1
|
Aurigemma C, Busco M, Bianchini F, Bianchini E, Di Brango C, Marchetta M, Bruno P, Nesta M, Romagnoli E, Burzotta F, Trani C. Clinical impact of multiple resheathing during transcatheter aortic valve implantation with Evolut self-expanding valves. Int J Cardiol 2024; 410:132218. [PMID: 38815673 DOI: 10.1016/j.ijcard.2024.132218] [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: 10/25/2023] [Revised: 05/02/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The possibility to resheath some transcatheter heart valves (THV) facilitates the optimization of self-expandable devices implantation. However, resheating manoeuvres (expecially when repeated) increase the interaction between the transcatheter prosthesis and the patient's tissues potentially causing side-effects. AIMS To assess the clinical outcomes of resheathing at midterm follow-up with a focus on the safety of multiple resheathing. METHODS This retrospective observational study included all consecutive patients who underwent TAVI with a self-expandable supra-annular THV between December 2018 and December 2022. Primary endpoint was a composite of cardiovascular (CV) mortality, neurological events, non-fatal acute myocardial infarction and CV rehospitalizations. All clinical endpoints were assessed according to VARC-3 criteria. RESULTS 469 TAVI procedures with self-expandable supra-annular THV were included in the study. The attempt to resheath and the resheath manoeuvres number was prospectively recorded into an electronic database. Resheating was attempted in 253 (53.9%) cases; 1, 2 and ≥ 3 resheathing were performed in respectively 122 (26.0%), 63 (13.4%) and 68 (14.5%) procedures. At a median follow-up of 640 days (interquartile range 340-1033 days), the incidence of the primary endpoint did not differ between 0 vs. ≥1 (22.7 vs. 26.1%, LogRank p = 0.584) and < 3 vs. ≥3 resheathing groups (24.2 vs. 26.5% LogRank p = 0.963). Furthermore, no significant differences in the primary endpoint were observed between 0, 1-2 and ≥ 3 resheathing (p = 0.84). CONCLUSIONS Our study found that resheathing of self-expandable THVs during TAVI did not result in worse clinical outcomes compared with no resheathing at mid-term follow-up. These results are independent from the number of resheathing, underling the safety of multiple resheathing in terms of peri-procedural and mid-term outcome. CONDENSED ABSTRACT In this retrospective observational study of 469 patients undergoing transcatheter aortic valve implantation (TAVI) for symptomatic severe aortic stenosis with self-expanding valves, we investigated the influence of resheathing on mid-term clinical outcomes. Specifically, we focused on the safety of multiple resheathing procedures. Our findings revealed no significant impact of resheathing on medium-term outcomes. The primary endpoint, a composite of cardiovascular mortality, neurological events, non-fatal acute myocardial infarction, and cardiovascular rehospitalizations, did not show statistically significant differences between no resheathing, single resheathing and multiple resheathing groups. Our study suggests that resheathing, even when performed multiple times, does not appear to significantly affect clinical outcomes at mid-term follow-up.
Collapse
Affiliation(s)
- Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Busco
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emiliano Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Di Brango
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Marchetta
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marialisa Nesta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
2
|
Merdler I, Case BC, Bhogal S, Reddy PK, Zhang C, Ali S, Gallino PE, Jackman C, Ben-Dor I, Satler LF, Cohen JE, Rogers T, Waksman R. Temporal trends with the Evolut family of self-expanding transcatheter heart valves: A single-center experience. Catheter Cardiovasc Interv 2024. [PMID: 38769727 DOI: 10.1002/ccd.31088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/29/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The Evolut self-expanding valve (SEV) systems (Medtronic), were designed to accommodate varying valve sizes and reduce paravalvular leak (PVL) while maintaining a low delivery profile. These systems have evolved between product generations, alongside valve deployment techniques changing over time. AIMS This study aimed to examine whether these changes impacted clinical outcomes. METHODS EPROMPT is a prospective, investigator-initiated, postmarketing registry of consecutive patients undergoing transfemoral transcatheter aortic valve replacement (TAVR) using the Evolut PRO/PRO+ SEV system. A total of 300 patients were divided into three consecutive cohorts of 100 patients according to implantation date (January to October 2018, November 2018 to July 2020, and August 2020 to November 2021). Procedural and clinical outcomes over these time periods were compared. RESULTS Valve Academic Research Consortium (VARC)-2 device implantation success improved over time (70.0% vs. 78.0% vs. 88.8%, p = 0.01), with a similar trend for VARC-3 device success (94.7% vs. 81.7% vs. 96.8%, p < 0.001). PVL (all degrees) frequency was likewise reduced over time (31.0% vs. 17.0% vs. 19.2%, p = 0.04). Furthermore, a trend was noticed toward shorter procedure times and shorter length of stay. However, postprocedural pacemaker implantation rates did not significantly differ (15.2% vs. 21.1% vs. 14.0%, p = 0.43). CONCLUSION During a 3-year period, we demonstrated better TAVR outcomes with newer SEV iterations, alongside changes in implantation techniques, which might result in better procedural and clinical outcomes. However, we did not see a significant change in peri-procedural pacemaker rates for SEV.
