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Elkholy M, Akkawi M, Kidess GG, Abdulelah Z, Rayyan A, Al-Dqour MR, Damlakhy A, Bahar Y, Alraies MC. Comparative Effectiveness and Safety of Self-Expanding Versus Balloon-Expandable Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Am J Med Sci 2025:S0002-9629(25)00992-9. [PMID: 40288578 DOI: 10.1016/j.amjms.2025.04.010] [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: 12/07/2024] [Revised: 04/20/2025] [Accepted: 04/21/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is a safe alternative to surgical aortic valve replacement for patients with symptomatic severe aortic stenosis at increased surgical risk. However, comparative data on self-expanding valves (SEV) versus balloon-expanding valves (BEV) remain limited. METHODS A comprehensive review of PubMed and Embase was conducted through April 2024, identifying eight studies (five randomized controlled trials and three propensity-matched observational studies) comparing SEV and BEV in TAVR. Primary outcomes included all-cause mortality, cardiovascular mortality, and device success per Valve Academic Research Consortium criteria, while secondary outcomes assessed bioprosthetic valve dysfunction and adverse events (annulus rupture/dissection, coronary artery occlusion, valve dislocation/embolization, valve thrombosis, moderate and severe paravalvular aortic regurgitation, endocarditis, permanent pacemaker implantation, major or life-threatening bleeding, acute kidney injury, and stroke). RESULTS The analysis included 4,032 patients (SEV = 2,006; BEV = 2,017). SEV was associated with higher rates of moderate-to-severe paravalvular aortic regurgitation [OR, 1.76; CI 1.13-2.74; P = 0.01] and permanent pacemaker placement [OR, 1.57; CI, 1.23-2.00; P = 0.0002] compared to BEV. No significant differences were observed in 30-day or 1-year all-cause mortality, cardiovascular mortality, device success, bioprosthetic valve dysfunction, valve dislocation/embolization, valve thrombosis, endocarditis, major or life-threatening bleeding, coronary artery occlusion, stroke, rehospitalization, or acute kidney injury. CONCLUSION SEV and BEV demonstrated comparable outcomes in mortality and device success. However, the higher risk of moderate-to-severe paravalvular aortic regurgitation and permanent pacemaker placement with SEV should be considered when selecting the optimal TAVR valve for individual patients.
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Affiliation(s)
- Montaser Elkholy
- Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA.
| | - Mohammad Akkawi
- Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA.
| | - George G Kidess
- Wayne State University School of Medicine, Detroit, MI, USA.
| | - Zaid Abdulelah
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK.
| | | | | | - Ahmad Damlakhy
- Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA.
| | | | - M Chadi Alraies
- Cardiovascular Institute, Detroit Medical Center, Detroit, MI, USA.
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2
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Tamargo M, Gutiérrez E, Carreño JG, Álvarez MEV, Sanz-Ruiz R, Huanca M, Ludeña E, Soriano J, Elízaga J, Fernández-Avilés F, Bermejo J. [[Projection selection and rapid atrial pacing improves early outcomes after self-expanding transcatheter aortic valves]]. REC: INTERVENTIONAL CARDIOLOGY 2025; 7:82-90. [PMID: 40438641 PMCID: PMC12118476 DOI: 10.24875/recic.m24000497] [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: 10/01/2024] [Accepted: 12/19/2024] [Indexed: 06/01/2025] Open
Abstract
Introduction and objectives Because of the potential need for permanent pacemaker implantation, patients are frequently monitored for days after transcatheter aortic valve implantation (TAVI), particularly when using self-expanding valves. We sought to determine whether the appearance and management of conduction disturbances after TAVI can be improved by combining the cusp overlap projection (COP) and a rapid atrial pacing (RAP) protocol to detect the need for pacemaker implantation. Methods We consecutively studied a total of 273 patients who underwent TAVI with self-expanding valves from 2018 through 2022 (134 undergoing standard implantations and 139 COP + RAP). Assessment included the 90-day follow-up. Results Complete heart block was reported in 25.4% and 14.4% in the standard-of-care and COP + RAP group, with a marked decrease in transient atrioventricular block (12.8% vs 2.9%, respectively; P = .007). The absence of the Wenckebach phenomenon during RAP had a negative predictive value of 97% (95%CI, 91-99) for pacemaker implantation at the follow-up, which significantly decreased the need for 24-hour temporary pacemaker monitoring in the COP + RAP group (91.8% vs 28.1%; P < .0001) and the median [IQR] length of stay (5.0 [4-8] days vs 2.0 [1-4] days; P < .0001). At the 90-day follow-up, COP + RAP reduced pacemaker implantation (OR, 0.48; 95%CI, 0.24-0.92; P = .031), as well as the risk of infection-related readmissions significantly (OR, 0.35; 95%CI, 0.12-0.89; P = .036). Conclusions The combination of COP + RAP during self-expanding TAVI improves postoperative screening for conduction disturbances, thus reducing the need for cardiac rhythm monitoring, and the length stay. The COP + RAP strategy improves the short-term clinical outcomes of self-expanding TAVI due to fewer infection-related readmissions.
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Affiliation(s)
- María Tamargo
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, EspañaDepartamento de CardiologíaHospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónMadridEspaña
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, EspañaFacultad de MedicinaUniversidad Complutense de MadridMadridEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridEspaña
| | - Enrique Gutiérrez
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, EspañaDepartamento de CardiologíaHospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónMadridEspaña
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, EspañaFacultad de MedicinaUniversidad Complutense de MadridMadridEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridEspaña
| | - Jorge García Carreño
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, EspañaDepartamento de CardiologíaHospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónMadridEspaña
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, EspañaFacultad de MedicinaUniversidad Complutense de MadridMadridEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridEspaña
| | - María Eugenia Vázquez Álvarez
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, EspañaDepartamento de CardiologíaHospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónMadridEspaña
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, EspañaFacultad de MedicinaUniversidad Complutense de MadridMadridEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridEspaña
| | - Ricardo Sanz-Ruiz
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, EspañaDepartamento de CardiologíaHospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónMadridEspaña
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, EspañaFacultad de MedicinaUniversidad Complutense de MadridMadridEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridEspaña
| | - Mike Huanca
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, EspañaDepartamento de CardiologíaHospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónMadridEspaña
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, EspañaFacultad de MedicinaUniversidad Complutense de MadridMadridEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridEspaña
| | - Erika Ludeña
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, EspañaDepartamento de CardiologíaHospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónMadridEspaña
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, EspañaFacultad de MedicinaUniversidad Complutense de MadridMadridEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridEspaña
| | - Javier Soriano
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, EspañaDepartamento de CardiologíaHospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónMadridEspaña
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, EspañaFacultad de MedicinaUniversidad Complutense de MadridMadridEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridEspaña
| | - Jaime Elízaga
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, EspañaDepartamento de CardiologíaHospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónMadridEspaña
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, EspañaFacultad de MedicinaUniversidad Complutense de MadridMadridEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridEspaña
| | - Francisco Fernández-Avilés
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, EspañaDepartamento de CardiologíaHospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónMadridEspaña
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, EspañaFacultad de MedicinaUniversidad Complutense de MadridMadridEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridEspaña
| | - Javier Bermejo
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, EspañaDepartamento de CardiologíaHospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónMadridEspaña
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, EspañaFacultad de MedicinaUniversidad Complutense de MadridMadridEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridEspaña
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Mas-Peiro S, Lhermusier T, Urena M, Nombela-Franco L, Vilalta V, Muñoz-Garcia A, Amat-Santos I, Atienza F, Kleiman N, Chamandi C, Serra V, Deyell MW, Campelo-Parada F, Mondoly P, Suc G, Canadas-Godoy V, Fernandez-Nofrerias E, Castrodeza J, Elizaga J, Baudinaud P, Francisco Pascual J, Webb JG, Pelletier-Beaumont E, Philippon F, Rodés-Cabau J. Late arrhythmic burden in patients with left bundle branch block after TAVR with the Evolut valve. Europace 2025; 27:euaf057. [PMID: 40103312 PMCID: PMC11983392 DOI: 10.1093/europace/euaf057] [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: 12/28/2024] [Revised: 03/04/2025] [Accepted: 03/06/2025] [Indexed: 03/20/2025] Open
Abstract
AIMS Arrhythmic burden after discharge in patients with new-onset persistent left bundle branch block (NOP-LBBB) following transcatheter aortic valve replacement (TAVR) with Evolut devices remains largely unknown. The aim of this study is to assess the incidence and type of arrhythmias at 2-year follow-up in patients with NOP-LBBB post-TAVR. METHODS AND RESULTS This is a prospective multicentre study including 88 patients with LBBB persisting for ≥3 days post-implantation. Before discharge, an implantable loop recorder (REVEAL XT/LINQ) was implanted; patients had continuous monitoring for 2 years. Arrhythmic events were adjudicated in a central core lab. Of the arrhythmic events, 411 were detected in 58 patients [65.9%; 2 (1-4) events per patient]. Symptoms were reported in 12/58 (20.7%), and therapy was changed in 25/58 (43.1%). There were 101 bradyarrhythmic events in 33 patients [35 high-grade atrioventricular block (HAVB) and 66 severe bradycardia]. The HAVB incidence was higher in the early (4-week) phase and remained stable over time, whereas severe bradycardia increased after 1 year. Permanent pacemaker was required in 11 (12.5%) patients (6.8% and 5.7% in the first and second year, respectively). There were 310 tachyarrhythmic events in 29 patients (120 AF/AFL, 111 AT, 72 SVT, 6 NSVT, and 1 VT); its incidence decreased throughout the 2 years. New AF/AFL episodes occurred in 20/69 patients [29%; symptomatic in 2/20 (10%)]. CONCLUSION Patients with NOP-LBBB post-TAVR with Evolut devices exhibited a high burden of late arrhythmias, with events occurring in two-thirds of patients and leading to treatment changes in about half of them. These data should inform future studies on cardiac monitoring devices for follow-up and treatment optimization in this challenging population.
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Affiliation(s)
- Silvia Mas-Peiro
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City, Quebec, Canada G1V4G5
| | - Thibault Lhermusier
- Department of Cardiology, Hôpital Universitaire de Toulouse, Toulouse, France
| | - Marina Urena
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Victoria Vilalta
- Department of Cardiology, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Ignacio Amat-Santos
- Department of Cardiology, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Felipe Atienza
- Department of Cardiology, Hospital Gregorio Marañón, Madrid, Spain
| | - Neal Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | | | - Vicenç Serra
- Department of Cardiology, Hospital Universitari Vall d’Hebron, CIBER-CV, Barcelona, Spain
| | - Marc W Deyell
- Department of Cardiology, St Paul’s Hospital, Vancouver, Canada
| | | | - Pierre Mondoly
- Department of Cardiology, Hôpital Universitaire de Toulouse, Toulouse, France
| | - Gaspard Suc
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | | | | | - Javier Castrodeza
- Department of Cardiology, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Jaime Elizaga
- Department of Cardiology, Hospital Gregorio Marañón, Madrid, Spain
| | - Pierre Baudinaud
- Department of Cardiology, Hôpital Européen George Pompidou, Paris, France
| | | | - John G Webb
- Department of Cardiology, St Paul’s Hospital, Vancouver, Canada
| | - Emilie Pelletier-Beaumont
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City, Quebec, Canada G1V4G5
| | - François Philippon
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City, Quebec, Canada G1V4G5
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City, Quebec, Canada G1V4G5
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4
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Beyer M, Demal TJ, Bhadra OD, Linder M, Ludwig S, Grundmann D, Voigtlaender-Buschmann L, Waldschmidt L, Schirmer J, Schofer N, Pecha S, Blankenberg S, Reichenspurner H, Conradi L, Seiffert M, Schaefer A. Transcatheter aortic valve implantation in patients with significant septal hypertrophy. Clin Res Cardiol 2025; 114:332-340. [PMID: 38466346 PMCID: PMC11914327 DOI: 10.1007/s00392-024-02432-3] [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: 10/06/2023] [Accepted: 02/29/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Previous reports suggest septal hypertrophy with an interventricular septum depth (IVSD) ≥ 14 mm may adversely affect outcomes after transcatheter aortic valve implantation (TAVI) due to suboptimal valve placement, valve migration, or residual increased LVOT pressure gradients. AIMS This analysis investigates the impact of interventricular septal hypertrophy on acute outcomes after TAVI. METHODS Between 2009 and 2021, 1033 consecutive patients (55.8% male, 80.5 ± 6.7 years, EuroSCORE II 6.3 ± 6.5%) with documented IVSD underwent TAVI at our center and were included for analysis. Baseline, periprocedural, and 30-day outcome parameters of patients with normal IVSD (< 14 mm; group 1) and increased IVSD (≥ 14 mm; group 2) were compared. Data were retrospectively analyzed according to updated Valve Academic Research Consortium-3 (VARC-3) definitions. Comparison of outcome parameters was adjusted for baseline differences between groups using logistic and linear regression analyses. RESULTS Of 1033 patients, 585 and 448 patients were allocated to groups 1 and 2, respectively. There was no significant difference between groups regarding transfemoral access rate (82.6% (n = 478) vs. 86.0% (n = 381), p = 0.157). Postprocedural mean transvalvular pressure gradient was significantly increased in group 2 (group 1, 7.8 ± 4.1 mmHg, vs. group 2, 8.9 ± 4.9 mmHg, p = 0.046). Despite this finding, there was no significant difference between groups regarding the rates of VARC-3 adjudicated composite endpoint device success (90.0% (n = 522) vs. 87.6% (n = 388), p = 0.538) or technical success (92.6% (n = 542) vs. 92.6% (n = 415), p = 0.639). Moreover, the groups showed no significant differences regarding the rates of paravalvular leakage ≥ moderate (3.1% (n = 14) vs. 2.6% (n = 9), p = 0.993), postprocedural permanent pacemaker implantation (13.4% (n = 77) vs. 13.8% (n = 61), p = 0.778), or 30-day mortality (5.1% (n = 30) vs. 4.5% (n = 20), p = 0.758). CONCLUSION Although transvalvular mean pressure gradients were significantly higher in patients with increased IVSD after TAVI, acute outcomes were comparable between groups suggesting no early impact of adverse hemodynamics due to elevated IVSD. However, how these differences in hemodynamic findings may affect mid- and long-term outcomes, especially in terms of valve durability, needs to be evaluated in further investigations.
