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Abril Molina A, Fernández Quero M, López Haldón JE, Villa Gil Ortega M, Díaz Fernández JF. An unusual complication after transcatheter aortic valve implantation: a case report. Eur Heart J Case Rep 2024; 8:ytae045. [PMID: 38332924 PMCID: PMC10852023 DOI: 10.1093/ehjcr/ytae045] [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: 08/29/2023] [Revised: 01/02/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
Background Ventricular septal defect (VSD) is an unusual complication of transcatheter aortic valve implantation (TAVI). The risk factors are not well understood but may include oversizing, calcification amount and location, left-ventricular chamber morphology, and valve-in-valve (ViV) procedures. Percutaneous treatment is challenging but is usually the preferred option. Case summary An 80-year-old woman with two previous surgical aortic valve replacements was admitted to our Cardiology Department for decompensated heart failure. New bioprosthesis degeneration (19 mm Mitroflow™, Sorin Group, Canada) was observed with severe intraprosthetic aortic regurgitation. After evaluation, the heart team chose to perform ViV TAVI. Because of the high risk of coronary obstruction, chimney stenting of both coronary arteries was performed. A 23 mm self-expandable Navitor™ valve (Abbott, IL, USA) was implanted, but the Mitroflow™ valve had to be cracked to minimize the persistent high gradient. During valve fracture, the non-compliant balloon broke and a small iatrogenic VSD appeared. However, the patient remained stable, so conservative management was selected. During follow-up, she developed severe haemolytic anaemia and heart failure; therefore, percutaneous closure of the iatrogenic VSD was performed twice, which was a difficult challenge. Discussion A viable alternative to redo surgery is ViV TAVI. Risks include higher rates of prosthesis-patient mismatch and coronary obstruction. Occasionally, bioprosthetic valve fracture is required, particularly in small bioprostheses, to achieve low gradients. Anecdotally, fracture has led to annular rupture and VSD. Most VSDs are small and without clinical or haemodynamic repercussions; however, in symptomatic cases, percutaneous closure is a viable alternative to surgery.
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Affiliation(s)
- Alba Abril Molina
- Cardiology Department, Juan Ramón Jiménez University Hospital, Ronda Norte, s/n, Huelva 21005, Spain
| | - Mónica Fernández Quero
- Cardiology Department, Virgen del Rocío University Hospital, Manuel Siurot, s/n, Seville 41013, Spain
| | - José E López Haldón
- Cardiology Department, Virgen del Rocío University Hospital, Manuel Siurot, s/n, Seville 41013, Spain
| | - Manuel Villa Gil Ortega
- Cardiology Department, Virgen del Rocío University Hospital, Manuel Siurot, s/n, Seville 41013, Spain
| | - José F Díaz Fernández
- Cardiology Department, Virgen del Rocío University Hospital, Manuel Siurot, s/n, Seville 41013, Spain
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Urzua Fresno CM, Ocazionez D, Groves DW, Vargas D. Computed Tomography of Transcatheter Aortic Valve Replacement-Related Complications. Semin Roentgenol 2024; 59:112-120. [PMID: 38388090 DOI: 10.1053/j.ro.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/22/2023] [Accepted: 11/25/2023] [Indexed: 02/24/2024]
Affiliation(s)
| | - Daniel Ocazionez
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston-McGovern Medical School, Houston, TX
| | - Daniel W Groves
- Departments of Medicine and Radiology, University of Colorado, Aurora, CO
| | - Daniel Vargas
- Department of Radiology, University of Colorado, Aurora, CO.
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3
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Cafaro A, Rizzo F, Fischetti D, Quarta L, Mussardo M, Mandurino-Mirizzi A, Tondo A, Ciccone MM, Iacovelli F, Colonna G. Intracoronary Pacing during "Chimney Technique" in Transcatheter Aortic Valve-in-Valve Implantation: An Alternative Temporary Rapid Ventricular Stimulation? J Cardiovasc Dev Dis 2023; 10:341. [PMID: 37623354 PMCID: PMC10455771 DOI: 10.3390/jcdd10080341] [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: 06/13/2023] [Revised: 07/19/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
Temporary rapid ventricular pacing (TRVP) is required during transcatheter aortic valve implantation (TAVI) in order to reduce cardiac output and to facilitate balloon aortic valvuloplasty, prosthesis deployment, and post-deployment balloon dilation. The two most frequently used TRVP techniques are right endocardial (RE)-TRVP and retrograde left endocardial temporary rapid ventricular pacing (RLE)-TRVP. The first one could be responsible for cardiac tamponade, one of the most serious procedural complications during TAVI, while the second one could often be unsuccessful. Intracoronary (IC)-TRVP through a coronary guidewire has been described as a safe and efficient procedure that could avoid such complications. We describe two clinical cases in which IC-TRVP has been effectively used during valve-in-valve TAVI with coronary protection via the "chimney technique", after unsuccessful RLE-TRVP.
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Affiliation(s)
- Alessandro Cafaro
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Francesco Rizzo
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (M.M.C.); (F.I.)
| | - Dionigi Fischetti
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Luca Quarta
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Marco Mussardo
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Alessandro Mandurino-Mirizzi
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Antonio Tondo
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Marco Matteo Ciccone
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (M.M.C.); (F.I.)
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (M.M.C.); (F.I.)
- Division of Cardiology, “SS. Annunziata” Hospital, 74121 Taranto, Italy
| | - Giuseppe Colonna
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
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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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Groin lymphorrhea after catheter ablation of atrial fibrillation: A case report. HeartRhythm Case Rep 2022; 9:178-180. [PMID: 36970391 PMCID: PMC10030298 DOI: 10.1016/j.hrcr.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Datta R, Bharadwaj P, Aggarwal N, Keshavamurthy G, Sharma P, Bajaj N, Bohra V, Guleria V, Singh B. Transcatheter aortic valve replacement in the developing world: Lessons learnt and its implications for practice. Med J Armed Forces India 2022; 78:387-393. [PMID: 36267505 PMCID: PMC9577349 DOI: 10.1016/j.mjafi.2022.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
Backrground Transcatheter aortic valve replacement (TAVR) has become an accepted modality of treatment in intermediate and high surgical risk patients of symptomatic severe calcific aortic stenosis (AS). We herein report Indian data of 84 intermediate and high-risk patients who underwent TAVR at two Armed Forces cardiac centres. Methods Most of the patients underwent TAVR in cardiac catheterization lab by percutaneous transfemoral approach, under conscious sedation. Patients were followed up and echocardiographic parameters were assessed after six months of procedure. Results Total of 84 intermediate and high-risk patients underwent TAVR between Jan 2017 and June 2021. Mean age of population was 71.5 ± 8.4 years; 28.5% of patients had bicuspid aortic valve and Mean STS score was 6.34 ± 2.08. Majority (92.8%) patients underwent the procedure under conscious sedation. Self-expanding valves were used in 72.6% and balloon expandable in 27.4% of patients. Predilatation was done in 64% patients while 13% cases underwent post dilatation. Procedural mortality was 2.3%. Rate of permanent pacemaker implantation was 4.9%. Ischemic stroke occurred in 1.1% of patents. There was no case of severe paravalvular leak. Emergency surgical aortic valve replacement was done in 2.4% patients. Procedural success in this study was 97.6%. All-cause mortality was 9.5% at 6 months. Conclusions TAVR is an effective treatment modality in intermediate and high-risk Indian patients with severe aortic stenosis. Patients with bicuspid or previous bio prosthetic aortic valves also have a good outcome post TAVR.
