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Oba Y, Kumamaru H, Hoshide S, Kohsaka S, Shimamura K, Ohno Y, Sato M, Kobayashi H, Funayama H, Harada K, Kawahito K, Kario K. Valve-in-Valve TAVR for Degenerated Surgical Valves in Patients With Small Aortic Annuli: A Report From a Japanese Nationwide Registry. Circ Cardiovasc Interv 2025:e015087. [PMID: 40394980 DOI: 10.1161/circinterventions.124.015087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Accepted: 04/30/2025] [Indexed: 05/22/2025]
Abstract
BACKGROUND Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) provides an alternative treatment for high-risk patients with failed surgical bioprosthetic aortic valves. However, limited data exist on ViV-TAVR outcomes in patients with small aortic annuli, particularly among the relatively small-statured Japanese population. METHODS We analyzed data from the J-TVT (Japan Transcatheter Valve Therapy) registry, which included all TAVR institutions across Japan, with data collected from July 2018, when ViV-TAVR was approved, through December 2022. A small aortic annulus was defined as an aortic annulus area of ≤314 mm², measured using preoperative computed tomography for ViV-TAVR. Prosthesis-patient mismatch (PPM) was defined as an indexed effective orifice area <0.85 cm²/m², assessed using echocardiography within 30 days after ViV-TAVR. The composite endpoint was evaluated at 30 days and 1 year. RESULTS Among 47 800 individuals, 1029 underwent ViV-TAVR, resulting in a final sample of 405 patients. The mean indexed effective orifice area was 0.83 cm²/m² in the small annulus group (n=225) and 0.94 cm²/m² in the nonsmall group (n=180), with PPM rates of 59.2% and 44.4%, respectively. Small annuli were independently associated with PPM (hazard ratio, 1.9 [95% CI, 1.26-2.87]; P=0.002). No differences in 30-day and 1-year outcomes were observed between groups. Among the 225 patients with small annuli, the mean indexed effective orifice area was 0.76 cm2/m2 in the balloon-expandable valve group (n=61) and 0.86 cm2/m2 in the supraannular self-expanding valve group (n=164), with PPM rates of 67.2% and 56.1%, respectively. No differences in outcomes were noted based on the type of valve implanted. CONCLUSIONS ViV-TAVR for small aortic annuli in Japanese patients was associated with an increased risk of PPM; however, no differences in clinical outcomes were observed according to aortic annulus size or valve type. Due to the small size of our sample, further research is required to validate these findings.
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Affiliation(s)
- Yusuke Oba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. (Y.O., S.H., M.S., H.K., H.F., K.H., K.K.)
| | | | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. (Y.O., S.H., M.S., H.K., H.F., K.H., K.K.)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.K.)
| | | | - Yohei Ohno
- Tokai University, Kanagawa, Japan (Y.O.)
| | - Masafumi Sato
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. (Y.O., S.H., M.S., H.K., H.F., K.H., K.K.)
| | - Hisaya Kobayashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. (Y.O., S.H., M.S., H.K., H.F., K.H., K.K.)
| | - Hiroshi Funayama
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. (Y.O., S.H., M.S., H.K., H.F., K.H., K.K.)
| | - Kenji Harada
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. (Y.O., S.H., M.S., H.K., H.F., K.H., K.K.)
| | - Koji Kawahito
- Department of Cardiovascular Surgery, Jichi Medical University School of Medicine, Tochigi, Japan. (K.K.)
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. (Y.O., S.H., M.S., H.K., H.F., K.H., K.K.)
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Mori M, Geirsson A, George I, Russo MJ. Revisiting Mechanical Aortic Valves in Younger Patients. J Am Coll Cardiol 2025; 85:1299-1301. [PMID: 40139885 DOI: 10.1016/j.jacc.2025.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Revised: 02/18/2025] [Accepted: 02/19/2025] [Indexed: 03/29/2025]
Affiliation(s)
- Makoto Mori
- Division of Cardiac Surgery, Columbia Irving Medical Center, New York, New York, USA.
| | - Arnar Geirsson
- Division of Cardiac Surgery, Columbia Irving Medical Center, New York, New York, USA
| | - Isaac George
- Division of Cardiac Surgery, Columbia Irving Medical Center, New York, New York, USA
| | - Mark J Russo
- Division of Cardiac Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Beerkens FJ, Tang GHL, Kini AS, Lerakis S, Dangas GD, Mehran R, Khera S, Goldman M, Fuster V, Bhatt DL, Webb JG, Sharma SK. Transcatheter Aortic Valve Replacement Beyond Severe Aortic Stenosis: JACC State-of-the-Art Review. J Am Coll Cardiol 2025; 85:944-964. [PMID: 40044299 DOI: 10.1016/j.jacc.2024.11.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 11/12/2024] [Accepted: 11/14/2024] [Indexed: 05/13/2025]
Abstract
Transcatheter aortic valve replacement (TAVR) has become the preferred treatment option in appropriate patients with symptomatic severe aortic stenosis (AS). A number of advancements have since expanded the eligible population to bicuspid aortic valve with feasible anatomy; small aortic annuli; low-flow, low-gradient AS; and younger patients. Focus has also shifted beyond the symptomatic severe patients to asymptomatic severe and moderate AS, as early valve replacement may prevent irreversible cardiac remodeling. Dedicated devices to treat native aortic regurgitation have shown encouraging short-term outcomes. While the expansion of TAVR to younger patients has raised questions about valve durability and feasibility of reintervention, valve-in-valve TAVR has thus far shown encouraging midterm results. In this review, we summarize the evidence in these contemporary TAVR populations, exploring both the promise and challenge of broadening the patient pool for this minimally invasive procedure.
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Affiliation(s)
| | - Gilbert H L Tang
- Mount Sinai Fuster Heart Hospital, New York, New York, USA; Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | | | | | | | - Roxana Mehran
- Mount Sinai Fuster Heart Hospital, New York, New York, USA
| | - Sahil Khera
- Mount Sinai Fuster Heart Hospital, New York, New York, USA
| | - Martin Goldman
- Mount Sinai Fuster Heart Hospital, New York, New York, USA
| | | | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, New York, New York, USA
| | - John G Webb
- Division of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Samin K Sharma
- Mount Sinai Fuster Heart Hospital, New York, New York, USA.
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Steul JH, Abdel-Wahab M, Stankowski T, Haussig S, Woitek FJ, Gasior T, Crusius L, Knorr L, Müller FV, Fritzsche D, Kiefer P, Kappert U, Holzhey D, Linke A, Mangner N. VARC-3 defined outcome of valve-in-valve transcatheter aortic valve implantation in stentless compared with stented aortic bioprostheses. Clin Res Cardiol 2025; 114:291-301. [PMID: 38078955 PMCID: PMC11913896 DOI: 10.1007/s00392-023-02347-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/16/2023] [Indexed: 03/18/2025]
Abstract
BACKGROUND Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is a viable alternative to redo surgery in selected patients with bioprosthetic valve dysfunction. Most ViV-TAVI procedures have been performed in stented bioprosthetic valves (ST); stentless bioprostheses (SL) lack fluoroscopic markers and could be more challenging for ViV-TAVI. Data on more recent patients applying Valve Academic Research Consortium (VARC)-3 defined outcomes are scarce. We compared patient characteristics, procedural outcomes, and 5-year mortality of patients with SL versus ST aortic bioprosthetic valve failure undergoing ViV-TAVI. METHODS Patients undergoing ViV-TAVI between 2007 and 2022 (52.5% of cases after 2015) at 3 German centers were included in this analysis. The co-primary outcome measures were technical success, device success, and early safety defined by VARC-3. Mortality was assessed up to 5 years. RESULTS Overall, 43 (11.8%) SL and 313 (88.2%) ST ViV-TAVI were included. Patients were comparable with regard to age, sex, clinically relevant baseline comorbidities, and surgical risk. Technical success (SL: 83.7% versus ST: 79.9%, p = 0.552), device success (SL: 67.4% versus ST: 54.3%, p = 0.105), and early safety (SL: 74.4% versus ST: 66.5%, p = 0.296) were comparable between groups. The 30-day mortality (SL: 7.0% versus ST: 2.6%, p = 0.136) and 5-year mortality rates (SL: 23.3% versus ST: 24.6%, p = 0.874) were not significantly different between groups. CONCLUSION SL and ST ViV-TAVI led to comparable short-term outcomes according to VARC-3- defined endpoints and similar mortality rates up to 5 years of follow-up.
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Affiliation(s)
- Jean-Honoré Steul
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Tomasz Stankowski
- Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Stephan Haussig
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
| | - Felix J Woitek
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
| | - Tomasz Gasior
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Lisa Crusius
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
| | - Luise Knorr
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
| | - Felicitas V Müller
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
| | - Dirk Fritzsche
- Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Philipp Kiefer
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Utz Kappert
- Department of Cardiac Surgery, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
| | - David Holzhey
- Department of Cardiac Surgery, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
| | - Norman Mangner
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany.
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Yeo YH, Lim GK, Mee XC, Ang QX, Tan MC. Predictors of in-hospital early mortality following valve-in-valve transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2025:S1553-8389(25)00028-4. [PMID: 39919980 DOI: 10.1016/j.carrev.2025.01.013] [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: 10/10/2024] [Revised: 01/17/2025] [Accepted: 01/28/2025] [Indexed: 02/09/2025]
Abstract
BACKGROUND There is an increasing preference of utilizing valve-in-valve transcatheter aortic valve replacement (ViV TAVR) after bioprosthetic valve failure. However, updated large-scale analysis investigating early-mortality after the patients underwent ViV TAVR is limited. OBJECTIVE This study aimed to assess in-hospital early mortality and analyze the factors associated with in-hospital early mortality among patients who underwent ViV TAVR. METHODS Using the all-payer, nationally representative National Readmission Database, our study included patients aged 18 years or older who had ViV TAVR between 2017 and 2020. We categorized the cohort into two groups depending on the occurrence of in-hospital early mortality (death within 30 days after the procedure). Based on the ICD-10, we identified the trend of in-hospital early mortality after ViV TAVR and further analyzed the significant factors associated with it. RESULTS After adjustment, a total of 11,009 patients who had ViV TAVR were included in this study. 329 (3.0 %) had in-hospital early mortality and 10,680 (97.0 %) without. There was a decreasing trend in in-hospital early mortality from 3.3 % in 2017 to 1.0 % in 2020, but it was insignificant (p = 0.71). In multivariable analysis, the independent factors associated with in-hospital early mortality were chronic liver disease (adjusted odds ratio [aOR]: 3.62; 95 % confidence interval [CI]: 1.96-6.71, p < 0.01), coagulation disorder (aOR: 1.77; CI: 1.16-2.68, p < 0.01) and pulmonary hypertension (aOR: 1.78; CI: 1.18-2.68, p < 0.01). Among patients who died during early readmission following ViV TAVR, the most common cardiac cause and non-cardiac cause of readmission were heart failure (15.4 %) and infection (23.1 %), respectively. CONCLUSION The in-hospital early mortality following ViV TAVR was low at 3.0 %. The independent factors associated with in-hospital early mortality post-procedurally were chronic liver disease, coagulation disorder, and pulmonary hypertension.
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Affiliation(s)
- Yong-Hao Yeo
- Department of Internal Medicine-Pediatrics, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA.
| | | | | | - Qi-Xuan Ang
- Department of Internal Medicine, Sparrow Health System and Michigan State University, East Lansing, MI, USA
| | - Min Choon Tan
- Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, NJ, USA; Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
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Takagi K, Kawamoto N, Irie Y, Kakuta T, Asaumi Y, Okada A, Amaki M, Kitai T, Kanzaki H, Izumi C, Fukushima S, Yamamoto K, Noguchi T, Fujita T. Peri-procedural outcome according to VARC-3 criteria and hemodynamic mid-term follow-up after Valve-in-valve transcatheter aortic valve replacement for failed aortic bioprosthesis. Cardiovasc Interv Ther 2025; 40:164-176. [PMID: 39613982 DOI: 10.1007/s12928-024-01063-9] [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: 08/29/2024] [Accepted: 10/25/2024] [Indexed: 12/01/2024]
Abstract
Despite the widespread adoption of valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) for patients with failed aortic bioprosthesis, the effectiveness of this treatment for Japanese patients frequently associated with small aortic annuli remains unclear. From December-2011 to October-2022, 41 consecutive patients undergoing VIV-TAVR were enrolled in this study. The endpoints were technical success, device success, early safety, and two-year mortality according to implanted surgical valve size (small valves: 19-mm and 21-mm, n = 23; large valves: 23-mm and 25-mm, n = 18). The patient population had a mean age of 80.5 years, 46.3% male. Technical success, device success, and early safety rates were 100%, 70.7%, and 87.8%, respectively. There was no significant increase in the transprosthetic gradient throughout the follow-up (mean pressure gradient pre-VIV, post-VIV, at one-year, and at two-year; 37.0 mmHg, 16.5 mmHg, 15.0 mmHg, and 12.0 mmHg, respectively). While technical success and two-year mortality were comparable (87.5% vs. 86.7%, log-rank p = 0.816), device success was significantly lower in the small valves than in the large valves (56.5% vs. 88.9%, p = 0.038). Early safety trended lower in the small valves. Valve hemodynamic performance improved in both groups, but severe prosthesis-patient mismatch was more common in the small valves. VIV-TAVR demonstrated acceptable technical performance and relatively low mid-term mortality in this Japanese population, irrespective of aortic annular size. However, device success and early safety were significantly worse in patients with small valves than in those with large valves.
