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Fan J, Li Z, Lin D, Miao J, Weng Z, Qi Y, Li M, Chen S, Zhang Y, Shen Z, Pan W, Zhou D, Ge J. Long-term outcomes in patients with bicuspid valve stenosis and aortic dilation undergoing transcatheter valve implantation. Int J Cardiol 2024; 409:132201. [PMID: 38782071 DOI: 10.1016/j.ijcard.2024.132201] [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: 04/14/2024] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND To date, whether ascending aorta dilation (AAD) should be considered a contraindication for transcatheter aortic valve replacement (TAVR) remains a topic of debate.. OBJECTIVE The study investigated the clinical outcome of TAVR in patients with bicuspid aortic valve stenosis (BAV-AS) complicated by AAD. METHODS We included patients with BAV-AS who underwent TAVR between 2012 and 2019. We collected patient perioperative clinical data., tracked clinical outcomes for over four years post-TAVR, and obtained echocardiography images one year postoperatively. The Kaplan-Meier method was employed for analyzing both unadjusted and adjusted survival data, which was compared using the log-rank test. COX regression and nomograms were used to assess the impact of AAD on post-TAVR clinical outcomes in patients with aortic stenosis (AS), with all-cause mortality as the primary clinical endpoint. RESULTS A total of 111 BAV patients were included in this study. Long-term follow-up showed an increased mortality risk in patients with BAV-AAD (adjusted Kaplan-Meier analysis: P = .02/0.001). Cox correlation analysis indicated that age (OR = 1.137; P = .034), AAD (OR = 3.51; P = .038), and postoperative left ventricular pressure (LVSP) (OR: 0.959; P = .044) were predictive factors for mortality more than four years after TAVR in patients with BAV. The area under the curve of the Nomogram predicting long-term survival for the training set of patients based on the above metrics was 0.845 (95% CI: 0.696-0.994). Short-term cardiac ultrasound follow-up showed a more rapid rate of AA expansion (0.29 [0-0.34] vs. -1 [-3.3-1] mm/month, P = .001) and a smaller proportion of AA diameter reduction (7.1% vs. 53.7%, P = .001) in patients who died. CONCLUSIONS Patients with BAV-AAD-AS treated with TAVR have an increased risk of long-term mortality, and clinical prediction models, including AAD age and postoperative LVSP, may predict long-term patient survival. CONDENSED ABSTRACT The study investigated the clinical outcome of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (BAV-AS) complicated by ascending aorta dilation (AAD). Patients with BAV-AAD-AS treated with TAVR have an increased risk of long-term mortality. AAD, age and postoperative LVSP, may predict long-term patient survival. Short-term cardiac ultrasound follow-up showed a more rapid rate of AA expansion and a smaller proportion of AA diameter reduction in patients who died. A high postoperative AAD expansion rate may indicate an adverse clinical outcome. Surgery regimens for tolerable BAV-AADs and can be considered as a treatment option.
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Affiliation(s)
- Jianing Fan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhenzhen Li
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Dawei Lin
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Jiaxin Miao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zilong Weng
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yiming Qi
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Mingfei Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shasha Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yuan Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhiyun Shen
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenzhi Pan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China National Clinical Research Center for Interventional Medicine, Shanghai, China
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Tirado-Conte G, Pardo Sanz A, Salido Tahoces L. Ascending aortic dilatation in TAVI: Actor or bystander? Int J Cardiol 2024; 406:132089. [PMID: 38663807 DOI: 10.1016/j.ijcard.2024.132089] [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: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Gabriela Tirado-Conte
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain. Instituto Ramón y Cajal de Investigación Sanitaria - IRYCIS, CYBER cardiovascular, University of Alcalá de Henares, Madrid, Spain.
