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Guo Y, Liu X, Li R, Ng S, Liu Q, Wang L, Hu P, Ren K, Jiang J, Fan J, He Y, Zhu Q, Lin X, Li H, Wang J. Comparison of downsizing strategy (HANGZHOU Solution) and standard annulus sizing strategy in type 0 bicuspid aortic stenosis patients undergoing transcatheter aortic valve replacement: Rationale and design of a randomized clinical trial. Am Heart J 2024; 274:65-74. [PMID: 38701961 DOI: 10.1016/j.ahj.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/21/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND There has not been a consensus on the prothesis sizing strategy in type 0 bicuspid aortic stenosis (AS) patients undergoing transcatheter aortic valve replacement (TAVR). Modifications to standard annular sizing strategies might be required due to the distinct anatomical characteristics. We have devised a downsizing strategy for TAVR using a self-expanding valve specifically for patients with type 0 bicuspid AS. The primary aim of this study is to compare the safety and efficacy of downsizing strategy with the Standard Annulus Sizing Strategy in TAVR for patients with type 0 bicuspid AS. TRIAL DESIGN It is a prospective, multi-center, superiority, single-blinded, randomized controlled trial comparing the Down Sizing and Standard Annulus Sizing Strategy in patients with type 0 bicuspid aortic stenosis undergoing transcatheter aortic valve replacement. Eligible participants will include patients with severe type 0 bicuspid AS, as defined by criteria such as mean gradient across aortic valve ≥40 mmHg, peak aortic jet velocity ≥4.0 m/s, aortic valve area (AVA) ≤1.0 cm², or AVA index ≤0.6 cm2/m2. These patients will be randomly assigned, in a 1:1 ratio, to either the Down Sizing Strategy group or the Standard Sizing Strategy group. In the Down Sizing Strategy group, a valve one size smaller will be implanted if the "waist sign" manifests along with less than mild regurgitation during balloon pre-dilatation. The primary end point of the study is a composite of VARC-3 defined device success, absence of both permanent pacemaker implantation due to high-degree atrioventricular block and new-onset complete left bundle branch block. CONCLUSION This study will compare the safety and efficacy of Down Sizing Strategy with the Standard Annulus Sizing Strategy and provide valuable insights into the optimal approach for sizing in TAVR patients with type 0 bicuspid AS. We hypothesize that the Down Sizing Strategy will demonstrate superiority when compared to the Standard Annulus Sizing Strategy. (Down Sizing Strategy (HANGZHOU Solution) vs Standard Sizing Strategy TAVR in Bicuspid Aortic Stenosis (Type 0) (TAILOR-TAVR), NCT05511792).
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Affiliation(s)
- Yuchao Guo
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China; Research Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzhou 310053, China
| | - Ranxi Li
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Stella Ng
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Qiong Liu
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Lihan Wang
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Po Hu
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Kaida Ren
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Jubo Jiang
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Jiaqi Fan
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Yuxin He
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Qifeng Zhu
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Xinping Lin
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Huajun Li
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Jian'an Wang
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China; Research Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzhou 310053, China.
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Rivera FB, Cha SW, Redula SC, Liston MBO, Ong EP, Bantayan NRB, Kaur G, Volgman AS, Mamas MA. Sex differences in transcatheter aortic valve replacement outcomes among patients with bicuspid aortic stenosis. Heart Lung 2024; 67:144-151. [PMID: 38762962 DOI: 10.1016/j.hrtlng.2024.05.003] [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: 10/17/2023] [Revised: 01/22/2024] [Accepted: 05/06/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Despite comprising almost half of all patients undergoing valvular repair, data on transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (BAS) are limited. OBJECTIVE We aimed to evaluate whether there are any sex differences in trends and outcomes of TAVR in this population. METHODS We utilized the National Inpatient Sample from 2012 to 2020 to identify admissions with BAS who underwent TAVR and analyzed trends and outcomes. Our primary outcome was in-hospital mortality and secondary outcomes were in-hospital complications. We used two models to adjust for demographics (A) and interventions (B). RESULTS Between 2012 to 2020, there were 76,540 hospitalizations for BAS patients who underwent AVR, among which 6,010 (7.9 %) underwent TAVR. There was an overall increasing trend in number of TAVR cases with a decreasing trend in mortality (2013: 8.7 %, 2020: 1.3 %). TAVR was performed more in males (61.1% vs 38.9 %). Despite the worse baseline characteristics in males, in-hospital mortality (2.4% vs. 1.5 %; OR: 1.584; 95 % CI: 0.621-4.038; p = 0.335) and secondary outcomes were similar across both sexes, even after adjusting for demographics and interventions. CONCLUSION TAVR in BAS has grown rapidly in the last decade. Males comprised the majority and had more comorbidities, but mortality and complications were similar in both sexes. Despite the increasing number of cases, a decreasing trend in mortality was observed for both sexes ultimately approaching that of SAVR, suggesting that TAVR may be a safe alternative among eligible males and females with bicuspid AS.
