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Antony I, Mehari Abraha H, Hameed A, Conway C. A European update on transcatheter aortic valve implantation (TAVI) in the COVID era. J Anat 2022; 242:50-63. [PMID: 36152032 PMCID: PMC9773167 DOI: 10.1111/joa.13740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 12/31/2022] Open
Abstract
Minimally invasive approaches for aortic valve replacement are now at the forefront of pathological aortic valve treatment. New trials show comparability of these devices to existing therapies, not only in high-risk surgical cohorts but also in low-risk and intermediate-risk cohorts. This review provides vital clinical and anatomical background to aortic valvular disease treatment guidelines, while also providing an update on transcatheter aortic valve implantation (TAVI) devices in Europe, their interventional trials and associated complications.
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Affiliation(s)
- Ishan Antony
- School of MedicineRCSI University of Medicine and Health SciencesDublinIreland,Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG)RCSI University of Medicine and Health SciencesDublinIreland
| | - Hyab Mehari Abraha
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG)RCSI University of Medicine and Health SciencesDublinIreland,Trinity Centre for Biomedical Engineering (TCBE)Trinity College DublinDublinIreland
| | - Aamir Hameed
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG)RCSI University of Medicine and Health SciencesDublinIreland,Trinity Centre for Biomedical Engineering (TCBE)Trinity College DublinDublinIreland
| | - Claire Conway
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG)RCSI University of Medicine and Health SciencesDublinIreland,Trinity Centre for Biomedical Engineering (TCBE)Trinity College DublinDublinIreland
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3
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Twelve-month outcomes of transapical transcatheter aortic valve implantation in patients with severe aortic valve stenosis. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:68-74. [PMID: 33868420 PMCID: PMC8039915 DOI: 10.5114/aic.2021.104771] [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: 11/15/2020] [Accepted: 02/13/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Transapical access (TA) transcatheter aortic valve implantation (TAVI) (TA-TAVI) represents one of the possible routes in patients with severe aortic stenosis (AS) who are not suitable for transfemoral access. Aim To assess early- and mid-term clinical outcomes after TA-TAVI. Material and methods Patients with severe symptomatic AS undergoing TA-TAVI from November 2008 to December 2019 were enrolled. Clinical and procedural characteristics as well as clinical outcomes including all-cause mortality during 12-month follow-up were assessed. Results Sixty-one consecutive patients underwent TA-TAVI for native AS. Patients were elderly with median age of 80.0 (76.0-84.0) years; 55.7% were males. Median baseline EuroSCORE I and STS scores were 18.2% (11.6-27.7) and 4.8% (3.3-8.2), respectively. The procedural success rate was 96.7%. In-hospital, 30-day and 12-month mortality rates were 9.8%; 18.0% and 24.6%, respectively. The main periprocedural and in-hospital complications were bleeding complications (14.8%). The following factors were associated with 12-month mortality: previous cerebrovascular event (CVE), glomerular filtration rate (GFR), aortic valve area (AVA), right ventricular systolic pressure (RVSP) and serum level of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (RR for CVE 3.17, 95% confidence interval (CI): 1.15-8.76: p = 0.026; RR for AVA per 0.1 cm2 1.28, 95% CI: 1.03-1.55: p = 0.024; RR for GFR per 1 ml/min 0.96: 95% CI: 0.94-0.99: p = 0.007; RR for NT-proBNP per 1000 pg/ml 1.07: 95% CI: 1.01-1.17: p = 0.033; RR for RVSP per 1 mm Hg 1.07: 95% CI 1.02-1.16: p = 0.011). Conclusions Transapical TAVI in high-risk patients provides good hemodynamic results with acceptable outcomes.
