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Montonati C, Pellegrini D, d'Atri DO, Pellicano M, Briguglia D, Giannini F, De Blasio G, Guagliumi G, Tespili M, Ielasi A. A novel balloon-expandable transcatheter aortic valve bioprosthesis: Myval and Myval Octacor. Expert Rev Cardiovasc Ther 2024; 22:325-337. [PMID: 38970466 DOI: 10.1080/14779072.2024.2375345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/28/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION Over the past two decades, transcatheter aortic valve replacement (TAVR) has expanded its application across all surgical risk levels, including low-risk patients, where, due to longer life expectancy, reducing common pitfalls of TAVR is essential. To address these needs, many technological advancements have been developed. Myval and the new generation Myval Octacor (Meril Life Sciences Pvt. Ltd) are novel balloon-expandable (BE) transcatheter heart valve (THV) systems designed for the treatment of severe aortic stenosis. AREAS COVERED This review aims to illustrate the design features of these novel THVs and the main evidence from available studies. Furthermore, we provide evidence of these THVs' performance in challenging scenarios such as extra-large aortic annuli, bicuspid aortic valves, and valve-in-valve/valve-in-ring procedures. EXPERT OPINION Myval and Myval Octacor have demonstrated comparable early safety and clinical efficacy to the leading contemporary THVs, exhibiting remarkably low rates of moderate to severe paravalvular leak (PVL) and permanent pacemaker implantation (PPI). The wide range of sizes offered by the Myval family may minimize the risk of under-/oversizing, potentially explaining the lower rates of the aforementioned phenomena. Moreover, the presence of both internal skirt and external reinforced cuff may also explain the low rate of moderate to severe PVL.
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Affiliation(s)
- Carolina Montonati
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Dario Pellegrini
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Daniele Oreste d'Atri
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
- Cardiothoracic Department, Università Vita-Salute San Raffaele, Milan, Italy
| | - Mariano Pellicano
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Daniele Briguglia
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Francesco Giannini
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Giuseppe De Blasio
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Giulio Guagliumi
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Maurizio Tespili
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Alfonso Ielasi
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
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Baumbach A, van Royen N, Amat-Santos IJ, Hudec M, Bunc M, Ijsselmuiden A, Laanmets P, Unic D, Merkely B, Hermanides RS, Ninios V, Protasiewicz M, Rensing BJWM, Martin PL, Feres F, De Sousa Almeida M, van Belle E, Linke A, Ielasi A, Montorfano M, Webster M, Toutouzas K, Teiger E, Bedogni F, Voskuil M, Pan M, Angerås O, Kim WK, Rothe J, Kristić I, Peral V, Garg S, Elzomor H, Tobe A, Morice MC, Onuma Y, Soliman O, Serruys PW. LANDMARK comparison of early outcomes of newer-generation Myval transcatheter heart valve series with contemporary valves (Sapien and Evolut) in real-world individuals with severe symptomatic native aortic stenosis: a randomised non-inferiority trial. Lancet 2024; 403:2695-2708. [PMID: 38795719 DOI: 10.1016/s0140-6736(24)00821-3] [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: 03/14/2024] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation is an established, guideline-endorsed treatment for severe aortic stenosis. Precise sizing of the balloon-expandable Myval transcatheter heart valve (THV) series with the aortic annulus is facilitated by increasing its diameter in 1·5 mm increments, compared with the usual 3 mm increments in valve size. The LANDMARK trial aimed to show non-inferiority of the Myval THV series compared with the contemporary THVs Sapien Series (Edwards Lifesciences, Irvine, CA, USA) or Evolut Series (Medtronic, Minneapolis, MN, USA). METHODS In this prospective, multinational, randomised, open-label, non-inferiority trial across 31 hospitals in 16 countries (Germany, France, Sweden, the Netherlands, Italy, Spain, New Zealand, Portugal, Greece, Hungary, Poland, Slovakia, Slovenia, Croatia, Estonia, and Brazil), 768 participants with severe symptomatic native aortic stenosis were randomly assigned (1:1) to the Myval THV or a contemporary THV. Eligibility was primarily decided by the heart team in accordance with 2021 European Society of Cardiology guidelines. As per the criteria of the third Valve Academic Research Consortium, the primary endpoint at 30 days was a composite of all-cause mortality, all stroke, bleeding (types 3 and 4), acute kidney injury (stages 2-4), major vascular complications, moderate or severe prosthetic valve regurgitation, and conduction system disturbances resulting in a permanent pacemaker implantation. Non-inferiority of the study device was tested in the intention-to-treat population using a non-inferiority margin of 10·44% and assuming an event rate of 26·10%. This trial is registered with ClinicalTrials.gov, NCT04275726, and EudraCT, 2020-000137-40, and is closed to new participants. FINDINGS Between Jan 6, 2021, and Dec 5, 2023, 768 participants with severe symptomatic native aortic stenosis were randomly assigned, 384 to the Myval THV and 384 to a contemporary THV. 369 (48%) participants had their sex recorded as female, and 399 (52%) as male. The mean age of participants was 80·0 years (SD 5·7) for those treated with the Myval THV and 80·4 years (5·4) for those treated with a contemporary THV. Median Society of Thoracic Surgeons scores were the same in both groups (Myval 2·6% [IQR 1·7-4·0] vs contemporary 2·6% [1·7-4·0]). The primary endpoint showed non-inferiority of the Myval (25%) compared with contemporary THV (27%), with a risk difference of -2·3% (one-sided upper 95% CI 3·8, pnon-inferiority<0·0001). No significant difference was seen in individual components of the primary composite endpoint. INTERPRETATION In individuals with severe symptomatic native aortic stenosis, the Myval THV met its primary endpoint at 30 days. FUNDING Meril Life Sciences.
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Affiliation(s)
- Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK; Cleveland Clinic, London, UK
| | - Niels van Royen
- Department of Cardiology, Radboud University Hospital, Nijmegen, Netherlands
| | - Ignacio J Amat-Santos
- CIVERCV, Centro de Investigación Biomédica en red - Enfermedades Cardiovasculares, University Clinical Hospital of Valladolid, Valladolid, Spain; Department of Cardiology, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Martin Hudec
- Department of Acute Cardiology, Middle-Slovak Institute Of Cardiovascular Diseases, Banska Bystrica, Slovakia
| | - Matjaz Bunc
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alexander Ijsselmuiden
- Department of Cardiology, Amphia Hospital, Breda, Netherlands; Department of Interventional Cardiology, Maastricht University Medical Center, Maastricht, Netherlands; Zuyderland Hospital, Limburg, Netherlands
| | - Peep Laanmets
- Department of Invasive Cardiology, North Estonia Medical Centre, Tallinn, Estonia
| | - Daniel Unic
- Department of Cardiac and Transplant Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Bela Merkely
- Heart and Vascular Centre, Semmelweis University Heart and Vascular Centre, Budapest, Hungary
| | | | - Vlasis Ninios
- Department of Cardiology, European Interbalkan Medical Center, Thessaloniki, Greece
| | - Marcin Protasiewicz
- Department of Cardiology, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland
| | | | - Pedro L Martin
- Department of Interventional Cardiology, University Hospital of Gran Canaria Dr Negrín, Las Palmas, Spain
| | - Fausto Feres
- Department of Invasive Cardiology, Instituto Dante Pazzanese, Sao Paulo, Brazil
| | | | - Eric van Belle
- Department of Interventional Cardiology, Lille University, Lille, France
| | - Axel Linke
- Department of Internal Medicine and Cardiology, University Clinic, Heart Center Dresden, University of Technology Dresden, Dresden, Germany
| | - Alfonso Ielasi
- Department of Interventional Cardiology, IRCCS Galeazzi Sant'Ambrogio Hospital, Milan, Italy
| | - Matteo Montorfano
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mark Webster
- Department of Cardiology, Auckland City Hospital, Auckland, New Zealand
| | | | - Emmanuel Teiger
- Department of Medico-surgical Cardiovascular and Anaesthesiology, Henri-Mondor University Hospital, Creteil, France
| | - Francesco Bedogni
- Department of Clinical Cardiology, San Donato Hospital, Milan, Italy
| | - Michiel Voskuil
- Department of Interventional Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Manuel Pan
- Department of Cardiology, University Hospital Reina Sofía, University of Córdoba, Córdoba, Spain
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical and Molecular Medicine, Gothenburg University, Gothenburg, Sweden
| | - Won-Keun Kim
- Department of Cardiology and Angiology, University of Giessen and Marburg, Giessen, Germany; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Jürgen Rothe
- Department of Cardiology and Angiology, University Heart Center Freiburg Bad Krozingen, University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ivica Kristić
- Department of Cardiology, University Hospital of Split, Split, Croatia
| | - Vicente Peral
- Department of Cardiology, Son Espases University Hospital, Palma, Spain
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Hesham Elzomor
- Department of Cardiology, School of Medicine, University of Galway, Galway, Ireland
| | - Akihiro Tobe
- Department of Cardiology, School of Medicine, University of Galway, Galway, Ireland
| | | | - Yoshinobu Onuma
- Department of Cardiology, School of Medicine, University of Galway, Galway, Ireland
| | - Osama Soliman
- Department of Cardiology, School of Medicine, University of Galway, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, School of Medicine, University of Galway, Galway, Ireland.
