1
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Moumneh MB, Damluji AA, Heslop AW, Sherwood MW. Structural heart disease review of TAVR in low-risk patients: importance of lifetime management. Front Cardiovasc Med 2024; 11:1362791. [PMID: 38495939 PMCID: PMC10941982 DOI: 10.3389/fcvm.2024.1362791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
| | | | | | - Matthew W. Sherwood
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Fairfax, VA, United States
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2
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Srinivasan A, Wong F, Wang B. Transcatheter aortic valve replacement: Past, present, and future. Clin Cardiol 2024; 47:e24209. [PMID: 38269636 PMCID: PMC10788655 DOI: 10.1002/clc.24209] [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: 10/21/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a ground-breaking, minimally invasive alternative to traditional open-heart surgery, primarily designed for elderly patients initially considered unsuitable for surgical intervention due to severe aortic stenosis. As a result of successful large-scale trials, TAVR is now being routinely applied to a broader spectrum of patients. In deciding between TAVR and surgical aortic valve replacement, clinicians evaluate various factors, including patient suitability and anatomy through preprocedural imaging, which guides prosthetic valve sizing and access site selection. Patient surgical risk is a pivotal consideration, with a multidisciplinary team making the ultimate decision in the patient's best interest. Periprocedural imaging aids real-time visualization but is influenced by anaesthesia choices. A comprehensive postprocedural assessment is critical due to potential TAVR-related complications. Numerous trials have demonstrated that TAVR matches or surpasses surgery for patients with diverse surgical risk profiles, ranging from extreme to low risk. However, long-term follow-up data, particularly in low-risk cases, remains limited, and the applicability of published results to younger patients is uncertain. This review delves into key TAVR studies, pinpointing areas for potential improvement while delving into the future of this innovative procedure. Furthermore, it explores the expanding role of TAVR technology in addressing other heart valve replacement procedures.
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Affiliation(s)
- Akash Srinivasan
- Division of Medical Sciences, Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Felyx Wong
- Guy's and St Thomas’ NHS Foundation TrustLondonUK
| | - Brian Wang
- Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial College LondonLondonUK
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3
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O'Gara PT. Survival After Surgical Aortic Valve Replacement in Low-Risk Patients. Ann Thorac Surg 2024; 117:13-14. [PMID: 37926386 DOI: 10.1016/j.athoracsur.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Patrick T O'Gara
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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4
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Baylous K, Helbock R, Kovarovic B, Anam S, Slepian M, Bluestein D. In silico fatigue optimization of TAVR stent designs with physiological motion in a beating heart model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107886. [PMID: 37925854 DOI: 10.1016/j.cmpb.2023.107886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND AND OBJECTIVE The rapid expansion of TAVR to younger, low-risk patients raises concerns regarding device durability. Necessarily, extended stent lifetime will become more critical for new generation devices. In vitro methods commonly used for TAVR stent fatigue testing exclude the effects of the beating heart. We present a more realistic in silico stent fatigue analysis utilizing a beating heart model in which TAVR stents experience complex, nonuniform dynamic loading. METHODS Virtual TAVR deployments were simulated in the SIMULIA Living Heart Human Model of a beating heart using stent models of the self-expandable nitinol 26-mm CoreValve and Evolut R devices, and a 27-mm PolyV-2. Stent deformation was monitored over three cardiac cycles, and fatigue resistance was evaluated for the nitinol stents using finite element analysis via ABAQUS/Explicit. The average strain and strain amplitude of each stent element were tracked, and established thresholds were applied to determine potential fatigue failure. Fatigue performance of control stents was compared to parametrically modified models with a 20% increase or decrease in strut width. RESULTS Stents with reduced strut width applied lower radial force against the contracting myocardium of the beating heart, resulting in larger displacements and higher strain values. Formulas relating in vivo strain to stent design do not account for this. In all models, there were elements in which strains exceeded fatigue failure. The PolyV-2 stent had far fewer failing elements since its struts were optimized to reduce the strain in stent joints, achieving better fatigue resistance in the stent crown and waist elements. Different stent sections showed markedly different fatigue resistance due to the varying loading conditions. CONCLUSIONS Our analysis indicates that previous studies underestimate strain amplitudes that may cause stent failure. This study demonstrates the utility of advanced in silico analysis of devices deployed within a beating heart that mimics in vivo loading, offering a cost-effective alternative to human or animal trials and establishing a platform to assess the impact of device design on device durability. The limited fatigue life of TAVR stents indicated here highlights a clinical complication that may eventually develop as younger, lower-risk TAVR patients, age.
