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Kalra A, Das R, Alkhalil M, Dykun I, Candreva A, Jarral O, Rehman SM, Majmundar M, Patel KN, Rodes-Cabau J, Reardon MJ, Puri R. Bicuspid Aortic Valve Disease: Classifications, Treatments, and Emerging Transcatheter Paradigms. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2024; 8:100227. [PMID: 38283572 PMCID: PMC10818151 DOI: 10.1016/j.shj.2023.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 09/02/2023] [Accepted: 09/14/2023] [Indexed: 01/30/2024]
Abstract
Bicuspid aortic valve (BAV) is a common congenital valvular malformation, which may lead to early aortic valve disease and bicuspid-associated aortopathy. A novel BAV classification system was recently proposed to coincide with transcatheter aortic valve replacement being increasingly considered in younger patients with symptomatic BAV, with good clinical results, yet without randomized trial evidence. Procedural technique, along with clinical outcomes, have considerably improved in BAV patients compared with tricuspid aortic stenosis patients undergoing transcatheter aortic valve replacement. The present review summarizes the novel BAV classification systems and examines contemporary surgical and transcatheter approaches.
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Affiliation(s)
- Ankur Kalra
- Department of Cardiology, Franciscan Health, Lafayette, Indiana, USA
| | - Rajiv Das
- Department of Cardiothoracic Services, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Mohammad Alkhalil
- Department of Cardiothoracic Services, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Iryna Dykun
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alessandro Candreva
- Department of Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Omar Jarral
- Department of Cardiothoracic Surgery, St. Thomas Hospital, London, UK
| | - Syed M. Rehman
- Department of Cardiothoracic Surgery, OLV Hospital, Aalst, Belgium
| | - Monil Majmundar
- Department of Cardiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kunal N. Patel
- Department of Cardiology, West Virginia University Hospital, Morgantown, West Virginia, USA
| | - Josep Rodes-Cabau
- Department of Interventional Cardiology, Quebec Heart & Lung Institute, Quebec City, Canada
| | - Michael J. Reardon
- Department of Cardiothoracic Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Holzamer A, Bedogni F, van Wyk P, Barwad P, Protasiewicz M, Ielasi A, Nombela-Franco L, Seidler T, Hilker M. Performance of the 32 mm Myval transcatheter heart valve for treatment of aortic stenosis in patients with extremely large aortic annuli in real-world scenario: First global, multicenter experience. Catheter Cardiovasc Interv 2023; 102:1364-1375. [PMID: 37698335 DOI: 10.1002/ccd.30820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/03/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Extremely large aortic valve anatomy is one of the remaining limitations leading to exclusion of patients for transcatheter aortic valve replacement (TAVR). AIMS The newly approved Myval 32 mm device is designed for use in aortic annulus areas up to 840 mm2 . Here we want to share the initial worldwide experience with the device. METHODS AND RESULTS Retrospective data were collected from 10 patients with aortic stenosis and very large annular anatomy (mean area 765.5 mm2 ), who underwent implantation with 32 mm Myval transcatheter heart valve at eight centers. Valve Academic Research Consortium-2 device success was achieved in all cases. Mild paravalvular leak was observed in three patients and two patients required new pacemaker implantation. One patient experienced retroperitoneal hemorrhage caused by the contralateral 6 F sheath and required surgical revision. No device-related complications, stroke, or death from any cause occurred within the 30-day follow-up period. In a studied cohort of 2219 consecutive TAVR-screened patients from a central European site, only 0.27% of patients showed larger anatomy than covered by the 32 mm Myval device by instructions for use without off-label use of overexpansion. This rate was significantly higher for the 34 mm Evolut Pro (1.8%) and 29 mm Sapien 3 (2.1%) devices. CONCLUSIONS The Myval 32 mm prosthesis showed promising initial results in a cohort of patients who previously had to be excluded from TAVR. It is desirable that all future TAVR systems accommodate larger anatomy to allow optimal treatment of all patients.
