1
|
Matsushita H, Saku K, Nishikawa T, Unoki T, Yokota S, Sato K, Morita H, Yoshida Y, Fukumitsu M, Uemura K, Kawada T, Kikuchi A, Yamaura K. Impact of right ventricular and pulmonary vascular characteristics on Impella hemodynamic support in biventricular heart failure: A simulation study. J Cardiol 2024:S0914-5087(24)00145-X. [PMID: 39097144 DOI: 10.1016/j.jjcc.2024.07.008] [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: 04/12/2024] [Revised: 07/23/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Impella (Abiomed, Danvers, MA, USA) is a percutaneous ventricular assist device commonly used in cardiogenic shock, providing robust hemodynamic support, improving the systemic circulation, and relieving pulmonary congestion. Maintaining adequate left ventricular (LV) filling is essential for optimal hemodynamic support by Impella. This study aimed to investigate the impact of pulmonary vascular resistance (PVR) and right ventricular (RV) function on Impella-supported hemodynamics in severe biventricular failure using cardiovascular simulation. METHODS We used Simulink® (Mathworks, Inc., Natick, MA, USA) for the simulation, incorporating pump performance of Impella CP determined using a mock circulatory loop. Both systemic and pulmonary circulation were modeled using a 5-element resistance-capacitance network. The four cardiac chambers were represented by time-varying elastance with unidirectional valves. In the scenario of severe LV dysfunction (LV end-systolic elastance set at a low level of 0.4 mmHg/mL), we compared the changes in right (RAP) and left atrial pressures (LAP), total systemic flow, and pressure-volume loop relationship at varying degrees of RV function, PVR, and Impella flow rate. RESULTS The simulation results showed that under low PVR conditions, an increase in Impella flow rate slightly reduced RAP and LAP and increased total systemic flow, regardless of RV function. Under moderate RV dysfunction and high PVR conditions, an increase in Impella flow rate elevated RAP and excessively reduced LAP to induce LV suction, which limited the increase in total systemic flow. CONCLUSIONS PVR is the primary determinant of stable and effective Impella hemodynamic support in patients with severe biventricular failure.
Collapse
Affiliation(s)
- Hiroki Matsushita
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Keita Saku
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.
| | - Takuya Nishikawa
- Department of Research Promotion and Management, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Takashi Unoki
- Department of Cardiology and Intensive Care Unit, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Shohei Yokota
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Kei Sato
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Hidetaka Morita
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Yuki Yoshida
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Masafumi Fukumitsu
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Kazunori Uemura
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan; NTTR-NCVC Bio Digital Twin Center, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Atsushi Kikuchi
- Department of Cardiology, Osaka General Medical Center, Suita, Japan
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
2
|
Abbas AE, Khalili H, Madanat L, Elmariah S, Shannon F, Al-Azizi K, Waggoner T, Pilgrim T, Okuno T, Bavry A, Ternacle J, Christensen J, Cabau JR, Mack M, Pibarot P. Echocardiographic Versus Invasive Aortic Valve Gradients in Different Clinical Scenarios. J Am Soc Echocardiogr 2023; 36:1302-1314. [PMID: 37507058 DOI: 10.1016/j.echo.2023.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The role of echocardiography in deriving transvalvular mean gradients from transaortic velocities in aortic stenosis (AS) and in structural valve degeneration (SVD) is well established. However, reports following surgical aortic valve replacement, post-transcatheter aortic valve replacement (TAVR), and valve-in-valve-TAVR (ViV-TAVR) have cautioned against the use of echocardiography-derived mean gradients to assess normal functioning bioprosthesis due to discrepancy compared with invasive measures in a phenomenon called discordance. METHODS In a multicenter study, intraprocedural echocardiographic and invasive mean gradients in AS, SVD, post-native TAVR, and post-ViV-TAVR were compared, when obtained concomitantly, and discharge echocardiographic gradients were recorded. Absolute discordance (intraprocedural echocardiographic - invasive mean gradient) and percent discordance (intraprocedural echocardiographic - invasive mean gradient/echocardiographic mean gradient) were calculated. Multivariable regression analysis was performed to determine variables independently associated with elevated postprocedure invasive gradients ≥20 mm Hg, absolute discordance >10 mm Hg, and discharge echocardiographic mean gradient ≥20 mm Hg. RESULTS A total of 5,027 patients were included in the registry: 4,725 native TAVR and 302 ViV-TAVR. Intraprocedural concomitant echocardiographic and invasive mean gradients were obtained pre-TAVR in AS (n = 2,418), pre-ViV-TAVR in SVD (n = 101), in post-ViV-TAVR (n = 77), and in post-TAVR (n = 823). Echocardiographic and invasive mean gradients demonstrated strong correlation (r = 0.69) and agreement (bias, 0.11; 95% CI, -0.4-0.62) in AS, moderate correlation (r = 0.56) and agreement (bias, 1.08; 95% CI, -2.53 to 4.59) in SVD, moderate correlation (r = 0.61) and weak agreement (bias, 6.47; 95% CI, 5.08-7.85) post-ViV-TAVR, and weak correlation (r = 0.18) and agreement (bias, 3.41; 95% CI, 3.16-3.65) post-TAVR. Absolute discordance occurs primarily in ViV-TVR and is not explained by sinotubular junction size and increases with increasing echocardiographic mean gradient. Percent discordance in AS and SVD (1.3% and 4%, respectively) was lower compared with post-TAVR/ViV-TAVR (66.7% and 100%, respectively). Compared with self-expanding valves, balloon expanding valves were independently associated with elevated discharge echocardiographic but lower invasive mean gradient (odds ratio = 3.411, 95% CI, 1.482-7.852, P = .004; vs odds ratio = 0.308, 95% CI, 0.130-0.731, P = .008, respectively). CONCLUSIONS Post-TAVR/ViV-TAVR, echocardiography is discordant from invasive mean gradients, and absolute discordance increases with increasing echocardiographic mean gradient and is not explained by sinotubular junction size. Percent discordance is significantly higher post-TAVR/ViV-TAVR than in AS and SVD. Post-TAVR/ViV-TAVR, poor correlation and wide limits of agreement suggest echocardiographic and invasive mean gradients may not be used interchangeably and a high residual echocardiographic mean gradient should be confirmed invasively before considering any additional procedure to "correct" the gradient. Transcatheter aortic valve replacement valve types have variable impact on echocardiographic and invasive mean gradients.