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Affiliation(s)
- Kyle Baylous
- Department of Biomedical Engineering, Stony Brook University, Health Sciences Center, Stony Brook, NY 11794-8084, USA
| | - Ryan Helbock
- Department of Biomedical Engineering, Stony Brook University, Health Sciences Center, Stony Brook, NY 11794-8084, USA
| | - Brandon Kovarovic
- Department of Biomedical Engineering, Stony Brook University, Health Sciences Center, Stony Brook, NY 11794-8084, USA
| | - Salwa Anam
- Department of Biomedical Engineering, Stony Brook University, Health Sciences Center, Stony Brook, NY 11794-8084, USA
| | - Marvin Slepian
- Department of Medicine and Biomedical Engineering Sarver Heart Center, University of Arizona, Tucson, AZ 85721, USA
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Health Sciences Center, Stony Brook, NY 11794-8084, USA.
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5
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Østergaard L. Stroke After Transcatheter Aortic Valve Replacement: The Patient or the Procedure? JACC Cardiovasc Interv 2023; 16:2997-2998. [PMID: 38151314 DOI: 10.1016/j.jcin.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Lauge Østergaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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6
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Patel SP, Garcia S, Sathananthan J, Tang GH, Albaghdadi MS, Pibarot P, Cubeddu RJ. Structural Valve Deterioration in Transcatheter Aortic Bioprostheses: Diagnosis, Pathogenesis, and Treatment. STRUCTURAL HEART 2023. [DOI: 10.1016/j.shj.2022.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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7
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Belzile-Dugas E, Fremes SE, Eisenberg MJ. Radiation-Induced Aortic Stenosis: An Update on Treatment Modalities. JACC. ADVANCES 2023; 2:100163. [PMID: 38939030 PMCID: PMC11198354 DOI: 10.1016/j.jacadv.2022.100163] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/14/2022] [Accepted: 11/16/2022] [Indexed: 06/29/2024]
Abstract
The adverse effects of radiation therapy for cancer are well described and can include a wide array of cardiac complications. Radiation-induced aortic stenosis (AS) is an increasingly recognized entity that poses particular therapeutic challenges. Several retrospective studies comparing the outcomes after transcatheter aortic valve replacement (TAVR) vs those after surgical aortic valve replacement patients with radiation-induced AS have found a trend toward decreased mortality and fewer major complications with TAVR. Surgical aortic valve replacement is associated with increased mortality in patients with radiation-induced AS compared with patients without a history of prior radiation. TAVR has been shown to be a safe and effective alternative in patients with radiation-induced AS, with safety similar to that for patients who have not received prior radiation. However, rare and unexpected complications may occur after TAVR from the deleterious effects of radiation on mediastinal structures. More studies are needed to identify the optimal way of managing patients with radiation-induced AS, and algorithms are needed for planning these complex interventions.
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Affiliation(s)
- Eve Belzile-Dugas
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Stephen E. Fremes
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mark J. Eisenberg
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Division of Cardiology, Jewish General Hospital/McGill University, Montreal, Québec, Canada
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8
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Russo G, Tang GHL, Sangiorgi G, Pedicino D, Enriquez-Sarano M, Maisano F, Taramasso M. Lifetime Management of Aortic Stenosis: Transcatheter Versus Surgical Treatment for Young and Low-Risk Patients. Circ Cardiovasc Interv 2022; 15:915-927. [PMID: 36378737 DOI: 10.1161/circinterventions.122.012388] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transcatheter aortic valve replacement is now indicated across all risk categories of patients with symptomatic severe aortic stenosis and has been proposed as first line option for the majority of patients >74 years old. However, median age of patients enrolled in the transcatheter aortic valve replacement low-risk trials is 74 years and transcatheter aortic valve replacement has never been systematically investigated in young low risk patients. Although the long-term data in surgical aortic valve replacement in young patients (age <75) are well known, such data remain lacking in transcatheter aortic valve replacement. In the absence of clear guideline recommendations in patients with challenging anatomies (eg, hostile calcium, bicuspid), it is important to know the potential advantages and disadvantages of each treatment and to consider how they might integrate with each other in the lifetime management of such patients. In this review, we discuss current outstanding issues on the management of severe aortic stenosis from a lifetime management perspective, particularly in terms of initial intervention and future reinterventions.
