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Belmonte M, De Colle C, Paolisso P, Danino A, Pichersky Y, Lereya C, Kislev E, Planer D, Viscusi MM, Botti G, Bertolone DT, Gallinoro E, Shumkova M, Ratti A, Barbato E, Penicka M, Vanderheyden M, Bartunek J. Implantation of a Stent Graft System for Torrential Tricuspid Regurgitation: A First-in-Human Experience. JACC Cardiovasc Interv 2023; 16:2678-2681. [PMID: 37804288 DOI: 10.1016/j.jcin.2023.08.008] [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: 06/25/2023] [Revised: 07/21/2023] [Accepted: 08/01/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Marta Belmonte
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Cristina De Colle
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | | | | | | | - Michele Mattia Viscusi
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giulia Botti
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; IRCCS Ospedale Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | - Angelo Ratti
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; University of Milan, Milan, Italy
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Martin Penicka
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium.
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2
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Afoke J, Crestanello J. Systolic anterior motion of a transatrial transcatheter mitral valve replacement causing left ventricular outflow tract obstruction. Perfusion 2023:2676591231206526. [PMID: 37823304 DOI: 10.1177/02676591231206526] [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] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Transatrial transcatheter mitral valve replacement is a hybrid strategy involving placing the patient on cardiopulmonary bypass and direct implantation of a transcatheter valve in a calcified annulus for mitral annular calcification. We report a rare phenomenon of systolic anterior motion of the leaflets of a transcatheter heart valve prosthesis used for mitral valve replacement causing left ventricular outflow tract obstruction. Although reported in transcatheter mitral valve replacement, we believe this is the first report of left ventricular outflow tract obstruction after transatrial mitral valve replacement and discuss the pre-disposing risk factors.
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Affiliation(s)
- Jonathan Afoke
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
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3
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Cuko B, Baudo M, Ternacle J, Leroux L, Modine T. Transfemoral Transcatheter Tricuspid Valve Replacement Using the EVOQUE System in an Octogenarian for Severe Tricuspid Valve Regurgitation. Cureus 2023; 15:e45848. [PMID: 37881383 PMCID: PMC10594838 DOI: 10.7759/cureus.45848] [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] [Accepted: 09/24/2023] [Indexed: 10/27/2023] Open
Abstract
Tricuspid regurgitation is a frequent condition that is linked to an elevated risk of cardiovascular events and significant mortality but is often overshadowed by left-sided valve diseases. Isolated surgical tricuspid valve surgery is still considered a high-risk surgery, and over recent years, various transcatheter procedures for tricuspid treatment have emerged as an alternative solution. Among the available transcatheter procedures, the EVOQUE system's transcatheter tricuspid valve replacement could potentially offer a solution, especially in patients considered non-eligible for transcatheter edge-to-edge tricuspid valve repair. We present a case report of an octogenarian patient considered at prohibitive risk for conventional surgery and not eligible for transcatheter edge-to-edge repair who was eventually treated with a transfemoral transcatheter tricuspid 52-mm EVOQUE valve implantation. Postprocedural recovery and follow-up at 18 months were uneventful, with a well-functioning tricuspid valve bioprosthesis.
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Affiliation(s)
- Besart Cuko
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Pessac, FRA
| | - Massimo Baudo
- Department of Cardiac Surgery, Azienda Socio Sanitaria Territoriale (ASST) degli Spedali Civili di Brescia, University of Brescia, Brescia, ITA
| | - Julien Ternacle
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Pessac, FRA
| | - Lionel Leroux
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Pessac, FRA
| | - Thomas Modine
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Pessac, FRA
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4
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Meier D, Sreedharan S, Akodad M, Salcudean H, Lai A, Chatfield AG, Ye J, Cheung A, Payne GW, Allen KB, Chhatriwalla AK, Wood DA, Webb JG, Leipsic JA, Sathananthan J, Sellers SL. Impact of Bioprosthetic Valve Fracture on Potential Embolic Debris Generation: Insights From the Bench. JACC Cardiovasc Interv 2022; 15:e137-9. [PMID: 35430175 DOI: 10.1016/j.jcin.2022.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 11/22/2022]
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5
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Spigel ZA, Adachi I, Binsalamah ZM, Parekh D, Qureshi AM. Transcatheter pulmonic valve implantation in adult patients with prior congenital heart surgery. Ann Cardiothorac Surg 2021; 10:658-666. [PMID: 34733693 DOI: 10.21037/acs-2021-tviv-28] [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] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022]
Abstract
Background Transcatheter pulmonary valve replacement (TPVR) is now an established modality for pulmonary valve replacement in suitable candidates. We aim to describe our experience with TPVR in adults. Methods This is a descriptive study of all TPVR performed in adults with congenital heart disease at a single institution from 2010-2020. All adult patients (defined as 18 years old or older at TPVR) were included. Time-to-event outcomes were described using Kaplan-Meier estimates with 95% confidence intervals (CIs). Results Out of a total of 200 patients that had undergone TPVR, 81 patients (57% male) met the inclusion criteria, with a median age and weight of 26 years (IQR 21-37) and 71.0 kg (IQR 54.6-89.0), respectively. In the cohort, 45 (56%) patients had tetralogy of Fallot. While 53 (65%) patients received a Melody valve, a Sapien valve (S3 in 20, XT in eight) was implanted in the rest. Pre-stenting was performed in 49 (52%) patients. One patient died of severe heart failure a year following TPVR. One patient had a second TPVR performed 2.2 years following initial TPVR for severe pulmonary regurgitation. Valve survival at 2.2 years was 94% (95% CI: 87-100%). Four patients developed endocarditis. Endocarditis-free survival was 89% (95% CI: 80-100%) at three years. Conclusions Our experience suggests favorable results of TPVR in adults with congenital heart disease. Additional research would be warranted with a focus on total valve longevity and patient reported outcomes, in order to improve the understanding of TPVR in this population and further refine this technology.
