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Rivera FB, Cha SW, Redula SC, Liston MBO, Ong EP, Bantayan NRB, Kaur G, Volgman AS, Mamas MA. Sex differences in transcatheter aortic valve replacement outcomes among patients with bicuspid aortic stenosis. Heart Lung 2024; 67:144-151. [PMID: 38762962 DOI: 10.1016/j.hrtlng.2024.05.003] [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] [Received: 10/17/2023] [Revised: 01/22/2024] [Accepted: 05/06/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Despite comprising almost half of all patients undergoing valvular repair, data on transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (BAS) are limited. OBJECTIVE We aimed to evaluate whether there are any sex differences in trends and outcomes of TAVR in this population. METHODS We utilized the National Inpatient Sample from 2012 to 2020 to identify admissions with BAS who underwent TAVR and analyzed trends and outcomes. Our primary outcome was in-hospital mortality and secondary outcomes were in-hospital complications. We used two models to adjust for demographics (A) and interventions (B). RESULTS Between 2012 to 2020, there were 76,540 hospitalizations for BAS patients who underwent AVR, among which 6,010 (7.9 %) underwent TAVR. There was an overall increasing trend in number of TAVR cases with a decreasing trend in mortality (2013: 8.7 %, 2020: 1.3 %). TAVR was performed more in males (61.1% vs 38.9 %). Despite the worse baseline characteristics in males, in-hospital mortality (2.4% vs. 1.5 %; OR: 1.584; 95 % CI: 0.621-4.038; p = 0.335) and secondary outcomes were similar across both sexes, even after adjusting for demographics and interventions. CONCLUSION TAVR in BAS has grown rapidly in the last decade. Males comprised the majority and had more comorbidities, but mortality and complications were similar in both sexes. Despite the increasing number of cases, a decreasing trend in mortality was observed for both sexes ultimately approaching that of SAVR, suggesting that TAVR may be a safe alternative among eligible males and females with bicuspid AS.
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Affiliation(s)
| | | | | | | | - Erika P Ong
- University of the Philippines Manila, Manila City, Philippines
| | | | - Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke-on-Trent, UK
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2
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Sá MP, Jacquemyn X, Sultan I. Editorial commentary: Transcatheter aortic valve implantation in bicuspid aortic valve stenosis. Trends Cardiovasc Med 2024; 34:314-316. [PMID: 37156328 DOI: 10.1016/j.tcm.2023.05.001] [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: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Xander Jacquemyn
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Chavarria J, Falcao F, AlRaddadi H, Aziz A, Dick A, Chung K, Meier D, Sathananthan J, Ali N, Um KJ, Velianou J, Natarajan M, Jaffer I, Wood D, Fam N, Sheth T. Bicuspid valve CT registry of balloon-expandable TAVR: BETTER TAVR registry. Catheter Cardiovasc Interv 2024; 104:105-114. [PMID: 38819623 DOI: 10.1002/ccd.31091] [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: 12/26/2023] [Revised: 04/02/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The anatomic substrate of bicuspid valves may lead to suboptimal TAVR stent expansion and geometry. AIM We evaluated determinants of stent geometry in bicuspid valves treated with Sapien transcatheter aortic valve replacement (TAVR) valves. METHODS A multicenter retrospective registry of patients (February 2019 to August 2022) who underwent post-TAVR computed tomography to determine stent area (vs. nominal valve area) and stent ellipticity (maximum diameter/minimum diameter). Predictors of relative stent expansion (minimum area/average of inflow + outflow area) and stent ellipticity were evaluated in a multivariable regression model, including valve calcium volume (indexed by annular area), presence of raphe calcium, sinus diameters indexed by area-derived annular diameter, and performance of pre-dilation and post-dilation. RESULTS The registry enrolled 101 patients from four centers. The minimum stent area (vs. nominal area) was 88.1%, and the maximum ellipticity was 1.10, with both observed near the midframe of the valve in all cases. Relative stent expansion ≥90% was observed in 64/101 patients. The only significant predictor of relative stent expansion ≥90% was the performance of post-dilation (OR: 4.79, p = 0.018). Relative stent expansion ≥90% was seen in 86% of patients with post-dilation compared to 57% without (p < 0.001). The stent ellipticity ≥1.1 was observed in 47/101 patients. The significant predictors of stent ellipticity ≥1.1 were the indexed maximum sinus diameter (OR: 0.582, p = 0.021) and indexed intercommisural diameter at 4 mm (OR: 2.42, p = 0.001). Stent expansion has a weak negative correlation with post-TAVR mean gradient (r = -0.324, p < 0.001). CONCLUSION Relative stent expansion ≥90% was associated with the performance of post-dilation, and stent ellipticity ≥1.1 was associated with indexed intercommisural diameter and indexed maximum sinus diameter. Further studies to determine optimal deployment strategies in bicuspid valves are needed.
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Affiliation(s)
- Jorge Chavarria
- McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Felipe Falcao
- McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Hatim AlRaddadi
- McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Amir Aziz
- McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | | | | | - David Meier
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Janar Sathananthan
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Noman Ali
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Kevin John Um
- Population Health Research Institute, Hamilton, Canada
| | - James Velianou
- McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Madhu Natarajan
- McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Iqbal Jaffer
- McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - David Wood
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Neil Fam
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Tej Sheth
- McMaster University and Hamilton Health Sciences, Hamilton, Canada
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Ogami T, Yousef S, Brown JA, Kliner DE, Toma C, Serna-Gallegos D, Doshi N, Wang Y, Sultan I. Readmission-related outcomes of surgical versus transcatheter aortic valve replacement in patients aged 65 or older with bicuspid aortic valve. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 63:16-20. [PMID: 38233251 DOI: 10.1016/j.carrev.2024.01.009] [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] [Received: 11/12/2023] [Revised: 12/20/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND There continues to be debate regarding the superiority of transcatheter (TAVR) over surgical aortic valve replacement (SAVR) in patients with bicuspid aortic valves (BAV). We aimed to compare outcomes during readmissions in elderly patients with BAV who underwent SAVR or TAVR. METHODS Patients 65 years or older with BAV who underwent TAVR or isolated SAVR were identified using the National Readmission Database from 2012 through 2018. We compared outcomes during readmissions within 90 days after discharge from the index surgery. Propensity score matching was performed to adjust the baseline differences. RESULTS During the study period, 8555 and 1081 elderly patients with BAV underwent SAVR and TAVR, respectively. The number of patients who underwent TAVR went up by 179 % from 2012 to 2018. Propensity score matching yielded 573 patients in each group. A total of 111 (19.4 %) in the SAVR group and 125 (21.8 %) in the TAVR group were readmitted within 90 days after the index surgery (p = .31). The mortality during the readmissions within 90 days was equivalent between the two groups (0.9 % in the SAVR group vs. 3.2 % in the TAVR group, p = .22). However, the median hospital cost was approximately doubled in the TAVR group during the readmission (18,250 dollars vs. 9310 dollars in the SAVR group, p < .001). CONCLUSIONS Readmission within 90 days was common in both groups. While the mortality during the readmissions after the surgery was equivalent between the two groups, hospital cost was significantly more expensive in the TAVR group.
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Affiliation(s)
- Takuya Ogami
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dustin E Kliner
- Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catalin Toma
- Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nandini Doshi
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yisi Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Lopes V, Almeida PC, Moreira N, Ferreira LA, Teixeira R, Donato P, Gonçalves L. Computed tomography imaging in preprocedural planning of transcatheter valvular heart interventions. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1163-1181. [PMID: 38780710 DOI: 10.1007/s10554-024-03140-9] [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: 11/05/2023] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
Cardiac Computed Tomography (CCT) has become a reliable imaging modality in cardiology providing robust information on the morphology and structure of the heart with high temporal and isotropic spatial resolution. For the past decade, there has been a paradigm shift in the management of valvular heart disease since previously unfavorable candidates for surgery are now provided with less-invasive interventions. Transcatheter heart valve interventions provide a real alternative to medical and surgical management and are often the only treatment option for valvular heart disease patients. Successful transcatheter valve interventions rely on comprehensive multimodality imaging assessment. CCT is the mainstay imaging technique for preprocedural planning of these interventions. CCT is critical in guiding patient selection, choice of procedural access, device selection, procedural guidance, as well as allowing postprocedural follow-up of complications. This article aims to review the current evidence of the role of CCT in the preprocedural planning of patients undergoing transcatheter valvular interventions.
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Affiliation(s)
- Vanessa Lopes
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal.
| | - Pedro Carvalho Almeida
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Nádia Moreira
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Luís Amaral Ferreira
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Rogério Teixeira
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
| | - Paulo Donato
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Univ Coimbra, Coimbra Institute for Biomedical Imaging and Translation Research (CIBIT), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), Univ Coimbra, Coimbra, Portugal
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6
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Al Ahmad J, Danson E. Transcatheter Aortic Valve Implantation for Severe Chronic Aortic Regurgitation. J Clin Med 2024; 13:2997. [PMID: 38792538 PMCID: PMC11122034 DOI: 10.3390/jcm13102997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/24/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has revolutionised the management of aortic valve disease, offering a less invasive alternative to traditional surgical valve replacement for severe aortic stenosis (AS). TAVI for pure aortic regurgitation (AR) is less well established, and, in fact, it was previously labelled as a relative contraindication. However, TAVI has been utilised for selected cases of pure or predominant AR. The primary limitations regarding the use of TAVI in AR are related to the absence of anatomical factors seen in patients with AS that have contributed to the safe and stable functioning of current-generation prostheses. These include aortic root dilatation, mobile valve leaflets and labile blood pressure within the aortic root, which may further increase the risk of valve migration and periprosthetic leak after deployment. Furthermore, patients with AR have more heterogeneous aortic root anatomies when compared to the population of patients with calcific or degenerative AS. This review article describes the current evidence for the off-label use of TAVI in pure AR and the various clinical syndromes associated with AR where there may be specific challenges in the application of TAVI.
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Affiliation(s)
- Judy Al Ahmad
- Department of Cardiology, Wollongong Hospital, Wollongong, NSW 2500, Australia
| | - Edward Danson
- Department of Cardiology, Wollongong Hospital, Wollongong, NSW 2500, Australia
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Chiariello GA, Di Mauro M, Pasquini A, Bruno P, Nesta M, Fabiani L, Mazza A, Meloni M, Baldo E, Ponzo M, Ferraro F, Conserva AD, D’Acierno E, Villa E, Trani C, Burzotta F, Massetti M. Progression of the ascending aorta diameter after surgical or transcatheter bicuspid aortic valve replacement. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae100. [PMID: 38775458 PMCID: PMC11142625 DOI: 10.1093/icvts/ivae100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/17/2024] [Accepted: 05/17/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVES Ascending aorta (AA) dilatation in patients with bicuspid aortic valve (AV) is related both to genetic and haemodynamic factors. The aim of this study is to compare late progression of AA dilatation in bicuspid AV patients undergoing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve implantation (TAVI). METHODS Data of 189 consecutive patients who underwent AV replacement for severe bicuspid AV stenosis were prospectively collected. Patients who underwent SAVR were compared to patients who underwent TAVI. Indication to the procedure was validated by the institutional Heart Team. Aortic diameters were evaluated by transthoracic echocardiogram. Differences between preoperative and long-term follow-up AA diameters were compared in the 2 groups. RESULTS Between January 2015 and December 2021, 143 (76%) patients underwent SAVR and 46 (24%) patients underwent TAVI. At 4.6 (standard deviation 1.7) years follow-up, patients in the TAVI group showed significantly lower survival (P = 0.00013) and event-free survival (P < 0.0001). AA diameter progression was lower in surgical compared to transcatheter patients, 0.95 (0.60, 1.30) vs 1.65 (0.67, 2.63) mm, P = 0.02. AA diameter progression indexed for body surface area and height was lower in the surgical group: 0.72 (0.38, 1.05) vs 1.05 (0.39, 1.71) mm/m2, P = 0.02, and 0.59 (0.36, 0.81) vs 1.11 (0.44, 1.78) mm/m, P = 0.001, respectively. At multivariable linear regression analysis transcatheter procedure, baseline aortic diameter and paravalvular leak were significantly associated with increased postoperative AA dilatation. CONCLUSIONS Bicuspid AV patients who underwent SAVR, showed significantly less long-term AA diameter progression than patients who underwent transcatheter procedure.
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Affiliation(s)
- Giovanni Alfonso Chiariello
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Michele Di Mauro
- Heart and Vascular Centre, Cardiovascular Research Institute, CARIM, Maastricht, Netherlands
| | - Annalisa Pasquini
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Marialisa Nesta
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Ludovica Fabiani
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Mazza
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Martina Meloni
- Department of Cardiology, Thoracic and Vascular Sciences, S. Matteo University Hospital, Pavia, Italy
| | | | - Myriana Ponzo
- Department of Cardiology, Cristo Re Hospital, Rome, Italy
| | - Francesco Ferraro
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Davide Conserva
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Edoardo D’Acierno
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Emmanuel Villa
- Department of Cardiovascular Surgery, Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Carlo Trani
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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8
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Wang C, Hu X, Luo S, Sun Y, Yang B, Zheng S, Chen J, Fu M, Fan R, Li J, Luo J. Assess the Outcomes of Transcatheter Aortic Valve Replacement in Bicuspid Valve with Mixed Disease versus Predominant Aortic Stenosis. Clin Interv Aging 2024; 19:695-703. [PMID: 38711477 PMCID: PMC11070846 DOI: 10.2147/cia.s447272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/04/2024] [Indexed: 05/08/2024] Open
Abstract
Purpose In mixed aortic valve disease (MAVD), the results of transcatheter aortic valve replacement (TAVR) are conflicting. There is limited data on the outcomes of TAVR in patients with bicuspid aortic valve (BAV) and MAVD. The objective of this study is to compare outcomes after TAVR in BAV patients with MAVD and predominant aortic stenosis (PAS). Patients and Methods Patients with BAV who underwent TAVR between January 2016 and April 2023 were included. The primary outcome was device success. The secondary endpoints were periprocedural mortality and other complications as defined by the Valve Academic Research Consortium-3 (VARC-3). Propensity score matching was used to minimize potential confounding. Results A total of 262 patients were included in this study, 83 of whom had MAVD. The median age was 72 years, and 55.7% were male. The baseline comorbidity risk files were comparable between the two groups. Patients with MAVD had more mitral regurgitation, tricuspid regurgitation and pulmonary hypertension, larger annular and left ventricular outflow tract dimensions, and more severe calcification than PAS. In the unmatched population, MAVD patients had similar device success rate (69.9% vs 79.9%, P=0.075) and 30-day mortality (3.6% vs 3.4%, P=1) compared to PAS. Propensity score matching resulted in 66 patient pairs. Device success rate were still comparable in the matched population. Other clinical outcomes, including stroke, bleeding (type 2-4), major vascular complications, acute kidney injury (stage 2-4) and permanent pacemaker implantation, were comparable between the two groups. Multivariable logistic regression analysis did not show MAVD to be an independent negative predictor of device success. At one year, survival was similar between patients with MAVD and those with PAS. Conclusion For the bicuspid valve, patients with MAVD had a more challenging anatomy. MAVD patients associated with comparable 30-day clinical outcomes after TAVR compared to PAS patients in patients with BAV.