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Affiliation(s)
- Giulio Russo
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome (G.R., G.S.)
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York (G.H.L.T.)
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome (G.R., G.S.)
| | - Daniela Pedicino
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italia (D.P.).,Università Cattolica del Sacro Cuore, Roma, Italia (D.P.)
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9
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Nitsche C, Koschutnik M, Donà C, Mutschlechner D, Halavina K, Spinka G, Dannenberg V, Mascherbauer K, Sinnhuber L, Kammerlander A, Winter MP, Bartko P, Goliasch G, Pibarot P, Hengstenberg C, Mascherbauer J. Incidence, causes, correlates, and outcome of bioprosthetic valve dysfunction and failure following transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2022; 24:796-806. [PMID: 36099163 DOI: 10.1093/ehjci/jeac188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS Bioprosthetic valve dysfunction (BVD) is a major concern regarding transcatheter aortic valve implantation (TAVI) durability. We aimed to assess incidence, correlates, causes, and outcome of early to mid-term BVD after TAVI in relation to patient's life expectancy. METHODS AND RESULTS Consecutive TAVI recipients (2007-20) with a follow-up ≥1 year were prospectively included. BVD and bioprosthetic valve failure (BVF) were assessed according to Valve-Academic-Research-Consortium-3. BVD/BVF and all-cause death served as endpoints. Average life expectancy was calculated from National Open Health Data and patients were stratified according to tertiles (1st: <6.85 years, 2nd: 6.85-9.7 years, 3rd: >9.7 years). Of 1047 patients (81.6 ± 6.8 years old, EuroSCORE II 4.5 ± 2.5), ≥2 follow ups were available from 622 (serial echo cohort). After a median echo follow up of 12.2 months, incidence rates of BVD/BVF were 8.4% (95% confidence interval 6.7-10.3), and 3.5% (2.5-4.9) per valve-year, respectively, without differences between life expectancy tertiles. The incidence of BVD was two-fold higher within the first year of implant (9.9% per valve-year) vs. beyond (4.8% per valve-year). Valve-in-valve procedure and residual stenosis, but not age/life expectancy predisposed for BVD. BVD/BVF were independently associated with outcome for patients in the first [adjusted hazard ratio (AHR) 1.72 (1.06-2.88)/2.97 (1.72-6.22)] and second [AHR 1.96 (1.02-3.73)/2.31 (1.00-5.30)], but not the third tertile of life expectancy (P = n.s.). CONCLUSIONS In this large prospective observational cohort, early to mid-term BVD after TAVI occurred at the same rate across the spectrum of life expectancy and was associated with increased mortality in patients with short but not in those with the longest life expectancy.
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Affiliation(s)
- Christian Nitsche
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Matthias Koschutnik
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Carolina Donà
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - David Mutschlechner
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Kseniya Halavina
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Georg Spinka
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Varius Dannenberg
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Leah Sinnhuber
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Andreas Kammerlander
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Max Paul Winter
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Philipp Bartko
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.,Herzzentrum Währing, Vienna, Austria
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Department of Medicine, Laval University, Québec, Canada
| | | | - Julia Mascherbauer
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine, Karl Landsteiner University of Health Sciences, 3, University Hospital St. Pölten, Krems, Austria
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10
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Sun M, Elkhodiry M, Shi L, Xue Y, Abyaneh MH, Kossar AP, Giuglaris C, Carter SL, Li RL, Bacha E, Ferrari G, Kysar J, Myers K, Kalfa D. A biomimetic multilayered polymeric material designed for heart valve repair and replacement. Biomaterials 2022; 288:121756. [PMID: 36041938 PMCID: PMC9801615 DOI: 10.1016/j.biomaterials.2022.121756] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 01/03/2023]
Abstract
Materials currently used to repair or replace a heart valve are not durable. Their limited durability related to structural degeneration or thrombus formation is attributed to their inadequate mechanical properties and biocompatibility profiles. Our hypothesis is that a biostable material that mimics the structure, mechanical and biological properties of native tissue will improve the durability of these leaflets substitutes and in fine improve the patient outcome. Here, we report the development, optimization, and testing of a biomimetic, multilayered material (BMM), designed to replicate the native valve leaflets. Polycarbonate urethane and polycaprolactone have been processed as film, foam, and aligned fibers to replicate the leaflet's architecture and anisotropy, through solution casting, lyophilization, and electrospinning. Compared to the commercialized materials, our BMMs exhibited an anisotropic behavior and a closer mechanical performance to the aortic leaflets. The material exhibited superior biostability in an accelerated oxidization environment. It also displayed better resistance to protein adsorption and calcification in vitro and in vivo. These results will pave the way for a new class of advanced synthetic material with long-term durability for surgical valve repair or replacement.
