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Hascoët S, Smolka G, Blanchard D, Kloëckner M, Brochet E, Bouisset F, Leurent G, Thambo JB, Combes N, Dumonteil N, Bauer F, Nejjari M, Pillière R, Dauphin C, Bonnet G, Ciobotaru V, Kételers R, Gallet R, Hammoudi N, Mangin L, Bouvaist H, Spaulding C, Aminian A, Kilic T, Popovic B, Armero S, Champagnac D, Gérardin B. Predictors of Clinical Success After Transcatheter Paravalvular Leak Closure: An International Prospective Multicenter Registry. Circ Cardiovasc Interv 2022; 15:e012193. [PMID: 36256693 DOI: 10.1161/circinterventions.122.012193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Transcatheter closure of a symptomatic prosthetic paravalvular leak (PVL) is feasible, but there is presently no conclusive evidence to show consistent efficacy. We aimed to identify predictors of clinical success after transcatheter PVL closure. METHODS Consecutive patients referred to 24 European centers for transcatheter PVL closure in 2017 to 2019 were included in a prospective registry (Fermeture de Fuite ParaProthétique, FFPP). Clinical success was absence of any of the following within 1 month: re-admission for heart failure, blood transfusion, open-heart valvular surgery, and death. RESULTS We included 216 symptomatic patients, who underwent 238 percutaneous PVL closure procedures on the mitral (64.3%), aortic (34.0%), or tricuspid (1.7%) valve. Symptoms were heart failure, hemolytic anemia, or both in 48.9%, 7.8%, and 43.3% of patients, respectively. One, 2, and 3 leaks were treated during the same procedure in 69.6%, 26.6%, and 3.8% of patients, respectively. The PVL was pinpoint or involved 1/8 or 1/4 of the valve circumference in 18.6%, 52.4%, and 28.1% of cases, respectively. The most frequently used devices were the Vascular Plug 3, Ventricular Septal Defect Occluder, Vascular Plug 2, and Paravalvular Leak Device (45.0%, 16.6%, 14.2%, and 13.6% of cases, respectively). Successful device(s) implantation with leak reduction to ≤grade 2 was obtained in 85.0% of mitral and 91.4% of aortic procedures, respectively (P=0.164); with major periprocedural adverse event rates of 3.3% and 1.2%, respectively (P=0.371); and clinical success rates of 70.3% and 88.0%, respectively (P=0.004). By multivariate analysis, technical failure, mechanical valve, and hemolytic anemia were independently associated with absence of clinical success (odds ratios [95% CIs], 7.7 [2.0-25.0]; P=0.002; 3.6 [1.1-11.1]; P=0.036; and 3.7 [1.2-11.9]; P=0.025; respectively). CONCLUSIONS Transcatheter PVL closure is efficient and safe in symptomatic patients but is associated with a lower clinical success rate in patients with hemolysis and/or a mechanical valve. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifiers: NCT05089136.
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Affiliation(s)
- Sébastien Hascoët
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, France (S.H., D.B., M.K., B.G.)
| | | | - David Blanchard
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, France (S.H., D.B., M.K., B.G.)
| | - Martin Kloëckner
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, France (S.H., D.B., M.K., B.G.)
| | - Eric Brochet
- Hôpital Bichat AP-HP, Hôpital Bichat-Paris, Paris, France (E.B.)
| | - Frederic Bouisset
- Department of Cardiology, Toulouse Rangueil University Hospital, UMR 1295 INSERM, Hôpital Rangueil, CHU Toulouse, Toulouse, France (F.B.)
| | - Guillaume Leurent
- Department of cardiology, Université Rennes, Inserm, LTSI - UMR1099, CHU Rennes, Rennes, France (G.L.)
| | | | | | | | | | | | - Rémy Pillière
- Clinique Ambroise Paré-25-27 boulevard Victor Hugo, France (R.P.)
| | - Claire Dauphin
- Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France (C.D.)
| | - Guillaume Bonnet
- CHU Timone, Assistance Publique des Hôpitaux de Marseille, France (G.B.)
| | | | | | | | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, and Hôpital Pitié-Salpêtrière AP-HP, Boulevard de l'Hôpital, Paris, France (N.H.)
| | - Lionel Mangin
- Hôpital d'Annecy, 1 avenue de l'Hôpital, France (L.M.)
| | - Hélène Bouvaist
- CHU Grenoble, avenue du Maquis du Grésivaudan, France (H.B.)
| | | | | | - Teoman Kilic
- Kocaeli University School of Medicine, Cardiology Department, Umuttepe, Yerteskesi, Kocaeli, Turkey (T.K.)
| | - Batric Popovic
- Lorraine University, CHRU Nancy, Cardiology department, Nancy, France (B.P.)
| | | | | | - Benoît Gérardin
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, France (S.H., D.B., M.K., B.G.)