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Affiliation(s)
- Changjin Wang
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
| | - Xiaolu Hu
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
- School of Medicine South China University of Technology, Guangzhou, People’s Republic of China
| | - Songyuan Luo
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
| | - Yinghao Sun
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
| | - Bangyuan Yang
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
| | - Shengneng Zheng
- Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
| | - Jiaohua Chen
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
| | - Ming Fu
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
| | - Ruixin Fan
- Department of Cardiac Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
| | - Jie Li
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
| | - Jianfang Luo
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
- School of Medicine South China University of Technology, Guangzhou, People’s Republic of China
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9
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Tan MC, Yeo YH, San BJ, Suleiman A, Lee JZ, Chatterjee A, Sell-Dottin KA, Sweeney JP, Fortuin FD, Lee KS. Trends and Disparities in Valvular Heart Disease Mortality in the United States From 1999 to 2020. J Am Heart Assoc 2024; 13:e030895. [PMID: 38587138 DOI: 10.1161/jaha.123.030895] [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: 05/06/2023] [Accepted: 10/19/2023] [Indexed: 04/09/2024]
Abstract
BACKGROUND Percutaneous heart valve procedures have been increasingly performed over the past decade, yet real-world mortality data on valvular heart disease (VHD) in the United States remain limited. METHODS AND RESULTS We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database among patients ≥15 years old from 1999 to 2020. VHD and its subtypes were listed as the underlying cause of death. We calculated age-adjusted mortality rate (AAMR) per 100 000 individuals and determined overall trends by estimating the average annual percent change using the Joinpoint regression program. Subgroup analyses were performed based on demographic and geographic factors. In the 22-year study, there were 446 096 VHD deaths, accounting for 0.80% of all-cause mortality (56 014 102 people) and 2.38% of the total cardiovascular mortality (18 759 451 people). Aortic stenosis recorded the highest mortality of VHD-related death in both male (109 529, 61.74%) and female (166 930, 62.13%) populations. The AAMR of VHD has declined from 8.4 (95% CI, 8.2-8.5) to 6.6 (95% CI, 6.5-6.7) per 100 000 population. Similar decreasing AAMR trends were also seen for the VHD subtypes. Men recorded higher AAMR for aortic stenosis and aortic regurgitation, whereas women had higher AAMR for mitral stenosis and mitral regurgitation. Mitral regurgitation had the highest change in average annual percent change in AAMR. CONCLUSIONS The mortality rate of VHD among the US population has declined over the past 2 decades. This highlights the likely efficacy of increasing surveillance and advancement in the management of VHD, resulting in improved outcomes.
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Affiliation(s)
- Min Choon Tan
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ USA
- Department of Internal Medicine New York Medical College at Saint Michael's Medical Center Newark NJ USA
| | - Yong Hao Yeo
- Department of Internal Medicine/Pediatrics Beaumont Health Royal Oak MI USA
| | | | - Addi Suleiman
- Department of Cardiovascular Medicine New York Medical College at Saint Michael's Medical Center Newark NJ USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland OH USA
| | - Arka Chatterjee
- Department of Cardiovascular Medicine University of Arizona Sarver Heart Center/Banner University Medical Center Tucson AZ USA
| | | | - John P Sweeney
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ USA
| | - F David Fortuin
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ USA
| | - Kwan S Lee
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ USA
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10
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Chrysostomidis G, Apostolos A, Papanikolaou A, Konstantinou K, Tsigkas G, Koliopoulou A, Chamogeorgakis T. The Application of Precision Medicine in Structural Heart Diseases: A Step towards the Future. J Pers Med 2024; 14:375. [PMID: 38673001 PMCID: PMC11051532 DOI: 10.3390/jpm14040375] [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: 02/07/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
The personalized applications of 3D printing in interventional cardiology and cardiac surgery represent a transformative paradigm in the management of structural heart diseases. This review underscores the pivotal role of 3D printing in enhancing procedural precision, from preoperative planning to procedural simulation, particularly in valvular heart diseases, such as aortic stenosis and mitral regurgitation. The ability to create patient-specific models contributes significantly to predicting and preventing complications like paravalvular leakage, ensuring optimal device selection, and improving outcomes. Additionally, 3D printing extends its impact beyond valvular diseases to tricuspid regurgitation and non-valvular structural heart conditions. The comprehensive synthesis of the existing literature presented here emphasizes the promising trajectory of individualized approaches facilitated by 3D printing, promising a future where tailored interventions based on precise anatomical considerations become standard practice in cardiovascular care.
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Affiliation(s)
- Grigorios Chrysostomidis
- Second Department of Adult Cardiac Surgery—Heart and Lung Transplantation, Onassis Cardiac Surgery Center, 176 74 Athens, Greece; (G.C.); (A.K.); (T.C.)
| | - Anastasios Apostolos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece;
| | - Amalia Papanikolaou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece;
| | - Konstantinos Konstantinou
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London 26504, UK;
| | - Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece;
| | - Antigoni Koliopoulou
- Second Department of Adult Cardiac Surgery—Heart and Lung Transplantation, Onassis Cardiac Surgery Center, 176 74 Athens, Greece; (G.C.); (A.K.); (T.C.)
| | - Themistokles Chamogeorgakis
- Second Department of Adult Cardiac Surgery—Heart and Lung Transplantation, Onassis Cardiac Surgery Center, 176 74 Athens, Greece; (G.C.); (A.K.); (T.C.)
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11
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Malhotra G, Cole CMW, Cox SV, Ross JDW, Dooris M, Moore PT, Chong AA, Dahiya A, Korver K, Hayman SM, Camuglia AC. Third-Generation Transcatheter Aortic Heart Valve with Reverse Parachute Sealing Cuff in Patients with Aortic Valve Disease. Heart Lung Circ 2024; 33:324-331. [PMID: 38184427 DOI: 10.1016/j.hlc.2023.11.019] [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] [Received: 06/08/2023] [Revised: 09/18/2023] [Accepted: 11/08/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND The Navitor (Abbott Inc, IL, USA) transcatheter heart valve is a novel third-generation self-expanding bioprosthesis with specific features to mitigate paravalvular regurgitation (PVR). Owing to its novelty, there is a paucity of data on its application in clinical practice. METHODS Consecutive cohort analysis of the use of the Navitor system in an as-treated clinical setting at a quaternary heart hospital. RESULTS Sixty consecutive non-clinical trial patients treated with Navitor were identified. All patients underwent a successful procedure. The mean age was 79.3 years (±SD 7.82), 56.67% (n=34) were female, and the mean STS score was 4.87 (±SD 5.70). At 30 days post-procedure, all patients were alive with no readmissions for heart failure. One patient had a major vascular complication (1.7%). Four patients (7.14% of patients without a pre-existing pacemaker) received a new permanent pacemaker. Two patients (3.4%) had a non-disabling stroke. PVR at 30 days was trivial or none in 75% of patients, and no patient had worse than mild PVR. CONCLUSIONS The Navitor system in this as-treated cohort was associated with favourable clinical, haemodynamic, and safety outcomes.
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Affiliation(s)
- Ganeev Malhotra
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Chris M W Cole
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Stephen V Cox
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Jordan D W Ross
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Mark Dooris
- University of Queensland, Brisbane, QLD, Australia; Mater Hospital and Health Service, Brisbane, QLD, Australia
| | - Peter T Moore
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Adrian A Chong
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia; Mater Hospital and Health Service, Brisbane, QLD, Australia
| | - Arun Dahiya
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Kellee Korver
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Sam M Hayman
- University of Queensland, Brisbane, QLD, Australia; Mater Hospital and Health Service, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Anthony C Camuglia
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia; Mater Hospital and Health Service, Brisbane, QLD, Australia.
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12
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Antequera-González B, Martínez-Micaelo N, Sureda-Barbosa C, Galian-Gay L, Siliato-Robles MS, Ligero C, Evangelista A, Alegret JM. Specific Multiomic Profiling in Aortic Stenosis in Bicuspid Aortic Valve Disease. Biomedicines 2024; 12:380. [PMID: 38397982 PMCID: PMC10887224 DOI: 10.3390/biomedicines12020380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION AND PURPOSE Bicuspid aortic valve (BAV) disease is associated with faster aortic valve degeneration and a high incidence of aortic stenosis (AS). In this study, we aimed to identify differences in the pathophysiology of AS between BAV and tricuspid aortic valve (TAV) patients in a multiomics study integrating metabolomics and transcriptomics as well as clinical data. METHODS Eighteen patients underwent aortic valve replacement due to severe aortic stenosis: 8 of them had a TAV, while 10 of them had a BAV. RNA sequencing (RNA-seq) and proton nuclear magnetic resonance spectroscopy (1H-NMR) were performed on these tissue samples to obtain the RNA profile and lipid and low-molecular-weight metabolites. These results combined with clinical data were posteriorly compared, and a multiomic profile specific to AS in BAV disease was obtained. RESULTS H-NMR results showed that BAV patients with AS had different metabolic profiles than TAV patients. RNA-seq also showed differential RNA expression between the groups. Functional analysis helped connect this RNA pattern to mitochondrial dysfunction. Integration of RNA-seq, 1H-NMR and clinical data helped create a multiomic profile that suggested that mitochondrial dysfunction and oxidative stress are key players in the pathophysiology of AS in BAV disease. CONCLUSIONS The pathophysiology of AS in BAV disease differs from patients with a TAV and has a specific RNA and metabolic profile. This profile was associated with mitochondrial dysfunction and increased oxidative stress.
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Affiliation(s)
- Borja Antequera-González
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain; (B.A.-G.); (C.L.)
| | - Neus Martínez-Micaelo
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain; (B.A.-G.); (C.L.)
| | - Carlos Sureda-Barbosa
- Cardiac Surgery Department, Hospital Vall d’Hebron (CIBERCV), Universitat Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Laura Galian-Gay
- Cardiology Department, Hospital Vall d’Hebron (CIBERCV), Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (L.G.-G.)
| | - M. Sol Siliato-Robles
- Cardiac Surgery Department, Hospital Vall d’Hebron (CIBERCV), Universitat Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Carmen Ligero
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain; (B.A.-G.); (C.L.)
- Cardiology Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Artur Evangelista
- Cardiology Department, Hospital Vall d’Hebron (CIBERCV), Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (L.G.-G.)
| | - Josep M. Alegret
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain; (B.A.-G.); (C.L.)
- Cardiology Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204 Reus, Spain
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13
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Lee SH, Oh S, Ko YG, Lee YJ, Lee SJ, Hong SJ, Ahn CM, Kim JS, Kim BK, Ko KY, Cho I, Shim CY, Hong GR, Choi D, Hong MK. Comparison of Intracardiac Echocardiography Versus Transesophageal Echocardiography for Guidance During Transcatheter Aortic Valve Replacement. Korean Circ J 2024; 54:63-75. [PMID: 38111184 PMCID: PMC10864253 DOI: 10.4070/kcj.2023.0195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/18/2023] [Accepted: 10/11/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence regarding the efficacy and safety of intracardiac echocardiography (ICE) for guidance during transcatheter aortic valve replacement (TAVR) is limited. This study aimed to compare the clinical efficacy and safety of ICE versus transesophageal echocardiography (TEE) for guiding TAVR. METHODS This prospective cohort study included patients who underwent TAVR from August 18, 2015, to June 31, 2021. Eligible patients were stratified by echocardiographic modality (ICE or TEE) and anesthesia mode (monitored anesthesia care [MAC] or general anesthesia [GA]). Primary outcome was the 1-year composite of all-cause mortality, rehospitalization for cardiovascular cause, or stroke, according to the Valve Academic Research Consortium-3 (VARC-3) definition. Propensity score matching was performed, and study outcomes were analyzed for the matched cohorts. RESULTS Of the 359 eligible patients, 120 patients were matched for the ICE-MAC and TEE-GA groups, respectively. The incidence of primary outcome was similar between matched groups (18.3% vs. 20.0%; adjusted hazard ratio, 0.94; 95% confidence interval [CI], 0.53-1.68; p=0.843). ICE-MAC and TEE-GA also had similar incidences of moderate-to-severe paravalvular regurgitation (PVR) (4.2% vs. 5.0%; adjusted odds ratio, 0.83; 95% CI, 0.23-2.82; p=0.758), new permanent pacemaker implantation, and VARC-3 types 2-4 bleeding. CONCLUSIONS ICE was comparable to TEE for guidance during TAVR for the composite clinical efficacy outcome, with similar incidences of moderate-to-severe PVR, new permanent pacemaker implantation, and major bleeding. These results suggest that ICE could be a safe and effective alternative echocardiographic modality to TEE for guiding TAVR.
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Affiliation(s)
- Sang-Hyup Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seunguk Oh
- Department of Cardiology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Yong-Joon Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Jun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Yong Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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14
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Aquino-Bruno H, Muratalla-González R, Garcia-Garcia JF, Triano-Doroteo JL, Rivera KF, Balcarcel GC, Navarrete-Osuna M. Transcatheter aortic valve replacement planning with cardiac computed tomography in quadricuspid aortic valve stenosis: a case series. Eur Heart J Case Rep 2024; 8:ytae079. [PMID: 38405198 PMCID: PMC10894008 DOI: 10.1093/ehjcr/ytae079] [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: 07/10/2023] [Revised: 01/21/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
Background The presence of severe aortic stenosis in quadricuspid aortic valve (QAV) is an extremely rare combination, and it is unknown whether transcatheter aortic valve replacement (TAVR) is a safe option due to the low incidence. Case summary We present two patients diagnosed with severe aortic stenosis with QAV morphology type 1 (Nakamura classification). All patients presented to our hospital for evaluation because of worsening functional class, dyspnoea, or syncope. During tomographic planning, the aortic annulus was measured at the level of the deepest sinus for the selection of the number of devices. Due to the presence of four cusps, the smallest cusp was excluded, and three sinuses were virtualized for placement of the pigtail catheter during the procedure. Without complications, a 23 mm Edwards SAPIEN 3 was deployed through the femoral artery in both patients. Control aortography showed no valve leakage or regurgitation. Discussion In patients with QAV and aortic stenosis undergoing TAVR, similar to the tricuspid valve, tomographic planning can be used to ensure the success of the procedure. However, unlike the tricuspid valve, where the selection of the device number is based on the measurements of the aortic annulus at the level of the non-coronary sinus, in these QAV cases, we perform the measurements at the level of the deepest aortic sinus (right coronary sinus).
