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Nikolayevska O, Conradi L, Schirmer J, Reichenspurner H, Deuschl F, Blankenberg S, Schäfer U. Comparison of a novel self-expanding transcatheter heart valve with two established devices for treatment of degenerated surgical aortic bioprostheses. Clin Res Cardiol 2024; 113:18-28. [PMID: 37017780 PMCID: PMC10808493 DOI: 10.1007/s00392-023-02181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/03/2023] [Indexed: 04/06/2023]
Abstract
AIMS This study was performed to compare haemodynamic properties of a novel transcatheter heart valve (THV) with two established valve technologies for treatment of failing surgical aortic bioprosthetic valves (SAV). The ALLEGRA THV has been recently described with a proven safety and performance profile. METHODS AND RESULTS The study was designed as a retrospective, single-centre study investigating 112 patients (77.7 ± 7.1 years, 53.8% female, STS score 6.8 ± 5.8% and logEuroSCORE I 27.4 ± 16.1%) with failing SAV. Patients were treated with the ALLEGRA THV (NVT, n = 24), the CoreValve/EvolutR (MTD, n = 64) or the Edwards Sapien/Sapien XT/Sapien 3 (EDW, n = 24). Adverse events, haemodynamic outcomes and patient safety were analysed according to VARC-3 definitions. Overall procedural success was high (94.6%), even though 58.9% of the treated SAV were classified as small (true inner diameter < 21 mm). After treatment, the mean pressure gradient was significantly reduced (baseline: 33.7 ± 16.5 mmHg, discharge: 18.0 ± 7.1 mmHg), with a corresponding increase in effective orifice area (EOA). The complication rates did not differ in between groups. There was a trend to lower mean transvalvular gradients after implantation of self-expanding THV with supra-annular valve function, despite a higher frequency of smaller SAVs in the NVT and MTD group. Additionally, comparison between NVT and MTD revealed statistically lower transvalvular gradients (NVT 14.9 ± 5.0 mmHg, MTD 18.7 ± 7.5 mmHg, p = 0.0295) in a subgroup analysis. CONCLUSIONS Valve-in-valve (ViV) treatment of failing SAV with supra-annular design like the ALLEGRA THV resulted in favourable haemodynamic outcomes with similar low clinical event rates and may therefore be an interesting alternative for VIV TAVI.
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Affiliation(s)
- Olga Nikolayevska
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Klinik für Kardiologie, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Deuschl
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Klinik für Kardiologie, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Klinik für Kardiologie, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Ulrich Schäfer
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Klinik für Kardiologie, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Cardiology, Heart and Vascular Centre Bad Bevensen, Bad Bevensen, Germany
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Akodad M, Kütting M, Sellers S, Kirsten A, Marx P, Kim I, Cheung A, Leipsic J, Søndergaard L, Toggweiler S, Wood DA, Webb JG, Sathananthan J. Redo Transcatheter Aortic Valve Implantation with the ALLEGRA Transcatheter Heart Valve: Insights from Bench Testing. Cardiovasc Eng Technol 2022; 13:930-938. [PMID: 35505271 DOI: 10.1007/s13239-022-00627-1] [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: 08/15/2021] [Accepted: 04/21/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Failure of transcatheter heart valves (THV) may potentially be treated with repeat transcatheter aortic valve implantation (redo TAVI). We assessed hydrodynamic performance, stability and pinwheeling utilizing the ALLEGRA (New Valve Technology, Hechingen, Germany) THV, a CE approved and marketed THV in Europe, inside different THVs. METHODS Redo TAVI was simulated with the 27 mm ALLEGRA THV at three implantation depths (-4 mm, 0 mm and +4 mm) in seven different 'failed' THVs: 26 mm Evolut Pro, 25 mm Lotus, 25 mm JenaValve, 25 mm Portico, 23 mm Sapien 3, 27 mm ALLEGRA and M ACURATE neo. Hydrodynamic evaluation was performed according to International Standards Organization 5840-3:2021. RESULTS The ALLEGRA THV was stable with acceptable performance (gradient <20 mmHg, effective orifice area >2 cm2, and regurgitant fraction <20%) in all 'failed' THVs except the Evolut Pro at -4 mm implantation depth. In this configuration, the outflow of the ALLEGRA frame was constrained by the Evolut Pro THV and the ALLEGRA leaflets were unable to fully close. Pinwheeling was severe for the ALLEGRA in Evolut Pro. The neo-skirt was higher with taller frame THVs. CONCLUSION The ALLEGRA THV had favorable hydrodynamic performance, stability and pinwheeling in all redo TAVI samples except the Evolut Pro at low implantation depth with compromised function. The choice of initial THV may have late implications on new THV choice and function.
