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Zhou J, Li Y, Wang J, Zhang H. Simultaneous transapical transcatheter aortic and mitral valve replacement in patients with severe valve dysfunction: initial experience. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02026-w. [PMID: 38649640 DOI: 10.1007/s11748-024-02026-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/18/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Simultaneous transcatheter mitral valve in valve (VIV) replacement and aortic valve replacement experience is limited. We report our initial experience with simultaneous transapical transcatheter aortic and mitral valve replacement in patients with severe valve dysfunction. METHODS A total of 8 patients had simultaneous transcatheter heart valve implants for severe mitral bioprosthesis failure (VIV), with a second valve procedure that included native aortic regurgitation (n = 3) or degenerated bioprostheses in the aortic position (n = 5). All patients were treated with a self-expandable J-valve transcatheter valve, using the transapical approach. RESULTS The mean age of the patients was 73.1 ± 6.2 years. The mean Society of Thoracic Surgeons score was 13.8 ± 6.3%. Device success was 100% according to Valve Academic Research Consortium-2 criteria. No other procedure-associated complications occurred, including left ventricular outflow tract obstruction and valve migration. The mean hospital lengths of stay after the procedure were 11.5 ± 8.0 days. No deaths occurred at 30 days. At a median follow-up period of 28.7 ± 22.3 months, no patients died. All patients were in New York Heart Association functional classes I-II. Echocardiographic parameters at follow-up showed a normofunctioning J valve in the mitral position and a mean max mitral flow velocity of 2.0 ± 0.5 m/s; the J valve in the aortic position was also normofunctioning, and the mean max aortic flow velocity was 2.3 ± 0.5 m/s. CONCLUSION Simultaneous transapical transcatheter aortic and mitral valve replacement using the self-expandable J valve appears to be a feasible and effective alternative to redo surgery.
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Affiliation(s)
- Jiawei Zhou
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Yuehuan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - JianGang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Haibo Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
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Meertens MM, Adam M, Beckmann A, Ensminger S, Frerker C, Seiffert M, Sinning JM, Bekeredjian R, Walther T, Beyersdorf F, Möllmann H, Balaban Ü, Eghbalzadeh K, Rudolph TK, Bleiziffer S. Non-femoral focused transaxillary access in TAVI: GARY data analysis and future trends. Clin Res Cardiol 2024:10.1007/s00392-024-02402-9. [PMID: 38436739 DOI: 10.1007/s00392-024-02402-9] [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: 10/20/2023] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND In patients not suitable for transfemoral transcatheter aortic valve implantation (TAVI), several access strategies can be chosen. AIM To evaluate the use and patient outcomes of transaxillary (TAx), transapical (TA), and transaortic (TAo) as alternative access for TAVI in Germany; to further evaluate surgical cutdown vs. percutaneous TAx access. METHODS All patients entered the German Aortic Valve Registry (GARY) between 2011 and 2019 who underwent non-transfemoral TAVI were included in this analysis. Patients with TA, TAo, or TAx TAVI were compared using a weighted propensity score model. Furthermore, a subgroup analysis was performed for TAx regarding the percutaneous or surgical cutdown approach. RESULTS Overall, 9686 patients received a non-transfemoral access. A total of 8918 patients (92.1%) underwent TA, 398 (4.1%) TAo, and 370 (3.8%) TAx approaches. Within the TAx subgroup, 141 patients (38.1%) received subclavian cutdown, while 200 (54.1%) underwent a percutaneous approach. The TA patients had a significantly lower 30-day survival than TAx patients (TA 90.92% vs. TAx 95.59%, p = 0.006; TAo 92.22% vs. TAx 95.59%, p = 0.102). Comparing percutaneous and cutdown TAx approaches, no significant differences were seen. However, more vascular complications occurred (TA 1.8%, TAo 2.4%, TAx 12.2%; p < .001), and the hospital length of stay was shorter (TA 12.9 days, TAo 14.1 days, TAx 12 days; p < .001) after TAx access. CONCLUSION It may be reasonable to consider TAx access first in patients not suitable for TF-TAVI, because the 30-day survival was higher compared with TA access and the 1-year survival was higher compared with TAo access. It remains important for the heart teams to offer alternative access modalities for patients not amenable to the standard TF-TAVI approaches.
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Affiliation(s)
- Max M Meertens
- Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
| | - Matti Adam
- Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Andreas Beckmann
- Department of Cardiac and Pediatric Cardiac Surgery, Evanglish Clinical Center Niederrhein, Heart Center Duisburg, Duisburg, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital of Schleswig Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Sie Hamburg-Kiel-Lübeck, Berlin, Germany
| | - Christian Frerker
- German Center for Cardiovascular Research (DZHK), Partner Sie Hamburg-Kiel-Lübeck, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Moritz Seiffert
- German Center for Cardiovascular Research (DZHK), Partner Sie Hamburg-Kiel-Lübeck, Berlin, Germany
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Raffi Bekeredjian
- Department of Cardiology and Angiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Thomas Walther
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt a. M., Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany
| | - Helge Möllmann
- The Department of Internal Medicine, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | - Ümniye Balaban
- Institute of Biostatistics and Mathematical Modelling, Goethe-University, Frankfurt, Frankfurt a. M., Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Tanja K Rudolph
- Department for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia Bochum, University Hospital of the Ruhr University, Bad Oeynhausen, Germany
| | - Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany.
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He F, Hong J, Xu B, Wang S, Chen H, Qian X. Transapical transcatheter mitral valve implantation with J-valve in patients with degenerated mitral bioprostheses. BMC Cardiovasc Disord 2023; 23:395. [PMID: 37563738 PMCID: PMC10416433 DOI: 10.1186/s12872-023-03414-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Due to the widespread application of bioprosthetic valve in the treatment of mitral valve disease in recent years, the incidence of valve failure has increased significantly, which is facing the need of reoperation. For high-risk patients, transcatheter mitral valve-in-valve placement is increasingly being used as an alternative to surgical reoperation. CASE PRESENTATION Here we report the successful transapical transcatheter mitral valve-in-valve implantations of J-Valves in 3 patients with high risk of mitral bioprostheses failure. All patients were discharged successfully, and the follow-up results were good 30 days after operation without major complication. CONCLUSIONS For high-risk patients, transcatheter implantation of the J-valve is a feasible solution for the treatment of degenerated mitral bioprostheses.
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Affiliation(s)
- Fan He
- Department of Cardiovascular Surgery, Sir Run Run Shaw Hospital, Zhejiang University, East Qingchun Road 3th, Hangzhou, 310020, Zhejiang, China
| | - Jianmao Hong
- Department of Cardiovascular Surgery, Sir Run Run Shaw Hospital, Zhejiang University, East Qingchun Road 3th, Hangzhou, 310020, Zhejiang, China
| | - Bijun Xu
- Department of Cardiovascular Surgery, Sir Run Run Shaw Hospital, Zhejiang University, East Qingchun Road 3th, Hangzhou, 310020, Zhejiang, China
| | - Shiqiang Wang
- Department of Cardiovascular Surgery, Sir Run Run Shaw Hospital, Zhejiang University, East Qingchun Road 3th, Hangzhou, 310020, Zhejiang, China
| | - Huaidong Chen
- Department of Cardiovascular Surgery, Sir Run Run Shaw Hospital, Zhejiang University, East Qingchun Road 3th, Hangzhou, 310020, Zhejiang, China
| | - Ximing Qian
- Department of Cardiovascular Surgery, Sir Run Run Shaw Hospital, Zhejiang University, East Qingchun Road 3th, Hangzhou, 310020, Zhejiang, China.
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Lin HC, Lee YT, Tsao TP, Yin WH. A valve embolized twice: a case report of Sapien 3 embolization in left ventricle and left atrium during transcatheter transapical mitral valve-in-valve implantations for a failed bioprosthesis. Eur Heart J Case Rep 2023; 7:ytad357. [PMID: 37637099 PMCID: PMC10456212 DOI: 10.1093/ehjcr/ytad357] [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: 12/12/2022] [Revised: 03/26/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023]
Abstract
Background Transcatheter mitral valve-in-valve (TMVIV) using the Sapien 3 (Edwards Lifesciences, Irvine, CA, USA) transcatheter heart valve is associated with high technical success and sustained valve performance. However, complications may occur or be detected during or after the procedure. Case summary We herein describe a rare case of a 59-year-old female who underwent TMVIV for a failed surgical mitral bioprosthesis. During the procedure, the device was embolized twice into the left ventricle and left atrium, respectively, resulting from the crimped transcatheter valve partially detaching from the balloon of the Certitude delivery system during passage through a tight transapical sheath. Fortunately, we were able to catch the dislodged valve and anchor it by the partially inflated device balloon, followed by successful repositioning and deployment. Discussion In cases where the valve has already detached, as in the present case, the sheath may be advanced against the proximal end of the valve as a pusher, providing good support to push the entire system to cross the bioprosthesis. Then, the delivery catheter should be withdrawn with the counteraction of the sheath in order to correct the interrelated positions of the valve and the balloon. Finally, the valve can be positioned and deployed after the sheath is withdrawn.
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Affiliation(s)
- Huan-Chiu Lin
- Heart Center, Cheng Hsin General Hospital, No. 45, Cheng Hsin St, Beitou, Taipei 112, Taiwan
| | - Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital, No. 45, Cheng Hsin St, Beitou, Taipei 112, Taiwan
- Institute of Microbiology and Immunology, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City 112, Taiwan
| | - Tien-Ping Tsao
- Heart Center, Cheng Hsin General Hospital, No. 45, Cheng Hsin St, Beitou, Taipei 112, Taiwan
- Faculty of Medicine, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City 112, Taiwan
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, No. 45, Cheng Hsin St, Beitou, Taipei 112, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City 112, Taiwan
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Sykopetrites V, Taibah A, Piras G, Giannuzzi AL, Mancini F, Sanna M. The otologic approach in the management of posterior petrous surface meningiomas. Eur Arch Otorhinolaryngol 2022; 279:5655-5665. [PMID: 35767053 DOI: 10.1007/s00405-022-07442-3] [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: 02/13/2022] [Accepted: 05/09/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Report our experience in the management of posterior petrous surface meningiomas (PPSMs), and identify features that affect hearing, facial nerve (FN) function, and control of the disease. METHODS Retrospective case series of 131 patients surgically managed for PPSMs. FN status, hearing and tumour radicality were assessed and compared between patients with tumours of different locations (Desgeorges classification) and internal auditory canal involvement (IAC). RESULTS At the time of surgery 74.8% of patients had a hearing loss. Hearing was mostly unserviceable in tumors attached to the meatus. Pure tone audiometry did not correlate to IAC extension, while speech discrimination scores were statistically worse when the tumor occupied the IAC (unpaired t test, p = 0.0152). Similarly, extrameatal tumors undergoing removal by otic preserving techniques maintained postoperative hearing, whereas hearing worsened significantly in tumors involving the IAC (paired t test, p = 0.048). The FN was affected preoperatively in 11.4% of cases. Postoperative FN palsy was significantly correlated to the IAC involvement (Fisher's exact test, p = 0.0013), while it was not correlated to tumor size. According to the Desgeorges classification, a postoperative FN palsy complicated the majority of anteriorly extending tumors and, two-fifths of meatus centred tumors. 75% of posterior located tumors had a postoperative FN grade I HB. CONCLUSIONS Since the involvement of the IAC by the tumor affects both hearing and FN function, the IAC is of primary importance in PPSMs and should be studied and addressed as much as the tumor location in the CPA.
