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Giordano A, Corcione N, Barbanti M, Costa G, Dipietro E, Amat-Santos IJ, Gómez-Herrero J, Latib A, Scotti A, Testa L, Bedogni F, Schaefer A, Russo M, Musumeci F, Ferraro P, Morello A, Cimmino M, Albanese M, Pepe M, Giordano S, Biondi-Zoccai G. Features and outcomes of bailout repeat transcatheter aortic valve implantation (TAVI): the Bailout Acute TAVI-in-TAVI to Lessen Events (BATTLE) international registry. Clin Res Cardiol 2024; 113:68-74. [PMID: 37294310 PMCID: PMC10808138 DOI: 10.1007/s00392-023-02239-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
AIM Transcatheter aortic valve implantation (TAVI) is a mainstay in the management of severe aortic stenosis in patients with intermediate to prohibitive surgical risk. When a single TAVI device fails and cannot be retrieved, TAVI-in-TAVI must be performed acutely, but outcomes of bailout TAVI-in-TAVI have been incompletely appraised. We aimed at analyzing patient, procedural and outcome features of patients undergoing bailout TAVI-in-TAVI in a multicenter registry. METHODS Details of patients undergoing bailout TAVI-in-TAVI, performed acutely or within 24 h of index TAVI, in 6 international high-volume institutions, were collected. For every case provided, 2 same-week consecutive controls (prior TAVI, and subsequent TAVI) were provided. Outcomes of interest were procedural and long-term events, including death, myocardial infarction, stroke, access site complication, major bleeding, and reintervention, and their composite (i.e. major adverse events [MAE]). RESULTS A total of 106 patients undergoing bailout TAVI-in-TAVI were included, as well as 212 controls, for a total of 318 individuals. Bailout TAVI-in-TAVI was less common in younger patients, those with higher body mass index, or treated with Portico/Navitor or Sapien devices (all p < 0.05). Bailout TAVI-in-TAVI was associated with higher in-hospital rates of death, emergency surgery, MAE, and permanent pacemaker implantation (all p < 0.05). Long-term follow-up showed that bailout TAVI-in-TAVI was associated with higher rates of death and MAE (both < 0.05). Similar findings were obtained at adjusted analyses (all p < 0.05). However, censoring early events, outlook was not significantly different when comparing the two groups (p = 0.897 for death, and p = 0.645 for MAE). CONCLUSIONS Bail-out TAVI-in-TAVI is associated with significant early and long-term mortality and morbidity. Thus, meticulous preprocedural planning and sophisticated intraprocedural techniques are of paramount importance to avoid these emergency procedures.
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Affiliation(s)
- Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Nicola Corcione
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Marco Barbanti
- Division of Cardiology, Università degli Studi di Enna "Kore", Enna, Italy
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "Rodolico-San Marco", University of Catania, Catania, Italy
| | - Elena Dipietro
- Division of Cardiology, A.O.U. Policlinico "Rodolico-San Marco", University of Catania, Catania, Italy
| | - Ignacio J Amat-Santos
- Department of Cardiology, CIBERCV, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Javier Gómez-Herrero
- Department of Cardiology, CIBERCV, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Andrea Scotti
- Department of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Luca Testa
- Cardiology Unit, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart and Vascular Center of Hamburg, Hamburg, Germany
| | - Marco Russo
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Francesco Musumeci
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Paolo Ferraro
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Alberto Morello
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Michele Cimmino
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Michele Albanese
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Martino Pepe
- Cardiovascular Diseases Section, Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
- Mediterranea Cardiocentro, Naples, Italy.
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2
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Halim J, den Heijer P, van den Branden B, Meuwissen M, Vos J, Schölzel B, IJsselmuiden A. Short-term outcome after transcatheter aortic valve replacement with a novel balloon-expandable valve. Neth Heart J 2023; 31:500-505. [PMID: 36480146 PMCID: PMC10667167 DOI: 10.1007/s12471-022-01738-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve replacement (TAVR) has been expanding rapidly with numerous transcatheter heart valve (THV) systems currently available. The Myval balloon-expandable (BE) valve (Meril Life Sciences Pvt. Ltd., India) is a novel THV system indicated for the treatment of patients with severe aortic stenosis. The primary objective of this study is to assess the safety and performance of the Myval BE valve. METHODS In this prospective single-centre study, 120 consecutive patients who underwent TAVR with the Myval BE valve were included. Clinical outcomes were evaluated at 30 days and 6 months using Valve Academic Research Consortium‑2 criteria. All-cause mortality, stroke, acute kidney injury, major vascular complications, moderate or severe paravalvular leakage (PVL) and need for a permanent pacemaker implantation (PPI) were investigated. RESULTS At 6‑month follow-up, all-cause death and cardiac death were seen in 5.8% and 0.8% of the patients respectively. Periprocedural stroke and need for PPI were both seen in 3.3% of the patients. Access-site-related vascular and bleeding complications were absent. Improved valve haemodynamics and no moderate to severe PVL could be seen at 30 days. An intermediate valve size was selected in 51% of the patients. CONCLUSIONS The Myval BE valve demonstrates improved valve haemodynamics, absence of moderate to severe PVL and good safety outcomes at 6‑month follow-up with low cardiac death rate and acceptable rates of permanent pacemaker implantation and periprocedural stroke. Future randomised controlled trials will further establish the clinical utility of the Myval BE valve.