Collapse
Affiliation(s)
- Amr E Abbas
- Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan; Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan.
| | | | - Luai Madanat
- Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan
| | | | - Francis Shannon
- Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan; Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
| | | | | | | | | | - Anthony Bavry
- Department of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Julien Ternacle
- Université Laval/Québec Heart and Lung Institute, Québec, Ontario, Canada
| | | | - Josep R Cabau
- Université Laval/Québec Heart and Lung Institute, Québec, Ontario, Canada
| | | | - Philippe Pibarot
- Université Laval/Québec Heart and Lung Institute, Québec, Ontario, Canada
| |
Collapse
|
3
|
Yamazaki C, Higuchi R, Saji M, Takamisawa I, Nanasato M, Doi S, Okazaki S, Tamura H, Sato K, Yokoyama H, Onishi T, Tobaru T, Shimizu A, Takanashi S, Isobe M. Discrepancy between invasive and echocardiographic transvalvular gradient after TAVI: Insights from the LAPLACE-TAVI registry. Int J Cardiol 2023:S0167-5273(23)00699-X. [PMID: 37201615 DOI: 10.1016/j.ijcard.2023.05.010] [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: 02/16/2023] [Revised: 04/02/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Echocardiography-based transvalvular mean pressure gradient (ECHO-mPG) used to assess the forward valve function and structural valve deterioration could overestimate the true pressure gradient. This study evaluated the discrepancy between invasive and ECHO-mPG after transcatheter aortic valve implantation (TAVI) with respective valve type and size, its impact on a device success criterion, and predictors of a pressure discrepancy. METHODS We analyzed 645 patients registered in a multicenter TAVI registry (balloon-expandable valve [BEV]: 500; self-expandable valve [SEV]: 145). The invasive transvalvular mPG was measured after valve implantation using two Pigtail catheters (CATH-mPG), while the ECHO-mPG was measured within 48 h after TAVI. Pressure recovery (PR) was calculated using the following formula: ECHO-mPG × effective orifice area (EOA)/ascending aortic area (AoA) × (1 - EOA/AoA). RESULTS ECHO-mPG was weakly correlated with (r = 0.29, p < 0.0001), and consistently overestimated CATH-mPG in both BEV and SEV, and respective valve sizes. The magnitude of the discrepancy was larger for BEV than SEV (p < 0.001) and smaller valves (p < 0.001). After the correction of PR using the above formula, the pressure discrepancy remained for BEV (p < 0.001) but not SEV (p = 0.10). The proportion of patients with an ECHO-mPG > 20 mmHg decreased from 7.0% to 1.6% after correction (p < 0.0001). Among the baseline and procedural variables, post-procedural ejection fraction, BEV versus SEV, and smaller valves were associated with a larger discrepancy in mPG. CONCLUSIONS ECHO-mPG could be overestimated after TAVI, especially in patients with a smaller BEV. A higher ejection fraction, BEV, and smaller valves were predictors of a pressure discrepancy between CATH- and ECHO-mPG.
Collapse
Affiliation(s)
- Chiemi Yamazaki
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Harutoshi Tamura
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University Hospital, Yamagata, Japan
| | - Kei Sato
- Department of Cardiology, Mie University Hospital, Mie, Japan
| | - Hiroaki Yokoyama
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Takayuki Onishi
- Department of Cardiology, Kawasaki Saiwai Hospital, Kanagawa, Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Kawasaki Saiwai Hospital, Kanagawa, Japan
| | - Atsushi Shimizu
- Department of Cardiac Surgery, Kawasaki Saiwai Hospital, Kanagawa, Japan
| | | | | |
Collapse
|
4
|
Comparison of Echocardiographic and Catheter Mean Gradient to Assess Stenosis After Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 191:110-118. [PMID: 36669380 DOI: 10.1016/j.amjcard.2022.12.026] [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: 09/20/2022] [Revised: 11/15/2022] [Accepted: 12/26/2022] [Indexed: 01/20/2023]
Abstract
Discordance exists between Doppler-derived and left heart catheterization (LHC)-derived mean gradient (MG) in transcatheter aortic valve implantation (TAVI). We compared echocardiographic parameters of prosthetic valve stenosis and LHC-derived MG in new TAVIs. In a retrospective, single-center study, intraoperative transesophageal echocardiogram (TEE)-derived MG, LHC-derived MG, and acceleration time (AT) were obtained before and after TAVI in 362 patients. Discharge MG, AT, and Doppler velocity index (DVI) using transthoracic echocardiogram (TTE) were also obtained. MG ≥10 mm Hg was defined as abnormal. During native valve assessment with pre-TAVI TEE and pre-TAVI LHC, Pearson correlation coefficient revealed a nearly perfect linear relation between both methods' MGs (r = 0.97, p <0.0001). Intraoperatively, after TAVI, Spearman correlation coefficient revealed a weak-to-moderate relation between post-TAVI TEE and LHC MGs (r = 0.33, p <0.0001). Significant differences were observed in categorizations between post-TAVI TEE MG and post-TAVI AT (McNemar test p = 0.0003) and between post-TAVI TEE MG and post-TAVI LHC MG (signed-rank test p <0.0001), with TEE MG more likely to misclassify a patient as abnormal. At discharge, 30% of patients had abnormal TTE MG, whereas 0% and 0.8% of patients had abnormal DVI and AT, respectively. Discharge TTE MG was not associated with death or hospitalization for heart failure at a median follow-up of 862 days. Post-TAVI Doppler-derived MG by intraoperative TEE was higher than LHC, despite being virtually identical before implantation. At discharge, patients were more likely to be classified as abnormal using MG than DVI and AT. Elevated MG at discharge was not associated with death or hospitalization for heart failure.
