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Mangieri A, Melillo F, Montalto C, Denti P, Praz F, Sala A, Winkel MG, Taramasso M, Tagliari AP, Fam NP, Rubbio AP, De Marco F, Bedogni F, Toggweiler S, Schofer J, Brinkmann C, Sievert H, Van Mieghem NM, Ooms JF, Paradis JM, Rodés-Cabau J, Brochet E, Himbert D, Perl L, Kornowski R, Ielasi A, Regazzoli D, Baldetti L, Masiero G, Tarantini G, Latib A, Laricchia A, Gattas A, Tchetchè D, Dumonteil N, Francesco G, Agricola E, Montorfano M, Lurz P, Crimi G, Maisano F, Colombo A. Management and Outcome of Failed Percutaneous Edge-to-Edge Mitral Valve Plasty: Insight From an International Registry. JACC Cardiovasc Interv 2022; 15:411-422. [PMID: 35210047 DOI: 10.1016/j.jcin.2021.11.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/09/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study evaluated the incidence, management, and outcome of patients who experienced MitraClip (Abbott Vascular) failure secondary to loss of leaflet insertion (LLI), single leaflet detachment (SLD), or embolization. BACKGROUND Transcatheter edge-to-edge repair with MitraClip is an established therapy for the treatment of mitral regurgitation (MR), but no data exist regarding the prevalence and outcome according to the mode of clip failure. METHODS Between January 2009 and December 2020, we retrospectively screened 4,294 procedures of MitraClip performed in 19 centers. LLI was defined as damage to the leaflet where the MitraClip was attached, SLD as demonstration of complete separation between the device and a single leaflet tissue, and clip embolization as loss of contact between MitraClip and both leaflets. RESULTS A total of 147 cases of MitraClip failure were detected (overall incidence = 3.5%), and these were secondary to LLI or SLD in 47 (31.9%) and 99 (67.3%) cases, respectively, whereas in 1 (0.8%) case clip embolization was observed. MitraClip failure occurred in 67 (45.5%) patients with functional MR, in 64 (43.5%) patients with degenerative MR, and 16 (10.8%) with mixed etiology. Although the majority of MitraClip failures were detected before discharge (47 intraprocedural and 42 in the hospital), up to 39.5% of cases were diagnosed at follow-up. In total, 80 (54.4%) subjects underwent a redo procedure, either percutaneously with MitraClip (n = 51, 34.7%) or surgically (n = 36, 24.5%) including 4 cases of surgical conversion of the index procedure and 7 cases of bailout surgery after unsuccessful redo MitraClip. After a median follow-up of 163 days (IQR: 22-720 days), 50 (43.9%) subjects presented moderate to severe MR, and 43 (29.3%) patients died. An up-front redo MitraClip strategy was associated with a trend toward a reduced rate of death at follow-up vs surgical or conservative management (P = 0.067), whereas postprocedural acute kidney injury, age, and moderate to severe tricuspid regurgitation were independent predictors of death. CONCLUSIONS MitraClip failure secondary to LLI and SLD is not a rare phenomenon and may occur during and also beyond hospitalization. Redo MitraClip strategy demonstrates a trend toward a reduced risk of death compared with bailout surgery and conservative management. A third of those patients remained with more than moderate MR and had substantial mortality at the intermediate-term follow-up.