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Affiliation(s)
| | | | - Pieter van Wyk
- Department of Cardiology, Netcare Sunninghill Hospital, Sunninghill, South Africa
| | - Parag Barwad
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | | | - Tim Seidler
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Michael Hilker
- University of Regensburg Medical Center, Regensburg, Germany
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Annoni AD, Mancini ME, Carlicchi E, Belmonte M, Formenti A, Mushtaq S, Marchetti F, Cilia F, Baggiano A, Fusini L, Bonomi A, Gennari M, Montorsi P, Pepi M, Pontone G. Pre-TAVI aortic annulus sizing: comparison between manual and semi-automated new generation software measurements in operators with different experience. Br J Radiol 2023; 96:20220733. [PMID: 37449675 PMCID: PMC10461289 DOI: 10.1259/bjr.20220733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 04/07/2023] [Accepted: 04/28/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES Aim of the study is to compare manual and semi-automatic measurements for aortic annulus assessment among different operators. METHODS Eighty patients who underwent TAVI were retrospectively enrolled. The measurements manually performed by an experienced reader for aortic annulus (minimum and maximum diameters, perimeter, area), annulus-to-coronary ostia distance and time needed for the whole evaluation, were collected. The same operator (observer 1) and two less experienced readers (observer 2 and 3, with >5 years and 1 year of experience, respectively) assessed the same measurements using a semi-automatic software. Differences between manual and semi-automatic measurements, reading time and suggested valves size derived by CT were compared. RESULTS Very good correlations were found between manual and software-aided measurements for aortic annulus area and perimeter in comparison with standard measurements for the three readers (ICC range 0.81-0.98). Good correlations were found for the distance with coronary ostia(0.75-0.79). The same area-derived prosthesis size for manual and semi-automatic measurements was selected in 96% of cases for observer 1; very good correlations were also found for observer 2 and 3 (ICC = 0.89 and 0.88, respectively). Using semi-automatic measurements, the mean time needed for CT images was significantly lower for observers 1 and 2 (1.50 and 1.72versus 3.14 min), respectively. CONCLUSIONS Pre-TAVI CT using semi-automatic software allows accurate and reproducible measurements, reducing reconstruction time up to 50% and is reliable even for operators with different experience. ADVANCES IN KNOWLEDGE The use of semi-automatic dedicated software for CT in TAVI planning is reliable even for operators without long time experience and allows accurate and reproducible measurements improving pre-TAVI workflow.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Laura Fusini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Lopes PM, Brito JD, Campante Teles R, Sousa Almeida M. Acute left main coronary occlusion after transcatheter aortic valve implantation: life-saving intervention using the snare technique-a case report. Eur Heart J Case Rep 2022; 7:ytac469. [PMID: 36582595 PMCID: PMC9792273 DOI: 10.1093/ehjcr/ytac469] [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: 04/15/2022] [Revised: 07/13/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
Background Transcatheter aortic valve implantation (TAVI) has rapidly evolved and changed the field of structural cardiovascular intervention. Its advances lead to a marked reduction in the risk of complications and improved outcomes. However, TAVI is still associated with potential serious complications. Case summary A 73-year-old man with severe aortic stenosis underwent TAVI using a 34-mm self-expanding aortic bioprosthesis. After valve deployment, the patient rapidly progressed to cardiac arrest. Acute left main occlusion, due to high valve implantation, was promptly recognized and advanced life support immediately initiated. Concomitantly, the valve was successfully retrieved toward the ascending aorta using the snare technique, resulting in immediate restoration of flow and successful cardiopulmonary resuscitation. Subsequently, a 29-mm balloon-expandable aortic bioprosthesis was uneventfully implanted. After TAVI, the patient had a remarkable clinical evolution and was discharged home at hospitalization day five without relevant electrocardiographic nor echocardiographic disturbances. At six-month follow-up, the patient remains asymptomatic and transthoracic echocardiography revealed a normofunctional aortic bioprosthesis with preserved left ventricular ejection fraction. Discussion Acute coronary occlusion is a rare and life-threating complication of TAVI that may be prevented with accurate procedure planning. Pre-procedural computed tomography angiography is essential for a comprehensive patient evaluation, allowing appropriate valve selection, a key factor for successful management. Self-expandable valve retrieval with snare technique can be an appropriate strategy for the management of this complication. This case highlights the importance of performing these procedures in highly experienced centres and with fully equipped catheterization laboratories to allow timely interventions when facing unexpected events.