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Affiliation(s)
| | | | | | | | - Erika P Ong
- University of the Philippines Manila, Manila City, Philippines
| | | | - Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke-on-Trent, UK
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Boiago M, Bellamoli M, De Biase C, Beneduce A, Alonso LG, Laforgia P, Feliachi S, Oliva OA, Dumonteil N, Tchétché D. Three-year clinical outcomes after transcatheter aortic valve implantation in patients with bicuspid aortic disease: Comparison between self-expanding and balloon-expandable valves. Catheter Cardiovasc Interv 2024. [PMID: 38577939 DOI: 10.1002/ccd.31041] [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: 11/13/2023] [Revised: 03/05/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Bicuspid aortic valve (BAV) stenosis is a complex anatomical scenario for transcatheter aortic valve implantation (TAVI). Favorable short-term clinical outcomes have been reported with TAVI in this setting, but long-term data are scarce. METHODS We retrospectively included, in a single-center registry, patients with BAV stenosis who underwent TAVI before 2020. We compared patients treated with self-expanding valves (SEV) versus balloon-expandable valves (BEV). The primary endpoint was a composite of all-cause mortality, stroke and need for aortic valve (AV) reintervention at 3 years. Secondary endpoints included each component of the primary endpoint, cardiovascular mortality, permanent pacemaker implantation (PPI) rate, mean gradient and ≥moderate paravalvular leak (PVL) rate. RESULTS A total of 150 consecutive patients (SEV = 83, BEV = 67) were included. No significant differences were reported between SEV and BEV groups for the primary composite endpoint (SEV 35.9% vs. BEV 32%, p = 0.66), neither for clinical secondary endpoints (all-cause mortality SEV 28.1% vs. BEV 28%, p = 0.988; cardiovascular mortality SEV 14.1% vs. BEV 20%, p = 0.399; stroke SEV 12.5% vs. BEV 6%, p = 0.342; need for AV reintervention SEV 0% vs. BEV 0%; PPI SEV 28.1% vs. BEV 24%, p = 0.620). A lower mean gradient persisted up to 3 years in the SEV group (SEV 8.8 ± 3.8 mmHg vs. BEV 10.7 ± 3.2 mmHg, p = 0.063), while no significant difference was found in the rate of ≥ moderate PVL (SEV 3/30 vs. BEV 0/25, p = 0.242). CONCLUSIONS In this single center registry, we observed favorable 3-year clinical outcomes in nonselected BAV patients treated with different generation devices, without significant differences between patients receiving SEV or BEV.
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Affiliation(s)
- Mauro Boiago
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Michele Bellamoli
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | | | - Pietro Laforgia
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Souehib Feliachi
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Didier Tchétché
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
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Zhang X, Wu H, Pan Z, Elkoumy A, Ruan Z, Wu T, Wu D, Soliman O, Wu L, Wu X. Mechanism of balloon burst during transcatheter aortic valve replacement pre-dilatation: Image observation and validation by finite element analysis. Comput Biol Med 2024; 168:107714. [PMID: 38035862 DOI: 10.1016/j.compbiomed.2023.107714] [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: 06/29/2023] [Revised: 10/26/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Balloon burst during transcatheter aortic valve replacement (TAVR) is serious complication. This study pioneers a novel approach by combining image observation and computer simulation validation to unravel the mechanism of balloon burst in a patient with bicuspid aortic valve (BAV) stenosis. METHOD A new computational model for balloon pre-dilatation was developed by incorporating the element failure criteria according to the Law of Laplace. The effects of calcification and aortic tissue material parameters, friction coefficients, balloon types and aortic anatomy classification were performed to validate and compare the expansion behavior and rupture mode of actual balloon. RESULTS Balloon burst was dissected into three distinct stages based on observable morphological changes. The mechanism leading to the complete transverse burst of the non-compliant balloon initiated at the folding edges, where contacted with heavily calcified masses at the right coronary sinus, resulting in high maximum principal stress. Local sharp spiked calcifications facilitated rapid crack propagation. The elastic moduli of calcification significantly influenced balloon expansion behavior and crack morphology. The simulation case of the calcific elastic modulus was set at 12.6 MPa could closely mirror clinical appearance of expansion behavior and crack pattern. Furthermore, the case of semi-compliant balloons introduced an alternative rupture mechanism as pinhole rupture, driven by local sharp spiked calcifications. CONCLUSIONS The computational model of virtual balloons could effectively simulate balloon dilation behavior and burst mode during TAVR pre-dilation. Further research with a larger cohort is needed to investigate the balloon morphology during pre-dilation by using this method to guide prosthesis sizing for potential favorable outcomes.
