201
|
Alkhouli M, Alqahtani F, Harris AH, Hohmann SF, Rihal CS. Early Experience With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in the United States. JAMA Intern Med 2020; 180:783-784. [PMID: 32091552 PMCID: PMC7042802 DOI: 10.1001/jamainternmed.2019.6767] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This survey study evaluates the early post–US Food and Drug Administration approval experience with an embolic protection device used during transcatheter aortic valve replacement procedures.
Collapse
Affiliation(s)
- Mohamad Alkhouli
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown.,Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Fahad Alqahtani
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown
| | | | - Samuel F Hohmann
- Center for Advanced Analytics and Informatics, Chicago, Illinois.,Department of Health Systems Management, Rush University, Chicago, Illinois
| | - Charanjit S Rihal
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota
| |
Collapse
|
202
|
Khera R, Girotra S. Cerebral Embolic Protection Devices in Transcatheter Aortic Valve Replacement-Effective in Stroke Prevention? JAMA Intern Med 2020; 180:785-786. [PMID: 32091530 DOI: 10.1001/jamainternmed.2019.6763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rohan Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Saket Girotra
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa and Comprehensive Access and Delivery Research & Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City
| |
Collapse
|
203
|
Châteauneuf G, Nazif TM, Beaupré F, Kodali S, Rodés-Cabau J, Paradis JM. Cerebrovascular events after transcatheter mitral valve interventions: a systematic review and meta-analysis. Heart 2020; 106:1759-1768. [DOI: 10.1136/heartjnl-2019-316331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 12/29/2022] Open
Abstract
ObjectiveCurrent guidelines support the use of transcatheter mitral valve interventions to treat some selected high-risk patients with significant mitral valvulopathy. As with any other interventional cardiac procedure, concerns have been raised about cerebrovascular event. The aim of this systematic review and meta-analysis was to determine the incidence of cerebrovascular events following (1) transcatheter mitral valve edge-to-edge repair with mitral valve clip and (2) transcatheter mitral valve replacement (TMVR).MethodsWe conducted a systematic review of studies reporting the cerebrovascular adverse events after transcatheter mitral valve edge-to-edge repair and TMVR procedures. The primary endpoint was the incidence of cerebrovascular events as defined by the Mitral Valve Academic Research Consortium. An event that occurred within 30 days or during index hospitalisation was defined as periprocedural; otherwise it was defined as non-periprocedural. This study was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Aggregated study-level data were pooled using a random effect model. The quality of each study was appraised with the Hawker checklist, a method of systematically reviewing research from different paradigms.ResultsSixty studies totalling 28 155 patients undergoing edge-to-edge repair with mitral valve clip were included in the analysis. Periprocedural stroke and non-periprocedural stroke rates were 0.9% (95% CI 0.6 to 1.1) and 2.4% (95% CI 1.6 to 3.2), respectively. For TMVR procedures, 26 studies including 1910 patients were analysed. The estimated periprocedural stroke incidence was 1% (95% CI 0.5 to 1.8) compared with 7% (95% CI 0.8 to 18.5) for non-periprocedural stroke.ConclusionsTranscatheter mitral valve interventions are associated with low rates of cerebrovascular events. The exact mechanisms of these complications are still poorly understood given the relative paucity of good quality data.Trial registration numberCRD42019117257.
Collapse
|
204
|
Sharma SP, Cheng J, Turagam MK, Gopinathannair R, Horton R, Lam YY, Tarantini G, D'Amico G, Freixa Rofastes X, Lange M, Natale A, Lakkireddy DR. Feasibility of Left Atrial Appendage Occlusion in Left Atrial Appendage Thrombus. JACC Clin Electrophysiol 2020; 6:414-424. [DOI: 10.1016/j.jacep.2019.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/05/2019] [Accepted: 11/21/2019] [Indexed: 12/19/2022]
|
205
|
Mas-Peiro S, Fichtlscherer S, Walther C, Vasa-Nicotera M. Current issues in transcatheter aortic valve replacement. J Thorac Dis 2020; 12:1665-1680. [PMID: 32395310 PMCID: PMC7212163 DOI: 10.21037/jtd.2020.01.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aortic stenosis is the most common valvular disease worldwide. With transcatheter aortic valve replacement (TAVR) being increasingly expanded to lower-risk populations, several challenging issues remain to be solved. The present review aims at discussing modern approaches to such issues as well as the current status of TAVR. TAVR has undergone several developments in the recent years: an increased use of transfemoral access, the development of prostheses in order to adapt to challenging anatomies, improved delivery systems with repositioning features, and outer skirts aiming at reducing paravalvular leak. The indication of TAVR is increasingly being expanded to patients with lower surgical risk. The main clinical trials supporting such expansion are reviewed and the latest data on low-risk patients are discussed. A number of challenges need still to be addressed and are also reviewed in this paper: the need for updated international guidelines including the latest evidence; a reduction of main complications such as permanent pacemaker implantation, paravalvular leak, and stroke (and its potential prevention by using anti-embolic protection devices); the appropriate role of TAVR in patients with concomitant cardiac ischemic disease; and durability of bio-prosthetic implanted valves. Finally, the future perspectives for TAVR use and next device developments are discussed.
Collapse
Affiliation(s)
- Silvia Mas-Peiro
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Claudia Walther
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| |
Collapse
|
206
|
Ro R, Tang GHL, Khera S, Krishnamoorthy P, Sharma SK, Kini A, Lerakis S. Murphy's Law or Domino Effect: Severe Aortic Annular Calcification in Transcatheter Aortic Valve Replacement. Circ Cardiovasc Imaging 2020; 13:e010162. [PMID: 32208736 DOI: 10.1161/circimaging.119.010162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Richard Ro
- Division of Cardiology, Mount Sinai Hospital (R.R., S.K., P.K., S.K.S., A.K., S.L.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System (G.H.L.T.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sahil Khera
- Division of Cardiology, Mount Sinai Hospital (R.R., S.K., P.K., S.K.S., A.K., S.L.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Parasuram Krishnamoorthy
- Division of Cardiology, Mount Sinai Hospital (R.R., S.K., P.K., S.K.S., A.K., S.L.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samin K Sharma
- Division of Cardiology, Mount Sinai Hospital (R.R., S.K., P.K., S.K.S., A.K., S.L.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Annapoorna Kini
- Division of Cardiology, Mount Sinai Hospital (R.R., S.K., P.K., S.K.S., A.K., S.L.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stamatios Lerakis
- Division of Cardiology, Mount Sinai Hospital (R.R., S.K., P.K., S.K.S., A.K., S.L.), Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
207
|
Simsek C, Schölzel BE, den Heijer P, Vos J, Meuwissen M, van den Branden B, IJsselmuiden AJJ. The rationale of using cerebral embolic protection devices during transcatheter aortic valve implantation. Neth Heart J 2020; 28:249-252. [PMID: 32152782 PMCID: PMC7190763 DOI: 10.1007/s12471-020-01380-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aortic valve stenosis is one of the most common valvular abnormalities, which can manifest as angina, syncope, dyspnoea and sudden cardiac death. Transcatheter aortic valve implantation (TAVI) has been introduced as an alternative to surgical valve replacement in patients with severe aortic valve stenosis, resulting in less morbidity, shorter time to recovery and similar mortality rates. Progress in this field has reduced complication rates. However, the incidence of peri-procedural stroke remains relatively high (around 4%). To fully utilise the potential of TAVI, cerebral embolic protection devices (CEPD) have been developed and introduced. In this position paper, we aim to summarise the available data on several CEPD.
Collapse
Affiliation(s)
- C Simsek
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - B E Schölzel
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - P den Heijer
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - J Vos
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - M Meuwissen
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | | | | |
Collapse
|
208
|
Cerebral protection device during TAVR in a young low-risk patient with a highly calcified aortic valve. Hellenic J Cardiol 2020; 61:433-434. [PMID: 32142895 DOI: 10.1016/j.hjc.2020.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/30/2020] [Accepted: 02/09/2020] [Indexed: 11/20/2022] Open
|
209
|
Carabello BA. Bioprosthetic Valve Leaflet Thrombosis. J Am Coll Cardiol 2020; 75:867-869. [DOI: 10.1016/j.jacc.2019.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 11/17/2022]
|
210
|
Yeoh J, Dworakowski R, Hill J, Byrne J. A contemporary and complete treatment solution for a high-risk patient with critical aortic stenosis, left ventricular thrombus, severe left ventricular dysfunction, and calcified left main stem disease. Catheter Cardiovasc Interv 2020; 95:851-854. [PMID: 31617327 DOI: 10.1002/ccd.28521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/17/2019] [Accepted: 09/17/2019] [Indexed: 11/11/2022]
Abstract
The combination of severe coronary disease, significant valvular dysfunction and impaired ventricular function pose patients at a very high procedural risk. In addition, the presence of left ventricular thrombus can complicate ventricular instrumentation increasing embolic risk. Contemporary techniques and devices have now become available to overcome these challenges to reduce risk and allow safer, more efficient procedures. We describe the feasibility of using Impella CP™ with cerebral protection to facilitate complete revascularisation and percutaneous valve replacement in a patient with critical aortic stenosis, severe left ventricular (LV) impairment, LV thrombus and a calcified left main stem disease.
Collapse
Affiliation(s)
- Julian Yeoh
- Department of Cardiology, King's College Hospital, London
| | | | - Jonathan Hill
- Department of Cardiology, King's College Hospital, London
| | - Jonathan Byrne
- Department of Cardiology, King's College Hospital, London
| |
Collapse
|
211
|
Voss S, Lange R. Filterbasierte Neuroprotektion bei Transkatheter-Aortenklappenimplantation. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2020. [DOI: 10.1007/s00398-020-00361-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
212
|
Braghiroli J, Kapoor K, Thielhelm TP, Ferreira T, Cohen MG. Transcatheter aortic valve replacement in low risk patients: a review of PARTNER 3 and Evolut low risk trials. Cardiovasc Diagn Ther 2020; 10:59-71. [PMID: 32175228 DOI: 10.21037/cdt.2019.09.12] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a mainstay in treatment for patients with severe aortic stenosis who are considered high-risk surgical candidates. The use of TAVR in low-risk patients with severe aortic stenosis is being explored as an alternative to surgical aortic valve replacement (SAVR). Recent results from the Medtronic Evolut Low Risk trial and the Placement of Aortic Transcatheter Valves (PARTNER) 3 trial shed light on the use of TAVR in low-risk surgical candidates. The Evolut Low Risk trial compared TAVR with a self-expanding supra-annular bioprosthesis to SAVR in 1468 patients with severe aortic stenosis who were low surgical risk. Patients with a mean age of 74 and a mean Society of Thoracic Surgeons (STS) risk score of 1.9% were randomized to either TAVR or SAVR groups. Using the composite end point of death or disabling stroke at 24 months, the study found an incidence of 5.3% in the TAVR arm and 6.7% in the surgical arm. The Evolut Low Risk trial thus concluded that TAVR was statistically noninferior but not superior to SAVR (difference, -1.4 percentage points; 95% Bayesian credible interval for the difference, -4.9 to 2.1; posterior probability of noninferiority, >0.999). The PARTNER 3 trial assigned 1,000 patients with severe aortic stenosis and low surgical risk to either TAVR with transfemoral placement of balloon expandable valve or SAVR. Patients with a mean age of 73 and a mean STS score of 1.9% were randomized to either TAVR or SAVR groups. With respect to the primary endpoint of composite death from any cause, stroke, or rehospitalization, the study found an occurrence of 8.5% in TAVR and 15.1% in SAVR, confirming both noninferiority and superiority in the TAVR group [absolute difference, -6.6 percentage points; 95% confidence interval (CI), -10.8 to -2.5; P<0.001 for noninferiority; hazard ratio, 0.54; 95% CI, 0.37 to 0.79; P=0.001 for superiority]. Both the Evolut low risk trial and the PARTNER 3 trial provide evidence that the use of TAVR extends beyond the scope of high and intermediate risk surgical patients and is at the very least equivalent to SAVR in the treatment low-risk surgical candidates when using a transfemoral approach in patients without bicuspid aortic valves. In this article we provide an extensive review on the Evolute low risk and PARTNER 3 trials, including a discussion on clinically relevant outcomes.
