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Yang YX, Liu XM, Fu Y, Li C, Wang HJ, Xu L, Xia K, Zhang ZY, Zhong JC, Chen ML, Su PX, Wang LF. Comparisons of different new-generation transcatheter aortic valve implantation devices for patients with severe aortic stenosis: a systematic review and network meta-analysis. Int J Surg 2023; 109:2414-2426. [PMID: 37161443 PMCID: PMC10442113 DOI: 10.1097/js9.0000000000000456] [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: 09/14/2022] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Whether there are differences among the new-generation transcatheter aortic valve implantation (TAVI) devices for patients with aortic stenosis remains unclear. The aim of the study was to compare the efficiency and safety of different new-generation TAVI devices for patients with aortic stenosis. MATERIALS AND METHODS A comprehensive search of PubMed, Embase and Web of Science from their inception to 1 February 2022. Randomized clinical trials and observational studies that compared two or more different TAVI devices were enroled. Pairwise meta-analysis and frequentist network meta-analysis were conducted to pool the outcome estimates of interest. RESULTS A total of 79 studies were finally included. According to the surface under the cumulative ranking, the top two ranked valves for lower rates of events were as follows: direct flow medical (DFM) (4.6%) and Lotus (48.8%) for lower rate of device success; Sapien 3 (16.8%) and DFM (19.7%) for lower mortality; DFM (8.6%) and Sapien 3 (25.5%) for lower rates of stroke; Evolut (27.6%) and DFM (35.8%) for lower rates of major and life-threatening bleeding; Portico (22.6%) and Sapien 3 (41.9%) for lower rates of acute kidney injury; Acurate (8.6%) and DFM (13.2%) for lower rates of permanent pacemaker implantation; Lotus (0.3%) and Sapien 3 (22.7%) for lower rates of paravalvular leak; Evolut (1.4%) and Portico (29.1%) for lower rates of mean aortic valve gradients. CONCLUSIONS The findings of the present study suggested that the device success rates were comparable among these new-generation valves except for DFM. After excluding DFM, Sapien 3 might be the best effective for decreased mortality and stroke; Lotus might be the best effective for decreased paravalvular leak; Evolut might be the best effective for decreased major and life-threatening bleeding and mean aortic valve gradients; Acurate and Portico might be the best effective for decreased permanent pacemaker implantation and acute kidney injury, respectively.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Pi-Xiong Su
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Chaoyang District, Beijing, China
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Ruile P, Pache G, Minners J, Hein M, Neumann FJ, Breitbart P. Fusion imaging of pre- and post-procedural computed tomography angiography in transcatheter aortic valve implantation patients: evaluation of prosthesis position and its influence on new conduction disturbances. Eur Heart J Cardiovasc Imaging 2020; 20:781-788. [PMID: 30544215 DOI: 10.1093/ehjci/jey195] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/23/2018] [Accepted: 11/15/2018] [Indexed: 02/03/2023] Open
Abstract
AIMS The purpose of this study was to evaluate prosthesis position by fusion of pre- and post-transcatheter aortic valve implantation (TAVI) computed tomography angiography (CTA) images and to investigate its influence on the occurrence of new conduction disturbances (CD). METHODS AND RESULTS We performed CTA fusion imaging in 120 TAVI patients (Edwards Sapien 3) on a standard image post-processing workstation to obtain a 3D reconstruction of the transcatheter heart valve (THV) position within the native annulus region. Optimal implantation depth of the THV was defined according to the manufacturers recommendations as 70-80% of the prosthesis above (aortic) and 20-30% below (ventricular) the native annulus plane. Pre- and post-interventional electrocardiograms (ECGs) were assessed for the development of new CD. THV position was found to be within, above, or below the prespecified margins in 32 patients (27%), 71 patients (59%), and 17 patients (14%), respectively. Interobserver reliability was high for fusion measurements [e.g. median THV position 0.983, 95% confidence interval (CI): 0.935-0.996]. Patients with low stent position were significantly more likely to develop new CD compared with patients with optimal or high stent position (P = 0.039). Independent predictors of CD in multivariate analysis were low THV position [odds ratio (CI): 1.362 (1.093-1.698), P = 0.006] and calcification of the device landing zone [odds ratio (CI): 1.149 (1.024-1.289), P = 0.018]. CONCLUSION Fusion imaging of pre- and post-TAVI-CTA allows for the exact evaluation of THV position in relation to the native annulus plane. A low THV position as assessed by fusion imaging is associated with the development of new CD post-TAVI.