Collapse
Affiliation(s)
- Ilan Merdler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Sukhdeep Bhogal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Pavan K Reddy
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Syed Ali
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Paige E Gallino
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Caroline Jackman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Jeffery E Cohen
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| |
Collapse
|
3
|
Ito S, Laham R, Nkomo VT, Forrest JK, Reardon MJ, Little SH, Mumtaz M, Gada H, Bajwa T, Langholz D, Heiser J, Chawla A, Jenson B, Attizanni G, Markowitz AH, Huang J, Oh JK. Impact of aortic valve replacement in symptomatic low-risk patients with less than severe aortic stenosis. Open Heart 2023; 10:e002297. [PMID: 37173100 PMCID: PMC10186477 DOI: 10.1136/openhrt-2023-002297] [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: 03/02/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE To evaluate whether transcatheter or surgical aortic valve replacement (TAVR or SAVR) affects clinical and haemodynamic outcomes in symptomatic patients with moderately-severe aortic stenosis (AS). METHODS Echocardiographic evidence of severe AS for enrolment in the Evolut Low Risk trial was based on site-reported measurements. For this post hoc analysis, core laboratory measurements identified patients with symptomatic moderately-severe AS (1.0 RESULTS Moderately-severe AS was identified in 113 out of 1414 patients (8%). Baseline AVA was 1.1±0.1 cm2, peak velocity 3.7±0.2 m/s, MG 32.7±4.8 mm Hg and aortic valve calcium volume 588 (364, 815) mm3. Valve haemodynamics improved following TAVR (AVA 2.5±0.7 cm2, peak velocity 1.9±0.5 m/s and MG 8.4±4.8 mm Hg; p<0.001 for all) and SAVR (AVA 2.0±0.6 cm2, peak velocity 2.1±0.4 m/s and MG 10.0±3.4 mm Hg; p<0.001 for all). At 24 months, the rates of death or disabling stroke were similar (TAVR 7.7% vs SAVR 6.5%; p=0.82). Kansas City Cardiomyopathy Questionnaire overall summary score assessing quality of life improved from baseline to 30 days after TAVR (67.0±20.6 to 89.3±13.4; p<0.001) and SAVR (67.5±19.6 to 78.3±22.3; p=0.001). CONCLUSIONS In symptomatic patients with moderately-severe AS, AVR appears to be beneficial. Determination of the clinical and haemodynamic profile of patients who can benefit from earlier isolated AVR needs further investigation in randomised clinical trials.