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Affiliation(s)
- Pedro M Lopes
- Corresponding author. Tel: +351 21 043 1000, Fax: +351 21 418 8095,
| | - João D Brito
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Lisbon, Portugal
| | - Rui Campante Teles
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Lisbon, Portugal,Nova Medical School, CEDOC, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
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Elnaggar HM, Schoels W, Mahmoud MS, Kishk YT, Kullmer M, Dia M, Algowhary M. Impact of balloon predilatation in patients with reduced versus preserved ejection fraction during transcatheter aortic valve implantation. Asian Cardiovasc Thorac Ann 2022; 30:985-991. [DOI: 10.1177/02184923221126086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Although there is a trend toward direct transcatheter aortic valve implantation (TAVI), still balloon predilatation is necessary in some cases, especially in patients with severe calcification. However, predilatation including rapid ventricular pacing may have adverse outcomes, especially in patients with reduced ejection factor (EF). Objective To evaluate the impact of predilatation on in-hospital outcomes in patients with reduced versus preserved EF underwent TAVI. Methods This was a prospective observational study including 110 patients (72 patients with preserved EF (≥50%) and 38 patients with reduced EF (<50%)) who underwent TAVI. The two groups were compared regarding in-hospital outcomes. Results Predilatation was done routinely in all 110 patients. The mean age was significantly higher in patients with preserved EF (82.76 ± 5.74 vs. 80.13 ± 6.51 years; p = 0.03). The majority (51.4%) of patients with preserved EF were females but the majority (73.7%) of those with reduced EF were males ( P < 0.001). Predilatation showed no statistical difference regarding in-hospital mortality (2.6% vs. 1.4%; p = 0.29), hemodynamic instability (5.3% vs. 0.0%; p = 0.11), stroke (0% vs. 1.4%; p = 0.67), conduction defects (13.2% vs. 19.4%; p = 0.29), permanent pacemaker implantation (7.9% vs. 5.5%; p = 0.45), paravalvular leakage (5.3% vs. 2.8%; p = 0.42), vascular complications (7.9% vs. 11.1%; p = 0.43), and acute kidney injury (7.9% vs. 7%; p = 0.4) in patients with reduced versus preserved EF, respectively. Conclusion When balloon predilatation is inevitable during TAVI it is safe in patients with reduced as well as preserved EF with no added risk of hemodynamic instability or other outcomes.
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Affiliation(s)
- Heba M. Elnaggar
- Cardiology Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
| | | | - Marwan S. Mahmoud
- Cardiology Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
- Cardiology Department, Duisburg Heart Center, Duisburg, Germany
| | - Yehia T. Kishk
- Cardiology Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
| | | | - Mohamad Dia
- Cardiac Surgery Department, Duisburg Heart Center, Duisburg, Germany
| | - Magdy Algowhary
- Cardiology Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
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Lim Y, Tan KA, Kuntjoro I, Hon JKF, Yip J, Tay E. Coronary Artery Disease in Patients Undergoing Transvalvular Aortic Valve Implantation. Interv Cardiol 2022; 17:e13. [PMID: 36304067 PMCID: PMC9585643 DOI: 10.15420/icr.2021.25] [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: 08/28/2021] [Accepted: 05/02/2022] [Indexed: 01/09/2023] Open
Abstract
Coronary artery disease (CAD) is common in patients with severe aortic stenosis. With the advent of transcatheter aortic valve implantation (TAVI) as a therapeutic option, management of CAD in such patients has undergone a revolution. Younger patients are now candidates for treatment, and have a greater life-time probability of requiring post-TAVI coronary access. Considerations include pre-procedural assessment and revascularisation, procedural planning to avoid coronary obstruction as well as optimisation of post-procedural coronary access. The authors review the challenges of managing CAD in TAVI patients, shed light on the evidence base, and provide guidance on how to optimise management.