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Affiliation(s)
- Rajat Datta
- Director General Armed Forces Medical Services, O/o DGAFMS, Defence Offices Complex, A Block, Africa Avenue, New Delhi, India
| | - Prashant Bharadwaj
- Director General Medical Services (Air), Air HQ, West Block 6, RK Puram, New Delhi, India
| | - Naveen Aggarwal
- Director (Cardiologist), Max Superspecialty Hospital, Phase 6, Mohali, Punjab, India
| | - G. Keshavamurthy
- Consultant (Cardiology), Army Hospital (R&R), Delhi Cantt, India
| | - Prafull Sharma
- Senior Advisor (Medicine) & Cardiologist, Military Hospital Jalandhar, India
| | - Nitin Bajaj
- Senior Advisor (Medicine) & Cardiologist, Army Institute of Cardio Thoracic Sciences, Pune, India
| | - Vijay Bohra
- Classified Specialist (Medicine) & Cardiologist, Command Hospital (CC), Lucknow, India
| | - V.S. Guleria
- Classified Specialist (Medicine) & Cardiologist, Army Hospital (R&R), Delhi Cantt, India
| | - Balbir Singh
- Classified Specialist (Medicine) & Cardiologist, 7 Air Force Hospital, Kanpur, India
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Brandt V, Schoepf UJ, Aquino GJ, Bekeredjian R, Varga-Szemes A, Emrich T, Bayer RR, Schwarz F, Kroencke TJ, Tesche C, Decker JA. Impact of machine-learning-based coronary computed tomography angiography-derived fractional flow reserve on decision-making in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Eur Radiol 2022; 32:6008-6016. [PMID: 35359166 DOI: 10.1007/s00330-022-08758-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/17/2022] [Accepted: 03/21/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To evaluate feasibility and diagnostic performance of coronary CT angiography (CCTA)-derived fractional flow reserve (CT-FFR) for detection of significant coronary artery disease (CAD) and decision-making in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) to potentially avoid additional pre-TAVR invasive coronary angiography (ICA). METHODS Consecutive patients with severe AS (n = 95, 78.6 ± 8.8 years, 53% female) undergoing pre-procedural TAVR-CT followed by ICA with quantitative coronary angiography were retrospectively analyzed. CCTA datasets were evaluated using CAD Reporting and Data System (CAD-RADS) classification. CT-FFR measurements were computed using an on-site machine-learning algorithm. A combined algorithm was developed for decision-making to determine if ICA is needed based on pre-TAVR CCTA: [1] all patients with CAD-RADS ≥ 4 are referred for ICA; [2] patients with CAD-RADS 2 and 3 are evaluated utilizing CT-FFR and sent to ICA if CT-FFR ≤ 0.80; [3] patients with CAD-RADS < 2 or CAD-RADS 2-3 and normal CT-FFR are not referred for ICA. RESULTS Twelve patients (13%) had significant CAD (≥ 70% stenosis) on ICA and were treated with PCI. Twenty-eight patients (30%) showed CT-FFR ≤ 0.80 and 24 (86%) of those were reported to have a maximum stenosis ≥ 50% during ICA. Using the proposed algorithm, significant CAD could be identified with a sensitivity, specificity, and positive and negative predictive value of 100%, 78%, 40%, and 100%, respectively, potentially decreasing the number of necessary ICAs by 65 (68%). CONCLUSION Combination of CT-FFR and CAD-RADS is able to identify significant CAD pre-TAVR and bears potential to significantly reduce the number of needed ICAs. KEY POINTS • Coronary CT angiography-derived fractional flow reserve (CT-FFR) using machine learning together with the CAD Reporting and Data System (CAD-RADS) classification safely identifies significant coronary artery disease based on quantitative coronary angiography in patients prior to transcatheter aortic valve replacement. • The combination of CT-FFR and CAD-RADS enables decision-making and bears the potential to significantly reduce the number of needed invasive coronary angiographies.
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Affiliation(s)
- Verena Brandt
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
- Department of Cardiology and Angiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA.
| | - Gilberto J Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Raffi Bekeredjian
- Department of Cardiology and Angiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Florian Schwarz
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Thomas J Kroencke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
- Department of Cardiology, Clinic Augustinum Munich, Munich, Germany
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany
| | - Josua A Decker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
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Hill JE, Mansoor M, Hamer O, Gomez KU, Clegg A. Predictors Of Post-Operative Negative Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation. BRITISH JOURNAL OF CARDIAC NURSING 2022; 17:0061. [PMID: 37915312 PMCID: PMC7615269 DOI: 10.12968/bjca.2022.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
With the advent of Transcatheter Aortic Valve Implantation (TAVI), populations who were previously not fit enough for heart valve surgery are now able to have a valve replacement without placing these higher risk individuals through major surgery. Complication rates following TAVI have reduced over the last few years, but recent studies suggest that the incidence of several complications remains high. Avoiding complications is key to reducing costs associated with TAVI, which is important given that the procedure is already more expensive than other treatment options. An emerging strategy for patients undergoing TAVI is to identify pre-operative factors predictive of post-operative adverse outcomes. This commentary summarises three systematic reviews exploring moderating factors for adverse events after TAVI surgery, with the aim of identifying statistically and clinically significant factors associated with poor surgical outcomes and contextualise these factors within clinical practice.
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Affiliation(s)
| | - Mohamed Mansoor
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
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Rouleau SG, Brady WJ, Koyfman A, Long B. Transcatheter aortic valve replacement complications: A narrative review for emergency clinicians. Am J Emerg Med 2022; 56:77-86. [DOI: 10.1016/j.ajem.2022.03.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/11/2022] [Accepted: 03/20/2022] [Indexed: 02/07/2023] Open
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10
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Aidietis A, Srimahachota S, Dabrowski M, Bilkis V, Buddhari W, Cheung GSH, Nair RK, Mussayev AA, Mattummal S, Chandra P, Mahajan AU, Chmielak Z, Govindan SC, Jose J, Hiremath MS, Chandra S, Shetty R, Mohanan S, John JF, Mehrotra S, Søndergaard L. 30-Day and 1-Year Outcomes With HYDRA Self-Expanding Transcatheter Aortic Valve: The Hydra CE Study. JACC Cardiovasc Interv 2022; 15:93-104. [PMID: 34991828 DOI: 10.1016/j.jcin.2021.09.004] [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: 04/30/2021] [Revised: 08/17/2021] [Accepted: 09/07/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study sought to evaluate the 30-day and 1-year safety and performance of the Hydra transcatheter aortic valve (THV) (in the treatment of symptomatic severe aortic stenosis in patients at high or extreme surgical risk. BACKGROUND The Hydra THV is a novel repositionable self-expanding system with supra-annular bovine pericardial leaflets. METHODS The Hydra CE study was a premarket, prospective, multicenter, single-arm study conducted across 18 study centers in Europe and Asia-Pacific countries. The primary endpoint was all-cause mortality at 30 days. All endpoints were adjudicated by an independent clinical events committee. RESULTS A total of 157 patients (79.2 ± 7.1 years of age, 58.6% female; Society of Thoracic Surgeons score 4.7 ± 3.4%) were enrolled. Successful implantation was achieved in 94.3% cases. At 30 days, there were 11 (7.0%) deaths, including 9 (5.7%) cardiovascular deaths, of which 5 (3.2%) were device related. At 1 year, there were 23 (14.6%) deaths, including 13 (8.3%) cardiovascular deaths. At 30 days, there were significant improvement of effective orifice area (from 0.7 ± 0.2 cm2 to 1.9 ± 0.6 cm2) and mean aortic valve gradient (from 49.5 ± 18.5 mm Hg to 8.1 ± 3.7 mm Hg), which were sustained up to 1 year. Moderate or severe paravalvular leak was observed in 6.3% of patients at 30 days and 6.9% of patients at 1 year. The rate of new permanent pacemaker implantation was 11.7% at 30 days and 12.4% at 1 year. CONCLUSIONS The Hydra CE study demonstrated that transcatheter aortic valve replacement with Hydra THV offered favorable efficacy at 1 year, providing large effective orifice area and low transvalvular gradient as well as acceptable complication rates with regard to new permanent pacemaker and paravalvular leak. (A Clinical Evaluation of the HYDRA Self Expanding Transcatheter Aortic Valve; NCT02434263).
