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Hájek P, Horvath M, Hansvenclova E, Pecková M, Adlova R. Increased cardiovascular mortality in patients with mechanically expandable transcatheter aortic valve and without permanent pacemaker. Open Heart 2023; 10:e002386. [PMID: 38097364 PMCID: PMC10729242 DOI: 10.1136/openhrt-2023-002386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Use of the mechanically expandable transcatheter aortic valve (MEV) has been recently linked to increased risks of valve dysfunction and cardiovascular mortality. The risk of developing conduction disturbance with the MEV valve is well known, and the negative prognostic impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation is another consideration. AIM This study aimed to compare the mid-term survival of patients with MEV and self-expandable valves (SEV), and to examine survival of both groups according to the presence or absence of PPI. METHODS This single-centre, retrospective, observational study examined data from MEV and SEV groups comprising 92 and 373 patients, respectively. The mean clinical follow-up was 2.5±1.7 years. Mortality information was obtained from the National Institutes of Health Information and Statistics. RESULTS Baseline characteristics were comparable between the groups. The log-rank test showed higher cardiovascular mortality in the MEV group (p=0.042; the relative risk (RR) 1.594 (95% CI 1.013 to 2.508)). The Cox proportional hazards model identified MEV implantation as an independent predictor of cardiovascular mortality. The rate of PPI was twice as high in the MEV vs SEV group (33.7% vs 16.1%; p<0.001). We compared the survival of both groups according to the presence or absence of PPI and found higher mortality in the MEV group without PPI versus the SEV group without PPI (p=0.007; RR 2.156 (95% CI 1.213 to 3.831)). Survival did not differ in the groups with PPI. CONCLUSIONS A higher mid-term cardiovascular mortality rate was observed with MEV versus SEV implants. Comparing both groups according to the presence or absence of PPI, we observed a higher mortality risk in patients with MEV without PPI than in SEV without PPI. In contrast, mortality did not differ between the groups when PPI was implanted.
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Affiliation(s)
- Petr Hájek
- Department of Cardiology, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Martin Horvath
- Department of Cardiology, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Eva Hansvenclova
- Department of Cardiology, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Monika Pecková
- Institute of Applied Mathematics and Information Technologies, Faculty of Science, Charles University, Prague, Czech Republic
| | - Radka Adlova
- Department of Cardiology, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
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Stephan T, Krohn-Grimberghe M, von Lindeiner genannt von Wildau A, Buck C, Baumhardt M, Mörike J, Gonska B, Rottbauer W, Buckert D. Cusp-overlap view reduces conduction disturbances and permanent pacemaker implantation after transcatheter aortic valve replacement even with balloon-expandable and mechanically-expandable heart valves. Front Cardiovasc Med 2023; 10:1269833. [PMID: 38107259 PMCID: PMC10722163 DOI: 10.3389/fcvm.2023.1269833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Background Conduction disturbances demanding permanent pacemaker implantation (PPI) remain a common complication after transcatheter aortic valve replacement (TAVR). Optimization of the implantation depth (ID) by introducing the cusp-overlap projection (COP) technique led to a reduced rate of PPI when self-expanding valves were used. Objectives The aim of the present study was to determine if using the novel COP view is applicable for all types of TAVR prosthesis and results in a higher ID and reduced incidence of new conduction disturbances and PPI. Methods In this prospective case-control study 586 consecutive patients undergoing TAVR with either balloon-expandable Edwards SAPIEN S3 (n = 280; 47.8%), or mechanically expandable Boston LOTUS Edge heart valve prostheses (n = 306; 52.2%) were included. ID as well as rates of periprocedural PPI and left bundle branch block (LBBB) were compared between the conventional three-cusp coplanar (TCC) projection and the COP view for implantation. Results Of 586 patients, 282 (48.1%) underwent TAVR using COP, whereas in 304 patients (51.9%) the TCC view was applied. Using COP a significantly higher ID was achieved in Edwards SAPIEN S3 TAVR procedures (ID mean difference -1.0 mm, 95%-CI -1.9 to -0.1 mm; P = 0.029), whereas the final platform position did not differ significantly between both techniques when a Boston LOTUS Edge valve was used (ID mean difference -0.1 mm, 95%-CI -1.1 to +0.9 mm; P = 0.890). In Edwards SAPIEN S3 valves, higher ID was associated with a numerically lower post-procedural PPI incidence (4.9% vs. 7.3%; P = 0.464). Moreover, ID was significantly deeper in patients requiring PPI post TAVR compared to those without PPI [8.7 mm (6.8-10.6 mm) vs. 6.5 mm (6.1-7.0 mm); P = 0.005]. In Boston LOTUS Edge devices, COP view significantly decreased the incidence of LBBB post procedure (28.1% vs. 47.9%; P < 0.001), while PPI rates were similar in both groups (21.6% vs. 25.7%; P = 0.396). Conclusion The present study demonstrates the safety, efficacy and reproducibility of the cusp-overlap view even in balloon-expandable and mechanically-expandable TAVR procedures. Application of COP leads to significantly less LBBB in repositionable Boston LOTUS Edge valves and a numerically lower PPI rate in Edwards SAPIEN S3 valves post TAVR compared to the standard TCC projection. The results should encourage to apply the COP view more widely in clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Dominik Buckert
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
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Briedis K, Mizariene V, Rumbinaite E, Jurenas M, Aldujeli A, Briede K, Jakuska P, Jankauskas A, Ceponiene I, Lenkutis T, Zaliunas R, Benetis R. Safety and performance of the Vienna self-expandable transcatheter aortic valve system: 6-month results of the VIVA first-in-human feasibility study. Front Cardiovasc Med 2023; 10:1199047. [PMID: 37522086 PMCID: PMC10373888 DOI: 10.3389/fcvm.2023.1199047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
Background The novel Vienna TAVI system is repositionable and retrievable, already pre-mounted on the delivery system, eliminating the need for assembly and crimping of the device prior to valve implantation. Aims The purpose of this first-in-human feasibility study was to determine the safety, feasibility, clinical and hemodynamic performance of the Vienna TAVI system at 6-month follow-up. (ClinicalTrials.gov identifier NCT04861805). Methods This is a prospective, non-randomized, single-arm, single-center, first-stage FIH feasibility study, which is followed by a second-stage pivotal, multicenter, multinational study in symptomatic patients with severe aortic stenosis (SAS). The first-stage FIH study evaluated the safety and feasibility, clinical and hemodynamic performance of the device in 10 patients with SAS based on recommendations by the VARC-2. Results All patients were alive at 3-month follow-up. 1 non-cardiovascular mortality was reported 5 months after implantation. There were no new cerebrovascular events, life-threatening bleeding or conduction disturbances observed at 6-month follow-up. The mean AV gradient significantly decreased from 48.7 ± 10.8 to 7.32 ± 2.0 mmHg and mean AVA increased from 0.75 ± 0.18 to 2.16 ± 0.42 cm2 (p < 0.00001). There was no incidence of moderate or severe total AR observed. In the QoL questionnaires, the patients reported a significant improvement from the baseline 12-KCCQ mean score 58 ± 15 to 76 ± 20. NYHA functional class improved in two patients, remained unchanged in one patient. There was an increase in mean 6-min-walk distance from baseline 285 ± 97 to 347 ± 57 m. Conclusions This study demonstrates that using Vienna TAVI system has favourable and sustained 6-month safety and performance outcomes in patients with symptomatic severe aortic stenosis.
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Affiliation(s)
- Kasparas Briedis
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vaida Mizariene
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Egle Rumbinaite
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Martynas Jurenas
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ali Aldujeli
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kamilija Briede
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Povilas Jakuska
- Department of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Antanas Jankauskas
- Department of Radiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Indre Ceponiene
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Tadas Lenkutis
- Department of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Remigijus Zaliunas
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimantas Benetis
- Department of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Prosthesis Tailoring for Patients Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2023; 12:jcm12010338. [PMID: 36615141 PMCID: PMC9821207 DOI: 10.3390/jcm12010338] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has risen over the past 20 years as a safe and effective alternative to surgical aortic valve replacement for treatment of severe aortic stenosis, and is now a well-established and recommended treatment option in suitable patients irrespective of predicted risk of mortality after surgery. Studies of numerous devices, either newly developed or reiterations of previous prostheses, have been accruing. We hereby review TAVI devices, with a focus on commercially available options, and aim to present a guide for prosthesis tailoring according to patient-related anatomical and clinical factors that may favor particular designs.
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Mid-term outcomes of patients with Lotus and Evolut transcatheter valves. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2022; 18:146-153. [PMID: 36051828 PMCID: PMC9421513 DOI: 10.5114/aic.2022.118531] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Long-term data on the Lotus® (Boston Scientific, USA) valve are lacking. Aim To evaluate mid-term outcomes of aortic stenosis patients treated with either Lotus or Evolut R® valves (Medtronic, USA). Material and methods Our study sample comprised 190 patients (71 Lotus and 119 Evolut valves). The mean clinical follow-up was 2.0 ±0.9 years. Information on mortality was obtained from the National Institutes of Health Information and Statistics. Results No significant differences existed in baseline characteristics between the groups. The rate of procedural complications was low and without significant differences between groups. The log rank test showed higher mortality in the Lotus group for cardiovascular mortality (p = 0.02; RR = 2.4, 95% CI: 1.123–5.075). Multivariable analysis revealed that the Lotus valve was independently associated with cardiovascular mortality (p = 0.03). At the end of echocardiography follow-up (4.1 ±0.9 years), we found a significantly higher mean aortic valve gradient (AVGm) in the Lotus group than in the Evolut group (17.9 ±9.5 vs. 10.2 ±3.5 mm Hg; p = 0.0006), and 3 (10%) patients from the Lotus group suffered from symptomatic re-stenosis requiering re-intervention. Conclusions The results of our study suggest that higher cardiovascular mortality rates during mid-term follow-up were associated with Lotus compared with Evolut valves. Higher AVGm in the Lotus valves suggests the possibility of accelerated prosthesis degeneration.
