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Nasir MM, Ikram A, Usman M, Sarwar J, Ahmed J, Hamza M, Farhan SA, Siddiqi R, Qadar LT, Shah SR, Khalid MR, Memon RS, Hameed I. Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo-Surgical Aortic Valve Replacement in Patients With Aortic Stenosis: A Systematic Review and Meta-analysis. Am J Cardiol 2024; 225:151-159. [PMID: 38723857 DOI: 10.1016/j.amjcard.2024.04.057] [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: 02/11/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/21/2024]
Abstract
Aortic stenosis is a common and significant valve condition requiring bioprosthetic heart valves with transcatheter aortic valve replacement (TAVR) being strongly recommended for high-risk patients or patients over 75 years. This meta-analysis aimed to pool existing data on postprocedural clinical as well as echocardiographic outcomes comparing valve-in-valve (ViV)-TAVR to redo-surgical aortic valve replacement to assess the short-term and medium-term outcomes for both treatment methods. A systematic literature search on Cochrane Central, Scopus, and Medline (PubMed interface) electronic databases from inception to August 2023. We used odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. Twenty-four studies (25,216 patients) were pooled with a mean follow-up of 16.4 months. The analysis revealed that ViV-TAVR group showed a significant reduction in 30-day mortality (OR 0.50, 95% confidence interval [CI] 0.43 to 0.58, p <0.00001), new-onset atrial fibrillation (OR 0.34, 95% CI 0.17 to 0.67, p = 0.002), major bleeding event (OR 0.28, 95% CI 0.17 to 0.45, p <0.00001) and lower rate of device success (OR 0.25, 95% CI 0.12 to 0.53, p = 0.0003). There were no significant differences between either group when assessing 1-year mortality, stroke, myocardial infarction, postoperative left ventricular ejection fraction, and effective orifice area. ViV-TAVR cohort showed a significantly increased incidence of paravalvular leaks, aortic regurgitation, and increased mean aortic valve gradient. ViV-TAVR is a viable short-term option for older patients with high co-morbidities and operative risks, reducing perioperative complications and improving 30-day mortality with no significant cardiovascular adverse events. However, both treatment methods present similar results on short-term to medium-term complications assessment.
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Affiliation(s)
- Muhammad Moiz Nasir
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
| | - Armeen Ikram
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Usman
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Jawad Sarwar
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Jawad Ahmed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mohammad Hamza
- Department of Internal Medicine, Guthrie Medical Group, Cortland, New York
| | - Syed Ali Farhan
- Department of Surgery, Ohio State University, Columbus, Ohio
| | - Rabbia Siddiqi
- Department of Internal Medicine, University of Toledo, Ohio
| | - Laila Tul Qadar
- Department of Internal Medicine, St Vincent's Medical Center, Bridgeport, Connecticut
| | - Syed Raza Shah
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
| | | | - Roha Saeed Memon
- Department of Internal Medicine, Jacobi Medical Center-New York City Health + Hospitals Corporation/Albert Einstein College of Medicine, Bronx, New York
| | - Irbaz Hameed
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
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2
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Cao D, Albani S, Gall E, Hovasse T, Unterseeh T, Seknadji P, Champagne S, Garot P, Sayah N, Akodad M. Aortic Valve-in-Valve Procedures: Challenges and Future Directions. J Clin Med 2024; 13:4723. [PMID: 39200865 PMCID: PMC11355095 DOI: 10.3390/jcm13164723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/05/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Aortic valve-in-valve (ViV) procedures are increasingly performed for the treatment of surgical bioprosthetic valve failure in patients at intermediate to high surgical risk. Although ViV procedures offer indisputable benefits in terms of procedural time, in-hospital length of stay, and avoidance of surgical complications, they also present unique challenges. Growing awareness of the technical difficulties and potential threats associated with ViV procedures mandates careful preprocedural planning. This review article offers an overview of the current state-of-the-art ViV procedures, with focus on patient and device selection, procedural planning, potential complications, and long-term outcomes. Finally, it discusses current research efforts and future directions aimed at improving ViV procedural success and patient outcomes.
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Affiliation(s)
- Davide Cao
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Stefano Albani
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
- Division of Cardiology, U. Parini Hospital, 11100 Aosta, Italy
| | - Emmanuel Gall
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
- Department of Cardiology, University Hospital of Lariboisiere, Université Paris-Cité, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010 Paris, France
- Inserm MASCOT—UMRS 942, University Hospital of Lariboisiere, 75010 Paris, France
- MIRACL.ai Laboratory, Multimodality Imaging for Research and Artificial Intelligence Core Laboratory, University Hospital of Lariboisiere (AP-HP), 75010 Paris, France
| | - Thomas Hovasse
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
| | - Thierry Unterseeh
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
| | - Patrick Seknadji
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
| | - Stéphane Champagne
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
| | - Philippe Garot
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
| | - Neila Sayah
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
| | - Mariama Akodad
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
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3
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Tran JH, Itagaki S, Zeng Q, Leon MB, O’Gara PT, Mack MJ, Gillinov AM, El-Hamamsy I, Tang GHL, Mikami T, Bagiella E, Moskowitz AJ, Adams DH, Gelijns AC, Borger MA, Egorova NN. Transcatheter or Surgical Replacement for Failed Bioprosthetic Aortic Valves. JAMA Cardiol 2024; 9:631-639. [PMID: 38776106 PMCID: PMC11112500 DOI: 10.1001/jamacardio.2024.1049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/13/2024] [Indexed: 05/25/2024]
Abstract
Importance The use of valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has been rapidly expanding as an alternative treatment to redo surgical aortic valve replacement (SAVR) for failed bioprosthetic valves despite limited long-term data. Objective To assess mortality and morbidity in patients undergoing intervention for failed bioprosthetic SAVR. Design, Setting, and Participants This was a retrospective population-based cohort analysis conducted between January 1, 2015, and December 31, 2020, with a median (IQR) follow-up time of 2.3 (1.1-4.0) years. A total of 1771 patients with a history of bioprosthetic SAVR who underwent ViV-TAVR or redo SAVR in California, New York, and New Jersey were included. Data were obtained from the California Department of Health Care Access and Information, the New York Statewide Planning and Research Cooperative System, and the New Jersey Discharge Data Collection System. Exclusion criteria included undergoing TAVR or redo SAVR within 5 years from initial SAVR, as well as infective endocarditis, concomitant surgical procedures, and out-of-state residency. Propensity matching yielded 375 patient pairs. Data were analyzed from January to December 2023. Interventions ViV-TAVR vs redo SAVR. Main Outcomes and Measurements The primary outcome was all-cause mortality. Secondary outcomes were stroke, heart failure hospitalization, reoperation, major bleeding, acute kidney failure, new pacemaker insertion, and infective endocarditis. Results From 2015 through 2020, the proportion of patients undergoing ViV-TAVR vs redo SAVR increased from 159 of 451 (35.3%) to 498 or 797 (62.5%). Of 1771 participants, 653 (36.9%) were female, and the mean (SD) age was 74.4 (11.3) years. Periprocedural mortality and stroke rates were similar between propensity-matched groups. The ViV-TAVR group had lower periprocedural rates of major bleeding (2.4% vs 5.1%; P = .05), acute kidney failure (1.3% vs 7.2%; P < .001), and new pacemaker implantations (3.5% vs 10.9%; P < .001). The 5-year all-cause mortality rate was 23.4% (95% CI, 15.7-34.1) in the ViV-TAVR group and 13.3% (95% CI, 9.2-18.9) in the redo SAVR group. In a landmark analysis, no difference in mortality was observed up to 2 years (hazard ratio, 1.03; 95% CI, 0.59-1.78), but after 2 years, ViV-TAVR was associated with higher mortality (hazard ratio, 2.97; 95% CI, 1.18-7.47) as well as with a higher incidence of heart failure hospitalization (hazard ratio, 3.81; 95% CI, 1.57-9.22). There were no differences in 5-year incidence of stroke, reoperation, major bleeding, or infective endocarditis. Conclusions and Relevance Compared with redo SAVR, ViV-TAVR was associated with a lower incidence of periprocedural complications and a similar incidence of all-cause mortality through 2 years' follow-up. However, ViV-TAVR was associated with higher rates of late mortality and heart failure hospitalization. These findings may be influenced by residual confounding and require adjudication in a randomized clinical trial.
