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Ordoñez S, Chu MWA, Diamantouros P, Valdis M, Chaumont G, Vila RCB, Teefy P, Bagur R. Next-Day Discharge After Transcatheter Aortic Valve Implantation With the ACURATE neo/neo2 Self-Expanding Aortic Bioprosthesis. Am J Cardiol 2024:S0002-9149(24)00511-3. [PMID: 38996897 DOI: 10.1016/j.amjcard.2024.07.005] [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: 09/18/2023] [Revised: 06/29/2024] [Accepted: 07/08/2024] [Indexed: 07/14/2024]
Abstract
Previous studies have shown the safety of early discharge pathways in selected patients and using selected transcatheter heart valves. Hence, we sought to evaluate the safety of next-day discharge (NDD) in patients who underwent transfemoral transcatheter aortic valve implantation (TF-TAVI) with the ACURATE neo/neo2 (Boston Scientific, Marlborough, Massachusetts) self-expanding aortic bioprosthesis. Patients who underwent TF-TAVI between January 2018 and April 2023 were prospectively included. Patients were stratified into 3 groups according to discharge times within 24 hours (NDD), between 24 and 48 hours, and those discharged >48 hours after TAVI. The primary outcome was the first unplanned readmission at 30 days after TAVI. Log-rank test was used to assess the differences in the outcome of interest between the groups. A total of 368 all-comers were included in this study. According to discharge times, 204 patients followed NDD, 69 patients 24 to 48 hours discharge, and 95 patients >48 hours discharge after TAVI. The mean age was 84 ± 6.3 years and 61% were women, without differences between the groups. The mean Society of Thoracic Surgeons score was lower in those with NDD versus 24 to 48 hours and >48 hours (2.9 ± 1.0, 3.2 ± 1.2, and 3.4 ± 1.4, respectively, p = 0.014). There were no differences between the groups in terms of preprocedural right bundle branch block or pacemaker. The need for new permanent pacemaker implantation was the leading postprocedural complication; it occurred more frequently in the >48 hours group than the 24 to 48 hours, and <24 hours groups (24% vs 8.6% and 2.2%, p <0.001). There were 5 strokes (1.4%) and all of them occurred in the >48 hours group (p = 0.005). At 30 days after discharge, there were no deaths and no differences in all-cause readmissions (9.3% in <24 hours, 8.6% in 24 to 48 hours, and 19% in >48 hours, log-rank p = 0.087). The readmission rates for new permanent pacemaker implantation requirement were 3.3% (n = 6) in NDD, 0% in 24 to 48 hours, and 1.6% (n = 5) in the >48 hours groups (p = 0.27). In conclusion, in unselected patients who underwent TF-TAVI with the ACURATE neo/neo2 self-expanding bioprosthesis, the NDD pathway is feasible and appears to be safe, without an increased risk of death or all-cause rehospitalization through 30 days after hospital discharge.
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Affiliation(s)
- Santiago Ordoñez
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Michael W A Chu
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Pantelis Diamantouros
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Matthew Valdis
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Gloria Chaumont
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
| | | | - Patrick Teefy
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada.
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Koliastasis L, Doundoulakis I, Rychter J, Zembala M, Ninios V, Ninios I, Evangelou S, Katsimagklis G, Mastrokostopoulos A, Moraitis S, Komporozos C, Hamilos M, Skalidis E, Syrseloudis D, Pagkalidou E, Benetos G, Latsios G, Drakopoulou M, Synetos A, Aggeli K, Tousoulis D, Tsioufis K, Toutouzas K. Transcatheter aortic valve implantation with self-expanding valves and the impact of balloon predilatation: The DIRECT II trial. Hellenic J Cardiol 2024; 77:122-124. [PMID: 37778638 DOI: 10.1016/j.hjc.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/23/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023] Open
Affiliation(s)
- Leonidas Koliastasis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece.
| | - Ioannis Doundoulakis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Jan Rychter
- Silesian Center for Heart Diseases, Zabrze, Poland
| | | | - Vlasis Ninios
- Second Department of Cardiology, Interbalkan Medical Center, Thessaloniki, Greece
| | - Ilias Ninios
- Second Department of Cardiology, Interbalkan Medical Center, Thessaloniki, Greece
| | - Sotirios Evangelou
- Second Department of Cardiology, Interbalkan Medical Center, Thessaloniki, Greece
| | | | | | - Sotiris Moraitis
- Department of Cardiology, Naval Hospital of Athens, Athens, Greece
| | | | - Michalis Hamilos
- Department of Cardiology, University Hospital of Heraklion, Crete, Greece
| | - Emmanouil Skalidis
- Department of Cardiology, University Hospital of Heraklion, Crete, Greece
| | - Dimitris Syrseloudis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Eirini Pagkalidou
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Benetos
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Georgios Latsios
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Maria Drakopoulou
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Andreas Synetos
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Konstantina Aggeli
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
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Rao K, Chan B, Baer A, Hansen P, Bhindi R. A Systematic Review of Delayed High-Grade Atrioventricular Block After Transcatheter Aortic Valve Implantation. CJC Open 2024; 6:86-95. [PMID: 38585677 PMCID: PMC10994975 DOI: 10.1016/j.cjco.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/03/2023] [Indexed: 04/09/2024] Open
Abstract
Background High-grade atrioventricular block (HGAVB) is common after transcatheter aortic valve implantation (TAVI), often necessitating permanent pacemaker (PPM) implantation. Delayed HGAVB has varying definitions but typically refers to onset 48 hours after TAVI or following discharge and may cause syncope and sudden cardiac death. This review estimates the incidence of delayed HGAVB and identifies limitations of current literature. Methods A systematic review was performed of the following online databases: Medline, Cochrane, Web of Science, and Scopus. Studies that labelled the outcome of "delayed" or "late" atrioventricular block after TAVI were included; patients with previous PPM or aortic valve surgery were excluded. Initial search yielded 775 studies, which, after screening, was narrowed to 19 studies. Results Nineteen studies with 14,898 patients were included. Mean age was 81.7 years, and 46.3% were male. Mean Society of Thoracic Surgeons (STS) score was 5.6%, and 31.3% of patients had known atrial fibrillation. The most common access site was transfemoral (84.8%), whereas balloon-expandable valves were used in 62.1%, self-expanding valves in 34.0%, and mechanically expanding valves in 3.9% of cases. The incidence of delayed HGAVB ranged from 1.7% to 14.6%, with significant methodologic heterogeneity noted among the included studies. Conclusions Delayed HGAVB is a common and potentially serious complication of TAVI, with similar risk factors to acute HGAVB. With a move toward an early discharge strategy post-TAVI, further prospective study of delayed HGAVB is warranted to improve understanding of predisposing factors, incidence, timing, and implications.
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Affiliation(s)
- Karan Rao
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
- Department of Cardiology, North Shore Private Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Bernard Chan
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Alexandra Baer
- Department of Cardiology, North Shore Private Hospital, Sydney, Australia
| | - Peter Hansen
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
- Department of Cardiology, North Shore Private Hospital, Sydney, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
- Department of Cardiology, North Shore Private Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
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Blusztein D, Raney A, Walsh J, Nazif T, Woods C, Daniels D. Best Practices in Left Ventricular Pacing for Transcatheter Aortic Valve Replacement. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100213. [PMID: 38046859 PMCID: PMC10692352 DOI: 10.1016/j.shj.2023.100213] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 12/05/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is continually evolving, with a recent emphasis on a "minimalist" approach toward reducing procedural invasiveness, duration, and recovery time. Whereas a better understanding of the relationship between TAVR and new conduction disturbances has led to improved periprocedural management, intraprocedural rapid-pacing techniques have not evolved beyond traditional right ventricular temporary pacing. An alternative strategy utilizing the left ventricular guidewire for rapid pacing has been developed with evidence supporting its safety, effectiveness, and potential reductions in procedure time and cost. This review will outline the current best practices in left ventricular pacing for TAVR, a practical technique that embraces the minimalist approach to TAVR and may be considered for routine use. It aims to explore the current evidence and combine this with expert opinion to offer a strategy for temporary pacing that encourages efficiencies for physicians and patients without compromising periprocedural safety.
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Affiliation(s)
- David Blusztein
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Aidan Raney
- Division of Cardiology, St. Joseph Hospital, Orange, California, USA
| | - Joe Walsh
- Division of Cardiology, St. Alphonsus Health System, Boise, Idaho, USA
| | - Tamim Nazif
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher Woods
- Division of Cardiology, California Pacific Medical Center, San Francisco, California, USA
| | - David Daniels
- Division of Cardiology, California Pacific Medical Center, San Francisco, California, USA
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Lemarchand L, Boulmier D, Leurent G, Bedossa M, Sharobeem S, Bakhti A, Le Breton H, Auffret V. Conductive disturbances in the transcatheter aortic valve implantation setting: An appraisal of current knowledge and unmet needs. Arch Cardiovasc Dis 2023; 116:419-425. [PMID: 37328391 DOI: 10.1016/j.acvd.2023.05.004] [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: 02/01/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 06/18/2023]
Abstract
New-onset conduction disturbances, including left bundle branch block and permanent pacemaker implantation, remain a major issue after transcatheter aortic valve implantation. Preprocedural risk assessment in current practice is most often limited to evaluation of the baseline electrocardiogram, whereas it may benefit from a multimodal approach, including ambulatory electrocardiogram monitoring and multidetector computed tomography. Physicians may encounter equivocal situations during the hospital phase, and the management of follow-up is not fully defined, despite the publication of several expert consensuses and the inclusion of recommendations regarding the role of electrophysiology studies and postprocedural monitoring in recent guidelines. This review provides an overview of current knowledge and future perspectives regarding the management of new-onset conduction disturbances in the setting of transcatheter aortic valve implantation, from the preprocedural phase to long-term follow-up.