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Jose J, Mandalay A, Cholenahally MN, Khandenahally RS, Budnur SC, Parekh M, Rao RS, Seth A, Chandra P, Kapoor R, Agarwal P, Mathur A, Kumar V, Kanchanahalli SS, Mullasari AS, Subban V, Khanolkar UB, Mehrotra S, Chopra M, Jain RK, Mehta H, Gupta R, Kumar V, Raghuraman B, Shastri N, Elzomor H, Soliman O, Gunasekaran S. Safety and effectiveness of the novel Myval Octacor transcatheter heart valve in severe, symptomatic aortic valve stenosis - A real-world Indian experience (The OCTACOR India Study). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 63:1-7. [PMID: 38423848 DOI: 10.1016/j.carrev.2024.01.016] [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: 11/30/2023] [Revised: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To evaluate the safety and effectiveness of the novel, next-generation Myval Octacor - Transcatheter Heart Valve (THV) in patients with severe, symptomatic, native aortic stenosis (AS). METHODS This multicenter, real-world observational registry included 123 patients with severe symptomatic AS, across 16 Indian centers who underwent treatment with the novel Myval Octacor THV. Study endpoints included all-cause mortality, all stroke, acute kidney injury (AKI), major vascular complications, moderate or severe paravalvular leakage (PVL) and new permanent pacemaker implantation (PPI) until 30 days follow-up. RESULTS Of the 123 patients (average age 70.07 ± 8.33 years), 37.4 % (n = 46) were female and 39.84 % presented with bicuspid valves. The technical success rate of the procedure was 100 % and the device success rate at 30 days was 98.4 %. At 30 days (n = 123) after the procedure, the overall mortality was 1.6 %. AKI occurred in 1.6 % of patients and there was no incidence of stroke, bleeding (types 3 and 4), and major vascular complications. In an analysis of 31 patients whose echocardiographic parameters were available across all timepoints, there were significant improvements in the mean pressure gradient (54.31 ± 18.19 mmHg vs. 10.42 ± 4.24 mmHg; p < 0.0001) and effective orifice area (0.66 ± 0.21 cm2 vs. 1.80 ± 0.44 cm2; p < 0.0001) from baseline to the 30-day follow-up. None of the patients experienced severe PVL, while moderate PVL was observed in two patients (1.6 %). CONCLUSIONS Early outcomes of the next-generation, novel Myval Octacor THV proved its safety and effectiveness in the treatment of severe AS.
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Affiliation(s)
- John Jose
- Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | | | - Manjunath N Cholenahally
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India; Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India
| | | | - Srinivas C Budnur
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India; Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India
| | - Maulik Parekh
- Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | | | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi, India
| | - Praveen Chandra
- Medanta-The Medicity Multi-Speciality Hospital, Gurgaon, Haryana, India
| | - Rajneesh Kapoor
- Medanta-The Medicity Multi-Speciality Hospital, Gurgaon, Haryana, India
| | | | - Atul Mathur
- Fortis Escorts Heart Institute, New Delhi, India
| | - Vijay Kumar
- Fortis Escorts Heart Institute, New Delhi, India
| | - Sadananda S Kanchanahalli
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India; Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India
| | | | | | | | - Sanjay Mehrotra
- Narayana Multispeciality Hospital, Bangalore, Karnataka, India
| | - Manik Chopra
- Narayana Multispeciality Hospital, Ahmedabad, Gujarat, India
| | - Rajendra K Jain
- Krishna Institute of Medical Sciences (KIMS), Hyderabad, Telangana, India
| | - Haresh Mehta
- S.L. Raheja Hospital, Mumbai, Maharashtra, India
| | | | - Viveka Kumar
- Max Super Speciality Hospital, Saket, New Delhi, India
| | | | | | - Hesham Elzomor
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland
| | - Osama Soliman
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland
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Halim J, den Heijer P, van den Branden B, Meuwissen M, Vos J, Schölzel B, IJsselmuiden A. Short-term outcome after transcatheter aortic valve replacement with a novel balloon-expandable valve. Neth Heart J 2023; 31:500-505. [PMID: 36480146 PMCID: PMC10667167 DOI: 10.1007/s12471-022-01738-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve replacement (TAVR) has been expanding rapidly with numerous transcatheter heart valve (THV) systems currently available. The Myval balloon-expandable (BE) valve (Meril Life Sciences Pvt. Ltd., India) is a novel THV system indicated for the treatment of patients with severe aortic stenosis. The primary objective of this study is to assess the safety and performance of the Myval BE valve. METHODS In this prospective single-centre study, 120 consecutive patients who underwent TAVR with the Myval BE valve were included. Clinical outcomes were evaluated at 30 days and 6 months using Valve Academic Research Consortium‑2 criteria. All-cause mortality, stroke, acute kidney injury, major vascular complications, moderate or severe paravalvular leakage (PVL) and need for a permanent pacemaker implantation (PPI) were investigated. RESULTS At 6‑month follow-up, all-cause death and cardiac death were seen in 5.8% and 0.8% of the patients respectively. Periprocedural stroke and need for PPI were both seen in 3.3% of the patients. Access-site-related vascular and bleeding complications were absent. Improved valve haemodynamics and no moderate to severe PVL could be seen at 30 days. An intermediate valve size was selected in 51% of the patients. CONCLUSIONS The Myval BE valve demonstrates improved valve haemodynamics, absence of moderate to severe PVL and good safety outcomes at 6‑month follow-up with low cardiac death rate and acceptable rates of permanent pacemaker implantation and periprocedural stroke. Future randomised controlled trials will further establish the clinical utility of the Myval BE valve.