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Affiliation(s)
- Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Gregor Pache
- Section of Cardiovascular Radiology, Department of Radiology, University of Freiburg, Hugstetterstr. 55, Freiburg, Germany
| | - Jan Minners
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Philipp Breitbart
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, Bad Krozingen, Germany
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Breitbart P, Pache G, Minners J, Hein M, Schröfel H, Neumann FJ, Ruile P. Predictors for low TAVI-prosthesis position assessed by fusion imaging of pre- and post-procedural CT angiography. Clin Res Cardiol 2020; 110:93-101. [PMID: 32399896 PMCID: PMC7806565 DOI: 10.1007/s00392-020-01654-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022]
Abstract
Background Low prosthesis position after transcatheter aortic valve implantation (TAVI) is associated with higher rates of new onset conduction disturbances and permanent pacemaker implantations. Purpose of this study was to investigate possible predictors of a low prosthesis position of the SAPIEN 3 (Edwards Lifesciences, Irvine, California, USA) valve type using fusion imaging of pre- and post-procedural computed tomography angiography (CTA). Methods CTA fusion imaging was performed in 120 TAVI-patients with 3D-reconstruction of the transcatheter heart valve (THV) position within the device landing zone. A low implantation position was defined according to the manufacturer’s recommendations as > 30% of the prosthesis below the native annulus plane. Results A low THV position was found in 17 patients (14%). Patients with low THV position had less calcification of the annulus region and a smaller annulus size compared to patients with a normal or high THV position (P = 0.003 and 0.041, respectively). The only independent predictor of a low THV position in multivariate logistic regression analysis was the extent of calcification of the cusp region (odds ratio [CI] 0.842 [0.727–0.976], P = 0.022). Conclusions Fusion imaging of pre-and post-procedural CTA identified reduced calcification of the cusp region as an independent predictor of a low THV position of the SAPIEN 3. This should be considered when planning the TAVI procedure. Graphic abstract Correlation of cusp region calcification and prosthesis position after TAVI ![]()
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Affiliation(s)
- Philipp Breitbart
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany.
| | - Gregor Pache
- Radiology Hegau Bodensee, Practice for Diagnostic Radiology, Singen, Germany
| | - Jan Minners
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Manuel Hein
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Holger Schröfel
- Division of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Philipp Ruile
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
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Mas-Peiro S, Fichtlscherer S, Walther C, Vasa-Nicotera M. Current issues in transcatheter aortic valve replacement. J Thorac Dis 2020; 12:1665-1680. [PMID: 32395310 PMCID: PMC7212163 DOI: 10.21037/jtd.2020.01.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aortic stenosis is the most common valvular disease worldwide. With transcatheter aortic valve replacement (TAVR) being increasingly expanded to lower-risk populations, several challenging issues remain to be solved. The present review aims at discussing modern approaches to such issues as well as the current status of TAVR. TAVR has undergone several developments in the recent years: an increased use of transfemoral access, the development of prostheses in order to adapt to challenging anatomies, improved delivery systems with repositioning features, and outer skirts aiming at reducing paravalvular leak. The indication of TAVR is increasingly being expanded to patients with lower surgical risk. The main clinical trials supporting such expansion are reviewed and the latest data on low-risk patients are discussed. A number of challenges need still to be addressed and are also reviewed in this paper: the need for updated international guidelines including the latest evidence; a reduction of main complications such as permanent pacemaker implantation, paravalvular leak, and stroke (and its potential prevention by using anti-embolic protection devices); the appropriate role of TAVR in patients with concomitant cardiac ischemic disease; and durability of bio-prosthetic implanted valves. Finally, the future perspectives for TAVR use and next device developments are discussed.