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Affiliation(s)
- Zachary A Spigel
- Department of Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Iki Adachi
- Department of Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Ziyad M Binsalamah
- Department of Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Dhaval Parekh
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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6
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Ovcharenko EA, Klyshnikov KU, Shilov AA, Kochergin NA, Rezvova MA, Belikov NV, Ganyukov VI. Mechanism of Vascular Injury in Transcatheter Aortic Valve Replacement. Sovrem Tekhnologii Med 2021; 13:6-13. [PMID: 34603750 PMCID: PMC8482820 DOI: 10.17691/stm2021.13.3.01] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Indexed: 11/14/2022] Open
Abstract
The aim of the study was to determine the potential mechanism of vascular complications due to “catheter–vascular wall” interaction in transcatheter aortic valve replacement using experimental and numerical analysis.
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Affiliation(s)
- E A Ovcharenko
- Head of Laboratory, Department of Experimental Medicine; Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Blvd, Kemerovo, 650002, Russia
| | - K U Klyshnikov
- Researcher, Department of Experimental Medicine; Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Blvd, Kemerovo, 650002, Russia
| | - A A Shilov
- Senior Researcher, Department of Cardiac and Vascular Surgery; Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Blvd, Kemerovo, 650002, Russia
| | - N A Kochergin
- Researcher, Department of Cardiac and Vascular Surgery; Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Blvd, Kemerovo, 650002, Russia
| | - M A Rezvova
- Junior Researcher, Department of Experimental Medicine; Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Blvd, Kemerovo, 650002, Russia
| | - N V Belikov
- Senior Lecturer, Department of Biomedical Technical Systems, Bauman Moscow State Technical University (National Research University), 5/1 Baumanskaya 2-ya St., Moscow, 105005, Russia
| | - V I Ganyukov
- Head of Department, Department of Cardiac and Vascular Surgery, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Blvd, Kemerovo, 650002, Russia
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7
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Wojakowski W, Chmielak Z, Widenka K, Pręgowski J, Perek B, Gackowski A, Bartuś K, Szymański P, Deja MA, Kalarus Z, Suwalski P, Trębacz J, Kołsut P, Ścisło P, Wróbel K, Smolka G, Gerber W, Dudek D, Hirnle T, Grygier M, Bartuś S, Witkowski A, Kuśmierczyk M. Transcatheter mitral valve repair and replacement. Expert consensus statement of the Polish Cardiac Society and the Polish Society of Cardiothoracic Surgeons. Kardiol Pol 2021; 79:1165-1177. [PMID: 34599502 DOI: 10.33963/kp.a2021.0116] [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] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.
| | - Zbigniew Chmielak
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Kazimierz Widenka
- Clinical Department of Cardiac Surgery, District Hospital no. 2, University of Rzeszow, Rzeszów, Poland
| | - Jerzy Pręgowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | - Andrzej Gackowski
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Kraków, Poland.,Department of Coronary Artery Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantation, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Piotr Szymański
- Clinical Cardiology Center, Central Clinical Hospital of the Ministry of the Interior in Warsaw and Center of Postgraduate Medical Education, Warszawa, Poland
| | - Marek A Deja
- Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Piotr Suwalski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warszawa, Poland
| | - Jarosław Trębacz
- Institute of Cardiology, Jagiellonian University, Kraków, Poland
| | - Piotr Kołsut
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, Warszawa, Poland
| | - Piotr Ścisło
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland 14Medicover Hospital, Warszawa, Poland
| | | | - Grzegorz Smolka
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Witold Gerber
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.,Maria Cecilia Hospital, GVM Care and Research, Contignola (RA), Ravenna, Italy
| | - Tomasz Hirnle
- Department of Cardiosurgery, University Hospital, Białystok, Poland
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Stanisław Bartuś
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Mariusz Kuśmierczyk
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, Warszawa, Poland
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8
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Chahal NS, Senior R. Severe Patient-Prosthesis Mismatch: Compelling Entity or an Epiphenomenon of Low Flow? Circ Cardiovasc Imaging 2021; 14:e012836. [PMID: 34384246 DOI: 10.1161/circimaging.121.012836] [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)
- Navtej S Chahal
- Northwick Park Hospital, London Northwest University Hospital Trust, Harrow, United Kingdom (N.S.C., R.S.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (N.S.C., R.S.)
| | - Roxy Senior
- Northwick Park Hospital, London Northwest University Hospital Trust, Harrow, United Kingdom (N.S.C., R.S.).,Royal Brompton Hospital, London, United Kingdom (R.S.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (N.S.C., R.S.)
