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Plant A, Stewart F, Hooks D. Implantable cardioverter-defibrillator lead failure and revision following transcutaneous bicaval valve (TricValve®) implantation. J Cardiovasc Electrophysiol 2024; 35:1050-1054. [PMID: 38501328 DOI: 10.1111/jce.16249] [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: 01/30/2024] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Tricuspid regurgitation is associated with significant morbidity and mortality, and occurs at a higher rate in patients with cardiovascular implantable electronic devices. Percutaneous strategies for managing tricuspid regurgitation are evolving, including the development of bicaval valve implantation which has been successfully used in patients with pacing leads. METHODS AND RESULTS We present the first documented case of lead failure following TricValve® implantation, a dedicated self-expanding system for bicaval valve implantation, and the first successful lead revision procedure in this setting. CONCLUSION The case illustrates important considerations in undertaking percutaneous intervention in patients with cardiovascular implantable electronic devices, and their ongoing management.
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Affiliation(s)
- Allan Plant
- Department of Cardiology, Wellington Regional Hospital, Te Whatu Ora Capital and Coast, Newtown, Wellington, New Zealand
| | - Fergus Stewart
- Department of Cardiology, Wellington Regional Hospital, Te Whatu Ora Capital and Coast, Newtown, Wellington, New Zealand
| | - Darren Hooks
- Department of Cardiology, Wellington Regional Hospital, Te Whatu Ora Capital and Coast, Newtown, Wellington, New Zealand
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Guerreiro C, Barreiro-Perez M, Estevez-Loureiro R, Baz JA, Caneiro-Queija B, Gonzalez-Ferreiro R, Iñiguez-Romo A. Fully Percutaneous Fusion-Guided Transcatheter Mitral Valve Replacement With a New Transseptal System. JACC Cardiovasc Interv 2024; 17:1063-1064. [PMID: 38520452 DOI: 10.1016/j.jcin.2024.01.290] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Claudio Guerreiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Manuel Barreiro-Perez
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain.
| | - Rodrigo Estevez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Jose Antonio Baz
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Berenice Caneiro-Queija
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Rocio Gonzalez-Ferreiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Andres Iñiguez-Romo
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
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3
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Lima MR, Brito J, Almeida M, Teles RC. Combined transcatheter aortic valve and tricuspid valve-in-valve implantation in a patient with a mitral mechanical prosthesis. Catheter Cardiovasc Interv 2024. [PMID: 38639138 DOI: 10.1002/ccd.31057] [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: 10/21/2023] [Revised: 02/25/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
Despite progressively uncommon in Western countries, rheumatic heart disease still portrays a significant global burden. In elderly or high-surgical risk patients, plurivalvular disease may require a complex percutaneous approach. Transcatheter aortic valve implantation (TAVI) in patients with previous monoleaflet mitral prosthesis is challenging due to interference between the aortic valve and the rigid mitral mechanical prosthesis "ring." Prior cases report the use of CoreValve or Edwards Sapien aortic valves in patients with adequate mitro-aortic distance. Performing a second major procedure, such as tricuspid valve-in-valve (TVIV), sequentially during a single percutaneous intervention, increases treatment complexity. An 83-year-old woman with rheumatic heart disease, with previous implantation of a Bjork-Shiley monoleaflet mitral prosthesis, and Carpentier-Edwards 29 tricuspid bioprosthesis presented with decompensated heart failure due to severe aortic stenosis and tricuspid bioprosthesis stenosis. After HeartTeam discussion, the patient was deemed as inoperable due to a prohibitive surgical risk. As an alternative, a TAVI (Navitor FlexNav) and a transcatheter TVIV replacement (Edwards Sapiens 3 Ultra) were discussed and proposed, with both techniques being performed sequentially in a single procedure. TAVI in a patient with a previous monoleaflet mitral mechanical prosthesis and TVIV may be a feasible approach in inoperable patients with plurivalvular disease.