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Affiliation(s)
- Léo Lemarchand
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Dominique Boulmier
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Guillaume Leurent
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Marc Bedossa
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Sam Sharobeem
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Abdelkader Bakhti
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Hervé Le Breton
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Vincent Auffret
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France.
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Koliastasis L, Doundoulakis I, Kokkinidis DG, Milkas A, Kostopoulos G, Drakopoulou M, Latsios G, Synetos A, Benetos G, Lampropoulos K, Economou F, Tsioufis K, Toutouzas K. Study Level Meta-Analysis of Transcatheter Aortic Valve Implantation With the ACURATE neo Self-Expanding Transcatheter Heart Valve. Cardiol Rev 2023; 31:108-114. [PMID: 35358104 DOI: 10.1097/crd.0000000000000453] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The ACURATE neo transcatheter aortic valve is a self-expanding device. Several studies have investigated safety and efficacy, but meta-analysis and pooled data are lacking. We aimed to provide a comprehensive systematic review and meta-analysis on the clinical outcomes of transcatheter aortic valve implantation with the ACURATE neo valve. A systematic literature search for eligible records was conducted. The primary endpoint was device success as designated by Valve Academic Research Consortium-2 criteria. The secondary endpoints (time frame: 30 days) were all-cause mortality, stroke, myocardial infarction, need for new permanent pacemaker, major vascular complications, major bleeding, acute kidney injury stage II or III, and paravalvular regurgitation grade moderate or severe (II or III). Our search yielded a total of 355 records, 20 of those (n = 5858 ACURATE neo receivers) were included in our meta-analysis. Device success was achieved in 94.5% (95% confidence interval [CI], 91.4-96.5%) of the patients. The 30-day all-cause mortality incidence proportion was 1.8% (95% CI, 1.3-2.4%). New pacemaker implantation was required in 7.7% (95% CI, 6.4-9.2%) of the patients, stroke occurred in 1.9% (95% CI, 1.6-2.3%), myocardial infarction in 0.5% (95% CI, 0.3-0.7%), major bleeding in 5.0% (95% CI, 3.9-6.5%), major vascular complication in 5.6% (95% CI, 4.0-7.8%), acute kidney injury stage ≥2 in 2.5% (95% CI, 1.8-3.4%), and paravalvular leak grade ≥moderate was observed in 4.3% (95% CI, 3.0-6.2%). Balloon predilatation and postdilatation incidence was 93.9% (95% CI, 87.0-97.3%) and 43.2% (95% CI, 37.9-48.6%), respectively. ACURATE neo appears to be safe and effective in our analysis with high device success incidence, low mortality, and low new pacemaker implantations.
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Affiliation(s)
- Leonidas Koliastasis
- From the First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
- Athens Naval and Veterans Hospital, Athens, Greece
| | - Ioannis Doundoulakis
- From the First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
- Department of Cardiology, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT
| | | | - Georgios Kostopoulos
- Department of Endocrinology, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Maria Drakopoulou
- From the First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Georgios Latsios
- From the First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Andreas Synetos
- From the First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Georgios Benetos
- From the First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | | | - Fotios Economou
- Department of Cardiology, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Konstantinos Tsioufis
- From the First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- From the First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
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Pellegrini C, Garot P, Morice MC, Tamburino C, Bleiziffer S, Thiele H, Scholtz S, Schramm R, Cockburn J, Cunnington M, Wolf A, Barbanti M, Tchétché D, Pagnotta P, Gilard M, Bedogni F, Van Belle E, Vasa-Nicotera M, Chieffo A, Bogaerts K, Hengstenberg C, Capodanno D, Joner M. Permanent pacemaker implantation and left bundle branch block with self-expanding valves - a SCOPE 2 subanalysis. EUROINTERVENTION 2023; 18:e1077-e1087. [PMID: 36128956 PMCID: PMC9909458 DOI: 10.4244/eij-d-22-00558] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/01/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND No detailed data on left bundle branch block (LBBB) and permanent pacemaker implantation (PPI) exist from randomised clinical trials comparing the ACURATE neo and CoreValve Evolut devices. AIMS Our aim was to assess the incidence and impact of new LBBB and PPI with self-expanding prostheses from a powered randomised comparison. METHODS From the SCOPE 2 trial, 648 patients with no previous pacemaker were analysed for PPI at 30 days, and 426 patients without previous LBBB were adopted for analysis of LBBB at 30 days. Results: At 30 days, 16.5% of patients required PPI; rates were higher in CoreValve Evolut compared to ACURATE neo recipients (21.0% vs 12.3%; p=0.004). Previous right bundle branch block (odds ratio [OR] 6.11, 95% confidence interval [CI]: 3.19-11.73; p<0.001) was associated with an increased risk of PPI at 30 days, whereas the use of the ACURATE neo (OR 0.50, 95% CI: 0.31-0.81; p=0.005) was associated with a decreased risk. One-year mortality was similar in patients with and without new PPI. A total of 9.4% of patients developed persistent LBBB at 30 days, with higher incidences in CoreValve Evolut recipients (13.4% vs 5.5%; p=0.007). New LBBB at 30 days was associated with lower ejection fraction at 1 year (65.7%±11.0 vs 69.1%±7.6; p=0.041). CONCLUSIONS New LBBB and PPI rates were lower in ACURATE neo compared to CoreValve Evolut recipients. The ACURATE neo valve was associated with a lower risk of PPI at 30 days. No effect on 1-year mortality was determined for PPI at 30 days, while LBBB at 30 days was associated with reduced ejection fraction at 1 year.
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Affiliation(s)
- Costanza Pellegrini
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Philippe Garot
- Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Ramsay-Santé, Massy, France
| | - Marie-Claude Morice
- Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Ramsay-Santé, Massy, France
| | - Corrado Tamburino
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - S. Marco" - University of Catania, Catania, Italy
| | - Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, University Hospital, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Smita Scholtz
- Department of Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Rene Schramm
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, University Hospital, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - James Cockburn
- Department of Cardiology, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - Michael Cunnington
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alexander Wolf
- Department of Interventional Cardiology, Elisabeth Hospital Essen, Essen, Germany
| | - Marco Barbanti
- Department of Cardio-Thoracic-Vascular diseases and transplantation, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Didier Tchétché
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Paolo Pagnotta
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Milano, Italy
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, Brest, France
| | | | - Eric Van Belle
- Department of Cardiology, University Hospital, Lille, France
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Kris Bogaerts
- KU Leuven, Faculty of Medicine, I-BioStat, Leuven, Belgium and UHasselt, I-BioStat, Hasselt, Belgium
| | | | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - S. Marco" - University of Catania, Catania, Italy
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
- Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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8
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Pellegrini C, Rheude T, Renker M, Wolf A, Wambach JM, Alvarez-Covarrubias HA, Dörr O, Singh P, Charitos E, Xhepa E, Joner M, Kim WK. ACURATE neo2 versus SAPIEN 3 Ultra for transcatheter aortic valve implantation. EUROINTERVENTION 2023; 18:987-995. [PMID: 36250307 PMCID: PMC9853033 DOI: 10.4244/eij-d-22-00164] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/14/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND No comparative data exist with the latest generation self-expanding ACURATE neo2 (Neo2) and the balloon-expandable SAPIEN 3 Ultra (Ultra) transcatheter heart valves (THV). AIMS We aimed to compare the outcomes after transcatheter aortic valve implantation (TAVI) using the Neo2 and the Ultra THV. METHODS A total of 1,356 patients at 4 centres were treated either with the Neo2 (n=608) or the Ultra (n=748). The primary endpoint was device success according to the latest Valve Academic Research Consortium definitions. The association of the THV used and the primary endpoint was assessed using inverse probability treatment weighting (IPTW) and 1:1 propensity score matching (PSM), which identified 472 matched pairs. Results: After PSM, there were no relevant differences between the groups. While rates of moderate to severe paravalvular leakage (PVL) were overall low (0.6% vs 1.1%; p=0.725), elevated transvalvular gradients (≥20 mmHg) were less frequent with the Neo2 (2.4% vs 7.7%; p<0.001), which translated into a significantly higher rate of device success with the Neo2 compared with the Ultra (91.9% vs 85.0%; p<0.001). Consistently, the Neo2 was associated with higher rates of device success in the IPTW analysis (odds ratio [OR] 1.961, 95% confidence interval [CI]: 1.269-3.031; p=0.002). Rates of mild PVL were significantly lower with the Ultra compared with the Neo2 (20.0% vs 32.8%; p<0.001). Clinical events at 30 days were comparable between the 2 groups. CONCLUSIONS Short-term outcomes after TAVI using the Neo2 or Ultra THV were excellent and, overall, comparable. However, transvalvular gradients were lower with the Neo2, which translated into higher rates of device success. Rates of mild PVL were significantly lower with the Ultra THV.
