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Mori R, Gemma D, Casado A, Sliwinsky F, Reyes RM, Palazuelos J. Transcatheter bi-caval valve system: The initial experience. J Cardiol 2024; 84:65-66. [PMID: 38582494 DOI: 10.1016/j.jjcc.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Ricardo Mori
- Cardiología Clínica e Intervencionista, Unidad Integral de Cardiología, Hospital Universitario La Luz, Grupo Quirónsalud, Madrid, Spain.
| | - Daniele Gemma
- Cardiología Clínica e Intervencionista, Unidad Integral de Cardiología, Hospital Universitario La Luz, Grupo Quirónsalud, Madrid, Spain
| | - Ana Casado
- Cardiología Clínica e Intervencionista, Unidad Integral de Cardiología, Hospital Universitario La Luz, Grupo Quirónsalud, Madrid, Spain
| | - Frank Sliwinsky
- Cardiología Clínica e Intervencionista, Unidad Integral de Cardiología, Hospital Universitario La Luz, Grupo Quirónsalud, Madrid, Spain
| | - Roberto Martín Reyes
- Cardiología Clínica e Intervencionista, Unidad Integral de Cardiología, Hospital Universitario La Luz, Grupo Quirónsalud, Madrid, Spain
| | - Jorge Palazuelos
- Cardiología Clínica e Intervencionista, Unidad Integral de Cardiología, Hospital Universitario La Luz, Grupo Quirónsalud, Madrid, Spain
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Pieri M, Dormio S, Morosato M, Belletti A, Silvestri D, Montorfano M, Monaco F. Shaping the Anesthetic Approach to TricValve Implantation: Insights From a Case Series. J Cardiothorac Vasc Anesth 2024; 38:911-917. [PMID: 38281824 DOI: 10.1053/j.jvca.2024.01.003] [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: 07/03/2023] [Revised: 11/29/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Caval valve implantation (CAVI) represents a minimally invasive strategy for managing severe tricuspid regurgitation in high-risk patients unsuitable for surgical or transcatheter tricuspid valve implantation. This case series aimed to assess the anesthesia management challenges and outcomes associated with this procedure, seeking to generate insights that can inform and refine anesthesia protocols. DESIGN A case series. SETTING At a cardiac catheterization laboratory of a teaching hospital. PARTICIPANTS Eight patients undergoing CAVI with the Tricvalve system INTERVENTIONS: The anesthetic protocol included preprocedural planning, fast-track general anesthesia, and postprocedural debriefing. Intraoperative management involved anesthesia depth monitoring, real-time guidance via transesophageal echocardiography, and hemodynamic stability maintenance. Postoperative analgesia involved preemptive intravenous paracetamol and morphine as needed. MEASUREMENTS AND MAIN RESULTS No anesthesia-related or implantation-related complications were observed, with a mean procedure duration of 112 ± 44 minutes. The median hospital stay was 4 days, and only 1 patient required brief intensive care unit monitoring. Postoperative right shoulder pain was reported by half of the patients, and was managed with morphine bolus administration (average dose 4.75 ± 3.6 mg). All patients had the device correctly positioned, as confirmed by postoperative transthoracic echocardiograms. None of the patients required outpatient analgesic therapy upon discharge. CONCLUSIONS The authors' study demonstrated the potential of TricValve implantation in effectively managing severe tricuspid regurgitation with no procedure-related complications and a 100% survival rate. A collaborative, interdisciplinary approach and targeted anesthesia management proved crucial for this success. Postoperative shoulder pain emerged as a frequent complication, whose pathogenesis is still not clear, and successfully was managed using targeted analgesic therapy.
