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Chew NWS, Soh RYH, Kong G, Lim Y, Kuntjoro I. Off-label transcatheter aortic valve-in-valve implantation in severe bioprosthetic aortic valve dysfunction after bioprosthetic Bentall operation: a scoping review, case study and proposed approach. Singapore Med J 2024; 65:415-420. [PMID: 38973191 PMCID: PMC11321543 DOI: 10.4103/singaporemedj.smj-2022-168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/16/2022] [Indexed: 07/09/2024]
Affiliation(s)
- Nicholas Wen-Sheng Chew
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Rodney Yu-Hang Soh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yinghao Lim
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ivandito Kuntjoro
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Ferrari E, Stortecky S, Heg D, Muller O, Nietlispach F, Tueller D, Toggweiler S, Noble S, Maisano F, Roffi M, Jeger R, Grünenfelder J, Huber C, Windecker S, Wenaweser P. The hospital results and 1-year outcomes of transcatheter aortic valve-in-valve procedures and transcatheter aortic valve implantations in the native valves: the results from the Swiss-TAVI Registry. Eur J Cardiothorac Surg 2019; 56:55-63. [DOI: 10.1093/ejcts/ezy471] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/09/2018] [Accepted: 12/13/2018] [Indexed: 12/15/2022] Open
Abstract
Abstract
OBJECTIVES
The SwissTAVI Registry includes all consecutive patients undergoing transcatheter aortic valve implantation (TAVI) and valve-in-valve (VinV) procedures for a failed bioprosthesis in Switzerland. We report the real world, all-comers, 30-day and 1-year outcomes of patients undergoing VinV and standard TAVI procedures.
METHODS
Prospectively collected data from the 2 groups (VinV and standard TAVI patients) were retrospectively analysed. In an adjusted analysis, in-hospital and 1-year outcomes of VinV patients were compared with those of patients undergoing TAVI for native aortic valve disease in the same registry. A subanalysis of VinV procedures in stenotic or regurgitant bioprosthesis was also performed.
RESULTS
Between February 2011 and December 2016, 4599 and 157 consecutive patients underwent TAVI in native aortic valves and VinV procedures in degenerate bioprosthesis, respectively. VinV patients were younger (78 ± 9.1 years vs 82.2 ± 6.3 years; P < 0.001) but at a higher risk for surgery (the logistic EuroSCORE: 28.48 ± 15.3% vs 18.2 ± 13.6%; P < 0.001; the Society of Thoracic Surgery (STS) score: 6.4 ± 5% vs 5.5 ± 4.3%; P = 0.008). Valve predilatation was less frequently performed during VinV procedures (22.9% vs 69.1%; P < 0.001), and the hospital stay was shorter after VinV procedure (8.46 ± 4.2 days vs 9.83 ± 6 days; P = 0.005). VinV patients showed higher predischarge transvalvular mean gradients (14.14 ± 7.9 mmHg vs 8.42 ± 5.0 mmHg; P < 0.001), smaller mean valve surface area (1.54 ± 0.7 cm2 vs 1.83 ± 0.5 cm2; P < 0.001) and a lower risk of moderate/severe paravalvular leak (1.3% vs 5%). Post-procedural kidney injury (1.3% vs 4.8%; P = 0.06) and new pacemakers for conduction abnormalities (3.3% vs 18.5%; P < 0.001) were higher after TAVI. All-cause mortality and cardiovascular mortality at 30 days were similar between the 2 groups (1.9% vs 3.8%; P = 0.242 and 1.9% vs 3.4%; P = 0.321), whereas after 1 year, all-cause mortality was lower for VinV patients (6.8% vs 13%; P = 0.035). The bioprosthetic valve size correlated inversely with postoperative gradients after VinV procedures.
CONCLUSIONS
VinV aortic procedures showed favourable 30-day and 1-year clinical outcomes compared with TAVI procedures for the native aortic valve disease. Despite higher transvalvular mean gradients following VinV implants, this appears not to impact the early clinical outcomes.
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Affiliation(s)
- Enrico Ferrari
- Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
| | - Dik Heg
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology and Cardiovascular Surgery, Zurich University Hospital, Zurich, Switzerland
| | - David Tueller
- Department of Cardiology, Triemlispital, Zurich, Switzerland
| | | | - Stéphane Noble
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - Francesco Maisano
- Department of Cardiology and Cardiovascular Surgery, Zurich University Hospital, Zurich, Switzerland
| | - Marco Roffi
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - Raban Jeger
- Department of Cardiology, Basel University Hospital, Basel, Switzerland
| | | | - Christoph Huber
- Department of Cardiovascular Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
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Affiliation(s)
- Fabien Praz
- Department of Cardiology, Bern University Hospital, Switzerland (F.P.)
| | - Peter Wenaweser
- Heart Clinic Hirslanden, Hirslanden Clinic Zurich, and Bern University Hospital, Switzerland (P.W.)