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Affiliation(s)
- Yinghao Lim
- Department of Cardiology, National University Heart CentreSingapore
| | - Kent Anthony Tan
- Department of Cardiology, National University Heart CentreSingapore
| | | | - Jimmy KF Hon
- Department of Cardiac, Thoracic, and Vascular Surgery, National University Heart CentreSingapore
| | - James Yip
- Department of Cardiology, National University Heart CentreSingapore
| | - Edgar Tay
- Department of Cardiology, National University Heart CentreSingapore
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Santos-Martinez S, Halim J, Castro-Mejía A, De Marco F, Trani C, Martin P, Infusino F, Ancona M, Moreno R, den Heijer P, Nombela-Franco L, Bedogni F, Sardella G, Montorfano M, Revilla-Orodea A, Delgado-Arana JR, Barrero A, Gómez-Salvador I, IJsselmuiden AJJ, Redondo A, Gutiérrez H, Serrador A, Serruys PW, Román JAS, Amat-Santos IJ. Myval versus alternative balloon- and self-expandable transcatheter heart valves: A central core lab analysis of conduction disturbances. Int J Cardiol 2022; 351:25-31. [PMID: 34979152 DOI: 10.1016/j.ijcard.2021.12.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several studies have compared surface electrocardiographic changes following different self-expandable (SE) (Evolut (Medtronic, USA); Acurate (Boston Scientific, USA); Portico (Abbott, USA); and Allegra (NVT, Germany)) and balloon-expandable (BE) Sapien-3 (Edwards Lifesciences, USA) transcatheter heart valves. We aimed to compare these prosthesis with the novel Myval BE prosthesis (Meril Life, India). METHODS Academic European registry of consecutive patients with severe aortic stenosis who received any of the 6 aforementioned valves. Baseline, post-procedural, and discharge 12‑leads electrocardiograms (ECG) were centrally analyzed and compared. RESULTS A total of 1131 patients were included: 135 Myval (11.9%), 290 Sapien-3 (25.6%), 298 Evolut (26.3%), 180 Acurate (15.9%), 125 Portico (11.1%), and 103 Allegra (9.1%). There were no baseline differences in intraventricular conduction disturbances rate. Compared to the novel BE Myval, there were similar procedural and in-hospital outcomes. Similar rates of early new permanent pacemaker implant (PPI) were observed amongst Myval (7.4%), Sapien-3 (13.4%), and Acurate (9.1%), but Evolut, Portico, and Allegra presented significantly higher rates (18.5%, p = 0.003; 29.5% p < 0.001 and 22%, p = 0.001, respectively). Central analysis of ECGs, unraveled significant prolongation of the PR segment with Evolut, Portico and Allegra whereas Evolut, Acurate, and Portico showed significant QRS widening compared to Myval. However, at discharge no differences in PR segment duration were observed while, Evolut, and Portico- but not Acurate, Allegra or Sapien-3 - still presented significant widening of QRS segment compared to Myval. CONCLUSIONS After blinded central ECG analysis, the novel Myval balloon-expandable prosthesis was associated with a low rate of early conduction disturbances.
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Affiliation(s)
| | | | | | | | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Pedro Martin
- Hospital Universitario de Gran Canaria Dr Negrin, Gran Canaria, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alfredo Redondo
- CIBERCV, Hospital Clinico Universitario de Valladolid, Spain
| | | | - Ana Serrador
- CIBERCV, Hospital Clinico Universitario de Valladolid, Spain
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland
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Vera Vera S, Nombela-Franco L, Santos-Martínez S, Moreno R, Jiménez-Díaz VA, Rodríguez-Gabella T, Catalá P, Castro-Mejía AF, Galeote G, Baz JA, Gutiérrez H, Serrador A, García-Gómez M, Redondo A, Baladrón C, Arnold R, Jiménez-Quevedo P, Carrasco-Moraleja M, Gómez Salvador I, San Román JA, Amat-Santos IJ. Self-expandable transcatheter heart valves for aortic stenosis. Short-term outcome and matched hemodynamic performance. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:1032-1041. [PMID: 33158760 DOI: 10.1016/j.rec.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Aortic self-expandable (SE) transcatheter aortic valve implantation (TAVI) devices are particularly useful for patients with aortic stenosis and small/tortuous vessels, small aortic annuli, or low coronary ostia. However, it is unclear whether the growing range of SE devices shows comparable hemodynamic and clinical outcomes. We aimed to determine the differential hemodynamic (residual valve area and regurgitation) and clinical outcomes of these devices in comparable scenarios. METHODS All patients were enrolled from 4 institutions and were managed with 4 different SE TAVI devices. Baseline and follow-up clinical data were collected and echocardiographic tests blindly and centrally analyzed. Patients were compared according to valve type and a 1:1 matched comparison was performed according to degree of calcification, aortic annulus dimensions, left ventricular ejection fraction, and body surface area. RESULTS In total, 514 patients were included (Evolut R/PRO, 217; ACURATE neo, 107; ALLEGRA, 102; Portico, 88). Surgical risk scores were comparable in the unmatched population. No differences were observed in the post-TAVI regurgitation rate and in in-hospital mortality (2.7%). The rate of pacemaker implantation at discharge was significantly different among devices (P=.049), with Portico showing the highest rate (23%) and ACURATE neo the lowest (9.5%); Evolut R/PRO and ALLEGRA had rates of 15.9% and 21.2%, respectively. The adjusted comparison showed worse residual TAVI gradients and aortic valve area with ACURATE neo vs ALLEGRA (P=.001) but the latter had higher risk of valve embolization and a tendency for more cerebrovascular events. CONCLUSIONS A matched comparison of 4 SE TAVI devices showed no differences regarding residual aortic regurgitation and in-hospital mortality.