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Affiliation(s)
- Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
| | | | - Claudio Montalto
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Denti
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alessandra Sala
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mirjam G Winkel
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maurizio Taramasso
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Ana Paula Tagliari
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Neil P Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Popolo Rubbio
- Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Federico De Marco
- Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Bedogni
- Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Joachim Schofer
- MVZ-Department Structural Heart Disease, Asklepios Clinic St Georg, Hamburg, Germany
| | - Christina Brinkmann
- MVZ-Department Structural Heart Disease, Asklepios Clinic St Georg, Hamburg, Germany
| | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany and Anglia Ruskin University, Chelmsford, United Kingdom
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Joris F Ooms
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jean-Michel Paradis
- Quebec Heart & Lung Institute, Laval University, Québec City, Québec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Québec City, Québec, Canada
| | - Eric Brochet
- Cardiology Department University Hospital Bichat, Paris, France
| | | | - Leor Perl
- Rabin Medical Center, Petah Tikva, Israel
| | | | | | | | - Luca Baldetti
- IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | | | - Angie Gattas
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Eustachio Agricola
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Montorfano
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gabriele Crimi
- Cardiovascular Disease Unit, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
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Moscarella E, Mangieri A, Giannini F, Tchetchè D, Kim WK, Sinning JM, Landes U, Kornowski R, Backer OD, Nickenig G, Biase CD, Soendergaard L, Marco FD, Bedogni F, Ancona M, Montorfano M, Regazzoli D, Stefanini G, Toggweiler S, Tamburino C, Immè S, Tarantini G, Sievert H, Schaefer U, Kempfert J, Woehrle J, Latib A, Calabrò P, Medda M, Tespili M, Colombo A, Ielasi A. 90 Annular size and interaction with trans-catheter aortic valves for the treatment of severe bicuspid aortic valve stenosis: insights from the beat registry. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Transcatheter aortic valve replacement (TAVR) is safe and feasible in patients with bicuspid aortic valve (BAV), but whether annular size may influence TAVR results in BAV patients remains unclear. We aimed at evaluating the impact of aortic annular size on procedural and clinical outcomes of BAV patients undergoing TAVR, as well as potential interactions between annular dimension and trans-catheter heart valve (THV) type [balloon-expandable (BEV) vs. self-expanding (SEV)].
Methods and results
BEAT is a multicentre registry of consecutive BAV stenosis undergoing TAVR. For this sub-study patients were classified according to annular dimension in small-annulus (area < 400 mm2 or perimeter <72 mm), medium-annulus (area ≥ 400 and < 575 mm2, perimeter ≥72 mm and< 85 mm), large-annulus (area ≥575 mm2 or perimeter ≥85 mm). Primary endpoint was Valve Academic Research Consortium-2 (VARC-2) device success. 45(15.5%) patients had small, 132(45.3%) medium, and 114(39.2%) large annuli. Compared with other groups, patients with large annuli were more frequently male, at younger age, had higher body mass index, larger aortic valve area, higher rate of moderate-severe calcification, lower mean trans-aortic valve gradient and lower left ventricular ejection fraction. In large-annuli SEVs were associated with a lower VARC-2 device success (75.9% vs. 90.6%, P = 0.049) driven by a higher rate of paravalvular valvular leak (PVL) compared to BEVs (20.7% vs. 1.2%, P < 0.001). However, no differences in clinical outcomes were observed according to annular size nor THV type.
Conclusions
TAVR in BAV patients is feasible irrespective of annular size. However in patients with large aortic annulus SEVs were associated with a significantly higher rate of PVLs compared to BEVs.
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Moscarella E, Mangieri A, Giannini F, Tchetchè D, Kim WK, Sinning JM, Landes U, Kornowski R, De Backer O, Nickenig G, De Biase C, Søndergaard L, De Marco F, Bedogni F, Ancona M, Montorfano M, Regazzoli D, Stefanini G, Toggweiler S, Tamburino C, Immè S, Tarantini G, Sievert H, Schäfer U, Kempfert J, Wöehrle J, Latib A, Calabrò P, Medda M, Tespili M, Colombo A, Ielasi A. Annular size and interaction with trans-catheter aortic valves for treatment of severe bicuspid aortic valve stenosis: Insights from the BEAT registry. Int J Cardiol 2021; 349:31-38. [PMID: 34843819 DOI: 10.1016/j.ijcard.2021.11.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/15/2021] [Accepted: 11/24/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is safe and feasible in patients with bicuspid aortic valve (BAV), but whether annular size may influence TAVR results in BAV patients remains unclear. We aimed at evaluating the impact of aortic annular size on procedural and clinical outcomes of BAV patients undergoing TAVR, as well as potential interactions between annular dimension and trans-catheter heart valve (THV) type (balloon-expandable (BEV) vs. self-expanding (SEV). METHODS BEAT is a multicenter registry of consecutive BAV stenosis undergoing TAVR. For this sub-study patients were classified according to annular dimension in small-annulus (area < 400 mm2 or perimeter <72 mm), medium-annulus (area ≥ 400 and < 575 mm2, perimeter ≥72 mm and< 85 mm), large-annulus (area ≥ 575 mm2 or perimeter ≥85 mm). Primary endpoint was Valve Academic Research Consortium-2 (VARC-2) device success. RESULTS 45(15.5%) patients had small, 132(45.3%) medium, and 114(39.2%) large annuli. Compared with other groups, patients with large annuli were more frequently male, younger, with higher body mass index, larger aortic valve area, higher rate of moderate-severe calcification, lower mean trans-aortic valve gradient and lower left ventricular ejection fraction. In large-annuli SEVs were associated with a lower VARC-2 device success (75.9% vs. 90.6%, p = 0.049) driven by a higher rate of paravalvular valvular leak (PVL) compared to BEVs (20.7% vs. 1.2%, p < 0.001). However, no differences in clinical outcomes were observed according to annular size nor THV type. CONCLUSIONS TAVR in BAV patients is feasible irrespective of annular size. However in patients with large aortic annulus SEVs were associated with a significantly higher rate of PVLs compared to BEVs.
