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Lopes V, Almeida PC, Moreira N, Ferreira LA, Teixeira R, Donato P, Gonçalves L. Computed tomography imaging in preprocedural planning of transcatheter valvular heart interventions. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1163-1181. [PMID: 38780710 DOI: 10.1007/s10554-024-03140-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
Cardiac Computed Tomography (CCT) has become a reliable imaging modality in cardiology providing robust information on the morphology and structure of the heart with high temporal and isotropic spatial resolution. For the past decade, there has been a paradigm shift in the management of valvular heart disease since previously unfavorable candidates for surgery are now provided with less-invasive interventions. Transcatheter heart valve interventions provide a real alternative to medical and surgical management and are often the only treatment option for valvular heart disease patients. Successful transcatheter valve interventions rely on comprehensive multimodality imaging assessment. CCT is the mainstay imaging technique for preprocedural planning of these interventions. CCT is critical in guiding patient selection, choice of procedural access, device selection, procedural guidance, as well as allowing postprocedural follow-up of complications. This article aims to review the current evidence of the role of CCT in the preprocedural planning of patients undergoing transcatheter valvular interventions.
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Affiliation(s)
- Vanessa Lopes
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal.
| | - Pedro Carvalho Almeida
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Nádia Moreira
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Luís Amaral Ferreira
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Rogério Teixeira
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
| | - Paulo Donato
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Univ Coimbra, Coimbra Institute for Biomedical Imaging and Translation Research (CIBIT), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), Univ Coimbra, Coimbra, Portugal
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Agricola E, Ancona F, Bartel T, Brochet E, Dweck M, Faletra F, Lancellotti P, Mahmoud-Elsayed H, Marsan NA, Maurovich-Hovart P, Monaghan M, Pontone G, Sade LE, Swaans M, Von Bardeleben RS, Wunderlich N, Zamorano JL, Popescu BA, Cosyns B, Donal E. Multimodality imaging for patient selection, procedural guidance, and follow-up of transcatheter interventions for structural heart disease: a consensus document of the EACVI Task Force on Interventional Cardiovascular Imaging: part 1: access routes, transcatheter aortic valve implantation, and transcatheter mitral valve interventions. Eur Heart J Cardiovasc Imaging 2023; 24:e209-e268. [PMID: 37283275 DOI: 10.1093/ehjci/jead096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 06/08/2023] Open
Abstract
Transcatheter therapies for the treatment of structural heart diseases (SHD) have expanded dramatically over the last years, thanks to the developments and improvements of devices and imaging techniques, along with the increasing expertise of operators. Imaging, in particular echocardiography, is pivotal during patient selection, procedural monitoring, and follow-up. The imaging assessment of patients undergoing transcatheter interventions places demands on imagers that differ from those of the routine evaluation of patients with SHD, and there is a need for specific expertise for those working in the cath lab. In the context of the current rapid developments and growing use of SHD therapies, this document intends to update the previous consensus document and address new advancements in interventional imaging for access routes and treatment of patients with aortic stenosis and regurgitation, and mitral stenosis and regurgitation.
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Affiliation(s)
- Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
- Vita-Salute San Raffaele University, via Olgettina 58, Milan 20132, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
| | - Thomas Bartel
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, 26th Street, Dubai, United Arab Emirates
| | - Eric Brochet
- Cardiology Department, Hopital Bichat, 46 rue Huchard, Paris 75018, France
| | - Marc Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Francesco Faletra
- Senior SHD Consultant Istituto Cardiocentro Via Tesserete 48, CH-6900 Lugano, Switzerland
- Senior Imaging Consultant ISMETT UPCM Hospital, Discesa dei Giudici, 4, 90133 Palermo, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, Domaine Universitaire du Sart Tilman, Liège B4000, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | | | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Leyla Elif Sade
- University of Pittsburgh-Heart & Vascular Institute UPMC, 200 Lothrop St Ste E354.2, Pıttsburgh, PA 15213, USA
- Cardiology Department, Baskent University, Ankara, Turkey
| | - Martin Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Nina Wunderlich
- Asklepios Klinik Langen Röntgenstrasse 20, Langen 63225, Germany
| | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila' -Euroecolab, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania
| | - Bernard Cosyns
- Cardiology Department, Centrum voor Hart en Vaatziekten (CHVZ), Universitair ziekenhuis Brussel, Brussels, Belgium
| | - Erwan Donal
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Universite´ de Rennes-1, Rennes, France
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3
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Lytra T, Kalogeras K, Pesiridis T, Moldovan C, Vavuranakis MA, Vogiatzi G, Oikonomou E, Dardas P, Chrissoheris M, Ninios V, Vavuranakis M. Correlation of Clinical Outcomes with the Prominent Indication of Transcatheter Paravalvular Leak Closure: A Multicenter Experience. J Clin Med 2023; 12:4047. [PMID: 37373740 DOI: 10.3390/jcm12124047] [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: 03/22/2023] [Revised: 05/07/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND A paravalvular leak (PVL) is a complication following valve replacement, which may lead to heart failure and hemolysis. The aim of this study is to investigate whether the clinical outcome after transcatheter PVL closure differs according to the prominent indication of the procedure (symptoms of heart failure or hemolysis). METHODS The data of consecutive patients who had transcatheter treatment for PVL between July 2011 and September 2022 in five Greek centers were analyzed. The primary endpoint was the technical, and clinical success rates with regards to the prominent indication of paravalvular leak closure. The secondary endpoints included the evaluation and comparison of the clinical and technical success in relation to the type of valve that was treated (aortic or mitral) as well as the survival analysis in relation to the closure indication and type of valve that was treated. RESULTS In total, 60 patients were retrospectively studied (39% men, mean age 69.5 ± 11 years). Regarding the primary outcomes, the technical success in patients mainly suffering from hemolysis was 86.1%, while in those presenting heart failure it was 95.8%, p = 0.387. Furthermore, the clinical success was 72.2% and 87.5% among hemolysis and heart failure patients, respectively, p = 0.210. During the follow-up period, the two-year survival rates were significantly better for patients treated for the aortic valve (78.94%) compared to those in the mitral position (48.78%), p = 0.014. In total, 25 patients died (41.7%) during 24 months of follow-up. CONCLUSIONS Transcatheter paravalvular leak closure can be performed with high technical and clinical success rates without any difference according to the prominent indication of closure.
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Affiliation(s)
- Thekla Lytra
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
- 1st Department of Cardiology, University of Athens, Hippokration Hospital, 11527 Athens, Greece
| | - Theodoros Pesiridis
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Carmen Moldovan
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | | | - Georgia Vogiatzi
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Evaggelos Oikonomou
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Petros Dardas
- Cardiology Department, Aghios Loukas Hospital, 55236 Thessaloniki, Greece
| | | | - Vlasis Ninios
- Cardiology Department, Interbalkan Medical Center, 55535 Thessaloniki, Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
- 1st Department of Cardiology, University of Athens, Hippokration Hospital, 11527 Athens, Greece
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El Garhy M, Owais T, Lauten P. Aortic valve calcium volume as measured by native versus contrast-enhanced computer tomography and the implications for the diagnosis of severe aortic stenosis in TAVR patients with low-gradient aortic stenosis. Egypt Heart J 2022; 74:71. [PMID: 36178641 PMCID: PMC9525474 DOI: 10.1186/s43044-022-00311-8] [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: 04/17/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Most of TAVR centers evaluate the calcium score in contrast-enhanced (ce) CT. We compared in this study between different methodologies to measure calcium score. We studied also the difference between patients with low-gradient (LG) and high-gradient (HG) severe aortic stenosis (AS) as regard the burden of aortic valve calcium (AVC).