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Abdelshafy M, Serruys PW, Kim WK, Rück A, Wang R, Tao L, Elkoumy A, Elzomor H, Garg S, Onuma Y, Mylotte D, Soliman O. Quantitative Angiographic Assessment of Aortic Regurgitation Following 11 TAVR Devices: An Update of a Multicenter Pooled Analysis. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100037. [PMID: 39131960 PMCID: PMC11308439 DOI: 10.1016/j.jscai.2022.100037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/11/2022] [Accepted: 02/28/2022] [Indexed: 08/13/2024]
Abstract
Background Aortic regurgitation (AR) following transcatheter aortic valve replacement (TAVR) is a major predictor of short- and long-term survival. Thus far, no independent quantitative comparison of AR among commercially available transcatheter heart valves (THVs) has been performed. Objectives We sought to assess and compare the degree of acute AR following TAVR between 11 commercially available THVs and update our previous multicenter, pooled analysis. Methods Analyses were performed by an independent academic core lab using quantitative videodensitometry, a technique relying solely on the aortogram acquired after TAVR. The pooled analysis (n = 2665) included data from the initial cohort of 7 valves (Lotus [n = 546], Evolut PRO [n = 95], SAPIEN 3 [n = 397], Evolut R [n = 295], SAPIEN XT [n = 239], ACURATE neo [n = 120], and CoreValve [n = 532]) to which data from 4 new valves were added (ACURATE neo2 [n = 120], Myval [n = 108], VitaFlow [n = 105], and Venus-A [n = 113]). Results The Lotus valve had the lowest mean AR (3.5% ± 4.4%) followed by ACURATE neo2 (4.4% ± 4.8%), VitaFlow (6.1% ± 6.4%), Myval (6.3% ± 6.3%), Evolut PRO (7.4% ± 6.5%), SAPIEN 3 (7.6% ± 7.1%), Evolut R (7.9% ± 7.4%), SAPIEN XT (8.8% ± 7.5%), Venus-A (8.9% ± 10%), ACURATE neo (9.6% ± 9.2%), and CoreValve (13.7% ± 10.7%, analysis of variance P-value < .001). The only valves that statistically differed from all their counterparts were Lotus, with the lowest regurgitation in comparison to other valves except ACURATE neo2, which had less regurgitation compared with SAPIEN 3, Evolut R, SAPIEN XT, Venus-A, ACURATE neo, and CoreValve. CoreValve had the highest mean of AR, with the rates of moderate/severe AR: ACURATE neo2 (1.7%), Lotus (2.2%), Myval (2.8%), VitaFlow (4.7%), Evolut PRO (5.3%), SAPIEN 3 (8.3%), Evolut R (8.8%), SAPIEN XT (10.9%), ACURATE neo (11.3%), Venus-A (14.2%), and CoreValve (30.1%)-χ2 P-value < .001. Conclusions In this updated pooled analysis, the Lotus valve had the lowest mean AR, while ACURATE neo2 had the lowest rate of moderate/severe AR. Myval, VitaFlow, and Venus-A THVs showed promising results.
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Affiliation(s)
- Mahmoud Abdelshafy
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
- Department of Cardiology, Al-Azhar University, Cairo, Egypt
| | - Patrick W. Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
- NHLI, Imperial College London, London, United Kingdom
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Centre, Bad Nauheim, Germany
| | - Andreas Rück
- Department of Cardiology, Karolinska Institute, Stockholm, Sweden
| | - Rutao Wang
- Department of Cardiology, Xijing Hospital, Xi'an, China
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Xi'an, China
| | - Ahmed Elkoumy
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
- Islamic Center of Cardiology and Cardiac Surgery, Al-Azhar University, Cairo, Egypt
| | - Hesham Elzomor
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
- Islamic Center of Cardiology and Cardiac Surgery, Al-Azhar University, Cairo, Egypt
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Darren Mylotte
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Osama Soliman
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
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Waldschmidt L, Goßling A, Ludwig S, Linder M, Voigtländer L, Grundmann D, Bhadra O, Demal T, Schirmer J, Reichenspurner H, Blankenberg S, Westermann D, Seiffert M, Conradi L, Schofer N. Impact of left ventricular outflow tract calcification in patients undergoing transfemoral transcatheter aortic valve implantation. EUROINTERVENTION 2022; 17:e1417-e1424. [PMID: 34658340 PMCID: PMC9896403 DOI: 10.4244/eij-d-21-00464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Left ventricular outflow tract (LVOT) calcification is known to be associated with adverse outcomes after transcatheter aortic valve implantation (TAVI) in patients receiving first-generation transcatheter heart valves (THV). AIMS The aim of the present study was to assess the prevalence of LVOT calcification as well as its impact on outcomes in a contemporary TAVI patient cohort. METHODS This retrospective single-centre analysis includes 1,207 patients who underwent transfemoral TAVI between 2012 and 2018 and in whom adequate contrast-enhanced multislice computed tomgraphy (MSCT) imaging for quantification of LVOT calcification was available. RESULTS Significant LVOT calcification, defined as >10 mm3, was present in 37.4% (n=451) of the patient cohort. After applying propensity score matching there was no difference between patients without (w/o; n=358) and with (w; n=358) significant LVOT calcification with respect to baseline clinical characteristics. At 30 days, the composite of all-cause mortality and non-disabling/disabling stroke occurred more often in patients w LVOT calcification compared to those w/o (4.6 vs 10.1%, p=0.008). Moreover, the composite VARC-3 endpoint of device success at 30 days was in favour of patients w/o LVOT calcification (82.2% vs 73.4%, p=0.007). According to Kaplan-Meier analysis, all-cause mortality one year after TAVI was higher in patients w vs w/o LVOT calcification (12.9 vs 21.4 %, p=0.004). CONCLUSIONS In patients undergoing TAVI, the presence of significant LVOT calcification is common and associated with worse short-term clinical and functional outcomes as well as higher one-year mortality rates compared to patients w/o LVOT calcification.
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Affiliation(s)
- Lara Waldschmidt
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Alina Goßling
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Matthias Linder
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lisa Voigtländer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - David Grundmann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Oliver Bhadra
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Till Demal
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany
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Haouzi A, Tuttle M, Eyal A, Tandon K, Tung P, Zimetbaum PJ, Kramer DB. Clinical management of conduction abnormalities following transcatheter aortic valve replacement: prospective evaluation of a standardized management pathway. J Interv Card Electrophysiol 2022; 64:195-202. [PMID: 35212830 PMCID: PMC8873349 DOI: 10.1007/s10840-022-01156-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/08/2022] [Indexed: 11/26/2022]
Abstract
Purpose Limited evidence guides management of conduction abnormalities following TAVR. Standardized clinical pathways may reduce variability in care while minimizing bradyarrhythmic morbidity, length of stay (LOS), and pacemaker (PPM) implantation rates. Methods A multidisciplinary consensus pathway to standardize post-TAVR management was developed. We evaluated (1) pathway adherence; (2) LOS; (3) PPM implantation rates; (4) 1-month survival, and (5) late heart block. Exploratory analyses evaluated factors associated with PPM implantation. Results A total of 181 consecutive patients without prior PPM who underwent TAVR between February 2020 and February 2021 (mean age 77.9 ± 9.1, 38% women) were included. Average LOS was 3.0 days (± 2.7), and no deaths related to syncope/bradyarrhythmia were reported by 1 month. Overall, 93% of the 181 patients were managed by pathway; deviations were due to failure of discharge with a heart monitor when it was clinically indicated for either pre-existing RBBB or new PR prolongation/new LBBB. PPM implantation occurred in 19 patients by discharge, and 21 by 1-month (13%). In our exploratory analysis, pre-existing RBBB, transient peri-procedural heart block, and LOTUS valves were associated with pacemaker implantation: OR (CI) of 8.16 (3.06–21.78), 6.83 (1.94–24.03), and 8.32 (1.11–62.49), respectively. Conclusions This report illustrates that a standardized protocol for the management of conduction abnormalities after TAVR can be implemented with high compliance, safe management of conduction disturbance, and relatively short LOS with discharge supported by ambulatory monitoring.
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Affiliation(s)
- Alice Haouzi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, 4th floor, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | | | - Patricia Tung
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, 4th floor, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Daniel B Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, 4th floor, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
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Gunarathne A, Tan J, Varcoe R, Bhandari S, Faour A, Tanseco K, Mylotte D, Mitchell A, Armario X, Owens C, Spence M, Cunnington M, Casserly I, Kovac J, Hildick-Smith D, Baig K. The impact of learning-curve-experience on transcatheter aortic valve replacement outcomes: Insights from the United Kingdom and Ireland all-comers second-generation ACURATE neo™ transcatheter aortic heart valve registry. Catheter Cardiovasc Interv 2021; 99:1172-1180. [PMID: 34792842 DOI: 10.1002/ccd.30000] [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] [Received: 07/16/2021] [Revised: 10/08/2021] [Accepted: 10/30/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The ACURATE neo™ is a novel, second-generation self-expanding supra-annular transcatheter heart valve (THV). The objective of this multi-centre registry is to assess the safety, clinical utility, and impact of 'learning-curve-experience' (LCE) on transcatheter aortic valve replacement outcomes in the United Kingdom (UK) and Ireland. METHODS We prospectively collected data from seven ACURATE neo™ THV implanting centres (n = 484) between February 2016 and November 2020. We compared mortality rates and outcomes in the LCE group (n = 120) compared to next successive 120 cases. RESULTS The mean age of the cohort was 81.9(SD: 6.1) years and the majority were in the moderate risk category (EuroSCORE-II):3.3(SD: 3). The 97.5% of cases were performed under local anesthetic. The valve was successfully deployed in 98.8% of cases. The survival rate at 30 days was 97.9%. The incidence of stroke was 2.5%. Life threatening bleeding occurred in 0.6% of cases and vascular access complications occurred in 21 (4.3%) patients. Implantation-related conduction abnormalities occurred in 8.3% but only 5.6% required a PPM. The successful valve deployment occurred in 96% of the patients in the LCE group compared to 100% in the other group (p = 0.04; OR-2[CI 1.7-2.3]). The mortality rates at 30 days (1.7% vs. 1.7%) and 1 year (1.9% vs. 2.7%) were comparable between the two groups. CONCLUSIONS This study represents the largest published UK and Ireland real-world experience of the ACURATE neo™ valve. The procedural success rates and safety outcomes were excellent and endorse its utility in clinical practice. The LCE appears to have an impact on the successful valve deployment but without translating into short-term or long-term outcomes.