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Affiliation(s)
- Audrius Aidietis
- Cardiology and Angiology Centre, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Suphot Srimahachota
- Cardiac Center and Division of Cardiovascular Disease, Department of Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Vaildas Bilkis
- Cardiology and Angiology Centre, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Wacin Buddhari
- Cardiac Center and Division of Cardiovascular Disease, Department of Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | - Gary S H Cheung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR
| | - Rajesh K Nair
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Abdurashid A Mussayev
- Catheterization Laboratory, National Research Center for Cardiac Surgery, Astana, Kazakhstan
| | - Shafeeq Mattummal
- Department of Adult Cardiology, ASTER MIMS Hospital, Kozhikode, India
| | - Praveen Chandra
- Division of Interventional Cardiology, Medanta The Medicity Hospital, Gurgaon, India
| | - Ajay U Mahajan
- Department of Cardiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, India
| | - Zbigniew Chmielak
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Sajeev C Govindan
- Department of Cardiology, Government Medical College, Calicut, India
| | - John Jose
- Department of Cardiology, Cardiology Unit 2, Christian Medical College Hospital, Vellore, India
| | | | - Sharad Chandra
- Department of Cardiology (Lari Heart Center), King George's Medical University, Lucknow, India
| | - Ranjan Shetty
- Department of Cardiology, Manipal Hospital, Bengaluru, India
| | - Sandeep Mohanan
- KMCT Heart Institute, KMCT Medical College Hospital, Kozhikode, India
| | - John F John
- Department of Cardiology, Baby Memorial Hospital, Calicut, India
| | - Sanjay Mehrotra
- Department of Cardiology, NH Institute of Cardiac Sciences, Bangalore, India
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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11
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Mach M, Poschner T, Hasan W, Szalkiewicz P, Andreas M, Winkler B, Geisler S, Geisler D, Rudziński PN, Watzal V, Strouhal A, Adlbrecht C, Delle-Karth G, Grabenwöger M. The Iliofemoral tortuosity score predicts access and bleeding complications during transfemoral transcatheter aortic valve replacement: DataData from the VIenna Cardio Thoracic aOrtic valve registrY (VICTORY). Eur J Clin Invest 2021; 51:e13491. [PMID: 33432599 PMCID: PMC8243921 DOI: 10.1111/eci.13491] [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] [Received: 11/26/2020] [Revised: 12/24/2020] [Accepted: 01/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Arterial tortuosity is linked to a higher risk of adverse clinical events after transfemoral transcatheter aortic valve replacement (TF-TAVR). Currently, there are no assessment tools that can quantify this variable in three-dimensional space. This study investigated the impact of novel scoring methods of iliofemoral tortuosity on access and bleeding complications after TF-TAVR. METHODS The main access vessel was assessed between the aortoiliacal and femoral bifurcation in preoperative multislice computed tomography scans of 240 consecutive patients undergoing TF-TAVR. Tortuosity was assessed by three methods: largest single angle, sum of all angles, and iliofemoral tortuosity (IFT) score [((true vessel length/ideal vessel length)-1)*100]. The primary study endpoint was a composite of access and bleeding complications. The secondary study endpoints were 30-day mortality and long-term survival. RESULTS Among 240 patients, only the IFT score demonstrated a good positive correlation with the composite primary endpoint of access and bleeding complications (P = 0.031). A higher incidence of access and bleeding complications was found in patients with a higher IFT score (56 [36.8%] vs 17 [19.3%]; P = 0.003). In a multivariate logistic regression analysis, only the IFT score was a significant predictor of the primary endpoint (OR: 2.11; 95% CI: 1.09-4.05; P = 0.026). CONCLUSION Vascular tortuosity is an underestimated risk factor during TF-TAVR. The IFT score is a valuable tool in risk stratification before TF-TAVR, predicting periprocedural access and bleeding complications.
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Affiliation(s)
- Markus Mach
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.,Department of Cardio-Vascular Surgery, Heart Team Vienna, Hospital Hietzing, and the Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria
| | - Thomas Poschner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Waseem Hasan
- Department of Cardio-Vascular Surgery, Heart Team Vienna, Hospital Hietzing, and the Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria.,Faculty of Medicine, Imperial College London, London, UK
| | - Philipp Szalkiewicz
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Bernhard Winkler
- Department of Cardio-Vascular Surgery, Heart Team Vienna, Hospital Hietzing, and the Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria
| | - Stephanie Geisler
- Department of Cardio-Vascular Surgery, Heart Team Vienna, Hospital Hietzing, and the Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria
| | - Daniela Geisler
- Department of Cardio-Vascular Surgery, Heart Team Vienna, Hospital Hietzing, and the Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria
| | - Piotr N Rudziński
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.,Department of Coronary and Structural Heart Diseases, The Cardinal Stefan Wyszyński Institute of Cardiology, Warsaw, Poland
| | - Victoria Watzal
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Strouhal
- Vienna North Hospital - Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Vienna, Austria
| | - Christopher Adlbrecht
- Vienna North Hospital - Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Vienna, Austria
| | - Georg Delle-Karth
- Vienna North Hospital - Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Vienna, Austria
| | - Martin Grabenwöger
- Department of Cardio-Vascular Surgery, Heart Team Vienna, Hospital Hietzing, and the Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria.,Imed19, Private Clinical Research Center, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
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12
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Gomes WJ, Almeida RMS, Petrucci O, Antunes MJ, Albuquerque LC. The 2020 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Management of Patients with Valvular Heart Disease. Should the World Jump In? Braz J Cardiovasc Surg 2021; 36:278-288. [PMID: 34048208 PMCID: PMC8163277 DOI: 10.21470/1678-9741-2021-0953] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Walter J Gomes
- Cardiovascular Surgery Discipline and São Paulo Hospital. Escola Paulista de Medicina. Federal University of São Paulo, São Paulo, Brazil
| | - Rui M S Almeida
- Faculty of Medicine of the University Center Assis Gurgacz, Cascavel, PR, Brazil
| | - Orlando Petrucci
- Faculty of Medical Sciences. State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | | | - Luciano C Albuquerque
- São Lucas Hospital of the Pontifical Catholic University of Porto Alegre, Porto Alegre, RS, Brazil
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13
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Carli AG, Perini P, Vignali L, Bianchini Massoni C, Fanelli M, Freyrie A. Loss of Prosthetic Aortic Valve during TAVI Procedure: Endovascular Treatment in Emergent Setting. Ann Vasc Surg 2021; 73:585-588. [PMID: 33556523 DOI: 10.1016/j.avsg.2020.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/04/2020] [Accepted: 12/30/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has proven over the years to be a viable alternative to open surgery. A rare but severe complication is represented by the valve migration. We report a case of TAVI complication due to the loss of the prosthetic valve in the abdominal aorta treated by endovascular approach. METHODS An 88-year-old patient with severe aortic valve stenosis, symptomatic for dyspnea was proposed for a TAVI because considered at high risk for surgery. During the TAVI procedure, the undeployed device (Edwards SAPIEN 3 - Edwards Lifesciences, Irvine, CA, USA) detached from its delivery system. Several attempts to withdraw the valve fluctuating in the aorta into its supporting system were performed without success. An emergency endovascular treatment was promptly planned to obtain the exclusion from the flow of the embolized valve. Under local anaesthesia, through the percutaneous femoral access already present, a tube aortic endograft (EndurantTM II, Medtronic, Santa Rosa, CA; ETTF2828C70EE) was successfully introduced and deployed in the infrarenal aorta without any related complications. The embolized valve was completely covered by the endgraft and thus fixed to the aortic wall. The first postoperative computer tomography angiography (CTA) confirmed the correct placement of the endograft, the exclusion of the valve from the flow and the patency of the great vessels. No perioperative or postoperative complications were recorded. The patient was discharged on the ninth postoperative day with the indication to a new attempt of TAVI, through transapical access. CONCLUSIONS In case of intraprocedural loss of an undeplyed valve during TAVI, the valve fixing through endograft deployment in infrarenal aorta is a possible solution.
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Affiliation(s)
- Anna Giulia Carli
- Vascular Surgery, Department of Medicine and Surgery, University of Parma Parma, Italy.
| | - Paolo Perini
- Vascular Surgery, Department of Medicine and Surgery, University of Parma Parma, Italy
| | - Luigi Vignali
- Interventional Cardiology, University Hospital of Parma, Parma, Italy
| | | | - Mara Fanelli
- Vascular Surgery, Department of Medicine and Surgery, University of Parma Parma, Italy
| | - Antonio Freyrie
- Vascular Surgery, Department of Medicine and Surgery, University of Parma Parma, Italy
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14
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Birkl K, Plank F, Bonaros N, Feuchtner G, Friedrich G. Transcatheter Aortic Valve Repair in a Patient With Anomalous Right Coronary Artery Originating From the Left Aortic Sinus and Myelodysplastic Syndrome. Cureus 2020; 12:e9073. [PMID: 32656049 PMCID: PMC7348210 DOI: 10.7759/cureus.9073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a patient with symptomatic low-flow high-grade aortic valve stenosis and myelodysplastic syndrome. Preinterventional imaging revealed an anomalous origin of the right coronary artery only defined by CT. The patient was classified as high risk in regard to conventional cardiac surgery by our heart team and therefore scheduled for transcatheter aortic valve repair (TAVR). The case presentation describes the potential effect of this anatomical coronary variant with regard to the peri- and postinterventional outcome: anomalous origin of the right coronary artery may lead to severe ischemia during TAVR due to occlusion of the coronary vessel. Conversion to open surgery with immediate coronary bypass surgery may rapidly restore myocardial perfusion and enhance clinical outcome of the patient.