Results We measured the calcium volume and score using Agatston methodology in non-contrast (nc) CT and with modified and fixed 850 Hounsfield unit (HU) thresholds in ce CT. The calcium score and volume in ceCT using even with modified thresholds is significantly lower than the assessed score and volume in ncCT. The median (IQR) of calcium score in nc CT and in cc CT were 1288 AU (750–1815) versus 947 HU (384–2202). The median (IQR) of calcium volume in nc CT and in cc CT with modified thresholds were 701 mm3 (239–1632) versus 197 mm3 (139–532). Agatston score and calcium volume were lower in patients with LG AS than HG AS; 2069 AU (899–2477) versus 928AU (572–1284) and 1537 mm3 (644–1860) versus 286 mm3 (160–700), respectively. Only 20% of patients with LGAS had Agatston score higher than the previously supposed AVC score threshold for the diagnosis of severe AS (> 2000AU in men and > 1200 in women).
Conclusions The diagnosis of severe LGAS should not depend on a single parameter as calcium score. In these patients, calcium score should be measured in nc CT and not in ce CT.
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5
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Hirasawa K, Izumo M. Role of 3D Transesophageal Echocardiography for Transcatheter Mitral Valve Repair—A Mini Review. Front Cardiovasc Med 2022; 9:815304. [PMID: 35187129 PMCID: PMC8849207 DOI: 10.3389/fcvm.2022.815304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
Edge-to-edge transcatheter mitral valve repair (TMVr) using MitraClip has been evolving rapidly in patients with severe mitral regurgitation (MR) at high surgical risk or having contraindications for surgery. Three-dimensional (3D) echocardiography plays an important role in the management of severe MR. In particular, 3D transesophageal echocardiography (TEE) imaging allows the evaluation of MV geometry and quantification of MR severity with dedicated software. Real-time 3D TEE is also commonly used to guide TMVr and facilitate the procedure. Further development of 3D echocardiography may help achieve safer and more beneficial results. The following article summarizes the current knowledge and the future perspectives of 3D TEE in TMVr.
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Affiliation(s)
- Kensuke Hirasawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- *Correspondence: Masaki Izumo
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6
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Baghi MM, Othman K, Alnabti AH, Abujalala S. Coronary artery occlusion during transcatheter aortic valve implantation: Early recognition have better outcome. Heart Views 2022; 23:55-59. [PMID: 35757453 PMCID: PMC9231540 DOI: 10.4103/heartviews.heartviews_27_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/23/2022] [Indexed: 11/05/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is one of the rapidly evolving treatment strategies for severe aortic stenosis. Included in this category are inoperable, high, intermediate, and low surgical risk patients. It has varying types of complications that may require urgent surgical or transcatheter interventions to prevent procedural mortality and morbidity. Coronary artery occlusion is a rare and dreaded complication of TAVI. Here, we report a 73-year-old man who was diagnosed with severe aortic stenosis and underwent transfemoral TAVI. Unfortunately, during preimplantation balloon valvuloplasty, the patient developed severe hypotension along with ischemic changes on the electrocardiographic monitor. Promptly, coronary angiography was performed which revealed complete occlusion of the left anterior descending artery secondary to embolic debris. He was successfully rescued by manual aspiration thrombectomy (MAT). MAT results in restoration of coronary flow and reversal of shock condition before completing TAVI procedure.
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7
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Wunderlich NC, Honold J, Swaans MJ, Siegel RJ. How to Image and Manage Prosthesis-Related Complications After Transcatheter Aortic Valve Replacement. Curr Cardiol Rep 2021; 23:94. [PMID: 34196775 DOI: 10.1007/s11886-021-01522-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW In this review, we provide an overview of potential prosthesis - related complications after transcatheter aortic valve replacement, their incidences, the imaging modalities best suited for detection, and possible strategies to manage these complications. RECENT FINDINGS Therapy for severe aortic valve stenosis requiring intervention has increasingly evolved toward transcatheter aortic valve replacement over the past decade, and the number of procedures performed has increased steadily in recent years. As more and more centers favor a minimalistic approach and largely dispense with general anesthesia and intra-procedural imaging by transesophageal echocardiography, post-procedural imaging is becoming increasingly important to promptly detect dysfunction of the transcatheter valve and potential complications. Complications after transcatheter aortic valve replacement must be detected immediately in order to initiate adequate therapeutic measures, which require a profound knowledge of possible complications that may occur after transcatheter aortic valve replacement, the imaging modalities best suited for detection, and available treatment options.
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Affiliation(s)
| | - Jörg Honold
- Cardiovascular Center Darmstadt, Darmstadt, Germany
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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8
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Salvatore T, Ricci F, Dangas GD, Rana BS, Ceriello L, Testa L, Khanji MY, Caterino AL, Fiore C, Popolo Rubbio A, Appignani M, Di Fulvio M, Bedogni F, Gallina S, Zimarino M. Selection of the Optimal Candidate to MitraClip for Secondary Mitral Regurgitation: Beyond Mitral Valve Morphology. Front Cardiovasc Med 2021; 8:585415. [PMID: 33614745 PMCID: PMC7887290 DOI: 10.3389/fcvm.2021.585415] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
Secondary mitral regurgitation (MR) occurs despite structurally normal valve apparatus due to an underlying disease of the myocardium leading to disruption of the balance between tethering and closing forces with ensuing failure of leaflet coaptation. In patients with heart failure (HF) and left ventricular dysfunction, secondary MR is independently associated with poor outcome, yet prognostic benefits related to the correction of MR have remained elusive. Surgery is not recommended for the correction of secondary MR outside coronary artery bypass grafting. Percutaneous mitral valve repair (PMVR) with MitraClip implantation has recently evolved as a new transcatheter treatment option of inoperable or high-risk patients with severe MR, with promising results supporting the extension of guideline recommendations. MitraClip is highly effective in reducing secondary MR in HF patients. However, the derived clinical benefit is still controversial as two randomized trials directly comparing PMVR vs. optimal medical therapy in severe secondary MR yielded virtually opposite conclusions. We reviewed current evidence to identify predictors of PMVR-related outcomes in secondary MR useful to improve the timing and the selection of patients who would derive maximal benefit from MitraClip intervention. Beyond mitral valve anatomy, optimal candidate selection should rely on a comprehensive diagnostic workup and a fine-tuned risk stratification process aimed at (i) recognizing the substantial heterogeneity of secondary MR and its complex interaction with the myocardium, (ii) foreseeing hemodynamic consequences of PMVR, (iii) anticipating futility and (iv) improving symptoms, quality of life and overall survival.