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Affiliation(s)
- Ashan Gunarathne
- Trent Cardiac Centre, University Hospital Nottingham NHS Trust, Nottingham, UK
| | - Joon Tan
- Trent Cardiac Centre, University Hospital Nottingham NHS Trust, Nottingham, UK
| | - Richard Varcoe
- Trent Cardiac Centre, University Hospital Nottingham NHS Trust, Nottingham, UK
| | - Sanjay Bhandari
- Department of Cardiology, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Amir Faour
- Department of Cardiology, University Hospitals Leeds NHS Trust, Leeds, UK
| | - Kristoffer Tanseco
- Department of Cardiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Andrew Mitchell
- Department of Cardiology, University Hospital Mater Misericordiae, Dublin, Ireland
| | - Xavier Armario
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Colum Owens
- Department of Cardiology, Belfast Cardiac Centre, Royal Victoria Hospital, Belfast, Ireland
| | - Mark Spence
- Department of Cardiology, Belfast Cardiac Centre, Royal Victoria Hospital, Belfast, Ireland
| | - Michael Cunnington
- Department of Cardiology, University Hospitals Leeds NHS Trust, Leeds, UK
| | - Ivan Casserly
- Department of Cardiology, University Hospital Mater Misericordiae, Dublin, Ireland
| | - Jan Kovac
- Department of Cardiology, University Hospitals Leicester NHS Trust, Leicester, UK
| | - David Hildick-Smith
- Department of Cardiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Kamran Baig
- Trent Cardiac Centre, University Hospital Nottingham NHS Trust, Nottingham, UK
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10
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Ravaux JM, Di Mauro M, Vernooy K, Kats S, Mariani S, Ronco D, Actis Dato G, Simons J, Hof AWV, Maessen JG, Lorusso R. Permanent pacemaker implantation following transcatheter aortic valve implantation using self-expandable, balloon-expandable, or mechanically expandable devices: a network meta-analysis. Europace 2021; 23:1998-2009. [PMID: 34379760 DOI: 10.1093/europace/euab209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/17/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Permanent pacemaker implantation (PPI) still limits the expansion of indications for transcatheter aortic valve implantation (TAVI). Comparison between different systems remains scarce. We aimed to determine the impact of the device type used on post-TAVI PPI. METHODS AND RESULTS A systematic literature review was performed to identify studies reporting the use of balloon-expandable valve (BEV), self-expandable valve (SEV), and mechanically expandable valve (MEV) and post-TAVI PPI. A network meta-analysis was used to compare TAVI mechanisms (Analysis A) and transcatheter heart valves (Analysis B) with respect to post-TAVI PPI. Analysis A included 40 181 patients with a pooled PPI rate of 19.2% in BEV, 24.7% in SEV, and 34.8% in MEV. Balloon-expandable valve showed lower risk compared to either SEV or MEV and SEV demonstrated lower risk for PPI than MEV. Implantation of BEV was associated with 39% and 62% lower PPI rate with respect to SEV and MEV. Implantation of SEV was associated with 38% lower PPI rate with respect to MEV. Analysis B included 36.143 patients with the lowest pooled PPI rate of 9.6% for Acurate Neo or others, and the highest pooled PPI rate of 34.3% for Lotus. CoreValve, Evolut Portico, and Lotus influenced significantly PPI rate, while Sapien group did not. CONCLUSION Implantation of BEV and also SEV were associated with lower post-TAVI PPI rate, while MEV were associated with higher post-TAVI PPI. Patient tailored-approach including devices characteristics may help to reduce post-TAVI PPI and to allow TAVI to take the leap towards extension of use in younger patients. PROSPERO NUMBER CRD42021238671.
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Affiliation(s)
- Justine M Ravaux
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Michele Di Mauro
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
| | - Suzanne Kats
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Silvia Mariani
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Daniele Ronco
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.,Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giulia Actis Dato
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Jorik Simons
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands
| | - Arnoud W Van't Hof
- Department of Cardiology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jos G Maessen
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Roberto Lorusso
- Departement of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
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11
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Strategies for Recovering an Embolized Percutaneous Device. Curr Cardiol Rep 2021; 23:123. [PMID: 34269875 DOI: 10.1007/s11886-021-01554-8] [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: 03/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Device embolization is a rare but potentially life-threatening complication of transcatheter structural heart interventions and may require prompt intervention. The present work aims to provide an overview of strategies for device retrievals in order to better guide the evaluation and management of device embolization. RECENT FINDINGS Although the evolution of transcatheter device therapies has had a tremendous impact on the management in structural heart disease, availability of various retrieval devices, knowledge in how to use them, and multidisciplinary collaboration are key for successful device retrieval. Understanding the reasons for embolization, strategies to avoid embolization, and the techniques for retrieval of devices used in structural heart disease should be appreciated by the treating physician.
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12
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Saito S, Hayashida K, Takayama M, Goto T, Ihlberg L, Sawa Y. Clinical Outcomes in Patients Treated With a Repositionable and Fully Retrievable Aortic Valve ― REPRISE Japan Study ―. Circ J 2021; 85:991-1000. [DOI: 10.1253/circj.cj-20-0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital
| | | | | | - Tsuyoshi Goto
- Department of Cardiology, Kurashiki Central Hospital
| | | | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
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13
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Kawashima H, Serruys PW, Mylotte D, Rosseel L, Amat-Santos IJ, Rao RS, Onuma Y, Wijns W, Abdel-Wahab M, Baumbach A, Soliman O. Operator preference and determinants of size selection when additional intermediate-size aortic transcatheter heart valves are made available. Int J Cardiol 2021; 338:168-173. [PMID: 34147554 DOI: 10.1016/j.ijcard.2021.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/22/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Appropriate size selection of transcatheter heart valves (THVs) is fundamental to reduce transcatheter aortic valve implantation (TAVI) related complications, particularly paravalvular aortic regurgitation, new permanent pacemaker implantation, and annular rupture. We sought to investigate the frequency of operator selection of intermediate-size balloon-expandable Myval THVs (Meril Life Sciences Pvt. Ltd., India) for TAVI in a real-world dataset. METHODS In this retrospective survey of patients treated with TAVI using the Myval THV, 20, 23, 26, and 29 mm are conventional-size THVs, 21.5, 24.5 and 27.5 mm are intermediate-size THVs, and 30.5 and 32 mm are extra-large THVs. Operator size selection for implantation was based on multislice computed tomography (MSCT) derived aortic-root dimensions. RESULTS A total of 1115 patients underwent Myval THV implantation in 27 countries worldwide. The Myval intermediate-size THVs were used in 468 (42.0%) patients. MSCT data were available in 562 patients. There was no statistical difference between the Intermediate/Upsized and Appropriately sized groups or Intermediate/Downsized and Appropriately sized groups in terms of different variables measured with MSCT except for annular dimensions and degree of calcification. CONCLUSIONS Intermediate-size Myval balloon-expandable THVs are used in nearly half of all cases in contemporary real-world TAVI practice, addressing the unmet need of TAVI operators for a more calibrated THV choice. Our hypothesis should be tested in randomized prospective studies currently initiated in Europe, including clinical outcomes of patients treated with both conventional- and intermediate-size THVs.
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Affiliation(s)
- Hideyuki Kawashima
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland; Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland; CÚRAM, the SFI Research Centre for Medical Devices, Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
| | - Darren Mylotte
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland
| | - Liesbeth Rosseel
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland
| | | | | | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland
| | - William Wijns
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Baumbach
- William Harvey Research Institute, Queen Mary University of London, and Barts Heart Centre, London, United Kingdom
| | - Osama Soliman
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland; CÚRAM, the SFI Research Centre for Medical Devices, Galway, Ireland
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14
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Toggweiler S. The LOTUS Edge Is Up for a Challenge. JACC Cardiovasc Interv 2021; 14:182-184. [PMID: 33478634 DOI: 10.1016/j.jcin.2020.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Stefan Toggweiler
- Heart Center Lucerne, Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland.
