301
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302
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Pineda AM, Bass TA. Challenges for Expanded Use of Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.006208. [PMID: 29246922 DOI: 10.1161/circinterventions.117.006208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andres M Pineda
- From the Division of Cardiology, University of Florida College of Medicine-Jacksonville
| | - Theodore A Bass
- From the Division of Cardiology, University of Florida College of Medicine-Jacksonville.
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303
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Gallo M, Putzu A, Conti M, Pedrazzini G, Demertzis S, Ferrari E. Embolic protection devices for transcatheter aortic valve replacement. Eur J Cardiothorac Surg 2017; 53:1118-1126. [DOI: 10.1093/ejcts/ezx457] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/12/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michele Gallo
- Department of Cardiac Surgery, Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - Alessandro Putzu
- Department of Cardiac Anaesthesia, Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - Michele Conti
- Department of Engineering, University of Pavia, Pavia, Italy
| | - Giovanni Pedrazzini
- Department of Cardiology, Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - Stefanos Demertzis
- Department of Cardiac Surgery, Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - Enrico Ferrari
- Department of Cardiac Surgery, Cardiocentro Ticino Foundation, Lugano, Switzerland
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304
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Zukunft der Transkatheter-Aortenklappenimplantation. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-017-0160-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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305
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Perrin N, Noble S. Insight from a large real-world cohort of patients: does it confirm the results of the randomized trials? ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:495. [PMID: 29299456 PMCID: PMC5750276 DOI: 10.21037/atm.2017.10.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Nils Perrin
- Division of Cardiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Stéphane Noble
- Division of Cardiology, University Hospitals of Geneva, Geneva, Switzerland
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306
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Vernikouskaya I, Rottbauer W, Gonska B, Rodewald C, Seeger J, Rasche V, Wöhrle J. Image-guidance for transcatheter aortic valve implantation (TAVI) and cerebral embolic protection. Int J Cardiol 2017; 249:90-95. [DOI: 10.1016/j.ijcard.2017.09.158] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/26/2017] [Accepted: 09/15/2017] [Indexed: 11/25/2022]
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307
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Mahtta D, Elgendy IY, Bavry AA. From CoreValve to Evolut PRO: Reviewing the Journey of Self-Expanding Transcatheter Aortic Valves. Cardiol Ther 2017; 6:183-192. [PMID: 29080095 PMCID: PMC5688966 DOI: 10.1007/s40119-017-0100-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Indexed: 12/31/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has become standard therapy for patients with severe aortic stenosis who are deemed at least intermediate risk for surgical valve replacement. Over the past decade, several technological advances have taken place to improve the quality and safety of these devices. The current commercially available valves are broadly grouped into balloon expandable and self-expandable valves. The latest iteration of the self-expandable valve is Medtronic's repositionable valve known as the Evolut PRO system. In this review, we highlight the evidence behind the use of TAVR, improvement in devices over previous generations, clinical evidence behind the CoreValve Evolut PRO system, and the future of TAVR.
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Affiliation(s)
- Dhruv Mahtta
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Islam Y Elgendy
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Anthony A Bavry
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA.
- North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.
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308
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Browndyke JN, Berger M, Smith PJ, Harshbarger TB, Monge ZA, Panchal V, Bisanar TL, Glower DD, Alexander JH, Cabeza R, Welsh-Bohmer K, Newman MF, Mathew JP. Task-related changes in degree centrality and local coherence of the posterior cingulate cortex after major cardiac surgery in older adults. Hum Brain Mapp 2017; 39:985-1003. [PMID: 29164774 DOI: 10.1002/hbm.23898] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/24/2017] [Accepted: 11/13/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Older adults often display postoperative cognitive decline (POCD) after surgery, yet it is unclear to what extent functional connectivity (FC) alterations may underlie these deficits. We examined for postoperative voxel-wise FC changes in response to increased working memory load demands in cardiac surgery patients and nonsurgical controls. EXPERIMENTAL DESIGN Older cardiac surgery patients (n = 25) completed a verbal N-back working memory task during MRI scanning and cognitive testing before and 6 weeks after surgery; nonsurgical controls with cardiac disease (n = 26) underwent these assessments at identical time intervals. We measured postoperative changes in degree centrality, the number of edges attached to a brain node, and local coherence, the temporal homogeneity of regional functional correlations, using voxel-wise graph theory-based FC metrics. Group × time differences were evaluated in these FC metrics associated with increased N-back working memory load (2-back > 1-back), using a two-stage partitioned variance, mixed ANCOVA. PRINCIPAL OBSERVATIONS Cardiac surgery patients demonstrated postoperative working memory load-related degree centrality increases in the left dorsal posterior cingulate cortex (dPCC; p < .001, cluster p-FWE < .05). The dPCC also showed a postoperative increase in working memory load-associated local coherence (p < .001, cluster p-FWE < .05). dPCC degree centrality and local coherence increases were inversely associated with global cognitive change in surgery patients (p < .01), but not in controls. CONCLUSIONS Cardiac surgery patients showed postoperative increases in working memory load-associated degree centrality and local coherence of the dPCC that were inversely associated with postoperative global cognitive outcomes and independent of perioperative cerebrovascular damage.
