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Holst K, Becker T, Magruder JT, Yadav P, Stewart J, Rajagopal V, Liu S, Polsani V, Dasi LP, Thourani VH. Beyond Static Planning: Computational Predictive Modeling to Avoid Coronary Artery Occlusion in TAVR. Ann Thorac Surg 2024:S0003-4975(24)00475-2. [PMID: 38901627 DOI: 10.1016/j.athoracsur.2024.05.041] [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: 11/05/2023] [Revised: 04/05/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Coronary artery occlusion (CO) during transcatheter aortic valve replacement (TAVR) is a devastating complication. The objective of this study was to assess the clinical impact of a computational predictive modeling algorithm for CO during TAVR planning. METHODS From January 2020 to December 2022, 116 patients (7.6%) who underwent TAVR evaluation were deemed to be at increased risk of CO on the basis of traditional criteria. Patients underwent prospective computational modeling (DASI Simulations) to assess their risk of CO during TAVR; procedural modifications and clinical results were reviewed retrospectively. RESULTS Of the 116 patients at risk for CO by traditional methodology, 53 had native aortic valve stenosis (45.7%), 47 had undergone previous surgical AVR (40.5%), and 16 had undergone previous TAVR (13.8%). Transcatheter valve choice, size, or implantation depth was modeled for all patients. Computational modeling predicted an increased risk of CO in 39 of 116 (31.9%) patients. Within this subcohort, 29 patients proceeded with TAVR. Procedural modifications to augment the risk of CO included bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR (n = 10), chimney coronary stents (n = 8), and coronary access without stents (n = 3). There were no episodes of coronary artery compromise among patients after TAVR, either for those predicted to be at high risk of CO (with procedural modifications) or those predicted to be at low risk (standard TAVR). CONCLUSIONS The use of preoperative simulations for TAVR in patient-specific geometry through computational predictive modeling of CO is an effective enhancement to procedure planning.
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Affiliation(s)
- Kimberly Holst
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Taylor Becker
- Department of Biomedical Sciences, The Ohio State University, Columbus, Ohio
| | - J Trent Magruder
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Piedmont Hospital, Athens, Georgia
| | - Pradeep Yadav
- Department of Cardiology, Piedmont Heart Institute, Piedmont Hospital, Atlanta, Georgia
| | - James Stewart
- Department of Cardiology, Piedmont Heart Institute, Piedmont Hospital, Atlanta, Georgia
| | - Vivek Rajagopal
- Department of Cardiology, Piedmont Heart Institute, Piedmont Hospital, Atlanta, Georgia
| | - Shizhen Liu
- Department of Cardiology, Piedmont Heart Institute, Piedmont Hospital, Atlanta, Georgia
| | - Venkateshwar Polsani
- Department of Cardiology, Piedmont Heart Institute, Piedmont Hospital, Atlanta, Georgia
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Piedmont Hospital, Atlanta, Georgia.
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Kaneko T, Bapat VN, Alakhtar AM, Zaid S, George I, Grubb KJ, Harrington K, Pirelli L, Atkins M, Desai ND, Bleiziffer S, Noack T, Modine T, Denti P, Kempfert J, Ruge H, Vitanova K, Falk V, Thourani VH, Bavaria JE, Reardon MJ, Mack MJ, Borger MA, Leon MB, Tang GHL, Fukuhara S. Transcatheter heart valve explantation for transcatheter aortic valve replacement failure: A Heart Valve Collaboratory expert consensus document on operative techniques. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00369-6. [PMID: 38677492 DOI: 10.1016/j.jtcvs.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Tsuyoshi Kaneko
- Department of Surgery, Washington University in St Louis, St Louis, Mo.
