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Lisi C, Catapano F, Brilli F, Scialò V, Corghi E, Figliozzi S, Cozzi OF, Monti L, Stefanini GG, Francone M. CT imaging post-TAVI: Murphy's first law in action-preparing to recognize the unexpected. Insights Imaging 2024; 15:157. [PMID: 38900378 PMCID: PMC11189851 DOI: 10.1186/s13244-024-01729-1] [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: 01/26/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Transfemoral aortic valve implantation (TAVI) has been long considered the standard of therapy for high-risk patients with severe aortic-stenosis and is now effectively employed in place of surgical aortic valve replacement also in intermediate-risk patients. The potential lasting consequences of minor complications, which might have limited impact on elderly patients, could be more noteworthy in the longer term when occurring in younger individuals. That's why a greater focus on early diagnosis, correct management, and prevention of post-procedural complications is key to achieve satisfactory results. ECG-triggered multidetector computed tomography angiography (CTA) is the mainstay imaging modality for pre-procedural planning of TAVI and is also used for post-interventional early detection of both acute and long-term complications. CTA allows detailed morphological analysis of the valve and its movement throughout the entire cardiac cycle. Moreover, stent position, coronary artery branches, and integrity of the aortic root can be precisely evaluated. Imaging reliability implies the correct technical setting of the computed tomography scan, knowledge of valve type, normal post-interventional findings, and awareness of classic and life-threatening complications after a TAVI procedure. This educational review discusses the main post-procedural complications of TAVI with a specific imaging focus, trying to clearly describe the technical aspects of CTA Imaging in post-TAVI and its clinical applications and challenges, with a final focus on future perspectives and emerging technologies. CRITICAL RELEVANCE STATEMENT: This review undertakes an analysis of the role computed tomography angiography (CTA) plays in the assessment of post-TAVI complications. Highlighting the educational issues related to the topic, empowers radiologists to refine their clinical approach, contributing to enhanced patient care. KEY POINTS: Prompt recognition of TAVI complications, ranging from value issues to death, is crucial. Adherence to recommended scanning protocols, and the optimization of tailored protocols, is essential. CTA is central in the diagnosis of TAVI complications and functions as a gatekeeper to treatment.
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Affiliation(s)
- Costanza Lisi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Federica Catapano
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy.
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy.
| | - Federica Brilli
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Vincenzo Scialò
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Eleonora Corghi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Stefano Figliozzi
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Ottavia Francesca Cozzi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Lorenzo Monti
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Giulio Giuseppe Stefanini
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
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Jneid H, Chikwe J, Arnold SV, Bonow RO, Bradley SM, Chen EP, Diekemper RL, Fugar S, Johnston DR, Kumbhani DJ, Mehran R, Misra A, Patel MR, Sweis RN, Szerlip M. 2024 ACC/AHA Clinical Performance and Quality Measures for Adults With Valvular and Structural Heart Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures. J Am Coll Cardiol 2024; 83:1579-1613. [PMID: 38493389 DOI: 10.1016/j.jacc.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
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Jneid H, Chikwe J, Arnold SV, Bonow RO, Bradley SM, Chen EP, Diekemper RL, Fugar S, Johnston DR, Kumbhani DJ, Mehran R, Misra A, Patel MR, Sweis RN, Szerlip M. 2024 ACC/AHA Clinical Performance and Quality Measures for Adults With Valvular and Structural Heart Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures. Circ Cardiovasc Qual Outcomes 2024; 17:e000129. [PMID: 38484039 DOI: 10.1161/hcq.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Affiliation(s)
- Hani Jneid
- ACC/AHA Joint Committee on Clinical Data Standards liaison
- Society for Cardiovascular Angiography and Interventions representative
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Prieto-Lobato A, Nuche J, Avvedimento M, Paradis JM, Dumont E, Kalavrouziotis D, Mohammadi S, Rodés-Cabau J. Managing the challenge of a small aortic annulus in patients with severe aortic stenosis. Expert Rev Cardiovasc Ther 2023; 21:747-761. [PMID: 37869793 DOI: 10.1080/14779072.2023.2271395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Small aortic annulus (SAA) poses a challenge in the management of patients with severe aortic stenosis requiring aortic valve replacement - both surgical and transcatheter - since it has been associated with worse clinical outcomes. AREAS COVERED This review aims to comprehensively summarize the available evidence regarding the management of aortic stenosis in patients with SAA and discuss the current controversies as well as future perspectives in this field. EXPERT OPINION It is paramount to agree in a common definition for diagnosing and properly treating SAA patients, and for that purpose, multidetector computer tomography is essential. The results of recent trials led to the expansion of transcatheter aortic valve replacement among patients of all the surgical-risk spectrum, and the choice of treatment (transcatheter, surgical) should be based on patient comorbidities, anatomical characteristics, and patient preferences.
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Affiliation(s)
- Alicia Prieto-Lobato
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
- Hospital del Mar, Barcelona, Spain
| | - Jorge Nuche
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Marisa Avvedimento
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | | | - Eric Dumont
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | | | - Siamak Mohammadi
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
- Clínic Barcelona, Barcelona, Spain
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Maeda S, Toda K, Shimamura K, Yoshioka D, Maeda K, Yamada Y, Igeta M, Sakata Y, Sawa Y, Miyagawa S. Long-term survival after surgical or transcatheter aortic valve replacement for low or intermediate surgical risk aortic stenosis: Comparison with general population. J Cardiol 2023; 81:68-75. [PMID: 35985870 DOI: 10.1016/j.jjcc.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Long-term survival after surgery for severe aortic stenosis (AS) provides important information regarding the choice between surgical (SAVR) and transcatheter (TAVR) aortic valve replacement. This study investigated the long-term survival of AS patients with low or intermediate surgical risk who underwent SAVR or TAVR in our institution versus that of the Japanese general population. METHODS From 2009 to 2019, 1276 consecutive patients underwent SAVR or TAVR for severe AS. Among them, we retrospectively investigated those with low (n = 383) or intermediate (n = 137) surgical risk treated with SAVR and those with low (n = 86) or intermediate (n = 333) surgical risk treated with TAVR. Their post-intervention survival was compared with that of an age- and gender-matched Japanese general population. RESULTS The overall 5-year survival rate of SAVR for patients with low surgical risk (mean age, 72 ± 9 years) was not significantly different from that of the general population (90 % vs. 89 %, respectively; p = 0.58), whereas that of patients with intermediate surgical risk (77 ± 6 years) was significantly lower than that of the general population (77 % vs. 84 %, respectively; p = 0.03). After TAVR, the 5-year survival of patients with low (78 ± 8 years) or intermediate (83 ± 5 years) surgical risk was significantly lower than that of the general population (low risk, 64 % vs. 81 %, p < 0.01; intermediate risk, 66 % vs. 71 %, respectively, p = 0.01). CONCLUSIONS Our study demonstrated that long-term survival after SAVR for AS patients with low surgical risk was as good as that of the age- and gender-matched general population, while the long-term survival after SAVR for intermediate-risk or TAVR for low- or intermediate-risk patients was lower than that of the general population. These findings suggest that SAVR is an appropriate option for AS patients with low surgical risk and good life expectancy, especially in Japan, where the life expectancy is the longest worldwide.
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Affiliation(s)
- Shusaku Maeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Koichi Maeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yu Yamada
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masataka Igeta
- Department of Biostatistics, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Grigoryan K, Demetrescu C, Kasouridis I, Abiola O, Masci PG, Oguz D, Benedetti G, SzeMun M, Parwani P, Preston R, Chiribiri A, Hancock J, Patterson T, Redwood S, Prendergast B, Grapsa J. Multimodality Imaging in Valvular Structural Interventions. Card Fail Rev 2022; 8:e31. [PMID: 36644647 PMCID: PMC9820006 DOI: 10.15420/cfr.2022.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022] Open
Abstract
Structural valvular interventions have skyrocketed in the past decade with new devices becoming available and indications for patients who would previously have been deemed inoperable. Furthermore, while echocardiography is the main imaging tool and the first line for patient screening, cardiac magnetic resonance and CT are now essential tools in pre-planning and post-procedural follow-up. This review aims to address imaging modalities and their scope in aortic, mitral and tricuspid structural valvular interventions, including multimodality imaging. Pulmonary valve procedures, which are mostly carried out in patients with congenital problems, are discussed. This article presents a guide on individualised imaging approcahes on each of the available interventional procedures.