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Affiliation(s)
- Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
| | - Naonori Kawamoto
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuki Irie
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Takashi Kakuta
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Tottori University, Tottori, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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Moubarak G, Salih M, Eisenga J, McCullough K, Ramos OG, Banwait J, Al-Azizi K, Mack MJ, DiMaio JM, Szerlip MI. Transcatheter Valve-in-Valve Replacement With Balloon- Versus Self-Expanding Valves in Patients With Degenerated Stentless Aortic Bioprosthesis. Am J Cardiol 2024; 230:50-57. [PMID: 39117008 DOI: 10.1016/j.amjcard.2024.08.001] [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: 03/22/2024] [Revised: 08/02/2024] [Accepted: 08/02/2024] [Indexed: 08/10/2024]
Abstract
Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has been associated with favorable outcomes in patients with degenerated stentless bioprosthesis. However, whether the outcomes after ViV TAVR for failed stentless bioprosthesis differ between balloon-expandable valves (BEVs) and self-expanding valves (SEVs) remains unknown. Therefore, we retrospectively analyzed 59 consecutive patients who underwent ViV TAVR for failed stentless bioprsothesis with BEVs (n = 42) versus SEVs (n = 17) in a single-health care system between 2013 and 2022. Overall, the mean age was 70.8 years and 74.6% were men. The mean transcatheter valve size was 26.3 ± 2.2 mm for BEVs and 26.4 ± 4 mm for SEVs (p = 0.93). The mean Society of Thoracic Surgeons score was 6.0 ± 3.6 for BEVs and 7.5 ± 5.5 for SEVs (p = 0.22). Compared with patients who received BEVs, those who received SEVs had higher rates of device malposition (2.4% vs 23.5%, p <0.01), postdeployment balloon dilation (11.9% vs 35.5%, p = 0.04) and need for a second transcatheter device (2.4% vs 35.5%, p <0.01). However, both groups showed similar improvement in aortic valve function at 30-day and 1-year follow-up (incidence of 1-year severe patient-prosthesis mismatch in BEVs: 17.6% vs 14.3% in SEVs, p = 0.78). The 1- and 3-year mortality did not differ between BEVs and SEVs (11.9% vs 11.8% and 25% vs 30%, respectively, Log rank p = 0.9). In conclusion, performing ViV TAVR for failed stentless bioprsothesis is technically challenging, especially when using SEVs; however, satisfactory positioning is possible in most cases, with excellent hemodynamic and clinical outcomes with BEVs and SEVs.
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Affiliation(s)
- Ghadi Moubarak
- Department of Research, Baylor Scott and White Research Institute Plano, Texas.
| | - Mohammed Salih
- Research Department, The Heart Hospital Baylor, Plano, Texas
| | - John Eisenga
- Department of Research, Baylor Scott and White Research Institute Plano, Texas
| | - Kyle McCullough
- Department of Research, Baylor Scott and White Research Institute Plano, Texas
| | | | - Jasjit Banwait
- Department of Research, Baylor Scott and White Research Institute Plano, Texas
| | - Karim Al-Azizi
- Research Department, The Heart Hospital Baylor, Plano, Texas
| | - Michael J Mack
- Department of Research, Baylor Scott and White Research Institute Plano, Texas; Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital Plano, Texas
| | - J Michael DiMaio
- Department of Research, Baylor Scott and White Research Institute Plano, Texas; Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital Plano, Texas
| | - Molly I Szerlip
- Department of Research, Baylor Scott and White Research Institute Plano, Texas; Research Department, The Heart Hospital Baylor, Plano, Texas
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Ellfors E, Dismorr M, Rück A, Settergren M, Sartipy U, Glaser N. Predicted prosthesis-patient mismatch and long-term clinical outcomes after transcatheter aortic valve replacement: A SWEDEHEART study. Am Heart J 2024; 276:70-82. [PMID: 39032585 DOI: 10.1016/j.ahj.2024.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/07/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND The impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is uncertain. This study was performed to investigate the risk of all-cause mortality, heart failure hospitalization, and aortic valve reintervention in patients with and without predicted PPM after TAVR. METHODS This nationwide, population-based cohort study included all patients who underwent transfemoral primary TAVR in Sweden from 2008 to 2022 in the SWEDEHEART register. PPM was defined according to published effective orifice areas for each valve model and size. The patients were divided into those with and without PPM. Additional baseline characteristics and outcome data were obtained from other national health data registers. Regression standardization was used to adjust for intergroup differences. RESULTS Of 8485 patients, 7879 (93%) had no PPM and 606 (7%) had PPM. The crude cumulative incidence of all-cause mortality at 1, 5, and 10 years in patients with versus without PPM was 7% versus 9%, 40% versus 44%, and 80% versus 85%, respectively. After regression standardization, there was no between-group difference in long-term mortality, and the absolute difference at 10 years was 1.5% (95% confidence interval, -2.9%-6.0%). The mean follow-up was 3.0 years (maximum, 14 years). There was no difference in the risk of heart failure hospitalization or aortic valve reintervention. CONCLUSIONS The risk of all-cause mortality, heart failure hospitalization, or aortic valve reintervention was not higher in patients with than without predicted PPM following TAVR. Furthermore, PPM was present in only 7% of patients, and severe PPM was almost nonexistent.
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Affiliation(s)
- Emma Ellfors
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Michael Dismorr
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Rück
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Settergren
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Natalie Glaser
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Cao D, Albani S, Gall E, Hovasse T, Unterseeh T, Seknadji P, Champagne S, Garot P, Sayah N, Akodad M. Aortic Valve-in-Valve Procedures: Challenges and Future Directions. J Clin Med 2024; 13:4723. [PMID: 39200865 PMCID: PMC11355095 DOI: 10.3390/jcm13164723] [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: 07/03/2024] [Revised: 08/05/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Aortic valve-in-valve (ViV) procedures are increasingly performed for the treatment of surgical bioprosthetic valve failure in patients at intermediate to high surgical risk. Although ViV procedures offer indisputable benefits in terms of procedural time, in-hospital length of stay, and avoidance of surgical complications, they also present unique challenges. Growing awareness of the technical difficulties and potential threats associated with ViV procedures mandates careful preprocedural planning. This review article offers an overview of the current state-of-the-art ViV procedures, with focus on patient and device selection, procedural planning, potential complications, and long-term outcomes. Finally, it discusses current research efforts and future directions aimed at improving ViV procedural success and patient outcomes.
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Affiliation(s)
- Davide Cao
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Stefano Albani
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
- Division of Cardiology, U. Parini Hospital, 11100 Aosta, Italy
| | - Emmanuel Gall
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
- Department of Cardiology, University Hospital of Lariboisiere, Université Paris-Cité, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010 Paris, France
- Inserm MASCOT—UMRS 942, University Hospital of Lariboisiere, 75010 Paris, France
- MIRACL.ai Laboratory, Multimodality Imaging for Research and Artificial Intelligence Core Laboratory, University Hospital of Lariboisiere (AP-HP), 75010 Paris, France
| | - Thomas Hovasse
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
| | - Thierry Unterseeh
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
| | - Patrick Seknadji
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
| | - Stéphane Champagne
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
| | - Philippe Garot
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
| | - Neila Sayah
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
| | - Mariama Akodad
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91100 Massy, France
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10
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Aldea GS, Burke CR, Fischlein T, Heimansohn DA, Haverich A, Suri RM, Ad N. Does valve size impact hemodynamic, left ventricular mass regression, and prosthetic valve deterioration with a sutureless aortic valve? J Thorac Cardiovasc Surg 2024; 168:502-509.e9. [PMID: 36858846 DOI: 10.1016/j.jtcvs.2023.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/22/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To assess the mid-term clinical outcomes, hemodynamics, left ventricular (LV) mass regression, and structural valve deterioration (SVD) in patients implanted with the Perceval aortic sutureless valve across valve sizes. METHODS Data were obtained from a multicenter European trial and a US Investigational Device Exemption trial. Echocardiography data were analyzed by an echocardiography core lab. A mixed-effects regression model was used to assess relationships between hemodynamic outcomes, time from the procedure, and valve sizes. The Valve Academic Research Consortium (VARC)-3 definition for bioprosthetic valve failure was applied. RESULTS A Perceval sutureless valve was implanted in 970 patients. The median patient age was 77.8 years, 57.2% were female, the median Society of Thoracic Surgeons predicated risk of mortality was 3.3% (range, 2.1%-6.2%), and 33.4% had a concomitant procedure. The median clinical follow-up was 45.7 months (range, 28.2-76.1 months). Small and medium valves were implanted more commonly in women than in men (16.9% vs 1.9% for small and 55.1% vs 19.5% for medium; P < .001). The mean aortic valve gradients decreased significantly postimplantation and remained stable across all valve sizes throughout the follow-up period. All patients were free from severe patient-prosthesis mismatch (with an effective orifice area/m2 of >0.8). Significant LV mass regression was documented regardless valve sizes, plateaued at -9.1% at 5 years. Freedom from SVD and reintervention were 95.2% and 96.3%, respectively, at 5 years and were independent of implanted valve size (P = .22). The VARC-3 stage 3 bioprosthetic valve failure rate was low, 2.8% at 5 years. CONCLUSIONS The Perceval valve demonstrated low and stable mean gradients, significant LV mass regression, and low SVD and reintervention rates across all valve sizes.
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Affiliation(s)
- Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
| | | | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | | | - Axel Haverich
- Clinic for Cardiac, Thoracic, Transplantation and Vascular Surgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Rakesh M Suri
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi and Cleveland Clinic Foundation, Cleveland, Ohio
| | - Niv Ad
- Cardiothoracic Surgery, Adventist White Oak Medical Center and Johns Hopkins University, Silver Spring, Md
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11
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Watanabe E, Kometani S, Tsutsumi J, Takei T, Tabata M. Emergency and Prophylactic Extracorporeal Membrane Oxygenation for Patients Undergoing Valve-in-Valve Transcatheter Aortic Valve Implantation With Small Surgical Bioprosthesis: A Report of Four Cases. Cureus 2024; 16:e66964. [PMID: 39280552 PMCID: PMC11401670 DOI: 10.7759/cureus.66964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2024] [Indexed: 09/18/2024] Open
Abstract
Mechanical circulatory support (MCS) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely implemented as a rescue device in transcatheter aortic valve implantation (TAVI). Although prophylactic VA-ECMO (pECMO) in TAVI is preferable to emergency VA-ECMO (eECMO) in terms of overall survival, there is currently no consensus on the introduction criteria for pECMO. Here, we report four cases of eECMO and pECMO performed in valve-in-valve TAVI (ViV-TAVI) with a small surgical bioprosthesis to consider the validity of the current pECMO indications. In the two cases that were placed on eECMO, a 19 mm and 21 mm Carpentier-Edwards perimount bioprosthesis (CEP), a stented bioprosthetic valve, were sewn. After the transcatheter heart valve (THV) passed through the surgical aortic valve, acute aortic regurgitation developed, thus leading to hemodynamic instability requiring cardiopulmonary resuscitation, and therefore VA-ECMO was introduced. In the two cases using pECMO, 19 mm of CEP were sewn, and the THV was safely placed once MCS had been established. In all four cases, the patients were removed from VA-ECMO in the operating room following ViV-TAVI. The eECMO patients were discharged on postoperative days 12 and 20, while the pECMO patients were discharged on postoperative days 7 and 9, respectively. From our experience and based on the findings of some published reviews, ViV-TAVI with a small surgical bioprosthesis is considered to belong to a high-risk patient group demonstrating hemodynamic instability. The introduction of pECMO for such cases may therefore be an effective option for obtaining a better prognosis.
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Affiliation(s)
- Eri Watanabe
- Anesthesiology, Yamato Seiwa Hospital, Yamato, JPN
| | | | | | - Tomohide Takei
- Anesthesiology, Yokohama City University Medical Center, Yokohama, JPN
| | - Mimiko Tabata
- Cardiovascular Surgery, Yamato Seiwa Hospital, Yamato, JPN
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12
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Ternacle J, Hecht S, Eltchaninoff H, Salaun E, Clavel MA, Côté N, Pibarot P. Durability of transcatheter aortic valve implantation. EUROINTERVENTION 2024; 20:e845-e864. [PMID: 39007831 PMCID: PMC11228542 DOI: 10.4244/eij-d-23-01050] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/22/2024] [Indexed: 07/16/2024]
Abstract
Transcatheter aortic valve implantation (TAVI) is now utilised as a less invasive alternative to surgical aortic valve replacement (SAVR) across the whole spectrum of surgical risk. Long-term durability of the bioprosthetic valves has become a key goal of TAVI as this procedure is now considered for younger and lower-risk populations. The purpose of this article is to present a state-of-the-art overview on the definition, aetiology, risk factors, mechanisms, diagnosis, clinical impact, and management of bioprosthetic valve dysfunction (BVD) and failure (BVF) following TAVI with a comparative perspective versus SAVR. Structural valve deterioration (SVD) is the main factor limiting the durability of the bioprosthetic valves used for TAVI or SAVR, but non-structural BVD, such as prosthesis-patient mismatch and paravalvular regurgitation, as well as valve thrombosis or endocarditis may also lead to BVF. The incidence of BVF related to SVD or other causes is low (<5%) at midterm (5- to 8-year) follow-up and compares favourably with that of SAVR. The long-term follow-up data of randomised trials conducted with the first generations of transcatheter heart valves also suggest similar valve durability in TAVI versus SAVR at 10 years, but these trials suffer from major survivorship bias, and the long-term durability of TAVI will need to be confirmed by the analysis of the low-risk TAVI versus SAVR trials at 10 years.