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Affiliation(s)
- Tanya Salvatore
- Institute of Cardiology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy
| | - Fabrizio Ricci
- Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden.,Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Casa di Cura Villa Serena, Città Sant'Angelo, Pescara, Italy
| | - George D Dangas
- Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, United States
| | - Bushra S Rana
- Imperial College Healthcare Trust, Hammersmith and Charing Cross Hospitals, London, United Kingdom
| | - Laura Ceriello
- Institute of Cardiology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy
| | - Mohammed Y Khanji
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Anna Laura Caterino
- Institute of Cardiology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | | | | | - Marianna Appignani
- Institute of Cardiology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Maria Di Fulvio
- Institute of Cardiology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy
| | - Sabina Gallina
- Institute of Cardiology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Marco Zimarino
- Institute of Cardiology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Interventional Cath Lab, Chieti, Italy
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Popescu (Chair) BA, Stefanidis A, Fox KF, Cosyns B, Delgado V, Di Salvo GD, Donal E, Flachskampf FA, Galderisi M, Lancellotti P, Muraru D, Sade LE, Edvardsen T. Training, competence, and quality improvement in echocardiography: the European Association of Cardiovascular Imaging Recommendations: update 2020. Eur Heart J Cardiovasc Imaging 2020; 21:1305-1319. [DOI: 10.1093/ehjci/jeaa266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022] Open
Abstract
Abstract
The primary mission of the European Association of Cardiovascular Imaging (EACVI) is ‘to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging’. Echocardiography is a key component in the evaluation of patients with known or suspected cardiovascular disease and is essential for the high quality and effective practice of clinical cardiology. The EACVI aims to update the previously published recommendations for training, competence, and quality improvement in echocardiography since these activities are increasingly recognized by patients, physicians, and payers. The purpose of this document is to provide the general requirements for training and competence in echocardiography, to outline the principles of quality evaluation, and to recommend a set of measures for improvement, with the ultimate goal of raising the standards of echocardiographic practice. Moreover, the document aims to provide specific guidance for advanced echo techniques, which have dramatically evolved since the previous publication in 2009.
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Affiliation(s)
- Bogdan A Popescu (Chair)
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila” - Euroecolab, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Sos. Fundeni 258, 022328 Bucharest, Romania
| | | | - Kevin F Fox
- Department of Cardiology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, UK
| | - Bernard Cosyns
- Department of Cardiology, Centrum voor Hart en vaatziekten (CHVZ), Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2300RC, The Netherlands
| | | | - Erwan Donal
- Service de Cardiologie Et Maladies Vasculaires Et CIC-IT 1414, CHU Rennes, 35000 Rennes, France
- Université de Rennes 1, LTSI, 35000 Rennes, France
| | - Frank A Flachskampf
- Department of Medical Sciences, Uppsala University, Clinical Physiology and Cardiology, Uppsala University Hospital, Uppsala, Sweden
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Anthea Hospital, Bari, Italy
| | - Denisa Muraru
- Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, P.le Brescia 201, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Leyla Elif Sade
- Department of Cardiology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Thor Edvardsen
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway
- Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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10
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Gavazzoni M, Taramasso M, Zuber M, Russo G, Pozzoli A, Miura M, Maisano F. Conceiving MitraClip as a tool: percutaneous edge-to-edge repair in complex mitral valve anatomies. Eur Heart J Cardiovasc Imaging 2020; 21:1059-1067. [PMID: 32408344 DOI: 10.1093/ehjci/jeaa062] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/25/2020] [Accepted: 03/23/2020] [Indexed: 11/13/2022] Open
Abstract
Improvements in procedural technique and intra-procedural imaging have progressively expanded the indications of percutaneous edge-to-edge technique. To date in higher volume centres and by experienced operators MitraClip is used for the treatment of complex anatomies and challenging cases in high risk-inoperable patients. This progressive step is superimposable to what observed in surgery for edge-to-edge surgery (Alfieri's technique). Moreover, the results of clinical studies on the treatment of patients with high surgical risk and functional mitral insufficiency have confirmed that the main goal to be achieved for improving clinical outcomes of patients with severe mitral regurgitation (MR) is the reduction of MR itself. The MitraClip should therefore be considered as a tool to achieve this goal in addition to medical therapy. Nowadays, evaluation of patient's candidacy to MitraClip procedure, discussed in local Heart Team, must take into account not only the clinical features of patients but even the experience of the operators and the volume of the centre, which are mostly related to the probability to achieve good procedural results. This 'relative feasibility' of challenges cases by experienced operators should always been taken into account in selecting patients for MitraClip. Here, we present a review of the literature available on the treatment of complex and challenging lesions.
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Affiliation(s)
- Mara Gavazzoni
- Heart and Valve Center, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Maurizio Taramasso
- Heart and Valve Center, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Michel Zuber
- Heart and Valve Center, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Giulio Russo
- Heart and Valve Center, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland.,Cardiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Alberto Pozzoli
- Heart and Valve Center, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Mizuki Miura
- Heart and Valve Center, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Francesco Maisano
- Heart and Valve Center, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland
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11
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Donatelle M, Ailawadi G. Transcatheter Mitral Valve Repair and Replacement: What's on the Horizon? Semin Thorac Cardiovasc Surg 2020; 33:291-298. [PMID: 32980535 DOI: 10.1053/j.semtcvs.2020.09.018] [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: 05/16/2020] [Revised: 09/06/2020] [Accepted: 09/13/2020] [Indexed: 11/11/2022]
Abstract
There are more than 4 million people affected by mitral regurgitation in both the United States and Europe. Prior to the last decade the only options for treatment of MR were medical therapy and open-heart surgery which left many high risk patients with little option once medically optimized. However, we saw a flood in innovative transcatheter mitral valve interventions. As the technologies are refined these new approaches are considerably less invasive and for some high-risk patients may represent a superior option to conventional open-heart surgery. There are 3 main approaches currently being considered for transcatheter mitral valve repair, edge to edge repair, indirect annuloplasty and direct annuloplasty. There have also been large advancements in recent years in transcatheter replacement of the mitral valve. Although many of these devices are under investigation still, we sought to examine the current state of innovative transcatheter mitral valve technologies.
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Affiliation(s)
- Marissa Donatelle
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
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12
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Milhorini Pio S, Bax J, Delgado V. How valvular calcification can affect the outcomes of transcatheter aortic valve implantation. Expert Rev Med Devices 2020; 17:773-784. [PMID: 32597265 DOI: 10.1080/17434440.2020.1789456] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction In transcatheter aortic valve implantation (TAVI), assessment of aortic valve calcification is not as standardized as aortic annulus measurement. Aortic valve calcification is important for stable anchoring of the prosthesis to the aortic annulus. However, excessive aortic valve calcification is related to procedural complications. Areas covered This review covers the methods to assess aortic valve calcification and the implications of aortic valve calcium burden for TAVI outcomes. We performed a systematic review of the literature in Pubmed and secondary sources. Furthermore, future perspectives on how to integrate aortic valve calcification assessment in the management of patients with aortic stenosis is discussed. Expert opinion Thorough assessment of the aortic valve and aortic root components including aortic valve calcification is key in the planning of TAVI. Aortic valve calcification load, location and extension are important contributors to paravalvular regurgitation. Asymmetric calcification burden with greater calcification of the left-coronary cusp related to higher need of permanent pacemaker implantation. Patients with moderate and severe left ventricular outflow tract/subannular calcification are more susceptible to aortic annular rupture. Periprocedural dislodgement of calcium form cusps and commissures is one of the main reasons of coronary artery ostial occlusion during transcatheter aortic valve implantation. Abbreviations Ao, aorta; LA, left atrium; LAA, left atrial appendage; LV, left ventricle; LVOT, left ventricular outflow tract; THV, transcatheter heart valve.