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Affiliation(s)
- Xinmin Zhang
- International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Department of Cardiology, Key Laboratory of Panvascular Diseases of Wenzhou, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haozhe Wu
- School of the Second Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Zhifang Pan
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ahmed Elkoumy
- Islamic Center of Cardiology, Al-Azhar University, Cairo, Egypt; Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, Ireland
| | - Zhisheng Ruan
- International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tianbo Wu
- International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Daozhu Wu
- International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Osama Soliman
- Islamic Center of Cardiology, Al-Azhar University, Cairo, Egypt
| | - Lianpin Wu
- International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Department of Cardiology, Key Laboratory of Panvascular Diseases of Wenzhou, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Xinlei Wu
- International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Department of Cardiology, Key Laboratory of Panvascular Diseases of Wenzhou, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Kalra A, Das R, Alkhalil M, Dykun I, Candreva A, Jarral O, Rehman SM, Majmundar M, Patel KN, Rodes-Cabau J, Reardon MJ, Puri R. Bicuspid Aortic Valve Disease: Classifications, Treatments, and Emerging Transcatheter Paradigms. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2024; 8:100227. [PMID: 38283572 PMCID: PMC10818151 DOI: 10.1016/j.shj.2023.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 09/02/2023] [Accepted: 09/14/2023] [Indexed: 01/30/2024]
Abstract
Bicuspid aortic valve (BAV) is a common congenital valvular malformation, which may lead to early aortic valve disease and bicuspid-associated aortopathy. A novel BAV classification system was recently proposed to coincide with transcatheter aortic valve replacement being increasingly considered in younger patients with symptomatic BAV, with good clinical results, yet without randomized trial evidence. Procedural technique, along with clinical outcomes, have considerably improved in BAV patients compared with tricuspid aortic stenosis patients undergoing transcatheter aortic valve replacement. The present review summarizes the novel BAV classification systems and examines contemporary surgical and transcatheter approaches.
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Affiliation(s)
- Ankur Kalra
- Department of Cardiology, Franciscan Health, Lafayette, Indiana, USA
| | - Rajiv Das
- Department of Cardiothoracic Services, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Mohammad Alkhalil
- Department of Cardiothoracic Services, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Iryna Dykun
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alessandro Candreva
- Department of Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Omar Jarral
- Department of Cardiothoracic Surgery, St. Thomas Hospital, London, UK
| | - Syed M. Rehman
- Department of Cardiothoracic Surgery, OLV Hospital, Aalst, Belgium
| | - Monil Majmundar
- Department of Cardiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kunal N. Patel
- Department of Cardiology, West Virginia University Hospital, Morgantown, West Virginia, USA
| | - Josep Rodes-Cabau
- Department of Interventional Cardiology, Quebec Heart & Lung Institute, Quebec City, Canada
| | - Michael J. Reardon
- Department of Cardiothoracic Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Stephan T, Krohn-Grimberghe M, von Lindeiner genannt von Wildau A, Buck C, Baumhardt M, Mörike J, Gonska B, Rottbauer W, Buckert D. Cusp-overlap view reduces conduction disturbances and permanent pacemaker implantation after transcatheter aortic valve replacement even with balloon-expandable and mechanically-expandable heart valves. Front Cardiovasc Med 2023; 10:1269833. [PMID: 38107259 PMCID: PMC10722163 DOI: 10.3389/fcvm.2023.1269833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Background Conduction disturbances demanding permanent pacemaker implantation (PPI) remain a common complication after transcatheter aortic valve replacement (TAVR). Optimization of the implantation depth (ID) by introducing the cusp-overlap projection (COP) technique led to a reduced rate of PPI when self-expanding valves were used. Objectives The aim of the present study was to determine if using the novel COP view is applicable for all types of TAVR prosthesis and results in a higher ID and reduced incidence of new conduction disturbances and PPI. Methods In this prospective case-control study 586 consecutive patients undergoing TAVR with either balloon-expandable Edwards SAPIEN S3 (n = 280; 47.8%), or mechanically expandable Boston LOTUS Edge heart valve prostheses (n = 306; 52.2%) were included. ID as well as rates of periprocedural PPI and left bundle branch block (LBBB) were compared between the conventional three-cusp coplanar (TCC) projection and the COP view for implantation. Results Of 586 patients, 282 (48.1%) underwent TAVR using COP, whereas in 304 patients (51.9%) the TCC view was applied. Using COP a significantly higher ID was achieved in Edwards SAPIEN S3 TAVR procedures (ID mean difference -1.0 mm, 95%-CI -1.9 to -0.1 mm; P = 0.029), whereas the final platform position did not differ significantly between both techniques when a Boston LOTUS Edge valve was used (ID mean difference -0.1 mm, 95%-CI -1.1 to +0.9 mm; P = 0.890). In Edwards SAPIEN S3 valves, higher ID was associated with a numerically lower post-procedural PPI incidence (4.9% vs. 7.3%; P = 0.464). Moreover, ID was significantly deeper in patients requiring PPI post TAVR compared to those without PPI [8.7 mm (6.8-10.6 mm) vs. 6.5 mm (6.1-7.0 mm); P = 0.005]. In Boston LOTUS Edge devices, COP view significantly decreased the incidence of LBBB post procedure (28.1% vs. 47.9%; P < 0.001), while PPI rates were similar in both groups (21.6% vs. 25.7%; P = 0.396). Conclusion The present study demonstrates the safety, efficacy and reproducibility of the cusp-overlap view even in balloon-expandable and mechanically-expandable TAVR procedures. Application of COP leads to significantly less LBBB in repositionable Boston LOTUS Edge valves and a numerically lower PPI rate in Edwards SAPIEN S3 valves post TAVR compared to the standard TCC projection. The results should encourage to apply the COP view more widely in clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Dominik Buckert