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Affiliation(s)
- Silvio Vera Vera
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - Sandra Santos-Martínez
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Raúl Moreno
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Victor A Jiménez-Díaz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Tania Rodríguez-Gabella
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pablo Catalá
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - Guillermo Galeote
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - José Antonio Baz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Hipólito Gutiérrez
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ana Serrador
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Mario García-Gómez
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Alfredo Redondo
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Carlos Baladrón
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Roman Arnold
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - Manuel Carrasco-Moraleja
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Itziar Gómez Salvador
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - J Alberto San Román
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ignacio J Amat-Santos
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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Vera Vera S, Nombela-Franco L, Santos-Martínez S, Moreno R, Jiménez-Díaz VA, Rodríguez-Gabella T, Catalá P, Castro-Mejía AF, Galeote G, Baz JA, Gutiérrez H, Serrador A, García-Gómez M, Redondo A, Baladrón C, Arnold R, Jiménez-Quevedo P, Carrasco-Moraleja M, Gómez Salvador I, San Román JA, Amat-Santos IJ. Prótesis percutáneas autoexpandibles para la estenosis aórtica: resultados a corto plazo y comparación hemodinámica tras emparejamiento. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Hughes E, Grossman PM. Transcatheter Aortic Valve Replacement with a Self-Expanding Prosthesis. Interv Cardiol Clin 2021; 10:441-453. [PMID: 34593108 DOI: 10.1016/j.iccl.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The self-expanding transcatheter heart valve (Medtronic Cardiovascular Corevalve and Evolut) is a supra-annular, trileafet porcine pericardial valves on a diamond lattice nickel-titanium alloy frame. The TAVR device has undergone significant improvements in design and procedural techniques to further increase safety, efficacy, and durability since they it was first released. Unique design characteristics, as well as patient and procedural factors, favor self-expanding over balloon-expandable prostheses in certain situations. The self-expanding transcatheter heart valve has proven to be an excellent option for severe aortic stenosis patients with any level of surgical risk and preliminary data suggest a comparable durability to surgical tissue valves.
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Affiliation(s)
- Erinn Hughes
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Frankel Cardiovascular Center, 1500 East Medical Center Drive, SPC 5869, Ann Arbor, MI 48109-5869, USA
| | - Paul Michael Grossman
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Frankel Cardiovascular Center, 1500 East Medical Center Drive, SPC 5869, Ann Arbor, MI 48109-5869, USA.
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El-Andari R, Bozso SJ, Kang JJ, Manikala VK, Moon MC, Al-Aklabi M, Welsh RC, Nagendran J. Surgical Repair of a Transannular Rupture During Transfemoral Transcatheter Aortic Valve Replacement. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 14:11795476211038126. [PMID: 34393537 PMCID: PMC8361553 DOI: 10.1177/11795476211038126] [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: 03/07/2021] [Accepted: 07/21/2021] [Indexed: 11/16/2022]
Abstract
Annular rupture is a rare but life-threatening complication of transcatheter aortic valve replacement (TAVR). Mortality rates are high if immediate intervention, most often necessitating surgical repair, is not performed. Herein, we describe an 87-year-old man who, after deployment of TAVR, experienced acute decompensation and required urgent conversion to a midline sternotomy to repair an aortic annular rupture. This case demonstrates an example of a rare but severe complication of TAVR. This report provides an in-depth description of the surgical approach to repair an aortic annular rupture and demonstrates the utility of performing minimally invasive procedures inside a hybrid operating room.