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Affiliation(s)
- Vittoria Sykopetrites
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Piacenza, Rome, Italy. .,Casa di Cura "Piacenza" S.P.A., Via Emmanueli 42, 29121, Piacenza, Italy.
| | - Abdelkader Taibah
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Piacenza, Rome, Italy.,Casa di Cura "Piacenza" S.P.A., Via Emmanueli 42, 29121, Piacenza, Italy
| | - Gianluca Piras
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Piacenza, Rome, Italy.,Casa di Cura "Piacenza" S.P.A., Via Emmanueli 42, 29121, Piacenza, Italy
| | - Anna Lisa Giannuzzi
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Piacenza, Rome, Italy.,Casa di Cura "Piacenza" S.P.A., Via Emmanueli 42, 29121, Piacenza, Italy
| | - Fernando Mancini
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Piacenza, Rome, Italy.,Casa di Cura "Piacenza" S.P.A., Via Emmanueli 42, 29121, Piacenza, Italy
| | - Mario Sanna
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Piacenza, Rome, Italy.,Casa di Cura "Piacenza" S.P.A., Via Emmanueli 42, 29121, Piacenza, Italy
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Mekhail A, Borrie A, Sasse A, Matsis P, Wilkins G, Galvin S. Transapical Closure of an Iatrogenic Left Ventricular Apical Pseudoaneurysm. Heart Lung Circ 2022; 31:e80-e81. [PMID: 35086754 DOI: 10.1016/j.hlc.2021.11.012] [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] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/13/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew Mekhail
- Cardiothoracic Surgery, Wellington Hospital, Wellington, NZ.
| | | | | | | | | | - Sean Galvin
- Cardiothoracic Surgery, Wellington Hospital, Wellington, NZ
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Owais T, El Garhy M, Elvinger S, Harmel E, Gross TMS, Lapp H, Kuntze T, Von Scheidt W, Girdauskas E, Al-Jassem M, Lauten P. Contemporary results of transcatheter mitral valve procedures: bi-centric retrospective analysis. Egypt Heart J 2022; 74:19. [PMID: 35347466 DOI: 10.1186/s43044-022-00257-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background Transcatheter mitral valve-in-valve (TMVIV) or valve-in-ring (TMVIR) replacement offer an alternative therapy for high risk patients. We aimed to highlight the operative and postoperative results of TMVIV and TMVIR procedures. Results We included all patients underwent TMVIV and TMVIR procedures between 2017 and 2020 at two heart centers in Germany. We included a total of 36 high risk patients in our study where 12 received TMVIV and 24 received TMVIR. All patients underwent TMVIV or TMVIR with Edwards Sapien XT or S3 transcatheter valves (Edwards Lifesciences). The mean age was 79 (75–83 years old). The median (IQR) preoperative STS score was 9 (7–13)% and EuroSCORE II was 14.5% (12–16). The majority of our patients were operated via transapical approach (n = 26) and the minority via transseptal approach (n = 10). Out of our records, none of our patients required reopening for bleeding or any other surgical complications. None of our patients required reintervention during the 6 months follow-up period. One mortality was recorded on fifth postoperative day due to low cardiac output syndrome (obviously because of LVOT obstruction by the anterior mitral leaflet). The average blood loss was 200 ml in the first 24 h in patients underwent transapical approach. Average operative time was 93 min and all patients were immediately extubated after the procedure in the operating room (even the patient with echocardiographically documented LVOT obstruction who died on the fifth postoperative day). Length of Intensive Care Unit stay was 2 ± 1.2 days and length of hospital stay was 4.1 ± 1.2 days. In the follow up period, echocardiograms showed normal prosthetic valve function with low transvalvular gradients, no LVOT obstruction in TMVIR cases and no evidence of valve migration or thrombosis (except in one patient). Concerning 6 months readmission, it was recorded in 2 patients due to right sided heart failure symptoms due to preexisting high degree of tricuspid valve regurge which did not disappear or even decrease after the operation and the other patient due to gastrointestinal bleeding. Conclusions TMVIV and TMVIR offer an efficient, safe and less invasive alternative in high surgical risk patients.
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Guo R, Xie M, Yim WY, Wu W, Jiang W, Wang Y, Hu X. Dose approach matter? A meta-analysis of outcomes following transfemoral versus transapical transcatheter aortic valve replacement. BMC Cardiovasc Disord 2021; 21:358. [PMID: 34320946 PMCID: PMC8320184 DOI: 10.1186/s12872-021-02158-4] [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: 10/01/2020] [Accepted: 07/09/2021] [Indexed: 01/01/2023] Open
Abstract
Background Transcatheter aortic valve replacement (TAVR) has gained increasing acceptance for patients with aortic disease. Both transfemoral (TF-TAVR) and transapical (TA-TAVR) approach were widely adopted while their performances are limited to a few studies with controversial results. This meta-analysis aimed to compare the mortality and morbidity of complications between TF- versus TA-TAVR based on the latest data. Methods Electronic databases were searched until April 2021. RCTs and observational studies comparing the outcomes between TF-TAVR versus TA-TAVR patients were included. Heterogeneity assumption was assessed by an I2 test. The pooled odds ratios(OR) or mean differences with corresponding 95% confidence intervals (CI) were used to evaluate the difference for each end point using a fixed-effect model or random-effect model based on I2 test. Results The meta-analysis included 1 RCT and 20 observational studies, enrolling 19,520 patients (TF-TAVR, n = 11,986 and TA-TAVR, n = 7,534). Compared with TA-TAVR, TF-TAVR patients showed significantly lower rate of postoperative in-hospital death (OR = 0.67, 95% CI 0.59–0.77, P < 0.001) and 1-year death (OR = 0.53, 95% CI 0.41–0.69, P < 0.001). Incidence of major bleeding and acute kidney injury were lower and length of hospital stay was shorter, whereas those of permanent pacemaker and major vascular complication were higher in TF-TAVR patients. There were no significant differences between TF-TAVR versus TA-TAVR for stroke and mid-term mortality. Conclusions There were fewer early deaths in patients with transfemoral approach, whereas the number of mid-term deaths and stroke was not significantly different between two approaches. TF-TAVR was associated with lower risk of bleeding, acute kidney injury as well as shorter in-hospital stay, but higher incidence of vascular complication and permanent pacemaker implantation. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02158-4.
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Affiliation(s)
- Ruikang Guo
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, China
| | - Minghui Xie
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, China
| | - Wai Yen Yim
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, China
| | - Wenconghui Wu
- Department of Gastroenterology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Weiwei Jiang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yin Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, China.
| | - Xingjian Hu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, China.
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Wendler O, Baghai M. Transapical aortic valve implantation: never limited by aortic disease or vascular access, but always needed? Eur J Cardiothorac Surg 2021; 59:1181-1182. [PMID: 33772311 DOI: 10.1093/ejcts/ezab120] [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: 11/14/2022] Open
Affiliation(s)
- Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital/King's Health Partners, London, UK.,Cleveland Clinic London, Heart, Vascular and Thoracic Institute, London, UK
| | - Max Baghai
- Department of Cardiothoracic Surgery, King's College Hospital/King's Health Partners, London, UK
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Useini D, Beluli B, Christ H, Schlömicher M, Ewais E, Patsalis P, Haldenwang P, Naraghi H, Moustafine V, Bechtel M, Strauch J. Transapical transcatheter aortic valve implantation in patients with aortic diseases. Eur J Cardiothorac Surg 2021; 59:1174-1181. [PMID: 33709139 DOI: 10.1093/ejcts/ezab050] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/07/2020] [Accepted: 12/18/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Patients scheduled for transcatheter aortic valve implantation (TAVI) treatment frequently present with concomitant aortic diseases, in which case they are usually considered to be at high interventional risk and, in particular, unable to undergo the transfemoral TAVI approach. Since the establishment of the 'transfemoral first' strategy for TAVI, there has been an evidence gap with regard to the outcomes of such patients. We aimed to evaluate the mid-term outcomes after transapical TAVI in patients with diverse aortic diseases. METHODS Fifty-five consecutive elderly patients (78.4 years; standard deviation: 8.6 years) at intermediate surgical risk with severe aortic stenosis and aortic diseases (porcelain aorta 36%, ascending aneurysm 15%, descending aneurysm 26%, type-B dissection 4%, aortic thrombus 7%, Leriche syndrome 4%, aortic kinking 11%, aortic ulcer 2%, previous aortic operation 20%, aortic elongation/tortuosity 4%) underwent transapical TAVI treatment between January 2011 and November 2019 at our institution. We used the second-and third-generation self- and balloon-expanding valves. The follow-up time was 92.6 patient-years. RESULTS The Society of Thoracic Surgery-Predicted Risk of Mortality score was 7% (standard deviation: 4%). The 30-day mortality and all-stroke rates were 6% and 4%, respectively. The median survival time was 24.9 months (95% confidence interval 17.6-32.3). The median time of freedom from a composite of death and cardio-cerebral adverse events was 24.3 months (95% confidence interval 11.9-36.8). The rate of moderate/severe paravalvular leakage was 2%. The pacemaker rate was 10%. No early or late aortic syndrome occurred. CONCLUSIONS Transapical TAVI is a safe method and shows very promising early and mid-term outcomes, without early/late aortic syndrome, in patients with aortic diseases for whom transfemoral TAVI as the first-line transcatheter method might be contraindicated or not feasible.
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Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Blerta Beluli
- Department of Internal Medicine, St. Anna Hospital, Herne, Germany
| | - Hildegard Christ
- Department of Medical Statistics, Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Cologne, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Elias Ewais
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Polykarpos Patsalis
- Department of Cardiology and Angiology, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Hamid Naraghi
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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Lu H, Fournier S, Namasivayam J, Roguelov C, Ferrari E, Eeckhout E, Monney P, Tozzi P, Marcucci C, Muller O, Kirsch M. Transapical approach versus transcervical approach for transcatheter aortic valve replacement: a retrospective monocentric study. Interact Cardiovasc Thorac Surg 2021; 31:781-788. [PMID: 33051655 DOI: 10.1093/icvts/ivaa202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/20/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Transfemoral approach is the standard access-route for transcatheter aortic valve replacement (TAVR). However, alternative approaches are needed in a number of patients and accesses such as transapical (TA) TAVR or transcervical (TC) are used. We aimed to compare clinical and echocardiographic outcomes after TA-TAVR or TC-TAVR. METHODS All patients who underwent TA- and TC-TAVR for severe aortic stenosis in our institution between 2008 and 2020 were retrospectively included. End points included 30-day all-cause mortality, procedural complications (according to the Valve Academic Research Consortium-2 criteria), procedure duration, intensive care unit (ICU) length of stay (LOS) and overall hospital LOS. For 30-day all-cause mortality, we furthermore used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics as well as difference in year of intervention. RESULTS TAVR was performed in 176 patients, using a TA approach (n = 127) or a TC approach (n = 49). Baseline clinical and echocardiographic characteristics were comparable between the 2 groups, except age and peripheral artery disease. All-cause 30-day mortality rates were not significantly different (8.5% in the TA group vs 2.3% in the TC group, P = 0.124). TC approach was associated with significantly shorter procedure duration {71.0 [interquartile range (IQR) 52.5-101.0] vs 93 [IQR 80.0-120.0] min, P < 0.001}, shorter ICU LOS [0.0 (IQR 0.0-0.0) vs 1.0 (IQR 1.0-3.0) days, P < 0.001] and shorter hospital LOS [7.0 (IQR 5.0-9.5) vs 14.0 (IQR 10.0-22.0) days, P < 0.001]. CONCLUSIONS The TC approach may be a good first-choice alternative in case of contraindications to transfemoral-TAVR.