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Affiliation(s)
- Silvia Mas-Peiro
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Claudia Walther
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
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5
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Alperi Garcia A, Muntané-Carol G, Junquera L, del Val D, Faroux L, Philippon F, Rodés-Cabau J. Can we reduce conduction disturbances following transcatheter aortic valve replacement? Expert Rev Med Devices 2020; 17:309-322. [DOI: 10.1080/17434440.2020.1741349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Lucia Junquera
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - David del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Laurent Faroux
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - François Philippon
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
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Gozdek M, Ratajczak J, Arndt A, Zieliński K, Pasierski M, Matteucci M, Fina D, Jiritano F, Meani P, Raffa GM, Malvindi PG, Pilato M, Paparella D, Słomka A, Landes U, Kornowski R, Kubica J, Lorusso R, Suwalski P, Kowalewski M. Transcatheter aortic valve replacement with Lotus and Sapien 3 prosthetic valves: a systematic review and meta-analysis. J Thorac Dis 2020; 12:893-906. [PMID: 32274157 PMCID: PMC7139024 DOI: 10.21037/jtd.2019.12.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Frequent occurrence of paravalvular leak (PVL) after transcatheter aortic valve replacement (TAVR) was the main concern with early-generation devices and focused technological improvements. Current systematic review and meta-analysis sought to compare outcomes of TAVR for severe native valve stenosis with next-generation devices: Lotus and Sapien 3. Methods Electronic databases were screened for studies comparing outcomes of TAVR with Lotus and Sapien 3. In a random-effects meta-analysis, the pooled incidence rates of procedural, clinical and functional outcomes according to VARC-2 definitions were assessed. Results Eleven observational studies including 2,836 patients (Lotus N=862 vs. Sapien 3 N=1,974) met inclusion criteria. No differences were observed regarding composite endpoints—device success and early safety. Similarly, 30-day mortality, major vascular complications, acute kidney injury and serious bleeding events were similar with both devices. Lotus valve demonstrated 35% reduction of the risk for mild PVL: risk ratio (RR) 0.65, 95% confidence interval (CI): 0.49–0.85, P=0.002; but there were no statistical differences with regard to moderate/severe PVL (RR 0.56, 95% CI: 0.18–1.77, P=0.320). Lotus valves produced significantly higher mean transaortic gradients: mean difference (MD) 0.88 mmHg, 95% CI, 0.24–1.53 mmHg, P=0.007; however, without translation into higher rate of prosthesis-patient mismatch (RR 1.10, 95% CI: 0.82–1.47, P=0.540). As compared to Sapien 3, Lotus device placement was associated with significantly higher rate of permanent pacemaker implantation (RR 2.30, 95% CI: 1.95–2.71, P<0.00001) and cerebrovascular events (RR 1.76, 95% CI: 1.03–2.99, P=0.040). Conclusions Lotus valve, as compared with Sapien 3, was associated with lower risk for PVL but higher risk for permanent pacemaker implantation and cerebrovascular events.
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Affiliation(s)
- Mirosław Gozdek
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Jakub Ratajczak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Adam Arndt
- Department of Anesthesiology and Intensive Therapy, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - Michał Pasierski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Matteo Matteucci
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Dario Fina
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Cardiovascular Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Federica Jiritano
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Paolo Meani
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Department of Intensive Care Unit, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | | | - Michele Pilato
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Domenico Paparella
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK.,Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy
| | - Artur Słomka
- Department of Pathophysiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Uri Landes
- Department of Cardiology, Institute of Interventional Cardiology, Rabin Medical Center, Petach Tikva and Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Institute of Interventional Cardiology, Rabin Medical Center, Petach Tikva and Tel Aviv University, Tel Aviv, Israel
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Piotr Suwalski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Mariusz Kowalewski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
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8
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Sathananthan J, Ding L, Yu M, Catlin B, Chan A, Charania J, Cheung A, Cook R, Murdoch DJ, Della Siega A, Latham T, Lauck S, Polderman J, Robinson SD, Virani S, Wong D, Wood D, Ye J, Webb JG. Implications of Transcatheter Heart Valve Selection on Early and Late Pacemaker Rate and on Length of Stay. Can J Cardiol 2019; 34:1165-1173. [PMID: 30170672 DOI: 10.1016/j.cjca.2018.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/24/2018] [Accepted: 06/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) can cause injury to the atrioventricular conduction system. We evaluated the effect of transcatheter heart valve (THV) type on the rate of new pacemaker implantation and length of hospital stay. METHODS Patients across all hospitals performing transfemoral TAVR in the province of British Columbia between 2012 and 2016 participated in a mandated registry with linkages to provincial health databases. We evaluated 1141 patients undergoing successful transfemoral TAVR for native aortic valve stenosis with 5 commonly used valves. RESULTS Valves implanted were balloon-expandable (BEV) (n = 728), self-expandable (SEV) (n = 341), and mechanically-expandable (MEV) (n = 72). Baseline clinical characteristics were similar between groups: mean age 82.5 years with multiple comorbidities. The mean Society of Thoracic Surgeons predicted risk of mortality was 6.0%. Indwelling temporary pacemakers after TAVR varied by THV type: (BEV) 4.0%, (SEV) 69.3%, and (MEV) 63.0% (P < 0.002). The need for a new permanent pacemaker varied by THV type: (BEV) 6.6%, (SEV) 24.0%, and (MEV) 32.8% at 30 days (P < 0.001). At 1 year, permanent pacemaker rates continued to rise, and remained divergent: (BEV) 8.9%, (SEV) 26.9%, and (MEV) 35.9% (P < 0.001). Median length of stay varied according to THV type: (BEV) 1, (SEV) 3, and (MEV) 4 days (P < 0.001 across groups). Crude mortality rates were not statistically different by THV type, either at 30 days (BEV 3.0%, SEV 2.9%, and MEV 0.0%; P = 0.33), or at 1 year (BEV 10.3%, SEV 15.0%, and MEV 8.3%; P = 0.11). CONCLUSIONS The choice of a THV device was associated with significant differences in the need for post-TAVR temporary pacemakers, hospital length of stay, and both early and late pacemaker implantation rates. These differences may have an impact on patient morbidity and resource utilization.