Collapse
|
5
|
Abushouk AI, Spilias N, Isogai T, Kansara T, Agrawal A, Hariri E, Abdelfattah O, Krishnaswamy A, Reed GW, Puri R, Yun J, Kapadia S. Three-Year Outcomes of Balloon-Expandable Transcatheter Aortic Valve Implantation According to Annular Size. Am J Cardiol 2023; 194:9-16. [PMID: 36921423 DOI: 10.1016/j.amjcard.2023.01.051] [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: 11/23/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 03/18/2023]
Abstract
Data on the association between annular size and transcatheter aortic valve implantation (TAVI) outcomes beyond 1 year are limited. The present study assessed the association between the aortic annulus size and TAVI clinical and hemodynamic outcomes at 3 years of follow-up. Patients were classified according to the aortic annulus size as having small, intermediate, and large annuli (size <400, 400 to 574, and ≥575 mm2, respectively). The co-primary endpoints were all-cause mortality and heart failure hospitalization. Further, the changes in hemodynamic outcomes over the follow-up period (median 37, interquartile range: 26 to 45 months) were assessed. The present analysis included 850 patients, with 182 patients (21.4%), 538 patients (63.3%), and 130 patients (15.3%) in the small, intermediate, and large-sized aortic annulus groups, respectively. The groups had comparable age and pre-TAVI pressure gradients; however, patients with small annuli had higher Society of Thoracic Surgeons risk scores. Adjusted Cox regression analysis showed that compared to patients with intermediate-sized annuli, patients with small and large annuli had similar all-cause mortality (hazard ratio [HR] = 1.11, 95% confidence interval [CI] 0.72 to 1.69 and HR = 0.74, 95% CI 0.48 to 1.16, respectively) and heart failure hospitalization rates (HR = 0.96, 95% CI 0.55 to 1.69 and HR = 1.26, 95% CI 0.73 to 2.17, respectively). However, patients with small annuli had consistently higher mean and peak pressure gradients and a higher risk of patient-prosthesis mismatch. The risks of moderate-to-severe regurgitation and structural valve deterioration were similar between the three groups. In conclusion, although patients with small annuli had higher transvalvular gradients, there was no significant association between the aortic annulus size and TAVI clinical outcomes at 3 years of follow-up. Future studies should compare the performance of transcatheter valve types in patients with different aortic annulus sizes.
Collapse
Affiliation(s)
- Abdelrahman I Abushouk
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nikolaos Spilias
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tikal Kansara
- Department of Internal Medicine, Cleveland Clinic Union Hospital, Dover, Ohio
| | - Ankit Agrawal
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Essa Hariri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Omar Abdelfattah
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - James Yun
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
| |
Collapse
|
6
|
Impact of residual transvalvular gradient on clinical outcomes following valve-in-valve transcatheter aortic valve replacement. Int J Cardiol 2022; 366:90-96. [DOI: 10.1016/j.ijcard.2022.06.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/09/2022] [Accepted: 06/29/2022] [Indexed: 11/19/2022]
|
7
|
Généreux P, Kipperman RM, Placido Disla JS, Aldaia L, Koulogiannis KP, Marcoff L, Mediratta A, Slater JP, Zaku B, Redfors B, Abdelfattah OM, Gillam LD. Evaluation of the OpSens OptoWire III and Novel TAVR Algorithm to Measure Pressure Gradient During TAVR. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100309. [PMID: 39131936 PMCID: PMC11307586 DOI: 10.1016/j.jscai.2022.100309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 08/13/2024]
Abstract
Background We aim to establish the degree of agreement related to gradient measurement during transcatheter aortic valve replacement (TAVR) between the OpSens OptoWire III and its new proprietary TAVR algorithm and hemodynamic value derived by catheterization and echocardiogram (transthoracic echocardiogram and transesophageal echocardiogram). Methods The current study was a prospective, single-arm, single-center study. All subjects underwent hemodynamic assessment before and after TAVR using standard hemodynamic assessment using 2 pigtails, transthoracic echocardiogram, transesophageal echocardiogram, and the OpSens OptoWire III. The primary end point was the final post-TAVR mean gradient correlation between OpSens OptoWire III and hemodynamic values derived by catheterization. Results Between July 2021 and September 2021, 20 patients were enrolled. The median age was 79 [6.5] years, and 9 (45%) patients were female. The mean gradient before TAVR derived by 2-pigtail technique and the mean gradient using the OpSens OptoWire III were similar (35 ± 14 mm Hg vs 35 ± 14 mm Hg, P = 1.00), with an absolute mean difference of 2.2 ± 3.5 mm Hg and a strong correlation (r = 0.96, P < .0001). After TAVR, the mean gradient derived by 2-pigtail technique and the mean gradient using the OpSens OptoWire III were similar (2.2 ± 3.5 vs 2.8 ± 2.7, P = .16), with an absolute mean difference of 1.2 ± 1.3 mm Hg and a strong correlation (r = 0.89, P < .0001). Conclusions Hemodynamic assessment derived by the OpSens OptoWire III wire and its new TAVR algorithm demonstrated excellent correlation with measurements derived by 2 pigtails both before and after TAVR. Integration of this new technology within a dedicated TAVR wire with live hemodynamic assessment could bring meaningful value to TAVR operators.