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Affiliation(s)
- Henri Lu
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Christian Roguelov
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Enrico Ferrari
- Department of Cardiovascular Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Department of Cardiovascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlo Marcucci
- Department of Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiovascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
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12
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Marie B. Reply to Useini. Eur J Cardiothorac Surg 2021; 60:1478. [PMID: 34179945 DOI: 10.1093/ejcts/ezab305] [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: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Basile Marie
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France
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13
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Zou Y, Teng P, Ma L. New stent for transapical mitral valve replacement in acute swine experiment. J Cardiothorac Surg 2021; 16:101. [PMID: 33882974 PMCID: PMC8059321 DOI: 10.1186/s13019-021-01483-1] [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: 12/05/2020] [Accepted: 04/06/2021] [Indexed: 12/04/2022] Open
Abstract
Background Many patients with mitral regurgitation are denied open-heart surgery due to perceived high risk. Transcatheter mitral valve replacement is a therapeutic alternative for patients at high surgical risk. This study aimed to assess the feasibility of a new self-expanding valved stent for transcatheter mitral valve replacement via apex in an acute animal model. Methods Eight porcine experiments were performed in the acute study. A left thoracotomy was performed, and the new self-expanding transcatheter valved stent was deployed under fluoroscopic guidance in the native mitral annulus via apex. Hemodynamic data were recorded before and after implantation. Mitral annulus diameter and valve area were measured using echocardiography. Transvalvular and left ventricular outflow tract pressure gradients were measured using invasive methods. Results Seven animals underwent successful transapical mitral valve replacement; the implantation was unsuccessful in one animal. The mean procedure time, defined from placement to tightening of the purse-string suture, was 17.14 ± 7.86 min. Hemodynamic data before and after transapical mitral valve replacement showed no difference in statistical analysis. The mean diameter of the self-expanding device after implantation was 2.58 ± 1.04 cm; the mean functional area was 2.70 ± 0.26 cm2. Trace-to-mild central and paravalvular leaks were detected in 7 valves. The mean pressure gradient across the self-expanding device was 2.00 ± 0.82 mmHg; the corresponding gradient across the LVOT was 3.28 ± 1.11 mmHg. Postmortem evaluation confirmed precise device positioning in 7 animals with no signs of LVOT obstruction. Conclusion Transcatheter mitral replacement of the new valved stent was confirmed feasible in acute preclinical models. The new stent reveals optimal design parameters.
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Affiliation(s)
- Yu Zou
- Department of Cardiovascular Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qing Chun Road, Hang Zhou, 310003, Zhejiang Province, China
| | - Peng Teng
- Department of Cardiovascular Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qing Chun Road, Hang Zhou, 310003, Zhejiang Province, China
| | - Liang Ma
- Department of Cardiovascular Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qing Chun Road, Hang Zhou, 310003, Zhejiang Province, China.
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14
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TANG JY, LU LH, LIU Y, LI LL, MA YY, YU SQ, LIU JC, YANG J. Transcatheter mitral valve implantation using a novel system: preclinical results. J Geriatr Cardiol 2020; 17:566-573. [PMID: 33117421 PMCID: PMC7568044 DOI: 10.11909/j.issn.1671-5411.2020.09.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND This preclinical study in sheep sought to demonstrate the initial safety and feasibility of a novel transcatheter mitral valve system (Mi-thos valve) composed of a self-expanding frame and a bovine pericardial tissue bioprosthesis. METHODS The valve was implanted in 26 sheep using a transapical approach for short- and long-term evaluation. The technical feasibility, safety, durability, and valve function were evaluated during and 6 months after the procedure using intracardiac and transthoracic echocardiography, multisliced computed tomography, histological analysis, and electron microscopy. RESULTS The success rate of valve implantation was 100%, and the immediate survival rate after surgery was 84%. Five animals died within 90 min after the development of the prosthetic valve due to an acute left ventricular outflow tract obstruction (n = 2) and sudden intraoperative ventricular fibrillation (n = 3). Twelve animals died within 1 month due to acute left heart dysfunction. Mild (n = 5) and moderate (n = 2) paravalvular leakage occurred in seven animals, and two moderate PVL animals died of chronic heart failure within three months. Multimodality imaging studies of the remaining seven animals showed excellent function and alignment of the valves, with no coronary artery obstruction, no left ventricular outflow tract obstruction, no severe transvalvular gradients and no paravalvular leakage. Macroscopic evaluation demonstrated stable, secure positioning of the valve, with full endothelialization of the valve leaflets without injury to the ventricular or atrial walls. Histological and electron microscopic examinations at six months showed no obvious macro- or microcalcification in the leaflets. CONCLUSIONS Preclinical studies indicate that transcatheter implantation of the Mi-thos valve is technically safe and feasible. The durability, functionality, and lack of leaflet calcification were all verified in animal experiments. The information from these preclinical studies will be applied to patient selection criteria and the first-in-human studies.
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Affiliation(s)
- Jia-You TANG
- />Department of Cardiovascular Surgery, the First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Lin-He LU
- />Department of Cardiovascular Surgery, the First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Yang LIU
- />Department of Cardiovascular Surgery, the First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Lan-Lan LI
- />Department of Cardiovascular Surgery, the First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Yan-Yan MA
- />Department of Cardiovascular Surgery, the First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Shi-Qiang YU
- />Department of Cardiovascular Surgery, the First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Jin-Cheng LIU
- />Department of Cardiovascular Surgery, the First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Jian YANG
- />Department of Cardiovascular Surgery, the First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
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15
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Gerosa G, Cibin G, Antonello M, D'Onofrio A. One-stage off pump combined transapical aortic valve replacement and ascending aorta endografting. Eur J Cardiothorac Surg 2020; 59:ezaa301. [PMID: 32910160 DOI: 10.1093/ejcts/ezaa301] [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: 05/28/2020] [Revised: 07/13/2020] [Accepted: 07/18/2020] [Indexed: 11/13/2022] Open
Abstract
An 84-year-old patient was referred for severe symptomatic aortic valve stenosis and focal chronic dissection of the ascending aorta. After multidisciplinary discussion, the patient was scheduled for combined transapical transcatheter aortic valve replacement and ascending aorta stent-grafting. The procedure was performed with a balloon aortic valvuloplasty followed by a custom-made stent graft implantation into the ascending aorta and then by balloon-expandable transapical transcatheter aortic valve replacement. The patient had an uneventful hospital stay. In conclusion, in selected high-risk patients, transapical combined ascending aorta stent-grafting and transcatheter aortic valve replacement are feasible and safe.
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Affiliation(s)
- Gino Gerosa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Giorgia Cibin
- Division of Cardiac Surgery, University of Padova, Padova, Italy
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16
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Blumenstein J, Möllmann H, Bleiziffer S, Bauer T, Ensminger S, Bekeredjian R, Walther T, Frerker C, Beyersdorf F, Hamm C, Beckmann A. Transcatheter aortic valve implantation in nonagenarians: insights from the German Aortic Valve Registry (GARY). Clin Res Cardiol 2020; 109:1099-1106. [PMID: 31989251 DOI: 10.1007/s00392-020-01601-4] [Citation(s) in RCA: 12] [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: 10/31/2019] [Accepted: 01/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to compare the outcome of nonagenarians (≥ 90 years) with that of younger (< 90 years) patients undergoing transcatheter aortic valve implantation (TAVI) in current practice. METHODS Data are collected from the German Aortic Valve Registry (GARY), which was designed to evaluate current practice in the invasive treatment of patients with aortic valve diseases in Germany. Data were analyzed regarding procedural outcome, 30-day, and 1-year outcomes of nonagenarians in comparison to that of younger patients. RESULTS Between 2011 and 2015, 2436/33,051 (7.3%) nonagenarians underwent TAVI and were included in GARY. Nonagenarians were significantly more often male (45.2% vs. 40.0%, p < 0.001), frail (38.7% vs. 34.7%, p < 0.001), and had higher EuroSCORE scores than younger patient group (23.2% vs. 17.0%). Nonagenarians were significantly less often treated via transapical access (16.3% vs. 22.3%, p < 0.001). Procedure was performed significantly less often in general anesthesia (58.2% vs. 60.7%, p = 0.02) in nonagenarians, while necessity of pacemaker implantation was significantly higher in nonagenarians (27.2% vs. 24.8%, p > 0.001). The incidence of other typical postprocedural complications such as severe bleeding events and vascular complications were comparable between groups. However, 30-day (5.2% vs. 3.9%) and 1-year (22.7% vs. 17.7%) mortality rates were significantly higher among nonagenarians and age ≥ 90 years could be identified as an isolated risk factor for mortality. CONCLUSION TAVI is a highly standardized procedure that can be performed safely with high procedural success even in very old patients. Although mortality is significantly higher in these patients-most probably due to the intrinsic higher risk profile of the very old patients-the results are still acceptable. To optimize outcome, especially elderly patients seem to profit from a procedure under local anesthesia or conscious sedation, to minimize the rate of postoperative delirium and the length of stay and to facilitate early mobilization.
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Affiliation(s)
- J Blumenstein
- Department of Internal Medicine I, St. Johannes Hospital, Johannesstrasse 9-13, 44137, Dortmund, Germany
| | - H Möllmann
- Department of Internal Medicine I, St. Johannes Hospital, Johannesstrasse 9-13, 44137, Dortmund, Germany.
| | - S Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - T Bauer
- Department of Cardiology, Sana-Klinikum, Offenbach, Germany
| | - S Ensminger
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Lübeck, Germany
| | - R Bekeredjian
- Department of Cardiology, Robert-Bosch Hospital, Stuttgart, Germany
| | - T Walther
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Frankfurt, Germany
| | - C Frerker
- Department of Cardiology, University Hospital, Heart Center, Cologne, Germany
| | - F Beyersdorf
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Heart Center, Freiburg, Germany
| | - C Hamm
- Department of Medical Clinic I, University Hospital, Giessen, Germany.,Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - A Beckmann
- Deutsche Gesellschaft für Thorax, Herz- Und Gefäßchirurgie, Berlin, Germany
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17
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Belhaj Soulami R, Anselmi A, Leurent G, Verhoye JP. Simultaneous transapical aortic and mitral valve implantation in a patient with porcelain aorta. Eur J Cardiothorac Surg 2019; 56:1202-1203. [PMID: 31102519 DOI: 10.1093/ejcts/ezz148] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/17/2019] [Accepted: 04/21/2019] [Indexed: 11/12/2022] Open
Abstract
Left-sided double valve disease in the setting of extensive mitral annular calcifications and porcelain aorta raises multiple surgical challenges when considering an open surgical repair. We herein present the case of a 67-year-old patient with severe symptomatic aortic and mitral stenosis associated with extensive mitral annular calcifications and porcelain aorta, successfully treated by simultaneous transapical transcatheter aortic and mitral valve implantation.
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Affiliation(s)
- Reda Belhaj Soulami
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Amedeo Anselmi
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Guillaume Leurent
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Rennes, France
| | - Jean-Philippe Verhoye
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
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18
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Parhar D, Klass D, Legiehn G, Chung J, Cheung A, Janusz M. Transapical Coil Embolization of a Postsurgical Ascending Thoracic Aortic Pseudoaneurysm. Cardiovasc Intervent Radiol 2019; 42:1500-1504. [PMID: 31338553 DOI: 10.1007/s00270-019-02291-w] [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: 05/28/2019] [Accepted: 07/17/2019] [Indexed: 11/29/2022]
Abstract
Ascending aortic pseudoaneurysms are a rare but potentially life-threatening complication of aortic root or cardiac surgery. Surgical repair is established as first-line treatment; however, patient comorbidities, technical considerations, and anatomic limitations often preclude patients from repeat surgery, thus necessitating alternative approaches. Here, we present a case of coil embolization of an ascending aortic pseudoaneurysm via a transapical approach in a particularly complex scenario where percutaneous and peripheral access was technically unfeasible.