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Weisskopf M, Glaus L, Trimmel NE, Hierweger MM, Leuthardt AS, Kukucka M, Stolte T, Stoeck CT, Falk V, Emmert MY, Kofler M, Cesarovic N. Dos and don'ts in large animal models of aortic insufficiency. Front Vet Sci 2022; 9:949410. [PMID: 36118338 PMCID: PMC9478759 DOI: 10.3389/fvets.2022.949410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/22/2022] [Indexed: 11/14/2022] Open
Abstract
Aortic insufficiency caused by paravalvular leakage (PVL) is one of the most feared complications following transcatheter aortic valve replacement (TAVI) in patients. Domestic pigs (Sus scrofa domestica) are a popular large animal model to study such conditions and develop novel diagnostic and therapeutic techniques. However, the models based on prosthetic valve implantation are time intensive, costly, and often hamper further hemodynamic measurements such as PV loop and 4D MRI flow by causing implantation-related wall motion abnormalities and degradation of MR image quality. This study describes in detail, the establishment of a minimally invasive porcine model suitable to study the effects of mild-to-moderate “paravalvular“ aortic regurgitation on left ventricular (LV) performance and blood flow patterns, particularly under the influence of altered afterload, preload, inotropic state, and heart rate. Six domestic pigs (Swiss large white, female, 60–70 kg of body weight) were used to establish this model. The defects on the hinge point of aortic leaflets and annulus were created percutaneously by the pierce-and-dilate technique either in the right coronary cusp (RCC) or in the non-coronary cusp (NCC). The hemodynamic changes as well as LV performance were recorded by PV loop measurements, while blood flow patterns were assessed by 4D MRI. LV performance was additionally challenged by pharmaceutically altering cardiac inotropy, chronotropy, and afterload. The presented work aims to elaborate the dos and don'ts in porcine models of aortic insufficiency and intends to steepen the learning curve for researchers planning to use this or similar models by giving valuable insights ranging from animal selection to vascular access choices, placement of PV Loop catheter, improvement of PV loop data acquisition and post-processing and finally the induction of paravalvular regurgitation of the aortic valve by a standardized and reproducible balloon induced defect in a precisely targeted region of the aortic valve.
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Affiliation(s)
- Miriam Weisskopf
- Center for Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas Glaus
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Nina E. Trimmel
- Center for Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Melanie M. Hierweger
- Center for Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea S. Leuthardt
- Center for Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marian Kukucka
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Thorald Stolte
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Christian T. Stoeck
- Center for Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Y. Emmert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Nikola Cesarovic
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- *Correspondence: Nikola Cesarovic
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Zorinas A, Janušauskas V, Austys D, Davidavičius G, Puodžiukaitė L, Zakarkaitė D, Samalavičius RS, Urbonas K, Kramena R, Onorato EM, Ručinskas K. A Comparison of the Catheter-Based Transapical and Surgical Treatment Modalities for Mitral Paravalvular Leak. J Clin Med 2022; 11:jcm11174999. [PMID: 36078929 PMCID: PMC9457088 DOI: 10.3390/jcm11174999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/03/2022] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background: There is a lack of studies where the outcomes of mitral paravalvular leak treatment were compared between surgery and catheter-based closure. The aim of this study was to compare the outcomes of re-do surgery with transapical catheter-based paravalvular leak closure. Methods: This is a retrospective observational study at a single institution; 76 patients were included. According to the treatment, two groups were formed: the “Surgical” group (49 patients after re-do surgery) and the “Catheter” group (27 patients after transapical catheter–based treatment). Results: In-hospital myocardial infarction occurred in 9 (18%) cases in the “Surgical” group and none in the “Catheter” group, p = 0.018. Procedure-related life-threatening bleeding occurred in 9 (18%) patients in the “Surgical” group and none in the “Catheter” group, p = 0.018. Nine (18%) patients died in 30 days in the “Surgical” group, and none died in the “Catheter” group, p = 0.039. A mean follow-up was 3.3 years. No difference was found between the groups by the degree of residual paravalvular regurgitation either at discharge or at follow-up. During the follow-up, 19 (39%) patients died in the “Surgical” group and 2 (7%) among the “Catheter” patients. Conclusions: Transapical catheter-based closure of mitral paravalvular leak seems to be a safer treatment procedure than conventional re-do surgery, and the effectiveness of these procedures does not differ.