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15
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Kawashima H, Soliman O, Wang R, Ono M, Hara H, Gao C, Zeller E, Thakkar A, Tamburino C, Bedogni F, Neumann FJ, Thiele H, Abdel-Wahab M, Morice MC, Webster M, Rosseel L, Mylotte D, Onuma Y, Wijns W, Baumbach A, Serruys PW. Rationale and design of a randomized clinical trial comparing safety and efficacy of myval transcatheter heart valve versus contemporary transcatheter heart valves in patients with severe symptomatic aortic valve stenosis: The LANDMARK trial. Am Heart J 2021; 232:23-38. [PMID: 33160946 DOI: 10.1016/j.ahj.2020.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/02/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The recent approval of transcatheter aortic valve replacement (TAVR) in patients with low operative risk has paved the way for the introduction of novel and potentially improved technologies. The safety and efficacy of these novel technologies should be investigated in randomized control trials against the contemporary TAVR devices. The objective of the LANDMARK trial is to compare the balloon-expandable Myval transcatheter heart valve (THV) series with contemporary THV (SAPIEN THV and Evolut THV series) series in patients with severe symptomatic native aortic stenosis. METHODS/DESIGN The LANDMARK trial (ClinicalTrials.govNCT04275726, EudraCT number 2020-000,137-40) is a prospective, randomized, multinational, multicenter, open-label, and noninferiority trial of approximately 768 patients treated with TAVR via the transfemoral approach. Patients will be allocated in a 1:1 randomization to Myval THV series (n = 384) or to contemporary THV (n = 384) (either of SAPIEN THV or Evolut THV series). The primary combined safety and efficacy endpoint is a composite of all-cause mortality, all stroke (disabling and nondisabling), bleeding (life-threatening or disabling), acute kidney injury (stage 2 or 3), major vascular complications, prosthetic valve regurgitation (moderate or severe), and conduction system disturbances (requiring new permanent pacemaker implantation), according to the Valve Academic Research Consortium-2 criteria at 30-day follow-up. All patients will have follow-up to 10 years following TAVR. SUMMARY The LANDMARK trial is the first randomized head-to-head trial comparing Myval THV series to commercially available THVs in patients indicated for TAVR. We review prior data on head-to-head comparisons of TAVR devices and describe the rationale and design of the LANDMARK trial.
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Affiliation(s)
- Hideyuki Kawashima
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Osama Soliman
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Hironori Hara
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Chao Gao
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Emeline Zeller
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | | | - Corrado Tamburino
- Ferrarotto Hospital, Policlinico Hospital and University of Catania, Catania, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy
| | - Franz-Josef Neumann
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Marie-Claude Morice
- Department of Cardiology, Cardiovascular Institute Paris-Sud, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | - Mark Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Liesbeth Rosseel
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Darren Mylotte
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - William Wijns
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Andreas Baumbach
- William Harvey Research Institute, Queen Mary University of London, and Barts Heart Centre, London, United Kingdom
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
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16
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Armario X, Rosseel L, Kharbanda R, Khogali S, Abdel-Wahab M, Van Mieghem NM, Tchétché D, Dumonteil N, De Backer O, Cotton J, McGrath B, Balakrishnan D, Ali N, Farhan S, Joseph J, Charbonnier G, Okuno T, McHugh F, Hildick-Smith D, Gilgen N, Hokken T, Spence MS, Frerker C, Angelillis M, Grygier M, Cockburn J, Bjursten H, Jeger RV, Teles R, Petronio AS, Pilgrim T, Sinning JM, Nickenig G, Søndergaard L, Blackman DJ, Mylotte D. Transcatheter Aortic Valve Replacement With the LOTUS Edge System: Early European Experience. JACC Cardiovasc Interv 2020; 14:172-181. [PMID: 33478633 DOI: 10.1016/j.jcin.2020.09.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/10/2020] [Accepted: 09/29/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the short-term safety and efficacy of transcatheter aortic valve replacement (TAVR) with the LOTUS Edge system. BACKGROUND The LOTUS Edge system was commercially re-released in April 2019. The authors report the first European experience with this device. METHODS A multicenter, single-arm, retrospective registry was initiated to evaluate short-term clinical outcomes. Included cases are the first experience with this device and new implantation technique in Europe. Clinical, echocardiographic, and computed tomographic data were analyzed. Endpoints were defined according to Valve Academic Research Consortium-2 and were site reported. RESULTS Between April and November 2019, 286 consecutive patients undergoing TAVR with the LOTUS Edge system at 18 European centers were included. The mean age and Society of Thoracic Surgeons score were 81.2 ± 6.9 years and 5.2 ± 5.4%, respectively. Nearly one-half of all patients (47.9%) were considered to have complex anatomy. Thirty-day major adverse events included death (2.4% [n = 7]) and stroke (3.5% [n = 10]). After TAVR, the mean aortic valve area was 1.9 ± 0.9 cm2, and the mean transvalvular gradient was 11.9 ± 5.7 mm Hg. None or trace paravalvular leak (PVL) occurred in 84.4% and moderate PVL in 2.0%. There were no cases of severe PVL. New permanent pacemaker (PPM) implantation was required in 25.9% among all patients and 30.8% among PPM-naive patients. CONCLUSIONS Early experience with the LOTUS Edge system demonstrated satisfactory short-term safety and efficacy, favorable hemodynamic data, and very low rates of PVL in an anatomically complex cohort. New PPM implantation remained high. Further study will evaluate if increasing operator experience with the device and new implantation technique can reduce the incidence of PPM implantation.
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Affiliation(s)
- Xavier Armario
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Liesbeth Rosseel
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Rajesh Kharbanda
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Saib Khogali
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | | | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Didier Tchétché
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | | | - Ole De Backer
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - James Cotton
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Brian McGrath
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Deepu Balakrishnan
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Noman Ali
- Department of Cardiology, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Serdar Farhan
- Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - Jubin Joseph
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | | | - Taishi Okuno
- Department of Cardiology, University of Bern, Bern, Switzerland
| | - Fiachra McHugh
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - David Hildick-Smith
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Nicole Gilgen
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thijmen Hokken
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Mark S Spence
- Department of Cardiology, Belfast City Hospital Trust, Belfast, United Kingdom
| | - Christian Frerker
- Department of Cardiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Marco Angelillis
- Cardiothoracic Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - James Cockburn
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
| | - Raban V Jeger
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Rui Teles
- Department of Interventional Cardiology, UNICARV, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Anna S Petronio
- Cardiothoracic Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Thomas Pilgrim
- Department of Cardiology, University of Bern, Bern, Switzerland
| | | | - Georg Nickenig
- Department of Cardiology, University Hospital Bonn, Bonn, Germany
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Daniel J Blackman
- Department of Cardiology, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, Galway, Ireland; National University of Ireland Galway, Galway, Ireland.
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17
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Wang R, Gao C, Kawashima H, Modolo R, Rosseel L, Onuma Y, Soliman O, Serruys PW, Mylotte D. Valvular heart interventions: advances from 2019 to 2020. EUROINTERVENTION 2020; 16:808-823. [PMID: 32958460 DOI: 10.4244/eij-d-20-00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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18
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Petronio AS, Angelillis M, De Backer O, Giannini C, Costa G, Fiorina C, Castriota F, Bedogni F, Laborde JC, Søndergaard L. Bicuspid aortic valve sizing for transcatheter aortic valve implantation: Development and validation of an algorithm based on multi-slice computed tomography. J Cardiovasc Comput Tomogr 2020; 14:452-461. [DOI: 10.1016/j.jcct.2020.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 01/01/2020] [Accepted: 01/23/2020] [Indexed: 01/10/2023]
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19
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Renker M, Kim WK. Choice of transcatheter heart valve: should we select the device according to each patient's characteristics or should it be "one valve fits all"? ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:961. [PMID: 32953761 PMCID: PMC7475391 DOI: 10.21037/atm.2020.04.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Since its introduction at the beginning of the century, transcatheter aortic valve replacement (TAVR) has implicated a paradigm shift in the treatment of patients with symptomatic aortic valve stenosis. The past years have brought about major improvements of procedural outcomes owing to advances in imaging and patient selection, global experience, and device technology. Whereas in the early stages of TAVR, only two different devices with limited sizes and access options were used, currently a variety of different transcatheter heart valves (THVs) are available. This has expanded the spectrum of patients that can be treated with TAVR and has allowed for sophisticated device selection tailored to the patients' individual anatomy and comorbidities. The big question is whether such a customized device selection is really necessary-or is there one valve type that fits all patients? With this question in mind, the authors provide an overview of contemporary THVs, including technical specifications and clinical data, that help us to understand the potential value of a differential use of THVs.
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Affiliation(s)
- Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany.,Department of Cardiology, University of Giessen, Giessen, Germany
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20
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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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Tchétché D, Windecker S, Kasel AM, Schaefer U, Worthley S, Linke A, Abdel-Wahab M, Le Breton H, Søndergaard L, Spence MS, Petronio S, Baumgartner H, Hovorka T, Blanke P, Reichenspurner H. 1-Year Outcomes of the CENTERA-EU Trial Assessing a Novel Self-Expanding Transcatheter Heart Valve. JACC Cardiovasc Interv 2020; 12:673-680. [PMID: 30947942 DOI: 10.1016/j.jcin.2019.01.231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 12/30/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The purpose of this study is to report the 1-year results of the CENTERA-EU trial. BACKGROUND The CENTERA transcatheter heart valve (THV) (Edwards Lifesciences, Irvine, California) is a low-profile (14-F eSheath compatible), self-expanding nitinol valve, with a motorized delivery system allowing for repositionability. The 30-day results of the CENTERA-EU trial demonstrated the short-term safety and effectiveness of the valve. METHODS Implantations were completed in 23 centers in Europe, Australia, and New Zealand. Transfemoral access was used in all patients. Echocardiographic outcomes were adjudicated by a core laboratory at baseline, discharge, 30 days, 6 months, and 1 year. Major adverse clinical events were adjudicated by an independent clinical events committee. RESULTS Between March 2015 and July 2016, 203 high-risk patients (age 82.7 ± 5.5 years, 67.5% women, 68.0% New York Heart Association functional class III or IV, Society of Thoracic Surgeons score 6.1 ± 4.2%) with severe, symptomatic aortic stenosis underwent transcatheter aortic valve replacement with the CENTERA THV. The primary endpoint of the study was 30-day mortality (1.0%). At 1 year, overall mortality was 9.1%, cardiovascular mortality was 4.6%, disabling stroke was 4.1%, new permanent pacemakers were implanted in 6.5% of patients at risk, and cardiac-related rehospitalization was 6.8%. Hemodynamic parameters were stable at 1 year, with a mean aortic valve gradient of 8.1 ± 4.7 mm Hg, a mean effective orifice area of 1.7 ± 0.42 cm2, and no incidences of severe or moderate aortic regurgitation. CONCLUSIONS The CENTERA-EU trial demonstrated mid-term safety and effectiveness of the CENTERA THV, with low mortality, sustained improvements in hemodynamic performances, and low incidence of permanent pacemaker implantations in high-risk patients with symptomatic aortic stenosis. (Safety and Performance of the Edwards CENTERA-EU Self-Expanding Transcatheter Heart Valve [CENTERA-2]; NCT02458560).