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Affiliation(s)
- Dennis Parhar
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
| | - Darren Klass
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Gerald Legiehn
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John Chung
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Anson Cheung
- Department of Cardiovascular Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Michael Janusz
- Department of Cardiovascular Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
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19
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Leveille L, Jaussaud N, Theron A, Riberi A, Collart F. Open-heart transcatheter aortic valve replacement in complex aortic valve reoperation: about a case series. Eur Heart J Case Rep 2019; 2:yty064. [PMID: 31020142 PMCID: PMC6177095 DOI: 10.1093/ehjcr/yty064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 05/02/2018] [Indexed: 11/13/2022]
Abstract
Introduction Aortic homograft and stentless aortic root are helpful in acute infective endocarditis of the aortic valve as biological conduit when total root replacement is required. Reoperation for failure of aortic homograft and stentless aortic root remains challenging for the surgeon as the entire root can be heavily calcified. Case presentation Here, are reported, three cases of patients successfully treated with open-heart transcatheter aortic valve replacement (TAVR) whereas no other prosthesis was implantable due to a massively calcified homograft or stentless prosthesis. Discussion Open-heart TAVR avoided the risk of complete root replacement which is higher than redo aortic valve replacement (AVR). This rescue technique facilitated risky surgical procedure by combining the strengths of both TAVR and conventional AVR.
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Affiliation(s)
- Laury Leveille
- Department of Cardiac Surgery, La Timone Hospital, Marseille, 264 rue Saint Pierre, Marseille, France
| | - Nicolas Jaussaud
- Department of Cardiac Surgery, La Timone Hospital, Marseille, 264 rue Saint Pierre, Marseille, France
| | - Alexis Theron
- Department of Cardiac Surgery, La Timone Hospital, Marseille, 264 rue Saint Pierre, Marseille, France
| | - Alberto Riberi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, 264 rue Saint Pierre, Marseille, France
| | - Frederic Collart
- Department of Cardiac Surgery, La Timone Hospital, Marseille, 264 rue Saint Pierre, Marseille, France
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20
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Nazir S, Lohani S, Tachamo N, Khan MS, Timilsina B, Luni FK, Donato A. Outcomes following transcatheter transseptal versus transapical mitral valve-in-valve and valve-in-ring procedures. J Cardiovasc Thorac Res 2019; 10:182-186. [PMID: 30680074 PMCID: PMC6335986 DOI: 10.15171/jcvtr.2018.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 11/15/2018] [Indexed: 02/02/2023] Open
Abstract
Introduction: Transcatheter mitral valve-in-valve (ViV) & valve-in-ring (ViR) are relatively novel therapeutic alternatives for patients with degenerated bioprostheses or failed annuloplasty rings whose reoperative risk is too high. The predominant procedural access for both procedures is transapical or transseptal. However, whether there are differences in outcomes of this procedure using transseptal versus transapical access has not yet been defined. Methods: We conducted a systematic review of all published articles from MEDLINE and EMBASE to explore the outcomes of these two procedural approaches. Results:total of 55 studies including 183 patients (154 ViV and 29 ViR) were included. Patients that underwent ViV (101 transapical and 53 transseptal) using the transseptal approach required more iatrogenic atrial septal defect (ASD) closure (19% versus 0.0 %; P < 0.001) and hence had a lower device success rate (68% versus 89%; P = 0.001). However, there was no significant difference between the two groups in procedural success and all-cause mortality at 30 days. Overall severe bleeding complications (major or life threatening) were not different the two groups (3.7% versus 7.9%; P = 0.321). In the ViR group (19 transapical and 10 transseptal), no difference in procedural success, device success or 30-day outcomes were identified between transseptal and transapical groups, although sample size was small. Conclusion: In conclusion, mitral ViV and ViR using the two different procedural approaches appear to confer equal and reasonable 30-day outcomes.
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Affiliation(s)
- Salik Nazir
- Department of Medicine, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USA
| | - Saroj Lohani
- Department of Medicine, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USA
| | - Niranjan Tachamo
- Department of Medicine, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USA
| | - Muhammad Sohail Khan
- Department of Medicine, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USA
| | - Bidhya Timilsina
- Department of Medicine, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USA
| | - Faraz Khan Luni
- Division of Cardiology, Mercy Saint Vincent Medical Center, Toledo, Ohio, USA
| | - Anthony Donato
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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21
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Imnadze G, Hofmann S, Billion M, Ferdosi A, Kowalski M, Smith KH, Deutsch C, Bramlage P, Warnecke H, Franz N. Transapical transcatheter aortic valve implantation in patients with a low ejection fraction. Interact Cardiovasc Thorac Surg 2019; 26:224-229. [PMID: 29049741 DOI: 10.1093/icvts/ivx315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/29/2017] [Accepted: 08/21/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES It may be expected that patients with left ventricular dysfunction may be at greater risk of complications after transcatheter aortic valve implantation (TAVI) via transapical (TA) access compared with via transfemoral (TF) access. There is a lack of data comparing the outcomes of TAVI using TA and TF access in patients with a reduced left ventricular ejection fraction (EF). METHODS This is a retrospective analysis of data from a high-volume heart centre in Germany. TAVI access route assignment was based on a 'best for TF' approach, where only patients who met a strict set of criteria underwent TF-TAVI, with the remainder receiving TA-TAVI. For this analysis, patients were included if they had a pre-TAVI EF of ≤ 40%. Early mortality and late (1-year) mortality were compared through multivariate logistic regression. RESULTS A total of 342 patients in the registry had an EF of ≤ 40%, of which 74.9% underwent TA-TAVI and 25.1% underwent TF-TAVI. Higher proportions of the TA group presented with certain comorbidities, and their logistic EuroSCORE and Society of Thoracic Surgeons (STS) risk scores were higher than in the TF group. At 1 year, TA access was associated with greater mortality in the univariate analysis (odd ratio 2.43; 95% confidence interval 1.04-5.69). However, after multivariate adjustment, no significant differences were found in either 30-day or 1-year mortality rates. CONCLUSIONS The data suggest that, for patients with a reduced EF, TA-TAVI is not associated with a poorer outcome compared with TF-TAVI. Therefore, TA access should not be discounted based on the presence of left ventricular dysfunction alone.
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Affiliation(s)
- Guram Imnadze
- Institut für Gesundheitsforschung und Bildung, Universität Osnabrück, Osnabrück, Germany.,Department of Cardiology, Klinikum Osnabrück, Am Finkenhügel 1, Osnabrück, Germany
| | - Steffen Hofmann
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Michael Billion
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Abbas Ferdosi
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Marek Kowalski
- Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Katherine H Smith
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Henning Warnecke
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany.,Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Norbert Franz
- Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany.,University Witten-Herdecke, Witten, Germany
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22
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Nogami E, Yunoki J, Kitsuka T, Itoh M, Tanaka A, Nishida T. Transapical thoracic endovascular aortic repair in aortic arch aneurysm through a pre-existent bioprosthetic aortic valve. J Vasc Surg Cases Innov Tech 2018; 4:265-267. [PMID: 30533573 PMCID: PMC6260461 DOI: 10.1016/j.jvscit.2018.07.003] [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] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/17/2018] [Indexed: 10/27/2022]
Abstract
An 80-year-old man had undergone Y-graft replacement for ruptured abdominal aortic aneurysm followed by bioprosthetic aortic valve replacement. Follow-up computed tomography revealed a 65-mm aneurysm at the distal aortic arch. We selected endovascular surgery because of the patient's high-risk condition, and the extreme curvature of the 8-mm artificial blood vessels led us to adopt a transapical approach. No signs of deterioration of the bioprosthesis were noted, and the patient's hemodynamic condition remained stable during surgery. Transapical thoracic endovascular aortic repair through a pre-existent aortic bioprosthesis is an efficient alternative approach for treating aortic aneurysm, even after bioprosthetic aortic valve replacement.
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Affiliation(s)
- Eijiro Nogami
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga, Japan
| | - Junji Yunoki
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga, Japan
| | - Takahiro Kitsuka
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga, Japan
| | - Manabu Itoh
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga, Japan
| | - Atsuhisa Tanaka
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga, Japan
| | - Takahiro Nishida
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga, Japan
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23
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Kim S, Ducaud C, Herrera RE, Moreno N, Zevallos JC, Katzen BT. Transapical endovascular repair of iatrogenic type A aortic dissection. J Vasc Surg Cases Innov Tech 2018; 4:257-261. [PMID: 30186998 PMCID: PMC6122382 DOI: 10.1016/j.jvscit.2018.05.007] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/30/2018] [Indexed: 11/10/2022]
Abstract
Intraoperative iatrogenic type A aortic dissection is a rare but known complication of cardiac surgery, with an incidence of 0.06% to 0.23%. Results are frequently catastrophic. The endovascular approach has made advances as an alternative treatment for aortic disease. However, the apical approach for transcatheter thoracic endovascular aortic repair is not well known. We present a 5-year follow-up of a case of iatrogenic type A aortic dissection after minimally invasive mitral valve repair successfully resolved by medical stabilization and subsequent transapical thoracic endovascular aortic repair.
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Affiliation(s)
- Sangmin Kim
- Division of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla.,Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, Fla.,Regional Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Cristobal Ducaud
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, Fla
| | - Raul E Herrera
- Division of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla
| | - Nibert Moreno
- Division of Cardiothoracic Surgery, Miami Cardiac and Vascular Institute, Miami, Fla
| | - Juan C Zevallos
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, Fla
| | - Barry T Katzen
- Division of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla
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24
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Doshi R, Shah P, Meraj PM. In-hospital outcomes comparison of transfemoral vs transapical transcatheter aortic valve replacement in propensity-matched cohorts with severe aortic stenosis. Clin Cardiol 2018; 41:326-332. [PMID: 29573452 DOI: 10.1002/clc.22866] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 10/18/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is the preferred option for high-risk patients with severe aortic stenosis. The preferred access for TAVR is transfemoral (TF). Alternatives include the transapical (TA), trans-subclavian (TS), and direct aortic (TAo) approaches. HYPOTHESIS The TF approach is associated with lower in-hospital outcomes as well as shorter length of stay and lower cost of hospitalization. METHODS The National Inpatient Sample database from 2012 through 2014 was used to obtain the TAVR study population. International Classification of Diseases, 9th Revision, Clinical Modification procedure codes were utilized to identify the 2 groups. In-hospital outcomes were compared in propensity-score-matched (1:3) cohorts, in which we took TA-TAVR as a control. RESULTS A total of 8210 (weighted N = 41 050) patients were identified. Of these, 1622 (weighted N = 8110) patients underwent TA-TAVR and 6588 (weighted N = 32 940) patients underwent TF-TAVR. In-hospital mortality was lower with TF-TAVR (4% vs 5.4%; P = 0.0355), along with a shorter length of stay (7.7 vs 9.7 days; P < 0.0001) and lower median hospitalization cost ($64 216 vs $74 735; P < 0.0001). Secondary outcomes of acute renal failure, transfusion, cardiogenic shock, and composite of all complications were lower with TF-TAVR. CONCLUSIONS TF-TAVR is safer and associated with lower in-hospital outcomes compared with TA-TAVR and should be the preferred approach. As TAVR is gaining popularity in intermediate- and low-risk patients, we must not lose sight of the serious mortality and secondary outcomes associated with TA-TAVR access.