Collapse
Affiliation(s)
- Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Robert M. Kipperman
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | | | - Lillian Aldaia
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | | | - Leo Marcoff
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Anuj Mediratta
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - James P. Slater
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Bledi Zaku
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Björn Redfors
- Cardiovascular Research Foundation, New York, New York
| | - Omar M. Abdelfattah
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Linda D. Gillam
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| |
Collapse
|
8
|
Rodés-Cabau J, Abbas A, Serra V, Vilalta V, Nombela-Franco L, Regueiro A, Al-Azizi KM, Iskander A, Conradi L, Forcillo J, Lilly S, Calabuig A, Fernandez-Nofrerias E, Mohammadi S, Panagides V, Pelletier-Beaumont E, Pibarot P. Balloon- Versus Self-Expanding Valve Systems for Treating Small Failed Surgical Aortic Bioprostheses: The LYTEN Trial. J Am Coll Cardiol 2022; 80:681-693. [PMID: 35597385 DOI: 10.1016/j.jacc.2022.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data comparing valve systems in the valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) field has been obtained from retrospective studies. OBJECTIVES To compare the hemodynamic results between the balloon-expandable SAPIEN (3/ULTRA) (BEV) and self-expanding Evolut (R/PRO/PRO+) (SEV) valves in ViV-TAVR. METHODS Patients with a failed small (≤23 mm) surgical valve. were randomized to receive a BEV or a SEV. The primary endpoint was valve hemodynamics (maximal/mean residual gradients; severe prosthesis patient mismatch [PPM] or moderate-severe aortic regurgitation [AR]) at 30 days as evaluated by Doppler-echocardiography. RESULTS A total of 102 patients were randomized, and of these, 98 patients finally underwent a ViV-TAVR procedure (BEV: 46, SEV: 52). The procedure was successful in all cases, with no differences in clinical outcomes at 30 days between groups (no death or stroke events). Patients in the SEV group exhibited lower mean and maximal transvalvular gradient values (15±8 vs 23±8 mmHg, p˂0.001; 28±16 vs 40±13 mmHg, p ˂0.001), and a tendency towards a lower rate of severe PPM (44% vs. 64%, p=0.07). There were no cases of moderate-severe AR. 55 consecutive patients (SEV: 27, BEV: 28) underwent invasive valve hemodynamic evaluation during the procedure, with no differences in mean and peak transvalvular gradients between both groups (p=0.41 and p=0.70, respectively). CONCLUSIONS In patients with small failed aortic bioprostheses, ViV-TAVR with a SEV was associated with improved valve hemodynamics as evaluated by echocardiography. There were no differences between groups in intra-procedural invasive valve hemodynamics and 30-day clinical outcomes (NCT03520101).
Collapse
Affiliation(s)
- Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada.
| | - Amr Abbas
- Beaumont Hospital, Royal Oak, Michigan, USA
| | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | | | | | | | - Scott Lilly
- OSU Heart and Vascular Research Organization, Richard M Ross Hospital, Columbus, Ohio, USA
| | | | | | - Siamak Mohammadi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | - Vassili Panagides
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | | | - Philippe Pibarot
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| |
Collapse
|
9
|
Szerlip M, Mack MJ. The Management of Transcatheter Heart Valve Dysfunction: Another Tool in the Box. J Am Coll Cardiol 2022; 79:1352-1355. [PMID: 35393015 DOI: 10.1016/j.jacc.2022.02.029] [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: 01/24/2022] [Accepted: 02/09/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Molly Szerlip
- Departments of Cardiology and Cardiac Surgery, Baylor Scott and White Health, Heart Hospital Plano, Plano, Texas, USA.
| | - Michael J Mack
- Departments of Cardiology and Cardiac Surgery, Baylor Scott and White Health, Heart Hospital Plano, Plano, Texas, USA
| |
Collapse
|
10
|
Barker M, Abbas AE, Webb JG, Pibarot P, Sathananthan J, Brunner N, Wang DD, Wang J, Leon MB, Wood DA. Standardized Invasive Hemodynamics for Management of Patients With Elevated Echocardiographic Gradients Post-Transcatheter Aortic Valve Replacement at Midterm Follow-Up. Circ Cardiovasc Interv 2021; 15:e011243. [PMID: 34802254 DOI: 10.1161/circinterventions.121.011243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Madeleine Barker
- Department of Cardiology, Center for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, University of British Columbia, Vancouver, Canada (M.B., J.G.W., J.S., N.B., J.W., D.A.W.)
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, MI (A.E.A.)
| | - John G Webb
- Department of Cardiology, Center for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, University of British Columbia, Vancouver, Canada (M.B., J.G.W., J.S., N.B., J.W., D.A.W.)
| | - Philippe Pibarot
- Department of Medicine, Laval University, Quebec City, QC, Canada (P.P.)
| | - Janarthanan Sathananthan
- Department of Cardiology, Center for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, University of British Columbia, Vancouver, Canada (M.B., J.G.W., J.S., N.B., J.W., D.A.W.)
| | - Nathan Brunner
- Department of Cardiology, Center for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, University of British Columbia, Vancouver, Canada (M.B., J.G.W., J.S., N.B., J.W., D.A.W.)
| | - Dee Dee Wang
- Department of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (D.D.W.)
| | - Jia Wang
- Department of Cardiology, Center for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, University of British Columbia, Vancouver, Canada (M.B., J.G.W., J.S., N.B., J.W., D.A.W.)
| | - Martin B Leon
- Cardiology Department, NewYork-Presbyterian/Columbia University Medical Center (M.B.L.)
| | - David A Wood
- Department of Cardiology, Center for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, University of British Columbia, Vancouver, Canada (M.B., J.G.W., J.S., N.B., J.W., D.A.W.)