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Affiliation(s)
- Martin Beyer
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany.
| | - Till Joscha Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Oliver D Bhadra
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Matthias Linder
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246, Hamburg, Germany
| | - David Grundmann
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246, Hamburg, Germany
| | | | - Lara Waldschmidt
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246, Hamburg, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246, Hamburg, Germany
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
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5
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Yashima F, Yamamoto M, Shirai S, Tada N, Naganuma T, Yamawaki M, Yamanaka F, Mizutani K, Noguchi M, Ueno H, Takagi K, Ohno Y, Izumo M, Nishina H, Suzuyama H, Yamasaki K, Nishioka K, Hachinohe D, Fuku Y, Otsuka T, Asami M, Watanabe Y, Hayashida K. Initial Findings Concerning the Latest Self-Expandable Evolut FX Valve: A Report Using OCEAN-TAVI Registry Data. Am J Cardiol 2025; 235:59-66. [PMID: 39461400 DOI: 10.1016/j.amjcard.2024.10.015] [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: 08/25/2024] [Revised: 10/02/2024] [Accepted: 10/14/2024] [Indexed: 10/29/2024]
Abstract
Data concerning the clinical effect of the latest-generation self-expandable transcatheter heart valve (Evolut FX) remain limited. We aimed to assess the in-hospital outcomes of 3 bioprosthetic valves (Evolut EPO, PRO+, and FX). We analyzed data from a Japanese multicenter registry involving 634 consecutive patients who underwent transcatheter aortic valve replacement with Evolut FX up until October 2023. Patients who underwent transcatheter aortic valve replacement with Evolut EPO between 2018 and 2020 (n = 1,128), and those with Evolut EPO+ between 2020 and 2023 (n = 1,696) served as the control groups. The exclusion criteria comprised patients on dialysis with a history of infective endocarditis or with insufficient data. Unmatched comparisons among the 3 valves were conducted, followed by a propensity score-matched comparison between Evolut EPO+ and FX. In the unmatched cohort, among the Evolut EPO, PRO+, and FX groups, all vascular complications (7.8% vs 5.2% vs 4.5%, respectively, p <0.01) and new pacemaker implantation rates (11.2% vs 6.1% vs 7.7%, respectively, p <0.01) differed significantly. In the propensity score-matched analysis, the rate of all bleeding events was significantly higher in the Evolut EPO+ group (11.0%) than in the FX group (7.0%) (p = 0.02), whereas all vascular complications (4.6% vs 4.6%, respectively, p = 1.00) and new pacemaker implantation (5.9% vs 7.6%, respectively, p = 0.28) rates were comparable. The incidence of stroke in the FX group was approximately half that of the EP+ group (3.7% vs 1.9%, p = 0.095), without statistical significance. In conclusion, compared with the Evolut EPO+, Evolut FX was associated with a lower incidence of in-hospital bleeding complications and may reduce the incidence of in-hospital stroke.
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Affiliation(s)
- Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan.
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan; Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kazuki Mizutani
- Division of Cardiology, Department of Medicine, Kindai University, Osaka, Japan
| | - Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Hiroshi Ueno
- Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, National Cerebral and Cardiovascular Center, Oasaka, Japan
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Masaki Izumo
- Department of Cardiology, St Marianna University School of Medicine, Tokyo, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Hiroto Suzuyama
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Kazumasa Yamasaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Kenji Nishioka
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Daisuke Hachinohe
- Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Yasushi Fuku
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan; Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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6
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Lella SK, Ferrell BE, Sugiura T. Contemporary Management of the Aortic Valve-Narrative Review of an Evolving Landscape. J Clin Med 2024; 14:134. [PMID: 39797217 PMCID: PMC11722002 DOI: 10.3390/jcm14010134] [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: 11/26/2024] [Revised: 12/25/2024] [Accepted: 12/27/2024] [Indexed: 01/13/2025] Open
Abstract
Background: Aortic valve replacement has undergone novel changes in recent decades, providing not only a multitude of procedural options but expanding the treatable patient population. Specifically, a number of minimally invasive and interventional treatment options have allowed for the treatment of high and prohibitive risk surgical patients. Further, technology is allowing for the development of innovative surgical and transcatheter valve models, which will advance the treatment of aortic valve disease in the future. Objective: Here, we choose to describe the modern aortic valve replacement techniques and the available valves and designs.
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Affiliation(s)
- Srihari K. Lella
- Division of Cardiothoracic Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY 10467, USA; (S.K.L.); (B.E.F.)
| | - Brandon E. Ferrell
- Division of Cardiothoracic Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY 10467, USA; (S.K.L.); (B.E.F.)
| | - Tadahisa Sugiura
- Division of Cardiothoracic Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY 10467, USA; (S.K.L.); (B.E.F.)
- Montefiore Medical Center, Department of Cardiothoracic and Vascular Surgery, Medical Arts Pavilion, 3400 Bainbridge Road, 5th Floor, Bronx, NY 10467, USA
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7
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Harvey JE, Puri R, Grubb KJ, Yakubov SJ, Mahoney PD, Gada H, Coylewright M, Poulin MF, Chetcuti SJ, Sorajja P, Rovin JD, Eisenberg R, Reardon MJ. Decreasing pacemaker implantation rates with Evolut supra-annular transcatheter aortic valves in a large real-world registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 69:1-9. [PMID: 38871537 DOI: 10.1016/j.carrev.2024.05.024] [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: 11/30/2023] [Revised: 04/29/2024] [Accepted: 05/17/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Permanent pacemaker implantation (PPI) rates following transcatheter aortic valve replacement (TAVR) remain a concern. We assessed the PPI rates over time in patients implanted with an Evolut supra-annular, self-expanding transcatheter valve from the US STS/ACC TVT Registry. METHODS Patients who underwent TAVR with an Evolut R, Evolut PRO or Evolut PRO+ valve between July 2018 (Q3) and June 2021 (Q2) were included. PPI rates were reported by calendar quarter. In-hospital PPI rates were reported as proportions and 30-day rates as Kaplan-Meier estimates. A Cox regression model was used to determine potential predictors of a new PPI within 30 days of the TAVR procedure. RESULTS From July 2018 to June 2021, 54,014 TAVR procedures were performed using Evolut valves. Mean age was 79.3 ± 8.8 years and 49.2 % were male. The 30-day PPI rate was 16.6 % in 2018 (Q3) and 10.8 % in 2021 (Q2, 34.9 % decrease, p < 0.001 for trend across all quarters). The in-hospital PPI rate decreased by 40.1 %; from 14.7 % in 2018 (Q3) to 8.8 % in 2021 (Q2) (p < 0.001 for trend across all quarters). Significant predictors of a new PPI within 30 days included a baseline conduction defect, history of atrial fibrillation, home oxygen, and diabetes mellitus. CONCLUSION From 2018 to 2021, TAVR with an Evolut transcatheter heart valve in over 50,000 patients showed a significant decreasing trend in the rates of in-hospital and 30-day PPI, representing the lowest rate of PPI in any large real-world registry of Evolut. During the same evaluated period, high device success and shorter length of stay was also observed.
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Affiliation(s)
- James E Harvey
- WellSpan York Hospital, 1001 S George Street, York, PA 17403, USA.
| | - Rishi Puri
- Cleveland Clinic, 2049 East 100(th) Street, Cleveland, OH 44195, USA.
| | - Kendra J Grubb
- Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA.
| | - Steven J Yakubov
- Riverside Methodist-Ohio Health, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Paul D Mahoney
- Sentara Healthcare, 600 Gresham Drive, Suite 8630A, Norfolk, VA 23507, USA
| | - Hemal Gada
- University of Pittsburgh-Pinnacle, 1000 N Front Street, Wormleysburg, PA 17043, USA
| | - Megan Coylewright
- Erlanger Heart and Lung Institute, 979 E 3rd Street, C-520, Chattanooga, TN 37403, USA.
| | - Marie-France Poulin
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - Stanley J Chetcuti
- University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Paul Sorajja
- Minneapolis Heart Institute-Abbott-Northwestern Hospital, 920 E 28th Street, Suite 100, Minneapolis, MN 55404, USA.
| | - Joshua D Rovin
- Morton Plant Hospital, 55 Pinellas St #320, Clearwater, FL 33756, USA.
| | - Ruth Eisenberg
- Medtronic, 8200 Coral Sea Street, Mounds View, MN 55112, USA.
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St #1401, Houston, TX, USA.
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8
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Blackman DJ, Ryschon AM, Barnett S, Garner AM, Forrest JK, Reardon MR, Pietzsch JB. Cost-effectiveness of TAVI in the United Kingdom: a long-term analysis based on 4-year data from the Evolut Low Risk Trial. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-024-01739-2. [PMID: 39579244 DOI: 10.1007/s10198-024-01739-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 11/07/2024] [Indexed: 11/25/2024]
Abstract
BACKGROUND The cost-effectiveness of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) has previously been reported across the spectrum of surgical mortality risk. We present an updated analysis specific to the UK based on 4-year data from the Evolut Low Risk Trial, which showed a maintained numerical survival benefit with TAVI. METHODS A decision-analytic Markov model was used to project outcomes and costs over a lifetime horizon. Adverse events and utilities were modeled based on 4-year trial data. Beyond 4 years, no difference in long-term survival between TAVR and SAVR was assumed. Costs were informed by NHS England reference costs and reflect resource utilization in the UK TAVI Trial, with costs and effects discounted at 3.5% p.a. The lifetime incremental cost-effectiveness ratio (ICER) was evaluated against the established £20,000-£ 30,000 per QALY cost-effectiveness threshold. Extensive sensitivity and scenario analyses were performed, including comparison to prior results based on 12-month data. RESULTS TAVI improved survival by 0.41 life years and added 0.28 QALYs at incremental cost of £5,021, resulting in a lifetime ICER of £17,883 per QALY gained. 57.5% and 85.3% of probabilistic sensitivity analysis simulations were cost-effective at the £20,000 and £30,000 per QALY thresholds. Use of 4- vs. 1-year trial data markedly improved lifetime cost-effectiveness. CONCLUSION Recent 4-year follow-up data from the Evolut Low Risk trial suggest TAVI adds meaningful patient benefit over lifetime and can be expected to be a cost-effective intervention compared to SAVR for low surgical risk patients in a UK setting.
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Affiliation(s)
- Daniel J Blackman
- Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, West Yorkshire, England
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9
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Mendiz OA, Fava C, Müller LI, Lev GA, Heredia G, Gómez SE, Cedeño J, Pérez JM, Lamelas P. Predictors of permanent pacemaker implantation for transcatheter self-expandable aortic valve implant in the cusp overlap era. Catheter Cardiovasc Interv 2024; 104:1071-1078. [PMID: 39154247 DOI: 10.1002/ccd.31176] [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: 02/13/2024] [Revised: 06/22/2024] [Accepted: 07/28/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Predictors of permanent pacemaker implantation (PPMI) after self-expanding transcatheter aortic valve implant (TAVI) were described. Is unknown if PPMI predictors remain in the era of high implants using the cusp overlap (COP). METHODS Single-center, prospective, consecutive case series of patients undergoing self-expanding TAVI with the COP approach. The status of PPMI and other clinical events were ascertained at 30 days. RESULTS A total of 261 patients were included (84% with Evolut, n = 219). Implant depth >4 mm was infrequent (13.8%). TAVI depth (OR 1.259; p = 0.005), first or second-degree auriculo-ventricular block (OR 3.406; p = 0.033), right-bundle (OR 15.477; p < 0.0001), and incomplete left-bundle branch block (OR 7.964; p = 0.036) were found to be independent predictors of PPMI. The risk of PPMI with deep implant and no electrical disturbances was 3%, and 0% with high implant and no prior electrical disturbances. Those who received PPMI had no statistically significant increased risk of death, myocardial infarction, stroke, bleeding events, or vascular complications at 30 days, but longer hospital stay (mean difference 1.43 days more, p = 0.003). CONCLUSIONS Implant depth and prior conduction abnormalities remain the main predictors of PPMI using self-expanding TAVI in the COP era. Patients with high implants and no prior conduction abnormalities may be candidates for early discharge after uneventful self-expanding TAVI, while the rest may need inpatient monitoring regardless of achieving a high implant. The need for PPMI was associated with longer hospital stays.