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Affiliation(s)
- J Halim
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands.
| | - P den Heijer
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - B van den Branden
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - M Meuwissen
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - J Vos
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - B Schölzel
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - A IJsselmuiden
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
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3
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Giordano A, Schaefer A, Bhadra OD, Barbanti M, Costa G, Sammartino S, Sondergaard L, De Backer O, Dalsgaard M, D'Ascenzo F, Musto C, Fineschi M, Maisano F, Testa L, Vercellino M, Berni A, Galasso G, Cammardella AG, Morello A, Pepe M, Albanese M, Cimmino M, Giordano S, Biondi-Zoccai G, Corcione N. Outcomes of Transcatheter Aortic Valve Replacement in Patients With Severely Reduced Left Ventricular Systolic Function in the Low Systolic Function and Transcatheter Aortic Valve Implantation (LOSTAVI) International Registry. Am J Cardiol 2023; 201:349-358. [PMID: 37423004 DOI: 10.1016/j.amjcard.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is an established therapy for severe, symptomatic aortic valve stenosis even in patients with impaired left ventricular systolic function. However, there is uncertainty on the clinical effectiveness of the currently available TAVR devices in patients with reduced left ventricular ejection fraction (LVEF). The LOSTAVI (Low Systolic function and Transcatheter Aortic Valve Implantation) registry is a retrospective observational study using baseline, procedural, discharge, and long-term follow-up details. A total of 3 groups of interest were distinguished: extremely reduced LVEF (<25%), severely reduced LVEF (25% to 30%), and reduced LVEF (31% to 35%). Unadjusted and adjusted analyses were carried out for in-hospital and follow-up outcomes. A total of 923 patients were included from 12 centers, with 146 patients (16%) with LVEF <25%, 425 (46%) with LVEF 25% to 30%, and 352 (38%) with LVEF 31% to 35%. Several baseline and procedural features were different across groups, including age, risk, functional class, and prevalence of bicuspid disease (all p <0.05). In-hospital mortality was similar in the 3 groups (7 [4.8%], 18 [4.2%], and 7 [2.0%], respectively, p = 0.661), but major adverse events were more common in those with extremely reduced and severely reduced LVEF (19 [13%], 53 [13%], and 25 [7.1%], respectively, p = 0.024). The 12-month follow-up confirmed the significant detrimental impact of reduced LVEF on both death (21 [14%], 49 [12%], and 25 [7.1%], respectively, p = 0.024) and major adverse events (37 [25%], 89 [21%], and 53 [15%], respectively, p = 0.016). The adjusted analysis confirmed the significant prognostic role of LVEF on both outcomes, whereas TAVR device type was not associated with death or major adverse events (all p >0.05). In conclusion, TAVR yields favorable early and 1-year results in patients with reduced LVEF, including those with extremely depressed systolic dysfunction. However, reduced LVEF still represents a major adverse prognostic factor for both short- and mid-term outcomes.
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Affiliation(s)
- Arturo Giordano
- Cardiovascular Interventions Unit, Pineta Grande Hospital, Castel Volturno, Italy; Hemodynamics Unit, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart and Vascular Center of Hamburg, Hamburg, Germany
| | - Oliver D Bhadra
- Department of Cardiovascular Surgery, University Heart and Vascular Center of Hamburg, Hamburg, Germany
| | - Marco Barbanti
- Division of Cardiology, Enna Kore University, Enna, Italy
| | - Giuliano Costa
- Division of Cardiology, A.G. Rodolico-San Marco Hospital, Catania, Italy
| | - Sofia Sammartino
- Division of Cardiology, A.G. Rodolico-San Marco Hospital, Catania, Italy
| | - Lars Sondergaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ole De Backer
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Marie Dalsgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department of Medical Sciences, University of Turin Hospital, Turin, Italy
| | - Carmine Musto
- Department of Cardiosciences, A.O. San Camillo Forlanini Hospital, Rome, Italy
| | - Massimo Fineschi
- Interventional Cardiology Unit, Siena University Hospital, Siena, Italy
| | - Francesco Maisano
- Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy
| | - Luca Testa
- Department of Cardiology, San Donato Hospital, San Donato Milanese, Milan, Italy
| | - Matteo Vercellino
- Department of Internal Medicine and Specialties, University of Genoa, and Cardiology Unit, Cardiothoracic and Vascular Department, San Martino Hospital, Genoa, Italy
| | - Andrea Berni
- Interventional Cardiology Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Gennaro Galasso
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Antonio G Cammardella
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Alberto Morello
- Cardiovascular Interventions Unit, Pineta Grande Hospital, Castel Volturno, Italy; Hemodynamics Unit, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Martino Pepe
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari Aldo Moro, Bari, Italy
| | - Michele Albanese
- Cardiovascular Interventions Unit, Pineta Grande Hospital, Castel Volturno, Italy; Hemodynamics Unit, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Michele Cimmino
- Cardiovascular Interventions Unit, Pineta Grande Hospital, Castel Volturno, Italy; Hemodynamics Unit, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy.
| | - Nicola Corcione
- Cardiovascular Interventions Unit, Pineta Grande Hospital, Castel Volturno, Italy; Hemodynamics Unit, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
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Bihan DCDSL, Barretto RBDM, Mathias W. Transcatheter Aortic Valve Implantation: What has Happened and What is Yet to Come. Arq Bras Cardiol 2023; 120:e20230401. [PMID: 37585898 PMCID: PMC10421602 DOI: 10.36660/abc.20230401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Affiliation(s)
- David Costa de Souza Le Bihan
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
- Fleury Medicina e SaúdeSão PauloSPBrasilFleury Medicina e Saúde, São Paulo, SP – Brasil
| | - Rodrigo Bellio de Mattos Barretto
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Wilson Mathias
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
- Fleury Medicina e SaúdeSão PauloSPBrasilFleury Medicina e Saúde, São Paulo, SP – Brasil
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Kneizeh K, Milzi A, Vogt F, Witte K, Marx N, Lehrke M, Almalla M, Schröder J. Efficacy and Safety of Low-Dose Protamine in Reducing Bleeding Complications during TAVI: A Propensity-Matched Comparison. J Clin Med 2023; 12:4243. [PMID: 37445282 DOI: 10.3390/jcm12134243] [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: 05/02/2023] [Revised: 06/09/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVES We aimed to evaluate the efficacy and safety of low-dose protamine in reducing access site-related complications during Transcatheter Aortic Valve Implantation (TAVI) as compared to full-dose protamine. BACKGROUND Access site-related complications represent an independent predictor of poor outcomes of TAVI. Data regarding heparin reversal with protamine and the dosage needed to prevent bleeding complications are scarce among patients undergoing TAVI. METHODS A total of 897 patients were retrospectively included in the study. Patients who underwent percutaneous coronary intervention within 4 weeks before or concomitantly with TAVI (n = 191) were given 0.5 mg protamine for each 100 units of unfractionated heparin. All other patients (n = 706) were considered as a control group and 1 mg protamine for each 100 units of heparin was administered. RESULTS The combined intra-hospital endpoint of death, life-threatening major bleeding, and major vascular complications were significantly more frequent in patients receiving low-dose protamine [29 (15.2%) vs. 50 (7.1%), p < 0.001]. After propensity matching (n = 130 for each group) for relevant clinical characteristics including anti-platelet therapy [19 (14.6%) vs. 6 (4.6%), p = 0.006], low-dose protamine predicted the combined endpoint (OR 3.54, 95%-CI 1.36-9.17, p = 0.009), and even in multivariable analysis, low-dose protamine continued to be a predictor of the combined endpoint in the matched model (OR 3.07, 95%-CI 1.17-8.08, p = 0.023) alongside baseline hemoglobin. CONCLUSIONS In this propensity-matched retrospective analysis, a low-dose protamine regime is associated with a higher rate of major adverse events compared to a full-dose protamine regime following transfemoral TAVI.