| |
Collapse
|
11
|
Rodés-Cabau J, Alperi A. Bioprosthetic valve fracture: haemodynamically effective but safe and clinically necessary? EUROINTERVENTION 2021; 17:785-786. [PMID: 34796876 PMCID: PMC9707430 DOI: 10.4244/eijv17i10a135] [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)
- Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada
| | - Alberto Alperi
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| |
Collapse
|
12
|
Stanová V, Rieu R, Côté N, Salaun E, Rodés-Cabau J, Pibarot P. In vitro Doppler versus catheter transvalvular pressure gradients in balloon-expandable versus self-expanding transcatheter aortic valves. Catheter Cardiovasc Interv 2021; 99:201-210. [PMID: 34632691 DOI: 10.1002/ccd.29974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/01/2021] [Accepted: 09/29/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The objective of this in vitro study was to compare Doppler versus catheter transvalvular pressure gradients (TPG) in third generations balloon-expandable (BE) versus self-expanding (SE) transcatheter heart valves (THV). BACKGROUND TPG is a key parameter to assess and follow valve hemodynamic function following transcatheter aortic valve implantation (TAVI). It remains uncertain and debated whether, and to which extent, TPGs differ according to the type of THV, that is, BE versus SE and to the method used for TPG measurement, that is, Doppler echocardiography versus cardiac catheterization. METHODS The CoreValve EVOLUT PRO 26 mm and the SAPIEN 3 23 mm THVs were tested in a left heart simulator using a 21 mm aortic annulus under following conditions: heart rate: 70 bpm, mean aortic pressure: 100 mmHg, stroke volume: 30, 70 and 100 ml. Mean TPGs were measured by continuous-wave Doppler and by micro-tip pressure catheters positioned in the left ventricle and at 50 mm downstream to the tip of the THV leaflets. RESULTS Doppler TPGs (9.5 ± 3.9 mmHg) were on average 40.5 ± 13.9% higher (p < 0.001) than catheter TPGs (6.3 ± 3.4 mmHg). Both Doppler and catheter TPGs were lower (p = 0.003) in the SE versus BE THVs (Doppler: 8.7 ± 3.5 vs. 10.7 ± 4.6; catheter: 5.0 ± 1.7 mmHg vs. 7.1 ± 2.2). The Doppler versus catheter difference in TPG increased with the higher flow conditions. The Doppler versus catheter difference in TPG was similar in BE versus SE THVs (3.6 ± 1.1 vs. 3.7 ± 1.4 mmHg or 42 ± 9 vs. 47 ± 9%; p = 0.58) overall and in each flow conditions. CONCLUSION The Doppler TPGs are, on average, 40% higher than the catheter TPGs for both BE and SE THVs. The SE THV had lower Doppler and catheter TPGs compared to the BE THV, at normal and high flow states. The absolute and percent differences between Doppler versus catheter TPGs were similar in BE versus SE THVs.
Collapse
Affiliation(s)
- Viktória Stanová
- Aix-Marseille University/Gustave Eiffel University, Marseille, France.,Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Régis Rieu
- Aix-Marseille University/Gustave Eiffel University, Marseille, France
| | - Nancy Côté
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Erwan Salaun
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | | | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| |
Collapse
|
13
|
Abbas AE, Mando R, Kadri A, Khalili H, Hanzel G, Shannon F, Al-Azizi K, Waggoner T, Kassas S, Pilgrim T, Okuno T, Camacho A, Selberg A, Elmariah S, Bavry A, Ternacle J, Christensen J, Gheewala N, Pibarot P, Mack M. Comparison of Transvalvular Aortic Mean Gradients Obtained by Intraprocedural Echocardiography and Invasive Measurement in Balloon and Self-Expanding Transcatheter Valves. J Am Heart Assoc 2021; 10:e021014. [PMID: 34585593 PMCID: PMC8649128 DOI: 10.1161/jaha.120.021014] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Concerns about discordance between echocardiographic and invasive mean gradients after transcatheter aortic valve replacement (TAVR) with balloon-expandable valves (BEVs) versus self-expanding valves (SEVs) exist. Methods and Results In a multicenter study, direct-invasive and echocardiography-derived transvalvular mean gradients obtained before and after TAVR were compared as well as post-TAVR and discharge echocardiographic mean gradients in BEVs versus SEVs in 808 patients. Pre-TAVR, there was good correlation (R=0.614; P<0.0001) between direct-invasive and echocardiography-derived mean gradients and weak correlation (R=0.138; P<0.0001) post-TAVR. Compared with post-TAVR echocardiographic mean gradients, both valves exhibit lower invasive and higher discharge echocardiographic mean gradients. Despite similar invasive mean gradients, a small BEV exhibits higher post-TAVR and discharge echocardiographic mean gradients than a large BEV, whereas small and large SEVs exhibit similar post-TAVR and discharge mean gradients. An ejection fraction <50% (P=0.028) and higher Society of Thoracic Surgeons predicted risk of mortality score (P=0.007), but not invasive or echocardiographic mean gradient ≥10 mm Hg (P=0.378 and P=0.341, respectively), nor discharge echocardiographic mean gradient ≥20 mm Hg (P=0.393), were associated with increased 2-year mortality. Conclusions Invasively measured and echocardiography-derived transvalvular mean gradients correlate well in aortic stenosis but weakly post-TAVR. Post-TAVR, echocardiography overestimates transvalvular mean gradients compared with invasive measurements, and poor correlation suggests these modalities cannot be used interchangeably. Moreover, echocardiographic mean gradients are higher on discharge than post-TAVR in all valves. Despite similar invasive mean gradients, a small BEV exhibits higher post-TAVR and discharge echocardiographic mean gradients than a large BEV, whereas small and large SEVs exhibit similar post-TAVR and discharge mean gradients. Immediately post-TAVR, elevated echocardiographic-derived mean gradients should be assessed with caution and compared with direct-invasive mean gradients. A low ejection fraction and higher Society of Thoracic Surgeons score, but not elevated mean gradients, are associated with increased 2-year mortality.