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Affiliation(s)
- Costanza Pellegrini
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Alexander Wolf
- Department of Cardiology, Elisabeth Hospital Essen, Essen, Germany
| | | | - Hector A Alvarez-Covarrubias
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
- Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, Cd. de México, México
| | - Oliver Dörr
- Department of Cardiology and Angiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
| | - Parminder Singh
- Department of Cardiology and Angiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
| | - Efstratios Charitos
- Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
- Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
- Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
- Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
- DZHK e.V. (German Centre for Cardiovascular Research), Partner Site Rhine-Main, Frankfurt, Germany
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9
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Ivanov B, Eghbalzadeh K, Djordjevic I, Zeriouh M, Gerfer S, Gaisendrees C, Sabashnikov A, Rustenbach C, Rahmanian P, Kuhn-Regnier F, Mader N, Adam M, Baldus S, Wahlers T, Kuhn E. Clinical results and 30-day outcomes of self-expanding transcatheter aortic valves: comparative case-matched analysis of CoreValve ® versus ACURATE neo™. Perfusion 2023; 38:115-123. [PMID: 34472999 DOI: 10.1177/02676591211042562] [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: 01/24/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is associated with excellent results in patients with severe aortic stenosis. In highly calcified aortic anuli with increased risk of annulus rupture and in favor of the supra-annular design, self-expandable prostheses are frequently used. In this regard, we aimed to perform a comparative analysis of clinical and 30-day outcomes after TAVR using the self-expanding CoreValve® Evolut R or ACURATE neo™ prosthesis. METHODS Out of 343 consecutive patients treated with either CoreValve® Evolut R or ACURATE neo™ from January 2014 to December 2017, 76 patients were assigned each per group after 1:1 propensity score matching in regard of preoperative characteristics. Pre- and periprocedural outcomes were retrospectively collected and assessed. Outcomes at 30 days are reported according to the established Valve Academic Research Consortium (VARC-2) criteria. RESULTS Device success and 30-day survival accounted for 93.4% (n = 71), respectively 97.4% (n = 74) in both groups (p = 1.00). No statistically significant differences regarding clinical parameters were observed. The combined safety endpoint at 30 days was comparable (84.2% (n = 64) CoreValve® vs 85.5% (n = 65) ACURATE neo™; p = 0.848). Except a trend toward higher stroke (p = 0.08) and pacemaker (p = 0.07) rate in the CoreValve® group, major vascular complications, incidence of life-threatening or disabling bleeding, and incidence of postoperative acute kidney injury were comparable. Postoperative hemodynamic parameters showed no significant differences between the implanted valves. CONCLUSION Both self-expandable prostheses showed good postoperative hemodynamic performance with a low incidence of severe paravalvular leakage, all- cause mortality, and comparable clinical outcomes.
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Affiliation(s)
- Borko Ivanov
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Mohamed Zeriouh
- Department of Cardiac Surgery, Campus Kerckhoff, University of Giessen, Bad Nauheim, Germany
| | - Stephen Gerfer
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Christopher Gaisendrees
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Christian Rustenbach
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Parwis Rahmanian
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Ferdinand Kuhn-Regnier
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
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10
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Toggweiler S, Brinkert M, Wolfrum M, Moccetti F, Stämpfli SF, De Boeck BWL, Magarzo G, Gassenmaier T, Attinger-Toller A, Bossard M, Fornaro J, Buhmann R, Cuculi F, Kobza R. Paravalvular Leak After Implantation of the ACURATE neo and the ACURATE neo2 Transcatheter Heart Valve. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 45:37-43. [PMID: 35902306 DOI: 10.1016/j.carrev.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/21/2022] [Indexed: 01/04/2023]
Affiliation(s)
| | - Miriam Brinkert
- Department of Cardiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Mathias Wolfrum
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Simon F Stämpfli
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Bart W L De Boeck
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Getulio Magarzo
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | | | - Matthias Bossard
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jürgen Fornaro
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Ralf Buhmann
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Florim Cuculi
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Richard Kobza
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
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11
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Ooms JF, Cornelis K, Stella PR, Rensing BJ, Van Der Heyden J, Chan AW, Wykrzykowska JJ, Rosseel L, Vandeloo B, Lenzen MJ, Cunnington MS, Hildick-Smith D, Wijeysundera HC, Van Mieghem NM. Rationale and design of the Project to look for early discharge in patients undergoing TAVR with ACURATE (POLESTAR Trial). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 44:71-77. [PMID: 35739011 DOI: 10.1016/j.carrev.2022.06.009] [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: 02/04/2022] [Revised: 05/11/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is now an established treatment strategy for elderly patients with symptomatic aortic stenosis (AS) across the entire operative risk spectrum. Streamlined TAVR protocols along with reduced procedure time and expedited ambulation promote early hospital discharge. Selection of patients suitable for safe early discharge after TAVR might improve healthcare efficiency. STUDY DESIGN The POLESTAR trial is an international, multi-center, prospective, observational study which aims to evaluate the safety of early discharge in selected patients who undergo TAVR with the supra-annular functioning self-expanding ACURATE Neo transcatheter heart valve (THV). A total of 250 patients will be included based on a set of baseline criteria indicating potential early discharge (within 48 h post-TAVR). Primary study endpoints include Valve Academic Research Consortium (VARC)-3 defined safety at 30 days and VARC-3 defined efficacy at 30 days and 1 year. Endpoints will be compared between early discharge and non-early discharge cohorts with a distinct landmark analysis at 48 h post-TAVR. Secondary endpoints include quality of life assessed using EQ5D-5L and Kansas City Cardiomyopathy Questionnaire (KCCQ) questionnaires and resource costs compared between discharge groups. SUMMARY The POLESTAR trial prospectively evaluates safety and feasibility of an early discharge protocol for TAVR using the ACURATE Neo THV.
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Affiliation(s)
- Joris F Ooms
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | | | | | - Albert W Chan
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | | | | | | | - Mattie J Lenzen
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - David Hildick-Smith
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
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12
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Reza S, Bianchi M, Kovarovic B, Anam S, Slepian MJ, Hamdan A, Haj-Ali R, Bluestein D. A computational framework for post-TAVR cardiac conduction abnormality (CCA) risk assessment in patient-specific anatomy. Artif Organs 2022; 46:1305-1317. [PMID: 35083748 DOI: 10.1111/aor.14189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/14/2021] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cardiac conduction abnormality (CCA)- one of the major persistent complications associated with transcatheter aortic valve replacement (TAVR) may lead to permanent pacemaker implantation. Localized stresses exerted by the device frame on the membranous septum (MS) which lies between the aortic annulus and the bundle of His, may disturb the cardiac conduction and cause the resultant CCA. We hypothesize that the area-weighted average maximum principal logarithmic strain (AMPLS) in the MS region can predict the risk of CCA following TAVR. METHODS Rigorous finite element-based modeling analysis was conducted in two patients (Balloon expandable TAVR recipients) to assess post-TAVR CCA risk. Following the procedure one of the patients required permanent pacemaker (PPM) implantation while the other did not (control case). Patient-specific aortic root was modeled, MS was identified from the CT image, and the TAVR deployment was simulated. Mechanical factors in the MS region such as logarithmic strain, contact force, contact pressure, contact pressure index (CPI) and their time history during the TAVR deployment; and anatomical factors such as MS length, implantation depth, were analyzed. RESULTS Maximum AMPLS (0.47 and 0.37, respectively), contact force (0.92 N and 0.72 N, respectively), and CPI (3.99 and 2.86, respectively) in the MS region were significantly elevated in the PPM patient as compared to control patient. CONCLUSION Elevated stresses generated by TAVR devices during deployment appear to correlate with CCA risk, with AMPLS in the MS region emerging as a strong predictor that could be used for preprocedural planning in order to minimize CCA risk.
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Affiliation(s)
- Symon Reza
- Department of Biomedical Engineering, Stony Brook University, NY, USA
| | - Matteo Bianchi
- Department of Biomedical Engineering, Stony Brook University, NY, USA
| | - Brandon Kovarovic
- Department of Biomedical Engineering, Stony Brook University, NY, USA
| | - Salwa Anam
- Department of Biomedical Engineering, Stony Brook University, NY, USA
| | - Marvin J Slepian
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Rami Haj-Ali
- The Fleischman Faculty of Engineering, School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, NY, USA
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13
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Santangelo G, Ielasi A, Pellicano M, Latib A, Tespili M, Donatelli F. An Update on New Generation Transcatheter Aortic Valves and Delivery Systems. J Clin Med 2022; 11:jcm11030499. [PMID: 35159952 PMCID: PMC8837046 DOI: 10.3390/jcm11030499] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/30/2021] [Accepted: 01/15/2022] [Indexed: 12/15/2022] Open
Abstract
Over the last 15 years, the management of aortic valve disease has been changed by transcatheter aortic valve replacement, which has become the standard of care across the entire spectrum of surgical risk. As a result of continuous evolution of this technique, several next-generation transcatheter heart valves (THVs) have been developed to minimize procedural complications and improve patient outcomes. This review aims to provide an update on the new generation THVs and delivery systems.