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Affiliation(s)
- Aleksejus Zorinas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
- Correspondence:
| | - Vilius Janušauskas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - Donatas Austys
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, M.K. Čiurlionio 21/27, LT-03101 Vilnius, Lithuania
| | - Giedrius Davidavičius
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - Lina Puodžiukaitė
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - Diana Zakarkaitė
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - Robertas Stasys Samalavičius
- Clinic of Emergency Medicine, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - Karolis Urbonas
- Clinic of Emergency Medicine, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - Rita Kramena
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - Eustaquio Maria Onorato
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University School of Milan, Via C. Parea 4, 20138 Milan, Italy
| | - Kęstutis Ručinskas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
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Bruscky LVR, Gun C, Ramos AIDO, Morais AL. Late Outcomes of Aortic Valve Replacement with Bioprosthesis and Mechanical Prosthesis. Arq Bras Cardiol 2021; 117:28-36. [PMID: 34320064 PMCID: PMC8294736 DOI: 10.36660/abc.20200135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite constant improvement and refinement of the prostheses, the decision between mechanical and biological valves for aortic valve replacement is still controversial. OBJECTIVE To compare outcomes of aortic valve replacement with bioprosthesis and mechanical prosthesis. METHODS This was an observational, historical cohort study with review of medical records. A total of 202 patients who underwent heart valve replacement surgery between 2004 and 2008 were selected, with a mean follow-up of 10 years. The level of significance set at 5%. RESULTS Mean age of patients was approximately 50 years; most patients were male (70%). Overall mortality- and reoperation-free survival was significantly higher in patients with mechanical prosthesis (HR=0.33; 95%CI=0.13-0.79; p=0.013). No difference was found in late mortality between the two groups. On the other hand, the risk of reoperation was significantly higher in patients with bioprosthesis than mechanical prosthesis (HR=0.062; 95%CI=0.008-0.457; p=0.006). The risk of composite adverse events - stroke, bleeding, endocarditis, thrombosis and paravalvular leak - was similar between the groups (HR=1.20; 95%CI= 0.74-1.93; p=0.44). The risk of bleeding was significantly higher in patients with mechanical prosthesis (HR=3.65; 95%CI= 1.43-9.29; p = 0.0064), although no case of fatal bleeding was reported. CONCLUSION No difference in 10-year mortality was found between the groups. The risk of reoperation significantly increases with the use of bioprosthesis, especially for patients younger than 30 years. Patients with mechanical prosthesis are at increased risk of nonfatal bleeding.
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Affiliation(s)
| | - Carlos Gun
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
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Sazzad F, Xian OZ, Ler A, Guohao C, Swee KG, Kofidis T. Incidence of valvular regurgitation and leaflet perforation by using automated titanium fasteners (CORKNOT®) in heart valve repair or replacement: less usual than reported. J Cardiothorac Surg 2021; 16:163. [PMID: 34099017 PMCID: PMC8186203 DOI: 10.1186/s13019-021-01512-z] [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: 10/28/2020] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND CORKNOT® facilitates a reduction in cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and operative time, but reported to be associated with other complications. We aim to quantify the incidence of valvular complications related to CORKNOT® and determine the feasibility of its use between different valvular surgeries. METHODS Patients who underwent heart valve repair or replacement surgery via the use of automated titanium suture fasteners (CORKNOT®) in a tertiary care hospital were included in the study. This single-centre retrospective study was conducted on 132 patients between January 2016 and June 2018. RESULTS In our study, the overall mean operative time was 320.0 ± 97.0 min, mean CPB time was 171.4 ± 76.0 min and the calculated mean ACC time was 105.9 ± 54.0 min. Fifty-eight patients (43.9%) underwent minimally invasive valve replacement or repair surgery and 66 patients (50.0%) underwent concomitant procedures. A total of 157 valves were operated on, with 112 (84.8%) single valve surgeries, 15 (11.4%) double valve surgeries and 5 (3.8%) triple valve surgeries. After reviewed by the cardiologist blinded towards the study, we report trivial and/or mild paravalvular leak (PVL) in immediate post-operative echocardiography was found in 1 (1.01%) patients. There were no reported cases of valvular thrombosis, leaflet perforation, device dislodgement or embolization, moderate and/or severe PVL during hospitalization and follow-up echocardiography within 1 year. Single mitral valve and aortic surgeries had comparable incidences of post surgical complications. CONCLUSION We conclude the feasibility of CORKNOT® utilisation in mitral and aortic valve surgeries. Additionally, incidence of CORKNOT® related complications in heart valve repair or replacement surgery is less usual in our setting than previously reported. These results motivate the use of CORKNOT® as a valid alternative with complete commitment.