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Affiliation(s)
- Stephan Milhorini Pio
- Department of Cardiology, Leiden University Medical Center , Leiden, The Netherlands
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center , Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center , Leiden, The Netherlands
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13
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Mas-Peiro S, Fichtlscherer S, Walther C, Vasa-Nicotera M. Current issues in transcatheter aortic valve replacement. J Thorac Dis 2020; 12:1665-1680. [PMID: 32395310 PMCID: PMC7212163 DOI: 10.21037/jtd.2020.01.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aortic stenosis is the most common valvular disease worldwide. With transcatheter aortic valve replacement (TAVR) being increasingly expanded to lower-risk populations, several challenging issues remain to be solved. The present review aims at discussing modern approaches to such issues as well as the current status of TAVR. TAVR has undergone several developments in the recent years: an increased use of transfemoral access, the development of prostheses in order to adapt to challenging anatomies, improved delivery systems with repositioning features, and outer skirts aiming at reducing paravalvular leak. The indication of TAVR is increasingly being expanded to patients with lower surgical risk. The main clinical trials supporting such expansion are reviewed and the latest data on low-risk patients are discussed. A number of challenges need still to be addressed and are also reviewed in this paper: the need for updated international guidelines including the latest evidence; a reduction of main complications such as permanent pacemaker implantation, paravalvular leak, and stroke (and its potential prevention by using anti-embolic protection devices); the appropriate role of TAVR in patients with concomitant cardiac ischemic disease; and durability of bio-prosthetic implanted valves. Finally, the future perspectives for TAVR use and next device developments are discussed.
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Affiliation(s)
- Silvia Mas-Peiro
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Claudia Walther
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
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14
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Okutucu S, Mach M, Oto A. Mitral Paravalvular Leak Closure: Transcatheter and Surgical Solutions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:422-431. [DOI: 10.1016/j.carrev.2019.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 11/29/2022]
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15
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Sanna GD, Moccia E, Pepi M, Parodi G. Anterior Mitral Leaflet Perforation and Infective Endocarditis Following Transcatheter Aortic Valve Replacement in a Patient Presenting with Heart Failure. J Cardiovasc Echogr 2020; 30:44-46. [PMID: 32766108 PMCID: PMC7307623 DOI: 10.4103/jcecho.jcecho_52_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/08/2020] [Accepted: 02/18/2020] [Indexed: 11/17/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is an alternative treatment option for patients with severe aortic stenosis. Although rarely described, mitral valve perforation because of mechanical stimulation due to low deployment of the prosthesis and the association with infective endocarditis, are potentially life-threatening complications that physicians should be aware of because patients should not be suitable for further surgical or percutaneous management. Herein, we present a case of an 88-year-old man presenting with worsening heart failure 6 months after TAVR. We discuss the diagnostic process and the therapeutic issues. Finally, we underline the invaluable role of echocardiography during TAVR procedures, due to its ability in detecting early complications and avoiding incorrect prosthetic deployment.
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Affiliation(s)
| | - Eleonora Moccia
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
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16
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17
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Queirós S, Morais P, Dubois C, Voigt JU, Fehske W, Kuhn A, Achenbach T, Fonseca JC, Vilaça JL, D'hooge J. Validation of a Novel Software Tool for Automatic Aortic Annular Sizing in Three-Dimensional Transesophageal Echocardiographic Images. J Am Soc Echocardiogr 2019; 31:515-525.e5. [PMID: 29625649 DOI: 10.1016/j.echo.2018.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Accurate aortic annulus (AoA) sizing is crucial for transcatheter aortic valve implantation planning. Three-dimensional (3D) transesophageal echocardiography (TEE) is a viable alternative to the standard multidetector row computed tomography (MDCT) for such assessment, with few automatic software solutions available. The aim of this study was to present and evaluate a novel software tool for automatic AoA sizing by 3D TEE. METHODS One hundred one patients who underwent both preoperative MDCT and 3D TEE were retrospectively analyzed using the software. The automatic software measurements' accuracy was compared against values obtained using standard manual MDCT, as well as against those obtained using manual 3D TEE, and intraobserver, interobserver, and test-retest reproducibility was assessed. Because the software can be used as a fully automatic or as an interactive tool, both options were addressed and contrasted. The impact of these measures on the recommended prosthesis size was then evaluated to assess if the software's automated sizes were concordant with those obtained using an MDCT- or a TEE-based manual sizing strategy. RESULTS The software showed very good agreement with manual values obtained using MDCT and 3D TEE, with the interactive approach having slightly narrower limits of agreement. The latter also had excellent intra- and interobserver variability. Both fully automatic and interactive analyses showed excellent test-retest reproducibility, with the first having a faster analysis time. Finally, either approach led to good sizing agreement against the true implanted sizes (>77%) and against MDCT-based sizes (>88%). CONCLUSIONS Given the automated, reproducible, and fast nature of its analyses, the novel software tool presented here may potentially facilitate and thus increase the use of 3D TEE for preoperative transcatheter aortic valve implantation sizing.
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Affiliation(s)
- Sandro Queirós
- Lab on Cardiovascular Imaging and Dynamics, KU Leuven, Leuven, Belgium; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; Algoritmi Center, School of Engineering, University of Minho, Guimarães, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Pedro Morais
- Lab on Cardiovascular Imaging and Dynamics, KU Leuven, Leuven, Belgium; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal; Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - Christophe Dubois
- Department of Cardiovascular Diseases, University Hospital Leuven, and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Leuven, and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Wolfgang Fehske
- Department of Cardiology, St. Vinzenz-Hospital, Cologne, Germany; Institute of Diagnostic and Interventional Radiology, St. Vinzenz-Hospital, Cologne, Germany
| | - Andreas Kuhn
- Department of Cardiology, St. Vinzenz-Hospital, Cologne, Germany; Institute of Diagnostic and Interventional Radiology, St. Vinzenz-Hospital, Cologne, Germany
| | - Tobias Achenbach
- Institute of Diagnostic and Interventional Radiology, St. Vinzenz-Hospital, Cologne, Germany
| | - Jaime C Fonseca
- Algoritmi Center, School of Engineering, University of Minho, Guimarães, Portugal
| | - João L Vilaça
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal; 2Ai- Polytechnic Institute of Cávado and Ave, Barcelos, Portugal
| | - Jan D'hooge
- Lab on Cardiovascular Imaging and Dynamics, KU Leuven, Leuven, Belgium
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18
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Francone M, Budde RPJ, Bremerich J, Dacher JN, Loewe C, Wolf F, Natale L, Pontone G, Redheuil A, Vliegenthart R, Nikolaou K, Gutberlet M, Salgado R. CT and MR imaging prior to transcatheter aortic valve implantation: standardisation of scanning protocols, measurements and reporting-a consensus document by the European Society of Cardiovascular Radiology (ESCR). Eur Radiol 2019; 30:2627-2650. [PMID: 31489471 PMCID: PMC7160220 DOI: 10.1007/s00330-019-06357-8] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/29/2019] [Accepted: 07/03/2019] [Indexed: 01/04/2023]
Abstract
Abstract Transcatheter aortic valve replacement (TAVR) is a minimally invasive alternative to conventional aortic valve replacement in symptomatic patients with severe aortic stenosis and contraindications to surgery. The procedure has shown to improve patient’s quality of life and prolong short- and mid-term survival in high-risk individuals, becoming a widely accepted therapeutic option which has been integrated into current clinical guidelines for the management of valvular heart disease. Nevertheless, not every patient at high-risk for surgery is a good candidate for TAVR. Besides clinical selection, which is usually established by the Heart Team, certain technical and anatomic criteria must be met as, unlike in surgical valve replacement, annular sizing is not performed under direct surgical evaluation but on the basis of non-invasive imaging findings. Present consensus document was outlined by a working group of researchers from the European Society of Cardiovascular Radiology (ESCR) and aims to provide guidance on the utilisation of CT and MR imaging prior to TAVR. Particular relevance is given to the technical requirements and standardisation of the scanning protocols which have to be tailored to the remarkable variability of the scanners currently utilised in clinical practice; recommendations regarding all required pre-procedural measurements and medical reporting standardisation have been also outlined, in order to ensure quality and consistency of reported data and terminology. Key Points • To provide a reference document for CT and MR acquisition techniques, taking into account the significant technological variation of available scanners. • To review all relevant measurements that are required and define a step-by-step guided approach for the measurements of different structures implicated in the procedure. • To propose a CT/MR reporting template to assist in consistent communication between various sites and specialists involved in the procedural planning. Electronic supplementary material The online version of this article (10.1007/s00330-019-06357-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Policlinico Umberto I, V.le Regina Elena 324, 00161, Rome, Italy.