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Affiliation(s)
- Marina Pieri
- Department of Cardiothoracic and Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Sara Dormio
- Department of Cardiothoracic and Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Morosato
- Cardiothoracic Department, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessandro Belletti
- Department of Cardiothoracic and Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Dario Silvestri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Vita-Salute San Raffaele University, Milan, Italy; Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Monaco
- Department of Cardiothoracic and Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Maisano F, Hahn R, Sorajja P, Praz F, Lurz P. Transcatheter treatment of the tricuspid valve: current status and perspectives. Eur Heart J 2024; 45:876-894. [PMID: 38426859 DOI: 10.1093/eurheartj/ehae082] [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: 08/02/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Transcatheter tricuspid valve interventions (TTVI) are emerging as alternatives to surgery in high-risk patients with isolated or concomitant tricuspid regurgitation. The development of new minimally invasive solutions potentially more adapted to this largely undertreated population of patients, has fuelled the interest for the tricuspid valve. Growing evidence and new concepts have contributed to revise obsolete and misleading perceptions around the right side of the heart. New definitions, classifications, and a better understanding of the disease pathophysiology and phenotypes, as well as their associated patient journeys have profoundly and durably changed the landscape of tricuspid disease. A number of registries and a recent randomized controlled pivotal trial provide preliminary guidance for decision-making. TTVI seem to be very safe and effective in selected patients, although clinical benefits beyond improved quality of life remain to be demonstrated. Even if more efforts are needed, increased disease awareness is gaining momentum in the community and supports the establishment of dedicated expert valve centres. This review is summarizing the achievements in the field and provides perspectives for a less invasive management of a no-more-forgotten disease.
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Affiliation(s)
- Francesco Maisano
- Division of Cardiac Surgery and Valve Center, IRCCS Ospedale San Raffaele, Università Vita Salute, Via Olgettina 60, 20132 Milano, Italy
| | - Rebecca Hahn
- Department of Medicine, Columbia University Irving Medical Center, New York, 161 Fort Washington Avenue, 10032 New York, NY, USA
| | - Paul Sorajja
- Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 East 28th Street, Suite 100, 55407 Minneapolis, MN, USA
| | - Fabien Praz
- Bern University Hospital, University of Bern, Anna-Seiler-Haus Freiburgstrasse 20, 3010 Bern, Switzerland
| | - Philipp Lurz
- Department of Cardiology, Universitätsmedizin Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
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Cersosimo A, Gavazzoni M, Inciardi RM, Radulescu CI, Adamo M, Arabia G, Metra M, Raddino R, Vizzardi E. Right ventricle assessment before tricuspid valve interventions. J Cardiovasc Med (Hagerstown) 2024; 25:95-103. [PMID: 38149699 PMCID: PMC10906196 DOI: 10.2459/jcm.0000000000001574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 12/28/2023]
Abstract
In the latest ESC/EACTS Guidelines for the Management of Valvular Heart Disease, right ventricular dilatation and dysfunction, severe pulmonary hypertension and tricuspid annulus dilatation were reported to be the most important parameters to consider in patient selection for tricuspid valve interventions. Indeed, comprehensive right ventricular assessment is crucial in patients with severe tricuspid regurgitation who may benefit from transcatheter or surgical procedures. However, the only guideline parameter considered for intervention has been tricuspid annular dilatation in the presence of at least mild to moderate tricuspid regurgitation, with no other right ventricular markers used in the decision-making process for invasive treatment. Notably, challenges in the assessment of right ventricular function may limit establishing thresholds for defining right ventricular dysfunction. The aim of this review is to summarize current evidence on the prognostic significance of right ventricular function in patients with tricuspid regurgitation undergoing percutaneous or surgical interventions.