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Affiliation(s)
- Gloria Santangelo
- San Paolo Hospital, Division of Cardiology, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy;
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, Via Faravelli 16, 20149 Milan, Italy; (M.P.); (M.T.)
- Correspondence:
| | - Mariano Pellicano
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, Via Faravelli 16, 20149 Milan, Italy; (M.P.); (M.T.)
| | - Azeem Latib
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 210th Street, Bronx, NY 10467, USA;
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, Via Faravelli 16, 20149 Milan, Italy; (M.P.); (M.T.)
| | - Francesco Donatelli
- Department of Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, University of Milan, Via Faravelli 16, 20149 Milan, Italy;
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14
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Werner N, Renker M, Dörr O, Bauer T, Nef H, Choi YH, Hamm CW, Zahn R, Kim WK. Anatomical suitability and off-label use of contemporary transcatheter heart valves. Int J Cardiol 2021; 350:96-103. [PMID: 34979147 DOI: 10.1016/j.ijcard.2021.12.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite excellent procedural results in a broad clinical population, certain anatomical or clinical conditions are still challenging for transcatheter aortic valve replacement (TAVI). Whether the adherence to the instructions for use (IFU) or the use of a clinically suitable device is a prerequisite for procedural success has not been well characterized. AIMS The anatomical and clinical suitability of new-generation transcatheter heart valves (THV) was evaluated in an all-comers population (n = 540) at a high-volume center. METHODS Conformity with anatomical IFU criteria was evaluated in each implanted THV. In addition, the suitability of the implanted THV was verified in each case according to clinical and anatomical criteria, which had been previously defined according to the results of an international survey including 20 renowned TAVI operators. Furthermore, criteria of clinical suitability and adherence to IFU of each THV were applied to the overall cohort to analyze the proportion of patients in whom the use of the respective THV would have been judged to be unsuitable or off-label. RESULTS An off-label use of THV based on anatomical considerations was found in 20% of all procedures, whereas the implantation of a THV deemed to be clinically unsuitable was noted in 16.3% of all procedures. Clinical suitability and conformity with IFU were present to a varying extent across the THV systems. Neither clinical suitability, nor conformity with IFU were associated with device failure or periprocedural mortality. On multivariable analysis, aortic tortuosity, mean transaortic gradient and ascending aorta diameter were identified as independent predictors of device failure (VARC-3). CONCLUSIONS Off-label TAVI and the use of clinically unsuitable THVs were common, but did not affect procedural outcomes. The variety of clinical and anatomical coverage of the different THV systems emphasizes the importance of an individualized THV selection.
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Affiliation(s)
- Nicolas Werner
- Sana Klinikum Offenbach, Department of Cardiology, Offenbach, Germany
| | - Matthias Renker
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Oliver Dörr
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Justus-Liebig University of Giessen and Marburg, Department of Cardiology, Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Timm Bauer
- Sana Klinikum Offenbach, Department of Cardiology, Offenbach, Germany; Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Holger Nef
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Justus-Liebig University of Giessen and Marburg, Department of Cardiology, Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Yeong-Hoon Choi
- Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Christian W Hamm
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Justus-Liebig University of Giessen and Marburg, Department of Cardiology, Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Ralf Zahn
- Herzzentrum Ludwigshafen, Department of Cardiology, Ludwigshafen, Germany
| | - Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; Justus-Liebig University of Giessen and Marburg, Department of Cardiology, Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany.
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15
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Guelker JE, Kim WK, Blumenstein J, Möllmann H, Husser O. ACURATE neo™ Aortic Valve System for the treatment of aortic stenosis. Future Cardiol 2021; 17:713-722. [PMID: 33733824 DOI: 10.2217/fca-2019-0035] [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: 11/21/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of patients with severe aortic stenosis and is now standard of care for high surgical risk patients and a valid alternative strategy in intermediate risk patients. Recently, TAVR has shown excellent results in low-risk patients, indicating an imminent extension toward this population. Improvements in procedural outcomes are the result of increasing operator experience, sophisticated imaging for procedural planning but also due to the continuous evolution of transcatheter heart valves developed to minimize procedural complications. 'Next-generation' valves are currently available, among them the self-expanding ACURATE neo. Here, the technical details and clinical outcomes of the ACURATE neo are reviewed, comparative data with other 'next-generation' valves and potential advantages and disadvantages are discussed.
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Affiliation(s)
- Jan-Erik Guelker
- Department of Cardiology, Klinik für Innere Medizin I, St.-Johannes-Hospital, Dortmund, Germany.,University Witten/Herdecke, Faculty of Health, Witten, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Centre, Bad Nauheim, Germany
| | - Johannes Blumenstein
- Department of Cardiology, Klinik für Innere Medizin I, St.-Johannes-Hospital, Dortmund, Germany
| | - Helge Möllmann
- Department of Cardiology, Klinik für Innere Medizin I, St.-Johannes-Hospital, Dortmund, Germany
| | - Oliver Husser
- Department of Cardiology, Klinik für Innere Medizin I, St.-Johannes-Hospital, Dortmund, Germany
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16
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Kim WK, Möllmann H, Walther T, Hamm CW. Predictors of permanent pacemaker implantation after ACURATE neo transcatheter heart valve implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:410-415. [PMID: 33373045 DOI: 10.1111/pace.14155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/16/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rates of permanent pacemaker implantation (PPI) have been low using the self-expanding ACURATE neo device, but data regarding risk factors of PPI for this specific device are scarce. METHODS The study cohort consisted of patients (n = 1000) with severe aortic stenosis undergoing transfemoral transcatheter aortic valve implantation (TAVI) using the ACURATE neo prosthesis in our center between May 2012 and December 2019. For the present analysis, we excluded patients with previous permanent pacemaker (n = 110), high-grade AV block prior to TAVI (n = 3), and patients requiring conversion to surgical valve replacement (n = 4) or the implantation of a second prosthesis as valve-in-valve (n = 15). Preexisting conduction abnormalities were determined, and the implantation depth of the prosthesis was measured on final angiography. Differences across quartiles based on the original consecutive cohort were analyzed with respect to implantation depth and PPI rate. Predictors of PPI were identified using logistic regression. RESULTS The PPI rate was 10%. Preexisting AV block I°, right bundle branch block (RBBB), and the implantation depth were independent predictors of PPI. Across quartiles, the implantation depth differed significantly with lowest values in the last quartile, whereas differences of PPI rates across quartiles were not statistically significant, but showed a notable decrease in the last quartile. CONCLUSION Preexisting RBBB, AV block I°, and low implantation depth were independent predictors of PPI following TAVI using the ACURATE neo device. Instead of deliberately aiming at a high position, avoidance of a low implantation depth may represent a reasonable compromise to reduce the rate of PPI without increasing the risk of malpositioning.
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Affiliation(s)
- Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center - Campus of University of Giessen, Bad Nauheim, Germany.,Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Johann-Wolfgang-Goethe University, Frankfurt, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart Center - Campus of University of Giessen, Bad Nauheim, Germany.,Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany
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17
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Wilkins B, Søndergaard L, De Backer O. Tailoring the valve choice to the patient: contemporary choices and their optimal applications. Ann Cardiothorac Surg 2020; 9:522-524. [PMID: 33312915 DOI: 10.21037/acs-2020-av-14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ben Wilkins
- The Heart Center, Rigshospitalet Copenhagen University, Copenhagen, Denmark
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet Copenhagen University, Copenhagen, Denmark
| | - Ole De Backer
- The Heart Center, Rigshospitalet Copenhagen University, Copenhagen, Denmark
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18
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Brinkert M, De Boeck B, Stämpfli SF, Wolfrum M, Moccetti F, Attinger-Toller A, Bossard M, Cuculi F, Kobza R, Toggweiler S. Predictors of paravalvular leak following implantation of the ACURATE neo transcatheter heart valve: the PREDICT PVL study. Open Heart 2020; 7:openhrt-2020-001391. [PMID: 33243930 PMCID: PMC7692991 DOI: 10.1136/openhrt-2020-001391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/05/2020] [Accepted: 10/19/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives Report predictors and the natural course of paravalvular leak (PVL) following implantation of the ACURATE neo transcatheter heart valve (THV). Background Understanding the mechanisms of PVL may help to improve patient selection, patient outcomes and the design of next-generation THVs. Methods A total of 30 patients (mean age 81±5 years, 47% women) undergoing transcatheter aortic valve replacement with the ACURATE neo were enrolled in the PREDICT PVL study. The effective regurgitant orifice area (EROA, in mm2) of PVL was assessed by transthoracic and transoesophageal echocardiography before discharge and at 6 months follow-up. Results PVL was none/trace in 10 (33%), mild in 18 (60%) and moderate in 2 (7%) patients and occurred in distinct locations with largest EROAs in the area of the left coronary cusp and its adjacent commissures. Independent predictors for EROA were implantation depth (r coefficient −1.9 mm2 per mm implantation depth, p=0.01), leaflet calcification (6.2 mm2 per calcification grade, p=0.03) and THV size L (7.6 mm2 more than size S or M, p=0.01). At 6 months follow-up, EROA decreased by 29% from 13.7±9.7 mm2 to 9.5±7.9 mm2 (p<0.01). Patients with smaller EROAs were more likely to be in New York Heart Association class 1 than patients with larger EROAs (p<0.01). Conclusions PVL occurred predominantly in the region of the left coronary cusp and decreased by 29% during 6 months of follow-up. Our results underscore the importance of adequate patient selection and optimal implantation depth.