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9
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Hell MM, Emrich T, Kreidel F, Kreitner KF, Schoepf UJ, Münzel T, von Bardeleben RS. Computed tomography imaging needs for novel transcatheter tricuspid valve repair and replacement therapies. Eur Heart J Cardiovasc Imaging 2021; 22:601-610. [PMID: 33247897 DOI: 10.1093/ehjci/jeaa308] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 08/27/2020] [Accepted: 10/30/2020] [Indexed: 01/03/2023] Open
Abstract
Transcatheter tricuspid valve therapies are an emerging field in structural heart interventions due to the rising number of patients with severe tricuspid regurgitation and the high risk for surgical treatment. Computed tomography (CT) allows exact measurements of the annular plane, evaluation of adjacent structures, assessment of the access route, and can also be used to identify optimal fluoroscopic projection planes to enhance periprocedural imaging. This review provides an overview of current transcatheter tricuspid valve repair and replacement therapies and to what extent CT can support these interventions.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany.,Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Felix Kreidel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
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10
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Verstraete A, Herregods MC, Verbrugghe P, Lamberigts M, Vanassche T, Meyns B, Oosterlinck W, Rega F, Adriaenssens T, Van Hoof L, Keuleers S, Vandenbriele C, Sinnaeve P, Janssens S, Dubois C, Meuris B, Verhamme P. Antithrombotic Treatment After Surgical and Transcatheter Heart Valve Repair and Replacement. Front Cardiovasc Med 2021; 8:702780. [PMID: 34422930 PMCID: PMC8375148 DOI: 10.3389/fcvm.2021.702780] [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: 04/29/2021] [Accepted: 07/05/2021] [Indexed: 12/14/2022] Open
Abstract
New antithrombotic drugs have been developed, new valve types have been designed and minimally invasive transcatheter techniques have emerged, making the choice of antithrombotic therapy after surgical or transcatheter heart valve repair and replacement increasingly complex. Moreover, due to a lack of large randomized controlled trials many recommendations for antithrombotic therapy are based on expert opinion, reflected by divergent recommendations in current guidelines. Therefore, decision-making in clinical practice regarding antithrombotic therapy for prosthetic heart valves is difficult, potentially resulting in sub-optimal patient treatment. This article compares the 2017 ESC/EACTS and 2020 ACC/AHA guidelines on the management of valvular heart disease and summarizes the available evidence. Finally, we established a convenient consensus on antithrombotic therapy after valve interventions based on over 800 annual cases of surgical and transcatheter heart valve repair and replacement and a multidisciplinary team discussion between the department of cardiovascular diseases and cardiac surgery of the University Hospitals Leuven, Belgium.
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Affiliation(s)
- Andreas Verstraete
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | | | - Peter Verbrugghe
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Marie Lamberigts
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Vanassche
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Wouter Oosterlinck
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tom Adriaenssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Lucas Van Hoof
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Siegmund Keuleers
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | | | - Peter Sinnaeve
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Stefan Janssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Dubois
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meuris
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
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11
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Morray BH, McElhinney DB. Semilunar Valve Interventions for Congenital Heart Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:71-9. [PMID: 33413944 DOI: 10.1016/j.jacc.2020.10.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 02/06/2023]
Abstract
Transcatheter balloon valvuloplasty for the treatment of aortic and pulmonary valve stenosis was first described nearly 40 years ago. Since that time, the technique has been refined in an effort to optimize acute outcomes while reducing the long-term need for reintervention and valve replacement. Balloon pulmonary valvuloplasty is considered first-line therapy for pulmonary valve stenosis and generally results in successful relief of valvar obstruction. Larger balloon to annulus (BAR) diameter ratios can increase the risk for significant valvar regurgitation. However, the development of regurgitation resulting in right ventricular dilation and dysfunction necessitating pulmonary valve replacement is uncommon in long-term follow-up. Balloon aortic valvuloplasty has generally been the first-line therapy for aortic valve stenosis, although some contemporary studies have documented improved outcomes following surgical valvuloplasty in a subset of patients who achieve tri-leaflet valve morphology following surgical repair. Over time, progressive aortic regurgitation is common and frequently results in the need for aortic valve replacement. Neonates with critical aortic valve stenosis remain a particularly high-risk group. More contemporary data suggest that acutely achieving an aortic valve gradient <35 mm Hg with mild aortic regurgitation may improve long-term valve performance and reduce the need for valve replacement. Continued study will help to further improve outcomes and reduce the need for future reinterventions.
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12
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Karahalios B, Breinholt JP, Little SH, Huie Lin C. Intentional bioprosthetic tricuspid valve fracture to facilitate transcatheter valve-in-valve deployment. Catheter Cardiovasc Interv 2021; 97:361-364. [PMID: 32141679 DOI: 10.1002/ccd.28837] [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: 06/28/2019] [Revised: 01/25/2020] [Accepted: 02/25/2020] [Indexed: 11/07/2022]
Abstract
While transcatheter valve-in-valve (ViV) implantation may reduce the number of lifetime surgical reinterventions in some patients with congenital heart disease, in other patients the bioprosthetic valve ring can lead to patient-prosthesis mismatch due to reduction of internal diameter if a transcatheter valve is implanted. A 49-year-old woman with multiple prior cardiac surgeries presented with heart failure due to bioprosthetic tricuspid valve stenosis. Initial predilation valvuloplasty suggested conventional ViV implant would produce patient-prosthesis mismatch, therefore, we intentionally fractured the bioprosthetic valve ring to facilitate optimal hemodynamics with implantation of a 29 mm transcatheter valve.
