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Gómez-Herrero J, Fernandez-Cordón C, Gonzalez JC, García-Gómez M, Turrión SB, Serrador A, Gutiérrez H, Campo A, Cortés C, Sevilla T, Aristizabal C, Ruiz J, Campillo S, Baladrón C, Carrasco-Moraleja M, Román JAS, Amat-Santos IJ. TAV-in-TAV in patients with prosthesis embolization: Impact of commissural alignment and global outcomes. Int J Cardiol 2024; 410:132179. [PMID: 38761972 DOI: 10.1016/j.ijcard.2024.132179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Optimal strategies to manage embolization of transcatheter aortic valve implantation (TAVI) devices are unclear; valve-in-valve (ViV) is often used. We aimed to describe through one-single center experience its rate, causes, consequences, and management as well as the rate and relevance of commissural alignment (CA) in this context. METHODS We identified across 1038 TAVI cases, those cases requiring ViV for the management of first device embolization. CA (absence or mild misalignment) after first and second device was assessed by CT or fluoroscopy. RESULTS A total of 23 cases (2.2%) were identified, 52.3% embolized towards the aorta and 47.7% towards the ventricle. Suboptimal implant height (38%) and embolization at the time of post-dilation (23%) were the most frequent mechanisms together with greater rate of bicuspid valve (p < 0.001) and a trend to greater annular eccentricity. Procedural and 1-year death occurred in 13% and 34%, respectively (vs. 1.1% and 7.8% in the global cohort, p < 0.001). CA was present in 76.9% of the prostheses initially implanted but was only spontaneously achieved in 30.8% of the second ViV device. Adequate CA of both prostheses was identified in only two cases (8.7%). There were no cases of coronary obstruction. CONCLUSIONS TAVI device embolization mechanisms can often be predicted and prevented. Mortality following bail-out ViV is higher than in regular TAVI procedures but 2/3 of these patients survived beyond 1-year follow-up. In them, valve degeneration or coronary re-access might be particularly challenging since CA was rarely achieved with both devices suggesting that greater efforts should be made in this regard.
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Affiliation(s)
| | | | | | | | | | - Ana Serrador
- Cardiology Department, University Clinic Hospital, Valladolid, Spain; Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | | | - Alberto Campo
- Cardiology Department, University Clinic Hospital, Valladolid, Spain
| | - Carlos Cortés
- Cardiology Department, University Clinic Hospital, Valladolid, Spain
| | - Teresa Sevilla
- Cardiology Department, University Clinic Hospital, Valladolid, Spain; Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | | | - Julio Ruiz
- Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - Sofía Campillo
- Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - Carlos Baladrón
- Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - Manuel Carrasco-Moraleja
- Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - J Alberto San Román
- Cardiology Department, University Clinic Hospital, Valladolid, Spain; Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - Ignacio J Amat-Santos
- Cardiology Department, University Clinic Hospital, Valladolid, Spain; Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain.
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Garcia-Garcia JF, Gayosso-Ortiz JR, Muratalla-Gonzalez R, Fuentes-Moreno JC, Aquino-Bruno H. Valve-in-valve as a rescue treatment in retrograde migration of the transcatheter aortic valve to the left ventricle: a case report. Eur Heart J Case Rep 2023; 7:ytad554. [PMID: 38034936 PMCID: PMC10686530 DOI: 10.1093/ehjcr/ytad554] [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: 04/22/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
Background The treatment of choice for patients with severe symptomatic pure native aortic valve regurgitation (PNAVR) is surgical aortic valve replacement (SAVR). However, not all patients are candidates for surgery because of comorbidities or are deemed high risk for surgery. In such cases, transcatheter aortic valve replacement (TAVR) has proved to be better than medical treatment. Case summary A 78-year-old male with a history of ankylosing spondylitis was admitted with New York Heart Association III heart failure. The echocardiogram showed severe aortic regurgitation and a left ventricular ejection fraction of 52%. Because of high surgical risk and being refractory to medical RX, he was accepted for TAVR. The tomography of anatomical characteristics reported the absence of calcium and dilation of the aortic ring and aortic root. During the TAVR procedure, the patient experienced valve migration, but it was autonomously repositioned in the aortic annulus. As a rescue measure, a second valve was placed. Here, we present a case of valve migration to the left ventricle treated with a valve-in-valve procedure without the need for surgical treatment. Discussion The absence of annulus calcification in PNAVR increases the risk of post-TAVR paravalvular leak and device embolization. Valve migration generally requires valve recovery and conversion to SAVR.