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Affiliation(s)
- Mariama Akodad
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Centre for Cardiovascular Innovation, Vancouver, Canada
| | | | - Stephanie Sellers
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Centre for Cardiovascular Innovation, Vancouver, Canada
- Cardiovascular Translational Laboratory, St. Paul's Hospital, Vancouver, BC, Canada
- Centre for Heart Lung Innovation, Vancouver, Canada
| | | | | | - Isabel Kim
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Centre for Cardiovascular Innovation, Vancouver, Canada
| | - Anson Cheung
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Centre for Cardiovascular Innovation, Vancouver, Canada
| | - Jonathon Leipsic
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Centre for Cardiovascular Innovation, Vancouver, Canada
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - David A Wood
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Centre for Cardiovascular Innovation, Vancouver, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Centre for Cardiovascular Innovation, Vancouver, Canada
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Centre for Cardiovascular Innovation, Vancouver, Canada.
- Cardiovascular Translational Laboratory, St. Paul's Hospital, Vancouver, BC, Canada.
- Centre for Heart Lung Innovation, Vancouver, Canada.
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Corcione N, Ferraro P, Morello A, Cimmino M, Albanese M, Pepe M, Giordano S, Biondi-Zoccai G, Giordano A. Transcatheter aortic valve implantation with Allegra: procedural and mid-term outcomes according to experience phase in a high-volume center. Minerva Cardiol Angiol 2022; 70:677-685. [PMID: 36222602 DOI: 10.23736/s2724-5683.22.06173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis. We aimed at appraising effectiveness of a new self-expandable TAVI device. METHODS We retrospectively analyzed our institutional experience with Allegra (Biosensors, Morges, Switzerland) for TAVI, focusing on procedural outcomes and 1-month adverse events. We explored the impact of operator experience with this device, dividing patients according to their time of intervention. RESULTS Between 2018 and 2021, a total of 50 patients underwent TAVI with Allegra, with average age of 81 years, 80% women, and 50% at low or intermediate surgical risk. No major significant difference in baseline patient features were found when comparing Phase 1 and Phase 2, except for baseline left ventricular ejection fraction and New York Heart Association, which were worse in Phase 1. All procedures were performed transfemorally and percutaneously, with predilation in 94% and postdilation in 36%, yielding device success in 98%, and procedural success in 96%. No significant differences in procedural features were found when comparing Phase 1 vs. Phase 2 (all P>0.05). One-month follow-up was also favorable, with no significant difference in adverse outcomes according to phase, and a total of 1 (4%) death, 1 (4%) myocardial infarction, 1 (4%) minor vascular complication, and 4 (8%) permanent pacemaker implantations. Consistent findings were obtained at exploratory 6-month follow-up. CONCLUSIONS The Allegra TAVI device is associated with favorable short-to-midterm outcomes in experienced hands. Operators already proficient with other devices can achieve satisfactory results even in the early phase of adoption of Allegra.