| | - Ricardo P J Budde
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Jens Bremerich
- Department of Radiology, University of Basel Hospital, Basel, Switzerland
| | - Jean Nicolas Dacher
- Department of Radiology, Normandie University, UNIROUEN, INSERM U1096 - Rouen University Hospital, F 76000, Rouen, France
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Florian Wolf
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Luigi Natale
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, Rome, Italy
| | | | - Alban Redheuil
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Department of Cardiovascular and Thoracic, Imaging and Interventional Radiology, Institute of Cardiology, APHP, Pitié-Salpêtrière University Hospital, Paris, France
- Laboratoire d'Imagerie Biomédicale, Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Paris, France
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Kostantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tübingen, Germany
| | - Matthias Gutberlet
- Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Rodrigo Salgado
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Radiology, Holy Heart Hospital, Lier, Belgium
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19
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Baldetti L, Giannini F, Van Mieghem N, El Faquir N, Tchétché D, De Biase C, Petronio AS, Giannini C, Tarantini G, Fraccaro C, Finkelstein A, Segev A, Barbash I, Bruschi G, Tamburino C, Barbanti M, Lim S, Kuntjoro I, Abdel-Wahab M, Colombo A, Latib A. Outcome of Patients Undergoing Transcatheter Implantation of Aortic Valve With Previous Mitral Valve Prosthesis (OPTIMAL) Study. Can J Cardiol 2019; 35:866-874. [PMID: 31292085 DOI: 10.1016/j.cjca.2019.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/27/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is the gold standard for severe valvular aortic stenosis in patients at high/prohibitive surgical risk. This procedure has also been used in patients with previous mitral valve (MV) prostheses, with contrasting outcomes reported. The aim of this study is to describe procedural and early outcomes of patients with previous MV prostheses undergoing TAVR. METHODS This is a retrospective registry of 154 patients with previous MV prostheses who underwent TAVR across high-volume medical centres at a mean of 11.7 ± 8.4 years after mitral surgery. RESULTS Mean mitroaortic distance at computed tomography was 9.7 ± 4.8 mm. Procedural success was achieved in 150 (97.4%) patients, with reduction of aortic gradients (42.6 ± 14.2 to 10.0 ± 7.0 mm Hg; P < 0.001). Device success was achieved in 133 (86.3%) patients. MV prosthesis interference by the TAVR device was observed in 2 patients; in both, the mitroaortic distance was <5 mm, with 1 complicated by TAVR prosthesis embolization. Periprocedural complications included 4 (2.6%) cerebrovascular accidents, 10 (6.6%) major vascular complications, 22 (14.4%) severe bleedings, 1 (0.7%) myocardial infarction, and 5 (3.2%) in-hospital deaths (all cases cardiovascular or procedure related). At a median follow-up of 13.5 (interquartile range 1.0 to 36.0) months, 26 (16.9%) deaths occurred; 15 (9.7%) were cardiac related. Late fatal mitral prosthesis thromboses occurred in 2 patients. We recorded a case of fatal hemorrhagic stroke; hospital readmission was observed in 25 (16.2%) patients due to worsening heart failure. CONCLUSIONS TAVR in patients with previous mitral prostheses appears to be safe and feasible, with good hemodynamic results at 30-day and at longer-term follow-up.
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Affiliation(s)
- Luca Baldetti
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Nicolas Van Mieghem
- Department of Interventional Cardiology, Erasmus Medical Center, Thoraxcentrum, Rotterdam, The Netherlands
| | - Nahid El Faquir
- Department of Interventional Cardiology, Erasmus Medical Center, Thoraxcentrum, Rotterdam, The Netherlands
| | - Didier Tchétché
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Chiara De Biase
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | | | - Cristina Giannini
- Department of Cardiology, AOUP Cisanello, University Hospital, Pisa, Italy
| | | | - Chiara Fraccaro
- Department of Cardiology, University of Padova, Padova, Italy
| | - Ariel Finkelstein
- Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Amit Segev
- Leviev Heart Center, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
| | - Israel Barbash
- Leviev Heart Center, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
| | - Giuseppe Bruschi
- Cardio-vascular Department, De Gasperis Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy
| | - Corrado Tamburino
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Marco Barbanti
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Scott Lim
- Advanced Cardiac Valve Center, Division of Cardiology, University of Virginia, Charlottesville, Virgina, USA
| | - Ivandito Kuntjoro
- Advanced Cardiac Valve Center, Division of Cardiology, University of Virginia, Charlottesville, Virgina, USA
| | | | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Azeem Latib
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Cardiology, Montefiore Medical Center, New York, New York, USA.
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20
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Zhang M, Wan L, Liu K, Wu W, Li H, Wang Y, Lu B, Wang H. Aortic roots assessment by an automated three-dimensional transesophageal echocardiography: an intra-individual comparison. Int J Cardiovasc Imaging 2019; 35:2029-2036. [PMID: 31297671 DOI: 10.1007/s10554-019-01664-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/03/2019] [Indexed: 01/01/2023]
Abstract
To evaluate the accuracy, reproducibility, and transcatheter heart valve (THV) sizing efficiency of an automated 3-dimensional transesophageal echocardiographic (3D-TEE) post-processing software in the assessments of aortic roots, intra-individually compared with multidetector computed tomography (MDCT). We prospectively studied 67 patients with normal aortic roots. We measured diameters of aortic annulus (AA), sinus of Valsalva (SOV), and sino-tubular junction (STJ) by full-automated and semi-automated methods using 3D-TEE datasets, then compared them to corresponding transthoracic echocardiography and MDCT values. THV sizes were chosen based on echocardiography and MDCT measurements according to recommended criterion. Taking MDCT planimetered diameters as reference, the full-automated (r: 0.4745-0.8792) and semi-automated (r: 0.6647-0.8805) 3D-TEE measurements were linearly correlated (p < 0.0001). The average differences between semi-automated or full-automated measurements and reference were 0.3 mm or 1.3 mm for AA, - 1.9 mm or - 0.5 mm for SOV, and - 0.1 mm or 1.9 mm for STJ, respectively. The intra-class correlation coefficients of semi-automated method were 0.79-0.96 (intra-observer) and 0.75-0.92 (inter-observer). THV sizing by semi-automated measurements using echocardiographic criteria was larger than that by MDCT measurements using MDCT criteria (p < 0.0001) but equivalent (p > 0.05) if both using MDCT standards. The new automated 3D-TEE software allows modeling and quantifying aortic roots with high reproducibility. Measurements by the semi-automated method closely approximate and well correlate with the corresponding MDCT, thus THV sizing by this modeled 3D-TEE measurements should adopt recommended MDCT criteria but not echocardiographic criteria. The full-automated 3D-TEE segmentations are yet immature. (Semi-automated assessMent of Aortic Roots by Three-dimensional transEsophageal echocaRdiography [SMARTER], NCT02724709).
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Affiliation(s)
- Minghui Zhang
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Linyuan Wan
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Kun Liu
- Department of Radiologic Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Weichun Wu
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Hui Li
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Yuan Wang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Bin Lu
- Department of Radiologic Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Hao Wang
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China.