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Affiliation(s)
- Kinan Kneizeh
- Department of Cardiology, Angiology and Critical Care (Medical Clinic 1), University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Andrea Milzi
- Department of Cardiology, Angiology and Critical Care (Medical Clinic 1), University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Felix Vogt
- Department of Cardiology, Angiology and Critical Care (Medical Clinic 1), University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Klaus Witte
- Department of Cardiology, Angiology and Critical Care (Medical Clinic 1), University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, Angiology and Critical Care (Medical Clinic 1), University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Michael Lehrke
- Department of Cardiology, Angiology and Critical Care (Medical Clinic 1), University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Mohammad Almalla
- Department of Cardiology, Angiology and Critical Care (Medical Clinic 1), University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Jörg Schröder
- Department of Cardiology, Angiology and Critical Care (Medical Clinic 1), University Hospital RWTH Aachen, 52074 Aachen, Germany
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Halim J, Rooijakkers M, den Heijer P, El Haddad M, van den Branden B, Vos J, Schölzel B, Meuwissen M, van Gameren M, El Messaoudi S, van Royen N, IJsselmuiden S. Assessing the Novel Myval Balloon-Expandable Valve with the Evolut Valve: A Propensity-Matched Study. J Clin Med 2023; 12:4213. [PMID: 37445248 DOI: 10.3390/jcm12134213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The Myval balloon-expandable (BE) valve has shown encouraging early clinical data in terms of safety and efficacy. Comparative data with other well-established contemporary valves are nonetheless still scarce. This study aims to compare the performance of the Myval BE valve with the Evolut self-expanding (SE) valve. METHODS In this retrospective single-center study, 223 patients with symptomatic severe aortic stenosis (AS) were included and treated with the Myval BE valve (n = 120) or with the Evolut SE valve (n = 103). Then, 91 pairs were compared after matching. Clinical outcomes were evaluated at 30 days and 1 year. Echocardiographic follow-up was performed at 30 days. RESULTS Procedural complications were rare in both groups. At the 30-day follow-up, no significant difference in cardiac death (Myval: 1% vs. Evolut: 2%, p = 0.56), stroke (2% vs. 4%, p = 0.41) and myocardial infarction (1% vs. 3%, p = 0.31) was observed. A permanent pacemaker implantation (PPI) was significantly less needed in the Myval group (4% vs. 15%, p = 0.01). At 1 year, cardiac death (2% vs. 4%, p = 0.41) and the stroke rate (7% vs. 5%, p = 0.76) were similar. Moderate-severe paravalvular leakage (PVL) was also comparable in both groups (1% vs. 4%, p = 0.17). CONCLUSION Safety and efficacy outcomes were comparable between the two valves, except for a higher PPI rate for the Evolut SE valve. Up to 1-year follow-up, clinical outcomes showed acceptable rates of stroke and cardiac death with both valves. Valve hemodynamics were excellent with a low rate of moderate-severe PVL in both groups.
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Affiliation(s)
- Jonathan Halim
- Department of Cardiology, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Maxim Rooijakkers
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Peter den Heijer
- Department of Cardiology, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Milad El Haddad
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, 8000 Bruges, Belgium
| | - Ben van den Branden
- Department of Cardiology, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Jeroen Vos
- Department of Cardiology, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Bas Schölzel
- Department of Cardiology, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Martijn Meuwissen
- Department of Cardiology, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Menno van Gameren
- Department of Cardiology, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Saloua El Messaoudi
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Sander IJsselmuiden
- Department of Cardiology, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
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7
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Corcione N, Ferraro P, Morello A, Cimmino M, Albanese M, Pepe M, Giordano S, Biondi-Zoccai G, Giordano A. Transcatheter aortic valve implantation with Allegra: procedural and mid-term outcomes according to experience phase in a high-volume center. Minerva Cardiol Angiol 2022; 70:677-685. [PMID: 36222602 DOI: 10.23736/s2724-5683.22.06173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis. We aimed at appraising effectiveness of a new self-expandable TAVI device. METHODS We retrospectively analyzed our institutional experience with Allegra (Biosensors, Morges, Switzerland) for TAVI, focusing on procedural outcomes and 1-month adverse events. We explored the impact of operator experience with this device, dividing patients according to their time of intervention. RESULTS Between 2018 and 2021, a total of 50 patients underwent TAVI with Allegra, with average age of 81 years, 80% women, and 50% at low or intermediate surgical risk. No major significant difference in baseline patient features were found when comparing Phase 1 and Phase 2, except for baseline left ventricular ejection fraction and New York Heart Association, which were worse in Phase 1. All procedures were performed transfemorally and percutaneously, with predilation in 94% and postdilation in 36%, yielding device success in 98%, and procedural success in 96%. No significant differences in procedural features were found when comparing Phase 1 vs. Phase 2 (all P>0.05). One-month follow-up was also favorable, with no significant difference in adverse outcomes according to phase, and a total of 1 (4%) death, 1 (4%) myocardial infarction, 1 (4%) minor vascular complication, and 4 (8%) permanent pacemaker implantations. Consistent findings were obtained at exploratory 6-month follow-up. CONCLUSIONS The Allegra TAVI device is associated with favorable short-to-midterm outcomes in experienced hands. Operators already proficient with other devices can achieve satisfactory results even in the early phase of adoption of Allegra.