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Affiliation(s)
- Jessica H. Tran
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shinobu Itagaki
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Qi Zeng
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Martin B. Leon
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Patrick T. O’Gara
- Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Michael J. Mack
- Cardiac and Thoracic Surgery, Baylor Scott & White Health, Dallas, Texas
| | - A. Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gilbert H. L. Tang
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Takahisa Mikami
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emilia Bagiella
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alan J. Moskowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David H. Adams
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annetine C. Gelijns
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Natalia N. Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
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Bajwa TK, Laham RJ, Khabbaz K, Dauerman HL, Waksman R, Weiss E, Allaqaband S, Badr S, Caskey M, Byrne T, Applegate RJ, Kon ND, Li S, Kleiman NS, Reardon MJ, Chetcuti SJ, Deeb GM. Five-Year Follow-Up from the CoreValve Expanded Use Transcatheter Aortic Valve-in-Surgical Aortic Valve Study. Am J Cardiol 2024; 214:1-7. [PMID: 38110018 DOI: 10.1016/j.amjcard.2023.11.071] [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: 10/24/2023] [Accepted: 11/24/2023] [Indexed: 12/20/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) provides an option for extreme-risk patients who underwent reoperation for a failed surgical aortic bioprosthesis. Long-term data on patients who underwent TAVR within a failed surgical aortic valve (TAV-in-SAV) are limited. The CoreValve Expanded Use Study evaluated patients at extreme surgical risk who underwent TAV-in-SAV. Outcomes at 5 years were analyzed by SAV failure mode (stenosis, regurgitation, or combined). Echocardiographic outcomes are site-reported. TAV-in-SAV was attempted in 226 patients with a mean age of 76.7 ± 10.8 years; 63.3% were male, the Society of Thoracic Surgeons predicted risk of mortality score was 9.0 ± 6.7%, and 87.5% had a New York Heart Association classification III or IV symptoms. Most of the failed surgical bioprostheses were stented (81.9%), with an average implant duration of 10.2 ± 4.3 years. The 5-year all-cause mortality or major stroke rate was 47.2% in all patients; 54.4% in the stenosis, 37.6% in the regurgitation, and 38.0% in the combined groups (p = 0.046). At 5 years, all-cause mortality was higher in patients with versus without 30-day severe prosthesis-patient mismatch (51.7% vs 38.3%, p = 0.026). The overall aortic valve reintervention rate was 5.9%; highest in the regurgitation group (12.6%). The mean aortic valve gradient was 14.1 ± 9.8 mm Hg and effective orifice area was 1.57 ± 0.70 at 5 years. Few patients had >mild paravalvular regurgitation at 5 years (5.5% moderate, 0.0% severe). TAV-in-SAV with supra-annular, self-expanding TAVR continues to represent a safe and lasting intermediate option for extreme-risk patients who have appropriate sizing of the preexisting failed surgical valve. Clinical and hemodynamic outcomes were stable through 5 years.
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Affiliation(s)
- Tanvir K Bajwa
- XXX, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin.
| | - Roger J Laham
- Department of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kamal Khabbaz
- Department of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Harold L Dauerman
- Department of Cardiovascular Medicine, University of Vermont, Burlington, Vermont
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC
| | - Eric Weiss
- XXX, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Suhail Allaqaband
- XXX, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Salem Badr
- XXX, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Michael Caskey
- Department of Cardiothoracic Surgery and Interventional Cardiology, Arizona Heart Hospital, Phoenix, Arizona
| | - Timothy Byrne
- Department of Cardiothoracic Surgery and Interventional Cardiology, Arizona Heart Hospital, Phoenix, Arizona
| | - Robert J Applegate
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Neal D Kon
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Shuzhen Li
- Department of Structural Heart and Aortic Statistics, Medtronic, Mounds View, Minnesota
| | - Neal S Kleiman
- Department of Cardiovascular Medicine and Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas
| | - Michael J Reardon
- Department of Cardiovascular Medicine and Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas
| | - Stanley J Chetcuti
- Department of Cardiology and Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - G Michael Deeb
- Department of Cardiology and Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
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5
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Kiaii BB, Moront MG, Patel HJ, Ruel M, Bensari FN, Kress DC, Liu F, Klautz RJM, Sabik JF. Outcomes of Surgical Bioprosthetic Aortic Valve Replacement in Patients Aged ≤65 and >65 Years. Ann Thorac Surg 2023; 116:483-490. [PMID: 35065064 DOI: 10.1016/j.athoracsur.2021.12.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/17/2021] [Accepted: 12/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Implantation of a bioprosthetic valve is a reasonable choice for patients aged > 65 years. For middle-aged patients there is less certainty about whether a mechanical or bioprosthetic valve is best. METHODS The Pericardial Surgical Aortic Valve Replacement (PERIGON) Pivotal Trial is evaluating the safety and efficacy of the Avalus bioprosthesis (Medtronic). We evaluated clinical and echocardiographic outcomes through 5 years of follow-up, stratified by age ≤ 65 and >65 years. RESULTS Two hundred seventy-one patients (24.2%) were ≤65 years old and 847 (75.8%) >65 years old. Most patients in both groups were men (217 [80.1%] vs 623 [73.6%], respectively; P = .031). Younger patients had a lower Society of Thoracic Surgeons risk of mortality (1.1% ± 0.9% vs 2.2% ± 1.4%, P < .001), better baseline New York Heart Association class (P = .004), and fewer comorbidities than older patients. At 5 years mortality was lower among younger than older patients (5.3% vs 14.0%, P < .001) and no cases of structural valve deterioration occurred in either group. Effective orifice area was similar between age groups (P = .11), and mean gradient was 13.9 ± 5.4 vs 12.0 ± 4.1 mm Hg (P < .001). Multivariable linear regression identified several parameters associated with mean aortic gradient at 5 years, including baseline age and mean aortic gradient, discharge stroke volume index and EOA, and implanted valve size. Ninety-five percent of patients were in New York Heart Association class I/II through 5 years in both age groups (P = .85). CONCLUSIONS Findings from this analysis demonstrate satisfactory safety, hemodynamic performance, and durability of the Avalus bioprosthesis through a 5-year follow-up in patients aged ≤ 65 and >65 years.
