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Dumpies O, Abdelhafez A, Rotta Detto Loria J, Richter I, Feistritzer HJ, Majunke N, Desch S, Noack T, Thiele H, Abdel-Wahab M. A study of bailout plug-based closure after failed suture-based closure in patients undergoing transfemoral TAVI. EUROINTERVENTION 2024; 20:e344-e353. [PMID: 38506741 PMCID: PMC10941667 DOI: 10.4244/eij-d-23-00750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/21/2023] [Indexed: 03/21/2024]
Abstract
BACKGROUND Percutaneous suture-based arterial access site closure (ProGlide) is commonly applied in patients undergoing transfemoral transcatheter aortic valve implantation (TAVI). However, the failure of a suture-based vascular closure device (VCD) may require additional treatment. AIMS We aimed to evaluate the efficacy and safety of bailout access site closure using a large-bore plug-based device (MANTA) in patients with failed suture-based closure during transfemoral TAVI. METHODS Patients undergoing a bailout attempt with the MANTA VCD were identified from a prospectively enrolling, institutional registry. Efficacy was defined as haemostasis at the access site without the need for alternative treatment other than manual compression or endovascular ballooning. Safety was defined as freedom from vascular dissection, stenosis and occlusion requiring intervention. RESULTS Of 2,505 patients, 66 underwent a bailout attempt with MANTA as a result of ProGlide failure, which occurred before the large-bore sheath insertion in 16.7% of patients and after the sheath removal in 83.3% of patients. Bailout MANTA was deemed effective in 75.8% of patients (50/66), and the technique was considered safe in 86.4% (57/66) of patients. Failure of bailout MANTA occurred because of its superficial application, resulting in persistent bleeding in 18.2% of patients (12/66), and because of its deep application, resulting in stenosis or occlusion in 6.1% of patients (4/66). Operator experience with the technique (odds ratio [OR] 12.29, 95% confidence interval [CI]: 1.99-75.99; p=0.007) and prior use of three ProGlides (OR 0.02, 95% CI: <0.01-0.39; p=0.010) were the only independent predictors of the efficacy endpoint. CONCLUSIONS Bailout MANTA after ProGlide failure was effective and safe, but operator experience seems to be crucial. Further technological refinements to facilitate accurate placement appear necessary.
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Affiliation(s)
- Oliver Dumpies
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ahmed Abdelhafez
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Johannes Rotta Detto Loria
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ines Richter
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Hans-Josef Feistritzer
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Nicolas Majunke
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Steffen Desch
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thilo Noack
- Department of Structural Heart Disease/Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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von Roeder M, Maeder M, Wahl V, Kitamura M, Rotta Detto Loria J, Dumpies O, Rommel KP, Kresoja KP, Blazek S, Richter I, Majunke N, Desch S, Thiele H, Lurz P, Abdel-Wahab M. Prognostic significance and clinical utility of left atrial reservoir strain in transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2024; 25:373-382. [PMID: 37862161 DOI: 10.1093/ehjci/jead268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 04/03/2023] [Revised: 08/29/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023] Open
Abstract
AIMS Patients with diastolic dysfunction (DD) experience worse outcomes after transcatheter aortic valve replacement (TAVR). We investigated the prognostic value and clinical utility of left atrial reservoir strain (LARS) in patients undergoing TAVR for aortic stenosis (AS). METHODS AND RESULTS All consecutive patients undergoing TAVR between January 2018 and December 2018 were included if discharge echocardiography and follow-up were available. LARS was derived from 2D-speckle-tracking. Patients were grouped into three tertiles according to LARS. DD was analysed using the ASE/EACVI-algorithm. The primary outcome was a composite of all-cause death and readmission for worsening heart failure 12 months after TAVR. Overall, 606 patients were available [age 80 years, interquartile range (IQR) 77-84], including 53% women. Median LARS was 13.0% (IQR 8.4-18.3). Patients were classified by LARS tertiles [mildly impaired 21.4% (IQR 18.3-24.5), moderately impaired 13.0% (IQR 11.3-14.6), severely impaired 7.1% (IQR 5.4-8.4), P < 0.0001]. The primary outcome occurred more often in patients with impaired LARS (mildly impaired 7.4%, moderately impaired 13.4%, and severely impaired 25.7%, P < 0.0001). On adjusted multivariable Cox regression analysis, LARS tertiles [hazard ratio (HR) 0.62, 95% confidence interval (CI) 0.44-0.86, P = 0.005] and higher degree of tricuspid regurgitation (HR 1.82, 95% CI 1.23-2.98, P = 0.003) were the only significant predictors of the primary endpoint. Importantly, DD was unavailable in 56% of patients, but LARS assessment allowed for reliable prognostication regarding the primary endpoint in subgroups without DD assessment (HR 0.64, 95% CI 0.47-0.87, P = 0.003). CONCLUSION Impaired LARS is independently associated with worse outcomes in patients undergoing TAVR. LARS allows for risk stratification at discharge even in patients where DD cannot be assessed by conventional echocardiographic means.