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Affiliation(s)
| | - Lillian Ding
- Cardiac Services British Columbia, Vancouver, British Columbia, Canada
| | - Maggie Yu
- Cardiac Services British Columbia, Vancouver, British Columbia, Canada
| | - Bonnie Catlin
- Cardiac Services British Columbia, Vancouver, British Columbia, Canada
| | - Albert Chan
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | | | - Anson Cheung
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada
| | - Richard Cook
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Dale J Murdoch
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada
| | | | - Tim Latham
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Sandra Lauck
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada
| | - Jopie Polderman
- Cardiac Services British Columbia, Vancouver, British Columbia, Canada
| | | | - Sean Virani
- St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Daniel Wong
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - David Wood
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada.
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Takagi H, Hari Y, Nakashima K, Kuno T, Ando T. Network meta-analysis of new-generation valves for transcatheter aortic valve implantation. Heart Vessels 2019; 34:1984-1992. [PMID: 31144096 DOI: 10.1007/s00380-019-01442-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/24/2019] [Indexed: 11/29/2022]
Abstract
To comprehensively compare and rank new-generation valves (NGVs) for transcatheter aortic valve implantation, we performed a network meta-analysis (NMA) of all eligible comparative studies. MEDLINE and EMBASE were searched through September 2018. We included all studies comparing 4 NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3) and an early generation valve (CoreValve) as the reference transcatheter heart valve (THV) each other and reporting at least one of postprocedural incidence of all-cause death, ≥ moderate aortic regurgitation (AR), and new permanent pacemaker implantation (PMI). To compare different THVs, a random-effects restricted-maximum-likelihood NMA based on a frequentist framework for indirect and mixed comparisons was used. Using surface under the cumulative ranking curve (SUCRA), the relative ranking probability of each THV was estimated and the hierarchy of competing THVs was obtained. We identified 29 eligible studies enrolling a total of 17,817 patients. In accordance with the estimated SUCRA probability, SAPIEN 3 was the best effective for a reduction in death (80.6%) and the second best for decreased ≥ moderate AR (74.4%) and PMI (74.1%) compared with the other THVs. Lotus was ranked the best for a reduction in ≥ moderate AR (94.5%;), whereas the worst for decreased PMI (1.2%) and the second worst for a reduction in mortality (38.6%). ACURATE was the best for decreased PMI (99.2%) and the second best for a reduction in mortality (77.9%). As a whole, SAPIEN 3 may be the best effective NGV among the 4 examined NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3).
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka, 411-8611, Japan. .,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Yosuke Hari
- Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka, 411-8611, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kouki Nakashima
- Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka, 411-8611, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Toshiki Kuno
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Tomo Ando
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
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10
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One year VARC-2-defined clinical outcomes after transcatheter aortic valve implantation with the SAPIEN 3. Clin Res Cardiol 2019; 108:1258-1265. [PMID: 31049679 PMCID: PMC6805964 DOI: 10.1007/s00392-019-01461-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/19/2019] [Indexed: 02/07/2023]
Abstract
AIMS To evaluate 1-year outcome after transcatheter aortic valve implantation (TAVI) using the SAPIEN 3 (S3) prosthesis with emphasis on the composite endpoints "clinical efficacy after 30 days" and "time-related valve safety" proposed by the updated Valve Academic Research Consortium (VARC-2). METHODS AND RESULTS Four hundred and two consecutive patients undergoing transfemoral TAVI with the S3 were enrolled. Mean age was 81 ± 6 years, 43% were female and median logistic EuroSCORE I was 12% [8-19]. Device success was achieved in 93% (374/402) with moderate or severe paravalvular leakage (PVL) in 2%. At 1 year all-cause mortality was 8.9% [95% CI 6.4-12.2] and new permanent pacemaker implantation rate was 16% [95% CI 12.7-20.4]. The composite endpoint time-related valve safety occurred in 29% with structural valve deterioration, defined as elevated gradients or more than moderate PVL, occurring in 13%. The clinical efficacy endpoint after 30 days was observed in 37% of patients with the main contributor symptom worsening with New York Heart Association functional class III + in 17% of cases. CONCLUSIONS For the first time, VARC-2-defined composite endpoints at 1 year are reported and reveal a considerable proportion of patients experiencing the endpoint of time-related valve safety (29%) and clinical efficacy after 30 days (37%).