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
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Fiorina C, Massussi M, Ancona M, Montorfano M, Petronio AS, Tarantini G, Castriota F, Chizzola G, Costa G, Tamburino C, Adamo M. Mid-term outcomes and hemodynamic performance of transcatheter aortic valve implantation in bicuspid aortic valve stenosis: Insights from the bicuSpid TAvi duraBILITY (STABILITY) registry. Catheter Cardiovasc Interv 2023; 102:1132-1139. [PMID: 37668083 DOI: 10.1002/ccd.30813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/11/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Limited data are available on transcatheter heart valves (THVs) durability in bicuspid aortic valve (BAV) stenosis. AIMS To evaluate evaluating 4-year clinical and echocardiographic outcomes of patients with BAV undergoing transcatheter aortic valve implantation (TAVI). METHODS The bicuSpid TAvi duraBILITY (STABILITY) registry is an Italian multicentre registry including all consecutive patients with BAV and severe aortic stenosis (AS), treated by means of TAVI between January 2011 and December 2017. Outcomes of interest were all-cause death at 4-year, over time changes in echocardiographic measurements, and THV durability according to the valve aortic research consortium (VARC)-3 update definitions. RESULTS Study population included 109 patients (50% females; mean age 78 ± 7.5 years) with a mean Society of Thoracic Surgeons Predicted Risk of Mortality score of 5.1 ± 4.3%. Median follow-up (FU) duration was 4.1 years [interquartile range: 2.8-5.1]. The overall cumulative incidence of all-cause death by Kaplan-Meier estimates at 4 years was 32%. Compared to baseline, a significant decrease in transprosthetic mean gradient was obtained after TAVI (54 ± 16 vs. 10 ± 5 mmHg; p < 0.001), whereas a significant increase was observed at 4-year (13 ± 6.4 mmHg, p = 0.03). Cumulative incidence of hemodynamic valve dysfunction (HVD) was 4%. Six patients met HVD criteria: three moderate and three severe HVD. All three cases of severe HVD were clinically relevant (bioprosthetic valve failure [BVF]) with two patients receiving a reintervention (TAVI in TAVI), and one patient experiencing a valve-related death due to endocarditis. CONCLUSIONS The STABILITY registry suggests that in patients with severe AS and BAV undergoing TAVI, postprocedural clinical benefits might last, over time, up to 4-year FU. The low rates of severe HVD and BVF may support the hypothesis of good THV durability also in BAV recipient.
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Affiliation(s)
- Claudia Fiorina
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili Brescia and Department of Medical and Surgery Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Mauro Massussi
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili Brescia and Department of Medical and Surgery Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ancona
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Anna Sonia Petronio
- Cardio Thoracic and Vascular Department, Cardiac Catheterization Laboratory, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giuseppe Tarantini
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Fausto Castriota
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care and Research, Maria Cecilia Hospita, Ravenna, Italy
| | - Giuliano Chizzola
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili Brescia and Department of Medical and Surgery Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili Brescia and Department of Medical and Surgery Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Tchétché D, Ziviello F, De Biase C, De Backer O, Hovasse T, Leroux L, Petronio AS, Saint-Etienne C, Teles RC, Modine T, Sudre A, Teiger E, Mylotte D, Souteyrand G, Piazza N, Casassus F, Sondergaard L, Angelillis M, Nolasco T, Siddiqui S, Kardys I, Dumonteil N, Van Mieghem NM. Transcatheter aortic valve implantation with the Evolut platform for bicuspid aortic valve stenosis: the international, multicentre, prospective BIVOLUTX registry. EUROINTERVENTION 2023; 19:502-511. [PMID: 37203860 PMCID: PMC10436069 DOI: 10.4244/eij-d-23-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/17/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Prospective data about transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BAV) patients are limited. AIMS We aimed to evaluate the clinical impact of the Evolut PRO and R (34 mm) self-expanding prostheses in BAV patients and explore the impact of different computed tomography (CT) sizing algorithms in a prospective registry. METHODS A total of 149 bicuspid patients were treated in 14 countries. The primary endpoint was the intended valve performance at 30 days. Secondary endpoints were 30-day and 1-year mortality, severe patient-prosthesis mismatch (PPM) and the ellipticity index at 30 days. All study endpoints were adjudicated according to Valve Academic Research Consortium 3 criteria. RESULTS The mean Society of Thoracic Surgeons score was 2.6% (1.7-4.2). Type I L-R BAV was observed in 72.5% of the patients. Evolut valve sizes 29 and 34 mm were utilised in 49.0% and 36.9% of the cases, respectively. The 30-day cardiac death rate was 2.6%; the 1-year cardiac death rate was 11.0%. Valve performance at 30 days was observed in 142/149 (95.3%) patients. The mean aortic valve area post-TAVI was 2.1 (1.8-2.6) cm2, and the mean aortic gradient was 7.2 (5.4-9.5) mmHg. No patient had more than moderate aortic regurgitation at 30 days. PPM was observed in 13/143 (9.1%) surviving patients and was severe in 2 patients (1.6%). Valve function was maintained at 1 year. The mean ellipticity index remained 1.3 (interquartile range 1.2-1.4). Overall, 30-day and 1-year clinical and echocardiography outcomes were similar between the two sizing strategies. CONCLUSIONS BIVOLUTX demonstrated a favourable bioprosthetic valve performance and good clinical outcomes after TAVI with the Evolut platform in patients with bicuspid aortic stenosis. No impact from the sizing methodology could be identified.