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Affiliation(s)
- Juan F Garcia-Garcia
- Interventional Cardiology Service, General Hospital of Mexico, Dr. Balmis 148, Col. Doctores, Cuauhtémoc, 06720 Mexico City, Mexico
- Interventional Cardiology Service, National Medical Center "November 20", Av. Felix Cuevas #540, Col. Del Valle Del. Benito Juarez, Mexico City 03100, Mexico
| | - Jose R Gayosso-Ortiz
- Interventional Cardiology Service, General Hospital of Mexico, Dr. Balmis 148, Col. Doctores, Cuauhtémoc, 06720 Mexico City, Mexico
| | - Roberto Muratalla-Gonzalez
- Interventional Cardiology Service, National Medical Center "November 20", Av. Felix Cuevas #540, Col. Del Valle Del. Benito Juarez, Mexico City 03100, Mexico
| | - Juan C Fuentes-Moreno
- Interventional Cardiology Service, National Medical Center "November 20", Av. Felix Cuevas #540, Col. Del Valle Del. Benito Juarez, Mexico City 03100, Mexico
| | - Heberto Aquino-Bruno
- Interventional Cardiology Service, National Medical Center "November 20", Av. Felix Cuevas #540, Col. Del Valle Del. Benito Juarez, Mexico City 03100, Mexico
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Wang Y, Yu S, Qian D, Li J, Fang Z, Cheng W, Li X, Liu T, Zeng Y, Xia H, Jin J. Anatomic predictor of severe prosthesis malposition following transcatheter aortic valve replacement with self- expandable Venus-A Valve among pure aortic regurgitation: A multicenter retrospective study. Front Cardiovasc Med 2022; 9:1002071. [PMID: 36568558 PMCID: PMC9775278 DOI: 10.3389/fcvm.2022.1002071] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Background Transcatheter aortic valve replacement (TAVR) in the treatment of patients with pure native aortic valve regurgitation (NAVR) has been based on the "off-label" indications, while the absence of aortic valve calcification and difficulty in anchoring was found to significantly increase the risk of prosthesis malposition. The aim of this study was to explore the anatomical predictors of severe prosthesis malposition following TAVR with the self-expandable Venus-A Valve among patients with NAVR. Methods A total of 62 patients with NAVR who underwent TAVR with Venus-A Valve at four Chinese clinical centers were retrospectively observed. The clinical features, aortic multidetector computed tomography (MDCT) data, and clinical outcomes were compared between non-/mild malposition and severe malposition groups. Univariate logistic regression analysis was used to identify the risk factors of severe prosthesis malposition, and the receiver operating characteristic (ROC) curve was used to explore the predictive value of the risk factors. Results Valve migration to ascending aortic direction occurred in 1 patient, and the remaining 61 patients (including 19 severe malposition cases and 42 non-/mild malposition cases) were included in the analysis. The diameter and height of the sinotubular junction (STJ) and STJ cover index (STJCI, calculated as 100%*STJ diameter/nominal prosthesis crown diameter) were all greater in the severe malposition group (all p < 0.05). Logistic regression showed that STJ diameter (OR = 1.23, 95% CI 1.04-1.47, p = 0.017), STJ height (OR = 1.24, 95% CI 1.04-1.47, p = 0.017), and STJCI (OR = 1.08, 95% CI 1.01-1.16, p = 0.032) were potential predictors for severe prosthesis malposition. The area under the ROC curve was 0.72 (95% CI 0.58-0.85, p = 0.008) for STJ diameter, 0.70 (95% CI 0.55-0.86, p = 0.012) for STJ height, and 0.69 (95% CI 0.55-0.83, p = 0.017) for STJCI, respectively. The cutoff value was 33.2 mm for STJ diameter (sensitivity was 84.2% and specificity was 65.8%), 24.1 mm for STJ height (sensitivity was 57.9% and specificity was 87.8%), and 81.0% for STJCI (sensitivity was 68.4% and specificity was 68.3%), respectively. Conclusion Larger and higher STJ, as well as greater STJ to valve crown diameter ratio, may help identify patients at high risk for severe prosthesis malposition among patients with NAVR undergoing TAVR with Venus-A prosthesis valve.