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11
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Modine T, Overtchouk P. Acurate neo and Evolut PRO in the NEOPRO Registry: Adding Another String to the Bow? JACC Cardiovasc Interv 2019; 12:444-447. [PMID: 30846082 DOI: 10.1016/j.jcin.2018.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas Modine
- Institut Cœur-Poumon, Service de Chirurgie Cardiovasculaire, Hôpital Cardiologique, CHRU de Lille, Lille, France.
| | - Pavel Overtchouk
- Institut Cœur-Poumon, Service de Chirurgie Cardiovasculaire, Hôpital Cardiologique, CHRU de Lille, Lille, France
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Predictores de necesidad de marcapasos permanente y alteraciones de la conducción con el implante transcatéter de una nueva válvula aórtica autoexpandible. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.01.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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del Val D, Ferreira-Neto AN, Asmarats L, Maes F, Guimaraes L, Junquera L, Wintzer J, Fischer Q, Barroso de Freitas Ferraz A, Puri R, Rodés-Cabau J. Transcatheter aortic valve replacement: relative safety and efficacy of the procedure with different devices. Expert Rev Med Devices 2018; 16:11-24. [DOI: 10.1080/17434440.2019.1552132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- David del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Lluis Asmarats
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Frédéric Maes
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Lucia Junquera
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Jérome Wintzer
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Quentin Fischer
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Rishi Puri
- Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
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Toggweiler S, Kobza R. Pacemaker implantation after transcatheter aortic valve: why is this still happening? J Thorac Dis 2018; 10:S3614-S3619. [PMID: 30505543 DOI: 10.21037/jtd.2018.06.103] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
During the past years, the industry and most transcatheter aortic valve operators have focused on reduction of paravalvular leaks rather than on the reduction of permanent pacemakers (PPM). However, since indication for transcatheter aortic valve implantation (TAVI) is moving toward a healthier and younger patient population, new PPMs may become more of an issue. Certain factors such as pre-existing conduction disorders or anatomical features cannot be changed. However, the amount of mechanical trauma to the conduction system and periprocedural medical management offers the potential for optimization. By optimizing our procedure, we may finally be able to achieve low, surgical-like, PPM rates.
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Affiliation(s)
| | - Richard Kobza
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
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Rheude T, Blumenstein J, Möllmann H, Husser O. Spotlight on the SAPIEN 3 transcatheter heart valve. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:353-360. [PMID: 30319292 PMCID: PMC6171512 DOI: 10.2147/mder.s143897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is increasingly performed in patients with severe aortic stenosis. The efficacy and safety have been demonstrated in large randomized trials in patients with high- or intermediate operative risk. With latest-generation transcatheter heart valve (THV) systems, growing operator experience and improved patient selection, clinical outcome has significantly improved with a decline of TAVI-related complications. In this review, the Edwards SAPIEN 3 THV is discussed in terms of technology, procedural advances and complication trends and future developments.
