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Cruz-González I, Antúnez-Muiños P, López-Tejero S, Arnold L, Oldroyd KG. Patient-Specific Commissural Alignment With a Self-Expanding Transcatheter Heart Valve. JACC Case Rep 2024; 29:102190. [PMID: 38379652 PMCID: PMC10874896 DOI: 10.1016/j.jaccas.2023.102190] [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: 10/05/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 02/22/2024]
Abstract
A simple and reproducible technique to achieve commissural alignment during transcatheter aortic valve replacement with the Allegra valve is described. Slight rotation of the system before system insertion is necessary. Moreover, thanks to its permaflow system (Biosensors) and its radiopaque markings, small adjustments before valve deployment can be made to reassess correct alignment.
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Affiliation(s)
- Ignacio Cruz-González
- Cardiology Department, Hospital Universitario de Salamanca, Salamanca, Spain
- Biomedical Research Institute of Salamanca, Salamanca, Spain
- Centro de Investigación Biomédica En Red. Enfermedades Cardiovasculares (CIBER-CV), Salamanca, Spain
| | - Pablo Antúnez-Muiños
- Cardiology Department, Hospital Universitario de Salamanca, Salamanca, Spain
- Biomedical Research Institute of Salamanca, Salamanca, Spain
- Centro de Investigación Biomédica En Red. Enfermedades Cardiovasculares (CIBER-CV), Salamanca, Spain
| | - Sergio López-Tejero
- Cardiology Department, Hospital Universitario de Salamanca, Salamanca, Spain
- Biomedical Research Institute of Salamanca, Salamanca, Spain
- Centro de Investigación Biomédica En Red. Enfermedades Cardiovasculares (CIBER-CV), Salamanca, Spain
| | - Lars Arnold
- Biosensors International, Singapore, Singapore
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Wolfrum M, Moccetti F, Conrad N, Loretz L, Bossard M, Attiger-Toller A, Cuculi F, Toggweiler S. The Allegra transcatheter heart valve: Long-term clinical and echocardiographic outcomes. J Invasive Cardiol 2023; 35. [PMID: 38108869 DOI: 10.25270/jic/23.00163] [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] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
OBJECTIVES The Allegra-THV is a novel, self-expanding THV with supra-annular bovine leaflets. The valve is available in 3 different sizes and is delivered through an 18 French sheath. To determine the safety and efficacy of the Allegra transcatheter heart valve (THV; Biosensors) for the treatment of severe aortic valve stenosis under real-world conditions. METHODS Consecutive patients undergoing transcatheter aortic valve replacement (TAVR) at the Heart-Centre Lucerne with the Allegra-THV were included. Echocardiographic data were collected at baseline, before discharge, and at 1-year follow-up; clinical outcomes were recorded for up to 3 years. Clinical endpoints were defined according to the definitions of the Valve-Academic-Research-Consortium. RESULTS One hundred-three patients (age 81 ± 7 years, 63% women) were enrolled. Median European System for Cardiac Operative Risk Evaluation II score was 4.1% (IQR 1.8%-4.2%). Mean aortic valve gradient was 6.9 ± 3.3 mm Hg and 7.7 ± 3.3 mm Hg, and an effective orifice area was 2.1 ± 0.5 cm2 and 2.0 ± 0.5 cm2 at 30 days and 1-year follow-up, respectively. More than mild paravalvular leak was observed in 2.0% of patients at 30 days and 3.3% at 1 year. At 1-year follow-up, 14.7% of patients required implantation of a new permanent pacemaker, 1 patient had endocarditis with an uneventful clinical course and good THV-function after antibiotic therapy, and no thrombosis, structural-valve-detoriation (SVD), or non-SVD had occurred. At 3-year follow-up, rates of all-cause and cardiovascular mortality were 31.4% and 18.8%, respectively. CONCLUSIONS Transfemoral implantation of the Allegra-THV resulted in favorable clinical and echocardiographic outcomes at up to 3-year follow-up. Head-to-head randomized clinical trials are necessary to determine if the Allegra-THV valve performs as well as current generation valves.