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Affiliation(s)
| | - Fabian Plank
- Cardiology, Medical University of Innsbruck, Innsbruck, AUT
| | - Nikos Bonaros
- Cardiac Surgery, Medical University of Innsbruck, Innsbruck, AUT
| | | | - Guy Friedrich
- Cardiology, Medical University of Innsbruck, Innsbruck, AUT
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15
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A novel technique to avoid perforation of the right ventricle by the temporary pacing lead during transcatheter aortic valve implantation. Cardiovasc Interv Ther 2020; 36:347-354. [PMID: 32474841 DOI: 10.1007/s12928-020-00676-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
Cardiac tamponade is a life-threatening complication during transcatheter aortic valve implantation (TAVI), often caused by perforation of the right ventricle (RV) by the temporary pacemaker used for rapid pacing during valve deployment. We aimed to assess the feasibility of performing rapid pacing while maintaining inflation of the pacing lead balloon in the RV during TAVI. Among 749 consecutive patients who underwent TAVI with SAPIEN XT valves between October 2013 and July 2015, 726 treated using rapid pacing with a transvenous balloon-tip lead were enrolled in our study, and were stratified into three groups according to the extent of balloon inflation in the RV as follows: full inflation (n = 100), partial inflation (n = 196), and deflation (n = 430). We compared the following clinical outcomes: pacing lead-related RV perforation, rapid pacing failure, valve malpositioning due to rapid pacing failure, device success, and 30-day mortality. Pacing lead-related RV perforation occurred only in patients in the deflation group (6 cases, 1.4%), but the differences among the groups were not statistically significant (p = 0.13). Rapid pacing failure, but no valve malpositioning, occurred most frequently in patients in the full inflation group (4.0% vs. 0.5% in the other groups, p = 0.004). The rate of device success (> 94%) and the 30-day mortality (2.0%) were similar among the three groups. Partial inflation of the balloon of the pacing lead may reduce the risk of RV perforation without increasing the risk of pacing failure or valve malpositioning.
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16
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Konsensuspapier der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG) zur kathetergestützten Aortenklappenimplantation (TAVI) 2020. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2020. [DOI: 10.1007/s00398-020-00373-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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17
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Kuck KH, Bleiziffer S, Eggebrecht H, Ensminger S, Frerker C, Möllmann H, Nef H, Thiele H, Treede H, Wimmer-Greinecker G, Walther T. Konsensuspapier der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG) zur kathetergestützten Aortenklappenimplantation (TAVI) 2020. KARDIOLOGE 2020. [DOI: 10.1007/s12181-020-00398-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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18
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Deharo P, Bisson A, Herbert J, Lacour T, Saint Etienne C, Grammatico-Guillon L, Porto A, Collart F, Bourguignon T, Cuisset T, Fauchier L. Impact of Sapien 3 Balloon-Expandable Versus Evolut R Self-Expandable Transcatheter Aortic Valve Implantation in Patients With Aortic Stenosis. Circulation 2020; 141:260-268. [DOI: 10.1161/circulationaha.119.043971] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background:
Two competing transcatheter aortic valve replacement (TAVR) technologies are currently available. Head-to-head comparisons of the relative performances of these 2 devices have been published. However, long-term clinical outcome evaluation remains limited by the number of patients analyzed, in particular, for recent-generation devices.
Methods:
Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients treated with a TAVR device commercialized in France between 2014 and 2018. Propensity score matching was used for the analysis of outcomes during follow-up. The objective of this study was to analyze the outcomes of TAVR according to Sapien 3 balloon-expandable (BE) versus Evolut R self-expanding TAVR technology at a nationwide level in France.
Results:
A total of 31 113 patients treated with either Sapien 3 BE or Evolut R self-expanding TAVR were found in the database. After matching on baseline characteristics, 20 918 patients were analyzed (10 459 in each group with BE or self-expanding valves). During follow-up (mean [SD], 358 [384]; median [interquartile range], 232 [10–599] days), BE TAVR was associated with a lower yearly incidence of all-cause death (relative risk, 0.88; corrected
P
=0.005), cardiovascular death (relative risk, 0.82; corrected
P
=0.002), and rehospitalization for heart failure (relative risk, 0.84; corrected
P
<0.0001). BE TAVR was also associated with lower rates of pacemaker implantation after the procedure (relative risk, 0.72; corrected
P
<0.0001).
Conclusions:
On the basis of the largest cohort available, we observed that Sapien 3 BE valves were associated with lower rates of all-cause death, cardiovascular death, rehospitalization for heart failure, and pacemaker implantation after a TAVR procedure.
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Affiliation(s)
- Pierre Deharo
- Département de Cardiologie (P.D., T.C.), CHU Timone, Marseille, France
- INSERM, INRA (P.D., F.C., T.C.), Aix Marseille Université, France
- Faculté de Médecine (P.D., F.C., T.C.), Aix Marseille Université, France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine (A.B., J.H., T.L., C.S.E., L.F.), France
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine (A.B., J.H., T.L., C.S.E., L.F.), France
- Service d’information médicale, d’épidémiologie et d’économie de la santé, Unité d’épidémiologie hospitalière régionale (J.H., T.L., L.G.-G.), France
| | - Thibaud Lacour
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine (A.B., J.H., T.L., C.S.E., L.F.), France
- Service d’information médicale, d’épidémiologie et d’économie de la santé, Unité d’épidémiologie hospitalière régionale (J.H., T.L., L.G.-G.), France
| | - Christophe Saint Etienne
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine (A.B., J.H., T.L., C.S.E., L.F.), France
| | - Leslie Grammatico-Guillon
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine (A.B., J.H., T.L., C.S.E., L.F.), France
| | | | - Frederic Collart
- Département de Chirurgie Cardiaque (F.C.), CHU Timone, Marseille, France
- INSERM, INRA (P.D., F.C., T.C.), Aix Marseille Université, France
- Faculté de Médecine (P.D., F.C., T.C.), Aix Marseille Université, France
| | | | - Thomas Cuisset
- Département de Cardiologie (P.D., T.C.), CHU Timone, Marseille, France
- INSERM, INRA (P.D., F.C., T.C.), Aix Marseille Université, France
- Faculté de Médecine (P.D., F.C., T.C.), Aix Marseille Université, France
| | - Laurent Fauchier
- Service d’information médicale, d’épidémiologie et d’économie de la santé, Unité d’épidémiologie hospitalière régionale (J.H., T.L., L.G.-G.), France
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19
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Naik M, McNamara C, Jabbour RJ, Gopalan D, Mikhail GW, Mirsadraee S, Ariff B. Imaging of transcatheter aortic valve replacement complications. Clin Radiol 2020; 76:27-37. [PMID: 31964536 DOI: 10.1016/j.crad.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/11/2019] [Indexed: 01/05/2023]
Abstract
Aortic stenosis is increasing in incidence and is now commonly managed with transcatheter aortic valve replacement (TAVR) in intermediate and high-risk patients. Radiologists are likely to encounter patients undergoing this procedure both pre- and postoperatively, and therefore, an understanding of procedural complications is essential. Complications may relate to the access site or approach, or the valve itself. This article will review the most common complications described in literature and focuses on the role of multidetector computed tomography (CT) in their evaluation either exclusively, or complementary to other imaging methods.
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Affiliation(s)
- M Naik
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - C McNamara
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - R J Jabbour
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - D Gopalan
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - G W Mikhail
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - S Mirsadraee
- Department of Radiology, Harefield Hospital, Hill End Road, Uxbridge, UB9 6JH, UK
| | - B Ariff
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.
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20
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Pericardial tamponade as a complication of invasive cardiac procedures: a review of the literature. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:394-403. [PMID: 31933655 PMCID: PMC6956453 DOI: 10.5114/aic.2019.90213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/21/2019] [Indexed: 01/26/2023] Open
Abstract
Cardiac tamponade (CT) is a rare but often life-threatening complication after invasive cardiac procedures. Some procedures favor CT. Furthermore, the incidence depends on patients’ comorbidities, sex and age and operators’ skills. In this paper we review studies and meta-analyses concerning the rate of iatrogenic CT. We define the risk factors of CT and show concise characteristics for each invasive cardiac procedure separately. According to our analysis CT occurs especially after procedures requiring transseptal puncture or perioperative anticoagulation. The overall rate of CT after such procedures varies among published studies from 0.089% to 4.8%. For this purpose we searched the PubMed database for clinical studies published up to December 2018. We included only those studies in which a defined minimum of procedures were performed (1000 for atrial fibrillation ablation, 6000 for percutaneous coronary intervention, 900 for permanent heart rhythm devices, 90 for left atrial appendage closure, 300 for transcatheter aortic valve implantation and percutaneous mitral valve repair with the Mitra-Clip system). The search was structured around the key words and variants of these terms. In addition, secondary source documents were identified by manual review of reference lists, review articles and guidelines. The search was limited to humans and adults (18+ years).