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Affiliation(s)
- Bob B Kiaii
- Department of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada.
| | | | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor, Michigan
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - David C Kress
- Department of Cardiothoracic Surgery, Aurora St Luke's Medical Center, Milwaukee, Wisconsin
| | - Fang Liu
- Department of Biostatistics, Medtronic, Mounds View, Minnesota
| | - Robert J M Klautz
- Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Joseph F Sabik
- University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
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Masuyama S, Mizui M, Maeda K, Shimamura K, Sakaguchi Y, Morita M, Kuratani T, Mizote I, Nakamura D, Sakata Y, Sawa Y, Miyagawa S, Isaka Y. Preoperative hypomagnesemia as a possible predictive factor for postoperative increase of transvalvular pressure gradient in hemodialysis patients treated with transcatheter aortic valve implantation. Ren Fail 2022; 44:1083-1089. [PMID: 35796036 PMCID: PMC9272925 DOI: 10.1080/0886022x.2022.2094272] [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: 10/26/2022] Open
Abstract
BACKGROUND Patients undergoing maintenance hemodialysis (HD) with severe aortic stenosis are at a high risk for bioprosthetic valve dysfunction after transcatheter aortic valve implantation (TAVI). Currently, preoperative factors that predict the occurrence of valve dysfunction after TAVI on HD patients remain to be elucidated. The aim of this study is to analyze the association between preoperative clinical factors and valve stenosis after TAVI on HD patients. METHODS Twenty-four of HD patients who underwent TAVI at our institution between April 2012 and January 2016 were analyzed. The mean aortic transvalvular pressure gradient (MPG) and effective orifice area index (EOAi) were assessed by serial echocardiography. Associations between preoperative clinical factors and time-series changes in MPG were examined using mixed-effects linear regression model for repeated measures. RESULTS Three patients developed severe structural valve deterioration with calcific valve stenosis requiring reoperation. A multivariate linear mixed-effects model showed that lower serum magnesium (sMg) levels were associated with the increase of MPG after TAVI (beta-coefficient = 0.019, p = 0.03). No correlation was observed with serum calcium, phosphorus, or intact parathyroid hormone. Time-series changes of MPG and EOAi had significant difference between lower and higher sMg group. All 3 of the patients who underwent reoperation showed lower preoperative sMgs. CONCLUSION Among bone-mineral metabolism markers, preoperative hypomagnesemia was associated with the increase of MPG after TAVI, suggesting that hypomagnesemia could predict post-TAVI valve dysfunction in HD patients. Further studies with larger sample sizes are warranted.
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Affiliation(s)
- Satoshi Masuyama
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masayuki Mizui
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koichi Maeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yusuke Sakaguchi
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Inter-Organ Communication Research in Kidney Diseases, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masashi Morita
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Isamu Mizote
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Daisuke Nakamura
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
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7
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Wilbring M, Kappert U, Haussig S, Winata J, Matschke K, Mangner N, Arzt S, Alexiou K. Hemodynamic follow-up after valve-in-valve TAVR for failed aortic bioprosthesis. J Card Surg 2022; 37:4654-4661. [PMID: 36273424 DOI: 10.1111/jocs.17048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/31/2022] [Accepted: 10/05/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND "valve-in-valve" TAVR (VIV-TAVR) is established and provides good initial clinical and hemodynamic outcomes. Lacking long-term durability data baffle the expand to lower risk patients. For those purposes, the present study adds a hemodynamic 3-years follow-up. METHODS A total of 77 patients underwent VIV-TAVR for failing aortic bioprosthesis during a 7-years period. Predominant mode of failure was stenosis in 87.0%. Patients had a mean age of 79.4 ± 5.8 years and a logistic EuroSCORE of 30.8 ± 15.7%. The Society of Thoracic Surgeons-PROM averaged 5.79 ± 2.63%. Clinical results and hemodynamic outcomes are reported for 30-days, 1-, 2-, and 3-years. Completeness of follow-up was 100% with 44 patients at risk after 3-years. Follow-up ranged up to 7.1 years. RESULTS Majority of the surgical valves were stented (94.8%) with a mean labeled size of 23.1 ± 2.3 mm and true-ID of 20.4 ± 2.6 mm. A true-ID ≤21 mm had 58.4% of the patients. Self-expanding valves were implanted in 68.8% (mean labeled size 24.1 ± 1.8 mm) and balloon-expanded in 31.2% (mean size 24.1 ± 1.8 mm). No patient died intraoperatively. Hospital mortality was 1.3% and three-years survival 57.1%. All patients experienced an initial significant dPmean-reduction to 16.8 ± 7.1 mmHg. After 3-years mean dPmean raised to 26.0 ± 12.2 mmHg. This observation was independent from true-ID or type of transcatheter aortic valve replacement (TAVR)-prosthesis. Patients with a true-ID ≤21 mm had a higher initial (18.3 ± 5.3 vs. 14.9 ± 7.1 mmHg; p = .005) and dPmean after 1-year (29.2 ± 8.2 vs. 13.0 ± 6.7 mmHg; p = .004). There were no significant differences in survival. CONCLUSIONS VIV-TAVR is safe and effective in the early period. In surgical valves with a true-ID ≤21 mm inferior hemodynamic and survival outcomes must be expected. Nonetheless, also patients with larger true-IDs showed steadily increasing transvalvular gradients. This raises concern about durability.
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Affiliation(s)
- Manuel Wilbring
- Medical Faculty "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Department for Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Utz Kappert
- Medical Faculty "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Department for Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Stephan Haussig
- Medical Faculty "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Department for Cardiology, University Heart Center Dresden, Dresden, Germany
| | - Johan Winata
- Medical Faculty "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Department for Cardiac Anesthesiology, University Heart Center Dresden, Dresden, Germany
| | - Klaus Matschke
- Medical Faculty "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Department for Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Norman Mangner
- Medical Faculty "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Department for Cardiology, University Heart Center Dresden, Dresden, Germany
| | - Sebastian Arzt
- Medical Faculty "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Department for Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Konstantin Alexiou
- Medical Faculty "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Department for Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
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8
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Alnajar A, Hamad N, Azhar MZ, Mousa Y, Arora Y, Lamelas J. Surgical versus transcatheter aortic valve replacement: Impact of patient-prosthesis mismatch on outcomes. J Card Surg 2022; 37:5388-5394. [PMID: 36378858 DOI: 10.1111/jocs.17217] [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: 08/24/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The hemodynamics of most prosthetic valves are often inferior to that of the normal native valve, and a significant proportion of patients undergoing surgical (SAVR) or transcatheter aortic valve replacement (TAVR) have high residual transaortic pressure gradients due to prosthesis-patient mismatch (PPM). As the experience with TAVR has increased and long-term outcomes are reported, a close look at the PPM literature is required in light of new evidence. METHODS For this review, we searched the Embase, Medline, and Cochrane databases from 2000 to 2022. Articles reporting PPM as an outcome following aortic valve replacements were identified and reviewed. RESULTS The impact of PPM on clinical outcomes in aortic valve replacement has not been clear as multiple studies failed to report PPM incidence. However, the PPM outcomes after SAVR vary more widely than after TAVR, ranging from 8% to 80% in SAVR and from 24% to 35% in TAVR. Incidence of severe PPM following redo SAVR ranges from 2% to 9% and following valve-in-valve TAVR is from 14% to 33%, however, while PPM is higher in valve-in-valve TAVR, patients had better survival rates. CONCLUSIONS The gap between valve performance and clinical outcomes in SAVR and TAVR could be reduced by carefully selecting patients for either treatment option. Understanding predictors of PPM can add to the safety, effectiveness, and increased survival benefit of both SAVR and TAVR.