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Affiliation(s)
- Faizus Sazzad
- Cardiac Surgery Experimental Laboratory, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Ong Zhi Xian
- Cardiac Surgery Experimental Laboratory, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Ashlynn Ler
- Cardiac Surgery Experimental Laboratory, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,School of Medicine, National University of Ireland, Galway, Ireland
| | - Chang Guohao
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, 1E Kent Ridge Road, Singapore, 119228, Singapore.,National University Hospital, National University Health System, Singapore, Singapore
| | - Kang Giap Swee
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, 1E Kent Ridge Road, Singapore, 119228, Singapore.,National University Hospital, National University Health System, Singapore, Singapore
| | - Theo Kofidis
- Cardiac Surgery Experimental Laboratory, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore. .,National University Hospital, National University Health System, Singapore, Singapore.
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Cannata L, Zocco Ramazzo C. Echocardiographic evaluation of paravalvular aortic regurgitation of a patient with recurrent aortic valve replacements. Monaldi Arch Chest Dis 2021; 91. [PMID: 33878851 DOI: 10.4081/monaldi.2021.1765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/12/2021] [Indexed: 11/22/2022] Open
Abstract
Paravalvular regurgitation (PVR) is a serious complication after surgical valve replacement. Echocardiography is the gold standard technique to assess the severity of PVR with an integrated approach. A 48-year-old male underwent aortic valve replacement due to infective endocarditis (IE). During in-hospital cardiac rehabilitation after a redo surgery for a new IE three years later, an echo-free anterior space around the valve with several PVRs through transthoracic echocardiography (TTE) was identified. On transesophageal echocardiography (TOE) a double PVR (anterior and posterior) with abscessual cavity was detected. The patient's conditions worsened within six months with hemodynamic instability: a massive PVR due to a large abscess cavity next to the right cusp was confirmed by TTE and TOE and a third surgery was carried out. On the third admission at our Rehabilitation Unit the echo features were normal. Patient did not report any cardiovascular symptoms at 1 year follow-up.
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Affiliation(s)
- Lorenzo Cannata
- Cardiac Rehabilitation Division, ICS Maugeri IRCCS, Gattico-Veruno.
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Transcatheter Closure of Mitral Paravalvular Leak via Multiple Approaches. J Interv Cardiol 2021; 2021:6630774. [PMID: 33746639 PMCID: PMC7943287 DOI: 10.1155/2021/6630774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/27/2021] [Accepted: 02/10/2021] [Indexed: 01/02/2023] Open
Abstract
Objectives The purpose of this study was to review the experiences with transcatheter closure of mitral PVL after surgical valve replacement. Background Transcatheter closure of paravalvular leak (PVL) is an intricate alternative to surgical closure. But it represents one of the most intricate procedures in the field of structural heart interventions, especially for patients with mitral PVL. Methods From January 2015 through January 2019, 35 patients with mitral PVL after valve replacement underwent transcatheter closure. We reviewed the catheter techniques, perioperative characteristics, and prognosis. The median follow-up was 26 (3–48) months. Results Acute procedural success was achieved in 33/35 (94.3%) patients. Twenty-five patients had single mitral prosthetic valve replacements; 10 had combined aortic and mitral prosthetic valve replacements previously; 28 had mechanical valves; and 7 had bioprosthetic valves. All percutaneous procedures were performed with local anesthesia except for seven transapical cases with general anesthesia. Multiple approaches were used: transfemoral, transapical, and transseptal via an arteriovenous loop. Multiple devices were deployed. There were no hospital deaths. The procedural time was 67–300 (124 ± 62) minutes. Fluoroscopic time was 17–50 (23.6 ± 12.1) minutes. The hospital stay was 5–17 (8.3 ± 3.2) days. Complications included recurrent hemolysis, residual regurgitation, acute renal insufficiency, and anemia. Twenty-seven (77.1%) patients improved by ≥1 New York Heart Association functional class at the 1-year follow-up. Conclusions Transcatheter mitral PVL closure requires complex catheter techniques. However, this minimally invasive treatment could provide reliable outcomes and shorter hospital stays in selected patients. This trial is registered with NCT02917980.