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Affiliation(s)
- Didier Tchétché
- Groupe Cardiovasculaire Interventionnel, Clinique Pasteur, Toulouse, France.
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Markus Kasel
- Department of Cardiovascular Diseases, German Heart Center, Munich, Germany
| | - Ulrich Schaefer
- Department of Cardiology, Marienkrankenhaus, Hamburg, Germany
| | - Stephen Worthley
- Department of Cardiovascular Medicine, Royal Adelaide Hospital, Adelaide Australia
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Universitätsklinik an der Technischen Universität Dresden, Dresden, Germany
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center and Leipzig Heart Institute, University of Leipzig, Leipzig, Germany
| | - Herve Le Breton
- Service de Cardiologie, CHU Rennes, Rennes, France; U1099, INSERM, Rennes, France; LTSI, Université de Rennes 1, Rennes, France
| | | | - Mark S Spence
- Cardiology Department, Royal Victoria Hospital, Belfast, United Kingdom
| | - Sonia Petronio
- Cardiothoracic and Vascular Department, Ospedale di Cisanelo, Pisa, Italy
| | - Helmut Baumgartner
- Department of Cardiology III: Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Münster, Germany
| | - Tomas Hovorka
- Statistics Department, Edwards Lifesciences, Prague, Czech Republic
| | - Philipp Blanke
- Department of Radiology, University of British Columbia, Vancouver, Canada
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Insights on Embolic Protection, Repositioning, and Stroke: A Subanalysis of the RESPOND Study. J Interv Cardiol 2020; 2020:3070427. [PMID: 32518532 PMCID: PMC7251468 DOI: 10.1155/2020/3070427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/12/2020] [Indexed: 11/21/2022] Open
Abstract
RESPOND is a prospective, single-arm study enrolling 1014 transcatheter aortic valve replacement (TAVR) patients. The objective of this analysis is to assess the impact of cerebral embolic protection (CEP) devices and prosthetic valve repositioning on the risk of neurologic complications in patients treated with the fully repositionable Lotus Valve in the RESPOND postmarket study. Valve repositioning and CEP use were at the operators' discretion. Stroke events were adjudicated by an independent medical reviewer. This analysis assessed the baseline differences among patients according to CEP use and valve repositioning and evaluated the neurological complications at 72 hours after TAVR, hospital discharge, and 30-day follow-up. A multivariate analysis was performed to identify the potential predictors of stroke. Of the 996 patients implanted with the Lotus Valve (mean age: 80.8 years, 50.8% female, STS score 6.0 ± 6.9), 92 cases (9.2%) used CEP. The overall rate of acute stroke/transient ischemic attack (TIA) was 3.0% at 72 hours after TAVR. The 72-hour stroke/TIA rate was 1.1% in patients who had CEP and 3.2% in those who did not. Use of CEP was associated with a 2.1% absolute reduction in the risk of acute neurological events (relative risk reduction: 65.6%), although the difference was not statistically significant (p=0.51). Repositioning of the Lotus Valve occurred in 313/996 procedures (31.4%). The 72-hour rate of stroke/TIA was similar in patients who had valve repositioning (2.9%) compared with those who did not (3.1%; p=0.86). The selective use of a CEP device in the RESPOND study was associated with a nonsignificantly lower risk for stroke within 72 hours. The use of the repositioning feature of the Lotus Valve did not increase the stroke risk.
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Abstract
Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to treat symptomatic severe aortic stenosis. The patient populations that have been shown to benefit from this procedure continue to grow with time. Techniques and technology in TAVR persistently advance with a continued trend toward improved outcomes for patients. In this review, we highlight the advances in vascular access, TAVR valve design, progress in reducing procedural complications, and emerging evidence in the field.
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Affiliation(s)
- Morgan H Randall
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Anthony A Bavry
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA.
- North Florida/South Georgia, Veterans Health System, Gainesville, FL, USA.
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Reardon MJ, Feldman TE, Meduri CU, Makkar RR, O'Hair D, Linke A, Kereiakes DJ, Waksman R, Babliaros V, Stoler RC, Mishkel GJ, Rizik DG, Iyer VS, Gleason TG, Tchétché D, Rovin JD, Lhermusier T, Carrié D, Hodson RW, Allocco DJ, Meredith IT. Two-Year Outcomes After Transcatheter Aortic Valve Replacement With Mechanical vs Self-expanding Valves: The REPRISE III Randomized Clinical Trial. JAMA Cardiol 2020; 4:223-229. [PMID: 30810703 DOI: 10.1001/jamacardio.2019.0091] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance To our knowledge, REPRISE III is the first large randomized comparison of 2 different transcatheter aortic valve replacement platforms: the mechanically expanded Lotus valve (Boston Scientific) and self-expanding CoreValve (Medtronic). Objective To evaluate outcomes of Lotus vs CoreValve after 2 years. Design, Setting, and Participants A total of 912 patients with high/extreme risk and severe, symptomatic aortic stenosis enrolled between September 22, 2014, and December 24, 2015, were randomized 2:1 to receive Lotus (607 [66.6%]) or CoreValve (305 [33.4%] at 55 centers in North America, Europe, and Australia. The first 2-year visit occurred on October 17, 2016, and the last was conducted on April 12, 2018. Clinical and echocardiographic assessments are complete through 2 years and will continue annually through 5 years. Main Outcomes and Measures All-cause mortality and all-cause mortality or disabling stroke at 2 years. Other clinical factors included overall stroke, disabling stroke, repeated procedures, rehospitalization, valve thrombosis, and pacemaker implantation. Echocardiographic analyses included effective orifice area, mean gradient, and paravalvular leaks (PVLs). Results Of 912 participants, the mean (SD) age was 82.8 (7.3) years, 465 (51%) were women, and the mean (SD) Society of Thoracic Surgeons predicted risk of mortality was 6.8% (4.0%). At 2 years, all-cause death was 21.3% with Lotus vs 22.5% with CoreValve (hazard ratio [HR], 0.94; 95% CI, 0.69-1.26; P = .67) and all-cause mortality or disabling stroke was 22.8% with Lotus and 27.0% with CoreValve (HR, 0.81; 95% CI, 0.61-1.07; P = .14). Overall stroke was 8.4% vs 11.4% (HR, 0.75; 95% CI, 0.48-1.17; P = .21); disabling stroke was more frequent with CoreValve vs Lotus (4.7% Lotus vs 8.6% CoreValve; HR, 0.53; 95% CI, 0.31-0.93; P = .02). More Lotus patients received a new permanent pacemaker (41.7% vs 26.1%; HR, 1.87; 95% CI, 1.41-2.49; P < .01) or had a valve thrombosis (3.0% vs 0.0%; P < .01) compared with CoreValve. More patients who received CoreValve experienced a repeated procedure (0.6% Lotus vs 2.9% CoreValve; HR, 0.19; 95% CI, 0.05-0.70; P < .01), valve migration (0.0% vs 0.7%; P = .05), or embolization (0.0% vs 2.0%; P < .01) than Lotus. Valve areas remained significantly larger and the mean gradient was lower with CoreValve than Lotus (valve area, mean [SD]: Lotus, 1.53 [0.49] cm2 vs CoreValve, 1.76 [0.51] cm2; P < .01; valve gradient, mean [SD]: Lotus, 13.0 [6.7] mm Hg vs 8.1 [3.7] mm Hg; P < .01). Moderate or greater PVL was more frequent with CoreValve (0.3% Lotus vs 3.8% CoreValve; P < .01) at 2 years. Larger improvements in New York Heart Association (NYHA) functional class were observed with Lotus compared with CoreValve (improved by ≥1 NYHA class: Lotus, 338 of 402 [84.1%] vs CoreValve, 143 of 189 [75.7%]; P = .01; improved by ≥2 NYHA classes: 122 of 402 [37.3%] vs 65 of 305 [21.3%]). Conclusions and Relevance After 2 years, all-cause mortality rates, mortality or disabling stroke were similar between Lotus and CoreValve. Disabling stroke, functional class, valve migration, and PVL favored the Lotus arm whereas valve hemodynamics, thrombosis, and new pacemaker implantation favored the CoreValve arm. Trial Registration clinicaltrials.gov Identifier: NCT02202434.
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Affiliation(s)
- Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Ted E Feldman
- Evanston Hospital Cardiology Division, Northshore University Health System, Evanston, Illinois
| | | | - Raj R Makkar
- Cedars-Sinai Heart Institute, Los Angeles, California
| | - Daniel O'Hair
- Aurora St Luke's Medical Center, Milwaukee, Wisconsin
| | - Axel Linke
- Heart Center Dresde, Dresden University Hospital, Dresden, Germany
| | - Dean J Kereiakes
- The Lindner Research Center, The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio
| | | | | | | | | | - David G Rizik
- HonorHealth, Scottsdale-Lincoln Health Network, Scottsdale, Arizona
| | - Vijay S Iyer
- Gates Vascular Institute, University at Buffalo, Buffalo, New York
| | - Thomas G Gleason
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Didier Tchétché
- Department of Internal Medicine/Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Joshua D Rovin
- Morton Plant Mease Healthcare System, Clearwater, Florida
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van Gils L, Van Mieghem NM. Transcatheter Aortic Valve Replacement with the Lotus Valve: Concept and Current State of the Data. Interv Cardiol Clin 2019; 8:393-402. [PMID: 31445723 DOI: 10.1016/j.iccl.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Multiple transcatheter heart valve iterations have created an interesting range of options with which to perform transcatheter aortic valve replacement. The Lotus valve has several attractive features. The ability to eradicate even mild paravalvular leak mirrors the outcomes of surgical aortic valve replacement. New design iterations of the Lotus valve and refined sizing algorithms may help mitigate the need for permanent pacemaker implantation and consolidate its best-in-class results in terms of paravalvular leak. Ongoing trials should help define the safety and efficacy of the Lotus transcatheter heart valve in contemporary practice.