| | - Ana Pardo Sanz
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain. Instituto Ramón y Cajal de Investigación Sanitaria - IRYCIS, CYBER cardiovascular, University of Alcalá de Henares, Madrid, Spain
| | - Luisa Salido Tahoces
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain. Instituto Ramón y Cajal de Investigación Sanitaria - IRYCIS, CYBER cardiovascular, University of Alcalá de Henares, Madrid, Spain
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Chiariello GA, Di Mauro M, Pasquini A, Bruno P, Nesta M, Fabiani L, Mazza A, Meloni M, Baldo E, Ponzo M, Ferraro F, Conserva AD, D’Acierno E, Villa E, Trani C, Burzotta F, Massetti M. Progression of the ascending aorta diameter after surgical or transcatheter bicuspid aortic valve replacement. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae100. [PMID: 38775458 PMCID: PMC11142625 DOI: 10.1093/icvts/ivae100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/17/2024] [Accepted: 05/17/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVES Ascending aorta (AA) dilatation in patients with bicuspid aortic valve (AV) is related both to genetic and haemodynamic factors. The aim of this study is to compare late progression of AA dilatation in bicuspid AV patients undergoing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve implantation (TAVI). METHODS Data of 189 consecutive patients who underwent AV replacement for severe bicuspid AV stenosis were prospectively collected. Patients who underwent SAVR were compared to patients who underwent TAVI. Indication to the procedure was validated by the institutional Heart Team. Aortic diameters were evaluated by transthoracic echocardiogram. Differences between preoperative and long-term follow-up AA diameters were compared in the 2 groups. RESULTS Between January 2015 and December 2021, 143 (76%) patients underwent SAVR and 46 (24%) patients underwent TAVI. At 4.6 (standard deviation 1.7) years follow-up, patients in the TAVI group showed significantly lower survival (P = 0.00013) and event-free survival (P < 0.0001). AA diameter progression was lower in surgical compared to transcatheter patients, 0.95 (0.60, 1.30) vs 1.65 (0.67, 2.63) mm, P = 0.02. AA diameter progression indexed for body surface area and height was lower in the surgical group: 0.72 (0.38, 1.05) vs 1.05 (0.39, 1.71) mm/m2, P = 0.02, and 0.59 (0.36, 0.81) vs 1.11 (0.44, 1.78) mm/m, P = 0.001, respectively. At multivariable linear regression analysis transcatheter procedure, baseline aortic diameter and paravalvular leak were significantly associated with increased postoperative AA dilatation. CONCLUSIONS Bicuspid AV patients who underwent SAVR, showed significantly less long-term AA diameter progression than patients who underwent transcatheter procedure.
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Affiliation(s)
- Giovanni Alfonso Chiariello
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Michele Di Mauro
- Heart and Vascular Centre, Cardiovascular Research Institute, CARIM, Maastricht, Netherlands
| | - Annalisa Pasquini
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Marialisa Nesta
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Ludovica Fabiani
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Mazza
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Martina Meloni
- Department of Cardiology, Thoracic and Vascular Sciences, S. Matteo University Hospital, Pavia, Italy
| | | | - Myriana Ponzo
- Department of Cardiology, Cristo Re Hospital, Rome, Italy
| | - Francesco Ferraro
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Davide Conserva
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Edoardo D’Acierno
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Emmanuel Villa
- Department of Cardiovascular Surgery, Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Carlo Trani
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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Rong LQ, Martinez A, Devereux RB, Weinsaft JW, Gaudino M. Ascending Aortic Growth After Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2024; 38:853-855. [PMID: 38160072 DOI: 10.1053/j.jvca.2023.12.009] [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: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY.
