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Halapas A, Koliastasis L, Doundoulakis I, Antoniou CK, Stefanadis C, Tsiachris D. Transcatheter Aortic Valve Implantation and Conduction Disturbances: Focus on Clinical Implications. J Cardiovasc Dev Dis 2023; 10:469. [PMID: 37998527 PMCID: PMC10672026 DOI: 10.3390/jcdd10110469] [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: 10/04/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is an established alternative to surgery in patients with symptomatic severe aortic stenosis and has expanded its indications to even low-surgical-risk patients. Conduction abnormalities (CA) and permanent pacemaker (PPM) implantations remain a relatively common finding post TAVI due to the close proximity of the conduction system to the aortic root. New onset left bundle branch block (LBBB) and high-grade atrioventricular block are the most commonly reported CA post TAVI. The overall rate of PPM implantation post TAVI varies and is related to pre- and intra-procedural factors. Therefore, when screening patients for TAVI, Heart Teams should take under consideration the various anatomical, pathophysiological and procedural conditions that predispose to CA and PPM requirement after the procedure. This is particularly important as TAVI is being offered to younger patients with longer life-expectancy. Herein, we highlight the incidence, predictors, impact and management of CA in patients undergoing TAVI.
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Affiliation(s)
- Antonios Halapas
- Department of Interventional Cardiologist and THV Program, Athens Medical Center, 11526 Athens, Greece;
| | - Leonidas Koliastasis
- Department of Cardiology, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium;
| | - Ioannis Doundoulakis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (C.-K.A.); (D.T.)
- Athens Heart Centre, Athens Medical Centre, 11526 Athens, Greece;
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (C.-K.A.); (D.T.)
- Athens Heart Centre, Athens Medical Centre, 11526 Athens, Greece;
| | | | - Dimitrios Tsiachris
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (C.-K.A.); (D.T.)
- Athens Heart Centre, Athens Medical Centre, 11526 Athens, Greece;
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See C, Wang Y, Huang H, Parise H, Yang Y, Tirziu D, Francese DP, Papoutsidakis N, Bader E, Kaple RK, Cleman M, Lansky AJ, Forrest JK. Impact of New-Onset Conduction Disturbances following Transcatheter Aortic Valve Replacement on Outcomes: A Single-Center Study. J Interv Cardiol 2023; 2023:5390338. [PMID: 37292113 PMCID: PMC10247319 DOI: 10.1155/2023/5390338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/05/2023] [Accepted: 04/18/2023] [Indexed: 06/10/2023] Open
Abstract
Background Transcatheter aortic valve replacement (TAVR) is known to increase the incidence of conduction disturbances compared to surgical aortic valve replacement; however, there are limited data on the impact and duration of these conduction disturbances on longer term outcomes. Objective To determine the differential impact of persistent versus nonpersistent new-onset conduction disturbances on TAVR-related complications and outcomes. Methods This is a single-center retrospective analysis of 927 consecutive patients with aortic stenosis who underwent TAVR at Yale New Haven Hospital from July 2012 to August 2019. Patients with new-onset conduction disturbances within 7 days following TAVR were selected for this study. Persistent and nonpersistent disturbances were, respectively, defined as persisting or not persisting on all patient ECGs for up to 1.5 years after TAVR or until death. Results Within 7 days after TAVR, conduction disturbances occurred in 42.3% (392/927) of the patients. Conduction disturbances persisted in 150 (38%) patients and did not persist in 187 (48%) patients, and 55 (14%) patients were excluded for having mixed (both persistent and nonpersistent) disturbances. Compared with nonpersistent disturbances, patients with persistent disturbances were more likely to receive a PPM within 7 days after the TAVR procedure (46.0% versus 4.3%, p < 0.001) and had a greater unadjusted 1-year cardiac-related and all-cause mortality risk (HR 2.54, p=0.044 and HR 1.90, p=0.046, respectively). Conclusion Persistent conduction disturbances were associated with a greater cardiac and all-cause mortality rate at one year following TAVR. Future research should investigate periprocedural factors to reduce persistent conduction disturbances and outcomes beyond one year follow-up.