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Affiliation(s)
| | | | | | | | | | - Lionel Leroux
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | | | - Rui Campante Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Thomas Modine
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Arnaud Sudre
- Centre Hospitalier Universitaire de Lille, Lille, France
| | - Emmanuel Teiger
- Centre Hospitalier Universitaire Henri-Mondor, Créteil, France
| | | | | | - Nicolo Piazza
- McGill University Health Centre, Montreal, QC, Canada
| | | | | | | | - Tiago Nolasco
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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9
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Zhou Y, Zhu Q, Lin X, Li H, Pu Z, Liu X, Wang J. Impact of early changes in cardiac damage following transcatheter aortic valve implantation. EUROINTERVENTION 2023; 19:267-276. [PMID: 36929934 PMCID: PMC11064681 DOI: 10.4244/eij-d-22-00817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/10/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The staging classification of aortic stenosis (AS) which characterises the extent of cardiac damage has been validated in patients undergoing transcatheter aortic valve implantation (TAVI). Short-term changes in cardiac damage after TAVI and their association with long-term prognosis remain unknown. AIMS This study aims to investigate the early evolution of cardiac damage after TAVI and the association of residual cardiac damage with clinical outcomes in TAVI recipients. METHODS AS patients undergoing TAVI were consecutively enrolled and classified into five stages of cardiac damage (0-4). Early change in cardiac damage was defined as any change of stage at 30 days (Δcardiac damage between baseline pre-TAVI and 30 days post-TAVI). RESULTS Within 30 days post-TAVI, the baseline cardiac damage stage had changed in 22.2% of 644 TAVI recipients, accompanied by improvements in the degree of dyspnoea and left ventricular ejection fraction (LVEF). Two-year mortality was associated with residual cardiac damage within 30 days post-TAVI (hazard ratio [HR] 2.97, 95% confidence interval [CI]: 2.07-4.25; p<0.001). Compared to unchanged cardiac damage post-TAVI, further cardiac damage within 30 days was associated with a higher crude risk of 2-year mortality (HR 22.04, 95% CI: 9.87-49.20; p<0.001). Cardiac deterioration within 30 days post-TAVI was an independent risk factor for 2-year mortality (HR 19.564, 95% CI: 8.047-47.565; p<0.001). CONCLUSIONS This investigation provided insight into the early evolution of cardiac damage in TAVI recipients and confirmed the predictive value of both residual and early changes in cardiac damage post-TAVI. Cardiac deterioration within 30 days is associated with poor clinical prognosis.
