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Gómez-Herrero J, Fernandez-Cordón C, Gonzalez JC, García-Gómez M, Turrión SB, Serrador A, Gutiérrez H, Campo A, Cortés C, Sevilla T, Aristizabal C, Ruiz J, Campillo S, Baladrón C, Carrasco-Moraleja M, Román JAS, Amat-Santos IJ. TAV-in-TAV in patients with prosthesis embolization: Impact of commissural alignment and global outcomes. Int J Cardiol 2024; 410:132179. [PMID: 38761972 DOI: 10.1016/j.ijcard.2024.132179] [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: 03/30/2024] [Revised: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Optimal strategies to manage embolization of transcatheter aortic valve implantation (TAVI) devices are unclear; valve-in-valve (ViV) is often used. We aimed to describe through one-single center experience its rate, causes, consequences, and management as well as the rate and relevance of commissural alignment (CA) in this context. METHODS We identified across 1038 TAVI cases, those cases requiring ViV for the management of first device embolization. CA (absence or mild misalignment) after first and second device was assessed by CT or fluoroscopy. RESULTS A total of 23 cases (2.2%) were identified, 52.3% embolized towards the aorta and 47.7% towards the ventricle. Suboptimal implant height (38%) and embolization at the time of post-dilation (23%) were the most frequent mechanisms together with greater rate of bicuspid valve (p < 0.001) and a trend to greater annular eccentricity. Procedural and 1-year death occurred in 13% and 34%, respectively (vs. 1.1% and 7.8% in the global cohort, p < 0.001). CA was present in 76.9% of the prostheses initially implanted but was only spontaneously achieved in 30.8% of the second ViV device. Adequate CA of both prostheses was identified in only two cases (8.7%). There were no cases of coronary obstruction. CONCLUSIONS TAVI device embolization mechanisms can often be predicted and prevented. Mortality following bail-out ViV is higher than in regular TAVI procedures but 2/3 of these patients survived beyond 1-year follow-up. In them, valve degeneration or coronary re-access might be particularly challenging since CA was rarely achieved with both devices suggesting that greater efforts should be made in this regard.
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Affiliation(s)
| | | | | | | | | | - Ana Serrador
- Cardiology Department, University Clinic Hospital, Valladolid, Spain; Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | | | - Alberto Campo
- Cardiology Department, University Clinic Hospital, Valladolid, Spain
| | - Carlos Cortés
- Cardiology Department, University Clinic Hospital, Valladolid, Spain
| | - Teresa Sevilla
- Cardiology Department, University Clinic Hospital, Valladolid, Spain; Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | | | - Julio Ruiz
- Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - Sofía Campillo
- Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - Carlos Baladrón
- Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - Manuel Carrasco-Moraleja
- Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - J Alberto San Román
- Cardiology Department, University Clinic Hospital, Valladolid, Spain; Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - Ignacio J Amat-Santos
- Cardiology Department, University Clinic Hospital, Valladolid, Spain; Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain.
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Meucci F, Di Muro FM, Martinucci P, Stolcova M, Di Mario C, Cecchi E. Tunnel stent technique as an alternative treatment for left main protection in valve-in-valve transcatheter aortic valve implantation. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2023; 19:371-374. [PMID: 38187483 PMCID: PMC10767559 DOI: 10.5114/aic.2023.133811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/22/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Francesco Meucci
- Structural Interventional Cardiology Division, Department of Cardiac Thoracic and Vascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesca Maria Di Muro
- Structural Interventional Cardiology Division, Department of Cardiac Thoracic and Vascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Pietro Martinucci
- Cardiology Division, Nuovo Ospedale San Giovanni di Dio, Florence, Italy
| | - Miroslava Stolcova
- Structural Interventional Cardiology Division, Department of Cardiac Thoracic and Vascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Cardiac Thoracic and Vascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Emanuele Cecchi
- General Cardiology Division, Department of Cardiac Thoracic and Vascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Liu Y, Zhai M, Mao Y, Xu C, Ma Y, Li L, Jin P, Yang J. Transcatheter aortic valve replacement in patients with quadricuspid aortic valve in a single center. Front Cardiovasc Med 2022; 9:1011466. [PMID: 36247444 PMCID: PMC9554142 DOI: 10.3389/fcvm.2022.1011466] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/12/2022] [Indexed: 12/02/2022] Open
Abstract
Background Quadricuspid aortic valve (QAV) is a rare congenital malformation that can present with aortic regurgitation or aortic stenosis (AS)), requiring surgical treatment. Transcatheter aortic valve replacement (TAVR) is an alternative treatment for older patients and its prognosis for QAV therapy remains challenging. We sought to examine our early experience with TAVR in patients with QAV. Materials and methods Prospectively collected data were retrospectively reviewed in patients with QAV undergoing TAVR in our institution. Results Five patients with QAV and AR or AS were treated with TAVR between January 2016 and January 2022. The mean age was 73.8 years (range 69–82 years), and the median Society of Thoracic Surgeons score was 7.51% (range 2.668–18.138%). Two patients had type B and three had either type A, D, or F according to the Hurwitz and Roberts classification for QAV. Four patients with pure aortic regurgitation underwent transapical TAVR using the J-Valve system, and the patient with severe AS underwent transfemoral TAVR using the Venus-A system. Procedural success was achieved in all five patients. Trivial paravalvular leak was only detected in one case after the procedure, and one patient received a permanent pacemaker due to high-degree atrioventricular block three days later. The median follow-up period was 18 (12–56) months. After discharge, no deaths occurred during the 1 year follow-up. All patients improved by ≥1 New York Heart Association functional class at 30 days; four patients were in functional class ≤II later in the follow-up period. All patients’ heart failure symptoms improved considerably. Conclusion Our early experience with TAVR in QAV demonstrates these procedures to be feasible with acceptable early results. Further follow-up is necessary to determine the long-term outcomes of this modality. Clinical trial registration [ClinicalTrials.gov], identifier [NCT02917980].
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The Heart in the Transcatheter Intervention Era: Where Are We? J Clin Med 2022; 11:jcm11175173. [PMID: 36079102 PMCID: PMC9456719 DOI: 10.3390/jcm11175173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022] Open
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Aurigemma C, Burzotta F, Vergallo R, Farina P, Romagnoli E, Cangemi S, Bianchini F, Nesta M, Bruno P, D'Amario D, Leone AM, Trani C. Transcatether Aortic Valve Implantation to Treat Degenerated Surgical Bioprosthesis: Focus on the Specific Procedural Challenges. Front Cardiovasc Med 2022; 9:895477. [PMID: 35711347 PMCID: PMC9194080 DOI: 10.3389/fcvm.2022.895477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Actually transcatheter aortic valve implantation within failed surgically bioprosthetic valves (VIV-TAVI) is an established procedure in patients at high risk for repeat surgical aortic valve intervention. Although less invasive than surgical reintervention, VIV-TAVI procedure offers potential challenges, such as higher rates of prosthesis-patient mismatch and coronary obstruction. Thus, optimal procedural planning plays an important role to minimize the risk of procedure complications. In this review, we describe the key points of a VIV-TAVI procedure to optimize outcomes and reduce the risk of procedure complications.
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Affiliation(s)
- Cristina Aurigemma
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rocco Vergallo
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Farina
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Cangemi
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Bianchini
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marialisa Nesta
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piergiorgio Bruno
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico D'Amario
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Maria Leone
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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