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Affiliation(s)
| | | | - Stephen H Little
- Houston Methodist Debakey Heart and Vascular Center, Houston, Texas, USA
| | - C Huie Lin
- Houston Methodist Debakey Heart and Vascular Center, Houston, Texas, USA
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13
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Martin AK, Weiner MM, Feinman JW, Bhatt HV, Fritz AV, Townsley MM, Sharma A, Stawiarski K, Patel SJ, Zhou EY, Addis DR, Ghofaily LA, Malhotra AK, Teixeira MT, Subramani S, Arora L, Cowart CR, Jayaraman AL, Ramakrishna H. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2020. J Cardiothorac Vasc Anesth 2020; 35:993-1005. [PMID: 33229168 PMCID: PMC7575453 DOI: 10.1053/j.jvca.2020.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 12/30/2022]
Abstract
THIS SPECIAL article is the 13th in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr Kaplan, and the editorial board for the opportunity to continue this series; namely, the research highlights of the past year in the specialty of cardiothoracic and vascular anesthesiology.1 The major themes selected for 2020 are outlined in this introduction, and each highlight is reviewed in detail in the main body of the article. The literature highlights in the specialty for 2020 begin with an update on valvular disease, with a focus on updates in management of aortic and mitral valve disorders. The second major theme is an update on coronary artery disease, with discussion of both medical and surgical management. The third major theme is focused on the perioperative management of patients with coronavirus disease 2019 (COVID-19), with the authors highlighting literature discussing medical, surgical, and anesthetic considerations for their cardiac care. The fourth major theme is an update in heart failure, with discussion of medical, psychosocial, and procedural aspects of this complicated disease process. The fifth and final theme focuses on the latest analyses regarding survival in heart transplantation. The themes selected for this 13th special article are only a few of the diverse advances in the specialty during 2020. These highlights will inform the reader of key updates on a variety of topics, leading to improvement of perioperative outcomes for patients with cardiothoracic and vascular disease.
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Affiliation(s)
- Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL.
| | - Menachem M Weiner
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jared W Feinman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Himani V Bhatt
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL; Bruno Pediatric Heart Center, Children's of Alabama, Birmingham, AL
| | - Archit Sharma
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Kristin Stawiarski
- Department of Cardiology, Bridgeport Hospital, Yale-New Haven Health, Bridgeport, CN
| | - Saumil J Patel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Y Zhou
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dylan R Addis
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Lourdes Al Ghofaily
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Anita K Malhotra
- Division of Cardiothoracic Anesthesiology and Critical Care, Penn State Hershey Medical Center, Hershey, PA
| | - Miguel T Teixeira
- Division of Critical Care Medicine, Department of Anesthesiology, Stanford School of Medicine, Palo Alto, CA
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Lovkesh Arora
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Christopher R Cowart
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Arun L Jayaraman
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Scottsdale, AZ
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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14
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Marin-Cuartas M, Noack T, Kiefer P, Borger MA. Transcatheter "valve-in-valve" mitral valve replacement for patient-prosthesis mismatch: Chronicle of a death foretold. J Card Surg 2020; 35:3606-3609. [PMID: 32985707 DOI: 10.1111/jocs.15050] [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] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/27/2022]
Abstract
Severe mitral annular calcification (MAC) may represent a challenging issue which can lead to poor outcomes and serious issues such as patient-prosthesis mismatch (PPM). The potential harmful effect of PPM must be prevented through the use of alternative techniques that allow mitral valve replacement with adequately sized bioprostheses in patients with MAC. PPM should be recognized as a contraindication for transcatheter valve-in-valve replacement as it leads to poor outcomes and early prosthetic degeneration.
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Affiliation(s)
- Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Thilo Noack
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Philipp Kiefer
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Michael A Borger
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
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15
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Gong FF, Peters AC, Malaisrie SC, Davidson CJ, Flaherty JD, Mehlman DJ, Narang A, Puthumana JJ. Optimal Imaging Guidance During Transcatheter Mitral Valve-in-Valve Replacement in Bioprostheses With Radiolucent Sewing Rings. JACC Case Rep 2020; 2:1129-1134. [PMID: 34317432 PMCID: PMC8311896 DOI: 10.1016/j.jaccas.2020.05.073] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/06/2020] [Accepted: 05/20/2020] [Indexed: 11/18/2022]
Abstract
Transcatheter mitral valve-in-valve replacement (TMVR) offers a less invasive strategy for managing bioprosthetic mitral valve dysfunction. TMVR positioning is challenging in the setting of a radiolucent bioprosthetic sewing ring. We present 2 cases demonstrating the roles of fluoroscopy and echocardiography in guiding TMVR placement within bioprostheses with radiolucent sewing rings. (Level of Difficulty: Intermediate.).
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Key Words
- LV, left ventricle
- LVOT, left-ventricular outflow tract
- MPR, multiplanar reconstruction
- MR, mitral regurgitation
- MV, mitral valve
- Medtronic Mosaic
- RV, right ventricle
- S3, Edwards SAPIEN 3 valve
- TEE, transesophageal echocardiography
- TMVR, transcatheter mitral valve-in-valve replacement
- TTE, transthoracic echocardiography
- bioprosthetic valve dysfunction
- mitral valve
- transcatheter valve replacement
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Affiliation(s)
- Fei Fei Gong
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Address for correspondence: Dr. Fei Fei Gong, Division of Cardiology, Northwestern Medicine, 676 North St. Clair Street, Suite 600, Chicago, Illinois 60611.
| | - Andrew C. Peters
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S. Chris Malaisrie
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles J. Davidson
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James D. Flaherty
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David J. Mehlman
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Akhil Narang
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jyothy J. Puthumana
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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16
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Abstract
Degenerative aortic stenosis is the most common valvular disease worldwide; however, its physiopathology remains poorly understood. Although, developments in prevention of this disease have remained relatively stagnant, the last decade has brought about innovative treatment options incorporating different percutaneous and surgical approaches. These advances have allowed physicians to offer relief to high-risk patients, previously deemed nonsurgical. Increasingly, there is a shift toward offering percutaneous valve replacement to moderate and low-risk patients with aortic stenosis. Enthusiasm for a new treatment option must always be tempered by caution; as defining appropriate patient selection is essential to achieve optimal outcomes.