Collapse
Affiliation(s)
- Amr E Abbas
- Beaumont Hospital Royal Oak Royal Oak MI.,Oakland University William Beaumont School of Medicine Auburn Hills MI
| | - Ramy Mando
- Beaumont Hospital Royal Oak Royal Oak MI
| | - Amer Kadri
- Beaumont Hospital Royal Oak Royal Oak MI
| | | | - George Hanzel
- Beaumont Hospital Royal Oak Royal Oak MI.,Oakland University William Beaumont School of Medicine Auburn Hills MI
| | - Francis Shannon
- Beaumont Hospital Royal Oak Royal Oak MI.,Oakland University William Beaumont School of Medicine Auburn Hills MI
| | | | | | | | | | | | | | | | | | | | - Julien Ternacle
- Université Laval/Québec Heart and Lung Institute Québec Canada
| | | | - Neil Gheewala
- Pima Heart and Vascular Tucson Medical Center Tucson AZ
| | | | | |
Collapse
|
14
|
Kadri AN, Hanzel G, Elmariah S, Shannon F, Al-Azizi K, Boura J, Mack M, Abbas AE. Invasive versus echocardiographic gradients in degenerated surgical aortic valve prostheses: A multicenter study. JTCVS OPEN 2021; 7:51-60. [PMID: 36003692 PMCID: PMC9390586 DOI: 10.1016/j.xjon.2021.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/04/2021] [Indexed: 01/26/2023]
Abstract
Objectives To compare echocardiographic and invasive mean gradients obtained concomitantly in degenerated bioprosthetic surgical aortic valves (SAVRs). Methods In a multicenter study, we compared concomitant echocardiographic and invasive mean gradients of SAVR, obtained before valve-in-valve transcatheter aortic valve replacement in all patients, patients with primary stenosis (AS), primary aortic regurgitation (AR), and mixed aortic valve disease (MAVD), and in small versus large valves (≤ or >23 mm). Dimensionless index (DI) was calculated in all groups. Results In total, 74 patients were included and data presented as median (interquartile range). Echocardiography-catheterization mean gradient discordance was observed in all patients (invasive = 22 mm Hg [11-34] vs echocardiographic = 32 mm Hg [21-42], P = .013), small valves (invasive = 15 mm Hg [8-34] vs echocardiographic = 28 mm Hg [21-41], P = .013), and large valves (invasive = 20 mm Hg [8.5-27.13] vs echocardiographic = 32 mm Hg [25.5 – 41.5], P < .0001), with a bias of 8 ± 15 mm Hg and wide limits of agreement (–22 to 39 mm Hg) on Bland–Altman plots, indicating these modalities may not be interchangeable. Discordance occurred in AR (invasive = 3 mm Hg [1-6] vs echocardiographic = 12 mm Hg [7-22], P = .017) and in MAVD (invasive = 19 mm Hg [12-29] vs echocardiographic = 31 mm Hg [23-39], P < .0001) but not in AS (invasive = 35 mm Hg [24-45] vs echocardiographic = 41 mm Hg [30-50], P = .45). A lower DI (0.21 [0.14-0.25]) occurred in AS compared with MAVD (0.31 [0.19-0.39]) and AR (0.55 [0.51-0.69]), P < .0001. Conclusions Discordance between echocardiography and invasive mean gradients exists in degenerated SAVR, regardless of valve size, but depends on mechanism of failure and DI helps stratify these patients. With a discrepancy between echocardiographic mean gradients AND the patient's symptoms OR the valve leaflet structure and/or mobility on imaging, especially before redo-SAVR or valve-in-valve transcatheter aortic valve replacement, invasive gradients may adjudicate the true valvular hemodynamics.
Collapse
Affiliation(s)
- Amer N. Kadri
- Division of Cardiology, Beaumont Health, Dearborn, Mich
| | - George Hanzel
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Mich
- Oakland University William Beaumont School of Medicine, Auburn Hills, Mich
| | - Sammy Elmariah
- Division of Cardiology, Massachusetts General Hospital, Boston, Mass
| | - Francis Shannon
- Oakland University William Beaumont School of Medicine, Auburn Hills, Mich
- Division of Cardiovascular Surgery, Beaumont Hospital, Royal Oak, Mich
| | - Karim Al-Azizi
- Division of Cardiology, The Heart Hospital Baylor Plano, Plano, Tex
| | - Judith Boura
- Department of General Medical Education, Ascension-Macomb Oakland Hospital, Warren, Mich
| | - Michael Mack
- Division of Cardiac Surgery, The Heart Hospital Baylor Plano, Plano, Tex
| | - Amr E. Abbas
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Mich
- Oakland University William Beaumont School of Medicine, Auburn Hills, Mich
- Address for reprints: Amr E. Abbas, MD, Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48073.