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Affiliation(s)
- Yong Wang
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Shiyong Yu
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Dehui Qian
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jie Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhenfei Fang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Cheng
- Department of Cardiac Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xiaoqing Li
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ting Liu
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ying Zeng
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Hongmei Xia
- Department of Ultrasound, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jun Jin
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China,*Correspondence: Jun Jin,
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Ghandour A, Bassawon R, Langlois H, Ergina PL, Shum-Tim D. Migration despite stabilization of an embolized transcatheter heart valve: A word of caution. J Card Surg 2022; 37:5588-5590. [PMID: 36335637 DOI: 10.1111/jocs.17141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/27/2022] [Indexed: 11/08/2022]
Abstract
This case report describes an initially stabilized transcatheter heart valve that embolized in the ascending aorta, leading to a postprocedural acute type A aortic dissection.
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Affiliation(s)
- Amale Ghandour
- Department of Surgery, Division of Cardiac Surgery, McGill University Health Centre, Montreal, Québec, Canada
| | - Rayhaan Bassawon
- Department of Surgery, Division of Cardiac Surgery, McGill University Health Centre, Montreal, Québec, Canada
| | - Hugo Langlois
- Department of Surgery, Division of Cardiac Surgery, McGill University Health Centre, Montreal, Québec, Canada
| | - Patrick L Ergina
- Department of Surgery, Division of Cardiac Surgery, McGill University Health Centre, Montreal, Québec, Canada
| | - Dominique Shum-Tim
- Department of Surgery, Division of Cardiac Surgery, McGill University Health Centre, Montreal, Québec, Canada
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Mehrotra S, Shetty DP, Govind SC, Shetty GG, Sane PS, Narayan P. Transcatheter Aortic Valve Implantation in the Descending Aorta: History Revisited! INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:452-455. [DOI: 10.1177/15569845221128799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An elderly patient with significant aortic regurgitation presented with heart failure. Dilation of the aortic root precluded a transcatheter anatomic site valve implantation, and prohibitive operative risk ruled against surgical implantation. A bail-out transcatheter implantation of the aortic valve in the descending aorta was successfully carried out with satisfactory outcomes.
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Affiliation(s)
- Sanjay Mehrotra
- Department of Cardiology, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Devi P. Shetty
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Satish C. Govind
- Department of Noninvasive Cardiology, Narayana Institute of Cardiac Sciences, Bangalore, India
| | | | - Pratik Sudhir Sane
- Department of Cardiology, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Pradeep Narayan
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Bangalore, India
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Yasmin F, Najeeb H, Fareed Siddiqui H, Hamayl Zeeshan M, Mehdi A, Sohaib Asghar M, Shaikh A, Aamir M. Mitral Valve Replacement: A Review of Current Practices and Considerations in Low and High-Risk Patients. Curr Probl Cardiol 2022; 48:101413. [PMID: 36155202 DOI: 10.1016/j.cpcardiol.2022.101413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/08/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
Mitral Regurgitation (MR) is the most common form of severe valvular disease occurring in developed countries, being caused either primarily on its own or secondary to cardiac disease. Surgical intervention is required for the correction of MR, which could include the replacement or repair of the affected valve. Transcatheter Mitral Valve Replacement (TMVR) in selected patients is of increasing importance, especially after the success of Transcatheter Aortic Valve Replacement (TAVR). TMVR can be divided into three types i.e., valve-in-valve (ViV) for severe mitral valve disease, valve-in-ring (ViR) for failed surgical repairs, and valve-in-mitral annular calcifications (ViMAC) for mitral valvular disease with severe mitral annular calcifications and poor surgical criteria. The FDA approved Mitral ViV for patients with a high surgical risk in 2017, while ViR and ViMAC are still currently under consideration. The SAPIEN M3 valve is relatively new with a trans-septal system, with a success rate of 86%, and no mortality in a 30-day outcome. The Cardiovalve is a bovine pericardium device that has a dual nitinol frame with a custom surgical design to facilitate TMVR. The AHEAD trial will evaluate whether the device is safe to use in a clinical setting and how effective it is for reducing MR in these patients. The trial consists of 30 patients in which the first 5 patients showed 100% technical success and a reduction of MR. This evolution of modern medicine has assisted in many different countries, including Pakistan where there is a higher prevalence of MR and hence, a greater need to apply TMVR in clinical practice.