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Affiliation(s)
- Ahmed Alnajar
- Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Naser Hamad
- Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Yaseen Mousa
- Florida Atlantic University, Boca Raton, Florida, USA
| | - Yingyot Arora
- Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joseph Lamelas
- Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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9
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Editorial: Minding the Gradient — Valve-in-Valve Transcatheter Aortic Valve Replacement vs. Redo Surgical Aortic Valve Replacements for Surgical Bioprosthetic Valve Failure. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Bruno F, Elia E, D'Ascenzo F, Marengo G, Deharo P, Kaneko T, Cuisset T, Fauchier L, De Filippo O, Gallone G, Andreis A, Fortuni F, Salizzoni S, La Torre M, Rinaldi M, De Ferrari GM, Conrotto F. Valve-in-valve transcatheter aortic valve replacement or re-surgical aortic valve replacement in degenerated bioprostheses: A systematic review and meta-analysis of short and midterm results. Catheter Cardiovasc Interv 2022; 100:122-130. [PMID: 35485723 DOI: 10.1002/ccd.30219] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/03/2022] [Accepted: 04/15/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Despite limited to short and midterm outcomes, valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as a valid alternative to re-surgical aortic valve replacement (re-SAVR) for high- and intermediate-risk patients with degenerated surgical bioprosthesis. METHODS All studies comparing multivariate adjustment between ViV TAVI and re-SAVR were screened. The primary end-points were all-cause and cardiovascular (CV) mortality at 30 days and at Midterm follow-up. Short-term complications were the secondary endpoints. RESULTS We obtained data from 11 studies, encompassing 8570 patients, 4224 undergoing ViV TAVI, and 4346 re-SAVR. Four studies included intermediate-risk patients and seven high-risk patients. 30-day all-cause and CV mortality were significantly lower in ViV (odds ratio [OR] 0.43, 95% confidence intervals [CIs] 0.29-0.64 and OR 0.44, 0.26-0.73 respectively), while after a mean follow-up of 717 (180-1825) days, there was no difference between the two groups (OR 1.04, 0.87-1.25 and OR 1.05, 0.78-1.43, respectively). The risk of stroke (OR 1.03, 0.59-1.82), MI (OR 0.70, 0.34-1.44), major vascular complications (OR 0.92, 0.50-1.67), and permanent pacemaker implantation (OR 0.67, 0.36-1.25) at 30 days did not differ, while major bleedings and new-onset atrial fibrillation were significantly lower in ViV patients (OR 0.41, 0.25-0.67 and OR 0.23, 0.12-0.42, respectively, all 95% CIs). CONCLUSIONS In high- and intermediate-risk patients with degenerated surgical bioprostheses, ViV TAVI is associated with reduced short-term mortality, compared with re-SAVR. Nevertheless, no differences were found in all-cause and CV mortality at midterm follow-up. PROSPERO CRD42021226488.
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Affiliation(s)
- Francesco Bruno
- Division of Cardiology, Department Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Edoardo Elia
- Division of Cardiology, Department Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Giorgio Marengo
- Division of Cardiology, Department Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Pierre Deharo
- Département de Cardiologie, CHU Timone, Marseille, France.,INSRRM, INRA, Aix Marseille University, Marseille, France
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Thomas Cuisset
- Département de Cardiologie, CHU Timone, Marseille, France.,INSRRM, INRA, Aix Marseille University, Marseille, France
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Trousseau, Tours, France
| | - Ovidio De Filippo
- Division of Cardiology, Department Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Department Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Alessandro Andreis
- Division of Cardiology, Department Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Federico Fortuni
- Division of Cardiology, Department Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiosurgery, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Michele La Torre
- Division of Cardiosurgery, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiosurgery, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Department Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
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11
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Buono A, Maffeo D, Troise G, Donatelli F, Tespili M, Ielasi A. Trans-Catheter Valve-in-Valve Implantation for the Treatment of Aortic Bioprosthetic Valve Failure. J Clin Med 2022; 11:344. [PMID: 35054038 PMCID: PMC8778204 DOI: 10.3390/jcm11020344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 02/01/2023] Open
Abstract
Aortic valve-in-valve (ViV) procedure is a valid treatment option for patients affected by bioprosthetic heart valve (BHV) degeneration. However, ViV implantation is technically more challenging compared to native trans-catheter aortic valve replacement (TAVR). A deep knowledge of the mechanism and features of the failed BHV is pivotal to plan an adequate procedure. Multimodal imaging is fundamental in the diagnostic and pre-procedural phases. The main challenges associated with ViV TAVR consist of a higher risk of coronary obstruction, severe post-procedural patient-prosthesis mismatch, and a difficult coronary re-access. In this review, we describe the principles of ViV TAVR.
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Affiliation(s)
- Andrea Buono
- Interventional Cardiology Unit, Fondazione Poliambulanza, 25124 Brescia, Italy; (A.B.); (D.M.)
| | - Diego Maffeo
- Interventional Cardiology Unit, Fondazione Poliambulanza, 25124 Brescia, Italy; (A.B.); (D.M.)
| | - Giovanni Troise
- Cardiac Surgery Unit, Cardiovascular Department, Hospital Poliambulanza Foundation, 25124 Brescia, Italy;
| | - Francesco Donatelli
- Department of Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, University of Milan, 20149 Milan, Italy;
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy;
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy;
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12
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Burgdorf C, Vukadinovikj Momchilovska A, Remppis BA. Outcomes after transcatheter valve-in-valve implantation using a balloon-expandable Edwards Sapien valve in patients with degenerated Freestyle aortic bioprosthesis. Ann Cardiothorac Surg 2021; 10:667-673. [PMID: 34733694 DOI: 10.21037/acs-2021-tviv-fs-43] [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: 03/24/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022]
Abstract
Background Transcatheter aortic valve-in-valve implantation (ViV TAVI) in degenerated Medtronic Freestyle aortic bioprosthesis (FSB) has been reported as being technically challenging. This study sought to evaluate procedural data and outcomes after ViV TAVI using a balloon-expandable Edwards valve in patients with failed FSB. Methods Between August 2014 and December 2020, twenty-seven consecutive patients underwent ViV TAVI for symptomatic FSB failure at our institution using a Sapien XT (n=1) and Sapien 3 (n=26) valve, respectively. Endpoints were defined according to the Valve Academic Research Consortium-2 (VARC-2) criteria and were retrospectively analyzed. Results Mean patient age was 75.7±8.2 years (female n=5, male n=22); Society of Thoracic Surgeons Predicted Risk of Mortality score was 7.3%±6.2%. ViV implantation with correct positioning of the Edwards Sapien valve within the FSB was successful in all cases. Intraprocedural transesophageal echocardiography revealed none/trace paravalvular regurgitation in twenty-five patients (92.6%), mild paravalvular regurgitation was present in two patients (7.4%). Neither of the patients had a mean gradient ≥20.0 mmHg excluding significant patient-prosthesis mismatch. Three early deaths (≤thirty days) occurred resulting in a device success rate of 88.8%. One-year and three-year survival rates for patients alive beyond day thirty after ViV TAVI were 95.8% and 70.0%, respectively. Conclusions ViV TAVI with Edwards Sapien valves lead to acceptable functional results in high-risk patients with degenerated FSB but early complications must be considered particularly during hospital stay.