| | - Andrew Martinez
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY
| | | | | | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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An K, Zhang F, Ouyang W, Pan X. Transcatheter aortic valve replacement in patients with preoperative ascending aortic diameter ≥45 mm. Cardiovasc Diagn Ther 2023; 13:939-947. [PMID: 38162114 PMCID: PMC10753242 DOI: 10.21037/cdt-23-324] [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: 07/29/2023] [Accepted: 10/08/2023] [Indexed: 01/03/2024]
Abstract
Background Current indication for concomitant replacement of ascending aorta (AA) in patients undergoing surgical aortic valve replacement is that AA diameter exceeds 45 mm. However, the impact of AA dilation (≥45 mm) in patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear. Methods We retrospectively evaluated 467 consecutive patients who underwent transfemoral TAVR from January 2016 to April 2021. Cox proportional hazards regression was performed to identify risk factors for all-cause mortality. The primary endpoint was the all-cause mortality, and the secondary endpoints were the occurrence of the aortic dissection and/or rupture. Results One hundred patients (21.4%) presented preoperative AA ≥45 mm. The median age was 73 years for patients with AA ≥45 mm and 75 years for patients with AA <45 mm (P=0.021). The in-hospital mortality rate was 1.1%. There was no iatrogenic injury to the AA. Only one patient (0.2%) in AA <45 mm group experienced retrograde type B aortic dissection in the descending aorta. The median follow-up was 19 [16-34] months in patients with AA ≥45 mm and 27 [15-37] months in patients with AA <45 mm (P=0.152). No statistical difference was found between the two groups regarding the overall survival (92.5%±3.5% vs. 78.3%±6.8%, P=0.198). Only one patient in AA <45 mm group experienced type A aortic dissection 10 months after the procedure. In both univariable and multivariable analysis, AA ≥45 mm was not an independent predictor for all-cause mortality. Conclusions Transfemoral TAVR can be performed safely in patients with preoperative AA ≥45 mm with a low intraprocedural risk. The mid-term survival appears not to be affected by the presence of AA ≥45 mm, and adverse aortic events are rare.
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Affiliation(s)
- Kang An
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Fengwen Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenbin Ouyang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiangbin Pan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Zheng HJ, Cheng YB, Lin DQ, Yan CJ, Yu SJ, He P, Li J, Cheng W. Effect of transcatheter aortic valve replacement on ascending aorta dilatation rate in patients with tricuspid and bicuspid aortic stenosis. IJC HEART & VASCULATURE 2023; 49:101313. [PMID: 38107428 PMCID: PMC10724657 DOI: 10.1016/j.ijcha.2023.101313] [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: 10/20/2023] [Revised: 11/07/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
Objectives The aim of the present study was to assess the differences between BAV and TAV patients with chronic moderate to severe or severe AS regarding presentation, incidence of TAVR, survival, ascending aorta diameter and dilatation rate before and after TAVR. Methods The study included 667 consecutive patients with chronic moderate to severe or severe AS from January 2012 and December 2022. Outcomes included all-cause mortality, incidence of TAVR, and ascending aorta diameter and dilatation rate. Results There were 185 BAV-AS and 482 TAV-AS patients, and BAV-AS patients were younger (67 vs 78 years, P = 0.027). Total follow-up was 4.5 years (IQR: 2.7-8.9 years), 290 patients underwent TAVR, and 165 patients died. The 8-year TAVR incidence was higher in BAV-AS (55% ± 4%) vs TAV-AS (41% ± 5%; P = 0.02). The 8-year survival was higher in BAV-AS (85% ± 6%) vs TAV-AS (71% ± 6%; P < 0.0001) and became insignificant after age adjustment (P = 0.33). The dilatation rate of ascending aorta was significantly faster in BAV-AS patients compared with TAV-AS patients before TAVR. However, the ascending aorta dilatation rate for BAV-AS and TAV-AS patients was not significantly different after TAVR. Conclusions Compared with TAV-AS, BAV-AS patients were younger and underwent TAVR more frequently, resulting in a considerable survival advantage. After TAVR, ascending aorta dilatation rates were similar in BAV-AS and TAV-AS patients, suggesting an important role of hemodynamics on ascending aorta dilatation in BAV-AS.