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Affiliation(s)
- Alice Le Huu
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, & The Texas Heart Institute, Houston, TX, USA
| | - Dominique Shum-Tim
- Division of Cardiac Surgery & Surgical Research, Department of Surgery, McGill University, Montreal, QC, Canada
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17
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Vallabhaneni S, Matka M, Olenchock S, Sarnoski C, Longo S, Shirani J. Commissural fusion as etiology of bioprosthetic mitral stenosis in a patient with rheumatic heart disease. Echocardiography 2020; 37:637-640. [PMID: 32181512 DOI: 10.1111/echo.14634] [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] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/20/2020] [Accepted: 03/01/2020] [Indexed: 11/28/2022] Open
Abstract
We report commissural fusion as a unique morphologic etiology of early bioprosthetic mitral valve failure in a woman with a history of rheumatic mitral stenosis. She had undergone mitral valve replacement with a 25-mm Edwards Magna Ease bovine pericardial bioprosthesis 3 years earlier and presented with progressive dyspnea. Transesophageal echocardiography revealed severe bioprosthetic stenosis due to commissural fusion. She underwent percutaneous valve-in-valve implantation with a 26-mm Edwards Sapien 3 prosthesis. Marked symptomatic improvement was noted postprocedurally. We speculate that commissural fusion may be a unique pathologic feature of failing bioprosthetic valves in patients with prior rheumatic mitral valve disease.
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Affiliation(s)
| | - Marsel Matka
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Stephen Olenchock
- Department of Cardiothoracic Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Christopher Sarnoski
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Santo Longo
- Department of Pathology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Jamshid Shirani
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
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18
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Reiff C, Zhingre Sanchez JD, Mattison LM, Iaizzo PA, Garcia S, Raveendran G, Gurevich S. 3-Dimensional printing to predict paravalvular regurgitation after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 96:E703-E710. [PMID: 32077222 DOI: 10.1002/ccd.28783] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 09/26/2019] [Revised: 11/29/2019] [Accepted: 02/10/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is no effective method to predict paravalvular regurgitation prior to transcatheter aortic valve replacement (TAVR). METHODS We retrospectively analyzed pre-TAVR computed tomography (CT) scans of 20 patients who underwent TAVR for severe, calcific aortic stenosis and subsequently printed 3-dimensional (3D) aortic root models of each patient. Models were printed using Ninjaflex thermoplastic polyurethane (TPU) (Ninjatek Manheim, PA) and TPU 95A (Ultimaker, Netherlands) on Ultimaker 3 Extended 3D printer (Ultimaker, Netherlands). The models were implanted at nominal pressure with same sized Sapien balloon-expandable frames (Edwards Lifesciences, CA) as received in-vivo. Ex-vivo implanted TAVR models (eTAVR) were scanned using Siemens SOMATOM flash dual source CT (Siemens, Malvern, PA) and then analyzed with Mimics software (Materialize NV, Leuven, Belgium) to evaluate relative stent appositions. eTAVR were then compared to post-TAVR echocardiograms for each patient to assess for correlations of identified and predicted paravalvular leak (PVL) locations. RESULTS A total of 20 patients (70% male) were included in this study. The median age was 77.5 (74-83.5) years. Ten patients were characterized to elicit mild (9/10) or moderate (1/10) PVL, and 10 patients presented no PVL. In patients with echocardiographic PVL, eTAVR 3D model analyses correctly identified the site of PVL in 8/10 cases. In patients without echocardiographic PVL, eTAVR 3D model analyses correctly predicted the lack of PVL in 9/10 cases. CONCLUSION 3D printing may help predict the potential locations of associated PVL post-TAVR, which may have implications for optimizing valve selection and sizing.
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Affiliation(s)
- Christopher Reiff
- University of Minnesota Fairview Medical Center, Minneapolis, Minnesota
| | - Jorge D Zhingre Sanchez
- Department of Surgery, The Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Lars M Mattison
- Department of Surgery, The Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Paul A Iaizzo
- Department of Surgery, The Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Santiago Garcia
- University of Minnesota Fairview Medical Center, Minneapolis, Minnesota.,Minneapolis Heart Institute, Minneapolis, Minnesota
| | - Ganesh Raveendran
- University of Minnesota Fairview Medical Center, Minneapolis, Minnesota
| | - Sergey Gurevich
- University of Minnesota Fairview Medical Center, Minneapolis, Minnesota
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19
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Yu S, Fabbro M, Aljure O. Expert Consensus Systems of Care Proposal to Optimize Care for Patients With Valvular Heart Disease Review of the 2019 Document for the Cardiac Anesthesiologist. J Cardiothorac Vasc Anesth 2020; 34:2476-2483. [PMID: 31917079 DOI: 10.1053/j.jvca.2019.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/09/2019] [Accepted: 11/28/2019] [Indexed: 11/11/2022]
Abstract
Valvular heart disease requiring intervention is increasing in prevalence in the adult population. With advancement in transcatheter and surgical procedures for valvular heart disease, optimization of patient selection, availability of resources and personnel, appropriate training and certification, and optimal periprocedural management rely on clinical evaluation, accurate echocardiographic interpretation, and understanding of valvular pathophysiology by the cardiac anesthesiologist. To optimize care and improve access for patients with valvular heart disease the Expert Consensus Systems of Care Document by Nishimura et al.1 was recently published. The authors propose a protocol with guidelines and performance metrics to create tiered-level valve centers. This review focuses and expands on aspects discussed in Nishimura et al.'s Expert Consensus Systems of Care Document that are relevant to the cardiac anesthesiologist in the periprocedural setting.