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Affiliation(s)
- Oscar A Mendiz
- Interventional Cardiology Department, Cardiology and Cardiovascular Surgery Institute (ICCYC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Carlos Fava
- Interventional Cardiology Department, Cardiology and Cardiovascular Surgery Institute (ICCYC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Lucas I Müller
- Cardiology Department, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Gustavo A Lev
- Interventional Cardiology Department, Cardiology and Cardiovascular Surgery Institute (ICCYC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Gaston Heredia
- Interventional Cardiology Department, Cardiology and Cardiovascular Surgery Institute (ICCYC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Silvina E Gómez
- Interventional Cardiology Department, Cardiology and Cardiovascular Surgery Institute (ICCYC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Joaquín Cedeño
- Interventional Cardiology Department, Cardiology and Cardiovascular Surgery Institute (ICCYC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Juan M Pérez
- Interventional Cardiology Department, Cardiology and Cardiovascular Surgery Institute (ICCYC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Pablo Lamelas
- Interventional Cardiology Department, Cardiology and Cardiovascular Surgery Institute (ICCYC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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10
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Bajwa T, Attizzani GF, Gada H, Chetcuti SJ, Williams MR, Ahmed M, Petrossian GA, Saybolt MD, Allaqaband SQ, Merhi WM, Stoler RC, Bezerra H, Mahoney P, Wu W, Jumper R, Lambrecht L, Tang GHL. Use and performance of the evolut FX transcatheter aortic valve system. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 67:1-7. [PMID: 38599918 DOI: 10.1016/j.carrev.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The next generation supra-annular, self-expanding Evolut FX transcatheter aortic valve (TAV) system was designed to improve catheter deliverability, provide stable and symmetric valve deployment, and assess commissural alignment during the procedure. The impact of these modifications has not been clinically evaluated. METHODS Procedural information was collected by survey in 2 Stages: Stage I comprised 23 centers with extensive experience with Evolut TAV systems, and Stage II comprised an additional 46 centers with a broad range of balloon- and self-expanding system experience. Operators were to compare the experience with the Evolut FX to the predicate Evolut PRO+ system. RESULTS There were 285 cases during Stage I from June 24 to August 12, 2022, and 254 cases during Stage II from August 15 to September 11, 2022. Overall, the cusp overlap technique was used in 88.6 %, and commissural alignment was achieved in 96.1 % of these cases. Compared to implanter's previous experience with the Evolut PRO+ system, less resistance was noted with the Evolut FX system: in 83.0 % of cases during vascular insertion, in 84.7 % of cases while tracking through the vasculature, in 84.4 % of cases while traversing over the arch, and 76.1 % of cases in advancing across the valve. Better symmetry of valve depth was observed in 423 of 525 cases (80.6 %). CONCLUSION Evolut FX system design modifications translated into improvements in catheter deliverability, deployment symmetry and stability, and commissural alignment as assessed by experienced self-expanding and balloon expandable operators.
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Affiliation(s)
- Tanvir Bajwa
- Advocate Aurora Health Care, 2801 W. Kinnickinnic River Parkway,Milwaukee, WI 53215, United States of America.
| | - Guilherme F Attizzani
- University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States of America.
| | - Hemal Gada
- University of Pittsburgh-Pinnacle, 1000 N Front Street, Wormleysburg, PA 17043, United States of America
| | - Stanley J Chetcuti
- University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, United States of America.
| | - Mathew R Williams
- New York University - Langone Health, 530 1st Ave. Suite 9V, New York, NY 10016, United States of America.
| | - Mustafa Ahmed
- University of Alabama Medicine, 2000 6th Avenue South, Floor 4, Birmingham, AL 35233, United States of America.
| | - George A Petrossian
- Saint Francis Hospital, Vizza Pavilion, 100 Port Washington Blvd Ste G04, Roslyn, NY 11576, United States of America
| | - Matthew D Saybolt
- Jersey Shore University Medical Center, 1945 NJ-33, Neptune Township, NJ 07753, United States of America
| | - Suhail Q Allaqaband
- Advocate Aurora Health Care, 2801 W. Kinnickinnic River Parkway,Milwaukee, WI 53215, United States of America.
| | - William M Merhi
- Spectrum Health Hospitals, 743 E Beltline Ave NE, Grand Rapids, MI 49525, United States of America.
| | - Robert C Stoler
- Baylor Scott & White Heart and Vascular Hospital at Baylor Scott & White University Medical Center, 621 N Hall St #500, Dallas, TX 75226, United States of America.
| | - Hiram Bezerra
- Tampa General Hospital, University of South Florida; 2 Tampa General Circle, Tampa, FL 33606, United States of America.
| | - Paul Mahoney
- Sentara Norfolk General Hospital, 600 Gresham Dr Ste 8630A, Norfolk, VA 23507, United States of America
| | - Willis Wu
- Rex Hospital, 2800 Blue Ridge Rd Suite 201, Raleigh, NC 27607, United States of America.
| | - Robert Jumper
- St. Vincent's Medical Center, 115 Technology Dr UNIT C300, Trumbull, CT 06611, United States of America.
| | - Larry Lambrecht
- Medtronic, 8200 Coral Sea St., Mounds View, MN 55112, United States of America.
| | - Gilbert H L Tang
- Mount Sinai Health System, 1190 5th Ave, New York, NY 10029, United States of America
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11
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Espejo-Paeres C, Marroquín-Donday LA, Hennessey B, Wang L, McInerney A, Paredes-Vázquez JG, Pérez-Vizcayno M, Tirado-Conte G, Macaya-Ten F, Mejía-Rentería H, Salinas P, Núñez-Gil IJ, Gonzalo N, Nombela-Franco L, Escaned J, Fernández-Ortiz A, Pérez-Villacastín J, Jiménez-Quevedo P. Left Ventricular Outflow Tract Morphology as a Predictor of Conductance Disturbances Following Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2024; 13:e034936. [PMID: 39344666 DOI: 10.1161/jaha.124.034936] [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: 02/08/2024] [Accepted: 07/16/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Conduction disturbances represent one of the most common complications following transcatheter aortic valve replacement (TAVR). We sought to investigate the role of left ventricular outflow tract (LVOT) morphology in the development of conduction disturbances following TAVR. METHODS AND RESULTS Consecutive patients who underwent TAVR in our center were included. The ratio between the LVOT area and the aortic annulus area was calculated. Patients were then divided into 2 groups on the basis of this ratio: group 1, which included patients with an LVOT area/aortic annulus area ratio <0.9; and group 2, which included patients with an LVOT area/aortic annulus area ratio ≥0.9. The primary end point was to assess the relationship between LVOT shape and the rate of permanent pacemaker implantation following TAVR. A multivariable analysis was performed to identify predictors of permanent pacemaker implantation following TAVR. From January 2018 to December 2020, 276 patients were included. Ninety-one patients with tapered LVOT morphology were assigned to group 1 and the rest (n=185 patients), tubular LVOT or flared LVOT shape, to group 2. The mean age was 81.5±5.7 years and 57% were women. After adjusting by confounding factors, tapered morphology of the LVOT and prior right bundle-branch block were found to be independent predictors of permanent pacemaker implantation (hazard ratio [HR], 2.6 [95% CI, 1.2-5.7]; P=0.014; and HR: 4.3 [95% CI 2.4-7.6], P<0.001); at a median follow-up time of 15.5 (interquartile range, 15) months. CONCLUSIONS A tapered-LVOT morphology was associated with increased risk for permanent pacemaker implantation. LVOT morphology may be an additional factor to consider when choosing prosthesis size.
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Affiliation(s)
| | | | | | - Lin Wang
- Clinico San Carlos University Hospital IdISSC Madrid Spain
| | | | | | | | | | | | | | - Pablo Salinas
- Clinico San Carlos University Hospital IdISSC Madrid Spain
| | | | - Nieves Gonzalo
- Clinico San Carlos University Hospital IdISSC Madrid Spain
| | | | - Javier Escaned
- Clinico San Carlos University Hospital IdISSC Madrid Spain
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12
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Álvarez-Velasco R, Almendárez M, Alperi A, Antuña P, del Valle R, Morís C, Pascual I. [The role of implant projection in optimizing transcatheter aortic valve implantation]. REC: INTERVENTIONAL CARDIOLOGY 2024; 6:332-339. [PMID: 40417347 PMCID: PMC12097345 DOI: 10.24875/recic.m24000476] [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: 03/27/2024] [Accepted: 06/25/2024] [Indexed: 05/27/2025] Open
Abstract
Severe aortic stenosis is the most frequent valve condition requiring surgery, and its incidence is increasing yearly. Transcatheter aortic valve implantation (TAVI) is the first-line treatment for patients at all levels of surgical risk. Nevertheless, modifications to the procedure often appear to improve clinical outcomes. A major concern after TAVI is the higher rate of permanent pacemaker implantation (PPMI) compared with surgical valve replacement. Optimal implantation depth is crucial to reduce the burden of PPMI without causing serious complications such as valve embolization. The classic implantation technique, where the 3 cusps are aligned in the same plane, has been modified to a cusp overlap projection by isolating the noncoronary cusp and superimposing the left and right cusps. This simple modification provides optimal visualization during deployment and helps to achieve the desired implant depth to reduce conduction disturbances and PPMI. Another limitation after TAVI is coronary reaccess due to the frame of the transcatheter valve obstructing the coronary ostia. Commissural alignment of the prostheses with the native valve may facilitate selective cannulation of the coronary arteries after this procedure. This review will discuss the techniques and supporting evidence for these modifications to the deployment and implant projection methods, and how they can improve TAVI outcomes.
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Affiliation(s)
- Rut Álvarez-Velasco
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, EspañaÁrea del CorazónHospital Universitario Central de AsturiasOviedoEspaña
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, EspañaInstituto de Investigación Sanitaria del Principado de AsturiasInstituto de Investigación Sanitaria del Principado de AsturiasOviedoEspaña
| | - Marcel Almendárez
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, EspañaÁrea del CorazónHospital Universitario Central de AsturiasOviedoEspaña
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, EspañaInstituto de Investigación Sanitaria del Principado de AsturiasInstituto de Investigación Sanitaria del Principado de AsturiasOviedoEspaña
| | - Alberto Alperi
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, EspañaÁrea del CorazónHospital Universitario Central de AsturiasOviedoEspaña
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, EspañaInstituto de Investigación Sanitaria del Principado de AsturiasInstituto de Investigación Sanitaria del Principado de AsturiasOviedoEspaña
| | - Paula Antuña
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, EspañaÁrea del CorazónHospital Universitario Central de AsturiasOviedoEspaña
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, EspañaInstituto de Investigación Sanitaria del Principado de AsturiasInstituto de Investigación Sanitaria del Principado de AsturiasOviedoEspaña
| | - Raquel del Valle
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, EspañaÁrea del CorazónHospital Universitario Central de AsturiasOviedoEspaña
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, EspañaInstituto de Investigación Sanitaria del Principado de AsturiasInstituto de Investigación Sanitaria del Principado de AsturiasOviedoEspaña
| | - Cesar Morís
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, EspañaÁrea del CorazónHospital Universitario Central de AsturiasOviedoEspaña
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, EspañaInstituto de Investigación Sanitaria del Principado de AsturiasInstituto de Investigación Sanitaria del Principado de AsturiasOviedoEspaña
- Facultad de Medicina, Universidad de Oviedo, Oviedo, Asturias, EspañaFacultad de MedicinaUniversidad de OviedoOviedoEspaña
| | - Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, EspañaÁrea del CorazónHospital Universitario Central de AsturiasOviedoEspaña
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, EspañaInstituto de Investigación Sanitaria del Principado de AsturiasInstituto de Investigación Sanitaria del Principado de AsturiasOviedoEspaña
- Facultad de Medicina, Universidad de Oviedo, Oviedo, Asturias, EspañaFacultad de MedicinaUniversidad de OviedoOviedoEspaña
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13
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Wang X, Xu Y, Zeng L, Tan K, Zhang X, Han X, Xiong T, Zhao Z, Peng Y, Wei J, Li Q, He S, Chen Y, Zhou M, Li X, Wei X, Liang Y, Zhou W, Jiang L, Liu X, Meng W, Zhou R, Xiong G, Dai M, Deng X, Feng Y, Chen M. Long-term outcomes of left bundle branch area pacing compared with right ventricular pacing in TAVI patients. Heart Rhythm 2024:S1547-5271(24)03318-6. [PMID: 39288882 DOI: 10.1016/j.hrthm.2024.09.021] [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: 07/24/2024] [Revised: 08/30/2024] [Accepted: 09/09/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND New-onset permanent pacemaker implantation (PPMI) is still a common complication after transcatheter aortic valve implantation (TAVI) with adverse clinical outcomes. OBJECTIVE The purpose of this study was to investigate whether left bundle branch area pacing (LBBAP) improves long-term clinical results compared with traditional right ventricular pacing (RVP) in patients requiring PPMI after TAVI. METHODS A total of 237 consecutive patients undergoing RVP (N = 117) or LBBAP (N = 120) after TAVI were retrospectively included. Long-term outcomes, including all-cause death, heart failure rehospitalization (HFH), and left ventricular ejection fraction (LVEF) change compared to baseline, were obtained until 5 years post-TAVI. RESULTS The mean age of the overall population was 74 years, with a mean surgical risk score of 4.4%. The paced QRS duration was significantly longer in the RVP group compared with the LBBAP group (151 ± 18 vs 122 ± 12 ms; P < .001). No difference was found between the 2 groups in all-cause death (13.7% vs 13.3%; adjusted hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.37-1.58; P = .466) or the composite endpoint of death and HFH (29.9% vs 19.2%; adjusted HR, 1.22; 95% CI, 0.70-2.13; P = .476); however, the risk of HFH was significantly higher in the RVP group at 5 years after TAVI (21.4% vs 7.5%; adjusted HR, 2.26; 95% CI, 1.01-5.08; P = .048). There was greater improvement of LVEF over time in the LBBAP group (P = .046 for LVEF changes over time between groups). CONCLUSIONS LBBAP improved long-term clinical outcomes compared with RVP in patients undergoing PPMI after TAVI in terms of less HFH and better LVEF improvement.