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Affiliation(s)
- Farah Yasmin
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hala Najeeb
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hasan Fareed Siddiqui
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Asad Mehdi
- Department of Medicine, Civil Hospital Sukkur, Sukkur, Pakistan
| | | | - Asim Shaikh
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Aamir
- Department of Cardiovascular Medicine, Lehigh Valley Heart and Vascular Institute, Philadelphia, PA, USA
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Castro-Mejía AF, Amat-Santos I, Ortega-Armas ME, Baz JA, Moreno R, Diaz J, Travieso A, Jimenez-Quevedo P, Santos-Martínez S, McInerney A, Galeote G, Díaz VAJ, Garrido JR, Tirado-Conte G, Barrero A, Marroquin L, Nuñez-Gil I, Gonzalo N, Fernandez-Ortiz A, Escaned J, Nombela-Franco L. Development of atrioventricular and intraventricular conduction disturbances in patients undergoing transcatheter aortic valve replacement with new generation self-expanding valves: A real world multicenter analysis. Int J Cardiol 2022; 362:128-136. [PMID: 35550389 DOI: 10.1016/j.ijcard.2022.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 05/01/2022] [Accepted: 05/06/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND High degree cardiac conduction disturbances (HDCD) remain a major complication after transcatheter aortic valve replacement (TAVR), especially with self-expandable valves (SEV). Our aim was to investigate peri-procedural and in-hospital modification of atrioventricular and intracardiac conduction associated to new generation SEV implantation, and the development of new HDCD resulting in permanent pacemaker implantation (PPM) in patients undergoing TAVR. METHODS AND RESULTS Three-hundred forty-four consecutive patients with severe aortic stenosis who underwent TAVR with a new generation SEV [Evolut-R/Pro (n = 130), Acurate-neo (n = 79), Portico (n = 75) and Allegra (n = 60)] were included. An analysis of baseline, post-TAVR and pre-discharge ECG and procedural aspects were centrally performed. A significant increase in baseline PR interval (169.6 ± 28.2 ms) and QRS complex width (101.7 ± 25.9 ms) was noted immediately post-TAVR (188.04 ± 34.49; 129.55 ± 30.02 ms), with a partial in-hospital reversal (179.4 ± 30.1; 123.06 ± 30.94 ms), resulting in a net increase at hospital discharge of 12.6 ± 38.8 ms and 21.4 ± 31.6 ms (p < 0.001), respectively. The global incidence of new onset persistent HDCD at hospital discharge was 46.3%, with 17.7% of patients requiring PPM. Independent predictors of new onset HCDC at hospital discharge were valve recapture (OR: 2.8; 95% IC: 1.1-7.2, p = 0.033) and implantation depth ≥ 6 mm (OR: 1.9 05% IC 1.1-3.3, p = 0.015), while higher implantation (<3 mm (OR: 0.3, 95% IC 0.1-0.7, p = 0.014) and use of Acurate-Neo valve (OR: 0.4; 95% IC 0.2-0.8, p = 0.009) were protective factor. CONCLUSIONS New generation self-expanding aortic valves were associated with a significant increase in PR and QRS interval at hospital discharge leading to a very high rate of HDCD. While valve recapture and implantation depth were independent predictors for the occurrence of HDCD, use of Accurate-Neo valve was a protective factor.