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Affiliation(s)
- Heberto Aquino-Bruno
- Interventional Cardiology Service, Centro Medico Nacional 20 de Noviembre, Av. Felix Cuevas #540, Col. Del Valle Del. Benito Juarez, Mexico City 03100, Mexico
| | - Roberto Muratalla-González
- Interventional Cardiology Service, Centro Medico Nacional 20 de Noviembre, Av. Felix Cuevas #540, Col. Del Valle Del. Benito Juarez, Mexico City 03100, Mexico
| | - Juan F Garcia-Garcia
- Interventional Cardiology Service, Centro Medico Nacional 20 de Noviembre, Av. Felix Cuevas #540, Col. Del Valle Del. Benito Juarez, Mexico City 03100, Mexico
| | - José L Triano-Doroteo
- Interventional Cardiology Service, Hospital Regional Culiacan ISSSTE, Sinaloa, Mexico
| | - Kevin Felix Rivera
- Interventional Cardiology Service, Hospital Regional Culiacan ISSSTE, Sinaloa, Mexico
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15
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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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16
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Takeji Y, Taniguchi T, Morimoto T, Shirai S, Kitai T, Tabata H, Kitano K, Ohno N, Murai R, Osakada K, Murata K, Nakai M, Tsuneyoshi H, Tada T, Amano M, Watanabe S, Shiomi H, Watanabe H, Yoshikawa Y, Nishikawa R, Yamamoto K, Obayashi Y, Toyofuku M, Tatsushima S, Kanamori N, Miyake M, Nakayama H, Nagao K, Izuhara M, Nakatsuma K, Inoko M, Fujita T, Kimura M, Ishii M, Usami S, Sawada K, Nakazeki F, Okabayashi M, Shirotani M, Inuzuka Y, Ando K, Komiya T, Minatoya K, Kimura T. In-hospital outcomes after SAVR or TAVI in patients with severe aortic stenosis. Cardiovasc Interv Ther 2024; 39:65-73. [PMID: 37349628 PMCID: PMC10764526 DOI: 10.1007/s12928-023-00942-x] [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] [Received: 02/08/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
There were no data comparing the in-hospital outcomes after transcatheter aortic valve implantation (TAVI) with those after surgical aortic valve replacement (SAVR) in Japan. Among consecutive patients with severe AS between April 2018 and December 2020 in the CURRENT AS Registry-2, we identified 1714 patients who underwent aortic valve replacement (TAVI group: 1134 patients, and SAVR group: 580 patients). Patients in the TAVI group were much older (84.4 versus 73.6 years, P < 0.001) and more often had comorbidities than those in the SAVR group. In-hospital death rate was numerically lower in the TAVI group than in the SAVR group (0.6% versus 2.2%). After excluding patients with dialysis, in-hospital death rate was very low and comparable in the TAVI and SAVR groups (0.6% versus 0.8%). The rates of major bleeding and new-onset atrial fibrillation during index hospitalization were higher after SAVR than after TAVI (72% versus 20%, and 26% versus 4.6%, respectively), while the rate of pacemaker implantation was higher after TAVI than after SAVR (8.1% versus 2.4%). Regarding the echocardiographic data at discharge, the prevalence of patient-prosthesis mismatch was lower in the TAVI group than in the SAVR group (moderate: 9.0% versus 26%, and severe: 2.6% versus 4.8%). In this real-world data in Japan, TAVI compared with SAVR was chosen in much older patients with more comorbidities with severe AS. In-hospital death rate was numerically lower in the TAVI group than in the SAVR group.
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Affiliation(s)
- Yasuaki Takeji
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Shirai
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyuki Tabata
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kazuki Kitano
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Nobuhisa Ohno
- Division of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Ryosuke Murai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kohei Osakada
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Koichiro Murata
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Masanao Nakai
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Tomohisa Tada
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shin Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryusuke Nishikawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Obayashi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Shojiro Tatsushima
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Norio Kanamori
- Division of Cardiology, Shimada General Medical Center, Shimada, Japan
| | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Hiroyuki Nakayama
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kazuya Nagao
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Masayasu Izuhara
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Kenji Nakatsuma
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Takanari Fujita
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Masahiro Kimura
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Mitsuru Ishii
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shunsuke Usami
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Kenichiro Sawada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Fumiko Nakazeki
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Marie Okabayashi
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Manabu Shirotani
- Division of Cardiology, Faculty of Medicine, Nara Hospital, Kinki University, Ikoma, Japan
| | - Yasutaka Inuzuka
- Department of Cardiology, Shiga General Hospital, Moriyama, Japan
| | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
- Department of Cardiology, Hirakata Kohsai Hospital, 1-2-1 Fujisaka Higashi-machi, Hirakata, 573-0153, Japan.
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Zhang X, Wu H, Pan Z, Elkoumy A, Ruan Z, Wu T, Wu D, Soliman O, Wu L, Wu X. Mechanism of balloon burst during transcatheter aortic valve replacement pre-dilatation: Image observation and validation by finite element analysis. Comput Biol Med 2024; 168:107714. [PMID: 38035862 DOI: 10.1016/j.compbiomed.2023.107714] [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] [Received: 06/29/2023] [Revised: 10/26/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Balloon burst during transcatheter aortic valve replacement (TAVR) is serious complication. This study pioneers a novel approach by combining image observation and computer simulation validation to unravel the mechanism of balloon burst in a patient with bicuspid aortic valve (BAV) stenosis. METHOD A new computational model for balloon pre-dilatation was developed by incorporating the element failure criteria according to the Law of Laplace. The effects of calcification and aortic tissue material parameters, friction coefficients, balloon types and aortic anatomy classification were performed to validate and compare the expansion behavior and rupture mode of actual balloon. RESULTS Balloon burst was dissected into three distinct stages based on observable morphological changes. The mechanism leading to the complete transverse burst of the non-compliant balloon initiated at the folding edges, where contacted with heavily calcified masses at the right coronary sinus, resulting in high maximum principal stress. Local sharp spiked calcifications facilitated rapid crack propagation. The elastic moduli of calcification significantly influenced balloon expansion behavior and crack morphology. The simulation case of the calcific elastic modulus was set at 12.6 MPa could closely mirror clinical appearance of expansion behavior and crack pattern. Furthermore, the case of semi-compliant balloons introduced an alternative rupture mechanism as pinhole rupture, driven by local sharp spiked calcifications. CONCLUSIONS The computational model of virtual balloons could effectively simulate balloon dilation behavior and burst mode during TAVR pre-dilation. Further research with a larger cohort is needed to investigate the balloon morphology during pre-dilation by using this method to guide prosthesis sizing for potential favorable outcomes.
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Affiliation(s)
- Xinmin Zhang
- International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Department of Cardiology, Key Laboratory of Panvascular Diseases of Wenzhou, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haozhe Wu
- School of the Second Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Zhifang Pan
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ahmed Elkoumy
- Islamic Center of Cardiology, Al-Azhar University, Cairo, Egypt; Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, Ireland
| | - Zhisheng Ruan
- International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tianbo Wu
- International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Daozhu Wu
- International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Osama Soliman
- Islamic Center of Cardiology, Al-Azhar University, Cairo, Egypt
| | - Lianpin Wu
- International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Department of Cardiology, Key Laboratory of Panvascular Diseases of Wenzhou, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Xinlei Wu
- International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Department of Cardiology, Key Laboratory of Panvascular Diseases of Wenzhou, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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18
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Verstraeten S, Hoeijmakers M, Tonino P, Brüning J, Capelli C, van de Vosse F, Huberts W. Generation of synthetic aortic valve stenosis geometries for in silico trials. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3778. [PMID: 37961993 DOI: 10.1002/cnm.3778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 11/15/2023]
Abstract
In silico trials are a promising way to increase the efficiency of the development, and the time to market of cardiovascular implantable devices. The development of transcatheter aortic valve implantation (TAVI) devices, could benefit from in silico trials to overcome frequently occurring complications such as paravalvular leakage and conduction problems. To be able to perform in silico TAVI trials virtual cohorts of TAVI patients are required. In a virtual cohort, individual patients are represented by computer models that usually require patient-specific aortic valve geometries. This study aimed to develop a virtual cohort generator that generates anatomically plausible, synthetic aortic valve stenosis geometries for in silico TAVI trials and allows for the selection of specific anatomical features that influence the occurrence of complications. To build the generator, a combination of non-parametrical statistical shape modeling and sampling from a copula distribution was used. The developed virtual cohort generator successfully generated synthetic aortic valve stenosis geometries that are comparable with a real cohort, and therefore, are considered as being anatomically plausible. Furthermore, we were able to select specific anatomical features with a sensitivity of around 90%. The virtual cohort generator has the potential to be used by TAVI manufacturers to test their devices. Future work will involve including calcifications to the synthetic geometries, and applying high-fidelity fluid-structure-interaction models to perform in silico trials.
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Affiliation(s)
- Sabine Verstraeten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Pim Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jan Brüning
- Institute of Computer-assisted Cardiovascular Medicine, Charite Universitaetsmedizin, Berlin, Germany
| | - Claudio Capelli
- Institute of Cardiovascular Science, University College London, London, UK
| | - Frans van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Wouter Huberts
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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Nhan VT, Khoa NQ, Thuy LT, Van Duong N, Van Tan N, Ngoc The TH, Vuong NL, Cong ND, Su LQ, Finkelstein A, Lafont A. Early safety and mid-term clinical outcomes of technology transfer of transcatheter aortic valve implantation in patients with severe aortic valve stenosis in Vietnam: a single-center experience of 90 patients. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 42:100956. [PMID: 38022713 PMCID: PMC10652144 DOI: 10.1016/j.lanwpc.2023.100956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/25/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023]
Abstract
Background This study investigated the early safety and mid-term outcomes of stepwise implementation of transcatheter aortic valve implantation (TAVI) in Vietnamese patients with severe aortic stenosis (AS) at a single center, following the process of technical transfer. Methods From 2017 to 2022, 90 patients with symptomatic severe AS underwent TAVI at a tertiary hospital in Vietnam. The first 30 cases received support for technology transfer from international proctors. One-year outcomes were evaluated using the Valve Academic Research Consortium-2 (VARC-2) criteria. Findings Forty patients (45.5%) had bicuspid aortic valve (BAV). The Medtronic Evolut R/Pro self-expanding valve system was used in 98.9% of all cases, with a 29-mm valve being the most common. Device success was achieved in 95.6% of cases, whereas one procedural death occurred. At one year, four deaths (5.3%) occurred and all were in the BAV group. Other complications included stroke (2.8%), hospital readmission due to the valve or worsening heart failure (2.8%), permanent pacemaker implantation (9.9%), and moderate paravalvular leak (3.0%). The left ventricular ejection fraction and mean transvalvular gradient significantly improved after TAVI. There were no significant differences in procedural success and mortality when the proctor support period and the subsequent solo operator period were compared. Interpretation TAVI procedure is safe for treating severe AS in Vietnamese patients, despite the high prevalence of BAV. The procedural complication rate was low, with promising outcomes at one year. These results also highlight the effectiveness of the TAVI technical transfer model in Vietnam. Funding No funding was provided for this study.
