1
|
Nitta K, Fukuda Y, Susawa H, Ikenaga H, Utsunomiya H, Ishibashi K, Kurisu S, Takahashi S, Nakano Y, Awai K, Sueda T, Kihara Y. Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement on Changes in Cardiac Sympathetic Nervous Function. Int Heart J 2020; 61:1188-1195. [PMID: 33191358 DOI: 10.1536/ihj.20-381] [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] [Indexed: 11/18/2022]
Abstract
The impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) on changes in cardiac sympathetic nervous (CSN) function remains unclear. Using 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, we investigated the impact of PPM after TAVR on CSN activity.We enrolled 44 of 117 patients with severe aortic stenosis who underwent TAVR for analysis in the present study. We conducted 123I-MIBG scintigraphy at baseline and at about 9 months after TAVR. Differences between baseline and post-TAVR 123I-MIBG parameters were compared between cases with and without PPM.There were 17 and 27 patients with and without PPM, respectively. Those without PPM exhibited significantly decreased left ventricular mass index (122 ± 36 g/m2 versus 108 ± 30 g/m2, P < 0.001) following TAVR, whereas those with PPM did not (117 ± 21 g/m2 versus 110 ± 17 g/m2, P = 0.09). Significant improvements in delayed heart-to-mediastinum (H/M) ratio (2.8 ± 0.4 versus 3.0 ± 0.4, P = 0.004) and washout rate (WR) (33% ± 10% versus 24% ± 12%, P < 0.001) were observed after TAVR in patients without PPM but not in those with PPM. Multivariable linear regression analysis revealed PPM to be a negative predictor of improvements in delayed H/M ratio and WR.Delayed H/M ratio and WR improve significantly after TAVR in the absence of PPM, whereas these improvements are not observed in patients with PPM. Hence, the presence of PPM is a negative predictor of improvements in delayed H/M ratio and WR in patients undergoing TAVR.
Collapse
Affiliation(s)
- Kazuhiro Nitta
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Hitoshi Susawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Hiroto Utsunomiya
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Ken Ishibashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Taijiro Sueda
- Department of Cardiovascular Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| |
Collapse
|
2
|
Bleakley C, Monaghan M. 3D transesophageal echocardiography in TAVR. Echocardiography 2020; 37:1654-1664. [PMID: 32608098 DOI: 10.1111/echo.14777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/24/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022] Open
Abstract
Recently, there has been an increasingly minimalistic approach to transcatheter aortic valve replacement (TAVR), with most procedures now performed under conscious sedation without real time transesophageal echocardiography (TEE) guidance. Proponents of echo should not feel discouraged by this; it is the initial insights that were gained with procedural TEE during the early years of TAVR that have allowed the procedure's gradual maturation and sophistication. Experienced centers that have promoted extensive TAVR TEE programs continue to maximize the benefits of echocardiography in both procedural planning and execution. Critical to this is the understanding of 3D TEE, allowing the annulus to be sized accurately, relevant neighboring anatomy defined, and complications flagged. This review will outline the current application of 3D TEE in TAVR and discuss challenges and opportunities for 3D echocardiography in this field.
Collapse
Affiliation(s)
| | - Mark Monaghan
- Department of Cardiology, Kings College Hospital, London, UK
| |
Collapse
|
3
|
He S, Fang Z. Incidence, predictors, and outcome of prosthesis-patient mismatch after transcatheter aortic valve replacement: A meta-analysis. Medicine (Baltimore) 2020; 99:e20717. [PMID: 32541522 PMCID: PMC7302587 DOI: 10.1097/md.0000000000020717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/14/2020] [Accepted: 05/09/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Prosthesis-patient mismatch (PPM) following transcatheter aortic valve replacement (TAVR) is common, but the incidence, predictors and outcome of PPM are still controversial. METHODS A total of 18 articles incorporating 72,016 patients were identified form PubMed and Embase online database. RESULTS The pooled incidences of overall, and severe PPM following TAVR were 32.0% and 10.0% separately. Comparing to surgical aortic valve replacement (SAVR), TAVR had lower incidence of overall (OR, 0.31, 95% CI, 0.20-0.50) and severe PPM (OR, 0.38, 95% CI, 0.28-0.52). PPM was associated with a larger body surface area (BSA), larger body mass index (BMI) and previous myocardial infarction in comparison with those patients without PPM. Although PPM was not rare after TAVR, no significant differences were observed both in short- and mid-term all-cause mortality (30 day: OR: 1.51, 95% CI, 0.79-2.87, 1 year: OR: 1.02, 95% CI, 0.96-1.08, and 2 years: OR: 0.99, 95% CI, 0.79-1.24) between patients with PPM and those without PPM. CONCLUSIONS Despite the fact that the incidence of PPM was lower than that of SAVR, PPM was not seen to have an impact on short- and mid-term survival.