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Affiliation(s)
- Claudia See
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Yanting Wang
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Hackensack Meridian Jersey Shore University Medical Center, NJ 07753, Neptune Township, USA
| | - Haocheng Huang
- Cardiovascular Medicine Clinical Research Analytics Group, Yale School of Medicine, New Haven, CT, USA
| | - Helen Parise
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Cardiovascular Medicine Clinical Research Analytics Group, Yale School of Medicine, New Haven, CT, USA
| | - Yiping Yang
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Daniela Tirziu
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Dominic P. Francese
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Nikolaos Papoutsidakis
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Eric Bader
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ryan K. Kaple
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Hackensack Meridian Jersey Shore University Medical Center, NJ 07753, Neptune Township, USA
| | - Michael Cleman
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Alexandra J. Lansky
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Barts Heart Centre, London and Queen Mary University of London, London, UK
| | - John K. Forrest
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
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3
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(Permanent pacemaker implantation in patients undergoing TAVR - single center study between years 2009 and 2021). COR ET VASA 2022. [DOI: 10.33678/cor.2022.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Peel JK, Neves Miranda R, Naimark D, Woodward G, Mamas MA, Madan M, Wijeysundera HC. Financial Incentives for Transcatheter Aortic Valve Implantation in Ontario, Canada: A Cost-Utility Analysis. J Am Heart Assoc 2022; 11:e025085. [PMID: 35411786 PMCID: PMC9238449 DOI: 10.1161/jaha.121.025085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transcatheter aortic valve implantation (TAVI) is a minimally invasive therapy for patients with severe aortic stenosis, which has become standard of care. The objective of this study was to determine the maximum cost‐effective investment in TAVI care that should be made at a health system level to meet quality indicator goals. Methods and Results We performed a cost‐utility analysis using probabilistic patient‐level simulation of TAVI care from the Ontario, Canada, Ministry of Health perspective. Costs and health utilities were accrued over a 2‐year time horizon. We created 4 hypothetical strategies that represented TAVI care meeting ≥1 quality indicator targets, (1) reduced wait times, (2) reduced hospital length of stay, (3) reduced pacemaker use, and (4) combined strategy, and compared these with current TAVI care. Per‐person costs, quality‐adjusted life years, and clinical outcomes were estimated by the model. Using these, incremental net monetary benefits were calculated for each strategy at different cost‐effectiveness thresholds between $0 and $100 000 per quality‐adjusted life year. Clinical improvements over the current practice were estimated with all comparator strategies. In Ontario, achieving quality indicator benchmarks could avoid ≈26 wait‐list deaths and 200 wait‐list hospitalizations annually. Compared with current TAVI care, the incremental net monetary benefit for this strategy varied from $10 765 (±$8721) and $17 221 (±$8977). This would translate to an annual investment of between ≈$14 to ≈$22 million by the Ontario Ministry of Health to incentivize these performance measures being cost‐effective. Conclusions This study has quantified the modest annual investment required and substantial clinical benefit of meeting improvement goals in TAVI care.
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Affiliation(s)
- John K Peel
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada.,Department of Anesthesiology and Pain Medicine University of Toronto Ontario Canada.,Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada
| | - Rafael Neves Miranda
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada.,Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada
| | - David Naimark
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada.,Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada.,Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada.,Department of Medicine University of Toronto Ontario Canada
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group Keele University Keele United Kingdom
| | - Mina Madan
- Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada.,Department of Medicine University of Toronto Ontario Canada
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada.,Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada.,Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada.,Department of Medicine University of Toronto Ontario Canada
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Ng L, Nair R, Ali F, Pasupati S. Dependence on permanent pacemakers inserted after transcatheter aortic valve implantation: predictive factors in a ten-year retrospective analysis: Rates and predictors of pacemaker dependence after TAVI. ASIAINTERVENTION 2021; 7:98-102. [PMID: 34913013 PMCID: PMC8658553 DOI: 10.4244/aij-d-21-00020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/28/2021] [Indexed: 06/14/2023]
Abstract
AIMS The requirement for a permanent pacemaker (PPM) is an important sequela after transcatheter aortic valve implantation (TAVI). The aim of this analysis was to identify predictive factors for pacemaker dependence in PPM-insertions post-TAVI. METHODS AND RESULTS A retrospective analysis of all PPM insertions done between January 2009 and December 2018 (n=1,373) identified 33 patients who received a PPM within one month of TAVI. Thirty-two had completed a PPM check at one year and were included in the final analyses. Of those who had PPM insertions after TAVI, 41% (13/32) were not PPM-dependent at one year. This cohort was predominantly European (94%) and over half were octogenerians (56%). Statistically significant associations with being PPM-dependent at one year include intraoperative PPM dependence (OR 5.714 [95% CI: 1.163-28.070]; p=0.032), third-degree heart block being the indication for PPM insertion (OR 8.533 [95% CI: 1.616-45.063]; p=0.012) and mean valve depth over 6.0 mm (OR 6.222 [95% CI: 1.200-32.273]; p=0.030). CONCLUSIONS A significant number of patients are not dependent on the PPMs inserted after TAVI. Although small, our study suggests that those who are pacing-dependent intraoperatively, have a third-degree heart block as their PPM indication or have a mean valve depth of over 6.0 mm, are more likely to be pacing-dependent in the long term. Larger studies are required to draw more definitive conclusions.