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Affiliation(s)
- Alex F Castro-Mejía
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Ignacio Amat-Santos
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Maria E Ortega-Armas
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Jose A Baz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Raúl Moreno
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Jose Diaz
- Hospital Juan Ramón Jimenez, Huelva, Spain
| | - Alejandro Travieso
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Pilar Jimenez-Quevedo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Sandra Santos-Martínez
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Angela McInerney
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Guillermo Galeote
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Victor Alfonso Jimenez Díaz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | | | - Gabriela Tirado-Conte
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Alejandro Barrero
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Luis Marroquin
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Ivan Nuñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Nieves Gonzalo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Fernandez-Ortiz
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain.
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Singh A, Garg V, Mehta Y. Migration and surgical retrieval of transcatheter aortic valve. Indian J Thorac Cardiovasc Surg 2022; 38:71-74. [PMID: 34898879 PMCID: PMC8630283 DOI: 10.1007/s12055-021-01252-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/16/2021] [Accepted: 08/08/2021] [Indexed: 01/03/2023] Open
Abstract
Migration of transcatheter aortic valve can occur during or after the deployment of the valve. We report a case of the migrated transcatheter aortic valve that required surgical intervention for its removal. The case highlights the importance of the availability of a cardiac surgical team and cardiopulmonary bypass machine when the percutaneous technique of retrieval is not feasible.
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Affiliation(s)
- Ajmer Singh
- Department of Cardiac Anaesthesia, Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Sector-38, Gurugram, Haryana 122001 India
| | - Vinit Garg
- Department of Cardiac Anaesthesia, Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Sector-38, Gurugram, Haryana 122001 India
| | - Yatin Mehta
- Department of Cardiac Anaesthesia, Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Sector-38, Gurugram, Haryana 122001 India
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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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10
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Kargoli F, Pagnesi M, Rahgozar K, Goldberg Y, Ho E, Chau M, Colombo A, Latib A. Current Devices and Complications Related to Transcatheter Mitral Valve Replacement: The Bumpy Road to the Top. Front Cardiovasc Med 2021; 8:639058. [PMID: 34179126 PMCID: PMC8230552 DOI: 10.3389/fcvm.2021.639058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
Mitral regurgitation is the most common valvular lesion in the developed world, with increasing prevalence, morbidity, and mortality. The experience with surgical mitral valve repair or replacement is very well-validated. However, more than 45% of these patients get denied surgery due to an elevated risk profile and advanced disease of the left ventricle at the time of presentation, promoting the need for less invasive transcatheter options such as transcatheter repair and transcatheter mitral valve replacement (TMVR). Early available TMVR studies have shown promising results, and several dedicated devices are under clinical evaluation. However, TMVR is still in the early developmental stages and is associated with a non-negligible risk of periprocedural and post-procedural complications. In this review, we discuss the current challenges facing TMVR and the potential TMVR-related complications, offering an overview on the measures implemented to mitigate these complications, and future implications.
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Affiliation(s)
- Faraj Kargoli
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Matteo Pagnesi
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Kusha Rahgozar
- Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Ythan Goldberg
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Edwin Ho
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Mei Chau
- Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
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Intraprocedural cardiac complications of transcatheter aortic and mitral valve interventions: "The eyes do not see what the mind does not know". CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:144-152. [PMID: 34053872 DOI: 10.1016/j.carrev.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/06/2021] [Accepted: 05/03/2021] [Indexed: 11/20/2022]
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Surgical challenges in retrieval of an embolized transcatheter valve from the aorta. Ann Thorac Surg 2021; 112:e325-e328. [PMID: 33662309 DOI: 10.1016/j.athoracsur.2021.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 11/21/2022]
Abstract
Embolization of a transcatheter aortic valve is a rare complication. Surgery is required if percutaneous retrieval is not possible. We present a case of embolization of an evolut R device (Medtronic, Minneapolis, Minnesota) into the ascending aorta. This device due to its taller profile presents unique surgical challenges in retrieval with respect to arterial access and cross clamping of the aorta. Prior knowledge of the profile of the various devices is critical in order to ensure a safe retrieval and smooth conduct of the operation.
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Lüscher TF. TAVI is on the move! How it compares with surgery and what complications we still have to consider. Eur Heart J 2019; 40:3129-3133. [DOI: 10.1093/eurheartj/ehz733] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK
- Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland
- Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, Zurich, Switzerland
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