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Affiliation(s)
- Rajkumar Doshi
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Priyank Shah
- Department of Cardiology, Medical College of Georgia-Southwest Clinical Campus, Albany, Georgia
| | - Perwaiz M Meraj
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
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25
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Börgermann J, Holzhey DM, Thielmann M, Girdauskas E, Schroefel H, Hofmann S, Treede H, Matschke K, Hilker M, Strauch JT, Carrel T, Wahlers T, Diegeler A, Kempfert J, Walther T. Transcatheter aortic valve implantation using the ACURATE TA™ system: 1-year outcomes and comparison of 500 patients from the SAVI registries. Eur J Cardiothorac Surg 2018; 51:936-942. [PMID: 28175264 PMCID: PMC5400020 DOI: 10.1093/ejcts/ezw423] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Received: 09/02/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES: The ACURATE TATM system is a self-expanding transcatheter heart valve system designed for transapical access which has been proven to be safe and effective in the controlled setting of clinical trials. The SAVI-1 and SAVI-2 registries aimed to assess whether these promising outcomes can be translated into all-comers clinical routine. METHODS: From November 2011 to 2012 (SAVI-1), and November 2013 to 2014 (SAVI-2), a total of 500 patients were enrolled in the prospective, all-comers, multicentre, multinational SAVI registries. Patients were treated according to the standard of care at their respective hospitals. We report and compare 30-day and 1-year clinical outcomes between SAVI-1 and -2. RESULTS: Patients were 80.8 ± 6.1 years old, the mean logistic EuroSCORE-I was 23.4 ± 14.3%. Valves were deployed under rapid pacing in 71.3% of the procedures in SAVI-1, and in 3.6% in SAVI-2. There was no relevant difference in clinical and echocardiographic outcomes between SAVI-1 and SAVI-2. Overall mortality at 30 days and 1 year was 6.8% and 19.9%, the stroke rate was 2.2% and 3.7%, respectively; 10.2% of patients had received a permanent pacemaker, and no transcatheter valve-related complications after discharge were observed. Paravalvular leakage ≥2+ was reported in 1.9% of the patients at the early follow-up, and in 2.6% at the 1-year follow-up. CONCLUSIONS: The SAVI-registries have confirmed that transapical implantation using the ACURATE TATM device is safe and effective in an all-comers setting with low complication rates and stable performance outcomes at short-term and 1 year; outcomes were similar between SAVI-1 and -2. ClinicalTrials.gov: NCT02663375
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Affiliation(s)
- Jochen Börgermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - David M Holzhey
- Department of Cardiac Surgery, Heart Center Leipzig University, Leipzig, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Evaldas Girdauskas
- Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany.,Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Holger Schroefel
- Clinic for Cardiac Surgery, Karlsruhe, Germany, Department of Cardiovascular Surgery, Heart Center Freiburg, Bad Krozingen, Germany
| | - Steffen Hofmann
- Schüchtermann-Schiller'sche Kliniken GmbH, Bad Rothenfelde, Germany
| | - Hendrik Treede
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.,Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle, Halle, Germany
| | - Klaus Matschke
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Michael Hilker
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Justus T Strauch
- Department of Cardiac and Thoracic Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Thierry Carrel
- Clinic for Cardiovascular Surgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Anno Diegeler
- Department of Cardiovascular Surgery, Herz-und Gefässklinik Bad Neustadt, Bad Neustadt a. d. Saale, Germany
| | - Jörg Kempfert
- Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany.,Department of Cardiovascular and Thoracic Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
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26
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Wakefield BJ, Mehta AR. Transapical Ablation of Symptomatic Premature Ventricular Contractions in a Patient With Mechanical Mitral and Aortic Valves. J Cardiothorac Vasc Anesth 2018; 32:2700-2704. [PMID: 29395817 DOI: 10.1053/j.jvca.2017.12.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/17/2017] [Indexed: 11/11/2022]
Affiliation(s)
| | - Anand R Mehta
- Anesthesiology Institute, Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH
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27
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Colli A, Besola L, Montagner M, Azzolina D, Soriani N, Manzan E, Bizzotto E, Zucchetta F, Bellu R, Pittarello D, Gerosa G. Prognostic impact of leaflet-to-annulus index in patients treated with transapical off-pump echo-guided mitral valve repair with NeoChord implantation. Int J Cardiol 2018; 257:235-237. [PMID: 29398137 DOI: 10.1016/j.ijcard.2018.01.049] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 05/16/2017] [Revised: 12/10/2017] [Accepted: 01/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The transapical echo-guided NeoChord repair is a procedure to correct mitral regurgitation (MR) without the need for concomitant annuloplasty for degenerative mitral valve (MV) disease. Lacking strict criteria to define normal annular dimensions for patients undergoing MV repair, we consequently missed having precise selection criteria to identify patients who can benefit from a ringless procedure with respect to who would need a combined annular and leaflet repair. The aim of this study is to identify whether a new preoperative echocardiographic index may predict postoperative outcomes after NeoChord repair. METHODS All consecutive patients with posterior leaflet disease who underwent NeoChord repair between November 2013 and January 2016 presenting complete postoperative echocardiographic assessment up to 1year were included. Leaflet-to-Annulus Index (LAI) was defined as the ratio between the sum of anterior leaflet length (AML) and posterior leaflet length (PML) over antero-posterior length (AP; AML+PML/AP). Measurements were performed with 2D transesophageal echocardiography. RESULTS Sixty-six patients were enrolled. At 1year MR was absent in (24) 38% of patients, mild in (28) 44%, moderate in (10) 16% and severe in (1) 2%. Logistic regression analysis identified LAI as positive prognostic predictor of MR≤mild for values >1.35 at 3months, 1.30 at 6months and 1.25 at 1year. At 30days LAI was not associated with the grade of residual MR. CONCLUSIONS LAI is a positive postoperative predictor of MR≤mild at 1-year follow-up and can be used to identify patients who could benefit from a ringless NeoChord repair procedure for the absence of a leaflet-to-annulus mismatch.
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Affiliation(s)
- Andrea Colli
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy.
| | - Laura Besola
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | - Matteo Montagner
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | - Danila Azzolina
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | - Nicola Soriani
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | - Erica Manzan
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | - Eleonora Bizzotto
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | - Fabio Zucchetta
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | - Roberto Bellu
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | | | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
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28
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Zanobini M, Manganiello S, Bonalumi G, Biondi R, Russo M, Mapelli M, Alamanni F, Saccocci M. Emergency transapical mitral valve-in-valve implantation for bioprosthesis failure: transapical implantation of an Edwards Sapien-XT in a dysfunctional mitral bioprosthesis in a critical patient. J Cardiothorac Surg 2017; 12:114. [PMID: 29237501 PMCID: PMC5729393 DOI: 10.1186/s13019-017-0680-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/30/2017] [Indexed: 11/17/2022] Open
Abstract
Background Valve-in-Valve (VIV) Transcatheter Aortic Valve Replacement (TAVR) is now the treatment of choice in high-surgical-risk patients with failing aortic bioprosthesis. Although less performed, VIV-Transcatheter Mitral Valve Replacement (TMVR) is a valid treatment option for selected high-risk patients with degenerated mitral bioprostheses. Several cases of elective ViV- TAVR and -TMVR have been reported but only few were performed in critical hemodynamic conditions. Case presentation We report the case of a patient underwent balloon-expandable transapical mitral valve-in-valve implantation in an emergency setting due to a severe stenosis of a bioprosthesis in mitral position. The procedure was successfully performed, with no residual mitral regurgitation or paravalvular leaks, and uneventful. Conclusion Transcatheter transapical mitral valve-in-valve implantation could represent a feasible and effective strategy even in critical setting.
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Affiliation(s)
- Marco Zanobini
- Department of Cardiac Surgery, IRCCS - Centro Cardiologico Monzino, Università degli Studi di Milano, Via C. Parea 4, 20138 Milano, Italy
| | - Sabrina Manganiello
- Department of Cardiac Surgery, IRCCS - Centro Cardiologico Monzino, Università degli Studi di Milano, Via C. Parea 4, 20138 Milano, Italy
| | - Giorgia Bonalumi
- Department of Cardiac Surgery, IRCCS - Centro Cardiologico Monzino, Università degli Studi di Milano, Via C. Parea 4, 20138 Milano, Italy
| | - Raoul Biondi
- Department of Cardiac Surgery, IRCCS - Centro Cardiologico Monzino, Università degli Studi di Milano, Via C. Parea 4, 20138 Milano, Italy
| | - Marco Russo
- Department of CardioVascular Surgery, Heart Center - University Hospital of Zurich, Zurich, Switzerland
| | - Massimo Mapelli
- Department of Cardiology -IRCCS - Centro Cardiologico Monzino, Università degli Studi di Milano, Milano, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, IRCCS - Centro Cardiologico Monzino, Università degli Studi di Milano, Via C. Parea 4, 20138 Milano, Italy
| | - Matteo Saccocci
- Department of Cardiac Surgery, IRCCS - Centro Cardiologico Monzino, Università degli Studi di Milano, Via C. Parea 4, 20138 Milano, Italy
- Department of CardioVascular Surgery, Heart Center - University Hospital of Zurich, Zurich, Switzerland
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29
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Ando T, Takagi H, Grines CL. Transfemoral, transapical and transcatheter aortic valve implantation and surgical aortic valve replacement: a meta-analysis of direct and adjusted indirect comparisons of early and mid-term deaths. Interact Cardiovasc Thorac Surg 2017; 25:484-492. [PMID: 28549125 DOI: 10.1093/icvts/ivx150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/23/2016] [Accepted: 03/06/2017] [Indexed: 11/13/2022] Open
Abstract
Clinical outcomes of transfemoral-transcatheter aortic valve implantation (TF-TAVI) versus surgical aortic valve replacement (SAVR) or transapical (TA)-TAVI are limited to a few randomized clinical trials (RCTs). Because previous meta-analyses only included a limited number of adjusted studies or several non-adjusted studies, our goal was to compare and summarize the outcomes of TF-TAVI vs SAVR and TF-TAVI vs TA-TAVI exclusively with the RCT and propensity-matched cohort studies with direct and adjusted indirect comparisons to reach more precise conclusions. We hypothesized that TF-TAVI would offer surgical candidates a better outcome compared with SAVR and TA-TAVI because of its potential for fewer myocardial injuries. A literature search was conducted through PUBMED and EMBASE through June 2016. Only RCTs and propensity-matched cohort studies were included. A direct meta-analysis of TF-TAVI vs SAVR, TA-TAVI vs SAVR and TF-TAVI vs TA-TAVI was conducted. Then, the effect size of an indirect meta-analysis was calculated from the direct meta-analysis. The effect sizes of direct and indirect meta-analyses were then combined. A random-effects model was used to calculate the hazards ratio and the odds ratio with 95% confidence intervals. Early (in-hospital or 30 days) and mid-term (≥1 year) all-cause mortality rates were assessed. Our search resulted in 4 RCTs (n = 2319) and 14 propensity-matched cohort (n = 7217) studies with 9536 patients of whom 3471, 1769 and 4296 received TF, TA and SAVR, respectively. Direct meta-analyses and combined direct and indirect meta-analyses of early and mid-term deaths with TF-TAVI and SAVR were similar. Early deaths with TF-TAVI vs TA-TAVI were comparable in direct meta-analyses (odds ratio 0.64, P = 0.35) and direct and indirect meta-analyses combined (odds ratio 0.73, P = 0.24). Mid-term deaths with TF-TAVI vs TA-TAVI were increased (hazard ratio 0.83, P = 0.07) in a direct meta-analysis and became significant after addition of the indirect meta-analysis (hazard ratio 0.78, 95% confidence interval 0.67-0.92, P = 0.003). In conclusion, TF-TAVI was associated with similar early and mid-term deaths compared with SAVR. The number of early deaths was not significantly different between TF-TAVI and TA-TAVI, whereas there were fewer mid-term deaths with TF-TAVI than with TA-TAVI.