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Watanabe M, Takahashi S, Yamaoka H, Sueda T, Piperata A, Zirphile X, Leroux L, Peltan J, Labrousse L. Comparison of Transcarotid vs. Transfemoral Transcatheter Aortic Valve Implantation. Circ J 2018; 82:2518-2522. [DOI: 10.1253/circj.cj-18-0530] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University Hospital
| | - Hironori Yamaoka
- Department of Cardiovascular Surgery, Hiroshima University Hospital
| | - Taijiro Sueda
- Department of Cardiovascular Surgery, Hiroshima University Hospital
| | | | | | - Lionel Leroux
- Hôpital Haut-Lévèque, Bordeaux Heart University Hospital
| | - Julien Peltan
- Hôpital Haut-Lévèque, Bordeaux Heart University Hospital
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Reul RM, Ramchandani MK, Reardon MJ. Transcatheter Aortic Valve-in-Valve Procedure in Patients with Bioprosthetic Structural Valve Deterioration. Methodist Debakey Cardiovasc J 2018; 13:132-141. [PMID: 29743998 DOI: 10.14797/mdcj-13-3-132] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Surgical aortic valve replacement is the gold standard procedure to treat patients with severe, symptomatic aortic valve stenosis or insufficiency. Bioprosthetic valves are used for surgical aortic valve replacement with a much greater prevalence than mechanical valves. However, bioprosthetic valves may fail over time because of structural valve deterioration; this often requires intervention due to severe bioprosthetic valve stenosis or regurgitation or a combination of both. In select patients, transcatheter aortic valve replacement is an alternative to surgical aortic valve replacement. Transcatheter valve-in-valve (ViV) replacement is performed by implanting a transcatheter heart valve within a failing bioprosthetic valve. The transcatheter ViV operation is a less invasive procedure compared with reoperative surgical aortic valve replacement, but it has been associated with specific complications and requires extensive preoperative work-up and planning by the heart team. Data from experimental studies and analyses of results from clinical procedures have led to strategies to improve outcomes of these procedures. The type, size, and implant position of the transcatheter valve can be optimized for individual patients with knowledge of detailed dimensions of the surgical valve and radiographic and echocardiographic measurements of the patient's anatomy. Understanding the complexities of the ViV procedure can lead surgeons to make choices during the original surgical valve implantation that can make a future ViV operation more technically feasible years before it is required.
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Affiliation(s)
- Ross M Reul
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Mahesh K Ramchandani
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Michael J Reardon
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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Transcarotid transcatheter aortic valve implantation: A systematic review. J Cardiol 2018; 71:525-533. [DOI: 10.1016/j.jjcc.2018.01.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/15/2017] [Accepted: 01/11/2018] [Indexed: 12/22/2022]
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Steiner JM, Cooper S, Kirkpatrick JN. Palliative care in end-stage valvular heart disease. Heart 2017; 103:1233-1237. [PMID: 28747535 DOI: 10.1136/heartjnl-2016-310538] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/30/2017] [Accepted: 03/31/2017] [Indexed: 02/07/2023] Open
Abstract
Valvular heart disease (VHD), particularly aortic valve disease, is prevalent with increasing incidence. When surgery is not possible, or when risks outweigh benefits, percutaneous treatment options may offer effective alternatives. However, procedures may not always go as planned, and frail patients or those whose symptoms are caused by other comorbidities may not benefit from valve intervention at all. Significant effort should be made to assess frailty, comorbidities and patient goals prior to intervention. Palliative care (PC) should play a critical role in the care of patients with severe valve disease. PC is specialised medical care that aims to optimise health-related quality of life by managing symptoms and clarifying patient values and goals of care. It should be implemented at the time of diagnosis and continue throughout the disease course. Because of the paucity of studies dedicated to the provision of PC to patients with advanced VHD, further research is needed.