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Affiliation(s)
- Xi Wang
- Department of Cardiology and Laboratory of Cardiac Structure and Function, West China Hospital, Sichuan University, China
| | - Yuanning Xu
- Department of Cardiology, West China Hospital, Sichuan University, China
| | - Lijun Zeng
- Department of Cardiology and Laboratory of Cardiac Structure and Function, West China Hospital, Sichuan University, China
| | - Kun Tan
- Health Care Big Data Center of Sichuan Province, China
| | - Xueli Zhang
- Health Care Big Data Center of Sichuan Province, China
| | - Xu Han
- Health Care Big Data Center of Sichuan Province, China
| | - Tianyuan Xiong
- Department of Cardiology and Laboratory of Cardiac Structure and Function, West China Hospital, Sichuan University, China
| | - Zhengang Zhao
- Department of Cardiology and Laboratory of Cardiac Structure and Function, West China Hospital, Sichuan University, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, China
| | - Jiafu Wei
- Department of Cardiology, West China Hospital, Sichuan University, China
| | - Qiao Li
- Department of Cardiology, West China Hospital, Sichuan University, China
| | - Sen He
- Department of Cardiology, West China Hospital, Sichuan University, China
| | - Yong Chen
- Department of Cardiology, West China Hospital, Sichuan University, China
| | - Minggang Zhou
- Department of Cardiology, West China Hospital, Sichuan University, China
| | - Xi Li
- Department of Cardiology and Laboratory of Cardiac Structure and Function, West China Hospital, Sichuan University, China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, China
| | - Yujia Liang
- Department of Cardiology, West China Hospital, Sichuan University, China
| | - Wenxia Zhou
- Department of Cardiology, West China Hospital, Sichuan University, China
| | - Lingyun Jiang
- Department of Cardiology, West China Hospital, Sichuan University, China
| | - Xingbin Liu
- Department of Cardiology, West China Hospital, Sichuan University, China
| | - Wei Meng
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, China
| | - Rui Zhou
- Department of Cardiology, Mianyang Central Hospital, China
| | - Guojun Xiong
- Department of Cardiology, Deyang People's Hospital, China
| | - Min Dai
- Department of Cardiology, Mianyang Central Hospital, China
| | - Xiaojian Deng
- Department of Cardiology, Deyang People's Hospital, China
| | - Yuan Feng
- Department of Cardiology and Laboratory of Cardiac Structure and Function, West China Hospital, Sichuan University, China
| | - Mao Chen
- Department of Cardiology and Laboratory of Cardiac Structure and Function, West China Hospital, Sichuan University, China.
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Gonnah AR, Khokhar AA, Chow JJ, Hartley A, Sethi R, Khawaja S, Hadjiloizou N, Ruparelia N, Mikhail G, Malik I. Reducing Length of Hospital Stay Following Transcatheter Aortic Valve Implantation. J Clin Med 2024; 13:5433. [PMID: 39336919 PMCID: PMC11431937 DOI: 10.3390/jcm13185433] [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: 08/14/2024] [Revised: 08/31/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as a safe and effective treatment for severe aortic stenosis across the spectrum of surgical risk cohorts. Subsequently, the dramatic increase in procedural volume worldwide has placed significant financial and logistical pressures on healthcare institutions, particularly regarding hospital length of stay (LOS), which can adversely affect patient flow. In this review article, we discuss different peri-procedural strategies developed to reduce LOS and facilitate early discharge after TAVI.
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Affiliation(s)
- Ahmed R Gonnah
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 OHS, UK
| | - Arif A Khokhar
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 OHS, UK
| | - Ji-Jian Chow
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 OHS, UK
| | - Adam Hartley
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 OHS, UK
| | - Rahul Sethi
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 OHS, UK
| | - Saud Khawaja
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 OHS, UK
| | | | - Neil Ruparelia
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 OHS, UK
| | - Ghada Mikhail
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 OHS, UK
| | - Iqbal Malik
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 OHS, UK
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15
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Ueyama HA, Block PC. And the beat goes on. Catheter Cardiovasc Interv 2024; 104:176-177. [PMID: 38837317 DOI: 10.1002/ccd.31119] [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: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 06/07/2024]
Abstract
Key points
Technical advancements in devices and the development of techniques to optimize valve implantation have been the cornerstone of improvement in outcomes of TAVR.
While device success and the rate of paravalvular leak have decreased over time, the rate of permanent pacemaker implantation following self‐expanding valve systems remains high.
Reduction in the rate of permanent pacemaker implantation compared to surgical aortic valve replacement remains a high priority.
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Affiliation(s)
- Hiroki A Ueyama
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter C Block
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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16
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Batchelor WB, Sanchez CE, Sorajja P, Harvey JE, Galper BZ, Kini A, Keegan P, Grubb KJ, Eisenberg R, Rogers T. Temporal Trends, Outcomes, and Predictors of Next-Day Discharge and Readmission Following Uncomplicated Evolut Transcatheter Aortic Valve Replacement: A Propensity Score-Matched Analysis. J Am Heart Assoc 2024; 13:e033846. [PMID: 38639328 PMCID: PMC11179905 DOI: 10.1161/jaha.123.033846] [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: 12/08/2023] [Accepted: 02/23/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Next-day discharge (NDD) outcomes following uncomplicated self-expanding transcatheter aortic valve replacement have not been studied. Here, we compare readmission rates and clinical outcomes in NDD versus non-NDD transcatheter aortic valve replacement with Evolut. METHODS AND RESULTS Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry patients (n=29 597) undergoing elective transcatheter aortic valve replacement with self-expanding supra-annular valves (Evolut R, PRO, and PRO+) from July 2019 to June 2021 were stratified by postprocedure length of stay: ≤1 day (NDD) versus >1 day (non-NDD). Propensity score matching was used to compare risk adjusted 30-day readmission rates and 1-year outcomes in NDD versus non-NDD, and multivariable regression to determine predictors of NDD and readmission. Between the first and last calendar quarter, the rate of NDD increased from 45.4% to 62.1% and median length of stay decreased from 2 days to 1. Propensity score matching produced relatively well-matched NDD and non-NDD cohorts (n=10 549 each). After matching, NDD was associated with lower 30-day readmission rates (6.3% versus 8.4%; P<0.001) and 1-year adverse outcomes (death, 7.0% versus 9.3%; life threatening/major bleeding, 1.6% versus 3.4%; new permanent pacemaker implantation/implantable cardioverter-defibrillator, 3.6 versus 11.0%; [all P<0.001]). Predictors of NDD included non-Hispanic ethnicity, preexisting permanent pacemaker implantation/implantable cardioverter-defibrillator, and previous surgical aortic valve replacement. CONCLUSIONS Most patients undergoing uncomplicated self-expanding Evolut transcatheter aortic valve replacement are discharged the next day. This study found that NDD can be predicted from baseline patient characteristics and was associated with favorable 30-day and 1-year outcomes, including low rates of permanent pacemaker implantation and readmission.
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Affiliation(s)
| | | | - Paul Sorajja
- Valve Science CenterMinneapolis Heart Institute Foundation, Abbott Northwestern HospitalMinneapolisMNUSA
| | | | | | - Anapoorna Kini
- Division of CardiologyMount Sinai Medical CenterNew YorkNYUSA
| | - Patricia Keegan
- Division of Cardiology, Emory Structural Heart and Valve CenterEmory University Hospital MidtownAtlantaGAUSA
| | - Kendra J. Grubb
- Division of Cardiothoracic Surgery, Emory Structural Heart and Valve CenterEmory University Hospital MidtownAtlantaGAUSA
| | | | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital CenterWashingtonDCUSA
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17
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Yu Q, Fu Q, Xia Y, Wu Y. Predictors, clinical impact, and management strategies for conduction abnormalities after transcatheter aortic valve replacement: an updated review. Front Cardiovasc Med 2024; 11:1370244. [PMID: 38650916 PMCID: PMC11033487 DOI: 10.3389/fcvm.2024.1370244] [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] [Received: 01/14/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has increasingly become a safe, feasible, and widely accepted alternative surgical treatment for patients with severe symptomatic aortic stenosis. However, the incidence of conduction abnormalities associated with TAVR, including left bundle branch block (LBBB) and high-degree atrioventricular block (HAVB), remains high and is often correlated with risk factors such as the severity of valvular calcification, preexisting conditions in patients, and procedural factors. The existing research results on the impact of post-TAVR conduction abnormalities and permanent pacemaker (PPM) requirements on prognosis, including all-cause mortality and rehospitalization, remain contradictory, with varied management strategies for post-TAVR conduction system diseases across different institutions. This review integrates the latest research in the field, offering a comprehensive discussion of the mechanisms, risk factors, consequences, and management of post-TAVR conduction abnormalities. This study provides insights into optimizing patient prognosis and explores the potential of novel strategies, such as conduction system pacing, to minimize the risk of adverse clinical outcomes.
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Affiliation(s)
| | | | | | - Yanqing Wu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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18
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Veulemans V, Maier O, Zeus T. Factors Influencing Implantation Depth During Transcatheter Aortic Valve Replacement. Interv Cardiol 2024; 19:e01. [PMID: 38464494 PMCID: PMC10918527 DOI: 10.15420/icr.2023.05] [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: 02/01/2023] [Accepted: 12/11/2023] [Indexed: 03/12/2024] Open
Abstract
Optimised implantation depth (OID) is crucial to obtain the best haemodynamic and clinical outcome during transcatheter heart valve (THV) deployment. OID ensures a better haemodynamic profile and is associated with a potential reduction in permanent pacemaker implantations, both of which are important during transcatheter aortic valve replacement (TAVR). Apart from patient-related anatomic conditions, many factors, such as THV and wire selection, as well as implantation strategies, can be controlled by the operator and facilitate the implantation process. However, there are only limited data dealing with predictors for OID. Therefore, the aim of this review was to outline factors and tools that might influence the final implantation depth during TAVR procedures, potentially influencing the outcome.
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Affiliation(s)
- Verena Veulemans
- Department of Cardiology, Pulmonology and Vascular Diseases, University Hospital Düsseldorf Düsseldorf, Germany
| | - Oliver Maier
- Department of Cardiology, Pulmonology and Vascular Diseases, University Hospital Düsseldorf Düsseldorf, Germany
| | - Tobias Zeus
- Department of Cardiology, Pulmonology and Vascular Diseases, University Hospital Düsseldorf Düsseldorf, Germany
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19
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Medranda GA, Rogers T, Case BC, Zhang C, Cellamare M, Shea C, Rappaport H, Cohen JE, Shults CC, Ben-Dor I, Satler LF, Waksman R. The impact of cusp overlap on permanent pacemaker requirement following self-expanding transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 59:9-13. [PMID: 37550124 DOI: 10.1016/j.carrev.2023.07.018] [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: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND/PURPOSE The cusp overlap technique has standardized implantation for self-expanding valves with the goal of achieving more consistent implantation depths and lowering permanent pacemaker (PPM) implantation rates. We retrospectively compared short-term outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) with a self-expanding valve implanted using the cusp overlap technique vs. the traditional coplanar technique in a large tertiary referral center. METHODS We conducted a retrospective study among PPM-naïve patients who underwent TAVR using the CoreValve Evolut PRO/PRO+. We compared in-hospital PPM rates in patients who underwent TAVR using the cusp overlap technique vs. the coplanar technique. Additional outcomes included in-hospital all-cause mortality, stroke, major vascular complications, annular rupture, and >mild paravalvular leak. Furthermore, we compared outcomes over time to see whether there was evidence of a learning curve. RESULTS Of the 528 patients included, 270 underwent TAVR using the coplanar technique and 258 underwent TAVR using the cusp overlap technique. The rate of new PPM implantation did not differ between cohorts (17.0 % vs. 16.7 %; p = 0.910). Additionally, rates of in-hospital all-cause mortality (0.0 % vs. 0.4 %; p = 0.328), stroke (3.7 % vs. 1.6 %; p = 0.124), major vascular complications (0.7 % vs. 1.2 %; p = 0.617), annular rupture (0.4 % vs. 0.0 %; p = 0.328) and >mild paravalvular leak (0.0 % vs. 0.4 %; p = 0.444) were similar. Our secondary analysis did not identify any evidence of a learning curve. CONCLUSIONS The cusp overlap technique may not yield a reduction in PPM rates when compared with the coplanar technique. Other confounders should be explored to further minimize in-hospital PPM rates.
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Affiliation(s)
- Giorgio A Medranda
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Matteo Cellamare
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Corey Shea
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Hank Rappaport
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Jeffrey E Cohen
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Christian C Shults
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
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20
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Rheude T, Pellegrini C, Landt M, Bleiziffer S, Wolf A, Renker M, Neuser J, Dörr O, Allali A, Rudolph TK, Wambach JM, Widder JD, Singh P, Berliner D, Alvarez-Covarrubias HA, Richardt G, Xhepa E, Kim WK, Joner M. Multicenter comparison of transcatheter aortic valve implantation with the self-expanding ACURATE neo2 versus Evolut PRO transcatheter heart valves. Clin Res Cardiol 2024; 113:38-47. [PMID: 37115228 PMCID: PMC10808401 DOI: 10.1007/s00392-023-02194-4] [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: 10/20/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND New-generation self-expanding transcatheter aortic heart valves (THV) were designed to overcome technical constraints of their preceding generations. We sought to compare the efficacy and safety of the self-expanding ACURATE neo2 (Neo2) versus Evolut PRO (PRO) devices. METHODS Seven hundred nine patients undergoing transfemoral transcatheter aortic valve implantation (TAVI) with either Neo2 (n = 496) or PRO (n = 213) were included. Propensity score matching (PSM) was performed to account for differences in baseline characteristics. In-hospital and 30-day clinical outcomes were evaluated according to Valve Academic Research Consortium-3 criteria. RESULTS Baseline characteristics were comparable between both groups after PSM (Neo2: n = 155, Evolut Pro: n = 155). Technical success rates were high in both groups (Neo2: 94.8% vs PRO: 97.4%; p = 0.239). Need for permanent pacemaker implantation was less frequent with Neo2 compared with PRO (7.5% vs 20.6%; p = 0.002), whereas major vascular complications were more frequent with Neo2 (Neo2: 11.6% vs PRO: 4.5%; p = 0.022). Intended valve performance at discharge was high in both groups without relevant differences among groups (Neo2: 97.4% vs. 95.3%; p = 0.328). CONCLUSIONS Short-term outcomes after TAVI using latest-generation self-expanding THV were excellent, with overall low rates of adverse events. However, Neo2 was associated with lower pacemaker rates and reduced the prevalence of moderate-severe paravalvular leakage. Transprosthetic gradients after TAVI were higher with Neo2 compared with PRO.