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Affiliation(s)
- Yaoyao Zhou
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
- Department of Cardiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People's Republic of China
| | - Qifeng Zhu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xinping Lin
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Huajun Li
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Zhaoxia Pu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xianbao Liu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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Elkoumy A, Jose J, Terkelsen CJ, Nissen H, Gunasekaran S, Abdelshafy M, Seth A, Elzomor H, Kumar S, Bedogni F, Ielasi A, Arsang-Jang S, Dora SK, Chandra S, Parikh K, Unic D, Baumbach A, Serruys P, Soliman O. One-Year Outcomes after Myval Implantation in Patients with Bicuspid Aortic Valve Stenosis-A Multicentre Real-World Experience. J Clin Med 2023; 12:jcm12062398. [PMID: 36983397 PMCID: PMC10054138 DOI: 10.3390/jcm12062398] [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: 01/30/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Bicuspid aortic valve (BAV) affects approximately 1.5% of the general population and is seen in nearly 50% of candidates for aortic valve replacement (AVR). Despite increasingly utilised transcatheter aortic valve implantation (TAVI) in aortic stenosis (AS) patients, its use among patients with severe bicuspid AS is limited as BAV is a heterogeneous disease associated with multiple and complex anatomical challenges. AIM To investigate the one-year outcomes of TAVI using the balloon-expandable Myval transcatheter heart valve (THV) (Meril Life Sciences Pvt. Ltd., Vapi, India) in patients with severe bicuspid AS. METHODS AND RESULTS We collected data from consecutive patients with bicuspid AS who underwent TAVI with the Myval THV and had at least one-year follow-up. Baseline characteristics, procedural, and 30-day echocardiographic and clinical outcomes were collected. Sixty-two patients were included in the study. The median age was 72 [66.3, 77.0] years, 45 (72.6%) were males, and the mean STS PROM score was 3.2 ± 2.2%. All TAVI procedures were performed via the transfemoral route. The median follow-up duration was 13.5 [12.2, 18.3] months; all-cause mortality was reported in 7 (11.3%) patients and cardiovascular hospitalisation in 6 (10.6%) patients. All-stroke was reported in 2 (3.2%), permanent pacemaker implantation 5 (8.3%), and myocardial infarction 1 (1.6%) patients. The echocardiographic assessment revealed a mean pressure gradient of 10 [8, 16.5] mmHg, effective orifice area 1.7 [1.4, 1.9] cm2, moderate AR in 1 (2%), mild AR in 14 (27%), and none/trace AR in 37 (71%). In total, 1 patient was diagnosed with valve thrombosis (2.1%), Stage II (moderate) haemodynamic deterioration was seen in 3 (6.4%), and stage III (severe) haemodynamic deterioration in 1 (2.1%) patient. CONCLUSIONS TAVI with the Myval THV in selected BAV anatomy is associated with favourable one-year hemodynamic and clinical outcomes.
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Affiliation(s)
- Ahmed Elkoumy
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
- Islamic Center of Cardiology, Al-Azhar University, Cairo 11651, Egypt
| | - John Jose
- Christian Medical College & Hospital, Vellore 632004, India
| | | | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark
| | | | - Mahmoud Abdelshafy
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
- Department of Cardiology, Al-Azhar University, Cairo 11311, Egypt
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi 110025, India
| | - Hesham Elzomor
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
| | - Sreenivas Kumar
- Department of Cardiology, Apollo Hospitals, Apollo Health City, Jubilee Hills, Hyderabad 500050, India
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, 20149 Milan, Italy
| | - Shahram Arsang-Jang
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
- CÚRAM-SFI Research Centre for Medical Devices, H91 TK33 Galway, Ireland
| | | | - Sharad Chandra
- Department of Cardiology, King George's Medical University, Lucknow 226003, India
| | - Keyur Parikh
- Care Institute of Medical Sciences, Ahmedabad 380060, India
| | - Daniel Unic
- Department of Cardiac and Transplant Surgery, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Andreas Baumbach
- Barts Heart Centre, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - Patrick Serruys
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, 20149 Milan, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London SW7 2AZ, UK
| | - Osama Soliman
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
- CÚRAM-SFI Research Centre for Medical Devices, H91 TK33 Galway, Ireland
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Technical Success after Transcatheter Aortic Valve Replacement for Bicuspid versus Tricuspid Aortic Stenosis. J Clin Med 2023; 12:jcm12010343. [PMID: 36615142 PMCID: PMC9821499 DOI: 10.3390/jcm12010343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Background: Comparative data of the Valve Academic Research Consortium (VARC-3)-defined technical success between bicuspid versus tricuspid aortic stenosis (AS) remain lacking. Aims: We sought to compare the technical success and other clinical outcomes between patients with bicuspid and tricuspid AS receiving transcatheter aortic valve replacement. Methods: A registration-based analysis was performed for 402 patients (211 and 191 cases of bicuspid and tricuspid AS, respectively). The primary outcome was VARC-3-defined technical success. Additional analysis was performed to assess outcomes for up to one year between the two groups. Results: Bicuspid AS patients tended to be younger (74 years vs. 77 years; p < 0.001) with a lower Society of Thoracic Surgeons score (4.4% vs. 5.4%; p = 0.003). Bicuspid AS patients showed a lower prevalence of hypertension and peripheral vascular diseases. Technical failure was encountered in 17.7% of these patients, driven primarily by the high incidence of second valve implantation. The technical success rates were comparable between the bicuspid and tricuspid AS groups (82.5% vs. 82.2%, p = 0.944). Chronic kidney disease (CKD) and larger sinotubular junctional diameter (STJ) were identified as predictors of technical failure, whereas CKD, impaired left ventricular ejection fraction (LVEF), along with larger STJ, were predictors of cardiac technical failure. Technical failure was associated with an increased risk of all-cause mortality at 30 days and 1 year, as evidenced by the Cox multivariable analysis. Conclusions: No significant differences were observed in the technical success rates and most clinical outcomes between the bicuspid and tricuspid AS groups. Technical failure conferred an increased risk for both 30-day and 1-year all-cause mortalities.