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Affiliation(s)
- Christof Burgdorf
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Germany
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13
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Alperi A, Garcia S, Rodés-Cabau J. Transcatheter valve-in-valve implantation in degenerated surgical aortic and mitral bioprosthesis: Current state and future perspectives. Prog Cardiovasc Dis 2021; 72:54-65. [PMID: 34688669 DOI: 10.1016/j.pcad.2021.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 10/16/2021] [Indexed: 12/27/2022]
Abstract
The use of bioprosthetic valves for treating patients with severe valve disease has increased over the last 2 decades, and, as a consequence, a growing number of patients with failing surgical bioprosthesis is expected in the near future. In this setting, valve-in-valve (ViV) transcatheter aortic/mitral valve replacement (TAVR and TMVR) has emerged as an alternative to redo surgery. Despite the increasing experience in ViV procedures, the development of these techniques faces several specific challenges, mainly related to the unique anatomical and physiological characteristics presented in ViV-TAVR/TMVR. Subsequently, various approaches have been proposed to overcome ViV-related complications and pitfalls. A growing body of evidence is currently available concerning early- and long-term clinical outcomes of patients undergoing ViV-TAVR/TMVR. These data should be comprehensively evaluated by the Heart Team in the decision-making process involving patients with failing surgical bioprostheses. In this review, we aimed to delineate the technical challenges and risks associated with ViV-TAVR and ViV-TMVR, provide an updated overview of the main clinical results, and summarize the future perspectives of this evolving field.
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Affiliation(s)
- Alberto Alperi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Santiago Garcia
- Minneapolis Heart Institute, Minneapolis, MN, United States of America
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
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14
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Abushouk AI, Abdelfattah O, Saad A, Isogai T, Farwati M, Yun J, Popovic Z, Shekhar S, Puri R, Reed GW, Krishnaswamy A, Kapadia SR. Predictors of Procedural Success in Patients With Degenerated Surgical Valves Undergoing Transcatheter Aortic Valve-in-Valve Implantation. Front Cardiovasc Med 2021; 8:718835. [PMID: 34631823 PMCID: PMC8497979 DOI: 10.3389/fcvm.2021.718835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Valve-in-Valve transcatheter aortic valve implantation (ViV-TAVI) is a growing alternative for redo-surgery in patients with degenerated surgical valves. To our knowledge, data are lacking on the determinants on ViV-TAVI procedural success in patients with degenerated surgical valves. Methods: All consecutive patients undergoing ViV-TAVI for degenerated surgical valves at the Cleveland Clinic were analyzed. Data were extracted from our patient registry on baseline patient characteristics, echocardiographic parameters, and procedural details. To identify possible predictors of ViV-TAVI procedural success, we employed a multivariate logistic regression model. Results: A total of 186 patients who underwent ViV-TAVI were analyzed, with procedural success (VARC-2 device success and absence of periprocedural MACCE) reported in 165 (88.7%) patients. Patients with successful ViV-TAVI were significantly younger and had more frequent utilization of the transfemoral access than those with failed procedure. Other baseline and procedural characteristics were comparable between both groups. In terms of echocardiographic parameters, the procedural success group had a significantly lower AV peak pressure gradient (62.1 ± 24.7 vs. 74.1 ± 34.6 mmHg; p = 0.04) and lower incidence of moderate-to-severe aortic regurgitation [AR] (30.4 vs. 55%; p = 0.04). However, no significant differences between both groups were noted in terms of AV mean pressure gradient and left ventricular measurements. In multivariate analysis, lower AV peak pressure gradient (OR = 0.97, 95% CI: 0.95–0.99) and absence of moderate-to-severe AR (OR = 0.65, 95% CI: 0.44–0.95) at baseline emerged as independent predictors of ViV-TAVI procedural success. Conclusion: Valve-in-Valve TAVI for degenerated surgical valves is a feasible approach with high success rates, especially in those with lower AV peak pressure gradient and absence of moderate-to-severe AR. Studies with larger sample size and longer follow-up are required to further characterize the predictors of ViV-TAVI success and other clinical outcomes.
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Affiliation(s)
- Abdelrahman I Abushouk
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Omar Abdelfattah
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States.,Department of Internal Medicine, Morristown Medical Center, Atlantic Health System, Morristown, NJ, United States
| | - Anas Saad
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Medhat Farwati
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - James Yun
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Zoran Popovic
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
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15
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Sengupta A, Alexis SL, Zaid S, Tang GHL. Will valve-in-valve transcatheter aortic valve replacement shift the treatment paradigm for young adults with aortic valve disease? Ann Cardiothorac Surg 2021; 10:509-511. [PMID: 34422563 DOI: 10.21037/acs-2020-rp-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/27/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Aditya Sengupta
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Sophia L Alexis
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Syed Zaid
- Division of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY, USA
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16
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Kaneko T, Makkar RR, Krishnaswami A, Hermiller J, Greenbaum A, Babaliaros V, Shah PB, Bailey SH, Bapat V, Kapadia S, Abbas AE. Valve-in-Surgical-Valve With SAPIEN 3 for Transcatheter Aortic Valve Replacement Based on Society of Thoracic Surgeons Predicted Risk of Mortality. Circ Cardiovasc Interv 2021; 14:e010288. [PMID: 34003666 DOI: 10.1161/circinterventions.120.010288] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Tsuyoshi Kaneko
- Division of Cardiac Surgery (T.K.), Brigham and Women's Hospital, Boston, MA
| | - Raj R Makkar
- Department of Cardiology, Cedars Sinai Medical Center, Los Angeles, CA (R.R.M.)
| | | | | | - Adam Greenbaum
- Division of Cardiology, Emory University Medical Center, Atlanta, GA (A.G., V.B.)
| | - Vasilis Babaliaros
- Division of Cardiology, Emory University Medical Center, Atlanta, GA (A.G., V.B.)
| | - Pinak B Shah
- Division of Cardiology (P.B.S.), Brigham and Women's Hospital, Boston, MA
| | - Stephen H Bailey
- Division of Cardiac Surgery, Allegheny General Hospital, Pittsburgh, PA (S.H.B.)
| | - Vinnie Bapat
- Division of Cardiac Surgery, Minneapolis Heart Institute, MN (V.B.)
| | - Samir Kapadia
- The Heart Center of Indiana, Indianapolis (J.H., S.K.)
| | - Amr E Abbas
- Division of Cardiac Surgery, Minneapolis Heart Institute, MN (V.B.)