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Affiliation(s)
| | | | - De-Qing Lin
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chao-Jun Yan
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - San-Jiu Yu
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ping He
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jun Li
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Wei Cheng
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Gupta R, Mahmoudi E, Behnoush AH, Malik AH, Mahajan P, Lin M, Bandyopadhyay D, Goel A, Chakraborty S, Aedma SK, Gupta HB, Vyas AV, Combs WG, Mathur M, Yakubov SJ, Patel NC. Clinical outcomes and the impact of valve morphology for transcatheter aortic valve replacement in bicuspid aortic valves: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2023; 102:721-730. [PMID: 37605512 DOI: 10.1002/ccd.30808] [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: 11/23/2022] [Revised: 05/16/2023] [Accepted: 08/13/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Bicuspid aortic valve (BAV) is present in approximately 0.5%-2% of the general population, causing significant aortic stenosis (AS) in 12%-37% of affected individuals. Transcatheter aortic valve replacement (TAVR) is being considered the treatment of choice in patients with symptomatic AS across all risk spectra. AIM Aim Our study aims to compare TAVR outcomes in patients with BAV versus tricuspid aortic valves (TAV). METHODS A comprehensive literature search was performed in PubMed, Web of Science, and Cochrane trials. Studies were included if they included BAV and TAV patients undergoing TAVR with quantitative data available for at least one of our predefined outcomes. Meta-analysis was performed by the random-effects model using Stata software. RESULTS Fifty studies of 203,288 patients were included. BAV patients had increased 30-day all-cause mortality (odds ratio [OR] = 1.23 [1.00-1.50], p = 0.05), in-hospital stroke (OR = 1.39 [1.01-1.93], p = 0.05), in-hospital and 30-day PPI (OR = 1.13 [1.00-1.27], p = 0.04; OR = 1.16 [1.04-1.13], p = 0.01) and in-hospital, 30-day and 1-year aortic regurgitation (AR) (OR = 1.48 [1.19-1.83], p < 0.01; OR = 1.79 [1.26-2.52], p < 0.01; OR = 1.64 [1.03-2.60], p = 0.04). Subgroup analysis on new-generation valves showed a reduced 1-year all-cause mortality (OR = 0.86 [CI = 0.75-0.98], p = 0.03), despite higher in-hospital and 30-day PPI (OR = 0.1.21 [1.04-1.41], p = 0.01; OR = 1.17 [1.05-1.31], p = 0.01) and in-hospital AR (OR = 1.62 [1.14-2.31], p = 0.01) in the BAV group. The quality of included studies was moderate-to-high, and only three analyses presented high heterogeneity. CONCLUSION TAVR is associated with comparable outcomes in patients with BAV and TAV. Careful selection of BAV cases by preprocedural assessment of valve anatomy and burden of calcification, pre- and post-procedural dilation, and implementing newer generations of valves may improve the safety and efficacy of TAVR in BAV patients.
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Affiliation(s)
- Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Elham Mahmoudi
- Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Pranav Mahajan
- Department of Medicine, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Muling Lin
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Dhrubajyoti Bandyopadhyay
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Akshay Goel
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Sandipan Chakraborty
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Surya K Aedma
- Department of Medicine, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Harsh Bala Gupta
- Guru Nanak Dev Hospital, Department of medicine, Government Medical College, Amritsar, Punjab, India
| | - Apurva V Vyas
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - William G Combs
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Moses Mathur
- Heart & Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-Ohio Health, Columbus, Ohio, USA
| | - Nainesh C Patel
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
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Boxhammer E, Hecht S, Kaufmann R, Kammler J, Kellermair J, Reiter C, Akbari K, Blessberger H, Steinwender C, Lichtenauer M, Hoppe UC, Hergan K, Scharinger B. The Presence of Ascending Aortic Dilatation in Patients Undergoing Transcatheter Aortic Valve Replacement Is Negatively Correlated with the Presence of Diabetes Mellitus and Does Not Impair Post-Procedural Outcomes. Diagnostics (Basel) 2023; 13:diagnostics13030358. [PMID: 36766463 PMCID: PMC9914357 DOI: 10.3390/diagnostics13030358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