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Affiliation(s)
- Tomo Ando
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center, Detroit, MI, USA
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Cindy L Grines
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center, Detroit, MI, USA
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30
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Dahle G, Rein KA, Fiane AE. Single centre experience with transapical transcatheter mitral valve implantation. Interact Cardiovasc Thorac Surg 2017; 25:177-184. [PMID: 28444177 DOI: 10.1093/icvts/ivx038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 09/15/2016] [Accepted: 01/18/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES A transcatheter heart valve technique can be used in failed mitral valve repairs with annuloplasty rings, deterioriated bioprostheses and in mitral annular calcification, all serving as 'docking stations' for balloon-expandable valves. Specially designed transcatheter mitral valve platforms are used in ongoing studies for native mitral valve regurgitation. We present our single centre experience with transcatheter mitral valve implantation-transapical approach procedures in eleven patients. METHODS Eleven patients were treated between 2011 and 2016. They had severe mitral regurgitation due to either failed repair annuloplasty rings (N = 6), failed bioprostheses (N = 2) or in the native valve (N = 3), all at high risk for open mitral valve surgery. Three different types of transcatheter valves were used: (1) the SAPIEN XT/SAPIEN 3, (2) the Lotus valve and (3) a Tendyne transcatheter mitral valve. Computed tomography reconstruction, echocardiography, 3D printing and bench tests were done in the preoperative evaluation and procedural planning. Transapical approach access was performed via a left minithoracotomy. RESULTS Implantation success was 100% with no left ventricular outflow tract obstruction. Good haemodynamics and improved New York Heart Association class were demonstrated in all patients. One patient died before 30 days due to sepsis. One patient had a valve thrombosis when switching from Coumadin to new oral anticoagulant and had a second valve implanted into the first one as a 'valve-in-valve' procedure. CONCLUSIONS The transapical approach is a safe and straight forward procedure for accessing the mitral valve. 'Transcatheter aortic valve implantation' prostheses may be used in redo surgery due to an already sufficient 'docking station'. These specially designed new prostheses may be beneficial for addressing mitral valve regurgitation, but are still under evaluation. Anticoagulation is mandatory.
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Affiliation(s)
- Gry Dahle
- Department of Cardiothoracic and Thoracic surgery, Oslo University Hospital, Oslo, Norway
| | - Kjell-Arne Rein
- Department of Cardiothoracic and Thoracic surgery, Oslo University Hospital, Oslo, Norway
| | - Arnt E Fiane
- Department of Cardiothoracic and Thoracic surgery, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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31
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Borgarelli M, Lanz O, Pavlisko N, Abbott JA, Menciotti G, Aherne M, Lahmers SM, Lahmers KK, Gammie JS. Mitral valve repair in dogs using an ePTFE chordal implantation device: a pilot study. J Vet Cardiol 2017; 19:256-267. [PMID: 28576476 DOI: 10.1016/j.jvc.2017.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 07/06/2016] [Revised: 02/07/2017] [Accepted: 03/28/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mitral valve (MV) regurgitation due to degenerative MV disease is the leading cause of cardiac death in dogs. We carried out preliminary experiments to determine the feasibility and short-term effects of beating-heart MV repair using an expanded polytetrafluorethylene (ePTFE) chordal implantation device (Harpoon TSD-5) in dogs. ANIMALS This study involved six healthy purpose-bred Beagles (weight range 8.9-11.4 kg). MATERIAL AND METHODS Following a mini-thoracotomy performed under general anesthesia, the TSD-5 was used to place 1 or 2 artificial ePTFE cords on the anterior MV leaflet or the posterior MV leaflet via a left-ventricular transapical approach. The procedure was guided and monitored by transesophageal echocardiography. Postoperative antithrombotic treatment consisted of clopidogrel or a combination of clopidogrel and apixaban. Dogs were serially evaluated by transthoracic echocardiography at day 1, 7, 14, 21, and 30. The hearts were then examined for evaluation of tissues reactions and to detect signs of endothelialization. RESULTS One or two chords were successfully implanted in five dogs. Four dogs completed the 30 days follow-up. One dog died intra-operatively because of aortic perforation. One dog died early post-operatively from a hemorrhagic pleural effusion attributed to overly aggressive antithrombotic treatment. One dog developed a thrombus surrounding both the knot and the synthetic cord. Postmortem exam confirmed secure placement of ePTFE knots in the mitral leaflets in all dogs and the presence of endothelialization of the knots and chords. CONCLUSIONS These preliminary results demonstrate the feasibility of artificial chordal placement using an ePTFE cordal implantation device in dogs.
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Affiliation(s)
- M Borgarelli
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA.
| | - O Lanz
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - N Pavlisko
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - J A Abbott
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - G Menciotti
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - M Aherne
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - S M Lahmers
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - K K Lahmers
- Department of Biomedical Sciences & Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, 205 Duck Pond Dr., VA 24061, USA
| | - J S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, 110 S. Paca St., MD 21201, USA
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32
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Ladia V, Panchal HB, O׳Neil TJ, Sitwala P, Bhatheja S, Patel R, Ramu V, Mukherjee D, Mahmud E, Paul TK. Incidence of Renal Failure Requiring Hemodialysis Following Transcatheter Aortic Valve Replacement. Am J Med Sci 2016; 352:306-13. [PMID: 27650237 DOI: 10.1016/j.amjms.2016.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/23/2015] [Accepted: 05/13/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Studies have shown that iodinated radiocontrast use is associated with acute renal failure especially in the presence of chronic kidney disease and multiple factors modulate this risk. The purpose of this meta-analysis is to compare the incidence of renal failure requiring hemodialysis between transfemoral (TF) and transapical (TA) transcatheter aortic valve replacement using the Edwards valve. METHODS The PubMed database was searched from January 2000 through December 2014. A total of 10 studies (n = 2,459) comparing TF (n = 1,268) and TA (n = 1,191) TAVR procedures using the Edwards valve were included. Variables of interest were baseline logistic EuroSCORE, prevalence of diabetes mellitus, hypertension, peripheral arterial disease, chronic kidney disease and amount of contrast used. The primary endpoint was incidence of renal failure requiring hemodialysis. The odds ratio and 95% CI were computed and P < 0.05 was considered as the level of significance. RESULTS The logistic EuroSCORE was significantly higher in TA compared to TF (P = 0.001) TAVR. The amount of contrast (mL) used was significantly higher in the TF group compared to the TA group (mean difference: 36.9, CI: 25.7-48.1, P < 0.001). The incidence of hemodialysis following the procedure was significantly higher in the TA group compared to TF group (odds ratio = 4.3, CI: 2.4-7.8, P < 0.00001). CONCLUSIONS This meta-analysis suggests that despite the lower amount of contrast used in TA-TAVR, the incidence of renal failure requiring hemodialysis was higher with the Edwards valve. This suggests that the incidence of renal failure requiring hemodialysis after TAVR is associated with baseline comorbidities in the TA-TAVR group rather than the volume of contrast used.
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Affiliation(s)
- Vatsal Ladia
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Hemang B Panchal
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Terrence J O׳Neil
- Department of Internal Medicine, Mountain Home VA Medical Center, Johnson City, Tennessee
| | - Puja Sitwala
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Samit Bhatheja
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Rakeshkumar Patel
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Vijay Ramu
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Debabrata Mukherjee
- Division of Cardiology, Department of Internal Medicine, Texas Tech University, El Paso, Texas
| | - Ehtisham Mahmud
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, San Diego, California
| | - Timir K Paul
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee.
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He C, Scalia G, Walters DL, Clarke A. Transapical Transcatheter Mitral Valve-in-Valve Implantation Using an Edwards SAPIEN 3 Valve. Heart Lung Circ 2016; 26:e19-e21. [PMID: 27746060 DOI: 10.1016/j.hlc.2016.05.111] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/04/2016] [Indexed: 11/25/2022]
Abstract
We describe a successful transcatheter, transapical mitral valve implant within a failed mitral bioprosthesis (valve-in-valve) in a symptomatic 86-year-old patient with prohibitive surgical risks, using the new Sapien 3 balloon-expandable valve. Post-deployment echocardiographic profile of the valve-in-valve was satisfactory and the patient was discharged from hospital uneventfully. This is the first reported case of the Sapien 3 valve used in the mitral valve-in-valve setting.
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Affiliation(s)
- Cheng He
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia.
| | - Gregory Scalia
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Darren L Walters
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Andrew Clarke
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia
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Bhindi R. Aortic Valve Replacement: The Era of Transcatheter Therapies. Heart Lung Circ 2016; 25:635-6. [PMID: 27241701 DOI: 10.1016/j.hlc.2016.05.001] [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: 10/21/2022]
Affiliation(s)
- Ravinay Bhindi
- Structural Heart Disease Program and Clinical Trials, Royal North Shore Hospital, Sydney, NSW, Australia.
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Papadopoulos N, El-Sayed Ahmad A, Thudt M, Fichtlscherer S, Meybohm P, Reyher C, Moritz A, Zierer A. Successful fast track protocol implementation for patients undergoing transapical transcatheter aortic valve implantation. J Cardiothorac Surg 2016; 11:55. [PMID: 27067581 PMCID: PMC4827191 DOI: 10.1186/s13019-016-0449-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 12/09/2015] [Accepted: 04/04/2016] [Indexed: 11/16/2022] Open
Abstract
Background The aim of the current study is to report our experience with fast-track treatment of patients undergoing transapical transcatheter aortic valve implantation (TA-TAVI) and to determine perioperative predictors for fast-track protocol failure. Methods Being one of the pioneering centers to start performing TA-TAVI back in 2005, we routinely included patients undergoing this procedure into our fast-track management program since 2008. Between January 2008 and June 2013, 207 consecutive high-risk patients (mean age 79 ± 7 years, mean Log. EuroSCORE 24 ± 10) who underwent TA-TAVI accordingly to our institutional fast-track approach were prospectively collected and analyzed. Uni- and multivariate analysis were performed to identify independent pre- and perioperative predictors of fast-track protocol failure, defined as inability to discharge the patient from the intensive care unit (ICU) on the day of surgery or as readmission to the ICU 48 h after the initial discharge. Results Fast-track management was successful in 83 % of the patients. 30-day mortality was 8 %. Fast-track protocol failure (17 %) was associated with an outcome worsening compared to the remaining patients (mortality: 40 % vs. 2 % and mean hospital stay: 19 ± 12 vs. 10 ± 9 days; P = .002). Independent predictors of fast-track protocol failure were age ≥85 years (OR 3.1; CI 95 % 1.89–6.21), ejection fraction (EF) ≤30 % (OR 2.6; CI 95 % 1.99–7.52), moderate to severe preoperative mitral valve regurgitation (OR 2.7; CI 95 % 1.27–6.43) and fluoroscopy time ≥12 min (OR 2.9; CI 95 % 1.28–7.46). Conclusions Fast-track patient management following TA-TAVI is safe and reproducible in the majority of patients. Besides patient-related preoperative risk factors (age ≥85 years, EF ≤30 % and moderate to severe preoperative mitral valve regurgitation) a technically challenging intraoperative course as evidenced in a prolonged fluoroscopy time are independent predictors of fast-track protocol failure which is associated with high loss of patient outcome.