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Affiliation(s)
- Ryaan El-Andari
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sabin J Bozso
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jimmy Jh Kang
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Vinod K Manikala
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Michael C Moon
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Mohammed Al-Aklabi
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Robert C Welsh
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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12
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Martinez-Dolz L, Pajares A, López-Cantero M, Osca J, Díez JL, Paniagua P, Argente P, Arana E, Alonso C, Rodriguez T, Vicente R, Anguita M, Alvarez J. Consensus document for anaesthesiologist-assisted sedation in interventional cardiology procedures. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:309-337. [PMID: 34147407 DOI: 10.1016/j.redare.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Affiliation(s)
- L Martinez-Dolz
- Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, IIS La Fe, CIBERCV, Valencia, Spain.
| | - A Pajares
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - M López-Cantero
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - J Osca
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - J L Díez
- Unidad de Hemodinámica, Servicio de Cardiología del Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - P Paniagua
- Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - P Argente
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - E Arana
- Unidad de Arritmias, Servicio de Cardiología, Hospital Virgen del Rocío, Sevilla, Spain
| | - C Alonso
- Unidad de Arritmias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - T Rodriguez
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, Spain
| | - R Vicente
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - M Anguita
- Servicio de Cardiología, Hospital Reina Sofía de Córdoba, Córdoba, Spain
| | - J Alvarez
- Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario de Santiago, Universidad de Santiago, Santiago de Compostela, Spain
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13
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Martinez-Dolz L, Pajares A, López-Cantero M, Osca J, Díez JL, Paniagua P, Argente P, Arana E, Alonso C, Rodriguez T, Vicente R, Anguita M, Alvarez J. Consensus document for anaesthesiologist-assisted sedation in interventional cardiology procedures. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:309-337. [PMID: 33931263 DOI: 10.1016/j.redar.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/01/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Affiliation(s)
- L Martinez-Dolz
- Servicio de Cardiología, Hospital Universitari i Politècnic La Fe. IIS La Fe. CIBERCV, Valencia, España.
| | - A Pajares
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - M López-Cantero
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - J Osca
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - J L Díez
- Unidad de Hemodinámica, Servicio de Cardiología del Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - P Paniagua
- Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - P Argente
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - E Arana
- Unidad de Arritmias, Servicio de Cardiología, Hospital Virgen del Rocío, Sevilla, España
| | - C Alonso
- Unidad de Arritmias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - T Rodriguez
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, España
| | - R Vicente
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - M Anguita
- Servicio de Cardiología, Hospital Reina Sofía de Córdoba., Córdoba, España
| | - J Alvarez
- Servicio Anestesia y Reanimación. Complejo Hospitalario Universitario de Santiago. Universidad de Santiago, Santiago de Compostela, España
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14
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Saad M, Seoudy H, Frank D. Challenging Anatomies for TAVR-Bicuspid and Beyond. Front Cardiovasc Med 2021; 8:654554. [PMID: 33928138 PMCID: PMC8076502 DOI: 10.3389/fcvm.2021.654554] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022] Open
Abstract
Transcatheter aortic valve replacement has emerged as the standard treatment for the majority of patients with symptomatic aortic stenosis. As transcatheter aortic valve replacement expands to patients across all risk groups, optimal patient selection strategies and device implantation techniques become increasingly important. A significant number of patients referred for transcatheter aortic valve replacement present with challenging anatomies and clinical indications that had been historically considered a contraindication for transcatheter aortic valve replacement. This article aims to highlight and discuss some of the potential obstacles that are encountered in clinical practice with a particular emphasis on bicuspid aortic valve disease.