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Affiliation(s)
- Julien Ternacle
- Unité Médico-Chirurgicale des Valvulopathies, Hôpital Haut-Leveque, CHU Bordeaux, Pessac, France
| | - Sébastien Hecht
- Department of Cardiology, Québec Heart & Lung Institute - Laval University, Québec, Canada
| | - Hélène Eltchaninoff
- Department of Cardiology, University of Rouen Normandie, Inserm U1096, CHU Rouen, Rouen, France
| | - Erwan Salaun
- Department of Cardiology, Québec Heart & Lung Institute - Laval University, Québec, Canada
| | - Marie-Annick Clavel
- Department of Cardiology, Québec Heart & Lung Institute - Laval University, Québec, Canada
| | - Nancy Côté
- Department of Cardiology, Québec Heart & Lung Institute - Laval University, Québec, Canada
| | - Philippe Pibarot
- Department of Cardiology, Québec Heart & Lung Institute - Laval University, Québec, Canada
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13
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Hallak O, Fischer K, Ailawadi S, Valencia D, Yatsynovich Y, Nazir R, Schwartz B. Effects of Bioprosthetic Valve Fracturing on Valve-in-Valve Transcatheter Aortic Valve Implantation Transvalvular Gradients. Tex Heart Inst J 2024; 51:e238304. [PMID: 39582677 PMCID: PMC11584884 DOI: 10.14503/thij-23-8304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2024]
Abstract
Background Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is quickly becoming a routine and effective means by which to treat degenerated bioprosthetic valves. A known complication of ViV-TAVI is patient-prosthesis mismatch, which substantially affects survival. Bioprosthetic valve fracture is a method by which to reduce the risk of patient-prosthesis mismatch and post-ViV-TAVI transvalvular gradients. This study sought to determine the safety and efficacy of post-ViV-TAVI bioprosthetic valve fracture. Methods Patients with a history of surgical aortic valve replacement undergoing ViV-TAVI bioprosthetic valve fracture (N = 25) at the corresponding institution from 2015 to 2022 were cataloged for a retrospective analysis. The implanted transcatheter valves were Medtronic Evolut R, Evolut PRO, and Evolut PRO+. Gradients were assessed before and after implantation and after fracturing using transthoracic echocardiogram. Results The mean left ventricular ejection fraction of patients who underwent fracturing was 55.04%. The average (SD) peak and mean (SD) transvalvular gradients before the intervention were 68.17 (19.09) mm Hg and 38.98 (14.37) mm Hg, respectively. After ViV-TAVI, the same gradients were reduced to 27.25 (12.27) mm Hg and 15.63 (6.47) mm Hg, respectively. After bioprosthetic valve fracture, the gradients further decreased to 17.59 (7.93) mm Hg and 8.860 (3.334) mm Hg, respectively. The average reduction in peak gradient associated with fracturing was 12.07 mm Hg (95% CI, 5.73-18.41 mm Hg; P = .001). The average reduction in mean gradient associated with valve fracturing was 6.97 mm Hg (95% CI, 3.99-9.74 mm Hg; P < .001). Conclusion Bioprosthetic valve fracture is a viable option for reducing residual transvalvular gradients after ViV-TAVI and should be considered in patients with elevated gradients (>20 mm Hg) or with concern for patient-prosthesis mismatch in patients who have an unacceptable risk for a redo sternotomy and surgical aortic valve replacement.
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Affiliation(s)
- Osama Hallak
- Department of Cardiovascular Medicine, Kettering Health, Kettering, Ohio
| | - Karley Fischer
- Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Shaina Ailawadi
- Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Damian Valencia
- Department of Cardiovascular Medicine, Kettering Health, Kettering, Ohio
- Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Yan Yatsynovich
- Department of Cardiovascular Medicine, Kettering Health, Kettering, Ohio
- Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Raja Nazir
- Department of Cardiovascular Medicine, Kettering Health, Kettering, Ohio
- Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Brian Schwartz
- Department of Cardiovascular Medicine, Kettering Health, Kettering, Ohio
- Boonshoft School of Medicine, Wright State University, Dayton, Ohio
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14
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Ahmad D, Yousef S, Kliner D, Brown JA, Serna-Gallegos D, Toma C, Makani A, West D, Wang Y, Thoma FW, Sultan I. Outcomes of Valve-in-Valve Transcatheter Aortic Valve Replacement. Am J Cardiol 2024; 215:1-7. [PMID: 38232811 DOI: 10.1016/j.amjcard.2023.12.061] [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: 09/10/2023] [Revised: 11/23/2023] [Accepted: 12/27/2023] [Indexed: 01/19/2024]
Abstract
Structural valve degeneration is increasingly seen given the higher rates of bioprosthetic heart valve use for surgical and transcatheter aortic valve replacement (TAVR). Valve-in-valve TAVR (VIV-TAVR) is an attractive alternate for patients who are otherwise at high risk for reoperative surgery. We compared patients who underwent VIV-TAVR and native valve TAVR through a retrospective analysis of our institutional transcatheter valve therapy (TVT) database from 2013 to 2022. Patients who underwent either a native valve TAVR or VIV-TAVR were included. VIV-TAVR was defined as TAVR in patients who underwent a previous surgical aortic valve replacement. Kaplan-Meier survival analysis was used to obtain survival estimates. A Cox proportional hazards regression model was used for the multivariable analysis of mortality. A total of 3,532 patients underwent TAVR, of whom 198 (5.6%) underwent VIV-TAVR. Patients in the VIV-TAVR cohort were younger than patients who underwent native valve TAVR (79.5 vs 84 years, p <0.001), with comparable number of women and a higher Society of Thoracic Surgeons risk score (6.28 vs 4.46, p <0.001). The VIV-TAVR cohort had a higher incidence of major vascular complications (2.5% vs 0.8%, p = 0.008) but lower incidence of permanent pacemaker placement (2.5% vs 8.1%, p = 0.004). The incidence of stroke was comparable between the groups (VIV-TAVR 2.5% vs native TAVR 2.4%, p = 0.911). The 30-day readmission rates (VIV-TAVR 7.1% vs native TAVR 9%, p = 0.348), as well as in-hospital (VIV-TAVR 2% vs native TAVR 1.4%, p = 0.46), and overall (VIV-TAVR 26.3% vs native TAVR 30.8%, p = 0.18) mortality at a follow-up of 1.8 years (0.83 to 3.5) were comparable between the groups. The survival estimates were also comparable between the groups (log-rank p = 0.27). On multivariable Cox regression analysis, VIV-TAVR was associated with decreased hazards of death (hazard ratio 0.68 [0.5 to 0.9], p = 0.02). In conclusion, VIV-TAVR is a feasible and safe strategy for high-risk patients with bioprosthetic valve failure. There may be potentially higher short-term morbidity with VIV-TAVR, with no overt impact on survival.
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Affiliation(s)
- Danial Ahmad
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dustin Kliner
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Catalin Toma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amber Makani
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David West
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yisi Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd W Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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15
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Khokhar AA, Curio J, Sticchi A, Hartley A, Demir OM, Ruparelia N. Transcatheter Aortic Valve Implantation to Treat Degenerated Aortic, Mitral and Tricuspid Bioprosthesis. J Clin Med 2024; 13:592. [PMID: 38276098 PMCID: PMC10816283 DOI: 10.3390/jcm13020592] [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: 12/22/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is now well established as the treatment of choice for patients with native aortic valve stenosis who are high or intermediate risk for surgical aortic valve replacement. Recent data has also supported the use of TAVI in patients at low surgical risk and also in anatomical subsets that were previously felt to be contra-indicated including bicuspid aortic valves and aortic regurgitation. With advancements and refinements in procedural techniques, the application of this technology has now been further expanded to include the management of degenerated bioprosthesis. After the demonstration of feasibility and safety in the management of degenerated aortic bioprosthetic valves, mitral and tricuspid bioprosthetic valve treatment is now also well-established and provides an attractive alternative to performing redo surgery. In this review, we appraise the latest clinical evidence and highlight procedural considerations when utilising TAVI technology in the management of degenerated aortic, mitral or tricuspid prosthesis.
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Affiliation(s)
- Arif A. Khokhar
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
| | - Jonathan Curio
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine, University Hospital, University of Cologne, 50937 Cologne, Germany;
| | - Alessandro Sticchi
- Cardiac Catheterisation Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy;
- Università di Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy
| | - Adam Hartley
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
| | - Ozan M. Demir
- Department of Cardiology, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon SS16 5NL, UK
| | - Neil Ruparelia
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
- Cardiology, Royal Berkshire Hospital, Reading RG1 5AN, UK
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16
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Nikolayevska O, Conradi L, Schirmer J, Reichenspurner H, Deuschl F, Blankenberg S, Schäfer U. Comparison of a novel self-expanding transcatheter heart valve with two established devices for treatment of degenerated surgical aortic bioprostheses. Clin Res Cardiol 2024; 113:18-28. [PMID: 37017780 PMCID: PMC10808493 DOI: 10.1007/s00392-023-02181-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/03/2023] [Indexed: 04/06/2023]
Abstract
AIMS This study was performed to compare haemodynamic properties of a novel transcatheter heart valve (THV) with two established valve technologies for treatment of failing surgical aortic bioprosthetic valves (SAV). The ALLEGRA THV has been recently described with a proven safety and performance profile. METHODS AND RESULTS The study was designed as a retrospective, single-centre study investigating 112 patients (77.7 ± 7.1 years, 53.8% female, STS score 6.8 ± 5.8% and logEuroSCORE I 27.4 ± 16.1%) with failing SAV. Patients were treated with the ALLEGRA THV (NVT, n = 24), the CoreValve/EvolutR (MTD, n = 64) or the Edwards Sapien/Sapien XT/Sapien 3 (EDW, n = 24). Adverse events, haemodynamic outcomes and patient safety were analysed according to VARC-3 definitions. Overall procedural success was high (94.6%), even though 58.9% of the treated SAV were classified as small (true inner diameter < 21 mm). After treatment, the mean pressure gradient was significantly reduced (baseline: 33.7 ± 16.5 mmHg, discharge: 18.0 ± 7.1 mmHg), with a corresponding increase in effective orifice area (EOA). The complication rates did not differ in between groups. There was a trend to lower mean transvalvular gradients after implantation of self-expanding THV with supra-annular valve function, despite a higher frequency of smaller SAVs in the NVT and MTD group. Additionally, comparison between NVT and MTD revealed statistically lower transvalvular gradients (NVT 14.9 ± 5.0 mmHg, MTD 18.7 ± 7.5 mmHg, p = 0.0295) in a subgroup analysis. CONCLUSIONS Valve-in-valve (ViV) treatment of failing SAV with supra-annular design like the ALLEGRA THV resulted in favourable haemodynamic outcomes with similar low clinical event rates and may therefore be an interesting alternative for VIV TAVI.
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Affiliation(s)
- Olga Nikolayevska
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Klinik für Kardiologie, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Deuschl
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Klinik für Kardiologie, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Klinik für Kardiologie, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Ulrich Schäfer
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Klinik für Kardiologie, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Cardiology, Heart and Vascular Centre Bad Bevensen, Bad Bevensen, Germany
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17
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Meier D, Puehler T, Lutter G, Shen C, Lai A, Gill H, Akodad M, Tzimas G, Chhatriwalla A, Allen KB, Blanke P, Payne GW, Wood DA, Leipsic JA, Webb JG, Sellers SL, Sathananthan J. Bioprosthetic Valve Remodeling in Nonfracturable Surgical Valves: Impact on THV Expansion and Hydrodynamic Performance. JACC Cardiovasc Interv 2023; 16:1594-1608. [PMID: 37294230 DOI: 10.1016/j.jcin.2023.03.035] [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: 01/11/2023] [Revised: 02/13/2023] [Accepted: 03/21/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND There are limited data on the effect of bioprosthetic valve remodeling (BVR) on transcatheter heart valve (THV) expansion and function following valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) in a nonfracturable surgical heart valve (SHV). OBJECTIVES This study sought to assess the impact of BVR of nonfracturable SHVs on THVs after VIV implantation. METHODS VIV TAVR was performed using 23-mm SAPIEN3 (S3, Edwards Lifesciences) or 23/26-mm Evolut Pro (Medtronic) THVs implanted in 21/23-mm Trifecta (Abbott Structural Heart) and 21/23-mm Hancock (Medtronic) SHVs with BVR performed with a noncompliant TRUE balloon (Bard Peripheral Vascular Inc). Hydrodynamic assessment was performed, and multimodality imaging including micro-computed tomography was performed before and after BVR to assess THV and SHV expansion. RESULTS BVR resulted in limited improvement of THV expansion. The largest gain in expansion was observed for the S3 in the 21-mm Trifecta with up to a 12.7% increase in expansion at the outflow of the valve. Minimal change was observed at the level of the sewing ring. The Hancock was less amenable to BVR with lower final expansion dimensions than the Trifecta. BVR also resulted in notable surgical post flaring of up to 17.6°, which was generally more marked with the S3 than with the Evolut Pro. Finally, BVR resulted in very limited improvement in hydrodynamic function. Severe pinwheeling was observed with the S3, which improved slightly but persisted despite BVR. CONCLUSIONS When performing VIV TAVR inside a Trifecta and Hancock SHV, BVR had a limited impact on THV expansion and resulted in SHV post flaring with unknown consequences on coronary obstruction risk and long-term THV function.