Collapse
Affiliation(s)
- Joao Braghiroli
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Kunal Kapoor
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Torin P Thielhelm
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Tanira Ferreira
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Mauricio G Cohen
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| |
Collapse
|
213
|
Contractor T, Co ML, Cooper JM, Mandapati R, Abudayyeh I. Management of inadvertent lead placement in the left ventricle via a patent foramen ovale: A multidisciplinary approach. HeartRhythm Case Rep 2020; 6:89-93. [PMID: 32099797 PMCID: PMC7026559 DOI: 10.1016/j.hrcr.2019.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Michael Lawrenz Co
- Loma Linda University Medical Center, Loma Linda, California
- Address reprint requests and correspondence: Dr Michael Lawrenz Co, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354.
| | | | - Ravi Mandapati
- Loma Linda University Medical Center, Loma Linda, California
| | - Islam Abudayyeh
- Loma Linda University Medical Center, Loma Linda, California
| |
Collapse
|
214
|
Shah AS, Akhmerov A, Gupta N, Chakravarty T, Makkar RR, Azizzadeh A. Use of a Dual-Filter Cerebral Embolic Protection Device in Thoracic Endovascular Aortic Repair. Ann Vasc Surg 2020; 65:54.e1-54.e4. [PMID: 31981683 DOI: 10.1016/j.avsg.2020.01.077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/10/2019] [Accepted: 01/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The risk of periprocedural stroke after thoracic endovascular aortic repair (TEVAR) ranges from 3% to 8%. Although cerebral embolic protection devices (CEPD) are widely utilized in transcatheter aortic valve replacement, there are currently no Food and Drug Administration approved CEPDs for use in TEVAR. We report our initial experience with the off-label use of a dual-filter CEPD in patients undergoing TEVAR. METHODS Two patients at high risk for embolic stroke underwent TEVAR for descending thoracic aortic aneurysms (DTAAs) at a single institution. A dual-filter CEPD (Sentinel; Boston Scientific, Marlborough, MA) was used in an off-label fashion in both cases. Patient 1 was a 62-year-old woman with a 6.2-cm DTAA, extending from the left subclavian artery (LSCA) to the diaphragm (Zones 3-5) and associated with extensive atherosclerotic disease of the aortic arch. Patient 2 was a 78-year-old woman with a 6.3-cm DTAA, extending from the LSCA (Zone 2) to the sixth intercostal space (Zone 4) with associated mural thrombus. Given the proximity of the aneurysm to the LSCA, a left carotid-subclavian bypass was performed for planned LSCA coverage. RESULTS Through a percutaneous right radial artery approach using a 6F sheath, the Sentinel dual-filter CEPD was delivered over a 0.014″ guidewire into the thoracic aorta. Under fluoroscopic guidance, the 2 filters were sequentially deployed in the innominate and left common carotid arteries, respectively. Appropriately sized devices were successfully delivered and deployed in the proximal and distal landing zones, respectively. Two devices were used for each patient. Completion angiograms showed successful exclusion of the DTAAs in both cases, without evidence of endoleak. The CEPD filters were retrieved in standard fashion without difficulty. Pathology demonstrated successful capture of embolic debris and fibrin clot in both patients. Neither patient exhibited neurological deficits or device-related complications. Both patients remained neurologically intact at 1- and 2-month follow-up, respectively. Surveillance angiograms revealed successful exclusion of the aneurysm without any evidence of endoleak. CONCLUSIONS We report the novel off-label use of a dual-filter CEPD in 2 patients undergoing TEVAR. Pathological confirmation of embolic debris in the filters makes this a potential tool for stroke prevention during TEVAR in high-risk patients.
Collapse
Affiliation(s)
- Aamir S Shah
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
| | | | - Navyash Gupta
- Division of Vascular Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ali Azizzadeh
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Division of Vascular Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| |
Collapse
|
215
|
Ho JYK, Chan JWY, Chow SCY, Yu PSY, Kwok MWT, Cheung GSH, Wong RHL. Application of Cerebral Protection System in Open Mitral Replacement with Extensive Calcified Left Atrial Thrombus. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 15:85-87. [PMID: 31875766 DOI: 10.1177/1556984519892242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neurological complications remain a major burden in cardiac surgery, despite various intraoperative measures attempting to reduce its occurrence. Advancement of percutaneous approach in valve replacement has brought focus to the use of cerebral protection system (CPS). We reported a novel application of percutaneous CPS in open heart surgery for a patient with an extensive calcified left atrial thrombus to reduce risk of embolic stroke. Although, there is no evidence to advocate routine use of CPS in all open cardiac surgical patients, we believe it is a technically feasible and probably safe approach for neurological protection in high-risk patients.
Collapse
Affiliation(s)
- Jacky Y K Ho
- 13621 Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China
| | - Joyce W Y Chan
- 13621 Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China
| | - Simon C Y Chow
- 13621 Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China
| | - Peter S Y Yu
- 13621 Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China
| | - Micky W T Kwok
- 13621 Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China
| | - Gary S H Cheung
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, China
| | - Randolph H L Wong
- 13621 Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China
| |
Collapse
|
216
|
Adams HSL, Ashokkumar S, Newcomb A, MacIsaac AI, Whitbourn RJ, Palmer S. Contemporary review of severe aortic stenosis. Intern Med J 2019; 49:297-305. [PMID: 30091235 DOI: 10.1111/imj.14071] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/24/2018] [Accepted: 07/31/2018] [Indexed: 01/17/2023]
Abstract
Severe aortic stenosis (AS) is the most common form of valvular heart disease in the developed world, with a rising prevalence due to an ageing Australian population. Transcatheter aortic valve implantation (TAVI) offers a less invasive option for the treatment of severe AS, with evidence supporting TAVI compared with medical therapy in inoperable patients and superior with surgical aortic valve replacement (SAVR) in high-risk patients. Equal outcomes have been observed in all-comer intermediate-risk populations. The Heart Team utilises a shared decision-making approach between physicians and surgeons in risk-stratifying patients and reduces the intrinsic bias that may occur if decisions are made in isolation. Geriatric assessment is useful for identifying preoperative frailty, a major risk factor for death post-aortic valve intervention. In severe AS, a decision can be made collaboratively to pursue TAVI, SAVR, a Ross Procedure or conservative management. The learning curve associated with TAVI has improved markedly, with overall complication rates decreasing around the world. Contemporary changes in practice, such as conscious sedation without general anaesthesia, expedited recovery and early discharge, will likely improve cost-effectiveness. In 2018, TAVI is a well-established procedure in Australia that has revolutionised the management of severe AS. In the future, with an expanding elderly population, the number of patients to benefit from transcatheter therapies for severe AS is hypothesised to increase 4-10-fold. Heart Team assessment is crucial in patients with severe AS to direct appropriate management.
Collapse
Affiliation(s)
- Heath S L Adams
- Department of Cardiology, St Vincent's Hospital, Victoria, Australia
| | - Srikkumar Ashokkumar
- Department of Cardiology, St Vincent's Hospital, Victoria, Australia.,Department of Medicine, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Andrew Newcomb
- Department of Cardiology, St Vincent's Hospital, Victoria, Australia.,Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St Vincent's Hospital, Victoria, Australia.,Department of Medicine, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | | | - Sonny Palmer
- Department of Cardiology, St Vincent's Hospital, Victoria, Australia.,Department of Medicine, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
217
|
Abstract
New developments in transcatheter valve technologies including aortic valve replacement and mitral valve and tricuspid valve interventions are described. Recent studies evaluating the success rate, patient outcomes, and anesthesiologic management of the procedures are discussed.
Collapse
Affiliation(s)
- Michael A Ackermann
- Department of Anesthesiology and Intensive Care Medicine, Heart Centre Leipzig, Struempellstr 39, Leipzig 04289, Germany
| | - Jörg K Ender
- Department of Anesthesiology and Intensive Care Medicine, Heart Centre Leipzig, Struempellstr 39, Leipzig 04289, Germany.
| |
Collapse
|
218
|
The Predictors of Peri-Procedural and Sub-Acute Cerebrovascular Events Following TAVR from OCEAN-TAVI Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:732-738. [PMID: 31761635 DOI: 10.1016/j.carrev.2019.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/01/2019] [Accepted: 10/09/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cerebrovascular events (CVEs) are not uncommon complications of transcatheter aortic valve replacement (TAVR). Our study aimed to determine the predictors of peri-procedural and sub-acute CVEs following TAVR. METHODS Using the Japanese multicenter registry, we evaluated 1613 patients undergoing TAVR between October-2013 and July-2016. Occurrences of 24-hour and 1- to 30-day CVEs were evaluated to clarify the predictors of CVEs following TAVR. RESULTS The mean age was 84.4 years and mean Society of Thoracic Surgeons score was 8.3%. Overall 24-hour and 30-day CVE rates were 1.2% and 2.7%, respectively. A multivariate analysis demonstrated that independent predictor of 24-hour CVEs was index aortic valve area (iAVA) [adjusted OR (adjusted-OR), 0.001; 95% CI, 0.001-0.13; p = .005]. The receiver operator curve derived cut-off value of iAVA for the prediction of 24-hour CVEs was 0.40 cm2/m2. In contrast, independent predictors of 1- to 30-day CVEs were paroxysmal atrial fibrillation (PAF; adjusted-OR, 3.35; 95% CI, 1.36-8.27; p = .009) and iAVA after TAVR (adjusted-OR, 0.11; 95% CI, 0.02-0.66; p = .02). Consequently, independent predictors of 30-day CVEs were prior stroke (adjusted-OR, 2.18; 95% CI, 1.07-4.45; p = .03), PAF (adjusted-OR, 2.18; 95% CI, 1.05-4.56; p = .04), and prior coronary artery disease (adjusted-OR, 1.88; 95% CI, 1.01-3.48; p = .05). CONCLUSIONS Within 24 h, small iAVA impacted the increased risk of CVEs, whereas PAF and iAVA after TAVR impacted the increased risk of 1- to 30-day CVEs following TAVR. The mechanism of CVEs might differ according to onset.
Collapse
|
219
|
Abstract
Initially, transcatheter aortic valve replacement (TAVR) was only used in patients with severe symptomatic aortic stenosis and prohibitive risk for surgical aortic valve replacement. Subsequently, TAVR was extended to patients with high and intermediate surgical risk. Recently, the results of randomized trials in low-surgical-risk patients showed superiority or noninferiority of TAVR versus surgical aortic valve replacement in this population. Procedural outcomes have been improved. Long-term durability of transcatheter heart valves remains to be confirmed. This article presents the evolution and current status of TAVR, with respect to the different types of devices and procedures as well as its outcomes.