| | - Vinayak N Bapat
- Department of Cardiac Surgery, Allina Abbott Northwestern Hospital, Minneapolis, Minn
| | - Ali M Alakhtar
- Department of Surgery, Washington University in St Louis, St Louis, Mo
| | - Syed Zaid
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Tex
| | - Isaac George
- Department of Surgery, New York-Presbyterian Hospital, New York, NY
| | - Kendra J Grubb
- Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Katherine Harrington
- Department of Cardiovascular and Thoracic Surgery, Baylor Scott & White Cardiac Surgery Specialists, Plano, Tex
| | - Luigi Pirelli
- Department of Surgery, New York-Presbyterian Hospital, New York, NY
| | - Marvin Atkins
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Tex
| | - Nimesh D Desai
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Thilo Noack
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Thomas Modine
- Medical Surgical Cardiac Acquired Disease Department, Hospital Haut Lévèque, CHU de Bordeaux, Bordeaux, France
| | - Paolo Denti
- Department of Cardiothoracic Surgery, San Raffaelle Hospital, Milan, Italy
| | - Joerg Kempfert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, and German Center for Cardiovascular Research, Berlin, Germany
| | - Hendrik Ruge
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Keti Vitanova
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, and German Center for Cardiovascular Research, Berlin, Germany
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
| | - Joseph E Bavaria
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Tex
| | - Michael J Mack
- Department of Cardiovascular and Thoracic Surgery, Baylor Scott & White Cardiac Surgery Specialists, Plano, Tex
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Martin B Leon
- Department of Medicine and Cardiology, Columbia University Irving Medical Center, New York, NY
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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Abbasciano RG, Magouliotis DE, Koulouroudias M, Spiliopoulos K, Xanthopoulos A, Kourliouros A, Casula R, Athanasiou T, Viviano A. Valve Type and Operative Risks in Surgical Explantation of Transcatheter Aortic Valves: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1262. [PMID: 38592075 PMCID: PMC10932147 DOI: 10.3390/jcm13051262] [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: 01/28/2024] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 04/10/2024] Open
Abstract
Indication to perform surgical explantation of TAVR is becoming increasingly more frequent, due to the higher number of transcatheter procedures performed in patients with longer life expectancy. We proposed to perform a systematic review and meta-analysis with metaregression to identify potential factors that can determine an increase in the high mortality and morbidity that characterize these surgical procedures. MEDLINE and Embase were searched for relevant studies. Twelve studies were eligible according to our inclusion criteria. TAVR explantation was confirmed as a procedure with high 30-day mortality (0.17; 95% CI, 0.14-0.21) and morbidity (stroke incidence 5%; 95% CI, 0.04-0.07; kidney injury incidence 16%; 95% CI, 0.11-0.24). The type of transcatheter valve implanted during the index procedure did not influence the outcomes after surgical explantation. The role of these high-risk operations is growing, and it will likely expand in the coming years. Specific tools for risk stratification are required.
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Affiliation(s)
- Riccardo G. Abbasciano
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (R.G.A.); (R.C.)
- Department of Surgery & Cancer, Imperial College, London SW7 2BX, UK;
| | - Dimitrios E. Magouliotis
- Unit of Quality Improvement, Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece;
| | - Marinos Koulouroudias
- Department of Cardiac Surgery, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
| | - Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece;
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, 413 34 Larissa, Greece;
| | - Antonios Kourliouros
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Roberto Casula
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (R.G.A.); (R.C.)
| | - Thanos Athanasiou
- Department of Surgery & Cancer, Imperial College, London SW7 2BX, UK;
| | - Alessandro Viviano
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (R.G.A.); (R.C.)
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4
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Magruder JT, Holst KA, Stewart J, Yadav PK, Thourani VH. Early Intervention in Asymptomatic Aortic Stenosis: What Are We Waiting For? Can J Cardiol 2024; 40:201-209. [PMID: 38036025 DOI: 10.1016/j.cjca.2023.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/06/2023] [Accepted: 11/25/2023] [Indexed: 12/02/2023] Open
Abstract
Aortic stenosis (AS) contributes to significant cardiovascular morbidity and mortality worldwide, and the natural history from symptoms to ventricular decompensation, heart failure, and death has been well documented. For more than 2 decades, technologies including imaging and biomarkers have shown a promising ability to detect myocardial damage associated with AS before symptoms arise. Current treatment guidelines rely heavily on symptoms or ventricular decompensation as triggers for aortic valve intervention. There is increasing appreciation of the relationship between myocardial damage due to AS before the emergence of symptoms, and a number of published randomised trials suggest a benefit to early intervention in asymptomatic AS, with additional trials actively enrolling. Future treatment paradigms may incorporate early detection of ventricular damage by noninvasive new technologies as triggers for asymptomatic intervention. Enthusiasm for early aortic valve replacement should be tempered by consideration of the competing risks of early valve intervention, but an increasing preponderance of evidence continues to suggest that earlier intervention in AS is warranted.
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Affiliation(s)
- J Trent Magruder
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Athens, Georgia, USA
| | - Kimberly A Holst
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jim Stewart
- Department of Cardiology, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Pradeep K Yadav
- Department of Cardiology, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Marcus Valve Center, Atlanta, Georgia, USA.