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Affiliation(s)
- Vo Thanh Nhan
- Cardiovascular Center, Vinmec Central Park International Hospital, Ho Chi Minh City, Vietnam
- Department of Geriatrics & Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Quoc Khoa
- Department of Cardiology, 30th April Hospital, Ho Chi Minh City, Vietnam
- Department of Geriatrics & Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - La Thi Thuy
- Cardiovascular Center, Vinmec Central Park International Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Van Duong
- Cardiovascular Center, Vinmec Central Park International Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Van Tan
- Department of Geriatrics & Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Interventional Cardiology, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
| | - Than Ha Ngoc The
- Department of Geriatrics & Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Geriatrics and Palliative Care, University Medical Center, Ho Chi Minh City, Vietnam
| | - Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Duc Cong
- Department of Geriatrics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Le Quoc Su
- Vinmec Central Park International Hospital, Ho Chi Minh City, Vietnam
| | | | - Antoine Lafont
- Division of Cardiology, European Hospital George Pompidou, Paris, France
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20
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Kalisz K, Moore A, Chaturvedi A, Rajiah PS. Multimodality Imaging in Planning of Complex TAVR Procedures. Semin Roentgenol 2024; 59:57-66. [PMID: 38388097 DOI: 10.1053/j.ro.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 02/24/2024]
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21
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Costa G, Saia F, Pilgrim T, Abdel-Wahab M, Garot P, Sammartino S, Gandolfo C, Branca L, Latib A, Amat-Santos I, Mylotte D, De Marco F, De Backer O, Nombela Franco L, Akodad M, Ribichini FL, Bedogni F, Mazzapicchi A, Tomii D, Laforgia P, Cannata S, Fiorina C, Scotti A, Fezzi S, Criscione E, Poletti E, Mazzucca M, Lunardi M, Mainardi A, Andreaggi S, Quagliana A, Montarello NJ, Hennessey B, Mon-Noboa M, Meier D, Adamo M, Sgroi C, Reddavid CM, Strazzieri O, Crescenzia Motta S, Frittitta V, Dipietro E, Comis A, Melfa C, Calì M, Laterra G, Thiele H, Webb JG, Sondergaard L, Tamburino C, Barbanti M. One-year clinical outcomes of transcatheter aortic valve implantation with the latest iteration of self-expanding or balloonexpandable devices: insights from the OPERA-TAVI registry. EUROINTERVENTION 2024; 20:95-103. [PMID: 37982161 PMCID: PMC10758986 DOI: 10.4244/eij-d-23-00720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/09/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Midterm comparative analyses of the latest iterations of the most used Evolut and SAPIEN platforms for transcatheter aortic valve implantation (TAVI) are lacking. AIMS We aimed to compare 1-year clinical outcomes of TAVI patients receiving Evolut PRO/PRO+ (PRO) or SAPIEN 3 Ultra (ULTRA) devices in current real-world practice. METHODS Among patients enrolled in the OPERA-TAVI registry, patients with complete 1-year follow-up were considered for the purpose of this analysis. One-to-one propensity score matching was used to compare TAVI patients receiving PRO or ULTRA devices. The primary endpoint was a composite of 1-year all-cause death, disabling stroke and rehospitalisation for heart failure. Five prespecified subgroups of patients were considered according to leaflet and left ventricular outflow tract calcifications, annulus dimensions and angulation, and leaflet morphology. RESULTS Among a total of 1,897 patients, 587 matched pairs of patients with similar clinical and anatomical characteristics were compared. The primary composite endpoint did not differ between patients receiving PRO or ULTRA devices (Kaplan-Meier [KM] estimates 14.0% vs 11.9%; log-rank p=0.27). Patients receiving PRO devices had higher rates of 1-year disabling stroke (KM estimates 2.6% vs 0.4%; log-rank p=0.001), predominantly occurring within 30 days after TAVI (1.4% vs 0.0%; p=0.004). Outcomes were consistent across all the prespecified subsets of anatomical scenarios (all pinteraction>0.10). CONCLUSIONS One-year clinical outcomes of patients undergoing transfemoral TAVI and receiving PRO or ULTRA devices in the current clinical practice were similar, but PRO patients had higher rates of disabling stroke. Outcomes did not differ across the different anatomical subsets of the aortic root.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Francesco Saia
- Cardiovascular Department, Policlinico S. Orsola, University of Bologna, Bologna, Italy
| | - Thomas Pilgrim
- Bern University Hospital, Inselspital, Bern, Switzerland
| | | | - Philippe Garot
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Sofia Sammartino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Caterina Gandolfo
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | | | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ignacio Amat-Santos
- Division of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Darren Mylotte
- Department of Cardiology, University Hospital, University of Galway, Ireland
| | - Federico De Marco
- Interventional Cardiology Department, IRCSS Centro Cardiologico Monzino, Milan, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Luis Nombela Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Mariama Akodad
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Francesco Bedogni
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Daijiro Tomii
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - Pietro Laforgia
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Stefano Cannata
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | | | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Simone Fezzi
- Department of Cardiology, University Hospital, University of Galway, Ireland
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Enrico Poletti
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Mattia Mazzucca
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Stefano Andreaggi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Angelo Quagliana
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicholas J Montarello
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Breda Hennessey
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Matias Mon-Noboa
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - David Meier
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Orazio Strazzieri
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Valentina Frittitta
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Elena Dipietro
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Alessandro Comis
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Chiara Melfa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Mariachiara Calì
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Abbott Vascular, Santa Clara, CA, USA
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
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22
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Chen Q, Malas J, Megna D, Tam DY, Gill G, Rowe G, Premananthan S, Krishnan A, Peiris A, Emerson D, Gupta A, Catarino P, Egorova N, Chikwe J, Bowdish ME. Bicuspid aortic stenosis: National three-year outcomes of transcatheter versus surgical aortic valve replacement among Medicare beneficiaries. J Thorac Cardiovasc Surg 2023:S0022-5223(23)01131-5. [PMID: 38065520 PMCID: PMC11181748 DOI: 10.1016/j.jtcvs.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Randomized trials of transcatheter versus surgical aortic valve replacements have excluded bicuspid anatomy. We compared 3-year outcomes of transcatheter aortic valve replacement versus surgical aortic valve replacement in patients aged more than 65 years with bicuspid aortic stenosis. METHODS The Centers for Medicare and Medicaid data were used to identify 6450 patients undergoing isolated surgical aortic valve replacement (n = 3771) or transcatheter aortic valve replacement (n = 2679) for bicuspid aortic stenosis (2012-2019). Propensity score matching with 21 baseline characteristics including frailty created 797 pairs. RESULTS Unmatched patients undergoing transcatheter aortic valve replacement were older than patients undergoing surgical aortic valve replacement (78 vs 70 years), with more comorbidities and frailty (all P < .001). After matching, transcatheter aortic valve replacement was associated with a similar mortality risk compared with surgical aortic valve replacement within the first 6 months (hazard ratio [HR], 1.08, 95% CI, 0.67-1.69) but a higher mortality risk between 6 months and 3 years (HR, 2.16, 95% CI, 1.22-3.83). Additionally, transcatheter aortic valve replacement was associated with a lower risk of heart failure readmissions before 6 months (HR, 0.51, 95% CI, 0.31-0.87) but a higher risk between 6 months and 3 years (HR, 4.78, 95% CI, 2.21-10.36). The 3-year risks of aortic valve reintervention (HR, 1.03, 95% CI, 0.30-3.56) and stroke (HR, 1.21, 95% CI, 0.75-1.96) were similar. CONCLUSIONS Among matched Medicare beneficiaries undergoing transcatheter aortic valve replacement or surgical aortic valve replacement for bicuspid aortic stenosis, 3-year mortality was higher after transcatheter aortic valve replacement. However, transcatheter aortic valve replacement was associated with a similar risk of mortality and a lower risk of heart failure readmissions during the first 6 months after the intervention. Randomized comparative data are needed to best inform treatment choice.
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Affiliation(s)
- Qiudong Chen
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Jad Malas
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Dominick Megna
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Derrick Y Tam
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - George Gill
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Georgina Rowe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Sharmini Premananthan
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Aasha Krishnan
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Achille Peiris
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Dominic Emerson
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Aakriti Gupta
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Pedro Catarino
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Natalia Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif.
| | - Michael E Bowdish
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
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23
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Hirji SA, Wegermann Z, Vemulapalli S, Newell P, Grau-Sepulveda M, O'Brien S, Thourani VH, Badhwar V, Kaneko T. Benchmarking Outcomes of Surgical Aortic Valve Replacement in Patients With Bicuspid Aortic Valves. Ann Thorac Surg 2023; 116:1222-1231. [PMID: 37454786 DOI: 10.1016/j.athoracsur.2023.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The relative roles for transcatheter and surgical aortic valve replacement (SAVR) for bicuspid aortic valve (AV) stenosis are debated. This study analyzes the 5-year longitudinal outcomes of isolated SAVR in bicuspid vs tricuspid AV patients, particularly in low-risk patients. METHODS All patients undergoing isolated index SAVR at 1146 United States hospitals in The Society of Thoracic Surgeons (STS) Adult Cardiac database between July 1, 2011, and December 31, 2018, with linkage to Medicare claims, were analyzed. RESULTS A total of 65,687 patients were analyzed, including of 9131 bicuspid patients (13.9%). Compared with tricuspid patients, bicuspid patients were significantly younger (median 70 vs 74 years, P < .001) with lower Society of Thoracic Surgeons predicted risk of mortality scores (mean 1.6% vs 2.3%, P < .001) and lower risk profile. Risk-adjusted 30-day mortality and major morbidity were similar, but risk-adjusted 5-year mortality was significantly lower in the bicuspid patients (adjusted hazard ratio, 0.72; 95% CI, 0.66-0.77), specifically in low-risk patients (adjusted hazard ratio, 0.69; 95% CI, 0.64-0.76). Additionally, the bicuspid cohort had a lower 5-year readmission risk of heart failure, stroke, bleeding, or other cardiovascular causes (all P < .05). CONCLUSIONS In this nationally representative study, 30-day mortality was similar, but risk-adjusted 5-year mortality was significantly lower in bicuspid patients undergoing isolated SAVR compared with tricuspid patients, specifically low-risk and normal left ventricular ejection fraction patients. This analysis provides a much-needed 5-year longitudinal national-level benchmark to better inform the discussion of transcatheter vs SAVR in bicuspid patients.
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Affiliation(s)
- Sameer A Hirji
- Division of Cardiac Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | | | | | - Paige Newell
- Division of Cardiac Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | | | - Sean O'Brien
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Tsuyoshi Kaneko
- Department of Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri.
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24
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Zheng HJ, Cheng YB, Lin DQ, Yan CJ, Yu SJ, He P, Li J, Cheng W. Effect of transcatheter aortic valve replacement on ascending aorta dilatation rate in patients with tricuspid and bicuspid aortic stenosis. IJC HEART & VASCULATURE 2023; 49:101313. [PMID: 38107428 PMCID: PMC10724657 DOI: 10.1016/j.ijcha.2023.101313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/07/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
Objectives The aim of the present study was to assess the differences between BAV and TAV patients with chronic moderate to severe or severe AS regarding presentation, incidence of TAVR, survival, ascending aorta diameter and dilatation rate before and after TAVR. Methods The study included 667 consecutive patients with chronic moderate to severe or severe AS from January 2012 and December 2022. Outcomes included all-cause mortality, incidence of TAVR, and ascending aorta diameter and dilatation rate. Results There were 185 BAV-AS and 482 TAV-AS patients, and BAV-AS patients were younger (67 vs 78 years, P = 0.027). Total follow-up was 4.5 years (IQR: 2.7-8.9 years), 290 patients underwent TAVR, and 165 patients died. The 8-year TAVR incidence was higher in BAV-AS (55% ± 4%) vs TAV-AS (41% ± 5%; P = 0.02). The 8-year survival was higher in BAV-AS (85% ± 6%) vs TAV-AS (71% ± 6%; P < 0.0001) and became insignificant after age adjustment (P = 0.33). The dilatation rate of ascending aorta was significantly faster in BAV-AS patients compared with TAV-AS patients before TAVR. However, the ascending aorta dilatation rate for BAV-AS and TAV-AS patients was not significantly different after TAVR. Conclusions Compared with TAV-AS, BAV-AS patients were younger and underwent TAVR more frequently, resulting in a considerable survival advantage. After TAVR, ascending aorta dilatation rates were similar in BAV-AS and TAV-AS patients, suggesting an important role of hemodynamics on ascending aorta dilatation in BAV-AS.
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Affiliation(s)
| | | | - De-Qing Lin
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chao-Jun Yan
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - San-Jiu Yu
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ping He
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jun Li
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Wei Cheng
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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He J, Xiong TY, Yao YJ, Peng Y, Wei JF, Zhao ZG, Chen G, Ou YW, Liu Q, Wang X, Zhu Z, Yang HR, Jia K, Mylotte D, Piazza N, Prendergast B, Feng Y, Chen M. Outcomes Following Transcatheter Aortic Valve Replacement for Aortic Stenosis in Patients With Type 0 Bicuspid, Type 1 Bicuspid, and Tricuspid Aortic Valves. Circ Cardiovasc Interv 2023; 16:e013083. [PMID: 37846559 DOI: 10.1161/circinterventions.123.013083] [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: 03/27/2023] [Accepted: 09/11/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Data concerning the outcomes of transcatheter aortic valve replacement in type 0 bicuspid aortic stenosis (AS) are scarce. The study aims to compare the outcomes of transcatheter aortic valve replacement for AS in patients with type 0 bicuspid, type 1 bicuspid, and tricuspid aortic valve anatomy. METHODS We enrolled consecutive patients undergoing transcatheter aortic valve replacement for severe AS between 2012 and 2022 in this single-center retrospective cohort study. The primary outcome was mortality, while secondary outcomes included in-hospital complications such as stroke and pacemaker implantation and transcatheter heart valve hemodynamic performance. RESULTS The number of patients with AS with type 0 bicuspid, type 1 bicuspid, and tricuspid aortic valve anatomy was 328, 302, and 642, respectively. Self-expanding transcatheter heart valves were used in the majority of patients (n=1160; 91.4%). In the matched population, differences in mortality (30 days: 4.2% versus 1.7% versus 1.7%, Poverall=0.522; 1 year: 10% versus 2.3% versus 6.2%, Poverall=0.099) and all stroke (30 days: 1.0% versus 0.9% versus 0.0%, Poverall=0.765; 1 year: 1.4% versus 1.6% versus 1.3%, Poverall=NS) were nonsignificant, and the incidence of overall in-hospital complications was comparable among groups. Ascending aortic diameter was the single predictor of 1-year mortality in type 0 bicuspid patients (hazard ratio, 1.59 [95% CI, 1.03-2.44]; P=0.035). The proportion of patients with a mean residual gradient ≥20 mm Hg was the highest in those with type 0 bicuspid anatomy, although the need for permanent pacemaker implantation was the lowest in this group. CONCLUSIONS Major clinical outcomes of transcatheter aortic valve replacement for AS in patients with type 0 bicuspid, type 1 bicuspid, and tricuspid aortic valve anatomy are equivalent at short- and mid-term follow-up. These observations merit further exploration in prospective international registries and randomized controlled trials.
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Affiliation(s)
- Jingjing He
- Department of Cardiology (J.H., T.-Y.X., Y.-J.Y., Y.P., J.-F.W., Z.-G.Z., Y.-W.O., Q.L., X.W., Z.Z., H.-R.Y., K.J., Y.F., M.C.), West China Hospital, Sichuan University
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.H.)
| | - Tian-Yuan Xiong
- Department of Cardiology (J.H., T.-Y.X., Y.-J.Y., Y.P., J.-F.W., Z.-G.Z., Y.-W.O., Q.L., X.W., Z.Z., H.-R.Y., K.J., Y.F., M.C.), West China Hospital, Sichuan University
- Laboratory of Heart Valve Disease (T.-Y.X., Z.-G.Z., H.-R.Y., M.C.), West China Hospital, Sichuan University
| | - Yi-Jun Yao
- Department of Cardiology (J.H., T.-Y.X., Y.-J.Y., Y.P., J.-F.W., Z.-G.Z., Y.-W.O., Q.L., X.W., Z.Z., H.-R.Y., K.J., Y.F., M.C.), West China Hospital, Sichuan University
| | - Yong Peng
- Department of Cardiology (J.H., T.-Y.X., Y.-J.Y., Y.P., J.-F.W., Z.-G.Z., Y.-W.O., Q.L., X.W., Z.Z., H.-R.Y., K.J., Y.F., M.C.), West China Hospital, Sichuan University
| | - Jia-Fu Wei
- Department of Cardiology (J.H., T.-Y.X., Y.-J.Y., Y.P., J.-F.W., Z.-G.Z., Y.-W.O., Q.L., X.W., Z.Z., H.-R.Y., K.J., Y.F., M.C.), West China Hospital, Sichuan University
| | - Zhen-Gang Zhao
- Department of Cardiology (J.H., T.-Y.X., Y.-J.Y., Y.P., J.-F.W., Z.-G.Z., Y.-W.O., Q.L., X.W., Z.Z., H.-R.Y., K.J., Y.F., M.C.), West China Hospital, Sichuan University
- Laboratory of Heart Valve Disease (T.-Y.X., Z.-G.Z., H.-R.Y., M.C.), West China Hospital, Sichuan University
| | - Guo Chen
- Department of Anesthesiology (G.C.), West China Hospital, Sichuan University
| | - Yuan-Weixiang Ou
- Department of Cardiology (J.H., T.-Y.X., Y.-J.Y., Y.P., J.-F.W., Z.-G.Z., Y.-W.O., Q.L., X.W., Z.Z., H.-R.Y., K.J., Y.F., M.C.), West China Hospital, Sichuan University
| | - Qi Liu
- Department of Cardiology (J.H., T.-Y.X., Y.-J.Y., Y.P., J.-F.W., Z.-G.Z., Y.-W.O., Q.L., X.W., Z.Z., H.-R.Y., K.J., Y.F., M.C.), West China Hospital, Sichuan University
| | - Xi Wang
- Department of Cardiology (J.H., T.-Y.X., Y.-J.Y., Y.P., J.-F.W., Z.-G.Z., Y.-W.O., Q.L., X.W., Z.Z., H.-R.Y., K.J., Y.F., M.C.), West China Hospital, Sichuan University
| | - Zhongkai Zhu
- Department of Cardiology (J.H., T.-Y.X., Y.-J.Y., Y.P., J.-F.W., Z.-G.Z., Y.-W.O., Q.L., X.W., Z.Z., H.-R.Y., K.J., Y.F., M.C.), West China Hospital, Sichuan University
| | - Hao-Ran Yang
- Department of Cardiology (J.H., T.-Y.X., Y.-J.Y., Y.P., J.-F.W., Z.-G.Z., Y.-W.O., Q.L., X.W., Z.Z., H.-R.Y., K.J., Y.F., M.C.), West China Hospital, Sichuan University
- Laboratory of Heart Valve Disease (T.-Y.X., Z.-G.Z., H.-R.Y., M.C.), West China Hospital, Sichuan University
| | - Kaiyu Jia
- Department of Cardiology (J.H., T.-Y.X., Y.-J.Y., Y.P., J.-F.W., Z.-G.Z., Y.-W.O., Q.L., X.W., Z.Z., H.-R.Y., K.J., Y.F., M.C.), West China Hospital, Sichuan University
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, National University of Ireland (D.M.)
| | - Nicolo Piazza
- Division of Cardiology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada (N.P.)
| | - Bernard Prendergast
- Department of Cardiology, St. Thomas' Hospital, London, United Kingdom (B.P.)