Collapse
Affiliation(s)
- Saki Ito
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Roger Laham
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - John K Forrest
- Department of Internal Medicine (Cardiology), Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Michael J Reardon
- Departments of Cardiology and Cardiothoracic Surgery, Houston Methodist Debakey Heart and Vascular Center, Houston, Texas, USA
| | - Stephen H Little
- Departments of Cardiology and Cardiothoracic Surgery, Houston Methodist Debakey Heart and Vascular Center, Houston, Texas, USA
| | - Mubashir Mumtaz
- Departments of Cardiothoracic Surgery and Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle Health, Wormsleyburg, Pennsylvania, USA
| | - Hemal Gada
- Departments of Cardiothoracic Surgery and Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle Health, Wormsleyburg, Pennsylvania, USA
| | - Tanvir Bajwa
- Aurora Cardiovascular and Thoracic Services, Aurora Saint Luke's Medical Center, Milwaukee, Wisconsin, USA
| | - David Langholz
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan, USA
| | - John Heiser
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan, USA
| | - Atul Chawla
- Department of Cardiology, Mercy Medical Center, IA, Mercy Medical Center, Des Moines, Iowa, USA
| | - Bart Jenson
- Department of Cardiology, Mercy Medical Center, IA, Mercy Medical Center, Des Moines, Iowa, USA
| | - Guilherme Attizanni
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Alan H Markowitz
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jian Huang
- Structural Heart and Aortic, Medtronic Inc, Mounds View, Minnesota, USA
| | - Jae K Oh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
4
|
Hibino M, Yoon SH, Dallan LAP, Pelletier MP, Rushing GD, Filby SJ, Elgudin Y, Ukaigwe AC, Baeza CR, Attizzani GF. Feasibility and Safety of Exclusive Noncontrast Computed Tomography for Planning of Transcatheter Aortic Valve Implantation With Self-Expandable Valves. Am J Cardiol 2023; 190:122-124. [PMID: 36623398 DOI: 10.1016/j.amjcard.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/08/2022] [Accepted: 12/18/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Makoto Hibino
- Divisions of Cardiac Surgery, Department of Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sung-Han Yoon
- Divisions of Cardiology, Department of Medicine, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Luis Augusto Palma Dallan
- Divisions of Cardiology, Department of Medicine, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Marc P Pelletier
- Divisions of Cardiac Surgery, Department of Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Gregory D Rushing
- Divisions of Cardiac Surgery, Department of Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Steven J Filby
- Divisions of Cardiology, Department of Medicine, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Yakov Elgudin
- Divisions of Cardiac Surgery, Department of Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Anene C Ukaigwe
- Divisions of Cardiology, Department of Medicine, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Cristian R Baeza
- Divisions of Cardiac Surgery, Department of Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Guilherme F Attizzani
- Divisions of Cardiology, Department of Medicine, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| |
Collapse
|
5
|
Gilchrist JH, Dangl MD, Grant JK, Albosta M, Vincent LT, Ebner BF, Maning J, Colombo RA. Trends and In-Hospital Outcomes of Patients With Baseline Right Bundle Branch Block Who Underwent Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 188:1-6. [PMID: 36446226 DOI: 10.1016/j.amjcard.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022]
Abstract
This study aimed to explore contemporary in-hospital outcomes and trends of transcatheter aortic valve implantation (TAVI) outcomes in patients with baseline right bundle branch block (RBBB) using data collected from a nationwide sample. Using the National Inpatient Sample, we identified patients hospitalized for an index TAVI procedure from 2016 to 2019. Primary outcomes included in-hospital all-cause mortality, complete heart block, and permanent pacemaker (PPM) implantation. A total of 199,895 hospitalizations for TAVI were identified. RBBB was present in 10,495 cases (5.3%). Patients with RBBB were older (median age 81 vs 80 years, p <0.001) and less likely to be female (35% vs 47.4%, p <0.001). After adjusting for differences in baseline characteristics and elective versus nonelective admission, patients with RBBB had a higher incidence of complete heart block (adjusted odds ratio [aOR] 4.77, confidence interval [CI] 4.55 to 5.01, p <0.001) and PPM implantation (aOR 4.15, CI 3.95 to 4.35, p <0.001) and no difference in-hospital mortality rate (aOR 0.85, CI 0.69 to 1.05, p = 0.137). Between 2016 and 2019, there was a 3.5% and 2.9% decrease in in-hospital PPM implantation in patients with and without RBBB, respectively. In conclusion, from 2016 to 2019, the rate of in-hospital PPM implantation decreased during index TAVI hospitalization in both patients with and without RBBB. However, in those with baseline RBBB, complete heart block complication rates requiring PPM implantation remain relatively high. Further research and advances are needed to continue to reduce complication rates and the need for PPM implantation.
