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Didagelos M, Ninios V, Kakderis C, Lakkas L, Kouparanis A, Nikas D, Naka KK, Rammos A, Zegkos T, Kamperidis V, Ninios I, Evangelou S, Tsalikakis DG, Michalis L, Ziakas A. Transcatheter Aortic Valve Implantation with the Portico Valve: 2-Year Outcomes of a Multicenter, Real-World Registry. Life (Basel) 2023; 13:1785. [PMID: 37629642 PMCID: PMC10455265 DOI: 10.3390/life13081785] [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: 07/04/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION The self-expanding, resheathable, repositionable transcatheter aortic heart valve Portico is being used successfully for transcatheter aortic valve implantation procedures (TAVI) in patients with severe aortic stenosis. The aim of this study was to evaluate outcomes at 2 years after TAVI with the Portico valve. METHODS Multicenter registry of clinical, echocardiographic and survival data from consecutive patients treated with the Portico TAVI system (Abbott, Chicago, IL, USA) in three cath labs in Northern Greece and Epirus during 2017-2020. The primary end point was all-cause mortality at 24 months. Secondary end points included procedural outcomes (efficacy and safety) and echocardiographic measurements. RESULTS A total of 90 patients (81 ± 6 years, 50% females, mean age 81 ± 6 years) were included in the registry. The indication for implantation was severe, symptomatic aortic stenosis (NYHA III, IV) in eighty-two (91.1%) and degeneration of a prosthetic aortic valve in eight (8.9%) patients. All patients were categorized as high surgical risk (mean Logistic Euroscore 25.9 ± 10, Euroscore II 7.7 ± 4.4 and STS score 10.8 ± 8.9). The procedure was performed transfemorally in all patients, under general anesthesia in 95.6%, under TOE guidance in 21.1%, with native valve predilatation in 46.7%, and the "resheath" option was used in 31.1% of the cases. The implantation was successful in 97.8% and there was a need for a second valve in 2.2% of the cases. Complications included permanent pacemaker implantation (16.7%), access cite complications (15.6%), arrythmias (23.3%), paravalvular leak (moderate 7.8%, severe 1.1%), acute kidney injury (7.8%), no strokes and one death during the procedure. Aortic valve peak velocity, peak and mean pressure gradients, were significantly reduced after the procedure. All-cause mortality at 1, 12 and 24 months was 4.4%, 6.7% and 7.8%, respectively. CONCLUSIONS TAVI with the Portico system comprises an effective and safe solution for the management of severe, symptomatic aortic stenosis in high-risk surgical patients.
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Affiliation(s)
- Matthaios Didagelos
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece
| | - Vlasis Ninios
- 2nd Cardiology Department, Interbalkan Medical Center, 55535 Thessaloniki, Greece
| | - Charalampos Kakderis
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece
| | - Lampros Lakkas
- 2nd Cardiology Department, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Antonios Kouparanis
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece
| | - Dimitrios Nikas
- 2nd Cardiology Department, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Katerina K. Naka
- 2nd Cardiology Department, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Aidonis Rammos
- 2nd Cardiology Department, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Thomas Zegkos
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece
| | - Vasileios Kamperidis
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece
| | - Ilias Ninios
- 2nd Cardiology Department, Interbalkan Medical Center, 55535 Thessaloniki, Greece
| | - Sotirios Evangelou
- 2nd Cardiology Department, Interbalkan Medical Center, 55535 Thessaloniki, Greece
| | - Dimitrios G. Tsalikakis
- Department of Informatics and Telecommunications Engineering, University of Western Macedonia, 50100 Kozani, Greece
| | - Lampros Michalis
- 2nd Cardiology Department, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Antonios Ziakas
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece