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Affiliation(s)
- Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Costanza Pellegrini
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Sabine Bleiziffer
- Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Alexander Wolf
- Department of Cardiology, Elisabeth Hospital Essen, Essen, Germany
| | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Jonas Neuser
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Oliver Dörr
- Medical Clinic I, Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | | | - Tanja K Rudolph
- Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | | | - Julian D Widder
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Parminder Singh
- Medical Clinic I, Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - Dominik Berliner
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Hector A Alvarez-Covarrubias
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
- Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, Cd. de México, México
| | - Gert Richardt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
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21
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Datta R, Bharadwaj P, Keshavamurthy G, Guleria VS, Kj R, Abbot AK. Transcatheter aortic valve implantation using coplanar and cuspal overlap techniques in Indian patients. Indian Heart J 2024; 76:36-43. [PMID: 38218314 PMCID: PMC10943560 DOI: 10.1016/j.ihj.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Transcatheter Aortic Valve Implantation (TAVI) techniques gradually evolved since 2002 and have undergone various refinements. Achieving optimal implantation depth has become crucial for good long term outcome. High implantation decreases the likelihood of conduction disturbances. Conventionally TAVI valve is positioned in a tricusp coplanar (CON) fluoroscopic projection however it does not ensure a optimal implantation. In an attempt to attain higher implantation(3 mm) and decrease rate of permanent pacemaker, cuspal overlap technique (COT) view has been developed. There is scarcity of Indian literature comparing TAVI deployment using coplanar and cuspal overlap techniques. METHODS We included 111 patients who underwent TAVR with a self-expanding Core Valve Evolut R (Medtronic, Minneapolis, Minnesota), between January 2017 to September 2022 at our centre.Transcatheter Heart Valves (THV) were implanted using the traditional coplanar in 55 patients, while in 56 patients valves were implanted using the COT. RESULTS Baseline characteristics including electrocardiographic findings were comparable in both groups. In all patients Evolut R or Evolut PRO valves were used. Procedure was done in conscious sedation in 90.9 % of patients in CON and 96.4 % in COT group. Predilatation and postdilatation was used in 38.8 % vs 33.9 % and 27 % vs 32 % in CON and COT groups respectively. 90 day PPI rate was less in COT group (7.3 % CON vs 3.5 % COP). Majority of patients who received permanent pacemaker implantation (PPI) had baseline ECG abnormality (RBBB in 50 %, LBBB in 16 %, Grade 1 AV block 16 %). Mean time of post procedure PPI was 5.6 days in COT group and 7.3 days in CON group. New onset LBBB was also less in COT group (21 % CON vs 12.5 % COT).There were 3.6 % intraprocedural deaths in CON group and 1.8 % in COT group. Depth of deployed valve was 4.8 ± 2.34 mm in COT and 6.6 ± 2.11 mm in CON group. Valve deployment time was more in COT group(10.40 CON vs 14.34 min COT). Average valve recapture rate was 2.58 in COP and 2.11 in CON. Stroke rate was more in COT group(3.6 % CON vs 7.14 % COT). Pericardial effusions were also more in COT group. All cause mortality at 3 months was 10.9 % in CON group and 5.3 % in COT. CONCLUSION In this study we achieved lower rates of PPI and new onset LBBB using COT technique in Indian patients using self-expandable prostheses. However valve deployment time, stroke rate and pericardial effusion were seen more in COT group. All cause mortality was low in cuspal overlap technique.
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Affiliation(s)
- Rajat Datta
- Department of Cardiology, AHRR, Delhi, India.
| | | | | | | | - Ratheesh Kj
- Department of Cardiology, AHRR, Delhi, India.
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22
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Takaseya T, Itaya N, Sasaki KI, Sasaki M, Yokomizo M, Honda A, Oshita K, Azuma J, Fukumoto Y, Tayama E. Cusp overlap technique decreases paravalvular leakage in self-expandable transcatheter aortic valve replacement. Heart Vessels 2024; 39:48-56. [PMID: 37606754 DOI: 10.1007/s00380-023-02307-z] [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: 03/20/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
The cusp overlap technique allows greater visual separation between the basal annular plane and the conduction system and decreases the permanent pacemaker implantation rate. We assessed the impact of the cusp overlap technique on conduction disturbance and paravalvular leakage after transcatheter aortic valve replacement. A total of 97 patients underwent transfemoral transcatheter aortic valve replacement with self-expandable valves at our institution from November 2018 to January 2023. The mean age of the patients was 85 years, and 23% were male. The patients were divided into two groups: the cusp overlap technique group and the non-cusp overlap technique group. We compared the clinical results between the two groups. The 30-day permanent pacemaker implantation rate was similar between the two groups (cusp overlap technique: 6.3% vs. non-cusp overlap technique: 10.2%, p = 0.48). The rate of new-onset conduction disturbance was slightly lower in the cusp overlap than non-cusp overlap technique group (18.8% vs. 34.7%, respectively; p = 0.08). The implanted valve function was similar between the two groups, but the rate of trivial or less paravalvular leakage (PVL) was significantly higher in the cusp overlap technique group on echocardiography (69% vs. 45%, p = 0.02). On multidetector computed tomography, the implantation depth at the membranous septum was significantly shorter in the cusp overlap technique group (2.0 ± 2.3 vs. 2.9 ± 1.5 mm, p = 0.02). The degree of canting was slightly smaller in the cusp overlap technique group (1.0 ± 2.2 vs. 1.7 ± 1.9 mm, p = 0.07). The relative risk of PVL equal to or greater than mild was 1.76 times higher for valve implantation without the cusp overlap technique (adjusted odds ratio, 3.74; 95% confidence interval, 1.45-9.69; p < 0.01). Transcatheter aortic valve replacement using the cusp overlap technique is associated with an optimized implantation depth, leading to fewer conduction disturbances. Optimal deployment may also maximize the radial force of self-expanding valves to reduce paravalvular leakage.
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Affiliation(s)
- Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-Machi, Kurume-Shi, Fukuoka, 830-0011, Japan.
| | - Naoki Itaya
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Ken-Ichiro Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Masahiro Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Michiko Yokomizo
- Department of Anesthesiology, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Akihiro Honda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Kensuke Oshita
- Department of Anesthesiology, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Junpei Azuma
- Division of Radiology, Kurume University Hospital, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-Machi, Kurume-Shi, Fukuoka, 830-0011, Japan
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Persia-Paulino YR, Almendarez Lacayo M, Alperi A, Hernández-Vaquero D, Fernández Asensio R, Cuevas Pérez J, Adeba A, Flórez P, Vigil-Escalera M, Álvarez Velasco R, Renilla A, Del Valle Fernández R, Antuña P, Morís de la Tassa C, Avanzas P, Pascual I. Self-expanding TAVI using the cusp overlap technique versus the traditional technique: electrocardiogram changes and 1-year cardiovascular outcomes. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:29-38. [PMID: 37437882 DOI: 10.1016/j.rec.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/18/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Transcatheter aortic valve implantation (TAVI) using the cusp overlap technique (COT) has shown a lower pacemaker implantation rate at 30 days. The objective of this study was to compare electrocardiogram changes and clinical outcomes between COT and the traditional technique (TT) at 1 year of follow-up. METHODS Observational, retrospective, nonrandomized study of consecutive patients undergoing TAVI between January 2015 and January 2021. Patients were matched using a propensity score and the TT was compared with COT. The primary endpoints were electrocardiogram changes and a combined endpoint including pacemaker implantation, hospitalization, or cardiovascular death at 1 year. RESULTS We included 254 patients. After propensity score matching, 184 patients (92 per group) remained. There were no statistically significant differences in baseline characteristics. At 1 year, COT patients showed a significant reduction in new onset left bundle branch block (49% vs 27%, P=.002) and less P wave (13.1±21.0 msec vs 5.47±12.5 msec; P=.003) and QRS prolongation (29.77±27.0 msec vs 16.38±25.4 msec, P <.001). COT was associated with a significant reduction in the occurrence of the primary endpoint (SHR, 0.39 [IC95%, 0.21-0.76]; P=.005). CONCLUSIONS At 1 year of follow-up, COT reduced the incidence of new onset left bundle branch block and diminished QRS and P wave widening compared with the TT. COT was also associated with a statistically significant reduction in the occurrence of the combined primary cardiovascular endpoint.
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Affiliation(s)
- Yván R Persia-Paulino
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Marcel Almendarez Lacayo
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | - Alberto Alperi
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | - Daniel Hernández-Vaquero
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | | | - Javier Cuevas Pérez
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Antonio Adeba
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Pablo Flórez
- Servicio de Cardiología, Hospital Valle del Nalón, Langreo, Asturias, Spain
| | - María Vigil-Escalera
- Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Rut Álvarez Velasco
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | - Alfredo Renilla
- Servicio de Cardiología, Hospital Vital Álvarez-Buylla, Mieres, Asturias, Spain
| | | | - Paula Antuña
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - César Morís de la Tassa
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
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Stephan T, Krohn-Grimberghe M, von Lindeiner genannt von Wildau A, Buck C, Baumhardt M, Mörike J, Gonska B, Rottbauer W, Buckert D. Cusp-overlap view reduces conduction disturbances and permanent pacemaker implantation after transcatheter aortic valve replacement even with balloon-expandable and mechanically-expandable heart valves. Front Cardiovasc Med 2023; 10:1269833. [PMID: 38107259 PMCID: PMC10722163 DOI: 10.3389/fcvm.2023.1269833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Background Conduction disturbances demanding permanent pacemaker implantation (PPI) remain a common complication after transcatheter aortic valve replacement (TAVR). Optimization of the implantation depth (ID) by introducing the cusp-overlap projection (COP) technique led to a reduced rate of PPI when self-expanding valves were used. Objectives The aim of the present study was to determine if using the novel COP view is applicable for all types of TAVR prosthesis and results in a higher ID and reduced incidence of new conduction disturbances and PPI. Methods In this prospective case-control study 586 consecutive patients undergoing TAVR with either balloon-expandable Edwards SAPIEN S3 (n = 280; 47.8%), or mechanically expandable Boston LOTUS Edge heart valve prostheses (n = 306; 52.2%) were included. ID as well as rates of periprocedural PPI and left bundle branch block (LBBB) were compared between the conventional three-cusp coplanar (TCC) projection and the COP view for implantation. Results Of 586 patients, 282 (48.1%) underwent TAVR using COP, whereas in 304 patients (51.9%) the TCC view was applied. Using COP a significantly higher ID was achieved in Edwards SAPIEN S3 TAVR procedures (ID mean difference -1.0 mm, 95%-CI -1.9 to -0.1 mm; P = 0.029), whereas the final platform position did not differ significantly between both techniques when a Boston LOTUS Edge valve was used (ID mean difference -0.1 mm, 95%-CI -1.1 to +0.9 mm; P = 0.890). In Edwards SAPIEN S3 valves, higher ID was associated with a numerically lower post-procedural PPI incidence (4.9% vs. 7.3%; P = 0.464). Moreover, ID was significantly deeper in patients requiring PPI post TAVR compared to those without PPI [8.7 mm (6.8-10.6 mm) vs. 6.5 mm (6.1-7.0 mm); P = 0.005]. In Boston LOTUS Edge devices, COP view significantly decreased the incidence of LBBB post procedure (28.1% vs. 47.9%; P < 0.001), while PPI rates were similar in both groups (21.6% vs. 25.7%; P = 0.396). Conclusion The present study demonstrates the safety, efficacy and reproducibility of the cusp-overlap view even in balloon-expandable and mechanically-expandable TAVR procedures. Application of COP leads to significantly less LBBB in repositionable Boston LOTUS Edge valves and a numerically lower PPI rate in Edwards SAPIEN S3 valves post TAVR compared to the standard TCC projection. The results should encourage to apply the COP view more widely in clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Dominik Buckert
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
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25
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Murakami T, Horinouchi H, Noda S, Hashimoto K, Miyamoto J, Kamioka N, Nagai T, Sakai K, Torii S, Tanaka S, Okada K, Cho Y, Urimoto G, Ito K, Nakazawa G, Ikari Y, Ohno Y. Feasibility and Outcome of Transjugular Intracardiac Echocardiography-Guided Transcatheter Aortic Valve Replacement. JACC. ASIA 2023; 3:925-934. [PMID: 38155789 PMCID: PMC10751646 DOI: 10.1016/j.jacasi.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/18/2023] [Accepted: 07/29/2023] [Indexed: 12/30/2023]
Abstract
Background There are limited data on the impact of intracardiac echocardiography (ICE)-guided transcatheter aortic valve replacement (TAVR) on the new permanent pacemaker implantation (PPMI) rate. Objectives This study investigated the feasibility and outcome of transjugular ICE (TJ-ICE) -guided TAVR, by visualizing the relationship between the membranous septum (MS) and the transcatheter aortic valve (TAV). Methods Among patients with severe aortic stenosis who underwent TAVR between February 2017 and June 2020, this study enrolled a total of 163 patients with TJ-ICE-guided TAVR. MS length was measured by ICE. The primary endpoint of this study was the incidence of new PPMI at 30 days. Results The mean age of the patients in this study was 84.9 ± 4.6 years, and 71.2% of the patients were female. Device success was 96.3% with TJ-ICE guidance. A TJ-ICE-related complication occurred in 1 case (0.6%). The median length of the MS was 5.8 mm (IQR: 5.0-6.9 mm). Excellent intraobserver (intraclass correlation coefficient [ICC]: 0.94; 95% CI:0.79-0.98; P < 0.001) and interobserver (ICC: 0.93; 95% CI: -0.05 to 0.98; P < 0.001) agreements were shown. The new PPMI rate was 6.7% at 30 days without a significant difference between balloon-expandable valves and self-expandable valves (3.4% vs 8.7%; P = 0.226). Patients with a TAV implantation depth less than MS length had a significantly lower incidence of new PPMI compared with patients with a TAV implantation depth greater than MS length (2.1% vs 13.4%; P = 0.005), regardless of baseline right bundle branch block presence (6.7% vs 66.7%; P = 0.004) or absence (1.2% vs 8.2%; P = 0.041). Conclusions TJ-ICE-guided TAVR demonstrated remarkable feasibility and safety. The TJ-ICE-guided final TAV position had a significant impact on the new PPMI rate. (Tokai Valve Registry; UMIN000036671).