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Affiliation(s)
- Jeffrey N Browndyke
- Geriatric Behavioral Health Division, Department of Psychiatry & Behavioral Sciences, Duke University Health System, Durham, North Carolina.,Duke Institute for Brain Sciences, Duke University, Durham, North Carolina.,Duke Brain Imaging and Analysis Center, Duke University, Durham, North Carolina
| | - Miles Berger
- Division of Neuroanesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Patrick J Smith
- Behavioral Medicine Division, Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Todd B Harshbarger
- Duke Brain Imaging and Analysis Center, Duke University, Durham, North Carolina.,Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Zachary A Monge
- Center for Cognitive Neuroscience, Duke University, Durham, North Carolina
| | - Viral Panchal
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Tiffany L Bisanar
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Donald D Glower
- Cardiovascular & Thoracic Division, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - John H Alexander
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Roberto Cabeza
- Duke Institute for Brain Sciences, Duke University, Durham, North Carolina.,Duke Brain Imaging and Analysis Center, Duke University, Durham, North Carolina.,Center for Cognitive Neuroscience, Duke University, Durham, North Carolina
| | - Kathleen Welsh-Bohmer
- Geriatric Behavioral Health Division, Department of Psychiatry & Behavioral Sciences, Duke University Health System, Durham, North Carolina.,Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Mark F Newman
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Joseph P Mathew
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
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309
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Pasala TKR, Ruiz CE. Transcatheter Aortic Valve Replacement for All-comers With Severe Aortic Stenosis: Could It Become a Reality? ACTA ACUST UNITED AC 2017; 71:141-145. [PMID: 29107502 DOI: 10.1016/j.rec.2017.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/12/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Tilak K R Pasala
- Structural and Congenital Heart Center, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Carlos E Ruiz
- Structural and Congenital Heart Center, Hackensack University Medical Center, Hackensack, New Jersey, United States.
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310
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Gargiulo G, Valgimigli M. Antithrombotic therapy after transcatheter aortic valve implantation: a new piece of the still unresolved puzzle. J Thorac Dis 2017; 9:4260-4265. [PMID: 29268486 PMCID: PMC5721050 DOI: 10.21037/jtd.2017.10.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/01/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Giuseppe Gargiulo
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
- Department of Advanced Biomedical Sciences, University Federico II of Naples, Naples, Italy
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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311
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Kapadia SR. Routine Use of Embolic Protection During Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2017; 10:2304-2306. [DOI: 10.1016/j.jcin.2017.07.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 07/25/2017] [Indexed: 10/18/2022]
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312
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Voss S, Nöbauer C, Lange R, Bleiziffer S. Cerebral protection during transcatheter aortic valve implantation in an extreme high-risk patient. Eur J Cardiothorac Surg 2017; 52:998-999. [PMID: 28977497 DOI: 10.1093/ejcts/ezx226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/31/2017] [Indexed: 11/14/2022] Open
Abstract
Stroke during transcatheter aortic valve replacement is one of the most feared complications. New technologies have been developed, attempting to prevent cerebral embolization of thrombotic and calcific debris. We report a 78-year-old patient (EuroSCORE log 45.6%, STS Stroke Score 5.1%) with calcific aortic stenosis at particular risk for cerebrovascular accidents. The patient underwent transapical transcatheter aortic valve replacement using the dual filter-based Claret Sentinel™ Device for cerebral protection. Claret Sentinel Device use was associated with capture of macroscopic debris. Postoperatively, no neurological deficits could be detected by the National Institutes of Health Stroke Scale and modified Rankin scale.
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Affiliation(s)
- Stephanie Voss
- Department of Cardiovascular Surgery, German Heart Center Munich, Clinic at the Technical University, Munich, Germany
| | - Christian Nöbauer
- Department of Cardiovascular Surgery, German Heart Center Munich, Clinic at the Technical University, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Clinic at the Technical University, Munich, Germany
| | - Sabine Bleiziffer
- Department of Cardiovascular Surgery, German Heart Center Munich, Clinic at the Technical University, Munich, Germany
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313
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Tummala R, Banerjee K, Sankaramangalam K, Mick S, Krishnaswamy A, White J, Fares M, Mehta A, Popovic Z, Svensson LG, Kapadia SR. Clinical and procedural outcomes with the SAPIEN 3 versus the SAPIEN XT prosthetic valves in transcatheter aortic valve replacement: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2017; 92:E149-E158. [DOI: 10.1002/ccd.27398] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/10/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Ramyashree Tummala
- Department of Internal Medicine; St. Vincent Charity Medical Center, An Affiliate of Case Western Reserve University; Cleveland Ohio
| | - Kinjal Banerjee
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | | | - Stephanie Mick
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | | | - Jonathon White
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | - Maan Fares
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | - Anand Mehta
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | - Zoran Popovic
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
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314
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Vlastra W, Piek JJ, Delewi R. The current status of antiplatelet therapy in patients undergoing transcatheter aortic valve implantation. J Thorac Dis 2017; 9:3652-3655. [PMID: 29268366 DOI: 10.21037/jtd.2017.09.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Wieneke Vlastra
- Heart Center, Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan J Piek
- Heart Center, Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ronak Delewi
- Heart Center, Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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315
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Cho SM, Deshpande A, Pasupuleti V, Hernandez AV, Uchino K. Radiographic and Clinical Brain Infarcts in Cardiac and Diagnostic Procedures. Stroke 2017; 48:2753-2759. [DOI: 10.1161/strokeaha.117.017541] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/06/2017] [Accepted: 08/08/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Sung-Min Cho
- From the Cerebrovascular Center, Neurological Institute (S.-M.C., K.U.) and Medicine Institute (A.D.), Cleveland Clinic, OH; ProEd Communications Inc, Cleveland, OH (V.P.); School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (A.V.H.); School of Pharmacy, University of Connecticut, Storrs (A.V.H.); and Hartford Hospital Evidence-Based Practice Center, CT (A.V.H.)
| | - Abhishek Deshpande
- From the Cerebrovascular Center, Neurological Institute (S.-M.C., K.U.) and Medicine Institute (A.D.), Cleveland Clinic, OH; ProEd Communications Inc, Cleveland, OH (V.P.); School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (A.V.H.); School of Pharmacy, University of Connecticut, Storrs (A.V.H.); and Hartford Hospital Evidence-Based Practice Center, CT (A.V.H.)