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Affiliation(s)
- Maximilian von Roeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Mauritius Maeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Vincent Wahl
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Mitsunobu Kitamura
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Johannes Rotta Detto Loria
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Oliver Dumpies
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
- Cardiovascular Research Foundation, NewYork, NY, USA
| | - Karl-Patrik Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Stephan Blazek
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Ines Richter
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Nicolas Majunke
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
- Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Mohamed Abdel-Wahab
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
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Kitamura M, Trejo-Velasco B, Dumpies O, Rotta Detto Loria J, Majunke N, Wilde J, Desch S, Noack T, Thiele H, Abdel-Wahab M. Fluoroscopic Measurement of Commissural Alignment for Self-Expanding Transcatheter Heart Valves. JACC Cardiovasc Interv 2023; 16:1425-1427. [PMID: 37316155 DOI: 10.1016/j.jcin.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 06/16/2023]
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Dumpies O, Jobs A, Obradovic D, van Wiechen M, Hartung P, Rotta Detto Loria J, Wilde J, Majunke N, Kiefer P, Noack T, Thiele H, van Mieghem N, Desch S, Abdel-Wahab M. Comparison of plug-based versus suture-based vascular closure for large-bore arterial access: a collaborative meta-analysis of observational and randomized studies. Clin Res Cardiol 2023; 112:614-625. [PMID: 36749418 PMCID: PMC10160216 DOI: 10.1007/s00392-022-02145-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/06/2022] [Accepted: 12/19/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Large-bore arteriotomies can be percutaneously closed with suture-based or plug-based vascular closure device (VCD) strategies. The efficacy of both techniques remains controversial. AIMS We conducted a meta-analysis of comparative studies between both VCD strategies, focusing on the most commonly applied VCDs (MANTA and ProGlide). METHODS We searched MEDLINE, the Cochrane Central Register of Controlled Trials and Google scholar for observational studies (OS) and randomized controlled trials (RCT) comparing vascular closure with the MANTA-based and the ProGlide-based technique. The principal endpoint of this analysis was access-site related vascular complications. Both study types were analyzed separately. RESULTS Access-site related vascular complications were less frequent after vascular closure with the MANTA technique in the analysis of OS (RR 0.61 [95%CI 0.43-0.89], p = 0.01, I2 = 0%), but more frequent in the analysis of RCT data (RR 1.70 [95%CI 1.16-2.51], p = 0.01, I2 = 0%). Both data sets provided no significant difference between the VCD techniques in terms of overall bleeding events (OS: RR 0.57 [95%CI 0.32-1.02], p = 0.06, I2 = 70%; and RCT: RR 1.37 [95%CI 0.82-2.28], p = 0.23, I2 = 30%). RCT data showed that endovascular stenting or vascular surgery due to VCD failure occurred more often after MANTA application (RR 3.53 [95%CI 1.07-11.33], p = 0.04, I2 = 0%). CONCLUSIONS While OS point to favorable outcomes for large-bore vascular closure with the MANTA-based technique, RCT data show that this strategy is associated with more access-site related vascular complications as well as endovascular stenting or vascular surgery due to device failure compared with the ProGlide-based technique.