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Transcatheter versus Surgical Aortic Valve Replacement after Previous Cardiac Surgery: A Systematic Review and Meta-Analysis. Cardiol Res Pract 2018; 2018:4615043. [PMID: 29850227 PMCID: PMC5907513 DOI: 10.1155/2018/4615043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/27/2017] [Accepted: 01/23/2018] [Indexed: 12/24/2022] Open
Abstract
Aim Aortic valve replacement (AVR) in patients with prior cardiac surgery might be challenging. Transcatheter aortic valve replacement (TAVR) offers a promising alternative in such patients. We therefore aimed at comparing the outcomes of patients with aortic valve diseases undergoing TAVR versus those undergoing surgical AVR (SAVR) after previous cardiac surgery. Methods and Results MEDLINE, EMBASE, and the Cochrane Central Register were searched. Seven relevant studies were identified, published between 01/2011 and 12/2015, enrolling a total of 1148 patients with prior cardiac surgery (97.6% prior CABG): 49.2% underwent TAVR, whereas 50.8% underwent SAVR. Incidence of stroke (3.8 versus 7.9%, p=0.04) and major bleeding (8.3 versus 15.3%, p=0.04) was significantly lower in the TAVR group. Incidence of mild/severe paravalvular leakage (14.4/10.9 versus 0%, p < 0.0001) and pacemaker implantation (11.3 versus 3.9%, p=0.01) was significantly higher in the TAVR group. There were no significant differences in the incidence of acute kidney injury (9.7 versus 8.7%, p=0.99), major adverse cardiovascular events (8.7 versus 12.3%, p=0.21), 30-day mortality (5.1 versus 5.5%, p=0.7), or 1-year mortality (11.6 versus 11.8%, p=0.97) between the TAVR and SAVR group. Conclusions TAVR as a redo procedure offers a safe alternative for patients presenting with aortic valve diseases after previous cardiac surgery especially those with prior CABG.
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Onorati F, D'Onofrio A, Biancari F, Salizzoni S, De Feo M, Agrifoglio M, Mariscalco G, Lucchetti V, Messina A, Musumeci F, Santarpino G, Esposito G, Santini F, Magagna P, Beghi C, Aiello M, Ratta ED, Savini C, Troise G, Cassese M, Fischlein T, Glauber M, Passerone G, Punta G, Juvonen T, Alfieri O, Gabbieri D, Mangino D, Agostinelli A, Livi U, Di Gregorio O, Minati A, Rinaldi M, Gerosa G, Faggian G. Results of surgical aortic valve replacement and transapical transcatheter aortic valve replacement in patients with previous coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2016; 22:806-12. [PMID: 26979656 DOI: 10.1093/icvts/ivw049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 01/18/2016] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To evaluate the results of aortic valve replacement through sternotomic approach in redo scenarios (RAVR) vs transapical transcatheter aortic valve replacement (TAVR), in patients in the eighth decade of life or older already undergone previous coronary artery bypass grafting (CABG). METHODS One hundred and twenty-six patients undergoing RAVR were compared with 113 patients undergoing TaTAVR in terms of 30-day mortality and Valve Academic Research Consortium-2 outcomes. The two groups were also analysed after propensity-matching. RESULTS TaTAVR patients demonstrated a higher incidence of 30-day mortality (P = 0.03), stroke (P = 0.04), major bleeding (P = 0.03), worse 'early safety' (P = 0.04) and lower permanent pacemaker implantation (P = 0.03). TaTAVR had higher follow-up hazard in all-cause mortality [hazard ratio (HR) 3.15, 95% confidence interval (CI) 1.28-6.62; P < 0.01] and cardiovascular mortality (HR 1.66, 95% CI 1.02-4.88; P = 0.04). Propensity-matched patients showed comparable 30-day outcome in terms of survival, major morbidity and early safety, with only a lower incidence of transfusions after TaTAVR (10.7% vs RAVR: 57.1%; P < 0.01). A trend towards lower Acute Kidney Injury Network Classification 2/3 (3.6% vs RAVR 21.4%; P = 0.05) and towards a lower freedom from all-cause mortality at follow-up (TaTAVR: 44.3 ± 21.3% vs RAVR: 86.6 ± 9.3%; P = .08) was demonstrated after TaTAVR, although cardiovascular mortality was comparable (TaTAVR: 86.5 ± 9.7% vs RAVR: 95.2 ± 4.6%; P = 0.52). Follow-up freedom from stroke, acute heart failure, reintervention on AVR and thrombo-embolisms were comparable (P = NS). EuroSCORE II (P = 0.02), perioperative stroke (P = 0.01) and length of hospitalization (P = 0.02) were the determinants of all-cause mortality at follow-up, whereas perioperative stroke (P = 0.03) and length of hospitalization (P = 0.04) impacted cardiovascular mortality at follow-up. CONCLUSIONS Reported differences in mortality and morbidity after TaTAVR and RAVR reflect differences in baseline risk profiles. Given the lower trend for renal complications, patients at higher perioperative renal risk might be better served by TaTAVR.