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Affiliation(s)
- Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Francesco Giannini
- Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
| | | | - Uri Landes
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ole De Backer
- The Heart Center-Rigshospitalet, Copenhagen, Denmark
| | - Georg Nickenig
- Cardiology Department, University Hospital Bonn, Bonn, Germany
| | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | | | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | | | - Corrado Tamburino
- Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy
| | | | | | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, United Kingdom
| | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, NY, United States of America; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Massimo Medda
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Antonio Colombo
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France; EMO GVM Centro Cuore Columbus, Milan, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy.
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4
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Bugani G, Pagnesi M, Tchetchè D, Kim WK, Khokhar A, Sinning JM, Landes U, Kornowski R, Codner P, De Backer O, Nickenig G, Ielasi A, De Biase C, Søndergaard L, De Marco F, Ancona M, Montorfano M, Regazzoli D, Stefanini G, Toggweiler S, Tamburino C, Immè S, Tarantini G, Sievert H, Schäfer U, Kempfert J, Wöehrle J, Tespili M, Laricchia A, Latib A, Giannini F, Colombo A, Mangieri A. Correction to: Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis. Clin Res Cardiol 2021; 110:1692. [PMID: 33755778 DOI: 10.1007/s00392-021-01824-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Giulia Bugani
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Ferrara, Italy
| | | | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Won- Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Arif Khokhar
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy
| | | | - Uri Landes
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Pablo Codner
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ole De Backer
- The Heart Center-Rigshospitalet, Copenhagen, Denmark
| | - Georg Nickenig
- Cardiology Department, University Hospital Bonn, Bonn, Germany
| | | | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | | | - Damiano Regazzoli
- Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulio Stefanini
- Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Corrado Tamburino
- Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy
| | | | | | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, UK
| | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | | | - Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, NY, USA.,Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy.,EMO GVM Centro Cuore Columbus, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy.
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5
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Bugani G, Pagnesi M, Tchetchè D, Kim WK, Khokhar A, Sinning JM, Landes U, Kornowski R, Codner P, De Backer O, Nickenig G, Ielasi A, De Biase C, Søndergaard L, De Marco F, Ancona M, Montorfano M, Regazzoli D, Stefanini G, Toggweiler S, Tamburino C, Immè S, Tarantini G, Sievert H, Schäfer U, Kempfert J, Wöehrle J, Tespili M, Laricchia A, Latib A, Giannini F, Colombo A, Mangieri A. Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis. Clin Res Cardiol 2021; 110:667-675. [PMID: 33389062 DOI: 10.1007/s00392-020-01793-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To define the incidence of high residual gradient (HRG) after transcatheter aortic valve replacement (TAVR) in BAVs and their impact on short term outcome and 1-year mortality. BACKGROUND Transcatheter heart valves (THVs) offer good performance in tricuspid aortic valves with low rate of HRG. However, data regarding their performance in bicuspid aortic valves (BAV) are still lacking. METHODS The BEAT (Balloon vs Self-Expandable valve for the treatment of bicuspid Aortic valve sTenosis) registry included 353 consecutive patients who underwent TAVR (Evolut R/PRO or Sapien 3 valves) in BAV between June 2013 and October 2018. The primary endpoint was device unsuccess with post-procedural HRG (mean gradient ≥ 20 mmHg). The secondary endpoint was to identify the predictors of HRG following the procedure. RESULTS Twenty patients (5.6%) showed HRG after TAVR. Patients with HRG presented higher body mass index (BMI) (30.7 ± 9.3 vs. 25.9 ± 4.8; p < 0.0001) and higher baseline aortic mean gradients (57.6 ± 13.4 mmHg vs. 47.7 ± 16.6, p = 0.013) and more often presented with BAV of Sievers type 0 than patients without HRG. At multivariate analysis, BMI [odds ratio (OR) 1.12; 95% confidence interval (CI) 1.05-1.20, p = 0.001] and BAV type 0 (OR 11.31, 95% CI 3.45-37.06, p < 0.0001) were confirmed as independent predictors of high gradient. CONCLUSION HRG following TAVR in BAVs is not negligible and is higher among patients with high BMI and with BAV 0 anatomy.