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Affiliation(s)
- Tobias Rheude
- Department of Cardiovascular Diseases, German Heart Centre, Technical University Munich, Munich, Germany
| | | | - Helge Möllmann
- Department of Cardiology, St.-Johannes-Hospital, Dortmund, Germany,
| | - Oliver Husser
- Department of Cardiology, St.-Johannes-Hospital, Dortmund, Germany,
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Husser O, Kim WK, Pellegrini C, Holzamer A, Walther T, Mayr PN, Joner M, Kasel AM, Trenkwalder T, Michel J, Rheude T, Kastrati A, Schunkert H, Burgdorf C, Hilker M, Möllmann H, Hengstenberg C. Multicenter Comparison of Novel Self-Expanding Versus Balloon-Expandable Transcatheter Heart Valves. JACC Cardiovasc Interv 2018; 10:2078-2087. [PMID: 29050625 DOI: 10.1016/j.jcin.2017.06.026] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/09/2017] [Accepted: 06/15/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to compare 2 next-generation transcatheter heart valves (THV), the self-expanding ACURATE neo (NEO) and the balloon-expandable SAPIEN 3 (S3), in terms of device failure and early safety at 30 days. BACKGROUND Deployment of these THV showed promising initial clinical results. However, no comparative data are available. METHODS Of 1,121 treated patients at 3 centers, a 1-to-2 nearest neighbor matching was performed to identify 2 patients treated with S3 (n = 622) for each patient treated with NEO (n = 311). RESULTS In-hospital complications were comparable between NEO and S3, including stroke (1.9% vs. 2.4%; p = 0.64), major vascular complications (10.3% vs. 8.5%; p = 0.38), or life-threatening bleeding (4.2% vs. 3.7%; p = 0.72). Device failure with NEO was comparable with S3 (10.9% vs. 9.6%; odds ratio: 1.09 [95% confidence interval: 0.69 to 1.73]; p = 0.71) with more paravalvular leakage (PVL II+, 4.8% vs. 1.8%; p = 0.01), but less elevated gradients (≥20 mm Hg, 3.2% vs. 6.9%; p = 0.02) and pacemaker implantations (9.9% vs. 15.5%; p = 0.02). Thirty-day mortality (2.3% vs. 1.9%; p = 0.74) and the early safety composite endpoint (15.8% vs. 15.6%; hazard ratio: 0.97 [95% confidence interval: 0.68 to 1.39]; p = 0.88) were similar with NEO and S3. CONCLUSIONS Very high success rates were achieved for both valves, and the clinical and procedural results were comparable. Compared with S3, NEO was associated with less new pacemaker implantations and less elevated gradients, but with more paravalvular leakage.
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Affiliation(s)
- Oliver Husser
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Costanza Pellegrini
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Andreas Holzamer
- Klinik für Herz, Thorax, und Herznahe Gefäßchirurgie, University of Regensburg Medical Center, Regensburg, Germany
| | - Thomas Walther
- Department of Cardiovascular Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Patrick N Mayr
- Institut für Anästhesiologie, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Michael Joner
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Albert M Kasel
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Teresa Trenkwalder
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Jonathan Michel
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Tobias Rheude
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Adnan Kastrati
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany; Deutsches Zentrum für Herz- und Kreislauf-Forschung (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany; Deutsches Zentrum für Herz- und Kreislauf-Forschung (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christof Burgdorf
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany; Herz und Gefäßzentrum Bad Bevensen, Klinik für Kardiologie, Bad Bevensen, Germany
| | - Michael Hilker
- Klinik für Herz, Thorax, und Herznahe Gefäßchirurgie, University of Regensburg Medical Center, Regensburg, Germany
| | - Helge Möllmann
- Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Christian Hengstenberg
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany; Deutsches Zentrum für Herz- und Kreislauf-Forschung (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
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17
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Schofer N, Deuschl F, Schön G, Seiffert M, Linder M, Schaefer A, Schirmer J, Lubos E, Reichenspurner H, Blankenberg S, Conradi L, Schäfer U. Comparative analysis of balloon- versus mechanically-expandable transcatheter heart valves considering landing zone calcification. J Cardiol 2018; 71:540-546. [PMID: 29548665 DOI: 10.1016/j.jjcc.2017.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/16/2017] [Accepted: 09/29/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The balloon-expandable Sapien 3 (Edwards Lifesciences, Irvine, CA, USA) and the mechanically-expandable Lotus valve (Boston Scientific, Marlborough, MA, USA) are established devices for transcatheter aortic valve implantation. We sought to compare both transcatheter heart valves (THV) under consideration of the extent of THV landing zone calcification. METHODS This retrospective analysis includes consecutive patients with severe aortic stenosis treated with Sapien 3 (S3; n=212) or Lotus (n=61) THV via transfemoral access. Outcome was assessed according to VARC II definitions. Rate of paravalvular leakage (PVL), periprocedural stroke, and permanent pacemaker implantation (PPI) was adjusted for THV landing zone calcification as calculated by multi-slice computed tomography. RESULTS There was no difference in preoperative risk (all results as follows S3 vs. Lotus: STS-PROM 5.9±5.6% vs. 4.8±2.6%, p=0.14), rate of device success (95.3% vs. 95.1%, p=0.67), 30-day mortality (1.9% vs. 4.9%, p=0.16), periprocedural stroke (1.4% vs. 4.9%, p=0.27), and major access site complications (9.4% vs. 9.8%, p=0.93). PPI was more frequent (19.4% vs. 34.4%, p=0.01) and significant PVL was less frequent (≥mild PVL: 17.6% vs. 3.7%, p=0.04) after Lotus implantation. No association was found between landing zone calcification and periprocedural stroke rate (OR 1.19, 95%CI 0.92-1.54, p=0.17) or need for PPI (OR 1.04, 95%CI 0.91-1.18, p=0.57). The extent of landing zone calcification was associated with risk for PVL ≥mild (OR 1.21, 95%CI 1.03-1.42, p=0.02). After adjusting for landing zone calcification risk for PVL ≥mild was lower with the Lotus valve (OR 0.15, 95%CI 0.02-0.54, p=0.01). CONCLUSION Both THVs yield comparable procedural and clinical outcomes except for a higher PPI rate with the Lotus valve, which is independent from the extent of landing zone calcification. The extent of landing zone calcification is associated with an increased risk for PVL for both THV, but is significantly reduced with the Lotus valve.