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Affiliation(s)
- Maria Rita Lima
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - João Brito
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Cardiovascular Intervention Unit, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Manuel Almeida
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Cardiovascular Intervention Unit, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Rui Campante Teles
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Cardiovascular Intervention Unit, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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Chehab O, Rajani R, Redwood S, Prendergast B, Patterson T. Editorial: Transcatheter mitral and tricuspid valve therapies. Front Cardiovasc Med 2023; 10:1329387. [PMID: 38111895 PMCID: PMC10726110 DOI: 10.3389/fcvm.2023.1329387] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023] Open
Affiliation(s)
- Omar Chehab
- Department of Cardiovascular Medicine, St Thomas’ Hospital, London, United Kingdom
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Ho EC, Assafin M, Sugiura T, Granada JF, Chau M, Latib A. 3-dimensional intracardiac echocardiography for structural heart interventions. Front Cardiovasc Med 2023; 10:1180299. [PMID: 38045907 PMCID: PMC10690929 DOI: 10.3389/fcvm.2023.1180299] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/25/2023] [Indexed: 12/05/2023] Open
Abstract
New generation 3-dimensional matrix array intracardiac echocardiography catheters have become commercially available recently, increasing image plane options compared to 2-dimensional and older generation 3-dimensional intracardiac echocardiography catheters. They are beginning to play an important role in structural heart interventions, especially for transcatheter tricuspid interventions, due to advantages in some situations that increase image quality over transesophageal echocardiography.
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Affiliation(s)
- Edwin C. Ho
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Manaf Assafin
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Tadahisa Sugiura
- Division of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Juan F. Granada
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
- Cardiovascular Research Foundation, New York, NY, United States
| | - Mei Chau
- Division of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM, Mendes LA, Arrighi JA, Breinholt JP, Day J, Dec GW, Denktas AE, Drajpuch D, Faza N, Francis SA, Hahn RT, Housholder-Hughes SD, Khan SS, Kondapaneni MD, Lee KS, Lin CH, Hussain Mahar J, McConnaughey S, Niazi K, Pearson DD, Punnoose LR, Reejhsinghani RS, Ryan T, Silvestry FE, Solomon MA, Spicer RL, Weissman G, Werns SW. 2023 ACC/AHA/SCAI advanced training statement on interventional cardiology (coronary, peripheral vascular, and structural heart interventions): A report of the ACC Competency Management Committee. J Thorac Cardiovasc Surg 2023; 166:e73-e123. [PMID: 37269254 DOI: 10.1016/j.jtcvs.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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7
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. JACC Cardiovasc Interv 2023; 16:1239-1291. [PMID: 37115166 DOI: 10.1016/j.jcin.2023.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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8
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. J Am Coll Cardiol 2023; 81:1386-1438. [PMID: 36801119 DOI: 10.1016/j.jacc.2022.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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9
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Huie LC, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. Circ Cardiovasc Interv 2023; 16:e000088. [PMID: 36795800 DOI: 10.1161/hcv.0000000000000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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10
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Barreiro-Pérez M, González-Ferreiro R, Caneiro-Queija B, Tavares-Silva M, Puga L, Parada-Barcia JA, Rodriguez-Perez A, Baz-Alonso JA, Pinon-Esteban MA, Estevez-Loureiro R, Iniguez-Romo A. Transcatheter Tricuspid Valve Replacement: Illustrative Case Reports and Review of State-of-Art. J Clin Med 2023; 12. [PMID: 36835907 DOI: 10.3390/jcm12041371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Tricuspid regurgitation (TR) is one of the most common heart valve diseases, associated a with poor prognosis since significant TR is associated with an increased mortality risk compared to no TR or mild regurgitation. Surgery is the standard treatment for TR, although it is associated with high morbidity, mortality, and prolonged hospitalization, particularly in tricuspid reoperation after left-sided surgery. Thus, several innovative percutaneous transcatheter approaches for repair and replacement of the tricuspid valve have gathered significant momentum and have undergone extensive clinical development in recent years, with favorable clinical outcomes in terms of mortality and rehospitalization during the first year of follow-up. We present three clinical cases of transcatheter tricuspid valve replacement in an orthotopic position with two different innovative systems along with a review of the state-of-the-art of this emergent topic.