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Affiliation(s)
- Karine Grigoryan
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Camelia Demetrescu
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Ioannis Kasouridis
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Olukayode Abiola
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Pier Giorgio Masci
- Department of Cardiac Magnetic Resonance, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Didem Oguz
- Department of Cardiology, Massachusetts General Hospital, Harvard Medical SchoolBoston, Massachusetts, US
| | - Giulia Benedetti
- Department of Radiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Mak SzeMun
- Department of Radiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University HealthCalifornia, US
| | - Rebecca Preston
- Department of Radiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Amedeo Chiribiri
- Department of Cardiac Magnetic Resonance, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Jane Hancock
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Tiffany Patterson
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Simon Redwood
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Bernard Prendergast
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Julia Grapsa
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
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Yang R, Grober AF, Riojas R, Ponna V, Shunk KA, Zimmet JM, Gustafson J, Ge L, Tseng EE. Midterm Durability and Structural Valve Degeneration of Transcatheter Aortic Valve Replacement in a Federal Facility. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:382-391. [PMID: 36217736 PMCID: PMC9761483 DOI: 10.1177/15569845221123259] [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]
Abstract
OBJECTIVE Transcatheter aortic valve replacement (TAVR), previously reserved for patients of intermediate to prohibitive surgical risk, has now been expanded to patients of any surgical risk with severe aortic stenosis. Bioprostheses are prone to structural valve degeneration (SVD), a progressive and multifactorial process that limits valve durability. As the population undergoing TAVR shifts toward a lower-risk and younger profile, long-term durability is a crucial determinant for patient outcomes. Our objective was to determine the incidence and risk factors of SVD at midterm follow-up in a veteran TAVR population. METHODS Patients undergoing TAVR at our federal facility were retrospectively evaluated for SVD and other endpoints with standardized consensus criteria. Multivariable Cox proportional hazards analysis was performed to evaluate risk factors for mortality and SVD. RESULTS From 2013 to 2020, 344 patients (median age, 78 years) underwent TAVR. Survival from all-cause mortality was 91.3% at 1 year, 75.1% at 3 years, and 61.7% at 5 years. Cumulative freedom from SVD was 98.2% at 1 year, 96.5% at 3 years, and 93.7% at 5 years. All 13 patients with SVD met hemodynamic criteria, and 1 required intervention. Median time to hemodynamic SVD was 1.04 years. Independent risk factors for SVD included age (hazard ratio [HR] = 0.92, 95% confidence interval [CI]: 0.86 to 0.99) and valve size (HR = 0.19, 95% CI: 0.04 to 0.89). CONCLUSIONS SVD was evident at a low but detectable rate at 5-year follow-up. Further understanding of TAVR biomechanics as well as continued longer-term follow-up will be essential for informing patient-specific risk of SVD.
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Affiliation(s)
- Rachel Yang
- Division of Cardiothoracic Surgery,
University of California San Francisco and San Francisco VA Medical Center, CA,
USA
| | - Aaron F. Grober
- Division of Cardiology, University of
California San Francisco and San Francisco VA Medical Center, CA, USA
| | - Ramon Riojas
- Division of Cardiothoracic Surgery,
University of California San Francisco and San Francisco VA Medical Center, CA,
USA
| | - Vimala Ponna
- Division of Cardiothoracic Surgery,
University of California San Francisco and San Francisco VA Medical Center, CA,
USA
| | - Kendrick A. Shunk
- Division of Cardiology, University of
California San Francisco and San Francisco VA Medical Center, CA, USA
| | - Jeffrey M. Zimmet
- Division of Cardiology, University of
California San Francisco and San Francisco VA Medical Center, CA, USA
| | - Joshua Gustafson
- Division of Cardiothoracic Surgery,
University of California San Francisco and San Francisco VA Medical Center, CA,
USA,Uniformed Services University of the
Health Sciences, Bethesda, MD, USA
| | - Liang Ge
- Division of Cardiothoracic Surgery,
University of California San Francisco and San Francisco VA Medical Center, CA,
USA
| | - Elaine E. Tseng
- Division of Cardiothoracic Surgery,
University of California San Francisco and San Francisco VA Medical Center, CA,
USA,Elaine E. Tseng, MD, Division of
Cardiothoracic Surgery, University of California San Francisco and San Francisco
VA Medical Center, 500 Parnassus Ave, Ste 405W, Box 0118, San Francisco, CA
94143, USA.
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Hu M, Peng X, Zhao Y, Yu X, Cheng C, Yu X. Dialdehyde pectin-crosslinked and hirudin-loaded decellularized porcine pericardium with improved matrix stability, enhanced anti-calcification and anticoagulant for bioprosthetic heart valves. Biomater Sci 2021; 9:7617-7635. [PMID: 34671797 DOI: 10.1039/d1bm01297e] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
To conveniently and effectively cure heart valve diseases or defects, combined with transcatheter valve technology, bioprosthetic heart valves (BHVs) originated from the decellularized porcine pericardium (D-PP) have been broadly used in clinics. Unfortunately, most clinically available BHVs crosslinked with glutaraldehyde (GA) were challenged in their long-term tolerance, degenerative structural changes, and even failure, owing to the synergistic impact of multitudinous elements (cytotoxicity, calcification, immune responses, etc.). In this work, dialdehyde pectin (AP) was prepared by oxidizing the o-dihydroxy of pectin with sodium periodate. Hereafter, the AP-fixed PP model was obtained by crosslinking D-PP with AP with high aldehyde content (6.85 mmol g-1), for acquiring excellent mechanical properties and outstanding biocompatibility. To further improve the hemocompatibility of the AP-fixed PP, a natural and specific inhibitor of thrombin (hirudin) was introduced to achieve surface modification of the AP-fixed PP. The feasibility of crosslinking and functionalizing AP-fixed PP, which was a potential leaflet material of BHVs, was exhaustively and systematically evaluated. In vitro studies found that hirudin-loaded and AP-fixed PP (AP + Hirudin-PP) had synchronously achieved effective fixation of collagen, highly effective anticoagulation, and good HUVECs-cytocompatibility. In vivo results revealed that the AP + Hirudin-PP specimens recruited the minimum immune cells in the implantation experiment, and also presented an excellent anti-calcification effect. Overall, AP + Hirudin-PP was endowed with competitive collagen stability (compared with GA-fixed PP), excellent hemocompatibility, good HUVECs-cytocompatibility, low immunogenicity and outstanding anti-calcification, suggesting that AP + Hirudin-PP might be a promising alternative to GA-fixed PP and exhibited a bright prospect in the clinical applications of BHVs.
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Affiliation(s)
- Mengyue Hu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P.R. China.
| | - Xu Peng
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P.R. China. .,Experimental and Research Animal Institute, Sichuan University, Chengdu 610065, P.R. China
| | - Yang Zhao
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P.R. China.
| | - Xiaoshuang Yu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P.R. China.
| | - Can Cheng
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P.R. China.
| | - Xixun Yu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P.R. China.
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Şentürk B, Dursun H, Çöllüoğlu T, Özdamar H, Ekin T, Tanrıverdi Z, Kaya D. Evaluation of structural valve deterioration and bioprosthetic valve failure utilizing the new European consensus definition in patients undergoing TAVI with first-generation devices: Outcomes beyond 5 years from a single center in Turkey. Anatol J Cardiol 2021; 25:579-587. [PMID: 34369886 DOI: 10.5152/anatoljcardiol.2021.37670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The long-term durability of transcatheter aortic bioprosthetic valves continues to be a major concern. Standardized criteria of the structural valve deterioration (SVD) and bioprosthetic valve failure (BVF) have recently been defined. Limited studies have evaluated the long-term durability of transcatheter aortic valve implantation (TAVI) according to these new definitions. We aim to analyze the durability of TAVI beyond 5 years and to report the frequency of SVD and BVF. METHODS A total of 89 patients who had undergone TAVI and had theoretically completed at least 5 years after the procedure were included. Either a Medtronic CoreValve or an Edwards SAPIEN XT valve were implanted in the patients. New standardized definitions were used to evaluate SVD and BVF. RESULTS The mean age of the patients was 78.70±6.95 years. SVD occured in 4 (4.5%) patients during 6 years of follow-up. Severe SVD was observed in 2 patients (2.2%), and these patients had the New York Heart Association class II symptoms. Both patients with severe SVD also met the criteria of BVF. Moderate SVD was observed in 2 patients (2.2%), and these patients had no valve-related symptoms. Of the 4 SVD cases, 2 were associated with increased mean transaortic gradients, whereas the remaining 2 cases were associated with intraprosthetic aortic regurgitation. All patients with SVD are still alive, and none of them have required aortic valve reintervention. CONCLUSION Although first-generation TAVI devices were used, we determined the low rate of SVD and BVF at the 6-year follow-up. It may be suggested that there is no major concern associated with TAVI even with first-generation devices regarding long-term durability.