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Affiliation(s)
- Nicola Corcione
- Unit of Cardiovascular Interventions, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Paolo Ferraro
- Operative Unit of Hemodynamics, Santa Lucia Hospital, San Giuseppe Vesuviano, Naples, Italy
| | - Alberto Morello
- Unit of Cardiovascular Interventions, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Michele Cimmino
- Unit of Cardiovascular Interventions, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Michele Albanese
- Operative Unit of Hemodynamics, Santa Lucia Hospital, San Giuseppe Vesuviano, Naples, Italy
| | - Martino Pepe
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Bari, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy
| | - Arturo Giordano
- Unit of Cardiovascular Interventions, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
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8
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Zervides C, Nohra O, Hunduma G, Thomas NW, Samia R. 2006 to 2019 Story; percutaneously implantable aortic valve prototypes. J Cardiothorac Surg 2021; 16:223. [PMID: 34362403 PMCID: PMC8348870 DOI: 10.1186/s13019-021-01597-6] [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: 06/06/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
Aims A review was conducted on the composition, advantages and limitations of available aortic valve prototypes to create an ideal valve for percutaneous implantation. Patients Patients with multiple comorbidities who cannot withstand the risks of open cardiac surgery. Methodology The search was performed using online databases and textbooks. Articles were excluded based on specific criterion. Results Ten prototypes created between 2006 and 2019 were found and reviewed. The prototypes had a set of advantages and limitations with their characteristics coinciding at times. Conclusions The ideal percutaneously implantable aortic valve should have minimum coaptation height, zero folds in the leaflets, minimum valve height, minimum leaflet flexion and three leaflets. It can be composed of biological or synthetic material, as long as it provides minimal risk of thrombosis. However, more studies are needed to ensure other ideal parameters.
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Affiliation(s)
- Constantinos Zervides
- University of Nicosia Medical School, University of Nicosia, 21 Ilia Papakyriakou, 2414, Engomi, Nicosia, Cyprus.
| | - Ornella Nohra
- University of Nicosia Medical School, University of Nicosia, 21 Ilia Papakyriakou, 2414, Engomi, Nicosia, Cyprus
| | - Gabriel Hunduma
- University of Nicosia Medical School, University of Nicosia, 21 Ilia Papakyriakou, 2414, Engomi, Nicosia, Cyprus
| | - Neil Wild Thomas
- University of Nicosia Medical School, University of Nicosia, 21 Ilia Papakyriakou, 2414, Engomi, Nicosia, Cyprus
| | - Ramy Samia
- University of Nicosia Medical School, University of Nicosia, 21 Ilia Papakyriakou, 2414, Engomi, Nicosia, Cyprus
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9
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Asgar AW, Jamart L. Out-of-Hospital Mortality Following TAVR: Decrypting the Enigma. JACC Cardiovasc Interv 2021; 14:275-277. [PMID: 33541538 DOI: 10.1016/j.jcin.2020.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Anita W Asgar
- Division of Cardiology, Montreal Heart Institute, Université de Montreal, Montreal, Quebec, Canada.
| | - Laurent Jamart
- Division of Cardiology, Montreal Heart Institute, Université de Montreal, Montreal, Quebec, Canada
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10
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Penati C, Incorvaia C, Mollo V, Lietti F, Gatto G, Stefanelli M, Centeleghe P, Talarico G, Mori I, Franzelli C, Ratti F, Ponticelli MP, Ridolo E, Febo OC. Cardiac rehabilitation outcome after transcatheter aortic valve implantation. Monaldi Arch Chest Dis 2021; 91. [PMID: 33849260 DOI: 10.4081/monaldi.2021.1621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/02/2020] [Indexed: 11/23/2022] Open
Abstract
Patients with severe aortic stenosis are increasingly treated with transcatheter aortic valve implantation (TAVI) as a safer option to surgical aortic valve replacement (sAVR). Similar to many other heart diseases, after the specific therapeutic intervention patients are eligible for cardiac rehabilitation (CR) for the purpose of functional recovery. Thus far, CR after both sAVR and TAVI has been used to a limited extent, as shown by the availability of only two meta-analyses including 5 studies and 6 studies, respectively. Recent observational studies reported a significant improvement in functional indexes such as the Barthel scale and the 6-minute walk test (6MWT). We evaluated the outcome of CR in patients after TAVI treatment by measuring changes in the commonly used Barthel scale and 6MWT and adding the short physical performance battery (SPPB) scale as an index to assess lower extremity function. All indexes demonstrated a significant improvement, namely p<0.001 with the Barthel scale, p=0.043 for the 6MWT, and p=0.002 for SPPB. These results confirm the significant improvement of the Barthel scale and 6MWT reported in the previous meta-analysis and suggest the utility of SPPB as a further index of efficacy of CR in patients with severe aortic stenosis treated with TAVI.
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Affiliation(s)
- Chiara Penati
- Cardiac/Pulmonary Rehabilitation, ASST Pini-CTO, Milan.
| | | | | | | | - Gemma Gatto
- Cardiac/Pulmonary Rehabilitation, ASST Pini-CTO, Milan.
| | | | | | | | - Ileana Mori
- Cardiac/Pulmonary Rehabilitation, ASST Pini-CTO, Milan.
| | | | - Fosco Ratti
- Cardiac/Pulmonary Rehabilitation, ASST Pini-CTO, Milan.
| | | | - Ermina Ridolo
- Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma.
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11
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Abstract
Aortic stenosis (AS) of moderate or greater severity has an estimated prevalence of 5% in people older than 65 years. Survival is poor after onset of symptoms, and surgical aortic valve replacement was the gold-standard treatment for decades. However, more than one-third of patients with symptomatic AS were untreated due to high surgical risk, exposing a clinical need for a less invasive therapy for aortic valve stenosis. The PARTNER trials were pivotal in presenting robust evidence for the safety, feasibility, and efficacy of transcatheter aortic valve replacement in the management of AS and paved the way for clinical use worldwide.