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8
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TAVR: A Review of Current Practices and Considerations in Low-Risk Patients. J Interv Cardiol 2020; 2020:2582938. [PMID: 33447165 PMCID: PMC7781688 DOI: 10.1155/2020/2582938] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/30/2020] [Accepted: 09/08/2020] [Indexed: 11/17/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is an established treatment for severe, symptomatic, aortic stenosis (AS) in patients of all risk categories and now comprises 12.5% of all aortic valve replacements. TAVR is a less invasive alternative to traditional surgical aortic valve replacement (SAVR), with equivalent or superior outcomes. The use of TAVR has increased rapidly. The success and increase in use of TAVR are a result of advances in technology, greater operator experience, and improved outcomes. Indications have recently expanded to include patients considered to be at low risk for SAVR. While TAVR outcomes have improved, remaining challenges include the management of coexistent coronary artery disease, prevention of periprocedural stroke, and issue of durability. These issues are even more relevant for low-risk, younger patients.
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9
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Abstract
Mitral paravalvular leaks (PVLs) commonly occur in patients with prosthetic valves. Paravalvular defects may be clinically inconsequential and may aggravate hemolysis or cause heart failure through regurgitation. Accordingly, patients may eventually require intervention such as redo surgery or a transcatheter closure of the defects. The introduction of purpose-specific closure devices and new steerable catheters has opened a new frontier for the transcatheter PVL closure. This mode of treatment is an initial therapy in most centers with experienced structural heart team. However, head-to-head data comparing two treatment modalities (surgery and transcatheter closure) are limited, and the world-wide experience is based on nonrandomized studies. Multimodality imaging, including three-dimensional transesophageal echocardiography, facilitates the delineation of mitral PVLs and provides essential data that aids the communication between the members of the structural heart team. In the near future, the success of interventional therapies will most probably increase in patients with mitral PVLs with the introduction of hybrid imaging modalities (echocardiography, cardiac computed tomography, and fluoroscopy). In conclusion, this paper summarizes the etiopathogenesis, clinical characteristics, diagnosis, and treatment of mitral PVLs. (Anatol J Cardiol 2020; 24: 350-60)
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10
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Ruparelia N, Cao J, Newton JD, Wilson N, Daniels MJ, Ormerod OJ. Paravalvular leak closure under intracardiac echocardiographic guidance. Catheter Cardiovasc Interv 2017; 91:958-965. [PMID: 29024359 DOI: 10.1002/ccd.27318] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/05/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The objective of this study was to determine the safety and efficacy of intracardiac echocardiography (ICE) to guide percutaneous paravalvular leak (PVL) closure. BACKGROUND PVL following surgical valve replacement occurs in 2%-15% of patients. Percutaneous treatment is an accepted management strategy in patients deemed to be too high risk for redo surgery. This is most commonly performed with transesophageal (TOE) guidance requiring general anesthesia that both potentially further increase the risk of intervention. ICE can be used to guide intervention, facilitating procedures to be performed under local anesthesia without esophageal intubation potentially making procedures shorter and safer and further enabling the treatment of patients that may have been turned down for intervention. METHODS All patients that underwent ICE-guided percutaneous transcatheter PVL closure between 2006 and 2016 at the John Radcliffe Hospital, Oxford, United Kingdom were retrospectively analyzed. RESULTS Twenty-one procedures were performed in 18 patients during the study period. Fourteen patients (77.8%) underwent successful ICE guided PVL closure. There were no ICE-related complications. Eleven patients (78.6%) reported symptomatic improvement of at least one New York Heart Association (NYHA) Class and the remaining 3 patients had no change. No patient demonstrated objective evidence of persistent hemolysis following successful closure. There was one death within 30 days of the procedure and 1 year survival was 71.4%. CONCLUSIONS Percutaneous paravalvular leak closure guided by ICE without the requirement of general anesthesia is feasible, safe, and associated with acceptable procedural success rates.
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Affiliation(s)
- Neil Ruparelia
- Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom
| | - Jacob Cao
- Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom
| | - James D Newton
- Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom
| | - Neil Wilson
- Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom.,Department of Paediatrics-Cardiology, Children's Hospital Colorado, Aurora, Colorado 80045
| | - Matthew J Daniels
- Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom
| | - Oliver J Ormerod
- Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom
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