Collapse
|
220
|
Case BC, Forrestal BJ, Yerasi C, Khan JM, Khalid N, Shlofmitz E, Chen Y, Musallam A, Chezar-Azerrad C, Satler LF, Ben-Dor I, Rogers T, Waksman R. Real-World Experience of the Sentinel Cerebral Protection Device: Insights From the FDA Manufacturer and User Facility Device Experience (MAUDE) Database. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:235-238. [PMID: 31780421 DOI: 10.1016/j.carrev.2019.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND/PURPOSE The Sentinel Cerebral Protection System (Boston Scientific, Marlborough, Massachusetts) is indicated for use as a cerebral protection device to capture and remove embolic material during transcatheter aortic valve procedures and was approved by the US Food and Drug Administration (FDA) in 2017. Robust data on the most commonly reported complications and modes of failure associated with the Sentinel device are limited. METHODS/MATERIALS We analyzed postmarketing surveillance data from the FDA Manufacturer and User Facility Device Experience (MAUDE) database from 2017 through 2019, yielding 43 reports. RESULTS Of the 43 reports of major complications involving Sentinel devices, 23 involved either death (3) or injury (20) related to the device. The 3 deaths were due to stroke, while 18 of the 20 injuries were reported as stroke. The other 20 reports were related to device modes of failure. Modes of failure were due to damaged device (5), difficulty retrieving/resheathing the device (5); package contamination (4), difficulty deploying the device (3), and, finally, complications with preparation (3). CONCLUSIONS Our analysis of the MAUDE database demonstrates that in real-world practice, the Sentinel Cerebral Protection System may be associated with complications, including death, stroke, vascular injury, and difficulties with the device itself. The MAUDE database serves as an important tool for both physicians and manufacturers to optimize performance and clinical outcomes.
Collapse
Affiliation(s)
- Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Nauman Khalid
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Evan Shlofmitz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Yuefeng Chen
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Anees Musallam
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Chava Chezar-Azerrad
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
| |
Collapse
|
221
|
Villablanca PA, Frisoli T, O'Neill W, Eng M. Using the Arm for Structural Interventions: Case Selection or Wave of the Future. Interv Cardiol Clin 2019; 9:63-74. [PMID: 31733742 DOI: 10.1016/j.iccl.2019.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The transradial approach has emerged as the preferred alternative to the traditional transfemoral approach owing to the increased evidence of its safety and efficacy. The field of structural heart disease is rapidly evolving; however, periprocedural complications related to access site remain a major determinant of morbidity and mortality. The transradial approach as primary or secondary access site in structural heart interventions like transcatheter aortic valve replacement, balloon aortic valvuloplasty, alternative access, alcohol septal ablations, paravalvular leak, valve snaring, coronary protection, and ventricular septal defect is feasible, safe, with lower vascular complications and high procedural success.
Collapse
Affiliation(s)
- Pedro A Villablanca
- Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
| | - Tiberio Frisoli
- Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - William O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Marvin Eng
- Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| |
Collapse
|
222
|
Gommeaux A, Manchuelle A. [Prostheses used in tavi]. Ann Cardiol Angeiol (Paris) 2019; 68:434-438. [PMID: 31722795 DOI: 10.1016/j.ancard.2019.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 11/28/2022]
Abstract
Since the first human implantation of a percutaneous aortic valve in 2002, tavi prosthesis didn't stop to improve their results. These improvements allowed to decrease dramatically tavi's complications and to extend the technic to patients with mid indeed low surgery risk. So tavi became the first treatment of aortic stenosis in France since a few years.
Collapse
Affiliation(s)
- A Gommeaux
- Service de cardiologie, hôpital privé de Bois-Bernard, route de Neuvireuil, 62320 Bois-Bernard, France.
| | - A Manchuelle
- Service de cardiologie, hôpital privé de Bois-Bernard, route de Neuvireuil, 62320 Bois-Bernard, France
| |
Collapse
|
223
|
Nanjudappa A, Bhagat A, Bates MC. A rare cause of stroke after transcatheter aortic valve replacement: Retained foreign body. Catheter Cardiovasc Interv 2019; 94:870-873. [PMID: 31237082 DOI: 10.1002/ccd.28374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/10/2019] [Indexed: 11/07/2022]
Abstract
The field of transcatheter aortic valve replacement (TAVR) has matured significantly with the outcome and durability data now supporting use in lower-risk patients. We present a preventable complication from early in our experience (5 years ago) that illustrates the importance of heart team communication and cautious multidiscipline cross-pollination during the formative years of a program. An 87-year old female developed confusion, slurred speech and left upper extremity weakness 1 day following TAVR with inconclusive findings on carotid artery duplex and transthoracic echocardiography. Subsequent CT-scan disclosed a linear, ring-like, structure in the ascending aorta. The foreign body (FB) was radiolucent and successfully snared via tactile sensation and anatomic landmarks informed by the CT. The extricated FB was the valvuloplasty balloon guard (BG) that was inadvertently introduced into the patient via ascending aortic large sheath access. The failure mode was traced back to the first time use of a new balloon system and unrecognized BG by the surgical physician and technician components of the Heart Team who took the lead role in device insertion due to the open chest access. Subsequently, the heart team made changes to mitigate similar future complications by sharing multidiscipline responsibility for all procedural steps and ensuring the use of all new adjuvant devices are preceded by a procedural pause and team consensus regarding device preparation and use. Additionally, the manufacturer addition of a radiopaque marker or flair on the valvuloplasty BG may be warranted.
Collapse
Affiliation(s)
- Aravinda Nanjudappa
- Cardiology and Structural Heart, Charleston Area Medical Center, Charleston, West Virginia
| | - Abhishek Bhagat
- Internal Medicine, Charleston Area Medical Center, Charleston, West Virginia
| | - Mark C Bates
- Cardiology and Vascular Medicine, Charleston Area Medical Center, Charleston, West Virginia.,Cardiology, West Virginia University, Morgantown, West Virginia.,Department of Surgery, West Virginia University, Charleston, West Virginia
| |
Collapse
|
224
|
Schmidt T, Leon MB, Mehran R, Kuck KH, Alu MC, Braumann RE, Kodali S, Kapadia SR, Linke A, Makkar R, Naber C, Romero ME, Virmani R, Frerker C. Debris Heterogeneity Across Different Valve Types Captured by a Cerebral Protection System During Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 11:1262-1273. [PMID: 29976363 DOI: 10.1016/j.jcin.2018.03.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/28/2018] [Accepted: 03/01/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study investigated differences between transcatheter heart valve (THV) types and regarding debris captured by a cerebral embolic protection system (Claret Medical Sentinel, Santa Rosa, California). BACKGROUND Differences of THV types and cerebral injury after transcatheter aortic valve replacement (TAVR) are not well understood. METHODS A total of 246 patients pooled from 2 prospective studies (SENTINEL [Cerebral Protection in Transcatheter Aortic Valve Replacement] trial, N = 100; SENTINEL-H [Histopathology of Embolic Debris Captured During Transcatheter Aortic Valve Replacement] trial, N = 146) were included in the analysis. Histopathologic assessment and histomorphometric analyses of debris were compared with THV types. Analyses were differentiated by particle size (≥150, ≥500, and ≥1,000 μm), particle count, total particle area, and maximum of largest dimension. Only commercially available THVs were included: 16% Evolut R (EvR), 15% Lotus, 59% SAPIEN 3 (S3), and 10% SAPIEN XT (XT). RESULTS Particles were captured in 99% of patients. There was a significantly higher amount of debris related to the vascular bed (valve tissue, arterial wall, calcification) in EvR patients compared with S3 patients; 53% of all patients irrespective of valve type had at least 1 particle ≥1 mm. Larger particles (≥500 and ≥1,000 μm) were significantly more frequent in EvR than XT and S3 patients. Lotus patients with particles ≥1,000 μm were significantly more frequent than in S3 patients. Particle count, total particle area, and maximum of largest dimension were significantly higher in both Lotus and EvR patients compared with S3 and XT. CONCLUSIONS Debris was captured in 99% of patients, of whom 53% had at least 1 particle of debris >1 mm. The number and size of particles captured during a procedure in which EvR or Lotus THV was used were higher and larger than with a Sapien THV. Regardless, embolic debris, including large particles, is universal across valve types and provides mechanistic support for the potential benefit of using cerebral embolic protection in all TAVR procedures.
Collapse
Affiliation(s)
- Tobias Schmidt
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York
| | | | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Maria C Alu
- Columbia University Irving Medical Center, New York, New York
| | | | - Susheel Kodali
- Columbia University Irving Medical Center, New York, New York
| | | | - Axel Linke
- Herzzentrum Leipzig GmbH-Universitätsklinik, Leipzig, Germany
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | | | - Christian Frerker
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| |
Collapse
|
225
|
Strom JB, Zhao Y, Faridi KF, Tamez H, Butala NM, Valsdottir LR, Curtis J, Brennan JM, Shen C, Boulware M, Popma JJ, Yeh RW. Comparison of Clinical Trials and Administrative Claims to Identify Stroke Among Patients Undergoing Aortic Valve Replacement: Findings From the EXTEND Study. Circ Cardiovasc Interv 2019; 12:e008231. [PMID: 31694411 DOI: 10.1161/circinterventions.119.008231] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cerebrovascular events (CVEs) are devastating complications after aortic valve replacement. We assessed whether billing claims accurately identify CVEs in place of clinical event adjudication in structural heart disease trials. METHODS Adult participants in the US CoreValve High Risk and SURTAVI trials (Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients) were linked to Medicare inpatient claims from January 1, 2006 to December 31, 2016. Claims consistent with CVEs within 14 days of a similar trial-adjudicated CVE were considered a match. The sensitivity, specificity, and positive and negative predictive values of International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification billing codes for cerebrovascular disease were determined against trial-defined CVEs as the criterion standard. Kaplan-Meier estimates of claims-defined versus trial-defined CVEs were compared. RESULTS Among 4230 linked trial participants (linkage rate 79.8%), 550 (13.0%) sustained 630 adjudicated CVEs over a 5-year follow-up period. Linked and nonlinked individuals were similar. An algorithm using 4 International Classification of Diseases, Ninth Revision, Clinical Modification codes (434.91, 434.11, 433.11, and 997.02) had a sensitivity of 60.9%, specificity of 99.0%, positive predictive value of 86.5%, and negative predictive value of 95.8% for identifying a trial-adjudicated ischemic stroke. An algorithm using 3 International Classification of Diseases, Tenth Revision, Clinical Modification codes (I63.9, I63.40, I63.49) had a sensitivity of 66.7%, specificity of 99.4%, positive predictive value of 88.9%, and negative predictive value of 97.6%. CONCLUSIONS In linked clinical trial and Medicare claims data, 4 International Classification of Diseases, Ninth Revision, Clinical Modification and 3 International Classification of Diseases, Tenth Revision, Clinical Modification billing codes identified half of trial-adjudicated CVEs during follow-up with high specificity and predictive value, but imperfect sensitivity. Although low sensitivity may limit the use of claims to substitute for traditional trial outcomes to identify CVEs, high specificity suggests claims could be used to trigger evaluation of neurological events, potentially improving the efficiency of the evaluation of techniques and devices designed to reduce such events.