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Affiliation(s)
- Ryan Markham
- Stanford Hospital, Palo Alto, CA, USA; Department of Cardiovascular Medicine, Stanford Hospital, 300 Pasteur Drive, Room H2103, Stanford, CA 94305, USA
| | - Rahul Sharma
- Stanford Hospital, Palo Alto, CA, USA; Department of Cardiovascular Medicine, Stanford Hospital, 300 Pasteur Drive, Room H2103, Stanford, CA 94305, USA.
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12
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Sharma SK, Rao RS, Chopra M, Sonawane A, Jose J, Sengottuvelu G. Myval transcatheter heart valve system in the treatment of severe symptomatic aortic stenosis. Future Cardiol 2020; 17:73-80. [PMID: 32628046 DOI: 10.2217/fca-2020-0020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The transcatheter aortic valve replacement (TAVR) is an established treatment for patients with severe symptomatic aortic stenosis (AS) at prohibitive risk for surgery. It is an alternative treatment to surgical aortic valve replacement in patients with AS at intermediate- and high-surgical risk. Although regulatory authorities extend the indications of TAVR to treat patients at low-surgical risk, the limitations of earlier-generation transcatheter heart valve (THV) systems accelerate the development of improved newer generation of THV systems. Myval™ THV (Meril Life Sciences Pvt. Ltd., Vapi, Gujarat, India) is a newer-generation, balloon-expandable TAVR system with features that facilitate accurate positioning of the bioprosthetic valve and favorable procedural and clinical outcomes. This review summarizes existing preclinical and clinical data on Myval THV for the intervention of symptomatic native AS and lays out the plan for future research program.
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Affiliation(s)
- Samin K Sharma
- Director of Clinical and Interventional Cardiology and Dean of International Clinical Affiliations, Mount Sinai Health System, NY, USA
| | - Ravinder S Rao
- Department of Cardiology, Eternal Heart Care Centre & Research Institute Pvt. Ltd., Jaipur, Rajasthan 302017, India
| | - Manik Chopra
- Department of Cardiology, Narayana Multispeciality Hospital, Ahmedabad, Gujarat 380023, India
| | - Anmol Sonawane
- Department of Cardiology, Breach Candy Hospital, Mumbai, Maharashtra 400026, India
| | - John Jose
- Department of Cardiology, Christian Medical College & Hospital, Vellore, Tamil Nadu 632002, India
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13
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Sammour Y, Kadri AN, Gajulapalli RD, Kaur M, Bazarbashi N, Banerjee K, Karrthik A, Dhaliwal K, Burns D, Yun J, Krishnaswamy A, Kapadia SR. Comparison of acute recoil after valve deployment and after p
ost‐dilation
in patients undergoing
transfemoral‐transcatheter
aortic valve replacement with
SAPIEN
‐3 valve. Catheter Cardiovasc Interv 2020; 96:1522-1530. [DOI: 10.1002/ccd.28968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/16/2020] [Accepted: 05/01/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Yasser Sammour
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Amer N. Kadri
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | | | - Manpreet Kaur
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Najdat Bazarbashi
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Kinjal Banerjee
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Antonette Karrthik
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | | | - Daniel Burns
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - James Yun
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Amar Krishnaswamy
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Samir R. Kapadia
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
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14
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Bidar E, Folliguet T, Kluin J, Muneretto C, Parolari A, Barili F, Suwalski P, Bonaros N, Punjabi P, Sadaba R, De Bonis M, Al-Attar N, Obadia JF, Czerny M, Shrestha M, Zegdi R, Natour E, Lorusso R. Postimplant biological aortic prosthesis degeneration: challenges in transcatheter valve implants. Eur J Cardiothorac Surg 2019; 55:191-200. [PMID: 30541101 DOI: 10.1093/ejcts/ezy391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/15/2018] [Indexed: 12/29/2022] Open
Abstract
Surgical aortic valve replacement (SAVR) is highly effective and can be achieved with relatively low risk in patients with severe aortic stenosis. Bioprostheses have been used most frequently during the past 60 years. However, the function of biological valves usually declines after 10-15 years from implant when structural valve degeneration occurs often mandating a reoperation once valve dysfunction becomes haemodynamically significant. Known for many years by surgeons and cardiologists taking care of patients with SAVR, the issue of postimplant structural valve degeneration has been recently highlighted also in patients with transcatheter aortic valve implant (TAVI). There is growing concern that TAVI valves exhibit structural valve degeneration due to inherent challenges of the deployment mode. The impact on postimplant degeneration of TAVI valves compared to SAVR has still to be understood and defined. Based on the ongoing process of expanding TAVI indications, several potential shortcomings and caveats, learned during the last 60 years of SAVR experience, should be taken into consideration to refine this technique.
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Affiliation(s)
- Elham Bidar
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Thierry Folliguet
- Centre Hospitalo-Universitaire Brabois ILCV, Hôpital Henri Mondor, Division of Cardio Thoracic Surgery and Transplantation, Université Paris 12 UPEC, France
| | - Jolanda Kluin
- Department of Cardio-Thoracic Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - Claudio Muneretto
- Cardiac Surgery Unit, University of Brescia Medical School, Brescia, Italy
| | - Alessandro Parolari
- Cardiac Surgery and Translational Research Units, IRCCS, Policlinico S. Donato, University of Milan, Milan, Italy
| | - Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Prakash Punjabi
- Department of Cardio-Thoracic Surgery, Imperial College Healthcare NHS Trust, Imperial College School of Medicine, London, UK
| | - Rafa Sadaba
- Department of Cardiac Surgery, Hospital de Navarra, Pamplona, Spain
| | - Michele De Bonis
- Department of Cardiac Surgery, S. Raffaele University Hospital, Milan, Italy
| | - Nawwar Al-Attar
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | - Jean Francois Obadia
- Department of Cardio-Thoracic Surgery, Hôpital Cardiothoracique Louis Pradel, Lyon, France
| | - Martin Czerny
- Department of Cardio-Vascular Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Malakh Shrestha
- Department of Cardio-Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Rachid Zegdi
- Hôpital Européen Georges Pompidou, Paris, France
| | - Ehsan Natour
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
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15
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McClellan M, Brown N, Califf RM, Warner JJ. Call to Action: Urgent Challenges in Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation 2019; 139:e44-e54. [PMID: 30674212 DOI: 10.1161/cir.0000000000000652] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although advances in care have spurred improvements in cardiovascular outcomes, cardiovascular disease remains the leading cause of death in the United States and around the world. Previous declines in cardiovascular disease mortality have slowed and even reversed for certain demographics. Further concerns exist with regard to cardiovascular drug innovation, quality of care, and healthcare costs. The Value in Healthcare Initiative-Transforming Cardiovascular Care, a collaboration of the American Heart Association and Duke University, Robert J. Margolis, MD, Center for Health Policy, aims to increase access to and affordability of cardiovascular treatment and to decrease barriers to care. The following Call to Action describes trends in cardiovascular care, identifies gaps in areas of cardiovascular disease prevention and treatment, highlights challenges with medical product innovation, and finally, outlines a series of learning collaboratives that will aid in the development of road maps for transforming cardiovascular care.