- Cleveland Clinic London, United Kingdom (B.P.)
| | - Yuan Feng
- Department of Cardiology (J.H., T.-Y.X., Y.-J.Y., Y.P., J.-F.W., Z.-G.Z., Y.-W.O., Q.L., X.W., Z.Z., H.-R.Y., K.J., Y.F., M.C.), West China Hospital, Sichuan University
| | - Mao Chen
- Department of Cardiology (J.H., T.-Y.X., Y.-J.Y., Y.P., J.-F.W., Z.-G.Z., Y.-W.O., Q.L., X.W., Z.Z., H.-R.Y., K.J., Y.F., M.C.), West China Hospital, Sichuan University
- Laboratory of Heart Valve Disease (T.-Y.X., Z.-G.Z., H.-R.Y., M.C.), West China Hospital, Sichuan University
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Shi WY, Malarczyk A, Watson RA, Patel P, Newell P, Awtry J, McGurk S, Kaneko T. Impact of reintervention after index aortic valve replacement on the risk of subsequent mortality. JTCVS OPEN 2023; 16:93-102. [PMID: 38204628 PMCID: PMC10775045 DOI: 10.1016/j.xjon.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/29/2023] [Accepted: 07/25/2023] [Indexed: 01/12/2024]
Abstract
Objectives The use of bioprosthetic aortic valve replacement (AVR) is inherently associated with a risk of structural valve degeneration (SVD) and the need for aortic valve (AV) reintervention. We sought to evaluate whether AV reintervention, in the form of repeat surgical AVR (SAVR) or valve-in-valve transcatheter aortic valve replacement (ViV-TAVR), negatively affects patients' subsequent long-term survival after index SAVR. Methods We identified patients who had undergone bioprosthetic SAVR from 2002 to 2017 at our institution. Median longitudinal follow-up after index SAVR was 7.3 years (10.9 years for those with and 7.2 years for those without AV reintervention), and median follow-up after AV reintervention was 1.9 years. Cox regression analyses using AV reintervention (re-SAVR and ViV-TAVR) as a time-varying covariate were used to determine the impact of reintervention on subsequent survival. Results Of 4167 patients who underwent index SAVR, 139 (3.3%) required AV reintervention for SVD, with re-SAVR being performed in 65 and ViV-TAVR in 74. Median age at the index SAVR was 73 years (interquartile range, 64-79 years), and 2541 (61%) were male. Overall, there were total of 1171 mortalities observed, of which 13 occurred after re-SAVR and 9 after ViV-TAVR. AV reintervention was associated with a greater risk of subsequent mortality compared with those patients who did not require AV reintervention (hazard ratio, 2.53; 95% confidence interval, 1.64-3.88, P < .001). This increased risk of subsequent mortality was more pronounced for those who received their index AVR when <65 years of age (hazard ratio, 5.60; 95% confidence interval, 2.57-12.22, P < .001) versus those ≥65 years (2.06, 1.21-3.52, P = .008). Direct comparison of survival between those who underwent re-SAVR versus ViV-TAVR showed 5-year survival to be comparable (re-SAVR: 74% vs ViV-TAVR: 80%, P = .67). Conclusions Among patients receiving bioprosthetic AVR, an AV reintervention for SVD is associated with an increased risk of subsequent mortality, regardless of re-SAVR or ViV-TAVR, and this risk is greater among younger patients. These findings should be balanced with individual preferences at index AVR in the context of patients' lifetime management of aortic stenosis.
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Affiliation(s)
- William Y. Shi
- Department of Cardiovascular Surgery, Northwell Health, New York, NY
| | | | - Ryan A. Watson
- Division of Cardiology, Allegheny Health Network, Pittsburgh, Pa
| | - Prem Patel
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Mass
| | - Paige Newell
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Mass
| | - Jake Awtry
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Mass
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Mass
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University in St Louis, St Louis, Mo
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Lu F, Wu B, Li J, Xu N, Jiang H, Shu X, Wang Y. Left ventricular myocardial work for the prediction of postoperative outcomes in patients with bicuspid aortic stenosis. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2497-2506. [PMID: 37831293 DOI: 10.1007/s10554-023-02959-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023]
Abstract
Chronic elevation of left ventricular (LV) afterload contributes to adverse LV remodeling and myocardial impairment in bicuspid aortic valve (BAV) patients with severe aortic stenosis (AS). Incorporating LV afterload into global longitudinal strain (GLS) analysis, myocardial work facilitates early detection of LV dysfunction. The present study was to evaluate myocardial work in BAV patients with severe AS undergoing surgical aortic valve replacement (SAVR) and to evaluate its prognostic impact on early postoperative outcomes. Between January 2021 and March 2022, BAV patients with severe AS scheduled for SAVR were included and underwent comprehensive transthoracic echocardiography. Quantification of LV myocardial work was performed to obtain LV global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). Clinical outcome was defined as a composite of major cardiovascular events including mortality, myocardial infarction, stroke, acute kidney injury, low cardiac output syndrome and vascular complications during hospitalization or within 30 days after operation. Among 103 BAV patients with severe AS undergoing SAVR (mean age of 65 ± 9 years, 57.3% male), 22 experienced postoperative major cardiovascular events. BAV patients with major cardiovascular events demonstrated lower LV GWI (P < 0.001) and GCW (P = 0.002) along with elder age (P = 0.030), decreased LVGLS (P = 0.026) and right ventricular longitudinal strain (P = 0.019), and higher prevalence of abnormal average E/e' ratio (P = 0.029) than those without major events. Decreased LV GWI and GCW was independently associated with the occurrence of major cardiovascular events (P < 0.01 for adjusted OR). Multivariable logistic regression model including LV GWI demonstrated superior power than the model including LVGLS and yielded best discrimination for BAV patients with and without major cardiovascular events during early postoperative period. Echocardiography-based LV myocardial work overcomes the limitations of LVGLS and presents as a promising novel index for the early detection of functional myocardial damage and the optimization of intervention timing among BAV patients with severe AS.
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Affiliation(s)
- Feiwei Lu
- Department of Echocardiography, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China
| | - Boting Wu
- Department of Transfusion, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Jun Li
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China
| | - Nuo Xu
- Department of Echocardiography, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China
| | - Hao Jiang
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yongshi Wang
- Department of Echocardiography, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China.
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Xiao Z, Yao J, Liu X, Yuan F, Yan Y, Luo T, Wang M, Zhang H, Ren F, Song G. Determinants of device success after transcatheter aortic valve replacement in patients with type-0 bicuspid aortic stenosis. Front Cardiovasc Med 2023; 10:1279687. [PMID: 38028471 PMCID: PMC10657190 DOI: 10.3389/fcvm.2023.1279687] [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: 08/18/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Clinical evidence of transcatheter aortic valve replacement in patients with type-0 bicuspid aortic valve was relatively scarce. Aims Our goal was to explore determinants of device success after transcatheter aortic valve replacement in patients with type-0 bicuspid aortic valve morphology. Methods In this retrospective multicenter analysis, we included 59 patients with symptomatic severe aortic stenosis with type-0 bicuspid aortic valve morphology who underwent transcatheter aortic valve replacement. Type-0 bicuspid aortic valve was identified with multidetector computed tomography scans. The technical success rate was 89.8%, and the device success rate was 81.4%. Patients were divided into a device success group and a device failure group according to Valve Academic Research Consortium- 3 criteria. Results When we compared the two groups, we found that the ellipticity index of the aortic root and the presence of bulky calcifications at the commissure were statistically different (ellipticity index 35.7 ± 1.7 vs. 29.7 ± 1.1, p = 0.018; bulky calcification at the commissure, 54.5% vs. 4.5%, p < 0.001). Further multivariate logistic analysis showed that bulky calcification at the commissure had a negative correlation with device success (odds ratio 0.030, 95% confidence interval 0.003-0.285, p = 0.002). Yet there was no statistical correlation between the ellipticity index and device success (odds ratio 0.818, 95% confidence interval 0.667-1.003, p = 0.053). Conclusions The presence of bulky calcifications at the commissure is negatively correlated with device success after transcatheter aortic valve replacement in patients with type-0 bicuspid aortic valve.
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Affiliation(s)
- Zhicheng Xiao
- Department of Cardiology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Jing Yao
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xinmin Liu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fei Yuan
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yunfeng Yan
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Taiyang Luo
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Moyang Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hongliang Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Faxin Ren
- Department of Cardiology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Guangyuan Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Hu M, Shi S, Peng X, Pu X, Yu X. A synergistic strategy of dual-crosslinking and loading intelligent nanogels for enhancing anti-coagulation, pro-endothelialization and anti-calcification properties in bioprosthetic heart valves. Acta Biomater 2023; 171:466-481. [PMID: 37793601 DOI: 10.1016/j.actbio.2023.09.045] [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] [Received: 05/04/2023] [Revised: 09/07/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023]
Abstract
Currently, glutaraldehyde (GA)-crosslinked bioprosthetic heart valves (BHVs) still do not guarantee good biocompatibility and long-term effective durability for clinical application due to their subacute thrombus, inflammation, calcification, tearing and limited durability. In this study, double-modified xanthan gum (oxidized/vinylated xanthan gum (O2CXG)) was acquired from xanthan gum for subsequent double crosslinking and modification platform construction. Sulfonic acid groups with anticoagulant properties were also introduced through the free radical polymerization of vinyl sulfonate (VS) and vinyl on O2CXG. Taking advantage of the drug-loading function of xanthan gum, the treated pericardium was further loaded with inflammation-triggered dual drug-loaded nanogel (heparin (Hep) and atorvastatin (Ator)). Mechanical properties of O2CXG-crosslinked porcine pericardium (O2CXG-PP) were significantly improved via the first network formed by Schiff base bonds and the second C-C bonds network. Due to the presence of sulfonic acid groups as well as the dual drug release from nanogels under the stimulation of H2O2, the hemocompatibility, anti-inflammatory, pro-endothelialization and anti-calcification properties of the crosslinked pericardium modified with nanogels loaded with Hep and Ator (O2CXG+VS+(Hep+Ator) nanogel-PP) was significantly better than that of GA-crosslinked PP (GA-PP). The collaborative strategy of double crosslinking and sequential release of anticoagulant/endothelium-promoting drugs triggered by inflammation could effectively meet the requirement of enhanced multiple performance and long-term durability of bioprosthetic heart valves and provide a valuable pattern for multi-functionalization of blood contacting materials. STATEMENT OF SIGNIFICANCE: Currently, glutaraldehyde-crosslinked bioprosthetic heart valves (BHVs) are subject to subacute thrombus, inflammation, calcification and tearing, which would not guarantee good biocompatibility and long-term effective durability. We developed a cooperative strategy of double crosslinking and surface modification in which double-modified xanthan gum plays a cornerstone. The mechanical properties of this BHV were significantly improved via the first network formed by Schiff base bonds and the second C-C bonds network. Inflammation-triggered combination delivery of heparin and atorvastatin has been demonstrated to enhance anticoagulation, anti-inflammatory and pro-endothelialization of BHVs by utilizing local inflammatory response. The collaborative strategy could effectively meet the requirement of enhanced multiple performance and long-term durability of BHVs and provide a valuable pattern for the multi-functionalization of blood-contacting materials.
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Affiliation(s)
- Mengyue Hu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China
| | - Shubin Shi
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China
| | - Xu Peng
- Experimental and Research Animal Institute, Sichuan University, Chengdu 610065, PR China
| | - Xinyun Pu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China
| | - Xixun Yu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China.
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Sullivan AE, Levack MM, Barker CM, Goel K. Backed Against a Wall: Iatrogenic Type A Aortic Dissection Pinned by Transcatheter Aortic Valve. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100218. [PMID: 38046863 PMCID: PMC10692345 DOI: 10.1016/j.shj.2023.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/23/2023] [Accepted: 08/10/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Alexander E. Sullivan
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melissa M. Levack
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Colin M. Barker
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kashish Goel
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Dayawansa NH, Noaman S, Teng LE, Htun NM. Transcatheter Aortic Valve Therapy for Bicuspid Aortic Valve Stenosis. J Cardiovasc Dev Dis 2023; 10:421. [PMID: 37887868 PMCID: PMC10607300 DOI: 10.3390/jcdd10100421] [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: 09/11/2023] [Revised: 10/01/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become first-line treatment for older adults with severe aortic stenosis (AS), however, patients with bicuspid aortic valve (BAV) have been traditionally excluded from randomised trials and guidelines. As familiarity and proficiency of TAVI operators have improved, case-series and observational data have demonstrated the feasibility of successful TAVI in bicuspid aortic valve aortic stenosis (BAV-AS), however, patients with BAV-AS have several distinct characteristics that influence the likelihood of TAVI success. This review aims to summarise the pathophysiology and classification of BAV, published safety data, anatomical challenges and procedural considerations essential for pre-procedural planning, patient selection and procedural success of TAVI in BAV.
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Affiliation(s)
- Nalin H. Dayawansa
- Alfred Health, Melbourne, VIC 3004, Australia; (N.H.D.); (S.N.); (L.E.T.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
- Baker Heart & Diabetes Institute, Melbourne, VIC 3004, Australia
| | - Samer Noaman
- Alfred Health, Melbourne, VIC 3004, Australia; (N.H.D.); (S.N.); (L.E.T.)
- Western Health, St Albans, VIC 3021, Australia
| | - Lung En Teng
- Alfred Health, Melbourne, VIC 3004, Australia; (N.H.D.); (S.N.); (L.E.T.)
| | - Nay Min Htun
- Alfred Health, Melbourne, VIC 3004, Australia; (N.H.D.); (S.N.); (L.E.T.)