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Affiliation(s)
- Tsutomu Murakami
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Hitomi Horinouchi
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Satoshi Noda
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Kaho Hashimoto
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Junichi Miyamoto
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Norihiko Kamioka
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Tomoo Nagai
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Katsuaki Sakai
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Sho Torii
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Shigemitsu Tanaka
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Kimiaki Okada
- Department of Cardiac Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Yasunori Cho
- Department of Cardiac Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Genya Urimoto
- Department of Anesthesiology, Tokai University School of Medicine, Isehara, Japan
| | - Kenji Ito
- Department of Anesthesiology, Tokai University School of Medicine, Isehara, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
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Hokken TW, Wienemann H, Dargan J, Ginkel DJV, Dowling C, Unbehaun A, Bosmans J, Bader-Wolfe A, Gooley R, Swaans M, Brecker SJ, Adam M, Van Mieghem NM. Clinical value of CT-derived simulations of transcatheter-aortic-valve-implantation in challenging anatomies the PRECISE-TAVI trial. Catheter Cardiovasc Interv 2023; 102:1140-1148. [PMID: 37668110 DOI: 10.1002/ccd.30816] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/28/2023] [Accepted: 08/19/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Preprocedural computed tomography planning improves procedural safety and efficacy of transcatheter aortic valve implantation (TAVI). However, contemporary imaging modalities do not account for device-host interactions. AIMS This study evaluates the value of preprocedural computer simulation with FEops HEARTguideTM on overall device success in patients with challenging anatomies undergoing TAVI with a contemporary self-expanding supra-annular transcatheter heart valve. METHODS This prospective multicenter observational study included patients with a challenging anatomy defined as bicuspid aortic valve, small annulus or severely calcified aortic valve. We compared the heart team's transcatheter heart valve (THV) planning decision based on (1) conventional multislice computed tomography (MSCT) and (2) MSCT imaging with FEops HEARTguideTM simulations. Clinical outcomes and THV performance were followed up to 30 days. RESULTS A total of 77 patients were included (median age 79.9 years (IQR 74.2-83.8), 42% male). In 35% of the patients, preprocedural planning changed after FEops HEARTguideTM simulations (change in valve size selection [12%] or target implantation height [23%]). A new permanent pacemaker implantation (PPI) was implanted in 13% and >trace paravalvular leakage (PVL) occurred in 28.5%. The contact pressure index (i.e., simulation output indicating the risk of conduction abnormalities) was significantly higher in patients with a new PPI, compared to those without (16.0% [25th-75th percentile 12.0-21.0] vs. 3.5% [25th-75th percentile 0-11.3], p < 0.01) The predicted PVL was 5.7 mL/s (25th-75th percentile 1.3-11.1) in patients with none-trace PVL, 12.7 (25th-75th percentile 5.5-19.1) in mild PVL and 17.7 (25th-75th percentile 3.6-19.4) in moderate PVL (p = 0.04). CONCLUSION FEops HEARTguideTM simulations may provide enhanced insights in the risk for PVL or PPI after TAVI with a self-expanding supra-annular THV in complex anatomies.
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Affiliation(s)
- Thijmen W Hokken
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hendrik Wienemann
- Clinic III for Internal Medicine, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - James Dargan
- Cardiology Clinical Academic Group, St. George's University of London, London, UK
| | - Dirk-Jan van Ginkel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Cameron Dowling
- MonashHeart, Monash Health and Vascular Surgery, Monash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia
- Stanford University School of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA
| | - Axel Unbehaun
- Department of Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Johan Bosmans
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | | | - Robert Gooley
- MonashHeart, Monash Health and Vascular Surgery, Monash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Martin Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's University of London, London, UK
| | - Matti Adam
- Clinic III for Internal Medicine, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
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27
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Grubb KJ, Tully A, Tom S. Editorial: TAVR quality improvement with Evolut FX and the role of cusp-overlapping technique. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 56:7-8. [PMID: 37648565 DOI: 10.1016/j.carrev.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA; Structural Heart and Valve Center, Emory University, Atlanta, GA, USA.
| | - Andy Tully
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA; Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
| | - Stephanie Tom
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA; Department of Surgery, Emory University, Atlanta, GA, USA
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28
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Blusztein D, Raney A, Walsh J, Nazif T, Woods C, Daniels D. Best Practices in Left Ventricular Pacing for Transcatheter Aortic Valve Replacement. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100213. [PMID: 38046859 PMCID: PMC10692352 DOI: 10.1016/j.shj.2023.100213] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 12/05/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is continually evolving, with a recent emphasis on a "minimalist" approach toward reducing procedural invasiveness, duration, and recovery time. Whereas a better understanding of the relationship between TAVR and new conduction disturbances has led to improved periprocedural management, intraprocedural rapid-pacing techniques have not evolved beyond traditional right ventricular temporary pacing. An alternative strategy utilizing the left ventricular guidewire for rapid pacing has been developed with evidence supporting its safety, effectiveness, and potential reductions in procedure time and cost. This review will outline the current best practices in left ventricular pacing for TAVR, a practical technique that embraces the minimalist approach to TAVR and may be considered for routine use. It aims to explore the current evidence and combine this with expert opinion to offer a strategy for temporary pacing that encourages efficiencies for physicians and patients without compromising periprocedural safety.
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Affiliation(s)
- David Blusztein
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Aidan Raney
- Division of Cardiology, St. Joseph Hospital, Orange, California, USA
| | - Joe Walsh
- Division of Cardiology, St. Alphonsus Health System, Boise, Idaho, USA
| | - Tamim Nazif
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher Woods
- Division of Cardiology, California Pacific Medical Center, San Francisco, California, USA
| | - David Daniels
- Division of Cardiology, California Pacific Medical Center, San Francisco, California, USA
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29
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Dykun I, Mahabadi AA, Jehn S, Kalra A, Isogai T, Wazni OM, Kanj M, Krishnaswamy A, Reed GW, Yun JJ, Totzeck M, Jánosi RA, Lind AY, Kapadia SR, Rassaf T, Puri R. The degree of permanent pacemaker dependence and clinical outcomes following transcatheter aortic valve implantation: implications for procedural technique. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead127. [PMID: 38105920 PMCID: PMC10721444 DOI: 10.1093/ehjopen/oead127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 10/27/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
Aims Conduction abnormalities necessitating permanent pacemaker (PPM) implantation remain the most frequent complication post-transcatheter aortic valve implantation (TAVI), yet reliance on PPM function varies. We evaluated the association of right-ventricular (RV)-stimulation rate post-TAVI with 1-year major adverse cardiovascular events (MACE) (all-cause mortality and heart failure hospitalization). Methods and results This retrospective cohort study of patients undergoing TAVI in two high-volume centers included patients with existing PPM pre-TAVI or new PPM post-TAVI. There was a bimodal distribution of RV-stimulation rates stratifying patients into two groups of either low [≤10%: 1.0 (0.0, 3.6)] or high [>10%: 96.0 (54.0, 99.9)] RV-stimulation rate post-TAVI. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated comparing MACE in patients with high vs. low RV-stimulation rates post-TAVI. Of 4659 patients, 408 patients (8.6%) had an existing PPM pre-TAVI and 361 patients (7.7%) underwent PPM implantation post-TAVI. Mean age was 82.3 ± 8.1 years, 39% were women. A high RV-stimulation rate (>10%) development post-TAVI is associated with a two-fold increased risk for MACE [1.97 (1.20, 3.25), P = 0.008]. Valve implantation depth was an independent predictor of high RV-stimulation rate [odds ratio (95% CI): 1.58 (1.21, 2.06), P=<0.001] and itself associated with MACE [1.27 (1.00, 1.59), P = 0.047]. Conclusion Greater RV-stimulation rates post-TAVI correlate with increased 1-year MACE in patients with new PPM post-TAVI or in those with existing PPM but low RV-stimulation rates pre-TAVI. A shallower valve implantation depth reduces the risk of greater RV-stimulation rates post-TAVI, correlating with improved patient outcomes. These data highlight the importance of a meticulous implant technique even in TAVI recipients with pre-existing PPMs.
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Affiliation(s)
- Iryna Dykun
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Amir Abbas Mahabadi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Stefanie Jehn
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Ankur Kalra
- Krannert Cardiovascular Research Center, Division of Cardiovascular Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Mohamad Kanj
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - James J Yun
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - R Alexander Jánosi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Alexander Y Lind
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
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30
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Asmarats L, Gutiérrez-Alonso L, Nombela-Franco L, Regueiro A, Millán X, Tirado-Conte G, Cepas P, Li CHP, Fernández-Peregrina E, Jiménez-Quevedo P, Freixa X, Arzamendi D. Cusp-overlap technique during TAVI using the self-expanding Portico FlexNav system. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:767-773. [PMID: 36804557 DOI: 10.1016/j.rec.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION AND OBJECTIVES The cusp overlap technique (COT) has been proposed to reduce conduction disturbances (CD) after transcatheter aortic valve implantation (TAVI) with self-expanding supra-annular devices, but there are scarce data on COT with intra-annular valves. The aim of this study was to determine whether the use of the COT during Portico implantation results in higher valve implantation and lower rates of CD. METHODS We included 85 patients undergoing TAVI with the Portico FlexNav system: 43 retrospective patients using the standard 3-cusp view and 42 prospective patients with the COT. Primary endpoints were implantation depth and new-onset CD (composite outcome of new-onset left bundle branch block and new permanent pacemaker implantation). RESULTS COT resulted in a higher implantation depth (noncoronary cusp: 4.9±3.9 vs 7.4±3.0; P=.005) and lower new-onset CD (31.0% vs 58.1%; P=.012), with a tendency toward a lower need for permanent pacemaker implantation (14.3% vs 30.2%, P=.078; 7.7% vs 31.0%; P=.011 in patients without pre-existing right bundle branch block). Transvalvular aortic gradients were slightly lower with COT (8.7±3.7 vs 11.0±6.1; P=.044). There were no differences in technical success or major procedure-related complications. On multivariate analysis, COT use was associated with a lower risk of new-onset CD. CONCLUSIONS Use of the COT during Portico implantation is feasible and facilitates a higher valve implant, which in turn may help to reduce rates of new-onset CD.
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Affiliation(s)
- Lluis Asmarats
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Lola Gutiérrez-Alonso
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Luis Nombela-Franco
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ander Regueiro
- Servicio de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Xavier Millán
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Gabriela Tirado-Conte
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pedro Cepas
- Servicio de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Chi Hion Pedro Li
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Estefanía Fernández-Peregrina
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pilar Jiménez-Quevedo
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Xavier Freixa
- Servicio de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Dabit Arzamendi
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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Kim WK. The cusp overlap technique for the Portico valve: it works! REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:755-756. [PMID: 37001810 DOI: 10.1016/j.rec.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany.
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Szotek M, Drużbicki Ł, Sabatowski K, Amoroso GR, De Schouwer K, Matusik PT. Transcatheter Aortic Valve Implantation and Cardiac Conduction Abnormalities: Prevalence, Risk Factors and Management. J Clin Med 2023; 12:6056. [PMID: 37762995 PMCID: PMC10531796 DOI: 10.3390/jcm12186056] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Over the last decades, transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has become a potential, widely accepted, and effective method of treating aortic stenosis in patients at moderate and high surgical risk and those disqualified from surgery. The method evolved what translates into a noticeable decrease in the incidence of complications and more beneficial clinical outcomes. However, the incidence of conduction abnormalities related to TAVI, including left bundle branch block and complete or second-degree atrioventricular block (AVB), remains high. The occurrence of AVB requiring permanent pacemaker implantation is associated with a worse prognosis in this group of patients. The identification of risk factors for conduction disturbances requiring pacemaker placement and the assessment of their relation to pacing dependence may help to develop methods of optimal care, including preventive measures, for patients undergoing TAVI. This approach is crucial given the emerging evidence of no worse outcomes for intermediate and low-risk patients undergoing TAVI in comparison to surgical aortic valve replacement. This paper comprehensively discusses the mechanisms, risk factors, and consequences of conduction abnormalities and arrhythmias, including AVB, atrial fibrillation, and ventricular arrhythmias associated with aortic stenosis and TAVI, as well as provides insights into optimized patient care, along with the potential of conduction system pacing and cardiac resynchronization therapy, to minimize the risk of unfavorable clinical outcomes.