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Affiliation(s)
- Mingze Sun
- Department of Surgery, Columbia University, New York, NY, USA
| | | | - Lei Shi
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Yingfei Xue
- Department of Surgery, Columbia University, New York, NY, USA
| | | | | | | | | | - Richard L. Li
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Emile Bacha
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Jeffrey Kysar
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Kristin Myers
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - David Kalfa
- Department of Surgery, Columbia University, New York, NY, USA,Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY, USA,Corresponding author. Pediatric Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children’s Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA. (D. Kalfa)
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11
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Tam DY, Sadri H. Annual Budget Impact Analysis Comparing Self-Expanding Transcatheter and Surgical Aortic Valve Replacement in Low-Risk Aortic Stenosis Patients. Can J Cardiol 2022; 38:1478-1484. [DOI: 10.1016/j.cjca.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/02/2022] Open
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12
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Bouhout I, Kalfa D, Shah A, Goldstone AB, Harrington J, Bacha E. Surgical Management of Complex Aortic Valve Disease in Young Adults: Repair, Replacement, and Future Alternatives. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2022; 25:28-37. [PMID: 35835514 DOI: 10.1053/j.pcsu.2022.04.002] [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: 10/27/2021] [Revised: 03/17/2022] [Accepted: 04/29/2022] [Indexed: 11/11/2022]
Abstract
The ideal aortic valve substitute in young adults remains unknown. Prosthetic valves are associated with a suboptimal survival and carry a significant risk of valve-related complications in young patients, mainly reinterventions with tissue valves and, thromboembolic events and major bleeding with mechanical prostheses. The Ross procedure is the only substitute that restores a survival curve similar to that of a matched general population, and permits a normal life without functional limitations. Though the risk of reintervention is the Achilles' heel of this procedure, it is very low in patients with aortic stenosis and can be mitigated in patients with aortic regurgitation by tailored surgical techniques. Finally, the Ozaki procedure and the transcatheter aortic valve implantation are seen by many as future alternatives but lack evidence and long-term follow-up in this specific patient population.
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Affiliation(s)
- Ismail Bouhout
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - David Kalfa
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - Amee Shah
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, New York, New York
| | - Andrew B Goldstone
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - Jamie Harrington
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, New York, New York
| | - Emile Bacha
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York.
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13
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Abdelfattah OM, Krishnaswamy A, Kapadia SR. Cautious Optimism Regarding Early Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2022; 11:e026010. [PMID: 35535624 PMCID: PMC9238571 DOI: 10.1161/jaha.122.026010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Omar M Abdelfattah
- Department of Internal Medicine Morristown Medical CenterAtlantic Health System Morristown NJ
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine Heart Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Samir R Kapadia
- Department of Cardiovascular Medicine Heart Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
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14
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Gallo M, Fovino LN, Blitzer D, Doulamis IP, Guariento A, Salvador L, Tagliari AP, Ferrari E. Transcatheter aortic valve replacement for structural degeneration of previously implanted transcatheter valves (TAVR-in-TAVR): a systematic review. Eur J Cardiothorac Surg 2021; 61:967-976. [PMID: 34662376 DOI: 10.1093/ejcts/ezab443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/26/2021] [Accepted: 09/19/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve replacement (TAVR) represents a valid treatment for patients with aortic valve stenosis and high or intermediate surgical risk. However, biological transcatheter valves can also experience a structural degeneration after years, and a redo-TAVR procedure (TAVR-in-TAVR) can be a valid option. We revised the current available literature for indications, procedural and technical details and outcome on TAVR-in-TAVR procedures for degenerated TAVR valves. METHODS A systematic search was conducted in the public medical database for scientific articles on TAVR-in-TAVR procedures for degenerated transcatheter valves. Data on demographics, indications, first and second transcatheter valve type and size, mortality, complications and follow-up were extracted