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Camuglia AC, Cole CMW, Boyne N, Hayman SM, Cox SV, Moore PT, Lau JK, Delacroix S, Williamson AE, Duong M, Schwarz N, Montarello JK, Worthley SG. 30-Day Outcomes With the Portico Transcatheter Heart Valve: Insights From a Multi-Centre Australian Observational Study. Heart Lung Circ 2023; 32:224-231. [PMID: 36344392 DOI: 10.1016/j.hlc.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/10/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is an established therapy for the treatment of aortic valve disease in appropriately selected patients. Previous studies using the self-expanding Portico transcatheter heart valve (THV), (Abbott Structural Heart, St Paul, MN, USA) have demonstrated the technical feasibility of this system albeit in the hands of relatively inexperienced Portico users. The objective of this study was to assess the real-world safety and efficacy of the Portico THV (with and without the FlexNav delivery system, Abbott Structural Heart) at the 30-day timepoint in an Australian cohort. METHODS AND RESULTS This study was a retrospective real-world cohort analysis of 269 consecutive patients with severe aortic valve disease who underwent TAVI at multiple centres within Australia between February 2015 and April 2021. Of the 269 patients, 51.7% were female, mean Society of Thoracic Surgeons (STS) score was 5.2 (±6.8) and 98.5% had successful implantations. Thirty (30)-day post-implantation all-cause mortality was observed in one (0.4%) patient, major vascular complications in two (0.7%) patients, more-than-mild paravalvular leak in six (2.2%) patients and requirement for new permanent pacemaker implantation in 27 (10.2%) patients. Haemodynamic parameters at 30 days included mean effective orifice area (EOA) of 2.3 (±0.9) cm2 and mean aortic valve gradient (AVG) of 9.6 (±6.2) mmHg. CONCLUSION This analysis of the Portico THV in a real-world setting suggested that the system is associated with satisfactory safety and efficacy parameters. Previously published datasets may not have found similar findings owing to lower operator experience with the Portico THV system.
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Affiliation(s)
- Anthony C Camuglia
- The Wesley Hospital, Brisbane, Qld, Australia; Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia.
| | - Christopher M W Cole
- The Wesley Hospital, Brisbane, Qld, Australia; Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | - Nicholas Boyne
- The Wesley Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | - Sam M Hayman
- The Wesley Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | - Stephen V Cox
- The Wesley Hospital, Brisbane, Qld, Australia; Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | - Peter T Moore
- The Wesley Hospital, Brisbane, Qld, Australia; Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | - Jerrett K Lau
- Royal Adelaide Hospital, Adelaide, SA, Australia; St. Andrew's Hospital, Adelaide, SA, Australia
| | - Sinny Delacroix
- GenesisCare, Adelaide, SA, Australia; Abbott Laboratories, Sylmar, CA, USA
| | | | | | | | - Joseph K Montarello
- Royal Adelaide Hospital, Adelaide, SA, Australia; St. Andrew's Hospital, Adelaide, SA, Australia
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Leone PP, Scotti A, Ho EC, Assafin M, Doolittle J, Chau M, Slipczuk L, Levitus M, Regazzoli D, Mangieri A, Latib A. Prosthesis Tailoring for Patients Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2023; 12:338. [PMID: 36615141 PMCID: PMC9821207 DOI: 10.3390/jcm12010338] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has risen over the past 20 years as a safe and effective alternative to surgical aortic valve replacement for treatment of severe aortic stenosis, and is now a well-established and recommended treatment option in suitable patients irrespective of predicted risk of mortality after surgery. Studies of numerous devices, either newly developed or reiterations of previous prostheses, have been accruing. We hereby review TAVI devices, with a focus on commercially available options, and aim to present a guide for prosthesis tailoring according to patient-related anatomical and clinical factors that may favor particular designs.