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Affiliation(s)
- Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | | | - Fausto Biancari
- Department of Cardiac Surgery, University of Oulu, Oulu, Finland
| | | | - Marisa De Feo
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Caserta, Italy
| | | | | | | | - Antonio Messina
- Cardiac Surgery Unit, Poliambulanza Foundation, Brescia, Italy
| | | | - Giuseppe Santarpino
- Cardiovascular Center, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Giampiero Esposito
- Division of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | | | | | - Cesare Beghi
- Cardiac Surgery Unit, Insubria University, Varese, Italy
| | | | - Ester Dalla Ratta
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Caserta, Italy
| | - Carlo Savini
- Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Giovanni Troise
- Cardiac Surgery Unit, Poliambulanza Foundation, Brescia, Italy
| | - Mauro Cassese
- Division of Cardiac Surgery, Clinica S. Maria, Bari, Italy
| | - Theodor Fischlein
- Cardiovascular Center, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | | | | | | | - Tatu Juvonen
- Department of Cardiac Surgery, University of Oulu, Oulu, Finland
| | | | | | | | | | - Ugolino Livi
- S. Maria della Misericordia Hospital, Udine, Italy
| | | | | | - Mauro Rinaldi
- Division of Cardiac Surgery, University of Torino, Turin, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, University of Padua, Padova, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
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O'Sullivan KE, Bargenda S, Sugrue D, Hurley J. Advances in the management of severe aortic stenosis. Ir J Med Sci 2016; 185:309-17. [PMID: 26886020 DOI: 10.1007/s11845-016-1417-7] [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: 02/06/2015] [Accepted: 11/16/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent developments in the management of severe aortic stenosis have resulted in a paradigm shift in the way we view the condition. Patients previously denied intervention in the form of surgical aortic valve replacement (SAVR) are now candidates for transcatheter aortic valve implantation and the risk and age profiles of those undergoing SAVR are rising with the ageing population. This review article is designed to provide an overview of developments in the surgical management of severe aortic stenosis. We also discuss the expanding role of minimally invasive surgical approaches to outline the current techniques available to treat patients with severe aortic stenosis. METHODS PubMed was searched using the terms 'severe aortic stenosis', 'surgical aortic valve replacement', 'transcatheter aortic valve replacement', 'mechanical aortic valve replacement' and 'sutureless aortic valve replacement'. Selection of articles was based on peer review, journal and relevance. Where possible articles from high-impact factor peer review journals were included. RESULTS Minimally invasive operative approaches include mini-sternotomy and mini-thoracotomy. Sutureless aortic prostheses reduce aortic cross-clamp time and cardiopulmonary bypass time; however, long-term follow-up data are unavailable at this time. Mechanical prostheses are advised for those under 60. CONCLUSION Multiple advances in the surgical management of aortic stenosis have occured in the past decade. An evolving spectrum of surgical and transcatheter interventions is now available depending on patient age and operative risk.
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Affiliation(s)
- K E O'Sullivan
- Department of Cardiothoracic Surgery, Mater Private Hospital, Eccles St., Dublin 7, Ireland.
| | - S Bargenda
- Department of Cardiothoracic Surgery, Mater Private Hospital, Eccles St., Dublin 7, Ireland
| | - D Sugrue
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - J Hurley
- Department of Cardiothoracic Surgery, Mater Private Hospital, Eccles St., Dublin 7, Ireland
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