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Affiliation(s)
- Oliver Dumpies
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Alexander Jobs
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
| | - Danilo Obradovic
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Maarten van Wiechen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Philipp Hartung
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Johannes Wilde
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Nicolas Majunke
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Kiefer
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thilo Noack
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Nicolas van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Steffen Desch
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
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Dumpies O, Pausch J, Reichenspurner H, Thiele H. Frühe Herzklappentherapie bei asymptomatischen Patienten – was gilt schon jetzt? Aktuelle Kardiologie 2022. [DOI: 10.1055/a-1842-4283] [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: 11/06/2022]
Abstract
ZusammenfassungBei einer asymptomatischen hochgradigen Aortenklappenstenose (AS) mit normaler linksventrikulärer Funktion sollte eine „Watchful-Waiting“-Strategie verfolgt werden. Asymptomatische
Patienten mit Risikofaktoren, wie sehr schwere AS, schwere kalzifizierter AS oder 3-fach erhöhtem proBNP-Level, können bei niedrigem operativem Risiko eine Intervention erhalten. Erste
randomisierte Studien weisen auf einen Vorteil des frühzeitigen Aortenklappenersatzes bei niedrigem OP-Risiko hin.Für Patienten mit einer asymptomatischen hochgradigen Aortenklappeninsuffizienz sollte bei niedrigem operativem Risiko bereits frühzeitig eine OP erwogen werden, wenn sich Zeichen der
linksventrikulären Schädigung zeigen.Bei asymptomatischer primärer Mitralklappeninsuffizienz (MI) kann die chirurgische Mitralklappenrekonstruktion bereits vor dem Auftreten einer linksventrikulären Dilatation oder
anderweitigen Folgeschäden erwogen werden, falls mit einer hohen Rekonstruktionswahrscheinlichkeit zu rechnen ist.
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Affiliation(s)
- Oliver Dumpies
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig – Universität Leipzig, Leipzig, Deutschland
| | - Jonas Pausch
- Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Hermann Reichenspurner
- Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Holger Thiele
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig – Universität Leipzig, Leipzig, Deutschland
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Abdel-Wahab M, Kitamura M, Fitzgerald SJ, Dumpies O, Wilde J, Gohmann RF, Majunke N, Gutberlet M, Kiefer P, Noack T, Lurz P, Desch S, Frawley C, Ward K, Borger MA, Holzhey D, Thiele H. Neo-Commissural Alignment Technique for Transcatheter Aortic Valve Replacement Using the ACURATE Neo Valve. Circ Cardiovasc Interv 2022; 15:e011993. [PMID: 35775417 DOI: 10.1161/circinterventions.122.011993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mohamed Abdel-Wahab
- Department of Structural Heart Disease/Cardiology (M.A.W., M.K., S.J.F., O.D., J.W., N.M., P.L., S.D., H.T.), Heart Center Leipzig at University of Leipzig, Germany
| | - Mitsunobu Kitamura
- Department of Structural Heart Disease/Cardiology (M.A.W., M.K., S.J.F., O.D., J.W., N.M., P.L., S.D., H.T.), Heart Center Leipzig at University of Leipzig, Germany.,Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (M.K.)