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Affiliation(s)
- Lance Ng
- Waikato Cardiology Department, Waikato Hospital, 183 Pembroke Street, Hamilton 3204, Waikato, New Zealand. E-mail:
| | - Rajesh Nair
- Waikato Cardiology Department, Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand
| | - Faeez Ali
- Waikato Cardiology Department, Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand
| | - Sanjeevan Pasupati
- Waikato Cardiology Department, Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand
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Next-Day Discharge vs Early Discharge After Transcatheter Aortic Valve Replacement: Systematic Review and Meta-Analysis. Curr Probl Cardiol 2021; 47:100998. [PMID: 34571105 DOI: 10.1016/j.cpcardiol.2021.100998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022]
Abstract
With the growing utilization of transcatheter aortic valve replacement (TAVR) as an alternative option to surgical valve replacement (SAVR) in patients considered to be suboptimal for surgery, there is a need to explore the possibility of next day discharge (NDD) and its potential outcomes. The aim of our study is to compare outcomes and complications following NDD vs the standard early discharge (ED) (less than 3 days). A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify relevant trials. Summary effects were calculated using a DerSimonian and Laird random effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. Studies comparing same-day or next-day discharge vs discharge within the next three days were included in our analysis. 6 studies with 2,672 patients were identified. The risk of bleeding and vascular complications was significantly lower in patients with NDD compared to ED (OR 0.10, P < 0.00001 and OR 0.22, P = 0.002 respectively). The incidence of permanent pacemaker (PPM) implants was significantly lower in patients who had NDD compared to ED (OR 0.21, P = 0.0005). The incidence of 30 day mortality, stroke, AKI and readmission rates was not different between the two groups. NDD after TAVR allows for reduction in hospital stay and can mitigate hospital costs without an increased risk of complications. Our analysis shows that complication rate is comparable to ED, NDD is a reasonable option for certain patients with severe aortic stenosis who undergo TAVR. Further studies are needed to elucidate whether higher risk patients who would benefit from an extended inpatient monitoring post TAVR.
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Gama F, Gonçalves PDA, Abecasis J, Ferreira AM, Freitas P, Gonçalves M, Carvalho S, Oliveira AF, Gabriel HM, Brito J, Raposo L, Adragão P, Almeida MDS, Teles RC. Predictors of pacemaker implantation after TAVI in a registry including self, balloon and mechanical expandable valves. Int J Cardiovasc Imaging 2021; 38:225-235. [PMID: 34390445 DOI: 10.1007/s10554-021-02365-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/24/2021] [Indexed: 11/24/2022]
Abstract
The need for permanent pacemaker implantation (PPMI) is a burdensome complication of transcatheter aortic valve implantation (TAVI). The aim of our study was to evaluate different anatomical, clinical, electrocardiographic, and procedural variables associated with the development of conduction abnormalities after TAVI across the entire device spectrum. Single-center prospective cohort of consecutive patients who underwent TAVI since March 2017. Final cohort was studied to detect areas of calcium within aortic valve characterized by leaflet sector and region. Membranous septum (MS) length was assessed throughout a modified coronal view. Device selection and positioning were performed according to the operator criteria. Device selection and positioning were performed according to the operator criteria. From the 273 patients included, 57 underwent PPMI (20.8%). Univariate analysis determined right bundle branch block (RBBB), QRS duration, MS length and calcium within LVOT of non-coronary cuspid as independent predictors. After multivariable logistic regression, both RBBB (OR 6.138; 95% CI 1.23-30.73, P = 0.027) and MS length (OR 0.259; 95% CI 0.164-0.399, P < 0.005) emerged as statistically significant. As a model, they could predict PPMI in 88.7%, independently of which valve used. Youden index analysis yielded 7.69 mm as the optimal cut-off with a negative and positive predictive value of 94.7 and 71.9%, respectively. In our experience, both RBBB pattern and short membranous septum (< 8 mm) were strongly and independently associated with new permanent pacemaker implantation, regardless of the device type. Our findings suggest that this simple evolved measure of MS length may guide device selection and implantation technique and facilitate early discharge.
