for transcatheter aortic VIV.
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Affiliation(s)
- Hsiu-An Lee
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Dong-Yi Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Hsin-Fu Lee
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Kuang-Tso Lee
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Shang-Hung Chang
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- * E-mail:
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Midterm Outcomes for Valve-in-Valve Transcatheter Aortic Valve Replacement in the Failed Freestyle Bioprosthesis. Ann Thorac Surg 2020; 110:1951-1957. [PMID: 32442615 DOI: 10.1016/j.athoracsur.2020.03.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/07/2020] [Accepted: 03/27/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is acceptable in patients at high risk for reoperation. Studies suggest that ViV TAVR in stentless valves may be technically more challenging. This study sought to evaluate midterm outcomes for ViV TAVR in the degenerative Freestyle ((Medtronic, Minneapolis, MN)) stentless bioprosthesis. METHODS Between October 2014 and January 2019, 56 patients underwent ViV TAVR for a failed Freestyle valve at a single institution using a commercially available self-expanding transcatheter aortic valve. Patient baseline characteristics and clinical outcomes data were collected retrospectively. Valve Academic Research Consortium-2 definitions were applied. RESULTS Mean patient age was 75 ± 8 years and The Society of Thoracic Surgeons mean risk score was 9% ± 8%. The predominant mode of Freestyle valve failure was regurgitation (77%), and 36 patients (64%) required urgent intervention for refractory acute heart failure. Device success using a self-expanding TAVR was 82%, with 6 cases (11%) requiring deployment of two transcatheter valves. There were 3 operative mortalities (5%). At 30-day follow-up, no patient had greater than moderate perivalvular regurgitation. Device success was higher in the later patients compared with patients done earlier (P = .02). Mean aortic valve gradients at 30 days and 1 year were 11 ± 8 and 9 ± 8 mm Hg, respectively. For patients alive beyond day 30, 3-year survival was 82%. CONCLUSIONS Performing ViV TAVR in the Freestyle valve using a self-expanding transcatheter valve presents a technical challenge, but may be feasible with good midterm results. Procedural success is associated with an early hazard learning curve.
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Hamilton GW, Koshy AN, Fulcher J, Tang GH, Bapat V, Murphy A, Horrigan M, Farouque O, Yudi MB. Meta-analysis Comparing Valve-In-Valve Transcatheter Aortic Valve Implantation With Self-Expanding Versus Balloon-Expandable Valves. Am J Cardiol 2020; 125:1558-1565. [PMID: 32247652 DOI: 10.1016/j.amjcard.2020.02.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 01/11/2023]
Abstract
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is an alternative to redo-surgery in patients with failed surgical bioprostheses. It remains unclear whether outcomes vary when using either self-expanding (SE) or balloon-expandable (BE) valves. The aim of this study was to compare outcomes between SE and BE transcatheter heart valves when used for ViV TAVI. A systematic review of PubMed, MEDLINE, and EMBASE was performed identifying studies reporting outcomes following ViV TAVI. Event rates were pooled for meta-analysis using a random-effects model. The primary outcome was all-cause mortality at 12 months. Secondary outcomes included 30-day and 3-year mortality in addition to standard safety outcomes after the procedure as per the Valve Academic Research Consortium criteria. Nineteen studies reporting outcomes for 1,772 patients were included: 924 in the SE group and 848 patients in the BE group. There was no significant difference in all-cause mortality at 12 months (SE 10.3% vs BE 12.6%, p = 0.165, I2 = 0%), or 3 years (SE 21.2% vs BE 31.2%, p = 0.407, I2 = 63.79). SE valves had lower transvalvular gradients after procedure and acute kidney injury, but higher rates of pacemaker insertion, moderate or severe paravalvular regurgitation and need for ≥2 valves (all p < 0.05). There were no differences in stroke, coronary obstruction, bleeding, or vascular complications. Despite significant differences in key procedural outcomes between SE and BE valves when used for ViV TAVI, we found no difference in 12-month mortality. Tailored device selection may further reduce the risk of adverse procedural outcomes, particularly over the longer term.
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Self-expanding transcatheter aortic valve implantation for degenerated Mitroflow bioprosthesis: Early outcomes. Int J Cardiol 2019; 287:53-58. [DOI: 10.1016/j.ijcard.2019.01.094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 12/23/2018] [Accepted: 01/28/2019] [Indexed: 01/15/2023]
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Nguyen TC. No "Freebies" With the Freestyle, but Valve-in-Valve Transcatheter Aortic Valve Replacement Does Offer a Reasonable Option. Semin Thorac Cardiovasc Surg 2018; 30:269-270. [PMID: 30165238 DOI: 10.1053/j.semtcvs.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Tom C Nguyen
- Associate Professor of Cardiothoracic Surgery, Director of Minimally Invasive Valve Surgery, University of Texas-Memorial Hermann, Houston, Texas.
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