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Affiliation(s)
- J Halim
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands.
| | - P den Heijer
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - B van den Branden
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - M Meuwissen
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - J Vos
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - B Schölzel
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - A IJsselmuiden
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
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Testa L, Criscione E, Popolo Rubbio A, Squillace M, Ielasi A, Tespili M, Brambilla N, Bedogni F. Safety and performance parameters of the Myval transcatheter aortic valve bioprosthesis: The SAPPHIRE prospective registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 55:22-27. [PMID: 37076413 DOI: 10.1016/j.carrev.2023.04.014] [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: 03/02/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND TAVR is an established treatment for patients with severe symptomatic aortic stenosis. Different THV platforms are nowadays available, each of them with its inherent limitations and others are under development aiming at overcoming such limitations. We thus sought to investigate the performance and 1-year clinical outcome of a new generation, balloon expandable, THV: the Myval™ (Meril Life Sciences Pvt. Ltd., Vapi, Gujarat, India). METHODS This registry included the first 100 consecutive patients (mean age 80.7 ± 7.7; STS 4.3 ± 3.3 %), who underwent transcatheter aortic valve implantation for severe stenosis of the native aortic valve from May 2020 to December 2020, in two Italian Centers. Clinical and procedural outcomes were defined according to VARC-3 criteria. RESULTS Transfemoral Myval THV was successfully implanted in all patients, with no intra-hospital mortality (technical success 100 %): vascular access complications were all "minor" (16 %), and managed by compression/balloon inflation; no cases of annular rupture or coronary obstruction occurred; 5 % of patients required an in-hospital pacemaker implantation (PM). Device success was 99 %. Overall and cardiovascular mortality were 6 % (CI 5 %-7 %) and 4 % (CI 2 %-5 %) at 1- year, while 12 % (CI 9 %-14 %) and 7 % (6-9 %) at 2 years. A total of 9 % of the patients required a PM within 12 months, and no further PM implantation occurred afterwards. No cerebrovascular events, renal failure and myocardial infarction occurred between discharge and 2-year follow-up. No events of structural valve deterioration but a sustained improvement of echocardiographic parameters were observed. CONCLUSION The Myval THV has a promising safety/efficacy profile at 2 year follow up. This performance should be further evaluated in the context of randomized trials to better elucidate its potential.
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Affiliation(s)
- Luca Testa
- Dept of Cardiology, IRCCS Pol. S. Donato, San Donato Milanese, Milan, Italy.
| | - Enrico Criscione
- Dept of Cardiology, IRCCS Pol. S. Donato, San Donato Milanese, Milan, Italy
| | | | - Mattia Squillace
- Dept of Cardiology, IRCCS Pol. S. Donato, San Donato Milanese, Milan, Italy
| | - Alfonso Ielasi
- Cardiology Division, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Maurizio Tespili
- Dept of Cardiology, IRCCS Pol. S. Donato, San Donato Milanese, Milan, Italy
| | - Nedy Brambilla
- Dept of Cardiology, IRCCS Pol. S. Donato, San Donato Milanese, Milan, Italy
| | - Francesco Bedogni
- Dept of Cardiology, IRCCS Pol. S. Donato, San Donato Milanese, Milan, Italy
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Abdelshafy M, Serruys PW, Tsai TY, Revaiah PC, Garg S, Aben JP, Schultz CJ, Abdelghani M, Tonino PAL, Miyazaki Y, Rutten MCM, Cox M, Sahyoun C, Teng J, Tateishi H, Abdel-Wahab M, Piazza N, Pighi M, Modolo R, van Mourik M, Wykrzykowska J, de Winter RJ, Lemos PA, de Brito FS, Kawashima H, Søndergaard L, Rosseel L, Wang R, Gao C, Tao L, Rück A, Kim WK, van Royen N, Terkelsen CJ, Nissen H, Adam M, Rudolph TK, Wienemann H, Torii R, Josef Neuman F, Schoechlin S, Chen M, Elkoumy A, Elzomor H, Amat-Santos IJ, Mylotte D, Soliman O, Onuma Y. Quantitative aortography for assessment of aortic regurgitation in the era of percutaneous aortic valve replacement. Front Cardiovasc Med 2023; 10:1161779. [PMID: 37529710 PMCID: PMC10389707 DOI: 10.3389/fcvm.2023.1161779] [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: 02/08/2023] [Accepted: 05/24/2023] [Indexed: 08/03/2023] Open
Abstract
Paravalvular leak (PVL) is a shortcoming that can erode the clinical benefits of transcatheter valve replacement (TAVR) and therefore a readily applicable method (aortography) to quantitate PVL objectively and accurately in the interventional suite is appealing to all operators. The ratio between the areas of the time-density curves in the aorta and left ventricular outflow tract (LVOT-AR) defines the regurgitation fraction (RF). This technique has been validated in a mock circulation; a single injection in diastole was further tested in porcine and ovine models. In the clinical setting, LVOT-AR was compared with trans-thoracic and trans-oesophageal echocardiography and cardiac magnetic resonance imaging. LVOT-AR > 17% discriminates mild from moderate aortic regurgitation on echocardiography and confers a poor prognosis in multiple registries, and justifies balloon post-dilatation. The LVOT-AR differentiates the individual performances of many old and novel devices and is being used in ongoing randomized trials and registries.
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Affiliation(s)
- Mahmoud Abdelshafy
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
- Department of Cardiology, Al-Azhar University, Cairo, Egypt
| | - Patrick W. Serruys
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
- NHLI, Imperial College London, London, United Kingdom
| | - Tsung-Ying Tsai
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Pruthvi Chenniganahosahalli Revaiah
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | | | - Carl J. Schultz
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Mohammad Abdelghani
- Department of Cardiology, Al-Azhar University, Cairo, Egypt
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Pim A. L. Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Yosuke Miyazaki
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Marcel C. M. Rutten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | | | | | - Justin Teng
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Hiroki Tateishi
- Department of Cardiology, Shibata Hospital, Yamaguchi, Japan
- Division of Cardiology, Department of Clinical Science and Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Mohamed Abdel-Wahab
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University, Montreal, QC, Canada
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Martijn van Mourik
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | | | - Robbert J. de Winter
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Pedro A. Lemos
- Heart Institute (InCor), University of São Paulo Medical School (USP), São Paulo, Brazil
| | - Fábio S. de Brito
- Heart Institute (InCor), University of São Paulo Medical School (USP), São Paulo, Brazil
| | - Hideyuki Kawashima
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Lars Søndergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Liesbeth Rosseel
- Department of Cardiology, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium
| | - Rutao Wang
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Andreas Rück
- Department of Cardiology, Karolinska Institute, Stockholm, Sweden
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Centre, Bad Nauheim, Germany
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Matti Adam
- Department of Cardiology, Faculty of Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Tanja K. Rudolph
- Department for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Hendrik Wienemann
- Department of Cardiology, Faculty of Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Franz Josef Neuman
- Division of Cardiology and Angiology II, University Heart Centre Freiburg—Bad Krozingen, Bad Krozingen, Germany
| | - Simon Schoechlin
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ahmed Elkoumy
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
- Islamic Center of Cardiology and Cardiac Surgery, Al-Azhar University, Cairo, Egypt
| | - Hesham Elzomor
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
- Islamic Center of Cardiology and Cardiac Surgery, Al-Azhar University, Cairo, Egypt
| | | | - Darren Mylotte
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Osama Soliman
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
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Seth A, Kumar V, Singh VP, Kumar D, Varma P, Rastogi V. Myval: A Novel Transcatheter Heart Valve for the Treatment of Severe Aortic Stenosis. Interv Cardiol 2023; 18:e12. [PMID: 37398875 PMCID: PMC10311401 DOI: 10.15420/icr.2020.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/04/2022] [Indexed: 07/04/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) performed using femoral arterial access is now a guideline recommended treatment for severe calcific aortic stenosis (AS) in elderly patients. Technological advancements and procedural refinements have focused on making TAVI simpler, safer, more effective and durable. Myval (Meril Lifesciences) is a new generation balloon-expandable transcatheter heart valve (THV) developed in India that possesses novel features to improve deliverability and aid precise deployment. Following the first-in-human study, Myval was approved in India for commercial implantation in October 2018 and was subsequently given a CE mark in April 2019. This article reviews the science, technology and up-to-date clinical evidence for the Myval THV.