| | - Vinay Pasupuleti
- From the Cerebrovascular Center, Neurological Institute (S.-M.C., K.U.) and Medicine Institute (A.D.), Cleveland Clinic, OH; ProEd Communications Inc, Cleveland, OH (V.P.); School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (A.V.H.); School of Pharmacy, University of Connecticut, Storrs (A.V.H.); and Hartford Hospital Evidence-Based Practice Center, CT (A.V.H.)
| | - Adrian V. Hernandez
- From the Cerebrovascular Center, Neurological Institute (S.-M.C., K.U.) and Medicine Institute (A.D.), Cleveland Clinic, OH; ProEd Communications Inc, Cleveland, OH (V.P.); School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (A.V.H.); School of Pharmacy, University of Connecticut, Storrs (A.V.H.); and Hartford Hospital Evidence-Based Practice Center, CT (A.V.H.)
| | - Ken Uchino
- From the Cerebrovascular Center, Neurological Institute (S.-M.C., K.U.) and Medicine Institute (A.D.), Cleveland Clinic, OH; ProEd Communications Inc, Cleveland, OH (V.P.); School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (A.V.H.); School of Pharmacy, University of Connecticut, Storrs (A.V.H.); and Hartford Hospital Evidence-Based Practice Center, CT (A.V.H.)
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316
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Rogers T, Alraies MC, Torguson R, Waksman R. Overview of the 2017 US Food and Drug Administration Circulatory System Devices Panel meeting on the Sentinel Cerebral Protection System. Am Heart J 2017; 192:113-119. [PMID: 28938957 DOI: 10.1016/j.ahj.2017.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/20/2017] [Indexed: 11/24/2022]
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317
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Seeger J, Gonska B, Otto M, Rottbauer W, Wöhrle J. Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement Significantly Reduces Death and Stroke Compared With Unprotected Procedures. JACC Cardiovasc Interv 2017; 10:2297-2303. [PMID: 28917515 DOI: 10.1016/j.jcin.2017.06.037] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/11/2017] [Accepted: 06/20/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of cerebral embolic protection on stroke-free survival in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND Imaging data on cerebral embolic protection devices have demonstrated a significant reduction in number and volume of cerebral lesions. METHODS A total of 802 consecutive patients were enrolled. The Sentinel cerebral embolic protection device (Claret Medical Inc., Santa Rosa, California) was used in 34.9% (n = 280) of consecutive patients. In 65.1% (n = 522) of patients TAVR was performed in the identical setting except without cerebral embolic protection. Neurological follow-up was done within 7 days post-procedure. The primary endpoint was a composite of all-cause mortality or all-stroke according to Valve Academic Research Consortium-2 criteria within 7 days. Propensity score matching was performed to account for possible confounders. RESULTS Both filters of the device were successfully positioned in 280 of 305 (91.8%) consecutive patients. With use of cerebral embolic protection rate of disabling and nondisabling stroke was significantly reduced from 4.6% to 1.4% (p = 0.03; odds ratio: 0.29, 95% confidence interval: 0.10 to 0.93) in the propensity-matched population (n = 560). The primary endpoint occurred significantly less frequently, with 2.1% (n = 6 of 280) in the protected group compared with 6.8% (n = 19 of 280) in the control group (p = 0.01; odds ratio: 0.30; 95% confidence interval: 0.12 to 0.77). In multivariable analysis Society of Thoracic Surgeons score for mortality (p = 0.02) and TAVR without protection (p = 0.02) were independent predictors for the primary endpoint. CONCLUSIONS In patients undergoing TAVR use of a cerebral embolic protection device demonstrated a significant higher rate of stroke-free survival compared with unprotected TAVR.
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Affiliation(s)
- Julia Seeger
- Department of Internal Medicine II, Cardiology, University of Ulm, Ulm, Germany
| | - Birgid Gonska
- Department of Internal Medicine II, Cardiology, University of Ulm, Ulm, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, Cardiology, University of Ulm, Ulm, Germany
| | - Jochen Wöhrle
- Department of Internal Medicine II, Cardiology, University of Ulm, Ulm, Germany.
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318
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Van Gils L, Kroon H, Daemen J, Ren C, Maugenest AM, Schipper M, De Jaegere PP, Van Mieghem NM. Complete filter-based cerebral embolic protection with transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2017; 91:790-797. [PMID: 28895285 DOI: 10.1002/ccd.27323] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/24/2017] [Accepted: 08/14/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To evaluate the value of left vertebral artery filter protection in addition to the current filter-based embolic protection technology to achieve complete cerebral protection during TAVR. BACKGROUND The occurrence of cerebrovascular events after transcatheter aortic valve replacement (TAVR) has fueled concern for its potential application in younger patients with longer life expectancy. Transcatheter cerebral embolic protection (TCEP) devices may limit periprocedural cerebrovascular events by preventing macro and micro-embolization to the brain. Conventional filter-based TCEP devices cover three extracranial contributories to the brain, yet leave the left vertebral artery unprotected. METHODS Patients underwent TAVR with complete TCEP. A dual-filter system was deployed in the brachiocephalic trunk and left common carotid artery with an additional single filter in the left vertebral artery. After TAVR all filters were retrieved and sent for histopathological evaluation by an experienced pathologist. RESULTS Eleven patients received a dual-filter system and nine of them received an additional left vertebral filter. In the remaining two patients, the left vertebral filter could not be deployed. No periprocedural strokes occurred. We found debris in all filters, consisting of thrombus, tissue derived debris, and foreign body material. The left vertebral filter contained debris in an equal amount of patients as the Sentinel filters. The size of the captured particles was similar between all filters. CONCLUSIONS The left vertebral artery is an important entry route for embolic material to the brain during TAVR. Selective filter protection of the left vertebral artery revealed embolic debris in all patients. The clinical value of complete filter-based TCEP during TAVR warrants further research.