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Affiliation(s)
- Pier Pasquale Leone
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Cardiovascular Research Foundation, New York, NY 10019, USA
| | - Edwin C. Ho
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Manaf Assafin
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - James Doolittle
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Mei Chau
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Leandro Slipczuk
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Matthew Levitus
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Mollmann H, Linke A, Nombela-Franco L, Sluka M, Dominguez JFO, Montorfano M, Kim WK, Arnold M, Vasa-Nicotera M, Conradi L, Camuglia A, Bedogni F, Manoharan G. Procedural Safety and Device Performance of the Portico™ Valve from Experienced TAVI Centers: 30-Day Outcomes in the Multicenter CONFIDENCE Registry. J Clin Med 2022; 11:jcm11164839. [PMID: 36013084 PMCID: PMC9409954 DOI: 10.3390/jcm11164839] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/30/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
A total of 1001 subjects (82.0 years, 62.5% female, 63.7% NYHA III/IV at baseline) with severe aortic stenosis at high surgical risk were enrolled in the prospective CONFIDENCE registry and treated with a Portico™ transcatheter heart valve (THV) using either a first-generation delivery system (DS) or the FlexNav™ DS. The objective of this registry is to characterize the procedural safety and device performance of the Portico™ THV at 30 days. The study collected ‘standard-of-care’ clinical and device performance data, with adverse events adjudicated by an independent clinical event committee according to the Valve Academic Research Consortium-2 criteria. The implantation of a single Portico™ THV was successful in 97.5% of subjects. The 30-day all-cause mortality, cardiovascular mortality, and disabling stroke rates were 2.6%, 2.1%, and 1.8%, respectively. A new pacemaker was implanted in 19.0% of subjects at 30 days. At 30 days, the effective orifice area and mean gradient values were 1.82 cm2 and 7.1 mmHg, respectively. The 30-day rate of moderate paravalvular leak (PVL) was 2.1%, with no occurrence of severe PVL. The Portico™ THV demonstrated improved hemodynamic performance and low rates of safety events at 30 days in a large cohort of subjects implanted with the Portico™ THV with either the first-generation DS or FlexNav™ DS.
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Affiliation(s)
- Helge Mollmann
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Correspondence:
| | - Axel Linke
- Klinik für Innere Medizin/Kardiologie, Universitätsklinik Technische Universität Dresden, Herzzentrum Dresden Fetscherstraße 76, 01307 Dresden, Germany
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Martin Sluka
- Department of Medicine-Cardiology, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | | | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Won-Keun Kim
- Kerckhoff Heart and Thorax Centre, 61231 Bad Nauheim, Germany
| | - Martin Arnold
- Department of Cardiology, Friedrich Alexander Universität Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Mariuca Vasa-Nicotera
- Klinikum der Johann Wolfgang Goethe Universitaet Frankfurt, 60596 Frankfurt, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center, 20251 Hamburg, Germany
| | - Anthony Camuglia
- Department of Cardiology, University of Queensland, Brisbane, QLD 4072, Australia
- Department of Cardiology, The Wesley Hospital, Brisbane, QLD 4066, Australia
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Ganesh Manoharan
- Department of Cardiology, Royal Victoria Hospital, Belfast BT12 6BA, UK
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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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Transcatheter Mitral Valve Implantation Systematic Review: Focus on Transseptal Approach and Mitral Annulus Calcification. Curr Cardiol Rep 2021; 23:37. [PMID: 33687594 DOI: 10.1007/s11886-021-01466-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION This systematic review was performed to evaluate the results of transcatheter mitral valve implantation (TMVI) in the native mitral valve. EVIDENCE ACQUISITION Medline, EMBASE, and the Cochrane Central register were systematically searched for studies that reported results of TMVI in mitral valve regurgitation and/or stenosis and mitral annular calcification. To improve the sensitivity of the literature search, we performed citation chasing in Google Scholar, Scopus, and Web of Science. EVIDENCE SYNTHESIS Twelve studies reporting results of TMVI in mitral regurgitation were retrieved and included 347 patients. The transseptal approach represented 28% of cases. Secondary mitral regurgitation was the predominant indication in 63% of cases. Thirty-day mortality was 11% and was lowered with the transseptal approach (7%). Technical success was 92%. Surgical conversion was needed in 5% of patients. Only one patient presented moderate to severe mitral regurgitation. These hemodynamic results were sustainable up to one year of follow-up. Three series focused on results of TMVI in mitral annulus calcification including 167 patients. Only nine patients were treated with TMVI dedicated prosthesis. Eighty-seven patients had their prosthesis delivered through a transseptal approach. Mitral stenosis was present in 63% of cases. Thirty-day mortality was 24%, and none with TMVI prosthesis. Technical success was achieved in 71% of cases and was improved by using TMVI prosthesis (89%). The main complication was left ventricular outflow tract obstruction (20%). Post procedural moderate to severe mitral regurgitation was observed in 4% of cases. CONCLUSION TMVI seems to be feasible, achieving good technical success and predictable and durable MR reduction.
