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Noble S, Bendjelid K. Pacemaker post transcatheter aortic valve replacement: A multifactorial risk? World J Cardiol 2024; 16:168-172. [PMID: 38690219 PMCID: PMC11056876 DOI: 10.4330/wjc.v16.i4.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/01/2024] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
Pacemaker post-transcatheter aortic valve replacement is related to multifactorial risk. Nwaedozie et al brought to the body of evidence electrocardiogram and clinical findings. However, procedural characteristics have at least as much impact on the final need for a permanent pacemaker and potentially on the pacing rate. In this regard, long-term follow-up and understanding of the impact of long-term stimulation is of utmost importance.
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Affiliation(s)
- Stephane Noble
- Department of Medicine, Structural Heart Unit, University Hospital of Geneva, Geneva 1211, Switzerland.
| | - Karim Bendjelid
- Department of Acute Medicine, Geneva University Hospitals, Geneva 1211, Switzerland
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Bajwa T, Attizzani GF, Gada H, Chetcuti SJ, Williams MR, Ahmed M, Petrossian GA, Saybolt MD, Allaqaband SQ, Merhi WM, Stoler RC, Bezerra H, Mahoney P, Wu W, Jumper R, Lambrecht L, Tang GHL. Use and performance of the evolut FX transcatheter aortic valve system. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00145-3. [PMID: 38599918 DOI: 10.1016/j.carrev.2024.04.002] [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: 01/12/2024] [Revised: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The next generation supra-annular, self-expanding Evolut FX transcatheter aortic valve (TAV) system was designed to improve catheter deliverability, provide stable and symmetric valve deployment, and assess commissural alignment during the procedure. The impact of these modifications has not been clinically evaluated. METHODS Procedural information was collected by survey in 2 Stages: Stage I comprised 23 centers with extensive experience with Evolut TAV systems, and Stage II comprised an additional 46 centers with a broad range of balloon- and self-expanding system experience. Operators were to compare the experience with the Evolut FX to the predicate Evolut PRO+ system. RESULTS There were 285 cases during Stage I from June 24 to August 12, 2022, and 254 cases during Stage II from August 15 to September 11, 2022. Overall, the cusp overlap technique was used in 88.6 %, and commissural alignment was achieved in 96.1 % of these cases. Compared to implanter's previous experience with the Evolut PRO+ system, less resistance was noted with the Evolut FX system: in 83.0 % of cases during vascular insertion, in 84.7 % of cases while tracking through the vasculature, in 84.4 % of cases while traversing over the arch, and 76.1 % of cases in advancing across the valve. Better symmetry of valve depth was observed in 423 of 525 cases (80.6 %). CONCLUSION Evolut FX system design modifications translated into improvements in catheter deliverability, deployment symmetry and stability, and commissural alignment as assessed by experienced self-expanding and balloon expandable operators.
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Affiliation(s)
- Tanvir Bajwa
- Advocate Aurora Health Care, 2801 W. Kinnickinnic River Parkway,Milwaukee, WI 53215, United States of America.
| | - Guilherme F Attizzani
- University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States of America.
| | - Hemal Gada
- University of Pittsburgh-Pinnacle, 1000 N Front Street, Wormleysburg, PA 17043, United States of America
| | - Stanley J Chetcuti
- University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, United States of America.
| | - Mathew R Williams
- New York University - Langone Health, 530 1st Ave. Suite 9V, New York, NY 10016, United States of America.
| | - Mustafa Ahmed
- University of Alabama Medicine, 2000 6th Avenue South, Floor 4, Birmingham, AL 35233, United States of America.
| | - George A Petrossian
- Saint Francis Hospital, Vizza Pavilion, 100 Port Washington Blvd Ste G04, Roslyn, NY 11576, United States of America
| | - Matthew D Saybolt
- Jersey Shore University Medical Center, 1945 NJ-33, Neptune Township, NJ 07753, United States of America
| | - Suhail Q Allaqaband
- Advocate Aurora Health Care, 2801 W. Kinnickinnic River Parkway,Milwaukee, WI 53215, United States of America.
