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Amat-Santos IJ, Gómez-Herrero J, Pinon P, Nombela-Franco L, Moreno R, Munoz-García AJ, Redondo A, Gómez-Menchero A, Gómez-Salvador I, San Román JA. Impact of commissural alignment on the hemodynamic performance of supra-annular self-expandable transcatheter aortic valves. Catheter Cardiovasc Interv 2024. [PMID: 39252591 DOI: 10.1002/ccd.31201] [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: 04/02/2024] [Revised: 07/08/2024] [Accepted: 08/16/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Hemodynamic impact of commissural alignment (CA) with self-expandable transcatheter aortic valves (TAVR) has not been investigated yet. AIMS To determine hemodynamic impact of CA with self-expandable TAVR. METHODS Multicentric ambispective study comparing patients who underwent self-expandable TAVR in seven centers with the Evolut Pro/Pro+ (EP) (Medtronic) and Acurate neo2 (AN2) (Boston Scientific) with and without CA strategies. The degree of commissural misalignment (CMA) was assessed by computed tomography/angiography and 1-year transvalvular gradients/regurgitation evaluated by echocardiography. A matched comparison according to annular dimensions/eccentricity, prosthesis size/type, and baseline left ventricular function and gradients was performed. RESULTS A total of 557 patients, mean age 80.7 ± 6.6 years, 61.4% men, and STS score of 4.3 ± 3.1% were analyzed. A CA technique was attempted in 215 patients (38.6%), including 113 patients with AN2 and 102 patients with EP. None/mild CMA was found in 158 (73.5% vs. 43.6% if no CA attempted, p < 0.001) with no differences between devices (AN2:75.2%; EP:71.6%, p = 0.545). Patients with moderate/severe CMA had a greater aortic peak gradient (22.3 ± 8.7 vs. 19.7 ± 8.5, p = 0.001), significantly greater progression of both peak (p = 0.002) and mean gradients (p = 0.001) after matching, and higher rate of central aortic regurgitation (1.2% vs. 0.4%, p = 0.005) at 1-year, but not a greater proportion of patients with mean gradient ≥ 10 mmHg. CONCLUSIONS The use of CA strategies significantly reduced the rate of CMA for the self-expandable TAVR devices ACN2 and EP which was associated to lower transvalvular gradients and intra-prosthetic regurgitation progression at 1-year although no criteria of structural deterioration were met at this follow up. CLINICALTRIALS org: NCT05097183.
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Affiliation(s)
- Ignacio J Amat-Santos
- Cardiology Department, University Clinic Hospital, Valladolid, Spain
- Centro de investigación biomédica en red - Enfermedades cardiovasculares (CIBERCV), Instituto de salud Carlos III, Madrid, Spain
| | | | - Pablo Pinon
- Cardiology Department, Complejo Hospitalario de La Coruña, A Coruna, Spain
| | | | - Raúl Moreno
- Cardiology Department, Hospital La Paz, Madrid, Spain
| | | | - Alfredo Redondo
- Cardiology Department, Hospital Clínico Universitario de Santiago, Spain
| | | | - Itziar Gómez-Salvador
- Cardiology Department, University Clinic Hospital, Valladolid, Spain
- Centro de investigación biomédica en red - Enfermedades cardiovasculares (CIBERCV), Instituto de salud Carlos III, Madrid, Spain
| | - J Alberto San Román
- Cardiology Department, University Clinic Hospital, Valladolid, Spain
- Centro de investigación biomédica en red - Enfermedades cardiovasculares (CIBERCV), Instituto de salud Carlos III, Madrid, Spain
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2
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Tomii D, Okuno T, Lanz J, Stortecky S, Windecker S, Pilgrim T. Aortic annulus ellipticity and outcomes after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2023; 101:199-208. [PMID: 36453455 DOI: 10.1002/ccd.30507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/10/2022] [Accepted: 11/20/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Elliptical shape of the aortic annulus has been associated with an increased risk of device failure after transcatheter aortic valve implantation (TAVI) compared with a circular annular shape. AIMS To assess the impact of annulus ellipticity on procedural outcomes and device performance in patients undergoing TAVI. METHODS In a prospective TAVI registry, aortic annulus ellipticity was assessed by preprocedural multidetector computed tomography. The annulus ratios, defined by the ratio of minimum and maximum annulus diameters measured in a transverse double oblique plane, were split into tertiles for comparisons between groups. RESULTS A total of 1732 patients undergoing TAVI between August 2007 and June 2020 were included in the present analysis. Patients in the tertile with the most elliptical shape of the annulus were more likely to be female (59.7% vs. 47.9%; p < 0.001) and had a higher Society of Thoracic Surgeons Predicted Risk of Mortality (5.4 ± 3.8 vs. 4.8 ± 3.5; p = 0.002). There were no significant differences in the rate of technical success (95.3% vs. 96.5%; p = 0.235), device success (83.6% vs. 86.5%; p = 0.118) and intended valve performance (90.7% vs. 91.7; p = 0.503) between patients in the most elliptical tertile and the rest. However, valve dislocation/embolization occurred more frequently in patients with elliptical as compared to circular annular shape (2.6% vs. 1.2%; p = 0.046). CONCLUSIONS Ellipticity of the aortic annulus does not affect procedural and device outcomes in patients undergoing TAVI irrespective of transcatheter heart valve design and generation. https:www.//clinicaltrials.gov. NCT01368250.