and analysed. RESULTS A total of 13 studies (1 multicentre, 3 case series, 9 case reports) were included in this review, with a total amount of 160 patients treated with TAVR-in-TAVR procedures for transcatheter valve failure. The mean age was 74.8 ± 7.8 with 84 males (52.8%). The mean elapsed time from the first TAVR procedure was 58.1 ± 23.4 months. Main indication for TAVR-in-TAVR was pure stenosis (38.4%, with mean gradient of 44.5 ± 18.5 mmHg), regurgitation (31.4%), mixed stenosis and regurgitation (29.5%) and leaflet thrombosis (8.8%). Procedural success rate was 86.8%, with second TAVR valve malposition occurred in 4 cases (2.5%). The hospital mortality rate was 1.25% (2/160). Post-procedural echocardiographic control showed moderate regurgitation in 5.6% of patients (9/160) and residual transvalvular mean gradient ≥20 mmHg in 5% of cases. Postoperative complications included major vascular complications (8.7%), new pacemaker implantation (8.7%), acute kidney failure (3.7%), stroke (0.6%) and coronary obstruction (0.6%). The mean follow-up time was 6 ± 5.6 months with 1 non-cardiovascular death reported. CONCLUSIONS TAVR-in-TAVR represents a valid alternative to standard surgery for the treatment of degenerated transcatheter valves in high-risk patients. Despite these promising results, further studies are required to assess durability and haemodynamic performances of the second TAVR valve. SUBJ COLLECTION 117, 122, 125.
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Affiliation(s)
- Michele Gallo
- Department of Cardiac Surgery, Cardiocentro Ticino Institute, Lugano, Switzerland.,Department of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Luca Nai Fovino
- Department of Cardiology, University of Padova, Padova, Italy
| | - David Blitzer
- Department of Surgery, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Ilias P Doulamis
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alvise Guariento
- Department of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Loris Salvador
- Department of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Ana Paula Tagliari
- Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Enrico Ferrari
- Department of Cardiac Surgery, Cardiocentro Ticino Institute, Lugano, Switzerland.,University of Zurich, Zurich, Switzerland
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15
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Engel Gonzalez P, Kumbhani DJ. Treatment of Bicuspid Aortic Valve Stenosis Using Transcatheter Heart Valves. Interv Cardiol Clin 2021; 10:541-552. [PMID: 34593116 DOI: 10.1016/j.iccl.2021.06.002] [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: 06/13/2023]
Abstract
The paucity of data regarding the use of transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) anatomy due to exclusion from pivotal studies and lack of studies assessing the long-term outcomes and valve performance continue to present a significant challenge as we expand TAVR to patients with BAV anatomy. This article discusses the important anatomic and clinical considerations in the selection and management of patients with BAV with TAVR and reviews the emerging evidence that increasingly suggests this procedure is safe, device success is excellent, and procedural outcomes are improving.
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Affiliation(s)
- Pedro Engel Gonzalez
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. https://twitter.com/engelpedro
| | - Dharam J Kumbhani
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Oyetunji SO, Otto CM. Transcatheter aortic valve implantation or replacement? Valve durability in the context of patient life expectancy. Eur Heart J 2021; 42:2920-2923. [PMID: 34195813 DOI: 10.1093/eurheartj/ehab393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shakirat O Oyetunji
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Catherine M Otto
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Bavry AA, Kumbhani DJ. As Patients Live Longer, Are We on the Cusp of a New Valve Epidemic? J Am Coll Cardiol 2021; 77:15-17. [PMID: 33413935 DOI: 10.1016/j.jacc.2020.11.024] [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] [Received: 11/03/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/24/2022]
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Leon MB, Mack MJ, Hahn RT, Thourani VH, Makkar R, Kodali SK, Alu MC, Madhavan MV, Chau KH, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Blanke P, Leipsic JA, Williams MR, McCabe JM, Brown DL, Babaliaros V, Goldman S, Herrmann HC, Szeto WY, Genereux P, Pershad A, Lu M, Webb JG, Smith CR, Pibarot P. Outcomes 2 Years After Transcatheter Aortic Valve Replacement in Patients at Low Surgical Risk. J Am Coll Cardiol 2021; 77:1149-1161. [DOI: 10.1016/j.jacc.2020.12.052] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 12/28/2022]
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Resar J. TAVR or SAVR: Unfinished Business. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:19-21. [PMID: 33491538 DOI: 10.1177/1556984520988797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jon Resar
