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Fukui M, Cavalcante JL, Bapat VN. Deformation in transcatheter heart valves: Clinical implications and considerations. J Cardiol 2024; 83:351-358. [PMID: 38432474 DOI: 10.1016/j.jjcc.2024.02.011] [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: 12/29/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a preferred treatment modality for aortic stenosis, marking a significant advancement in cardiac interventions. Transcatheter heart valves (THVs) have also received approval for treating failed bioprosthetic valves and rings across aortic, mitral, tricuspid, and pulmonic positions. Unlike surgically implanted valves, which are sewn into the annulus, THVs are anchored through relative oversizing. Although THVs are designed to function optimally in a fully expanded state, they exhibit a certain degree of tolerance to underexpansion. However, significant deformation beyond this tolerance can adversely affect the valve's hemodynamics and durability, ultimately impacting patient outcomes. Such post-implantation deviations from the valve's intended three-dimensional design are influenced by a variety of physiological and anatomical factors unique to each patient and procedure, leading to underexpansion, eccentric expansion, and vertical deformation. These deformation patterns increase leaflet stress and strain, potentially causing fatigue and damage. This review article delves into the extent of THV deformation, its impact on leaflet function, hypoattenuating leaflet thickening, and structural valve degeneration. It provides an in-depth analysis of deformation specifics in different procedural contexts, including TAVR in native aortic stenosis, aortic and mitral valve-in-valve procedures, and redo-TAVR. Additionally, the review discusses strategies to mitigate THV deformation during the procedure, offering insights into potential solutions to these challenges.
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Affiliation(s)
- Miho Fukui
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
| | - João L Cavalcante
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Vinayak N Bapat
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
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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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Khokhar AA, Curio J, Sticchi A, Hartley A, Demir OM, Ruparelia N. Transcatheter Aortic Valve Implantation to Treat Degenerated Aortic, Mitral and Tricuspid Bioprosthesis. J Clin Med 2024; 13:592. [PMID: 38276098 PMCID: PMC10816283 DOI: 10.3390/jcm13020592] [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: 12/22/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is now well established as the treatment of choice for patients with native aortic valve stenosis who are high or intermediate risk for surgical aortic valve replacement. Recent data has also supported the use of TAVI in patients at low surgical risk and also in anatomical subsets that were previously felt to be contra-indicated including bicuspid aortic valves and aortic regurgitation. With advancements and refinements in procedural techniques, the application of this technology has now been further expanded to include the management of degenerated bioprosthesis. After the demonstration of feasibility and safety in the management of degenerated aortic bioprosthetic valves, mitral and tricuspid bioprosthetic valve treatment is now also well-established and provides an attractive alternative to performing redo surgery. In this review, we appraise the latest clinical evidence and highlight procedural considerations when utilising TAVI technology in the management of degenerated aortic, mitral or tricuspid prosthesis.
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Affiliation(s)
- Arif A. Khokhar
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
| | - Jonathan Curio
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine, University Hospital, University of Cologne, 50937 Cologne, Germany;
| | - Alessandro Sticchi
- Cardiac Catheterisation Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy;
- Università di Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy
| | - Adam Hartley
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
| | - Ozan M. Demir
- Department of Cardiology, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon SS16 5NL, UK
| | - Neil Ruparelia
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
- Cardiology, Royal Berkshire Hospital, Reading RG1 5AN, UK
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Molina-Lopez VH, Ortiz-Cartagena I, Mercado-Crespo J, Campos-Esteve MA. Optimizing Valve Selection in Valve-in-Valve Transcatheter Aortic Valve Replacement: A Case Study on Addressing Patient-Prosthesis Mismatch and Early Structural Valve Deterioration in a Morbidly Obese Patient. Cureus 2024; 16:e53191. [PMID: 38425595 PMCID: PMC10901697 DOI: 10.7759/cureus.53191] [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] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has increasingly become a fundamental approach for treating aortic valve stenosis (AVS), especially in high surgical risk patients. This case study underscores the criticality of meticulous procedural planning and precise valve selection in patients with severe AVS compounded by obesity. We report a case of a patient who, after receiving a 26 mm Edwards Sapiens 3 valve, presented with worsening exertional dyspnea and a declining indexed effective orifice area (EOAi). This deterioration indicated early structural valve deterioration (SVD), presumably due to patient-prosthesis mismatch (PPM). A subsequent valve-in-valve (ViV) TAVR using a 29 mm Medtronic Evolut Fx valve was successfully executed, leading to a notable improvement in EOAi. This case study emphasizes the complexities inherent in valve choice and sizing in TAVR, particularly highlighting the impact of PPM on obese patients and its potential to precipitate early SVD. The report further explores the emerging strategies in addressing TAVR valve dysfunctions via ViV interventions, shedding light on the nuanced and dynamic nature of TAVR management in obese patients. It advocates for tailored treatment strategies in managing such intricate cases, demonstrating the evolving landscape of TAVR procedures.
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