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Affiliation(s)
- David Meier
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Puehler
- German Centre for Cardiovascular Research, Partner Site Kiel/Hamburg/Lübeck, Kiel Germany; Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holsten, Campus Kiel, Kiel, Germany
| | - Georg Lutter
- German Centre for Cardiovascular Research, Partner Site Kiel/Hamburg/Lübeck, Kiel Germany; Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holsten, Campus Kiel, Kiel, Germany
| | - Carol Shen
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada
| | - Althea Lai
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada
| | - Hacina Gill
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada
| | - Mariama Akodad
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Ramsay Santé, Institut Cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Massy, France
| | - Georgios Tzimas
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adnan Chhatriwalla
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Keith B Allen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - David A Wood
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon A Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie L Sellers
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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18
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AlBadri A, Joseph J, Patel V, Patel D, Koren O, Cheng W, Jilaihawi H, Makkar R. Hemodynamic and Mid-Term Outcomes for Transcatheter Aortic Valve Replacement in Degenerated Internally Stented Valves. JACC Cardiovasc Interv 2023; 16:542-554. [PMID: 36922040 DOI: 10.1016/j.jcin.2023.01.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/03/2023] [Accepted: 01/30/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Valve-in-valve (ViV) transcatheter aortic valve replacement is indicated in patients undergoing repeat intervention for degenerative aortic valve bioprostheses. Patients with internally stented valves (ie, Mitroflow and Trifecta) are at high risk for coronary artery obstruction during ViV procedures because of valve design, as the leaflets are mounted outside the valve stent. OBJECTIVES The aim of this study was to compare the hemodynamic and clinical outcomes of transcatheter aortic valve replacement within internally stented valves (ViV-IS) vs other surgical valves (ViV-OS). METHODS Baseline characteristics, hemodynamic parameters, and clinical outcomes of patients who underwent ViV-IS were retrospectively collected and compared with those of patients who underwent ViV-OS. RESULTS A total of 250 patients (65% men, median Society of Thoracic Surgeons score 4.4% [IQR: 2.2%-8.4%]) were included. Seventy-one patients (28%) underwent ViV-IS, and 179 (72%) patients underwent ViV-OS. Patients who underwent ViV-OS had better periprocedural hemodynamic status compared with those who underwent ViV-IS (median mean gradient 6 [IQR: 2-13] vs 12 [IQR: 6-16]; P < 0.001). This was not significantly different when both groups were matched on the basis of age, sex, and valve internal diameter size (median mean gradient: 18 [IQR: 13-25] for ViV-OS vs 18 [IQR: 11-24] for ViV-IS; P = 0.36). Coronary protection for potential occlusion was performed more in ViV-IS vs ViV-OS pr (79% vs 6%, respectively; P < 0.001). Patients who underwent ViV-IS had a higher risk for coronary occlusion, requiring stent deployment, compared with those who underwent ViV-OS (54% vs 3%, respectively; P < 0.001. There was no difference in mortality at 3 years between the 2 groups (P = 0.59). CONCLUSIONS Patients who underwent ViV-IS had a very high incidence of coronary compromise that can be safely and effectively treated. In the setting of a systematic coronary protection strategy, ViV-OS and ViV-IS provide similar mid-term outcome, and periprocedural hemodynamic status (following adjustment for age, sex, and true internal diameter).
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Affiliation(s)
- Ahmed AlBadri
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jubin Joseph
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Vivek Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dhairya Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ofir Koren
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Wen Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hasan Jilaihawi
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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19
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Fukui M, Sorajja P, Cavalcante JL, Thao KR, Okada A, Sato H, Wang C, Koike H, Hamid N, Enriquez-Sarano M, Lesser JR, Bapat VN. Deformation of Transcatheter Heart Valve Following Valve-in-Valve Transcatheter Aortic Valve Replacement: Implications for Hemodynamics. JACC Cardiovasc Interv 2023; 16:515-526. [PMID: 36922036 DOI: 10.1016/j.jcin.2023.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/23/2022] [Accepted: 01/10/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) may be associated with adverse hemodynamics, which might affect clinical outcomes. OBJECTIVES This study sought to evaluate the extent and predictors of transcatheter heart valve (THV) deformity in ViV TAVR and the relation to postprocedural hemodynamics. METHODS We examined 53 patients who underwent ViV TAVR in surgical heart valves with self-expanding Evolut prostheses. THV deformation was examined using cardiac computed tomography prospectively performed 30 days after ViV TAVR, and correlated with 30-day echocardiographic hemodynamic data. RESULTS Near complete expansion of the functional portion of the implanted ViV prostheses (ie, >90%) was observed in 16 (30.2%) patients. Factors related to greater expansion of the functional portion and consequently larger neosinus volume were absence of polymer surgical frame, higher implantation and use of balloon aortic valvuloplasty or bioprosthetic valve fracture during the procedure (all P < 0.05). Underexpansion of the functional portion, but not the valve inflow frame, was closely associated with mean gradient and effective orifice area at 30 days on echocardiography, with and without adjustment for the sizes of the THV and surgical heart valve. CONCLUSIONS Underexpansion of the functional portion of THV prostheses is common during ViV TAVR, occurs more frequently with deep implantation and the presence of a polymer surgical stent frame, and is associated with worse postprocedural hemodynamics. Procedural techniques, such as higher implantation and balloon postdilatation, may be used to help overcome problems with THV underexpansion and improve clinical outcomes.
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Affiliation(s)
- Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Kiahltone R Thao
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Atsushi Okada
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Hirotomo Sato
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Cheng Wang
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Hideki Koike
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Nadira Hamid
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - John R Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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20
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Chhatriwalla AK, Allen KB, Depta JP, Rodriguez E, Thourani VH, Whisenant BK, Zahr F, Bapat V, Garcia S. Outcomes of Bioprosthetic Valve Fracture in Patients Undergoing Valve-in-Valve TAVR. JACC Cardiovasc Interv 2023; 16:530-539. [PMID: 36922038 DOI: 10.1016/j.jcin.2022.12.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) is increasingly used to treat degenerated surgical bioprostheses. Bioprosthetic valve fracture (BVF) has been shown to improve hemodynamic status in VIV TAVR in case series. However, the safety and efficacy of BVF are unknown. OBJECTIVES The primary objective of this study was to assess the safety and efficacy of VIV TAVR using SAPIEN 3 and SAPIEN 3 Ultra valves with or without BVF using data from the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry. METHODS The primary outcome was in-hospital mortality. Secondary outcomes included echocardiography-derived valve gradient and aortic valve area. Inverse probability of treatment weighting was used to adjust for baseline characteristics. RESULTS A total of 2,975 patients underwent VIV TAVR from December 15, 2020, to March 31, 2022. BVF was attempted in 619 patients (21%). In adjusted analyses, attempted BVF was associated with higher in-hospital mortality (OR: 2.51; 95% CI: 1.30-4.84) and life-threatening bleeding (OR: 2.55; 95% CI: 1.44-4.50). At discharge, VIV TAVR with attempted BVF was associated with larger aortic valve area (1.6 cm2 vs 1.4 cm2; P < 0.01) and lower mean gradient (16.3 mm Hg vs 19.2 mm Hg; P < 0.01). When BVF was compared with no BVF according to timing (before vs after transcatheter heart valve implantation), BVF after transcatheter heart valve implantation was associated with improved hemodynamic status and similar mortality. CONCLUSIONS BVF as an adjunct to VIV TAVR with the SAPIEN 3 and SAPIEN 3 Ultra valves is associated with a higher risk for in-hospital mortality and significant bleeding and modest improvements in echocardiography-derived hemodynamic status. The timing of BVF is an important determinant of safety and efficacy.
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Affiliation(s)
- Adnan K Chhatriwalla
- St. Luke's Mid America Heart Institute and the University of Missouri, Kansas City, Missouri, USA.
| | - Keith B Allen
- St. Luke's Mid America Heart Institute and the University of Missouri, Kansas City, Missouri, USA
| | - Jeremiah P Depta
- Sands-Constellation Heart Institute/Rochester General Hospital, Rochester, New York, USA
| | | | | | | | - Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA
| | - Vinayak Bapat
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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21
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Meier D, Payne GW, Mostaço-Guidolin LB, Bouchareb R, Rich C, Lai A, Chatfield AG, Akodad M, Salcudean H, Lutter G, Puehler T, Pibarot P, Allen KB, Chhatriwalla AK, Sondergaard L, Wood DA, Webb JG, Leipsic JA, Sathananthan J, Sellers SL. Timing of bioprosthetic valve fracture in transcatheter valve-in-valve intervention: impact on valve durability and leaflet integrity. EUROINTERVENTION 2023; 18:1165-1177. [PMID: 36534495 PMCID: PMC9936256 DOI: 10.4244/eij-d-22-00644] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/07/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Bioprosthetic valve fracture (BVF) can be used to improve transcatheter heart valve (THV) haemodynamics following a valve-in-valve (ViV) intervention. However, whether BVF should be performed before or after THV deployment and the implications on durability are unknown. Aims: We sought to assess the impact of BVF timing on long-term THV durability. METHODS The impact of BVF timing was assessed using small ACURATE neo (ACn) or 23 mm SAPIEN 3 (S3) THV deployed in 21 mm Mitroflow valves compared to no-BVF controls. Valves underwent accelerated wear testing up to 200 million (M) cycles (equivalent to 5 years). At 200M cycles, THV were evaluated by hydrodynamic testing, second-harmonic generation (SHG) microscopy, scanning electron microscopy (SEM) and histology. RESULTS At 200M cycles, the regurgitant fraction (RF) and effective orifice area (EOA) for the ACn were 8.03±0.30%/1.74±0.01 cm2 (no BVF), 12.48±0.70%/1.97±0.02 cm2 (BVF before ViV) and 9.29±0.38%/2.21±0.0 cm2 (BVF after ViV), respectively. For the S3 these values were 2.63±0.51%/1.26±0.01 cm2, 2.03±0.42%/1.65±0.01 cm2, and 1.62±0.38%/2.22±0.01 cm2, respectively. Further, SHG and SEM revealed a higher degree of superficial leaflet damage when BVF was performed after ViV for the ACn and S3. However, the histological analysis revealed significantly less damage, as determined by matrix density analysis, through the entire leaflet thickness when BVF was performed after ViV with the S3 and a similar but non-significant trend with the ACn. Conclusions: BVF performed after ViV appears to offer superior long-term EOA without increased RF. Ultrastructure leaflet analysis reveals that the timing of BVF can differentially impact leaflets, with more superficial damage but greater preservation of overall leaflet structure when BVF is performed after ViV.
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Affiliation(s)
- David Meier
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Geoffrey W Payne
- University of Northern British Columbia, Prince George, BC, Canada
| | | | | | | | - Althea Lai
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Andrew G Chatfield
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Mariama Akodad
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Hannah Salcudean
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Kiel/Hamburg, Hamburg, Germany
| | - Thomas Puehler
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Kiel/Hamburg, Hamburg, Germany
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Department of Medicine, Laval University, Québec, QC, Canada
| | - Keith B Allen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Lars Sondergaard
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David A Wood
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jonathon A Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie L Sellers
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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22
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Formica F, Gallingani A, Tuttolomondo D, Hernandez-Vaquero D, D’Alessandro S, Pattuzzi C, Çelik M, Singh G, Ceccato E, Niccoli G, Lorusso R, Nicolini F. Redo Surgical Aortic Valve Replacement versus Valve-In-Valve Transcatheter Aortic Valve Implantation: A Systematic Review and Reconstructed Time-To-Event Meta-Analysis. J Clin Med 2023; 12:jcm12020541. [PMID: 36675469 PMCID: PMC9866823 DOI: 10.3390/jcm12020541] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023] Open
Abstract
Objective. Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) has emerged as a useful alternative intervention to redo-surgical aortic valve replacement (Redo-SVAR) for the treatment of degenerated bioprosthesis valve. However, there is no robust evidence about the long-term outcome of both treatments. The aim of this meta-analysis was to analyze the long-term outcomes of Redo-SVAR versus ViV-TAVI by reconstructing the time-to-event data. Methods. The search strategy consisted of a comprehensive review of relevant studies published between 1 January 2000 and 30 September 2022 in three electronic databases, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE. Relevant studies were retrieved for the analysis. The primary endpoint was the long-term mortality for all death. The comparisons were made by the Cox regression model and by landmark analysis and a fully parametric model. A random-effect method was applied to perform the meta-analysis. Results. Twelve studies fulfilled the eligibility criteria and were included in the final analysis. A total of 3547 patients were included. Redo-SAVR group included 1783 patients, and ViV-TAVI included 1764 subjects. Redo-SAVR showed a higher incidence of all-cause mortality within 30-days [Hazard ratio (HR) 2.12; 95% CI = 1.49−3.03; p < 0.0001)], whereas no difference was observed between 30 days and 1 year (HR = 1.03; 95% CI = 0.78−1.33; p = 0.92). From one year, Redo-SAVR showed a longer benefit (HR = 0.52; 95% CI = 0.40−0.67; p < 0.0001). These results were confirmed for cardiovascular death (HR = 2.04; 95% CI = 1.29−3.22; p = 0.001 within one month from intervention; HR = 0.35; 95% CI = 0.18−0.71; p = 0.003 at 4-years follow-up). Conclusions. Although the long-term outcomes seem similar between Redo-SAVR and ViV-TAVI at a five-year follow-up, ViV-TAVI shows significative lower mortality within 30 days. This advantage disappeared between 30 days and 1 year and reversed in favor of redo-SAVR 1 year after the intervention.
