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Yamani N, Ali SH, Sadiq M, Ahmed AB, Bhojwani KD, Lohana VP, Fatmah S, Khalid S, Shamsi HR, Zehra B, Fatima K, Baloch ZQ. Trans-femoral versus trans-carotid access for transcatheter aortic valve replacement: an updated systematic review and meta-analysis. Future Sci OA 2024; 10:FSO930. [PMID: 38817364 PMCID: PMC11137775 DOI: 10.2144/fsoa-2023-0101] [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: 06/06/2023] [Accepted: 10/27/2023] [Indexed: 06/01/2024] Open
Abstract
Aim: This meta-analysis aims to shed light on any primacy the trans-carotid (TC-TAVR) access may have over the trans-femoral access (TF-TAVR) for those undergoing transcatheter aortic valve replacement (TAVR). Methods: PubMed/MEDLINE and Cochrane Library were searched, from inception to March 2023 retrieving seven adjusted studies with a total of 6609 patients, of which 5048 underwent TF-TAVR while 1561 underwent TC-TAVR. Results: No divergence in risk of mortality, major bleeding or stroke/transient ischemic attack in TC-TAVR when compared with TF-TAVR was found. In TC-TAVR, the risk of vascular complications was low (OR: 0.51, 95% CI: 0.32-0.83, p = 0.003) as compared with TF-TAVR. Conclusion: As of this analysis, the viability of TC-TAVR as first alternative to TF-TAVR is plausible.
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Affiliation(s)
- Naser Yamani
- Division of Cardiology, University of Arizona Phoenix Medical Center, AZ 85721, USA
| | - Syed Hasham Ali
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Mahnoor Sadiq
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Afeera B Ahmed
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Kapil D Bhojwani
- Faculty of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Vivek P Lohana
- Faculty of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Saba Fatmah
- Faculty of Medicine, Karachi Medical & Dental College, Karachi, 74700, Pakistan
| | - Shazra Khalid
- Faculty of Medicine, Sindh Medical College, Jinnah Sindh Medical University, Karachi, 75510, Pakistan
| | - Hammad R Shamsi
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Batool Zehra
- Faculty of Medicine, Karachi Medical & Dental College, Karachi, 74700, Pakistan
| | - Kaneez Fatima
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Zulfiqar Q Baloch
- Division of Cardiology, Sparrow Hospital, Michigan State University, MI 48912, USA
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Robles N, Graziano JN, Ruth JK, Brady K, Velez DA. Transapical Delivery of a Sapien Valve for Transcatheter Aortic Valve Replacement in an 11-Year-Old Patient with Truncus Arteriosus. Pediatr Cardiol 2023; 44:1629-1631. [PMID: 37285040 DOI: 10.1007/s00246-023-03196-9] [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: 02/06/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023]
Abstract
Complex congenital heart defects may necessitate repeated surgical interventions throughout a patient's lifetime. Each subsequent procedure exposes patients to a greater cumulative risk, thus adding to the potential morbidity and mortality of the surgery. Transcatheter interventions can help mitigate the surgical risk for many defects and can delay or mitigate the need for surgery. This case report describes the rare use of a transapically delivered transcatheter aortic valve replacement (TAVR) therapy in a high-risk pediatric patient to postpone the need for surgery and potentially reduce the number of lifelong surgical interventions. The case highlights how transcatheter aortic valve therapies can be considered for non-standard, higher risk pediatric patients to postpone the need for surgical valve replacement and may serve as a paradigm shift in the care of complex patients with aortic valve pathology.
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Affiliation(s)
- Nicholas Robles
- Division of Cardiology, Phoenix Children's Center for Heart Care, 1919 East Thomas Road, Phoenix, AZ, 85016, USA
| | - Joseph N Graziano
- Division of Cardiology, Phoenix Children's Center for Heart Care, 1919 East Thomas Road, Phoenix, AZ, 85016, USA.
| | - John K Ruth
- Division of Anesthesiology, Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ, 85016, USA
| | - Kevin Brady
- Department of Cardiovascular Surgery, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ, 85013, USA
| | - Daniel A Velez
- Division of Cardiothoracic Surgery, Phoenix Children's Center for Heart Care, 1919 East Thomas Road, Phoenix, AZ, 85016, USA
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Alabdaljabar MS, Eleid MF. Risk Factors, Management, and Avoidance of Conduction System Disease after Transcatheter Aortic Valve Replacement. J Clin Med 2023; 12:4405. [PMID: 37445439 DOI: 10.3390/jcm12134405] [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: 05/05/2023] [Revised: 06/14/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Transcatheter valve replacement (TAVR) is a rapidly developing modality to treat patients with aortic stenosis (AS). Conduction disease post TAVR is one of the most frequent and serious complications experienced by patients. Multiple factors contribute to the risk of conduction disease, including AS and the severity of valve calcification, patients' pre-existing conditions (i.e., conduction disease, anatomical variations, and short septum) in addition to procedure-related factors (e.g., self-expanding valves, implantation depth, valve-to-annulus ratio, and procedure technique). Detailed evaluation of risk profiles could allow us to better prevent, recognize, and treat this entity. Available evidence on management of conduction disease post TAVR is based on expert opinion and varies widely. Currently, conduction disease in TAVR patients is managed depending on patient risk, with minimal-to-no inpatient/outpatient observation, inpatient monitoring (24-48 h) followed by ambulatory monitoring, or either prolonged inpatient and outpatient monitoring or permanent pacemaker implantation. Herein, we review the incidence and risk factors of TAVR-associated conduction disease and discuss its management.