Both relevant aortic valve stenosis (AS) and aortic valve insufficiency significantly contribute to structural changes in the ascending aorta (AA) and thus to its dilatation. In patients with severe AS undergoing transcatheter aortic valve replacement (TAVR), survival data regarding aortic changes and laboratory biomarker analyses are scarce. METHODS A total of 179 patients with severe AS and an available computed tomography were included in this retrospective study. AA was measured, and dilatation was defined as a diameter ≥ 40 mm. Thirty-two patients had dilatation of the AA. A further 32 patients from the present population with a normal AA were matched to the aortic dilatation group with respect to gender, age, body mass index and body surface area, and the resulting study groups were compared with each other. In addition to echocardiographic and clinical characteristics, the expression of cardiovascular biomarkers such as brain natriuretic peptide (BNP), soluble suppression of tumorigenicity-2 (sST2), growth/differentiation of factor-15 (GDF-15), heart-type fatty-acid binding protein (H-FABP), insulin-like growth factor binding protein 2 (IGF-BP2) and soluble urokinase-type plasminogen activator receptor (suPAR) was analyzed. Kaplan-Meier curves for short- and long-term survival were obtained, and Pearson's and Spearman's correlations were calculated to identify the predictors between the diameter of the AA and clinical parameters. RESULTS A total of 19% of the total cohort had dilatation of the AA. The study group with an AA diameter ≥ 40 mm showed a significantly low comorbidity with respect to diabetes mellitus in contrast to the comparison cohort with an AA diameter < 40 mm (p = 0.010). This result continued in the correlation analyses performed, as the presence of diabetes mellitus correlated negatively not only with the diameter of the AA (r = -0.404; p = 0.001) but also with the presence of aortic dilatation (r = -0.320; p = 0.010). In addition, the presence of AA dilatation after TAVR was shown to have no differences in terms of patient survival at 1, 3 and 5 years. There were no relevant differences in the cardiovascular biomarkers studied between the patients with dilated and normal AAs. CONCLUSION The presence of AA dilatation before successful TAVR was not associated with a survival disadvantage at the respective follow-up intervals of 1, 3 and 5 years. Diabetes mellitus in general seemed to have a protective effect against the development of AA dilatation or aneurysm in patients with severe AS.
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Affiliation(s)
- Elke Boxhammer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
- Correspondence: (E.B.); (S.H.); (B.S.)
| | - Stefan Hecht
- Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
- Correspondence: (E.B.); (S.H.); (B.S.)
| | - Reinhard Kaufmann
- Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Jürgen Kammler
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4020 Linz, Austria
| | - Jörg Kellermair
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4020 Linz, Austria
| | - Christian Reiter
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4020 Linz, Austria
| | - Kaveh Akbari
- Department of Radiology, Johannes Kepler University Hospital Linz, 4020 Linz, Austria
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4020 Linz, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4020 Linz, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Uta C. Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Klaus Hergan
- Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Bernhard Scharinger
- Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
- Correspondence: (E.B.); (S.H.); (B.S.)
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Xiong TY, Ali WB, Feng Y, Hayashida K, Jilaihawi H, Latib A, Lee MKY, Leon MB, Makkar RR, Modine T, Naber C, Peng Y, Piazza N, Reardon MJ, Redwood S, Seth A, Sondergaard L, Tay E, Tchetche D, Yin WH, Chen M, Prendergast B, Mylotte D. Transcatheter aortic valve implantation in patients with bicuspid valve morphology: a roadmap towards standardization. Nat Rev Cardiol 2023; 20:52-67. [PMID: 35726019 DOI: 10.1038/s41569-022-00734-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 02/08/2023]
Abstract
Indications for transcatheter aortic valve implantation (TAVI) have expanded in many countries to include patients with aortic stenosis who are at low surgical risk, and a similar expansion to this cohort is anticipated elsewhere in the world, together with an increase in the proportion of patients with bicuspid aortic valve (BAV) morphology as the age of the patients being treated decreases. To date, patients with BAV have been excluded from major randomized trials of TAVI owing to anatomical considerations. As a consequence, BAV has been a relative contraindication to the use of TAVI in international guidelines. Although clinical experience and observational data are accumulating, BAV presents numerous anatomical challenges for successful TAVI, despite advances in device design. Furthermore, in those with BAV, substantial geographical variation exists in patient characteristics, clinical approach and procedural strategy. Therefore, in this Roadmap article, we summarize the existing evidence and provide consensus recommendations from an international group of experts on the application of TAVI in patients with BAV in advance of the anticipated growth in the use of this procedure in this challenging cohort of patients.