Collapse
Affiliation(s)
- Jordan B Strom
- The Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology (J.B.S., Y.Z., K.F.F., H.T., L.R.V., C.S., R.W.Y.).,Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center (J.B.S., Y.Z., K.F.F., H.T., L.R.V., C.S., J.J.P., R.W.Y.).,Harvard Medical School (J.B.S.,Y.Z., K.F.F., H.T., N.M.B., L.R.V., C.S., J.J.P., R.W.Y.)
| | - Yuansong Zhao
- The Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology (J.B.S., Y.Z., K.F.F., H.T., L.R.V., C.S., R.W.Y.).,Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center (J.B.S., Y.Z., K.F.F., H.T., L.R.V., C.S., J.J.P., R.W.Y.).,Harvard Medical School (J.B.S.,Y.Z., K.F.F., H.T., N.M.B., L.R.V., C.S., J.J.P., R.W.Y.)
| | - Kamil F Faridi
- The Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology (J.B.S., Y.Z., K.F.F., H.T., L.R.V., C.S., R.W.Y.).,Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center (J.B.S., Y.Z., K.F.F., H.T., L.R.V., C.S., J.J.P., R.W.Y.).,Harvard Medical School (J.B.S.,Y.Z., K.F.F., H.T., N.M.B., L.R.V., C.S., J.J.P., R.W.Y.)
| | - Hector Tamez
- The Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology (J.B.S., Y.Z., K.F.F., H.T., L.R.V., C.S., R.W.Y.).,Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center (J.B.S., Y.Z., K.F.F., H.T., L.R.V., C.S., J.J.P., R.W.Y.).,Harvard Medical School (J.B.S.,Y.Z., K.F.F., H.T., N.M.B., L.R.V., C.S., J.J.P., R.W.Y.)
| | - Neel M Butala
- Harvard Medical School (J.B.S.,Y.Z., K.F.F., H.T., N.M.B., L.R.V., C.S., J.J.P., R.W.Y.).,Division of Cardiology, Massachusetts General Hospital, Boston (N.M.B.)
| | - Linda R Valsdottir
- The Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology (J.B.S., Y.Z., K.F.F., H.T., L.R.V., C.S., R.W.Y.).,Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center (J.B.S., Y.Z., K.F.F., H.T., L.R.V., C.S., J.J.P., R.W.Y.).,Harvard Medical School (J.B.S.,Y.Z., K.F.F., H.T., N.M.B., L.R.V., C.S., J.J.P., R.W.Y.)
| | - Jeptha Curtis
- Yale University School of Medicine, New Haven, CT (J.C.)
| | | | - Changyu Shen
- The Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology (J.B.S., Y.Z., K.F.F., H.T., L.R.V., C.S., R.W.Y.).,Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center (J.B.S., Y.Z., K.F.F., H.T., L.R.V., C.S., J.J.P., R.W.Y.).,Harvard Medical School (J.B.S.,Y.Z., K.F.F., H.T., N.M.B., L.R.V., C.S., J.J.P., R.W.Y.)
| | | | - Jeffrey J Popma
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center (J.B.S., Y.Z., K.F.F., H.T., L.R.V., C.S., J.J.P., R.W.Y.).,Harvard Medical School (J.B.S.,Y.Z., K.F.F., H.T., N.M.B., L.R.V., C.S., J.J.P., R.W.Y.)
| | - Robert W Yeh
- The Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology (J.B.S., Y.Z., K.F.F., H.T., L.R.V., C.S., R.W.Y.).,Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center (J.B.S., Y.Z., K.F.F., H.T., L.R.V., C.S., J.J.P., R.W.Y.).,Harvard Medical School (J.B.S.,Y.Z., K.F.F., H.T., N.M.B., L.R.V., C.S., J.J.P., R.W.Y.).,Baim Institute for Clinical Research, Boston, MA (R.W.Y.)
| |
Collapse
|
226
|
Iizuka T, Oki K, Hayashida K, Minami K, Izawa Y, Takahashi S, Shimizu H, Fukuda K, Nakahara J. Cerebral Infarction after Transcatheter Aortic Valve Implantation in Japan: Retrospective Analysis at a Single High-Volume Center. J Stroke Cerebrovasc Dis 2019; 28:104455. [PMID: 31680032 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Perioperative cerebral infarction is one of the concerning complications after transcatheter aortic valve implantation in patients with aortic stenosis. Several studies have reported on this complication; however, those included only Caucasians and analyzed a small number of cases. Here, we report on the characteristics and risk factors of symptomatic cerebral infarction after transcatheter aortic valve implantation in a single, high-volume center in Japan. METHODS We included 308 consecutive patients who underwent transcatheter aortic valve implantation in our facility between 2013 and 2016. We retrospectively analyzed the occurrence, characteristics, and prognoses of symptomatic cerebral infarction within 7 days after the procedure and statistically compared the risk factors between patients with or without cerebral infarction. RESULTS Five patients (1.6%) suffered from symptomatic cerebral infarction, which was usually recognized just after the procedure, with mild symptoms. Long-term prognoses tended to be good unless other factors influenced disability. Comorbidities, such as carotid artery stenosis and peripheral artery disease, were significantly higher in patients with cerebral infarction (P = .036 and .002, respectively); in addition, coronary artery disease and longer anesthesia duration (indicating challenging catheter procedures) tended to be associated with cerebral infarction (P = .080 and .069, respectively). CONCLUSIONS Symptomatic cerebral infarction occurred in 1.6% of patients after transcatheter aortic valve implantation in a single, high-volume center in Japan; the infarctions were of mild severity tending toward good long-term prognoses. We speculate arterial embolism from atherosclerotic large arteries, especially from the aortic arch, during catheter procedures might be the mechanistic basis of cerebral infarction.
Collapse
Affiliation(s)
- Takashi Iizuka
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Oki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan; Department of Neurology, Saiseikai Central Hospital, Tokyo, Japan.
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kazushi Minami
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshikane Izawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Shinichi Takahashi
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan; Department of Neurology and Stroke, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
227
|
Krishnan S, Sharma A, Subramani S, Arora L, Mohananey D, Villablanca P, Ramakrishna H. Analysis of Neurologic Complications After Surgical Versus Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2019; 33:3182-3195. [DOI: 10.1053/j.jvca.2018.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Indexed: 11/11/2022]
|
228
|
Di Eusanio M, Cefarelli M, Berretta P, Capestro F. Minimally invasive aortic valve replacement with a catheter-based cerebral protection system: transferring percutaneous technologies into a surgical intervention. Eur J Cardiothorac Surg 2019; 56:1016-1017. [PMID: 31056703 DOI: 10.1093/ejcts/ezz126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/21/2019] [Accepted: 03/24/2019] [Indexed: 11/14/2022] Open
Abstract
Patients with severe aortic valve stenosis are currently treated with 2 different interventional techniques: surgical aortic valve replacement or transcatheter aortic valve implantation (TAVI). Both have strengths and limitations. On the one hand, TAVI represents a valuable option in high- and intermediate-risk patients and is commonly preferred over surgical aortic valve replacement in subjects with porcelain or severely calcified aorta, on the other, the lack of data on valve durability raises concerns on its use in young, low-risk patients. We present herein the case of a low-risk 71-year-old patient with a severely calcified ascending aorta. We successfully combined our minimally invasive surgical approach with the use of a percutaneous cerebral protection system commonly employed during TAVI procedures. We believe that cardiac surgeons could adopt transcatheter technology to improve operative results.
Collapse
Affiliation(s)
- Marco Di Eusanio
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Ospedali Riuniti di Ancona, Polytechnic University of Marche, Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Ospedali Riuniti di Ancona, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Ospedali Riuniti di Ancona, Polytechnic University of Marche, Ancona, Italy
| | - Filippo Capestro
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Ospedali Riuniti di Ancona, Polytechnic University of Marche, Ancona, Italy
| |
Collapse
|
229
|
Thosani A, Raina A, Liu E, Lasorda D, Chenarides J. Malpositioned endocardial left ventricular pacing lead extraction with transcatheter cerebral embolic protection in the setting of multiple prior embolic strokes. HeartRhythm Case Rep 2019; 5:552-554. [PMID: 31890572 PMCID: PMC6926233 DOI: 10.1016/j.hrcr.2019.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 12/03/2022] Open
Affiliation(s)
- Amit Thosani
- Address reprint requests and correspondence: Dr Amit Thosani, Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA 15212.
| | | | | | | | | |
Collapse
|
230
|
De Backer O, Butt JH, Wong YH, Torp-Pedersen C, Terkelsen CJ, Nissen H, Fosbøl EL, Køber L, Søndergaard L. Early and late risk of ischemic stroke after TAVR as compared to a nationwide background population. Clin Res Cardiol 2019; 109:791-801. [DOI: 10.1007/s00392-019-01565-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/18/2019] [Indexed: 11/29/2022]
|
231
|
Abstract
Evidence in transcatheter aortic valve replacement (TAVR) has accumulated rapidly over the last few years and its application to clinical decision making are becoming more important. In this review, we discuss the advances in TAVR for patient selection, expanding indications, complications, and emerging technologies.
Collapse
|
232
|
Cubero-Gallego H, Pascual I, Rozado J, Ayesta A, Hernandez-Vaquero D, Diaz R, Alperi A, Avanzas P, Moris C. Cerebral protection devices for transcatheter aortic valve replacement. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:584. [PMID: 31807565 DOI: 10.21037/atm.2019.09.25] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aortic stenosis is the most prevalent primary valve disease in developed countries. Its prevalence is increasing due to population aging. Transcatheter aortic valve replacement (TAVR) is a sterling therapy for symptomatic patients with severe aortic stenosis and high or intermediate surgery risk. The number of procedures has increased exponentially expanding to younger and lower risk patients. Despite new-generation TAVR devices and enhanced operator skills, cerebrovascular events (CVEs) carry on being one of the most severe complications, increasing morbi-mortality. CVE might be under reported because there are few studies with rigorous neurological clinical assessment. Several imaging studies show most of CVE after TAVR has a probable embolic etiology. The risk of CVE ranges from 2.7% to 5.5% at 30 days. As TAVR expands to younger and lower risk patients, the prevention of stroke plays an increasingly important role. Cerebral protection devices (CPD) were designed to reduce the risk of CVE during TAVR. This review describes the scientific evidence on CVE after TAVR and summarizes the performance and results of the main CPDs.
Collapse
Affiliation(s)
| | - Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Universidad de Oviedo, Departamento de Medicina, Oviedo, Spain
| | - José Rozado
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ana Ayesta
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Daniel Hernandez-Vaquero
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Rocio Diaz
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Alberto Alperi
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Universidad de Oviedo, Departamento de Medicina, Oviedo, Spain
| | - Cesar Moris
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Universidad de Oviedo, Departamento de Medicina, Oviedo, Spain
| |
Collapse
|
233
|
Durko AP, Reardon MJ, Kleiman NS, Popma JJ, Van Mieghem NM, Gleason TG, Bajwa T, O'Hair D, Brown DL, Ryan WH, Chang Y, De Leon SD, Kappetein AP. Neurological Complications After Transcatheter Versus Surgical Aortic Valve Replacement in Intermediate-Risk Patients. J Am Coll Cardiol 2019; 72:2109-2119. [PMID: 30360820 DOI: 10.1016/j.jacc.2018.07.093] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/19/2018] [Accepted: 07/30/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Neurological events after aortic valve interventions are associated with increased mortality and morbidity. Transcatheter aortic valve replacement (TAVR) is increasingly offered for lower-risk patients with severe aortic stenosis, previously considered candidates for surgical aortic valve replacement (SAVR). Differences in post-procedural neurological events have important implications in treatment allocation. OBJECTIVES The authors sought to analyze the neurological events in the randomized SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial. METHODS Patients with severe, symptomatic aortic stenosis at intermediate surgical risk were randomized 1:1 to TAVR or SAVR. The rates of neurological events and quality of life were analyzed at 30 days, and 6 and 12 months post-procedure in a modified intention-to-treat population (mean age 79.8 ± 6.2 years; N = 1,660). RESULTS The rates of early (30-day) stroke and post-procedural encephalopathy were higher after SAVR versus TAVR (5.4% vs. 3.3%; p = 0.031; and 7.8% vs. 1.6%; p < 0.001, respectively). At 12 months, the rate of stroke was not different between SAVR and TAVR (6.9% vs. 5.2%; p = 0.136). Early stroke and early encephalopathy resulted in an elevated mortality at 12 months in both treatment groups. Quality of life after an early stroke was significantly lower in SAVR versus TAVR patients at 30 days and was similar at 6 and 12 months. CONCLUSIONS The early stroke rate was lower after TAVR than SAVR. In patients with early strokes, QOL improved earlier after TAVR. At 12-month follow-up, stroke rates and QOL were not different between TAVR and SAVR patients. (Surgical Replacement and Transcatheter Aortic Valve Implantation [SURTAVI]; NCT01586910).