| |
Collapse
|
15
|
Abbas AE, Ternacle J, Pibarot P, Xu K, Alu M, Rogers E, Hahn RT, Leon M, Thourani VH. Impact of Flow on Prosthesis-Patient Mismatch Following Transcatheter and Surgical Aortic Valve Replacement. Circ Cardiovasc Imaging 2021; 14:e012364. [PMID: 34387097 DOI: 10.1161/circimaging.120.012364] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Severe prosthesis-patient mismatch (PPM) is diagnosed by an indexed effective orifice area <0.65 cm2/m2, which is derived from stroke volume index. We examined the impact of flow, determined by stroke volume index, on severe PPM following transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). METHODS We included SAVR patients from the PARTNER 2A trial (Placement of Aortic Transcatheter Valve 2A) and TAVR patients from the PARTNER 2 S3i (Placement of Aortic Transcatheter Valve 2 S3i) registry. The primary end point was the separate analysis of all-cause death, cardiac death, and rehospitalization at 5 years. Following TAVR and SAVR, we compared the primary end points between severe versus no-severe PPM in all patients, in low flow (LF), and in normal flow. Multivariable analysis was performed to determine variables associated with the end points. RESULTS Nine hundred fifty-four TAVR and 726 SAVR patients with PPM and flow data were included. Severe PPM following TAVR was significantly lower compared with SAVR in all patients (9% versus 28%, P<0.0001), in normal flow (5% versus 8%, P=0.04), and in LF (20% versus 42%, P<0.0001). Severe PPM was associated with rehospitalization following TAVR (odds ratio, 1.52 [95% CI, 1.01-2.29], P=0.0456) and SAVR (odds ratio, 1.51 [95% CI, 1.06-2.16], P=0.0237). Severe PPM in LF was independently associated with cardiac death following TAVR (odds ratio, 1.85 [95% CI, 1.06-3.23], P=0.0308). Following SAVR, severe PPM in LF and low ejection fraction was associated with increased cardiac death (35.26% versus 12.51%, P=0.01) and rehospitalization (37.59% versus 15.46%, P=0.006) compared with severe PPM in LF and preserved ejection fraction, respectively. Severe PPM in normal flow was not associated with clinical outcomes despite higher gradients and smaller valves compared with severe PPM in LF. CONCLUSIONS Severe PPM is more common following SAVR compared with TAVR. Regardless of the implanted valve size or gradient, severe PPM impacts mortality only in patients with LF following TAVR and LF and low ejection fraction following SAVR. Severe PPM in normal flow is not associated with poor outcomes. Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01314313 and NCT02687035.
Collapse
Affiliation(s)
- Amr E Abbas
- Department of Internal Medicine. Oakland University William Beaumont School of Medicine, Auburn Hills, MI (A.E.A.).,Department of Cardiovascular Medicine. Beaumont Hospital Royal Oak, MI (A.E.A.)
| | - Julien Ternacle
- Institut Universitaire de cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Canada (J.T., P.P.)
| | - Philippe Pibarot
- Institut Universitaire de cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Canada (J.T., P.P.)
| | - Ke Xu
- Edwards Lifesciences, Irvine, CA (K.X., E.R.)
| | - Maria Alu
- Department of Cardiovascular Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital (M.A., R.T.H., M.L.).,Cardiovascular Research Foundation, New York, NY (M.A., R.T.H., M.L.)
| | - Erin Rogers
- Edwards Lifesciences, Irvine, CA (K.X., E.R.)
| | - Rebecca T Hahn
- Department of Cardiovascular Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital (M.A., R.T.H., M.L.).,Cardiovascular Research Foundation, New York, NY (M.A., R.T.H., M.L.)
| | - Martin Leon
- Department of Cardiovascular Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital (M.A., R.T.H., M.L.).,Cardiovascular Research Foundation, New York, NY (M.A., R.T.H., M.L.)
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA (V.H.T)
| |
Collapse
|
16
|
Ternacle J, Pibarot P, Herrmann HC, Kodali S, Leipsic J, Blanke P, Jaber W, Mack MJ, Clavel MA, Salaun E, Guzzetti E, Annabi MS, Bernier M, Beaudoin J, Khalique OK, Weissman NJ, Douglas P, Bax J, Dahou A, Xu K, Alu M, Rogers E, Leon M, Thourani VH, Abbas AE, Hahn RT. Prosthesis-Patient Mismatch After Aortic Valve Replacement in the PARTNER 2 Trial and Registry. JACC Cardiovasc Interv 2021; 14:1466-1477. [PMID: 34238557 DOI: 10.1016/j.jcin.2021.03.069] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to compare incidence and impact of measured prosthesis-patient mismatch (PPMM) versus predicted PPM (PPMP) after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). BACKGROUND TAVR studies have used measured effective orifice area indexed (EOAi) to body surface area (BSA) to define PPM, but most SAVR series have used predicted EOAi. This difference may contribute to discrepancies in incidence and outcomes of PPM between series. METHODS The study analyzed SAVR patients from the PARTNER (Placement of Aortic Transcatheter Valves) 2A trial and TAVR patients from the PARTNER 2 SAPIEN 3 Intermediate Risk registry. PPM was classified as moderate if EOAi ≤0.85 cm2/m2 (≤0.70 if obese: body mass index ≥30 kg/m2) and severe if EOAi ≤0.65 cm2/m2 (≤0.55 if obese). PPMM was determined by the core lab-measured EOAi on 30-day echocardiogram. PPMP was determined by 2 methods: 1) using normal EOA reference values previously reported for each valve model and size (PPMP1; n = 929 SAVR, 1,069 TAVR) indexed to BSA; and 2) using normal reference EOA predicted from aortic annulus size measured by computed tomography (PPMP2; n = 864 TAVR only) indexed to BSA. Primary endpoint was the composite of 5-year all-cause death and rehospitalization. RESULTS The incidence of moderate and severe PPMP was much lower than PPMM in both SAVR (PPMP1: 28.4% and 1.2% vs. PPMM: 31.0% and 23.6%) and TAVR (PPMP1: 21.0% and 0.1% and PPMP2: 17.0% and 0% vs. PPMM: 27.9% and 5.7%). The incidence of severe PPMM and severe PPMP1 was lower in TAVR versus SAVR (P < 0.001). The presence of PPM by any method was associated with higher transprosthetic gradient. Severe PPMP1 was independently associated with events in SAVR after adjustment for sex and Society of Thoracic Surgeons score (hazard ratio: 3.18;95% CI: 1.69-5.96; P < 0.001), whereas no association was observed between PPM by any method and outcomes in TAVR. CONCLUSIONS EOAi measured by echocardiography results in a higher incidence of PPM following SAVR or TAVR than PPM based on predicted EOAi. Severe PPMP is rare (<1.5%), but is associated with increased all-cause death and rehospitalization after SAVR, whereas it is absent following TAVR.