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12
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Yu J, Wang Z, Bao Q, Lei S, You Y, Yin Z, Xie X. Global burden of calcific aortic valve disease and attributable risk factors from 1990 to 2019. Front Cardiovasc Med 2022; 9:1003233. [PMID: 36505369 PMCID: PMC9727398 DOI: 10.3389/fcvm.2022.1003233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Calcific aortic valve disease (CAVD) was highly prevalent among developed countries and caused numerous deaths. Based on the Global Burden of Disease 2019, this study was designed to present comprehensive epidemiological information, attributable risks, and relevant factors. Methods All data were available online via the Global Health Data Exchange (GHDx). In this study, we analyzed the global incidence, prevalence, deaths, and disability-adjusted life years (DALYs) of CAVD across different regions from 1990 to 2019. We applied the estimated annual percentage changes (EAPCs) to evaluate the change trends and their attributable risks. In addition, we explored several relevant factors. Results From 1990 to 2019, the incidence cases, prevalence cases, CAVD-related deaths, and DALYs of CAVD gradually increased globally. However, the age-standardized death rate (ASDR) was relatively stable, and the age-standardized DALYs rate gradually declined during the past 30 years. Males and elderly individuals were more likely to suffer from CAVD. High systolic blood pressure (SBP) was the predominant attributable risk of disease burden that presented a global downward trend (death: EAPC = -0.68, 95% CI -0.77~-0.59, P < 0.001; DALYs: EAPC = -0.99, 95% CI -1.09 to -0.89, P < 0.001). Alcohol consumption (R = 0.79, P < 0.001), smoking prevalence (R = 0.75, P < 0.001), and calcium (R = 0.72, P < 0.001) showed a positive correlation with the age-standardized incidence rate (ASIR), whereas classic monsoon region (R = -0.68, P < 0.001) and mean temperature (R = -0.7, P < 0.001) showed a negative correlation with age-standardized incidence rate (ASIR). Besides, medical and healthcare resources presented a positive correlation with ASIR. Meanwhile, similar relationships were found in age-standardized prevalence rate (ASPR), ASDR, and age-standardized DALY rate (ASDALYR). Conclusion CAVD displays widely varied spatial distribution around the world, of which high SDI regions have the highest burdens. Age is a powerful factor and hypertension a predominant attributable risk factor. Moreover, controlling blood pressure, avoiding smoking, reducing alcohol consumption, and so on, could effectively reduce the burden of CAVD.
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13
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Liu X, Zhou D, Fan J, Dai H, Zhu G, Chen J, Guo Y, Yidilisi A, Zhu Q, He Y, Wei Y, Liu Q, Qi X, Wang J. Cerebral Ischemic Lesions after Transcatheter Aortic Valve Implantation in Patients with Non-Calcific Aortic Stenosis. J Clin Med 2022; 11:6502. [PMID: 36362730 PMCID: PMC9655232 DOI: 10.3390/jcm11216502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 04/24/2024] Open
Abstract
Evidence for transcatheter aortic valve implantation (TAVI) is scarce among patients with non-calcific aortic stenosis, and it is not known whether aortic valve calcification is associated with new cerebral ischemic lesions (CILs) that are detected by diffusion-weighted magnetic resonance imaging. So, our study enrolled 328 patients who underwent transfemoral TAVI using a self-expanding valve between December 2016 and June 2021 from the TORCH registry (NCT02803294). A total of 34 patients were finally confirmed as non-calcific AS and the remaining 294 patients were included in the calcific AS group. Incidence of new CILs (70.6% vs. 85.7%, p = 0.022), number of lesions (2.0 vs. 3.0, p = 0.010), and lesions volume (105.0 mm3 vs. 200.0 mm3, p = 0.047) was significantly lower in the non-calcific AS group. However, the maximum and average lesion volumes were comparable between two groups. Non-calcific AS was associated with lower risk for developing new CILs by univariate logistic regression analysis [Odds ratio (OR): 0.040, 95% confident interval (CI): 0.18-0.90, p = 0.026] and multivariate analysis (OR: 0.031, 95% CI: 0.13-0.76, p = 0.010). In summary, non-calcific AS patients had a lower risk of developing new cerebral ischemic infarction after TAVI compared to calcific AS patients. However, new ischemic lesions were still found in over 70% of patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jian’an Wang
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, China
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14
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Chen Y, Zhu G, Liu X, Wu W, Chai H, Tao M, Kong D, Li Y, Wang L. Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:927642. [PMID: 36061562 PMCID: PMC9428452 DOI: 10.3389/fcvm.2022.927642] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Permanent pacemaker implantation (PPI) is a common complication after transcatheter aortic valve replacement (TAVR). Recently, the cusp-overlap projection (COP) technique was thought to be a feasible method to reduce PPI risk. However, the evidence is still relatively scarce. Therefore, this meta-analysis was performed to compare COP and standard three-cusp coplanar (TCC) projection technique. Methods PubMed and EMBASE databases were systematically searched for relevant literature published from the inception (EMBASE from 1974 and PubMed from 1966) to 16 April 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome of interest was post-operative (including in-hospital and 30-day) PPI. Results Total of 3,647 subjects from 11 studies were included in this meta-analysis. Of those, 1,453 underwent self-expanding