Collapse
Affiliation(s)
| | - Michael D Dangl
- Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Jelani K Grant
- Department of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Michael Albosta
- Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Louis T Vincent
- Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Bertrand F Ebner
- Cardiovascular Division, Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Jennifer Maning
- Cardiovascular Division, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rosario A Colombo
- Cardiovascular Division, Department of Medicine, Jackson Memorial Hospital, Miami, Florida
| |
Collapse
|
6
|
Maier O, Piayda K, Binnebößel S, Berisha N, Afzal S, Polzin A, Klein K, Westenfeld R, Horn P, Jung C, Kelm M, Veulemans V, Zeus T. Real-world experience with the cusp-overlap deployment technique in transcatheter aortic valve replacement: A propensity-matched analysis. Front Cardiovasc Med 2022; 9:847568. [PMID: 36119734 PMCID: PMC9471948 DOI: 10.3389/fcvm.2022.847568] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background The implantation depth (ID) is a critical condition for optimal hemodynamic and clinical outcomes in transcatheter aortic valve replacement (TAVR). The recently recommended cusp-overlap technique (COT) offers optimized fluoroscopic projections facilitating a precise ID. This single-center observational study aimed to investigate short-term clinical performance, safety, and efficacy outcomes in patients undergoing TAVR with self-expandable prostheses and application of COT in a real-world setting. Materials and methods From September 2020 to April 2021, a total of 170 patients underwent TAVR with self-expandable devices and the application of COT, while 589 patients were treated from January 2016 to August 2020 with a conventional three-cusp coplanar view approach. The final ID and 30-day outcomes were compared after 1:1 propensity score matching, resulting in 150 patients in both cohorts. Results The mean ID was significantly reduced in the COT cohort (−4.2 ± 2.7 vs. −4.9 ± 2.3 mm; p = 0.007) with an improvement of ID symmetry of less than 2 mm difference below the annular plane (47.3 vs. 57.3%; p = 0.083). The rate of new permanent pacemaker implantation (PPI) following TAVR was effectively reduced (8.0 vs. 16.8%; p = 0.028). While the fluoroscopy time decreased (18.4 ± 7.6 vs. 19.8 ± 7.6 min; p = 0.023), the dose area product increased in the COT group (4951 ± 3662 vs. 3875 ± 2775 Gy × cm2; p = 0.005). Patients implanted with COT had a shorter length of in-hospital stay (8.4 ± 4.0 vs. 10.3 ± 6.7 days; p = 0.007). Conclusion Transcatheter aortic valve replacement using the cusp-overlap deployment technique is associated with an optimized implantation depth, leading to fewer permanent conduction disturbances. However, our in-depth analysis showed for the first time an increase of radiation dose due to extreme angulations of the gantry to obtain the cusp-overlap view.
Collapse
Affiliation(s)
- Oliver Maier
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Kerstin Piayda
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany
| | - Stephan Binnebößel
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Nora Berisha
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Shazia Afzal
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Amin Polzin
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Kathrin Klein
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Verena Veulemans
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- *Correspondence: Verena Veulemans,
| | - Tobias Zeus
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| |
Collapse
|
7
|
Panagides V, Mesnier J, Nuche J, Delarochellière R, Paradis JM, Kalavrouziotis D, Dumont E, Mohammadi S, Rodes-Cabau J. From the Evolut Pro to the Evolut FX self-expanding transcatheter aortic valve replacement systems: current status and future perspectives. Expert Rev Med Devices 2022; 19:561-569. [PMID: 36005274 DOI: 10.1080/17434440.2022.2113386] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Since the initial experience with the CoreValve (Medtronic, Minneapolis, Minnesota), there have been continuous iterations of this valve system in order to improve procedural success and reduce periprocedural complications. The Evolut Pro, Pro+, and FX are the latest generations of this transcatheter heart valve (THV). AREAS COVERED This review paper aims to analyze the main characteristics and clinical evidence about the Evolut Pro THV and summarize the main iterations of the newer generation Evolut FX valve system. EXPERT OPINION The Evolut Pro system has been associated with good clinical outcomes and excellent valve hemodynamic performance including reduced rates of paravalvular leaks. Technical enhancements to improve valve positioning, orientation, and vascular access have been implemented in the newer generation Evolut FX system.