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Affiliation(s)
- Lennart van Gils
- Department of Interventional Cardiology, Thoraxcenter, ErasmusMC, Room Rg-628, 's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, ErasmusMC, Room Rg-628, 's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands.
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Modolo R, Chang CC, Tateishi H, Miyazaki Y, Pighi M, Abdelghani M, Roos MA, Wolff Q, Wykrzykowska JJ, de Winter RJ, Piazza N, Richardt G, Abdel-Wahab M, Soliman OI, Onuma Y, Van Mieghem NM, Serruys PW. Quantitative aortography for assessing aortic regurgitation after transcatheter aortic valve implantation: results of the multicentre ASSESS-REGURGE Registry. EUROINTERVENTION 2019; 15:420-426. [DOI: 10.4244/eij-d-19-00362] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Latib A, Giannini F. Should We Look Beyond the Annulus to Improve Prosthesis Size Selection? JACC Cardiovasc Interv 2019; 12:1172-1174. [PMID: 31221308 DOI: 10.1016/j.jcin.2019.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, New York.
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
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Fujita B, Schmidt T, Bleiziffer S, Bauer T, Beckmann A, Bekeredjian R, Möllmann H, Walther T, Landwehr S, Hamm C, Beyersdorf F, Katus HA, Harringer W, Ensminger S, Frerker C. Impact of new pacemaker implantation following surgical and transcatheter aortic valve replacement on 1-year outcome. Eur J Cardiothorac Surg 2019; 57:151-159. [DOI: 10.1093/ejcts/ezz168] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 04/26/2019] [Accepted: 05/03/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
OBJECTIVES
The purpose of this study was to evaluate the incidence of new pacemaker implantation (NPMI) after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR), and investigate its influence on 1-year mortality.
METHODS
Patients who were enrolled in ‘The German Aortic Valve Registry’ undergoing isolated TAVR or SAVR between 2011 and 2015 were analysed. The rate of NPMI was analysed for both groups and multivariable Cox regression analysis was performed to investigate the possible independent association between NPMI and 1-year mortality.
RESULTS
Twenty thousand eight hundred and seventy-two patients who underwent TAVR and 17 750 patients who received SAVR were included in this study. The rate of NPMI was 16.6% after TAVR and 3.6% after SAVR. In the TAVR group, NPMI was associated with significantly increased 1-year mortality in univariable Cox regression analysis [hazard ratio (HR) 1.29, confidence interval (CI) 1.18–1.41; P < 0.001]. This association persisted after adjustment for confounding factors (HR 1.29, CI 1.16–1.43; P < 0.001). In the SAVR group, NPMI significantly increased 1-year mortality in univariable analysis as well (HR 1.55, CI 1.08–2.22; P = 0.02), whereas after multivariable adjustment, NPMI did not emerge as an independent risk factor (HR 1.29, 0.88–1.89; P = 0.19). NPMI was not associated with 30-day mortality in both procedure groups.
CONCLUSIONS
The rate of NPMI was markedly higher after TAVR compared with SAVR and was independently associated with 1-year mortality after TAVR, whereas this was not significant after SAVR. As 30-day mortality was not different for TAVR and SAVR, the subsequent procedure of an NPMI itself seems not to increase the risk of mortality.
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Affiliation(s)
- Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University of Schleswig-Holstein, Lübeck, Germany
| | - Tobias Schmidt
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
| | - Sabine Bleiziffer
- Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Timm Bauer
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Andreas Beckmann
- German Society of Thoracic, Cardiac and Vascular Surgery, Berlin, Germany
| | | | - Helge Möllmann
- Department of Internal Medicine I, St.-Johannes-Hospital, Dortmund, Germany
| | - Thomas Walther
- Department of Thoracic, Cardiac and Vascular Surgery, University of Frankfurt, Frankfurt, Germany
| | - Sandra Landwehr
- BQS Institute for Quality and Patient Safety, Düsseldorf, Germany
| | - Christian Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Medical Faculty of the University of Freiburg, Freiburg, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Wolfgang Harringer
- Department of Cardiac, Thoracic and Vascular Surgery, Klinikum Braunschweig, Brunswick, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University of Schleswig-Holstein, Lübeck, Germany
| | - Christian Frerker
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
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Conzelmann LO, Würth A, Balthasar V, Neuber C, Tzamalis P, Gonska BD, Schmitt C, Mehlhorn U, Schymik G. Transcatheter aortic valve implantation in severe calcified annulus using the Lotus valve system: Increased incidence of fatal major vascular complications. Catheter Cardiovasc Interv 2019; 95:E21-E29. [PMID: 31115146 DOI: 10.1002/ccd.28339] [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] [Received: 11/15/2018] [Accepted: 05/02/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study reports the outcome of a highly selected transcatheter aortic valve implantation (TAVI) population. BACKGROUND In patients with aortic valve stenosis and severe calcification of the left ventricular outflow tract and/or the annulus, the Boston Scientific Lotus valve provided a low paravalvular leakage rate omitting the risk of annular rupture. METHODS Until now more than 3,600 TAVI procedures were performed at our institution. Between 8/2015 and 2/2017, 634 TAVI procedures were performed, of which 80 TAVI patients with severe calcifications consecutively received the Lotus valve. Valve Academic Research Consortium (VARC)-2 criteria of these procedures were prospectively documented in our institutional TAVI registry. One year follow-up for the Lotus treated patients was completed. RESULTS Mean age was 82.0 ± 5.5 years. Device success was 95.0%. Conversion was required in two cases (2.5%). New permanent pacemaker implantation rate was 33.3%. Vascular complications occurred more frequent in comparison to non-Lotus treated patients (13.8 vs. 8.1%; p < .05): five minor and six major vascular complications (6.3 and 7.5%), including four fatal aortic injuries (three acute aortic dissections type A, one rupture of the aortic arch). Seventy-two-hour and 30-day mortality rates were also higher in Lotus patients (6.3 and 12.5% vs. 0.3 and 2.5%; each p < .05). One-year mortality in Lotus patients was 22.5%. CONCLUSIONS In TAVI procedures with the Lotus valve occurrence of vascular complications including lethal aortic injuries and mortality rates were considerably high. Furthermore, in every TAVI procedure careful examination of the aorta should be mandatory and be a part of planning it.
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Affiliation(s)
| | - Alexander Würth
- Medical Clinic III - Department of Cardiology, ViDia Clinics, Sankt Vincentius Hospital Karlsruhe, Karlsruhe, Germany
| | | | | | - Panagiotis Tzamalis
- Medical Clinic IV - Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Bernd-Dieter Gonska
- Medical Clinic III - Department of Cardiology, ViDia Clinics, Sankt Vincentius Hospital Karlsruhe, Karlsruhe, Germany
| | - Claus Schmitt
- Medical Clinic IV - Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Uwe Mehlhorn
- HELIOS Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany
| | - Gerhard Schymik
- Medical Clinic IV - Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
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Wendt D, Shehada SE, König L, Kahlert P, Frey U, Mourad F, Jakob H, Thielmann M, El Gabry M. Modified implantation height of the Sapien3™ transcatheter heart valve. MINIM INVASIV THER 2019; 29:70-77. [PMID: 31012785 DOI: 10.1080/13645706.2019.1599958] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Sharaf-Eldin Shehada
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Luisa König
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Philipp Kahlert
- Department of Cardiology, West German Heart and Vascular Center Essen, Essen, Germany
| | - Ulrich Frey
- Clinic for Anesthesiology and Intensive Care, University Hospital Essen, Essen, Germany
| | - Fanar Mourad
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Mohamed El Gabry
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
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Bourantas CV, Modolo R, Baumbach A, Søndergaard L, Prendergast BD, Ozkor M, Kennon S, Mathur A, Mullen MJ, Serruys PW. The evolution of device technology in transcatheter aortic valve implantation. EUROINTERVENTION 2019; 14:e1826-e1833. [PMID: 30719977 DOI: 10.4244/eij-d-18-01048] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has rapidly evolved and changed the landscape of structural interventional cardiology. Advances in transcatheter heart valve (THV) prostheses and TAVI-enabling devices have simplified the procedure, reduced the risk of complications, improved short- and long-term outcomes and broadened the applications of TAVI, not only in challenging patients and complex anatomies but also in intermediate-risk or even in low-risk patients, where surgical valve replacement constitutes an effective and well-established therapy. In this review article, we provide an overview of the developments in TAVI devices which have played a vital role in TAVI evolution: we describe the prostheses that failed to reach clinical practice, we present the characteristics of the first valves that were tested in the clinical arena, we summarise the evidence from the first studies that highlighted the potential but also the limitations of TAVI, and we present the advanced next-generation THV prostheses that have an improved performance and safety profile.