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Affiliation(s)
| | - Mackram F Eleid
- Division of Interventional Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
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Temporal changes of patient characteristics over 12 years in a single-center transcatheter aortic valve implantation cohort. Clin Res Cardiol 2023; 112:691-701. [PMID: 36792752 PMCID: PMC10160189 DOI: 10.1007/s00392-023-02166-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Beneficial results of transcatheter aortic valve implantation (TAVI) compared to surgical aortic valve replacement (SAVR) in patients at all risk strata have led to substantial changes in guideline recommendations for valvular heart disease. AIM To examine influence of these guideline changes on a real-world TAVI cohort, we evaluated how risk profiles and outcomes of TAVI patients developed in our single-center patient cohort over a period of 12 years. METHODS Baseline, procedural and 30-day outcome parameters of TAVI patients were retrospectively compared between three time periods (period 1: 2008-2012, period 2: 2013-2017, period 3: 2018-2020). RESULTS Between 03/2008 and 12/2020, a total of 3678 patients underwent TAVI at our center. The median age was 81.1 years (25th, 75th percentile: 76.7, 84.9) with no significant change over time. The EuroSCORE II showed a continuous and significant decline from 5.3% (3.3, 8.6) in period 1 to 2.8% (1.7, 5.0) in period 3 (p < 0.001). Furthermore, rates of permanent pacemaker implantation, acute kidney injury, and paravalvular leakage ≥ moderate continuously declined over time. Accordingly, the 30-day mortality fell from 9.3% in period 1 to 4.3% in period 3 (p < 0.001). CONCLUSION Despite substantial guideline alterations, median patient age remained largely unchanged in our TAVI cohort over the past 12 years. Therefore, increased age still appears to be the main reason to choose TAVI over SAVR. However, risk profiles declined substantially. Significant improvements in early outcomes suggest favorable influence of less invasive access routes, improved device platforms and growing user experience.
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Fangmin M, Shaohua L, Lai W, Cuizhen P. A case report of transcatheter repair of severe functional mitral regurgitation in cardiac amyloidosis. Eur Heart J Case Rep 2022; 7:ytac471. [PMID: 36582592 PMCID: PMC9792274 DOI: 10.1093/ehjcr/ytac471] [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: 06/23/2022] [Revised: 08/02/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
Background Transcatheter therapy has become an alternative for functional mitral regurgitation (FMR) in patients at high surgical risk. However, the intervention of FMR in cardiac amyloidosis (CA) with transcatheter edge-to-edge repair (TEER) is controversial due to the potential risk of left atrial pressure (LAP) elevation. Case summary An 83-year-old woman with repeated heart failure (HF) and severe mitral regurgitation (MR) was referred to our centre for TEER. Pre-procedural transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE) confirmed the degree of MR and a functional aetiology. A peculiar LAP increase in this patient occurred immediately after successful TEER clip implantation and her n-terminal prohormone of brain natriuretic peptide significantly increased post-operatively. The diagnosis of CA was suspected and was subsequently established through endomyocardial biopsy. Aggressive anti-HF therapy was initiated and the patient was discharged after her HF symptoms were relieved. At 6-month follow-up, the patient was still alive and no episode of acute HF was experienced. Discussion Severe functional MR in CA treated with TEER has the potential risk of increasing LAP. During the short-term follow-up, TEER appears beneficial for left heart function (reduction of MR) but harmful for right heart function (increase of LAP). CA patients with severe FMR should be carefully evaluated about the benefits and potential harm of TEER intervention.