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11
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Laricchia A, Cereda A, Lucreziotti S, Sticchi A, Regazzoli D, Reimers B, Colombo A, Latib A, Mangieri A. Expanding our horizons for the use of transcatheter self-expanding valves: what does the future hold? Expert Rev Cardiovasc Ther 2022; 20:497-501. [PMID: 35673979 DOI: 10.1080/14779072.2022.2085688] [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] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) is an established alternative to aortic valve surgery in patient with severe aortic valve stenosis. As interventionalists are pushing towards treatment of patients with lower risk profile with a wide range of anatomies, contemporary transcatheter heart valves (THV) should offer an excellent performance in terms of residual gradient, rate of pacemaker and perivalvular leak. AREAS COVERED Self-expandable (SE) valve offer a valid alternative to balloon-expandable (BE) valves, nevertheless comparative trials suggest a better outcome of patients treated with BE over SE platforms. New generation SE valves offer an excellent outcome in terms of procedural safety, however implementations in valve design and performance are required to reach the BE valves performance. EXPERT COMMENTARY in the near future, new devices should be able to obtain optimal results with a negligible rate of complications. Developments in the design of the delivery system together with refinements in valve technology are desirable to achieve results which are comparable to surgical aortic valve replacement.
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Affiliation(s)
| | - Alberto Cereda
- Cardiovascular department, ASST Santi Paolo Carlo, Milano, Italy
| | | | - Alessandro Sticchi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
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Barreiro-Perez M, Estevez-Loureiro R, Puga L, Caneiro-Queija B, Baz JA, Iñiguez-Romo A. Real-Time Echocardiography-Fluoroscopy Fusion Imaging With Automated 3D Heart Segmentation During Transcatheter Structural Heart Interventions. JACC Cardiovasc Interv 2022; 15:e155-e158. [PMID: 35643764 DOI: 10.1016/j.jcin.2022.04.004] [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] [Received: 03/16/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Manuel Barreiro-Perez
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain.
| | - Rodrigo Estevez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Luis Puga
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Berenice Caneiro-Queija
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Jose Antonio Baz
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Andres Iñiguez-Romo
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
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13
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Barreiro-Perez M, Estevez-Loureiro R, Alarcon R, Caneiro-Queija B, Baz JA, Iñiguez-Romo A. Percutaneous Retrieval of Dislodged Device With Double Biopsy Forceps During Double-Device LAAO: Successful Double-Double. JACC Cardiovasc Interv 2022; 15:e45-e47. [PMID: 35093282 DOI: 10.1016/j.jcin.2021.11.038] [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] [Received: 10/28/2021] [Accepted: 11/30/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Manuel Barreiro-Perez
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain.
| | - Rodrigo Estevez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Robert Alarcon
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Berenice Caneiro-Queija
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Jose Antonio Baz
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Andres Iñiguez-Romo
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
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Barreiro-Perez M, Caneiro-Queija B, Puga L, Gonzalez-Ferreiro R, Alarcon R, Parada JA, Iñiguez-Romo A, Estevez-Loureiro R. Imaging in Transcatheter Mitral Valve Replacement: State-of-Art Review. J Clin Med 2021; 10:jcm10245973. [PMID: 34945268 PMCID: PMC8706772 DOI: 10.3390/jcm10245973] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
Mitral regurgitation is the second-most frequent valvular heart disease in Europe and it is associated with high morbidity and mortality. Recognition of MR should encourage the assessment of its etiology, severity, and mechanism in order to determine the best therapeutic approach. Mitral valve surgery constitutes the first-line therapy; however, transcatheter procedures have emerged as an alternative option to treat inoperable and high-risk surgical patients. In patients with suitable anatomy, the transcatheter edge-to-edge mitral leaflet repair is the most frequently applied procedure. In non-reparable patients, transcatheter mitral valve replacement (TMVR) has appeared as a promising intervention. Thus, currently TMVR represents a new treatment option for inoperable or high-risk patients with degenerated or failed bioprosthetic valves (valve-in-valve); failed repairs, (valve-in-ring); inoperable or high-risk patients with native mitral valve anatomy, or those with severe annular calcifications, or valve-in-mitral annular calcification. The patient selection requires multimodality imaging pre-procedural planning to select the best approach and device, study the anatomical landing zone and assess the risk of left ventricular outflow tract obstruction. In the present review, we aimed to highlight the main considerations for TMVR planning from an imaging perspective; before, during, and after TMVR.