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17
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Kornowski R, Chevalier B, Verhoye JP, Holzhey D, Harnath A, Schӓfer U, Teiger E, Manigold T, Modine T, Souteyrand G, Champagnac D, Oh JK, Li S, Tchétché D. Transcatheter Aortic Valve Implantation for Failed Surgical Aortic Bioprostheses Using a Self-Expanding Device (from the Prospective VIVA Post Market Study). Am J Cardiol 2021; 144:118-124. [PMID: 33383007 DOI: 10.1016/j.amjcard.2020.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
Patients with symptomatic aortic stenosis are often treated with a surgical valve replacement. Surgical bioprosthetic valves degenerate over time and therefore may necessitate a redo surgery. This analysis reports the 2-year clinical outcomes of the Valve-in-Valve study, which evaluated transcatheter aortic valve implantation using the CoreValve and Evolut R devices in patients with degenerated surgical aortic bioprostheses at high risk for surgery. The prospective Valve-in-Valve study enrolled 202 eligible patients with failing surgical aortic bioprostheses due to stenosis, regurgitation, or a combination of both. The Evolut R bioprosthesis was used in 90.5% of valve-in-valve transcatheter aortic valve implantation cases. Two-year all-cause and cardiovascular mortality rates were 16.5% and 11.1%, respectively. Other clinical events included stroke (7.9%), disabling stroke (1.7%), and new pacemaker implantation (10.1%). The 2-year all-cause mortality rate was significantly higher in patients with discharge mean gradients ≥20 mmHg vs. those with lower mean gradients (21.0% vs 7.6%, p = 0.025). Discharge mean gradients ≥20 mm Hg were associated with smaller surgical bioprostheses (OR, 7.2 [95% CI 2.3 to 22.1]. In patients with failing surgical aortic bioprostheses, valve-in-valve treatment using a supra-annular self-expanding bioprosthesis provides significant functional improvements with acceptable rates of complications, especially if a postprocedural mean gradient of <20 mmHg can be achieved.
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18
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Patel KV, Omar W, Gonzalez PE, Jessen ME, Huffman L, Kumbhani DJ, Bavry AA. Expansion of TAVR into Low-Risk Patients and Who to Consider for SAVR. Cardiol Ther 2020; 9:377-394. [PMID: 32875469 PMCID: PMC7584721 DOI: 10.1007/s40119-020-00198-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Indexed: 12/15/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis (AS) over the last decade. The results of the Placement of Aortic Transcatheter Valves (PARTNER) 3 and Evolut Low Risk trials demonstrated the safety and efficacy of TAVR in low-surgical-risk patients and led to the approval of TAVR for use across the risk spectrum. Heart teams around the world will now be faced with evaluating a deluge of younger, healthier patients with severe AS. Prior to the PARTNER 3 and Evolut Low Risk studies, this heterogenous patient population would have undergone surgical aortic valve replacement (SAVR). It is unlikely that TAVR will completely supplant SAVR for the treatment of severe AS in patients with a low surgical risk, as SAVR has excellent short- and long-term outcomes and years of durability data. In this review, we outline the critical role that SAVR will continue to play in the treatment of severe AS in the post-PARTNER 3/Evolut Low Risk era.
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Affiliation(s)
- Kunal V Patel
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Wally Omar
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Pedro Engel Gonzalez
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Michael E Jessen
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, USA
| | - Lynn Huffman
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, USA
| | - Dharam J Kumbhani
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Anthony A Bavry
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA.
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19
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In-Vitro Assessment of the Effects of Transcatheter Aortic Valve Leaflet Design on Neo-Sinus Geometry and Flow. Ann Biomed Eng 2020; 49:1046-1057. [PMID: 33098058 DOI: 10.1007/s10439-020-02664-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
Transcatheter aortic valve (TAV) leaflet thrombosis is a clinical risk with potentially fatal consequences. Studies have identified neo-sinus flow stasis as a cause of leaflet thrombosis. Flow stasis is influenced by the TAV leaflets, which affect the local fluid dynamics in the aortic sinus and neo-sinus. This study evaluated the effects of TAV leaflet features on the neo-sinus flow as a measure of leaflet thrombosis risk. Five TAVs of varied leaflet length and insertion height were tested in a simulator. Hydrodynamics and leaflet kinematics through en-phase imaging were quantified. Velocity fields were assessed using high-speed particle image velocimetry. Regions of flow stasis and particle residence times (PRTs) were quantified. TAVs with shorter leaflet length exhibited larger orifice areas and lower transvalvular pressure gradients. Shorter leaflet length and increased leaflet insertion TAVs additionally exhibited lower neo-sinus PRTs (0.44 ± 0.21 vs 2.83 ± 0.48 cycles, p < 0.05) and higher neo-sinus peak velocities (0.15 ± 0.009 vs 0.07 ± 0.005 m/s, p < 0.05) than TAVs with longer leaflet length and lower leaflet insertion. The average neo-sinus volume positively correlated with PRT(r = 0.810, p < 0.001), and extent of flow stasis (r = 0.682, p < 0.05). These results suggest that a small neo-sinus volume may reduce flow stagnation and particle residence, potentially reducing the risk of leaflet thrombosis. We propose that leaflet design features might be proactively controlled in the design of future transcatheter aortic valves.
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Mahmoud AN, Gad MM, Elgendy IY, Mahmoud AA, Taha Y, Elgendy AY, Ahuja KR, Saad AM, Simonato M, McCabe JM, Reisman M, Kapadia SR, Dvir D. Systematic review and meta-analysis of valve-in-valve transcatheter aortic valve replacement in patients with failed bioprosthetic aortic valves. EUROINTERVENTION 2020; 16:539-548. [DOI: 10.4244/eij-d-19-00928] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bleiziffer S, Simonato M, Webb JG, Rodés-Cabau J, Pibarot P, Kornowski R, Windecker S, Erlebach M, Duncan A, Seiffert M, Unbehaun A, Frerker C, Conzelmann L, Wijeysundera H, Kim WK, Montorfano M, Latib A, Tchetche D, Allali A, Abdel-Wahab M, Orvin K, Stortecky S, Nissen H, Holzamer A, Urena M, Testa L, Agrifoglio M, Whisenant B, Sathananthan J, Napodano M, Landi A, Fiorina C, Zittermann A, Veulemans V, Sinning JM, Saia F, Brecker S, Presbitero P, De Backer O, Søndergaard L, Bruschi G, Franco LN, Petronio AS, Barbanti M, Cerillo A, Spargias K, Schofer J, Cohen M, Muñoz-Garcia A, Finkelstein A, Adam M, Serra V, Teles RC, Champagnac D, Iadanza A, Chodor P, Eggebrecht H, Welsh R, Caixeta A, Salizzoni S, Dager A, Auffret V, Cheema A, Ubben T, Ancona M, Rudolph T, Gummert J, Tseng E, Noble S, Bunc M, Roberts D, Kass M, Gupta A, Leon MB, Dvir D. Long-term outcomes after transcatheter aortic valve implantation in failed bioprosthetic valves. Eur Heart J 2020; 41:2731-2742. [DOI: 10.1093/eurheartj/ehaa544] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/09/2020] [Accepted: 06/22/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There are no data on long-term outcomes after aortic ViV. Our aim was to perform a large-scale assessment of long-term survival and reintervention after aortic ViV.