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Affiliation(s)
- Lennart Van Gils
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Herbert Kroon
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Claire Ren
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Peter P De Jaegere
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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319
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Editorial commentary: TAVR-Is there a path to an all-surgical-risk indication? Trends Cardiovasc Med 2017; 28:184-186. [PMID: 28882365 DOI: 10.1016/j.tcm.2017.08.013] [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: 08/20/2017] [Accepted: 08/22/2017] [Indexed: 11/21/2022]
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320
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Sorrentino S, Giustino G, Dangas GD. Reply: TAVR and Stroke Prevention: Importance of Cerebral Embolic Protection Device Data. J Am Coll Cardiol 2017; 70:1307. [PMID: 28859799 DOI: 10.1016/j.jacc.2017.06.064] [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] [Received: 06/03/2017] [Accepted: 06/05/2017] [Indexed: 11/30/2022]
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321
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Schäfer U. Safety and Efficacy of Protected Cardiac Intervention: Clinical Evidence for Sentinel Cerebral Embolic Protection. Interv Cardiol 2017; 12:128-132. [PMID: 29588741 PMCID: PMC5808684 DOI: 10.15420/icr.2017:19:2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/12/2017] [Indexed: 11/04/2022] Open
Abstract
Stroke is a well-documented potential risk of structural cardiac interventions. As a result of the far-reaching burden of stroke on patients, caregivers and the healthcare system, new medical interventions and therapies are being developed to help mitigate this risk. One such intervention is the recently FDA-cleared Sentinel™ Cerebral Protection System (Sentinel; Claret Medical, Santa Rosa, CA, USA) designed to capture and remove debris dislodged during transcatheter aortic valve replacement procedures. In the SENTINEL IDE Study, and in a more recent all-comers trial, Sentinel significantly reduced periprocedural strokes by 63 and 70 % respectively. In this paper, we review the growing body of evidence supporting the use of Sentinel in transcatheter aortic valve replacement and other endovascular procedures.
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Affiliation(s)
- Ulrich Schäfer
- Department of General and Interventional Cardiology, University Hospital Eppendorf, Hamburg, Germany
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322
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Terré JA, George I, Smith CR. Pros and cons of transcatheter aortic valve implantation (TAVI). Ann Cardiothorac Surg 2017; 6:444-452. [PMID: 29062739 PMCID: PMC5639221 DOI: 10.21037/acs.2017.09.15] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/31/2017] [Indexed: 11/06/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) or replacement (TAVR) was recently approved by the FDA for intermediate risk patients with severe aortic stenosis (AS). This technique was already worldwide adopted for inoperable and high-risk patients. Improved device technology, imaging analysis and operator expertise has reduced the initial worrisome higher complications rate associated with TAVR, making it comparable to surgical aortic valve replacement (SAVR). However, many answers need to be addressed before adoption in lower risk patients. This paper highlights the pros and cons of TAVI based mostly on randomized clinical trials involving the two device platforms approved in the United States. We focused our analysis on metrics that will play a key role in expanding TAVR indication in healthier individuals. We review the significance and gave a perspective on paravalvular leak (PVL), valve performance, valve durability, leaflet thrombosis, stroke and pacemaker requirement.
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Affiliation(s)
- Juan A Terré
- New York Presbyterian Hospital-Columbia University Medical Center, New York, NY, USA
| | - Isaac George
- New York Presbyterian Hospital-Columbia University Medical Center, New York, NY, USA
| | - Craig R Smith
- New York Presbyterian Hospital-Columbia University Medical Center, New York, NY, USA
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Mack MJ, Acker MA, Gelijns AC, Overbey JR, Parides MK, Browndyke JN, Groh MA, Moskowitz AJ, Jeffries NO, Ailawadi G, Thourani VH, Moquete EG, Iribarne A, Voisine P, Perrault LP, Bowdish ME, Bilello M, Davatzikos C, Mangusan RF, Winkle RA, Smith PK, Michler RE, Miller MA, O’Sullivan KL, Taddei-Peters WC, Rose EA, Weisel RD, Furie KL, Bagiella E, Moy CS, O’Gara PT, Messé SR. Effect of Cerebral Embolic Protection Devices on CNS Infarction in Surgical Aortic Valve Replacement: A Randomized Clinical Trial. JAMA 2017; 318:536-547. [PMID: 28787505 PMCID: PMC5808875 DOI: 10.1001/jama.2017.9479] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Stroke is a major complication of surgical aortic valve replacement (SAVR). OBJECTIVE To determine the efficacy and adverse effects of cerebral embolic protection devices in reducing ischemic central nervous system (CNS) injury during SAVR. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial of patients with calcific aortic stenosis undergoing SAVR at 18 North American centers between March 2015 and July 2016. The end of follow-up was December 2016. INTERVENTIONS Use of 1 of 2 cerebral embolic protection devices (n = 118 for suction-based extraction and n = 133 for intra-aortic filtration device) vs a standard aortic cannula (control; n = 132) at the time of SAVR. MAIN OUTCOMES AND MEASURES The primary end point was freedom from clinical or radiographic CNS infarction at 7 days (± 3 days) after the procedure. Secondary end points included a composite of mortality, clinical ischemic stroke, and acute kidney injury within 30 days after surgery; delirium; mortality; serious adverse events; and neurocognition. RESULTS Among 383 randomized patients (mean age, 73.9 years; 38.4% women; 368 [96.1%] completed the trial), the rate of freedom from CNS infarction at 7 days was 32.0% with suction-based extraction vs 33.3% with control (between-group difference, -1.3%; 95% CI, -13.8% to 11.2%) and 25.6% with intra-aortic filtration vs 32.4% with control (between-group difference, -6.9%; 95% CI, -17.9% to 4.2%). The 30-day composite end point was not significantly different between suction-based extraction and control (21.4% vs 24.2%, respectively; between-group difference, -2.8% [95% CI, -13.5% to 7.9%]) nor between intra-aortic filtration and control (33.3% vs 23.7%; between-group difference, 9.7% [95% CI, -1.2% to 20.5%]). There were no significant differences in mortality (3.4% for suction-based extraction vs 1.7% for control; and 2.3% for intra-aortic filtration vs 1.5% for control) or clinical stroke (5.1% for suction-based extraction vs 5.8% for control; and 8.3% for intra-aortic filtration vs 6.1% for control). Delirium at postoperative day 7 was 6.3% for suction-based extraction vs 15.3% for control (between-group difference, -9.1%; 95% CI, -17.1% to -1.0%) and 8.1% for intra-aortic filtration vs 15.6% for control (between-group difference, -7.4%; 95% CI, -15.5% to 0.6%). Mortality and overall serious adverse events at 90 days were not significantly different across groups. Patients in the intra-aortic filtration group vs patients in the control group experienced significantly more acute kidney injury events (14 vs 4, respectively; P = .02) and cardiac arrhythmias (57 vs 30; P = .004). CONCLUSIONS AND RELEVANCE Among patients undergoing SAVR, cerebral embolic protection devices compared with a standard aortic cannula did not significantly reduce the risk of CNS infarction at 7 days. Potential benefits for reduction in delirium, cognition, and symptomatic stroke merit larger trials with longer follow-up. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02389894.