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Mylonas KS, Angouras DC. Bioprosthetic Valves for Lifetime Management of Aortic Stenosis: Pearls and Pitfalls. J Clin Med 2023; 12:7063. [PMID: 38002679 PMCID: PMC10672358 DOI: 10.3390/jcm12227063] [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: 09/10/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
This review explores the use of bioprosthetic valves for the lifetime management of patients with aortic stenosis, considering recent advancements in surgical (SAV) and transcatheter bioprostheses (TAV). We examine the strengths and challenges of each approach and their long-term implications. We highlight differences among surgical bioprostheses regarding durability and consider novel surgical valves such as the Inspiris Resilia, Intuity rapid deployment, and Perceval sutureless bioprostheses. The impact of hemodynamics on the performance and durability of these prostheses is discussed, as well as the benefits and considerations of aortic root enlargement during Surgical Aortic Valve Replacement (SAVR). Alternative surgical methods like the Ross procedure and the Ozaki technique are also considered. Addressing bioprosthesis failure, we compare TAV-in-SAV with redo SAVR. Challenges with TAVR, such as TAV explantation and considerations for coronary circulation, are outlined. Finally, we explore the potential challenges and limitations of several clinical strategies, including the TAVR-first approach, in the context of aortic stenosis lifetime management. This concise review provides a snapshot of the current landscape in aortic bioprostheses for physicians and surgeons.
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Affiliation(s)
| | - Dimitrios C. Angouras
- Department of Cardiac Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece;
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6
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Zaid S, Bapat VN, Sathananthan J, Landes U, De Backer O, Tarantini G, Grubb KJ, Kaneko T, Khalique OK, Jilaihawi H, Fukui M, Madhavan M, Cangut B, Harrington K, Thourani VH, Makkar RR, Leon MB, Mack MJ, Tang GHL. Challenges and Future Directions in Redo Aortic Valve Reintervention After Transcatheter Aortic Valve Replacement Failure. Circ Cardiovasc Interv 2023; 16:e012966. [PMID: 37988437 DOI: 10.1161/circinterventions.123.012966] [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] [Indexed: 11/23/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is increasingly being performed in younger and lower surgical risk patients. Reintervention for failed transcatheter heart valves will likely increase in the future as younger patients are expected to outlive the initial bioprosthesis. While redo-TAVR has emerged as an attractive and less invasive alternative to surgical explantation (TAVR-explant) to treat transcatheter heart valve failure, it may not be feasible in all patients due to the risk of coronary obstruction and impaired coronary access. Conversely, TAVR-explant can be offered to most patients who are surgical candidates, but the reported outcomes have shown high mortality and morbidity. This review provides the latest evidence, current challenges, and future directions on redo-TAVR and TAVR-explant for transcatheter heart valve failure, to guide aortic valve reintervention and facilitate patients' lifetime management of aortic stenosis.
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Affiliation(s)
- Syed Zaid
- Division of Cardiology, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX (S.Z.)
| | - Vinayak N Bapat
- Cardiothoracic Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (V.N.B., M.F.)
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.S.)
| | - Uri Landes
- Department of Cardiology, Edith Wolfson Medical Center, Tel-Aviv University, Holon, Israel (U.L.)
| | - Ole De Backer
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark (O.D.B.)
| | | | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (K.J.G.)
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (T.K.)
| | - Omar K Khalique
- DeMatteis Cardiovascular Institute; Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY (O.K.K.)
| | - Hasan Jilaihawi
- Division of Cardiology, Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, CA (H.J., R.R.M.)
| | - Miho Fukui
- Cardiothoracic Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (V.N.B., M.F.)
| | - Mahesh Madhavan
- Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY (M.M, M.B.L.)
| | - Busra Cangut
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY (B.C., G.H.L.T.)
| | - Katherine Harrington
- Department of Cardiothoracic Surgery, Baylor, Scott and White the Heart Hospital, Plano, TX (K.H., M.J.M.)
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA (V.H.T.)
| | - Raj R Makkar
- Division of Cardiology, Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, CA (H.J., R.R.M.)
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY (M.M, M.B.L.)
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor, Scott and White the Heart Hospital, Plano, TX (K.H., M.J.M.)
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY (B.C., G.H.L.T.)