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Affiliation(s)
- Mathias Wolfrum
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Nina Conrad
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Lucca Loretz
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matthias Bossard
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Florim Cuculi
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
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Tébar Márquez D, Moreno R, Galeote G, Jurado-Roman A, Jimenez-Valero S, García-Escobar A, Vera S, Moreno-Gómez I, Lopez de Sa E. Transcatheter aortic valve with a novel self-expandable device in patients with previous mechanical mitral valve prosthesis. Catheter Cardiovasc Interv 2022; 100:1286-1290. [PMID: 36273418 DOI: 10.1002/ccd.30449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aim of this study was to describe the procedural and early outcomes of patients with mechanical mitral valve prosthesis (MVP) undergoing transcatheter aortic valve replacement (TAVR) with a novel self-expandable retrievable device. BACKGROUND TAVR in patients with prior MVP may have an increased risk of complications related to device positioning and interference between both prosthetic valves. METHODS An observational study was conducted, including eight patients with severe symptomatic aortic stenosis and prior mechanical MVP who underwent TAVR with the novel device AllegraTM (Biosensors). No transesophageal monitoring was used. RESULTS The mean age of the study population was 75 years. The mean distance between MVP and aortic annulus was 3.8 mm. Procedural success was achieved in all patients with no major intraprocedural, in-hospital, or follow-up complications. CONCLUSIONS TAVR with Allegra TAVI system in patients with prior MVP offers good procedural and clinical outcomes.
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Affiliation(s)
| | - Raul Moreno
- Cardiology Department, University Hospital La Paz, Madrid, Spain
| | | | | | | | | | - Silvio Vera
- Cardiology Department, University Hospital La Paz, Madrid, Spain
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Neuser J, Kempf T, Bauersachs J, Widder JD. Novel self-expanding ALLEGRA transcatheter aortic valve for native aortic stenosis and degenerated bioprosthesis. Catheter Cardiovasc Interv 2021; 99:1234-1242. [PMID: 34787372 DOI: 10.1002/ccd.30003] [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: 06/21/2021] [Accepted: 10/20/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate the safety and efficacy of the ALLEGRA valve in routine use. BACKGROUND The ALLEGRA aortic valve is a self-expanding transcatheter heart valve (THV) with bovine pericardial tissue and was CE approved in March 2017. Its unique design was developed to provide low prosthesis gradients. METHODS We analyzed patients receiving an ALLEGRA THV between May 2017 and March 2021 at our center for treatment of aortic valve stenosis or degenerated valve prosthesis. Hemodynamic results and clinical outcome according to the Valve Academic Research Consortium-2 consensus criteria were evaluated at discharge and three months post transcatheter aortic valve replacement (TAVR) procedure. 93 patients with a mean age of 82.5 ± 4.8 years and a median EuroScore II of 4.7 ± 3.4 were treated, 15 of them were valve-in-valve procedures. RESULTS Implantation was successful in 97.8% (91/93) and VARC-2 defined device success was achieved in 94.6% (88/93). In-hospital all-cause mortality was 2.2% (2/93). Life-threatening bleeding, major vascular complications and strokes were 3.2% (3/93), 2.2% (2/93) and 3.2% (3/93), respectively. Paravalvular leakage was none to trace in 60.4%, mild in 38.5% and moderate in 1.1%. Permanent pacemaker implantation in pacemaker naive patients was necessary in 9.5% (8/84). Mean gradient at discharge was 8.2 ± 4.3 mmHg for all patients; 7.1 ± 2.6 mmHg in patients treated for stenosis of the native aortic valve and 13.8 ± 6.3 mmHg in patients treated valve-in-valve. CONCLUSIONS The ALLEGRA THV provides excellent hemodynamic results and a good safety profile with a low complication rate.
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Affiliation(s)
- Jonas Neuser
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Julian D Widder
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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Milan J, Gozdek M, Targoński R, Kowalewski M, Stańska A, Fijałkowski M, Lango R, Jaguszewski M, Jagielak D. Transfermoral transcatheter aortic valve implantation using self-expanding Allegra bioprosthesis: One-year single-center outcomes. Cardiol J 2021; 28:825-830. [PMID: 34490606 PMCID: PMC8747808 DOI: 10.5603/cj.a2021.0093] [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: 04/29/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background The NAUTILUS study aimed to evaluate the safety and performance of the Allegra bioprosthesis in high-risk recipients undergoing transcatheter aortic valve implantation and previously reported 30-day outcomes. In the current investigation 1-year results of the trial are presented. Methods Twenty-seven recipients with severe, symptomatic aortic valve stenosis at high surgical risk, who underwent treatment using the next-generation self-expanding Allegra via transfemoral approach were prospectively enrolled. Clinical endpoints assessed were: mortality, stroke, permanent pacemaker implantation, New York Heart Association class and re-hospitalizations. Prosthetic valve performance evaluation comprised of: mean gradient, effective orifice area and paravalvular leak. Results Patients were elderly (82.8 ± 4.2 years) and predominantly female (n = 19, 70.4%). All of them were deemed to be at high surgical risk with a mean logistic EuroSCORE of 12.5 ± 6.7. The bioprosthesis was successfully implanted in 92.6% of the cases (n = 25). At 1-year, all-cause mortality was 12.0% (n = 3) and stroke was 4.0% (n = 1). Three (12%) of patients developed complete atrioventricular block and received permanent pacemakers. 84% of patients were in New York Heart Association class II or lower. Need for subsequent hospitalization arose in 48% patients. The echocardiographic assessment confirmed an acceptable hemodynamic profile of the Allegra with low mean transprosthetic gradient (9.5 ± 3.4 mmHg), absence of severe paravalvular leak and a 20%-presence of moderate paravalvular leak. Conclusions The current follow-up observation study shows that the Allegra was associated with a satisfactory safety profile and hemodynamic performance at 1-year after implantation.