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Affiliation(s)
- Michał Szotek
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
| | - Łukasz Drużbicki
- Department of Cardiovascular Surgery and Transplantology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
| | - Karol Sabatowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Kraków, Poland
| | - Gisella R. Amoroso
- Department of Cardiovascular Medicine, “SS Annunziata” Hospital, ASL CN1-Savigliano, Via Ospedali 9, 12038 Savigliano, Italy
| | - Koen De Schouwer
- Department of Cardiology, Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Paweł T. Matusik
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
- Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 80 Prądnicka St., 31-202 Kraków, Poland
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Moura AR, Rodrigues JA, Braga P, Melica B, Santos L, Pires-Morais G, Sampaio F, Fontes-Carvalho R. Impact of the use of cusp-overlap projection on the incidence of permanent pacemaker implantation post-transcatheter aortic valve implantation with self-expanding valves. Rev Port Cardiol 2023; 42:759-769. [PMID: 36948457 DOI: 10.1016/j.repc.2022.10.011] [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: 07/05/2022] [Revised: 09/14/2022] [Accepted: 10/11/2022] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION Current rates of permanent pacemaker implantation (PPMI) after transcatheter aortic valve implantation (TAVI) range between 3.4% and 25.9%. PPMI is associated with a worse prognosis. A lower valve implantation depth is associated with an increased risk of conduction disturbances. Theoretically, cusp-overlap projection (COP) has the potential to enable higher valve deployment. OBJECTIVE To compare the 30-day PPMI incidence post-TAVI using self-expanding valves according to the fluoroscopic guidance technique. METHODS This retrospective single-center study assessed consecutive patients undergoing TAVI with CoreValve™ valves between April 2019 and November 2021, grouped according to the fluoroscopic guidance technique (COP vs. coplanar implantation technique [CIT]). RESULTS A total of 122 patients were included, predominantly women (52.5%), with a mean age of 81.6±5.5 years. COP was used in 49.2% of the sample. The CIT group had a significantly higher prevalence of previous beta-blocker use (p<0.01), lower baseline left ventricular ejection fraction (p=0.04) and a higher EuroSCORE II (p=0.02). The 30-day PPMI rate was 27.9% (n=34), with no significant difference between the COP and CIT groups (26.7% vs. 29.0%, p=0.77). Complete atrioventricular block was the main cause (38.5%). Likewise, mean fluoroscopy time (p=0.14) and contrast volume (p=0.35) used were similar between the two groups. Radiation dose was lower in the COP group (p=0.02). There was no significant difference between post-TAVI grades III and IV aortic valve regurgitation (p=0.27) and there were no cases of periprocedural acute coronary occlusion. CONCLUSIONS This study shows that the COP technique, although safe and not associated with increased complexity, did not significantly reduce the 30-day PPMI rate compared to the traditional CIT view.
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Affiliation(s)
- Ana Rita Moura
- Cardiology Department, Hospital Distrital de Santarém, Santarém, Portugal.
| | | | - Pedro Braga
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Bruno Melica
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Lino Santos
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Gustavo Pires-Morais
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Francisco Sampaio
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal
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Park DY, An S, Kassab K, Jolly N, Attanasio S, Sawaqed R, Malhotra S, Doukky R, Vij A. Chronological comparison of TAVI and SAVR stratified to surgical risk: a systematic review, meta-analysis, and meta-regression. Acta Cardiol 2023; 78:778-789. [PMID: 37294002 DOI: 10.1080/00015385.2023.2218025] [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: 05/11/2022] [Revised: 12/19/2022] [Accepted: 05/19/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has been established as a reasonable alternative to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis. However, long-term outcomes including valve durability and the need for reintervention are unanswered, especially in younger patients who tend to be low surgical risk. We performed a meta-analysis comparing clinical outcomes after TAVI and SAVR over 5 years stratified to low, intermediate, and high surgical risks. METHODS We identified propensity score-matched observational studies and randomised controlled trials comparing TAVI and SAVR. Primary outcomes, including all-cause mortality, moderate or severe aortic regurgitation, moderate or severe paravalvular regurgitation, pacemaker placement, and stroke, were extracted. Meta-analyses of outcomes after TAVI compared to SAVR were conducted for different periods of follow-up. Meta-regression was also performed to analyse the correlation of outcomes over time. RESULTS A total of 36 studies consisting of 7 RCTs and 29 propensity score-matched studies were selected. TAVI was associated with higher all-cause mortality at 4-5 years in patients with low or intermediate surgical risk. Meta-regression time demonstrated an increasing trend in the risk of all-cause mortality after TAVI compared with SAVR. TAVI was generally associated with a higher risk of moderate or severe aortic regurgitation, moderate or severe paravalvular regurgitation, and pacemaker placement. CONCLUSIONS TAVI demonstrated an increasing trend of all-cause mortality compared with SAVR when evaluated over a long-term follow-up. More long-term data from recent studies using newer-generation valves and state-of-the-art techniques are needed to accurately assign risks.
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, IL, USA
| | - Seokyung An
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
| | - Kameel Kassab
- Division of Cardiology, Ascension Borgess Hospital/Michigan State University, Kalamazoo, MI, USA
| | - Neeraj Jolly
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Steve Attanasio
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Ray Sawaqed
- Division of Cardiothoracic Surgery, Cook County Health, Chicago, IL, USA
- Division of Cardiothoracic Surgery, Rush Medical College, Chicago, IL, USA
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health, Chicago, IL, USA
- Division of Cardiology, Rush Medical College, Chicago, IL, USA
| | - Rami Doukky
- Division of Cardiology, Cook County Health, Chicago, IL, USA
- Division of Cardiology, Rush Medical College, Chicago, IL, USA
| | - Aviral Vij
- Division of Cardiology, Cook County Health, Chicago, IL, USA
- Division of Cardiology, Rush Medical College, Chicago, IL, USA
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Nobre Menezes M. The cusp-overlap technique for reducing pacemaker implantation after transcatheter aortic valve implantation: Game-changer or gimmick? Rev Port Cardiol 2023; 42:771-773. [PMID: 36958574 DOI: 10.1016/j.repc.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Affiliation(s)
- Miguel Nobre Menezes
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, Lisboa, Portugal; Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
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36
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Jilaihawi H. Fast Is Fine, But Accuracy Is Everything. JACC Cardiovasc Interv 2023; 16:2018-2020. [PMID: 37480888 DOI: 10.1016/j.jcin.2023.06.005] [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: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 07/24/2023]
Affiliation(s)
- Hasan Jilaihawi
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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37
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Pagnesi M, Kim WK, Baggio S, Scotti A, Barbanti M, De Marco F, Adamo M, Eitan A, Estévez-Loureiro R, Conradi L, Toggweiler S, Mylotte D, Veulemans V, Søndergaard L, Wolf A, Giannini F, Maffeo D, Pilgrim T, Montorfano M, Zweiker D, Ferlini M, Kornowski R, Hildick-Smith D, Taramasso M, Abizaid A, Schofer J, Sinning JM, Van Mieghem NM, Wöhrle J, Khogali S, Van der Heyden JAS, Wood DA, Ielasi A, MacCarthy P, Brugaletta S, Hamm CW, Costa G, Testa L, Massussi M, Alarcón R, Schäfer U, Brunner S, Reimers B, Lunardi M, Zeus T, Vanhaverbeke M, Naber CK, Di Ienno L, Buono A, Windecker S, Schmidt A, Lanzillo G, Vaknin-Assa H, Arunothayaraj S, Saccocci M, Siqueira D, Brinkmann C, Sedaghat A, Ziviello F, Seeger J, Rottbauer W, Brouwer J, Buysschaert I, Jelisejevas J, Bharucha A, Regueiro A, Metra M, Colombo A, Latib A, Mangieri A. Incidence, Predictors, and Prognostic Impact of New Permanent Pacemaker Implantation After TAVR With Self-Expanding Valves. JACC Cardiovasc Interv 2023; 16:2004-2017. [PMID: 37480891 DOI: 10.1016/j.jcin.2023.05.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/23/2023] [Accepted: 05/08/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES The authors sought to evaluate the incidence, predictors, and outcomes of new permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) with contemporary self-expanding valves (SEV). BACKGROUND Need for PPI is frequent post-TAVR, but conflicting data exist on new-generation SEV and on the prognostic impact of PPI. METHODS This study included 3,211 patients enrolled in the multicenter NEOPRO (A Multicenter Comparison of Acurate NEO Versus Evolut PRO Transcatheter Heart Valves) and NEOPRO-2 (A Multicenter Comparison of ACURATE NEO2 Versus Evolut PRO/PRO+ Transcatheter Heart Valves 2) registries (January 2012 to December 2021) who underwent transfemoral TAVR with SEV. Implanted transcatheter heart valves (THV) were Acurate neo (n = 1,090), Acurate neo2 (n = 665), Evolut PRO (n = 1,312), and Evolut PRO+ (n = 144). Incidence and predictors of new PPI and 1-year outcomes were evaluated. RESULTS New PPI was needed in 362 patients (11.3%) within 30 days after TAVR (8.8%, 7.7%, 15.2%, and 10.4%, respectively, after Acurate neo, Acurate neo2, Evolut PRO, and Evolut PRO+). Independent predictors of new PPI were Society of Thoracic Surgeons Predicted Risk of Mortality score, baseline right bundle branch block and depth of THV implantation, both in patients treated with Acurate neo/neo2 and in those treated with Evolut PRO/PRO+. Predischarge reduction in ejection fraction (EF) was more frequent in patients requiring PPI (P = 0.014). New PPI was associated with higher 1-year mortality (16.9% vs 10.8%; adjusted HR: 1.66; 95% CI: 1.13-2.43; P = 0.010), particularly in patients with baseline EF <40% (P for interaction = 0.049). CONCLUSIONS New PPI was frequently needed after TAVR with SEV (11.3%) and was associated with higher 1-year mortality, particularly in patients with EF <40%. Baseline right bundle branch block and depth of THV implantation independently predicted the need of PPI.
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Affiliation(s)
- Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Sara Baggio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Amnon Eitan
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Rodrigo Estévez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
| | - Stefan Toggweiler
- Heart Center Lucerne, Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospitals, Galway, Ireland
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Lars Søndergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alexander Wolf
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Essen, Germany
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - David Zweiker
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - David Hildick-Smith
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | | | | | - Joachim Schofer
- Department for Percutaneous Treatment of Structural Heart Disease, Albertinen Heart Center, Hamburg, Germany; MVZ Department Structural Heart Disease, Asklepios St. Georg Clinic, Hamburg, Germany
| | - Jan-Malte Sinning
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jochen Wöhrle
- Department of Cardiology and Intensive Care, Medical Campus Lake Constance, Friedrichshafen, Germany
| | - Saib Khogali
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Jan A S Van der Heyden
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands; Interventional Cardiology Unit, AZ Sint-Jan Hospital, Bruges, Belgium
| | - David A Wood
- Centre for Heart Valve and Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Salvatore Brugaletta
- Clinic Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Christian W Hamm
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Giuliano Costa
- Department of Cardiology, C.A.S.T. Policlinico G. Rodolico, Catania, Italy
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Mauro Massussi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Robert Alarcón
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Ulrich Schäfer
- Department of Internal Medicine, Marienkrankenhaus, Hamburg, Germany
| | - Stephanie Brunner
- Heart Center Lucerne, Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Mattia Lunardi
- Department of Cardiology, Galway University Hospitals, Galway, Ireland
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoph K Naber
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Essen, Germany
| | - Luca Di Ienno
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Andrea Buono
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Albrecht Schmidt
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Giuseppe Lanzillo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | | | - Matteo Saccocci
- Cardiac Surgery Unit, Fondazione Poliambulanza, Brescia, Italy
| | | | - Christina Brinkmann
- MVZ Department Structural Heart Disease, Asklepios St. Georg Clinic, Hamburg, Germany
| | - Alexander Sedaghat
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Francesca Ziviello
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Julia Seeger
- Department of Cardiology and Intensive Care, Medical Campus Lake Constance, Friedrichshafen, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Jorn Brouwer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Ian Buysschaert
- Interventional Cardiology Unit, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Julius Jelisejevas
- Centre for Heart Valve and Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Apurva Bharucha
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Ander Regueiro
- Clinic Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
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Lemarchand L, Boulmier D, Leurent G, Bedossa M, Sharobeem S, Bakhti A, Le Breton H, Auffret V. Conductive disturbances in the transcatheter aortic valve implantation setting: An appraisal of current knowledge and unmet needs. Arch Cardiovasc Dis 2023; 116:419-425. [PMID: 37328391 DOI: 10.1016/j.acvd.2023.05.004] [Citation(s) in RCA: 2] [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: 02/01/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 06/18/2023]
Abstract
New-onset conduction disturbances, including left bundle branch block and permanent pacemaker implantation, remain a major issue after transcatheter aortic valve implantation. Preprocedural risk assessment in current practice is most often limited to evaluation of the baseline electrocardiogram, whereas it may benefit from a multimodal approach, including ambulatory electrocardiogram monitoring and multidetector computed tomography. Physicians may encounter equivocal situations during the hospital phase, and the management of follow-up is not fully defined, despite the publication of several expert consensuses and the inclusion of recommendations regarding the role of electrophysiology studies and postprocedural monitoring in recent guidelines. This review provides an overview of current knowledge and future perspectives regarding the management of new-onset conduction disturbances in the setting of transcatheter aortic valve implantation, from the preprocedural phase to long-term follow-up.
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Affiliation(s)
- Léo Lemarchand
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Dominique Boulmier
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Guillaume Leurent
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Marc Bedossa
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Sam Sharobeem
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Abdelkader Bakhti
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Hervé Le Breton
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Vincent Auffret
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France.
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Freire AFD, Nicz PFG, Ribeiro HB, Filippini FB, Accorsi TD, Liberato G, Nomura CH, Cassar RDS, Vieira MLC, Mathias W, Pomerantzeff PMA, Tarasoutchi F, Abizaid A, Kalil Filho R, de Brito FS. Non-contrast transcatheter aortic valve implantation for patients with aortic stenosis and chronic kidney disease: a pilot study. Front Cardiovasc Med 2023; 10:1175600. [PMID: 37388643 PMCID: PMC10305775 DOI: 10.3389/fcvm.2023.1175600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/19/2023] [Indexed: 07/01/2023] Open
Abstract
Background Acute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI). Of note, it is associated with a threefold increase in all-cause and cardiac death. We propose a new non-contrast strategy for evaluating and performing the TAVI procedure that can be especially valuable for patients with aortic stenosis (AS) and chronic kidney disease (CKD) to prevent AKI. Methods Patients with severe symptomatic AS and CKD stage ≥3a were evaluated for TAVI using four non-contrast imaging modalities for procedural planning: transesophageal echocardiogram (TEE), cardiac magnetic resonance, multidetector computed tomography (MDCT), and aortoiliac CO2 angiography. Patients underwent transfemoral (TF) TAVI using the self-expandable Evolut R/Pro, and the procedures were guided by fluoroscopy and TEE. Contrast MDCT and contrast injection at certain checkpoints during the procedure were used in a blinded fashion to guarantee patient safety. Results A total of 25 patients underwent TF-TAVI with the zero-contrast technique. The mean age was 79.9 ± 6.1 years, 72% in NYHA class III/IV, with a mean STS-PROM of 3.0% ± 1.5%, and creatinine clearance of 49 ± 7 ml/min. The self-expandable Evolut R and Pro were implanted in 80% and 20% of patients, respectively. In 36% of the cases, the transcatheter heart valve (THV) chosen was one size larger than the one by contrast MDCT, but none of these cases presented adverse events. Device success and the combined safety endpoint (at 30 days) both achieved 92%. Pacemaker implantation was needed in 17%. Conclusion This pilot study demonstrated that the zero-contrast technique for procedural planning and THV implantation was feasible and safe and might become the preferable strategy for a significant population of CKD patients undergoing TAVR. Future studies with a larger number of patients are still needed to confirm such interesting findings.