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Affiliation(s)
- Nicola Corcione
- Unit of Cardiovascular Interventions, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Paolo Ferraro
- Operative Unit of Hemodynamics, Santa Lucia Hospital, San Giuseppe Vesuviano, Naples, Italy
| | - Alberto Morello
- Unit of Cardiovascular Interventions, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Michele Cimmino
- Unit of Cardiovascular Interventions, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Michele Albanese
- Operative Unit of Hemodynamics, Santa Lucia Hospital, San Giuseppe Vesuviano, Naples, Italy
| | - Martino Pepe
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Bari, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy
| | - Arturo Giordano
- Unit of Cardiovascular Interventions, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
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Vogl BJ, El Shaer A, Crestanello JA, Alkhouli M, Hatoum H. Flow dynamics in the sinus and downstream of third and fourth generation balloon expandable transcatheter aortic valves. J Mech Behav Biomed Mater 2022; 127:105092. [DOI: 10.1016/j.jmbbm.2022.105092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/27/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
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Hatoum H, Gooden SCM, Sathananthan J, Sellers S, Kutting M, Marx P, Lilly SM, Ihdayhid AR, Thourani VH, Dasi LP. Neosinus and Sinus Flow After Self-Expanding and Balloon-Expandable Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2021; 14:2657-2666. [PMID: 34838462 DOI: 10.1016/j.jcin.2021.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate flow dynamics in the aortic sinus and the neosinus (NS) after transcatheter heart valve (THV) implantation in valve-in-valve (ViV). BACKGROUND Leaflet thrombosis may occur on THVs and affect performance and durability. Differences in flow dynamics may affect the risk for leaflet thrombosis. METHODS Hemodynamic assessment following THV implantation in a surgical aortic valve was performed in a left heart simulator under pulsatile physiological conditions. Assessment was performed using a 23-mm polymeric surgical aortic valve (not diseased) and multiple THV platforms, including self-expanding devices (26-mm Evolut, 23-mm Allegra, small ACURATE neo) and a balloon-expandable device (23-mm SAPIEN 3). Particle image velocimetry was performed to assess flow in the sinus and NS. Sinus and NS washout, shear stress, and velocity were calculated. RESULTS Sinus and NS washout was fastest and approximately 1 cardiac cycle for each with the Evolut, ACURATE neo, and Allegra compared with the SAPIEN 3, with washout in 2 and 3 cardiac cycles, respectively. The Allegra showed the largest shear stress distribution in the sinus, followed by the SAPIEN 3. In the NS, all 4 valves showed equal likelihoods of occurrence of shear stress <1 Pa, but the Allegra showed the highest likelihoods of occurrence for shear stress >1 Pa. The velocities in the sinus and NS were 0.05, 0.078, 0.080, and 0.075 m/s for Evolut, SAPIEN 3, ACURATE neo, and Allegra ViV, respectively. CONCLUSIONS Sinus and NS flow dynamics differ substantially among THVs after ViV. Self-expanding supra-annular valves seem to have faster washouts compared with an equivalent-size balloon-expandable THV.
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Affiliation(s)
- Hoda Hatoum
- Biomedical Engineering Department, Michigan Technological University, Houghton, Michigan, USA; Health Research Institute, Houghton, Michigan, USA; Center for Biocomputing and Digital Health, Michigan Technological University, Houghton, Michigan, USA.
| | - Shelley C M Gooden
- Biomedical Engineering Department, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Janarthanan Sathananthan
- Center for Cardiovascular Innovation, Cardiovascular Translational Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Sellers
- Center for Cardiovascular Innovation, Cardiovascular Translational Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Scott M Lilly
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Abdul R Ihdayhid
- Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, Perth, Australia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Lakshmi Prasad Dasi
- Biomedical Engineering Department, Georgia Institute of Technology, Atlanta, Georgia, USA
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Allen KB, Chhatriwalla AK, Saxon JT, Huded CP, Sathananthan J, Nguyen TC, Whisenant B, Webb JG. Bioprosthetic valve fracture: a practical guide. Ann Cardiothorac Surg 2021; 10:564-570. [PMID: 34733685 DOI: 10.21037/acs-2021-tviv-25] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/18/2021] [Indexed: 11/06/2022]
Abstract
Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) is currently indicated for the treatment of failed surgical tissue valves in patients determined to be at high surgical risk for re-operative surgical valve replacement. VIV TAVR, however, often results in suboptimal expansion of the transcatheter heart valve (THV) and can result in patient-prosthesis mismatch (PPM), particularly in small surgical valves. Bioprosthetic valve fracture (BVF) and bioprosthetic valve remodeling (BVR) can facilitate VIV TAVR by optimally expanding the THV and reducing the residual transvalvular gradient by utilizing a high-pressure inflation with a non-compliant balloon to either fracture or stretch the surgical valve ring, respectively. This article, along with the supplemental video, will provide patient selection, procedural planning and technical insights for performing BVF and BVR.
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Affiliation(s)
- Keith B Allen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - John T Saxon
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - Chetan P Huded
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation and Centre for Heart Valve Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
| | | | | | - John G Webb
- Centre for Cardiovascular Innovation and Centre for Heart Valve Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
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Sathananthan J, Landes U, Flaction L, Humair A, Delaloye S, Toggweiler S, Søndergaard L, Wood DA, Webb JG. Long-Term Durability of the Next-Generation Acurate neo 2 Transcatheter Heart Valve: Insights From Bench Testing to 25 Years. JACC Cardiovasc Interv 2021; 14:586-588. [PMID: 33663791 DOI: 10.1016/j.jcin.2020.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 10/22/2022]
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