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Affiliation(s)
- Ashok Seth
- Interventional Cardiology and Structural Therapies, Fortis Escorts Heart Institute New Delhi, India
| | - Vijay Kumar
- Interventional Cardiology and Structural Therapies, Fortis Escorts Heart Institute New Delhi, India
| | - Vivudh Pratap Singh
- Interventional Cardiology and Structural Therapies, Fortis Escorts Heart Institute New Delhi, India
| | - Dhananjay Kumar
- Interventional Cardiology and Structural Therapies, Fortis Escorts Heart Institute New Delhi, India
| | - Puneet Varma
- Interventional Cardiology and Structural Therapies, Fortis Escorts Heart Institute New Delhi, India
| | - Vishal Rastogi
- Interventional Cardiology and Structural Therapies, Fortis Escorts Heart Institute New Delhi, India
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Elkoumy A, Jose J, Gunasekaran S, Kumar A, Srinivas BC, Manjunath CN, Ravindranath KS, Parekh M, Chandra P, Kapoor R, Abdelshafy M, Seth A, Agrawal P, Mathur A, Rao RS, Elzomor H, Sadanada KS, Kumar V, Arsang-Jang S, Mehrotra S, Raghuraman B, Khanolkar U, Premchand RK, Chopra M, Krishna P, Mehta H, Gupta R, Kumar V, Boopathy N, Baumbach A, Serruys PW, Soliman O. Angiographic quantification of aortic regurgitation following myval octacor implantation; independent core lab adjudication. Int J Cardiol 2023; 382:68-75. [PMID: 37028710 DOI: 10.1016/j.ijcard.2023.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND The balloon expandable Myval transcatheter heart valve (THV) showed encouraging results regarding residual aortic regurgitation (AR) from multiple observational studies. The newly designed Myval Octacor has been introduced recently, aiming for a reduction in AR and improved performance. OBJECTIVES The focus of this study is to report the incidence of AR using the validated quantitative Videodensitometry angiography technology (qLVOT-AR%) in the first in human use of the Myval Octacor THV system. METHODOLOGY We report on the first in human use of the Myval Octacor THV system in 125 patients in 18 Indian centres. Independent retrospective analysis of the final aortograms following implantation of the Myval Octacor was performed using the CAAS-A-Valve software. AR is reported as a regurgitation fraction. The previously validated cutoff values have been used to identify ≥moderate AR (RF% >17%), mild (6% < RF% ≤17%), and none or trace AR (RF% ≤ 6%). RESULTS Final aortogram was analysable for 103 patients (84.4%) among the 122 available aortograms. 64 (62%) patients, had tricuspid aortic valve (TAV), 38 (37%) with bicuspid AV (BAV), and one with unicuspid AV. The median absolute RF% was 2% [1, 6], moderate or more AR incidence was 1.9%, mild AR in 20.4%, and none or trace AR in 77.7%. The two cases with RF% >17% were in the BAV group. CONCLUSION The initial results of Myval Octacor using quantitative angiography-derived regurgitation fraction demonstrated a favourable outcome regarding residual AR, possibly due to improved device design. Results must be confirmed in a larger randomised study, including other imaging modalities.
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Affiliation(s)
- Ahmed Elkoumy
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; Islamic Center of Cardiology, Al-Azhar University, Nasr City, Cairo 11651, Egypt
| | - John Jose
- Department of Cardiology, Christian Medical College & Hospital, Vellore 632004, India
| | | | - Asish Kumar
- Department of Cardiology, Meitra Hospital, Calicut, Kerala 673005, India
| | - B C Srinivas
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru 560041, India
| | - C N Manjunath
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru 560041, India
| | - K S Ravindranath
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru 560041, India
| | - Maulik Parekh
- Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra 400004, India
| | | | | | - Mahmoud Abdelshafy
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi 110025, India
| | | | - Atul Mathur
- Fortis Escorts Heart Institute, New Delhi 110025, India
| | | | - Hesham Elzomor
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland
| | - K S Sadanada
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru, Karnataka 570016, India
| | - Vijay Kumar
- Madras Medical Mission Hospital, Chennai, Tamil Nadu 600037, India
| | - Shahram Arsang-Jang
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, H91 W2TY Galway, Ireland
| | - Sanjay Mehrotra
- Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka 560099, India
| | | | - Uday Khanolkar
- Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka 560099, India
| | | | - Manik Chopra
- Narayana Hospital (NH), Ahmedabad, Gujarat 380023, India
| | - Prem Krishna
- P S Govindaswami (PSG), Coimbatore 641004, India
| | - Haresh Mehta
- S. L. Raheja Hospital - Fortis, Mumbai, Maharashtra 400016, India
| | - Rahul Gupta
- Apollo Hospital, Navi Mumbai, Maharashtra 400614, India
| | - Viveka Kumar
- Max Hospital, Saket, New Delhi, Delhi 110017, India
| | | | - Andreas Baumbach
- William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London EC1M 6BQ, UK
| | - Patrick W Serruys
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, H91 W2TY Galway, Ireland
| | - Osama Soliman
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, H91 W2TY Galway, Ireland.
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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; 12:2398. [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; (A.E.)
- 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; (A.E.)
- 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; (A.E.)
| | - 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; (A.E.)
- 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; (A.E.)
- 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; (A.E.)
- CÚRAM—SFI Research Centre for Medical Devices, H91 TK33 Galway, Ireland
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Abdelshafy M, Serruys PW, Kim WK, Rück A, Wang R, Tao L, Elkoumy A, Elzomor H, Garg S, Onuma Y, Mylotte D, Soliman O. Quantitative Angiographic Assessment of Aortic Regurgitation Following 11 TAVR Devices: An Update of a Multicenter Pooled Analysis. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100037. [PMID: 39131960 PMCID: PMC11308439 DOI: 10.1016/j.jscai.2022.100037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/11/2022] [Accepted: 02/28/2022] [Indexed: 08/13/2024]
Abstract
Background Aortic regurgitation (AR) following transcatheter aortic valve replacement (TAVR) is a major predictor of short- and long-term survival. Thus far, no independent quantitative comparison of AR among commercially available transcatheter heart valves (THVs) has been performed. Objectives We sought to assess and compare the degree of acute AR following TAVR between 11 commercially available THVs and update our previous multicenter, pooled analysis. Methods Analyses were performed by an independent academic core lab using quantitative videodensitometry, a technique relying solely on the aortogram acquired after TAVR. The pooled analysis (n = 2665) included data from the initial cohort of 7 valves (Lotus [n = 546], Evolut PRO [n = 95], SAPIEN 3 [n = 397], Evolut R [n = 295], SAPIEN XT [n = 239], ACURATE neo [n = 120], and CoreValve [n = 532]) to which data from 4 new valves were added (ACURATE neo2 [n = 120], Myval [n = 108], VitaFlow [n = 105], and Venus-A [n = 113]). Results The Lotus valve had the lowest mean AR (3.5% ± 4.4%) followed by ACURATE neo2 (4.4% ± 4.8%), VitaFlow (6.1% ± 6.4%), Myval (6.3% ± 6.3%), Evolut PRO (7.4% ± 6.5%), SAPIEN 3 (7.6% ± 7.1%), Evolut R (7.9% ± 7.4%), SAPIEN XT (8.8% ± 7.5%), Venus-A (8.9% ± 10%), ACURATE neo (9.6% ± 9.2%), and CoreValve (13.7% ± 10.7%, analysis of variance P-value < .001). The only valves that statistically differed from all their counterparts were Lotus, with the lowest regurgitation in comparison to other valves except ACURATE neo2, which had less regurgitation compared with SAPIEN 3, Evolut R, SAPIEN XT, Venus-A, ACURATE neo, and CoreValve. CoreValve had the highest mean of AR, with the rates of moderate/severe AR: ACURATE neo2 (1.7%), Lotus (2.2%), Myval (2.8%), VitaFlow (4.7%), Evolut PRO (5.3%), SAPIEN 3 (8.3%), Evolut R (8.8%), SAPIEN XT (10.9%), ACURATE neo (11.3%), Venus-A (14.2%), and CoreValve (30.1%)-χ2 P-value < .001. Conclusions In this updated pooled analysis, the Lotus valve had the lowest mean AR, while ACURATE neo2 had the lowest rate of moderate/severe AR. Myval, VitaFlow, and Venus-A THVs showed promising results.