| | - Sean J Fitzgerald
- Department of Structural Heart Disease/Cardiology (M.A.W., M.K., S.J.F., O.D., J.W., N.M., P.L., S.D., H.T.), Heart Center Leipzig at University of Leipzig, Germany
| | - Oliver Dumpies
- Department of Structural Heart Disease/Cardiology (M.A.W., M.K., S.J.F., O.D., J.W., N.M., P.L., S.D., H.T.), Heart Center Leipzig at University of Leipzig, Germany
| | - Johannes Wilde
- Department of Structural Heart Disease/Cardiology (M.A.W., M.K., S.J.F., O.D., J.W., N.M., P.L., S.D., H.T.), Heart Center Leipzig at University of Leipzig, Germany
| | - Robin F Gohmann
- Department of Diagnostic and Interventional Radiology (R.F.G., M.G.), Heart Center Leipzig at University of Leipzig, Germany
| | - Nicolas Majunke
- Department of Structural Heart Disease/Cardiology (M.A.W., M.K., S.J.F., O.D., J.W., N.M., P.L., S.D., H.T.), Heart Center Leipzig at University of Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology (R.F.G., M.G.), Heart Center Leipzig at University of Leipzig, Germany
| | - Philipp Kiefer
- Department of Structural Heart Disease/Cardiac Surgery (P.K., T.N., M.A.B., D.H.), Heart Center Leipzig at University of Leipzig, Germany
| | - Thilo Noack
- Department of Structural Heart Disease/Cardiac Surgery (P.K., T.N., M.A.B., D.H.), Heart Center Leipzig at University of Leipzig, Germany
| | - Philipp Lurz
- Department of Structural Heart Disease/Cardiology (M.A.W., M.K., S.J.F., O.D., J.W., N.M., P.L., S.D., H.T.), Heart Center Leipzig at University of Leipzig, Germany
| | - Steffen Desch
- Department of Structural Heart Disease/Cardiology (M.A.W., M.K., S.J.F., O.D., J.W., N.M., P.L., S.D., H.T.), Heart Center Leipzig at University of Leipzig, Germany
| | - Christopher Frawley
- Structural Heart Valve Research and Development Campus, Boston Scientific Corporation, Ballybrit, Galway, Ireland (C.F., K.W.)
| | - Kevin Ward
- Structural Heart Valve Research and Development Campus, Boston Scientific Corporation, Ballybrit, Galway, Ireland (C.F., K.W.)
| | - Michael A Borger
- Department of Structural Heart Disease/Cardiac Surgery (P.K., T.N., M.A.B., D.H.), Heart Center Leipzig at University of Leipzig, Germany
| | - David Holzhey
- Department of Structural Heart Disease/Cardiac Surgery (P.K., T.N., M.A.B., D.H.), Heart Center Leipzig at University of Leipzig, Germany
| | - Holger Thiele
- Department of Structural Heart Disease/Cardiology (M.A.W., M.K., S.J.F., O.D., J.W., N.M., P.L., S.D., H.T.), Heart Center Leipzig at University of Leipzig, Germany
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Dumpies O, Kaur J, Stachel G, Kitamura M, Allali A, Landt M, Thiele H, Holzhey D, Richardt G, Abdel-Wahab M. Long-Term Clinical and Echocardiographic Outcome After TAVR With the Mechanically Expanding Lotus Valve. JACC Cardiovasc Interv 2022; 15:1186-1188. [PMID: 35595670 DOI: 10.1016/j.jcin.2022.02.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 12/22/2022]
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Kitamura M, Wilde J, Dumpies O, Richter I, Obradovic D, Krieghoff C, Gohmann RF, Majunke N, Desch S, Gutberlet M, Borger M, Marwan M, Thiele H, Holzhey D, Abdel-Wahab M. Risk Assessment of Coronary Obstruction During Transcatheter Aortic Valve Replacement: Insights From Post-BASILICA Computed Tomography. JACC Cardiovasc Interv 2022; 15:496-507. [PMID: 35272774 DOI: 10.1016/j.jcin.2022.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/12/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to examine the predictive value of preprocedural computed tomography (CT)-based risk stratification of coronary obstruction during transcatheter aortic valve replacement (TAVR) on the basis of geometric measurements on postprocedural CT. BACKGROUND Proper patient selection for additional procedures to prevent coronary obstruction during TAVR has not been adequately evaluated. METHODS Pre- and postprocedural computed tomographic scans of 28 patients treated using bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) and TAVR were analyzed. Using the postprocedural computed tomographic images, threatened coronary obstruction (TCO) was defined as: 1) ostial obstruction (adherence of the transcatheter heart valve [THV] to the coronary ostium with leaflet extension above the ostium); and/or 2) sinus sequestration (THV adherence to the sinotubular junction [STJ] with leaflet extension above the STJ) and was substratified into complete and incomplete types. RESULTS A total of 51 leaflets were evaluated (88% surgical tissue valves) after excluding leaflets not visible on CT (n = 5). On postprocedural CT, complete TCO was observed in 25.4% (13 of 51 leaflets). On preprocedural CT, leaflets were at high risk for complete TCO (incidence 53%) if the virtual THV-to-coronary distance (VTC) was <3.0 mm, or if the virtual THV-to-STJ distance (VTSTJ) was <1.0 mm with STJ height - leaflet length <0 mm (leaflet-STJ mismatch). Leaflets were at low risk (incidence 0%) if the VTC was ≥3 mm and VTSTJ was ≥3.0 mm or STJ height - leaflet length was ≥+2.0 mm. Of 28 leaflets treated using BASILICA, complete TCO was seen in 35.7% (n = 10), due to sinus sequestration (100%) with coexisting ostial obstruction (30%). Actual coronary events occurred in 7.1% (n = 2) because of leaflet prolapse, corresponding to an absolute risk reduction by BASILICA of 29% (P = 0.021). CONCLUSIONS Risk assessment of coronary obstruction after TAVR may improve with a multiparametric approach incorporating VTC, VTSTJ, and leaflet-STJ mismatch. BASILICA appeared to reduce actual coronary events even in leaflets with anticipated coronary obstruction.