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21
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Nandy S, Wan SH, Klarich K. Implantation of Leadless Pacemaker for the Development of New Left Bundle Branch Block and Symptomatic Pause Following Transcatheter Aortic Valve Replacement. Heart Views 2019; 20:170-171. [PMID: 31803374 PMCID: PMC6881870 DOI: 10.4103/heartviews.heartviews_91_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 09/11/2019] [Indexed: 11/04/2022] Open
Abstract
Cardiac conduction disturbances such as left bundle branch block (LBBB) and atrioventricular blocks (AVB) occur frequently following transcatheter aortic valve replacement (TAVR) and may be associated with adverse clinical events. There is a lack of consensus regarding permanent pacemaker implantation in the case of occurrence of TAVR-related bundle branch blocks or combination of AVB and bundle blocks. Furthermore, there are no guidelines regarding the use of the leadless pacemaker in this setting. We present a patient who underwent successful implantation of a leadless pacemaker for a new LBBB post-TAVR.
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Affiliation(s)
- Sneha Nandy
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Siu-Hin Wan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Kyle Klarich
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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22
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Scarsini R, De Maria GL, Joseph J, Fan L, Cahill TJ, Kotronias RA, Burzotta F, Newton JD, Kharbanda R, Prendergast B, Ribichini F, Banning AP. Impact of Complications During Transfemoral Transcatheter Aortic Valve Replacement: How Can They Be Avoided and Managed? J Am Heart Assoc 2019; 8:e013801. [PMID: 31522627 PMCID: PMC6818016 DOI: 10.1161/jaha.119.013801] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Roberto Scarsini
- Oxford Heart Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom.,Division of Cardiology Department of Medicine University of Verona Italy
| | - Giovanni L De Maria
- Oxford Heart Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Jubin Joseph
- Oxford Heart Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom.,Guy's and St.Thomas' Hospitals NHS Foundation Trust London United Kingdom
| | - Lampson Fan
- Oxford Heart Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Thomas J Cahill
- Oxford Heart Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Rafail A Kotronias
- Oxford Heart Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom.,Department of Cardiovascular Medicine University of Oxford United Kingdom
| | | | - James D Newton
- Oxford Heart Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Rajesh Kharbanda
- Oxford Heart Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | | | - Flavio Ribichini
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Adrian P Banning
- Oxford Heart Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
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23
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Sarkar K. TAVI-thick on technology but thin on evidence. Indian J Thorac Cardiovasc Surg 2018; 35:468-472. [PMID: 33061032 PMCID: PMC7525850 DOI: 10.1007/s12055-018-0731-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/06/2018] [Accepted: 08/10/2018] [Indexed: 01/12/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as one of the most popularly deployed interventional innovations of recent times. After addressing the inoperable and high-risk patients, it is application is being extended to intermediate and low-risk category. There is some disquiet about the strength of evidence on which the clinical application is based. Durability and pacemaker requirement are also areas of concern. This review highlights the areas of concern on these aspects. There is also a need to address these deficiencies in future trials and also bring updated database reports in the public domain.
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Affiliation(s)
- Kunal Sarkar
- Medica Superspecialty Hospital, Kolkata, 700099 India
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24
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Piayda K, Hellhammer K, Veulemans V, Zeus T. Sealing capacity of the ventricular muscle band after iatrogenic left ventricular perforation during transcatheter aortic valve implantation. BMJ Case Rep 2018; 2018:bcr-2018-225439. [PMID: 30030253 DOI: 10.1136/bcr-2018-225439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Left ventricular (LV) perforation accompanied by acute cardiac tamponade is a rare but one of the most feared complication during transcatheter aortic valve implantation. Few cases with the need of emergent surgical repair are described in literature. Handling of this uncommon but possible life-threatening event requires well-considered action by the implanting team and is associated with substantially increased intrahospital mortality. We present a unique case of LV perforation management with percutaneous pericardiocentesis only. As a possible underlying physiological mechanism, we identified the movement of the ventricular muscle band which possibly sealed the perforation side due to transverse and circumferential muscle contractions.
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Affiliation(s)
- Kerstin Piayda
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Katharina Hellhammer
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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25
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Meredith IT, Dumonteil N, Blackman DJ, Tchétché D, Walters DL, Hildick-Smith D, Manoharan G, Harnek J, Worthley SG, Rioufol G, Lefèvre T, Modine T, Van Mieghem NM, Feldman T, Allocco DJ, Dawkins KD. Repositionable percutaneous aortic valve implantation with the LOTUS valve: 30-day and 1-year outcomes in 250 high-risk surgical patients. EUROINTERVENTION 2018; 13:788-795. [PMID: 28555592 DOI: 10.4244/eij-d-16-01024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The REPRISE IIE trial aimed to evaluate outcomes following transcatheter aortic valve implantation of the fully repositionable and retrievable LOTUS valve with a unique seal designed to minimise paravalvular leak (PVL). METHODS AND RESULTS This prospective, multicentre study enrolled 250 patients with severe aortic stenosis considered high-risk for surgery by a multidisciplinary Heart Team. An independent clinical events committee adjudicated events per Valve Academic Research Consortium criteria. Mean age was 84 years; 77% were in NYHA Class III/IV. LOTUS valve implantation produced significant haemodynamic improvements at one year without valve embolisation, ectopic valve deployment, or additional valve implantation. Primary endpoints were met as the 30-day mortality rate in the extended cohort (4.4%, N=250), and mean valve gradient in the main cohort (11.5±5.2 mmHg, N=120) were below (p<0.001) their predefined performance objectives. At 30 days, disabling stroke was 2.8% and new pacemaker implantation was 28.9% in all patients and 32.0% in pacemaker-naïve patients. By one year, all-cause mortality was 11.6%, disabling stroke was 3.6%, 95% of patients alive were in NYHA Class I/II, and there was no core laboratory-adjudicated moderate/severe PVL. CONCLUSIONS LOTUS valve implantation produced good valve haemodynamics, minimal PVL, sustained significant improvement in functional status, and good clinical outcomes one year post implant.
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Affiliation(s)
- Ian T Meredith
- Monash Heart, Monash Medical Centre, and Monash University, Clayton, Victoria, Australia
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26
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Mitrosz M, Kazimierczyk R, Chlabicz M, Sobkowicz B, Waszkiewicz E, Lisowska A, Dobrzycki S, Musial WJ, Hirnle T, Kaminski KA, Tycinska AM. Perioperative thrombocytopenia predicts poor outcome in patients undergoing transcatheter aortic valve implantation. Adv Med Sci 2018; 63:179-184. [PMID: 29145170 DOI: 10.1016/j.advms.2017.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/26/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the time point at which thrombocytopenia after TAVI procedure is an indicator of the worst prognosis, with special consideration of perioperative platelet and coagulation activation as its potential causes. METHODS Thirty two patients (mean age 78.5±7.9years, 62% females) qualified for TAVI procedure were prospectively evaluated. Platelet counts were assessed at baseline and for the next three postoperative (POD) days. Platelet activation was evaluated by P-selectin (PS, serum, ELISA) and platelet factor 4 (PF-4, CTAD plasma), and blood coagulation activation by prothrombin fragments 1+2 (F1+2, plasma, ELISA). Composite end point (CEP) including death and the need of cardiovascular rehospitalization was assessed after a mean of 14.1±6.7months. RESULTS During the follow up period half of the patients reached CEP. Thrombocytopenia was more profound and frequent in patients with CEP as compared to those without (p<0.05). No differences regarding either the biomarkers of platelet (PS, PF-4) or coagulation (F1+F2) activation between the groups with and without CEP were found. Patients with moderate-to-severe thrombocytopenia at baseline had worse prognosis (log-rank test, p=0.0003). Based on the receiver operating characteristic curve analysis, the differences between platelet count on each postoperative day and the baseline count did not have any predictive value in CEP occurrence. CONCLUSIONS Patients with thrombocytopenia following TAVI procedure have poor prognosis, however, the changes on the particular days are not more important than initial platelet count. Further studies are needed to evaluate platelet and blood coagulation activation as potential causes of thrombocytopenia and impaired prognosis related to it.