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7
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Makkar RR, Kapadia S, Chakravarty T, Cubeddu RJ, Kaneko T, Mahoney P, Patel D, Gupta A, Cheng W, Kodali S, Bhatt DL, Mack MJ, Leon MB, Thourani VH. Outcomes of repeat transcatheter aortic valve replacement with balloon-expandable valves: a registry study. Lancet 2023; 402:1529-1540. [PMID: 37660719 DOI: 10.1016/s0140-6736(23)01636-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND With increasing numbers of patients undergoing transcatheter aortic valve replacement (TAVR), data on management of failed TAVR, including repeat TAVR procedure, are needed. The aim of this study was to assess the safety and efficacy of redo-TAVR in a national registry. METHODS This study included all consecutive patients in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry from Nov 9, 2011, to Dec 30, 2022 who underwent TAVR with balloon-expandable valves in failed transcatheter heart valves (redo-TAVR) or native aortic valves (native-TAVR). Procedural, echocardiographic, and clinical outcomes were compared between redo-TAVR and native-TAVR cohorts using propensity score matching. FINDINGS Among 350 591 patients (1320 redo-TAVR; 349 271 native-TAVR), 1320 propensity-matched pairs of patients undergoing redo-TAVR and native-TAVR were analysed (redo-TAVR cohort: mean age 78 years [SD 9]; 559 [42·3%] of 1320 female, 761 [57·7%] male; mean predicted surgical risk of 30-day mortality 8·1%). The rates of procedural complications of redo-TAVR were low (coronary compression or obstruction: four [0·3%] of 1320; intraprocedural death: eight [0·6%] of 1320; conversion to open heart surgery: six [0·5%] of 1319) and similar to native-TAVR. There was no significant difference between redo-TAVR and native-TAVR populations in death at 30 days (4·7% vs 4·0%, p=0·36) or 1 year (17·5% vs 19·0%, p=0·57), and stroke at 30 days (2·0% vs 1·9%, p=0·84) or 1 year (3·2% vs 3·5%, p=0·80). Redo-TAVR reduced aortic valve gradients at 1 year, although they were higher in the redo-TAVR group compared with the native-TAVR group (15 mm Hg vs 12 mm Hg; p<0·0001). Moderate or severe aortic regurgitation rates were similar between redo-TAVR and native-TAVR groups at 1 year (1·8% vs 3·3%, p=0·18). Death or stroke after redo-TAVR were not significantly affected by the timing of redo-TAVR (before or after 1 year of index TAVR), or by index transcatheter valve type (balloon-expandable or non-balloon-expandable). INTERPRETATION Redo-TAVR with balloon-expandable valves effectively treated dysfunction of the index TAVR procedure with low procedural complication rates, and death and stroke rates similar to those in patients with a similar clinical profile and predicted risk undergoing TAVR for native aortic valve stenosis. Redo-TAVR with balloon-expandable valves might be a reasonable treatment for failed TAVR in selected patients. FUNDING Edwards Lifesciences.
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Affiliation(s)
- Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | | | - Tarun Chakravarty
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | | | - Dhairya Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aakriti Gupta
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Wen Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Banovic M, Iung B, Wojakowski W, Van Mieghem N, Bartunek J. Asymptomatic Severe and Moderate Aortic Stenosis: Time for Appraisal of Treatment Indications. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100201. [PMID: 37745683 PMCID: PMC10512009 DOI: 10.1016/j.shj.2023.100201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 09/26/2023]
Abstract
Over the last decades, we have witnessed considerable improvements in diagnostics and risk stratification of patients with significant aortic stenosis (AS), paralleled by advances in operative and anesthetic techniques. In addition, accumulating evidence points to the potential benefit of early valve replacement in such patients prior to the onset of symptoms. In parallel, interventional randomized trials have proven the benefit of transcatheter aortic valve replacement in comparison to a surgical approach to valve replacement over a broad risk spectrum in symptomatic patients with AS. This article reviews contemporary management approaches and scrutinizes open questions regarding timing and mode of intervention in asymptomatic patients with severe AS. We also discuss the challenges surrounding the management of symptomatic patients with moderate AS as well as emerging dilemmas related to the concept of a life-long treatment strategy for patients with AS.
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Affiliation(s)
- Marko Banovic
- Belgrade Medical Faculty, University of Belgrade, Belgrade, Serbia
- Cardiology Department, University Clinical Center of Serbia, Belgrade, Serbia
| | - Bernard Iung
- University of Paris, Paris, France
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, Paris, France
| | - Wojtek Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
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Sánchez-Ceña J, Asmarats L, Li CHP, Millán X, Fernández-Peregrina E, Menduiña I, Massó van Roessel A, Arzamendi D. Redo transcatheter aortic valve replacement in degenerated transcatheter bioprosthesis (TAV-in-TAV). Expert Rev Cardiovasc Ther 2023; 21:703-712. [PMID: 37815845 DOI: 10.1080/14779072.2023.2266368] [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: 08/07/2023] [Accepted: 09/29/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION With the expanding indications of transcatheter aortic valve replacement (TAVR) to younger and low-risk patients, the life expectancy of patients currently undergoing TAVR will likely outlive the durability of transcatheter bioprosthesis. Consequently, the number of failed transcatheter bioprosthesis requiring surgical valve explant or redo TAVR is expected to increase. AREAS COVERED The aim of this review is to provide an updated overview of redo TAVR for treating degenerated transcatheter bioprosthesis, focusing on pre-procedural planning, potential challenges of coronary reaccess during TAVR-in-TAVR and main outcomes of TAVR explant and redo TAVR. EXPERT OPINION Patient-tailored device selection and individualized implantation height should be carefully assessed during the index TAVR procedure (weighting between pacemaker avoidance and the potential risk of coronary occlusion in future TAVR-in-TAVR). Future prospective studies comparing safety and clinical outcomes between redo TAVR vs TAVR explant are eagerly awaited.