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Affiliation(s)
- Christos V Bourantas
- Department of Cardiology, Barts Heart Center, Barts Health NHS Trust, London, United Kingdom
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Asami M, Pilgrim T, Stortecky S, Heg D, Roost E, Windecker S, Hunziker L. Impact of valvular resistance on aortic regurgitation after transcatheter aortic valve replacement according to the type of prosthesis. Clin Res Cardiol 2019; 108:1343-1353. [PMID: 30929034 DOI: 10.1007/s00392-019-01469-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/22/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The impact of aortic valvular resistance (VR) on the degree of post-transcatheter aortic valve replacement (TAVR) aortic regurgitation (AR) remains unclear. The objective of the study was to investigate the relationship between VR and paravalvular AR after TAVR. METHODS Between August 2007 and December 2015, 708 TAVR patients had sufficient data to calculate VR before the intervention and were eligible for the present analysis. The patient population was dichotomized according to VR. The association between VR and post-TAVR AR was separately assessed by prosthesis type. RESULTS Among patients with low VR (LVR; < 238 dynes/cm5), 176 (49.7%) patients were treated with balloon-expandable (BE) valves and 178 (51.3%) patients with self-expandable (SE) transcatheter valves. Among patients with high VR (HVR ≥ 238), 147 (41.5%) and 207 (68.5%) patients received BE and SE, respectively. Baseline characteristics were similar in both groups irrespective of the type of valve. Patients with HVR had a 2.5-fold risk of ≥ moderate post-TAVR AR compared to patients with LVR. Both, HVR (HRadj 2.45, 95% CI 1.33-4.51) and the use of SE (HRadj 3.11, 95% CI 1.66-5.82), emerged as independent predictors of ≥ moderate post-TAVR AR. Moderate or greater post-AR was consistently predicted in patients treated with SE (HRadj 2.42, 95% CI 1.22-4.80) irrespective of the level of VR. CONCLUSIONS HVR is associated with a nearly 2.5-fold increased risk of moderate or greater post-TAVR AR and is an independent predictor of post-TAVR AR.
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Affiliation(s)
- Masahiko Asami
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland
| | - Dik Heg
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Eva Roost
- Department of Cardiac Surgery, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland.
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Berntorp K, Koul S, Nozohoor S, Harnek J, Bjursten H, Götberg M. Single-center evaluation of a next generation fully repositionable and retrievable transcatheter aortic valve replacement. BMC Cardiovasc Disord 2019; 19:44. [PMID: 30808296 PMCID: PMC6390309 DOI: 10.1186/s12872-019-1021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The mechanically expandable Lotus Valve System is a fully repositionable and retrievable valve with an adaptive seal to minimize paravalvular leak (PVL). The aim of this study was to evaluate the short- and long-term safety and efficacy of the new device with focus on a new implantation technique to reduce the need for a permanent pacemaker (PPM) post procedure. METHODS We performed a prospective single-center, non-randomized evaluation of the Lotus Valve System. The first 100 consecutive Lotus Valve implantations were included in the analysis. Outcome was assessed according to VARC2-criteria. Postoperative pacemaker rates were assessed using the national pacemaker registry and electronic medical records. Mortality at 30 days and 12 months were acquired from the national population registry. RESULTS Mean age was 82.7 ± 5.6 years, mean Euroscore I was 25.3 ± 14.5%, mean STS-score was 6.5 ± 4.1% and mean aortic valve area was 0.6 ± 0.1 cm2. There were no cases of valve embolization, ectopic valve deployment or additional valve implantation. Device success according to the VARC2-criteria was 97%. The 30-day mortality rate was 3%. Two deaths occurred due to stroke and one due to a ventricular rupture. Major stroke rate was 2% and major vascular complication rate was 2%. The 12-month mortality rate was 14%. At discharge 87% of patients had no/trace PVL, 12% had mild PVL and one patient had a moderate PVL. A total of 13% received a new PPM post valve implantation. Among patients who did not have a PPM before the procedure, the PPM rate was 15.3%. CONCLUSIONS This single-center evaluation of the Lotus Valve System demonstrated a good clinical outcome with a low mortality, in a high-risk population. Introduction of a new implantation technique resulted in lower PPM rates than previously reported without negatively affecting PVL. TRIAL REGISTRATION Current Controlled Trials ISRCTN14952278 , retrospectively registered 06/11/2017.
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Affiliation(s)
- Karolina Berntorp
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, 221-85, Lund, SE, Sweden.
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, 221-85, Lund, SE, Sweden
| | - Shahab Nozohoor
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, 221-85, Lund, SE, Sweden
| | - Jan Harnek
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, 221-85, Lund, SE, Sweden
| | - Henrik Bjursten
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, 221-85, Lund, SE, Sweden
| | - Matthias Götberg
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, 221-85, Lund, SE, Sweden
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Blackman DJ, Van Gils L, Bleiziffer S, Gerckens U, Petronio AS, Abdel-Wahab M, Werner N, Khogali SS, Wenaweser P, Wöhrle J, Soliman O, Laborde JC, Allocco DJ, Meredith IT, Falk V, Van Mieghem NM. Clinical outcomes of the Lotus Valve in patients with bicuspid aortic valve stenosis: An analysis from the RESPOND study. Catheter Cardiovasc Interv 2019; 93:1116-1123. [PMID: 30773838 PMCID: PMC6593645 DOI: 10.1002/ccd.28120] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 01/04/2019] [Accepted: 01/20/2019] [Indexed: 11/08/2022]
Abstract
AIMS Patients with bicuspid valves represent a challenging anatomical subgroup for transcatheter aortic valve implantation (TAVI). This analysis evaluated the clinical outcomes of the fully repositionable and retrievable Lotus Valve System in patients with bicuspid aortic valves enrolled in the RESPOND post-market registry. METHODS AND RESULTS The prospective, open-label RESPOND study enrolled 1,014 patients at 41 centers in Europe, New Zealand, and Latin America, 31 (3.1%) of whom had bicuspid aortic valves. The mean age in the bicuspid patient cohort was 76.4 years, 64.5% were male, and the baseline STS score was 6.0 ± 10.2. Procedural success was 100%, with no cases of malpositioning, valve migration, embolization, or valve-in-valve. Repositioning was attempted in 10 cases (32.3%). There was one death (3.2%) and one stroke (3.2%) at 30-day follow-up. Mean AV gradient was reduced from 48.7 ± 17.0 mmHg at baseline to 11.8 ± 5.1 mmHg at hospital discharge (P < 0.001); mean effective orifice area (EOA) was increased from 0.6 ± 0.2 cm2 to 1.7 ± 0.4 cm2 (P < 0.001). There were no cases of moderate or severe paravalvular leak (PVL) adjudicated by the core laboratory; four subjects (13.8%) had mild PVL, 5 (17.2%) had trace PVL. The rate of pacemaker (PM) implantation for PM-naïve patients was 22.2% (6/27). CONCLUSIONS Data from the RESPOND registry demonstrate good clinical and echocardiographic outcomes up to 1 year postimplantation in patients with bicuspid aortic valves using the repositionable Lotus Valve.
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Affiliation(s)
- Daniel J Blackman
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Lennart Van Gils
- Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, CE, Rotterdam, The Netherlands
| | - Sabine Bleiziffer
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Ulrich Gerckens
- Department of Cardiology, University of Rostock, Rostock, Germany
| | - Anna Sonia Petronio
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Nikos Werner
- Interventional Cardiology, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Saib S Khogali
- The Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Peter Wenaweser
- Swiss Cardiovascular Center Bern, University Hospital Bern, Bern, Switzerland
| | - Jochen Wöhrle
- Department of Internal Medicine II, University of Ulm, Germany
| | - Osama Soliman
- Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, CE, Rotterdam, The Netherlands
| | - Jean-Claude Laborde
- Department of Cardiology and Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom
| | - Dominic J Allocco
- Interventional Cardiology, Boston Scientific Corporation, Marlborough, Massachusetts
| | - Ian T Meredith
- Interventional Cardiology, Boston Scientific Corporation, Marlborough, Massachusetts
| | - Volkmar Falk
- Deutsches Herzzentrum Berlin, Klinik für Herz-Thorax-Gefässchirurgie, Berlin, Germany
| | - Nicolas M Van Mieghem
- Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, CE, Rotterdam, The Netherlands
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36
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Xu Q, Liu X, Jiang J, He Y, Zhu Q, Gao F, Du F, He W, Cheng J, Kong M, Pu Z, Zhou Q, Gooley R, Wang J. Transcatheter aortic valve replacement in atypical valve anatomy using the Lotus valve : A Chinese single-center experience. Herz 2019; 46:63-70. [PMID: 30694372 PMCID: PMC7862532 DOI: 10.1007/s00059-018-4778-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/28/2018] [Accepted: 12/09/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND In the West, the safety and efficacy of the Lotus valve have been demonstrated; however, data in the Chinese population are still lacking. Few studies have compared the clinical outcomes of transcatheter aortic valve replacement (TAVR) with the Lotus valve in patients with bicuspid or tricuspid aortic valve stenosis. Our aim was to assess TAVR outcomes with the Lotus aortic valve in a Chinese patient cohort. METHODS In total, 23 symptomatic, high-surgical risk patients with severe aortic valve stenosis were enrolled. Among them, nine patients (39%) had bicuspid aortic valves, and three patients had a large annulus dimension. The Lotus valve was successfully implanted in all patients. To facilitate accurate positioning, partial re-sheathing was attempted in ten patients (43.5%), while one patient had a full retrieval. One-year clinical follow-up was completed in all patients. RESULTS There were no deaths, strokes, or major adverse cardiac and cerebrovascular events in 22 of the 23 patients at 30 days; the all-cause mortality rate at 1 year was 4.4% (1 of 23 patients). The mean aortic valve gradient decreased from 51.5 ± 8.8 mm Hg at baseline to 13.4 ± 4.9 mm Hg (p < 0.001) and the valve area increased from 0.6 ± 0.2 cm2 to 1.5 ± 0.4 cm2 (p < 0.001) at 30 days. Paravalvular leakage was absent or mild (22%), and no patient had severe paravalvular leakage. Six patients (26.1%) required a postprocedural pacemaker. There was no difference regarding the procedural and the 1‑year outcomes between patients with bicuspid and tricuspid aortic valve stenosis. CONCLUSION Our single-center experience demonstrated that the Lotus valve is feasible and effective for Chinese patients with aortic valve stenosis, including atypical cases with bicuspid aortic valves or large aortic annulus size.