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Affiliation(s)
- Giulia Bugani
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Ferrara, Italy
| | | | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Won- Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Arif Khokhar
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy
| | | | - Uri Landes
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Pablo Codner
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ole De Backer
- The Heart Center-Rigshospitalet, Copenhagen, Denmark
| | - Georg Nickenig
- Cardiology Department, University Hospital Bonn, Bonn, Germany
| | | | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | | | - Damiano Regazzoli
- Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulio Stefanini
- Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Corrado Tamburino
- Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy
| | | | | | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, UK
| | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | | | - Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, NY, USA.,Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy.,EMO GVM Centro Cuore Columbus, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy.
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6
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Tamburino C, Bleiziffer S, Thiele H, Scholtz S, Hildick-Smith D, Cunnington M, Wolf A, Barbanti M, Tchetchè D, Garot P, Pagnotta P, Gilard M, Bedogni F, Van Belle E, Vasa-Nicotera M, Chieffo A, Deutsch O, Kempfert J, Søndergaard L, Butter C, Trillo-Nouche R, Lotfi S, Möllmann H, Joner M, Abdel-Wahab M, Bogaerts K, Hengstenberg C, Capodanno D. Comparison of Self-Expanding Bioprostheses for Transcatheter Aortic Valve Replacement in Patients With Symptomatic Severe Aortic Stenosis. Circulation 2020; 142:2431-2442. [DOI: 10.1161/circulationaha.120.051547] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background:
Few randomized trials have compared bioprostheses for transcatheter aortic valve replacement, and no trials have compared bioprostheses with supra-annular design. The SCOPE 2 trial (Safety and Efficacy Comparison of Two TAVI Systems in a Prospective Randomized Evaluation 2) was designed to compare the clinical outcomes of the ACURATE neo and CoreValve Evolut bioprostheses for transcatheter aortic valve replacement.
Methods:
SCOPE 2 was a randomized trial performed at 23 centers in 6 countries between April 2017 and April 2019. Patients ≥75 years old with an indication for transfemoral transcatheter aortic valve replacement as agreed by the heart team were randomly assigned to receive treatment with either the ACURATE neo (n=398) or the CoreValve Evolut bioprostheses (n=398). The primary end point, powered for noninferiority of the ACURATE neo bioprosthesis, was all-cause death or stroke at 1 year. The key secondary end point, powered for superiority of the ACURATE neo bioprosthesis, was new permanent pacemaker implantation at 30 days.
Results:
Among 796 randomized patients (mean age, 83.2±4.3 years; mean Society of Thoracic Surgeons Predicted Risk of Mortality score, 4.6±2.9%), clinical follow-up information was available for 778 (98%) patients. Within 1 year, the primary end point occurred in 15.8% of patients in the ACURATE neo group and in 13.9% of patients in the CoreValve Evolut group (absolute risk difference, 1.8%, upper 1-sided 95% confidence limit, 6.1%;
P
=0.0549 for noninferiority). The 30-day rates of new permanent pacemaker implantation were 10.5% in the ACURATE neo group and 18.0% in the CoreValve Evolut group (absolute risk difference, –7.5% [95% CI, –12.4 to –2.60];
P
=0.0027). No significant differences were observed in the components of the primary end point. Cardiac death at 30 days (2.8% versus 0.8%;
P
=0.03) and 1 year (8.4% versus 3.9%;
P
=0.01), and moderate or severe aortic regurgitation at 30 days (10% versus 3%;
P
=0.002) were significantly increased in the ACURATE neo group.