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Zeniou V, Chen S, Gilon D, Segev A, Finkelstein A, Planer D, Barbash I, Halkin A, Beeri R, Lotan C, Danenberg HD. Ventricular Septal Defect as a Complication of TAVI: Mechanism and Incidence. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2018. [DOI: 10.1080/24748706.2018.1434580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Vicki Zeniou
- Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Shmuel Chen
- Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Dan Gilon
- Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Amit Segev
- Department of Cardiology, Sheba Medical Center, Ramat Gan, Israel
| | - Arik Finkelstein
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - David Planer
- Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Israel Barbash
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Amir Halkin
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ronen Beeri
- Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Chaim Lotan
- Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Haim D. Danenberg
- Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Ali N, Patel PA, Lindsay SJ. Recent developments and controversies in transcatheter aortic valve implantation. Eur J Heart Fail 2018; 20:642-650. [PMID: 29368369 DOI: 10.1002/ejhf.1141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/03/2017] [Accepted: 12/26/2017] [Indexed: 12/19/2022] Open
Abstract
Interventional cardiology has been revolutionised by transcatheter aortic valve implantation (TAVI), which has become established as the benchmark treatment for severe aortic stenosis in patients at high risk for surgical aortic valve replacement (AVR). Increased procedural familiarity and progression in device technology has enabled improvements to be made in complication rates, which have led to a commensurate expansion in the use of TAVI; it is now a viable alternative to AVR in patients at intermediate surgical risk, and has been used in cohorts such as those with bicuspid aortic valves or pure, severe aortic regurgitation. Given the rapid expansion in the use of TAVI, including cohorts of younger patients with fewer co-morbidities, attention must be paid to further reducing remaining complications, such as cardiac tamponade or stroke. To this end, novel techniques and devices have been devised and trialled, with varying levels of success. Furthermore, significant work has gone into refining the technique with exploration of alternative imaging modalities, as well as alternative access routes to provide greater options for patients with challenging vascular anatomy. Whilst significant progress has been made with TAVI, areas of uncertainty remain such as the management of concomitant coronary artery disease and the optimum post-procedure antiplatelet regimen. As such, research in this field continues apace, and is likely to continue as use of TAVI becomes more widespread. This review provides a summary of the existing evidence, as well as an overview of recent developments and contentious issues in the field of TAVI.
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Affiliation(s)
- Noman Ali
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Peysh A Patel
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Steven J Lindsay
- Department of Cardiology, Bradford Royal Infirmary, Bradford, UK
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Monteiro C, Ferrari ADL, Caramori PRA, Carvalho LAF, Siqueira DADA, Thiago LEKS, Perin M, Lima VCD, Guérios E, Brito Junior FSD. Permanent Pacing After Transcatheter Aortic Valve Implantation: Incidence, Predictors and Evolution of Left Ventricular Function. Arq Bras Cardiol 2017; 109:550-559. [PMID: 29185614 PMCID: PMC5783436 DOI: 10.5935/abc.20170170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 07/12/2017] [Indexed: 12/21/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is a well-established
procedure; however, atrioventricular block requiring permanent pacemaker
implantation (PPI) is a common complication. Objectives To determine the incidence, predictors and clinical outcomes of PPI after
TAVI, focusing on how PPI affects left ventricular ejection fraction (LVEF)
after TAVI. Methods The Brazilian Multicenter TAVI Registry included 819 patients submitted to
TAVI due to severe aortic stenosis from 22 centers from January/2008 to
January/2015. After exclusions, the predictors of PPI were assessed in 670
patients by use of multivariate regression. Analysis of the ROC curve was
used to measure the ability of the predictors; p < 0.05 was the
significance level adopted. Results Within 30 days from TAVI, 135 patients (20.1%) required PPI. Those patients
were older (82.5 vs. 81.1 years; p = 0.047) and mainly of the male sex
(59.3% vs 45%; p = 0.003). Hospital length of stay was longer in patients
submitted to PPI (mean = 15.7 ± 25.7 vs. 11.8 ± 22.9 days; p
< 0.001), but PPI affected neither all-cause death (26.7% vs. 25.6%; p =
0.80) nor cardiovascular death (14.1% vs. 14.8%; p = 0.84). By use of
multivariate analysis, the previous presence of right bundle-branch block
(RBBB) (OR, 6.19; 3.56-10.75; p ≤ 0.001), the use of
CoreValve® prosthesis (OR, 3.16; 1.74-5.72; p ≤
0.001) and baseline transaortic gradient > 50 mm Hg (OR, 1.86; 1.08-3.2;
p = 0.025) were predictors of PPI. The estimated risk of PPI ranged from 4%,
when none of those predictors was present, to 63%, in the presence of all of
them. The model showed good ability to predict the need for PPI: 0.69
(95%CI: 0.64 - 0.74) in the ROC curve. The substudy of 287 echocardiograms
during the 1-year follow-up showed worse LVEF course in patients submitted
to PPI (p = 0.01). Conclusion BRD prévio, gradiente aórtico médio > 50 mmHg e
CoreValve® são preditores independentes de implante de MPD
pós-TAVI. Ocorreu implante de MPD em aproximadamente 20% dos casos de
TAVI, o que prolongou a internação hospitalar, mas não
afetou a mortalidade. O implante de MPD afetou negativamente a FEVE
pós-TAVI.
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Affiliation(s)
- Cláudio Monteiro
- Centro de Pesquisas Cardiovasculares do Hospital São Lucas da PUCRS, Porto Alegre, RS - Brazil
| | - Andres Di Leoni Ferrari
- Centro de Pesquisas Cardiovasculares do Hospital São Lucas da PUCRS, Porto Alegre, RS - Brazil
| | | | | | | | | | - Marco Perin
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
| | - Valter C de Lima
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS - Brazil
| | - Enio Guérios
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR - Brazil - Brazil
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Mariathas M, Rawlins J, Curzen N. Transcatheter aortic valve implantation: where are we now? Future Cardiol 2017; 13:551-566. [DOI: 10.2217/fca-2017-0056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) was first used in clinical practice in 2002. Since 2002, there has been a rapid increase in TAVI activity in patients with symptomatic severe aortic stenosis. This has been supported by systematic randomized data comparing TAVI against the gold standard treatment for the last 50 years’ surgical aortic valve replacement. TAVI is now currently a recommended therapeutic intervention in the treatment of severe aortic stenosis patients who are deemed either high risk or inoperable. The indications for TAVI continue to expand. Within this review we will focus on the current guidelines for TAVI, the evidence for it, the complications of TAVI, postprocedure care, the technology available to clinicians now and finally the future perspectives for TAVI.
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Affiliation(s)
- Mark Mariathas
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - John Rawlins
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
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Van Gestel R, Müller T, Bosmans J. Does my high blood pressure improve your survival? Overall and subgroup learning curves in health. HEALTH ECONOMICS 2017; 26:1094-1109. [PMID: 28449316 DOI: 10.1002/hec.3505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/09/2017] [Accepted: 02/16/2017] [Indexed: 06/07/2023]
Abstract
Learning curves in health are of interest for a wide range of medical disciplines, healthcare providers, and policy makers. In this paper, we distinguish between three types of learning when identifying overall learning curves: economies of scale, learning from cumulative experience, and human capital depreciation. In addition, we approach the question of how treating more patients with specific characteristics predicts provider performance. To soften collinearity problems, we explore the use of least absolute shrinkage and selection operator regression as a variable selection method and Theil-Goldberger mixed estimation to augment the available information. We use data from the Belgian Transcatheter Aorta Valve Implantation (TAVI) registry, containing information on the first 860 TAVI procedures in Belgium. We find that treating an additional TAVI patient is associated with an increase in the probability of 2-year survival by about 0.16%-points. For adverse events like renal failure and stroke, we find that an extra day between procedures is associated with an increase in the probability for these events by 0.12%-points and 0.07%-points, respectively. Furthermore, we find evidence for positive learning effects from physicians' experience with defibrillation, treating patients with hypertension, and the use of certain types of replacement valves during the TAVI procedure.