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Affiliation(s)
- Miriam Brinkert
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Bart De Boeck
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Simon F Stämpfli
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Mathias Wolfrum
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Federico Moccetti
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Richard Kobza
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stefan Toggweiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
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19
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Chen S, Chau KH, Nazif TM. The incidence and impact of cardiac conduction disturbances after transcatheter aortic valve replacement. Ann Cardiothorac Surg 2020; 9:452-467. [PMID: 33312903 PMCID: PMC7724062 DOI: 10.21037/acs-2020-av-23] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/21/2020] [Indexed: 12/29/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has developed into an established therapy for patients with severe aortic stenosis (AS) across the spectrum of surgical risk. Despite improvements in transcatheter heart valve (THV) technologies and procedural techniques, cardiac conduction disturbances, including high degree atrioventricular block (AVB) requiring permanent pacemaker (PPM) implantation and new-onset left bundle branch block (LBBB), remain frequent complications. TAVR-related conduction disturbances occur due to injury to the conduction system from interactions with interventional equipment and the transcatheter valve stent frame. Risk factors for post-TAVR conduction disturbances have been identified and include clinical characteristics, baseline electrocardiogram findings (right bundle branch block), anatomic factors, and potentially modifiable procedural factors (type of transcatheter valve, depth of implantation, over-sizing). New-onset LBBB and PPM implantation after TAVR have been shown to be associated with adverse long-term clinical outcomes, including mortality and heart failure hospitalization. These clinical consequences are likely to be of increasing importance as TAVR is utilized in younger and lower risk population. This review provides an updated overview of the literature regarding the incidence, predictors, and clinical outcomes of TAVR-related conduction disturbances, as well as proposed strategies for the management of this frequent clinical challenge.
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Affiliation(s)
- Shmuel Chen
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Katherine H Chau
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Tamim M Nazif
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
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20
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Alperi A, Muntané-Carol G, Freitas-Ferraz AB, Junquera L, Del Val D, Faroux L, Philippon F, Rodés-Cabau J. Overcoming the transcatheter aortic valve replacement Achilles heel: conduction abnormalities-a systematic review. Ann Cardiothorac Surg 2020; 9:429-441. [PMID: 33312901 DOI: 10.21037/acs-2020-av-40] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Transcatheter aortic valve replacement (TAVR) has been shown to be a good alternative to surgery for treating severe symptomatic aortic stenosis (AS) across the whole range of surgical risk patients. Whereas most periprocedural TAVR complications have significantly decreased over time, conduction disturbances remain high. Approaches to decrease this shortcoming are under continuous investigation. Methods We conducted a systematic review focusing on modifiable factors impacting post-TAVR conduction disturbances, such as balloon aortic valvuloplasty (BAV), type of new-generation transcatheter valve and implantation depth (ID). Search strategies were based on the best available evidence from each study. Primary endpoints were post-TAVR need of permanent pacemaker implantation (PPI) and new onset left bundle branch block (NOLBBB). Results Data from 35 studies with a total of 29,982 patients were analyzed. BAV did not negatively impact PPI rates after TAVR. In propensity-matched and randomized trials, the Evolut R valve was associated with higher rates of PPI compared to the Sapien 3 valve (25% vs. 19.2% in propensity-matched studies; 22.9% vs. 19% in a randomized trial). The Acurate Neo valve was associated with the lowest PPI rate in observational studies (10.4%), but a PPI rate similar to Sapien 3 was reported in a randomized trial (10% vs. 9%). The Portico valve system was associated with a higher PPI risk (PPI rate of 21.9% and 27.7% in propensity-matched and randomized studies, respectively). ID and its relation with the membranous septum (MS) length predicted post-TAVR conduction disturbances, particularly with Evolut R and Sapien 3 valves. Conclusions Pre-TAVR BAV did not increase the risk of conduction disturbances post-TAVR. Among the new-generation transcatheter valve systems, Sapien 3 and Acurate Neo valves were associated with the lowest PPI rates followed by the Evolut and Portico valves. A deeper valve implantation and a shorter MS length determined an increased risk of conduction disturbances post-TAVR.
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Affiliation(s)
- Alberto Alperi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Lucia Junquera
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - David Del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Laurent Faroux
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Philippon
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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21
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Pellegrini C, Rheude T, Michel J, Alvarez-Covarrubias HA, Wünsch S, Mayr NP, Xhepa E, Kastrati A, Schunkert H, Joner M, Kasel M. Comparison of latest generation supra-annular and intra-annular self-expanding transcatheter heart valves. J Thorac Dis 2020; 12:6769-6779. [PMID: 33282378 PMCID: PMC7711404 DOI: 10.21037/jtd-20-1700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study compares two latest-generation self-expanding transcatheter heart valves (THV), the supra-annular ACURATE neo (Boston Scientific) and the intra-annular Centera THV (Edwards Lifesciences). Methods In this single center observational cohort trial 317 patients treated with the ACURATE neo and 78 patients treated with the Centera TVH were included. The main endpoints were device success and the early safety endpoint at 30 days. Results Besides higher incidence of diabetes mellitus and higher body mass index in patients treated with the ACURATE neo THV, there were no baseline differences between the groups. Device success was similar in both groups (neo: 91.8% vs. Centera: 93.6%; P=0.598), with numerically higher rates of moderate to severe paravalvular leakage in the ACURATE neo group (4.7% vs. 1.3%; P=0.214). At 30 days all-cause mortality rates were low in both groups (0.3% vs. 0%; P=0.620) and no difference occurred in the early safety at 30 days (19.3% vs. 16.7%; P=0.599). However, all-cause stroke rates were significantly higher in patients treated with the Centera THV (6.4 vs. 1.6%; P=0.015). Conclusions The ACURATE neo and the Centera THV show low mortality rates as well as comparable, favorable hemodynamics. The finding of higher stroke rates at 30 days with the repositionable Centera SE-THV needs further assessment.
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Affiliation(s)
- Costanza Pellegrini
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Tobias Rheude
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Jonathan Michel
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Hector A Alvarez-Covarrubias
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Sarah Wünsch
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - N Patrick Mayr
- Institut für Anästhesiologie, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Erion Xhepa
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Adnan Kastrati
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz-und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz-und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Joner
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz-und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Markus Kasel
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
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22
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Effectiveness and Safety of the ACURATE Neo Prosthesis in 1,000 Patients With Aortic Stenosis. Am J Cardiol 2020; 131:12-16. [PMID: 32622500 DOI: 10.1016/j.amjcard.2020.05.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 01/01/2023]
Abstract
The ACURATE neo transcatheter heart valve has demonstrated a balanced profile with low rates of permanent pacemaker implantation, low risk of coronary obstruction, and favorable hemodynamic properties whilst having an acceptable rate of ≥moderate paravalvular leakage (PVL). Here, we report in-hospital results and assess the learning curve for implantation of the ACURATE neo device in a large, single-center cohort. The cohort of this retrospective, observational study comprised 1,000 consecutive patients with severe aortic stenosis who underwent transfemoral transcatheter aortic valve implantation using the ACURATE neo prosthesis between May 2012 and December 2019. We determined procedural outcomes with emphasis on PVL and analyzed the learning curve. The median age was 81.9 years [IQR 78.8; 85.1], and the Euroscore II was 4.2% [IQR 2.7; 7.3]. The rate of PVL ≥moderate measured by echocardiography at discharge was 3.7% (37 of 988). We observed a learning curve, with a decline in ≥moderate PVL from 6.7% in the first quartile to 0.8% in the last quartile, that was related to better patient selection, more oversizing, and consideration of the amount and distribution of aortic valve calcification. In this thus far largest single-center experience using the ACURATE neo prosthesis, we demonstrate that after completing a learning curve and observation of precepts that include patient selection, careful sizing, and procedural aspects, the rate of ≥moderate PVL may be reduced to <1%.