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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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Claessen BE, Tang GHL, Kini AS, Sharma SK. Considerations for Optimal Device Selection in Transcatheter Aortic Valve Replacement: A Review. JAMA Cardiol 2020; 6:102-112. [PMID: 32902569 DOI: 10.1001/jamacardio.2020.3682] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Aortic valve stenosis (AS) is the most common manifestation of acquired valvular heart disease in developed countries. Several large-scale randomized clinical trials investigating the entire spectrum of patients with severe symptomatic AS from low to prohibitive risk have established transcatheter aortic valve replacement (TAVR) as a safe and effective alternative to surgical aortic valve replacement. Observations There are currently only 3 types of TAVR devices commercially available in the US, but several other valve types are undergoing clinical trials in the US. Because of fundamental differences in engineering features, each TAVR device type has specific strengths and limitations. This review aims to provide an overview of design features and clinical outcomes of various TAVR devices that are either commercially available or undergoing clinical investigation. Conclusions and Relevance Given the lack of large-scale head-to-head comparisons of various TAVR devices and the rapid development of new device iterations, there is insufficient evidence to claim superiority of one device type over another. Nonetheless, as each TAVR device has unique design characteristics, certain patient-related and anatomy-related factors may slightly favor one or several particular designs.
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Affiliation(s)
- Bimmer E Claessen
- Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York.,Division of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna S Kini
- Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K Sharma
- Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
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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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10
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Fontana GP, Bedogni F, Groh M, Smith D, Chehab BM, Garrett HE, Yong G, Worthley S, Manoharan G, Walton A, Hermiller J, Dhar G, Waksman R, Ramana RK, Mahoney P, Asch FM, Chakravarty T, Jilaihawi H, Makkar RR. Safety Profile of an Intra-Annular Self-Expanding Transcatheter Aortic Valve and Next-Generation Low-Profile Delivery System. JACC Cardiovasc Interv 2020; 13:2467-2478. [PMID: 33153563 DOI: 10.1016/j.jcin.2020.06.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of this study was to characterize the safety profile of an intra-annular self-expanding valve with a next-generation low-profile delivery system (DS). BACKGROUND Key design modifications to the FlexNav DS include the addition of a hydrophilic-coated, integrated sheath and stability layer to facilitate gradual, controlled deployment in vessels with diameter ≥5 mm. METHODS Patients were pooled from 2 concurrent prospective, multicenter, single-arm studies (FlexNav DS arm of PORTICO IDE [Portico Re-Sheathable Transcatheter Aortic Valve System U.S. IDE Trial] [n = 134] and the FlexNav EU CE Mark Study [n = 46]) for the analysis. The primary endpoint was Valve Academic Research Consortium-2-defined major vascular complications at 30 days. Clinical outcomes and valve performance were assessed through 30 days by an independent clinical events committee and an echocardiography core laboratory, respectively. RESULTS One hundred forty high-risk and 40 extreme-risk subjects enrolled between October 15, 2018, and December 10, 2019, from 28 sites in the United States, Australia, and Europe who underwent attempted transfemoral Portico valve implantation were included. The mean age was 85.1 ± 5.6 years, 60% were women, the mean Society of Thoracic Surgeons score was 5.3%, and 96.1% presented with ≥1 frailty factor. Technical device success was 96.7%. At 30 days, the rate of major vascular complications was 5.0%, with 4.4% of complications adjudicated as access site-related (3.3% transcatheter aortic valve replacement DS access site-related). Death (0.6%) and disabling stroke (1.1%) were rare. The rate of new permanent pacemaker implantation was 15.4%. Echocardiography revealed a mean gradient of 7.1 ± 3.2 mm Hg, mean valve area of 1.77 ± 0.41 cm2, and a 4.1% rate of moderate paravalvular leak at 30 days. CONCLUSIONS Portico valve implantation with the FlexNav DS was associated with an excellent safety profile at 30 days.