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Affiliation(s)
- Jill M Steiner
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Stephanie Cooper
- Division of Cardiology, University of Washington, Seattle, Washington, USA.,Division of Cardiology, Harborview Medical Center, Seattle, Washington, USA
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Folliguet T, Laurent N, Bertram M, Zannis K, Elfarra M, Vanhuyse F, Maureira P, Modine T. Transcarotid transcatheter aortic valve implantation: multicentre experience in France. Eur J Cardiothorac Surg 2017; 53:157-161. [DOI: 10.1093/ejcts/ezx264] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/27/2017] [Indexed: 11/14/2022] Open
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Kallinikou Z, Berger A, Ruchat P, Khatchatourov G, Fleisch I, Korkodelovic B, Henchoz E, Marti RA, Cook S, Togni M, Goy JJ. Transcutaneous aortic valve implantation using the carotid artery access: Feasibility and clinical outcomes. Arch Cardiovasc Dis 2017; 110:389-394. [PMID: 28433509 DOI: 10.1016/j.acvd.2016.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/19/2016] [Accepted: 10/13/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transcarotid access is an alternative route for transcutaneous aortic valve implantation (TAVI) in patients with impossible transfemoral access. AIMS We evaluated the safety, effectiveness and early and late clinical outcomes of CoreValve® implantation via the common carotid artery. METHODS Eighteen patients (10 men, 8 women; mean age 84±5 years) at high surgical risk (mean EuroSCORE II 16±13%) with significant peripheral artery disease underwent TAVI via common carotid artery access under general anaesthesia. Mean aortic valve area was 0.64±0.13cm2 (0.36±0.07cm2/m2). RESULTS At a mean follow-up of 605±352 days, two patients (11%) had died in hospital, on days 6 and 20, as a result of sepsis with multiorgan failure (n=1) or pneumonia (n=1). There were no perioperative deaths, myocardial infarctions or strokes. Perioperative prosthesis embolization occurred in one patient (6%), requiring implantation of a second valve. In-hospital complications occurred in four patients (23%): blood transfusion for transient significant bleeding at the access site in one patient (6%); permanent pacemaker implantation in two patients (11%); and pericardial drainage in one patient (6%). The rate of event-free in-hospital stay was 66%. Post-procedural echocardiography showed very good haemodynamic performance, with a mean gradient of 8±3mmHg. Moderate paravalvular leak was present in one patient (6%). Mean intensive care unit stay was 48±31h; mean in-hospital stay was 7±3 days. CONCLUSION TAVI performed by transcarotid access in this small series of severely ill patients was associated with a low incidence of complications, which were associated with the procedure itself rather than the access route.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Stéphane Cook
- Department of Cardiology, University and Hospital of Fribourg, Switzerland; Clinique Cecil, Lausanne, Switzerland
| | - Mario Togni
- Department of Cardiology, University and Hospital of Fribourg, Switzerland; Clinique Cecil, Lausanne, Switzerland
| | - Jean-Jacques Goy
- Department of Cardiology, University and Hospital of Fribourg, Switzerland; Clinique Cecil, Lausanne, Switzerland.
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Stonier T, Harrison M, Choong AM. A systematic review of transcatheter aortic valve implantation via carotid artery access. Int J Cardiol 2016; 219:41-55. [DOI: 10.1016/j.ijcard.2016.05.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
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Gallo M, Dvir D, Demertzis S, Pedrazzini G, Berdajs D, Ferrari E. Transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic and mitral valves. Expert Rev Med Devices 2016; 13:749-58. [DOI: 10.1080/17434440.2016.1207521] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Chiam PTL, Ewe SH. The expanding indications of transcatheter aortic valve implantation. Future Cardiol 2016; 12:209-19. [PMID: 26916608 DOI: 10.2217/fca.15.86] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI), also known as transcatheter aortic valve replacement, is increasingly performed worldwide and is a technology that is here to stay. It has become the treatment of choice for inoperable patients and an alternative option for patients at high surgical risk with severe aortic stenosis. Early results of TAVI in intermediate-risk patients appear promising although larger randomized trial results are awaited before the widespread adoption of this technology in this big pool of patients. In patients with bicuspid aortic stenosis and degenerated surgical bioprostheses, TAVI has been shown to be feasible and relatively safe, though certain important considerations remain. Indications for TAVI are likely to grow as newer generation and improved devices and delivery systems become available.
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Affiliation(s)
- Paul T L Chiam
- The Heart & Vascular Centre, Mount Elizabeth Hospital, 3 Mount Elizabeth, 228510, Singapore.,National University of Singapore, Yong Loo Lin School of Medicine, 1E Kent Ridge Rd 119228, NUHS Tower Block, Level 11, 117597, Singapore
| | - See Hooi Ewe
- Department of Cardiology, National Heart Centre, 5 Hospital Dr, 169609, Singapore
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O'Sullivan CJ, Wenaweser P. Optimizing clinical outcomes of transcatheter aortic valve implantation patients with comorbidities. Expert Rev Cardiovasc Ther 2015; 13:1419-32. [PMID: 26479904 DOI: 10.1586/14779072.2015.1102056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) has revolutionized the management of high-risk or inoperable patients presenting with symptomatic severe aortic stenosis (AS). There are several factors to consider to optimize patient outcomes from TAVI. Before TAVI, patient selection is key and an understanding the effects of common comorbidities on outcomes after TAVI is critical. Some comorbidities share common risk factors with AS (e.g. coronary artery disease), others are directly or indirectly caused or exacerbated by severe AS (e.g. atrial fibrillation, pulmonary hypertension, mitral regurgitation, tricuspid regurgitation and right ventricular dysfunction), whereas others are not directly related to severe AS (e.g. chronic kidney disease and chronic lung disease). Choice of transcatheter heart valve prosthesis, vascular access route and mode of anesthesia are important considerations during TAVI. New onset conduction disturbances and arrhythmias remain a vexing issue after TAVI. The aim of the present review is to provide an overview of these issues.
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Affiliation(s)
| | - Peter Wenaweser
- b Department of Cardiology , Bern University Hospital , Bern , Switzerland
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