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Affiliation(s)
- Mahmoud Abdelshafy
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
- Department of Cardiology, Al-Azhar University, Cairo, Egypt
| | - Patrick W. Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
- NHLI, Imperial College London, London, United Kingdom
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Centre, Bad Nauheim, Germany
| | - Andreas Rück
- Department of Cardiology, Karolinska Institute, Stockholm, Sweden
| | - Rutao Wang
- Department of Cardiology, Xijing Hospital, Xi'an, China
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Xi'an, China
| | - Ahmed Elkoumy
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
- Islamic Center of Cardiology and Cardiac Surgery, Al-Azhar University, Cairo, Egypt
| | - Hesham Elzomor
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
- Islamic Center of Cardiology and Cardiac Surgery, Al-Azhar University, Cairo, Egypt
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Darren Mylotte
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Osama Soliman
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
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11
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Barki M, Ielasi A, Buono A, Maliandi G, Pellicano M, Bande M, Casilli F, Messina F, Uccello G, Briguglia D, Medda M, Tespili M, Donatelli F. Clinical Comparison of a Novel Balloon-Expandable Versus a Self-Expanding Transcatheter Heart Valve for the Treatment of Patients with Severe Aortic Valve Stenosis: The EVAL Registry. J Clin Med 2022; 11:959. [PMID: 35207232 PMCID: PMC8876233 DOI: 10.3390/jcm11040959] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is an effective treatment option for patients with severe, symptomatic AS, regardless of the transcatheter heart valve (THV) implanted. Prior studies demonstrated a higher device success with lower paravalvular leak (PVL) using the balloon-expandable (BE) Sapien/XT THV vs. a self-expanding (SE) THV. However, few data are available on the performance of a novel BE THV. PURPOSE to compare early clinical performance and safety of the newly available BE Myval THV (Myval, Meril Life Sciences Pvt. Ltd., India) vs. the commonly used SE (Evolut R, Medtronic) THV. METHODS A single-center, retrospective cohort analysis was performed with 166 consecutive patients undergoing TAVR from March 2019 to March 2021 for severe symptomatic AS treated with either the novel BE Myval or the SE Evolut R (ER) bioprosthesis. The primary endpoint was device success at day 30 according to the Valve Academic Research Consortium-3 (VARC-3). Secondary endpoints included 30-day all-cause mortality, cardiovascular mortality, more than mild PVL, permanent pacemaker implantation (PPI) rates and a composite of all-cause mortality and disabling stroke at 6 months. RESULTS Among the 166 included patients, 108 patients received the SE ER THV and 58 patients were treated with the BE Myval THV. At baseline, the two groups showed comparable demographic characteristics. The primary composite endpoint of early device success occurred in 55 patients (94.8%) in the BE Myval group and in 90 patients (83.3%) in the SE ER group (OR 3.667, 95% CI 1.094-12.14; p = 0.048). At day 30, the BE Myval THV group exhibited a significantly lower incidence of more than mild PVL (BE Myval 3.45% vs. SE ER 14.8%, OR 0.2, 95% CI 0.05-0.8; p = 0.0338), along with a lower rate of PPI (BE Myval 11% vs. SE ER 24.2%, OR 0.38, 95% CI 0.15-0.99; p = 0.0535). At the 6-month follow-up, the incidence of all-cause mortality and disabling stroke did not significantly differ between the two groups, while the incidence of PPI (BE Myval 11% vs. SE ER 27.5%, OR 0.32, CI 95% 0.1273-0.8; p = 0.02) and ≥moderate PVL (BE Myval 6.9% vs. SE ER 19.8%, OR 0.31, 95% CI 0.1-0.94; p = 0.0396) was significantly lower in the BE Myval group. CONCLUSIONS In patients with severe symptomatic AS undergoing TAVR, the novel Myval BE THV provided a comparable performance to the well-known ER SE THV, and it was associated with a lower rate of PPI and ≥moderate PVL within 30 days and 6 months after the procedure. Randomized, head-to-head comparison trials are needed to confirm our results.
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Affiliation(s)
- Monica Barki
- Clinical and Interventional Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (M.B.); (A.B.); (G.M.); (M.P.); (M.B.); (F.C.); (F.M.); (G.U.); (D.B.); (M.M.); (M.T.)
| | - Alfonso Ielasi
- Clinical and Interventional Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (M.B.); (A.B.); (G.M.); (M.P.); (M.B.); (F.C.); (F.M.); (G.U.); (D.B.); (M.M.); (M.T.)
| | - Andrea Buono
- Clinical and Interventional Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (M.B.); (A.B.); (G.M.); (M.P.); (M.B.); (F.C.); (F.M.); (G.U.); (D.B.); (M.M.); (M.T.)
| | - Gabriele Maliandi
- Clinical and Interventional Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (M.B.); (A.B.); (G.M.); (M.P.); (M.B.); (F.C.); (F.M.); (G.U.); (D.B.); (M.M.); (M.T.)
| | - Mariano Pellicano
- Clinical and Interventional Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (M.B.); (A.B.); (G.M.); (M.P.); (M.B.); (F.C.); (F.M.); (G.U.); (D.B.); (M.M.); (M.T.)
| | - Marta Bande
- Clinical and Interventional Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (M.B.); (A.B.); (G.M.); (M.P.); (M.B.); (F.C.); (F.M.); (G.U.); (D.B.); (M.M.); (M.T.)
| | - Francesco Casilli
- Clinical and Interventional Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (M.B.); (A.B.); (G.M.); (M.P.); (M.B.); (F.C.); (F.M.); (G.U.); (D.B.); (M.M.); (M.T.)
| | - Francesca Messina
- Clinical and Interventional Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (M.B.); (A.B.); (G.M.); (M.P.); (M.B.); (F.C.); (F.M.); (G.U.); (D.B.); (M.M.); (M.T.)
| | - Giuseppe Uccello
- Clinical and Interventional Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (M.B.); (A.B.); (G.M.); (M.P.); (M.B.); (F.C.); (F.M.); (G.U.); (D.B.); (M.M.); (M.T.)
| | - Daniele Briguglia
- Clinical and Interventional Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (M.B.); (A.B.); (G.M.); (M.P.); (M.B.); (F.C.); (F.M.); (G.U.); (D.B.); (M.M.); (M.T.)
| | - Massimo Medda
- Clinical and Interventional Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (M.B.); (A.B.); (G.M.); (M.P.); (M.B.); (F.C.); (F.M.); (G.U.); (D.B.); (M.M.); (M.T.)
| | - Maurizio Tespili
- Clinical and Interventional Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (M.B.); (A.B.); (G.M.); (M.P.); (M.B.); (F.C.); (F.M.); (G.U.); (D.B.); (M.M.); (M.T.)