Collapse
Affiliation(s)
- Vassili Panagides
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Jules Mesnier
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Jorge Nuche
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Robert Delarochellière
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Jean-Michel Paradis
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Dimitri Kalavrouziotis
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Eric Dumont
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Siamak Mohammadi
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | - Josep Rodes-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| |
Collapse
|
8
|
Tsushima T, Main A, Al-Kindi SG, Dallan LAP, Wheat HL, Baeza CR, Pelletier MP, Arruda MS, Mackall JA, Thal SG, Ohno Y, Lee KH, Siqueira DA, Kaneko T, Harloff MT, Costa G, Barbanti M, Attizzani GF. Risk Stratification of New Persistent Left Bundle Branch Block After Transcatheter Aortic Valve Implantation. Am J Cardiol 2022; 175:80-87. [PMID: 35597627 DOI: 10.1016/j.amjcard.2022.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 11/15/2022]
Abstract
Previous studies reported that new-onset persistent left bundle branch block (NOP-LBBB) was related to worse outcomes after transcatheter aortic valve implantation (TAVI). However, these results can be confounded by the presence of permanent pacemaker (PPM) implantation before and after TAVI. Long-term outcomes and the risk stratification of NOP-LBBB not having PPM implantation before and after TAVI have not been fully investigated. This is an international, multicenter, retrospective study of patients who underwent TAVI from July 31, 2007, to May 8, 2020. A total of 2,240 patients were included, and 17.5% of patients developed NOP-LBBB. NOP-LBBB was associated with cardiac mortality (adjusted hazard ratio [aHR] 1.419, 95% confidence interval [CI] 1.014 to 1.985, p = 0.041) and the composite outcomes of cardiac mortality and/or heart failure readmission (aHR 1.313, 95% CI 1.027 to 1.678, p = 0.030). Patients who developed NOP-LBBB with pre-TAVI left ventricular ejection fraction (LVEF) <40% were significantly associated with cardiac mortality (aHR 2.049, 95% CI 1.039 to 4.041, p = 0.038), heart failure (aHR 3.990, 95% CI 2.362 to 6.741, p <0.001), and the composite outcome (aHR 2.729, 95% CI 1.703 to 4.374, p <0.001). Although NOP-LBBB with pre-TAVI LVEF >40% had a significant decrease in LVEF 6 to 12 months after TAVI (-1.8 ± 9.7% vs +0.6 ± 8.1%, p = 0.003), NOP-LBBB with pre-TAVI LVEF <40% had a significant increase in LVEF 6 to 12 months after TAVI (+9.7 ± 13.6% vs +13.0 ± 11.7%, p = 0.157). In conclusion, patients with NOP-LBBB without pre-TAVI and post-TAVI PPM developed significantly worse long-term outcomes, especially in patients with pre-TAVI LVEF <40%. Further prospective investigation should be undertaken.
Collapse
Affiliation(s)
- Takahiro Tsushima
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Anthony Main
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sadeer G Al-Kindi
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Luis Augusto Palma Dallan
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Heather L Wheat
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Cristian R Baeza
- Department of Surgery, Division of Cardiac Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Marc P Pelletier
- Department of Surgery, Division of Cardiac Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Mauricio S Arruda
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Judith A Mackall
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sergio G Thal
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Kyong-Hee Lee
- Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Dimytri A Siqueira
- Department of Cardiology, Instituto Dante Pazzanese de Cardiologia - Fundação Adib Jatene, Sao Paulo, Brazil
| | - Tsuyoshi Kaneko
- Department of Surgery, Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Morgan T Harloff
- Department of Surgery, Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Giuliano Costa
- Division of Cardiology, Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Guilherme F Attizzani
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| |
Collapse
|
9
|