Collapse
Affiliation(s)
- Andras P Durko
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Michael J Reardon
- Departments of Cardiology and Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Neal S Kleiman
- Departments of Cardiology and Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | | | | | - Thomas G Gleason
- Department of Cardiovascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Tanvir Bajwa
- Departments of Cardiology and Cardiac Surgery, St. Luke's Medical Center/Aurora Health Care, Milwaukee, Wisconsin
| | - Daniel O'Hair
- Departments of Cardiology and Cardiac Surgery, St. Luke's Medical Center/Aurora Health Care, Milwaukee, Wisconsin
| | - David L Brown
- Departments of Cardiology and Cardiovascular Surgery, The Heart Hospital-Baylor Plano, Plano, Texas
| | - William H Ryan
- Departments of Cardiology and Cardiovascular Surgery, The Heart Hospital-Baylor Plano, Plano, Texas
| | - Yanping Chang
- Clinical and Statistical Services, Medtronic, Minneapolis, Minnesota
| | | | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands. https://twitter.com/AKappetein
| |
Collapse
|
234
|
Kapadia SR, Huded CP, Kodali SK, Svensson LG, Tuzcu EM, Baron SJ, Cohen DJ, Miller DC, Thourani VH, Herrmann HC, Mack MJ, Szerlip M, Makkar RR, Webb JG, Smith CR, Rajeswaran J, Blackstone EH, Leon MB. Stroke After Surgical Versus Transfemoral Transcatheter Aortic Valve Replacement in the PARTNER Trial. J Am Coll Cardiol 2019; 72:2415-2426. [PMID: 30442284 DOI: 10.1016/j.jacc.2018.08.2172] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/07/2018] [Accepted: 08/20/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transfemoral-transcatheter aortic valve replacement (TF-TAVR) is increasingly used to treat aortic stenosis, but risk of post-procedure stroke is uncertain. OBJECTIVES The purpose of this study was to assess stroke risk and its association with quality of life after surgical aortic valve replacement (SAVR) versus TF-TAVR. METHODS The authors performed a propensity-matched study of 1,204 pairs of patients with severe aortic stenosis treated with SAVR versus TF-TAVR in the PARTNER (Placement of AoRTic TraNscathetER Valves) trials from April 2007 to October 2014. Outcomes were: 1) 30-day neurological events; 2) time-varying risk of neurological events early (≤7 days) and late (7 days to 48 months) post-procedure; and 3) association between stroke and quality of life 1 year post-procedure by the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score. RESULTS Thirty-day stroke (5.1% vs. 3.7%; p = 0.09) was similar, but 30-day major stroke (3.9% vs. 2.2%; p = 0.018) was lower after TF-TAVR than SAVR. In both groups, risk of stroke peaked in the first post-procedure day, followed by a near-constant low-level risk to 48 months. Major stroke was associated with a decline in quality of life at 1 year in both SAVR (KCCQ score median [15th, 85th percentile]: 79 [53, 94] without major stroke vs. 64 [30, 94] with major stroke; p = 0.03) and TF-TAVR (78 [49, 96] without major stroke vs. 60 [8, 99] with major stroke; p = 0.04). CONCLUSIONS Despite similar early-peaking (<1 day post-procedure) neurological risk profiles, SAVR is associated with a higher risk of early major stroke than TF-TAVR. Periprocedural strategies are needed to reduce stroke risk after aortic valve procedures. (Placement of AoRTic TraNscathetER Valve Trial [PARTNER]; NCT00530894).
Collapse
Affiliation(s)
- Samir R Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
| | - Chetan P Huded
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Susheel K Kodali
- Department of Medicine, Division of Cardiology, Columbia University Medical Center/New York Presbyterian Hospital, New York, New York
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - E Murat Tuzcu
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Suzanne J Baron
- Department of Cardiology, Saint Luke's Health System, Kansas City, Missouri
| | - David J Cohen
- Department of Cardiology, Saint Luke's Health System, Kansas City, Missouri
| | - D Craig Miller
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC
| | - Howard C Herrmann
- Division of Cardiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Michael J Mack
- Department of Cardiovascular Surgery, Baylor Scott & White Health, Plano, Texas
| | - Molly Szerlip
- Department of Cardiology, Baylor Scott & White Health, Plano, Texas
| | - Raj R Makkar
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - John G Webb
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Craig R Smith
- Department of Surgery, Columbia University Medical Center/New York Presbyterian Hospital, New York, New York
| | | | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Martin B Leon
- Division of Cardiology, Columbia University Medical Center/New York Presbyterian Hospital, New York, New York
| | | |
Collapse
|
235
|
Permanent Percutaneous Carotid Artery Filter to Prevent Stroke in Atrial Fibrillation Patients. J Am Coll Cardiol 2019; 74:829-839. [DOI: 10.1016/j.jacc.2019.04.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/22/2022]
|
236
|
Rahhab Z, Labarre Q, Nijenhuis VJ, El Faquir N, de Biase C, Philippart R, Heijmen R, Kardys I, Dumonteil N, de Jaegere P, van der Heijden J, Tchetche D, Van Mieghem NM. Myocardial Injury Post Transcatheter Aortic Valve Implantation Comparing Mechanically Expanded Versus Self-Expandable Versus Balloon-Expandable Valves. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2019.1639234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Zouhair Rahhab
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Quentin Labarre
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | | | - Nahid El Faquir
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Chiara de Biase
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | | | - Robin Heijmen
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Peter de Jaegere
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan van der Heijden
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Didier Tchetche
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Nicolas M. Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
237
|
Linke A, Holzhey D, Möllmann H, Manoharan G, Schäfer U, Frerker C, Worthley SG, van Boven AJ, Redwood S, Kovac J, Butter C, Søndergaard L, Lauten A, Schymik G, Walther T. Treatment of Aortic Stenosis With a Self-Expanding, Resheathable Transcatheter Valve: One-Year Results of the International Multicenter Portico Transcatheter Aortic Valve Implantation System Study. Circ Cardiovasc Interv 2019; 11:e005206. [PMID: 29444998 DOI: 10.1161/circinterventions.117.005206] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 12/18/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aim of the Portico TAVI (transcatheter aortic valve implantation) system study was to evaluate outcomes ≤1 year after implantation of a novel resheathable, self-expanding TAVI system in a multicenter patient population with severe aortic stenosis (AS). METHODS AND RESULTS High-risk patients (n=222) with symptomatic severe AS (mean age, 83.0±4.6 years; 74.3% women) were enrolled across 12 centers in Europe and Australia. The study's primary end point was all-cause mortality at 30 days. A total of 209 patients who received the Portico TAVI system were available for follow-up after the 30-day visit. Data collection included hemodynamic assessment by echocardiography with core laboratory evaluation and assessment of functional status. Valve Academic Research Consortium-defined adverse events were adjudicated by an independent Clinical Events Committee. TAVI using the Portico valve led to a significant and persistent improvement in aortic valve function at 1 year. More than mild paravalvular leak was present in 5.7% and 7.5% of patients at 30 days and 1 year, respectively. Kaplan-Meier estimates at 30 days and 1 year were 3.6% and 13.8% for all-cause mortality, 3.6% and 9.6% for cardiovascular mortality, and 3.2% and 5.8% for major (disabling) stroke. After 30 days and ≤1 year of follow-up, adverse events included stage 3 acute kidney injury (n=3), major vascular complications (n=5), and life-threatening/disabling bleeding (n=3). Overall permanent pacemaker rate was 14.7%. At 1 year, 74.8% improved ≥1 New York Heart Association class compared with baseline (P<0.0001). CONCLUSIONS The Portico TAVI system is safe and effective at 1 year, yielding low mortality and stroke rates in high-risk patients with severe AS. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01493284.
Collapse
Affiliation(s)
- Axel Linke
- From the Technical University Dresden Heart Center, Germany (A.L); Herzzentrum Leipzig, Germany (D.H.); St. Johannes Hospital, Dortmund, Germany (H.M.); Royal Victoria Hospital, Belfast, United Kingdom (G.M.); University Heart Center Hamburg, Germany (U.S.); Asklepios Kliniken, Hamburg, Germany (C.F.); Genesis Care, Adelaide, Australia (S.G.W.); MC Leeuwarden, the Netherlands (A.J.v.B.); St Thomas' Hospital, London, United Kingdom (S.R.); Glenfield Hospital, Leicester, England (J.K.); Heart Center of Bernau, Germany (C.B.); Righospitalet, University of Copenhagen, Denmark (L.S.); Department of Cardiology, Charité-Universitaetsmedizin Berlin, Germany (A.L.); Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Germany (G.S.); and Universitat Frankfurt Zentrum der Chirurgie, Germany (T.W.).
| | - David Holzhey
- From the Technical University Dresden Heart Center, Germany (A.L); Herzzentrum Leipzig, Germany (D.H.); St. Johannes Hospital, Dortmund, Germany (H.M.); Royal Victoria Hospital, Belfast, United Kingdom (G.M.); University Heart Center Hamburg, Germany (U.S.); Asklepios Kliniken, Hamburg, Germany (C.F.); Genesis Care, Adelaide, Australia (S.G.W.); MC Leeuwarden, the Netherlands (A.J.v.B.); St Thomas' Hospital, London, United Kingdom (S.R.); Glenfield Hospital, Leicester, England (J.K.); Heart Center of Bernau, Germany (C.B.); Righospitalet, University of Copenhagen, Denmark (L.S.); Department of Cardiology, Charité-Universitaetsmedizin Berlin, Germany (A.L.); Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Germany (G.S.); and Universitat Frankfurt Zentrum der Chirurgie, Germany (T.W.)
| | - Helge Möllmann
- From the Technical University Dresden Heart Center, Germany (A.L); Herzzentrum Leipzig, Germany (D.H.); St. Johannes Hospital, Dortmund, Germany (H.M.); Royal Victoria Hospital, Belfast, United Kingdom (G.M.); University Heart Center Hamburg, Germany (U.S.); Asklepios Kliniken, Hamburg, Germany (C.F.); Genesis Care, Adelaide, Australia (S.G.W.); MC Leeuwarden, the Netherlands (A.J.v.B.); St Thomas' Hospital, London, United Kingdom (S.R.); Glenfield Hospital, Leicester, England (J.K.); Heart Center of Bernau, Germany (C.B.); Righospitalet, University of Copenhagen, Denmark (L.S.); Department of Cardiology, Charité-Universitaetsmedizin Berlin, Germany (A.L.); Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Germany (G.S.); and Universitat Frankfurt Zentrum der Chirurgie, Germany (T.W.)
| | - Ganesh Manoharan
- From the Technical University Dresden Heart Center, Germany (A.L); Herzzentrum Leipzig, Germany (D.H.); St. Johannes Hospital, Dortmund, Germany (H.M.); Royal Victoria Hospital, Belfast, United Kingdom (G.M.); University Heart Center Hamburg, Germany (U.S.); Asklepios Kliniken, Hamburg, Germany (C.F.); Genesis Care, Adelaide, Australia (S.G.W.); MC Leeuwarden, the Netherlands (A.J.v.B.); St Thomas' Hospital, London, United Kingdom (S.R.); Glenfield Hospital, Leicester, England (J.K.); Heart Center of Bernau, Germany (C.B.); Righospitalet, University of Copenhagen, Denmark (L.S.); Department of Cardiology, Charité-Universitaetsmedizin Berlin, Germany (A.L.); Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Germany (G.S.); and Universitat Frankfurt Zentrum der Chirurgie, Germany (T.W.)