- 1501 Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Sumal AS, Ali JM, Kyriacou H, Tuttle CJ, Moorjani N. Aortic valve replacement in patients over 60: Real-world surgical outcomes. J Card Surg 2021; 36:1468-1476. [PMID: 33491235 DOI: 10.1111/jocs.15353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/14/2020] [Accepted: 12/30/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE With the advent of transcatheter aortic valve implantation (TAVI) has come an expectation that there will be a decline in surgical aortic valve replacement (SAVR). This has been fueled by trials comparing outcomes between TAVI and SAVR in lower-risk patients. The aim of this study was to examine outcomes following SAVR in patients over the age of 60. MATERIALS AND METHODS This retrospective cohort study observed 1005 patients ≥60 who underwent isolated primary SAVR from January 2015 to December 2018. The cohort was stratified by surgical risk, defined as European System for Cardiac Operative Risk Evaluation (EuroSCORE) II < 4 versus ≥4. The cohort was also divided by age (60-69, 70-79, ≥80) for additional comparisons. Outcomes included in-hospital complications and patient survival. RESULTS The median age and EuroSCORE II were 75 years and 1.6, respectively. The overall 30-day mortality was 1.7% and increased significantly with surgical risk (p = .007). The 30-day mortality of elective patients was 1.1%. Overall, 1- and 2-year survival rates were 94.3% and 91.7%, respectively, which significantly decreased with surgical risk (p < .001) and age (p = .002, p = .003). The rates of postoperative stroke and pacemaker implantations were 1.2% and 3.6%, respectively. CONCLUSIONS SAVR can be performed in patients ≥60 years old with excellent outcomes, which compare favorably with outcomes from TAVI trials, with their highly selected patient cohorts. SAVR remains a reliable, tried and tested, treatment option in these patients.
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Affiliation(s)
- Anoop S Sumal
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jason M Ali
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Harry Kyriacou
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Narain Moorjani
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
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21
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REPLY FROM THE AUTHOR: Aortic root enlargement-more important than ever? J Thorac Cardiovasc Surg 2020; 161:e160-e161. [PMID: 33309097 DOI: 10.1016/j.jtcvs.2020.10.140] [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: 10/16/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 11/24/2022]
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22
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Tam DY, Khan FM, Robinson NB, Hameed I, Rong LQ, Fremes SE, Girardi LN, Gaudino M. Decision analysis and personalized clinical tool for cerebrospinal fluid drains in thoracoabdominal aortic aneurysms repair. J Card Surg 2020; 36:171-175. [PMID: 33135254 DOI: 10.1111/jocs.15162] [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: 09/24/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM The routine use of cerebrospinal fluid (CSF) drainage in patients undergoing operative repair of thoracoabdominal aneurysms (TAAA) has been associated with decreased rates of spinal cord ischemia. The use of CSF drains is not without consequence, however with complications including subarachnoid hemorrhage, epidural hematoma, meningitis, and, in 1% of cases, death. To date, a decision analysis tool to help clinicians decide when to use and not to use a CSF drain does not exist. In this analysis, we set out to develop a decision analysis tool for CSF drain placement in patients undergoing operative repair of TAAA. METHODS A Markov state-transition cohort model that compared TAAA repair with adjunctive CSF drain insertion to TAAA repair without drain insertion for the outcome of life expectancy was developed in TreeAge 2020. The cycle length was 1 month and the time horizon was 60 months. RESULTS The use of a CSF drain was associated with improved 5-year life expectancy (3.21 ± 0.10 vs. 3.09 ± 0.11 life-years gained). In the sensitivity analysis that varied the effectiveness of a CSF drain (odds ratio closer to 1 = less effective), the use of a CSF drain resulted in higher life expectancy in almost all scenarios. CONCLUSIONS The routine use of a CSF drain in patients undergoing TAAA repair is safe and effective, with few exceptions. This decision analysis tool can be used by clinicians to develop a personalized approach.
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Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Faiza M Khan
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, New York, USA
| | - N Bryce Robinson
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, New York, USA
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, New York, USA
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York City, New York, USA
| | - Stephen E Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, New York, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, New York, USA
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Affiliation(s)
- George S. Hanzel
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI (G.S.H.)
| | - Bernard J. Gersh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN (B.J.G.)
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