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Affiliation(s)
- Francisco Gama
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal.
| | - Pedro de Araújo Gonçalves
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal.,Department of Interventional Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal.,CHRC, CEDOC, NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - João Abecasis
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - António Miguel Ferreira
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - Pedro Freitas
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - Mariana Gonçalves
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal.,Department of Interventional Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - Salomé Carvalho
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - Afonso Félix Oliveira
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal.,Department of Interventional Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal.,Faculdade de Medicina, Centro Académico de Medicina de Lisboa, Instituto de Farmacologia e Neurociências, Universidade de Lisboa, Lisbon, Portugal
| | - Henrique Mesquita Gabriel
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal.,Department of Interventional Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - João Brito
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal.,Department of Interventional Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - Luís Raposo
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal.,Department of Interventional Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - Pedro Adragão
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - Manuel de Sousa Almeida
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal.,Department of Interventional Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal.,CHRC, CEDOC, NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Rui Campante Teles
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal.,Department of Interventional Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal.,CHRC, CEDOC, NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
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Sandhu A, Tzou WS. A Disruptive Technology: Determining Need for Permanent Pacing After TAVR. Curr Cardiol Rep 2021; 23:53. [PMID: 33871728 DOI: 10.1007/s11886-021-01481-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW Transcatheter aortic valve replacement (TAVR) has changed the paradigm for management of severe aortic stenosis. Despite evolution of TAVR over the past 2 decades, conduction system disturbances remain a concern post-TAVR. In this review, we describe (1) permanent pacemaker (PP) implant rates associated with TAVR, (2) risk factors predicting need for PP therapy post-TAVR, (3) management of perioperative conduction abnormalities, and (4) novel areas of research. RECENT FINDINGS Conduction disturbances remain a common issue post-TAVR, in particular, left bundle branch block (LBBB). Though newer data describes resolution of a significant fraction of these disturbances over time, rates of pacemaker therapy remain high despite improvements in valve technology and procedural technique. Recent consensus statements and guideline documents are important first steps in standardizing an approach to post-TAVR conduction disturbances. New areas of research show promise in both prediction and treatment of conduction disturbances post-TAVR.
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Affiliation(s)
- Amneet Sandhu
- Division of Cardiology, Cardiac Electrophysiology Section, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, 80045, USA.,Division of Cardiology, Denver VA Medical Center, Denver, CO, USA
| | - Wendy S Tzou
- Division of Cardiology, Cardiac Electrophysiology Section, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, 80045, USA.
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Trivedi DP, Chigarapalli SR, Gangahar DM, Machiraju VR. The impact of advances in percutaneous catheter interventions on redo cardiac surgery. Indian J Thorac Cardiovasc Surg 2021; 37:61-69. [PMID: 33442208 PMCID: PMC7778657 DOI: 10.1007/s12055-020-01029-5] [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: 05/18/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022] Open
Abstract
Toward the end of the twentieth century, redo cardiac surgery accounted for approximately 15-20% of total cardiac surgical volume. Major risk factors for redo cardiac surgery include young age at time of the first operation, progression of native coronary artery disease (CAD), vein graft atherosclerosis, bioprosthetic valve failure and endocarditis, and transplantation for end stage heart failure. Historically, redo coronary artery bypass grafting (CABG) alone carried a mortality risk of around 4%. Factors such as older age, female sex, comorbidities, combined procedures, hemodynamic instability, and emergency procedures contributed to even higher mortality and morbidity. These poor outcomes made it necessary to look for less invasive alternate methods of treatment. Advances in catheter-based interventions have made a major impact on redo cardiac surgeries, making it no longer the first option in a majority of cases. Percutaneous interventions for recurrence following CABG, transcutaneous aortic valve replacement (TAVR) for calcific aortic stenosis, valve in valve (VIV) implantations, device closure of paravalvular leaks (PVL), and thoracic endovascular aortic repair (TEVAR) for residual and recurrent aneurysms and mitral clip to correct mitral regurgitation (MR) in heart failure are rapidly developing or developed, obviating the need for redo cardiac surgery. Our intent is to review these advances and their impact on redo cardiac surgery.