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Affiliation(s)
- Mohammed Saad
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
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15
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TAVI imaging: over the echocardiography. Radiol Med 2020; 125:1148-1166. [DOI: 10.1007/s11547-020-01281-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/03/2020] [Indexed: 12/26/2022]
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16
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Meyer A, Kofler M, Montagner M, Unbehaun A, Sündermann S, Buz S, Klein C, Stamm C, Solowjowa N, Emmert MY, Falk V, Kempfert J. Reliability and Influence on Decision Making of fully-automated vs. semi-automated Software Packages for Procedural Planning in TAVI. Sci Rep 2020; 10:10746. [PMID: 32612266 PMCID: PMC7329903 DOI: 10.1038/s41598-020-67111-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 05/04/2020] [Indexed: 11/21/2022] Open
Abstract
Precise procedural planning is crucial to achieve excellent results in patients undergoing Transcatheter aortic valve implantation (TAVI). The aim of this study was to compare the semi-automated 3mensio (3 m) software to the fully-automated HeartNavigator3 (HN) software. We randomly selected 100 patients from our in-house TAVI-registry and compared aortic annulus and perimeter as well as coronary distances between 3m-measurements and post-hoc HN-measurements. Finally, we retrospectively simulated prosthesis choice based on HN-measurements and analyzed the differences compared to routinely used 3 m based strategy. We observed significant differences between the two software packages regarding area (3 m 464 ± 88 mm², HN 482 ± 96 mm², p < 0.001), perimeter (3 m 77 ± 7 mm, HN 79 ± 8 mm, p < 0.001) and coronary distances (LCA: 3 m 13 ± 3 mm, HN 12 ± 3 mm, p < 0.001; RCA: 3 m 16 ± 3 mm, HN 15 ± 3 mm, p < 0.001). Prosthesis choice simulation based on newly obtained HN-measurements would have led to a decision change in 18% of patients, with a further reduction to 4% following manual adjustment of HN-measurements. The fully-automatic HN-software provides higher values for annular metrics and lower annulus-to-coronary-ostia distances compared to 3m-software. Measurement differences did not influence clinical outcome. Both, the HN-software and the 3m-software are sophisticated, reliable and easy to use for the clinician. Manual adjustment of HN-measurements may increase precision in complex aortic annulus anatomy.
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Affiliation(s)
- Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany. .,Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
| | - Matteo Montagner
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Simon Sündermann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany.,Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Semih Buz
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany
| | - Christoph Klein
- Department of Cardiology, German Heart Center, Berlin, Germany
| | - Christof Stamm
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany
| | - Natalia Solowjowa
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany
| | - Maximilian Y Emmert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany.,Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany.,Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany
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17
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Tsuda M, Mizote I, Mukai T, Sakata Y. Aortic root rupture during balloon-expandable transcatheter aortic valve replacement in a patient without recognized risk factors for aortic root rupture: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-4. [PMID: 32617490 PMCID: PMC7319835 DOI: 10.1093/ehjcr/ytaa073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/19/2019] [Accepted: 03/12/2020] [Indexed: 12/22/2022]
Abstract
Background Aortic root rupture is a severe complication of balloon-expandable transcatheter aortic valve replacement (TAVR). Although previous studies have revealed several risk factors for this complication, predicting this complication is occasionally difficult. Case summary A 78-year-old male patient underwent TAVR via a transfemoral approach using a 29-mm balloon-expandable valve. No recognized risk factors for aortic root rupture existed in pre-procedural multi-detector computed tomography (MDCT) analysis. However, after the valve deployment, sudden haemodynamic collapse occurred. Transoesophageal echocardiography revealed pericardial effusion, which led to an immediate diagnosis of cardiac tamponade following aortic root rupture. Following pericardial drainage via a subxiphoid approach, the haemodynamics were immediately stabilized. After 10 days of close observation, the patient was discharged on Day 39 without additional problems. He was still alive at the 6-month follow-up without sequelae. Discussion Established risk factors for aortic root rupture include >20% area oversizing, bicuspid aortic valve, small annulus (<20 mm), shallow sinus of Valsalva (SOV) compared with the aortic annulus, and massive annular or subannular calcification. Our patient did not have any of the recognized risk factors for aortic root rupture, suggesting the existence of other factors. Pre-procedural MDCT showed a flat calcification orthogonal to the aortic root wall, and post-procedural MDCT revealed that this calcification penetrated the SOV with extravasation. Thus, we suggest that a flat calcification orthogonal to the aortic root wall might be an additional risk factor for aortic root rupture.
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Affiliation(s)
- Masaki Tsuda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan
| | - Isamu Mizote
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan
| | - Takashi Mukai
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan
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18
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Harowicz MR, Shah A, Zimmerman SL. Preoperative Planning for Structural Heart Disease. Radiol Clin North Am 2020; 58:733-751. [PMID: 32471541 DOI: 10.1016/j.rcl.2020.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Preoperative assessment with computed tomography (CT) is critical before transcatheter interventions for structural heart disease. CT provides information for device selection, device sizing, and vascular access approach. The interpreting radiologist must have knowledge of appropriate CT protocols, how and where to obtain the important measurements, and know additional imaging characteristics that are important to describe for optimal support of the interventionalist. CT is the modality of choice for pre-operative evaluation in patients undergoing transcatheter aortic valve replacement and left atrial appendage occlusion, and is also useful before transcatheter mitral valve replacement, which is an ongoing area of research.