Conclusions:
Transfemoral transcatheter aortic valve replacement with the self-expanding ACURATE neo did not meet noninferiority compared with the self-expanding CoreValve Evolut in terms of all-cause death or stroke at 1 year, and it was associated with a lower incidence of new permanent pacemaker implantation. In secondary analyses, the ACURATE neo was associated with more moderate or severe aortic regurgitation at 30 days and cardiac death at 30 days and 1 year.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03192813.
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Affiliation(s)
- Corrado Tamburino
- Department of General Surgery and Medical-Surgical Subspecialties, University of Catania, Italy (C.T., D.C.)
| | - Sabine Bleiziffer
- Department of Cardiothoracic Surgery (S.B.), Heart and Diabetes Center Northrhein-Westfalia, Bad Oeynhausen, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Germany (H.T., M.A.-W.)
| | - Smita Scholtz
- Department of Interventional Cardiology (S.S.), Heart and Diabetes Center Northrhein-Westfalia, Bad Oeynhausen, Germany
| | - David Hildick-Smith
- Department of Cardiology, Brighton and Sussex University Hospitals National Health Service Trust, Brighton, United Kingdom (D.H.-S.)
| | - Michael Cunnington
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals National Health Service Trust, United Kingdom (M.C.)
| | - Alexander Wolf
- Department of Cardiology, Elisabeth Hospital Essen, Germany (A.W.)
| | - Marco Barbanti
- Department of Cardio-Thoracic-Vascular Diseases and Transplantations, Azienda Ospedaliero-Universitaria Policlinico “G. Rodolico-San Marco,” Catania, Italy (M.B.)
| | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France (D.T.)
| | - Philippe Garot
- Hôpital Privé Jacques Cartier, Institut Cardio-vasculaire Paris-Sud, Ramsay-Santé, Massy, France (P.G.)
| | - Paolo Pagnotta
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Milano, Italy (P.P.)
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, France (M.G.)
| | - Francesco Bedogni
- Cardiology Department, Istituti di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milano, Italy (F.B.)
| | - Eric Van Belle
- Department of Cardiology, University Hospital, Lille, France (E.V.B.)
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany (M.V.-N.)
| | - Alaide Chieffo
- Interventional Cardiology Unit, Istituti di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy (A.C.)
| | - Oliver Deutsch
- Department of Cardiovascular Surgery, German Heart Centre Munich, Germany (O.D.)
| | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany (J.K.)
| | | | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg in Bernau and Brandenburg Medical School, Germany (C.B.)
| | - Ramiro Trillo-Nouche
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Spain (R.T.-N.)
| | - Shahram Lotfi
- Department of Cardiovascular Surgery, University Hospital RWTH Aachen, Germany (S.L.)
| | - Helge Möllmann
- Department of Cardiology, St Johannes Hospital, Dortmund, Germany (H.M.)
| | - Michael Joner
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (M.J.)
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Germany (H.T., M.A.-W.)
| | - Kris Bogaerts
- Department of Public Health and Primary Care, I-BioStat, KU Leuven, Belgium (K.B.)
- I-BioStat, Universiteit Hasselt, Belgium (K.B.)
| | | | - Davide Capodanno
- Department of General Surgery and Medical-Surgical Subspecialties, University of Catania, Italy (C.T., D.C.)