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Huang GS, Sheehan FH, Gill EA. Transesophageal echocardiography simulation: A review of current technology. Echocardiography 2021; 39:89-100. [PMID: 34913188 DOI: 10.1111/echo.15281] [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] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/19/2021] [Accepted: 11/26/2021] [Indexed: 01/27/2023] Open
Abstract
Transesophageal echocardiography (TEE) has experienced tremendous increase in interest and demand alongside the rapid growth of transcatheter structural cardiac interventions. TEE instruction prolongs the procedure, increasing the risk of probe malfunction from overheating and patient complications from prolonged sedation. Echocardiographic simulation programs have been developed to hone the procedural skills of novice operators in a time-unrestricted, low-pressure environment before they perform TEEs on real patients. Simulators likely benefit training in interventional TEE for the same reasons. We searched PubMed, basic Google, and Google Scholar for currently marketed TEE simulators, including foreign as well as US companies. We queried the vendors regarding features of the simulators that pertain to effective instructional design for diagnostic TEE. We also queried regarding the simulators' applicability to training in interventional TEE. The vendors' responses are reported here. In addition, we discuss the specific training needs for structural heart interventions, for which echocardiographic simulation could be a powerful educational tool. Lastly, we discuss the role of simulation for formative and summative assessment, and the advances required to improve training in complex procedures within the field of interventional echocardiography.
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Affiliation(s)
- Gary S Huang
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Florence H Sheehan
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Edward A Gill
- Department of Medicine, Division of Cardiology, University of Colorado, Denver, Colorado, USA
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Chandavimol M, Ngernsritrakul T, Meemook K, Apinyasawat S, Tangcharoen T, Pienvichit P, Samankatiwat P, Boonbaichaiyapruck S. Transcatheter tricuspid valve-in-valve implantation for degenerative surgical bio-prosthesis using SAPIEN 3: A case series. Clin Case Rep 2021; 9:e05029. [PMID: 34824847 PMCID: PMC8603360 DOI: 10.1002/ccr3.5029] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/01/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022] Open
Abstract
We evaluated early outcomes of transcatheter valve-in-valve (ViV) implantation in patients with degenerated bio-prosthesis in tricuspid position. Total of 5 patients were included in our case series. Baseline native tricuspid valve etiology were highly varied ranging from chest wall trauma, Ebstein anomaly, rheumatic heart disease, infective endocarditis and complex congenital heart disease. These differences also made patient comorbidities highly varied. Procedure details were also varied due to different clinical and technical challenges. All cases underwent successful Tricuspid VIV implantation with satisfactory hemodynamics results. All patients experienced improved clinical symptoms at follow up.
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Affiliation(s)
- Mann Chandavimol
- Faculty of MedicineRamathibodi HospitalMahidiol UniversityBangkokThailand
| | | | - Krissada Meemook
- Faculty of MedicineRamathibodi HospitalMahidiol UniversityBangkokThailand
| | - Sirin Apinyasawat
- Faculty of MedicineRamathibodi HospitalMahidiol UniversityBangkokThailand
| | | | - Pavit Pienvichit
- Faculty of MedicineRamathibodi HospitalMahidiol UniversityBangkokThailand
| | - Piya Samankatiwat
- Faculty of MedicineRamathibodi HospitalMahidiol UniversityBangkokThailand
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Barreiro-Perez M, Cruz-González I, Gil-Ortega MV, Rasco AG, Sánchez PL. Photo-Realistic Echocardiography Imaging During Percutaneous Paravalvular Leak Closure. JACC Cardiovasc Interv 2021; 13:e185-e187. [PMID: 33092721 DOI: 10.1016/j.jcin.2020.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Manuel Barreiro-Perez
- Cardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca, Salamanca, Spain; Network Biomedical Research Center, Cardiovascular Diseases, CIBER-CV, Spain.