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Affiliation(s)
- Bihter Şentürk
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - Hüseyin Dursun
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - Tuğçe Çöllüoğlu
- Department of Cardiology, Karabük University Training and Research Hospital; Karabük-Turkey
| | - Hatice Özdamar
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - Tuba Ekin
- Clinic of Cardiology, Sorgun State Hospital; Yozgat-Turkey
| | - Zülkif Tanrıverdi
- Department of Cardiology, Faculty of Medicine, Harran University; Şanlıurfa-Turkey
| | - Dayimi Kaya
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
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10
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Gallo M, Sá MPBO, Doulamis IP, Hussein N, Laforgia PL, Kampaktsis PN, Tagliari AP, Ferrari E. Transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic and mitral valves - an update on indications, techniques, and clinical results. Expert Rev Med Devices 2021; 18:597-608. [PMID: 34080501 DOI: 10.1080/17434440.2021.1939009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Aortic and mitral bioprosthesis are the gold standard treatment to replace a pathological native valve. However, bioprostheses are prone to structural valve degeneration, resulting in limited long-term durability. During the past decade, the implantation of transcatheter stent-valves within degenerated aortic and mitral bioprostheses, (the so-called 'valve-in-valve' procedure), represents a valid alternative to redo surgery in patients with high-risk surgical profiles.Areas covered: We reviewed the clinical outcomes and the procedural details of transcatheter aortic and mitral valve-in-valve series according to current published literature and include a practical guide for valve sizing and stent-valve positioning and strategies to prevent complications.Expert opinion: In both aortic and mitral positions meticulous planning is fundamental in these procedures to avoid serious complications including patient prosthesis mismatch, coronary obstruction and left ventricular outflow tract obstruction.
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Affiliation(s)
- Michele Gallo
- Cardiovascular Surgery, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Michel Pompeu B O Sá
- Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco PROCAPE, University of Pernambuco-UPE, Recife, Brazil
| | - Ilias P Doulamis
- Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nabil Hussein
- Department of Congenital Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, England, UK
| | - Pietro L Laforgia
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France
| | | | - Ana Paula Tagliari
- Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Enrico Ferrari
- Cardiovascular Surgery, Cardiocentro Ticino Institute, Lugano, Switzerland
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11
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Navaratnarajah M, Luthra S, Ohri S. Transcatheter aortic valve implantation in low-risk patients: A case of rational over exuberance. The time is not now. Asian Cardiovasc Thorac Ann 2021; 29:836-847. [PMID: 34034507 DOI: 10.1177/02184923211018589] [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: 11/17/2022]
Abstract
BACKGROUND Review of evidence and concerns, relating to extension of transcatheter aortic valve implantation usage to low-risk patients. METHODS Comprehensive literature review was conducted identifying articles relating to transcatheter aortic valve implantation. RESULTS Transcatheter aortic valve implantation is effective in patients with aortic stenosis. Currently, long-term durability and cost-effectiveness are unproven, anticoagulation requirement undefined, permanent pacemaker implantation and paravalvular leak rates higher than following surgical aortic valve replacement. CONCLUSIONS Current evidence supporting transcatheter aortic valve implantation usage in low-risk patients is insufficient. Extending use now, to this large young patient population is premature, and should be delayed.
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Affiliation(s)
| | - Suvitesh Luthra
- Department of Cardiac Surgery, Southampton University Hospital, Southampton, UK
| | - Sunil Ohri
- Department of Cardiac Surgery, Southampton University Hospital, Southampton, UK
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Early and mid-term results of transcatheter aortic valve implantation and valve durability assessment. Heart Vessels 2021; 36:1566-1573. [PMID: 33871699 DOI: 10.1007/s00380-021-01842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
This study aimed to evaluate the early and mid-term outcomes of transcatheter aortic valve implantation (TAVI) and to assess valve durability. A total of 146 consecutive patients who underwent TAVI for severe aortic stenosis between October 2013 and August 2018 were retrospectively reviewed. All patients (mean age, 84 ± 6 years; age range 53-98 years; 42 males [28.7%]) had multiple comorbidities, with a mean logistic EuroSCORE of 30.9 ± 17.4%. Eighteen patients (12.3%) were aged 90 years or over. Five in-hospital deaths (3.4%) occurred, and 36 patients (24.7%) experienced major TAVI-related complications. With the transfemoral approach, 10 patients had major vascular complications, which mostly occurred with first-generation devices (n = 9) but less commonly with new-generation low-profile devices (P = 0.0078). During a follow-up period of 580 ± 450 (11-1738) days, 29 late deaths occurred. The survival rate was 86.0%, 78.0%, and 61.7% at 1, 2, and 3 years, respectively. Multivariate Cox hazard regression analysis revealed that more-than-moderate tricuspid regurgitation was the only independent risk factor for late deaths due to any cause (hazard ratio, 3.145; 95% confidence interval, 1.129-8.762; P = 0.0283). No statistically significant differences between post-TAVI before discharge from the hospital and at 4 years after TAVI were observed with respect to aortic valve area (1.76 ± 0.49 cm2 vs. 1.64 ± 0.38 cm2; P = 0.1871) and mean pressure gradient (10.0 ± 4.6 mmHg vs. 7.9 ± 3.3 mmHg; P = 0.5032). TAVI was a feasible method with acceptable early and mid-term outcomes and valve durability for at least 4 years in poor-risk patients. Further close follow-up is essential to evaluate late outcomes and valve durability.
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Henning RJ. The current diagnosis and treatment of patients with aortic valve stenosis. Future Cardiol 2021; 17:1143-1160. [PMID: 33728942 DOI: 10.2217/fca-2020-0140] [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: 11/21/2022] Open
Abstract
Aortic valve stenosis (AS) is the third most frequent cardiovascular abnormality after coronary artery disease and hypertension. A bicuspid aortic valve is the most common cause for AS until seventh decade and calcific valve degeneration is responsible thereafter. In symptomatic patients, The risk of death increases from ≤1%/year to 2%/month. An echo valve area ≤1 cm2, peak transaortic velocity ≥4 m/s, mean valve gradient ≥40 mmHg and/or computerized tomography valve calcium score >2000 Agatston units (AU) for males or more than 1200 AU for females indicate severe AS. AS stages and management are discussed. Valve replacement is based on surgical risk, valve durability/hemodynamics, need for anticoagulation and patient preferences. EuroSCORE ≥20%, Society of Thoracic Surgeons Predicted Risk of Mortality ≥8% and co-morbidities indicate high surgical risk. Surgery is recommended for low-intermediate risk patients. Transcatheter aortic valve implantation is an alternative in older patients at low, intermediate, high or prohibitive risk. Transaortic valve implantation/replacement trials are summarized.
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Ferreira-Neto AN, Rodriguez-Gabella T, Guimaraes L, Freitas-Ferraz A, Bernier M, Figueiredo Guimaraes C, Pasian S, Paradis JM, Delarochellière R, Dumont E, Mohammadi S, Kalavrouziotis D, Côté M, Pibarot P, Rodés-Cabau J. Multimodality evaluation of transcatheter structural valve degeneration at long-term follow-up. ACTA ACUST UNITED AC 2021; 74:247-256. [DOI: 10.1016/j.rec.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/20/2020] [Indexed: 11/24/2022]
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Ferreira-Neto AN, Rodriguez-Gabella T, Guimaraes L, Freitas-Ferraz A, Bernier M, Figueiredo Guimaraes C, Pasian S, Paradis JM, Delarochellière R, Dumont E, Mohammadi S, Kalavrouziotis D, Côté M, Pibarot P, Rodés-Cabau J. Evaluación multimodal de la degeneración estructural de válvulas percutáneas en el seguimiento a largo plazo. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 555] [Impact Index Per Article: 185.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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17
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Incidence and Predictors of Structural Valve Deterioration after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. J Interv Cardiol 2020; 2020:4075792. [PMID: 33214775 PMCID: PMC7657687 DOI: 10.1155/2020/4075792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/01/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Transcatheter aortic valve replacement (TAVR), widely used as an alternative therapy in patients with severe aortic stenosis, is expected to be offered to low-risk patents with a longer life expectancy. The durability of transcatheter aortic valve is becoming of increasing importance. Method PubMed, Embase, and Cochrane CENTRAL from the inception to March 2020 were systematically screened for studies reporting on structural valve deterioration (SVD) in TAVR patients. Incidence of SVD was diagnosed according to the latest European consensus as the primary end point. Predictors of SVD evaluated at multivariable analysis and cumulative incidence function (CIF) of SVD were the secondary end point. Result Twelve studies encompassing 10031 patients evaluating the incidence of SVD were included, with a follow-up between 1 and 8 years. The pooled incidence of SVD was 4.93% (95% CI, 2.75%–7.70%, I2 = 96%) at 1 year and 8.97% (95% CI, 6.89%–11.29%, I2 = 86%) in the long term (≥5 years). Subgroup analysis was performed to identify the valve type that may result in partial heterogeneity. SVD was more frequent in patents with a valve diameter of <26 mm (HR: 3.57, 1.47–8.69), oral anticoagulants (OAC), exposure at discharge (OR: 0.48, 0.38–0.61), or by a disease of renal dysfunction (OR 1.42, 1.03–1.96). Conclusion SVD represents infrequent events after TAVR in the long term (>5 years), occurring more commonly in renal dysfunction patients, with small valve diameter and without OAC exposure. There may be an underestimation of the incidence if we assume death as a competing risk.