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23
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Kooistra NH, Intan-Goey VMP, Ziviello F, Leenders GE, Kraaijeveld AO, Doevendans PA, Van Mieghem NM, Voskuil M, Stella PR. Comparison of the Sapien 3 versus the ACURATE neo valve system: A propensity score analysis. Catheter Cardiovasc Interv 2020; 97:E597-E606. [PMID: 32886869 PMCID: PMC7984444 DOI: 10.1002/ccd.29240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 07/31/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022]
Abstract
Objectives To compare the outcomes of transfemoral ACURATE neo (NEO) and Sapien 3 (S3) patients in terms of device success and clinical safety outcomes using a propensity score analysis. Background Differences in clinical outcomes between the latest‐generation balloon‐expandable S3 and self‐expanding NEO in a “real‐world transfemoral TAVI population” are still unclear. Methods We compared up to 6 months clinical outcomes using a propensity score analysis (inverse probability of treatment weighting [IPTW]) to account for differences in baseline characteristics. Results A total of 345 patients underwent transfemoral transcatheter aortic valve implantation (TAVI) with either NEO or S3 at two centers in the Netherlands. Composite device success and early safety endpoints were comparable between NEO and S3 (Device success: IPTW‐adjusted OR: 0.35 [95% CI: 0.12–1.18], and early safety: IPTW‐adjusted OR: 0.51 [95% CI: 0.19–1.38]). Six‐months mortality was 5.3 versus 3.6%, stroke was 2.8 versus 3.3%, and pacemaker rate was 6.1 versus 8.6%, respectively with p = NS. Mean aortic gradient was lower in the NEO group (5.72 ± 2.47 vs. 9.05 ± 3.48; p = <.001), with a comparable rate of moderate or severe paravalvular leak (0 versus 2.1%; p = NS). Conclusions Device success and clinical safety outcomes were comparable for both valves. Up to 6‐months follow‐up clinical outcomes and mortality rate remained excellent. Mean aortic gradient was lower after ACURATE neo implantation.
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Affiliation(s)
- Nynke H Kooistra
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Valent M P Intan-Goey
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Francesca Ziviello
- Department of Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Geert E Leenders
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Adriaan O Kraaijeveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Central Military Hospital, Utrecht, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pieter R Stella
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
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24
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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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25
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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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26
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Abstract
Purpose of Review Critical appraisal of the available evidence on the self-expanding ACURATE neo transcatheter heart valve (THV) for the treatment of aortic valve disease. Recent Findings In an investigator-initiated, multicenter, randomized non-inferiority trial with broad inclusion criteria, ACURATE neo failed to meet non-inferiority compared with SAPIEN 3 with regard to a primary composite safety and efficacy endpoint at 30 days. The difference was driven by higher rates of moderate or severe paravalvular regurgitation and higher rates of acute kidney injury. In turn, registry data suggest that the safety and efficacy profile of the ACURATE neo is comparable to that of other commercially available devices. Randomized evidence indicated favorable hemodynamic results with large effective orifice areas and low residual gradients. Summary The self-expanding ACURATE neo THV is associated with higher rates of residual aortic regurgitation compared to the balloon-expandable SAPIEN 3 THV. The supra-annular design with low residual gradients may be advantageous in patients with small anatomy and mild degree of calcification.
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Affiliation(s)
- Taishi Okuno
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland.
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27
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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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28
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Renker M, Kim WK. Choice of transcatheter heart valve: should we select the device according to each patient's characteristics or should it be "one valve fits all"? ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:961. [PMID: 32953761 PMCID: PMC7475391 DOI: 10.21037/atm.2020.04.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Since its introduction at the beginning of the century, transcatheter aortic valve replacement (TAVR) has implicated a paradigm shift in the treatment of patients with symptomatic aortic valve stenosis. The past years have brought about major improvements of procedural outcomes owing to advances in imaging and patient selection, global experience, and device technology. Whereas in the early stages of TAVR, only two different devices with limited sizes and access options were used, currently a variety of different transcatheter heart valves (THVs) are available. This has expanded the spectrum of patients that can be treated with TAVR and has allowed for sophisticated device selection tailored to the patients' individual anatomy and comorbidities. The big question is whether such a customized device selection is really necessary-or is there one valve type that fits all patients? With this question in mind, the authors provide an overview of contemporary THVs, including technical specifications and clinical data, that help us to understand the potential value of a differential use of THVs.
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Affiliation(s)
- Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany.,Department of Cardiology, University of Giessen, Giessen, Germany
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29
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Siqueira DA, Simonato M, Ramos AA, Bignoto T, Le Bihan D, Barreto RBM, Senra T, Pinto IM, Kambara AM, Santos MA, Viana R, Sousa AGMR, Abizaid AAC. Mid‐ to long‐term clinical and echocardiographic outcomes after transcatheter aortic valve replacement with a new‐generation, self‐expandable system. Catheter Cardiovasc Interv 2020; 97:167-174. [DOI: 10.1002/ccd.28999] [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: 09/01/2019] [Revised: 04/03/2020] [Accepted: 05/12/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Dimytri A. Siqueira
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Matheus Simonato
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Auristela A. Ramos
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Tiago Bignoto
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - David Le Bihan
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Rodrigo B. M. Barreto
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Tiago Senra
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Ibraim M. Pinto
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Antonio M. Kambara
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Magaly A. Santos
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Renata Viana
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - Amanda G. M. R. Sousa
- Invasive Cardiology section Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
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30
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Kim WK, Hengstenberg C, Hilker M, Schäfer U, Rudolph TK, Toggweiler S, Rück A, Søndergaard L, Conradi L, Hamm C, Walther T, Möllmann H. Transcatheter aortic valve implantation with the ACURATE neo valve: indications, procedural aspects and clinical outcomes. EUROINTERVENTION 2020; 15:e1571-e1579. [PMID: 31911402 DOI: 10.4244/eij-d-19-00908] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The ACURATE neo aortic valve system is a self-expanding transcatheter device that was granted CE mark in 2014 and has since been widely adopted in the treatment of patients with severe aortic stenosis. The ACURATE neo can be used in a wide clinical spectrum, but there are some specific indications and anatomies where this device is particularly suitable. Recently, it was shown that, with appropriate patient screening, size selection, and optimised positioning, results can be improved substantially. This review provides an overview of existing data and compiles a standardised manual of best practice for the implantation of this device based on both evidence and individual experience.
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Affiliation(s)
- Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
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31
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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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32
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Brinkert M, Wolfrum M, Moccetti F, Bossard M, Berte B, Cuculi F, Kobza R, Toggweiler S. Relevance of New Conduction Disorders After Implantation of the ACURATE Neo Transcatheter Heart Valve in the Aortic Valve Position. Am J Cardiol 2020; 125:783-787. [PMID: 31898969 DOI: 10.1016/j.amjcard.2019.11.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/16/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
The ACURATE neo transcatheter heart valve has been associated with very low rates of new conduction disorders (CDs). We assessed the clinical relevance of new CDs in patients undergoing transcatheter aortic valve replacement (TAVR) with this valve. Data of consecutive patients without a pre-existing left bundle branch block (LBBB) or a permanent pacemaker (PPM) undergoing TAVR with the ACURATE neo were analyzed from the prospective SwissTAVI registry. Patients with new CDs were compared with patients with an unchanged electrocardiogram (ECG). ACURATE neo was implanted in 203 patients (mean age 82 ± 6 years, 63% women), CDs occurred in 28 patients (22 [11%] developed a LBBB, 6 [3%] required a PPM). New CDs resulted in a longer median duration of hospitalization (7 vs 5 days, interquartile range 4 to 13 vs 3 to 8 days, p = 0.04). At 1-year follow-up, left ventricular ejection fraction was significantly lower in patients with new CDs comparedwith patients with an unchanged ECG (54% ± 13% vs 61% ± 9%, p <0.01). Kaplan-Meier estimates of survival at 1-year were 89% in patients with new CDs and 95% in patients with an unchanged ECG (hazard ratio 2.0, 95% confidence interval 0.7 to 6.2, p = 0.22). After TAVR with the self-expanding ACURATE neo valve, the rate of new CDs, including complete LBBB was low and very few patients required a new PPM. However, new CDs prolonged initial hospitalization and increased the risk for left ventricular-dysfunction at 1-year follow-up. Patients without new CDs had excellent outcomes with a very high survival rate at 1-year follow-up.
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33
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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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Wheen P, Armstrong R, Maree A, O'Connor S. Late ventricular standstill following an elective TAVI. BMJ Case Rep 2019; 12:12/12/e232477. [PMID: 31852692 DOI: 10.1136/bcr-2019-232477] [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: 11/03/2022] Open
Abstract
Transcatheter aortic valve implantations (TAVIs) may be complicated by a need for permanent pacemaker implantation post procedure, usually due to local trauma or compression on the conduction system. There are some features that might help predict that a patient is high risk for developing conduction disease following TAVI, for example, underlying right bundle branch block or use of certain types of TAVI. It might also become apparent during the procedure, or before temporary wire removal post procedure. Higher risk patients may undergo rhythm monitoring for longer periods post TAVI. We present a case where a patient required an unexpected emergency pacemaker following a TAVI, despite low risk clinical features, a low risk baseline ECG, and the use of a low risk TAVI valve. In addition, this very significant conduction disease only became apparent over 72 hours following implantation, despite normal resting ECGs and telemetry up to that point.