| | - William M Merhi
- Spectrum Health Hospitals, 743 E Beltline Ave NE, Grand Rapids, MI 49525, United States of America.
| | - Robert C Stoler
- Baylor Scott & White Heart and Vascular Hospital at Baylor Scott & White University Medical Center, 621 N Hall St #500, Dallas, TX 75226, United States of America.
| | - Hiram Bezerra
- Tampa General Hospital, University of South Florida; 2 Tampa General Circle, Tampa, FL 33606, United States of America.
| | - Paul Mahoney
- Sentara Norfolk General Hospital, 600 Gresham Dr Ste 8630A, Norfolk, VA 23507, United States of America
| | - Willis Wu
- Rex Hospital, 2800 Blue Ridge Rd Suite 201, Raleigh, NC 27607, United States of America.
| | - Robert Jumper
- St. Vincent's Medical Center, 115 Technology Dr UNIT C300, Trumbull, CT 06611, United States of America.
| | - Larry Lambrecht
- Medtronic, 8200 Coral Sea St., Mounds View, MN 55112, United States of America.
| | - Gilbert H L Tang
- Mount Sinai Health System, 1190 5th Ave, New York, NY 10029, United States of America
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Vora AN, Gada H, Manandhar P, Kosinski A, Kirtane A, Nazif T, Reardon M, Kodali S, Cohen DJ, Thourani V, Sherwood M, Julien H, Vemulapalli S. National Variability in Pacemaker Implantation Rate Following TAVR: Insights From the STS/ACC TVT Registry. JACC Cardiovasc Interv 2024; 17:391-401. [PMID: 38355267 DOI: 10.1016/j.jcin.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Although permanent pacemaker (PPM) implantation is a common complication of transcatheter aortic valve replacement (TAVR), hospital variation and change in PPM implantation rates are ill defined. OBJECTIVES The aim of this study was to determine hospital-level variation and temporal trends in the rate of PPM implantation following TAVR. METHODS Using the American College of Cardiology/Society of Thoracic Surgeons TVT (Transcatheter Valve Therapy) Registry, temporal changes in variation of in-hospital and 30-day PPM implantation were determined among 184,452 TAVR procedures across 653 sites performed from 2016 to 2020. The variation in PPM implantation adjusted for valve type by annualized TAVR volume was determined, and characteristics of sites below, within, and above the 95% boundary were identified. A series of stepwise multivariable hierarchical models were then fit, and the median OR was used to measure variation in pacemaker rates among sites. RESULTS From 2016 to 2020, the overall rate of PPM implantation was 11.3%, with wide variation across sites (range: 0%-36.4%); rates trended lower over time. Adjusted for annualized volume, there were 34 sites with PPM implantation rates above the 95th percentile CI and 28 with rates below, with wide variation among the remaining sites. After adjusting for patient-level covariates, there was variation among sites in the probability of PPM implantation (median OR: 1.39; 95% CI: 1.35-1.43, P < 0.001); although some of the variation was explained by the addition of valve type, residual variation in PPM implantation rates persisted in additional models incorporating site-level covariates (annualized volume, region, teaching status, hospital beds, etc). CONCLUSIONS Although PPM implantation rates have decreased over time, substantial site-level variation remains even after accounting for observed patient characteristics and site-level factors. As there are numerous outlier sites both above and below the 95% confidence limit, dissemination of best practices from high-performing sites to low-performing sites and guideline-based education may be important quality improvement initiatives to reduce rates of this common complication.
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Affiliation(s)
- Amit N Vora
- UPMC Pinnacle Heart and Vascular Institute, Harrisburg, Pennsylvania, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA; Yale University School of Medicine, New Haven, CT.