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21
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Queirós S, Morais P, Fehske W, Papachristidis A, Voigt JU, Fonseca JC, D'hooge J, Vilaça JL. Assessment of aortic valve tract dynamics using automatic tracking of 3D transesophageal echocardiographic images. Int J Cardiovasc Imaging 2019; 35:881-895. [PMID: 30701439 DOI: 10.1007/s10554-019-01532-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/08/2019] [Indexed: 12/13/2022]
Abstract
The assessment of aortic valve (AV) morphology is paramount for planning transcatheter AV implantation (TAVI). Nowadays, pre-TAVI sizing is routinely performed at one cardiac phase only, usually at mid-systole. Nonetheless, the AV is a dynamic structure that undergoes changes in size and shape throughout the cardiac cycle, which may be relevant for prosthesis selection. Thus, the aim of this study was to present and evaluate a novel software tool enabling the automatic sizing of the AV dynamically in three-dimensional (3D) transesophageal echocardiography (TEE) images. Forty-two patients who underwent preoperative 3D-TEE images were retrospectively analyzed using the software. Dynamic measurements were automatically extracted at four levels, including the aortic annulus. These measures were used to assess the software's ability to accurately and reproducibly quantify the conformational changes of the aortic root and were validated against automated sizing measurements independently extracted at distinct time points. The software extracted physiological dynamic measurements in less than 2 min, that were shown to be accurate (error 2.2 ± 26.3 mm2 and 0.0 ± 2.53 mm for annular area and perimeter, respectively) and highly reproducible (0.85 ± 6.18 and 0.65 ± 7.90 mm2 of intra- and interobserver variability, respectively, in annular area). Using the maximum or minimum measured values rather than mid-systolic ones for device sizing resulted in a potential change of recommended size in 7% and 60% of the cases, respectively. The presented software tool allows a fast, automatic and reproducible dynamic assessment of the AV morphology from 3D-TEE images, with the extracted measures influencing the device selection depending on the cardiac moment used to perform its sizing. This novel tool may thus ease and potentially increase the observer's confidence during prosthesis' size selection at the preoperative TAVI planning.
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Affiliation(s)
- Sandro Queirós
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal. .,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal. .,Lab on Cardiovascular Imaging and Dynamics, KU Leuven, Leuven, Belgium. .,Algoritmi Center, School of Engineering, University of Minho, Guimarães, Portugal.
| | - Pedro Morais
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Lab on Cardiovascular Imaging and Dynamics, KU Leuven, Leuven, Belgium.,2Ai-Polytechnic Institute of Cávado and Ave, Barcelos, Portugal
| | - Wolfgang Fehske
- Department of Cardiology, St Vinzenz-Hospital, Cologne, Germany
| | | | - Jens-Uwe Voigt
- Department of Cardiology, University Hospital Leuven, Leuven, Belgium
| | - Jaime C Fonseca
- Algoritmi Center, School of Engineering, University of Minho, Guimarães, Portugal
| | - Jan D'hooge
- Lab on Cardiovascular Imaging and Dynamics, KU Leuven, Leuven, Belgium
| | - João L Vilaça
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,2Ai-Polytechnic Institute of Cávado and Ave, Barcelos, Portugal
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22
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Coisne A, Dreyfus J, Bohbot Y, Pelletier V, Collette E, Cescau A, Cariou E, Alexandrino C, Coulibaly S, Seemann A, Karsenty C, Theron A, Caspar T, Soulat-Dufour L, Ternacle J. Transoesophageal echocardiography current practice in France: A multicentre study. Arch Cardiovasc Dis 2018; 111:730-738. [PMID: 30539734 DOI: 10.1016/j.acvd.2018.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 01/29/2018] [Accepted: 03/20/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Few data are available on the application of transoesophageal echocardiography (TOE) recommendations in daily practice. AIMS To evaluate TOE practice based on echocardiography societies' guidelines, and to determine complication rates and factors associated with patient feelings. METHODS Between April and June 2017, we prospectively included all consecutive patients referred to 14 French hospitals for a transoesophageal echocardiogram (TOE). A survey was taken just after the examination, which included questions about pre-procedural anxiety, and any pain, unpleasant feeling or breathing difficulties experienced during the examination. RESULTS Overall, 1718 TOEs were performed, mainly for stroke evaluation. A standardized operating procedure checklist was completed in half of the patients before the examination. TOE was unpleasant for 62.4% of patients, but was stopped for agitation or intolerance in 3.5 and 1.4% of cases, respectively. We observed one severe complication (pulmonary oedema). The mean TOE duration was short (9.2±4.6minutes), but was longer with residents than with more experienced physicians (11±4.7 vs. 8.8±4.7minutes for junior physicians [P=0.0027]; vs. 8.9±4.8minutes for senior physicians [P=0.0013]; and vs. 7.5±4.1minutes for associate professors/professors [P<0.0001]). The visual analogue scale (VAS) score after TOE was good (8.3±1.7 out of 10), and was better in patients with general anaesthesia (GA) than in those without GA (9.3±0.9 vs. 8.1±1.7; P<0.0001). In patients without GA, the VAS score was similar with and without local anaesthesia (8.1±1.7 vs. 8.2±1.6; P=0.19). After multivariable adjustment, absence of anxiety before TOE and greater operator experience were consistently associated with a higher VAS score. CONCLUSIONS TOE is safe, with a low rate of complications and few stops for intolerance. A shorter TOE duration and better patient feelings were observed for experienced operators, highlighting the importance of the learning curve, and paving the way for teaching on a TOE simulator.
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Affiliation(s)
- Augustin Coisne
- Department of clinical physiology and echocardiography, Heart Valve Clinic, Institut Cœur-Poumon, CHU de Lille, 59000 Lille, France.
| | - Julien Dreyfus
- Department of cardiology, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - Yohann Bohbot
- Department of cardiology, Amiens University Hospital, 80054 Amiens, France
| | - Vincent Pelletier
- Department of cardiology, SOS Endocardites, Henri-Mondor Hospital, 94010 Creteil, France
| | | | - Arthur Cescau
- Department of cardiology and radiology, Lariboisière Hospital, 75010 Paris, France
| | - Eve Cariou
- Department of cardiology, CHU de Toulouse, 31059 Toulouse, France
| | | | | | - Aurélien Seemann
- NCT+ Saint Gatient Alliance, Institut Cardiologique Saint-Gatien, 37000 Tours, France
| | - Clément Karsenty
- Department of cardiology, European Hospital Georges-Pompidou, 75015 Paris, France
| | - Alexis Theron
- Department of cardiac surgery, La Timone Hospital, Aix-Marseille University, 13005 Marseille, France
| | - Thibault Caspar
- Nouvel Hôpital Civil, Strasbourg University Hospital, 67091 Strasbourg, France
| | | | - Julien Ternacle
- Department of cardiology, SOS Endocardites, Henri-Mondor Hospital, 94010 Creteil, France
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23
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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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24
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Donatelle M, Lim DS. Percutaneous tricuspid annuloplasty. Minerva Cardioangiol 2018; 66:713-717. [PMID: 29963812 DOI: 10.23736/s0026-4725.18.04756-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Severe tricuspid regurgitation (TR) is a common problem, affecting approximately 1.6 million Americans, with the majority (85%) of TR being functional in nature. When left untreated, TR is associated with progressive right-sided heart failure, with a poor prognosis entailing high morbidity and mortality. Surgical repair is still the gold standard for TR, but only a small proportion of patients undergo surgical repair leaving a high clinical demand for alternatives to conventional surgery. Percutaneous repair and replacement of cardiac valves have exponentially advanced in the past decade, including transcatheter tricuspid valve repair. There are still anatomical challenges that need to be addressed when performing a percutaneous transcatheter annuloplasty compared to a surgical annuloplasty, such as approach, access, landing zone, proximal structures and visibility. Current percutaneous annuloplasty systems either obtain a direct (Cardioband) or indirect (TriCinch and Trialign) annuloplasty. Both direct and indirect percutaneous annuloplasties are modeled after surgical experiences. This review will investigate novel direct and indirect transcatheter annuloplasty devices for repair of severe tricuspid regurgitation.