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Affiliation(s)
- Angelica Cersosimo
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Mara Gavazzoni
- Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Riccardo Maria Inciardi
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Crina Ioana Radulescu
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Gianmarco Arabia
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Marco Metra
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Riccardo Raddino
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Enrico Vizzardi
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
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Dershowitz L, Lawlor MK, Hamid N, Kampaktsis P, Ning Y, Vahl TP, Nazif T, Khalique O, Ng V, Kurlansky P, Leon M, Hahn R, Kodali S, George I. Right ventricular remodeling and clinical outcomes following transcatheter tricuspid valve intervention. Catheter Cardiovasc Interv 2024; 103:367-375. [PMID: 37890014 DOI: 10.1002/ccd.30850] [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: 04/07/2023] [Revised: 08/20/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023]
Abstract
AIMS Characterize the impact of residual tricuspid regurgitation (TR) on right ventricle (RV) remodeling and clinical outcomes after transcatheter tricuspid valve intervention. METHODS We performed a single-center retrospective analysis of transcatheter tricuspid valve repair (TTVr) or replacement (TTVR) patients. The primary outcomes were longitudinal tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), pulmonary artery systolic pressure (PASP), and RV dimensions (RVd). We used multivariable linear mixed models to evaluate association with replacement versus repair and degree of TR reduction with changes in these echo measures over time. Multivariable Cox regression was used to identify associations between changes in these echo measures and a composite clinical outcome of death, heart failure hospitalization, or re-do tricuspid valve intervention. RESULTS We included a total of 61 patients; mean age was 77.5 ± 11.7 and 62% were female. TTVR was performed in 25 (41%) and TTVr in 36 (59%). Initially, 72% (n = 44) had ≤ severe TR and 28% (n = 17) had massive or torrential TR. The median number of follow up echos was 2: time to 1st follow-up was 50 days (interquartile range [IQR]: 20, 91) and last follow-up was 147 (IQR: 90, 327). Median TR reduction was 1 (IQR: 0, 2) versus 4 (IQR: 3, 6) grades in TTVr versus TTVR (p < 0.0001). In linear mixed modeling, TTVR was associated with decline in TAPSE and PASP, and TR reduction was associated with decreased RVd. In multivariable Cox regression, greater RVd was associated with the clinical outcome (hazard ratio: 9.27, 95% confidence interval: 1.23-69.88, p = 0.03). CONCLUSION Greater TR reduction is achieved by TTVR versus TTVr, which is in turn associated with RV reverse remodeling. RV dimension in follow-up is associated with increased risk of a composite outcome of death, heart failure hospitalization, or re-do tricuspid valve intervention.
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Affiliation(s)
- Lyle Dershowitz
- Division of Internal Medicine, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Matthew K Lawlor
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Nadira Hamid
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Polydoros Kampaktsis
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Yuming Ning
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York City, New York, USA
| | - Torsten P Vahl
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Tamim Nazif
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Omar Khalique
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Vivian Ng
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Paul Kurlansky
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York City, New York, USA
| | - Martin Leon
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Rebecca Hahn
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Susheel Kodali
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Isaac George
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
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Stocker TJ. Last, But Not Least: TricValve Implantation Reduces Heart Failure Burden in Severe Tricuspid Regurgitation. JACC Cardiovasc Interv 2024; 17:73-75. [PMID: 38069987 DOI: 10.1016/j.jcin.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Thomas J Stocker
- Department of Cardiology, Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