Methods and results
A total of 1006 aortic ViV procedures performed more than 5 years ago [mean age 77.7 ± 9.7 years; 58.8% male; median STS-PROM score 7.3% (4.2–12.0)] were included in the analysis. Patients were treated with Medtronic self-expandable valves (CoreValve/Evolut, Medtronic Inc., Minneapolis, MN, USA) (n = 523, 52.0%), Edwards balloon-expandable valves (EBEV, SAPIEN/SAPIEN XT/SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) (n = 435, 43.2%), and other devices (n = 48, 4.8%). Survival was lower at 8 years in patients with small-failed bioprostheses [internal diameter (ID) ≤ 20 mm] compared with those with large-failed bioprostheses (ID > 20 mm) (33.2% vs. 40.5%, P = 0.01). Independent correlates for mortality included smaller-failed bioprosthetic valves [hazard ratio (HR) 1.07 (95% confidence interval (CI) 1.02–1.13)], age [HR 1.21 (95% CI 1.01–1.45)], and non-transfemoral access [HR 1.43 (95% CI 1.11–1.84)]. There were 40 reinterventions after ViV. Independent correlates for all-cause reintervention included pre-existing severe prosthesis–patient mismatch [subhazard ratio (SHR) 4.34 (95% CI 1.31–14.39)], device malposition [SHR 3.75 (95% CI 1.36–10.35)], EBEV [SHR 3.34 (95% CI 1.26–8.85)], and age [SHR 0.59 (95% CI 0.44–0.78)].
Conclusions
The size of the original failed valve may influence long-term mortality, and the type of the transcatheter valve may influence the need for reintervention after aortic ViV.
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Affiliation(s)
- Sabine Bleiziffer
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Matheus Simonato
- Division of Cardiac Surgery, Escola Paulista de Medicina - Universidade Federal de São Paulo, R. Botucatu, 740, São Paulo - SP, 04023-062, Brazil
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada
| | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 1050 Avenue de la Médecine Local 4211 Ferdinand Vandry Pavillon, Québec, QC G1V 0A6, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 1050 Avenue de la Médecine Local 4211 Ferdinand Vandry Pavillon, Québec, QC G1V 0A6, Canada
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital in Petach Tikva & Faculty of Medicine at Tel Aviv University, 39 Jabotinski St., Petah Tikva 49100
| | - Stephan Windecker
- Universitätsklinik für Kardiologie, Inselspital Bern, Freiburgstrasse 15 3010 Bern, Switzerland
| | - Magdalena Erlebach
- Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München, Lazarettstraße 36, 80636 München, Germany
| | - Alison Duncan
- Department of Echocardiography, The Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - Moritz Seiffert
- Universitäres Herz- und Gefäßzentrum, Universitätsklinikum Hamburg-Eppendorf, Villa Garbrecht, Martinistraße 52, 20251 Hamburg, Germany
| | - Axel Unbehaun
- Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Augustenburger Platz 1 13353 Berlin, Germany
| | - Christian Frerker
- Klinik III für Innere Medizin, Uniklinik Köln, Köln, Kerpener Str. 62, 50937 Köln, Germany
| | - Lars Conzelmann
- Helios Klinik für Herzchirurgie Karlsruhe, Helios Karlsruhe, Franz-Lust-Straße 30, 76185 Karlsruhe, Germany
| | - Harindra Wijeysundera
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave. Toronto, ON M4N 3M5 Canada
| | - Won-Keun Kim
- Abteilung für Kardiologie, Kerckhoff-Klinik, Benekestr. 2 - 8, 61231 Bad Nauheim, Germany
| | - Matteo Montorfano
- Unità Operativa di Cardiologia Interventistica ed Emodinamica, I.R.C.C.S. Ospedale San Raffaele, Via Olgettina n. 60, 20132 Milan, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, 111 East 210th Street Bronx, NY 10467-2401, USA
| | - Didier Tchetche
- Division of Cardiology, Clinique Pasteur, 45 avenue de Lombez BP 27617 31076 Toulouse Cedex 3, France
| | - Abdelhakim Allali
- Klinik für Kardiologie & Angiologie, Segeberger Kliniken, Am Kurpark 1, 23795 Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Abteilung für Strukturelle Herzerkrankungen, Universitätsklinikum Leipzig, Strümpellstraße 39 04289 Leipzig, Germany
| | - Katia Orvin
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital in Petach Tikva & Faculty of Medicine at Tel Aviv University, 39 Jabotinski St., Petah Tikva 49100
| | - Stefan Stortecky
- Universitätsklinik für Kardiologie, Inselspital Bern, Freiburgstrasse 15 3010 Bern, Switzerland
| | - Henrik Nissen
- Department of Cardiology, Odense Universitetshospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Andreas Holzamer
- Herz-, Thorax- und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Marina Urena
- Department of Cardiology, Hôpital Bichat-Claude-Bernard, 46 Rue Henri Huchard, 75018 Paris, France
| | - Luca Testa
- Department of Cardiology, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Italy
| | - Marco Agrifoglio
- Sezione di Malattie dell’Apparato Cardiovascolare, Centro Cardiologico Monzino, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Brian Whisenant
- Intermountain Heart Institute, Intermountain Healthcare, 5169 Cottonwood St #520, Murray, UT 84107, USA
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada
| | - Massimo Napodano
- Dipartimento di Scienze Cardiologiche Toraciche e Vascolari, Università degli Studi di Padova, Via Giustiniani, 2 - 35128 Padova, Italy
| | - Antonio Landi
- Dipartimento di Scienze Cardiologiche Toraciche e Vascolari, Università degli Studi di Padova, Via Giustiniani, 2 - 35128 Padova, Italy
| | - Claudia Fiorina
- Emodinamica, Spedali Civili di Brescia, Piazzale Spedali Civili, 125123 Brescia, Italy
| | - Armin Zittermann
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Verena Veulemans
- Klinik für Kardiologie, Pneumologie & Angiologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Jan-Malte Sinning
- Herzzentrum Bonn, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Francesco Saia
- Laboratorio di Emodinamica dell'Istituto di Cardiologia, Università degli Studi di Bologna, Policlinico S.Orsola-Malpighi, Via Giuseppe Massarenti, 9, 40138 Bologna, Italy
| | - Stephen Brecker
- Structural Heart Disease Clinic, Department of Cardiology, St. George's University Hospitals, Blackshaw Rd, Tooting, London SW17 0QT, UK
| | - Patrizia Presbitero
- Cardiologia clinica e interventistica, Cardio Center, Humanitas, Via Manzoni 56, 20089 Rozzano, Milano, Italy
| | - Ole De Backer
- Hjertemedicinsk Klinik, Center for Hjerte-, Kar-, Lunge- og Infektionssygdomme, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lars Søndergaard
- Hjertemedicinsk Klinik, Center for Hjerte-, Kar-, Lunge- og Infektionssygdomme, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Giuseppe Bruschi
- Cardiochirurgia, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3 - 20162 Milan, Italy
| | - Luis Nombela Franco
- Servicio de Cardiología, Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
| | - Anna Sonia Petronio
- Sezione Dipartimentale di Emodinamica, Università di Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Marco Barbanti
- Malattie dell'apparato cardiovascolare, Università degli Studi di Catania, Via Santa Maria del Rosario, 9 (1° piano) 95131 - Catania, Italy
| | - Alfredo Cerillo
- Cardiochirurgia, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3 - 50134 Firenze, Italy
| | - Konstantinos Spargias
- Transcatheter Heart Valves Department, Hygeia Hospital, Athens, Erithrou Stavrou 4, Marousi 151 23, Greece
| | - Joachim Schofer
- Innere Medizin und Kardiologie, Medizinisches Versorgungszentrum, Wördemanns Weg 25-27 22527 Hamburg Germany
| | - Mauricio Cohen