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Affiliation(s)
- Juan Sánchez-Ceña
- Hospital Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Barcelona, Spain
| | - Lluis Asmarats
- Hospital Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Barcelona, Spain
| | - Chi Hion Pedro Li
- Hospital Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Barcelona, Spain
| | - Xavier Millán
- Hospital Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Barcelona, Spain
| | | | - Irene Menduiña
- Hospital Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Barcelona, Spain
| | | | - Dabit Arzamendi
- Hospital Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Barcelona, Spain
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10
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Hayashida K, Kobari Y. The ongoing quest for optimal transcatheter aortic valve implantation for patients with small annuli. EUROINTERVENTION 2023; 19:196-197. [PMID: 37326380 PMCID: PMC11075967 DOI: 10.4244/eij-e-23-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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11
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Schaeffer T, Koechlin L, Jeger R, Leibundgut G, Reuthebuch O. Severe structural valve deterioration after TAVR with ACURATE Neo: report of two cases. Front Cardiovasc Med 2023; 10:1135496. [PMID: 37304949 PMCID: PMC10248160 DOI: 10.3389/fcvm.2023.1135496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/03/2023] [Indexed: 06/13/2023] Open
Abstract
Structural valve deterioration (SVD) of transcatheter implanted aortic valve (TAVR) prostheses leading to prosthesis dysfunction is an uncommon yet increasingly described complication. Literature is scarce on specific mechanisms and clinical presentation of SVD after TAVR, notably on self-expanding valve ACURATE Neo. We report on two cases with severe bioprosthetic failure after ACURATE Neo implantation due to leaflet disruption, and we treated them with surgical aortic valve replacement. Based on the literature, we further discuss the incidence of SVD after TAVR, the durability of ACURATE NEO, and the modes of failure of biological valve prostheses.
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Affiliation(s)
- Thibault Schaeffer
- Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Luca Koechlin
- Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raban Jeger
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gregor Leibundgut
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
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Norton EL, Ward AF, Tully A, Leshnower BG, Guyton RA, Paone G, Keeling WB, Miller JS, Halkos ME, Grubb KJ. Trends in surgical aortic valve replacement in pre- and post-transcatheter aortic valve replacement eras at a structural heart center. Front Cardiovasc Med 2023; 10:1103760. [PMID: 37283574 PMCID: PMC10239805 DOI: 10.3389/fcvm.2023.1103760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/03/2023] [Indexed: 06/08/2023] Open
Abstract
Background The advent of transcatheter aortic valve replacement (TAVR) has directly impacted the lifelong management of patients with aortic valve disease. The U.S. Food and Drug Administration has approved TAVR for all surgical risk: prohibitive (2011), high (2012), intermediate (2016), and low (2019). Since then, TAVR volumes are increasing and surgical aortic valve replacements (SAVR) are decreasing. This study sought to evaluate trends in isolated SAVR in the pre- and post-TAVR eras. Methods From January 2000 to June 2020, 3,861 isolated SAVRs were performed at a single academic quaternary care institution which participated in the early trials of TAVR beginning in 2007. A formal structural heart center was established in 2012 when TAVR became commercially available. Patients were divided into the pre-TAVR era (2000-2011, n = 2,426) and post-TAVR era (2012-2020, n = 1,435). Data from the institutional Society of Thoracic Surgeons National Database was analyzed. Results The median age was 66 years, similar between groups. The post-TAVR group had a statistically higher rate of diabetes, hypertension, dyslipidemia, heart failure, more reoperative SAVR, and lower STS Predicted Risk of Mortality (PROM) (2.0% vs. 2.5%, p < 0.0001). There were more urgent/emergent/salvage SAVRs (38% vs. 24%) and fewer elective SAVRs (63% vs. 76%), (p < 0.0001) in the post-TAVR group. More bioprosthetic valves were implanted in the post-TAVR group (85% vs. 74%, p < 0.0001). Larger aortic valves were implanted (25 vs. 23 mm, p < 0.0001) and more annular enlargements were performed (5.9% vs. 1.6%, p < 0.0001) in the post-TAVR era. Postoperatively, the post-TAVR group had less blood product transfusion (49% vs. 58%, p < 0.0001), renal failure (1.4% vs. 4.3%, p < 0.0001), pneumonia (2.3% vs. 3.8%, p = 0.01), shorter lengths of stay, and lower in-hospital mortality (1.5% vs. 3.3%, p = 0.0007). Conclusion The approval of TAVR changed the landscape of aortic valve disease management. At a quaternary academic cardiac surgery center with a well-established structural heart program, patients undergoing isolated SAVR in the post-TAVR era had lower STS PROM, more implantation of bioprosthetic valves, utilization of larger valves, annular enlargement, and lower in-hospital mortality. Isolated SAVR continues to be performed in the TAVR era with excellent outcomes. SAVR remains an essential tool in the lifetime management of aortic valve disease.