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16
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Tarro Genta F. Cardiac Rehabilitation for Transcatheter Aortic Valve Replacement. Clin Geriatr Med 2019; 35:539-548. [DOI: 10.1016/j.cger.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Lam NN, James MT. Evaluating Transcatheter Aortic Valve Replacement in Kidney Transplant Recipients: Characterizing Opportunities to Improve Outcomes. Can J Cardiol 2019; 35:1085-1087. [DOI: 10.1016/j.cjca.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022] Open
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18
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Figulla HR, Franz M, Lauten A. The History of Transcatheter Aortic Valve Implantation (TAVI)-A Personal View Over 25 Years of development. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:398-403. [PMID: 31383557 DOI: 10.1016/j.carrev.2019.05.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/23/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
Abstract
In the early 1990s, the idea of Transcatheter Aortic Valve Implantation (TAVI) emerged from clinicians by the insight that the long-term hemodynamic and clinical results of aortic balloon valvuloplasty to treat aortic stenonosis were not satisfying. Thus, Anderson and Cribier developed the balloon-expandable and Figulla and Laborde the self-expendable TAVI systems. Sceptical views by the surgical colleagues and the industry delayed the rapid development of this disruptive new therapy until 2002, when Alain Cribier demonstrated for the first time the proof of his concept. Bulky devices and paravalvular leakages in patients treated in terms of compassionate care resulted in high mortality rates. From 2005 onwards, the treatment of patients not at highest risk using smoother devices in clinical trials could demonstrate that the technology was equivalent to surgical aortic valve replacement. The transapical access route initiated the heart team approach with the surgical colleagues, however, this access route is presently expiring due to its greater trauma. The need to treat also aortic regurgitation is addressed by the "clipping technology" of JenaValve™. Ongoing clinical trials investigate an extended indication for TAVI at an earlier stage of aortic stenosis, or in reduced ejection fraction, and just demonstrated the safety and efficiency even in low surgical risk patients.
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Affiliation(s)
| | - Marcus Franz
- Friedrich Schiller University Jena, Jena University Hospital, Department of Internal Medicine I, Jena, Germany
| | - Alexander Lauten
- Charité-Universitätsmedizin Berlin, University Heart Centre, Department of Cardiology, German Centre for Cardiovascular Research (DZHK), Berlin, Germany
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19
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Evaluation of transcatheter heart valve biomaterials: Computational modeling using bovine and porcine pericardium. J Mech Behav Biomed Mater 2019; 97:159-170. [PMID: 31125889 DOI: 10.1016/j.jmbbm.2019.05.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 04/20/2019] [Accepted: 05/13/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The durability of bioprosthetic heart valve (BHV) devices, commonly made of bovine (BP) and porcine (PP) pericardium tissue, is partly limited by device calcification and tissue degeneration, which has been associated with pathological levels of mechanical stress. This study investigated the impacts of BP and PP tissues with different thicknesses and tissue mechanical properties in BHV applications. METHODS Second Harmonic Generation (SHG) imaging was employed to visualize the collagen fibers on each side of the pericardium. Structural constitutive modeling that incorporates collagen fiber distribution obtained from multiphoton microscopy for each tissue type were derived to characterize the corresponding biaxial mechanical testing data collected in a previous study. The models were verified through finite element (FE) simulations of the biaxial test and implemented in valve closing simulations. RESULTS Smooth side collagen fibers were found to correlate with the mechanical response. BHVs with adult (ABP) and calf (CBP) BP tissues had lower maximum principal stresses than those with PP and fetal (FBP) BP tissues. Collagen fiber orientation along the circumferential axis resulted in lower maximum principal stresses and more uniform and symmetric stress distributions throughout the valve. CONCLUSIONS The use of PP and FBP tissue resulted in higher peak stresses than ABP and CBP tissues in the given valve design. Additionally, ensuring collagen fiber orientation along the circumferential axis led to lower maximum stresses felt by the valve leaflets, which could also improve BHV durability.
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20
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Nguyen TC, Keegan P, Nguyen S, Loyalka P, Kaneko T, Shah PB, Grubb KJ, Babaliaros VC. Balloon-expandable transcatheter aortic valve replacement outcomes by procedure location: Catheterization laboratory versus operating room. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:149-154. [PMID: 31178348 DOI: 10.1016/j.carrev.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 03/20/2019] [Accepted: 04/05/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The impact of procedure location on clinical outcomes after TAVR remains unclear. We aimed to compare short-term outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) in the catheterization laboratory (CATH) versus surgical operating room (OR). METHODS A retrospective review of 63,581 trans-femoral TAVR patients using balloon-expandable valves from 2015 to 2018 were captured utilizing the TVT Registry. Propensity score matching was performed using 24 covariates resulting in 2 risk-adjusted groups. Patients were further stratified by STS Risk Score with outcomes compared. RESULTS Propensity score matching resulted in 24,160 risk-matched CATH and OR patient pairs. Short-term clinical outcomes including all-cause mortality, stroke, major vascular complications, life-threatening bleeding, and new dialysis were similar between CATH and OR (p = all ns). There was no difference in conversion to open heart surgery between CATH and OR with both occurring at a very low rate (0.4% vs. 0.5%, p = 0.07). Moreover, the 30-day survival post-conversion was similar whether TAVR was performed in CATH versus OR (43.3% and 49.7%, p = 0.28). When stratified by STS Risk Score, there was no difference in conversion to surgery or 30-day mortality in low and intermediate risk patients between CATH and OR. For high risk patients, however, conversion to surgery was lower in CATH vs. OR (0.2% vs. 0.4%, p = 0.04) with no difference in 30-day survival (46% vs. 43%, p = 0.94). CONCLUSIONS Procedure location has minimal impact on TAVR procedural and 30-day outcomes with a very low conversion to open surgery rate between CATH versus OR for low, intermediate, and high-risk patients.