| | - Ignacio Cruz-González
- Cardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca, Salamanca, Spain; Network Biomedical Research Center, Cardiovascular Diseases, CIBER-CV, Spain; Medicine Faculty, University of Salamanca, Salamanca, Spain
| | | | | | - Pedro L Sánchez
- Cardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca, Salamanca, Spain; Network Biomedical Research Center, Cardiovascular Diseases, CIBER-CV, Spain; Medicine Faculty, University of Salamanca, Salamanca, Spain
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Barreiro-Perez M, Cruz-González I, Martin-Moreiras J, Diaz-Pelaez E, Nuñez JC, Luengo-Mondéjar P, Sánchez PL. Transillumination and Tissue-Transparency Photo-Realistic Echocardiography Imaging During Percutaneous Mitral Valve Interventions. JACC Cardiovasc Interv 2021; 14:919-922. [PMID: 33812818 DOI: 10.1016/j.jcin.2021.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Received: 01/05/2021] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Manuel Barreiro-Perez
- Cardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Network Biomedical Research Center-Cardiovascular Diseases, CIBER-CV (ISCiii), Madrid, Spain.
| | - Ignacio Cruz-González
- Cardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Network Biomedical Research Center-Cardiovascular Diseases, CIBER-CV (ISCiii), Madrid, Spain; Medicine Faculty, University of Salamanca (USAL), Salamanca, Spain. https://twitter.com/icruzgonzalez
| | - Javier Martin-Moreiras
- Cardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Network Biomedical Research Center-Cardiovascular Diseases, CIBER-CV (ISCiii), Madrid, Spain; Medicine Faculty, University of Salamanca (USAL), Salamanca, Spain. https://twitter.com/jmmoreiras
| | - Elena Diaz-Pelaez
- Cardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Network Biomedical Research Center-Cardiovascular Diseases, CIBER-CV (ISCiii), Madrid, Spain. https://twitter.com/elenadpelaez
| | - Jean Carlos Nuñez
- Cardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Network Biomedical Research Center-Cardiovascular Diseases, CIBER-CV (ISCiii), Madrid, Spain. https://twitter.com/JeanNunezG
| | - Pablo Luengo-Mondéjar
- Cardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Network Biomedical Research Center-Cardiovascular Diseases, CIBER-CV (ISCiii), Madrid, Spain. https://twitter.com/LuengoMondejarP
| | - Pedro L Sánchez
- Cardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Network Biomedical Research Center-Cardiovascular Diseases, CIBER-CV (ISCiii), Madrid, Spain; Medicine Faculty, University of Salamanca (USAL), Salamanca, Spain. https://twitter.com/pedroluisSF
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Dawson K, Jones TL, Kearney KE, McCabe JM. Emerging Role of Large-bore Percutaneous Axillary Vascular Access: A Step-by-step Guide. ACTA ACUST UNITED AC 2020; 15:e07. [PMID: 32612679 PMCID: PMC7312195 DOI: 10.15420/icr.2019.22] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/02/2020] [Indexed: 11/04/2022]
Abstract
Advances in transcatheter structural heart interventions and temporary mechanical circulatory support have led to increased demand for alternative sites for large-bore vascular access. Percutaneous axillary artery access is an appealing alternative to femoral access in patients with peripheral arterial disease, obesity or for prolonged haemodynamic support where patient mobilisation may be valuable. In particular, axillary access for mechanical circulatory support allows for increased mobility while using the device, facilitating physical therapy and reducing morbidity associated with prolonged bed rest. This article outlines the basic approach to percutaneous axillary vascular access, including patient selection and procedure planning, anatomic axillary artery landmarks, access techniques, sheath removal and management of complications.