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Affiliation(s)
- Dhaval Pravin Trivedi
- Department of Cardiothoracic Surgery, Los Angeles Medical Center, Kaiser Permanente, Los Angeles, CA USA
| | - SukeshKumar Reddy Chigarapalli
- Department of Cardiothoracic Surgery, Asian Institute of Gastroenterology Hospitals, Gachibowli, Hyderabad, TG 500031 India
| | - Deepak Mohan Gangahar
- Department of Thoracic Surgery, University of Nebraska Medical Center, Omaha, NE USA
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Chiocchi M, Ricci F, Pasqualetto M, D'Errico F, Benelli L, Pugliese L, Cavallo AU, Forcina M, Presicce M, De Stasio V, Di Donna C, Di Tosto F, Spiritigliozzi L, Floris R, Romeo F. Role of computed tomography in transcatheter aortic valve implantation and valve-in-valve implantation: complete review of preprocedural and postprocedural imaging. J Cardiovasc Med (Hagerstown) 2020; 21:182-191. [PMID: 32012138 DOI: 10.2459/jcm.0000000000000899] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
: Since 2002, transcatheter aortic valve implantation (TAVI) has revolutionized the treatment and prognosis of patients with aortic stenosis. A preprocedural assessment of the patient is vital for achieving optimal outcomes from the procedure. Retrospective ECG-gated cardiac computed tomography (CT) today it is the gold-standard imaging technique that provides three-dimensional images of the heart, thus allowing a rapid and complete evaluation of the morphology of the valve, ascending aorta, coronary arteries, peripheral access vessels, and prognostic factors, and also provides preprocedural coplanar fluoroscopic angle prediction to obtain complete assessment of the patient. The most relevant dimension in preprocedural planning of TAVI is the aortic annulus, which can determine the choice of prosthesis size. CT is also essential to identify patients with increased anatomical risk for coronary artery occlusion in Valve in Valve (ViV) procedures.Moreover, CT is very useful in the evaluation of late complications, such as leakage, thrombosis and displacements. At present, CT is the cornerstone imaging modality for the extensive and thorough work-up required for planning and performing each TAVI procedure, to achieve optimal outcomes. Both the CT procedure and analysis should be performed by trained and experienced personnel, with a radiological background and a deep understanding of the TAVI procedure, in close collaboration with the implantation team. An accurate pre-TAVI CT and post-processing for the evaluation of all the points recommended in this review allow a complete planning for the choice of the valve dimensions and type (balloon or self-expandable) and of the best percutaneous access.
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Affiliation(s)
- Marcello Chiocchi
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Francesca Ricci
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Monia Pasqualetto
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | | | - Leonardo Benelli
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Luca Pugliese
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | | | - Marco Forcina
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Matteo Presicce
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | | | - Carlo Di Donna
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Federica Di Tosto
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | | | - Roberto Floris
- Divison of Diagnostic Imaging, Department of Biomedicine and Prevention
| | - Francesco Romeo
- Unit of Cardiology and Interventional Cardiology, University of Rome 'Tor Vergata', Rome, Italy
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Pott D, Sedaghat A, Schmitz C, Werner N, Schmitz-Rode T, Steinseifer U, Jansen SV. Hemodynamics inside the neo- and native sinus after TAVR: Effects of implant depth and cardiac output on flow field and coronary flow. Artif Organs 2020; 45:68-78. [PMID: 32750157 DOI: 10.1111/aor.13789] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/19/2020] [Accepted: 07/20/2020] [Indexed: 12/22/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a widely used therapy for aortic valve diseases. With TAVR, flow hemodynamics may change leading to areas of flow stagnation prone to thrombosis risk. The neo-sinus, created by introducing a prosthesis inside the diseased native valve, may prompt leaflet thrombosis due to areas of flow stasis. This study attempted to understand the effect of different prosthesis implant depths on the flow field within the neo- and native sinus and on the coronary perfusion. Experiments were performed inside an in vitro pulse duplicator producing physiological conditions according to ISO 5840-1:2015 standard. Flow fields were obtained for two cardiac outputs (CO) using particle image velocimetry (PIV). Washout was calculated as a measure of flow stasis. The two main results are: a lower implant position and a lower CO/frequency led to better native sinus washout, but worsened neo-sinus washout. In contrast, a higher implant position led to higher coronary flow (for higher CO/frequency). No significant effect of implant depth on coronary flow was observed for lower CO/frequency. In summary, a higher implant position using this self-expanding prosthesis is associated with reduced neo-sinus flow stasis. Hereby, washout of the native sinus, as well as coronary flow, are dependent on cardiac output.