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Affiliation(s)
- Soojie Yu
- University of Miami Miller School of Medicine, Department of Anesthesiology, Miami, FL.
| | - Michael Fabbro
- University of Miami Miller School of Medicine, Department of Anesthesiology, Miami, FL
| | - Oscar Aljure
- University of Miami Miller School of Medicine, Department of Anesthesiology, Miami, FL
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20
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Castillo JG, Tang GHL, Adams DH, El-Eshmawi A. Hybrid Mitral Valve Replacement: A Heart-Team Approach to Severe Mitral Annular Calcification. JACC Case Rep 2019; 1:495-9. [PMID: 34316863 DOI: 10.1016/j.jaccas.2019.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/07/2019] [Accepted: 08/14/2019] [Indexed: 11/24/2022]
Abstract
Mitral annular calcification tends to be significant in patients of advanced age or with underlying processes such as increased mechanical stress. When severe, it can significantly affect perioperative outcomes, especially if mitral decalcification is required for success. This report describes a versatile heart-team approach to a very complex condition. (Level of Difficulty: Advanced.).
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21
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Mathew RP, Alexander T, Patel V, Low G. Chest radiographs of cardiac devices (Part 1): Cardiovascular implantable electronic devices, cardiac valve prostheses and Amplatzer occluder devices. SA J Radiol 2019; 23:1730. [PMID: 31754536 PMCID: PMC6837806 DOI: 10.4102/sajr.v23i1.1730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/04/2019] [Accepted: 05/05/2019] [Indexed: 11/25/2022] Open
Abstract
Several new innovative cardiac devices have been created over the last few decades. Chest radiographs (CXRs) are the most common imaging investigations undertaken because of their value in evaluating the cardiorespiratory system. It is important for the interpreting radiologist to not only identify these iatrogenic objects but also to assess for their accurate placement, as well as for any complications related to their placement, which may be seen either on the immediate post-procedural CXR or on a follow-up CXR.
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Affiliation(s)
- Rishi P Mathew
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Timothy Alexander
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Vimal Patel
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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22
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Evans AS, Weiner MM, Shaefi S, Patel PA, Townsley MM, Kumaresan A, Feinman JW, Fritz AV, Martin AK, Steinberg TB, Renew JR, Gui JL, Radvansky B, Bhatt H, Subramani S, Sharma A, Gutsche JT, Augoustides JG, Ramakrishna H. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2019. J Cardiothorac Vasc Anesth 2019; 34:1-11. [PMID: 31759862 DOI: 10.1053/j.jvca.2019.10.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 12/26/2022]
Abstract
This highlights in our specialty for 2019 begin with the ongoing major developments in transcatheter valve interventions. Thereafter, the advances in left ventricular assist devices are reviewed. The recent focus on conduit selection and robotic options in coronary artery bypass surgery are then explored. Finally, this special articles closes with a discussion of pulmonary hypertension in noncardiac surgery, anesthetic technique in cardiac surgery, as well as postoperative pneumonia and its outcome consequences.
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Affiliation(s)
| | - Menachem M Weiner
- Department of Anesthesiology, Perioperative, and Pain Medicine Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine Beth Israel, Deaconess Medical Center, Boston, MA
| | - Prakash A Patel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Abirami Kumaresan
- Department of Anesthesiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - Jared W Feinman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - Ashley V Fritz
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Archer K Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Toby B Steinberg
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - J Ross Renew
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Jane L Gui
- Department of Anesthesiology, Perioperative, and Pain Medicine Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brian Radvansky
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - Himani Bhatt
- Department of Anesthesiology, Perioperative, and Pain Medicine Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Archit Sharma
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Jacob T Gutsche
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA.
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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23
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Stamou SC, Lin N, James T, Rothenberg M, Lovitz L, Faber C, Kapila A, Nores MA. Alternative Access Versus Transfemoral Transcatheter Aortic Valve Replacement in Nonagenarians. J Invasive Cardiol 2019; 31:171-175. [PMID: 30982779] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Previous studies suggest that alternative access (AA) such as transapical (TA) approach to transcatheter aortic valve replacement (TAVR) is inferior to transfemoral (TF) approach. However, there is a paucity of data characterizing these outcomes, and studies often do not consider transaortic (TAO) and transaxillary (TAX) TAVR approaches. Therefore, the purpose of this study was to compare the outcomes of nonagenarians undergoing AA-TAVR compared to TF-TAVR. METHODS A concurrent cohort study of 148 consecutive nonagenarian patients (≥90 years old) undergoing TAVR from April 2012 to July 2017 was carried out. We stratified the patient cohort into two groups based on access approach: TF-TAVR (n = 112); and AA-TAVR (n = 36), which included TA (n = 24), TAX (n = 8), and TAO (n = 4) approaches. Preoperative, operative, and postoperative outcomes and 5-year actuarial survival rates were analyzed. RESULTS Compared to TF-TAVR, patients undergoing AA-TAVR were more likely to require blood transfusions (28% vs 69%; P<.001) and readmission (16% vs 58%; P<.001). AA-TAVR also resulted in significantly higher rates of postoperative complications, such as stroke (1% vs 8%; P=.02) and atrial fibrillation (19% vs 36%; P=.03). There was no significant difference in aortic valve gradients (P>.05), operative mortality rate (6% vs 8%; P=.66), or actuarial 5-year survival rate (68% vs 44%, log-rank P=.10). CONCLUSION There is a higher risk of adverse events following AA-TAVR compared with TF-TAVR. Therefore, TF-TAVR is recommended when feasible, with AA approach as a viable back-up option in nonagenarians.