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Affiliation(s)
- Daijiro Tomii
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
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3
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Guo Y, Zhou D, Dang M, He Y, Zhang S, Fang J, Wu S, Huang Q, Chen L, Yuan Y, Fan J, Jilaihawi H, Liu X, Wang J. The Predictors of Conduction Disturbances Following Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: A Multicenter Study. Front Cardiovasc Med 2021; 8:757190. [PMID: 34912864 PMCID: PMC8667767 DOI: 10.3389/fcvm.2021.757190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/15/2021] [Indexed: 12/29/2022] Open
Abstract
Objective: To evaluate the predictors of new-onset conduction disturbances in bicuspid aortic valve patients using self-expanding valve and identify modifiable technical factors. Background: New-onset conduction disturbances (NOCDs), including complete left bundle branch block and high-grade atrioventricular block, remain the most common complication after transcatheter aortic valve replacement (TAVR). Methods: A total of 209 consecutive bicuspid patients who underwent self-expanding TAVR in 5 centers in China were enrolled from February 2016 to September 2020. The optimal cut-offs in this study were generated from receiver operator characteristic curve analyses. The infra-annular and coronal membranous septum (MS) length was measured in preoperative computed tomography. MSID was calculated by subtracting implantation depth measure on postoperative computed tomography from infra-annular MS or coronal MS length. Results: Forty-two (20.1%) patients developed complete left bundle branch block and 21 (10.0%) patients developed high-grade atrioventricular block after TAVR, while 61 (29.2%) patients developed NOCDs. Coronal MS <4.9 mm (OR: 3.08, 95% CI: 1.63-5.82, p = 0.001) or infra-annular MS <3.7 mm (OR: 2.18, 95% CI: 1.04-4.56, p = 0.038) and left ventricular outflow tract perimeter <66.8 mm (OR: 4.95 95% CI: 1.59-15.45, p = 0.006) were powerful predictors of NOCDs. The multivariate model including age >73 years (OR: 2.26, 95% CI: 1.17-4.36, p = 0.015), Δcoronal MSID <1.8 mm (OR: 7.87, 95% CI: 2.84-21.77, p < 0.001) and prosthesis oversizing ratio on left ventricular outflow tract >3.2% (OR: 3.42, 95% CI: 1.74-6.72, p < 0.001) showed best predictive value of NOCDs, with c-statistic = 0.768 (95% CI: 0.699-0.837, p < 0.001). The incidence of NOCDs was much lower (7.5 vs. 55.2%, p < 0.001) in patients without Δcoronal MSID <1.8 mm and prosthesis oversizing ratio on left ventricular outflow tract >3.2% compared with patients who had these two risk factors. Conclusion: The risk of NOCDs in bicuspid aortic stenosis patients could be evaluated based on MS length and prosthesis oversizing ratio. Implantation depth guided by MS length and reducing the oversizing ratio might be a feasible strategy for heavily calcified bicuspid patients with short MS.