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Affiliation(s)
- Desiree Pott
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | | | - Christoph Schmitz
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Nikos Werner
- Innere Medizin III/Kardiologie, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
| | - Thomas Schmitz-Rode
- Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Sebastian Victor Jansen
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Aachen, Germany
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12
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Toggweiler S, Kobza R. New-Onset Arrhythmias After Transcatheter Aortic Valve Replacement May Not Always Be New-Onset Arrhythmias. JACC Cardiovasc Interv 2020; 13:1774-1776. [PMID: 32682673 DOI: 10.1016/j.jcin.2020.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/14/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Richard Kobza
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
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13
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Toggweiler S, Berte B. Transcatheter aortic valve implantation-associated conduction disturbances are moving to center stage. Rev Port Cardiol 2020; 39:441-442. [PMID: 32763100 DOI: 10.1016/j.repc.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Benjamin Berte
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
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14
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Spence MS, Baan J, Iacovelli F, Martinelli GL, Muir DF, Saia F, Bortone AS, Densem CG, Owens CG, van der Kley F, Vis M, van Mourik MS, Costa G, Sykorova L, Lüske CM, Deutsch C, Kurucova J, Thoenes M, Bramlage P, Tamburino C, Barbanti M. Prespecified Risk Criteria Facilitate Adequate Discharge and Long-Term Outcomes After Transfemoral Transcatheter Aortic Valve Implantation. J Am Heart Assoc 2020; 9:e016990. [PMID: 32715844 PMCID: PMC7792272 DOI: 10.1161/jaha.120.016990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Despite the availability of guidelines for the performance of transcatheter aortic valve implantation (TAVI), current treatment pathways vary between countries and institutions, which impact on the mean duration of postprocedure hospitalization. Methods and Results This was a prospective, multicenter registry of 502 patients to validate the appropriateness of discharge timing after transfemoral TAVI, using prespecified risk criteria from FAST‐TAVI (Feasibility and Safety of Early Discharge After Transfemoral [TF] Transcatheter Aortic Valve Implantation), based on hospital events within 1‐year after discharge. The end point—a composite of all‐cause mortality, vascular access–related complications, permanent pacemaker implantation, stroke, cardiac rehospitalization, kidney failure, and major bleeding—was reached in 27.0% of patients (95% CI, 23.3–31.2) within 1 year after intervention; 7.5% (95% CI, 5.5–10.2) had in‐hospital complications before discharge and 19.6% (95% CI, 16.3–23.4) within 1 year after discharge. Overall mortality within 1 year after discharge was 7.3% and rates of cardiac rehospitalization 13.5%, permanent pacemaker implantation 4.2%, any stroke 1.8%, vascular‐access–related complications 0.7%, life‐threatening bleeding 0.7%, and kidney failure 0.4%. Composite events within 1 year after discharge were observed in 18.8% and 24.3% of patients with low risk of complications/early (≤3 days) discharge and high risk and discharged late (>3 days) (concordant discharge), respectively. Event rate in patients with discordant discharge was 14.3% with low risk but discharged late and increased to 50.0% in patients with high risk but discharged in ≤3 days. Conclusions The FAST‐TAVI risk assessment provides a tool for appropriate, risk‐based discharge that was validated with the 1‐year event rate after transfemoral TAVI. Registration URL: https://www.ClinicalTrials.gov; Unique identifier: NCT02404467.
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Affiliation(s)
- Mark S. Spence
- Cardiology DepartmentRoyal Victoria HospitalBelfastUnited Kingdom
| | - Jan Baan
- Department of CardiologyAmsterdam UMCUniversity of AmsterdamThe Netherlands
| | - Fortunato Iacovelli
- Cardiology DepartmentDepartment of Advanced Biomedical SciencesUniversity of NaplesItaly
- Cardiac Surgery DepartmentClinica San GaudenzioNovaraItaly
| | | | - Douglas F. Muir
- Cardiothoracic DivisionThe James Cook University HospitalMiddlesbroughUnited Kingdom
| | - Francesco Saia
- Cardiovascular and Thoracic DepartmentS. Orsola‐Malpighi University HospitalBolognaItaly
| | | | | | - Colum G. Owens
- Cardiology DepartmentRoyal Victoria HospitalBelfastUnited Kingdom
| | - Frank van der Kley
- Cardiology DepartmentLeiden University Medical CenterLeidenThe Netherlands
| | - Marije Vis
- Department of CardiologyAmsterdam UMCUniversity of AmsterdamThe Netherlands
| | | | - Giuliano Costa
- Catania Division of CardiologyPoliclinico‐Vittorio Emanuele HospitalUniversity of CataniaItaly
| | | | - Claudia M. Lüske
- Institute for Pharmacology and Preventive MedicineCloppenburgGermany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive MedicineCloppenburgGermany
| | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive MedicineCloppenburgGermany
| | - Corrado Tamburino
- Catania Division of CardiologyPoliclinico‐Vittorio Emanuele HospitalUniversity of CataniaItaly
| | - Marco Barbanti
- Catania Division of CardiologyPoliclinico‐Vittorio Emanuele HospitalUniversity of CataniaItaly
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15
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Transcatheter aortic valve implantation-associated conduction disturbances are moving to center stage. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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16
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Risk factors for permanent pacemaker implantation in patients receiving a balloon-expandable transcatheter aortic valve prosthesis. Heart Vessels 2020; 35:1735-1745. [DOI: 10.1007/s00380-020-01653-6] [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: 04/30/2020] [Accepted: 06/17/2020] [Indexed: 11/27/2022]
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17