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Belluschi I, Buzzatti N, Castiglioni A, De Bonis M, Montorfano M, Alfieri O. Severe aortic stenosis in the young, with or without bicuspid valve: is transcatheter aortic valve implantation the first choice? Eur Heart J Suppl 2020; 22:L1-L5. [PMID: 33654459 PMCID: PMC7904077 DOI: 10.1093/eurheartj/suaa123] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
During the last decade, transcatheter aortic valve implantation (TAVI) has represented a valid alternative to surgical aortic valve replacement in patients with aortic stenosis and elevated surgical risk. Recent randomized clinical trials reported excellent results also for patients at low surgical risk, but in clinical practice, the mean age of the patients treated remain over 75 years, and the presence of a bicuspid aortic valve still represents an important exclusion criteria. Today, aortic valve replacement with a mechanical prosthesis remains the treatment of choice for young adults with aortic stenosis, although the desire to avoid oral anticoagulants drives more patients younger than 65 years of age towards biological prostheses. Furthermore, despite the follow-up of patients after TAVI is still limited to a few years, the opportunity of a second percutaneous treatment (TAVI-in-TAVI), extends the scope of percutaneous strategy. In the next few years, TAVI has to face many challenges to become a valid alternative to surgery in the younger patients as well.
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Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Castiglioni
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Department of Interventional Cardiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Kostyunin AE, Yuzhalin AE, Rezvova MA, Ovcharenko EA, Glushkova TV, Kutikhin AG. Degeneration of Bioprosthetic Heart Valves: Update 2020. J Am Heart Assoc 2020; 9:e018506. [PMID: 32954917 PMCID: PMC7792365 DOI: 10.1161/jaha.120.018506] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The implantation of bioprosthetic heart valves (BHVs) is increasingly becoming the treatment of choice in patients requiring heart valve replacement surgery. Unlike mechanical heart valves, BHVs are less thrombogenic and exhibit superior hemodynamic properties. However, BHVs are prone to structural valve degeneration (SVD), an unavoidable condition limiting graft durability. Mechanisms underlying SVD are incompletely understood, and early concepts suggesting the purely degenerative nature of this process are now considered oversimplified. Recent studies implicate the host immune response as a major modality of SVD pathogenesis, manifested by a combination of processes phenocopying the long‐term transplant rejection, atherosclerosis, and calcification of native aortic valves. In this review, we summarize and critically analyze relevant studies on (1) SVD triggers and pathogenesis, (2) current approaches to protect BHVs from calcification, (3) obtaining low immunogenic BHV tissue from genetically modified animals, and (4) potential strategies for SVD prevention in the clinical setting.
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Affiliation(s)
- Alexander E Kostyunin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Arseniy E Yuzhalin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation.,Department of Molecular and Cellular Oncology The University of Texas MD Anderson Cancer Center Houston TX
| | - Maria A Rezvova
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Evgeniy A Ovcharenko
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Tatiana V Glushkova
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Anton G Kutikhin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
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Brown RA, Reid AB, Turaga M, Huang AL, Maggiore PL, Sellers SL, Kiritchkov L, Tarazi SC, Blanke P, Leipsic JA. Subclinical Leaflet Thrombosis Post Transcatheter Aortic Valve Replacement – An Update for 2020. STRUCTURAL HEART 2020. [DOI: 10.1080/24748706.2020.1805534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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21
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Sousa Uva M. Transcatheter aortic valve implantation in low-risk patients: is it too early? Heart 2020; 105:s51-s56. [PMID: 30846526 DOI: 10.1136/heartjnl-2018-314248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/15/2018] [Indexed: 11/04/2022] Open
Abstract
The median age of patients treated by transcatheter aortic valve implantation (TAVI) is falling across Europe, and low-risk patients with severe aortic stenosis (AS) represent 80% of patients with severe AS undergoing surgical aortic valve replacement (SAVR). There are few data for TAVI in low-risk patients, but there are four ongoing randomised trials of SAVR versus TAVI. The key issues relate to pacemaker implantation rates and the associated potential longer term deleterious effects, and the need to minimise vascular complications and paravalvular leak. Valve leaflet thrombosis and paucity of data on valve durability remain a concern. Given the higher incidence of bicuspid aortic valves in younger patients, outcomes of TAVI in this setting need clarification and are discussed.
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Affiliation(s)
- Miguel Sousa Uva
- Department of Cardiac Surgery, Hospital Santa Cruz, Lisbon, Portugal
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22
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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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23
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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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Durand E, Sokoloff A, Urena-Alcazar M, Chevalier B, Chassaing S, Didier R, Tron C, Litzler PY, Bouleti C, Himbert D, Hovasse T, Bar O, Avinée G, Iung B, Blanchard D, Gilard M, Cribier A, Lefevre T, Eltchaninoff H. Assessment of Long-Term Structural Deterioration of Transcatheter Aortic Bioprosthetic Valves Using the New European Definition. Circ Cardiovasc Interv 2020; 12:e007597. [PMID: 30998397 DOI: 10.1161/circinterventions.118.007597] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The durability of transcatheter aortic bioprosthetic valves is a crucial issue, but data are scarce, especially beyond 5 years of follow-up. We aimed to assess long-term (7 years) structural valve deterioration (SVD) and bioprosthetic valve failure of transcatheter aortic bioprosthetic valves. METHODS AND RESULTS Consecutive patients with at least 5-year follow-up available undergoing transcatheter aortic valve implantation from April 2002 to December 2011 in 5 French centers were included. Incidence of SVD and bioprosthetic valve failure were defined according to newly standardized criteria of the European Association of Percutaneous Cardiovascular Interventions/European Society of Cardiology/European Association for Cardio-Thoracic Surgery and reported as cumulative incidence function to account for the competing risk of death. One thousand four hundred three consecutive patients were included with a mean age of 82.6±7.5 years and with a mean logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) of 21.3±7.5%. A balloon-expandable valve was used in 83.7% of cases. Survival rates were 83.5% (95% CI, 81.4%-85.5%) and 18.6% (95% CI, 15.3%-21.8%) at 1 and 7 years, respectively. Median duration of follow-up was 3.9 years. Bioprosthetic valve failure occurred in 19 patients with a 7-year cumulative incidence of 1.9% (95% CI, 1.4%-2.4%). SVD occurred in 49 patients (moderate, n=32; severe, n=17) with a 7-year cumulative incidence of moderate and severe SVD of 7.0% (95% CI, 5.6%-8.4%) and 4.2% (95% CI, 2.9%-5.5%), respectively. Five patients had aortic valve reintervention (1.0%; 95% CI, 0.4%-1.6%) including 1 case of surgical aortic valve replacement and 4 redo-transcatheter aortic valve implantation. The incidences of SVD and bioprosthetic valve failure were not significantly different between balloon and self-expandable prostheses. CONCLUSIONS The long-term assessment of transcatheter aortic bioprosthetic valves durability is limited by the poor survival of our population beyond 5 years. Further studies are warranted, particularly in younger and lower-risk patients.
