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Sacri C, Durand E, Tron C, Barbe T, Hemery T, Burdeau J, Dacher JN, Eltchaninoff H. Right ventricular dysfunction before transcatheter aortic valve implantation: incidence, predictive factors and prognostic impact. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1569] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricular dysfunction (RVD) is considered to be a late marker of advanced aortic stenosis (AS) and is associated with poor prognosis. Currently. there are conflicting data on the impact of RVD on clinical outcomes in patients with severe AS treated with TAVI. Moreover, few studies have studied the evolution (recovery or persistence) of RVD and its prognostic impact.
Objectives
To assess the incidence and predictive factors of RVD before TAVI, its prognostic impact and its evolution after TAVI.
Methods
All patients treated with TAVI for severe AS were included in a prospective single center database. Only patients who had a quantitative assessment of RV including Tricuspid Annular Plane Systolic Excursion (TAPSE) and/or doppler tissue imaging-derived tricuspid lateral annular systolic velocity (S') measurements, were eligible to this study. RVD was defined by a TAPSE <17 mm or S' <9.5 cm/s if TAPSE was not available.
Results
Between May 2014 and April 2019, 503 patients with RV function evaluation were included. Incidence of RVD before TAVI was 18.7%. Predictors of RVD were diabetes (P=0.03), atrial fibrillation (P=0.001), altered left ventricular ejection fraction (P<0.0001), left ventricular dilatation (P=0.007), and previous cardiac surgery (P=0.002). Long-term survival was altered in patients with RVD before TAVI as compared to those without RVD (HR 1.97, 95% CI: 1.1–3.4, P=0.01). One year after TAVI, 58.7% of patients with baseline RVD had a normal RV function and had similar outcome as compared to those without RVD at baseline. In contrast, patients with persistent RVD had the worst prognosis.
Conclusions
RVD is not rare and has a deleterious prognostic impact in patients treated by TAVI. Recovery of normal RV function is frequent after TAVI whereas persistence of RVD is associated with poor outcomes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Sacri
- INSERM U1096, Cardiology, Rouen, France
| | - E Durand
- INSERM U1096, Cardiology, Rouen, France
| | - C Tron
- INSERM U1096, Cardiology, Rouen, France
| | - T Barbe
- INSERM U1096, Cardiology, Rouen, France
| | - T Hemery
- INSERM U1096, Cardiology, Rouen, France
| | - J Burdeau
- INSERM U1096, Cardiology, Rouen, France
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4
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Durand E, Penso M, Hemery T, Levesque T, Moles G, Tron C, Bouhzam N, Bettinger N, Wong S, Dacher JN, Eltchaninoff H. Standardized Measurement of Femoral Artery Depth by Computed Tomography to Predict Vascular Complications After Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 145:119-127. [PMID: 33460601 DOI: 10.1016/j.amjcard.2020.12.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/10/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022]
Abstract
Vascular complications (VCs) are difficult to predict and remain an important issue after transfemoral (TF) transcatheter aortic valve implantation (TAVI) although their incidence has decreased with size reduction of introducers. We aimed to evaluate a standardized measurement of femoral artery depth (FAD) using computed tomography (CT) to predict VCs after TAVI. We performed a retrospective study of 679 TF TAVI patients. We evaluated a standardized CT method to measure FAD immediately above the bifurcation. Sheath-to-femoral-artery ratio (SFAR), calcification, and tortuosity were also evaluated. VCs were defined by the Valve Academic Research Consortium (VARC)-2. Receiver operating characteristic (ROC) curves were used to predict major VCs and the need for a stent-graft. The median values of FAD and SFAR were 49.0 (36.2 to 66.7) mm and 0.95 (0.81 to 1.18), respectively. Major VCs occurred in 37 (5.4%) patients and a stent-graft was required in 49 (7.1%) patients. FAD predicted the need for a stent-graft [0.61 (0.51 to 0.70), p = 0.04] but not major VCs [0.52 (0.40 to 0.63), p = 0.76]. In contrast, SFAR did not predict the need for a stent-graft [0.53 (0.43 to 0.62), p = 0.61] but predicted major VCs [0.70 (0.58 to 0.81), p = 0.001]. Calcification and tortuosity predicted neither major VCs nor the need for a stent-graft. In conclusion, the results of our study suggest that CT measurements of FAD and SFAR provide additional information to predict major VCs and the need for a femoral stent-graft after TF TAVI.