Moroni F, Azzalini L, Sondergaard L, Attizzani GF, García S, Jneid H, Mamas MA, Bagur R. Transcatheter Aortic Valve Implantation With and Without Resheathing and Repositioning: A Systematic Review and Meta-analysis. J Am Heart Assoc 2022; 11:e024707. [PMID: 35699176 PMCID: PMC9238664 DOI: 10.1161/jaha.121.024707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background There is a concern that resheathing/repositioning of transcatheter heart valves during transcatheter aortic valve implantation (TAVI) may lead to an increased risk of periprocedural complications. We aimed to evaluate the short‐ and long‐term impact on clinical outcomes of resheathing for repositioning of transcatheter heart valves during TAVI procedures. Methods and Results We conducted a systematic search of Embase, MEDLINE, and Cochrane Central Register of Controlled Trials databases to identify studies comparing outcomes between patients requiring resheathing/repositioning during TAVI and those who did not. Random‐effects meta‐analyses were used to estimate the association of resheathing compared with no resheathing with clinical outcomes after TAVI. Seven studies including 4501 participants (pooled mean age, 80.9±7.4 years; 54% women; and 1374 [30.5%] patients requiring resheathing/repositioning) were included in this study. No significant differences between the 2 groups were identified with regards to safety: 30‐day mortality (n=3125; odds ratio [OR], 0.74 [95% confidence interval [CI], 0.41–1.33]; I2=0%), stroke (n=4121; OR, 1.09 [95% CI, 0.74–1.62]; I2=0%), coronary obstruction (n=3000; OR, 2.35 [95% CI, 0.17–33.47]; I2=75%), major vascular complications (n=3125; OR, 0.92 [95% CI, 0.66–1.33]; I2=0%), major bleeding (n=3125; OR, 1.13 [95% CI, 0.94–2.01]; I2=39%), acute kidney injury (n=3495; OR, 1.30 [95% CI, 0.64–2.62]; I2=44%), and efficacy outcomes: device success (n=1196; OR, 0.77 [95% CI, 0.51–1.14]; I2=0%), need for a second valve (n=3170; OR, 2.86 [95% CI, 0.96–8.48]; I2=62%), significant (moderate or higher) paravalvular leak (n=1151; OR, 1.53 [95% CI, 0.83–2.80]; I2=0%), and permanent pacemaker implantation (n=1908; OR, 1.04 [95% CI, 0.68–1.57]; I2=58%). One‐year mortality was similar between groups (n=1972; OR, 1.00 [95% CI, 0.68–1.47]; I2=0%). Conclusions Resheathing of transcatheter heart valves during TAVI is associated with similar periprocedural risk compared with no resheathing in several patient‐important outcomes. These data support the safety of current self‐expanding transcatheter heart valves with resheathing features. Registration URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021273715.
Collapse
Affiliation(s)
- Francesco Moroni
- Division of Cardiology Pauley Heart CenterVirginia Commonwealth University Richmond VA
| | - Lorenzo Azzalini
- Division of Cardiology Department of Medicine University of Washington Seattle WA
| | - Lars Sondergaard
- The Heart Centre, RigshospitaletCopenhagen University Hospital Copenhagen Denmark
| | - Guilherme F Attizzani
- Harrington Heart and Vascular InstituteUniversity Hospitals Cleveland Medical Center Cleveland OH
| | - Santiago García
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital Cincinnati OH
| | - Hani Jneid
- Division of Cardiology Baylor School of Medicine and the Michael E. DeBakey VAMC Houston TX
| | - Mamas A Mamas
- Keele Cardiovascular Research Group Centre for Prognosis ResearchInstitute of Primary Care and Health SciencesKeele University Stoke-on-Trent United Kingdom
| | - Rodrigo Bagur
- Keele Cardiovascular Research Group Centre for Prognosis ResearchInstitute of Primary Care and Health SciencesKeele University Stoke-on-Trent United Kingdom.,Department of Epidemiology and Biostatistics Schulich School of Medicine & Dentistry Western University London Ontario Canada
| |
Collapse
|
10
|
Tugaoen Z, Nguyen P, Arora S, Vavalle J. The selection of transcatheter heart valves in transcatheter aortic valve replacement. Trends Cardiovasc Med 2021; 32:513-522. [PMID: 34634481 DOI: 10.1016/j.tcm.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
Transcatheter heart valve technology has rapidly progressed since initial approval in the United States. There are currently two widely available transcatheter heart valve delivery systems approved in the US; however limited data exist on optimal device selection for various patient populations. This review explores the characteristics of currently approved transcatheter heart valve systems and scenarios where one valve system may be favored over others. We provide a simplified decision tree for selecting the optimal transcatheter valve system for specific patient-centered characteristics.
Collapse
Affiliation(s)
- Zachary Tugaoen
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Peter Nguyen
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States
| | - Sameer Arora
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States
| | - John Vavalle
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States.