Collapse
|
4
|
Demir OM, Mitomo S, Giannini F, Mangieri A, Ancona MB, Montorfano M, Latib A, Colombo A. Supra-Annular Transcatheter Aortic Valve Position May Correct Annular Under-Expansion Due to Valvular Asymmetry. Circ J 2019; 83:691. [PMID: 30175802 DOI: 10.1253/circj.cj-18-0691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ozan Mehmet Demir
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University.,Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University
| | - Francesco Giannini
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University
| | - Antonio Mangieri
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University
| | - Marco B Ancona
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University
| | - Matteo Montorfano
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University
| | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University
| |
Collapse
|
5
|
Shibayama K, Mihara H, Berdejo J, Harada K, Siegel RJ, Makkar RR, Shiota T. Association of postprocedural aortic regurgitation with mitral regurgitation worsened after transcatheter aortic valve replacement. Echocardiography 2017; 35:346-352. [PMID: 29272553 DOI: 10.1111/echo.13780] [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] Open
Abstract
BACKGROUND There is a paucity of investigation which demonstrates a predictor of mitral regurgitation (MR) worsened after aortic valve replacement (TAVR). AIM The aim of this study was to identify the predictor of worsened MR after transcatheter TAVR. METHODS We retrospectively studied a total of 209 patients with mild or less MR at baseline who underwent TAVR for the treatment of severe aortic stenosis with the balloon-expandable device. We found the presence of MR worsened after TAVR in 6% (12 patients) of all patients. Moderate or more postprocedural aortic regurgitation (AR) (odds ratio, 8.104; 95% confidence interval, 1.78-36.87; P = .007) was identified as a predictor of MR worsening after TAVR. In-hospital outcomes indicated that patients within whom MR worsened suffered congestive heart failure more than those with unchanged or improved MR after TAVR (P < .05). CONCLUSION Significant postprocedural AR was associated with MR worsened from mild or less to moderate or more after TAVR. Worsened MR might affect in-hospital congestive heart failure.
Collapse
Affiliation(s)
- Kentaro Shibayama
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA.,Heart Center, Tokyo Bay Urayasu/Ichikawa Medical Center, Urayasu, Japan
| | | | | | - Kenji Harada
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | | | - Raj R Makkar
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | | |
Collapse
|
6
|
Liao YB, Li YJ, Jun-Li L, Zhao ZG, Wei X, Tsauo JY, Xiong TY, Xu YN, Feng Y, Chen M. Incidence, Predictors and Outcome of Prosthesis-Patient Mismatch after Transcatheter Aortic Valve Replacement: a Systematic Review and Meta-analysis. Sci Rep 2017; 7:15014. [PMID: 29118326 PMCID: PMC5678180 DOI: 10.1038/s41598-017-15396-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/26/2017] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to investigate the incidence, predictors and outcome of prosthesis-patient mismatch (PPM) following transcatheter aortic valve replacement (TAVR). A total of 30 articles incorporating 4,691 patients were identified. The pooled incidences of overall, moderate and severe PPM following TAVR were 33.0%, 25.0% and 11.0% respectively. Medtronic CoreValve (MCV) had lower incidence of overall (32% vs: 40%, P < 0.0001) and moderate (23% vs 32%, P < 0.0001) than Edwards Sapien (ESV). PPM was associated with a younger age, smaller annulus diameter and lower left ventricular ejection fraction in comparison with those patients without PPM. Post-dilation (OR, 0.51, 95% CI, 0.38 to 0.68, p < 0.001) during TAVR would decrease the incidence of PPM. Although PPM was common after TAVR, no significant differences were observed both in short- and mid-term all-cause mortality (30 day: OR: 1.1, 95% CI, 0.70 to 1.73 and 2 year: OR: 1.01, 95% CI, 0.74 to 1.38) between patients with PPM and those without PPM. In conclusion, despite being common after TAVR, the incidence of PPM was lower than that of surgical aortic valve replacement (SAVR) and decreased with the experience accumulating, and PPM was not seen to impact on short- and mid-term survival, regardless of its magnitude.
Collapse
Affiliation(s)
- Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yi-Jian Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Li Jun-Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Zhen-Gang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Jiay-Yu Tsauo
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yuan-Ning Xu
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China.
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China.
| |
Collapse
|