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Affiliation(s)
- Gregory P Fontana
- Cardiovascular Institute, Los Robles Regional Medical Center, Thousand Oaks, California.
| | | | - Mark Groh
- Mission Health and Hospitals, Asheville, North Carolina
| | - David Smith
- Morriston Hospital - Swansea Bay University Health Board, Swansea, United Kingdom
| | - Bassem M Chehab
- Ascension Via Christi Hospital, University of Kansas, Wichita, Kansas
| | - H Edward Garrett
- Department of Surgery, University of Tennessee, Memphis, Tennessee
| | | | - Stephen Worthley
- Royal Adelaide Hospital, Adelaide, Australia; Genesis Care, Sydney, Australia
| | | | | | | | - Gaurav Dhar
- Sparrow Clinical Research Institute, Lansing, Michigan
| | - Ron Waksman
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Ravi K Ramana
- Advocate Christ Medical Center, Oak Lawn, Illinois; Heart Care Centers of Illinois, Palos Park, Illinois
| | - Paul Mahoney
- Sentara Norfolk General Hospital, Norfolk, Virginia
| | - Federico M Asch
- MedStar Health Research Institute, Washington, District of Columbia
| | - Tarun Chakravarty
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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11
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Hirji S, Leya G, Pelletier M. Are we compromising on value versus performance: time to consider the Portico valve as a third major market player? EUROINTERVENTION 2019; 15:e818-e819. [PMID: 31579012 DOI: 10.4244/eij-d-18-00966l] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sameer Hirji
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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12
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Bourantas CV, Modolo R, Baumbach A, Søndergaard L, Prendergast BD, Ozkor M, Kennon S, Mathur A, Mullen MJ, Serruys PW. The evolution of device technology in transcatheter aortic valve implantation. EUROINTERVENTION 2019; 14:e1826-e1833. [PMID: 30719977 DOI: 10.4244/eij-d-18-01048] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has rapidly evolved and changed the landscape of structural interventional cardiology. Advances in transcatheter heart valve (THV) prostheses and TAVI-enabling devices have simplified the procedure, reduced the risk of complications, improved short- and long-term outcomes and broadened the applications of TAVI, not only in challenging patients and complex anatomies but also in intermediate-risk or even in low-risk patients, where surgical valve replacement constitutes an effective and well-established therapy. In this review article, we provide an overview of the developments in TAVI devices which have played a vital role in TAVI evolution: we describe the prostheses that failed to reach clinical practice, we present the characteristics of the first valves that were tested in the clinical arena, we summarise the evidence from the first studies that highlighted the potential but also the limitations of TAVI, and we present the advanced next-generation THV prostheses that have an improved performance and safety profile.
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Affiliation(s)
- Christos V Bourantas
- Department of Cardiology, Barts Heart Center, Barts Health NHS Trust, London, United Kingdom
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13
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Taramasso M, Miura M, Gavazzoni M, Andreas M, Saccocci M, Gülmez G, Puri R, Maisano F. The Portico transcatheter aortic valve for the treatment of severe aortic stenosis. Future Cardiol 2019; 15:31-37. [DOI: 10.2217/fca-2018-0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The Portico TAVI system (Abbott Vascular, Santa Clara, CA, USA) has been specifically designed to mitigate some of the complications associated with first-generation valves. Most of the data generated from randomized studies comparing transcatheter aortic valve implantation with surgery stem from reported experiences with first generation transcatheter heart valve devices. The aim of this review is to describe the repositionable and retrievable Portico system and its implantation technique, coupled with our single-center experience and to provide a review of the clinical results reported so far in the literature.