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Affiliation(s)
- Marissa Donatelle
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, VI, USA -
| | - D Scott Lim
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, VI, USA.,Division of Cardiovascular Medicine, Department of Pediatrics, University of Virginia, Charlottesville, VI, USA
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25
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La Canna G, Scarfo' I, Caso I. How to differentiate functional from degenerative mitral regurgitation. J Cardiovasc Med (Hagerstown) 2018. [PMID: 29538148 DOI: 10.2459/jcm.0000000000000579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Giovanni La Canna
- Echocardiography Service, Department of Cardiac Surgery, San Raffaele Hospital, Milan, Italy
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26
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Vilela EM, Ribeiro J, Almeida J, Fonseca M, Dias A, Primo J, Braga P, Gama V. Percutaneous treatment of tricuspid regurgitation: A new therapeutic horizon. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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27
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Thonghong T, De Backer O, Søndergaard L. Comprehensive update on the new indications for transcatheter aortic valve replacement in the latest 2017 European guidelines for the management of valvular heart disease. Open Heart 2018. [PMID: 29531767 PMCID: PMC5845407 DOI: 10.1136/openhrt-2017-000753] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
New European guidelines on the management of valvular heart disease—supported by the European Society of Cardiology (ESC) and European Association of CardioThoracic Surgery (EACTS)—were recently published. Although these guidelines are very comprehensive, these typically are not very inviting to read. In this document, we aimed to distil all the information about transcatheter aortic valve replacement (TAVR) in the new 2017 ESC/EACTS guidelines to the essential and give additional comments on the position of TAVR in 2017.
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28
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Vilela EM, Ribeiro J, Almeida J, Fonseca M, Dias A, Primo J, Braga P, Gama V. Percutaneous treatment of tricuspid regurgitation: A new therapeutic horizon. Rev Port Cardiol 2018; 37:267.e1-267.e4. [PMID: 29415818 DOI: 10.1016/j.repc.2017.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/02/2017] [Accepted: 01/22/2017] [Indexed: 12/28/2022] Open
Abstract
Functional tricuspid regurgitation is a prevalent disease, especially among patients with other valve disorders, and is associated with significant morbidity and mortality. Its management is challenging, and many patients deemed at high surgical risk are managed conservatively. Despite optimization of pharmacological treatment, many patients continue to be symptomatic, thus leading to interest in percutaneous interventional techniques. The Mitralign system has recently been used for the treatment of functional tricuspid regurgitation, with favorable clinical and imaging results. We report the first case in Portugal to our knowledge of percutaneous tricuspid regurgitation treatment with the Mitralign system.
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Affiliation(s)
- Eduardo M Vilela
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia/Espinho, Portugal.
| | - José Ribeiro
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia/Espinho, Portugal
| | - João Almeida
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia/Espinho, Portugal
| | - Marlene Fonseca
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia/Espinho, Portugal
| | - Adelaide Dias
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia/Espinho, Portugal
| | - João Primo
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia/Espinho, Portugal
| | - Pedro Braga
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia/Espinho, Portugal
| | - Vasco Gama
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia/Espinho, Portugal
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29
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Buzzatti N, Castiglioni A, Agricola E, Barletta M, Stella S, Giannini F, Regazzoli D, Mangieri A, Ancona M, Spagnolo P, Chieffo A, Montorfano M, Alfieri O, Colombo A, Latib A. Five-year evolution of mild aortic regurgitation following transcatheter aortic valve implantation: early insights from a single-centre experience. Interact Cardiovasc Thorac Surg 2017; 25:75-82. [PMID: 28379385 DOI: 10.1093/icvts/ivx070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/07/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To assess the follow-up evolution and impact of mild aortic regurgitation (1 + AR) following transcatheter aortic valve implantation (TAVI). METHODS We evaluated the follow-up outcomes and AR evolution of 558 patients affected by native aortic stenosis who underwent TAVI with residual AR ≤ 1+. RESULTS No residual AR was found in 294 (52.7%) patients, whereas 1 + AR was found in 264 (47.3%) patients. At 5.5 years, freedom from all-cause mortality (56.9% vs 53.5%), cardiac mortality (75.0% vs 74.3%) and heart failure (70.0% vs 63.9%) were similar between no-AR and 1 + AR groups, respectively (all P > 0.05). New York Heart Association Class I-II was found in 88.9% vs 82.4% of patients respectively ( P = 0.013). Freedom from AR ≥3+ at 5.5 years was 98.6% in the no-AR group vs 82.5% in the 1 + AR group (log-rank <0.001). Residual 1 + AR was found to be an independent predictor of increased follow-up AR ≥3+ ( P = 0.012). In 1 + AR group, higher left ventricle mass index independently predicted increased cardiac death [hazards ratio (HR) 1.01, confidence interval (CI) 1.00-1.02, P = 0.036] and heart failure rate (HR 1.01, CI 1.00-1.02, P = 0.002), while larger native aortic annulus perimeter predicted follow-up AR ≥ 3+ (HR 1.12, CI 1.02-1.22, P = 0.016). CONCLUSIONS 5 years after TAVI, a higher progression of paravalvular AR to Grade ≥3+ together with worse symptoms were found in patients with residual 1 + AR compared with no-AR, although no marked difference in survival was observed. These findings raise further concerns about 1+ residual AR after TAVI, especially in the perspective of expanding indications to younger low-risk patients. Mechanisms that cause progression of paravalvular AR after TAVI remain to be clarified.
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Affiliation(s)
- Nicola Buzzatti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | | | - Eustachio Agricola
- Department of Echocardiography, San Raffaele Scientific Institute, Milan, Italy
| | - Marta Barletta
- Department of Echocardiography, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Stella
- Department of Echocardiography, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Regazzoli
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Ancona
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Spagnolo
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
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30
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Bouchard MA, Côté-Laroche C, Beaudoin J. Multi-Modality Imaging in the Evaluation and Treatment of Mitral Regurgitation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:91. [PMID: 29027633 DOI: 10.1007/s11936-017-0589-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OPINION STATEMENT Mitral regurgitation (MR) is frequent and associated with increased mortality and morbidity when severe. It may be caused by intrinsic valvular disease (primary MR) or ventricular deformation (secondary MR). Imaging has a critical role to document the severity, mechanism, and impact of MR on heart function as selected patients with MR may benefit from surgery whereas other will not. In patients planned for a surgical intervention, imaging is also important to select candidates for mitral valve (MV) repair over replacement and to predict surgical success. Although standard transthoracic echocardiography is the first-line modality to evaluate MR, newer imaging modalities like three-dimensional (3D) transesophageal echocardiography, stress echocardiography, cardiac magnetic resonance (CMR), and computed tomography (CT) are emerging and complementary tools for MR assessment. While some of these modalities can provide insight into MR severity, others will help to determine its mechanism. Understanding the advantages and limitations of each imaging modality is important to appreciate their respective role for MR assessment and help to resolve eventual discrepancies between different diagnostic methods. With the increasing use of transcatheter mitral procedures (repair or replacement) for high-surgical-risk patients, multimodality imaging has now become even more important to determine eligibility, preinterventional planning, and periprocedural guidance.