| | - Ulrich Schäfer
- From the Technical University Dresden Heart Center, Germany (A.L); Herzzentrum Leipzig, Germany (D.H.); St. Johannes Hospital, Dortmund, Germany (H.M.); Royal Victoria Hospital, Belfast, United Kingdom (G.M.); University Heart Center Hamburg, Germany (U.S.); Asklepios Kliniken, Hamburg, Germany (C.F.); Genesis Care, Adelaide, Australia (S.G.W.); MC Leeuwarden, the Netherlands (A.J.v.B.); St Thomas' Hospital, London, United Kingdom (S.R.); Glenfield Hospital, Leicester, England (J.K.); Heart Center of Bernau, Germany (C.B.); Righospitalet, University of Copenhagen, Denmark (L.S.); Department of Cardiology, Charité-Universitaetsmedizin Berlin, Germany (A.L.); Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Germany (G.S.); and Universitat Frankfurt Zentrum der Chirurgie, Germany (T.W.)
| | - Christian Frerker
- From the Technical University Dresden Heart Center, Germany (A.L); Herzzentrum Leipzig, Germany (D.H.); St. Johannes Hospital, Dortmund, Germany (H.M.); Royal Victoria Hospital, Belfast, United Kingdom (G.M.); University Heart Center Hamburg, Germany (U.S.); Asklepios Kliniken, Hamburg, Germany (C.F.); Genesis Care, Adelaide, Australia (S.G.W.); MC Leeuwarden, the Netherlands (A.J.v.B.); St Thomas' Hospital, London, United Kingdom (S.R.); Glenfield Hospital, Leicester, England (J.K.); Heart Center of Bernau, Germany (C.B.); Righospitalet, University of Copenhagen, Denmark (L.S.); Department of Cardiology, Charité-Universitaetsmedizin Berlin, Germany (A.L.); Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Germany (G.S.); and Universitat Frankfurt Zentrum der Chirurgie, Germany (T.W.)
| | - Stephen G Worthley
- From the Technical University Dresden Heart Center, Germany (A.L); Herzzentrum Leipzig, Germany (D.H.); St. Johannes Hospital, Dortmund, Germany (H.M.); Royal Victoria Hospital, Belfast, United Kingdom (G.M.); University Heart Center Hamburg, Germany (U.S.); Asklepios Kliniken, Hamburg, Germany (C.F.); Genesis Care, Adelaide, Australia (S.G.W.); MC Leeuwarden, the Netherlands (A.J.v.B.); St Thomas' Hospital, London, United Kingdom (S.R.); Glenfield Hospital, Leicester, England (J.K.); Heart Center of Bernau, Germany (C.B.); Righospitalet, University of Copenhagen, Denmark (L.S.); Department of Cardiology, Charité-Universitaetsmedizin Berlin, Germany (A.L.); Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Germany (G.S.); and Universitat Frankfurt Zentrum der Chirurgie, Germany (T.W.)
| | - A J van Boven
- From the Technical University Dresden Heart Center, Germany (A.L); Herzzentrum Leipzig, Germany (D.H.); St. Johannes Hospital, Dortmund, Germany (H.M.); Royal Victoria Hospital, Belfast, United Kingdom (G.M.); University Heart Center Hamburg, Germany (U.S.); Asklepios Kliniken, Hamburg, Germany (C.F.); Genesis Care, Adelaide, Australia (S.G.W.); MC Leeuwarden, the Netherlands (A.J.v.B.); St Thomas' Hospital, London, United Kingdom (S.R.); Glenfield Hospital, Leicester, England (J.K.); Heart Center of Bernau, Germany (C.B.); Righospitalet, University of Copenhagen, Denmark (L.S.); Department of Cardiology, Charité-Universitaetsmedizin Berlin, Germany (A.L.); Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Germany (G.S.); and Universitat Frankfurt Zentrum der Chirurgie, Germany (T.W.)
| | - Simon Redwood
- From the Technical University Dresden Heart Center, Germany (A.L); Herzzentrum Leipzig, Germany (D.H.); St. Johannes Hospital, Dortmund, Germany (H.M.); Royal Victoria Hospital, Belfast, United Kingdom (G.M.); University Heart Center Hamburg, Germany (U.S.); Asklepios Kliniken, Hamburg, Germany (C.F.); Genesis Care, Adelaide, Australia (S.G.W.); MC Leeuwarden, the Netherlands (A.J.v.B.); St Thomas' Hospital, London, United Kingdom (S.R.); Glenfield Hospital, Leicester, England (J.K.); Heart Center of Bernau, Germany (C.B.); Righospitalet, University of Copenhagen, Denmark (L.S.); Department of Cardiology, Charité-Universitaetsmedizin Berlin, Germany (A.L.); Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Germany (G.S.); and Universitat Frankfurt Zentrum der Chirurgie, Germany (T.W.)
| | - Jan Kovac
- From the Technical University Dresden Heart Center, Germany (A.L); Herzzentrum Leipzig, Germany (D.H.); St. Johannes Hospital, Dortmund, Germany (H.M.); Royal Victoria Hospital, Belfast, United Kingdom (G.M.); University Heart Center Hamburg, Germany (U.S.); Asklepios Kliniken, Hamburg, Germany (C.F.); Genesis Care, Adelaide, Australia (S.G.W.); MC Leeuwarden, the Netherlands (A.J.v.B.); St Thomas' Hospital, London, United Kingdom (S.R.); Glenfield Hospital, Leicester, England (J.K.); Heart Center of Bernau, Germany (C.B.); Righospitalet, University of Copenhagen, Denmark (L.S.); Department of Cardiology, Charité-Universitaetsmedizin Berlin, Germany (A.L.); Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Germany (G.S.); and Universitat Frankfurt Zentrum der Chirurgie, Germany (T.W.)
| | - Christian Butter
- From the Technical University Dresden Heart Center, Germany (A.L); Herzzentrum Leipzig, Germany (D.H.); St. Johannes Hospital, Dortmund, Germany (H.M.); Royal Victoria Hospital, Belfast, United Kingdom (G.M.); University Heart Center Hamburg, Germany (U.S.); Asklepios Kliniken, Hamburg, Germany (C.F.); Genesis Care, Adelaide, Australia (S.G.W.); MC Leeuwarden, the Netherlands (A.J.v.B.); St Thomas' Hospital, London, United Kingdom (S.R.); Glenfield Hospital, Leicester, England (J.K.); Heart Center of Bernau, Germany (C.B.); Righospitalet, University of Copenhagen, Denmark (L.S.); Department of Cardiology, Charité-Universitaetsmedizin Berlin, Germany (A.L.); Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Germany (G.S.); and Universitat Frankfurt Zentrum der Chirurgie, Germany (T.W.)
| | - Lars Søndergaard
- From the Technical University Dresden Heart Center, Germany (A.L); Herzzentrum Leipzig, Germany (D.H.); St. Johannes Hospital, Dortmund, Germany (H.M.); Royal Victoria Hospital, Belfast, United Kingdom (G.M.); University Heart Center Hamburg, Germany (U.S.); Asklepios Kliniken, Hamburg, Germany (C.F.); Genesis Care, Adelaide, Australia (S.G.W.); MC Leeuwarden, the Netherlands (A.J.v.B.); St Thomas' Hospital, London, United Kingdom (S.R.); Glenfield Hospital, Leicester, England (J.K.); Heart Center of Bernau, Germany (C.B.); Righospitalet, University of Copenhagen, Denmark (L.S.); Department of Cardiology, Charité-Universitaetsmedizin Berlin, Germany (A.L.); Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Germany (G.S.); and Universitat Frankfurt Zentrum der Chirurgie, Germany (T.W.)
| | - Alexander Lauten
- From the Technical University Dresden Heart Center, Germany (A.L); Herzzentrum Leipzig, Germany (D.H.); St. Johannes Hospital, Dortmund, Germany (H.M.); Royal Victoria Hospital, Belfast, United Kingdom (G.M.); University Heart Center Hamburg, Germany (U.S.); Asklepios Kliniken, Hamburg, Germany (C.F.); Genesis Care, Adelaide, Australia (S.G.W.); MC Leeuwarden, the Netherlands (A.J.v.B.); St Thomas' Hospital, London, United Kingdom (S.R.); Glenfield Hospital, Leicester, England (J.K.); Heart Center of Bernau, Germany (C.B.); Righospitalet, University of Copenhagen, Denmark (L.S.); Department of Cardiology, Charité-Universitaetsmedizin Berlin, Germany (A.L.); Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Germany (G.S.); and Universitat Frankfurt Zentrum der Chirurgie, Germany (T.W.)
| | - Gerhard Schymik
- From the Technical University Dresden Heart Center, Germany (A.L); Herzzentrum Leipzig, Germany (D.H.); St. Johannes Hospital, Dortmund, Germany (H.M.); Royal Victoria Hospital, Belfast, United Kingdom (G.M.); University Heart Center Hamburg, Germany (U.S.); Asklepios Kliniken, Hamburg, Germany (C.F.); Genesis Care, Adelaide, Australia (S.G.W.); MC Leeuwarden, the Netherlands (A.J.v.B.); St Thomas' Hospital, London, United Kingdom (S.R.); Glenfield Hospital, Leicester, England (J.K.); Heart Center of Bernau, Germany (C.B.); Righospitalet, University of Copenhagen, Denmark (L.S.); Department of Cardiology, Charité-Universitaetsmedizin Berlin, Germany (A.L.); Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Germany (G.S.); and Universitat Frankfurt Zentrum der Chirurgie, Germany (T.W.)
| | - Thomas Walther
- From the Technical University Dresden Heart Center, Germany (A.L); Herzzentrum Leipzig, Germany (D.H.); St. Johannes Hospital, Dortmund, Germany (H.M.); Royal Victoria Hospital, Belfast, United Kingdom (G.M.); University Heart Center Hamburg, Germany (U.S.); Asklepios Kliniken, Hamburg, Germany (C.F.); Genesis Care, Adelaide, Australia (S.G.W.); MC Leeuwarden, the Netherlands (A.J.v.B.); St Thomas' Hospital, London, United Kingdom (S.R.); Glenfield Hospital, Leicester, England (J.K.); Heart Center of Bernau, Germany (C.B.); Righospitalet, University of Copenhagen, Denmark (L.S.); Department of Cardiology, Charité-Universitaetsmedizin Berlin, Germany (A.L.); Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Germany (G.S.); and Universitat Frankfurt Zentrum der Chirurgie, Germany (T.W.)
| |
Collapse
|
238
|
Ray HM, Al Rstum Z, Saqib NU. Successful cerebral protection during removal of large right atrial thrombus with AngioVac in a patient with patent foramen ovale and recent embolic stroke. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:201-204. [PMID: 31289763 PMCID: PMC6593228 DOI: 10.1016/j.jvscit.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/04/2019] [Indexed: 12/16/2022]
Abstract
Complications associated with central venous catheterization include deep venous thrombosis and atrial thrombi, among others. Large thrombi, including intracardiac thrombi, have classically been managed medically or with open surgery. However, recent reports detail the utility of the AngioVac system (AngioDynamics, Latham, NY), a vacuum-assisted suction thrombectomy system using a venous-venous extracorporeal circuit. Here, we present the case of a critically ill woman with large right atrial thrombus, patent foramen ovale, and recent embolic stroke who underwent successful vacuum-assisted suction thrombectomy with use of the Sentinel Cerebral Protection System (Boston Scientific, Marlborough, Mass) for stroke prevention.