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Affiliation(s)
- Francesco Formica
- Department of Medicine and Surgery, University of Parma, 43124 Parma, Italy
- Correspondence: or
| | - Alan Gallingani
- Cardiac Surgery Clinic, University Hospital of Parma, Via Gramsci 14, 43125 Parma, Italy
| | | | | | | | - Claudia Pattuzzi
- Department of Medicine and Surgery, University of Parma, 43124 Parma, Italy
- Cardiac Surgery Clinic, University Hospital of Parma, Via Gramsci 14, 43125 Parma, Italy
| | - Mevlüt Çelik
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, 3062 Rotterdam, The Netherlands
| | - Gurmeet Singh
- Division of Cardiac Surgery, Department of Critical Care Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB 11220, Canada
| | - Evelina Ceccato
- Department of Medicine and Surgery, University of Parma, 43124 Parma, Italy
- Medical Library, University of Parma, 43124 Parma, Italy
| | - Giampaolo Niccoli
- Department of Medicine and Surgery, University of Parma, 43124 Parma, Italy
- Cardiology Unit, University Hospital of Parma, Via Gramsci 14, 43125 Parma, Italy
| | - Roberto Lorusso
- Cardiovascular Research Institute Maastricht (CARIM), 6200 Maastricht, The Netherlands
| | - Francesco Nicolini
- Department of Medicine and Surgery, University of Parma, 43124 Parma, Italy
- Cardiac Surgery Clinic, University Hospital of Parma, Via Gramsci 14, 43125 Parma, Italy
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23
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Costa G, Saia F, Pilgrim T, Abdel-Wahab M, Garot P, Valvo R, Gandolfo C, Branca L, Latib A, Santos IA, Mylotte D, De Marco F, De Backer O, Franco LN, Akodad M, Mazzapicchi A, Tomii D, Laforgia P, Cannata S, Fiorina C, Scotti A, Lunardi M, Poletti E, Mazzucca M, Quagliana A, Hennessey B, Meier D, Adamo M, Sgroi C, Reddavid CM, Strazzieri O, Motta SC, Frittitta V, Dipietro E, Comis A, Melfa C, Thiele H, Webb JG, Søndergaard L, Tamburino C, Barbanti M. Transcatheter Aortic Valve Replacement With the Latest-Iteration Self-Expanding or Balloon-Expandable Valves: The Multicenter OPERA-TAVI Registry. JACC Cardiovasc Interv 2022; 15:2398-2407. [PMID: 36121242 DOI: 10.1016/j.jcin.2022.08.057] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The latest iterations of devices for transcatheter aortic valve replacement (TAVR) have brought refinements to further improve patient outcomes. OBJECTIVES This study sought to compare early outcomes of patients undergoing TAVR with the self-expanding (SE) Evolut PRO/PRO+ (Medtronic, Inc) or balloon-expandable (BE) Sapien 3 ULTRA (Edwards Lifesciences) devices. METHODS The OPERA-TAVI (Comparative Analysis of Evolut PRO vs Sapien 3 Ultra Valves for Transfemoral Transcatheter Aortic Valve Implantation) registry collected data from 14 high-volume centers worldwide on patients undergoing TAVR with SE or BE devices. After excluding patients who were not eligible for both devices, patients were compared using 1:1 propensity score matching. The primary efficacy and safety outcomes were Valve Academic Research Consortium-3 device success and early safety, respectively. RESULTS Among 2,241 patients eligible for the present analysis, 683 pairs of patients were matched. The primary efficacy outcome did not differ between patients receiving SE or BE transcatheter aortic valves (SE: 87.4% vs BE: 85.9%; P = 0.47), but the BE device recipients showed a higher rate of the primary safety outcome (SE: 69.1% vs BE: 82.6%; P < 0.01). This finding was driven by the higher rates of permanent pacemaker implantation (SE: 17.9% vs BE: 10.1%; P < 0.01) and disabling stroke (SE: 2.3% vs BE: 0.7%; P = 0.03) in SE device recipients. On post-TAVR echocardiography, the rate of moderate to severe paravalvular regurgitation was similar between groups (SE: 3.2% vs BE: 2.3%; P = 0.41), whereas lower mean transvalvular gradients were observed in the SE cohort (median SE: 7.0 vs BE: 12.0 mm Hg; P < 0.01). CONCLUSIONS The OPERA-TAVI registry showed that SE and BE devices had comparable Valve Academic Research Consortium-3 device success rates, but the BE device had a higher rate of early safety. The higher permanent pacemaker implantation and disabling stroke rates in SE device recipients drove this composite endpoint.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Francesco Saia
- Cardiovascular Department, Policlinico S. Orsola, University of Bologna, Bologna, Italy
| | - Thomas Pilgrim
- Bern University Hospital, Inselspital, Bern, Switzerland
| | | | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Roberto Valvo
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Caterina Gandolfo
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | | | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ignacio Amat Santos
- Division of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Darren Mylotte
- Department of Cardiology, University Hospital, National University of Ireland Galway, Ireland
| | - Federico De Marco
- Interventional Cardiology Department, Istituto di Ricovero e Cura a Carattere Scientifico Centro Cardiologico Monzino, Milan, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Mariama Akodad
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Daijiro Tomii
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - Pietro Laforgia
- Institut Cardiovasculaire Paris Sud, Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Stefano Cannata
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | | | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mattia Lunardi
- Department of Cardiology, University Hospital, National University of Ireland Galway, Ireland
| | - Enrico Poletti
- Division of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Italy
| | - Mattia Mazzucca
- Division of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Italy
| | - Angelo Quagliana
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - David Meier
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Carmelo Sgroi
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Claudia Maria Reddavid
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Orazio Strazzieri
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Silvia Crescenzia Motta
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Valentina Frittitta
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Elena Dipietro
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Alessandro Comis
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Chiara Melfa
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Corrado Tamburino
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," Catania, Italy.
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Saadi RP, Tagliari AP, Polanczyck CA, Ferreira Leal JC, Saadi EK. Balloon Fracturing Valve-in-Valve: How to Do It and a Case Report of TAVR in a Rapid Deployment Prosthesis. J Interv Cardiol 2022; 2022:4368887. [PMID: 35600211 PMCID: PMC9095411 DOI: 10.1155/2022/4368887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) to treat degeneration of bioprosthetic heart valves (BHVs), called as valve-in-valve (ViV), is becoming a key feature since the number of BHVs requiring intervention is increasing and many patients are at high risk for a redo cardiac surgery. However, a TAVR inside a small previous cardiac valve may lead to prosthesis-patient mismatch (PPM) and not be as effective as we hoped for. An effective option to decrease the chance of PPM is to fracture the previous heart valve implanted using a high-pressure balloon. By performing a valve fracture, the inner valve ring of small BHVs can be opened up by a single fracture line, allowing subsequent implantation of a properly sized transcatheter heart valve, without increasing substantially the procedure risk. In this article, we provide a step-by-step procedure on how to safely and properly fracture a BHV and report a case of a TAVR in a degenerated rapid deployment valve.
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Affiliation(s)
- Rodrigo Petersen Saadi
- Post Graduate Program in Cardiology and Cardiovascular Science, Federal University of Rio Grande do Sul., Porto Alegre, Brazil
| | - Ana Paula Tagliari
- Post Graduate Program in Cardiology and Cardiovascular Science, Federal University of Rio Grande do Sul. Cardiovascular Surgeon at Hospital São Lucas da PUC-RS, Porto Alegre, Brazil
| | - Carisi Anne Polanczyck
- Graduate Program in Cardiology, Federal University of Rio Grande do Sul Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Eduardo Keller Saadi
- Cariovascular Surgery, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Hahn RT, Webb J, Pibarot P, Ternacle J, Herrmann HC, Suri RM, Dvir D, Leipsic J, Blanke P, Jaber WA, Kodali S, Kapadia S, Makkar R, Thourani V, Williams M, Salaun E, Vincent F, Xu K, Leon MB, Mack M. 5-Year Follow-Up From the PARTNER 2 Aortic Valve-in-Valve Registry for Degenerated Aortic Surgical Bioprostheses. JACC Cardiovasc Interv 2022; 15:698-708. [PMID: 35393102 DOI: 10.1016/j.jcin.2022.02.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to report the outcomes of valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) at 5 years. BACKGROUND TAVR for degenerated surgical bioprostheses in patients at high risk for reoperative surgery is an important treatment option that may delay or obviate the need for surgical intervention; however, long-term outcomes of this procedure are unknown. METHODS The PARTNER (Placement of Aortic Transcatheter Valves) 2 ViV and continued access registries prospectively enrolled patients with failed surgical bioprostheses at high risk for reoperation. Five-year clinical and echocardiographic follow-up data were obtained in 95.9% of patients. RESULTS In 365 (96 registry and 269 continued access) patients, the mean age was 78.9 ± 10.2 years, the mean Society of Thoracic Surgeons predicted risk of surgical mortality score was 9.1 ± 4.7%, and New York Heart Association functional class was III or IV in 90.4%. At 5 years, the Kaplan-Meier rates of all-cause mortality and any stroke were 50.6% and 10.5%, respectively. Using Valve Academic Research Consortium 3 definitions, the incidence of structural valve deterioration, related hemodynamic valve deterioration, or bioprosthetic valve failure at 5 years was 6.6%. Aortic valve re-replacement was performed in 6.3% (n = 14), the majority of which was due to stenosis (n = 6) and combined aortic insufficiency/paravalvular regurgitation (n = 3). The mean gradient, Doppler velocity index, paravalvular regurgitation, and quality of life measured by Kansas City Cardiomyopathy Questionnaire scores in survivors remained stable from 30 days postprocedure through 5 years. CONCLUSIONS At the 5-year follow-up, TAVR for bioprosthetic aortic valve failure in high surgical risk patients was associated with sustained improvement in clinical and echocardiographic outcomes.
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York, USA.
| | - John Webb
- University of British Columbia and St. Paul's Hospital, Vancouver, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Department of Medicine, Laval University, Québec, Canada
| | - Julien Ternacle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Department of Medicine, Laval University, Québec, Canada; Heart Valve Unit, Haut-Leveque Cardiologic Hospital, Bordeaux University, Pessac, France
| | - Howard C Herrmann
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Danny Dvir
- Jesselson Integrated Heart Center, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
| | - Jonathon Leipsic
- University of British Columbia and St. Paul's Hospital, Vancouver, Canada
| | - Philipp Blanke
- University of British Columbia and St. Paul's Hospital, Vancouver, Canada
| | | | - Susheel Kodali
- Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | | | - Raj Makkar
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Vinod Thourani
- Department of Cardiothoracic Surgery, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Mathew Williams
- Department of Cardiothoracic Surgery, Piedmont Heart Institute, Atlanta, Georgia, USA; NYU Langone Medical Center, New York, New York, USA
| | - Erwan Salaun
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Department of Medicine, Laval University, Québec, Canada
| | - Flavien Vincent
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, Institut Pasteur de Lille, CHU Lille, Lille, France
| | - Ke Xu
- Edwards Lifesciences, Irvine, California, USA
| | - Martin B Leon
- Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
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26
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Buono A, Maffeo D, Troise G, Donatelli F, Tespili M, Ielasi A. Trans-Catheter Valve-in-Valve Implantation for the Treatment of Aortic Bioprosthetic Valve Failure. J Clin Med 2022; 11:344. [PMID: 35054038 PMCID: PMC8778204 DOI: 10.3390/jcm11020344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 02/01/2023] Open
Abstract
Aortic valve-in-valve (ViV) procedure is a valid treatment option for patients affected by bioprosthetic heart valve (BHV) degeneration. However, ViV implantation is technically more challenging compared to native trans-catheter aortic valve replacement (TAVR). A deep knowledge of the mechanism and features of the failed BHV is pivotal to plan an adequate procedure. Multimodal imaging is fundamental in the diagnostic and pre-procedural phases. The main challenges associated with ViV TAVR consist of a higher risk of coronary obstruction, severe post-procedural patient-prosthesis mismatch, and a difficult coronary re-access. In this review, we describe the principles of ViV TAVR.
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Affiliation(s)
- Andrea Buono
- Interventional Cardiology Unit, Fondazione Poliambulanza, 25124 Brescia, Italy; (A.B.); (D.M.)
| | - Diego Maffeo
- Interventional Cardiology Unit, Fondazione Poliambulanza, 25124 Brescia, Italy; (A.B.); (D.M.)
| | - Giovanni Troise
- Cardiac Surgery Unit, Cardiovascular Department, Hospital Poliambulanza Foundation, 25124 Brescia, Italy;
| | - Francesco Donatelli
- Department of Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, University of Milan, 20149 Milan, Italy;
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy;
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy;
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27
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Guerrero M, Sabbagh A, Al-Hijji M. Transcatheter aortic valve implantation for degenerated surgical aortic bioprosthesis: A systematic review. Heart Views 2022; 23:1-9. [PMID: 35757448 PMCID: PMC9231545 DOI: 10.4103/heartviews.heartviews_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/24/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Transcatheter aortic valve in valve (Aviv) replacement has been shown to be an effective therapeutic option in patients with failed aortic bioprosthetic valves. This review intended to evaluate contemporary 1-year outcomes of Aviv in recent studies. Methods: A systematic review on outcomes of Aviv was performed using the best available evidence from studies obtained using a MEDLINE, Cochrane database, and SCOPUS search. Endpoints of interest were survival, coronary artery obstruction, prosthesis-patient mismatch (PPM), stroke, pacemaker implantation, and structural valve deterioration. Results: A total of 3339 patients from 23 studies were included. Mean age was 68–80 years, 20%–50% were female, and Society of Thoracic Surgeons score ranged from 5.7 to 31.1. Thirty-day all-cause mortality ranged from 2% to 8%, and 1-year all-cause mortality ranged from 8% to 33%. Coronary artery obstruction risk after Aviv ranged from 0.6% to 4%. One-year stroke ranged from 2% to 8%. Moderate-severe PPM occurred in 11%–58%, and pacemaker rate at 1 year ranged from 5% to 12%. Conclusion: Transcatheter aortic ViV has emerged as an effective therapeutic option to treat patients with failed bioprostheses. The acceptable complication rate and favorable 1-year outcomes make Aviv an appropriate alternative to redo surgical aortic valve replacement.