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7
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Ielasi A, Moscarella E, Mangieri A, Giannini F, Tchetchè D, Kim WK, Sinning JM, Landes U, Kornowski R, De Backer O, Nickenig G, De Biase C, Søndergaard L, De Marco F, Bedogni F, Ancona M, Montorfano M, Regazzoli D, Stefanini G, Toggweiler S, Tamburino C, Immè S, Tarantini G, Sievert H, Schäfer U, Kempfert J, Wöehrle J, Latib A, Calabrò P, Medda M, Tespili M, Colombo A. Procedural and clinical outcomes of type 0 versus type 1 bicuspid aortic valve stenosis undergoing trans-catheter valve replacement with new generation devices: Insight from the BEAT international collaborative registry. Int J Cardiol 2020; 325:109-114. [PMID: 33148461 DOI: 10.1016/j.ijcard.2020.10.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/01/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although bicuspid aortic valve (BAV) is not considered a "sweet spot" to trans-catheter aortic valve replacement (TAVR), a certain number of BAV underwent TAVR. Whether BAV phenotype affects outcomes following TAVR remains debated. We aimed at evaluating the impact of BAV phenotype on procedural and clinical outcomes after TAVR using new generation trans-catheter heart valves (THVs). METHODS patients included in the BEAT registry were classified according to the BAV phenotype revealed at multi-slice computed tomography (MSCT) in type 0 (no raphe) vs. type 1 (1 raphe). Primary end-point was Valve Academic Research Consortium-2 (VARC-2) device success. Secondary end-points included procedural complications, rate of permanent pacemaker implantation, clinical outcomes at 30-day and 1-year. RESULTS Type 0 BAV was present in 25(7.1%) cases, type 1 in 218(61.8%). Baseline characteristics were well balanced between groups. Moderate-severe aortic valve calcifications at MSCT were less frequently present in type 0 vs. type 1 (52%vs.71.1%,p = 0.05). No differences were reported for THV type, size, pre and post-dilation between groups. VARC-2 success tended to be lower in type 0 vs. type 1 BAV (72%vs86.7%;p = 0.07). Higher rate of mean transprosthetic gradient ≥20 mmHg was observed in type 0 vs. type 1 group (24%vs6%,p = 0.007). No differences were reported in the rate of post-TAVR moderate-severe aortic regurgitation and clinical outcomes between groups. CONCLUSIONS Our study confirms TAVR feasibility in both BAV types, however a trend toward a lower VARC-2 device success and a higher rate of mean transprosthetic gradient ≥20 mmHg was observed in type 0 vs. type 1 BAV.
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Affiliation(s)
- Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy, Italy.
| | - Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Mangieri
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Francesco Giannini
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
| | | | - Uri Landes
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ole De Backer
- The Heart Center-Rigshospitalet, Copenhagen, Denmark
| | - Georg Nickenig
- Cardiology Department, University Hospital Bonn, Bonn, Germany
| | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | | | - Damiano Regazzoli
- Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulio Stefanini
- Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Corrado Tamburino
- Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy
| | | | | | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany and Anglia Ruskin University, Chelmsford, United Kingdom
| | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, NY, New York, United States of America; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Massimo Medda
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy, Italy
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy, Italy
| | - Antonio Colombo
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy; EMO GVM Centro Cuore Columbus, Milan, Italy
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8
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Mangieri A, Tchetchè D, Kim WK, Pagnesi M, Sinning JM, Landes U, Kornowski R, De Backer O, Nickenig G, Ielasi A, De Biase C, Søndergaard L, De Marco F, Montorfano M, Chiarito M, Regazzoli D, Stefanini G, Presbitero P, Toggweiler S, Tamburino C, Immè S, Tarantini G, Sievert H, Schäfer U, Kempfert J, Wöehrle J, Gallo F, Laricchia A, Latib A, Giannini F, Colombo A. Balloon Versus Self-Expandable Valve for the Treatment of Bicuspid Aortic Valve Stenosis: Insights From the BEAT International Collaborative Registrys. Circ Cardiovasc Interv 2020; 13:e008714. [PMID: 32646304 DOI: 10.1161/circinterventions.119.008714] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Large data comparing the performance