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Affiliation(s)
- Elizabeth L. Norton
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
| | - Alison F. Ward
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
| | - Andy Tully
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
- Structural Heart and Valve Center, Emory University, Atlanta, GA, United States
| | - Bradley G. Leshnower
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
- Structural Heart and Valve Center, Emory University, Atlanta, GA, United States
| | - Robert A. Guyton
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
- Structural Heart and Valve Center, Emory University, Atlanta, GA, United States
| | - Gaetano Paone
- Structural Heart and Valve Center, Emory University, Atlanta, GA, United States
| | - William B. Keeling
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
- Structural Heart and Valve Center, Emory University, Atlanta, GA, United States
| | - Jeffrey S. Miller
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
- Structural Heart and Valve Center, Emory University, Atlanta, GA, United States
| | - Michael E. Halkos
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
- Structural Heart and Valve Center, Emory University, Atlanta, GA, United States
| | - Kendra J. Grubb
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States
- Structural Heart and Valve Center, Emory University, Atlanta, GA, United States
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13
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Tang GHL, Zaid S, Kleiman NS, Goel SS, Fukuhara S, Marin-Cuartas M, Kiefer P, Abdel-Wahab M, De Backer O, Søndergaard L, Saha S, Hagl C, Wyler von Ballmoos M, Bhadra O, Conradi L, Grubb KJ, Shih E, DiMaio JM, Szerlip M, Vitanova K, Ruge H, Unbehaun A, Kempfert J, Pirelli L, Kliger CA, Van Mieghem N, Hokken TW, Adrichem R, Modine T, Corona S, Wang L, Petrossian G, Robinson N, Meier D, Webb JG, Cheung A, Ramlawi B, Herrmann HC, Desai ND, Andreas M, Mach M, Waksman R, Schults CC, Ahmad H, Goldberg JB, Geirsson A, Forrest JK, Denti P, Belluschi I, Ben-Ali W, Asgar AW, Taramasso M, Rovin JD, Di Eusanio M, Colli A, Kaneko T, Nazif TN, Leon MB, Bapat VN, Mack MJ, Reardon MJ, Sathananthan J. Explant vs Redo-TAVR After Transcatheter Valve Failure: Mid-Term Outcomes From the EXPLANTORREDO-TAVR International Registry. JACC Cardiovasc Interv 2023; 16:927-941. [PMID: 37100556 DOI: 10.1016/j.jcin.2023.01.376] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/02/2023] [Accepted: 01/31/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Valve reintervention after transcatheter aortic valve replacement (TAVR) failure has not been studied in detail. OBJECTIVES The authors sought to determine outcomes of TAVR surgical explantation (TAVR-explant) vs redo-TAVR because they are largely unknown. METHODS From May 2009 to February 2022, 396 patients in the international EXPLANTORREDO-TAVR registry underwent TAVR-explant (181, 46.4%) or redo-TAVR (215, 54.3%) for transcatheter heart valve (THV) failure during a separate admission from the initial TAVR. Outcomes were reported at 30 days and 1 year. RESULTS The incidence of reintervention after THV failure was 0.59% with increasing volume during the study period. Median time from index-TAVR to reintervention was shorter in TAVR-explant vs redo-TAVR (17.6 months [IQR: 5.0-40.7 months] vs 45.7 months [IQR: 10.6-75.6 months]; P < 0.001], respectively. TAVR-explant had more prosthesis-patient mismatch (17.1% vs 0.5%; P < 0.001) as the indication for reintervention, whereas redo-TAVR had more structural valve degeneration (63.7% vs 51.9%; P = 0.023), with a similar incidence of ≥moderate paravalvular leak between groups (28.7% vs 32.8% in redo-TAVR; P = 0.44). There was a similar proportion of balloon-expandable THV failures (39.8% TAVR-explant vs 40.5% redo-TAVR; P = 0.92). Median follow-up was 11.3 (IQR: 1.6-27.1 months) after reintervention. Compared with redo-TAVR, TAVR-explant had higher mortality at 30 days (13.6% vs 3.4%; P < 0.001) and 1 year (32.4% vs 15.4%; P = 0.001), with similar stroke rates between groups. On landmark analysis, mortality was similar between groups after 30 days (P = 0.91). CONCLUSIONS In this first report of the EXPLANTORREDO-TAVR global registry, TAVR-explant had a shorter median time to reintervention, with less structural valve degeneration, more prosthesis-patient mismatch, and similar paravalvular leak rates compared with redo-TAVR. TAVR-explant had higher mortality at 30 days and 1 year, but similar rates on landmark analysis after 30 days.