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Affiliation(s)
- Yuchao Guo
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dao Zhou
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengqiu Dang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuxing He
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shenwei Zhang
- Department of Cardiology, Zhengzhou Cardiovascular Hospital (The Seventh People' Hospital of Zheng Zhou), Zhengzhou, China
| | - Jun Fang
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shili Wu
- Department of Cardiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Qiong Huang
- Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Lianglong Chen
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yiqiang Yuan
- Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Jiaqi Fan
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hasan Jilaihawi
- Heart Valve Center, NYU Langone Health, New York City, NY, United States
| | - Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian'an Wang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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4
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Mach M, Szalkiewicz P, Poschner T, Hasan W, Andreas M, Winkler B, Hasimbegovic E, Steinkellner T, Strouhal A, Adlbrecht C, Delle-Karth G, Grabenwöger M. The use of semi-compliant versus non-compliant balloon systems for predilatation during the implantation of self-expandable transcatheter aortic valves: Data from the VIenna CardioThOracic Aortic Valve RegistrY (VICTORY). Eur J Clin Invest 2021; 51:e13570. [PMID: 33954997 PMCID: PMC8459263 DOI: 10.1111/eci.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/11/2021] [Accepted: 04/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to evaluate the differences in outcome arising from the use of semi-compliant (SCB) versus non-compliant balloon (NCB) systems for predilatation during self-expanding transcatheter aortic valve replacement (TAVR). METHODS 251 TAVR procedures with the implantation of self-expanding valves after predilatation were analyzed. SCB systems were used in 166 and NCB systems in 85 patients. The primary endpoint was defined as device success, a composite endpoint comprising the absence of procedural mortality, correct valve positioning, adequate valve performance and the absence of more than a mild paravalvular leak. The secondary endpoints were chosen in accordance with the valve academic research consortium (VARC-2) endpoint definitions. RESULTS No significant differences were observed with regard to procedural device success between the SCB- and NCB cohort (SCB: 142 [85.5%%] vs. NCB: 77 [90.6%]; P = .257). There was a notable difference between the rates of conversion to open surgery and the postdilatation rate, both of which were higher for the NCB group (SCB: 1 [0.6%] vs. NCB: 4 [5.1%]; P = .042; SCB: 30 [18.1%] vs. NCB: 34 [40%]; P < .001). In a multivariate logistic regression analysis, the use of semi-compliant balloon systems for predilatation was associated with a lower risk for postdilatation (OR: 0.296; 95% CI: 0.149-0.588) and conversion to open surgery (OR: 0.205; 95% CI: 0.085-0.493; P = .001) but not for device success. CONCLUSION While the balloon compliance did not affect the procedural mortality, device success or the rate of paravalvular leakage, the use of semi-compliant balloons for predilatation during TAVR should be investigated in larger randomized trials in the light of the lower rates of postdilatation and conversion to open surgery compared to their non-compliant counterparts.
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Affiliation(s)
- Markus Mach
- Department of Cardiac Surgery, Medical University of Vienna - Vienna General Hospital, Vienna, Austria.,Heart Team Vienna, Department of Cardio-Vascular Surgery, Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria
| | - Philipp Szalkiewicz
- Department of Cardiac Surgery, Medical University of Vienna - Vienna General Hospital, Vienna, Austria.,Heart Team Vienna, Department of Cardio-Vascular Surgery, Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria
| | - Thomas Poschner
- Department of Cardiac Surgery, Medical University of Vienna - Vienna General Hospital, Vienna, Austria
| | - Waseem Hasan
- Faculty of Medicine, Imperial College London, London, UK
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna - Vienna General Hospital, Vienna, Austria
| | - Bernhard Winkler
- Heart Team Vienna, Department of Cardio-Vascular Surgery, Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria
| | - Ena Hasimbegovic
- Department of Cardiac Surgery, Medical University of Vienna - Vienna General Hospital, Vienna, Austria.,Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna - Vienna General Hospital, Vienna, Austria