| | - Hemal Gada
- UPMC Pinnacle Heart and Vascular Institute, Harrisburg, Pennsylvania, USA
| | - Pratik Manandhar
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrezej Kosinski
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Ajay Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Tamim Nazif
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michael Reardon
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Susheel Kodali
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | | | | | | | - Howard Julien
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
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Datta R, Bharadwaj P, Keshavamurthy G, Guleria VS, Kj R, Abbot AK. Transcatheter aortic valve implantation using coplanar and cuspal overlap techniques in Indian patients. Indian Heart J 2024; 76:36-43. [PMID: 38218314 PMCID: PMC10943560 DOI: 10.1016/j.ihj.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Transcatheter Aortic Valve Implantation (TAVI) techniques gradually evolved since 2002 and have undergone various refinements. Achieving optimal implantation depth has become crucial for good long term outcome. High implantation decreases the likelihood of conduction disturbances. Conventionally TAVI valve is positioned in a tricusp coplanar (CON) fluoroscopic projection however it does not ensure a optimal implantation. In an attempt to attain higher implantation(3 mm) and decrease rate of permanent pacemaker, cuspal overlap technique (COT) view has been developed. There is scarcity of Indian literature comparing TAVI deployment using coplanar and cuspal overlap techniques. METHODS We included 111 patients who underwent TAVR with a self-expanding Core Valve Evolut R (Medtronic, Minneapolis, Minnesota), between January 2017 to September 2022 at our centre.Transcatheter Heart Valves (THV) were implanted using the traditional coplanar in 55 patients, while in 56 patients valves were implanted using the COT. RESULTS Baseline characteristics including electrocardiographic findings were comparable in both groups. In all patients Evolut R or Evolut PRO valves were used. Procedure was done in conscious sedation in 90.9 % of patients in CON and 96.4 % in COT group. Predilatation and postdilatation was used in 38.8 % vs 33.9 % and 27 % vs 32 % in CON and COT groups respectively. 90 day PPI rate was less in COT group (7.3 % CON vs 3.5 % COP). Majority of patients who received permanent pacemaker implantation (PPI) had baseline ECG abnormality (RBBB in 50 %, LBBB in 16 %, Grade 1 AV block 16 %). Mean time of post procedure PPI was 5.6 days in COT group and 7.3 days in CON group. New onset LBBB was also less in COT group (21 % CON vs 12.5 % COT).There were 3.6 % intraprocedural deaths in CON group and 1.8 % in COT group. Depth of deployed valve was 4.8 ± 2.34 mm in COT and 6.6 ± 2.11 mm in CON group. Valve deployment time was more in COT group(10.40 CON vs 14.34 min COT). Average valve recapture rate was 2.58 in COP and 2.11 in CON. Stroke rate was more in COT group(3.6 % CON vs 7.14 % COT). Pericardial effusions were also more in COT group. All cause mortality at 3 months was 10.9 % in CON group and 5.3 % in COT. CONCLUSION In this study we achieved lower rates of PPI and new onset LBBB using COT technique in Indian patients using self-expandable prostheses. However valve deployment time, stroke rate and pericardial effusion were seen more in COT group. All cause mortality was low in cuspal overlap technique.
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Affiliation(s)
- Rajat Datta
- Department of Cardiology, AHRR, Delhi, India.
| | | | | | | | - Ratheesh Kj
- Department of Cardiology, AHRR, Delhi, India.