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Affiliation(s)
- Q Xu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - X Liu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - J Jiang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Y He
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Q Zhu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - F Gao
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - F Du
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - W He
- Department of Anesthesia, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - J Cheng
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - M Kong
- Department of Cardiac Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Z Pu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Q Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - R Gooley
- Monash Cardiovascular Research Centre, Monash University, Victoria, Clayton, Australia
| | - J Wang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China.
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The Lotus Valve Is Safe and Effective, But Will Atrioventricular Block Improve With the Next-Generation System? JACC Cardiovasc Interv 2019; 12:50-51. [PMID: 30621977 DOI: 10.1016/j.jcin.2018.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/13/2018] [Indexed: 11/20/2022]
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38
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Quantitative Assessment of Aortic Regurgitation After Transcatheter Aortic Valve Replacement With Videodensitometry in a Large, Real-World Study Population. JACC Cardiovasc Interv 2019; 12:216-218. [DOI: 10.1016/j.jcin.2018.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 11/18/2022]
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39
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Van Mieghem NM, Wöhrle J, Hildick-Smith D, Bleiziffer S, Blackman DJ, Abdel-Wahab M, Gerckens U, Linke A, Ince H, Wenaweser P, Allocco DJ, Meredith IT, Falk V. Use of a Repositionable and Fully Retrievable Aortic Valve in Routine Clinical Practice. JACC Cardiovasc Interv 2019; 12:38-49. [DOI: 10.1016/j.jcin.2018.10.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 11/29/2022]
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40
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Device Embolization in Structural Heart Interventions. JACC Cardiovasc Interv 2019; 12:113-126. [DOI: 10.1016/j.jcin.2018.08.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/16/2018] [Accepted: 08/21/2018] [Indexed: 12/31/2022]
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41
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Solomonica A, Choudhury T, Bagur R. Newer-generation of Edwards transcatheter aortic valve systems: SAPIEN 3, Centera, and SAPIEN 3 Ultra. Expert Rev Med Devices 2018; 16:81-87. [DOI: 10.1080/17434440.2019.1555465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Rodrigo Bagur
- London Health Sciences Centre, London, Canada
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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42
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del Val D, Ferreira-Neto AN, Asmarats L, Maes F, Guimaraes L, Junquera L, Wintzer J, Fischer Q, Barroso de Freitas Ferraz A, Puri R, Rodés-Cabau J. Transcatheter aortic valve replacement: relative safety and efficacy of the procedure with different devices. Expert Rev Med Devices 2018; 16:11-24. [DOI: 10.1080/17434440.2019.1552132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- David del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Lluis Asmarats
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Frédéric Maes
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Lucia Junquera
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Jérome Wintzer
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Quentin Fischer
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Rishi Puri
- Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
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43
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Solomonica A, Choudhury T, Bagur R. The mechanically expandable LOTUS Valve and LOTUS Edge transcatheter aortic valve systems. Expert Rev Med Devices 2018; 15:763-769. [DOI: 10.1080/17434440.2018.1536543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Amir Solomonica
- Cardiology Division, London Health Sciences Centre, London, Ontario, Canada
| | - Tawfiq Choudhury
- Cardiology Division, London Health Sciences Centre, London, Ontario, Canada
| | - Rodrigo Bagur
- Cardiology Division, London Health Sciences Centre, London, Ontario, Canada
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
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44
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Maisano F, Worthley S, Rodés-Cabau J, Linke AHP, Fichtlscherer S, Schäfer U, Makkar RR, Fontana G, Asch FM, Søndergaard L. Early commercial experience from transcatheter aortic valve implantation using the Portico™ bioprosthetic valve: 30-day outcomes in the multicentre PORTICO-1 study. EUROINTERVENTION 2018; 14:886-893. [DOI: 10.4244/eij-d-18-00343] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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45
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Yalta K, Gurdogan M, Zorkun C, Gurlertop Y. Mechanically expanding transcatheter aortic valves: pros and cons of a unique device technology. Cardiovasc Diagn Ther 2018; 8:538-542. [PMID: 30214873 DOI: 10.21037/cdt.2018.04.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kenan Yalta
- Department of Cardiology, Trakya University, Edirne, Turkey
| | | | - Cafer Zorkun
- Department of Cardiology, Trakya University, Edirne, Turkey
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46
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Barker CM, Reardon MJ. Transcatheter aortic valve replacement with the Lotus valve system. Future Cardiol 2018; 14:367-373. [PMID: 30141342 DOI: 10.2217/fca-2018-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Transcatheter aortic valve replacement has become an acceptable alternative to surgical aortic valve replacement in patients who are intermediate to high risk for surgery. The Lotus™ valve system (Boston Scientific, MA, USA) is an unique, mechanically expanded device. The system includes a braided nitinol frame and an adaptive seal to minimize paravalvular regurgitation. REPRISE III illustrated that among high-risk patients the use of the Lotus valve compared with a self-expanding valve did not result in inferior outcomes for the primary safety end point or the primary effectiveness end point. Future investigation of the Lotus valve system includes the use in low to intermediate risk patients with aortic stenosis as well as those with bicuspid aortic valves and mitral annular calcification.
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Affiliation(s)
- Colin M Barker
- Department of Cardiology and Reardon Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX 77030, USA
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47
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Seeger J, Virmani R, Romero M, Gonska B, Rottbauer W, Wöhrle J. Significant Differences in Debris Captured by the Sentinel Dual-Filter Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement Among Different Valve Types. JACC Cardiovasc Interv 2018; 11:1683-1693. [PMID: 30154060 DOI: 10.1016/j.jcin.2018.06.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/17/2018] [Accepted: 06/05/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the debris captured by the Claret Sentinel cerebral embolic dual-filter protection device during transfemoral transcatheter aortic valve replacement (TAVR) with different valve types. BACKGROUND Risk for embolization of debris during TAVR may vary by TAVR device. METHODS The filters of 100 consecutive patients were collected and captured debris was analyzed by histopathology and histomorphometry. Three valve types were implanted: the balloon-expandable Edwards SAPIEN 3 (n = 42), the self-expandable Medtronic Evolut R (n = 35), and the mechanically implantable Boston Scientific Lotus (n = 23). RESULTS Among the 3 groups there was no difference in baseline data, including Society of Thoracic Surgeons score for mortality, calcification, or pre-dilation. The type of captured debris did not differ among the 3 valve types in the proximal or distal filter. With the balloon-expandable valve, there were significantly more patients with large debris measuring ≥1,000 μm. The number of particles in the proximal filter was significantly lower with the Lotus (89.8 ± 106.3) compared with the Evolut R (187.3 ± 176.9) and Edwards SAPIEN 3 (172.3 ± 133.5) valves (p = 0.035). Total tissue area in the proximal filter was significantly smaller for the Lotus compared with the other 2 valve types (7.1 ± 6.3, 20.1 ± 19.0, and 21.3 ± 15.1 mm2; p = 0.0014). In contrast, for the distal filter, there were no differences with respect to valve type for total tissue area, particle size, and number of particles. CONCLUSIONS A significant difference was observed in the size and number of captured tissue particles with the double-filter embolic protection device among different valve types in patients undergoing TAVR. The largest particles were observed in patients treated with a balloon-expandable valve.
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Affiliation(s)
- Julia Seeger
- Department of Internal Medicine II, Cardiology, University of Ulm, Ulm, Germany
| | | | | | - Birgid Gonska
- Department of Internal Medicine II, Cardiology, University of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, Cardiology, University of Ulm, Ulm, Germany
| | - Jochen Wöhrle
- Department of Internal Medicine II, Cardiology, University of Ulm, Ulm, Germany.
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Mangieri A, Montalto C, Pagnesi M, Lanzillo G, Demir O, Testa L, Colombo A, Latib A. TAVI and Post Procedural Cardiac Conduction Abnormalities. Front Cardiovasc Med 2018; 5:85. [PMID: 30018969 PMCID: PMC6038729 DOI: 10.3389/fcvm.2018.00085] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/12/2018] [Indexed: 01/20/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a worldwide accepted alternative for treating patients at intermediate or high risk for surgery. In recent years, the rate of complications has markedly decreased except for new-onset atrioventricular and intraventricular conduction block that remains the most common complication after TAVI. Although procedural, clinical, and electrocardiographic predisposing factors have been identified as predictors of conduction disturbances, new strategies are needed to avoid such complications, particularly in the current TAVI era that is moving quickly toward the percutaneous treatment of low-risk patients. In this article, we will review the incidence, predictive factors, and clinical implications of conduction disturbances after TAVI.
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Affiliation(s)
| | | | | | | | - Ozan Demir
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Azeem Latib
- IRCCS San Raffaele Scientific Institute, Milan, Italy
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49
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Modolo R, Miyazaki Y, Chichareon P, Asano T, Collet C, Tenekecioglu E, Katagiri Y, Soliman O, Garg S, Onuma Y, Serruys PW. Interventional cardiology: review of the year 2017. EUROINTERVENTION 2018; 13:2083-2096. [PMID: 29437035 DOI: 10.4244/eij-d-18-00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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50
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van Rosendael PJ, Delgado V, Bax JJ. Pacemaker implantation rate after transcatheter aortic valve implantation with early and new-generation devices: a systematic review. Eur Heart J 2018; 39:2003-2013. [DOI: 10.1093/eurheartj/ehx785] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/17/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- Philippe J van Rosendael
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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