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Affiliation(s)
- Nestoras Papadopoulos
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany.
| | - Ali El-Sayed Ahmad
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Marlene Thudt
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Stephan Fichtlscherer
- Division of Cardiology, Johann-Wolfgang-Goethe University Frankfurt/Main, Frankfurt, Germany
| | - Patrick Meybohm
- Clinic of Anesthesiology, Intensive Care Medicine and Pain Therapy, Goethe-University Hospital Frankfurt/Main, Frankfurt, Germany
| | - Christian Reyher
- Clinic of Anesthesiology, Intensive Care Medicine and Pain Therapy, Goethe-University Hospital Frankfurt/Main, Frankfurt, Germany
| | - Anton Moritz
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Andreas Zierer
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany
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Sündermann SH, Holzhey D, Bleiziffer S, Treede H, Jacobs S, Falk V. Second-generation transapical valves: the Medtronic Engager system. Multimed Man Cardiothorac Surg 2016; 2014:mmu001. [PMID: 24568935 DOI: 10.1093/mmcts/mmu001] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The Medtronic Engager aortic valve system is a second-generation transcatheter aortic valve implantation bioprosthesis combined with a delivery system designed for over-the-wire transapical implantation of the valve. The self-expandable stent has control arms to be placed into the native aortic sinuses to achieve correct positioning of the bioprosthesis in a predefined height. The purpose of the lower skirt is to reduce paravalvular leakage. A three-leaflet, bovine pericardium valve is mounted on the stent. The implantation is facilitated by the control arms and rotational positioning of the commissural posts. A multicentre feasibility study showed promising results. The results from the following European pivotal trial led to CE mark approval in 2013. Here, we describe technical details of the device and its implantation technique and highlight special steps of the procedure.
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Affiliation(s)
- Simon H Sündermann
- Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
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Abstract
Approximately 30 % of patients suffering from severe valvular heart disease, such as mitral valve regurgitation are non-compliant to the gold standard of minimally invasive surgery, reconstruction or valve replacement. The number of these mostly old patients with severe comorbidities is increasing; therefore, transcatheter interventions have been developed to address an unmet clinical need and may be an alternative therapeutic option to the reference standard. Apart from the successful MitraClip therapy, alternative transcatheter reconstruction technologies are being developed. As with transcatheter aortic valve implantation (TAVI) procedures, the off-pump implantation of a valved stent into the mitral position mainly via a transapical approach will be of great benefit. Recently, the feasibility of transcatheter mitral valved stent implantation in high-risk patients has already been reported.
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Affiliation(s)
- G Lutter
- Klinik für Herz- und Gefäßchirurgie, Lehrstuhl für Experimentelle Herzchirurgie und Herzklappenersatz, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.
| | - D Frank
- Klinik für Kardiologie und Angiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
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McLeod AJ, Currie ME, Moore JT, Bainbridge D, Kiaii BB, Chu MWA, Peters TM. Phantom study of an ultrasound guidance system for transcatheter aortic valve implantation. Comput Med Imaging Graph 2014; 50:24-30. [PMID: 25595049 DOI: 10.1016/j.compmedimag.2014.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 05/13/2014] [Revised: 09/28/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Abstract
A guidance system using transesophageal echocardiography and magnetic tracking is presented which avoids the use of nephrotoxic contrast agents and ionizing radiation required for traditional fluoroscopically guided procedures. The aortic valve is identified in tracked biplane transesophageal echocardiography and used to guide stent deployment in a mixed reality environment. Additionally, a transapical delivery tool with intracardiac echocardiography capable of monitoring stent deployment was created. This system resulted in a deployment depth error of 3.4mm in a phantom. This was further improved to 2.3mm with the custom-made delivery tool. In comparison, the variability in deployment depth for traditional fluoroscopic guidance was estimated at 3.4mm.
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Affiliation(s)
- A Jonathan McLeod
- Robarts Research Institute, Western University, London, Ontario, Canada.
| | - Maria E Currie
- Robarts Research Institute, Western University, London, Ontario, Canada; Department of Cardiac Surgery, London Health Science Centre, London, Ontario, Canada
| | - John T Moore
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Daniel Bainbridge
- Department of Anesthesiology, London Health Science Centre, London, Ontario, Canada
| | - Bob B Kiaii
- Department of Cardiac Surgery, London Health Science Centre, London, Ontario, Canada
| | - Michael W A Chu
- Department of Cardiac Surgery, London Health Science Centre, London, Ontario, Canada
| | - Terry M Peters
- Robarts Research Institute, Western University, London, Ontario, Canada
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Kempfert J, Holzhey D, Hofmann S, Girdauskas E, Treede H, Schröfel H, Thielmann M, Walther T. First registry results from the newly approved ACURATE TA™ TAVI system†. Eur J Cardiothorac Surg 2014; 48:137-41. [PMID: 25425552 DOI: 10.1093/ejcts/ezu367] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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: 04/25/2014] [Accepted: 08/15/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The novel ACURATE TA™ transcatheter aortic valve (Symetis, Ecublens, Switzerland) is composed of a self-expanding nitinol stent covered by an anti-paravalvular leak skirt designed for transapical implantation. Since Conformite Europeenne (CE)-mark approval, the first 250 patients implanted with the newly approved device have been included in this post-market, multicentre registry. METHODS The registry was conducted at 17 sites in Germany, Italy, Switzerland and Argentina to treat 250 high-risk elderly patients. This all-comers population presented preoperatively with a mean aortic gradient of 43.2 ± 17.4 mmHg, mean age of 80.9 ± 6.3 years, mean society of thoracic surgeons risk score of 8.0 ± 5.9% and mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) I of 22.3 ± 12.7%. The majority of patients (93%) were in New York Heart Association (NYHA) class III/IV. All patients were treated within a multidisciplinary Heart Team. RESULTS The procedural success rate was 98% (n = 245) with two valve-in-valve procedures and three conversions to conventional surgery. The 30-day mortality rate was 6.8%. Postimplant echocardiography revealed a relevant paravalvular leak (moderate 2+) in 2.3% of patients, with all other patients demonstrating either none/trace or a 1+ leak. The 30-day stroke rate was 2.8% and the mean transvalvular gradient was 12.4 ± 5.8 mmHg. A new pacemaker implantation was required in 10.0% of patients and 85% of patients returning for the follow-up presented in NYHA class I/II. CONCLUSIONS The short-term result of the registry shows a safety and efficacy profile comparable, if not improved in some aspects, with previously approved transcatheter aortic valve implantation devices. These 'real-world' data highlight an excellent functional outcome, especially in regard to a low rate of relevant paravalvular leak.
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Affiliation(s)
- Jörg Kempfert
- Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - David Holzhey
- Department of Cardiac Surgery, Heart Center University of Leipzig, Leipzig, Germany
| | - Steffen Hofmann
- Department of Cardiac Surgery, Schüchtermann-Schillersche Kliniken, Bad Rothenfelde, Germany
| | - Evaldas Girdauskas
- Department of Cardiac Surgery, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Hendrik Treede
- Department of Cardiac Surgery, Heart Center University of Hamburg, Hamburg, Germany
| | - Holger Schröfel
- Department of Cardiac Surgery, Clinic for Heart Surgery Karlsruhe, Karlsruhe, Germany
| | - Matthias Thielmann
- Department of Cardiac Surgery, West German Heart Center University of Essen, Essen, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
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Neves PC, Paulo NS, Gama V, Vouga L. Transapical aortic valve and mitral valve in ring prosthesis implantation - a new advance in transcatheter procedures. Interact Cardiovasc Thorac Surg 2014; 19:344-6. [PMID: 24786177 DOI: 10.1093/icvts/ivu137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Transcatheter valve implantation offers a new treatment modality to those patients whose general condition makes conventional surgery very risky. However, the transcatheter option has only been available for the aortic valve. We describe a case of a successful implantation of two Edwards SAPIEN(®) 26 and 29 mm transapical valves, respectively, in aortic and mitral positions, on a 74-year-old patient with severe aortic and mitral stenosis. The procedure progressed uneventfully. Predischarge echocardiogram showed a peak aortic gradient of 20 mmHg, mild periprosthetic regurgitation, peak and mean mitral gradients of 12 and 4, respectively, and moderate (II/IV) periprosthetic regurgitation. Indications for transapical valve implantation will rapidly increase in the near future. It is essential to individualize the treatment be applied for each patient, in order to optimize the success of the procedure.
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Affiliation(s)
- Paulo C Neves
- Departments of Cardiothoracic Surgery and Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal
| | - Nelson Santos Paulo
- Departments of Cardiothoracic Surgery and Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal
| | - Vasco Gama
- Departments of Cardiothoracic Surgery and Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal
| | - Luís Vouga
- Departments of Cardiothoracic Surgery and Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal
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Pasic M, Buz S, Drews T, Unbehaun A. Bleeding from the apex during transapical transcatheter aortic valve implantation: a simple solution by balloon occlusion of the apex. Interact Cardiovasc Thorac Surg 2014; 19:306-7. [PMID: 24737789 DOI: 10.1093/icvts/ivu110] [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: 11/14/2022] Open
Abstract
Bleeding from the apex during transapical transcatheter aortic valve implantation is a potentially catastrophic event, which may seem at first sight to be an uncontrollable circumstance. We describe a simple 'trick' to control this problem that we used successfully in 5 patients. A Fogarty occlusion aortic catheter is gently inserted into the left ventricular cavity through the apical hole used for the transcatheter procedure, the balloon is slowly inflated with 10-15 ml of saline and the catheter is slightly pulled back 1 or 2 cm. This manoeuvre immediately stops the bleeding and enables safe suturing of the apex.
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Affiliation(s)
| | - Semih Buz
- Deutsches Herzzentrum Berlin, Berlin, Germany
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Kempfert J, Meyer A, Kim WK, van Linden A, Arsalan M, Blumenstein J, Möllmann H, Walther T. First experience without pre-ballooning in transapical aortic valve implantation: a propensity score-matched analysis. Eur J Cardiothorac Surg 2014; 47:31-8; discussion 38. [PMID: 24674906 DOI: 10.1093/ejcts/ezu097] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 11/12/2022] Open
Abstract
OBJECTIVES Transapical aortic valve implantation (TA-AVI) using the Edwards SAPIEN™ prosthesis has evolved into a routine procedure for selected high-risk elderly patients. The recently introduced SAPIEN™ delivery system (Ascendra II+™) with an added nose cone seems to facilitate direct valve implantation without prior balloon valvuloplasty (BAV). Here, we report our initial experience with this device. METHODS A total of 128 patients were enrolled in the study in 2012 and 2013 and were designated Cohort I. For a subset of 79 patients, exact cardio- computed tomography-based measurements were available; these patients were assigned to Cohort II. All patients received SAPIEN XT™ valves using the TA approach. TA-AVI without pre-ballooning was performed in 31.2% (Cohort I) and 31.6% (Cohort II) of patients. To adjust for baseline variables, propensity score (PS)-based pair matching was used. RESULTS All valves were implanted successfully. The use of PS matching resulted in bias reduction for both cohorts. For Cohort I, there were no significant differences in the primary end points, which were aortic valve incompetence≥2+, Pmean postimplantation, major stroke, transient ischaemic attack (TIA), requirement for post-dilatation and necessity for new pacemaker implantation. As expected, fluoroscopy time was significantly lower in no-BAV patients. In Cohort II, the 30-day TIA rate was lower in the no-BAV group. CONCLUSIONS Direct TA implantation of the SAPIEN valve without pre-ballooning is feasible, safe, does not seem to compromise functional outcomes and may be associated with fewer neurological events.