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Affiliation(s)
- Joanna Milan
- 1st Department of Cardiology, Medical University of Gdańsk, Poland
| | - Mirosław Gozdek
- Department of Cardiology and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Poland. .,Department of Cardiac Surgery, Medinet Heart Center Ltd, Wrocław, Poland.
| | - Radosław Targoński
- Department of Cardiac and Vascular Surgery Medical University of Gdańsk, Poland
| | - Mariusz Kowalewski
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.,Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warszawa, Poland.,Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Aleksandra Stańska
- Department of Cardiac and Vascular Surgery Medical University of Gdańsk, Poland
| | | | - Romuald Lango
- Department of Cardiac Anesthesiology Medical University of Gdańsk, Poland
| | | | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery Medical University of Gdańsk, Poland
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Wolfrum M, Moccetti F, Piuhola J, Lehtola H, Baz JA, Iñiguez A, van Nunen LX, Tonino PAL, Niemelä M, Toggweiler S. The Allegra transcatheter heart valve: Short term results from a multicenter registry. Catheter Cardiovasc Interv 2021; 98:1204-1209. [PMID: 34137483 DOI: 10.1002/ccd.29833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/18/2021] [Accepted: 06/05/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We aimed to determine the safety and efficacy of the Allegra transcatheter heart valve (THV) for the treatment of severe aortic valve stenosis in a large patient population treated under real-world conditions. BACKGROUND The Allegra is a novel self-expanding THV with supra-annular bovine leaflets. The valve is available in three different sizes (23, 27, and 31 mm), all are delivered through an 18F sheath. METHODS Consecutive patients undergoing TAVR with the Allegra THV were enrolled in a multicenter-registry. Data were collected throughout initial hospital-stay and at 30-day follow-up. Clinical endpoints were defined according to the updated definitions of the Valve-Academic-Research-Consortium. RESULTS This registry included 255 patients (mean age 83 ± 6 years, 48% women) from four European centers. Median European System for Cardiac Operative Risk Evaluation II score (EuroSCORE II) was 3.3% (IQR 1.9-5.8%). Acute device success was 95.7%. The remaining 11 patients had either moderate paravalvular regurgitation immediately after the procedure (7 patients) or the device could not be optimal positioned requiring implantation of a second THV (4 patients). Major vascular complications and major/life-threatening bleedings occurred in 10 (3.9%) and 12 (4.7%) patients, respectively. At 30 day follow-up, mean effective orifice area was 2.2 ± 0.5 cm2 , mean gradient was 6.9 ± 3.8 mmHg, 7 (3.3%) patients had more than mild paravalvular leakage, 3 patients (1.2%) had died, 6 patients (2.4%) had a stroke and 30 (12.8%) patients had required implantation of a new permanent pacemaker. CONCLUSIONS Transfemoral implantation of the Allegra THV resulted in favorable clinical and echocardiographic outcomes during hospitalization and short-term follow up.
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Affiliation(s)
- Mathias Wolfrum
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Jarkko Piuhola
- Division of Cardiology, Department of Internal Medicine, University of Oulu, Oulu, Finland
| | - Heidi Lehtola
- Division of Cardiology, Department of Internal Medicine, University of Oulu, Oulu, Finland
| | - José Antonio Baz
- Department of Cardiology, Interventional Cardiology Unit, University Hospital Álvaro Cunqueiro of Vigo, Pontevedra, Spain
| | - Andrés Iñiguez
- Department of Cardiology, Interventional Cardiology Unit, University Hospital Álvaro Cunqueiro of Vigo, Pontevedra, Spain
| | | | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Matti Niemelä
- Division of Cardiology, Department of Internal Medicine, University of Oulu, Oulu, Finland
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Comparison table: Some oral drugs for allergic rhinitis. Med Lett Drugs Ther 2021; 63:e63-5. [PMID: 33848282] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Drugs for allergic rhinitis and allergic conjunctivitis. Med Lett Drugs Ther 2021; 63:57-64. [PMID: 33848281] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Intravenous Cetirizine (Quzyttir) for Acute Urticaria. Med Lett Drugs Ther 2020; 62:55-6. [PMID: 32324180] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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OTC drugs for seasonal allergies. Med Lett Drugs Ther 2019; 61:57-60. [PMID: 31169808] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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