| | - Theresia Steinkellner
- Division of Anatomy, Center of Anatomy and Cell Biology, Medical University of Vienna - Vienna General Hospital, Vienna, Austria
| | - Andreas Strouhal
- Department of Cardiology, Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Vienna, Austria
| | - Christopher Adlbrecht
- Department of Cardiology, Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Vienna, Austria.,Imed19-privat, private clinical research center, Vienna, Austria
| | - Georg Delle-Karth
- Department of Cardiology, Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Vienna, Austria
| | - Martin Grabenwöger
- Heart Team Vienna, Department of Cardio-Vascular Surgery, Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria.,Medical faculty, Sigmund Freud University, Vienna, Austria
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5
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Matsushita K, Kanso M, Ohana M, Marchandot B, Kibler M, Heger J, Peillex M, Trimaille A, Hess S, Grunebaum L, Reydel A, De Poli F, Leddet P, Rischner J, Plastaras P, Jesel L, Morel O, Ohlmann P. Periprocedural Predictors of New-Onset Conduction Abnormalities After Transcatheter Aortic Valve Replacement. Circ J 2020; 84:1875-1883. [DOI: 10.1253/circj.cj-20-0257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kensuke Matsushita
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
- UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg
| | - Mohamad Kanso
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Mickael Ohana
- Department of Radiology, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Marion Kibler
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Joe Heger
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Marilou Peillex
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Antonin Trimaille
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Sébastien Hess
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Lelia Grunebaum
- Department of Haemostasis, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Antje Reydel
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Fabien De Poli
- Department of Cardiology, Centre Hospitalier de Haguenau
| | - Pierre Leddet
- Department of Cardiology, Centre Hospitalier de Haguenau
| | | | | | - Laurence Jesel
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Olivier Morel
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
- UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
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6
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Hase H, Yoshijima N, Yanagisawa R, Tanaka M, Tsuruta H, Shimizu H, Fukuda K, Naganuma T, Mizutani K, Yamawaki M, Tada N, Yamanaka F, Shirai S, Tabata M, Ueno H, Takagi K, Watanabe Y, Yamamoto M, Hayashida K. Transcatheter aortic valve replacement with Evolut R versus Sapien 3 in Japanese patients with a small aortic annulus: The OCEAN-TAVI registry. Catheter Cardiovasc Interv 2020; 97:E875-E886. [PMID: 32926552 DOI: 10.1002/ccd.29259] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To compare safety, efficacy, and hemodynamics of transfemoral transcatheter aortic valve replacement (TAVR) using self-expanding and balloon-expandable transcatheter heart valves (THVs) in patients with a small aortic annulus. BACKGROUND Few studies have directly compared TAVR outcomes using third-generation THVs, focusing on patients with small aortic annuli. METHODS In a multicenter TAVR registry, we analyzed data from 576 patients with a small annulus and who underwent transfemoral TAVR using third-generation THVs. Propensity score matching was used to adjust baseline clinical characteristics. RESULTS The device success rate in the overall cohort was 92.0% (Evolut R: 92.1% vs. Sapien 3:92.0%, p = 0.96). One year after TAVR, patients treated with Evolut R maintained a lower mean pressure gradient (mPG) and a higher indexed effective orifice area (iEOA) in the matched cohort {mPG: 9.0 [interquartile range (IQR): 6.0-11.9] vs. 12.0 [IQR: 9.9-16.3] mmHg, p < .001; iEOA: 1.20 [IQR: 1.01-1.46] vs. 1.08 [IQR: 0.90-1.28] cm2 /m2 , p < .001}. However, no significant differences were reported in the incidence of severe prosthesis-patient mismatch and aortic regurgitation at 1 year. Furthermore, both groups showed comparable outcomes with no differences in terms of all-cause mortality (log-lank test, p = .81). CONCLUSIONS TAVR for patients with a small annulus using third-generation THVs was associated with high device success. Evolut R seems to be superior to Sapien 3 in hemodynamic performance for patients with a small annulus and body surface area up to 1 year after TAVR. Nevertheless, all-cause mortality at 1 year was similar between both groups.