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Affiliation(s)
- Raf Van Gestel
- Department of Economics, University of Antwerp, Prinsstraat 13, 2000 Antwerpen, Belgium
| | - Tobias Müller
- Seminar of Health Economics, Universitat Luzern, Frohburgstrasse 3, 6002 Luzern, Switzerland
| | - Johan Bosmans
- Department of Cardiology, University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
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Zivelonghi C, Pesarini G, Scarsini R, Lunardi M, Piccoli A, Ferrero V, Gottin L, Vassanelli C, Ribichini F. Coronary Catheterization and Percutaneous Interventions After Transcatheter Aortic Valve Implantation. Am J Cardiol 2017; 120:625-631. [PMID: 27964903 DOI: 10.1016/j.amjcard.2016.10.046] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 11/17/2022]
Abstract
Coronary artery disease (CAD) is often present in patients with severe aortic valve stenosis candidates to transcatheter aortic valve implantation (TAVI). Mild CAD may also worsen and need treatment years after TAVI. The implantation of a transcatheter valve may interfere with the capability of reengaging the coronary arteries. We prospectively assessed the feasibility of performing coronary angiography (CA), fractional flow reserve, and, where indicated, percutaneous coronary intervention after valve implantation in a consecutive series of patients with CAD undergoing TAVI. Valve type and size were decided according to accurate computed tomography scan and angiographic measurement of the aortic root structures. We analyzed 66 consecutive patients undergoing TAVI, 41 with balloon-expandable, and 25 with self-expandable transcatheter valves. Right and left coronary catheterization (132 vessels) was successful in all cases except in 1 left coronary artery after a high implantation of a self-expandable valve (unsuccess rate, 1 in 50 vessels). In 6 of 132 vessels (4%), CA was initially nonselective, but after positioning the 0.014″ intracoronary guidewire, selective injections were obtained in all these cases. Percutaneous coronary intervention was performed successfully in 19 coronary vessels (17 patients) as indicated by fractional flow reserve measurements. In conclusion, catheterization of the coronary ostia after transfemoral TAVI with balloon or self-expandable valves is safe and feasible in almost all cases. Accurate imaging of the aortic root and procedural planning may help to avoid too high implantation of supra-annular self-expandable valves to obviate difficulties in accessing coronary ostia. Use of intracoronary guidewires facilitates selective CA in cases with difficult access.
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Affiliation(s)
- Carlo Zivelonghi
- Division of Cardiology, Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Mattia Lunardi
- Division of Cardiology, Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Anna Piccoli
- Division of Cardiology, Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Valeria Ferrero
- Division of Cardiology, Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Leonardo Gottin
- Division of Cardiology, Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Corrado Vassanelli
- Division of Cardiology, Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, School of Medicine, University of Verona, Verona, Italy.
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Marzahn C, Koban C, Seifert M, Isotani A, Neuß M, Hölschermann F, Butter C. Conduction recovery and avoidance of permanent pacing after transcatheter aortic valve implantation. J Cardiol 2017; 71:101-108. [PMID: 28818562 DOI: 10.1016/j.jjcc.2017.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/05/2017] [Accepted: 06/25/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is an established treatment option for patients with severe aortic stenosis and high surgical risk. Currently, various prosthesis types are available. Atrioventricular block (AVB) requiring pacemaker (PM) implantation is a typical complication after TAVI. This study investigated the recovery of AV node conduction and mid-term outcome of patients with or without PM implantation after TAVI according to prosthesis type. METHODS From July 2008 to May 2015, 856 transcatheter heart valves were implanted at our center (age: 80.5±6.1 years; logistic EuroSCORE: 15.4%). These patients were followed up regularly in our outpatient clinic. RESULTS PM implantation was performed in 16.9% of patients due to severe conduction disturbances, mainly third-degree AVB. The need for PM implantation differed between the various prosthesis types: Medtronic CoreValve (Medtronic Inc., Minneapolis, MN, USA): 22.8% (n=272), Edwards Sapien XT (Edwards Lifesciences, Irvine, CA, USA): 13.0% (n=262), Edwards Sapien 3 (Edwards Lifesciences, Irvine, CA, USA): 16.2% (n=234), Direct Flow Medical (Direct Flow Medical, Santa Rosa, CA, USA): 7.3% (n=41), St. Jude Medical Portico (St. Jude Medical, St. Paul, MN, USA): 15.4% (n=26), Boston Scientific Lotus (Boston Scientific, Marlborough, MA, USA): 21.4% (n=14) and Medtronic Evolut R (Medtronic Inc., Minneapolis, MN, USA): 14.3% (n=7). Kaplan-Meier analysis for all-cause mortality did not reveal any differences between the various prosthesis types. PM implantation rates declined over the years of experience in a stable intervention team; 45% of PM patients showed sufficient AV node conduction after PM reprogramming at our follow-up examination. CONCLUSIONS Mid-term all-cause survival after TAVI seems to be independent of prosthesis type and PM implantation after TAVI. Intrinsic AV node conduction recovers in a significant proportion of patients. Therefore, regular PM interrogations including reprogramming are required to avoid unnecessary permanent right ventricular stimulation.
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Affiliation(s)
- Corinne Marzahn
- Heart Center Brandenburg in Bernau, Medical School Brandenburg, Bernau, Germany; Charité Universitätsmedizin Berlin, Germany
| | - Cornel Koban
- Heart Center Brandenburg in Bernau, Medical School Brandenburg, Bernau, Germany
| | - Martin Seifert
- Heart Center Brandenburg in Bernau, Medical School Brandenburg, Bernau, Germany
| | - Akihiro Isotani
- Heart Center Brandenburg in Bernau, Medical School Brandenburg, Bernau, Germany; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Michael Neuß
- Heart Center Brandenburg in Bernau, Medical School Brandenburg, Bernau, Germany
| | - Frank Hölschermann
- Heart Center Brandenburg in Bernau, Medical School Brandenburg, Bernau, Germany
| | - Christian Butter
- Heart Center Brandenburg in Bernau, Medical School Brandenburg, Bernau, Germany.
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Spaziano M, Sawaya F, Chevalier B, Roy A, Neylon A, Garot P, Hovasse T, Benamer H, Romano M, Unterseeh T, Bouvier E, Cormier B, Morice MC, Lefèvre T. Comparison of Systematic Predilation, Selective Predilation, and Direct Transcatheter Aortic Valve Implantation With the SAPIEN S3 Valve. Can J Cardiol 2017; 33:260-268. [DOI: 10.1016/j.cjca.2016.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/14/2016] [Accepted: 09/06/2016] [Indexed: 10/24/2022] Open
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Hecker F, Arsalan M, Walther T. Managing Stroke During Transcatheter Aortic Valve Replacement. Interv Cardiol 2017; 12:25-30. [PMID: 29588726 DOI: 10.15420/icr.2016:26:1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has become the default treatment option for high-risk patients with aortic stenosis and an alternative to surgical aortic valve replacement in intermediate-risk patients. There are, however, concerns regarding strokes during TAVR. Reported stroke rates vary strongly depending on the type of study, stroke definition, cohort and study period. Furthermore, stroke after TAVR occurs in three distinct phases: 1) early high-risk, directly procedure related; 2) elevated risk interval between day 2 and day 30; 3) late hazard interval. Each of these phases is caused by the different aetiologies of stroke. This review summarises the different aetiologies and potential strategies for managing stroke during TAVR.
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Affiliation(s)
- Florian Hecker
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Mani Arsalan
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
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Abstract
Transcatheter aortic valve implantation (TAVI) has evolved as the treatment modality of choice for elderly patients with symptomatic severe aortic stenosis who are at high risk for surgery. More than 10,000 TAVI procedures were undertaken in Germany during 2014.A mortality benefit has been shown for TAVI compared with conservative treatment in patients deemed inoperable, and the procedure was proven to be at least non-inferior to surgical aortic valve replacement in high-risk patients. Through improvements in preprocedural imaging and in valve technology as well as increasing operator and surgical team experience, TAVI has developed rapidly in the past few years. Complication rates declinded considerably and the latest study results even suggest a superiority of TAVI to surgical valve replacement in patients at intermediate operative risk. Nevertheless, the challenge to avoid procedure-specific complications influencing the outcome still remains. Therefore, making an individual decision about the approach and the valve prosthesis in an interdisciplinary heart team consisting of a cardiologist and a cardiac surgeon is indispensable for guaranteeing the best therapy for the patient.Considering the rapid developments and procedural improvements in this field, randomized trials are required to assess whether the indication for TAVI may be extended to patients at lower perioperative risk in the future.