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Konsensuspapier der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG) zur kathetergestützten Aortenklappenimplantation (TAVI) 2020. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2020. [DOI: 10.1007/s00398-020-00373-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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18
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Kuck KH, Bleiziffer S, Eggebrecht H, Ensminger S, Frerker C, Möllmann H, Nef H, Thiele H, Treede H, Wimmer-Greinecker G, Walther T. Konsensuspapier der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG) zur kathetergestützten Aortenklappenimplantation (TAVI) 2020. KARDIOLOGE 2020. [DOI: 10.1007/s12181-020-00398-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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19
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Mas-Peiro S, Fichtlscherer S, Walther C, Vasa-Nicotera M. Current issues in transcatheter aortic valve replacement. J Thorac Dis 2020; 12:1665-1680. [PMID: 32395310 PMCID: PMC7212163 DOI: 10.21037/jtd.2020.01.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aortic stenosis is the most common valvular disease worldwide. With transcatheter aortic valve replacement (TAVR) being increasingly expanded to lower-risk populations, several challenging issues remain to be solved. The present review aims at discussing modern approaches to such issues as well as the current status of TAVR. TAVR has undergone several developments in the recent years: an increased use of transfemoral access, the development of prostheses in order to adapt to challenging anatomies, improved delivery systems with repositioning features, and outer skirts aiming at reducing paravalvular leak. The indication of TAVR is increasingly being expanded to patients with lower surgical risk. The main clinical trials supporting such expansion are reviewed and the latest data on low-risk patients are discussed. A number of challenges need still to be addressed and are also reviewed in this paper: the need for updated international guidelines including the latest evidence; a reduction of main complications such as permanent pacemaker implantation, paravalvular leak, and stroke (and its potential prevention by using anti-embolic protection devices); the appropriate role of TAVR in patients with concomitant cardiac ischemic disease; and durability of bio-prosthetic implanted valves. Finally, the future perspectives for TAVR use and next device developments are discussed.
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Affiliation(s)
- Silvia Mas-Peiro
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Claudia Walther
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
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20
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Alperi Garcia A, Muntané-Carol G, Junquera L, del Val D, Faroux L, Philippon F, Rodés-Cabau J. Can we reduce conduction disturbances following transcatheter aortic valve replacement? Expert Rev Med Devices 2020; 17:309-322. [DOI: 10.1080/17434440.2020.1741349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Lucia Junquera
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - David del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Laurent Faroux
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - François Philippon
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
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21
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Braghiroli J, Kapoor K, Thielhelm TP, Ferreira T, Cohen MG. Transcatheter aortic valve replacement in low risk patients: a review of PARTNER 3 and Evolut low risk trials. Cardiovasc Diagn Ther 2020; 10:59-71. [PMID: 32175228 DOI: 10.21037/cdt.2019.09.12] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a mainstay in treatment for patients with severe aortic stenosis who are considered high-risk surgical candidates. The use of TAVR in low-risk patients with severe aortic stenosis is being explored as an alternative to surgical aortic valve replacement (SAVR). Recent results from the Medtronic Evolut Low Risk trial and the Placement of Aortic Transcatheter Valves (PARTNER) 3 trial shed light on the use of TAVR in low-risk surgical candidates. The Evolut Low Risk trial compared TAVR with a self-expanding supra-annular bioprosthesis to SAVR in 1468 patients with severe aortic stenosis who were low surgical risk. Patients with a mean age of 74 and a mean Society of Thoracic Surgeons (STS) risk score of 1.9% were randomized to either TAVR or SAVR groups. Using the composite end point of death or disabling stroke at 24 months, the study found an incidence of 5.3% in the TAVR arm and 6.7% in the surgical arm. The Evolut Low Risk trial thus concluded that TAVR was statistically noninferior but not superior to SAVR (difference, -1.4 percentage points; 95% Bayesian credible interval for the difference, -4.9 to 2.1; posterior probability of noninferiority, >0.999). The PARTNER 3 trial assigned 1,000 patients with severe aortic stenosis and low surgical risk to either TAVR with transfemoral placement of balloon expandable valve or SAVR. Patients with a mean age of 73 and a mean STS score of 1.9% were randomized to either TAVR or SAVR groups. With respect to the primary endpoint of composite death from any cause, stroke, or rehospitalization, the study found an occurrence of 8.5% in TAVR and 15.1% in SAVR, confirming both noninferiority and superiority in the TAVR group [absolute difference, -6.6 percentage points; 95% confidence interval (CI), -10.8 to -2.5; P<0.001 for noninferiority; hazard ratio, 0.54; 95% CI, 0.37 to 0.79; P=0.001 for superiority]. Both the Evolut low risk trial and the PARTNER 3 trial provide evidence that the use of TAVR extends beyond the scope of high and intermediate risk surgical patients and is at the very least equivalent to SAVR in the treatment low-risk surgical candidates when using a transfemoral approach in patients without bicuspid aortic valves. In this article we provide an extensive review on the Evolute low risk and PARTNER 3 trials, including a discussion on clinically relevant outcomes.