- Peninsula Health, Frankston, VIC 3199, Australia
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Yousef S, Bianco V, Kliner D, Toma C, Serna-Gallegos D, West D, Makani A, Zhu J, Thoma FW, Brown JA, Ogami T, Sultan I. Outcomes of Transcatheter Aortic Valve Replacement in Patients With Concomitant Aortic Regurgitation. Ann Thorac Surg 2023; 116:728-734. [PMID: 36791833 DOI: 10.1016/j.athoracsur.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/12/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND This study sought to evaluate outcomes of transcatheter aortic valve replacement (TAVR) in patients with moderate or greater aortic regurgitation (AR). METHODS This was an observational study using an institutional database of TAVRs from November 2012 to April 2022. The study compared outcomes of TAVR in patients with isolated aortic stenosis (AS) vs patients with AS and concomitant AR (moderate or greater). Those patients with trace or mild AR were excluded. Clinical and echocardiographic outcomes were compared, with end points established by the Valve Academic Research Consortium 3. Kaplan-Meier survival estimation and Cox regression for mortality were performed. Competing-risk cumulative incidence estimates for heart failure readmissions were also compared. RESULTS Of 3295 patients, 605 (53.4%) had severe AS with no AR and 529 (46.6%) had severe AS with moderate or severe AR. There were no significant differences in in-hospital mortality, length of stay, stroke, myocardial infarction, permanent pacemaker requirement, transfusion requirement, minor or major vascular complications, or 30-day readmissions between the 2 groups (P > .05). There were also no significant differences in annular dissection or rupture, coronary obstruction, or device embolization. Mean gradient and paravalvular leak rates at 30 days and 1 year were similar between the groups. Survival estimates were comparable, and, on multivariable Cox regression, mixed aortic valvular disease was not associated with an increased hazard of death as compared with isolated AS (hazard ratio, 1.01; 95% CI, 0.81-1.25; P = .962). Cumulative incidence estimates for heart failure readmissions were comparable between groups. CONCLUSIONS TAVR can be safely performed in patients with mixed valvular disease, with outcomes comparable to those in isolated AS.
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Affiliation(s)
- Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Valentino Bianco
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dustin Kliner
- Heart and Vascular Institute, University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
| | - Catalin Toma
- Heart and Vascular Institute, University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
| | - David West
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
| | - Amber Makani
- Heart and Vascular Institute, University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
| | - Jianhui Zhu
- Heart and Vascular Institute, University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
| | - Floyd W Thoma
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
| | - James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Takuya Ogami
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center Pittsburgh, Pennsylvania.
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Bulut HI, Arjomandi Rad A, Syrengela AA, Ttofi I, Djordjevic J, Kaur R, Keiralla A, Krasopoulos G. A Comprehensive Review of Management Strategies for Bicuspid Aortic Valve (BAV): Exploring Epidemiology, Aetiology, Aortopathy, and Interventions in Light of Recent Guidelines. J Cardiovasc Dev Dis 2023; 10:398. [PMID: 37754827 PMCID: PMC10531880 DOI: 10.3390/jcdd10090398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVE bicuspid aortic valve (BAV) stands as the most prevalent congenital heart condition intricately linked to aortic pathologies encompassing aortic regurgitation (AR), aortic stenosis, aortic root dilation, and aortic dissection. The aetiology of BAV is notably intricate, involving a spectrum of genes and polymorphisms. Moreover, BAV lays the groundwork for an array of structural heart and aortic disorders, presenting varying degrees of severity. Establishing a tailored clinical approach amid this diverse range of BAV-related conditions is of utmost significance. In this comprehensive review, we delve into the epidemiology, aetiology, associated ailments, and clinical management of BAV, encompassing imaging to aortic surgery. Our exploration is guided by the perspectives of the aortic team, spanning six distinct guidelines. METHODS We conducted an exhaustive search across databases like PubMed, Ovid, Scopus, and Embase to extract relevant studies. Our review incorporates 84 references and integrates insights from six different guidelines to create a comprehensive clinical management section. RESULTS BAV presents complexities in its aetiology, with specific polymorphisms and gene disorders observed in groups with elevated BAV prevalence, contributing to increased susceptibility to other cardiovascular conditions. The altered hemodynamics inherent to BAV instigate adverse remodelling of the aorta and heart, thus fostering the development of epigenetically linked aortic and heart diseases. Employing TTE screening for first-degree relatives of BAV patients might be beneficial for disease tracking and enhancing clinical outcomes. While SAVR is the primary recommendation for indicated AVR in BAV, TAVR might be an option for certain patients endorsed by adept aortic teams. In addition, proficient teams can perform aortic valve repair for AR cases. Aortic surgery necessitates personalized evaluation, accounting for genetic makeup and risk factors. While the standard aortic replacement threshold stands at 55 mm, it may be tailored to 50 mm or even 45 mm based on patient-specific considerations. CONCLUSION This review reiterates the significance of considering the multifactorial nature of BAV as well as the need for further research to be carried out in the field.
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Affiliation(s)
- Halil Ibrahim Bulut
- Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey;
| | | | | | - Iakovos Ttofi
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, UK; (I.T.); (J.D.); (R.K.); (A.K.)
| | - Jasmina Djordjevic
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, UK; (I.T.); (J.D.); (R.K.); (A.K.)
| | - Ramanjit Kaur
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, UK; (I.T.); (J.D.); (R.K.); (A.K.)
| | - Amar Keiralla
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, UK; (I.T.); (J.D.); (R.K.); (A.K.)
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, UK; (I.T.); (J.D.); (R.K.); (A.K.)
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Fang J, Qian Y, Chen J, Xu D, Cao N, Zhu G, Hu W, Hu H, Qian N, Yang S, Wang J, Liu X. Human antigen R regulates autophagic flux by stabilizing autophagy-associated mRNA in calcific aortic valve disease. Cardiovasc Res 2023; 119:2117-2129. [PMID: 37183487 DOI: 10.1093/cvr/cvad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 03/23/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
AIMS The incidence of calcific aortic valve disease (CAVD) has risen over the last decade and is expected to continue rising; however, pharmacological approaches have proven ineffective. In this study, we evaluated the role and underlying mechanisms of human antigen R (HuR)-mediated post-transcriptional regulation in CAVD. METHODS AND RESULTS We found that HuR was significantly upregulated in human calcified aortic valves and primary aortic valvular interstitial cells (VICs) following osteogenic stimulation. Subsequent functional studies revealed that HuR silencing ameliorated calcification both in vitro and in vivo. For the first time, we demonstrated that HuR directly interacted with the transcript of phosphatidylinositol-5-phosphate 4-kinase, type II, alpha (PIP4K2A), which mediates phosphatidylinositol signalling, facilitates autophagy, and acts as an mRNA stabilizer. HuR positively modulated PIP4K2A expression at the post-transcriptional level and consequently influenced the AKT/mTOR/ATG13 pathway to regulate autophagy and CAVD progression. CONCLUSION Our study provides new insights into the post-transcriptional regulatory role of HuR in modulating autophagy-positive factors to regulate the pathogenesis of CAVD. Our findings highlight the potential of HuR as an innovative therapeutic target in CAVD treatment.
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Affiliation(s)
- Juan Fang
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Cardiovascular Disease of Zhejiang Province, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yi Qian
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Cardiovascular Disease of Zhejiang Province, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
- Department of Cardiology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, China
| | - Jinyong Chen
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Cardiovascular Disease of Zhejiang Province, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Dilin Xu
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Cardiovascular Disease of Zhejiang Province, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Naifang Cao
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Cardiovascular Disease of Zhejiang Province, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Gangjie Zhu
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Cardiovascular Disease of Zhejiang Province, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Wangxing Hu
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Cardiovascular Disease of Zhejiang Province, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Haochang Hu
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Cardiovascular Disease of Zhejiang Province, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Ningjing Qian
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Cardiovascular Disease of Zhejiang Province, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Shuangshuang Yang
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Cardiovascular Disease of Zhejiang Province, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Cardiovascular Disease of Zhejiang Province, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xianbao Liu
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Cardiovascular Disease of Zhejiang Province, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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Mihailovič PM, Žižek D, Vitez L, Holc P, Klokočovnik T, Bunc M. Case report: A complex case of valve-in-valve TAVI and left bundle branch pacing for severe aortic regurgitation with partially corrected type A aortic dissection and low ejection fraction. Front Cardiovasc Med 2023; 10:1206811. [PMID: 37636302 PMCID: PMC10449538 DOI: 10.3389/fcvm.2023.1206811] [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: 04/16/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
Background Aortic regurgitation is a major concern following transcatheter aortic valve implantation (TAVI), as even low-grade regurgitation is associated with increased mortality. This is of particular concern to patients with pre-existing aortic disease who are at increased risk of TAVI valve slippage. Furthermore, conduction system disturbances after TAVI, namely left bundle branch block (LBBB), may have an additional detrimental effect on cardiac function. Case presentation This report documents a successful treatment strategy in a frail patient with a bicuspid aortic valve and aortic disease after valve-sparing surgical repair in 1998, who subsequently developed aortic stenosis and underwent TAVI with an Evolut R self-expanding aortic valve. The progression of aortic disease, aortic root dilatation, and leaflet degeneration over the following years caused aortic regurgitation of the self-expanding aortic valve, resulting in left ventricular dilatation and heart failure along with LBBB and left ventricular (LV) mechanical dyssynchrony. Diagnostic workup of the patient showed persistence of the aneurysm distal to the graft with a dissection spanning the ascending aorta, arch, and terminating proximal to the aortic isthmus. After consideration by the cardiac team, a balloon-expandable valve was chosen for a valve-in-valve (ViV) procedure to provide sufficient radial force to expand the existing valve and correct the regurgitation. Due to the anatomy, a J-wire and pigtail catheter were successfully used for a safe approach and placement of the valve. Following the procedure, intermittent complete atrioventricular block was observed in addition to the pre-existing left bundle branch block, necessitating resynchronization pacing. Due to anatomical considerations, ease of placement, and the expected good level of resynchronization due to the proximal block, we opted for left bundle branch pacing, which showed improvement in left ventricular dyssynchrony and LV function at follow-up. Conclusion Valve-in-valve implantation of a balloon-expandable Myval TAVI device to treat aortic regurgitation caused by slippage and right leaflet disfunction of slef valve is feasible in challenging anatomical scenarios. Left bundle branch pacing is a viable alternative to correct mechanical dyssynchrony in complex patients with LBBB and anatomical challenges necessitating resynchronization.
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Affiliation(s)
| | - David Žižek
- Department of Cardiology, University Medical Center Ljubljana, Slovenia
| | - Luka Vitez
- Department of Cardiology, University Medical Center Ljubljana, Slovenia
| | - Primoz Holc
- Department of Cardiology, University Medical Center Ljubljana, Slovenia
| | - Tomislav Klokočovnik
- Department of Cardiovascular Surgery, University Medical Center Ljubljana, Slovenia
| | - Matjaž Bunc
- Department of Cardiology, University Medical Center Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Slovenia
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Yao YJ, Zhao ZG, Wang X, Peng Y, Wei JF, He S, Li YJ, He JJ, Zhu ZK, Feng Y, Chen M. Snaring Self-Expanding Devices to Facilitate Transcatheter Aortic Valve Replacement in Patients with Complex Aortic Anatomies. J Clin Med 2023; 12:5067. [PMID: 37568469 PMCID: PMC10420027 DOI: 10.3390/jcm12155067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
The snare-assisted technique has been described to facilitate transcatheter aortic valve replacement (TAVR) delivery system advancement in complex aortic anatomies. However, the evidence is limited to case reports. To evaluate the safety profile of the snare-facilitated approach and its impact on self-expanding (SE) TAVR outcomes, we collected consecutive patients who underwent transfemoral SE-TAVR for aortic stenosis, using propensity score matching (PSM) separately in tricuspid and type-0 and type-1 bicuspid aortic valve morphology between the snare and non-snare groups. In 766 patients, despite the snare group having significantly larger annulus angulation and maximal ascending aortic diameter, both groups achieved comparable 30-day device success rates, regardless of first-generation or new-generation valve use. After PSM, the snare group had a significantly lower new permanent pacemaker implantation rate among 193 type-0 patients (3.3% vs. 18.3%, p = 0.01). The ipsilateral group used new-generation valves less frequently (23.0% vs. 75.4%, p < 0.001), but there were no significant inter-group differences in procedure-related events, except for a lower incidence of PVL ≥ mild in the ipsilateral group (14.9% vs. 32.3%, p = 0.01). In conclusion, the snare-assisted technique appears useful in SE-TAVR with angulated aortic root anatomy, and the benefits were comparable between ipsilateral and contralateral snare techniques.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.-J.Y.); (Y.P.); (J.-F.W.); (S.H.); (Y.-J.L.); (J.-J.H.); (Z.-K.Z.)
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.-J.Y.); (Y.P.); (J.-F.W.); (S.H.); (Y.-J.L.); (J.-J.H.); (Z.-K.Z.)
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Taduru SS, Ramakrishnan M, Pamulapati H. Successful Transcatheter Aortic Valve Replacement in an Elderly Patient with Calcified Bicuspid Aortic Valve with Calcified Raphe: A Case Report. Cureus 2023; 15:e41850. [PMID: 37583742 PMCID: PMC10423847 DOI: 10.7759/cureus.41850] [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: 07/13/2023] [Indexed: 08/17/2023] Open
Abstract
At present, transcatheter aortic valve replacement (TAVR) is not only used in high-surgical-risk patients with aortic stenosis (AS), but its use has also been extended to low-risk patients, resulting in its increasing utilization in patients with bicuspid aortic valve (BAV). BAV however presents unique challenges for TAVR due to its distinct valvular anatomy, and surgical aortic valve replacement (SAVR) remains the primary recommended method of aortic valve replacement in patients with BAV. Nonetheless, observational data have been quickly accumulating regarding the successful use of TAVR in BAV. Here, we present a case of a 73-year-old female who presented with heart failure symptoms and was found to have severe AS and BAV with calcified raphe (Sievers 1a). Due to her age and complicated medical history, including coronary artery disease and chronic kidney disease, she was considered to be at intermediate surgical risk (Society of Thoracic Surgeons (STS) score 5.4%) and underwent TAVR with the successful deployment of a 29 mm Edwards SAPIEN valve (Edwards Lifesciences, California, USA). A post-procedure echocardiogram confirmed the appropriate placement of the prosthesis without any valvular or paravalvular regurgitation. This case, therefore, adds to the growing body of evidence regarding the use of TAVR in patients with BAV despite anatomical challenges.
