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Inanc IH, Mutlu D, Marmagkiolis K, Iliescu C, Ates I, Cilingiroglu M. Use of SAFARI 2™ as workhorse wire for left-sided structural heart interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00024-1. [PMID: 38388247 DOI: 10.1016/j.carrev.2024.02.003] [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: 12/21/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND With the advances in percutaneous treatment technologies, the left atrial appendage occlusion (LAAO) and the transcatheter mitral valve repair using MitraClip (TMVR) are increasingly being performed today. The SAFARI 2™ guidewire is primarily used during transcatheter aortic valve implantation (TAVI), our group has also been using it during MitraClip and LAAO procedures. Our clinical study aimed to share our data on the safety and effectiveness for the use of the SAFARI 2™ guidewire during MitraClip or LAAO procedures. METHODS This study included a total of 1730 patients (948 patients of MitraClip and 782 of LAAO). It was designed as single arm, retrospective, and multicenter between July 2016 and August 2022. SAFARI 2™ guidewire was used exclusively during all the procedures. RESULTS A total of 1730 patients (male 55.8 %) were included in the study. There was no guidewire-related complications, stroke/transient ischemic attack, bleeding (minor/major/life-threatening), need for cardiac surgery, pneumonia, and vascular dissection/rupture in patients undergoing LAAO. There were 2 device-related pericardial effusions without tamponade. No stroke/transient ischemic attack, bleeding (minor/major/life-threatening), mortality, need for cardiac surgery, pneumonia, guidewire-related complication, pericardial effusion, vascular dissection/rupture, or clip embolization was observed in patients undergoing MitraClip. CONCLUSIONS By taking advantage of its pre-shaped structure, the SAFARI 2™ guidewire seems to offer a reliable and safe device delivery for both MitraClip and LAAO procedures as a regular work horse wire. Our results should be confirmed by larger randomized or prospective trials.
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Affiliation(s)
- Ibrahim H Inanc
- Kırıkkale Yuksek Ihtisas Hospital, Department of Cardiology, Kırıkkale, Turkey
| | - Deniz Mutlu
- Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Kostas Marmagkiolis
- University of Texas in Houston, MD Anderson Cancer Center, Houston, TX, USA; Tampa General Hospital, University of South Florida, Tampa, FL, USA
| | - Cezar Iliescu
- University of Texas in Houston, MD Anderson Cancer Center, Houston, TX, USA.
| | - Ismail Ates
- Department of Cardiology, Yeniyuzyil University Hospital, Istanbul, Turkey
| | - Mehmet Cilingiroglu
- University of Texas in Houston, MD Anderson Cancer Center, Houston, TX, USA.
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Akodad M, Trpkov C, Cheung A, Ye J, Chatfield AG, Alosail A, Besola L, Yu M, Leipsic JA, Lounes Y, Meier D, Yang C, Nestelberger T, Tzimas G, Sathananthan J, Wood DA, Moss RR, Blanke P, Sathananthan G, Webb JG. Valve-in-Valve Transcatheter Mitral Valve Replacement: A Large First-in-Human 13-Year Experience. Can J Cardiol 2023; 39:1959-1970. [PMID: 37625668 DOI: 10.1016/j.cjca.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/04/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Favourable early outcomes have been reported following valve-in-valve transcatheter mitral valve replacement (TMVR). However, reports of long-term outcomes are lacking. We aimed to evaluate early and late outcomes in a large first-in-human valve-in-valve TMVR 13-year experience. METHODS All patients undergoing valve-in-valve TMVR in our centre from 2008 to 2021 were included. Clinical and echocardiographic outcomes, defined according to the Mitral Valve Academic Research Consortium, were reported. RESULTS A total of 119 patients were analysed: mean age 76.8 ± 10.2 years, mean Society of Thoracic Surgeons score 10.7 ± 6.8%, 55.4% female, 63.9% transapical access. Thirty-day mortality was 2.5% for the total population and 0.0% after transseptal TMVR. Maximum follow-up was 13.1 years. During a median follow-up of 3.4 years (interquartile range 1.8-5.3 years), 55 patients (46.2%) died, mainly from noncardiovascular causes. Valve hemodynamics were acceptable at 5 years, with 2.5% structural dysfunction. Patients treated from 2016 on (n = 68; 57.1%), following the advent of routine use of the Sapien 3 valve, CT screening, and transseptal access, were compared with those treated before 2016 (n = 51; 42.9%). Patients from 2016 on had a higher technical success rate (100.0% vs 94.1%; P = 0.04), shorter hospitalisation (P < 0.001), trending lower 30-day mortality (1.5% vs 3.9%; P = 0.4) and better 5-year survival (74.7% vs 41.1%; P = 0.03). CONCLUSIONS Valve-in-valve TMVR can be performed with little morbidity and low mortality. Mid- to long-term survival remains limited owing to advanced age and comorbidities. Structural bioprosthetic valve dysfunction was rare and redo TMVR feasible in selected patients. Outcomes continue to improve, but the role for valve-in-valve TMVR in lower surgical risk patients remains unclear.
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Affiliation(s)
- Mariama Akodad
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Cvet Trpkov
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Anson Cheung
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jian Ye
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Andrew G Chatfield
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Abdulmajeed Alosail
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Laura Besola
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Maggie Yu
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada
| | - Jonathon A Leipsic
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Youcef Lounes
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - David Meier
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Cathevine Yang
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Thomas Nestelberger
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Georgios Tzimas
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - David A Wood
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Rob R Moss
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gnalini Sathananthan
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - John G Webb
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada.
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