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Affiliation(s)
- Jörg Kempfert
- Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Alexander Meyer
- Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Won-Keun Kim
- Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany Department of Cardiology, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Arnaud van Linden
- Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Mani Arsalan
- Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | | | - Helge Möllmann
- Department of Cardiology, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
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Huber C. Re: Is valve choice a significant determinant of paravalvular leak post-transcatheter aortic valve implantation? A systematic review and meta-analysis. Eur J Cardiothorac Surg 2013; 45:834-5. [PMID: 24306946 DOI: 10.1093/ejcts/ezt558] [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: 11/13/2022] Open
Affiliation(s)
- Christoph Huber
- Department of Cardiovascular Surgery, Swiss Cardiovascular Centre, University Hospital of Bern, Bern, Switzerland
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Gaia DF, Breda JR, Fischer CH, Palma JH. Off-pump transapical closure of a mitral periprosthetic leak: a new approach to a difficult problem. Interact Cardiovasc Thorac Surg 2013; 17:1048-50. [PMID: 23996734 DOI: 10.1093/icvts/ivt395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/14/2022] Open
Abstract
A 60-year old male patient with multiple risk factors and two previous interventions over the mitral valve was admitted to the emergency unit with symptoms of cardiac failure. Initial examination revealed a competent mitral bioprosthesis with severe perivalvular mitral insufficiency. Based on previous experiences with transapical procedures, a transapical transcatheter closure of the perivalvular leak was performed. The apex was punctured with a 7 French introducer sheath, and a hydrophilic guidewire was advanced with the aid of a right Judkins catheter and positioned across the defect in the left atrium. Fluoroscopic and tridimensional transoesophageal echocardiography was used to guide the manoeuvre. Next, a long introducer sheath was advanced through the guidewire and positioned inside the left atrium. Two Amplatzer Vascular Plug II (St Jude Medical) were deployed, resulting in a significant reduction in the perivalvular leak. The procedure was considered to be successful. The patient regained consciousness, and the orotracheal tube was removed in the operating theatre. No neurological deficits were detected, and the patient was transferred to the intensive care unit. The patient recovered well and was transferred to the ward after 1 day. Discharge was accomplished after 4 days.
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Affiliation(s)
- Diego Felipe Gaia
- Department of Cardiovascular Surgery, Federal University of São Paulo, São Paulo, Brazil
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Brinks H, Nietlispach F, Göber V, Englberger L, Wenaweser P, Meier B, Carrel T, Huber C. Transapical access closure: the TA PLUG device. Interact Cardiovasc Thorac Surg 2013; 17:806-9; discussion 809-10. [PMID: 23842759 DOI: 10.1093/icvts/ivt309] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 11/14/2022] Open
Abstract
OBJECTIVES Percutaneous closure of the transapical (TA) access site for large-calibre devices is an unsolved issue. We report the first experimental data on the TA PLUG device for true-percutaneous closure following large apical access for transcatheter aortic valve implantation. METHODS The TA PLUG, a self-sealing full-core closure device, was implanted in an acute animal study in six pigs (60.2 ± 0.7 kg). All the pigs received 100 IU/kg of heparin. The targeted activated clotting time was left to normalize spontaneously. After accessing the left ventricular apex with a 39 French introducer, the closure plug device was delivered with a 33 French over-the-wire system under fluoroscopic guidance into the apex. Time to full haemostasis as well as rate of bleeding was recorded. Self-anchoring properties were assessed by haemodynamic push stress under adrenalin challenge. An additional feasibility study was conducted in four pigs (58.4 ± 1.1 kg) with full surgical exposure of the apex, and assessed device anchoring by pull-force measurements with 0.5 Newton (N) increments. All the animals were electively sacrified. Post-mortem analysis of the heart was performed and the renal embolic index assessed. RESULTS Of six apical closure devices, five were correctly inserted and fully deployed at the first attempt. One became blocked in the delivery system and was placed successfully at the second attempt. In all the animals, complete haemostasis was immediate and no leak was recorded during the 5-h observation period. Neither leak nor any device dislodgement was observed under haemodynamic push stress with repeated left ventricular peak pressure of up to 220 mmHg. In the feasibility study assessing pull-stressing, device migration occurred at a force of 3.3 ± 0.5 N corresponding to 247.5 mmHg. Post-mortem analyses confirmed full expansion of all devices at the intended target. No macroscopic damage was identified at the surrounding myocardium. The renal embolic index was zero. CONCLUSIONS True-percutaneous left ventricular apex closure following large access is feasible with the self-sealing TA PLUG. The device allows for immediate haemostasis and a reliable anchoring in the acute animal setting. This is the first report of a true-percutaneous closure for large-calibre transcatheter aortic valve implantation access.
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Affiliation(s)
- Henriette Brinks
- Department of Cardiovascular Surgery, Swiss Cardiovascular Centre, University Hospital of Bern, Bern, Switzerland
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Emmert MY, Weber B, Behr L, Sammut S, Frauenfelder T, Wolint P, Scherman J, Bettex D, Grünenfelder J, Falk V, Hoerstrup SP. Transcatheter aortic valve implantation using anatomically oriented, marrow stromal cell-based, stented, tissue-engineered heart valves: technical considerations and implications for translational cell-based heart valve concepts. Eur J Cardiothorac Surg 2013; 45:61-8. [PMID: 23657551 DOI: 10.1093/ejcts/ezt243] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES While transcatheter aortic valve implantation (TAVI) has rapidly evolved for the treatment of aortic valve disease, the currently used bioprostheses are prone to continuous calcific degeneration. Thus, autologous, cell-based, living, tissue-engineered heart valves (TEHVs) with regeneration potential have been suggested to overcome these limitations. We investigate the technical feasibility of combining the concept of TEHV with transapical implantation technology using a state-of-the-art transcatheter delivery system facilitating the exact anatomical position in the systemic circulation. METHODS Trileaflet TEHVs fabricated from biodegradable synthetic scaffolds were sewn onto self-expanding Nitinol stents seeded with autologous marrow stromal cells, crimped and transapically delivered into the orthotopic aortic valve position of adult sheep (n = 4) using the JenaValve transapical TAVI System (JenaValve, Munich, Germany). Delivery, positioning and functionality were assessed by angiography and echocardiography before the TEHV underwent post-mortem gross examination. For three-dimensional reconstruction of the stent position of the anatomically oriented system, a computed tomography analysis was performed post-mortem. RESULTS Anatomically oriented, transapical delivery of marrow stromal cell-based TEHV into the orthotopic aortic valve position was successful in all animals (n = 4), with a duration from cell harvest to TEHV implantation of 101 ± 6 min. Fluoroscopy and echocardiography displayed sufficient positioning, thereby entirely excluding the native leaflets. There were no signs of coronary obstruction. All TEHV tolerated the loading pressure of the systemic circulation and no acute ruptures occurred. Animals displayed intact and mobile leaflets with an adequate functionality. The mean transvalvular gradient was 7.8 ± 0.9 mmHg, and the mean effective orifice area was 1.73 ± 0.02 cm(2). Paravalvular leakage was present in two animals, and central aortic regurgitation due to a single-leaflet prolapse was detected in two, which was primarily related to the leaflet design. No stent dislocation, migration or affection of the mitral valve was observed. CONCLUSIONS For the first time, we demonstrate the technical feasibility of a transapical TEHV delivery into the aortic valve position using a commercially available and clinically applied transapical implantation system that allows for exact anatomical positioning. Our data indicate that the combination of TEHV and a state-of-the-art transapical delivery system is feasible, representing an important step towards translational, transcatheter-based TEHV concepts.
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Bruschi G, De Marco F, Barosi A, Colombo P, Botta L, Nonini S, Martinelli L, Klugmann S. Self-expandable transcatheter aortic valve implantation for aortic stenosis after mitral valve surgery. Interact Cardiovasc Thorac Surg 2013; 17:90-5. [PMID: 23537849 DOI: 10.1093/icvts/ivt086] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 11/12/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve implantation has emerged as a valuable option to treat patients with symptomatic severe aortic stenosis, who are not being considered for surgery because of significant comorbidities. Concerns exist over treating patients who have previously undergone mitral valve surgery for possible interference between the percutaneous aortic valve and the mitral prosthesis or ring. METHODS At our centre, from May 2008 to December 2012, 172 patients (76 male) with severe symptomatic aortic stenosis were eligible for transcatheter aortic valve implant. Nine patients, affected by severe aortic stenosis, had previously undergone mitral valve surgery (4 mono-leaflet, 3 bileaflet, 1 bioprosthesis, 1 mitral ring); they were considered high-risk surgical candidates following joint evaluation by cardiac surgeons and cardiologist and had undergone TAVI. RESULTS Seven patients underwent standard femoral retrograde CoreValve(®) (Medtronic Inc., Minneapolis, USA) implantation, two patients underwent a direct aortic implantation through a mini-thoracotomy. All patients experienced immediate improvement of their haemodynamic status. No deformation of the nitinol tubing of the CoreValve, nor distortion or malfunction of the mechanical valve or mitral ring, occurred as assessed by echographical and fluoroscopic evaluation. No major postoperative complications occurred. In all patients , echocardiography indicated normal valve function during follow-up. CONCLUSIONS Our experience confirms the feasibility of CoreValve implantation in patients with mechanical mitral valves or mitral annuloplasty ring.
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Affiliation(s)
- Giuseppe Bruschi
- A De Gasperis Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Milan, Italy.
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Attia R, Visagan R, Nowell J, Chadalavada S, Thomas M, Bapat V. Transapical transcatheter aortic valve implantation in a complex aortic surgical patient: A case involving the youngest valve-in-valve implantation with a 29 mm transcather valve. Exp Clin Cardiol 2012; 17:251-253. [PMID: 23592947 PMCID: PMC3627286] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The present article reports a case involving a 29-year-old man who developed severe cardiac failure (New York Heart Association class IV). He had a complex surgical history, beginning with the repair of an anterior sinus of Valsalva aneurysm and closure of a ventricular septal defect at eight months of age. His residual Valsalva aneurysm and mixed aortic valve disease necessitated mechanical aortic valve replacement at 14 years of age. One year later, he developed coagulase-negative staphylococcal prosthetic valve infective endocarditis, necessitating an additional replacement of his valve with a pulmonary homograft. Subsequent follow-up revealed a dilated ascending aorta (6 cm) and increased regurgitation through his homograft, with significant dilation of the left ventricle. At 20 years of age, he underwent excision of the aneurysmal ascending aorta and arch of the aorta, and the aortic valve was replaced with a 29 mm bioprosthetic valve. This proved satisfactory for nine years until he presented at Guy's and St Thomas' National Health Services Foundation Trust (London, United Kingdom) with severe aortic regurgitation. His logistic EuroScore was 5.9 and Parsonnet score was 17 but, due to extensive previous surgery, he was considered and accepted for transcatheter aortic valve implantation. A 29 mm Edwards Sapien valve (Edwards Lifesciences, USA) was successfully implanted using a valve-in-valve procedure. The patient remained well and symptom free at early follow-up. Technical aspects of this complex adult congenital case that, to the authors' knowledge is the youngest case of transcatheter aortic valve implantation and the first 29 mm valve-in-valve procedure, are discussed.
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Affiliation(s)
- Rizwan Attia
- Correspondence: Mr Rizwan Attia, 6th Floor East Wing, Department of Cardiothoracic Surgery, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom. Telephone 44-0-207-188-0214, fax 44-0-207-188-1006, e-mail
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