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Affiliation(s)
- Michael J. Mack
- Department of Cardiothoracic Surgery, Baylor Research Institute, Baylor Scott & White Health, Plano, Texas
| | - Michael A. Acker
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia
| | - Annetine C. Gelijns
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jessica R. Overbey
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael K. Parides
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey N. Browndyke
- Division of Geriatric Behavioral Health, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Mark A. Groh
- Cardiovascular and Thoracic Surgery, Mission Health and Hospitals, Asheville, North Carolina
| | - Alan J. Moskowitz
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Neal O. Jeffries
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville
| | - Vinod H. Thourani
- Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Ellen G. Moquete
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexander Iribarne
- Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Pierre Voisine
- Institut Universitaire de Cardiologie de Québec, Hôpital Laval, Quebec, Quebec, Canada
| | - Louis P. Perrault
- Montréal Heart Institute, University of Montréal, Montreal, Quebec, Canada
| | - Michael E. Bowdish
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Michel Bilello
- Department of Radiology, University of Pennsylvania, Philadelphia
| | | | - Ralph F. Mangusan
- Cardiovascular and Thoracic Surgery, Mission Health and Hospitals, Asheville, North Carolina
| | - Rachelle A. Winkle
- Department of Cardiothoracic Surgery, Baylor Research Institute, Baylor Scott & White Health, Plano, Texas
| | - Peter K. Smith
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Robert E. Michler
- Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Marissa A. Miller
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Karen L. O’Sullivan
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Wendy C. Taddei-Peters
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Eric A. Rose
- Department of Cardiac Surgery, Mount Sinai Health System, New York, New York
| | - Richard D. Weisel
- Peter Munk Cardiac Centre and Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network and the Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karen L. Furie
- Department of Neurology, Rhode Island Hospital, Miriam Hospital and Bradley Hospital, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Emilia Bagiella
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Claudia Scala Moy
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Patrick T. O’Gara
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Steven R. Messé
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia
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Jobanputra Y, Jones BM, Mohananey D, Fatima B, Kandregula K, Kapadia SR. Cerebral protection devices for transcatheter aortic valve replacement. Expert Rev Med Devices 2017; 14:529-543. [DOI: 10.1080/17434440.2017.1347038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yash Jobanputra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brandon M Jones
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Divyanshu Mohananey
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Benish Fatima
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Krishna Kandregula
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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326
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Jones BM, Krishnaswamy A, Tuzcu EM, Mick S, Jaber WA, Svensson LG, Kapadia SR. Matching patients with the ever-expanding range of TAVI devices. Nat Rev Cardiol 2017; 14:615-626. [DOI: 10.1038/nrcardio.2017.82] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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327
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Gray A, McQuillan C, Menown IBA. Advances in Clinical Cardiology 2016: A Summary of the Key Clinical Trials. Adv Ther 2017; 34:1503-1527. [PMID: 28537000 PMCID: PMC5504210 DOI: 10.1007/s12325-017-0560-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The findings of many new cardiology clinical trials over the last year have been published or presented at major international meetings. This paper aims to describe and place in context a summary of the key clinical trials in cardiology presented between January and December 2016. METHODS The authors reviewed clinical trials presented at major cardiology conferences during 2016 including the American College of Cardiology (ACC), European Association for Percutaneous Cardiovascular Interventions (EuroPCR), European Society of Cardiology (ESC), European Association for the Study of Diabetes (EASD), Transcatheter Cardiovascular Therapeutics (TCT), and the American Heart Association (AHA). Selection criteria were trials with a broad relevance to the cardiology community and those with potential to change current practice. RESULTS A total of 57 key cardiology clinical trials were identified for inclusion. Here we describe and place in clinical context the key findings of new data relating to interventional and structural cardiology including delayed stenting following primary angioplasty, contrast-induced nephropathy, management of jailed wires, optimal duration of dual antiplatelet therapy (DAPT), stenting vs bypass for left main disease, new generation stents (BioFreedom, Orsiro, Absorb), transcatheter aortic valve implantation (Edwards Sapien XT, transcatheter embolic protection), and closure devices (Watchman, Amplatzer). New preventative cardiology data include trials of bariatric surgery, empagliflozin, liraglutide, semaglutide, PCSK9 inhibitors (evolocumab and alirocumab), and inclisiran. Antiplatelet therapy trials include platelet function monitoring and ticagrelor vs clopidogrel for peripheral vascular disease. New data are also presented in fields of heart failure (sacubitril/valsartan, aliskiren, spironolactone), atrial fibrillation (rivaroxaban in patients undergoing coronary intervention, edoxaban in DC cardioversion), cardiac devices (implantable cardioverter defibrillator in non-ischemic cardiomyopathy), and electrophysiology (cryoballoon vs radiofrequency ablation). CONCLUSION This paper presents a summary of key clinical cardiology trials during the past year and should be of practical value to both clinicians and cardiology researchers.