| | - Francesco Donatelli
- Cardiac Surgery, Department of Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, University of Milan, 20122 Milan, Italy;
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Wang R, Kawashima H, Gao C, Mou F, Li P, Zhang J, Yang J, Luo J, Mylotte D, Wijns W, Onuma Y, Soliman O, Tao L, Serruys PW. Comparative Quantitative Aortographic Assessment of Regurgitation in Patients Treated With VitaFlow Transcatheter Heart Valve vs. Other Self-Expanding Systems. Front Cardiovasc Med 2022; 8:747174. [PMID: 35146004 PMCID: PMC8821967 DOI: 10.3389/fcvm.2021.747174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives To compare the quantitative angiographic aortic regurgitation (AR) of six self-expanding valves after transcatheter aortic valve replacement (TAVR). Background Quantitative videodensitometric aortography (LVOT-AR) is an accurate and reproducible tool for assessment of AR following TAVR. Methods This is a retrospective central core-lab analysis of 1,257 consecutive cine aortograms performed post-TAVR. The study included 107 final aortograms of consecutive patients who underwent TAVR with first-generation VitaFlow in four Chinese centers and 1,150 aortograms with five other transcatheter aortic valves (Evolut Pro, Evolut R, CoreValve, Venus A-Valve, and Acurate Neo). LVOT-AR analyses of these five valves were retrieved from a previously published pooled database. Results Among 172 aortograms of patients treated with VitaFlow, 107 final aortograms (62.2%) were analyzable by LVOT-AR. In this first in man eight cases necessitated a procedural valve in valve due to inappropriate TAVR positioning and severe aortic paravalvular regurgitation. In the VitaFlow group, the mean LVOT-AR of the intermediate aortograms was 7.3 ± 7.8% and the incidence of LVOT-AR >17% was 8.6%. The mean LVOT-AR of the final aortogram was 6.1 ± 6.4% in the VitaFlow group, followed by Evolut Pro (7.3 ± 6.5%), Evolut R (7.9 ± 7.4%), Venus A-valve (8.9 ± 10.0%), Acurate Neo (9.6 ± 9.2%), and lastly CoreValve (13.7 ± 10.7%) (analysis of variance p < 0.001). Post hoc 2-by-2 testing showed that CoreValve had significantly higher LVOT-AR compared with each of the other five THVs. No statistical difference in LVOT-AR was observed between VitaFlow, Evolut Pro, Evolut R, Acurate Neo, and Venus A-valves. The VitaFlow system had the lowest proportion of patients with LVOT-AR >17% (4.7%) (AR after the final aortograms), followed by Evolut Pro (5.3%), Evolut R (8.8%), Acurate Neo (11.3%), Venus A-valve (14.2%), and CoreValve (30.1%) (chi-square p < 0.001). Conclusion Compared to other commercially available self-expanding valves, VitaFlow seems to have a low degree of AR and a low proportion of patients with ≥moderate/severe AR as assessed by quantitative videodensitometric angiography. Once the learning phase is completed, comparisons of AR between different transcatheter heart valves should be attempted in a prospective randomized trial.
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Affiliation(s)
- Rutao Wang
- Department of Cardiology, Xijing Hospital, Xi'an, China
- Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, NUIG, Galway, Ireland
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hideyuki Kawashima
- Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, NUIG, Galway, Ireland
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Xi'an, China
- Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, NUIG, Galway, Ireland
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Fangjun Mou
- Department of Cardiology, Xijing Hospital, Xi'an, China
| | - Ping Li
- Department of Cardiology, Yulin First People's Hospital, The Sixth Affiliated Hospital of Guangxi Medical University, Yulin, China
| | - Junjie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jian Yang
- Department of Cardiovascular Surgery, Xijing Hospital, Xi'an, China
| | - Jianfang Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Darren Mylotte
- Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, NUIG, Galway, Ireland
| | - William Wijns
- Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, NUIG, Galway, Ireland
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, NUIG, Galway, Ireland
| | - Osama Soliman
- Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, NUIG, Galway, Ireland
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Xi'an, China
- *Correspondence: Ling Tao
| | - Patrick W. Serruys
- Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, NUIG, Galway, Ireland
- Department of Cardiology, Imperial College London, London, United Kingdom
- Patrick W. Serruys
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13
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Santangelo G, Ielasi A, Pellicano M, Latib A, Tespili M, Donatelli F. An Update on New Generation Transcatheter Aortic Valves and Delivery Systems. J Clin Med 2022; 11:jcm11030499. [PMID: 35159952 PMCID: PMC8837046 DOI: 10.3390/jcm11030499] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/30/2021] [Accepted: 01/15/2022] [Indexed: 12/15/2022] Open
Abstract
Over the last 15 years, the management of aortic valve disease has been changed by transcatheter aortic valve replacement, which has become the standard of care across the entire spectrum of surgical risk. As a result of continuous evolution of this technique, several next-generation transcatheter heart valves (THVs) have been developed to minimize procedural complications and improve patient outcomes. This review aims to provide an update on the new generation THVs and delivery systems.
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Affiliation(s)
- Gloria Santangelo
- San Paolo Hospital, Division of Cardiology, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy;
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, Via Faravelli 16, 20149 Milan, Italy; (M.P.); (M.T.)
- Correspondence:
| | - Mariano Pellicano
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, Via Faravelli 16, 20149 Milan, Italy; (M.P.); (M.T.)
| | - Azeem Latib
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 210th Street, Bronx, NY 10467, USA;
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, Via Faravelli 16, 20149 Milan, Italy; (M.P.); (M.T.)
| | - Francesco Donatelli
- Department of Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, University of Milan, Via Faravelli 16, 20149 Milan, Italy;
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14
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Elkoumy A, Jose J, Terkelsen CJ, Nissen H, Gunasekaran S, Abdelshafy M, Seth A, Elzomor H, Kumar S, Bedogni F, Ielasi A, Dora SK, Chandra S, Parikh K, Unic D, Wijns W, Baumbach A, Mylotte D, Serruys P, Soliman O. Safety and Efficacy of Myval Implantation in Patients with Severe Bicuspid Aortic Valve Stenosis-A Multicenter Real-World Experience. J Clin Med 2022; 11:443. [PMID: 35054137 PMCID: PMC8779274 DOI: 10.3390/jcm11020443] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
Bicuspid aortic valve (BAV) is the most common valvular congenital anomaly and is apparent in nearly 50% of candidates for AV replacement. While transcatheter aortic valve implantation (TAVI) is a recommended treatment for patients with symptomatic severe aortic stenosis (AS) at all surgical risk levels, experience with TAVI in severe bicuspid AS is limited. TAVI in BAV is still a challenge due to its association with multiple and complex anatomical considerations. A retrospective study has been conducted to investigate TAVI's procedural and 30-day outcomes using the Myval transcatheter heart valve (THV) (Meril Life Sciences Pvt. Ltd. Vapi, Gujarat, India) in patients with severe bicuspid AS. Data were collected on 68 patients with severe bicuspid AS who underwent TAVI with the Myval THV. Baseline characteristics, procedural, 30-day echocardiographic and clinical outcomes were collected. The mean age and STS PROM score were 72.6 ± 9.4 and 3.54 ± 2.1. Procedures were performed via the transfemoral route in 98.5%. Major vascular complications (1.5%) and life-threatening bleeding (1.5%) occurred infrequently. No patient had coronary obstruction, second valve implantation or conversion to surgery. On 30-day echocardiography, the mean transvalvular gradient and effective orifice area were 9.8 ± 4.5 mmHg and 1.8 ± 0.4 cm2, respectively. None/trace aortic regurgitation occurred in 76.5%, mild AR in 20.5% and moderate AR in 3%. The permanent pacemaker implantation rate was 8.5% and 30-day all-cause death occurred in 3.0% of cases. TAVI with the Myval THV in selected BAV anatomy is associated with favorable short-term hemodynamic and clinical outcomes.
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Affiliation(s)
- Ahmed Elkoumy
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (A.E.); (M.A.); (H.E.); (W.W.); (D.M.)
| | - John Jose
- Department of Cardiology, Christian Medical College & Hospital, Vellore 632004, India;
| | | | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, DK-5000 Odense, Denmark;
| | | | - Mahmoud Abdelshafy
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (A.E.); (M.A.); (H.E.); (W.W.); (D.M.)
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi 110025, India;
| | - Hesham Elzomor
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (A.E.); (M.A.); (H.E.); (W.W.); (D.M.)
| | - 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;
| | | | - 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;
| | - William Wijns
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (A.E.); (M.A.); (H.E.); (W.W.); (D.M.)