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Affiliation(s)
- Meng Fangmin
- Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, 200032 Shanghai, China,Department of Echocardiography, Zhongshan Hospital, Fudan University, 180 Fenglin Road, 200032 Shanghai, China
| | - Lu Shaohua
- Department of pathology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, 200032 Shanghai, China
| | - Wei Lai
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, 200032 Shanghai, China
| | - Pan Cuizhen
- Corresponding author. Tel/Fax: +021 64041990,
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Abu Rmilah AA, Al-Zu’bi H, Haq IU, Yagmour AH, Jaber SA, Alkurashi AK, Qaisi I, Kowlgi GN, Cha YM, Mulpuru S, DeSimone CV, Deshmukh AJ. Predicting Permanent Pacemaker Implantation following Trans-catheter Aortic Valve Replacement: A Contemporary Meta-Analysis of 981,168 patients. Heart Rhythm O2 2022; 3:385-392. [PMID: 36097458 PMCID: PMC9463692 DOI: 10.1016/j.hroo.2022.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Heart block requiring permanent pacemaker (PPM) implantation is a relatively frequent complication of transcatheter aortic valve replacement (TAVR). Objective The purpose of this study was to perform a contemporary meta-analysis to provide an updated assessment of clinically useful predictors of PPM implantation post-TAVR. Methods Medline and EMBASE searches were performed to include all studies reporting PPM post-TAVR between 2015 and 2020. Pertinent data were extracted from the studies for further analysis. RevMan was used to create forest plots and calculate risk ratios (RRs). Results We evaluated 41 variables from 239 studies with a total of 981,168 patients. From this cohort, 17.4% received a PPM following TAVR. Strong predictors for PPM implant were right bundle branch block (RBBB) (RR 3.12; P <.001) and bifascicular block (RR 2.40; P = .002). Intermediate factors were chronic kidney disease (CKD) (RR 1.53; P <.0001) and first-degree atrioventricular block (FDAVB) (RR 1.44; P <.001). Weak factors (RR 1–1.50; P <.05) were male gender, age ≥80 years, body mass index ≥25, diabetes mellitus (DM), atrial fibrillation (AF), and left anterior fascicular block (LAFB). These factors along with increased left ventricular outflow tract (LVOT) area (>435 mm2) and/or aortic annulus diameter (>24.4 mm) were incorporated to propose a new scoring system to stratify patients into high- and low-risk groups. Conclusion Male gender, age ≥80 years, FDAVB, RBBB, AF, DM, CKD, Medtronic CoreValve, transfemoral TAVR, increased LVOT, and aortic annulus diameter were significant predictors of post-TAVR PPM implantation. Preprocedural assessment should consider these factors to guide clinical decision-making before TAVR. Validation of our scoring system is warranted.
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Affiliation(s)
- Anan A. Abu Rmilah
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hossam Al-Zu’bi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ikram-Ul Haq
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Suhaib A. Jaber
- Department of Internal Medicine, Al Hamadi Hospital, Riyadh, Saudi Arabia
| | - Adham K. Alkurashi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ibraheem Qaisi
- An-Najah National University School of Medicine, Palestine
| | | | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Siva Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Abhishek J. Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Address reprint requests and correspondence: Dr Abhishek J. Deshmukh, Department of Cardiovascular Disease, Mayo Clinic, 200 First St SW, Rochester, MN 55902.
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Aslani A, Moaref A, Zarrabi K, Hassanzadeh M, Fasihyan M, Namdar Z. Comparing clinical and hemodynamic parameters between the two aortic valve replacement in patients with severe aortic stenosis. J Cardiovasc Echogr 2022; 32:112-115. [PMID: 36249432 PMCID: PMC9558645 DOI: 10.4103/jcecho.jcecho_78_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/15/2022] [Accepted: 01/27/2022] [Indexed: 12/02/2022] Open
Abstract
Context: Various techniques have been proposed for suturing following prosthetic aortic valve implantation, but each has its potential side effects such as patient-prosthesis mismatch (PPM) and paravalvular leak (PVL). Aims: In the present study, we aimed to compare the postoperative sequels of aortic valve replacement (AVR) following the use of two suturing techniques including from the inside of the aorta as the common and classic suturing techniques as compared to new approach including from the outside of the aorta. Settings and Design: This cross-sectional study was performed on patients suffering from symptomatic severe aortic valve disease and candidates for AVR in one of three referral hospitals for cardiovascular disease patients in Shiraz from 2019–2021. Subjects and Methods: The patients underwent one of the two considered surgical techniques for AVR including traditional approach (n = 60) or the tested approach (suturing from the outside of the aorta) (n = 30). Statistical Analysis Used: For statistical analysis, results were presented as mean ± standard deviation for quantitative variables and were summarized by frequency (percentage) for categorical variables. Results: PVL and PPM were revealed in none of the participants undergoing the tested approach, while the pointed complications were found in 41.7% and 25.0% of patients underwent traditional approach, respectively, indicating a significant difference. There was no evidence of abnormal dimensionless valve index (DVI) in the patients undergoing sutures from outside the aorta, whereas the rate of DVI abnormality in the patients undergoing traditional procedures was shown to be 18.3%. The mean aortic valve gradient was significantly higher in the group scheduling for the traditional surgical method. Conclusions: Applying new suturing method as suturing from the outside of the aorta, due to the selection of appropriate valve size, the risk for adverse consequences including PPM, PVL, or DVI can be significantly reduced.
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