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28
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Brinkmann C, Abdel-Wahab M, Bedogni F, Bhadra O, Charbonnier G, Conradi L, Hildick-Smith D, Kargoli F, Latib A, Stripling J, Taramasso M, Tchétché D, Testa L, Thiele H, Webb J, Windecker S, Witt J, Wohlmuth P, Schofer J, Windecker S, Witt J, Wohlmuth P, Schofer J. Outcomes of valve-in-valve transcatheter aortic valve implantation with and without bioprosthetic valve fracture. EUROINTERVENTION 2021; 17:848-855. [PMID: 34031022 PMCID: PMC9724846 DOI: 10.4244/eij-d-21-00254] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Bioprosthetic valve fracture (BVF) is a technique to reduce gradients in valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) procedures. The outcome of VIV-TAVI with BVF has not been compared with VIV-TAVI without BVF. AIMS The aim of this study was to evaluate the outcome of VIV-TAVI with BVF compared to VIV-TAVI without BVF. METHODS In total, 81 cases of BVF VIV-TAVI (BVF group) from 14 centres were compared to 79 cases of VIV-TAVI without BVF (control group). RESULTS VARC-2-defined device success was 93% in the BVF group and 68.4% in the control group (p<0.001). The mean transvalvular gradient decreased from 37±13 mmHg to 10.8±5.9 mmHg (p<0.001) in the BVF group and from 35±16 mmHg to 15.8±6.8 mmHg (p<0.001) in the control group with a significantly higher final gradient in the control group (p<0.001). The transvalvular gradients did not change significantly over time. In-hospital major adverse events occurred in 3.7% in the BVF group and 7.6% in the control group (p=0.325). A linear mixed model identified BVF, self-expanding transcatheter heart valves (THVs) and other surgical aortic valve (SAV) types other than Mitroflow as predictors of lower transvalvular gradients. CONCLUSIONS Compared to VIV-TAVI alone, VIV-TAVI with BVF resulted in a significantly lower transvalvular gradient acutely and at follow-up. Independent predictors of lower gradients were the use of self-expanding THVs and the treatment of SAVs other than Mitroflow, irrespective of BVF performance. BVF significantly reduced the gradient independently from transcatheter or surgical valve type.
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Affiliation(s)
- Christina Brinkmann
- MVZ Department Structural Heart Disease, Asklepios St. Georg, Hamburg, Germany
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | - Oliver Bhadra
- Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg, Germany
| | | | - Lenard Conradi
- Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg, Germany
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton & Sussex University Hospitals, Brighton, United Kingdom
| | - Faraj Kargoli
- Montefiore Medical Center / Albert Einstein College of Medicine, New York, NY, USA
| | - Azeem Latib
- Montefiore Medical Center / Albert Einstein College of Medicine, New York, NY, USA
| | | | | | | | - Luca Testa
- IRCCS Policlinico San Donato, Milan, Italy
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - John Webb
- St. Paul’s Hospital, Vancouver, BC, Canada
| | | | | | | | - Joachim Schofer
- MVZ Department Structural Heart Disease, Asklepios Clinic St. Georg, Wördemanns Weg 25-27, 22527 Hamburg, Germany
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29
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Wang T, Ou A, Xia P, Tian J, Wang H, Cheng Z. Predictors for the risk of permanent pacemaker implantation after transcatheter aortic valve replacement: A systematic review and meta-analysis. J Card Surg 2021; 37:377-405. [PMID: 34775652 DOI: 10.1111/jocs.16129] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/22/2021] [Accepted: 09/26/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is a less invasive treatment than surgery for severe aortic stenosis. However, its use is restricted by the fact that many patients eventually require permanent pacemaker implantation (PPMI). This meta-analysis was performed to identify predictors of post-TAVR PPMI. METHODS The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched. Relevant studies that met the inclusion criteria were included in the pooling analysis after quality assessment. RESULTS After pooling 67 studies on post-TAVR PPMI risk in 97,294 patients, balloon-expandable valve use was negatively correlated with PPMI risk compared with self-expandable valve (SEV) use (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.37-0.53). Meta-regression analysis revealed that history of coronary artery bypass grafting and higher Society of Thoracic Surgeons (STS) risk score increased the risk of PPMI with SEV utilization. Patients with pre-existing cardiac conduction abnormalities in 28 pooled studies also had a higher risk of PPMI (OR: 2.33, 95% CI: 1.90-2.86). Right bundle branch block (OR: 5.2, 95% CI: 4.37-6.18) and first-degree atrioventricular block (OR: 1.97, 95% CI: 1.38-2.79) also increased PPMI risk. Although the trans-femoral approach was positively correlated with PPMI risk, the trans-apical pathway showed no statistical difference to the trans-femoral pathway. The approach did not increase PPMI risk in patients with STS scores >8. Patient-prosthesis mismatch did not influence post-TAVR PPMI risk (OR: 0.88, 95% CI: 0.67-1.16). We also analyzed implantation depth and found no difference between patients with PPMI after TAVR and those without. CONCLUSIONS SEV selection, pre-existing cardiac conduction abnormality, and trans-femoral pathway selection are positively correlated with PPMI after TAVR. Pre-existing left bundle branch block, patient-prosthesis mismatch, and implantation depth did not affect the risk of PPMI after TAVR.
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Affiliation(s)
- Tongyu Wang
- Department of Cardiovascular Medicine, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Aixin Ou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ping Xia
- Department of Cardiovascular Medicine, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jiahu Tian
- Department of Cardiovascular Medicine, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongchang Wang
- Department of Emergency Medicine, The First Affiliated Hospital of Lanzhou Medical University, Lanzhou, China
| | - Zeyi Cheng
- Department of Cardiac Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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30
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Perri JL, Blusztein D, Mahadevan VS, Nguyen TC. Fracture of a 21 mm failed bioprosthetic aortic valve. Ann Cardiothorac Surg 2021; 10:708-710. [PMID: 34733703 DOI: 10.21037/acs-2021-tviv-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/11/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Jennifer L Perri
- Division of Adult Cardiothoracic Surgery, UCSF Medical Center, San Francisco, CA, USA
| | - David Blusztein
- Division of Cardiology, UCSF Medical Center, San Francisco, CA, USA
| | | | - Tom C Nguyen
- Division of Adult Cardiothoracic Surgery, UCSF Medical Center, San Francisco, CA, USA
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31
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Cekmecelioglu D, Preventza O, Dougherty KG, Chatterjee S, Green SY, Silva GV, Díez JG, Coselli JS. Transcatheter valve-in-valve implantation for degenerated stentless aortic bioroots. Ann Cardiothorac Surg 2021; 10:641-650. [PMID: 34733691 DOI: 10.21037/acs-2021-tviv-124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022]
Abstract
Background Open surgical repair of a failed valve-sparing aortic root replacement (VSARR) or stentless bioroot aortic root replacement (bio-ARR) entails significant operative risks. Whether valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is feasible in patients with a previous VSARR or stentless bio-ARR remains unclear, given lingering concerns about the ill-defined aortic annulus in these patients and the potential for coronary obstruction. We present our experience with patients who had a previous VSARR or stentless bio-ARR and underwent ViV-TAVR to repair a degenerated aortic valve with combined valvular disease, aortic insufficiency and aortic stenosis. Methods In this retrospective data review, we identified and analyzed consecutive patients with a previous VSARR or stentless bio-ARR who underwent ViV-TAVR between December 1, 2014 and August 31, 2019. Results ViV-TAVR was performed in twelve high-risk patients with previous VSARR or bio-ARR during the study period. Of these, seven received Medtronic Freestyle porcine stentless bioprosthetic aortic roots, three received homograft aortic roots, one underwent a Ross procedure and one underwent VSARR. ViV-TAVR restored satisfactory valve function in all patients, and technical success was 100%. No patient had more than mild regurgitation after implantation. No thirty-day mortality was seen. One patient had major bleeding after transapical access, one patient had a transient ischemic stroke, and one patient needed permanent pacemaker implantation. At a median last follow-up of 21.5 months (interquartile range, 9.0-69.0 months), all patients remained alive and had satisfactory valve function. Conclusions In this study, ViV-TAVR was a clinically effective option for treating patients with a failed stentless bio-ARR or previous VSARR. Short-term and intermediate-term results after these procedures were favorable. These findings may have important implications for treating high-risk patients with structural aortic root deterioration and call for better transcatheter heart valves that are suitable for treating aortic insufficiency.
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Affiliation(s)
- Davut Cekmecelioglu
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Kathryn G Dougherty
- Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Subhasis Chatterjee
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA.,Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College Medicine, Houston, Texas, USA
| | - Susan Y Green
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Office of Surgical Research, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Guilherme V Silva
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jose G Díez
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiology, Texas Heart Institute, Houston Texas, USA
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
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32
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Allen KB, Chhatriwalla AK, Saxon JT, Huded CP, Sathananthan J, Nguyen TC, Whisenant B, Webb JG. Bioprosthetic valve fracture: a practical guide. Ann Cardiothorac Surg 2021; 10:564-570. [PMID: 34733685 DOI: 10.21037/acs-2021-tviv-25] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/18/2021] [Indexed: 11/06/2022]
Abstract
Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) is currently indicated for the treatment of failed surgical tissue valves in patients determined to be at high surgical risk for re-operative surgical valve replacement. VIV TAVR, however, often results in suboptimal expansion of the transcatheter heart valve (THV) and can result in patient-prosthesis mismatch (PPM), particularly in small surgical valves. Bioprosthetic valve fracture (BVF) and bioprosthetic valve remodeling (BVR) can facilitate VIV TAVR by optimally expanding the THV and reducing the residual transvalvular gradient by utilizing a high-pressure inflation with a non-compliant balloon to either fracture or stretch the surgical valve ring, respectively. This article, along with the supplemental video, will provide patient selection, procedural planning and technical insights for performing BVF and BVR.
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Affiliation(s)
- Keith B Allen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - John T Saxon
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - Chetan P Huded
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation and Centre for Heart Valve Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
| | | | | | - John G Webb
- Centre for Cardiovascular Innovation and Centre for Heart Valve Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
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33
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Kherallah RY, Koneru S, Krajcer Z, Preventza O, Dougherty KG, McCormack ML, Costello BT, Coulter S, Strickman NE, Plana Gomez JC, Mortazavi A, Díez JG, Livesay JJ, Coselli JS, Silva GV. Hemodynamic outcomes after valve-in-valve transcatheter aortic valve replacement: a single-center experience. Ann Cardiothorac Surg 2021; 10:630-640. [PMID: 34733690 DOI: 10.21037/acs-2021-tviv-131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 08/26/2021] [Indexed: 11/06/2022]
Abstract
Background Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) has emerged as a safe, effective alternative to redo aortic valve surgery in high-risk patients with degenerated surgical bioprosthetic valves. However, ViV-TAVR has been associated high postprocedural valvular gradients, compared with TAVR for native-valve aortic stenosis. Methods We performed a retrospective study of all patients who underwent ViV-TAVR for a degenerated aortic valve bioprosthesis between January 1, 2013 and March 31, 2019 at our center. The primary outcome was postprocedural mean aortic valve gradient. Outcomes were compared across surgical valve type (stented versus stentless), surgical valve internal diameter (≤19 versus >19 mm), and transcatheter aortic valve type (self-expanding vs. balloon-expandable). Results Overall, 89 patients underwent ViV-TAVR. Mean age was 69.0±12.6 years, 61% were male, and median Society of Thoracic Surgeons Predicted Risk of Mortality score was 5.4 [interquartile range, 3.2-8.5]. Bioprosthesis mode of failure was stenotic (58% of patients), regurgitant (24%), or mixed (18%). The surgical valve was stented in 75% of patients and stentless in 25%. The surgical valve's internal diameter was ≤19 mm in 45% of cases. A balloon-expandable transcatheter valve was used in 53% of procedures. Baseline aortic valve area and mean gradients were 0.87±0.31 cm2 and 36±18 mmHg, respectively. These improved after ViV-TAVR to 1.38±0.55 cm2 and 18±11 mmHg at a median outpatient follow-up of 331 [67-394] days. Higher postprocedural mean gradients were associated with surgical valves having an internal diameter ≤19 mm (24±13 versus 16±8, P=0.002) and with stented surgical valves (22±11 versus 12±6, P<0.001). Conclusions ViV-TAVR is an effective option for treating degenerated surgical aortic bioprostheses, with acceptable hemodynamic outcomes. Small surgical valves and stented surgical valves are associated with higher postprocedural gradients.
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Affiliation(s)
- R Yazan Kherallah
- Division of Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Srikanth Koneru
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, TX, USA
| | - Kathryn G Dougherty
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Melissa L McCormack
- Division of Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Briana T Costello
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | | | - Neil E Strickman
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Juan Carlos Plana Gomez
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ali Mortazavi
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Jose G Díez
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - James J Livesay
- Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, TX, USA
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, TX, USA
| | - Guilherme V Silva
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Geicu L, Busuttil O, D’Ostrevy N, Pernot M, Benali W, Labrousse L, Modine T. Updates on the Latest Surgical Approach of the Aortic Stenosis. J Clin Med 2021; 10:5140. [PMID: 34768660 PMCID: PMC8584939 DOI: 10.3390/jcm10215140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Over the last twenty years, we marked significant progresses in the field of tissue engineering and the development of new aortic valve structural and delivery systems. These continuous iterations on the field, have completely changed the surgical indications and approaches for AVR. Nowadays, therapeutic decisions are endorsed by international guidelines; however, new technical advances need a new integrated approach. The clinical scenarios issued from the interaction between the Guidelines and the newest approaches and technologies are regularly on debate by the Heart Team. We will present some of our most encountered situations and the pattern of our therapeutic decisions. To easily navigate through Guidelines and clinical scenarios, we reported in this review a simplified and easy to use Clinical decision-making algorithm that may be a valuable tool in our daily practice.
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Affiliation(s)
- Lucian Geicu
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal University, Montreal, QC H1T 1C8, Canada; (L.G.); (W.B.)
| | - Olivier Busuttil
- Unité Médico-Chirurgicale, Hôpital Haut Lévêque, CHU de Bordeaux, CEDEX, 33604 Pessac, France; (O.B.); (M.P.); (L.L.)
| | - Nicolas D’Ostrevy
- Cardiac Surgery Department, CHU de Clermont Ferrand, 63003 Clermont Ferrand, France;
| | - Mathieu Pernot
- Unité Médico-Chirurgicale, Hôpital Haut Lévêque, CHU de Bordeaux, CEDEX, 33604 Pessac, France; (O.B.); (M.P.); (L.L.)
| | - Walid Benali
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal University, Montreal, QC H1T 1C8, Canada; (L.G.); (W.B.)
| | - Louis Labrousse
- Unité Médico-Chirurgicale, Hôpital Haut Lévêque, CHU de Bordeaux, CEDEX, 33604 Pessac, France; (O.B.); (M.P.); (L.L.)
| | - Thomas Modine
- Unité Médico-Chirurgicale, Hôpital Haut Lévêque, CHU de Bordeaux, CEDEX, 33604 Pessac, France; (O.B.); (M.P.); (L.L.)