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Affiliation(s)
- Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, Heart and Vascular Institute, University of Texas Medical School at Houston, Houston, TX, USA.
| | - Patricia Keegan
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie Nguyen
- Department of Cardiothoracic and Vascular Surgery, Heart and Vascular Institute, University of Texas Medical School at Houston, Houston, TX, USA
| | - Pranav Loyalka
- Department of Cardiothoracic and Vascular Surgery, Heart and Vascular Institute, University of Texas Medical School at Houston, Houston, TX, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Pinak B Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Vasilis C Babaliaros
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA, USA
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21
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22
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Rostagno C. Heart valve disease in elderly. World J Cardiol 2019; 11:71-83. [PMID: 30820277 PMCID: PMC6391621 DOI: 10.4330/wjc.v11.i2.71] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/13/2019] [Accepted: 01/26/2019] [Indexed: 02/06/2023] Open
Abstract
The incidence of heart valve disease increases significantly with age. Degenerative abnormalities associated with severe aortic stenosis and mitral and tricuspid regurgitation are found in not less than 10% of the population aged ≥ 75 years. Surgical treatment has been considered for years to be the treatment of choice. However, it was not uncommonly associated with high perioperative morbidity and mortality due to frequent comorbidities and overall frailty conditions of these patients. Conventional risk scores such as Society of Thoracic Surgeons and European System for Cardiac Operative Risk Evaluation may underestimate the risk of surgery in elderly patients, leading to inappropriate surgical indication. On the other hand, at least 30% of patients with severe conditions are left untreated due to prohibitive surgical risk. Interventional procedures, which are in continuous development, may be actually considered for high risk patients and, as recent results suggest, also for intermediate risk patients.
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Affiliation(s)
- Carlo Rostagno
- Department of Internal Medicine, University of Florence, Florence 50134, Italy
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23
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Meng S, Mao J, Rouse EN, Le-Bel G, Bourget JM, Reed RR, Philippe E, How D, Zhang Z, Germain L, Guidoin R. The Red Kangaroo pericardium as a material source for the manufacture of percutaneous heart valves. Morphologie 2019; 103:37-47. [PMID: 30638803 DOI: 10.1016/j.morpho.2018.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The kangaroo pericardium might be considered to be a good candidate material for use in the manufacture of the leaflets of percutaneous heart valves based upon the unique lifestyle. The diet consists of herbs, forbs and strubs. The kangaroo pericardium holds an undulated structure of collagen. MATERIAL AND METHOD A Red Kangaroo was obtained after a traffic fatality and the pericardium was dissected. Four compasses were cut from four different sites: auricular (AUR), atrial (ATR), sternoperitoneal (SPL) and phrenopericardial (PPL). They were investigated by means of scanning electron microscopy, light microscopy and transmission electron microscopy. RESULTS All the samples showed dense and wavy collagen bundles without vascularisation from both the epicardium and the parietal pericardium. The AUR and the ATR were 150±25μm thick whereas the SPL and the PPL were thinner at 120±20μm. The surface of the epicardium was smooth and glistening. The filaments of collagen were well individualized without any aggregation, but the banding was poorly defined and somewhat blurry. CONCLUSION This detailed morphological analysis of the kangaroo pericardium illustrated a surface resistant to thrombosis and physical characteristics resistant to fatigue. The morphological characteristics of the kangaroo pericardium indicate that it represents an outstanding alternative to the current sources e.g., bovine and porcine. However, procurement of tissues from the wild raises supply and sanitary issues. Health concerns based upon sanitary uncertainty and reliability of supply of wild animals remain real problems.
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Affiliation(s)
- S Meng
- Chongqing Key Lab of Catalysis and Functional Organic Molecules; College of Environment and Biotechnology, Chongqing Technology and Business University, Chongqing, PR China
| | - J Mao
- Axe Médecine Régénératrice, Centre de Recherche du CHU and Département de Chirurgie, Faculté de Médecine, Université Laval, Québec Canada
| | - E N Rouse
- Department of Comparative Medicine, College of Veterinary of Tennessee, Knoxville, TN, USA
| | - G Le-Bel
- Axe Médecine Régénératrice, Centre de Recherche du CHU and Département de Chirurgie, Faculté de Médecine, Université Laval, Québec Canada
| | - J M Bourget
- Axe Médecine Régénératrice, Centre de Recherche du CHU and Département de Chirurgie, Faculté de Médecine, Université Laval, Québec Canada
| | - R R Reed
- Department of Comparative Medicine, College of Veterinary of Tennessee, Knoxville, TN, USA
| | - E Philippe
- Axe Médecine Régénératrice, Centre de Recherche du CHU and Département de Chirurgie, Faculté de Médecine, Université Laval, Québec Canada
| | - D How
- Peninsula College of Medicine and Dentistry (PCMD), Plymouth, Devon, UK
| | - Z Zhang
- Axe Médecine Régénératrice, Centre de Recherche du CHU and Département de Chirurgie, Faculté de Médecine, Université Laval, Québec Canada
| | - L Germain
- Axe Médecine Régénératrice, Centre de Recherche du CHU and Département de Chirurgie, Faculté de Médecine, Université Laval, Québec Canada
| | - R Guidoin
- Axe Médecine Régénératrice, Centre de Recherche du CHU and Département de Chirurgie, Faculté de Médecine, Université Laval, Québec Canada.