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Affiliation(s)
- Siva Sagar Taduru
- Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, USA
| | - Madhuri Ramakrishnan
- Nephrology, Hays Medical Center, Hays, USA
- Nephrology, University of Kansas Medical Center, Kansas City, USA
| | - Hema Pamulapati
- Cardiovascular Disease, University of Kansas Medical Center, Kansas City, USA
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Chen ZY, Mao SF, Guo LH, Qin J, Yang LX, Liu Y. Effect of maternal pregestational diabetes mellitus on congenital heart diseases. World J Pediatr 2023; 19:303-314. [PMID: 35838899 DOI: 10.1007/s12519-022-00582-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The increasing population of diabetes mellitus in adolescent girls and women of childbearing age contributes to a large number of pregnancies with maternal pregestational diabetes mellitus. Congenital heart diseases are a common adverse outcome in mothers with pregestational diabetes mellitus. However, there is little systematic information between maternal pregestational diabetes mellitus and congenital heart diseases in the offspring. DATA SOURCES Literature selection was performed in PubMed. One hundred and seven papers were cited in our review, including 36 clinical studies, 26 experimental studies, 31 reviews, eight meta-analysis articles, and six of other types. RESULTS Maternal pregestational diabetes mellitus poses a high risk of congenital heart diseases in the offspring and causes variety of phenotypes of congenital heart diseases. Factors such as persistent maternal hyperglycemia, oxidative stress, polymorphism of uncoupling protein 2, polymorphism of adiponectin gene, Notch 1 pathway, Nkx2.5 disorders, dysregulation of the hypoxia-inducible factor 1, and viral etiologies are associated with the occurrence of congenital heart diseases in the offspring of mothers with pregestational diabetes mellitus. Treatment options including blood sugar-reducing, anti-oxidative stress drug supplements and exercise can help to prevent maternal pregestational diabetes mellitus from inducing congenital heart diseases. CONCLUSIONS Our review contributes to a better understanding of the association between maternal pregestational diabetes mellitus and congenital heart diseases in the offspring and to a profound thought of the mechanism, preventive and therapeutic measurements of congenital heart diseases caused by maternal pregestational diabetes mellitus.
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Affiliation(s)
- Zhi-Yan Chen
- Department of Basic Medical Sciences, Sichuan Vocational College of Health and Rehabilitation, Zigong, 643000, China
| | - Shuang-Fa Mao
- Department of Basic Medical Sciences, Sichuan Vocational College of Health and Rehabilitation, Zigong, 643000, China
| | - Ling-Hong Guo
- Department of Pharmacology, West China School of Basic Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Jian Qin
- Department of Basic Medical Sciences, Sichuan Vocational College of Health and Rehabilitation, Zigong, 643000, China
| | - Li-Xin Yang
- Department of Basic Medical Sciences, Sichuan Vocational College of Health and Rehabilitation, Zigong, 643000, China
| | - Yin Liu
- Department of Basic Medical Sciences, Sichuan Vocational College of Health and Rehabilitation, Zigong, 643000, China.
- Department of Pharmacology, West China School of Basic Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China.
- Department of Anesthesiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610000, China.
- Animal Research Institute, Sichuan University, Chengdu, China.
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Elkoumy A, Jose J, Terkelsen CJ, Nissen H, Gunasekaran S, Abdelshafy M, Seth A, Elzomor H, Kumar S, Bedogni F, Ielasi A, Arsang-Jang S, Dora SK, Chandra S, Parikh K, Unic D, Baumbach A, Serruys P, Soliman O. One-Year Outcomes after Myval Implantation in Patients with Bicuspid Aortic Valve Stenosis-A Multicentre Real-World Experience. J Clin Med 2023; 12:jcm12062398. [PMID: 36983397 PMCID: PMC10054138 DOI: 10.3390/jcm12062398] [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: 01/30/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Bicuspid aortic valve (BAV) affects approximately 1.5% of the general population and is seen in nearly 50% of candidates for aortic valve replacement (AVR). Despite increasingly utilised transcatheter aortic valve implantation (TAVI) in aortic stenosis (AS) patients, its use among patients with severe bicuspid AS is limited as BAV is a heterogeneous disease associated with multiple and complex anatomical challenges. AIM To investigate the one-year outcomes of TAVI using the balloon-expandable Myval transcatheter heart valve (THV) (Meril Life Sciences Pvt. Ltd., Vapi, India) in patients with severe bicuspid AS. METHODS AND RESULTS We collected data from consecutive patients with bicuspid AS who underwent TAVI with the Myval THV and had at least one-year follow-up. Baseline characteristics, procedural, and 30-day echocardiographic and clinical outcomes were collected. Sixty-two patients were included in the study. The median age was 72 [66.3, 77.0] years, 45 (72.6%) were males, and the mean STS PROM score was 3.2 ± 2.2%. All TAVI procedures were performed via the transfemoral route. The median follow-up duration was 13.5 [12.2, 18.3] months; all-cause mortality was reported in 7 (11.3%) patients and cardiovascular hospitalisation in 6 (10.6%) patients. All-stroke was reported in 2 (3.2%), permanent pacemaker implantation 5 (8.3%), and myocardial infarction 1 (1.6%) patients. The echocardiographic assessment revealed a mean pressure gradient of 10 [8, 16.5] mmHg, effective orifice area 1.7 [1.4, 1.9] cm2, moderate AR in 1 (2%), mild AR in 14 (27%), and none/trace AR in 37 (71%). In total, 1 patient was diagnosed with valve thrombosis (2.1%), Stage II (moderate) haemodynamic deterioration was seen in 3 (6.4%), and stage III (severe) haemodynamic deterioration in 1 (2.1%) patient. CONCLUSIONS TAVI with the Myval THV in selected BAV anatomy is associated with favourable one-year hemodynamic and clinical outcomes.
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Affiliation(s)
- Ahmed Elkoumy
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
- Islamic Center of Cardiology, Al-Azhar University, Cairo 11651, Egypt
| | - John Jose
- Christian Medical College & Hospital, Vellore 632004, India
| | | | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark
| | | | - Mahmoud Abdelshafy
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
- Department of Cardiology, Al-Azhar University, Cairo 11311, Egypt
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi 110025, India
| | - Hesham Elzomor
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
| | - Sreenivas Kumar
- Department of Cardiology, Apollo Hospitals, Apollo Health City, Jubilee Hills, Hyderabad 500050, India
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, 20149 Milan, Italy
| | - Shahram Arsang-Jang
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
- CÚRAM-SFI Research Centre for Medical Devices, H91 TK33 Galway, Ireland
| | | | - Sharad Chandra
- Department of Cardiology, King George's Medical University, Lucknow 226003, India
| | - Keyur Parikh
- Care Institute of Medical Sciences, Ahmedabad 380060, India
| | - Daniel Unic
- Department of Cardiac and Transplant Surgery, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Andreas Baumbach
- Barts Heart Centre, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - Patrick Serruys
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, 20149 Milan, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London SW7 2AZ, UK
| | - Osama Soliman
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
- CÚRAM-SFI Research Centre for Medical Devices, H91 TK33 Galway, Ireland
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Sanaiha Y, Hadaya JE, Tran Z, Shemin RJ, Benharash P. Transcatheter and Surgical Aortic Valve Replacement in Patients With Bicuspid Aortic Valve Stenosis. Ann Thorac Surg 2023; 115:611-618. [PMID: 35841951 DOI: 10.1016/j.athoracsur.2022.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/07/2022] [Accepted: 06/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is not widely used in patients with bicuspid aortic valve (BAV) disease and has not yet been studied in randomized clinical trials. We characterized the rate of use and outcomes of TAVR and surgical aortic valve replacement (SAVR) in patients with BAV. METHODS Adults with BAV stenosis receiving SAVR or TAVR procedures were abstracted from the 2012 to 2019 Nationwide Readmissions Database (NRD). Risk-adjusted analyses were performed with NRD-provided weights and inverse probability of treatment weights (IPTW) to examine the association of treatment strategy on inpatient mortality, complications, and hospitalization resource utilization. Nonelective readmissions within 90 days of discharge and reintervention at the first readmission were also examined. RESULTS Of an estimated 56 331 patients with BAV requiring aortic valve replacement, 6.8% underwent TAVR. Unadjusted analysis demonstrated higher index hospitalization mortality for TAVR compared with SAVR. Upon risk adjustment using NRD-provided weights, the odds of pacemaker implantation remained significantly higher for TAVR patients compared with SAVR, with no significant difference in mortality. When NRD-provided survey weights were applied, TAVR had higher rates of 90-day readmission. Adjustment with inverse probability of treatment weights resolved these differences between the 2 groups. Regardless of the risk-adjustment method, the odds of reintervention were consistently higher among BAV TAVR patients compared with SAVR. CONCLUSIONS The present analysis demonstrates comparable in-hospital mortality and morbidity for TAVR and SAVR patients in the moderate-risk era. With increasing TAVR use in BAV, surgeons must further refine selection criteria with consideration of concomitant aortopathy and implications of reintervention.
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Affiliation(s)
- Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California
| | - Joseph E Hadaya
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California
| | - Zachary Tran
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California
| | - Richard J Shemin
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California.
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Slade JJ, Ambrosy AP, Leong TK, Sung SH, Garcia EA, Ku IA, Solomon MD, McNulty EJ, Rassi AN, Lange DC, Philip F, Go AS, Mishell JM. Outcomes of Adults with Severe Aortic Stenosis Undergoing Urgent or Emergent vs. Elective Transcatheter Aortic Valve Replacement Within an Integrated Health Care Delivery System. STRUCTURAL HEART 2023. [PMID: 37520133 PMCID: PMC10382976 DOI: 10.1016/j.shj.2023.100166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Background Transcatheter aortic valve replacement (TAVR) may be used to urgently or emergently treat severe aortic stenosis, but outcomes for this high-risk population have not been well-characterized. We sought to describe the incidence, clinical characteristics, and outcomes of patients undergoing urgent or emergent vs. elective TAVR. Methods We identified all adults who received TAVR for primary aortic stenosis between 2013 and 2019 within an integrated health care delivery system in Northern California. Elective or urgent/emergent procedure status was based on standard Society of Thoracic Surgeons definitions. Data were obtained from electronic health records, the Society of Thoracic Surgeons-American College of Cardiology Transcatheter Valve Therapy Registry, and state/national reporting databases. Logistic regression and Cox proportional hazard models were performed. Results Among 1564 eligible adults that underwent TAVR, 81 (5.2%) were classified as urgent/emergent. These patients were more likely to have heart failure (63.0% vs. 47.4%), reduced left ventricular ejection fraction (21.0% vs. 11.8%), or a prior aortic valve balloon valvuloplasty (13.6% vs. 5.0%) and experienced higher unadjusted rates of 30-day and 1-year morbidity and mortality. Urgent/emergent TAVR status was independently associated with non-improved quality of life at 30-days (hazard ratio, 4.87; p < 0.01) and acute kidney injury within 1-year post-TAVR (hazard ratio, 2.11; p = 0.01). There was not a significant difference in adjusted 1-year mortality with urgent/emergent TAVR. Conclusions Urgent/emergent TAVR status was uncommon and associated with high-risk clinical features and higher unadjusted rates of short- and long-term morbidity and mortality. Procedure status may be useful to identify patients less likely to experience significant short term improvement in health-related quality of life post-TAVR.
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Zhu Z, Xiong T, Chen M. Comparison of patients with bicuspid and tricuspid aortic valve in transcatheter aortic valve implantation. Expert Rev Med Devices 2023; 20:209-220. [PMID: 36815427 DOI: 10.1080/17434440.2023.2184686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has emerged as a safe and effective alternative to surgery for aortic stenosis (AS). However, there are still differences in the procedural process and outcome of bicuspid aortic valve (BAV) treated with TAVI compared with tricuspid aortic valve. AREAS COVERED This review paper aims to summarize the main characteristics and clinical evidence of TAVI in patients with bicuspid and tricuspid aortic valves and compare the outcomes of TAVI procedure. EXPERT OPINION The use of TAVI in patients with BAV has shown similar clinical outcomes compared with tricuspid aortic valve. The efficacy of TAVI for challenging BAV anatomies remains a concern due to the lack of randomized trials. Detailed preprocedural planning is of great importance in low-surgical-risk BAV patients. A better understanding of which subtypes of BAV anatomy are at greater risk for adverse outcomes can potentially benefit the selection of TAVI or open-heart surgery in low surgical risk AS patients.
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Affiliation(s)
- Zhongkai Zhu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Tianyuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Yu T, Li G, Chen X, Kuang D, Jiang Q, Guo Y, Wang Y. A versatile drug-controlled release polymer brush hybrid non-glutaraldehyde bioprosthetic heart valves with enhanced anti-inflammatory, anticoagulant and anti-calcification properties, and superior mechanical performance. Biomaterials 2023; 296:122070. [PMID: 36868031 DOI: 10.1016/j.biomaterials.2023.122070] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/14/2023] [Accepted: 02/26/2023] [Indexed: 03/02/2023]
Abstract
Transcatheter heart valve replacement (THVR) is a novel treatment modality for severe heart valves diseases and has become the main method for the treatment of heart valve diseases in recent years. However, the lifespan of the commercial glutaraldehyde cross-linked bioprosthetic heart valves (BHVs) used in THVR can only serve for 10-15 years, and the essential reason for the failure of the valve leaflet material is due to these problems such as calcification, coagulation, and inflammation caused by glutaraldehyde cross-linking. Herein, a kind of novel non-glutaraldehyde cross-linking agent bromo-bicyclic-oxazolidine (OX-Br) has been designed and synthesized with both crosslinking ability and in-situ atom transfer radical polymerization (ATRP) function. Then OX-Br treated porcine pericardium (OX-Br-PP) are stepwise modified with co-polymer brushes of reactive oxygen species (ROS) response anti-inflammatory drug conjugated block and anti-adhesion polyzwitterion polymer block through the in-situ ATRP reaction to obtain the functional BHV material MPQ@OX-PP. Along with the great mechanical properties and anti-enzymatic degradation ability similar to glutaraldehyde-crosslinked porcine pericardium (Glut-PP), good biocompatibility, improved anti-inflammatory effect, robust anti-coagulant ability and superior anti-calcification property have been verified for MPQ@OX-PP by a series of in vitro and in vivo investigations, indicating the excellent application potential as a multifunctional heart valve cross-linking agent for OX-Br. Meanwhile, the strategy of synergistic effect with in situ generations of reactive oxygen species-responsive anti-inflammatory drug blocks and anti-adhesion polymer brushes can effectively meet the requirement of multifaceted performance of bioprosthetic heart valves and provide a valuable reference for other blood contacting materials and functional implantable materials with great comprehensive performance.
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Affiliation(s)
- Tao Yu
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, 29 Wangjiang Road, Chengdu, 610064, China
| | - Gaocan Li
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, 29 Wangjiang Road, Chengdu, 610064, China
| | - Xiaotong Chen
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, 29 Wangjiang Road, Chengdu, 610064, China
| | | | - Qing Jiang
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, 29 Wangjiang Road, Chengdu, 610064, China
| | - Yingqiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, PR China.
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, 29 Wangjiang Road, Chengdu, 610064, China.