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Affiliation(s)
- Eric Durand
- Normandie Univ, UNIROUEN, INSERM U1096, Rouen University Hospital, Department of Cardiology, FHU REMOD-VHF, France (E.D., A.S., C.T., P.Y.L., G.A., A.C., H.E.)
| | - Anastasia Sokoloff
- Normandie Univ, UNIROUEN, INSERM U1096, Rouen University Hospital, Department of Cardiology, FHU REMOD-VHF, France (E.D., A.S., C.T., P.Y.L., G.A., A.C., H.E.)
| | - Marina Urena-Alcazar
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Faculté de Médecine Paris-Diderot University, Department of Cardiology, DHU Fire, INSERM U1148, Paris-Diderot University Paris, France (M.U.-A., C.B., D.H., B.I.)
| | - Bernard Chevalier
- Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Department of Cardiology, Massy, France (B.C., T.H., T.L.)
| | - Stephan Chassaing
- Clinique Saint Gatien, Department of Cardiology, Tours, France (S.C., O.B., D.B.)
| | - Romain Didier
- Brest University Hospital, Department of Cardiology, France (R.D., M.G.)
| | - Christophe Tron
- Normandie Univ, UNIROUEN, INSERM U1096, Rouen University Hospital, Department of Cardiology, FHU REMOD-VHF, France (E.D., A.S., C.T., P.Y.L., G.A., A.C., H.E.)
| | - Pierre-Yves Litzler
- Normandie Univ, UNIROUEN, INSERM U1096, Rouen University Hospital, Department of Cardiology, FHU REMOD-VHF, France (E.D., A.S., C.T., P.Y.L., G.A., A.C., H.E.)
| | - Claire Bouleti
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Faculté de Médecine Paris-Diderot University, Department of Cardiology, DHU Fire, INSERM U1148, Paris-Diderot University Paris, France (M.U.-A., C.B., D.H., B.I.)
| | - Dominique Himbert
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Faculté de Médecine Paris-Diderot University, Department of Cardiology, DHU Fire, INSERM U1148, Paris-Diderot University Paris, France (M.U.-A., C.B., D.H., B.I.)
| | - Thomas Hovasse
- Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Department of Cardiology, Massy, France (B.C., T.H., T.L.)
| | - Olivier Bar
- Clinique Saint Gatien, Department of Cardiology, Tours, France (S.C., O.B., D.B.)
| | - Guillaume Avinée
- Normandie Univ, UNIROUEN, INSERM U1096, Rouen University Hospital, Department of Cardiology, FHU REMOD-VHF, France (E.D., A.S., C.T., P.Y.L., G.A., A.C., H.E.)
| | - Bernard Iung
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Faculté de Médecine Paris-Diderot University, Department of Cardiology, DHU Fire, INSERM U1148, Paris-Diderot University Paris, France (M.U.-A., C.B., D.H., B.I.)
| | - Didier Blanchard
- Clinique Saint Gatien, Department of Cardiology, Tours, France (S.C., O.B., D.B.)
| | - Martine Gilard
- Brest University Hospital, Department of Cardiology, France (R.D., M.G.)
| | - Alain Cribier
- Normandie Univ, UNIROUEN, INSERM U1096, Rouen University Hospital, Department of Cardiology, FHU REMOD-VHF, France (E.D., A.S., C.T., P.Y.L., G.A., A.C., H.E.)
| | - Thierry Lefevre
- Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Department of Cardiology, Massy, France (B.C., T.H., T.L.)
| | - Hélène Eltchaninoff
- Normandie Univ, UNIROUEN, INSERM U1096, Rouen University Hospital, Department of Cardiology, FHU REMOD-VHF, France (E.D., A.S., C.T., P.Y.L., G.A., A.C., H.E.)
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Sun Z, Liu J, Wang X, Jing H, Li B, Kong D, Leng X, Wang Z. Epoxy Chitosan-Crosslinked Acellular Bovine Pericardium with Improved Anti-calcification and Biological Properties. ACS APPLIED BIO MATERIALS 2020; 3:2275-2283. [PMID: 35025279 DOI: 10.1021/acsabm.0c00067] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Glutaraldehyde (GA) was conventionally used to crosslink bovine pericardium to prepare bioprosthetic heart valves (BHVs), which usually fail within 10 years because of valve deterioration and calcification. To overcome the high cytotoxicity and severe calcification of GA-crosslinked BHVs, a quaternary ammonium salt of epoxy chitosan (epoxy group-modified 3-chlorine-2-hydroxypropyl trimethyl chitosan, abbreviated as "eHTCC") was developed to modify the acellular bovine pericardium to substitute GA and improve its anti-calcification and biocompatible properties. Mechanical test, enzymatic stability test, blood compatibility assay, and cytocompatibility assay were used to investigate its mechanical property and biocompatibility. The anti-calcification effect of the eHTCC-modified bovine pericardium (eHTCC-BP) was assessed by in vitro assay and rat subcutaneous implantation assay. The results showed that eHTCC-BP could improve the mechanical properties and anti-enzymolysis ability of BP, as well as retain the original three-dimensional structure, compared with the uncrosslinked-BP group. Moreover, the in vivo calcification level of the eHTCC-BP group was much lower than that of the GA-BP group, which was 5.1% (2 weeks), 2.3% (4 weeks), and 0.8% (8 weeks) of the GA-BP group. In summary, this study demonstrated that eHTCC could be a potential crosslinking agent for the extracellular matrix for its favorable crosslinking effects, anti-enzymolysis, anti-calcification, and biocompatibility.
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Affiliation(s)
- Zhiting Sun
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
| | - Jing Liu
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
| | - Xiaoxiao Wang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
| | - Huimin Jing
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
| | - Binhan Li
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
| | - Deling Kong
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China.,Key Laboratory of Bioactive Materials of Ministry of Education, State Key Laboratory of Medicinal Chemical Biology, College of Life Science, Nankai University, Tianjin 300071, China
| | - Xigang Leng
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
| | - Zhihong Wang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
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Abstract
PURPOSE OF REVIEW Bioprosthetic valves are now used for the majority of surgical aortic valve replacements and for all transcatheter aortic valve replacements. However, bioprostheses are subject to structural valve deterioration (SVD) and have, therefore limited durability. RECENT FINDINGS Clinical, imaging, and circulating biomarkers may help to predict or indicate the presence of bioprosthetic valve SVD. The most important biomarkers of SVD includes: patient-related clinical biomarkers, such as diabetes and renal failure; valve-related biomarkers, such as absence of antimineralization process and severe prosthesis-patient mismatch; imaging biomarkers: the presence of valve leaflet mineralization on multidetector computed tomography or sodium fluoride uptake on positron emission tomography; and circulating biomarkers including: increased levels of HOMA index, ApoB/ApoA-I ratio, PCSK9, Lp-PLA2, phosphocalcic product. The assessment of these biomarkers may help to enhance risk stratification for SVD following AVR and may contribute to open novel pharmacotherapeutic avenues for the prevention of SVD. SUMMARY SVD may affect all bioprostheses after aortic valve replacement, and is the main cause of bioprosthetic valve failure and reintervention during the follow-up. Comprehensive assessment of clinical, imaging, and circulating biomarkers associated with earlier SVD could help strengthen the follow-up in high-risk patients and provide novel pharmacologic therapeutic strategies.