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Affiliation(s)
- Hiromu Hase
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuhiro Yoshijima
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Yanagisawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Tanaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hikaru Tsuruta
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Kazuki Mizutani
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | | | | | | | | | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | | | | | | | - Masanori Yamamoto
- Toyohashi Heart Center, Toyohashi, Japan.,Nagoya Heart Center, Nagoya, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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7
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Gorla R, De Marco F, Morganti S, Finotello A, Brambilla N, Testa L, Agnifili ML, Tusa M, Auricchio F, Bedogni F. Transcatheter aortic valve implantation with the Portico and Evolut R bioprostheses in patients with elliptic aortic annulus. EUROINTERVENTION 2020; 15:e1588-e1591. [DOI: 10.4244/eij-d-19-00115] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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8
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Schäfer U, Kempfert J, Verheye S, Maisano F, Thiele H, Landt M, Haude M, Rudolph TK, Ince H, Kische S, Treede H, Tonino P, Conradi L. Safety and Performance Outcomes of a Self-Expanding Transcatheter Aortic Heart Valve: The BIOVALVE Trials. JACC Cardiovasc Interv 2020; 13:157-166. [PMID: 31629751 DOI: 10.1016/j.jcin.2019.07.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/20/2019] [Accepted: 07/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to assess the safety and performance of a newly introduced transfemoral self-expanding supra-annular transcatheter heart valve. BACKGROUND Transcatheter aortic valve replacement has become an established procedure, and newer transcatheter heart valves aim to supplement the current armamentarium. METHODS BIOVALVE-I is a prospective, single-center feasibility study enrolling 13 high-risk patients with severe aortic stenosis, and BIOVALVE-II is a multicenter pilot study enrolling a further 55 patients under the same protocol. RESULTS Patients' mean age was 82.4 ± 5.3 years, 57.4% had concomitant coronary artery disease, 50.0% had renal insufficiency stage ≥3, 32.4% had diabetes mellitus, 29.4% had current anemia, 19.1% had chronic obstructive pulmonary disease, 19.1% were frail, and 17.6% had prior cerebrovascular events. The primary endpoint, early safety according to the Valve Academic Research Consortium-2 guidelines, was observed in 13 patients (19.1%). One patient (1.5%) died through 30 days of a noncardiac cause, and 4 patients (7.8%) died through 180 days. Disabling stroke occurred at 30 days in 1 patient (1.5%) and at 180 days in 2 patients (3.2%). New permanent pacemakers up to 30 days were implanted in 9 patients (13.4%). Two patients (3.8%) had moderate or severe paravalvular leakage at 30 days and 4 (9.1%) at 6 months, mean effective orifice area was 2.0 ± 0.4 cm2 and 1.9 ± 0.5 cm2, and mean gradient was 6.4 mm Hg at 30 days and 6 months. CONCLUSIONS Clinical outcomes with the Biovalve self-expanding transcatheter heart valve were similar to those seen in other first-in-human studies with first-generation devices for severe aortic stenosis.
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Affiliation(s)
- Ulrich Schäfer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Stefan Verheye
- Interventional Cardiology, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Francesco Maisano
- Division of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Martin Landt
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Michael Haude
- Medical Clinic I Städtische Kliniken Neuss Lukaskrankenhaus, Neuss, Germany
| | - Tanja K Rudolph
- Clinic for Cardiology, Angiology, and Pneumology and Intensive Care Medicine, Heart Center of the University Clinic Cologne, Cologne, Germany
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany; Department of Cardiology, Universitätsmedizin Rostock, Rostock, Germany
| | - Stephan Kische
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany; Department of Cardiology, Universitätsmedizin Rostock, Rostock, Germany
| | - Hendrik Treede
- Department of Cardiac Surgery, Mid-German Heart Centre, University Hospital Halle, Halle, Germany
| | - Pim Tonino
- Department of Cardiology, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
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9
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Ghannam M, Cunnane R, Menees D, Grossman MP, Chetcuti S, Patel H, Deeb M, Jongnarangsin K, Pelosi F, Oral H, Latchamsetty R. Atrioventricular conduction in patients undergoing pacemaker implant following self-expandable transcatheter aortic valve replacement. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:980-988. [PMID: 30969440 DOI: 10.1111/pace.13694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/11/2019] [Accepted: 04/07/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Heart block requiring a pacemaker is common after self-expandable transcatheter aortic valve replacement (SE-TAVR); however, conduction abnormalities may improve over time. Optimal device management in these patients is unknown. OBJECTIVE To evaluate the long-term, natural history of conduction disturbances in patients undergoing pacemaker implantation following SE-TAVR. METHODS All patients who underwent new cardiac implantable electronic device (CIED) implantation at Michigan Medicine following SE-TAVR placement between January 1, 2012 and September 25, 2017 were identified. Electrocardiogram and device interrogation data were examined during follow-up to identify patients with recovery of conduction. Logistic regression analysis was used to compare clinical and procedural variables to predict conduction recovery. RESULTS Following SE-TAVR, 17.5% of patients underwent device placement for new atrioventricular (AV) block. Among 40 patients with an average follow-up time of 17.1 ± 8.1 months, 20 (50%) patients had durable recovery of AV conduction. Among 20 patients without long-term recovery, four (20%) had transient recovery. The time to transient conduction recovery was 2.2 ± 0.2 months with repeat loss of conduction at 8.2 ± 0.9 months. On multivariate analysis, larger aortic annular size (odds ratio: 0.53 [0.28-0.86]/mm, P = 0.02) predicted lack of conduction recovery. CONCLUSIONS Half of the patients undergoing CIED placement for heart block following SE-TAVR recovered AV conduction within several months and maintained this over an extended follow-up period. Some patients demonstrated transient recovery of conduction before recurrence of conduction loss. Larger aortic annulus diameter was negatively associated with conduction recovery.