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Affiliation(s)
- Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | | | - Martin B Leon
- Columbia University Medical Center, New York, NY, USA
| | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Thomas Modine
- Department of Heart Valve Therapy, CHU Bordeaux, Bordeaux, France.,IHU Lyric, Bordeaux-, Pessac, France.,Shanghai Jiaotong University, Shanghai, China
| | - Christoph Naber
- Department of Cardiology, Klinikum Wilhelmshaven, Wilhelmshaven, Germany
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Nicolo Piazza
- Division of Cardiology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, TX, USA
| | - Simon Redwood
- Department of Cardiology, St Thomas' Hospital, London, UK
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi, India
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Edgar Tay
- National University Heart Center, National University of Singapore, Singapore, Singapore
| | - Didier Tchetche
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Wei-Hsian Yin
- Heart Center, ChengHsin General Hospital, Taipei, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Bernard Prendergast
- Department of Cardiology, St Thomas' Hospital, London, UK. .,Cleveland Clinic London, London, UK.
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, National University of Ireland, Galway, Ireland.
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10
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Kusner JJ, Brown JY, Gleason TG, Edelman ER. The Natural History of Bicuspid Aortic Valve Disease. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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11
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Ahmad Y, Agarwal V, Williams ML, Wang DD, Reardon MJ, Cavalcante JL, Makkar R, Forrest JK. Imaging, Treatment Options, Patient Selection, and Outcome Considerations for Patients With Bicuspid Aortic Valve Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100506. [PMID: 39132366 PMCID: PMC11307905 DOI: 10.1016/j.jscai.2022.100506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 08/13/2024]
Abstract
Transcatheter aortic valve replacement has emerged as a safe and effective alternative to surgical aortic valve replacement for patients with severe symptomatic aortic stenosis across the spectrum of surgical risks based on a series of foundational randomized clinical trials. Of note, patients with bicuspid aortic valve (BAV) disease were excluded from all these pivotal randomized trials, leaving a significant knowledge gap because BAVs are commonly encountered in patients referred for aortic valve surgery or intervention. In this comprehensive review, we aim to provide heart teams with a detailed insight into how to approach patients with BAV disease, focusing on imaging and characterization of bicuspid valves, an overview of surgical approaches, and an understanding of the current data behind the role of transcatheter aortic valve replacement for patients with BAV disease.
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Affiliation(s)
- Yousif Ahmad
- Division of Cardiology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Vratika Agarwal
- Division of Cardiology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Matthew L. Williams
- Division of Cardiac Surgery, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Dee Dee Wang
- Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan
| | | | - João L. Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - John K. Forrest
- Division of Cardiology, Yale School of Medicine, Yale University, New Haven, Connecticut
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12
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Lei YL. Value of superior-mesenteric-artery-diameter/superiormesenteric-vein-diameter on non-enhanced computed tomography in the early diagnosis of spontaneous isolated superior mesenteric artery dissection. World J Emerg Med 2022; 13:202-207. [DOI: 10.5847/wjem.j.1920-8642.2022.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/16/2022] [Indexed: 11/19/2022] Open
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13
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Aortic Valve Replacement in Low-Risk Patients With Severe Aortic Stenosis Outside Randomized Trials. J Am Coll Cardiol 2021; 77:111-123. [PMID: 33446305 DOI: 10.1016/j.jacc.2020.10.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/14/2020] [Accepted: 10/26/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Recent randomized trials including low-risk patients showed positive results for transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR), but patients with non-tricuspid aortic valve (NTAV), severe coronary artery disease (SevCAD), and those requiring concomitant mitral/tricuspid valve (CMTV) or concomitant ascending aorta replacement (CAAR) interventions were excluded. OBJECTIVES This study sought to evaluate the presence and impact of the main clinical variables not evaluated in TAVR versus SAVR trials (NTAV, SevCAD, and CMTV or CAAR intervention) in a large series of consecutive low-risk patients with severe aortic stenosis (SAS) undergoing SAVR. METHODS Single-center study including consecutive patients with SAS and low surgical risk (Society of Thoracic Surgeons score of <4%) undergoing SAVR. Baseline, procedural characteristics, and 30-day outcomes were prospectively collected. RESULTS Of 6,772 patients with SAS who underwent SAVR between 2000 and 2019, 5,310 (78.4%) exhibited a low surgical risk (mean Society of Thoracic Surgeons score: 1.94 ± 0.87%). Of these, 2,165 patients (40.8%) had at least 1 of the following: NTAV (n = 1,468, 27.6%), SevCAD (n = 307, 5.8%), CMTV (n = 306, 5.8%), and CAAR (n = 560, 10.5%). The 30-day mortality and stroke rates for the overall low-risk SAS cohort were 1.9% and 2.4%, respectively. The mortality rate was similar in the SevCAD (2.6%) and CAAR (2.1%) groups versus the rest of the cohort (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 0.85 to 3.75, and OR: 1.64; 95% CI: 0.88 to 3.05, respectively), lower in the NTAV group (0.9%; OR: 0.42; 95% CI: 0.22 to 0.81), and higher in the CMTV group (5.9%; OR: 2.61; 95% CI: 1.51 to 4.5). CONCLUSIONS In a real-world setting, close to one-half of the low-risk patients with SAS undergoing SAVR exhibited at least 1 major criterion not evaluated in TAVR versus SAVR randomized trials. Clinical outcomes were better than or similar to those predicted by surgical scores in all groups but those patients requiring CMTV intervention. These results may help determine the impact of implementing the results of TAVR-SAVR trials in real practice and may inform future trials in specific groups.