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Affiliation(s)
- Sotiris C Stamou
- JFK Medical Center, 180 JFK Drive, Suite 320, Atlantis, FL 33462 USA.
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24
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James TM, Stamou SC, Rothenberg M, Nores MA. Transcatheter aortic valve in valve implantation with bioprosthetic valve fracture. Catheter Cardiovasc Interv 2019; 93:1170-1172. [PMID: 30790421 DOI: 10.1002/ccd.28113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/23/2018] [Revised: 12/26/2018] [Accepted: 01/20/2019] [Indexed: 11/07/2022]
Abstract
Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) has emerged as a preferable option for high surgical risk patients requiring redo aortic valve replacement. However, VIV TAVR may restrict flow, especially in small native aortic valves. To remedy this, bioprosthetic valve fracture has been utilized to increase the effective orifice area and improve hemodynamics. We present three cases in which bioprosthetic valve fracture was used to increase hemodynamic flow in VIV TAVR procedures.
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Affiliation(s)
- Taylor M James
- Departments of Cardiology and Cardiothoracic Surgery, JFK Medical Center, Atlantis, Florida
| | - Sotiris C Stamou
- Departments of Cardiology and Cardiothoracic Surgery, JFK Medical Center, Atlantis, Florida
| | - Mark Rothenberg
- Departments of Cardiology and Cardiothoracic Surgery, JFK Medical Center, Atlantis, Florida
| | - Marcos A Nores
- Departments of Cardiology and Cardiothoracic Surgery, JFK Medical Center, Atlantis, Florida
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25
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Aktuerk D, Jansz P, Shaw M, Muller DWM. Successful repositioning of apically tethered transcatheter mitral valve replacement in the off-bypass, beating heart. Catheter Cardiovasc Interv 2019; 95:E37-E39. [PMID: 30919551 DOI: 10.1002/ccd.28210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/17/2018] [Revised: 02/01/2019] [Accepted: 03/16/2019] [Indexed: 11/08/2022]
Abstract
A 73-year-old man with severe, symptomatic secondary mitral regurgitation (MR) underwent successful transcatheter mitral valve replacement using the Tendyne™ mitral valve system. The device was deployed from the left ventricular (LV) apex and secured in position by a tether attached to an epicardial pad. Three days postoperatively, the patient developed hemolytic anemia and a paravalvular leak (PVL) associated with indentation of the LV apex. Adjustment of the tether tension and placement of an epicardial disc under the pad resulted in reduction in the PVL, and resolution of the hemolytic anemia.
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Affiliation(s)
- Dincer Aktuerk
- Department of Cardiothoracic Surgery, St. Vincent's Hospital, Sydney, Australia
| | - Paul Jansz
- Department of Cardiothoracic Surgery, St. Vincent's Hospital, Sydney, Australia
| | - Marty Shaw
- Department of Cardiothoracic Surgery, St. Vincent's Hospital, Sydney, Australia
| | - David W M Muller
- Department of Cardiology, St. Vincent's Hospital, Sydney, Australia
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26
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Zaleska-Kociecka M, Dabrowski M, Stepinska J. Acute kidney injury after transcatheter aortic valve replacement in the elderly: outcomes and risk management. Clin Interv Aging 2019; 14:195-201. [PMID: 30718946 PMCID: PMC6345183 DOI: 10.2147/cia.s149916] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Aortic stenosis is the most common cause of valve replacement in Europe and North America with prevalence increasing with age. Transcatheter valve replacement (TAVR) represents an alternative for surgical valve replacement of severely stenotic valves. Despite lower risk of acute kidney injury compared to that associated with surgery, this complication remains prevalent in patients undergoing TAVR. There is a paucity of data confirming the relation of acute kidney injury with high morbidity and mortality, especially when superimposed on chronic kidney disease, which is a frequent comorbidity in the elderly with severe aortic stenosis. As there is no consensus on the prevention of acute kidney injury in patients undergoing TAVR, identification and limitation of risk factors are crucial. In this review, we aim to discuss the key aspects of acute kidney injury diagnosis, risk assessment, and outcomes in TAVR patients, and to point out gaps in current knowledge.
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Affiliation(s)
| | - Maciej Dabrowski
- Interventional Cardiology and Angiology Clinic, Institute of Cardiology, Warsaw, Poland
| | - Janina Stepinska
- Cardiac Intensive Therapy Clinic, Institute of Cardiology, Warsaw, Poland,
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27
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Abstract
Severe tricuspid valve (TV) dysfunction in patients with congenital heart disease (CHD) is usually treated by open heart surgery in relatively young patients. If a valve plasty is not possible, a biological valve is implanted with a limited durability. Due to valve degeneration repeated valve exchanges are necessary in these patients. To expand the lifetime of a bioprosthesis in tricuspid position percutaneous TV implantation (PTVI) was introduced recently. PTVI is a promising new catheter interventional technology. The current review summarizes the indication for PTVI, describes the procedure itself and gives an outlook on medium to long-term results of this catheter intervention. PTVI in patients with severe TV dysfunction is less invasive, safe and effective, if performed by an experienced operator, and may help to reduce the total number of open-heart surgeries during a patient's life time. However, further studies with larger patient numbers and longer follow-up are needed.