Collapse
Affiliation(s)
- Hunter M Ray
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Tex
| | - Zain Al Rstum
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Tex
| | - Naveed U Saqib
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Tex
| |
Collapse
|
239
|
Khan JM, Greenbaum AB, Babaliaros VC, Rogers T, Eng MH, Paone G, Leshnower BG, Reisman M, Satler L, Waksman R, Chen MY, Stine AM, Tian X, Dvir D, Lederman RJ. The BASILICA Trial: Prospective Multicenter Investigation of Intentional Leaflet Laceration to Prevent TAVR Coronary Obstruction. JACC Cardiovasc Interv 2019; 12:1240-1252. [PMID: 31202947 PMCID: PMC6669893 DOI: 10.1016/j.jcin.2019.03.035] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/20/2019] [Accepted: 03/11/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The BASILICA (Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction during TAVR) investigational device exemption trial was a prospective, multicenter, single-arm safety and feasibility study. BACKGROUND Coronary artery obstruction is a rare but devastating complication of transcatheter aortic valve replacement (TAVR). Current stent-based preventative strategies are suboptimal. Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR (BASILICA) is a novel transcatheter technique performed immediately before TAVR to prevent coronary artery obstruction. METHODS Subjects with severe native or bioprosthetic aortic valve disease at high or extreme risk for surgery, and at high risk of coronary artery obstruction, were included. The primary success endpoint was successful BASILICA and TAVR without coronary obstruction or reintervention. The primary safety endpoint was freedom from major adverse cardiovascular events. Data were independently monitored. Endpoints were independently adjudicated. A core laboratory analyzed computed tomography images. RESULTS Between February 2018 and July 2018, 30 subjects were enrolled. Primary success was met in 28 (93%) subjects. BASILICA traversal and laceration was successful in 35 of 37 (95%) attempted leaflets. There was 100% freedom from coronary obstruction and reintervention. Primary safety was met in 21 (70%), driven by 6 (20%) major vascular complications related to TAVR but not BASILICA. There was 1 death at 30 days. There was 1 (3%) disabling stroke and 2 (7%) nondisabling strokes. Transient hemodynamic compromise was rare (7%) and resolved promptly with TAVR. CONCLUSIONS BASILICA was feasible in both native and bioprosthetic valves. Hemodynamic compromise was uncommon. Safety was acceptable and needs confirmation in larger studies. BASILICA appears effective in preventing coronary artery obstruction from TAVR in subjects at high risk.
Collapse
Affiliation(s)
- Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Adam B Greenbaum
- Center for Structural Heart Disease, Division of Cardiology, and Division of Cardiac Surgery, Henry Ford Health System, Detroit, Michigan; Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
| | | | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Medstar Washington Hospital Center, Washington, DC
| | - Marvin H Eng
- Center for Structural Heart Disease, Division of Cardiology, and Division of Cardiac Surgery, Henry Ford Health System, Detroit, Michigan
| | - Gaetano Paone
- Center for Structural Heart Disease, Division of Cardiology, and Division of Cardiac Surgery, Henry Ford Health System, Detroit, Michigan
| | - Bradley G Leshnower
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
| | | | | | - Ron Waksman
- Medstar Washington Hospital Center, Washington, DC
| | - Marcus Y Chen
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Annette M Stine
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Xin Tian
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Danny Dvir
- University of Washington, Seattle, Washington
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
| |
Collapse
|
240
|
Tabata N, Sinning JM, Kaikita K, Tsujita K, Nickenig G, Werner N. Current status and future perspective of structural heart disease intervention. J Cardiol 2019; 74:1-12. [DOI: 10.1016/j.jjcc.2019.02.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
|
241
|
Huded CP, Tuzcu EM, Krishnaswamy A, Mick SL, Kleiman NS, Svensson LG, Carroll J, Thourani VH, Kirtane AJ, Manandhar P, Kosinski AS, Vemulapalli S, Kapadia SR. Association Between Transcatheter Aortic Valve Replacement and Early Postprocedural Stroke. JAMA 2019; 321:2306-2315. [PMID: 31211345 PMCID: PMC6582268 DOI: 10.1001/jama.2019.7525] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Reducing postprocedural stroke is important to improve the safety of transcatheter aortic valve replacement (TAVR). OBJECTIVE This study evaluated the trends of stroke occurring within 30 days after the procedure during the first 5 years TAVR was used in the United States, the association of stroke with 30-day mortality, and the association of medical therapy with 30-day stroke risk. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study including 101 430 patients who were treated with femoral and nonfemoral TAVR at 521 US hospitals in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry from November 9, 2011, through May 31, 2017. Thirty-day follow-up ended June 30, 2017. EXPOSURES TAVR. MAIN OUTCOMES AND MEASURES The rates of 30-day transient ischemic attack and stroke were assessed. Association of stroke with 30-day mortality and association of antithrombotic medical therapies with postdischarge 30-day stroke were assessed with a Cox proportional hazards model and propensity-score matching, respectively. RESULTS Among 101 430 patients included in the study (median age, 83 years [interquartile range {IQR}, 76-87 years]; 47 797 women [47.1%]; and 85 147 patients [83.9%] treated via femoral access), 30-day postprocedure follow-up data was assessed in all patients. At day 30, there were 2290 patients (2.3%) with a stroke of any kind (95% CI, 2.2%-2.4%), and 373 patients (0.4%) with transient ischemic attacks (95% CI, 0.3%-0.4%) . During the study period, 30-day stroke rates were stable without an increasing or decreasing trend in all patients (P for trend = .22) and in the large femoral access subgroup (P trend = .47). Among cases of stroke within 30 days, 1119 strokes (48.9%) occurred within the first day and 1567 (68.4%) within 3 days following TAVR. The occurrence of stroke was associated with a significant increase in 30-day mortality: 383 patients (16.7%) of 2290 who had a stroke vs 3662 patients (3.7%) of 99 140 who did not have a stroke died (P < .001; risk-adjusted hazard ratio [HR], 6.1 [95% CI, 5.4-6.8]; P < .001). After propensity-score matching, 30-day stroke risk was not associated with whether patients in the femoral cohort were (0.55%) or were not (0.52%) treated with dual antiplatelet therapy at hospital discharge (HR, 1.04; 95% CI, 0.74-1.46) nor was it associated with whether patients in the nonfemoral cohort were (0.71%) or were not (0.69%) treated with dual antiplatelet therapy (HR, 1.02; 95% CI, 0.54-1.95). Similarly, 30-day stroke risk was not associated with whether patients in the femoral cohort were (0.57%) or were not (0.55) treated with oral anticoagulant therapy at hospital discharge (HR, 1.03; 95% CI, 0.73-1.46) nor was it associated with whether patients in the nonfemoral cohort were (0.75%) or were not (0.82%) treated with an oral anticoagulant (HR, 0.93; 95% CI, 0.47-1.83). CONCLUSIONS AND RELEVANCE Between 2011 and 2017, the rate of 30-day stroke following transcatheter aortic valve replacement in a US registry population remained stable.
Collapse
Affiliation(s)
- Chetan P. Huded
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - E. Murat Tuzcu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephanie L. Mick
- Department of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic, Ohio
| | - Neal S. Kleiman
- Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Lars G. Svensson
- Department of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic, Ohio
| | - John Carroll
- Division of Cardiology, Department of Medicine,University of Colorado Hospital, Denver
| | - Vinod H. Thourani
- Department of Cardiac Surgery, Medstar Heart and Vascular Institute and Georgetown University School of Medicine, Washington, DC
| | - Ajay J. Kirtane
- Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital, New York
| | - Pratik Manandhar
- Duke University Clinical Research Institute, Duke Medical Center, Durham, North Carolina
| | - Andrzej S. Kosinski
- Duke University Clinical Research Institute, Duke Medical Center, Durham, North Carolina
| | - Sreekanth Vemulapalli
- Duke University Clinical Research Institute, Duke Medical Center, Durham, North Carolina
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
242
|
Messé SR, Ailawadi G. Stroke After Transcatheter Aortic Valve Replacement: An Important but Underreported Outcome in Clinical Practice. JAMA 2019; 321:2287-2289. [PMID: 31211329 DOI: 10.1001/jama.2019.8613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Steven R Messé
- Division of Vascular Neurology, University of Pennsylvania, Philadelphia
| | - Gorav Ailawadi
- Division of Cardiac Surgery, University of Virginia, Charlottesville
| |
Collapse
|
243
|
Kroon HG, van der Werf HW, Hoeks SE, van Gils L, van den Berge FR, El Faquir N, Rahhab Z, Daemen J, Poelman J, Schurer RAJ, van den Heuvel A, de Jaegere P, van der Harst P, Van Mieghem NM. Early Clinical Impact of Cerebral Embolic Protection in Patients Undergoing Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2019; 12:e007605. [PMID: 31195822 DOI: 10.1161/circinterventions.118.007605] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background We aimed to compare the rate of neurological events in patients with or without cerebral embolic protection (CEP) during transcatheter aortic valve replacement (TAVR). Methods and Results Data on clinical end points including neurological events ≤30 days post-TAVR were collected for all patients who underwent transfemoral TAVR in 2 academic tertiary care institutions. Patients were matched through propensity scoring, which resulted in 333 pairs of patients with versus without CEP out of a total of 831 consecutive patients. The median age was 81 (76-85) years, and the median logistic EuroScore was 14% (9%-20%). The CEP group experienced less neurological events at 24 hours (1% versus 4%; P=0.035) and at 30 days (3% versus 7%; P=0.029). There were significantly more disabling strokes in unprotected patients at 30 days (1% versus 4%; P=0.039). CEP was associated with significantly fewer neurological events at 24 hours after TAVR (odds ratio, 0.20; 95% CI, 0.06-0.73; P=0.015) by multiple regression analysis, while age and valve type did not contribute significantly. Overall, 67% (2 of 3) in the CEP versus 83% (10 of 12) in the non-CEP cohort experienced neurological events in protected areas (ie, not dependent on the left vertebral artery). Conclusions The use of filter-based CEP during TAVR was associated with less neurological events, especially in CEP-protected brain territories.