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Affiliation(s)
- Michael Ghannam
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ryan Cunnane
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Daniel Menees
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael P Grossman
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Stanley Chetcuti
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Himanshu Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Frank Pelosi
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Hakan Oral
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
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Sritharan D, Fathi P, Weaver JD, Retta SM, Wu C, Duraiswamy N. Impact of Clinically Relevant Elliptical Deformations on the Damage Patterns of Sagging and Stretched Leaflets in a Bioprosthetic Heart Valve. Cardiovasc Eng Technol 2018; 9:351-364. [PMID: 29948838 PMCID: PMC10451785 DOI: 10.1007/s13239-018-0366-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/21/2018] [Indexed: 01/31/2023]
Abstract
After implantation of a transcatheter bioprosthetic heart valve its original circular circumference may become distorted, which can lead to changes in leaflet coaptation and leaflets that are stretched or sagging. This may lead to early structural deterioration of the valve as seen in some explanted transcatheter heart valves. Our in vitro study evaluates the effect of leaflet deformations seen in elliptical configurations on the damage patterns of the leaflets, with circular valve deformation as the control. Bovine pericardial tissue heart valves were subjected to accelerated wear testing under both circular (N = 2) and elliptical (N = 4) configurations. The elliptical configurations were created by placing the valve inside custom-made elliptical holders, which caused the leaflets to sag or stretch. The hydrodynamic performance of the valves was monitored and high resolution images were acquired to evaluate leaflet damage patterns over time. In the elliptically deformed valves, sagging leaflets experienced more damage from wear compared to stretched leaflets; the undistorted leaflets of the circular valves experienced the least leaflet damage. Free-edge thinning and tearing were the primary modes of damage in the sagging leaflets. Belly region thinning was seen in the undistorted and stretched leaflets. Leaflet and fabric tears at the commissures were seen in all valve configurations. Free-edge tearing and commissure tears were the leading cause of valve hydrodynamic incompetence. Our study shows that mechanical wear affects heart valve pericardial leaflets differently based on whether they are undistorted, stretched, or sagging in a valve configuration. Sagging leaflets are more likely to be subjected to free-edge tear than stretched or undistorted leaflets. Reducing leaflet stress at the free edge of non-circular valve configurations should be an important factor to consider in the design and/or deployment of transcatheter bioprosthetic heart valves to improve their long-term performance.
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Affiliation(s)
- Deepa Sritharan
- Division of Applied Mechanics (DAM), Office of Science and Engineering Laboratories (OSEL), Center for Devices and Radiological Health (CDRH), Food and Drug Administration (FDA), 10903 New Hampshire Avenue, WO62, #2206, Silver Spring, MD, 20993, USA
| | - Parinaz Fathi
- Division of Applied Mechanics (DAM), Office of Science and Engineering Laboratories (OSEL), Center for Devices and Radiological Health (CDRH), Food and Drug Administration (FDA), 10903 New Hampshire Avenue, WO62, #2206, Silver Spring, MD, 20993, USA
| | - Jason D Weaver
- Division of Applied Mechanics (DAM), Office of Science and Engineering Laboratories (OSEL), Center for Devices and Radiological Health (CDRH), Food and Drug Administration (FDA), 10903 New Hampshire Avenue, WO62, #2206, Silver Spring, MD, 20993, USA
| | - Stephen M Retta
- Division of Applied Mechanics (DAM), Office of Science and Engineering Laboratories (OSEL), Center for Devices and Radiological Health (CDRH), Food and Drug Administration (FDA), 10903 New Hampshire Avenue, WO62, #2206, Silver Spring, MD, 20993, USA
| | - Changfu Wu
- Division of Cardiovascular Devices (DCD), Office of Device Evaluation (ODE), Center for Devices and Radiological Health (CDRH), Food and Drug Administration (FDA), 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Nandini Duraiswamy
- Division of Applied Mechanics (DAM), Office of Science and Engineering Laboratories (OSEL), Center for Devices and Radiological Health (CDRH), Food and Drug Administration (FDA), 10903 New Hampshire Avenue, WO62, #2206, Silver Spring, MD, 20993, USA.
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