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Affiliation(s)
- Andreas Eicken
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technische Universität Munich, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technische Universität Munich, Munich, Germany
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O'Neill B, Wang DD, Pantelic M, Song T, Guerrero M, Greenbaum A, O'Neill WW. Transcatheter caval valve implantation using multimodality imaging: roles of TEE, CT, and 3D printing. JACC Cardiovasc Imaging 2015; 8:221-5. [PMID: 25677894 DOI: 10.1016/j.jcmg.2014.12.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 11/13/2014] [Revised: 12/16/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Brian O'Neill
- Temple Heart and Vascular Institute, Temple University, Philadelphia, Pennsylvania
| | - Dee Dee Wang
- Institute for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan.
| | - Milan Pantelic
- Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - Thomas Song
- Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - Mayra Guerrero
- Institute for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan
| | - Adam Greenbaum
- Institute for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan
| | - William W O'Neill
- Institute for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan
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Xiong TY, Liao YB, Zhao ZG, Xu YN, Wei X, Zuo ZL, Li YJ, Cao JY, Tang H, Jilaihawi H, Feng Y, Chen M. Causes of Death Following Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2015; 4:e002096. [PMID: 26391132 PMCID: PMC4599496 DOI: 10.1161/jaha.115.002096] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement in patients at high surgical risk. However, there is little published literature on the exact causes of death. Methods and Results The PubMed database was systematically searched for studies reporting causes of death within and after 30 days following TAVR. Twenty-eight studies out of 3934 results retrieved were identified. In the overall analysis, 46.4% and 51.6% of deaths were related to noncardiovascular causes within and after the first 30 days, respectively. Within 30 days of TAVR, infection/sepsis (18.5%), heart failure (14.7%), and multiorgan failure (13.2%) were the top 3 causes of death. Beyond 30 days, infection/sepsis (14.3%), heart failure (14.1%), and sudden death (10.8%) were the most common causes. All possible subgroup analyses were made. No significant differences were seen for proportions of cardiovascular deaths except the comparison between moderate (mean STS score 4 to 8) and high (mean STS score >8) -risk patients after 30 days post-TAVR (56.0% versus 33.5%, P=0.005). Conclusions Cardiovascular and noncardiovascular causes of death are evenly balanced both in the perioperative period and at long-term follow-up after TAVR. Infection/sepsis and heart failure were the most frequent noncardiovascular and cardiovascular causes of death. This study highlights important areas of clinical focus that could further improve outcomes after TAVR.
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Affiliation(s)
- Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Zhen-Gang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Yuan-Ning Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Zhi-Liang Zuo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Yi-Jian Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Jia-Yu Cao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Hong Tang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Hasan Jilaihawi
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.J.)
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
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Harries IB, Kovac J, Ramcharitar S. Transcatheter mitral valve therapies for mitral regurgitation: are we getting closer? Future Cardiol 2014; 10:687-91. [PMID: 25495810 DOI: 10.2217/fca.14.60] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Iwan B Harries
- Wiltshire Cardiac Centre, Great Western Hospital, Swindon, UK
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Lederman RJ, Chen MY, Rogers T, Wang DD, Paone G, Guerrero M, O'Neill WW, Greenbaum AB. Planning transcaval access using CT for large transcatheter implants. JACC Cardiovasc Imaging 2014; 7:1167-71. [PMID: 25459598 DOI: 10.1016/j.jcmg.2014.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 05/05/2014] [Revised: 05/14/2014] [Accepted: 05/22/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Robert J Lederman
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.
| | - Marcus Y Chen
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Toby Rogers
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Dee Dee Wang
- Institute for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan
| | - Gaetano Paone
- Institute for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan
| | - Mayra Guerrero
- Institute for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan
| | - William W O'Neill
- Institute for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan
| | - Adam B Greenbaum
- Institute for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan
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Cheatham SL, Holzer RJ, Chisolm JL, Cheatham JP. The Medtronic Melody® transcatheter pulmonary valve implanted at 24-mm diameter--it works. Catheter Cardiovasc Interv 2013; 82:816-23. [PMID: 23359563 DOI: 10.1002/ccd.24821] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [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: 07/31/2012] [Revised: 01/05/2013] [Accepted: 01/09/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVES We report the Melody valve implanted and/or expanded to 24-mm diameter. BACKGROUND The Medtronic Melody valve has been implanted up to 22 mm in the pulmonary position for over a decade. METHODS A retrospective chart review was performed on 82 patients who underwent Melody valve implant. Technical implant method, pre- and postimplant echocardiographic findings, and initial follow-up were reviewed. RESULTS Between 04/2008 and 12/2011, 13 Melody valves were successfully implanted in 11 patients, median age 35 years (range 16-61 years), in the pulmonary (bioprosthetic valve, right ventricle to pulmonary artery conduit, native valve) position (n = 9), tricuspid position (bioprosthetic valve n = 3), and aortic position (bioprosthetic valve n = 1). Ten valves were delivered on a 24-mm balloon in balloon catheter and three were implanted using a 22-mm Ensemble balloon delivery system, followed by postdilation using a 24-mm × 2-cm Atlas balloon catheter. Postimplant, the median peak systolic gradient across the pulmonary valve was 7 mm Hg and median gradient across the tricuspid valve was 3 mm Hg. There was no change in gradient across the Melody valve in the aortic position where valve prosthesis-patient mismatch was present. Postimplant intracardiac echocardiography demonstrated none or mild valve regurgitation. No more than mild regurgitation was noted at a median follow-up of 9.5 months. CONCLUSIONS The Melody valve can be implanted at 24 mm in the stenotic/regurgitant bioprosthetic pulmonary, tricuspid, and aortic valve, dysfunctional right ventricle to pulmonary artery conduit, and the native right ventricular outflow tract, whereas the valve remains competent with only mild regurgitation.
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