| |
Collapse
|
11
|
Affiliation(s)
- Rodrigo Bagur
- Interventional Cardiology Division of Cardiology London Health Sciences CentreSchulich School of Medicine & DentistryWestern University London Ontario Canada
| |
Collapse
|
12
|
Bernardi FLM, Rodés-Cabau J, Tirado-Conte G, Amat Santos IJ, Plachtzik C, Cura F, Sztejfman M, Mangione FM, Tumeleiro R, Esteves VBC, Pessoa de Melo EF, Alcocer Chauvet A, Fuchs F, Sarmento-Leite R, de Campos Martins EC, Nombela-Franco L, Delgado-Arana JR, Bocksch W, Lamelas P, Giuliani C, Campanha-Borges DC, Mangione JA, de Brito FS, Abizaid AC, Ribeiro HB. Incidence, Predictor, and Clinical Outcomes of Multiple Resheathing With Self-Expanding Valves During Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2021; 10:e020682. [PMID: 34546114 PMCID: PMC8649510 DOI: 10.1161/jaha.120.020682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background No study has evaluated the impact of the additional manipulation demanded by multiple resheathing (MR) in patients undergoing transcatheter aortic valve replacement with repositionable self‐expanding valves. Methods and Results This study included a real‐world, multicenter registry involving 16 centers from Canada, Germany, Latin America, and Spain. All consecutive patients who underwent transcatheter aortic valve replacement with the Evolut R, Evolut PRO, and Portico valves were included. Patients were divided according to the number of resheathing: no resheathing, single resheathing (SR), and MR. The primary end point was device success. Secondary outcomes included procedural complications, early safety events, and 1‐year mortality. In 1026 patients, the proportion who required SR and MR was 23.9% and 9.3%, respectively. MR was predicted by the use of Portico and moderate/severe aortic regurgitation at baseline (both with P<0.01). Patients undergoing MR had less device success (no resheathing=89.9%, SR=89.8%, and MR=80%; P=0.01), driven by more need for a second prosthesis and device embolization. At 30 days, there were no differences in safety events. At 1 year, more deaths occurred with MR (no resheathing=10.5%, SR=8.0%, and MR=18.8%; P=0.014). After adjusting for baseline differences and center experience by annual volume, MR associated with less device success (odds ratio, 0.42; P=0.003) and increased 1‐year mortality (hazard ratio, 2.06; P=0.01). When including only the Evolut R/PRO cases (N=837), MR continued to have less device success (P<0.001) and a trend toward increased mortality (P=0.05). Conclusions Repositioning a self‐expanding valve is used in a third of patients, being multiple in ≈10%. MR, but not SR, was associated with more device failure and higher 1‐year mortality, regardless of the type of valve implanted.
Collapse
Affiliation(s)
- Fernando L M Bernardi
- Instituto do Coração Hospital das Clinicas HCFMUSP Faculdade de MedicinaUniversidade de Sao Paulo Sao Paulo Brazil
| | - Josep Rodés-Cabau
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada.,Hospital Clínic de Barcelona Barcelona Spain
| | | | - Ignacio J Amat Santos
- Centro de Investigación Biomédica en Red de Enfermedades CardiovascularesHospital Clínico Universitario de Valladolid Valladolid Spain
| | | | - Fernando Cura
- Instituto Cardiovascular de Buenos Aires Buenos Aires Argentina
| | | | | | | | | | | | | | - Felipe Fuchs
- Hospital de Clínicas de Porto Alegre Porto Alegre Brazil
| | | | | | | | - José Raul Delgado-Arana
- Centro de Investigación Biomédica en Red de Enfermedades CardiovascularesHospital Clínico Universitario de Valladolid Valladolid Spain
| | | | - Pablo Lamelas
- Instituto Cardiovascular de Buenos Aires Buenos Aires Argentina
| | | | - Diego Carter Campanha-Borges
- Instituto do Coração Hospital das Clinicas HCFMUSP Faculdade de MedicinaUniversidade de Sao Paulo Sao Paulo Brazil.,Hospital Samaritano Paulista São Paulo Brazil
| | | | - Fábio Sandoli de Brito
- Instituto do Coração Hospital das Clinicas HCFMUSP Faculdade de MedicinaUniversidade de Sao Paulo Sao Paulo Brazil
| | - Alexandre C Abizaid
- Instituto do Coração Hospital das Clinicas HCFMUSP Faculdade de MedicinaUniversidade de Sao Paulo Sao Paulo Brazil
| | - Henrique B Ribeiro
- Instituto do Coração Hospital das Clinicas HCFMUSP Faculdade de MedicinaUniversidade de Sao Paulo Sao Paulo Brazil.,Hospital Samaritano Paulista São Paulo Brazil
| |
Collapse
|
13
|
Barthélémy O, Collet JP. Would Anyone Dare Abandon Repositioning of Self-Expanding TAVR? JACC Cardiovasc Interv 2020; 13:1825-1827. [PMID: 32763074 DOI: 10.1016/j.jcin.2020.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Olivier Barthélémy
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié-Salpêtrière University Hospital (AP-HP), Paris, France.
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié-Salpêtrière University Hospital (AP-HP), Paris, France
| |
Collapse
|