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Affiliation(s)
- Mitsunobu Kitamura
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Johannes Wilde
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Oliver Dumpies
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ines Richter
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Danilo Obradovic
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Christian Krieghoff
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Robin F Gohmann
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Nicolas Majunke
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Steffen Desch
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Structural Heart Disease/Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Holger Thiele
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - David Holzhey
- Department of Structural Heart Disease/Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
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Abdel-Wahab M, Hartung P, Dumpies O, Obradovic D, Wilde J, Majunke N, Boekstegers P, Müller R, Seyfarth M, Vorpahl M, Kiefer P, Noack T, Leontyev S, Sandri M, Rotta Detto Loria J, Kitamura M, Borger MA, Funkat AK, Hohenstein S, Desch S, Holzhey D, Thiele H. Comparison of a Pure Plug-Based versus a Primary Suture-Based Vascular Closure Device Strategy for Transfemoral Transcatheter Aortic Valve Replacement: The CHOICE-CLOSURE Randomized Clinical Trial. Circulation 2021; 145:170-183. [PMID: 34738828 DOI: 10.1161/circulationaha.121.057856] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [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: 01/31/2023]
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an established treatment option for patients with severe symptomatic aortic stenosis (AS), and is most commonly performed through the transfemoral access route. Percutaneous access site closure can be achieved using dedicated plug-based or suture-based vascular closure device (VCD) strategies, but randomized comparative studies are scarce. Methods: The CHOICE-CLOSURE (Randomized Comparison of CatHeter-based Strategies fOr Interventional ACcess SitE CLOSURE during Transfemoral Transcatheter Aortic Valve Implantation) trial is an investigator-initiated, multicenter study, in which patients undergoing transfemoral TAVR were randomly assigned to vascular access site closure using either a pure plug-based technique (MANTA, Teleflex, Wayne, Pennsylvania) with no additional VCDs or a primary suture-based technique (ProGlide, Abbott Vascular, Abbott Park, Illinois) potentially complemented by a small-plug. The primary endpoint consisted of access-site or access-related major and minor vascular complications during index hospitalization, defined according to the Valve Academic Research Consortium-2 criteria. Secondary endpoints included the rate of access-site or access-related bleeding, VCD failure, and time to hemostasis Results: A total of 516 patients were included and randomized. The mean age of the study population was 80.5±6.1 years, 55.4% were male, 7.6% of patients had peripheral vascular disease, and the mean Society of Thoracic Surgeons score was 4.1±2.9%. The primary endpoint occurred in 19.4% (50/258) of the pure plug-based group and 12.0% (31/258) of the primary suture-based group (relative risk [RR]: 1.61, 95% confidence interval [CI]: 1.07-2.44, p=0.029). Access-site or access-related bleeding occurred in 11.6% vs. 7.4% (RR: 1.58, 95%CI: 0.91-2.73, p=0.133) and device failure in 4.7% vs. 5.4% (RR: 0.86, 95%CI: 0.40-1.82, p=0.841) in the respective groups. Time to hemostasis was significantly shorter in the pure plug-based group (80 [32, 180] vs. 240 [174, 316] seconds, p<0.001). Conclusions: Among patients treated with transfemoral TAVR, a pure plug-based vascular closure technique using the MANTA VCD is associated with a higher rate of access-site or access-related vascular complications but a shorter time to hemostasis compared to a primary suture-based technique using the ProGlide VCD.