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Affiliation(s)
- Niklas Schofer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
| | - Florian Deuschl
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Moritz Seiffert
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Matthias Linder
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Edith Lubos
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | | | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Ulrich Schäfer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
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Predictors of Need for Permanent Pacemaker Implantation and Conduction Abnormalities With a Novel Self-expanding Transcatheter Heart Valve. ACTA ACUST UNITED AC 2018; 72:145-153. [PMID: 29551701 DOI: 10.1016/j.rec.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/30/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES The incidence of permanent pacemaker implantation (PPI) and new conduction abnormalities (CA) with the ACURATE neo (Symetis S.A., Eclubens, Switzerland) has not been studied in detail. We aimed to analyze their predictors, evaluating patient- and device-related factors, including implantation depth and device-to-annulus ratio (DAR). METHODS Two analyses of a multicenter population were performed: new PPI in pacemaker-naive patients (n = 283), and PPI/new-CA in patients without prior CA or pacemaker (n = 232). RESULTS A new PPI was required in 9.9% of patients, who had a higher body mass index, higher rate of right bundle branch block and bradycardia. Neither implantation depth nor DAR differed in patients with PPI compared with those without. In the multivariable analysis neither DAR (OR, 1.010; 95%CI, 0.967-1.055; P = .7) nor implantation depth (OR, 0.972; 95%CI, 0.743-1.272; P = .8) predicted PPI. Only high body mass index, bradycardia and right bundle branch block persisted as independent predictors. PPI/new-onset CA occurred in 22.8% of patients and was associated with a higher logistic EuroSCORE. Neither implantation depth nor DAR differed in patients with PPI/new-CA vs those without (7.3 ± 1.9 vs 7.1 ± 1.5mm; P = .6 and 41.0 ± 7.9 vs 42.2 ± 10.1%; P = .4). The only predictor of PPI/new-CA was a higher logistic EuroSCORE (OR, 1.039; 95%CI, [1.008-1.071]; P = .013). CONCLUSIONS New PPI and new-onset CA rates were low with the ACURATE neo. These were mainly influenced by patient characteristics and not by device-depending factors.
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van Rosendael PJ, Delgado V, Bax JJ. Pacemaker implantation rate after transcatheter aortic valve implantation with early and new-generation devices: a systematic review. Eur Heart J 2018; 39:2003-2013. [DOI: 10.1093/eurheartj/ehx785] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/17/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- Philippe J van Rosendael
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Pellegrini C, Hengstenberg C, Husser O. The Lotus dilemma-respond to paravalvular leakage, but not answering pacemaker implantations? J Thorac Dis 2017; 9:2804-2807. [PMID: 29221244 DOI: 10.21037/jtd.2017.08.64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Costanza Pellegrini
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christian Hengstenberg
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Deutsches Zentrum für Herz-und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Oliver Husser
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Auffret V, Puri R, Urena M, Chamandi C, Rodriguez-Gabella T, Philippon F, Rodés-Cabau J. Conduction Disturbances After Transcatheter Aortic Valve Replacement. Circulation 2017; 136:1049-1069. [DOI: 10.1161/circulationaha.117.028352] [Citation(s) in RCA: 302] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a well-accepted option for treating patients with aortic stenosis at intermediate to high or prohibitive surgical risk. TAVR-related conduction disturbances, mainly new-onset left bundle-branch block and advanced atrioventricular block requiring permanent pacemaker implantation, remain the most common complication of this procedure. Furthermore, improvements in TAVR technology, akin to the increasing experience of operators/centers, have translated to a major reduction in periprocedural complications, yet the incidence of conduction disturbances has remained relatively high, with perhaps an increasing trend over time. Several factors have been associated with a heightened risk of conduction disturbances and permanent pacemaker implantation after TAVR, with prior right bundle-branch block and transcatheter valve type and implantation depth being the most commonly reported. New-onset left bundle-branch block and the need for permanent pacemaker implantation may have a significant detrimental association with patients’ prognosis. Consequently, strategies intended to reduce the risk and to improve the management of such complications are of paramount importance, particularly in an era when TAVR expansion toward treating lower-risk patients is considered inevitable. In this article, we review the available evidence on the incidence, predictive factors, and clinical association of conduction disturbances after TAVR and propose a strategy for the management of these complications.