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Affiliation(s)
- Eric Durand
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France.
| | - Maryline Penso
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Thibault Hemery
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Thomas Levesque
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Gustavo Moles
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Christophe Tron
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Najime Bouhzam
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Nicolas Bettinger
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Stephanie Wong
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Radiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Jean-Nicolas Dacher
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Radiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Hélène Eltchaninoff
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
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5
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Simonato M, Whisenant B, Ribeiro HB, Webb JG, Kornowski R, Guerrero M, Wijeysundera H, Søndergaard L, De Backer O, Villablanca P, Rihal C, Eleid M, Kempfert J, Unbehaun A, Erlebach M, Casselman F, Adam M, Montorfano M, Ancona M, Saia F, Ubben T, Meincke F, Napodano M, Codner P, Schofer J, Pelletier M, Cheung A, Shuvy M, Palma JH, Gaia DF, Duncan A, Hildick-Smith D, Veulemans V, Sinning JM, Arbel Y, Testa L, de Weger A, Eltchaninoff H, Hemery T, Landes U, Tchetche D, Dumonteil N, Rodés-Cabau J, Kim WK, Spargias K, Kourkoveli P, Ben-Yehuda O, Teles RC, Barbanti M, Fiorina C, Thukkani A, Mackensen GB, Jones N, Presbitero P, Petronio AS, Allali A, Champagnac D, Bleiziffer S, Rudolph T, Iadanza A, Salizzoni S, Agrifoglio M, Nombela-Franco L, Bonaros N, Kass M, Bruschi G, Amabile N, Chhatriwalla A, Messina A, Hirji SA, Andreas M, Welsh R, Schoels W, Hellig F, Windecker S, Stortecky S, Maisano F, Stone GW, Dvir D. Transcatheter Mitral Valve Replacement After Surgical Repair or Replacement. Circulation 2021; 143:104-116. [DOI: 10.1161/circulationaha.120.049088] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [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: 11/16/2022]
Abstract
Background:
Mitral valve-in-valve (ViV) and valve-in-ring (ViR) are alternatives to surgical reoperation in patients with recurrent mitral valve failure after previous surgical valve repair or replacement. Our aim was to perform a large-scale analysis examining midterm outcomes after mitral ViV and ViR.
Methods:
Patients undergoing mitral ViV and ViR were enrolled in the Valve-in-Valve International Data Registry. Cases were performed between March 2006 and March 2020. Clinical endpoints are reported according to the Mitral Valve Academic Research Consortium (MVARC) definitions. Significant residual mitral stenosis (MS) was defined as mean gradient ≥10 mm Hg and significant residual mitral regurgitation (MR) as ≥ moderate.
Results:
A total of 1079 patients (857 ViV, 222 ViR; mean age 73.5±12.5 years; 40.8% male) from 90 centers were included. Median STS-PROM score 8.6%; median clinical follow-up 492 days (interquartile range, 76–996); median echocardiographic follow-up for patients that survived 1 year was 772.5 days (interquartile range, 510–1211.75). Four-year Kaplan-Meier survival rate was 62.5% in ViV versus 49.5% for ViR (
P
<0.001). Mean gradient across the mitral valve postprocedure was 5.7±2.8 mm Hg (≥5 mm Hg; 61.4% of patients). Significant residual MS occurred in 8.2% of the ViV and 12.0% of the ViR patients (
P
=0.09). Significant residual MR was more common in ViR patients (16.6% versus 3.1%;
P
<0.001) and was associated with lower survival at 4 years (35.1% versus 61.6%;
P
=0.02). The rates of Mitral Valve Academic Research Consortium–defined device success were low for both procedures (39.4% total; 32.0% ViR versus 41.3% ViV;
P
=0.01), mostly related to having postprocedural mean gradient ≥5 mm Hg. Correlates for residual MS were smaller true internal diameter, younger age, and larger body mass index. The only correlate for residual MR was ViR. Significant residual MS (subhazard ratio, 4.67; 95% CI, 1.74–12.56;
P
=0.002) and significant residual MR (subhazard ratio, 7.88; 95% CI, 2.88–21.53;
P
<0.001) were both independently associated with repeat mitral valve replacement.