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Alperi A, Garcia S, Rodés-Cabau J. Transcatheter valve-in-valve implantation in degenerated surgical aortic and mitral bioprosthesis: Current state and future perspectives. Prog Cardiovasc Dis 2021; 72:54-65. [PMID: 34688669 DOI: 10.1016/j.pcad.2021.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 10/16/2021] [Indexed: 12/27/2022]
Abstract
The use of bioprosthetic valves for treating patients with severe valve disease has increased over the last 2 decades, and, as a consequence, a growing number of patients with failing surgical bioprosthesis is expected in the near future. In this setting, valve-in-valve (ViV) transcatheter aortic/mitral valve replacement (TAVR and TMVR) has emerged as an alternative to redo surgery. Despite the increasing experience in ViV procedures, the development of these techniques faces several specific challenges, mainly related to the unique anatomical and physiological characteristics presented in ViV-TAVR/TMVR. Subsequently, various approaches have been proposed to overcome ViV-related complications and pitfalls. A growing body of evidence is currently available concerning early- and long-term clinical outcomes of patients undergoing ViV-TAVR/TMVR. These data should be comprehensively evaluated by the Heart Team in the decision-making process involving patients with failing surgical bioprostheses. In this review, we aimed to delineate the technical challenges and risks associated with ViV-TAVR and ViV-TMVR, provide an updated overview of the main clinical results, and summarize the future perspectives of this evolving field.
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Affiliation(s)
- Alberto Alperi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Santiago Garcia
- Minneapolis Heart Institute, Minneapolis, MN, United States of America
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
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36
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Salem SA, Foerst JR. Valve-in-Valve Transcatheter Aortic Valve Replacement, with Present-Day Innovations and Up-to-Date Techniques. Interv Cardiol Clin 2021; 10:491-504. [PMID: 34593112 DOI: 10.1016/j.iccl.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Approximately 51,000 to 65,000 surgical aortic valve replacement (SAVR) cases are performed in the United States anually. Bioprosthetic degeneration commonly occurs within 10 to 15 years, and nearly 800 redo SAVR cases occur each year. Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has emerged as a safe and effective alternative, as the Food and Drug Administration approved ViV TAVR with self-expanding transcatheter heart valve in 2015 and balloon-expandable valve in 2017 for failed surgical valves cases at high risk of reoperation. We review ViV TAVR, with specific attention to procedural planning, technical challenges, associated complications, and long-term follow-up.
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Affiliation(s)
- Salem A Salem
- Structural and Interventional Cardiology, Virginia Tech Carilion School of Medicine, Carilion Clinic, 1906 Belleview Avenue SE, Roanoke, VA 24014, USA
| | - Jason R Foerst
- Structural and Interventional Cardiology, Virginia Tech Carilion School of Medicine, Carilion Clinic, 1906 Belleview Avenue SE, Roanoke, VA 24014, USA.
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Sá MP, Rayol SC, Van den Eynde J, Cavalcanti LRP, Escorel Neto AC, Perazzo ÁM, Weymann A, Ruhparwar A, Torregrossa G, Sicouri S, Ramlawi B. Bioprosthetic valve fracture for valve-in-valve transcatheter aortic valve implantation in patients with structural valve degeneration: Systematic review with meta-analysis. J Card Surg 2021; 36:4722-4731. [PMID: 34580899 DOI: 10.1111/jocs.16032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the outcomes of bioprosthetic valve fracture (BVF) in valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) for patients with structural valve degeneration (SVD) of bioprosthetic surgical valves (BSV) implanted during surgical aortic valve replacement (SAVR). METHODS A systematic review was conducted including studies published by May 2021. The primary endpoints of the study were 30-day mortality, annular rupture, stroke, paravalvular leak, pacemaker implantation, and coronary obstruction. The secondary endpoints were mean valve gradients (mmHg) and aortic valve area (AVA-cm2 ). A meta-analysis was conducted using the software R, version 3.6.3 (R Foundation for Statistical Computing). RESULTS Four studies including 242 patients met our eligibility criteria. The overall proportions for 30-day mortality, annular rupture, stroke, paravalvular leak, pacemaker implantation and coronary obstruction were 2.1%, <1.0%, <1.5%, <1.0%, <1.0%, and <1.5%, respectively. After ViV-TAVI with BVF, the difference in means for mean valve gradients showed a significant reduction (random-effects model: -26.7; -28.8 to -24.7; p < .001), whereas the difference in means for AVA showed a significant increase (random-effects model: 0.55 cm2 ; 0.13-0.97; p = .029). Despite the improvement in AVA means, these remain too low after the procedure highly likely due to the small size of the bioprosthetic valves implanted during the index SAVR. CONCLUSION ViV-TAVI with BVF has proven to be a promising option but data are still too scarce to enable us to draw definitive conclusions. Despite the decrease in gradients, postprocedural AVA remains worrisome. Studies with better designs and larger sample sizes are needed to advance this treatment option.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Sérgio C Rayol
- Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.,University of Pernambuco (UPE), Recife, Brazil.,Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute (FCM/ICB), Recife, Brazil
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Luiz Rafael P Cavalcanti
- Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.,University of Pernambuco (UPE), Recife, Brazil
| | - Antonio C Escorel Neto
- Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.,University of Pernambuco (UPE), Recife, Brazil
| | - Álvaro M Perazzo
- Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.,University of Pernambuco (UPE), Recife, Brazil
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
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Christ T, Borck R, Dushe S, Sündermann SH, Falk V, Grubitzsch H. Propensity matched long-term analysis of mechanical versus stentless aortic valve replacement in the younger patient. Eur J Cardiothorac Surg 2021; 60:276-283. [PMID: 33693656 DOI: 10.1093/ejcts/ezab090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/13/2021] [Accepted: 01/22/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The choice of prosthesis for aortic valve replacement (AVR) in younger patients remains controversial. Stentless AVR was introduced 3 decades ago, with the aim of better haemodynamics and durability than stented xenografts. The objective of this analysis was to compare the long-term outcomes to mechanical prostheses in younger patients (age ≤60 years). METHODS All adult patients who underwent AVR due to aortic valve stenosis and/or insufficiency between 1993 and 2002 were identified. After the exclusion of patients with congenital heart defects, aortic dissections and Ross-procedures, 158 patients with stentless valves and 226 patients with bi-leaflet mechanical valves were finally included in this analysis. Sixty-six patient pairs could be included in a propensity matched analysis. Mortality and morbidity including stroke, bleeding, endocarditis and reoperation were analysed. RESULTS Group baseline characteristics and operative data did not differ significantly after propensity matching. Hospital mortality was 0.0% in the stentless and 1.5% in the mechanical group. Total patient years/median follow-up was 2029.1/15.4 years (completeness: 100.0%, range: 0-25 years). After 20 years, actuarial survival was 47.0 ± 6.4% in the stentless and 53.3 ± 6.6% in mechanical group (P = 0.69). Bleeding, endocarditis and stroke occurred rarely and did not differ significantly between groups. After 20 years, actuarial overall freedom-from-reoperation was 45.1 ± 8.2% in the stentless group and 90.4 ± 4.1% in the mechanical group (P < 0.001). Hospital mortality while reoperation was 7.4% in the stentless group and 0% in the mechanical group (P = 1.0). CONCLUSIONS Long-term morbidity and mortality of stentless and mechanical aortic valves were statistically not different besides a significantly higher reoperation rate after stentless AVR combined with a probably higher risk of in-hospital mortality. Thus, mechanical AVR should remain the procedure of choice in younger patients.
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Affiliation(s)
- Torsten Christ
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Robin Borck
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Simon Dushe
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Simon Harald Sündermann
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site, Berlin, Germany.,Department of Health Science and Technology, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Herko Grubitzsch
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Xhepa E, Alvarez-Covarrubias HA, Joner M. Pushing the limits for interventional treatment of aortic valve stenosis. Herz 2021; 46:429-436. [PMID: 34427692 DOI: 10.1007/s00059-021-05057-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 12/19/2022]
Abstract
As we approach 20 years of clinical experience with transcatheter aortic valve replacement (TAVR), a vast portfolio of high-quality clinical data has accumulated, confirming the safety and efficacy of TAVR across the entire spectrum of surgical risk. Although many aspects of this innovative therapy have been thoroughly studied, several challenges remain. As TAVR is expanding to include younger low-risk patients, with longer life expectancy, one major unsolved issue is represented by transcatheter heart valve (THV) durability, since robust THV durability data are currently limited to approximately 5-6 years. Additionally, steric interactions between THV components and coronary ostia may render coronary access particularly difficult, and thus personalized decisions regarding THV type and implanting techniques are of paramount importance to secure future coronary access. Since bicuspid aortic valve (BAV) stenosis may be associated with unfavorable anatomic factors, it has represented an exclusion criterion in major randomized TAVR trials. Albeit promising data are available from multicenter registries, results of specifically designed randomized trials are eagerly needed to inform use of TAVR for BAV stenosis. Although valve-in-valve (ViV) TAVR has emerged as an effective treatment option for degenerated aortic bioprostheses, ViV procedures are associated with specific risks, which mandated the development of specific techniques aimed at reducing the occurrence of periprocedural adverse events. Despite the transfemoral approach represents the access of choice for TAVR, a significant proportion of patients have significant peripheral artery disease and alternative vascular access routes have been increasingly evaluated with encouraging data regarding their safety and feasibility.
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Affiliation(s)
- Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Hector A Alvarez-Covarrubias
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. .,Partner Site Munich Heart Alliance, DZHK (German Center for Cardiovascular Research), Munich, Germany.
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40
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Sá MPBO, Van den Eynde J, Simonato M, Cavalcanti LRP, Doulamis IP, Weixler V, Kampaktsis PN, Gallo M, Laforgia PL, Zhigalov K, Ruhparwar A, Weymann A, Pibarot P, Clavel MA. Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo Surgical Aortic Valve Replacement: An Updated Meta-Analysis. JACC Cardiovasc Interv 2021; 14:211-220. [PMID: 33478639 DOI: 10.1016/j.jcin.2020.10.020] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate early results of valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) versus redo surgical aortic valve replacement (SAVR) for structural valve degeneration (SVD). BACKGROUND ViV TAVR has been increasingly used for SVD, but it remains unknown whether it produces better or at least comparable results as redo SAVR. METHODS Observational studies comparing ViV TAVR and redo SAVR were identified in a systematic search of published research. Random-effects meta-analysis was performed, comparing clinical outcomes between the 2 groups. RESULTS Twelve publications including a total of 16,207 patients (ViV TAVR, n = 8,048; redo SAVR, n = 8,159) were included from studies published from 2015 to 2020. In the pooled analysis, ViV TAVR was associated with lower rates of 30-day mortality overall (odds ratio [OR]: 0.53; 95% confidence interval [CI]: 0.32 to 0.87; p = 0.017) and for matched populations (OR: 0.419; 95% CI: 0.278 to 0.632; p = 0.003), stroke (OR: 0.65; 95% CI: 0.55 to 0.76; p < 0.001), permanent pacemaker implantation (OR: 0.73; 95% CI: 0.22 to 2.43; p = 0.536), and major bleeding (OR: 0.49; 95% CI: 0.26 to 0.93; p = 0.034), as well as with shorter hospital stay (OR: -3.30; 95% CI: -4.52 to -2.08; p < 0.001). In contrast, ViV TAVR was associated with higher rates of myocardial infarction (OR: 1.50; 95% CI: 1.01 to 2.23; p = 0.045) and severe patient-prosthesis mismatch (OR: 4.63; 95% CI: 3.05 to 7.03; p < 0.001). The search revealed an important lack of comparative studies with long-term results. CONCLUSIONS ViV TAVR is a valuable option in the treatment of patients with SVD because of its lower incidence of post-operative complications and better early survival compared with redo SAVR. However, ViV TAVR is associated with higher rates of myocardial infarction and severe patient-prosthesis mismatch.
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Affiliation(s)
- Michel Pompeu B O Sá
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco-PROCAPE, University of Pernambuco-UPE, Recife, Brazil.
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Matheus Simonato
- Division of Cardiac Surgery, Escola Paulista de Medicina-UNIFESP, São Paulo, Brazil
| | - Luiz Rafael P Cavalcanti
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco-PROCAPE, University of Pernambuco-UPE, Recife, Brazil
| | - Ilias P Doulamis
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Michele Gallo
- Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Pietro L Laforgia
- I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Philippe Pibarot
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Marie-Annick Clavel
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
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High Post-Procedural Transvalvular Gradient or Delayed Mean Gradient Increase after Transcatheter Aortic Valve Implantation: Incidence, Prognosis and Associated Variables. The FRANCE-2 Registry. J Clin Med 2021; 10:jcm10153221. [PMID: 34362005 PMCID: PMC8347874 DOI: 10.3390/jcm10153221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 11/23/2022] Open
Abstract
Mean Gradient (MG) elevation can be detected immediately after transcatheter aortic valve implantation (TAVI) or secondarily during follow-up. Comparisons and interactions between these two parameters and their impact on outcomes have not previously been investigated. This study aimed to identify incidence, influence on prognosis, and parameters associated with immediate high post-procedural mean transvalvular gradient (PPMG) and delayed mean gradient increase (6 to 12 months after TAVI, DMGI) in the FRANCE 2 (French Aortic National CoreValve and Edwards 2) registry. The registry includes all consecutive symptomatic patients with severe aortic stenosis who have undergone TAVI. Three groups were analyzed: (1) PPMG < 20 mmHg without DMGI > 10 mmHg (control); (2) PPMG < 20 mmHg with DMGI > 10 mmHg (Group 1); and (3) PPMG ≥ 20 mmHg (Group 2). From January 2010 to January 2012, 4201 consecutive patients were prospectively enrolled in the registry. Controls comprised 2078 patients. In Group 1(n = 131 patients), DMGI exceeded 10 mmHg in 5.6%, and was not associated with greater 4-years mortality than in controls (32.6% vs. 40.1%, p = 0.27). In Group 2 (n = 144 patients), PPMG was at least 20 mmHg in 6.1% and was associated with higher 4-year mortality (48.7% versus 40.1%, p = 0.005). A total of two-thirds of the patients with PPMG ≥ 20 mmHg had MG < 20 mmHg at 1 year, with mortality similar to the controls (39.2% vs. 40.1%, p = 0.73). Patients with PPMG > 20 mmHg 1 year post-TAVI had higher 4-years mortality than the general population of the registry, unlike patients with MG normalization.