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Duncan A, Mirsadraee S, Quarto C, Davies S. Transcatheter aortic valve implantation 10 years after valve‐in‐valve transcatheter aortic valve implantation for failing aortic valve homograft root replacement. Catheter Cardiovasc Interv 2019; 96:228-235. [DOI: 10.1002/ccd.28658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/12/2019] [Accepted: 12/07/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Alison Duncan
- Heart DivisionRoyal Brompton Hospital London United Kingdom
| | | | - Cesare Quarto
- Heart DivisionRoyal Brompton Hospital London United Kingdom
| | - Simon Davies
- Heart DivisionRoyal Brompton Hospital London United Kingdom
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Zareian R, Tseng JC, Fraser R, Meganck J, Kilduff M, Sarraf M, Dvir D, Kheradvar A. Effect of stent crimping on calcification of transcatheter aortic valves. Interact Cardiovasc Thorac Surg 2019; 29:64-73. [PMID: 30793744 DOI: 10.1093/icvts/ivz024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 12/26/2018] [Accepted: 12/27/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Although many challenges related to the acute implantation of transcatheter aortic valves have been resolved, durability and early degeneration are currently the main concerns. Recent reports indicate the potential for early valve degeneration and calcification. However, only little is known about the underlying mechanisms behind the early degeneration of these valves. The goal of this study was to test whether stent crimping increases the risk for early calcification. METHODS Stented valves that were crimped at 18-Fr and 14-Fr catheter and uncrimped controls were exposed to a standard calcifying solution for 50 million cycles in an accelerated wear test system. Subsequently, the leaflets of the valves were imaged by microcomputed tomography (micro-CT) followed by histochemical staining and microscopic analyses to quantify calcification and other changes in the leaflets' characteristics. RESULTS Heavily calcified regions were found over the stent-crimped leaflets compared to uncrimped controls, particularly around the stent's struts. Micro-CT studies measured the total volume of calcification in the uncrimped valves as 77.31 ± 1.63 mm3 vs 95.32 ± 5.20 mm3 in 18-Fr and 110.01 ± 8.33 mm3 in 14-Fr stent-crimped valves, respectively. These results were congruent with the increase in leaflet thickness measured by CT scans (0.44 ± 0.07 mm in uncrimped valves vs 0.69 ± 0.15 mm and 0.75 ± 0.09 mm in 18-Fr and 14-Fr stent-crimped valves, respectively). Histological studies confirmed the micro-CT results, denoting that the percentage of calcification in uncrimped leaflets at the valve's posts was 5.34 ± 3.97 compared to 19.97 ± 6.18 and 27.64 ± 13.17 in the 18-Fr and 14-Fr stent-crimped leaflets, respectively. CONCLUSIONS This study concludes that stent-crimping damage is associated with a higher level of passive leaflet calcification, which may contribute to early valve degeneration.
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Affiliation(s)
- Ramin Zareian
- The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California Irvine, Irvine, CA, USA
| | | | | | | | | | - Mohammad Sarraf
- Cardiovascular Division, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Danny Dvir
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Arash Kheradvar
- The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California Irvine, Irvine, CA, USA
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Boukhris M, Forcillo J, Potvin J, Gobeil JF, Noiseux N, Stevens LM, Hillani A, Masson JB. Evolving Role of Transcatheter Valve Replacement for the Treatment of Severe Aortic Stenosis. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2019.1692397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Marouane Boukhris
- From Divisions of Cardiology and Cardiac Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Québec, Canada
| | - Jessica Forcillo
- From Divisions of Cardiology and Cardiac Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Québec, Canada
| | - Jeannot Potvin
- From Divisions of Cardiology and Cardiac Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Québec, Canada
| | - Jean-François Gobeil
- From Divisions of Cardiology and Cardiac Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Québec, Canada
| | - Nicolas Noiseux
- From Divisions of Cardiology and Cardiac Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Québec, Canada
| | - Louis-Mathieu Stevens
- From Divisions of Cardiology and Cardiac Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Québec, Canada
| | - Ali Hillani
- From Divisions of Cardiology and Cardiac Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Québec, Canada
| | - Jean-Bernard Masson
- From Divisions of Cardiology and Cardiac Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Québec, Canada
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Abstract
Current guidelines for management of adults with aortic stenosis recommend aortic valve replacement for patients with clinical consequences due to hemodynamically severe valve obstruction. However, advances in surgical and transcatheter techniques, and improved valve design have led to decreased procedural risk and improved long-term outcomes. Transcatheter aortic valve replacement (TAVR) is recommended for patients with prohibitive surgical risk and is reasonable in intermediate and high-risk patients. Recent trials demonstrated favorable short-term outcomes in patients with low surgical risk undergoing TAVR compared with surgical AVR. We review the current Guidelines recommendations and highlight key controversies in management due to evidence gaps.
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Affiliation(s)
- Andrew W Harris
- Department of Medicine, Division of Cardiology, University of Washington, 1959 Northeast Pacific Street, Box 356422, Seattle, WA 98195, USA
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumonologie de Québec (Québec Heart and Lung Institute), Laval University, 2725 Chemin Sainte Foy, Québec, QC G1V-4G5, Canada
| | - Catherine M Otto
- Department of Medicine, Division of Cardiology, University of Washington, 1959 Northeast Pacific Street, Box 356422, Seattle, WA 98195, USA.
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31
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Abstract
Initially, transcatheter aortic valve replacement (TAVR) was only used in patients with severe symptomatic aortic stenosis and prohibitive risk for surgical aortic valve replacement. Subsequently, TAVR was extended to patients with high and intermediate surgical risk. Recently, the results of randomized trials in low-surgical-risk patients showed superiority or noninferiority of TAVR versus surgical aortic valve replacement in this population. Procedural outcomes have been improved. Long-term durability of transcatheter heart valves remains to be confirmed. This article presents the evolution and current status of TAVR, with respect to the different types of devices and procedures as well as its outcomes.
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32
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Gommeaux A, Manchuelle A. [Prostheses used in tavi]. Ann Cardiol Angeiol (Paris) 2019; 68:434-438. [PMID: 31722795 DOI: 10.1016/j.ancard.2019.09.022] [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: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 11/28/2022]
Abstract
Since the first human implantation of a percutaneous aortic valve in 2002, tavi prosthesis didn't stop to improve their results. These improvements allowed to decrease dramatically tavi's complications and to extend the technic to patients with mid indeed low surgery risk. So tavi became the first treatment of aortic stenosis in France since a few years.
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Affiliation(s)
- A Gommeaux
- Service de cardiologie, hôpital privé de Bois-Bernard, route de Neuvireuil, 62320 Bois-Bernard, France.
| | - A Manchuelle
- Service de cardiologie, hôpital privé de Bois-Bernard, route de Neuvireuil, 62320 Bois-Bernard, France
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33
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Minimalistic Approach for Transcatheter Aortic Valve Implantation (TAVI): Open Vascular Vs. Fully Percutaneous Approach. ACTA ACUST UNITED AC 2019; 40:5-14. [PMID: 31605589 DOI: 10.2478/prilozi-2019-0009] [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: 11/20/2022]
Abstract
BACKGROUND Aortic stenosis (AS) is the most common valvular heart disease in elderly people. Transcatheter aortic valve implantation (TAVI) has emerged as a revolutionary treatment for elderly patients with symptomatic severe aortic stenosis. The authors present the first experiences with transcatheter aortic valve implantation treatment in Macedonia and compare their findings in regard to differences between open vascular vs. minimalistic transfemoral TAVI approach. METHODS The procedure was performed in 54 patients with severe and symptomatic AS in the period from December 2014 until February 2018. All patients were deemed having high surgical risk or were denied surgery. Pre-procedural screening included detailed clinical and echocardiographic evaluation, coronary, peripheral and carotid angiography and computed tomography scan of the aortic root. A self-expandable aortic valve (Core Valve/Evolut R, Medtronic, USA) was implanted in all patients. RESULTS Mean patient age was 75 ± 7.2 years, 28 (52%) were female, 26 patients (48%) male. All interventions were successfully performed through right transfemoral approach with 100% implantation success. Ancillary right radial and ulnar approach was used for correct valve positioning and control. 22(40%) cases were performed under general anesthesia and open vascular access to the femoral artery. All other 32(60%) cases were performed with minimalistic approach (local anaesthesia and analgosedation of the patients, access site was closed with closure devices). Patients in the minimalistic approach group were older, with more chronic conditions as anaemia, chronic kidney disease, poor mobility and peripheral vascular disease (p<0.0001). Also 4(12.5%) patients in the minimalistic group had bicuspid valve TAVI implantation (p<0.0001). Procedural time and contrast amount spent were shorter in this group with 97± 38 vs. 121± 38.3(p<0.0001) and 287± 122 vs. 330± 115 ml, while fluoroscopy time was similar in both groups. Immediate hemodynamic improvement was obtained in all patients. Echocardiographic peak gradient decreased from 85 ± 25 to 17 ± 8 mmHg (p < 0.001) and mean pressure gradient from 49 ± 26 to 8.3 ± 4.2 mmHg, (p < 0.001). Effective valve orifice area was 1.8±0.4 cm2 after intervention. None of the patients had significant aortic regurgitation after implantation. After intervention 7(12%) patients developed a permanent heart block and required implantation of a permanent pacemaker. There was a larger Hgb drop after intervention with open vs. minimalistic approach 1,9±0.9 vs. 0.7±0,2 g/dL (p<0.0001). 3 (13% vs.0%) patients from the open vascular access group had a major bleeding complication with 2 requiring transfusion after intervention (p<0.0001). Mortality was 5.5%, 2 with open-vascular and 1 with minimalistic approach. MACCE rate that included MI, Stroke, Major bleeding and Death rate, was recorded in 5(18%) patients with open vascular approach vs. 1(3.1%) in minimalistic approach (p<0.0001). Hospital discharge was 8.7±3.1 vs. 4±3.1 days respectively (p<0.0001). All TAVI patients with minimalistic approach were discharged the following day after intervention. All discharged patients had a good neurological condition, which was assessed based on the CPC-1 (Cerebra Performance Categories Scale). After median follow up of 26 months, the survival rate was 95% with clinical improvement in all patients. CONCLUSION Percutaneous aortic valve implantation can be successfully conducted with high success rate and low rate of complications in patients with severe aortic stenosis. Using a less invasive approach with local anaesthesia and analgosedation is associated with shorter length of stay and a decrease in post-procedural complication rates and MACCE.