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Affiliation(s)
- Peter Wheen
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Andrew Maree
- Department of Cardiology, St James Hospital, Dublin, Ireland
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Toggweiler S, Brinkert M. Can Risk Scores Help to Further Improve Transcatheter Aortic Valve Replacement? JACC Cardiovasc Interv 2019; 12:2143-2144. [PMID: 31699375 DOI: 10.1016/j.jcin.2019.08.028] [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: 08/13/2019] [Accepted: 08/20/2019] [Indexed: 10/25/2022]
Affiliation(s)
| | - Miriam Brinkert
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
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Holzamer A, Kim WK, Rück A, Sathananthan J, Keller L, Cosma J, Bauer T, Nef H, Amat-Santos IJ, Brinkert M, Husser O, Pellegrini C, Schofer J, Nerla R, Montorfano M, Giannini F, Stella P, Kuwata S, Hilker M, Castriota F, Ussia GP, Webb JG, Nietlispach F, Toggweiler S. Valve-in-Valve Implantation Using the ACURATE Neo in Degenerated Aortic Bioprostheses. JACC Cardiovasc Interv 2019; 12:2309-2316. [DOI: 10.1016/j.jcin.2019.07.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/26/2019] [Accepted: 07/23/2019] [Indexed: 12/21/2022]
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Ibrahim R, Simon F. A Step Toward a Patient-Tailored Therapy in TAVR. JACC Cardiovasc Interv 2019; 12:1794-1795. [PMID: 31537279 DOI: 10.1016/j.jcin.2019.06.033] [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: 06/03/2019] [Accepted: 06/19/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Reda Ibrahim
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
| | - Francois Simon
- Université Catholique de Louvain, CHU UCL-Namur, Namur, Belgium
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Husser O, Pellegrini C, Kim WK, Holzamer A, Pilgrim T, Toggweiler S, Schäfer U, Blumenstein J, Deuschl F, Rheude T, Joner M, Hilker M, Hengstenberg C, Möllmann H. Transcatheter Valve SELECTion in Patients With Right Bundle Branch Block and Impact on Pacemaker Implantations. JACC Cardiovasc Interv 2019; 12:1781-1793. [DOI: 10.1016/j.jcin.2019.05.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/06/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
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Affiliation(s)
- Maarten van Wiechen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
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40
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Muntané-Carol G, Guimaraes L, Ferreira-Neto AN, Wintzer-Wehekind J, Junquera L, del Val D, Faroux L, Philippon F, Rodés-Cabau J. How does new-onset left bundle branch block affect the outcomes of transcatheter aortic valve repair? Expert Rev Med Devices 2019; 16:589-602. [DOI: 10.1080/17434440.2019.1624161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | | | | | | | | | - David del Val
- Quebec Heart & Lung Institute, Quebec City, QC, Canada
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41
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Moriyama N, Vento A, Laine M. Safety of Next-Day Discharge After Transfemoral Transcatheter Aortic Valve Replacement With a Self-Expandable Versus Balloon-Expandable Valve Prosthesis. Circ Cardiovasc Interv 2019; 12:e007756. [DOI: 10.1161/circinterventions.118.007756] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Noriaki Moriyama
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Finland (N.M., A.V., M.L.)
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Japan (N.M.)
| | - Antti Vento
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Finland (N.M., A.V., M.L.)
| | - Mika Laine
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Finland (N.M., A.V., M.L.)
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Mäkikallio T, Jalava MP, Husso A, Virtanen M, Laakso T, Ahvenvaara T, Tauriainen T, Maaranen P, Kinnunen EM, Dahlbacka S, Jaakkola J, Airaksinen J, Anttila V, Savontaus M, Laine M, Juvonen T, Valtola A, Raivio P, Eskola M, Niemelä M, Biancari F. Ten-year experience with transcatheter and surgical aortic valve replacement in Finland. Ann Med 2019; 51:270-279. [PMID: 31112060 PMCID: PMC7880078 DOI: 10.1080/07853890.2019.1614657] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Aim: We investigated the outcomes of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in Finland during the last decade. Methods: The nationwide FinnValve registry included data from 6463 patients who underwent TAVR or SAVR with a bioprosthesis for aortic stenosis from 2008 to 2017. Results: The annual number of treated patients increased three-fold during the study period. Thirty-day mortality declined from 4.8% to 1.2% for TAVR (p = .011) and from 4.1% to 1.8% for SAVR (p = .048). Two-year survival improved from 71.4% to 83.9% for TAVR (p < .001) and from 87.2% to 91.6% for SAVR (p = .006). During the study period, a significant reduction in moderate-to-severe paravalvular regurgitation was observed among TAVR patients and a reduction of the rate of acute kidney injury was observed among both SAVR and TAVR patients. Similarly, the rate of red blood cell transfusion and severe bleeding decreased significantly among SAVR and TAVR patients. Hospital stay declined from 10.4 ± 8.4 to 3.7 ± 3.4 days after TAVR (p < .001) and from 9.0 ± 5.9 to 7.8 ± 5.1 days after SAVR (p < .001). Conclusions: In Finland, the introduction of TAVR has led to an increase in the invasive treatment of severe aortic stenosis, which was accompanied by improved early outcomes after both SAVR and TAVR. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03385915 Key Messages This study demonstrated that the introduction of transcatheter aortic valve replacement has led to its widespread use as an invasive treatment for severe aortic stenosis. Early and 2-year survival after transcatheter and surgical aortic valve replacement has improved during past decade. Transcatheter aortic valve replacement has fulfilled its previously unmet clinical needs and has surpassed surgical aortic valve replacement as the most common invasive treatment for aortic stenosis.
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Affiliation(s)
- Timo Mäkikallio
- a Department of Internal Medicine , Oulu University Hospital , Oulu , Finland
| | - Maina P Jalava
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | | | - Marko Virtanen
- d Heart Hospital , Tampere University Hospital , Tampere , Finland
| | - Teemu Laakso
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Tuomas Ahvenvaara
- f Department of Surgery , Oulu University Hospital and University of Oulu , Finland
| | - Tuomas Tauriainen
- f Department of Surgery , Oulu University Hospital and University of Oulu , Finland
| | - Pasi Maaranen
- d Heart Hospital , Tampere University Hospital , Tampere , Finland
| | | | | | - Jussi Jaakkola
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Juhani Airaksinen
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Vesa Anttila
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Mikko Savontaus
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Mika Laine
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Tatu Juvonen
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Antti Valtola
- c Heart Center , Kuopio University Hospital , Kuopio , Finland
| | - Peter Raivio
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Markku Eskola
- d Heart Hospital , Tampere University Hospital , Tampere , Finland
| | - Matti Niemelä
- a Department of Internal Medicine , Oulu University Hospital , Oulu , Finland
| | - Fausto Biancari
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland.,f Department of Surgery , Oulu University Hospital and University of Oulu , Finland.,g Department of Surgery , University of Turku, Turku , Finland
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43
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Pellegrini C, Rheude T, Trenkwalder T, Mayr NP, Michel J, Kastrati A, Schunkert H, Kasel AM, Joner M, Hengstenberg C, Husser O. One-year clinical outcome with a novel self-expanding transcatheter heart valve. Catheter Cardiovasc Interv 2019; 94:783-792. [PMID: 30801906 PMCID: PMC6899934 DOI: 10.1002/ccd.28144] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/08/2019] [Accepted: 01/28/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate 1-year outcome using the ACURATE neo (Symetis S.A., a Boston Scientific Company, Ecublens, Switzerland) according to the updated Valve Academic Research Consortium (VARC-2) with emphasis on the composite endpoints "clinical efficacy after 30 days" and "time-related valve safety". BACKGROUND Initial reports on the clinical performance of patients treated with the ACURATE neo are promising; however, information regarding one-year outcome is scarce, especially with regard to the composite endpoints proposed by the VARC-2. METHODS One hundred and fifty one consecutive patients undergoing transfemoral transcatheter aortic valve replacement (TAVR) with the ACURATE neo for severe aortic valve stenosis were enrolled. Data were prospectively collected and event rates during follow-up were calculated as the Kaplan-Meier estimates. RESULTS Mean age was 81.1 ± 5.9 years and 49.7% (75/151) were female with a median logistic EuroScore of 13.8% [8.2-20.5]. Device success was achieved in 88.1% (133/151) and procedure related mortality was 0.7% (1/151). At one-year, all-cause mortality was 3.3% (5/151), while permanent pacemaker implantation occurred in 12.7% (19/151) of patients. The "clinical efficacy after 30 days" was observed in 24.8% (37/151), where the main contributor was symptom worsening in 14.8% (22/151) of cases. "Time-related valve safety" occurred in 22.0% (33/151) with structural valve deterioration as main contributor in 10.7% (16/151) of cases. CONCLUSIONS Using the ACURATE neo, we found a favorable safety profile with low all-cause mortality at 1 year. The reported VARC-2 defined composite endpoints at 1 year reveal low rates of "clinical efficacy after 30 days" and "time-related valve safety".