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Blasco-Turrión S, Briedis K, Estévez-Loureiro R, Sánchez-Recalde A, Cruz-González I, Pascual I, Mascherbauer J, Abdul-Jawad Altisent O, Nombela-Franco L, Pan M, Trillo R, Moreno R, Delle Karth G, Sánchez-Luna JP, Gonzalez-Gutiérrez JC, Revilla-Orodoea A, Zamorano JL, Gómez-Salvador I, Puri R, San Román JA, Amat-Santos IJ. Bicaval TricValve Implantation in Patients With Severe Symptomatic Tricuspid Regurgitation: 1-Year Follow-Up Outcomes. JACC Cardiovasc Interv 2024; 17:60-72. [PMID: 38069986 DOI: 10.1016/j.jcin.2023.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Several orthotopic transcatheter strategies have been developed to treat severe tricuspid regurgitation (TR); however, many patients are deemed unsuitable. Caval valve implantation with the TricValve system addresses this unmet need. OBJECTIVES This study sought to determine the impact of TricValve on systemic congestion and quality of life (QOL) at 1 year. METHODS The TRICUS (Safety and Efficacy of the TricValve® Transcatheter Bicaval Valves System in the Superior and Inferior Vena Cava in Patients With Severe Tricuspid Regurgitation) and TRICUS EURO studies were prospective, nonblinded, nonrandomized, single-arm trials representing the early-in-man experience of the TricValve system in NYHA functional class III or IV severe TR patients, optimally medicated and ineligible for open heart surgery, with significant caval backflow. The primary endpoint was QOL metrics and functional status. The 1-year results of the combined cohort are described here. RESULTS Forty-four patients were included. Mean age was 76.2 ± 7.5 years, 81.0% were women, and the TRISCORE (risk score model for isolated tricuspid valve surgery) was 5.3 ± 1.3. Clinical improvement at 1 year was achieved in 42 (95.5%) patients, measured by (at least 1 of) an increase in ≥15 points from baseline in 12-item Kansas City Cardiomyopathy Questionnaire score, improvement to NYHA functional class to I or II, or an increase ≥40 m in the 6-minute walk test. There were 3 (6.8%) deaths at 1-year follow-up (1 cardiovascular), and the heart failure rehospitalization rate was 29.5%. Stent fracture, conduction system disturbances, or clinically significant leaflet thrombosis were not detected. Abolished hepatic vein backflow was achieved and persisted in 63.8% of the patients, contributing towards a reduction in congestive symptoms, N-terminal pro-B-type natriuretic peptide levels (P = 0.032), and diuretic treatment. CONCLUSIONS Caval valve implantation with the TricValve system associated with meaningful 1-year clinical improvements in terms of QOL along with relatively low mortality rates. (TRICUS Study - Safety and Efficacy of the TricValve® Device; NCT03723239).
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Affiliation(s)
| | - Kasparas Briedis
- Kaunas Klinikos, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | | | - Ignacio Cruz-González
- Instituto de Investigación Biomédica de Salamanca, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Julia Mascherbauer
- Department of Cardiology, University Hospital Sankt Poelten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | | | | | - Manuel Pan
- Hospital Universitario Reina Sofia, Córdoba, Spain
| | - Ramiro Trillo
- Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
| | - Raul Moreno
- Instituto de Investigación Hospital Universitario La Paz, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | - Ana Revilla-Orodoea
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
| | - Jose Luis Zamorano
- Hospital Universitario Ramon y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
| | - Itziar Gómez-Salvador
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
| | | | - J Alberto San Román
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
| | - Ignacio J Amat-Santos
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain.
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Meier D, Akodad M, Tzimas G, Muller O, Cheung A, Wood DA, Blanke P, Sathananthan J, Praz F, Boone RH, Webb JG. Update on Transcatheter Treatment of Mitral and Tricuspid Valve Regurgitation. Curr Cardiol Rep 2023; 25:1361-1371. [PMID: 37698820 DOI: 10.1007/s11886-023-01954-y] [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] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE OF REVIEW Mitral and tricuspid regurgitation represents a clinical challenge. They are associated with a poor prognosis, and many patients are not eligible for conventional surgery. Transcatheter therapies have been the focus of numerous studies and devices over the past decade. Here, we provide a summary of current options for transcatheter treatment of these 2 entities. RECENT FINDINGS Recent studies have demonstrated the benefits of edge-to-edge repair for increasing numbers of patients. Encouraging early results with transcatheter valve replacement are also becoming available. To date, transcatheter edge-to-edge repair is currently the first-line transcatheter treatment for both mitral and tricuspid regurgitation for many patients who are not candidates for surgery. A number of transcatheter replacement devices are under development and clinical investigation but, for the most part, their current use is limited to compassionate cases or clinical trials.
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Affiliation(s)
- David Meier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mariama Akodad
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Massy, France
| | - Georgios Tzimas
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anson Cheung
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Philipp Blanke
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, Canada
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert H Boone
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada.
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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