TAVR using COP and 2,194 using TCC technique. In a pooled analysis, the cumulative PPI incidence was 9.3% [95% confidence interval (CI): 6.9–11.7%] and 18.9% (95% CI: 15.5–22.3%) in the COP group and TCC group, respectively. The application of the COP technique was associated with a significant PPI risk reduction (I2 = 40.3% and heterogeneity Chi-square p = 0.070, random-effects OR: 0.49, 95% CI: 0.36–0.66, p < 0.001). A higher implantation depth was achieved in the COP group compared with the TCC group [standardized mean difference (SMD) = −0.324, 95% CI: (−0.469, −0.180)]. There was no significant difference between the two groups in second valve implantation, prosthesis pop-out, fluoroscopic time, post-operative left bundle branch block, mortality, stroke, moderate/severe paravalvular leakage, mean gradient, and length of hospital stay. However, radiation doses were higher in the COP group [SMD = 0.394, 95% CI: (0.216, 0.572), p < 0.001]. Conclusion In self-expanding TAVR, the application of the cusp overlap projection technique was associated with a lower risk of PPI compared with the standard TCC technique. Systematic review registration [https://inplasy.com/inplasy-2022-4-0092/], identifier [INPLASY202240092].
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Affiliation(s)
- Yujing Chen
- Department of Hepatobiliary Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Yujing Chen,
| | - Gangjie Zhu
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin Liu
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weilin Wu
- Department of Endocrinology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Chai
- Department of Hepatobiliary Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minjie Tao
- Department of Hepatobiliary Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dongmei Kong
- Department of Hepatobiliary Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yingzi Li
- Department of Hepatobiliary Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li Wang
- Department of Hepatobiliary Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Li Wang,
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Dai H, Zhou D, Fan J, Wang L, Yidilisi A, Zhu G, Jiang J, Li H, Liu X, Wang J. Emergently Alteration of Procedural Strategy During Transcatheter Aortic Valve Replacement to Prevent Coronary Occlusion: A Case Report. Front Cardiovasc Med 2022; 9:931595. [PMID: 35966563 PMCID: PMC9363569 DOI: 10.3389/fcvm.2022.931595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCoronary occlusion is an uncommon but fatal complication of transcatheter aortic valve replacement (TAVR) with a poor prognosis.Case PresentationA patient with symptomatic severe bicuspid aortic valve stenosis was admitted to a high-volume center specializing in transfemoral TAVR with self-expanding valves. No anatomical risk factors of coronary occlusion were identified on pre-procedural computed tomography analysis. The patient was scheduled for a transfemoral TAVR with a self-expanding valve. Balloon pre-dilatation prior to prosthesis implantation was routinely used for assessing the supra-annular structure and assessing the risk of coronary occlusion. Immediately after the tubular balloon inflation, fluoroscopy revealed that the right coronary artery was not visible, and the flow in the left coronary artery was reduced. The patient would be at high-risk of coronary occlusion if a long stent self-expanding valve was implanted. Therefore, our heart team decided to suspend the ongoing procedure. A transapical TAVR with a 23 mm J-valve was performed 3 days later. The prosthesis was deployed at a proper position without blocking the coronary ostia and the final fluoroscopy showed normal flow in bilateral coronary arteries with the same filling as preoperatively.DiscussionOur successful case highlights the importance of a comprehensive assessment of coronary risk and a thorough understanding of the TAVR procedure for the heart team. A short-stent prosthesis is feasible for patients at high risk of coronary occlusion. Most importantly TAVR should be called off even if the catheter has been introduced when an extremely high risk of coronary obstruction is identified during the procedure and no solution can be found.
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Affiliation(s)
- Hanyi Dai
- Internal Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Dao Zhou
- Internal Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaqi Fan
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Lihan Wang
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Abuduwufuer Yidilisi
- Internal Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Gangjie Zhu
- Internal Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jubo Jiang
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Huajun Li
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xianbao Liu
- Internal Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Xianbao Liu,
| | - Jian’an Wang
- Internal Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- Jian’an Wang,
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Van Belle E, Vincent F. Durability of transcatheter aortic valve implantation in bicuspid aortic valve stenosis: the last missing piece? EUROINTERVENTION 2022; 18:185-187. [PMID: 35747951 PMCID: PMC9912969 DOI: 10.4244/eij-e-22-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Eric Van Belle
- Department of Cardiology, Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, Bd Professeur Jules Leclercq, 59037 Lille, France
| | - Flavien Vincent
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Cœur Poumon, Cardiology, CHU Lille, Lille, France,Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
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