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Affiliation(s)
- Maurizio Taramasso
- Cardiovascular Surgical Department, Heart Valve Clinic, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Mizuki Miura
- Cardiovascular Surgical Department, Heart Valve Clinic, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Mara Gavazzoni
- Cardiovascular Surgical Department, Heart Valve Clinic, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Andreas
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Matteo Saccocci
- Cardiovascular Surgical Department, Heart Valve Clinic, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Gökhan Gülmez
- Cardiovascular Surgical Department, Heart Valve Clinic, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Francesco Maisano
- Cardiovascular Surgical Department, Heart Valve Clinic, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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14
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Søndergaard L, Rodés-Cabau J, Hans-Peter Linke A, Fichtlscherer S, Schäfer U, Kuck KH, Kempfert J, Arzamendi D, Bedogni F, Asch FM, Worthley S, Maisano F. Transcatheter Aortic Valve Replacement With a Repositionable Self-Expanding Prosthesis: The PORTICO-I Trial 1-Year Outcomes. J Am Coll Cardiol 2018; 72:2859-2867. [PMID: 30261238 DOI: 10.1016/j.jacc.2018.09.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The new self-expanding, repositionable transcatheter heart valve (THV) system was designed for treatment of severe, symptomatic aortic stenosis in patients with high surgical risk. OBJECTIVES The purpose of this study was to report 1-year outcomes of transcatheter aortic valve replacement with the new THV system. METHODS This ongoing, international, multicenter study evaluated patients with severe, symptomatic aortic stenosis implanted with the THV via transfemoral access and follow-up at 30 days, 1 year, and annually through 5 years. The primary endpoint is all-cause mortality at 1 year; secondary endpoints include clinical outcomes and echocardiographic measurements, both adjudicated. RESULTS A total of 941 patients (82.4 ± 5.9 years; 65.7% female; Society of Thoracic Surgeons Predicted Risk of Operative Mortality score: 5.8%) were enrolled and underwent an implant at 61 sites in Europe, Australia, and Canada. At 1 year, Kaplan-Meier estimates for all-cause mortality, cardiovascular mortality, disabling stroke rates, and myocardial infarction were 12.1%, 6.6%, 2.2%, and 2.5%, respectively. Mean aortic transvalvular gradient and aortic valve area were 8.66 mm Hg and 1.75 cm2, respectively. Paravalvular leakage was moderate or higher in 2.6% of patients with no severe leakage. New pacemaker rates were 18.7% and 21.3% for pacemaker naïve patients at 30 days and 1 year, respectively. Functional class, exercise capacity, and quality of life improved significantly from baseline to 1 year. CONCLUSIONS Transcatheter aortic valve replacement with the new THV in patients who are at increased surgical risk is associated with low 1-year mortality and stroke rates. Favorable hemodynamic results at 1 year are observed with low transvalvular pressure gradient and incidence of significant paravalvular leakage. (5 Year Observation of Patients With PORTICO Valves [PORTICO-I]; NCT01802788).
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Affiliation(s)
- Lars Søndergaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Ulrich Schäfer
- UKE Hamburg (Universitatsklinik Eppendorf), Hamburg, Germany
| | - Karl-Heinz Kuck
- Asklepios Klinik St. Georg, Lohmuehlenstrasse, Hamburg, Germany
| | | | - Dabit Arzamendi
- Hospital de la Santa Creu I Sant Pau, Sant Antoni Maria Claret, Barcelona, Spain
| | - Francesco Bedogni
- IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, Italy
| | - Federico M Asch
- Cardiovascular Core Laboratories, MedStar Health Research Institute at Washington Hospital Center, Washington, DC
| | | | - Francesco Maisano
- Clinic for Heart and Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
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