Collapse
Affiliation(s)
- Julien Ternacle
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada.
| | - Howard C Herrmann
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Susheel Kodali
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jonathon Leipsic
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Marie-Annick Clavel
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Erwan Salaun
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Ezequiel Guzzetti
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | | | - Mathieu Bernier
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Jonathan Beaudoin
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Omar K Khalique
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Neil J Weissman
- MedStar Heath Research Institute, Georgetown University, Washington, DC, USA
| | - Pamela Douglas
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Ke Xu
- Edwards Lifesciences, Irvine, California, USA
| | - Maria Alu
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Erin Rogers
- Edwards Lifesciences, Irvine, California, USA
| | - Martin Leon
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Amr E Abbas
- Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan, USA; Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA
| | - Rebecca T Hahn
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| |
Collapse
|
17
|
Rodés-Cabau J, Alperi A, Pibarot P. Should Transcatheter Aortic Valve Replacement Become the Standard of Care for the Treatment of Failed Surgical Bioprosthetic Valves? Circ Cardiovasc Interv 2021; 14:e010883. [PMID: 34003668 DOI: 10.1161/circinterventions.121.010883] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Alberto Alperi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| |
Collapse
|
18
|
Kaneko T, Makkar RR, Krishnaswami A, Hermiller J, Greenbaum A, Babaliaros V, Shah PB, Bailey SH, Bapat V, Kapadia S, Abbas AE. Valve-in-Surgical-Valve With SAPIEN 3 for Transcatheter Aortic Valve Replacement Based on Society of Thoracic Surgeons Predicted Risk of Mortality. Circ Cardiovasc Interv 2021; 14:e010288. [PMID: 34003666 DOI: 10.1161/circinterventions.120.010288] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Tsuyoshi Kaneko
- Division of Cardiac Surgery (T.K.), Brigham and Women's Hospital, Boston, MA
| | - Raj R Makkar
- Department of Cardiology, Cedars Sinai Medical Center, Los Angeles, CA (R.R.M.)
| | | | | | - Adam Greenbaum
- Division of Cardiology, Emory University Medical Center, Atlanta, GA (A.G., V.B.)
| | - Vasilis Babaliaros
- Division of Cardiology, Emory University Medical Center, Atlanta, GA (A.G., V.B.)
| | - Pinak B Shah
- Division of Cardiology (P.B.S.), Brigham and Women's Hospital, Boston, MA
| | - Stephen H Bailey
- Division of Cardiac Surgery, Allegheny General Hospital, Pittsburgh, PA (S.H.B.)
| | - Vinnie Bapat
- Division of Cardiac Surgery, Minneapolis Heart Institute, MN (V.B.)
| | - Samir Kapadia
- The Heart Center of Indiana, Indianapolis (J.H., S.K.)
| | - Amr E Abbas
- Division of Cardiac Surgery, Minneapolis Heart Institute, MN (V.B.)
| |
Collapse
|
19
|
Eng MH, Abbas AE, Hahn RT, Lee J, Wang DD, Eleid MF, O'Neill WW. Real world outcomes using 20 mm balloon expandable SAPIEN 3/ultra valves compared to larger valves (23, 26, and 29 mm)-a propensity matched analysis. Catheter Cardiovasc Interv 2021; 98:1185-1192. [PMID: 33984182 DOI: 10.1002/ccd.29756] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/30/2021] [Accepted: 05/03/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE/BACKGROUND Small balloon expandable valves have higher echocardiographic transvalvular gradients and rates of prosthesis-patient mismatch (PPM) compared to larger valves. However, the impact of these echocardiographic findings on clinical outcomes is unknown. We sought to determine the clinical outcomes of 20 mm SAPIEN 3 (S3 BEV) compared to larger S3 BEV in relation to echocardiographic hemodynamics. METHODS Using the STS/ACC transcatheter valve registry, we performed a propensity-matched comparison of patients undergoing treatment of native aortic valve stenosis using transfemoral, balloon-expandable implantation of 20 mm and ≥ 23 mm S3 BEVs. Baseline and procedure characteristics, echocardiographic variables and survival were analyzed. Multivariable logistic regression was used to identify predictors of 1-year mortality. RESULTS After propensity matching of the 20 mm and ≥ 23 mm SAPIEN 3 valves, 3,931 pairs with comparable baseline characteristics were identified. Small valves were associated with significantly higher echocardiographic gradients at discharge (15.7 ± 7.1 mmHg vs. 11.7 ± 5.5 mmHg, p < 0.0001) and severe PPM rates (21.5% vs. 9.7%, p < 0.0001). There was no significant difference in 1-year all-cause mortality (20 mm: 13.0% vs. ≥23 mm: 12.7%, p = 0.72) or other major adverse event rates and outcomes between the two cohorts. Based on a multivariable analysis, elevated discharge mean gradient (>20 mmHg), severe PPM and the use of 20 mm versus ≥23 mm were not independent predictors of 1-year mortality. CONCLUSION SAPIEN 3 20 mm valves were associated with higher echocardiographic gradients, and severe PPM rates compared to larger valves but these factors were not associated with significant differences in 1-year all-cause mortality or rehospitalization.
Collapse
Affiliation(s)
- Marvin H Eng
- Department of Medicine, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan, USA
| | - Rebecca T Hahn
- New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - James Lee
- Department of Medicine, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Dee Dee Wang
- Department of Medicine, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William W O'Neill
- Department of Medicine, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| |
Collapse
|
20
|
Ternacle J, Abbas AE, Pibarot P. Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement: Has It Become Obsolete? JACC Cardiovasc Interv 2021; 14:977-980. [PMID: 33958171 DOI: 10.1016/j.jcin.2021.03.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Julien Ternacle
- Haut-Lévêque Cardiology Hospital, University Hospital of Bordeaux, Pessac, France
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA
| | - Philippe Pibarot
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, Québec, Canada.
| |
Collapse
|