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Affiliation(s)
| | - Syed Zaid
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Sachin S Goel
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | | | | | | | | | - Ole De Backer
- The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Søndergaard
- The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Shekhar Saha
- German Centre for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Christian Hagl
- Ludwig Maximillian University of Munich, Munich, Germany
| | | | - Oliver Bhadra
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lenard Conradi
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Emily Shih
- Baylor Scott and White Health, Heart Hospital Plano, Plano, Texas, USA
| | - J Michael DiMaio
- Baylor Scott and White Health, Heart Hospital Plano, Plano, Texas, USA
| | - Molly Szerlip
- Baylor Scott and White Health, Heart Hospital Plano, Plano, Texas, USA
| | | | | | | | | | | | | | | | | | - Rik Adrichem
- Eramus University Medical Center, Rotterdam, the Netherlands
| | - Thomas Modine
- UMCV Hôpital Haut-Lévêque, CHU Bordeaux, Bordeaux, France
| | - Silvia Corona
- UMCV Hôpital Haut-Lévêque, CHU Bordeaux, Bordeaux, France
| | - Lin Wang
- St. Francis Hospital, Roslyn, New York, USA
| | | | | | - David Meier
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Anson Cheung
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Basel Ramlawi
- Lankanau Heart Institute at Main Line Health, Philadelphia, Pennsylvania, USA
| | | | - Nimesh D Desai
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Markus Mach
- Medical University of Vienna, Vienna, Austria
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Hasan Ahmad
- Westchester Medical Center, Valhalla, New York, USA
| | | | | | | | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | | | | | | | | | | | | | | | - Tsuyoshi Kaneko
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tamim N Nazif
- Columbia University Irving Medical Center, New York, New York, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Michael J Mack
- Baylor Scott and White Health, Heart Hospital Plano, Plano, Texas, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
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14
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Tarantini G, Fabris T. Redo Aortic Valve Interventions: A Good Start Is Half the Job to Subsequent Permutations. JACC Cardiovasc Interv 2023; 16:954-957. [PMID: 37100558 DOI: 10.1016/j.jcin.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 04/28/2023]
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy.
| | - Tommaso Fabris
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
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15
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Paone G. Commentary: Reason for optimism-or the start of a long, dark winter? J Thorac Cardiovasc Surg 2023; 165:1333-1334. [PMID: 33965219 DOI: 10.1016/j.jtcvs.2021.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Gaetano Paone
- Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Ga.
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16
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Transcatheter Aortic Valve Replacement in Failed Transcatheter Bioprosthetic Valves. JACC Cardiovasc Interv 2022; 15:1777-1793. [PMID: 36137681 DOI: 10.1016/j.jcin.2022.07.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 10/14/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is increasingly being performed in younger and lower surgical risk patients. Given the longer life expectancy of these patients, the bioprosthetic valve will eventually fail, and aortic valve reintervention may be necessary. Although currently rare, redo-TAVR will likely increase in the future as younger patients are expected to outlive their transcatheter bioprosthesis. This review provides a contemporary overview of the indications, procedural planning, implantation technique, and outcomes of TAVR in failed transcatheter bioprosthetic aortic valves.
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17
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Eng MH, Tandon V, Greenbaum AB, Fang K. Percutaneous Paravalvular Leak Repair. Interv Cardiol Clin 2022; 11:233-243. [PMID: 35710279 DOI: 10.1016/j.iccl.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Paravalvular leaks (PVLs) are challenging lesions that require a comprehensive understanding of surgical and transcatheter heart therapies, multimodality imaging, and transcatheter techniques. Approach to a transcatheter heart valve (THV) or surgical prosthesis for PVL differs in terms of options and varies according to the location (aortic or mitral). A suggested framework for transcatheter PVL repair is defect localization, access planning, defect crossing, sheath delivery. and occluder deployment. Careful planning facilitates success, but operators begin the case with a flexible mindset because many initial strategies may not succeed.