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Affiliation(s)
- Marc-André Bouchard
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute), Department of Medicine, Laval University, Québec, QC, Canada
| | - Claudia Côté-Laroche
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute), Department of Medicine, Laval University, Québec, QC, Canada
| | - Jonathan Beaudoin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute), Department of Medicine, Laval University, Québec, QC, Canada.
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31
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Vahanian A, Brochet E. Transseptal puncture for structural heart intervention: an old technique with new indications. Heart 2017; 103:1830-1837. [DOI: 10.1136/heartjnl-2016-310483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/30/2017] [Accepted: 07/02/2017] [Indexed: 01/06/2023] Open
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33
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Hagendorff A, Stoebe S, Jurisch D, Neef M, Metze M, Pfeiffer D. Neues und Bewährtes in der kardiologischen Diagnostik mithilfe der TEE. Herz 2017; 42:232-240. [DOI: 10.1007/s00059-017-4534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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34
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Chambers JB, Garbi M, Nieman K, Myerson S, Pierard LA, Habib G, Zamorano JL, Edvardsen T, Lancellotti P, Delgado V, Cosyns B, Donal E, Dulgheru R, Galderisi M, Lombardi M, Muraru D, Kauffmann P, Cardim N, Haugaa K, Rosenhek R. Appropriateness criteria for the use of cardiovascular imaging in heart valve disease in adults: a European Association of Cardiovascular Imaging report of literature review and current practice. Eur Heart J Cardiovasc Imaging 2017; 18:489-498. [DOI: 10.1093/ehjci/jew309] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/17/2016] [Indexed: 01/16/2023] Open
Affiliation(s)
- John B. Chambers
- Cardiothoracic Centre, Guy’s and St Thomas Hospitals, London, UK
| | - Madalina Garbi
- King's Health Partners, King's College Hospital NHS Foundation Trust, London, UK
| | - Koen Nieman
- Departments of Cardiology and Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Gilbert Habib
- Aix-Marseille University, URMITE, Marseille, France
- Department of Cardiology, APHM, La Timone Hospital, Marseille, France
| | | | - Thor Edvardsen
- Department of Cardiology and Centre of Cardiological Innovation, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
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35
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Patzelt J, Zhang Y, Magunia H, Jorbenadze R, Droppa M, Ulrich M, Cai S, Lausberg H, Walker T, Wengenmayer T, Rosenberger P, Schreieck J, Seizer P, Gawaz M, Langer HF. Immediate increase of cardiac output after percutaneous mitral valve repair (PMVR) determined by echocardiographic and invasive parameters: Patzelt: Increase of cardiac output after PMVR. Int J Cardiol 2017; 236:356-362. [PMID: 28185701 DOI: 10.1016/j.ijcard.2016.12.190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 12/31/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Successful percutaneous mitral valve repair (PMVR) in patients with severe mitral regurgitation (MR) causes changes in hemodynamics. Echocardiographic calculation of cardiac output (CO) has not been evaluated in the setting of PMVR, so far. Here we evaluated hemodynamics before and after PMVR with the MitraClip system using pulmonary artery catheterization, transthoracic (TTE) and transesophageal (TEE) echocardiography. METHODS 101 patients with severe MR not eligible for conventional surgery underwent PMVR. Hemodynamic parameters were determined during and after the intervention. We evaluated changes in CO and pulmonary artery systolic pressure before and after PMVR. CO was determined with invasive parameters using the Fick method (COi) and by a combination of TTE and TEE (COe). RESULTS All patients had successful clip implantation, which was associated with increased COi (from 4.6±1.4l/min to 5.4±1.6l/min, p<0.001). Furthermore, pulmonary artery systolic pressure (PASP) showed a significant decrease after PMVR (47.6±16.1 before, 44.7±15.5mmHg after, p=0.01). In accordance with invasive measurements, COe increased significantly (COe from 4.3±1.7l/min to 4.8±1.7l/min, p=0.003). Comparing both methods to calculate CO, we observed good agreement between COi and COe using Bland Altman plots. CONCLUSIONS CO increased significantly after PMVR as determined by echocardiography based and invasive calculation of hemodynamics during PMVR. COe shows good agreement with COi before and after the intervention and, thus, represents a potential non-invasive method to determine CO in patients with MR not accessible by conventional surgery.
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Affiliation(s)
- Johannes Patzelt
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Yingying Zhang
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; University Hospital, Department of Cardiology, Qingdao University, 266003 Qingdao, China
| | - Harry Magunia
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Rezo Jorbenadze
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Michal Droppa
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Miriam Ulrich
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Shanglang Cai
- University Hospital, Department of Cardiology, Qingdao University, 266003 Qingdao, China
| | - Henning Lausberg
- University Hospital, Department of Cardiovascular Surgery, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Tobias Walker
- University Hospital, Department of Cardiovascular Surgery, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Tobias Wengenmayer
- Department of Cardiology and Angiology, Heart Center Freiburg University, 79106 Freiburg im Breisgau, Germany
| | - Peter Rosenberger
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Juergen Schreieck
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Peter Seizer
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Meinrad Gawaz
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Harald F Langer
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
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Automatic 3D aortic annulus sizing by computed tomography in the planning of transcatheter aortic valve implantation. J Cardiovasc Comput Tomogr 2017; 11:25-32. [DOI: 10.1016/j.jcct.2016.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/29/2016] [Indexed: 11/24/2022]
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37
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Queiros S, Papachristidis A, Morais P, Theodoropoulos KC, Fonseca JC, Monaghan MJ, Vilaca JL, Dhooge J. Fully Automatic 3-D-TEE Segmentation for the Planning of Transcatheter Aortic Valve Implantation. IEEE Trans Biomed Eng 2016; 64:1711-1720. [PMID: 28113205 DOI: 10.1109/tbme.2016.2617401] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A novel fully automatic framework for aortic valve (AV) trunk segmentation in three-dimensional (3-D) transesophageal echocardiography (TEE) datasets is proposed. The methodology combines a previously presented semiautomatic segmentation strategy by using shape-based B-spline Explicit Active Surfaces with two novel algorithms to automate the quantification of relevant AV measures. The first combines a fast rotation-invariant 3-D generalized Hough transform with a vessel-like dark tube detector to initialize the segmentation. After segmenting the AV wall, the second algorithm focuses on aligning this surface with the reference ones in order to estimate the short-axis (SAx) planes (at the left ventricular outflow tract, annulus, sinuses of Valsalva, and sinotubular junction) in which to perform the measurements. The framework has been tested in 20 3-D-TEE datasets with both stenotic and nonstenotic AVs. The initialization algorithm presented a median error of around 3 mm for the AV axis endpoints, with an overall feasibility of 90%. In its turn, the SAx detection algorithm showed to be highly reproducible, with indistinguishable results compared with the variability found between the experts' defined planes. Automatically extracted measures at the four levels showed a good agreement with the experts' ones, with limits of agreement similar to the interobserver variability. Moreover, a validation set of 20 additional stenotic AV datasets corroborated the method's applicability and accuracy. The proposed approach mitigates the variability associated with the manual quantification while significantly reducing the required analysis time (12 s versus 5 to 10 min), which shows its appeal for automatic dimensioning of the AV morphology in 3-D-TEE for the planning of transcatheter AV implantation.
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