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Affiliation(s)
- Alastair Gray
- Craigavon Cardiac Centre, Southern Trust, Craigavon, Northern Ireland, UK
| | - Conor McQuillan
- Craigavon Cardiac Centre, Southern Trust, Craigavon, Northern Ireland, UK
| | - Ian B A Menown
- Craigavon Cardiac Centre, Southern Trust, Craigavon, Northern Ireland, UK.
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328
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Rodés-Cabau J, Masson JB, Welsh RC, Garcia del Blanco B, Pelletier M, Webb JG, Al-Qoofi F, Généreux P, Maluenda G, Thoenes M, Paradis JM, Chamandi C, Serra V, Dumont E, Côté M. Aspirin Versus Aspirin Plus Clopidogrel as Antithrombotic Treatment Following Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve. JACC Cardiovasc Interv 2017; 10:1357-1365. [DOI: 10.1016/j.jcin.2017.04.014] [Citation(s) in RCA: 227] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 11/29/2022]
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Abstract
Transcatheter aortic valve replacement (TAVR) has become a standard treatment for patients with severe, symptomatic aortic stenosis. Whereas its use was first limited to inoperable high-risk patients, recent studies demonstrated that TAVR was not inferior to standard surgical aortic valve replacement (SAVR) for intermediate-risk patients. Besides equivalent outcomes, the type and rates of complications differ between the two procedures. Here, we provide an overview of the latest randomized study results comparing TAVR with SAVR and describe possible future directions in transcatheter aortic valve treatment.
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331
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Patel PA, Ackermann AM, Augoustides JG, Ender J, Gutsche JT, Giri J, Vallabhajosyula P, Desai ND, Kostibas M, Brady MB, Eoh EJ, Gaca JG, Thompson A, Fitzsimons MG. Anesthetic Evolution in Transcatheter Aortic Valve Replacement: Expert Perspectives From High-Volume Academic Centers in Europe and the United States. J Cardiothorac Vasc Anesth 2017; 31:777-790. [DOI: 10.1053/j.jvca.2017.02.051] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Indexed: 11/11/2022]
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332
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Heuser RR. SENTINEL: The Tip of the Iceberg in Transcatheter Cerebral Embolic Protection. J Am Coll Cardiol 2017; 69:2679. [PMID: 28545649 DOI: 10.1016/j.jacc.2017.02.069] [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] [Received: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 11/16/2022]
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333
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Antithrombotic Therapy for Prevention of Cerebral Thromboembolic Events After Transcatheter Aortic Valve Replacement: Evolving Paradigms and Ongoing Directions. JACC Cardiovasc Interv 2017; 10:1366-1369. [PMID: 28527775 DOI: 10.1016/j.jcin.2017.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/03/2017] [Indexed: 02/07/2023]
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334
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Bagur R, Solo K, Alghofaili S, Nombela-Franco L, Kwok CS, Hayman S, Siemieniuk RA, Foroutan F, Spencer FA, Vandvik PO, Schäufele TG, Mamas MA. Cerebral Embolic Protection Devices During Transcatheter Aortic Valve Implantation. Stroke 2017; 48:1306-1315. [DOI: 10.1161/strokeaha.116.015915] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/01/2017] [Accepted: 02/15/2017] [Indexed: 12/29/2022]
Abstract
Background and Purpose—
Silent ischemic embolic lesions are common after transcatheter aortic valve implantation (TAVI). The use of embolic protection devices (EPD) may reduce the occurrence of these embolic lesions. Thus, a quantitative overview and credibility assessment of the literature was necessary to draw a robust message about EPD. Therefore, the aim of this meta-analysis was to study whether the use of EPD reduces silent ischemic and clinically evident cerebrovascular events associated with TAVI.
Methods—
We conducted a comprehensive search to identify studies that evaluated patients undergoing TAVI with or without EPD. Random-effects meta-analyses were performed to estimate the effect of EPD compared with no-EPD during TAVI using aggregate data.
Results—
Sixteen studies involving 1170 patients (865/305 with/without EPD) fulfilled the inclusion criteria. The EPD delivery success rate was reported in all studies and was achieved in 94.5% of patients. Meta-analyses evaluating EPD versus without EPD strategies could not confirm or exclude any differences in terms of clinically evident stroke (relative risk, 0.70; 95% confidence interval [CI], 0.38–1.29;
P
=0.26) or 30-day mortality (relative risk, 0.58; 95% CI, 0.20–1.64;
P
=0.30). There were no significant differences in new-single, multiple, or total number of lesions. The use of EPD was associated with a significantly smaller ischemic volume per lesion (standardized mean difference, −0.52; 95% CI, −0.85 to −0.20;
P
=0.002) and smaller total volume of lesions (standardized mean difference, −0.23; 95% CI, −0.42 to −0.03;
P
=0.02). Subgroup analysis by type of valve showed an overall trend toward significant reduction in new lesions per patient using EPD (standardized mean difference, −0.41; 95% CI, −0.82 to 0.00;
P
=0.05), driven by self-expanding devices.
Conclusions—
The use of EPD during TAVI may be associated with smaller volume of silent ischemic lesions and smaller total volume of silent ischemic lesions. However, EPD may not reduce the number of new-single, multiple, or total number of lesions. There was only very low quality of evidence showing no significant differences between patients undergoing TAVI with or without EPD with respect to clinically evident stroke and mortality.