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24
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Barbanti M. Early Outcomes of the Evolut R Transcatheter Aortic Valve: A New Technology Between Achieved Goals and Desirable Improvements. JACC Cardiovasc Interv 2018; 10:283-285. [PMID: 28183468 DOI: 10.1016/j.jcin.2016.12.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Marco Barbanti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
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25
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Eitan A, Witt J, Stripling J, Haselbach T, Rieß F, Schofer J. Performance of the Evolut‐R 34 mm versus Sapien‐3 29 mm in Transcatheter aortic valve replacement patients with larger annuli: Early outcome results of Evolut‐R 34 mm as compared with Sapien‐3 29 mm in patients with Annuli ≥26 mm. Catheter Cardiovasc Interv 2018. [DOI: 10.1002/ccd.27588] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Amnon Eitan
- Medical Care CenterHamburg Germany
- Albertinen Heart CenterHamburg Germany
| | | | | | | | | | - Joachim Schofer
- Medical Care CenterHamburg Germany
- Albertinen Heart CenterHamburg Germany
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Zegrean M. Never Too Late: A Case Report on Transcatheter Aortic Valve Implantation in a 97-Year-Old Patient. Geriatrics (Basel) 2017; 2:geriatrics2030025. [PMID: 31011035 PMCID: PMC6371167 DOI: 10.3390/geriatrics2030025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 06/29/2017] [Accepted: 07/12/2017] [Indexed: 11/24/2022] Open
Abstract
Aortic valve stenosis is a well-recognized valvular problem in the aging population. Transcatheter aortic valve implantation (TAVI) is becoming an increasingly popular treatment alternative to surgical aortic valve replacement for frail elderly individuals with symptomatic severe aortic valve stenosis. There are multiple research reports documenting the effectiveness of TAVI in octogenarians; however, few authors discuss the success of this procedure in nonagenarians. This case report depicts the successful transfemoral implantation of a prosthetic aortic valve in a 97-year-old man. Moreover, the current literature on TAVI outcomes in nonagenarians is reviewed.
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Yeo I, Ahmad H, Aronow WS. Impact of sleep apnea on in-hospital outcomes after transcatheter aortic valve replacement: insight from National Inpatient Sample database 2011-2014. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:203. [PMID: 28603718 DOI: 10.21037/atm.2017.04.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sleep apnea is associated with worse outcomes following various kinds of surgeries. There is a paucity of data on the association of sleep apnea with clinical outcomes after transcatheter aortic valve replacement (TAVR). METHODS We used National Inpatient Sample (NIS) data 2011-2014 to identify patients undergoing TAVR. Association between sleep apnea and in-hospital postoperative outcomes were assessed by multivariate logistic regression and 1:1 propensity score matching analyses. RESULTS Of 42,189 patients who received TAVR, 4,605 patients (10.9%) had sleep apnea. Patients with sleep apnea were more likely to be younger and male with higher prevalences of hypertension, diabetes mellitus, dyslipidemia, chronic kidney disease, pulmonary hypertension and obesity who less frequently received transapical access than those without sleep apnea. The group with sleep apnea had less bleeding requiring transfusion (8.6% vs. 11.9%, P=0.01) than the counterpart. After adjusting for confounders, the presence of sleep apnea was no longer independently associated with any of the studied outcomes including all-cause mortality (OR 0.95; 95% CI: 0.64-1.42), stroke (OR 1.08; 95% CI: 0.65-1.81), myocardial infarction (OR 0.66; 95% CI: 0.36-1.22), acute respiratory failure (OR 0.94; 95% CI: 0.72-1.23), pneumothorax (OR 0.64; 95% CI: 0.26-1.59), vascular complication (OR 0.91; 95% CI: 0.69-1.22), bleeding requiring transfusion (OR 0.85; 95% CI: 0.65-1.11), acute kidney injury requiring hemodialysis (OR 0.94; 95% CI: 0.53-1.66) and permanent pacemaker implantation (OR 1.12; 95% CI: 0.87-1.43). The length and cost of hospital stay were not affected by sleep apnea, either. CONCLUSIONS With a prevalence of 10.9%, the presence of sleep apnea was not independently associated with postoperative in-hospital outcomes in patients undergoing TAVR in NIS data 2011 to 2014.
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Affiliation(s)
- Ilhwan Yeo
- Division of Hospital Medicine, Department of Medicine, The Mount Sinai Hospital, New York, NY, USA
| | - Hasan Ahmad
- Cardiology Division, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Wilbert S Aronow
- Cardiology Division, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
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Chamsi-Pasha MA, Little SH, Reardon MJ. The use of transcatheter mitral valve system: can we make mitral regurgitation better again? J Thorac Dis 2017; 9:1174-1177. [PMID: 28616265 DOI: 10.21037/jtd.2017.04.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mohammed A Chamsi-Pasha
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Stephen H Little
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
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Akujuo AC, Dellis SL, Delago AJ, Bennett EV. Transcatheter aortic and mitral valve implantation in bioprosthetic valves: When one correction is not enough. J Thorac Cardiovasc Surg 2015; 150:e15-7. [DOI: 10.1016/j.jtcvs.2015.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/17/2015] [Accepted: 05/05/2015] [Indexed: 11/27/2022]
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Volodarsky I, Shimoni S, George J. The current status of transcutaneous aortic valve implantation. Expert Rev Cardiovasc Ther 2014; 12:1205-18. [PMID: 25223332 DOI: 10.1586/14779072.2014.954553] [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] [Indexed: 11/08/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is a relatively novel procedure first performed in 2002 and has undergone rapid development since then. Its main indication is treatment of severe symptomatic aortic valve stenosis. Initially, the procedure was indicated for very sick patients who were not eligible for surgical aortic valve replacement. However, rapid development of the technology and operator skill required for TAVI allowed widening of the indications for its use. Currently, there is evidence that TAVI could be better than the surgical intervention in a broad population and not only in the most sick. This paper reviews the medical literature regarding TAVI, including the relevant medical equipment, different modes of its deployment, main complications of the procedure, main indications and contraindications, and the outcome of the patients who undergo it.
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