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Affiliation(s)
- Marvin H Eng
- Division of Cardiology, Banner University Medical Center, 755 East McDowell Road, Phoenix, AZ 85006, USA; Structural Heart Program, University of Arizona, Banner University Medical Center, 755 East McDowell Road, Phoenix, AZ 85006, USA.
| | - Varun Tandon
- Division of Cardiology, Banner University Medical Center, 755 East McDowell Road, Phoenix, AZ 85006, USA
| | - Adam B Greenbaum
- Emory Structural Heart and Valve Center, 550 Peachtree Street, NE, Atlanta, GA 30308, USA
| | - Kenith Fang
- Division of Cardiothoracic Surgery, Banner University Medical Center, 1111 East McDowell, Phoneix, AZ 85006, USA
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18
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Yokoyama Y, Kuno T, Zaid S, Kaneko T, Takagi H, Tang GH, Fukuhara S. Surgical explantation of transcatheter aortic bioprosthesis: A systematic review and meta-analysis. JTCVS OPEN 2021; 8:207-227. [PMID: 36004168 PMCID: PMC9390557 DOI: 10.1016/j.xjon.2021.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/15/2021] [Indexed: 11/18/2022]
Abstract
Background Despite the rapid adoption of transcatheter aortic valve replacement (TAVR), aortic valve reintervention, particularly surgical TAVR valve explantation (TAVR explant), has not been well described. Methods MEDLINE, Embase, and Web of Science were searched through July 2021 to identify observational studies and case series reporting clinical outcomes of TAVR explant. Data on the frequency of TAVR explant, patient demographic characteristics, clinical indications, operative data, and perioperative outcomes were extracted. Study-specific estimates were combined using one-group meta-analysis in a random-effects model. Results A total of 10 studies were identified that included 1690 patients undergoing a TAVR explant. The frequency of TAVR explant among TAVR recipients was 0.4% (95% confidence interval [CI], 0.2%-0.6%). The mean patient age was 73.7 years (95% CI, 72.9-74.6 years). The mean Society of Thoracic Surgeons predicted risk of mortality was 5.9% (95% CI, 2.9%-8.8%) at the index TAVR and 8.1% (95% CI, 5.4%-10.8%) at TAVR explant. The mean time from implant to explant was 345.0 days (95% CI, 196.7-493.3 days). Among patients with documented device type, 59.8% (95% CI, 43.5%-76.0%) had a balloon-expandable valve and 40.2% (95% CI, 24.0%-56.5%) had a self-expandable valve. Concomitant procedures during TAVR explant were performed in 52.9% of patients (95% CI, 33.8%-72.0%), and the most common concomitant procedure was aortic repair (28.5%; 95% CI, 14.0%-42.9%). The 30-day mortality after TAVR explant was 16.7% (95% CI, 12.2%-21.2%). Conclusions TAVR explant in patients with a failing TAVR appears to be rare; however, the clinical impact of TAVR explant is substantial. Implanters must be mindful of the need for a lifetime management strategy in younger and lower-risk patients when choosing the valve type for the initial procedure.
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Affiliation(s)
- Yujiro Yokoyama
- Department of Surgery, St Luke's University Health Network, Bethlehem, Pa
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY
| | - Syed Zaid
- Division of Cardiology, Westchester Medical Center, Valhalla, NY
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Gilbert H.L. Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
- Address for reprints: Shinichi Fukuhara, MD, Department of Cardiac Surgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109.
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19
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Jawitz OK, Raman V, Chen EP. Reoperation after transcatheter aortic valve replacement: the future is here. Eur J Cardiothorac Surg 2021; 60:1156-1157. [PMID: 34343270 DOI: 10.1093/ejcts/ezab313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Oliver K Jawitz
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Vignesh Raman
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Edward P Chen
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Bartoli-Leonard F, Aikawa E. Old Drugs for an Old Pathology? Drug Repurposing for Calcific Aortic Valve Disease. Circ Res 2021; 128:1317-1319. [PMID: 33914606 DOI: 10.1161/circresaha.121.319149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Francesca Bartoli-Leonard
- Division of Cardiovascular Medicine, Department of Medicine, Center for Interdisciplinary Cardiovascular Sciences (F.B.-L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Elena Aikawa
- Division of Cardiovascular Medicine, Department of Medicine, Center for Excellence in Vascular Biology (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Human Pathology, Sechenov First Moscow State Medical University, Russia (E.A.)
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