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14
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Vincent F, Ternacle J, Denimal T, Shen M, Redfors B, Delhaye C, Simonato M, Debry N, Verdier B, Shahim B, Pamart T, Spillemaeker H, Schurtz G, Pontana F, Thourani VH, Pibarot P, Van Belle E. Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Stenosis. Circulation 2021; 143:1043-1061. [PMID: 33683945 DOI: 10.1161/circulationaha.120.048048] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
After 15 years of successive randomized, controlled trials, indications for transcatheter aortic valve replacement (TAVR) are rapidly expanding. In the coming years, this procedure could become the first line treatment for patients with a symptomatic severe aortic stenosis and a tricuspid aortic valve anatomy. However, randomized, controlled trials have excluded bicuspid aortic valve (BAV), which is the most frequent congenital heart disease occurring in 1% to 2% of the total population and representing at least 25% of patients 80 years of age or older referred for aortic valve replacement. The use of a less invasive transcatheter therapy in this elderly population became rapidly attractive, and approximately 10% of patients currently undergoing TAVR have a BAV. The U.S. Food and Drug Administration and the "European Conformity" have approved TAVR for low-risk patients regardless of the aortic valve anatomy whereas international guidelines recommend surgical replacement in BAV populations. Given this progressive expansion of TAVR toward younger and lower-risk patients, heart teams are encountering BAV patients more frequently, while the ability of this therapy to treat such a challenging anatomy remains uncertain. This review will address the singularity of BAV anatomy and associated technical challenges for the TAVR procedure. We will examine and summarize available clinical evidence and highlight critical knowledge gaps regarding TAVR utilization in BAV patients. We will provide a comprehensive overview of the role of computed tomography scans in the diagnosis, and classification of BAV and TAVR procedure planning. Overall, we will offer an integrated framework for understanding the current role of TAVR in the treatment of bicuspid aortic stenosis and for guiding physicians in clinical decision-making.
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Affiliation(s)
- Flavien Vincent
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.).,Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- European Genomic Institute for Diabetes, F-59000 Lille, France (F.V., E.VB.).,Clinical Trials Center, Cardiovascular Research Foundation, New York (F.V., B.R., M. Simonato).,Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (F.V., J.T., M. Shen, P.P.)
| | - Julien Ternacle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (F.V., J.T., M. Shen, P.P.).,Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France (J.T.)
| | - Tom Denimal
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.)
| | - Mylène Shen
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (F.V., J.T., M. Shen, P.P.)
| | - Bjorn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York (F.V., B.R., M. Simonato)
| | - Cédric Delhaye
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.)
| | - Matheus Simonato
- Clinical Trials Center, Cardiovascular Research Foundation, New York (F.V., B.R., M. Simonato)
| | - Nicolas Debry
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.)
| | - Basile Verdier
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.)
| | - Bahira Shahim
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.)
| | - Thibault Pamart
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.)
| | - Hugues Spillemaeker
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.)
| | - Guillaume Schurtz
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.)
| | | | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA (V.H.T.)
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (F.V., J.T., M. Shen, P.P.)
| | - Eric Van Belle
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.).,Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- European Genomic Institute for Diabetes, F-59000 Lille, France (F.V., E.VB.)
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