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Abdelshafy M, Elkoumy A, Elzomor H, Abdelghani M, Campbell R, Kennedy C, Kenny Gibson W, Fezzi S, Nolan P, Wagener M, Arsang-Jang S, Mohamed SK, Mostafa M, Shawky I, MacNeill B, McInerney A, Mylotte D, Soliman O. Predictors of Conduction Disturbances Requiring New Permanent Pacemaker Implantation following Transcatheter Aortic Valve Implantation Using the Evolut Series. J Clin Med 2023; 12:4835. [PMID: 37510950 PMCID: PMC10381756 DOI: 10.3390/jcm12144835] [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: 05/27/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Conduction disturbance requiring a new permanent pacemaker (PPM) after transcatheter aortic valve implantation (TAVI) has traditionally been a common complication. New implantation techniques with self-expanding platforms have reportedly reduced the incidence of PPM. We sought to investigate the predictors of PPM at 30 days after TAVI using Evolut R/PRO/PRO+; (2) Methods: Consecutive patients who underwent TAVI with the Evolut platform between October 2019 and August 2022 at University Hospital Galway, Ireland, were included. Patients who had a prior PPM (n = 10), valve-in-valve procedures (n = 8) or received >1 valve during the index procedure (n = 3) were excluded. Baseline clinical, electrocardiographic (ECG), echocardiographic and multislice computed tomography (MSCT) parameters were analyzed. Pre-TAVI MSCT analysis included membranous septum (MS) length, a semi-quantitative calcification analysis of the aortic valve leaflets, left ventricular outflow tract, and mitral annulus. Furthermore, the implantation depth (ID) was measured from the final aortography. Multivariate binary logistic analysis and receiver operating characteristic (ROC) curve analysis were used to identify independent predictors and the optimal MS and ID cutoff values to predict new PPM requirements, respectively; (3) Results: A total of 129 TAVI patients were included (age = 81.3 ± 5.3 years; 36% female; median EuroSCORE II 3.2 [2.0, 5.4]). Fifteen patients (11.6%) required PPM after 30 days. The patients requiring new PPM at 30 days were more likely to have a lower European System for Cardiac Operative Risk Evaluation II, increased prevalence of right bundle branch block (RBBB) at baseline ECG, have a higher mitral annular calcification severity and have a shorter MS on preprocedural MSCT analysis, and have a ID, as shown on the final aortogram. From the multivariate analysis, pre-TAVI RBBB, MS length, and ID were shown to be predictors of new PPM. An MS length of <2.85 mm (AUC = 0.85, 95%CI: (0.77, 0.93)) and ID of >3.99 mm (area under the curve (AUC) = 0.79, (95% confidence interval (CI): (0.68, 0.90)) were found to be the optimal cut-offs for predicting new PPM requirements; (4) Conclusions: Membranous septum length and implantation depth were found to be independent predictors of new PPM post-TAVI with the Evolut platform. Patient-specific implantation depth could be used to mitigate the requirement for new PPM.
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Affiliation(s)
- Mahmoud Abdelshafy
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
- CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; (S.A.-J.); (S.K.M.)
- Department of Cardiology, Al-Azhar University, Cairo 11311, Egypt; (M.A.); (M.M.); (I.S.)
| | - Ahmed Elkoumy
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
- CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; (S.A.-J.); (S.K.M.)
- Islamic Center of Cardiology and Cardiac Surgery, Al-Azhar University, Cairo 11651, Egypt
| | - Hesham Elzomor
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
- CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; (S.A.-J.); (S.K.M.)
- Islamic Center of Cardiology and Cardiac Surgery, Al-Azhar University, Cairo 11651, Egypt
| | - Mohammad Abdelghani
- Department of Cardiology, Al-Azhar University, Cairo 11311, Egypt; (M.A.); (M.M.); (I.S.)
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Ruth Campbell
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
| | - Ciara Kennedy
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
| | - William Kenny Gibson
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
| | - Simone Fezzi
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
| | - Philip Nolan
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
| | - Max Wagener
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
| | - Shahram Arsang-Jang
- CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; (S.A.-J.); (S.K.M.)
- Discipline of Medicine, Clinical Science Institute, University of Galway, H91 YR71 Galway, Ireland
| | - Sameh K. Mohamed
- CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; (S.A.-J.); (S.K.M.)
| | - Mansour Mostafa
- Department of Cardiology, Al-Azhar University, Cairo 11311, Egypt; (M.A.); (M.M.); (I.S.)
| | - Islam Shawky
- Department of Cardiology, Al-Azhar University, Cairo 11311, Egypt; (M.A.); (M.M.); (I.S.)
| | - Briain MacNeill
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
| | - Angela McInerney
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
| | - Darren Mylotte
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
- Discipline of Medicine, Clinical Science Institute, University of Galway, H91 YR71 Galway, Ireland
| | - Osama Soliman
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
- CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; (S.A.-J.); (S.K.M.)