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Affiliation(s)
- Joao Braghiroli
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Kunal Kapoor
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Torin P Thielhelm
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Tanira Ferreira
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Mauricio G Cohen
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
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22
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Toggweiler S, Loretz L, Brinkert M, Bossard M, Wolfrum M, Moccetti F, Berte B, Cuculi F, Kobza R. Simplifying transfemoral ACURATE neo implantation using the TrueFlow nonocclusive balloon catheter. Catheter Cardiovasc Interv 2020; 96:E640-E645. [PMID: 31971346 DOI: 10.1002/ccd.28741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/12/2019] [Accepted: 01/11/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study aimed to investigate the safety and efficacy of ACURATE neo transcatheter aortic valve replacement (TAVR) facilitated by predilatation with the nonocclusive TrueFlow balloon catheter. BACKGROUND Now that TAVR is moving forward, physicians have attempted to simplify and streamline the procedure and the so-called minimalist approach has become more popular. METHODS We enrolled 142 patients (mean age: 82 ± 5 years, 61% female) in a prospective registry. Patients at low risk for intraprocedural third-degree atrioventricular block (AVB) underwent TAVR with the TrueFlow balloon without rapid pacing and without insertion of a provisional pacemaker (n = 121). The remaining 21 patients were predilated with rapid pacing using a provisional pacemaker and a standard balloon. RESULTS Predilatation with the TrueFlow balloon was successful in all 121 patients. Postdilatation was less frequently required after predilatation with the TrueFlow (25% vs. 57%, p = .003). Moreover, median procedural duration with the TrueFlow was significantly shorter (42 [interquartile range, IQR: 34-53] vs. 55 [IQR: 46-61] min, p = .004). In-hospital outcomes were similar. At 30 days, there was no mortality, two (1%) patients had suffered a stroke and only four (3%) had required implantation of a new pacemaker. CONCLUSION Among patients with a low risk for intraprocedural third-degree AVB, the TrueFlow nonocclusive balloon catheter facilitates implantation of the ACURATE neo without the necessity of rapid pacing and a provisional pacemaker.
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Affiliation(s)
- Stefan Toggweiler
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Lucca Loretz
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Miriam Brinkert
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matthias Bossard
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mathias Wolfrum
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Federico Moccetti
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Benjamin Berte
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Florim Cuculi
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Richard Kobza
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
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23
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Outcomes after pacemaker implantation in patients with new-onset left bundle-branch block after transcatheter aortic valve replacement. Am Heart J 2019; 218:128-132. [PMID: 31806088 DOI: 10.1016/j.ahj.2019.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 07/13/2019] [Indexed: 11/24/2022]
Abstract
New-onset left bundle branch block (N-LBBB) after transcatheter aortic valve replacement (TAVR) is a challenging clinical dilemma. In our single-center study, 60 out of 172 patients who underwent permanent pacemaker implantation (PPM) after TAVR had N-LBBB (34.9%). At a median follow-up duration of 357 days (IQR, 178; 560 days), two patients (3.5%) were completely pacemaker-dependent, and four others (7%) were partially dependent. Twelve patients (24%) recovered conduction in their left bundle at a median follow-up duration of 5 weeks (IQR, 4; 14 weeks). Due to the lack of clinical predictors of pacemaker dependency, active surveillance is warranted and may be an alternative to permanent pacemaker implantation.
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