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Shirakawa K, Murata M. Significance of echocardiographic evaluation for transcatheter aortic valve implantation. Cardiovasc Interv Ther 2019; 35:85-95. [PMID: 31502235 DOI: 10.1007/s12928-019-00617-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is widely accepted as an alternative to surgical aortic valve replacement (SAVR) for the treatment of severe aortic stenosis (AS). Existing scientific evidence demonstrates that TAVI is superior to SAVR, and it is expected that indications for the clinical applications of TAVI will be expanded in the future. Echocardiography plays a key role in perioperative assessment of patients undergoing TAVI. Preprocedural echocardiographic evaluation is important to determine the severity of AS in addition to patients' anatomical suitability for TAVI. Furthermore, echocardiography is essential for intraoperative guidance, assessment of complications, postoperative evaluation, and prognostic prediction. Inaccurate echocardiographic measurements and evaluation can lead to less-than-optimal/inappropriate treatment strategies in patients with AS. Therefore, a thorough understanding of the limitations of echocardiographic evaluation is important. This review summarizes the role of echocardiographic evaluation in patients undergoing TAVI.
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Affiliation(s)
- Kohsuke Shirakawa
- Japan Society for the Promotion of Science, Tokyo, Japan.,Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mitsushige Murata
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. .,School of Medicine, Center for Preventive Medicine, Keio University, Tokyo, Japan.
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35
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Vollema EM, Delgado V, Bax JJ. Echocardiography in Transcatheter Aortic Valve Replacement. Heart Lung Circ 2019; 28:1384-1399. [DOI: 10.1016/j.hlc.2018.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 12/11/2018] [Accepted: 12/16/2018] [Indexed: 02/06/2023]
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36
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Affiliation(s)
- Christopher R Burke
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - James N Kirkpatrick
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Catherine M Otto
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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37
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Ichibori Y, Mizote I, Tsuda M, Mukai T, Maeda K, Onishi T, Kuratani T, Sawa Y, Sakata Y. Long-Term Outcomes of High-Risk or Inoperable Patients Who Underwent Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 124:573-579. [PMID: 31255236 DOI: 10.1016/j.amjcard.2019.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/01/2019] [Accepted: 05/07/2019] [Indexed: 01/07/2023]
Abstract
Few studies have evaluated transcatheter aortic valve implantation (TAVI) beyond 5 years. We investigated long-term outcomes (≥5 years) and transcatheter heart valve (THV) performance in patients who had undergone TAVI at least 5 years previously, based on annual follow-up. We reviewed 114 consecutive patients who were of high surgical risk or inoperable and underwent TAVI for severe aortic stenosis from October 2009 to November 2013. There was no lost to follow-up, and median time to death or latest follow-up was 5.0 years (range: 0.1 to 8.5). Structural valve degeneration (SVD) was defined on transthoracic echocardiography (TTE) as follows: (1) mean pressure gradient ≥20 mm Hg with a >10 mm Hg increase from the post-TAVI baseline, and/or (2) moderate or severe transvalvular regurgitation. The mean patient age was 82.7 ± 6.4 years, and 37.7% of patients were men. Median Society of Thoracic Surgeons score was 7.6% (interquartile range 5.8 to 10.9). TTE ≥5 years was 76.1% complete (51 of 67 patients who survived ≥5 years postoperatively). The estimated cumulative survival rates at 1, 3, 5, and 7 years were 88.6%, 72.8%, 58.8%, and 45.3%, respectively. Albumin <3.5 g/dl was strongly associated with increased long-term mortality on multivariate analysis. Longitudinal TTE confirmed durable performance of THV up to 7 years in the majority of patients; however, 6 patients (5.3% of the total cohort) experienced SVD during the follow-up. In conclusion, this study demonstrated favorable long-term survival and stable THV performance after TAVI, although SVD was not rare.
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38
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Bagur R. Transcatheter aortic valve looking for low-risk patients: a post hoc analysis of SURTAVI keeps opening the door. EUROINTERVENTION 2019; 14:846-848. [PMID: 30339129 DOI: 10.4244/eijv14i8a151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Rodrigo Bagur
- London Health Sciences Centre, London, Ontario, Canada
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39
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Nelson AJ, Montarello NJ, Cosgrove CS, Roberts-Thomson RL, Delacroix S, Chokka RG, Montarello JK, Worthley SG. Transcatheter aortic valve implantation: a new standard of care. Med J Aust 2019; 209:136-141. [PMID: 30071816 DOI: 10.5694/mja17.01255] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 08/03/2018] [Indexed: 12/31/2022]
Abstract
Aortic stenosis is the most common valvular lesion requiring intervention and with an ageing population, its burden is likely to increase. Increasing comorbidity and a desire for less invasive treatment strategies has facilitated the expansion of percutaneous aortic valve therapies. Robust clinical trial data are now available to support the role of transcatheter aortic valve implantation (TAVI) in patients of prohibitive, high and now intermediate surgical risk. The introduction of a Medicare Benefits Schedule reimbursement is likely to see TAVI use grow exponentially in Australia over the next 5 years. Clinical trials evaluating low risk patients may be the final frontier to see TAVI become the standard of care for most patients with severe aortic stenosis.
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40
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Koh JQ, Walton A, Marasco S, Duffy SJ. Transcatheter Mitral Valve Implantation with the Medtronic Intrepid™ Transcatheter Mitral Valve Replacement System. Future Cardiol 2019; 15:281-293. [PMID: 31074640 DOI: 10.2217/fca-2018-0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Mitral regurgitation is the most prevalent yet undertreated valvulopathy despite its adverse prognosis. With the emergence of transcatheter mitral interventions, the potential for this huge unmet disease burden to be addressed may finally be realized. Medtronic Intrepid™ Transcatheter Mitral Valve Replacement System represents one of several novel solutions. Based on early data from the pilot study, its efficacy and clinical utility is currently being tested against the mainstay treatment of surgical mitral valve replacement in a randomized trial. While there remain significant challenges before transcatheter mitral intervention can become part of the routine treatment algorithm, the authors are optimistic that transcatheter mitral valve repair and intervention have the potential in revolutionizing the management of severe symptomatic mitral regurgitation.
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Affiliation(s)
- Ji Qs Koh
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Antony Walton
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Silvana Marasco
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology & Preventive Medicine, Centre of Cardiovascular Research & Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
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41
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Affiliation(s)
- Catherine M Otto
- From the Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle
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42
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Bilkhu R, Jahangiri M, Otto CM. Patient-prosthesis mismatch following aortic valve replacement. Heart 2019; 105:s28-s33. [DOI: 10.1136/heartjnl-2018-313515] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/01/2018] [Accepted: 10/14/2018] [Indexed: 01/12/2023] Open
Abstract
Patient-prosthesis mismatch (PPM) occurs when an implanted prosthetic valve is too small for the patient; severe PPM is defined as an indexed effective orifice area (iEOA) <0.65 cm2/m2 following aortic valve replacement (AVR). This review examines articles from the past 10 years addressing the prevalence, outcomes and options for prevention and treatment of PPM after AVR. Prevalence of PPM ranges from 8% to almost 80% in individual studies. PPM is thought to have an impact on mortality, mainly in patients with severe PPM, although severe PPM accounts for only 10–15% of cases. Outcomes of patients with moderate PPM are not significantly different to those without PPM. PPM is associated with higher rates of perioperative stroke and renal failure and lack of left ventricular mass regression. Predictors include female sex, older age, hypertension, diabetes, renal failure and higher surgical risk score. PPM may be a marker of comorbidity rather than a risk factor for adverse outcomes. PPM should be suspected in patients with persistent cardiac symptoms after AVR when there is high prosthetic valve velocity or gradient and a small calculated effective orifice area. After exclusion of other causes of increased transvalvular gradient, re-intervention may be considered if symptoms persist and are unresponsive to medical therapy. However, this decision needs to consider the available options to relieve PPM and whether expected benefits justify the risk of intervention. The only effective intervention is redo surgery with implantation of a larger valve and/or annular enlargement. Therefore, focus needs to be on prevention.