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Affiliation(s)
- Kathryn Dawson
- Division of Cardiology, Department of Medicine, University of Washington Heart Institute Seattle, WA, US
| | - Tara L Jones
- Division of Cardiovascular Medicine, University of Utah Salt Lake City, UT, US
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington Heart Institute Seattle, WA, US
| | - James M McCabe
- Division of Cardiology, Department of Medicine, University of Washington Heart Institute Seattle, WA, US
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21
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Corrigan FE, Hall MJ, Iturbe JM, Condado JF, Kamioka N, Howell S, Thourani VH, Clements SD, Babaliaros VC, Lerakis S. Radioprotective strategies for interventional echocardiographers during structural heart interventions. Catheter Cardiovasc Interv 2018; 93:356-361. [PMID: 30196578 DOI: 10.1002/ccd.27843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 02/26/2018] [Accepted: 07/28/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We investigated radioprotective strategies for the interventional echocardiographer (IE) during structural heart interventions in comparison with the interventional cardiologist (IC). BACKGROUND Structural heart interventions are expanding in complexity with increased reliance on IE. Recent reports have demonstrated concerning exposure and higher radiation to the IE. METHODS We monitored 32 structural interventions - 19 transcatheter aortic valve replacements (TAVR), 6 transcatheter mitral valve repairs, 5 paravalvular leak closures, and 2 atrial septal defect closures. Seventeen utilized transesophageal echocardiography (TEE) while 15 used transthoracic echocardiography (TTE). Members of the IC and IE teams wore multiple dosimeters on different sites of the body to measure radiation dose to the total body, lens of the eye, and hand. During each case, IE utilized dedicated radiation shielding. RESULTS Mean doses were higher for the primary IC than the primary IE: IC#1-99, 222, 378; IE#1-48, 52, 416 (body, lens, and hand doses in μSv). IE radioprotective strategies were able to reduce body and lens doses compared to IC during both TTE and TEE-guided procedures. Hand equivalent dose remained higher for the IE driven by exposure during TEE-guided procedures (IC#1 294 vs. IE#1 676 μSv). In a subgroup using radioprotective drapes during TTE-guided TAVR, IC dose was reduced without effect on the IE. CONCLUSIONS Radiation exposure during structural heart interventions is concerning. With dedicated shielding, IE received lower doses to the body and lens than IC. Further optimization of structural suite design and shielding is needed.
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Affiliation(s)
- Frank E Corrigan
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.,Cardiovascular Medicine, Wellstar Health System, Marietta, GA, USA
| | - Michael J Hall
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jose Miguel Iturbe
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jose F Condado
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Norihiko Kamioka
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Sharon Howell
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Vinod H Thourani
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.,Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Stephen D Clements
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Vasilis C Babaliaros
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Stamatios Lerakis
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
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Rogers T, Ratnayaka K, Schenke WH, Faranesh AZ, Mazal JR, O’Neill WW, Greenbaum AB, Lederman RJ. Intentional right atrial exit for microcatheter infusion of pericardial carbon dioxide or iodinated contrast to facilitate sub-xiphoid access. Catheter Cardiovasc Interv 2015; 86:E111-8. [PMID: 25315516 PMCID: PMC4537524 DOI: 10.1002/ccd.25698] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 10/11/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We test the safety of transatrial pericardial access using small catheters, infusion of carbon dioxide (CO2 ) or iodinated contrast to facilitate sub-xiphoid access, and catheter withdrawal under full anticoagulation. BACKGROUND Sub-xiphoid pericardial access is required for electrophysiological and structural heart interventions. If present, an effusion protects the heart from needle injury by separating the myocardium from the pericardium. However, if the pericardium is 'dry' then there is a significant risk of right ventricle or coronary artery laceration caused by the heart beating against the needle tip. Intentional right atrial exit is an alternative pericardial access route, through which contrast media could be infused to separate pericardial layers. METHODS Transatrial pericardial access was obtained in a total of 30 Yorkshire swine using 4Fr or 2.8Fr catheters. In 16 animals, transatrial catheters were withdrawn under anticoagulation and MRI was performed to monitor for pericardial hemorrhage. In 14 animals, iodinated contrast or CO2 was infused before sub-xiphoid access was obtained. RESULTS Small effusions (mean 18.5 ml) were observed after 4Fr (1.3 mm outer-diameter) but not after 2.8Fr (0.9 mm outer-diameter) transatrial catheter withdrawal despite full anticoagulation (mean activated clotting time 383 sec), with no hemodynamic compromise. Pericardial CO2 resorbed spontaneously within 15 min. CONCLUSIONS Intentional transatrial exit into the pericardium using small catheters is safe and permits infusion of CO2 or iodinated contrast to separate pericardial layers and facilitate sub-xiphoid access. This reduces the risk of right ventricular or coronary artery laceration. 2.8Fr transatrial catheter withdrawal does not cause any pericardial hemorrhage, even under full anticoagulation.