Collapse
Affiliation(s)
- Herbert G Kroon
- Department of Cardiology (H.G.K., L.v.G., F.R.v.d.B., N.E.F., Z.R., J.D., P.d.J., N.M.V.M.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hindrik W van der Werf
- Department of Cardiology, University Medical Center Groningen, the Netherlands (H.W.v.d.W., R.A.J.S., A.v.d.H., P.v.d.H., J.P.)
| | - Sanne E Hoeks
- Department of Anaesthesiology/Epidemiology (S.E.H.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lennart van Gils
- Department of Cardiology (H.G.K., L.v.G., F.R.v.d.B., N.E.F., Z.R., J.D., P.d.J., N.M.V.M.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fauve R van den Berge
- Department of Cardiology (H.G.K., L.v.G., F.R.v.d.B., N.E.F., Z.R., J.D., P.d.J., N.M.V.M.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nahid El Faquir
- Department of Cardiology (H.G.K., L.v.G., F.R.v.d.B., N.E.F., Z.R., J.D., P.d.J., N.M.V.M.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Zouhair Rahhab
- Department of Cardiology (H.G.K., L.v.G., F.R.v.d.B., N.E.F., Z.R., J.D., P.d.J., N.M.V.M.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology (H.G.K., L.v.G., F.R.v.d.B., N.E.F., Z.R., J.D., P.d.J., N.M.V.M.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Janny Poelman
- Department of Cardiology, University Medical Center Groningen, the Netherlands (H.W.v.d.W., R.A.J.S., A.v.d.H., P.v.d.H., J.P.)
| | - Remco A J Schurer
- Department of Cardiology, University Medical Center Groningen, the Netherlands (H.W.v.d.W., R.A.J.S., A.v.d.H., P.v.d.H., J.P.)
| | - Ad van den Heuvel
- Department of Cardiology, University Medical Center Groningen, the Netherlands (H.W.v.d.W., R.A.J.S., A.v.d.H., P.v.d.H., J.P.)
| | - Peter de Jaegere
- Department of Cardiology (H.G.K., L.v.G., F.R.v.d.B., N.E.F., Z.R., J.D., P.d.J., N.M.V.M.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Groningen, the Netherlands (H.W.v.d.W., R.A.J.S., A.v.d.H., P.v.d.H., J.P.)
| | - Nicolas M Van Mieghem
- Department of Cardiology (H.G.K., L.v.G., F.R.v.d.B., N.E.F., Z.R., J.D., P.d.J., N.M.V.M.), Erasmus University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
244
|
Valvo R, Costa G, Tamburino C, Barbanti M. Antithrombotic Therapy in Transcatheter Aortic Valve Replacement. Front Cardiovasc Med 2019; 6:73. [PMID: 31214599 PMCID: PMC6554284 DOI: 10.3389/fcvm.2019.00073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 05/15/2019] [Indexed: 11/13/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has recently emerged as an effective alternative to medical treatment or surgical aortic valve replacement in all symptomatic patients with severe aortic stenosis and high or prohibitive risk and in intermediate risk when transfemoral access is feasible. Patients undergoing TAVR are often at high risk for either bleeding or cerebrovascular complications, or both, so adjuvant antithrombotic therapies are commonly used before, during and after the procedure. Today, there is no clear evidence on the best antithrombotic regimen in this context. In this review, we will try to go through the mechanisms involved in bleeding and embolic complications and we will discuss the current points of antithrombotic treatment in patients during and after TAVR, with or without oral anticoagulation (OAC) indication.
Collapse
Affiliation(s)
| | | | | | - Marco Barbanti
- Division of Cardiology, Policlinico–Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| |
Collapse
|
245
|
Voss S, Deutsch MA, Schechtl J, Erlebach M, Sideris K, Lange R, Bleiziffer S. Impact of a Two-Filter Cerebral Embolic Protection Device on the Complexity and Risk of Transcatheter Aortic Valve Replacement. Thorac Cardiovasc Surg 2019; 68:616-622. [PMID: 31091551 DOI: 10.1055/s-0039-1688483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is a growing use of cerebral protection devices in patients undergoing transcatheter aortic valve replacement (TAVR). We aimed to analyze if the use of these devices itself has an impact on the complexity and the risk of TAVR. METHODS Between February 2016 and July 2017, 391 patients underwent transfemoral TAVR with Medtronic CoreValve Evolut R (n = 196) or Edwards Sapien 3 (n = 195). In 39 patients, the Claret Sentinel™ embolic protection device (CS-EPD) was used. Prospectively collected data were retrospectively analyzed, comparing fluoroscopy/operation time, amount of contrast used, vascular events, and postprocedural renal function in TAVR patients with (n = 39) and without (n = 352) CS-EPD. RESULTS The CS-EPD was placed through the right radial (n = 35) or brachial (n = 4) artery. Procedural success rate defined as correct deployment and retraction of both filters was 94.9%. No device-related vascular complications occurred. TAVR patients with CS-EPD showed a significantly higher total operation time, total fluoroscopy time, and amount of used contrast (85.4 ± 39.3 vs. 64 ± 29.8 minutes, p = 0.002; 20.7 ± 9.3 vs. 13.7 ± 7 minutes, p ≤ 0.001; 133.7 ± 42.6 vs. 109.7 ± 44.5 mL, p = 0.001). Comparing the initial third of patients receiving a CS-EPD with the last third of CS-EPD cases, procedural time had decreased significantly (102.5 ± 34.9 vs. 67 ± 11.9; p = 0.002). There were no differences in postprocedural renal failure (p = 0.80). CONCLUSION Our data add evidence that the application of the CS-EPD is not associated with an additional risk for the patient. Although procedural time and amount of contrast are still higher when using the CS-EPD, there were no device-related complications or increased incidence of renal failure.
Collapse
Affiliation(s)
- Stephanie Voss
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Institute of Translational Cardiac Surgery (Insure), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Marcus-André Deutsch
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Institute of Translational Cardiac Surgery (Insure), German Heart Center Munich, Technische Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Johanna Schechtl
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Institute of Translational Cardiac Surgery (Insure), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Magdalena Erlebach
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Institute of Translational Cardiac Surgery (Insure), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Konstantinos Sideris
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Institute of Translational Cardiac Surgery (Insure), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Institute of Translational Cardiac Surgery (Insure), German Heart Center Munich, Technische Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Sabine Bleiziffer
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Institute of Translational Cardiac Surgery (Insure), German Heart Center Munich, Technische Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Munich, Germany
| |
Collapse
|
246
|
Pagnesi M, Regazzoli D, Ancona MB, Mangieri A, Lanzillo G, Giannini F, Buzzatti N, Prendergast BD, Kodali S, Lansky AJ, Colombo A, Latib A. Cerebral Embolic Risk During Transcatheter Mitral Valve Interventions: An Unaddressed and Unmet Clinical Need? JACC Cardiovasc Interv 2019; 11:517-528. [PMID: 29566796 DOI: 10.1016/j.jcin.2017.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/04/2017] [Accepted: 12/12/2017] [Indexed: 10/17/2022]
Abstract
As new transcatheter mitral valve (MV) interventions continuously evolve, potential procedure-related adverse events demand careful investigation. The risk of cerebral embolic damage is ubiquitous in any left-sided structural heart intervention (and potentially linked to long-term neurocognitive sequelae); therefore, efforts to evaluate these aspects in the field of catheter-based MV procedures are justified. Given the peculiarities of MV anatomy, MV disease, and MV procedures, the lessons learned from other transcatheter heart interventions (i.e., transcatheter aortic valve replacement) cannot be directly translated to MV applications. Through a systematic assessment of available evidence, the authors present and discuss procedure- and patient-related factors potentially associated with cerebral embolic risk during catheter-based MV interventions. Given the paucity of available data in this field, future large, dedicated studies are needed to understand whether cerebral embolic injury represents a real clinical issue during MV procedures.
Collapse
Affiliation(s)
- Matteo Pagnesi
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Regazzoli
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Lanzillo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiovascular and Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | | | - Susheel Kodali
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Alexandra J Lansky
- Division of Cardiovascular Medicine and Yale Cardiovascular Research Group, Yale University School of Medicine, New Haven, Connecticut; Department of Cardiology, St Bartholomew's Hospital and William Harvey Research Institute and Queen Mary University of London, London, United Kingdom
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
| |
Collapse
|
247
|
Williams JV, Flynn Makic MB. Postoperative Care for Transcatheter Aortic Valve Replacement. J Perianesth Nurs 2019; 34:431-434. [PMID: 30819598 DOI: 10.1016/j.jopan.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/31/2018] [Indexed: 11/28/2022]
|
248
|
Vlastra W, Jimenez-Quevedo P, Tchétché D, Chandrasekhar J, de Brito FS, Barbanti M, Kornowski R, Latib A, D’Onofrio A, Ribichini F, Baan J, Tijssen JG, De la Torre Hernandez JM, Dumonteil N, Sarmento-Leite R, Sartori S, Rosato S, Tarantini G, Lunardi M, Orvin K, Pagnesi M, Hernandez-Antolin R, Modine T, Dangas G, Mehran R, Piek JJ, Delewi R. Predictors, Incidence, and Outcomes of Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation Complicated by Stroke. Circ Cardiovasc Interv 2019; 12:e007546. [DOI: 10.1161/circinterventions.118.007546] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wieneke Vlastra
- Heart Center, Amsterdam, the Netherlands (W.V., J.C., J.B., J.G.P.T., J.J.P., R.D.)
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (W.V., J.C., J.B., J.G.P.T., J.J.P., R.D.)
| | | | | | - Jaya Chandrasekhar
- Heart Center, Amsterdam, the Netherlands (W.V., J.C., J.B., J.G.P.T., J.J.P., R.D.)
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (W.V., J.C., J.B., J.G.P.T., J.J.P., R.D.)
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.C., S.S., G.D., R.M.)
| | - Fabio S. de Brito
- Heart Institute (InCor), University of São Paulo Medical School, Brazil (F.S.d.B.)
| | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Italy (M.B.)
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petach Tikva, Israel (R.K., K.O.)
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.L., M.P.)
| | - Augusto D’Onofrio
- Interventional Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (A.D., G.T.)
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Italy (F.R., M.L.)
| | - Jan Baan
- Heart Center, Amsterdam, the Netherlands (W.V., J.C., J.B., J.G.P.T., J.J.P., R.D.)
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (W.V., J.C., J.B., J.G.P.T., J.J.P., R.D.)
| | - Jan G.P. Tijssen
- Heart Center, Amsterdam, the Netherlands (W.V., J.C., J.B., J.G.P.T., J.J.P., R.D.)
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (W.V., J.C., J.B., J.G.P.T., J.J.P., R.D.)
| | | | | | | | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.C., S.S., G.D., R.M.)
| | - S. Rosato
- National Centre for Global Helath, Istituto Superiore di Sanità, Rome, Italy (S.R.)
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (A.D., G.T.)
| | - Mattia Lunardi
- Division of Cardiology, Department of Medicine, University of Verona, Italy (F.R., M.L.)
| | - Katia Orvin
- Cardiology Department, Rabin Medical Center, Petach Tikva, Israel (R.K., K.O.)
| | - Matteo Pagnesi
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.L., M.P.)
| | | | - Thomas Modine
- Centre Hospitalier Universitaire, Lille, France (T.M.)
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.C., S.S., G.D., R.M.)
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.C., S.S., G.D., R.M.)
| | - Jan J. Piek
- Heart Center, Amsterdam, the Netherlands (W.V., J.C., J.B., J.G.P.T., J.J.P., R.D.)
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (W.V., J.C., J.B., J.G.P.T., J.J.P., R.D.)
| | - Ronak Delewi
- Heart Center, Amsterdam, the Netherlands (W.V., J.C., J.B., J.G.P.T., J.J.P., R.D.)
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (W.V., J.C., J.B., J.G.P.T., J.J.P., R.D.)
| |
Collapse
|
249
|
|
250
|
Teitelbaum M, Kotronias RA, Sposato LA, Bagur R. Cerebral Embolic Protection in TAVI: Friend or Foe. ACTA ACUST UNITED AC 2019; 14:22-25. [PMID: 30858888 PMCID: PMC6406126 DOI: 10.15420/icr.2018.32.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Cerebrovascular accidents including stroke or transient ischaemic attack are one of the most feared complications after transcatheter aortic valve implantation. Transcatheter aortic valve implantation procedures have been consistently associated with silent ischaemic cerebral embolism as assessed by diffusion-weighted MRI. To reduce the risk of cerebrovascular accidents and silent emboli, cerebral embolic protection devices were developed with the aim of preventing procedural debris reaching the cerebral vasculature. The authors summarise the available data regarding cerebral embolic protection devices and its clinical significance.
Collapse
Affiliation(s)
| | - Rafail A Kotronias
- Oxford University Clinical Academic Graduate School, University of Oxford Oxford, UK.,Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust Oxford, UK.,Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele Stoke-on-Trent, UK
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, Stroke, Dementia & Heart Disease Laboratory London, Ontario, Canada
| | - Rodrigo Bagur
- London Health Sciences Centre London, Ontario, Canada.,Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele Stoke-on-Trent, UK.,Department of Epidemiology and Biostatistics, Western University London, Ontario, Canada
| |
Collapse
|