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Affiliation(s)
- Luise Gaede
- Abteilung Kardiologie, Kerckhoff-Klinik Bad Nauheim, Benekestrasse 2-8, 61231, Bad Nauheim, Deutschland
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Transfemoral aortic valve implantation of Edwards SAPIEN 3 without predilatation. Catheter Cardiovasc Interv 2016; 89:E38-E43. [DOI: 10.1002/ccd.26464] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/20/2015] [Accepted: 01/22/2016] [Indexed: 11/07/2022]
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Efficacy of intraoperative transesophageal echocardiography in a case of protamine shock during transcatheter aortic valve implantation. JA Clin Rep 2016; 2:29. [PMID: 29492424 PMCID: PMC5815465 DOI: 10.1186/s40981-016-0053-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/23/2016] [Indexed: 11/11/2022] Open
Abstract
Here, we report the case of a patient who developed protamine shock during a transcatheter aortic valve implant (TAVI) procedure, which was diagnosed by intraoperative transesophageal echocardiography (TEE). A 77-year-old man with symptomatic severe aortic stenosis and reduced left ventricular (LV) function underwent TAVI under general anesthesia. During the procedure, a transcatheter heart valve (THV) was deployed via the transfemoral approach, without any other major complications. The entire device system was then removed, and protamine sulfate was administered intravenously in 2 min. Two minutes after the protamine administration, severe hypotension occurred. TEE did not reveal THV malfunction or any other major complications. However, comparison of the TEE image obtained before protamine administration and that obtained 2 min after protamine administration showed right ventricular (RV) dilatation, RV free wall motion abnormality, and LV volume reduction, without any electrocardiographic changes. We diagnosed this as protamine shock and bolus infusions of phenylephrine and norepinephrine were administered, and chest compressions were initiated immediately. After 1 min, hypotension as well as the right and left ventricular size and dysfunction immediately reverted to baseline. The severe systemic hypotension resolved as well. Thereafter, he recovered from anesthesia without other complications. This case showed the clinical features of protamine shock with acute pulmonary hypertension. The TEE images, in this case, should be a reminder for all doctors who perform intraoperative TEE for patient monitoring when they perform procedures to treat structural heart diseases.
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Allahwala UK, Hansen PS, Danson EJ, Straiton N, Sinhal A, Walters DL, Bhindi R. Transcatheter aortic valve implantation: current trends and future directions. Future Cardiol 2015; 12:69-85. [PMID: 26696562 DOI: 10.2217/fca.15.73] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has been increasingly utilized for the treatment of severe symptomatic aortic stenosis in inoperable and high surgical risk patients. Recent advances in valve technology include repositionable scaffolds and smaller delivery systems, as well as improvement in periprocedural imaging. These advances have resulted in reduction of vascular complications, rates of paravalvular aortic regurgitation and periprocedural stroke and improved overall outcomes. Increasingly, TAVI is the preferred treatment for high-risk surgical patients with severe aortic stenosis. Consequently, there is growing interest for the use of TAVI in lower surgical risk patients. Furthermore, the role of TAVI has expanded to include valve-in-valve procedures for the treatment of degenerative bioprosthetic valves and bicuspid aortic valves. Questions remain in regard to the optimal management of concurrent coronary artery disease, strategies to minimize valve leaflet restriction and treatment of conduction abnormalities as well as identifying newer indications for its use.
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Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Peter S Hansen
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Edward J Danson
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Nicola Straiton
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Ajay Sinhal
- Department of Cardiology, Flinders Medical Centre, Adelaide, Australia
| | - Darren L Walters
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
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Gluing of an Aortic Perforation During Transcatheter Aortic Valve Replacement: An Alternative Treatment for Annular Rupture? JACC Cardiovasc Interv 2015; 8:2037-2038. [PMID: 26627993 DOI: 10.1016/j.jcin.2015.08.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 08/13/2015] [Indexed: 11/21/2022]
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Inohara T, Hayashida K, Watanabe Y, Yamamoto M, Takagi K, Yashima F, Arai T, Shimizu H, Chevalier B, Lefèvre T, Fukuda K, Morice MC. Streamlining the learning process for TAVI: Insight from a comparative analysis of the OCEAN-TAVI and the massy registries. Catheter Cardiovasc Interv 2015; 87:963-70. [DOI: 10.1002/ccd.26266] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/26/2015] [Accepted: 09/16/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Taku Inohara
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Kentaro Hayashida
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Yusuke Watanabe
- Division of Cardiology, Department of Internal Medicine; Teikyo University School of Medicine; Tokyo Japan
| | - Masanori Yamamoto
- Division of Cardiovascular Medicine; Toyohashi Heart Center; Toyohashi Japan
| | - Kensuke Takagi
- Interventional Cardiology Unit; New Tokyo Hospital; Chiba Japan
| | - Fumiaki Yashima
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Takahide Arai
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
- Department of Interventional Cardiology; Institut Cardiovasculaire Paris Sud; Massy France
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery; Keio University School of Medicine; Tokyo Japan
| | - Bernard Chevalier
- Department of Interventional Cardiology; Institut Cardiovasculaire Paris Sud; Massy France
| | - Thierry Lefèvre
- Department of Interventional Cardiology; Institut Cardiovasculaire Paris Sud; Massy France
| | - Keiichi Fukuda
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Marie-Claude Morice
- Department of Interventional Cardiology; Institut Cardiovasculaire Paris Sud; Massy France
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Walther T, Hamm CW, Schuler G, Berkowitsch A, Kötting J, Mangner N, Mudra H, Beckmann A, Cremer J, Welz A, Lange R, Kuck KH, Mohr FW, Möllmann H. Perioperative Results and Complications in 15,964 Transcatheter Aortic Valve Replacements: Prospective Data From the GARY Registry. J Am Coll Cardiol 2015; 65:2173-80. [PMID: 25787198 DOI: 10.1016/j.jacc.2015.03.034] [Citation(s) in RCA: 303] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 03/06/2015] [Accepted: 03/06/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has evolved into a routine procedure with good outcomes in high-risk patients. OBJECTIVES TAVR complication rates were evaluated based on prospective data from the German Aortic Valve Registry (GARY). METHODS From 2011 to 2013, a total of 15,964 TAVR procedures were registered. We evaluated the total cohort for severe vital complications (SVCs), including the following: death on the day of intervention, conversion to sternotomy, low cardiac output that required mechanical support, aortic dissection, and annular rupture; technical complications of the procedures (TCOs), such as repositioning or retrieval of the valve prosthesis and embolization of the prosthesis; and other complications. RESULTS Mean patient age was 81 ± 6 years, 54% of the patients were women, the median logistic Euroscore I was 18.3, the German aortic valve score was 5.6, and the Society of Thoracic Surgeons score was 5.0. Overall in-hospital mortality was 5.2%, whereas SVCs occurred in 5.0% of the population. Independent predictors for SVCs were female sex, pre-operative New York Heart Association functional class IV, ejection fraction <30%, pre-operative intravenous inotropes, arterial vascular disease, and higher degree of calcifications. TCOs occurred in 4.7% of patients and decreased significantly from 2011 to 2013. An emergency sternotomy was performed in 1.3% of the patients; however, multivariate analysis did not identify any predictors for conversion to sternotomy. CONCLUSIONS The all-comers GARY registry revealed good outcomes after TAVR and a regression in complications. Survival of approximately 60% of patients who experienced SVCs or who required sternotomy underlines the need for heart team-led indication, intervention, and follow-up care of TAVR patients.
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Affiliation(s)
- Thomas Walther
- Kerckhoff Herzzentrum, Abteilung Herzchirurgie, Bad Nauheim, Germany.
| | - Christian W Hamm
- Kerckhoff Herzzentrum, Abteilung Kardiologie, Bad Nauheim, Germany
| | - Gerhard Schuler
- Herzzentrum Leipzig, Abteilung Kardiologie, Leipzig, Germany
| | | | | | - Norman Mangner
- Herzzentrum Leipzig, Abteilung Kardiologie, Leipzig, Germany
| | - Harald Mudra
- Städtisches Klinikum Munich, Klinikum Neuperlach, Department of Cardiology/Pneumology, Munich, Germany
| | - Andreas Beckmann
- Deutsche Gesellschaft für Thorax-, Herz-, und Gefässchirurgie, Berlin, Germany
| | - Jochen Cremer
- Universität Kiel, Abteilung für Herzchirurgie, Kiel, Germany
| | - Armin Welz
- Universität Bonn, Abteilung Herzchirurgie, Bonn, Germany
| | - Rüdiger Lange
- Deutsches Herzzentrum München, Abteilung Herzchirurgie, München, Germany
| | - Karl-Heinz Kuck
- St. Georg Krankenhaus, Abteilung Kardiologie, Hamburg, Germany
| | | | - Helge Möllmann
- Kerckhoff Herzzentrum, Abteilung Kardiologie, Bad Nauheim, Germany
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