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Daghem M, Weidinger F, Achenbach S. Computed tomography to guide transcatheter aortic valve implantation. Herz 2023; 48:359-365. [PMID: 37594503 DOI: 10.1007/s00059-023-05203-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/19/2023]
Abstract
Since its introduction in 2022, transcatheter aortic valve implantation (TAVI) has revolutionized the treatment and prognosis of patients with aortic stenosis. Robust clinical trial data and a wealth of scientific evidence support its efficacy and safety. One of the key factors for success of the TAVI procedure is careful preprocedural planning using imaging. Computed tomography (CT) has developed into the standard imaging method for comprehensive patient assessment in this context. Suitability of the femoral and iliac arteries for transfemoral access, exact measurement of aortic annulus size and geometry as the basis for prosthesis selection, quantification of the spatial relationship of the coronary ostia to the aortic annular plane, and identification of optimal fluoroscopic projection angles for the implantation procedure are among the most important information that can be gained from preprocedural CT. Further research is aimed at improving risk stratification, for example, with respect to annular perforation, periprosthetic aortic regurgitation, and need for postprocedural implantation of a permanent pacemaker.
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Affiliation(s)
- Marwa Daghem
- Medizinische Klinik 2, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
| | - Florian Weidinger
- Medizinische Klinik 2, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
| | - Stephan Achenbach
- Medizinische Klinik 2, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054, Erlangen, Germany.
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Sawaya FJ, Bajoras V, Vanhaverbeke M, Wang C, Bieliauskas G, Søndergaard L, De Backer O. Intravascular Lithotripsy-Assisted Transfemoral TAVI: The Copenhagen Experience and Literature Review. Front Cardiovasc Med 2021; 8:739750. [PMID: 34631837 PMCID: PMC8492918 DOI: 10.3389/fcvm.2021.739750] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is currently an established therapy for elderly patients with symptomatic severe aortic valve stenosis across all surgical risk categories. Access is an important aspect when planning for and performing TAVI. The superiority of a transfemoral (TF) approach compared to a transthoracic (transapical, direct aortic) approach has been demonstrated in several studies. Recently, the introduction of intravascular lithotripsy (IVL) has made it possible to treat patients with calcified iliofemoral disease by TF approach. This article aimed to provide a comprehensive overview on the following aspects: (1) preprocedural planning for IVL-assisted TF-TAVI; (2) procedural aspects in IVL-assisted TF-TAVI; (3) outcomes of IVL-assisted TF-TAVI in an experienced TAVI center; and (4) literature review and discussion of this new emerging approach.
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Affiliation(s)
- Fadi J Sawaya
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Vilhelmas Bajoras
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christina Wang
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gintautas Bieliauskas
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Søndergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Rzucidlo J, Jaspan V, Paone D, Jilaihawi H, Xia Y, Kapitman A, Nakashima M, He Y, Ibrahim H, Pushkar I, Neuburger PJ, Saric M, Bamira D, Paschke S, Kalish C, Staniloae C, Shah B, Williams M. Long-term outcomes after transcatheter aortic valve replacement with minimal contrast in chronic kidney disease. Catheter Cardiovasc Interv 2020; 98:319-327. [PMID: 33180381 DOI: 10.1002/ccd.29378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with renal insufficiency have poor short-term outcomes after transcatheter aortic valve replacement (TAVR). METHODS Retrospective chart review identified 575 consecutive patients not on hemodialysis who underwent TAVR between September 2014 and January 2017. Outcomes were defined by VARC-2 criteria. Primary outcome of all-cause mortality was evaluated at a median follow-up of 811 days (interquartile range 125-1,151). RESULTS Preprocedural glomerular filtration rate (GFR) was ≥60 ml/min in 51.7%, 30-60 ml/min in 42.1%, and < 30 ml/min in 6.3%. Use of transfemoral access (98.8%) and achieved device success (91.0%) did not differ among groups, but less contrast was used with lower GFR (23 ml [15-33], 24 ml [14-33], 13 ml [8-20]; p < .001). Peri-procedural stroke (0.7%, 2.1%, 11.1%; p < .001) was higher with lower GFR. Core lab analysis of preprocedural computed tomography scans of patients who developed a peri-procedural stroke identified potential anatomic substrate for stroke in three out of four patients with GFR 30-60 ml/min and all three with GFR <30 ml/min (severe atheroma was the most common subtype of anatomical substrate present). Compared to GFR ≥60 ml/min, all-cause mortality was higher with GFR 30-60 ml/min (HR 1.61 [1.00-2.59]; aHR 1.61 [0.91-2.83]) and GFR <30 ml/min (HR 2.41 [1.06-5.48]; aHR 2.34 [0.90-6.09]) but not significant after multivariable adjustment. Follow-up echocardiographic data, available in 63%, demonstrated no difference in structural heart valve deterioration over time among groups. CONCLUSIONS Patients with baseline renal insufficiency remain a challenging population with poor long-term outcomes despite procedural optimization with a transfemoral-first and an extremely low-contrast approach.
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Affiliation(s)
- Justyna Rzucidlo
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Vita Jaspan
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Darien Paone
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Hasan Jilaihawi
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Yuhe Xia
- Department of Biostatistics, NYU Langone Health, New York, New York
| | - Anna Kapitman
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Makoto Nakashima
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Yuxin He
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Homam Ibrahim
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Illya Pushkar
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Langone Health, New York, New York
| | - Muhamed Saric
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Daniel Bamira
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Sonja Paschke
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Chloe Kalish
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Cezar Staniloae
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Binita Shah
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York.,Department of Medicine, Division of Cardiology, VA New York Harbor Healthcare System: Manhattan Campus, New York, New York
| | - Mathew Williams
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
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