- The Elaine and Sydney Sussman Cardiac Catheterization Laboratories, Cardiovascular Division, University of Miami Miller School of Medicine, 1400 NW 12th Ave, Miami, FL 33136, USA
| | - Antonio Muñoz-Garcia
- Unidad de Hemodinámica, Hospital Universitario Virgen de la Victoria, Campus de Teatinos, S/N, 29010 Málaga, Spain
| | - Ariel Finkelstein
- Division of Cardiology, Tel-Aviv Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel
| | - Matti Adam
- Klinik III für Innere Medizin, Uniklinik Köln, Köln, Kerpener Str. 62, 50937 Köln, Germany
| | - Vicenç Serra
- Servicio de Cardiología, Hospital Vall d’Hebron, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - Rui Campante Teles
- Divisão de Cardiologia, Hospital de Santa Cruz, Lisboa, Av. Prof. Dr. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Didier Champagnac
- Cardiologie Interventionnelle, Cardiologie Tonkin, 158 Rue Léon Blum 69100 Villeurbanne, France
| | - Alessandro Iadanza
- Emodinamica, Azienda Ospedaliera Universitaria Senese, Viale Mario Bracci, 16, 53100 Siena, Italy
| | - Piotr Chodor
- Department of Cardiology, Silesian Center for Heart Disease, Marii Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Holger Eggebrecht
- Interventionelle Kardiologie, Cardioangiologisches Centrum Bethanien, Im Prüfling 23, 60389 Frankfurt am Main, Germany
| | - Robert Welsh
- Mazankowski Alberta Heart Institute, University of Alberta, 11220 83 Ave NW, Edmonton, AB T6G 2B7, Canada
| | - Adriano Caixeta
- Divisão de Cardiologia, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - Morumbi, São Paulo - SP, 05653-010, Brazil
| | - Stefano Salizzoni
- Dipartimento Cardiovascolare e Toracico, Città della Salute e della Scienza - "Molinette" Hospital, Corso Bramante, 88, 10126 Torino, Italy
| | - Antonio Dager
- Cardiología, Clinica de Occidente, Cl. 18 Nte. #5-34 Cali, Valle del Cauca, Colombia
| | - Vincent Auffret
- Cardiologie et maladies vasculaires, Centre Hospitalier Universitaire de Rennes, 2 Rue Henri le Guilloux, 35000 Rennes, France
| | - Asim Cheema
- Interventional Cardiology, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada
| | - Timm Ubben
- Herz-, Gefäß- und Diabeteszentrum, Asklepios Klinik St. Georg, Lohmühlenstraße 5, 20099 Hamburg, Germany
| | - Marco Ancona
- Unità Operativa di Cardiologia Interventistica ed Emodinamica, I.R.C.C.S. Ospedale San Raffaele, Via Olgettina n. 60, 20132 Milan, Italy
| | - Tanja Rudolph
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Jan Gummert
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Elaine Tseng
- Division of Adult Cardiothoracic Surgery, University of California San Francisco, 4150 Clement St, (112) San Francisco, CA 9412,USA
| | - Stephane Noble
- Unité de cardiologie structurelle, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4 1205 Genève, Switzerland
| | - Matjaz Bunc
- Interventional Cardiology, Ljubljana University Medical Centre, Zaloška cesta 7, 1000 Ljubljana, Slovenia
| | - David Roberts
- Division of Cardiology, Blackpool Teaching Hospitals, Whinney Heys Rd, Blackpool FY3 8NR,UK
| | - Malek Kass
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, 409 Tache Ave, Winnipeg, MB R2H 2A6, Canada
| | - Anuj Gupta
- Cardiac Catheterization Laboratory, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201, USA
| | - Martin B Leon
- Center for Interventional Vascular Therapy, Columbia University Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Danny Dvir
- Division of Cardiology, University of Washington, 1959 NE Pacific Street, C502-A, PO Box 356422, Seattle, WA 98195, USA
- Jesselson Integrated Heart Center, Shaare Zedek Medical Centre, Hebrew University, Shmu'el Bait St 12, Jerusalem, 9103102, Israel
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22
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MacGillivray TE, Reardon MJ. Reoperation After Transcatheter Aortic Valve Replacement: Breaking Up Is Hard to Do. JACC Cardiovasc Interv 2020; 13:1526-1528. [PMID: 32535009 DOI: 10.1016/j.jcin.2020.04.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/28/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas.
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Hamilton GW, Koshy AN, Fulcher J, Tang GH, Bapat V, Murphy A, Horrigan M, Farouque O, Yudi MB. Meta-analysis Comparing Valve-In-Valve Transcatheter Aortic Valve Implantation With Self-Expanding Versus Balloon-Expandable Valves. Am J Cardiol 2020; 125:1558-1565. [PMID: 32247652 DOI: 10.1016/j.amjcard.2020.02.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 01/11/2023]
Abstract
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is an alternative to redo-surgery in patients with failed surgical bioprostheses. It remains unclear whether outcomes vary when using either self-expanding (SE) or balloon-expandable (BE) valves. The aim of this study was to compare outcomes between SE and BE transcatheter heart valves when used for ViV TAVI. A systematic review of PubMed, MEDLINE, and EMBASE was performed identifying studies reporting outcomes following ViV TAVI. Event rates were pooled for meta-analysis using a random-effects model. The primary outcome was all-cause mortality at 12 months. Secondary outcomes included 30-day and 3-year mortality in addition to standard safety outcomes after the procedure as per the Valve Academic Research Consortium criteria. Nineteen studies reporting outcomes for 1,772 patients were included: 924 in the SE group and 848 patients in the BE group. There was no significant difference in all-cause mortality at 12 months (SE 10.3% vs BE 12.6%, p = 0.165, I2 = 0%), or 3 years (SE 21.2% vs BE 31.2%, p = 0.407, I2 = 63.79). SE valves had lower transvalvular gradients after procedure and acute kidney injury, but higher rates of pacemaker insertion, moderate or severe paravalvular regurgitation and need for ≥2 valves (all p < 0.05). There were no differences in stroke, coronary obstruction, bleeding, or vascular complications. Despite significant differences in key procedural outcomes between SE and BE valves when used for ViV TAVI, we found no difference in 12-month mortality. Tailored device selection may further reduce the risk of adverse procedural outcomes, particularly over the longer term.
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Winkel MG, Stortecky S, Wenaweser P. Transcatheter Aortic Valve Implantation Current Indications and Future Directions. Front Cardiovasc Med 2019; 6:179. [PMID: 31921895 PMCID: PMC6930157 DOI: 10.3389/fcvm.2019.00179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/18/2019] [Indexed: 01/06/2023] Open
Abstract
Degenerative heart valve disease is associated with significant morbidity and mortality and healthcare expenditures. Transcatheter heart valve repair and replacement has introduced a fundamental change in the therapeutic management and transcatheter aortic valve replacement (TAVR) has gained substantial popularity. Favorable results from randomized trials and large real world registries lead to TAVR being considered a standard procedure with high rates of procedural success and low rates of peri-procedural complications. This article aims to review the past evolution, summarize the available evidence, discuss current indications and limitations and venture a glimpse into the future of percutaneous interventions for aortic valve disease.
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Affiliation(s)
- Mirjam Gauri Winkel
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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