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Affiliation(s)
- Vincent Auffret
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Rishi Puri
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Marina Urena
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Chekrallah Chamandi
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Tania Rodriguez-Gabella
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - François Philippon
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Josep Rodés-Cabau
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
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Transcatheter aortic valve replacement with new-generation devices: A systematic review and meta-analysis. Int J Cardiol 2017; 245:83-89. [PMID: 28760396 DOI: 10.1016/j.ijcard.2017.07.083] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 06/17/2017] [Accepted: 07/21/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to conduct a weighted meta-analysis to determine the rates of acute (≤30days) major outcomes after (TAVR) with second-generation devices. METHODS A comprehensive search of multiple electronic databases from January 2011 to May 2017 was conducted using predefined criteria. New-generation TAVR devices were defined as any device which received CE mark approval or is still under evaluation for CE marking after CoreValve and SAPIEN XT prostheses. RESULTS A total of 37 studies including 10,822 patients met inclusion criteria and were included in the analysis. Devices investigated in the studies were the following: SAPIEN 3 (n=5423, 45.9%), Lotus Valve (n=3007, %), Portico (n=130, 1.1%), JenaValve (n=345, 2.9%), Symetis Acurate (n=1314, 11,1%), and Evolut R (n=1603, 13.6%). Thirty-day all-cause and cardiovascular 30-day death were 2.2% (95% CI: 1.6% to 2.8%) and 1.6% (95% CI: 0.9% to 2.3%), respectively; Any stroke and major/disabling stroke occurred at a pooled estimate rate of 2.6% (95% CI: 2.0% to 3.3%) and 0.9% (95% CI: 0.2% to 1.6%), respectively; life-threatening bleeding, 3.9% (95% CI: 2.9% to 5.0%); major vascular complications, 4.5% (95% CI: 3.7% to 5.4%); pacemaker implantation, 16.2% (95% CI: 12.7% to 19.6%); more than mild aortic regurgitation, 1.6% (95% CI: 0.9 to 2.3). CONCLUSIONS Second-generation TAVR devices are associated with very low mortality and major complications rates at 30-day, and improved prosthesis performance with <2% of patients having more than mild post-procedural aortic regurgitation. On the other hand, the need for pacemaker implantation seems to remain an unresolved issue, and warrants further investigation.
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Gomes B, Katus HA, Bekeredjian R. Repositionable self-expanding aortic bioprosthesis. Expert Rev Med Devices 2017; 14:565-576. [PMID: 28571486 DOI: 10.1080/17434440.2017.1338136] [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: 10/19/2022]
Abstract
INTRODUCTION Transcatheter aortic valve implantation/replacement (TAVI or TAVR) has been established as a first line therapy in patients with symptomatic severe aortic stenosis (AS) at high or prohibitive surgical risk and as an alternative in elderly patients with intermediate surgical risk. Since its first-in-human procedure in 2002, the past 15-years have shown rapid developments in TAVI technology with the introduction and further improvement of new transcatheter heart valves (THV). Areas covered: There are currently several THV systems available, based on balloon-expandable, self-expandable or other technologies. Some of these are repositionable and retrievable even after partial or full deployment, potentially reducing the risk of malpositioning. The aim of this review is to describe such repositionable self-expandable THV systems. Expert commentary: Repositionability potentially represents a crucial step towards higher safety and efficacy of TAVI. It is unclear if full self-expandability or a combination of self and mechanical expansion will be more advantageous.
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Affiliation(s)
- Bruna Gomes
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
| | - Hugo A Katus
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
| | - Raffi Bekeredjian
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
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