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Affiliation(s)
- Costanza Pellegrini
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Teresa Trenkwalder
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - N Patrick Mayr
- Institut für Anästhesiologie, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Jonathan Michel
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Adnan Kastrati
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Albert M Kasel
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian Hengstenberg
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Oliver Husser
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Department of Internal Medicine I, Cardiology, St. Johannes-Hospital, Dortmund, Germany
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44
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Predictores de necesidad de marcapasos permanente y alteraciones de la conducción con el implante transcatéter de una nueva válvula aórtica autoexpandible. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.01.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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45
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del Val D, Ferreira-Neto AN, Asmarats L, Maes F, Guimaraes L, Junquera L, Wintzer J, Fischer Q, Barroso de Freitas Ferraz A, Puri R, Rodés-Cabau J. Transcatheter aortic valve replacement: relative safety and efficacy of the procedure with different devices. Expert Rev Med Devices 2018; 16:11-24. [DOI: 10.1080/17434440.2019.1552132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- David del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Lluis Asmarats
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Frédéric Maes
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Lucia Junquera
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Jérome Wintzer
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Quentin Fischer
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Rishi Puri
- Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
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46
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Toggweiler S, Kobza R. Pacemaker implantation after transcatheter aortic valve: why is this still happening? J Thorac Dis 2018; 10:S3614-S3619. [PMID: 30505543 DOI: 10.21037/jtd.2018.06.103] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
During the past years, the industry and most transcatheter aortic valve operators have focused on reduction of paravalvular leaks rather than on the reduction of permanent pacemakers (PPM). However, since indication for transcatheter aortic valve implantation (TAVI) is moving toward a healthier and younger patient population, new PPMs may become more of an issue. Certain factors such as pre-existing conduction disorders or anatomical features cannot be changed. However, the amount of mechanical trauma to the conduction system and periprocedural medical management offers the potential for optimization. By optimizing our procedure, we may finally be able to achieve low, surgical-like, PPM rates.
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Affiliation(s)
| | - Richard Kobza
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
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47
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Conradi L, Hilker M, Kempfert J, Börgermann J, Treede H, Holzhey DM, Schröfel H, Kim WK, Schaefer U, Walther T. Prospective multicentre evaluation of a novel, low-profile transapical delivery system for self-expandable transcatheter aortic valve implantation: 6-month outcomes. Eur J Cardiothorac Surg 2018; 54:762-767. [PMID: 29554265 DOI: 10.1093/ejcts/ezy097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 02/11/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We assessed the safety and efficacy of a novel low-profile, 22-Fr transapical delivery system together with the ACURATE neo™ resheathable transcatheter heart valve. METHODS This prospective, single-arm, multicentre study enrolled 60 patients with severe symptomatic aortic stenosis and high surgical risk ineligible for transfemoral access. Primary end points were 6-month mortality and procedural success. RESULTS The mean age of patients was 79.8 ± 4.7 years, and the patients had severe comorbidities including coronary artery disease (71.7%), diabetes (38.3%), atrial fibrillation (30.0%) and chronic obstructive pulmonary disease (21.7%); logistic EuroSCORE-I, -II and the Society of Thoracic Surgeons (STS) scores were 20.9 ± 8.9%, 6.1 ± 5.0% and 4.3 ± 2.9%, respectively. A non-rib spreading approach using soft tissue retractors only was used in 88.3% of patients (n = 53). Resheathing and repositioning of transcatheter heart valve were performed in 6.7% of cases (n = 4); the device implantation time was 3 ± 2 min. Apical access site complications occurred in 1.7% (n = 1). Procedural success was 98.3% (n = 59), and procedural success in the absence of major adverse cardiac and cerebrovascular events at 30 days was 90.0% (n = 54). At 30 days, cardiovascular and overall mortality were 8.3% (n = 5), stroke rate was 1.7% (n = 1), and 17.2% of patients (n = 10) received a permanent pacemaker implant. No paravalvular leakage ≥2+ was observed, and the mean transvalvular gradient was 5.9 ± 2.7 mmHg. At 6 months, survival was 84.3% with sustained haemodynamic results. CONCLUSIONS This study indicates safety and efficacy of transapical aortic valve implantation using a novel low-profile delivery system. High procedural success, short implantation times and a low rate of apical access site complications underline the favourable safety profile and ease of use. Clinical trial registration ClinicalTrials.gov: NCT02950428.
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Affiliation(s)
- Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Michael Hilker
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Jörg Kempfert
- Department of Cardiac Surgery, German Heart Center, Berlin, Germany
| | - Jochen Börgermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Hendrik Treede
- Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle, Halle, Germany
| | - David M Holzhey
- Department of Cardiac Surgery, Heart Center Leipzig University, Leipzig, Germany
| | - Holger Schröfel
- Department of Cardiovascular Surgery, Heart Center Freiburg, Bad Krozingen, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany.,Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Ulrich Schaefer
- Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany.,Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
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48
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Kim WK, Möllmann H, Liebetrau C, Renker M, Rolf A, Simon P, Van Linden A, Arsalan M, Doss M, Hamm CW, Walther T. The ACURATE neo Transcatheter Heart Valve. JACC Cardiovasc Interv 2018; 11:1721-1729. [DOI: 10.1016/j.jcin.2018.04.039] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/11/2018] [Accepted: 04/17/2018] [Indexed: 01/29/2023]
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49
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Ando T, Akintoye E, Holmes AA, Briasoulis A, Pahuja M, Takagi H, Schreiber T, Grines CL, Afonso L. Clinical End Points of Transcatheter Aortic Valve Implantation Compared With Surgical Aortic Valve Replacement in Patients <65 Years of Age (From the National Inpatient Sample Database). Am J Cardiol 2018; 122:279-283. [PMID: 29880287 DOI: 10.1016/j.amjcard.2018.03.356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/16/2018] [Accepted: 03/21/2018] [Indexed: 11/28/2022]
Abstract
It is unknown if transcatheter aortic valve implantation (TAVI) is a safe alternative to surgical aortic valve replacement (SAVR) in patients <65 years old. Data from the National Inpatient Sample database were utilized. Patients from 2011 to 2015, ages 18 to 64 years old (inclusive) who underwent TAVI and SAVR were included. Patients who underwent SAVR and who also received a concomitant nonaortic valve surgery were excluded. A propensity score analysis was used. A total of 18,970 (528 TAVI and 18,442 SAVR) patients were identified. Patients who underwent TAVI were older (57 ± 7 vs 54 ± 10 years old, p <0.001) with more frequent co-morbidities. Overall in-hospital mortality was similar between TAVI and SAVR (odds ratio [OR] = 0.52, p = 0.12). Postprocedure stroke (OR = 0.50, p = 0.24), acute kidney injury (OR = 0.98, p = 0.89), acute myocardial infarction (OR = 0.48, p = 0.08), and vascular complication requiring surgery (OR = 0.20, p = 0.11) were similar between patients who underwent TAVI and SAVR. Bleeding requiring transfusion (OR = 0.32, p <0.01) was less frequent in patients who underwent TAVI, but new pacemakers (OR = 1.7, p = 0.02) were more frequent in these patients. Patients who underwent TAVI had shorter hospital stays (7.9 vs 10.0 days, p <0.001) and were more likely to be discharged to home. Cost between TAVI and SAVR was similar ($49,014 vs $42,907, respectively, p = 0.82). In the <65 years old patient population, TAVI also conferred similar overall in-hospital mortality compared with patients who underwent SAVR. TAVI resulted in fewer major complications, shorter hospital stay, and more frequent discharge to home, but higher rates of pacemaker implantation compared with SAVR. Therefore, TAVI appears to be a safe alternative to SAVR in patients <65 years old.
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Affiliation(s)
- Tomo Ando
- Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan.
| | - Emmanuel Akintoye
- Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Anthony A Holmes
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Alexandros Briasoulis
- Divison of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa, Iowa
| | - Mohit Pahuja
- Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Theodore Schreiber
- Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Cindy L Grines
- Division of Cardiology, North Shore University Hospital, Hofstra Norwell School of Medicine, Manhasset, New York
| | - Luis Afonso
- Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan
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50
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Predictors of Need for Permanent Pacemaker Implantation and Conduction Abnormalities With a Novel Self-expanding Transcatheter Heart Valve. ACTA ACUST UNITED AC 2018; 72:145-153. [PMID: 29551701 DOI: 10.1016/j.rec.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/30/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES The incidence of permanent pacemaker implantation (PPI) and new conduction abnormalities (CA) with the ACURATE neo (Symetis S.A., Eclubens, Switzerland) has not been studied in detail. We aimed to analyze their predictors, evaluating patient- and device-related factors, including implantation depth and device-to-annulus ratio (DAR). METHODS Two analyses of a multicenter population were performed: new PPI in pacemaker-naive patients (n = 283), and PPI/new-CA in patients without prior CA or pacemaker (n = 232). RESULTS A new PPI was required in 9.9% of patients, who had a higher body mass index, higher rate of right bundle branch block and bradycardia. Neither implantation depth nor DAR differed in patients with PPI compared with those without. In the multivariable analysis neither DAR (OR, 1.010; 95%CI, 0.967-1.055; P = .7) nor implantation depth (OR, 0.972; 95%CI, 0.743-1.272; P = .8) predicted PPI. Only high body mass index, bradycardia and right bundle branch block persisted as independent predictors. PPI/new-onset CA occurred in 22.8% of patients and was associated with a higher logistic EuroSCORE. Neither implantation depth nor DAR differed in patients with PPI/new-CA vs those without (7.3 ± 1.9 vs 7.1 ± 1.5mm; P = .6 and 41.0 ± 7.9 vs 42.2 ± 10.1%; P = .4). The only predictor of PPI/new-CA was a higher logistic EuroSCORE (OR, 1.039; 95%CI, [1.008-1.071]; P = .013). CONCLUSIONS New PPI and new-onset CA rates were low with the ACURATE neo. These were mainly influenced by patient characteristics and not by device-depending factors.
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