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Mendoza CE. Dawn of a new era: The Matryoshka procedure. J Card Surg 2021; 36:3384-3385. [PMID: 34096102 DOI: 10.1111/jocs.15716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Cesar E Mendoza
- Division of Cardiovascular Disease, Jackson Memorial Hospital, Miami, Florida, USA
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Leone PP, Fazzari F, Cannata F, Sanz-Sanchez J, Mangieri A, Monti L, Cozzi O, Stefanini GG, Bragato R, Colombo A, Reimers B, Regazzoli D. Clinical and Technical Challenges of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Implantation. Front Cardiovasc Med 2021; 8:670457. [PMID: 34150868 PMCID: PMC8211887 DOI: 10.3389/fcvm.2021.670457] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/22/2021] [Indexed: 12/30/2022] Open
Abstract
Prosthesis-patient mismatch (PPM) is present when the effective area of a prosthetic valve inserted into a patient is inferior to that of a normal human valve; the hemodynamic consequence of a valve too small compared with the size of the patient's body is the generation of higher than expected transprosthetic gradients. Despite evidence of increased risk of short- and long-term mortality and of structural valve degeneration in patients with PPM after surgical aortic valve replacement, its clinical impact in patients subject to transcatheter aortic valve implantation (TAVI) is yet unclear. We aim to review and update on the definition and incidence of PPM after TAVI, and its prognostic implications in the overall population and in higher-risk subgroups, such as small aortic annuli or valve-in-valve procedures. Last, we will focus on the armamentarium available in order to reduce risk of PPM when planning a TAVI procedure.
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Affiliation(s)
- Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Jorge Sanz-Sanchez
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | | | - Ottavia Cozzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Giulio Giuseppe Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
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Saha S, Peterss S, Mueller C, Deseive S, Sadoni S, Hausleiter J, Massberg S, Hagl C, Joskowiak D. Cardiac surgery following transcatheter aortic valve replacement. Eur J Cardiothorac Surg 2021; 60:1149-1155. [PMID: 34021322 DOI: 10.1093/ejcts/ezab217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/12/2021] [Accepted: 03/09/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The objective of this study was to retrospectively analyse surgical outcomes of patients undergoing secondary cardiac surgery after initial transcatheter aortic valve replacement (TAVR). METHODS Between December 2012 and February 2020, a total of 41 consecutive patients underwent cardiac surgery after a TAVR procedure at our institution. Patients who underwent emergency operations due to periprocedural complications such as ventricular rupture and TAVR dislocation were excluded from this study (n = 12). Thus, 29 patients were included in the analysis. Data are presented as medians (25th-75th quartiles) or as absolute numbers (percentages). RESULTS The median age was 76 years (68-80); 58.6% were men. The median time to a secondary conventional procedure was 23 months (8-40), with 8 patients requiring surgical intervention within the first year post TAVR. The indications for secondary conventional procedures were prosthesis endocarditis (n = 15), prosthesis degeneration or dysfunction (n = 7) and progression of valvular, aortic or coronary artery disease (n = 7). Surgical redo aortic valve replacement was performed in 24 patients (82.8%). No complications involving the aortic root or the aortomitral continuity were observed. The operative mortality was 10.3%. Extracorporeal life support was required in 3 patients (10.3%) for a median duration of 3 days (3-3 days). No adverse cerebrovascular events were observed postoperatively. Postoperatively, 4 patients (13.8%) required a pacemaker and 7 patients (24.1%) required renal replacement therapy. Overall survival at 1 year was 83.0%. CONCLUSIONS Conventional cardiac surgical procedures following TAVR are feasible with reasonable results and a low complication rate.
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Affiliation(s)
- Shekhar Saha
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Christoph Mueller
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Simon Deseive
- Department of Cardiology, LMU University Hospital, Munich, Germany
| | - Sebastian Sadoni
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Jörg Hausleiter
- Department of Cardiology, LMU University Hospital, Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, LMU University Hospital, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
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Brinkmann C, Abdel-Wahab M, Bedogni F, Bhadra OD, Charbonnier G, Conradi L, Hildick-Smith D, Kargoli F, Latib A, Van Mieghem NM, Miura M, Mylotte D, Landes U, Pilgrim T, Riess FC, Taramasso M, Tchétché D, Testa L, Thiele H, Webb J, Windecker S, Witt J, Wohlmuth P, Wolf A, Schofer J. Bioprosthetic valve fracture: Predictors of outcome and follow-up. Results from a multicenter study. Catheter Cardiovasc Interv 2021; 98:756-764. [PMID: 33991385 DOI: 10.1002/ccd.29755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/21/2021] [Accepted: 05/03/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate outcome and its predictors of bioprosthetic valve fracture (BVF) in patients undergoing valve-in-valve transcatheter aortic valve replacement (VIV-TAVR). BACKGROUND BVF is feasible and reduces transvalvular gradients in VIV-TAVR-procedures, but follow-up-data and information on factors influencing the outcome are missing. METHODS The 81 cases of BVF-VIV-TAVR were collected from 14 international centers. RESULTS Predominantly transcatheter heart valve (THV) was implanted first, followed by BVF. VARC-2 defined device success was 93%, most failures were attributed to residual high gradients. Mean gradients decreased from 37 ± 13 mmHg to 10.8 ± 5.9 mmHg (p < 0.001). BVF reduced the gradient by 16 mmHg. During follow-up (FU, 281 ± 164 days) mean gradient remained stable (10.8 ± 5.9 mmHg at discharge, 12.4 ± 6.3 mmHg at FU, p = ns). In-hospital major adverse events occurred in 3.7%. Event-free survival at 276 ± 237.6 days was 95.4%. The linear mixed model identified balloon-expandable valves (BEV), Mitroflow surgical valve, stenotic surgical bioprostheses and balloon only 1 mm larger than the true internal diameter of the surgical valve as predictors for higher gradients. CONCLUSIONS BVF is safe and can significantly reduce gradients, which remain stable at FU. BEV, Mitroflow surgical valve, stenotic bioprostheses and balloon larger than the true internal diameter of the surgical valve of only 1 mm are predictors for higher final gradients.
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Affiliation(s)
- Christina Brinkmann
- MVZ Department Structural Heart Disease, Asklepios St. Georg, Hamburg, Germany
| | | | | | - Oliver D Bhadra
- Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg, Germany
| | | | - Lenard Conradi
- Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg, Germany
| | | | - Faraj Kargoli
- Division of Cardiology, Montefiore Medical Center / Albert Einstein College of Medicine, New York, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center / Albert Einstein College of Medicine, New York, USA
| | | | - Mizuki Miura
- Universitäres Herzzentrum, Universitätsspital Zürich, Zürich, Switzerland
| | - Darren Mylotte
- Cardiology Department, Bon Secours Hospital, Galway, Ireland
| | - Uri Landes
- Heart Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Thomas Pilgrim
- Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | | | - Maurizio Taramasso
- Universitäres Herzzentrum, Universitätsspital Zürich, Zürich, Switzerland
| | | | - Luca Testa
- Cardiologica, IRCCS Policlinico San Donato, Milan, Italy
| | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - John Webb
- Heart Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Julian Witt
- Cardiothoracic Surgery, Albertinen Heart Center, Hamburg, Germany
| | | | - Alexander Wolf
- Klinik für Kardiologie, Elisabeth-Krankenhaus Essen, Essen, Germany
| | - Joachim Schofer
- MVZ Department Structural Heart Disease, Asklepios St. Georg, Hamburg, Germany
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Spaziano M, Levett JY, Piazza N. Failing Surgical Aortic Valve?: It Is Time for a Change. JACC Cardiovasc Interv 2021; 14:221-223. [PMID: 33478640 DOI: 10.1016/j.jcin.2020.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Marco Spaziano
- Division of Cardiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Jeremy Y Levett
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Nicolo Piazza
- Division of Cardiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Abstract
Aortic stenosis is the most common valvular disease requiring valve replacement. Valve replacement therapies have undergone progressive evolution since the 1960s. Over the last 20 years, transcatheter aortic valve replacement has radically transformed the care of aortic stenosis, such that it is now the treatment of choice for many, particularly elderly, patients. This review provides an overview of the pathophysiology, presentation, diagnosis, indications for intervention, and current therapeutic options for aortic stenosis.
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Affiliation(s)
- Marko T Boskovski
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
| | - Thomas G Gleason
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
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Ahmed A, Levy KH. Valve-in-valve transcatheter aortic valve replacement versus redo surgical aortic valve replacement: A systematic review and meta-analysis. J Card Surg 2021; 36:2486-2495. [PMID: 33797799 DOI: 10.1111/jocs.15546] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/09/2021] [Accepted: 03/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND/AIM With the growing contemporary use of bioprosthetic valves, whose limited long-term durability has been well-documented, an increase in the need for reintervention is expected. We perform a meta-analysis to compare the current standard of care, redo surgical aortic valve replacement (Redo SAVR) with the less invasive alternative, valve-in-valve transcatheter aortic valve replacement (ViV TAVR) for treating structural valve deterioration. METHODS After a comprehensive literature search, studies comparing ViV TAVR to Redo SAVR were pooled to perform a pairwise meta-analysis using the random-effects model. Primary outcomes were 30-day and follow-up mortality. RESULTS A total of nine studies including 9127 patients were included. ViV TAVR patients were significantly older (mean difference [MD], 5.82; p = .0002) and more frequently had hypercholesterolemia (59.7 vs. 60.0%; p = .0006), coronary artery disease (16.1 vs. 16.1%; p = .04), periphery artery disease (15.4 vs. 5.7%; p = .004), chronic obstructive pulmonary disease (29.3 vs. 26.2%; p = .04), renal failure (30.2 vs. 24.0%; p = .009), and >1 previous cardiac surgery (23.6 vs. 15.9%; p = .004). Despite this, ViV TAVR was associated with decreased 30-day mortality (OR, 0.56; p < .0001). Conversely, Redo SAVR had lower 30-day paravalvular leak (OR, 6.82; p = .04), severe patient-prosthesis mismatch (OR, 3.77; p < .0001), and postoperative aortic valve gradients (MD, 5.37; p < .0001). There was no difference in follow-up mortality (HR, 1.02; p = .86). CONCLUSIONS Despite having patients with an increased baseline risk, ViV TAVR was associated with lower 30-day mortality, while Redo SAVR had lower paravalvular leak, severe patient-prosthesis mismatch, and postoperative gradients. Although ViV TAVR remains a feasible treatment option in high-risk patients, randomized trials are necessary to elucidate its efficacy over Redo SAVR.
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Affiliation(s)
- Adham Ahmed
- CUNY School of Medicine, New York, New York, USA
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49
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Baumgartner H. Transcatheter valve-in-valve implantation in failed aortic bioprosthetic valves: a word of caution in times of euphoria. Eur Heart J 2021; 41:2743-2746. [PMID: 32712649 DOI: 10.1093/eurheartj/ehaa560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Helmut Baumgartner
- Department of Cardiology III: Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert Schweitzer Campus 1, Building A1, D-48149 Muenster, Germany
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50
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Comparison of safety and haemodynamic performance between the Avalus™ stented aortic valve bioprosthesis and Magna™ valve in Japanese patients. Gen Thorac Cardiovasc Surg 2021; 69:1060-1069. [PMID: 33400197 PMCID: PMC8203521 DOI: 10.1007/s11748-020-01566-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/04/2020] [Indexed: 11/26/2022]
Abstract
Objectives A new stented bovine pericardial valve (Avalus™) has been proven safe and effective with good hemodynamic performance in Western populations. However, its use in Japanese patients is poorly understood. We retrospectively compared the feasibility, safety, and valve haemodynamics between the Avalus™ and Magna™ valves in patients who underwent surgical aortic valve replacement (SAVR). Methods This study included 87 patients receiving an Avalus™ valve and 387 receiving a Magna™ valve. We evaluated adverse events, outcomes, and valve haemodynamics within 1 year postoperatively. There were no significant differences in any surgical risk scores. Results No in-hospital mortality occurred in the Avalus™ group, but two mortality events occurred in the Magna™ group. No pacemaker implantation for complete atrioventricular block was required in the Avalus™ group. There was no significant difference in in-hospital or clinical outcomes between the two groups until 1 year postoperatively. Left ventricular mass index reduction appeared to predominate in the Avalus™ over Magna™ group. There was no significant difference in the mean pressure gradient or effective orifice area of each valve size at 1 week or 1 year between the two groups, apart from the mean pressure gradient of the 23-mm valve at 1 week. Three patients (3.4%) in the Avalus™ group and 39 (10.8%) in the Magna™ group (p = 0.12) had severe patient–prosthesis mismatch at 1 week postoperatively. Conclusions The new Avalus™ stented aortic valve bioprosthesis was associated with good in-hospital outcomes and good valve functionality post-SAVR in Japanese patients.
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