of new-generation self-expandable versus balloon-expandable transcatheter heart valves in bicuspid aortic stenosis are lacking. We aim to compare the safety and performance of balloon-expandable and self-expandable transcatheter heart valves in the treatment of bicuspid aortic stenosis. METHODS The BEAT (balloon versus self-expandable valve for the treatment of bicuspid aortic valve stenosis) registry included 353 consecutive patients who underwent transcatheter aortic valve implantation using new-generation Evolut R/PRO or Sapien 3 valves in bicuspid aortic valve. RESULTS A total of 353 patients (n=242 [68.6%] treated with Sapien 3 and n=111 [68.6%] treated with Evolut R (n=70)/PRO [n=41]) were included. Mean age was 77.8±8.3 years and mean Society of Thoracic Surgeons Predicted Risk of Mortality was 4.4±3.3%. Valve Academic Research Consortium-2 device success was similar between Sapien 3 and Evolut R/PRO (85.6% versus 87.2%; P=0.68). In the Sapien 3 group, 4 patients experienced annular rupture whereas this complication did not occur in the Evolut R/PRO group. After propensity score matching, Valve Academic Research Consortium-2 device success was similar between both groups (Sapien 3=85.7% versus Evolut R/Pro=84.4%; P=0.821). Both in the overall and in the matched population, no differences in the rate of permanent pacemaker implant were observed. At 1-year follow-up, the rate of overall death and cardiovascular death were similar between the 2 groups. In the unmatched population, the 1-year echocardiographic follow-up demonstrated similar rate of moderate-to-severe paravalvular aortic regurgitation (Evolut R/PRO 10.5% versus Sapien 3 4.2%, P=0.077); however, after propensity matching, the rate of moderate-to-severe paravalvular leak became significantly higher among patients treated with self-expandable valves (9.3% versus 0%; P=0.043). CONCLUSIONS Our study confirms the feasibility of both Sapien 3 and Evolut R/PRO implantation in bicuspid aortic valve anatomy; a higher rate of moderate-severe paravalvular aortic regurgitation was observed in the Evolut R/PRO group at 1-year follow-up in the matched cohort, although patients treated with balloon-expandable valve had a higher rate of annular rupture.
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Affiliation(s)
- Antonio Mangieri
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy (A.M., F.G., A.L., F.G., A.C.)
- San Raffaele Scientific Institute, Milan, Italy (A.M., M.P., M.M.)
| | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse (D.T., C.D.B.)
| | - Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany (W.-K.K.)
| | - Matteo Pagnesi
- San Raffaele Scientific Institute, Milan, Italy (A.M., M.P., M.M.)
| | - Jean-Malte Sinning
- Cardiology Department, University Hospital Bonn, Germany (J.-M.S., G.N.)
| | - Uri Landes
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (U.L., R.K.)
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (U.L., R.K.)
| | - Ole De Backer
- The Heart Center-Rigshospitalet, Copenhagen, Denmark (O.D.B., L.S.)
| | - Georg Nickenig
- Cardiology Department, University Hospital Bonn, Germany (J.-M.S., G.N.)
| | | | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse (D.T., C.D.B.)
| | - Lars Søndergaard
- The Heart Center-Rigshospitalet, Copenhagen, Denmark (O.D.B., L.S.)
| | - Federico De Marco
- Department of Cardiology, Istituto Clinico San Donato, Milan, Italy (F.D.M.)
| | | | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy (M.C., D.R., G.S., P.P.)
| | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy (M.C., D.R., G.S., P.P.)
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy (M.C., D.R., G.S., P.P.)
| | - Patrizia Presbitero
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy (M.C., D.R., G.S., P.P.)
| | | | - Corrado Tamburino
- Cardiology Division, CAST Policlinico Hospital, University of Catania, Italy (C.T.)
| | | | | | - Horst Sievert
- Cardiovascular Center Frankfurt, Germany (H.S.)
- Anglia Ruskin University, Chelmsford, United Kingdom (H.S.)
| | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Germany (J.K.)
| | | | - Francesco Gallo
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy (A.M., F.G., A.L., F.G., A.C.)
| | - Alessandra Laricchia
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy (A.M., F.G., A.L., F.G., A.C.)
- Department of Cardiology, Montefiore Medical Center, New York (A.L.)
| | | | - Francesco Giannini
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy (A.M., F.G., A.L., F.G., A.C.)
| | - Antonio Colombo
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy (A.M., F.G., A.L., F.G., A.C.)
- Centro Cuore Columbus, GVM care and research, Milan, Italy (A.C.)
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