- CÚRAM, The SFI Research Centre for Medical Devices, H91 TK33 Galway, Ireland
| | - Andreas Baumbach
- William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London EC1M 6BQ, UK;
| | - Darren Mylotte
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (A.E.); (M.A.); (H.E.); (W.W.); (D.M.)
| | - Patrick Serruys
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (A.E.); (M.A.); (H.E.); (W.W.); (D.M.)
- CÚRAM, The SFI Research Centre for Medical Devices, H91 TK33 Galway, Ireland
- National Heart and Lung Institute (NHLI), Imperial College London, London SW7 2AZ, UK
| | - Osama Soliman
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (A.E.); (M.A.); (H.E.); (W.W.); (D.M.)
- CÚRAM, The SFI Research Centre for Medical Devices, H91 TK33 Galway, Ireland
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15
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Edlinger C, Paar V, Kheder SH, Krizanic F, Lalou E, Boxhammer E, Butter C, Dworok V, Bannehr M, Hoppe UC, Kopp K, Lichtenauer M. Endothelialization and Inflammatory Reactions After Intracardiac Device Implantation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1401:1-22. [DOI: 10.1007/5584_2022_712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Serruys P, Kawashima H, Chang C, Modolo R, Wang R, de Winter R, Van Hauwermeiren H, El-Kurdi M, van den Bergh W, Cox M, Onuma Y, Flameng W, Soliman O. Chronic haemodynamic performance of a biorestorative transcatheter heart valve in an ovine model. EUROINTERVENTION 2021; 17:e1009-e1018. [PMID: 34278989 PMCID: PMC9725010 DOI: 10.4244/eij-d-21-00386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Xeltis biorestorative transcatheter heart valve (BTHV) leaflets are made from an electrospun bioabsorbable supramolecular polycarbonate-urethane and are mounted on a self-expanding nitinol frame. The acute haemodynamic performance of this BTHV was favourable. AIMS We sought to demonstrate the preclinical feasibility of a novel BTHV by evaluating the haemodynamic performances of five pilot valve designs up to 12 months in a chronic ovine model. METHODS Five design iterations (A, B, B', C, and D) of the BTHV were transapically implanted in 46 sheep; chronic data were available in 39 animals. Assessments were performed at implantation, 3, 6, and 12 months including quantitative aortography, echocardiography, and histology. RESULTS At 12 months, greater than or equal to moderate AR on echocardiography was seen in 0%, 100%, 33.3%, 100%, and 0% in the iterations A, B, B', C, and D, respectively. Furthermore, transprosthetic mean gradients on echocardiography were 10.0±2.8 mmHg, 19.0±1.0 mmHg, 8.0±1.7 mmHg, 26.8±2.4 mmHg, and 11.2±4.1 mmHg, and effective orifice area was 0.7±0.3 cm2, 1.1±0.3 cm2, 1.5±1.0 cm2, 1.5±0.6 cm2, and 1.0±0.4 cm2 in the iterations A, B, B', C, and D, respectively. On pathological evaluation, the iteration D demonstrated generally intact leaflets and advanced tissue coverage, while different degrees of structural deterioration were observed in the other design iterations. CONCLUSIONS Several leaflet material iterations were compared for the potential to demonstrate endogenous tissue restoration in an aortic valve in vivo. The most promising iteration showed intact leaflets and acceptable haemodynamic performance at 12 months, illustrating the potential of the BTHV.
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Affiliation(s)
- Patrick Serruys
- Department of Cardiology, National University of Ireland Galway (NUIG) and CORRIB Corelab and Centre for Research and Imaging, University Road, Galway, H91 TK33, Ireland. E-mail:
| | - Hideyuki Kawashima
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Chun Chang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan
| | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands,Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil
| | - Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Robbert de Winter
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland
| | - William Flameng
- Department of Cardiac Surgery, Katholieke Universiteit (K.U) Leuven, Leuven, Belgium
| | - Osama Soliman
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland,CÚRAM, the SFI Research Centre for Medical Devices, Galway, Ireland
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17
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Rück A, Kim WK, Kawashima H, Abdelshafy M, Elkoumy A, Elzomor H, Wang R, Meduri CU, Verouhis D, Saleh N, Onuma Y, Mylotte D, Serruys PW, Soliman O. Paravalvular Aortic Regurgitation Severity Assessed by Quantitative Aortography: ACURATE neo2 versus ACURATE neo Transcatheter Aortic Valve Implantation. J Clin Med 2021; 10:jcm10204627. [PMID: 34682750 PMCID: PMC8539505 DOI: 10.3390/jcm10204627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 12/29/2022] Open
Abstract
The new-generation ACURATE neo2 system was commercially released in September 2020. In this study, we sought to compare the aortic regurgitation (AR) severity of the ACURATE neo2 versus the ACURATE neo transcatheter heart valve, using quantitative videodensitometric angiography (qAR). This is a retrospective, Corelab analysis of final post-transcatheter aortic valve implantation (TAVI) aortograms of patients treated with the ACURATE neo2 and ACURATE neo systems. The ACURATE neo2 cohort comprised consecutive patients treated between September 2020 and January 2021 at two centers. The ACURATE neo cohort included consecutive patients treated before September 2020. Our primary objective was to compare AR severity on qAR following TAVI with ACURATE neo2 and ACURATE neo. Out of 401 aortograms, 228 (56.9%) were analyzable, with 120 in the ACURATE neo2 cohort, and 108 in the ACURATE neo cohort. The mean AR fraction was 4.4 ± 4.8% in the neo2 cohort, and 9.9 ± 8.2% in the neo cohort (p < 0.001). Furthermore, moderate or severe AR (qAR > 17%) was detected in 2 aortograms (1.7%) in the neo2 cohort and 15 aortograms (13.9%) in the neo cohort (p < 0.001). Quantitative aortography shows a lower rate of moderate or severe paravalvular AR in what is the first European experience of the new-generation, self-expanding ACURATE neo2 when compared to the first-generation ACURATE neo. Moreover, aortographic data need to be correlated and compared to Core Laboratory-adjudicated 30-day echocardiographic data.
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Affiliation(s)
- Andreas Rück
- Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden; (A.R.); (C.U.M.); (D.V.); (N.S.)
| | - Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, 61231 Bad Nauheim, Germany;
| | - Hideyuki Kawashima
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (H.K.); (M.A.); (A.E.); (H.E.); (R.W.); (Y.O.); (D.M.); (P.W.S.)
- Academic Medical Centre, Department of Cardiology, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Mahmoud Abdelshafy
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (H.K.); (M.A.); (A.E.); (H.E.); (R.W.); (Y.O.); (D.M.); (P.W.S.)
| | - Ahmed Elkoumy
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (H.K.); (M.A.); (A.E.); (H.E.); (R.W.); (Y.O.); (D.M.); (P.W.S.)
| | - Hesham Elzomor
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (H.K.); (M.A.); (A.E.); (H.E.); (R.W.); (Y.O.); (D.M.); (P.W.S.)
| | - Rutao Wang
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (H.K.); (M.A.); (A.E.); (H.E.); (R.W.); (Y.O.); (D.M.); (P.W.S.)
- Department of Cardiology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Christopher U. Meduri
- Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden; (A.R.); (C.U.M.); (D.V.); (N.S.)
| | - Dinos Verouhis
- Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden; (A.R.); (C.U.M.); (D.V.); (N.S.)
| | - Nawzad Saleh
- Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden; (A.R.); (C.U.M.); (D.V.); (N.S.)
| | - Yoshinobu Onuma
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (H.K.); (M.A.); (A.E.); (H.E.); (R.W.); (Y.O.); (D.M.); (P.W.S.)
| | - Darren Mylotte
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (H.K.); (M.A.); (A.E.); (H.E.); (R.W.); (Y.O.); (D.M.); (P.W.S.)
| | - Patrick W. Serruys
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (H.K.); (M.A.); (A.E.); (H.E.); (R.W.); (Y.O.); (D.M.); (P.W.S.)