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Affiliation(s)
- Rodrigo Bagur
- From the Division of Cardiology, Department of Medicine, London Health Sciences Center (R.B., S.A., S.H.) and Department of Epidemiology and Biostatistics (R.B., K.S.), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Keele Cardiovascular Research Group, Institute of Applied Clinical Science (R.B., C.S.K., M.A.M.), Keele University and Royal Stoke Hospital, Stoke-on-Trent, United Kingdom; Division of Cardiology, Hospital Clínico San Carlos, Madrid, Spain (L.N
| | - Karla Solo
- From the Division of Cardiology, Department of Medicine, London Health Sciences Center (R.B., S.A., S.H.) and Department of Epidemiology and Biostatistics (R.B., K.S.), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Keele Cardiovascular Research Group, Institute of Applied Clinical Science (R.B., C.S.K., M.A.M.), Keele University and Royal Stoke Hospital, Stoke-on-Trent, United Kingdom; Division of Cardiology, Hospital Clínico San Carlos, Madrid, Spain (L.N
| | - Saleh Alghofaili
- From the Division of Cardiology, Department of Medicine, London Health Sciences Center (R.B., S.A., S.H.) and Department of Epidemiology and Biostatistics (R.B., K.S.), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Keele Cardiovascular Research Group, Institute of Applied Clinical Science (R.B., C.S.K., M.A.M.), Keele University and Royal Stoke Hospital, Stoke-on-Trent, United Kingdom; Division of Cardiology, Hospital Clínico San Carlos, Madrid, Spain (L.N
| | - Luis Nombela-Franco
- From the Division of Cardiology, Department of Medicine, London Health Sciences Center (R.B., S.A., S.H.) and Department of Epidemiology and Biostatistics (R.B., K.S.), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Keele Cardiovascular Research Group, Institute of Applied Clinical Science (R.B., C.S.K., M.A.M.), Keele University and Royal Stoke Hospital, Stoke-on-Trent, United Kingdom; Division of Cardiology, Hospital Clínico San Carlos, Madrid, Spain (L.N
| | - Chun Shing Kwok
- From the Division of Cardiology, Department of Medicine, London Health Sciences Center (R.B., S.A., S.H.) and Department of Epidemiology and Biostatistics (R.B., K.S.), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Keele Cardiovascular Research Group, Institute of Applied Clinical Science (R.B., C.S.K., M.A.M.), Keele University and Royal Stoke Hospital, Stoke-on-Trent, United Kingdom; Division of Cardiology, Hospital Clínico San Carlos, Madrid, Spain (L.N
| | - Samual Hayman
- From the Division of Cardiology, Department of Medicine, London Health Sciences Center (R.B., S.A., S.H.) and Department of Epidemiology and Biostatistics (R.B., K.S.), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Keele Cardiovascular Research Group, Institute of Applied Clinical Science (R.B., C.S.K., M.A.M.), Keele University and Royal Stoke Hospital, Stoke-on-Trent, United Kingdom; Division of Cardiology, Hospital Clínico San Carlos, Madrid, Spain (L.N
| | - Reed A. Siemieniuk
- From the Division of Cardiology, Department of Medicine, London Health Sciences Center (R.B., S.A., S.H.) and Department of Epidemiology and Biostatistics (R.B., K.S.), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Keele Cardiovascular Research Group, Institute of Applied Clinical Science (R.B., C.S.K., M.A.M.), Keele University and Royal Stoke Hospital, Stoke-on-Trent, United Kingdom; Division of Cardiology, Hospital Clínico San Carlos, Madrid, Spain (L.N
| | - Farid Foroutan
- From the Division of Cardiology, Department of Medicine, London Health Sciences Center (R.B., S.A., S.H.) and Department of Epidemiology and Biostatistics (R.B., K.S.), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Keele Cardiovascular Research Group, Institute of Applied Clinical Science (R.B., C.S.K., M.A.M.), Keele University and Royal Stoke Hospital, Stoke-on-Trent, United Kingdom; Division of Cardiology, Hospital Clínico San Carlos, Madrid, Spain (L.N
| | - Frederick A. Spencer
- From the Division of Cardiology, Department of Medicine, London Health Sciences Center (R.B., S.A., S.H.) and Department of Epidemiology and Biostatistics (R.B., K.S.), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Keele Cardiovascular Research Group, Institute of Applied Clinical Science (R.B., C.S.K., M.A.M.), Keele University and Royal Stoke Hospital, Stoke-on-Trent, United Kingdom; Division of Cardiology, Hospital Clínico San Carlos, Madrid, Spain (L.N
| | - Per O. Vandvik
- From the Division of Cardiology, Department of Medicine, London Health Sciences Center (R.B., S.A., S.H.) and Department of Epidemiology and Biostatistics (R.B., K.S.), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Keele Cardiovascular Research Group, Institute of Applied Clinical Science (R.B., C.S.K., M.A.M.), Keele University and Royal Stoke Hospital, Stoke-on-Trent, United Kingdom; Division of Cardiology, Hospital Clínico San Carlos, Madrid, Spain (L.N
| | - Tim G. Schäufele
- From the Division of Cardiology, Department of Medicine, London Health Sciences Center (R.B., S.A., S.H.) and Department of Epidemiology and Biostatistics (R.B., K.S.), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Keele Cardiovascular Research Group, Institute of Applied Clinical Science (R.B., C.S.K., M.A.M.), Keele University and Royal Stoke Hospital, Stoke-on-Trent, United Kingdom; Division of Cardiology, Hospital Clínico San Carlos, Madrid, Spain (L.N
| | - Mamas A. Mamas
- From the Division of Cardiology, Department of Medicine, London Health Sciences Center (R.B., S.A., S.H.) and Department of Epidemiology and Biostatistics (R.B., K.S.), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Keele Cardiovascular Research Group, Institute of Applied Clinical Science (R.B., C.S.K., M.A.M.), Keele University and Royal Stoke Hospital, Stoke-on-Trent, United Kingdom; Division of Cardiology, Hospital Clínico San Carlos, Madrid, Spain (L.N
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Abstract
PURPOSE OF REVIEW With widespread adoption of transcatheter aortic valve replacement, there has been a change in the approach to management of valvular heart disease. New interest has taken hold in transcatheter therapies for valvular heart disease, as well as research into pathophysiology and progression of disease. Additionally, several key trials have further refined our understanding of surgical management of valvular heart disease. This review will elucidate recent clinical trial data leading to changes in practice. RECENT FINDINGS There have been several landmark trials expanding the indications for transcatheter aortic valve replacement. Additionally, although still early, trials are beginning to demonstrate the feasibility and safety of transcatheter mitral valves. Options for transcatheter management of right-sided valvular disease continue to evolve, and these are areas of active investigation. SUMMARY The emergence of novel therapies for valvular heart disease has expanded the management options available, allowing physicians to better individualize treatment of patients with valvular heart disease. This review will focus on the recent (within 2 years) trials in this field of interest.