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Affiliation(s)
- Michael R Harowicz
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 601 North Caroline Street, Room 4223, Baltimore, MD 21287, USA
| | - Amar Shah
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Stefan L Zimmerman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 North Wolfe Street, Halsted B180, Baltimore, MD 21287, USA.
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19
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Valvo R, Costa G, Barbanti M. How to Avoid Coronary Occlusion During TAVR Valve-in-Valve Procedures. Front Cardiovasc Med 2019; 6:168. [PMID: 31803761 PMCID: PMC6877473 DOI: 10.3389/fcvm.2019.00168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/04/2019] [Indexed: 11/22/2022] Open
Abstract
Transcatheter aortic valve-in-valve replacement has been recently reported as a less-invasive alternative to re-do surgery in patients with bioprosthetic valve failure. Although procedural success is achieved in the great majority of patients, this therapy is associated with several potential complications, and coronary occlusion is one of the most feared. This is a rare event, but it is associated with an extremely poor prognosis. In this review, the mechanisms, the identification of patients at high risk, the primary prevention strategies, and treatment of coronary occlusion will be discussed.
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Affiliation(s)
- Roberto Valvo
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
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20
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Barbanti M, Webb JG, Dvir D, Prendergast BD. Residual challenges in TAVI: moving forward. EUROINTERVENTION 2019; 15:857-866. [DOI: 10.4244/eij-d-19-00788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Abstract
Due to its high temporal and isotropic spatial resolution, CT has become firmly established for pre-procedural imaging in the context of structural heart disease interventions. CT allows to very exactly measure dimensions of the target structure, CT can provide information regarding the access route and, as a very valuable addition, volumetric CT data sets can be used to identify fluoroscopic projection angulations to optimally visualize the target structure and place devices. This review provides an overview of current methods and applications of pre-interventional CT to support adult cardiac interventions including transcatheter aortic valve implantation, percutaneous mitral valve intervention, left atrial appendage occlusion and paravalvular leak closure.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) , Erlangen , Germany
| | - Stephan Achenbach
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) , Erlangen , Germany
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22
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Ali N, Patel PA, Lindsay SJ. Recent developments and controversies in transcatheter aortic valve implantation. Eur J Heart Fail 2018; 20:642-650. [PMID: 29368369 DOI: 10.1002/ejhf.1141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/03/2017] [Accepted: 12/26/2017] [Indexed: 12/19/2022] Open
Abstract
Interventional cardiology has been revolutionised by transcatheter aortic valve implantation (TAVI), which has become established as the benchmark treatment for severe aortic stenosis in patients at high risk for surgical aortic valve replacement (AVR). Increased procedural familiarity and progression in device technology has enabled improvements to be made in complication rates, which have led to a commensurate expansion in the use of TAVI; it is now a viable alternative to AVR in patients at intermediate surgical risk, and has been used in cohorts such as those with bicuspid aortic valves or pure, severe aortic regurgitation. Given the rapid expansion in the use of TAVI, including cohorts of younger patients with fewer co-morbidities, attention must be paid to further reducing remaining complications, such as cardiac tamponade or stroke. To this end, novel techniques and devices have been devised and trialled, with varying levels of success. Furthermore, significant work has gone into refining the technique with exploration of alternative imaging modalities, as well as alternative access routes to provide greater options for patients with challenging vascular anatomy. Whilst significant progress has been made with TAVI, areas of uncertainty remain such as the management of concomitant coronary artery disease and the optimum post-procedure antiplatelet regimen. As such, research in this field continues apace, and is likely to continue as use of TAVI becomes more widespread. This review provides a summary of the existing evidence, as well as an overview of recent developments and contentious issues in the field of TAVI.
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Affiliation(s)
- Noman Ali
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Peysh A Patel
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Steven J Lindsay
- Department of Cardiology, Bradford Royal Infirmary, Bradford, UK
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23
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Barbanti M, Webb J, Gilard M, Capodanno D, Tamburino C. Transcatheter aortic valve implantation in 2017: state of the art. EUROINTERVENTION 2017; 13:AA11-AA21. [DOI: 10.4244/eij-d-17-00567] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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