- CÚRAM, the SFI Research Centre for Medical Devices, H91 TK33 Galway, Ireland
- NHLI, Imperial College London, London SW7 2AZ, UK
| | - Osama Soliman
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (H.K.); (M.A.); (A.E.); (H.E.); (R.W.); (Y.O.); (D.M.); (P.W.S.)
- CÚRAM, the SFI Research Centre for Medical Devices, H91 TK33 Galway, Ireland
- Correspondence: ; Tel.: +353-91-493-781
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18
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García-Gómez M, Delgado-Arana JR, Halim J, De Marco F, Trani C, Martin P, Won-Keun K, Montorfano M, den Heijer P, Bedogni F, Sardella G, IJsselmuiden AJJ, Campante Teles R, Aristizabal-Duque CH, Gordillo X, Santos-Martinez S, Barrero A, Gómez-Salvador I, Ancona M, Redondo A, Román JAS, Amat-Santos IJ. Next-generation balloon-expandable Myval transcatheter heart valve in low-risk aortic stenosis patients. Catheter Cardiovasc Interv 2021; 99:889-895. [PMID: 34390296 DOI: 10.1002/ccd.29923] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We aimed to describe hemodynamic performance and clinical outcomes at 30-day follow-up of the balloon-expandable (BE) Myval transcatheter heart valve (THV) in low-risk patients. BACKGROUND The results of the next-generation BE Myval THV in low-risk aortic stenosis (AS) patients are still unknown. METHODS Retrospective registry performed in nine European centers including patients with low predicted operative mortality risk according to Society of thoracic surgeons (STS) and European system for cardiac operative risk evaluation (EuroSCORE-II) scores. RESULTS Between September 2019 and February 2021, a total of 100 patients (51% males, mean age 80 ± 6.5 years) were included. Mean STS score and EuroSCORE-II were 2.4 ± 0.8% and 2.2 ± 0.7%, respectively. Intermediate sizes were used in 39% (21.5 mm: 8%, 24.5 mm: 15%, 27.5 mm: 15%). There were no cases of valve embolization, coronary artery occlusion, annulus rupture, or procedural death. A definitive pacemaker implantation was needed in eight patients (8%). At 30-day follow-up aortic valve area (0.7 ± 0.2 vs. 2.1 ± 0.6 cm2 ) and mean aortic valve gradient (43.4 ± 11.1 vs. 9.0 ± 3.7 mmHg) improved significantly (p < 0.001). Moderate aortic regurgitation occurred in 4%. Endpoints of early safety and clinical efficacy were 3 and 1%, respectively. CONCLUSIONS Hemodynamic performance and 30-day clinical outcomes of the BE Myval THV in low-risk AS patients were favorable. Longer-term follow-up is warranted.
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Affiliation(s)
- Mario García-Gómez
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Jose Raúl Delgado-Arana
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Jonathan Halim
- Cardiology Department, Amphia Hospital Breda, Breda, Netherlands
| | | | - Carlo Trani
- Cardiology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pedro Martin
- Cardiology Department, Hospital Universitario de Gran Canaria Dr Negrin, Gran Canaria, Spain
| | - Kim Won-Keun
- Cardiology Department, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Matteo Montorfano
- Cardiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - Peter den Heijer
- Cardiology Department, Amphia Hospital Breda, Breda, Netherlands
| | | | | | | | | | | | - Ximena Gordillo
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Sandra Santos-Martinez
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Alejandro Barrero
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Itziar Gómez-Salvador
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Marco Ancona
- Cardiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alfredo Redondo
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - J Alberto San Román
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Ignacio J Amat-Santos
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
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Wang R, Kawashima H, Mylotte D, Rosseel L, Gao C, Aben JP, Abdelshafy M, Onuma Y, Yang J, Soliman O, Tao L, Serruys PW. Quantitative Angiographic Assessment of Aortic Regurgitation After Transcatheter Implantation of the Venus A-valve: Comparison with Other Self-Expanding Valves and Impact of a Learning Curve in a Single Chinese Center. Glob Heart 2021; 16:54. [PMID: 34381675 PMCID: PMC8344958 DOI: 10.5334/gh.1046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/20/2021] [Indexed: 01/14/2023] Open
Abstract
Objectives We aimed to compare the quantitative angiographic aortic regurgitation (AR) into the left ventricular out flow tract (LVOT-AR) of five different types of transcatheter self-expanding valves and to investigate the impact of the learning curve on post-TAVR AR. Background Quantitative video densitometric aortography is an objective, accurate, and reproducible tool for assessment of AR following TAVR. Methods and results This retrospective academic core-lab analysis, analyzed 1150 consecutive cine aortograms performed immediately post-TAVR. Quantitative angiographic AR of post-procedural aortography in 181 consecutive patients, who underwent TAVR with the Venus A-valve in a single Chinese center, were compared to the results of Evolut Pro, Evolut R, CoreValve, (Medtronic, Dublin, Ireland) and Acurate Neo (Boston Scientific, Massachusetts, US) transcatheter heart valves (THVs), from a previously published pooled database. Among the 181 aortograms of patients treated with the Venus A-Valve, 113 (62.4%) were analyzable for quantitative assessment of AR. The mean LVOT-AR was 8.9% ± 10.0% with 14.2% of patients having moderate or severe AR in the Venus A-valve group. No significant difference in mean LVOT-AR was observed between Evolut Pro, Evolut R, Acurate Neo, and Venus A-valve. The incidence of LVOT-AR >17%, which correlates with echocardiographic derived ≥ moderate AR, with the Evolut Pro was lower than with the Venus A-valve (5.3% vs. 14.2%, p = 0.034), but was not different from the Evolut R (5.3% vs. 8.8%, p = 0.612), or the Acurate Neo (5.3% vs. 11.3% p = 0.16) systems. A landmark analysis after recruitment of the first half of patients treated with the Venus A valve (N = 56), showed a significantly lower mean LVOT-AR in the second half of the series (11.3% ± 11.9% vs. 6.5% ± 7.1%, p = 0.011). The incidence of LVOT-AR >17% in the latest 57 cases was also numerically lower (7.0% vs. 21.4%, p = 0.857) and compared favorably with the best in class of the self-expanding valves. Conclusion The Venus A-valve has comparable mean LVOT-AR to other self-expanding valves but has a higher rate of moderate or severe AR than the Evolut Pro THV. However, after completion of a learning phase, results improved and compared favorably with the best in class of the commercially available self-expanding valves. These findings should be confirmed in prospective randomized comparisons of AR between different THVs.
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Affiliation(s)
- Rutao Wang
- Department of Cardiology, Xijing Hospital, Xi’an, CN
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway and CORRIB Research Center for Advanced Imaging and Core laboratory, IE
- Department of Cardiology, Radboud University Medical Center, Nijmegen, NL
| | - Hideyuki Kawashima
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway and CORRIB Research Center for Advanced Imaging and Core laboratory, IE
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, NL
| | - Darren Mylotte
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway and CORRIB Research Center for Advanced Imaging and Core laboratory, IE
| | - Liesbeth Rosseel
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway and CORRIB Research Center for Advanced Imaging and Core laboratory, IE
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Xi’an, CN
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway and CORRIB Research Center for Advanced Imaging and Core laboratory, IE
- Department of Cardiology, Radboud University Medical Center, Nijmegen, NL
| | | | - Mahmoud Abdelshafy
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway and CORRIB Research Center for Advanced Imaging and Core laboratory, IE
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway and CORRIB Research Center for Advanced Imaging and Core laboratory, IE
| | - Jian Yang
- Department of Cardiovascular Surgery, Xijing Hospital, Xi’an, CN
| | - Osama Soliman
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway and CORRIB Research Center for Advanced Imaging and Core laboratory, IE
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Xi’an, CN
| | - Patrick W. Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway and CORRIB Research Center for Advanced Imaging and Core laboratory, IE
- NHLI, Imperial College London, London, UK
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