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Affiliation(s)
- Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Hartung
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Oliver Dumpies
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Danilo Obradovic
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Johannes Wilde
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Nicolas Majunke
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Peter Boekstegers
- Department of Cardiology, Helios Klinikum Siegburg, Siegburg, Germany; Witten Herdecke University, Witten, Germany
| | - Ralf Müller
- Department of Cardiology, Helios Klinikum Siegburg, Siegburg, Germany
| | - Melchior Seyfarth
- Witten Herdecke University, Witten, Germany; Department of Cardiology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Marc Vorpahl
- Witten Herdecke University, Witten, Germany; Department of Cardiology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Philipp Kiefer
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Thilo Noack
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Sergey Leontyev
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Marcus Sandri
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Mitsunobu Kitamura
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | | | - Steffen Desch
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - David Holzhey
- Witten Herdecke University, Witten, Germany; University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany; Department of Cardiac Surgery, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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Dumpies O, Kitamura M, Majunke N, Hartung P, Haag A, Wilde J, Desch S, Sandri M, Crusius L, Noack T, Kiefer P, Leontyev S, Borger M, Thiele H, Holzhey D, Abdel-Wahab M. Manta versus Perclose ProGlide vascular closure device after transcatheter aortic valve implantation: Initial experience from a large European center. Cardiovasc Revasc Med 2021; 37:34-40. [PMID: 34257057 DOI: 10.1016/j.carrev.2021.06.134] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/02/2021] [Accepted: 06/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Vascular and bleeding complications are common after transcatheter aortic valve implantation (TAVI) and are associated with worse outcomes. The plug-based Manta (M) vascular closure device (VCD) is a novel option to achieve haemostasis for large-bore arterial access sites. OBJECTIVE We aimed to compare vascular and bleeding complications between the M-VCD and the established suture-based Perclose ProGlide (P)-VCD. METHODS From February to September 2019 a total of 578 patients underwent transfemoral TAVI at a single high-volume centre. Access site closure was performed using M-VCD in 195 patients (33.7%) and P-VCD in 383 patients (66.3%). We assessed vascular and access site-related complications as well as bleeding events according to the Valve Academic Research Consortium-2 definition. RESULTS Overall vascular complications occurred less frequently in the M-VCD group (10.7% vs. 19.0%, p = 0.011) driven by a significantly lower rate of major vascular events (2.0% vs. 6.5%, p = 0.025). Access site-related complications were significantly less frequent in the M-VCD cohort (10.7% vs. 16.6%, p = 0.048). The M-VCD was associated with significantly lower rates of major (0.5% vs. 4.4%, p = 0.009) and life-threatening bleeding (0% vs. 2.3%, p = 0.032). In multivariable analysis, the use of M-VCD was the only independent predictor of vascular complications (odds ratio 0.54, 95% confidence interval 0.32-0.91, p = 0.022). CONCLUSIONS The M-VCD was associated with a reduction of vascular and access-site complications as well as severe bleeding after transfemoral TAVI compared to the P-VCD in this observational study.
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Affiliation(s)
- Oliver Dumpies
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mitsunobu Kitamura
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Nicolas Majunke
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Phillip Hartung
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Anna Haag
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Johannes Wilde
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Steffen Desch
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Marcus Sandri
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Lisa Crusius
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thilo Noack
- Department of Structural Heart Disease/Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Kiefer
- Department of Structural Heart Disease/Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Sergey Leontyev
- Department of Structural Heart Disease/Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Structural Heart Disease/Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - David Holzhey
- Department of Structural Heart Disease/Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
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