Conclusions:
Significant residual MS and/or MR were not infrequent after mitral ViV and ViR procedures and were both associated with a need for repeat valve replacement. Strategies to improve postprocedural hemodynamics in mitral ViV and ViR should be further explored.
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Affiliation(s)
- Matheus Simonato
- The Cardiovascular Research Foundation, New York (M.Simonato, G.W.S., O.B-Y.)
- Escola Paulista de Medicina – Universidade Federal de São Paulo, São Paulo, Brazil (M.Simonato, J.H.P., D.F.G.)
| | | | - Henrique Barbosa Ribeiro
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (H.B.R., J.H.P.)
| | - John G. Webb
- St. Paul’s Hospital, Vancouver, Canada (J.G.W., A.Cheung, U.L.)
| | - Ran Kornowski
- Rabin Medical Center, Petah Tikva, Israel (R.K., P.C.)
| | | | | | | | | | | | | | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Berlin, Germany (J.K., A.U.)
| | - Axel Unbehaun
- Deutsches Herzzentrum Berlin, Berlin, Germany (J.K., A.U.)
| | | | | | | | | | - Marco Ancona
- I.R.C.C.S. Ospedale San Raffaele, Milan, Italy (M.M., M.Ancona)
| | | | - Timm Ubben
- Asklepios Klinik St. Georg, Hamburg, Germany (T.U., F.Meincke)
| | - Felix Meincke
- Asklepios Klinik St. Georg, Hamburg, Germany (T.U., F.Meincke)
| | | | - Pablo Codner
- Rabin Medical Center, Petah Tikva, Israel (R.K., P.C.)
| | | | - Marc Pelletier
- University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH (M.P.)
| | - Anson Cheung
- St. Paul’s Hospital, Vancouver, Canada (J.G.W., A.Cheung, U.L.)
| | - Mony Shuvy
- Hadassah Medical Center, Jerusalem, Israel (M.Shuvy)
| | - José Honório Palma
- Escola Paulista de Medicina – Universidade Federal de São Paulo, São Paulo, Brazil (M.Simonato, J.H.P., D.F.G.)
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (H.B.R., J.H.P.)
| | - Diego Felipe Gaia
- Escola Paulista de Medicina – Universidade Federal de São Paulo, São Paulo, Brazil (M.Simonato, J.H.P., D.F.G.)
| | - Alison Duncan
- The Royal Brompton Hospital, London, United Kingdom (A.D.)
| | | | | | | | - Yaron Arbel
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel (Y.A.)
| | - Luca Testa
- I.R.C.C.S. Policlinico San Donato, Milan, Italy (L.T.)
| | - Arend de Weger
- Leids Universitair Medisch Centrum, Leiden, the Netherlands (A.d.W.)
| | | | | | - Uri Landes
- St. Paul’s Hospital, Vancouver, Canada (J.G.W., A.Cheung, U.L.)
| | | | | | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada (J.R-C.)
| | | | | | | | - Ori Ben-Yehuda
- The Cardiovascular Research Foundation, New York (M.Simonato, G.W.S., O.B-Y.)
- University of California San Diego (O.B-Y.)
| | | | - Marco Barbanti
- Università degli Studi di Catania, Catania, Italy (M.B.)
| | | | | | | | - Noah Jones
- Mount Carmel Health System, Columbus, OH (N.J.)
| | | | | | | | | | - Sabine Bleiziffer
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany (S.B.)
| | | | | | - Stefano Salizzoni
- Città della Salute e della Scienza - “Molinette” Hospital, Torino, Italy (S.Salizzoni)
| | | | | | | | - Malek Kass
- University of Manitoba, Winnipeg, Canada (M.K.)
| | | | | | - Adnan Chhatriwalla
- Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.Chhatriwalla)
| | - Antonio Messina
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (A.M.)
| | | | - Martin Andreas
- Medizinische Universität Wien, Vienna, Austria (M.Andreas)
| | | | | | - Farrel Hellig
- Sunninghill Hospital, Johannesburg, South Africa (F.H.)
| | | | | | | | - Gregg W. Stone
- The Cardiovascular Research Foundation, New York (M.Simonato, G.W.S., O.B-Y.)
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.W.S.)
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