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Affiliation(s)
- Toby Rogers
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kanishka Ratnayaka
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Cardiology, Children’s National Medical Center, Washington, DC, USA
| | - William H. Schenke
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anthony Z. Faranesh
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan R. Mazal
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - William W. O’Neill
- Institute for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, MI, USA
| | - Adam B. Greenbaum
- Institute for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, MI, USA
| | - Robert J. Lederman
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Lam SCC, Bertog S, Gafoor S, Vaskelyte L, Boehm P, Ho RWJ, Franke J, Hofmann I, Sievert H. Left atrial appendage closure using the Amulet device: an initial experience with the second generation amplatzer cardiac plug. Catheter Cardiovasc Interv 2014; 85:297-303. [PMID: 25158644 DOI: 10.1002/ccd.25644] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 10/07/2013] [Revised: 07/06/2014] [Accepted: 08/17/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Aim of this study was to demonstrate the feasibility, safety, and short-term outcome of left atrial appendage (LAA) closure with a new generation LAA closure device. BACKGROUND The Amulet device (AGA, St Jude Medical, Minneapolis, MN) is a new generation of the amplatzer cardiac plug (ACP), specifically designed for LAA closure. This new version is designed to facilitate the implantation process and minimize procedural or device-related complications. METHODS The device was implanted in 17 patients with nonvalvular atrial fibrillation (AF). Clinical data were obtained at baseline, during the procedure, at discharge, at 30 and 90 days. RESULTS All devices were implanted successfully. Device sizes ranged from 20 mm to 31 mm. A 12 French (Fr) or 14 Fr delivery sheath was used depending on the selected device size. Full and partial recapture was performed in 1 case and 3 cases, respectively. There was 1 procedure-related pericardial effusion successfully managed with pericardiocentesis. There was no device embolization. The mean length of stay was 2.1 ± 0.3 days. At 90 days, there were no deaths, strokes, systemic thromboembolism, or bleeding complications. There was no device-related thrombus or pericardial effusion at 90-day TEE. In 2 of the 17 patients minimal peridevice flow (smaller than 2 mm) was present. CONCLUSIONS The Amulet device, which has new novel features as compared with the first generation ACP, is a feasible option for LAA closure. From our initial experience, implantation of the Amulet is associated with high success rate and good short-term outcome.
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Lardizabal JA, Macon CJ, O'Neill BP, Singh V, Martinez CA, Alfonso C, Cohen MG, Williams DB, O'Neill WW, Heldman AW. Clinical outcomes with on-label and off-label use of the transcatheter heart valve in the United States. Catheter Cardiovasc Interv 2014; 84:124-8. [PMID: 24659187 DOI: 10.1002/ccd.25489] [Citation(s) in RCA: 3] [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: 01/28/2014] [Revised: 03/03/2014] [Accepted: 03/12/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We explored the efficacy, safety, and clinical consequences of on-label and off-label transcatheter aortic valve replacement (TAVR) in the real-world setting. BACKGROUND The transcatheter heart valve (THV) was initially approved only for transfemoral (TF) delivery (on-label use) during TAVR in inoperable patients with severe aortic stenosis (AS). Because of lack of alternative options in TAVR-eligible patients with inadequate TF access, other routes have been utilized for THV implantation (off-label use), outcomes of which were previously unknown. METHODS Consecutive patients with severe inoperable AS who underwent clinical TAVR at our site were enrolled in a prospective database. Fifty subjects underwent TF-TAVR (on-label group), while non-TF routes were utilized in 60 subjects (off-label group). Procedural events, 30-day clinical outcomes, and 1-year all-cause mortality data were analyzed. RESULTS Technical device success was similar between on-label and off-label groups (88% vs. 87%, respectively; P = 0.92), as was the incidence of procedural complications and 30-day clinical events. The on-label group had lower 1-year all-cause death rate (12%) compared to the off-label group (32%; P = 0.02). The 1-year all-cause mortality in the off-label group was comparable to published clinical trial and registry data on TAVR, and appeared lower than historical outcomes with conservative medical therapy. CONCLUSION On-label use of the THV in the real-world setting was associated with favorable survival outcomes compared to off-label TAVR and historical data. Off-label use of the THV appeared to be safe and effective when used in select patients with inoperable AS who are not eligible for TAVR via TF approach.
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Affiliation(s)
- Joel A Lardizabal
- The Multi-Disciplinary Structural Heart Disease Program of the University of Miami, Miller School of Medicine, Miami, Florida
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