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44
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Blackman DJ, Saraf S, MacCarthy PA, Myat A, Anderson SG, Malkin CJ, Cunnington MS, Somers K, Brennan P, Manoharan G, Parker J, Aldalati O, Brecker SJ, Dowling C, Hoole SP, Dorman S, Mullen M, Kennon S, Jerrum M, Chandrala P, Roberts DH, Tay J, Doshi SN, Ludman PF, Fairbairn TA, Crowe J, Levy RD, Banning AP, Ruparelia N, Spence MS, Hildick-Smith D. Long-Term Durability of Transcatheter Aortic Valve Prostheses. J Am Coll Cardiol 2019; 73:537-545. [DOI: 10.1016/j.jacc.2018.10.078] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/23/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
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45
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Transcatheter Aortic Heart Valves. JACC Cardiovasc Imaging 2019; 12:135-145. [DOI: 10.1016/j.jcmg.2018.06.028] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/09/2018] [Accepted: 06/22/2018] [Indexed: 12/21/2022]
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46
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Choudhury T, Solomonica A, Bagur R. The Evolut R and Evolut PRO transcatheter aortic valve systems. Expert Rev Med Devices 2018; 16:3-9. [PMID: 30518281 DOI: 10.1080/17434440.2019.1557045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Transcatheter aortic valves have evolved over the last 15 years. Second- and third- generation devices have considerably improved, and a range of newer devices have also been introduced with the aim of decreasing the incidence of paravalvular leak, reducing the need for permanent pacemaker implantation and minimizing procedure- and device-related complications. Areas covered: In this review, we highlight the special features of the latest generation of self-expanding Evolut PRO (Medtronic, Minneapolis, Minnesota) transcatheter aortic valve system. A detailed literature search on the Medtronic Evolut R and Evolut PRO transcatheter aortic valves was undertaken using Ovid, PubMed and Web of Science. Expert commentary: In a single, small study, the Evolut PRO has shown significant improvement over the Evolut R in terms of reduced paravalvular leak and pacemaker implantation. Larger scaled studies are needed to ascertain the performance of the Evolut PRO.
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Affiliation(s)
| | | | - Rodrigo Bagur
- a London Health Sciences Centre , London , Ontario , Canada.,b Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences , University of Keele , Stoke-on-Trent , UK
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47
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Solomonica A, Choudhury T, Bagur R. Newer-generation of Edwards transcatheter aortic valve systems: SAPIEN 3, Centera, and SAPIEN 3 Ultra. Expert Rev Med Devices 2018; 16:81-87. [DOI: 10.1080/17434440.2019.1555465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Rodrigo Bagur
- London Health Sciences Centre, London, Canada
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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48
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Bagur R. Unmet issues in transcatheter aortic valve implantation. J Thorac Dis 2018; 10:S3557-S3359. [PMID: 30505534 DOI: 10.21037/jtd.2018.10.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rodrigo Bagur
- London Health Sciences Centre, London, Ontario, Canada.,Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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49
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Kotronias RA, Teitelbaum M, Bagur R. Pre-implantation balloon-aortic valvuloplasty before transcatheter aortic valve implantation: is this still needed? J Thorac Dis 2018; 10:S3599-S3603. [PMID: 30505541 DOI: 10.21037/jtd.2018.06.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Balloon aortic valvuloplasty (BAV) has historically been recommended prior to transcatheter aortic valve implantation (TAVI). Pre-implantation BAV (pBAV) creates fractures at the level of calcified leaflets, thereby facilitating delivery of the transcatheter valve system across the diseased aortic valve and, enhances prosthesis implantation and expansion within the calcified aortic valve annulus. New device designs, lower profile delivery systems and increasing operator experience have enabled direct-TAVI (without pBAV), and its appeal amongst TAVI operators enhanced the dissemination of a direct TAVI approach across many centres. In this review, we discuss contemporary evidence that inform the debate on the need for routine pBAV for TAVI candidates and present a framework that may assist operators in selecting patients for pBAV.
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Affiliation(s)
- Rafail A Kotronias
- Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK.,Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
| | - Michael Teitelbaum
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK.,London Health Sciences Centre, Western University, London, Ontario, Canada
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50
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Benamer H, Auffret V, Cayla G, Chevalier B, Dupouy P, Eltchaninoff H, Gilard M, Guerin P, Iung B, Koning R, Monsegu J, Lantelme P, Le Breton H, Lefèvre T, Verhoye JP, Commeau P, Motreff P. Position paper of French Interventional Group (GACI) for TAVI in France in 2018. Ann Cardiol Angeiol (Paris) 2018; 67:455-465. [PMID: 30376969 DOI: 10.1016/j.ancard.2018.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Aortic stenosis is a frequent disease in the elderly. Its prevalence is 0.4% with a sharp increase after the age of 65, and its outcome is very poor when the patient becomes symptomatic. The interventional procedure known as TAVI (trans-catheter aortic valve implantation), which was developed in France and carried out for the first time in Rouen by Prof. Alain Cribier and his team in 2002, has proven to be a valid alternative to surgical aortic valve replacement. At first, this technique was shown to be efficient in patients with contra-indications to surgical treatment or deemed to be at high surgical risk. Given the very promising outcomes achieved as a result of close heart team collaboration, appropriate patient selection, simplified procedures and reduced complication rates, transfemoral (TF) TAVI is now preferred in symptomatic intermediate risk patients>75 years old according to the latest ESC guidelines. In 2017, in France, TAVI is currently performed in 50 centers with on-site cardiac surgery. The 2016 TAVI outcomes recorded in the French national TAVI registry (France TAVI) are very encouraging and show that for 7133 patients treated (age 83.4±7 years, logistic Euroscore 14%), 87% of whom via the TF approach, cross-over to surgery was very low (0.5%) with a 3.0% in-hospital mortality rate. The substantial increase in TAVI indications and the improvement of its outcomes may in the near future call for a reconsideration of the number of high volume centers authorized to carry out this technique.
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Affiliation(s)
- H Benamer
- ICPS Jacques Cartier, Ramsay générale de santé, 6, avenue du Noyer Lambert, 91300 Massy, France.
| | - V Auffret
- Inserm U1099, service de cardiologie et maladies vasculaires, CIC-IT 804, laboratoire de traitement du signal et de l'image, université de Rennes 1, CHU Pontchaillou, 35000 Rennes, France
| | - G Cayla
- Service de cardiologie, université de Montpellier, CHU Nîmes, 34000 Nîmes, France
| | - B Chevalier
- ICPS Jacques Cartier, Ramsay générale de santé, 6, avenue du Noyer Lambert, 91300 Massy, France
| | - P Dupouy
- Hôpital privé d'Anthony, 25, rue De La Providence, 92160 Antony, France
| | - H Eltchaninoff
- Inserm U1096, department of cardiology, FHU REMOD-VHF, Rouen university hospital, Normandie Univ, Unirouen, 76000 Rouen, France
| | - M Gilard
- CHU La Cavale Blanche, boulevard Tanguy Prigent, 29609 Brest, France
| | - P Guerin
- CHU hôpital G R Laennec, boulevard Jacques Monod, 44800 St Herblain, France
| | - B Iung
- Hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - R Koning
- Clinique Saint Hilaire, 2, place Saint Hilaire, 76000 Rouen, France
| | - J Monsegu
- Groupe hospitalier mutualiste de Grenoble, 8, rue du Dr Calmette, 38000 Grenoble cedex 1, France
| | - P Lantelme
- Hôpital Croix Rousse, 103, Gr De La Croix Rousse à Lyon, 34000 Lyon, France
| | - H Le Breton
- Inserm U1099, service de cardiologie et maladies vasculaires, CIC-IT 804, laboratoire de traitement du signal et de l'image, université de Rennes 1, CHU Pontchaillou, 35000 Rennes, France
| | - T Lefèvre
- ICPS Jacques Cartier, Ramsay générale de santé, 6, avenue du Noyer Lambert, 91300 Massy, France
| | - J-P Verhoye
- Service de chirurgie cardiaque, université de Rennes, CHU Pontchaillou, 35000 Rennes, France
| | - P Commeau
- Polyclinique Les Fleurs Quartier Quiez, 83190 Ollioules, France
| | - P Motreff
- Department of cardiology, Gabriel Montpied hospital, Clermont-Ferrand university hospital, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France
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