- CÚRAM Centre for Medical Devices, H91 TK33 Galway, Ireland
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Zaid S, Attizzani GF, Krishnamoorthy P, Yoon SH, Palma Dallan LA, Chetcuti S, Fukuhara S, Grossman PM, Goel SS, Atkins MD, Kleiman NS, Puri R, Bakhtadze B, Byrne T, Ibrahim AW, Grubb KJ, Tully A, Herrmann HC, Faggioni M, Ramlawi B, Khera S, Lerakis S, Dangas GD, Kini AS, Sharma SK, Reardon MJ, Tang GHL. First-in-Human Multicenter Experience of the Newest Generation Supra-Annular Self-Expanding Evolut FX TAVR System. JACC Cardiovasc Interv 2023; 16:1626-1635. [PMID: 37438029 DOI: 10.1016/j.jcin.2023.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND The latest-generation Evolut FX TAVR system (Medtronic) offers several potential design improvements over its predecessors, but early reported experience has been limited. OBJECTIVES This study sought to report our multicenter, limited market release, first-in-human experience of transcatheter aortic valve replacement (TAVR) with the Evolut FX system and compare it with a single-center PRO+ (Medtronic) experience. METHODS From June 27 to September 16, 2022, 226 consecutive patients from 9 US centers underwent transfemoral TAVR with the Evolut FX system for native aortic stenosis (89.4%) or prosthetic valve degeneration (10.6%). Commissural alignment was defined as 0° to 30° between native and FX commissures. Patient, anatomical, and procedural characteristics were retrospectively reviewed, and 30-day clinical and echocardiographic outcomes per Valve Academic Research Consortium-3 definitions were reported. RESULTS Of 226 patients, 34.1% were low risk, 4% had a bicuspid valve, and 11.5% had a horizontal root (≥60°). Direct Inline sheath (Medtronic) was used in 67.6% and Lunderquist stiff wire (Cook Medical) in 35.4% of cases. Optimal hat marker orientation during deployment was achieved in 98.4%, with commissural alignment in 96.5%. At 30 days, 14.3% mild, 0.9% moderate, and no severe paravalvular leak were observed. Compared with the Evolut PRO+ experience from 1 center, FX had a more symmetrical implantation with shallower depth at the left coronary cusp (P < 0.001), fewer device recaptures (26.1% vs 39.5%; P = 0.004), and improved commissural alignment (96.5% vs 80.2%; P < 0.001). CONCLUSIONS The Evolut FX system demonstrated favorable 30-day outcomes with a significant improvement over PRO+ in achieving commissural alignment, fewer device recaptures, and more symmetrical implantation. These features may benefit younger patients undergoing TAVR with the supra-annular, self-expanding valve, where lifetime management would be important.
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Affiliation(s)
- Syed Zaid
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | | - Sung-Han Yoon
- University Hospitals of Cleveland, Cleveland, Ohio, USA
| | | | | | | | | | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Marvin D Atkins
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | | - Timothy Byrne
- Abrazo Arizona Heart Hospital, Phoenix, Arizona, USA
| | | | | | | | - Howard C Herrmann
- University of Pennsylvania Perlman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michela Faggioni
- University of Pennsylvania Perlman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Basel Ramlawi
- Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Sahil Khera
- Mount Sinai Hospital, New York, New York, USA
| | | | | | | | | | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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7
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Zaid S, Atkins MD, Kleiman NS, Reardon MJ, Tang GHL. What's New with TAVR? An Update on Device Technology. Methodist Debakey Cardiovasc J 2023; 19:4-14. [PMID: 37213874 PMCID: PMC10198244 DOI: 10.14797/mdcvj.1230] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 05/23/2023] Open
Abstract
Over the last 20 years, transcatheter aortic valve replacement (TAVR) has revolutionized the management of aortic stenosis and has become the standard of care across the entire spectrum of surgical risk. Expansion of TAVR in treating younger, lower-risk patients with longer life expectancies, and treating earlier in the disease process, has seen a continuous evolution in device technology, with several next-generation transcatheter heart valves developed to minimize procedural complications and improve patient outcomes. This review provides an update on the latest advances in transcatheter delivery systems, devices, and leaflet technology.
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Affiliation(s)
- Syed Zaid
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US
| | - Marvin D. Atkins
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US
| | - Neal S. Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US
| | - Michael J. Reardon
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US
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