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336
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Bozinovski J. Measuring and mitigating stroke in transcatheter aortic valve implantation: Long roads to the easy answers. J Thorac Cardiovasc Surg 2017; 154:884-885. [PMID: 28262294 DOI: 10.1016/j.jtcvs.2017.02.009] [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: 01/28/2017] [Accepted: 02/04/2017] [Indexed: 11/26/2022]
Affiliation(s)
- John Bozinovski
- Division of Cardiac Surgery, University of British Columbia and the Royal Jubilee Hospital, Victoria, British Columbia, Canada.
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337
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Harjai KJ, Grines CL, Paradis JM, Kodali S. Transcatheter aortic valve replacement: The year in review 2016. J Interv Cardiol 2017; 30:105-113. [PMID: 28256067 DOI: 10.1111/joic.12372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 01/01/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) continued to make major strides in 2016, simultaneously expanding its application to lower risk patients as well as more technically challenging subsets of patients with aortic stenosis (AS). The two major accomplishments this year were the establishment of TAVR as the preferred treatment strategy over surgical aortic valve replacement (SAVR) in intermediate risk patients, and initial signals that TAVR and SAVR may be clinically equivalent in low-risk populations. Meanwhile, there is continued expansion of TAVR to challenging clinical subsets (bicuspid aortic valve [BAV], patients with concomitant advanced coronary artery disease [CAD], and failed surgical bioprostheses), and encouraging initial experiences with newer transcatheter heart valve systems. This paper summarizes the major research studies published on TAVR in 2016.
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Affiliation(s)
- Kishore J Harjai
- Geisinger Clinic, Pearsall Heart Hospital, Wilkes-Barre, Pennsylvania
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Poulin MF, Kavinsky CJ. Routine Predeployment Balloon Aortic Valvuloplasty During Transcatheter Aortic Valve Replacement: Time to Move On? J Am Heart Assoc 2017; 6:e005314. [PMID: 28214796 PMCID: PMC5523791 DOI: 10.1161/jaha.116.005314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marie-France Poulin
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Clifford J Kavinsky
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
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Pelberg J, Gray WA. Good to great: TAVR tackles stroke risk. Catheter Cardiovasc Interv 2017; 89:478-479. [PMID: 28220649 DOI: 10.1002/ccd.26937] [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: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Justin Pelberg
- Lankenau Heart Institute/Main Line Health, Wynnewood, PA
| | - William A Gray
- Lankenau Heart Institute/Main Line Health, Wynnewood, PA
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340
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Latib A, Pagnesi M. Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2017; 69:378-380. [DOI: 10.1016/j.jacc.2016.10.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
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341
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Kroon HG, Van Mieghem NM. Need for Embolic Protection During Transcatheter Aortic Valve Implantation: An Interventionalist's Perspective on Histopathology Findings. Interv Cardiol 2017; 12:36-39. [PMID: 29588728 DOI: 10.15420/icr.2016:30:2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a less invasive aortic valve replacement technique and is indicated for patients with symptomatic severe aortic stenosis and a high operative risk. Cerebral embolisation seems inherent to TAVI, as illustrated by the consistent appearance of new brain lesions on post-procedural MRI studies. Embolic protection devices may capture or deflect embolised material en route to the brain and thus reduce TAVI-related brain injury. Histopathology studies of captured debris revealed a diverse aetiology including recent or organised thrombotic material, tissue originating from the aortic valve, atherosclerotic plaques or myocardium and foreign body components. In this overview we provide a perspective on current evidence and implications for embolic protection devices in the dynamic TAVI field.
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Affiliation(s)
- Herbert G Kroon
- Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
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342
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Mohammed Imran G, Alexandra L. Understanding Neurologic Complications Following TAVR. Interv Cardiol 2017; 13:27-32. [PMID: 29593833 DOI: 10.15420/icr.2017:25:1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Transcatheter aortic valve replacement is a groundbreaking treatment modality for severe, symptomatic aortic stenosis. Despite the rapid progression in indications to include intermediate-risk patients, the risk of peri-procedural stroke remains, with a higher incidence rate than previously reported. Accurate assessment of peri-procedural stroke rates requires selection of careful and meaningful trial endpoints during evaluation of neuroprotective devices. In this article, we review recommendations and stroke definitions from academic research consortiums along with device trial results.
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343
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Mossad SB, Quintini C. Primary Cytomegalovirus Syndrome: An Unexpected Cause of Donor Morbidity Shortly After Right Lobectomy for Living-Donor Liver Transplant. EXP CLIN TRANSPLANT 2015; 15:585-586. [PMID: 26135161 DOI: 10.6002/ect.2015.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present a case of initially unexplained fever in a living right liver lobe transplant donor that turned out to be due to primary cytomegalovirus infection.
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