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Bhogal S, Rogers T, Aladin A, Ben-Dor I, Cohen JE, Shults CC, Wermers JP, Weissman G, Satler LF, Reardon MJ, Yakubov SJ, Waksman R. TAVR in 2023: Who Should Not Get It? Am J Cardiol 2023; 193:1-18. [PMID: 36857839 DOI: 10.1016/j.amjcard.2023.01.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/10/2023] [Accepted: 01/21/2023] [Indexed: 03/03/2023]
Abstract
Since the first transcatheter delivery of an aortic valve prosthesis was performed by Cribier et al in 2002, the picture of aortic stenosis (AS) therapeutics has changed dramatically. Initiated from an indication of inoperable to high surgical risk, extending to intermediate and low risk, transcatheter aortic valve replacement (TAVR) is now an approved treatment for patients with severe, symptomatic AS across all the risk categories. The current evidence supports TAVR as a frontline therapy for treating severe AS. The crucial question remains concerning the subset of patients who still are not ideal candidates for TAVR because of certain inherent anatomic, nonmodifiable, and procedure-specific factors. Therefore, in this study, we focus on these scenarios and reasons for referring selected patients for surgical aortic valve replacement in 2023.
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Affiliation(s)
- Sukhdeep Bhogal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amer Aladin
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Jeffrey E Cohen
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Christian C Shults
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Jason P Wermers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Gaby Weissman
- Department of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Michael J Reardon
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, Texas
| | - Steven J Yakubov
- Department of Cardiology, McConnell Heart Hospital at Riverside Methodist Hospital, Columbus, Ohio
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
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Rosalia L, Ozturk C, Goswami D, Bonnemain J, Wang SX, Bonner B, Weaver JC, Puri R, Kapadia S, Nguyen CT, Roche ET. Soft robotic patient-specific hydrodynamic model of aortic stenosis and ventricular remodeling. Sci Robot 2023; 8:eade2184. [PMID: 36812335 PMCID: PMC10280738 DOI: 10.1126/scirobotics.ade2184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023]
Abstract
Aortic stenosis (AS) affects about 1.5 million people in the United States and is associated with a 5-year survival rate of 20% if untreated. In these patients, aortic valve replacement is performed to restore adequate hemodynamics and alleviate symptoms. The development of next-generation prosthetic aortic valves seeks to provide enhanced hemodynamic performance, durability, and long-term safety, emphasizing the need for high-fidelity testing platforms for these devices. We propose a soft robotic model that recapitulates patient-specific hemodynamics of AS and secondary ventricular remodeling which we validated against clinical data. The model leverages 3D-printed replicas of each patient's cardiac anatomy and patient-specific soft robotic sleeves to recreate the patients' hemodynamics. An aortic sleeve allows mimicry of AS lesions due to degenerative or congenital disease, whereas a left ventricular sleeve recapitulates loss of ventricular compliance and diastolic dysfunction (DD) associated with AS. Through a combination of echocardiographic and catheterization techniques, this system is shown to recreate clinical metrics of AS with greater controllability compared with methods based on image-guided aortic root reconstruction and parameters of cardiac function that rigid systems fail to mimic physiologically. Last, we leverage this model to evaluate the hemodynamic benefit of transcatheter aortic valves in a subset of patients with diverse anatomies, etiologies, and disease states. Through the development of a high-fidelity model of AS and DD, this work demonstrates the use of soft robotics to recreate cardiovascular disease, with potential applications in device development, procedural planning, and outcome prediction in industrial and clinical settings.
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Affiliation(s)
- Luca Rosalia
- Health Sciences and Technology Program, Harvard–Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, USA
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Caglar Ozturk
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Debkalpa Goswami
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Health Sciences and Technology, ETH-Zürich, Zürich, Switzerland
- Institute of Robotics and Intelligent Systems, ETH-Zürich, Zürich, Switzerland
| | - Jean Bonnemain
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sophie X. Wang
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Benjamin Bonner
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, USA
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - James C. Weaver
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher T. Nguyen
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, USA
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Cardiovascular Innovation Research Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ellen T. Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
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Sa YK, Hwang BH, Chung WB, Lee KY, Lee J, Kang D, Ko YG, Yu CW, Kim J, Choi SH, Bae JW, Chae IH, Choi YS, Park CS, Yoo KD, Jeon DS, Kim HS, Chung WS, Chang K. Real-World Comparison of Transcatheter Versus Surgical Aortic Valve Replacement in the Era of Current-Generation Devices. J Clin Med 2023; 12:jcm12020571. [PMID: 36675500 PMCID: PMC9864945 DOI: 10.3390/jcm12020571] [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: 12/14/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/13/2023] Open
Abstract
Few studies have reported comparisons of out-of-hospital clinical outcomes after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS) in the era of current-generation valves that reflect the real-world situation. Data on patients with severe AS aged 65 years or older who underwent TAVR or SAVR between 2015 and 2018 were obtained from the National Health Insurance Service in Korea and clinical event rate was analyzed. The primary endpoint was all-cause death at 1 year. The cohort included a total of 4623 patients over 65 years of age, of whom 1269 (27.4%) were treated with TAVR. After 1:1 propensity score matching, 2120 patients were included in the study. TAVR was associated with reduced 1-year mortality (hazard ratio (HR): 0.55; 95% confidence interval (CI): 0.42−0.70; p < 0.001). There was no difference between the groups in the incidence of ischemic stroke (HR: 0.72, 95% CI: 0.43−1.20; p = 0.21) and intracranial hemorrhage (HR: 1.10; p = 0.74). Permanent pacemaker insertion was observed more frequently in the TAVR cohort (9.4% vs. 2.5%, HR: 3.95, 95% CI: 2.57−6.09; p < 0.001), whereas repeat procedures were rare in both treatments (0.5% vs. 0.3%, p = 0.499). In the nation-wide real-world data analysis, TAVR with current-generation devices showed significantly lower 1-year mortality compared to SAVR in severe AS patients.
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Affiliation(s)
- Young Kyoung Sa
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Woo-Baek Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kwan Yong Lee
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jungkuk Lee
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul 05545, Republic of Korea
| | - Dongwoo Kang
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul 05545, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University, Seoul 03722, Republic of Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University, Seoul 02841, Republic of Korea
| | - Juhan Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University, Gwangju 61469, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University, Seongnam 13620, Republic of Korea
| | - Yun-Seok Choi
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Chul Soo Park
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Ki Dong Yoo
- Division of Cardiology, Department of Internal Medicine, St. Vincent Hospital, The Catholic University of Korea, Suwon 65091, Republic of Korea
| | - Doo Soo Jeon
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon 06591, Republic of Korea
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University, Seoul 03080, Republic of Korea
| | - Wook-Sung Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Correspondence:
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Transcatheter Interventions for Atrioventricular Dysfunction in Patients with Adult Congenital Heart Disease: An International Case Series. J Clin Med 2023; 12:jcm12020521. [PMID: 36675450 PMCID: PMC9864755 DOI: 10.3390/jcm12020521] [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: 12/12/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION A substantial proportion of patients with adult congenital heart disease (ACHD) suffer from worsening valvular dysfunction in adulthood. Transcatheter valve interventions can offer a therapeutic alternative to surgery for those at high surgical risk. There is emerging but limited data on transcatheter interventions for atrioventricular (AV) valve dysfunction in patients with ACHD. METHODS We compiled an international collaborative multi-center registry focusing on adult patients with congenital heart disease undergoing transcatheter AV valve interventions (repair or replacement). Included were patients from three international centers who underwent procedures between 2016 and 2022. Demographic, clinical, and procedural data were compiled. RESULTS Nine patients with ACHD underwent AV valve interventions. The median age was 48 years (IQR (37; 56), 55% women). At baseline, seven patients (78%) were in NYHA functional class III and two (22%) were in NYHA functional class II. The diagnosis of ACHD varied. Three valve interventions were performed on the subpulmonary AV valve and six on the systemic AV valve. The primary valvular pathology was regurgitation (six patients, 78%). Five procedures were valve-in-valve interventions, and four procedures were transcatheter edge-to-edge repair procedures. There were no major complications or peri-procedural complications or peri-procedural mortality. One patient developed a suspected non-obstructive thrombus on the valve that was medically treated. One patient did not improve clinically following the procedure and underwent a heart transplant, one patient died 6 months following the procedure due to a cardiovascular implantable electronic device infection. At one year, six patients were in NYHA functional class I, and one patient was in NYHA functional class III. In conclusion, transcatheter AV heart valve interventions are feasible and safe procedures in carefully selected ACHD patients. These procedures can offer an effective treatment option in these younger patients with high surgical risk.
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Jin Q, Li W, Chen S, Li M, Zhou D, Zhang X, Ge J. Aortic valve morphology and paravalvular leak regression after a self-expandable transcatheter aortic valve replacement. Front Physiol 2023; 13:1088681. [PMID: 36685205 PMCID: PMC9853023 DOI: 10.3389/fphys.2022.1088681] [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: 11/03/2022] [Accepted: 12/01/2022] [Indexed: 01/09/2023] Open
Abstract
Aims: The study aimed to compare paravalvular leak (PVL) changes after a transcatheter aortic valve replacement (TAVR) with self-expandable prosthesis between different aortic valve morphologies and evaluate the impact of paravalvular leak regression on clinical prognosis. Methods: Patients with aortic stenosis (AS) successfully treated with a self-expandable TAVR who were followed up for at least 1 year at our centre were consecutively enrolled from January 2016 to August 2019. Paired serial changes in paravalvular leak and other haemodynamic parameters by echocardiography were collected and compared between the bicuspid valve (BAV) and tricuspid aortic valve (TAV). A logistic regression model was used to explore the predictors of paravalvular leak regression (<1 grade) 1 year after transcatheter aortic valve replacement, while its impact on subsequent clinical outcomes (all-cause mortality and rehospitalisation for heart failure (HF)) was further evaluated using Kaplan-Meier analysis. Results: A total of 153 bicuspid valve and 114 tricuspid aortic valve patients were finally enrolled; haemodynamic parameters and paravalvular leak severity were comparable before the discharge between the two groups. The peak transaortic velocity, mean transvalvular gradient, and effective orifice area all significantly improved (p < 0.05) without intergroup differences at all follow-up timepoints. Significant paravalvular leak reduction was observed only in the TAV group (1.75% vs. 4.39%, p = 0.029), while moderate paravalular leak was still more prevalent in BAV (7.19% vs. 1.75%, p = 0.041) at the 1-year follow-up. Multivariable analyses identified the bicuspid valve, asymmetric calcification, and undersizing as independent predictors of failure of the 1-year paravalvular leak reduction in patients with mild or moderate paravalvular leak after discharge. Patients without a paravalvular leak reduction within 1 year showed a relatively higher 2-year all-cause mortality and HF (HR: 5.994, 95% CI: 1.691-21.240, and p = 0.053) rates thereafter. Conclusion: In AS patients after self-expandable transcatheter aortic valve replacement, paravalvular leak regression within 1 year was less prevalent in bicuspid valve morphology. The failure of paravalvular leak reduction might lead to an increased risk of poorer prognosis in the long run.
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Affiliation(s)
- Qinchun Jin
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wei Li
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shasha Chen
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Mingfei Li
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China,National Clinical Research Center for Interventional Medicine, Shanghai, China,*Correspondence: Daxin Zhou, , ; Xiaochun Zhang,
| | - Xiaochun Zhang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China,National Clinical Research Center for Interventional Medicine, Shanghai, China,*Correspondence: Daxin Zhou, , ; Xiaochun Zhang,
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China,National Clinical Research Center for Interventional Medicine, Shanghai, China
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Helbock RT, Anam SB, Kovarovic BJ, Slepian MJ, Hamdan A, Haj-Ali R, Bluestein D. Designing a Novel Asymmetric Transcatheter Aortic Valve for Stenotic Bicuspid Aortic Valves Using Patient-Specific Computational Modeling. Ann Biomed Eng 2023; 51:58-70. [PMID: 36042099 DOI: 10.1007/s10439-022-03039-3] [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: 05/04/2022] [Accepted: 07/25/2022] [Indexed: 01/13/2023]
Abstract
Bicuspid aortic valve (BAV), the most common congenital heart malformation, is characterized by the presence of only two valve leaflets with asymmetrical geometry, resulting in elliptical systolic opening. BAV often leads to early onset of calcific aortic stenosis (AS). Following the rapid expansion of transcatheter aortic valve replacement (TAVR), designed specifically for treating conventional tricuspid AS, BAV patients with AS were initially treated "off-label" with TAVR, which recently gained FDA and CE regulatory approval. Despite its increasing use in BAV, pathological BAV anatomy often leads to complications stemming from mismatched anatomical features. To mitigate these complications, a novel eccentric polymeric TAVR valve incorporating asymmetrical leaflets was designed specifically for BAV anatomies. Computational modeling was used to optimize its asymmetric leaflets for lower functional stresses and improved hemodynamic performance. Deployment and flow were simulated in patient-specific BAV models (n = 6) and compared to a current commercial TAVR valve (Evolut R 29 mm), to assess deployment and flow parameters. The novel eccentric BAV-dedicated valve demonstrated significant improvements in peak systolic orifice area, along with lower jet velocity and wall shear stress (WSS). This feasibility study demonstrates the clinical potential of the first known BAV-dedicated TAVR design, which will foster advancement of patient-dedicated valvular devices.
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Affiliation(s)
- Ryan T Helbock
- Biofluids Research Group, Department of Biomedical Engineering, T8-050 Health Sciences Center, Stony Brook University, Stony Brook, NY11794-8084, USA
| | - Salwa B Anam
- Biofluids Research Group, Department of Biomedical Engineering, T8-050 Health Sciences Center, Stony Brook University, Stony Brook, NY11794-8084, USA
| | - Brandon J Kovarovic
- Biofluids Research Group, Department of Biomedical Engineering, T8-050 Health Sciences Center, Stony Brook University, Stony Brook, NY11794-8084, USA
| | - Marvin J Slepian
- Department of Medicine and Biomedical Engineering Sarver Heart Center, University of Arizona, Tucson, AZ, 85721, USA
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, 4941492, Petah Tikva, Israel
| | - Rami Haj-Ali
- School of Mechanical Engineering, Faculty of Engineering, Tel Aviv University, 69978, Tel Aviv, Ramat Aviv, Israel
| | - Danny Bluestein
- Biofluids Research Group, Department of Biomedical Engineering, T8-050 Health Sciences Center, Stony Brook University, Stony Brook, NY11794-8084, USA.
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Prosthesis Tailoring for Patients Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2023; 12:jcm12010338. [PMID: 36615141 PMCID: PMC9821207 DOI: 10.3390/jcm12010338] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has risen over the past 20 years as a safe and effective alternative to surgical aortic valve replacement for treatment of severe aortic stenosis, and is now a well-established and recommended treatment option in suitable patients irrespective of predicted risk of mortality after surgery. Studies of numerous devices, either newly developed or reiterations of previous prostheses, have been accruing. We hereby review TAVI devices, with a focus on commercially available options, and aim to present a guide for prosthesis tailoring according to patient-related anatomical and clinical factors that may favor particular designs.
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