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Istrate M, Dregoesc MI, Bolboaca SD, Solomonean AG, Botis C, Stef A, Hagiu R, Moț ȘDC, Bindea DI, Oprea A, Trifan CA, Iancu AC. The Influence of the Learning Curve on Clinical Outcomes in Balloon-Expandable versus Self-Expandable Transfemoral Transcatheter Aortic Valve Implantation. Cardiology 2023; 148:335-346. [PMID: 37279710 DOI: 10.1159/000531401] [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: 03/15/2023] [Accepted: 05/28/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Balloon-expandable (BE) and self-expandable (SE) prostheses are the main types of devices currently used in transcatheter aortic valve implantation (TAVI). Despite the different designs, clinical practice guidelines do not make any specific recommendation on the selection of one device over the other. Most operators are trained in using both BE and SE prostheses, but operator experience with each of the two designs might influence patient outcomes. The aim of this study was to compare the immediate and mid-term clinical outcomes during the learning curve in BE versus SE TAVI. METHODS The transfemoral TAVI procedures performed in a single center between July 2017 and March 2021 were grouped according to the type of implanted prosthesis. The procedures in each group were ordered according to the case sequence number. For each patient, a minimum follow-up time of 12 months was required for inclusion in the analysis. The outcomes of the BE TAVI procedures were compared with the outcomes of the SE TAVI procedures. Clinical endpoints were defined according to the Valve Academic Research Consortium 3 (VARC-3). RESULTS The median follow-up time was 28 months. Each device group included 128 patients. In the BE group, case sequence number predicted mid-term all-cause mortality at an optimal cutoff value ≤58 procedures (AUC 0.730; 95% CI: 0.644-0.805; p < 0.001), while in the SE group, the cutoff value was ≤85 procedures (AUC 0.625; 95% CI: 0.535-0.710; p = 0.04). A direct comparison of the AUC showed that case sequence number was equally adequate in predicting mid-term mortality, irrespective of prosthesis type (p = 0.11). A low case sequence number was associated with an increased rate of VARC-3 major cardiac and vascular complications (OR 0.98 95% CI: 0.96-0.99; p = 0.03) in the BE device group, and with an increased rate of post-TAVI aortic regurgitation ≥ grade II (OR 0.98; 95% CI: 0.97-0.99; p = 0.03) in the SE device group. CONCLUSIONS In transfemoral TAVI, case sequence number influenced mid-term mortality irrespective of prosthesis type, but the learning curve was longer in the case of SE devices.
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Affiliation(s)
- Mihnea Istrate
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania
| | - Mihaela Ioana Dregoesc
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania
| | - Sorana D Bolboaca
- Department of Medical Informatics and Biostatistics, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Aurelia G Solomonean
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania
- Department of Cardiovascular Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Catalin Botis
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania
| | - Adrian Stef
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania
- Department of Cardiovascular Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Hagiu
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania
| | - Ștefan D C Moț
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania
| | - Dan I Bindea
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania
- Department of Cardiovascular Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alexandru Oprea
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania
- Department of Cardiovascular Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cătălin A Trifan
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania
- Department of Cardiovascular Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adrian C Iancu
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania
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Wienemann H, Maier O, Beyer M, Portratz M, Tanaka T, Mauri V, Ernst A, Waldschmidt L, Kuhn E, Bleiziffer S, Wilde N, Schaefer A, Zeus T, Baldus S, Zimmer S, Veulemans V, Rudolph TK, Adam M. Cusp overlap versus standard three-cusp technique for self-expanding Evolut transcatheter aortic valves. EUROINTERVENTION 2023; 19:e176-e187. [PMID: 37013922 PMCID: PMC10240731 DOI: 10.4244/eij-d-22-01030] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/14/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Reducing rates of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) is important for achieving the best procedural outcomes. The cusp overlap technique (COT) implements procedural steps including an overlap angulation of the right and left coronary cusp to mitigate this complication. AIMS We investigated the incidence of PPI and complication rates following the COT compared to the standard three-cusp implantation technique (3CT) in an all-comers cohort. METHODS A total of 2,209 patients underwent TAVI with the self-expanding Evolut platform from January 2016 to April 2022 at five sites. Baseline, procedural and in-hospital outcome characteristics were compared for both techniques before and after one-to-one propensity score matching. RESULTS A total of 1,151 patients were implanted using the 3CT and 1,058 using the COT. At discharge, the rates of PPI (17.0 vs 12.3%; p=0.002) and moderate/severe paravalvular regurgitation (4.6% vs 2.4%; p=0.006) were significantly reduced with the COT compared with 3CT within the unmatched cohort. Overall procedural success and complication rates were similar; major bleeding was less common in the COT group (7.0% vs 4.6%; p=0.020). These results remained consistent after propensity score matching. In multivariable logistic regression analysis, right bundle branch block (odds ratio [OR] 7.19, 95% confidence interval [CI]: 5.18-10.0; p<0.001) and diabetes mellitus (OR 1.38, 95% CI: 1.05-1.80; p=0.021) emerged as predictors of PPI, whereas the COT (OR 0.63, 95% CI: 0.49-0.82; p<0.001) was protective. CONCLUSIONS The introduction of the COT was associated with a significant and relevant reduction of PPI and paravalvular regurgitation rates without an increase in complication rates.
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Affiliation(s)
- Hendrik Wienemann
- Clinic III for Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Oliver Maier
- Department of Cardiology, Pneumology, and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Martin Beyer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Max Portratz
- Clinic for General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Tetsu Tanaka
- Clinic II for Internal Medicine, University Hospital Bonn, Bonn, Germany
| | - Victor Mauri
- Clinic III for Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Angela Ernst
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Lara Waldschmidt
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Elmar Kuhn
- Department of Cardiovascular Surgery, University Hospital Cologne, Cologne, Germany
| | - Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Nihal Wilde
- Clinic II for Internal Medicine, University Hospital Bonn, Bonn, Germany
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Tobias Zeus
- Department of Cardiology, Pneumology, and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Clinic III for Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Sebastian Zimmer
- Clinic II for Internal Medicine, University Hospital Bonn, Bonn, Germany
| | - Verena Veulemans
- Department of Cardiology, Pneumology, and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tanja Katharina Rudolph
- Clinic for General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Matti Adam
- Clinic III for Internal Medicine, University Hospital Cologne, Cologne, Germany
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Ochiai T, Yamanaka F, Shishido K, Moriyama N, Komatsu I, Yokoyama H, Miyashita H, Sato D, Sugiyama Y, Hayashi T, Yamashita T, Tobita K, Matsumoto T, Mizuno S, Tanaka Y, Murakami M, Takahashi S, Makkar R, Saito S. Impact of High Implantation of Transcatheter Aortic Valve on Subsequent Conduction Disturbances and Coronary Access. JACC Cardiovasc Interv 2023; 16:1192-1204. [PMID: 37225290 DOI: 10.1016/j.jcin.2023.03.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Data regarding the impact of high transcatheter heart valve (THV) implantation on coronary access after transcatheter aortic valve replacement (TAVR) as assessed by postimplantation computed tomography (CT) are scarce. OBJECTIVES The authors sought to assess the impact of high THV implantation on coronary access after TAVR. METHODS We included 160 and 258 patients treated with Evolut R/PRO/PRO+ and SAPIEN 3 THVs, respectively. In the Evolut R/PRO/PRO+ group, the target implantation depth was 1 to 3 mm using the cusp overlap view with commissural alignment technique for the high implantation technique (HIT), whereas it was 3 to 5 mm using 3-cusp coplanar view for the conventional implantation technique (CIT). In the SAPIEN 3 group, the HIT employed the radiolucent line-guided implantation, whereas the central balloon marker-guided implantation was used for the CIT. Post-TAVR CT was performed to analyze coronary accessibility. RESULTS HIT reduced the incidence of new conduction disturbances after TAVR for both THVs. In the Evolut R/PRO/PRO+ group, post-TAVR CT showed that the HIT group had a higher incidence of the interference of THV skirt (22.0% vs 9.1%; P = 0.03) and a lower incidence of the interference of THV commissural posts (26.0% vs 42.7%; P = 0.04) with access to 1 or both coronary ostia compared with the CIT group. These incidences were similar between the HIT and CIT groups in the SAPIEN 3 group (THV skirt: 0.9% vs 0.7%; P = 1.00; THV commissural tabs: 15.7% vs 15.3%; P = 0.93). In both THVs, CT-identified risk of sinus sequestration in TAVR-in-TAVR was significantly higher in the HIT group compared with the CIT group (Evolut R/PRO/PRO+ group: 64.0% vs 41.8%; P = 0.009; SAPIEN 3 group: 17.6% vs 5.3%; P = 0.002). CONCLUSIONS High THV implantation substantially reduced conduction disturbances after TAVR. However, post-TAVR CT revealed that there is a risk for unfavorable future coronary access after TAVR and sinus sequestration in TAVR-in-TAVR. (Impact of High Implantation of Transcatheter Heart Valve during Transcatheter Aortic Valve Replacement on Future Coronary Access; UMIN000048336).
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Affiliation(s)
- Tomoki Ochiai
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Koki Shishido
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Noriaki Moriyama
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Ikki Komatsu
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Hiroaki Yokoyama
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Hirokazu Miyashita
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Daisuke Sato
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Yoichi Sugiyama
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Takahiro Hayashi
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Takayoshi Yamashita
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Kazuki Tobita
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Takashi Matsumoto
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Shingo Mizuno
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Yutaka Tanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Masato Murakami
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Saeko Takahashi
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
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Grubb KJ, Yakubov S. Reply: Optimized Pro Pathway-A Step in the Right Direction But Not There Yet. . . and the Use of the Membranous Septum Length in Evolut Implantation. JACC Cardiovasc Interv 2023; 16:1306-1307. [PMID: 37225303 DOI: 10.1016/j.jcin.2023.04.035] [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: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/26/2023]
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Mylotte D, Fezzi S. TAVR Roulette: Go High or Go Low. JACC Cardiovasc Interv 2023; 16:1205-1207. [PMID: 37225291 DOI: 10.1016/j.jcin.2023.04.021] [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: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Darren Mylotte
- Department of Cardiology, SAOLTA Healthcare Group, Galway University Hospital, Health Service Executive and National University of Ireland Galway, Galway, Ireland.
| | - Simone Fezzi
- Department of Cardiology, SAOLTA Healthcare Group, Galway University Hospital, Health Service Executive and National University of Ireland Galway, Galway, Ireland; The Lambe Institute for Translational Medicine and CURAM, National University of Ireland Galway, Galway, Ireland; Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
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45
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Rawish E, Macherey S, Jurczyk D, Pätz T, Jose J, Stiermaier T, Eitel I, Frerker C, Schmidt T. Reduction of permanent pacemaker implantation by using the cusp overlap technique in transcatheter aortic valve replacement: a meta-analysis. Clin Res Cardiol 2023; 112:633-644. [PMID: 36656375 PMCID: PMC10160159 DOI: 10.1007/s00392-022-02150-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/23/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The need for permanent pacemaker (PPM) implantation is a common complication after transcatheter aortic valve replacement (TAVR). Deep implantation position is a risk factor for PPM implantation. Thus, in the field of self-expandable (SE) transcatheter heart valves (THV) cusp overlap projection (COP) technique was implemented to reduce parallax, allowing a more precise guidance of implantation depth. AIMS This meta-analysis aims to report the outcome of patients undergoing TAVR with SE THV using COP versus conventional implantation technique (CIT). METHODS Systematical search in MEDLINE and EMBASE yielded five observational controlled studies comparing both implantation techniques for the SE Evolut prosthesis (Medtronic Intern. Ltd., CA, USA) and fulfilling the inclusion criteria for meta-analysis. RESULTS Totally, 1227 patients were included, comprising 641 who underwent COP and 586 CIT TAVR. Incidence of post-procedural need for PPM implantation was significantly lower in COP group (9.8% vs 20.6%; OR = 0.43; p < 0.00001). This was accompanied by significantly higher implantation position in COP group (mean difference distance from distal end of the intraventricular portion of the THV to the non-coronary cusp (NCC): - 1.03 mm; p = 0.00001). Incidence of new-onset left bundle branch block did not differ. Regarding procedural and 30-day mortality, technical success, post-procedural aortic regurgitation, and rates of multiple device implantation, no difference between COP and CIT was found. CONCLUSION COP is an effective and safe implantation technique to reduce the need for a permanent pacemaker implantation during TAVR with SE Evolut prosthesis.
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Affiliation(s)
- Elias Rawish
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
| | - Sascha Macherey
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Dominik Jurczyk
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Toni Pätz
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - John Jose
- Cardiac Valve and Structural Heart Disease Clinic, Christian Medical College Hospital, Vellore, India
| | - Thomas Stiermaier
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Christian Frerker
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Tobias Schmidt
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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Grubb KJ, Gada H, Mittal S, Nazif T, Rodés-Cabau J, Fraser DGW, Lin L, Rovin JD, Khalil R, Sultan I, Gardner B, Lorenz D, Chetcuti SJ, Patel NC, Harvey JE, Mahoney P, Schwartz B, Jafar Z, Wang J, Potluri S, Vora AN, Sanchez C, Corrigan A, Li S, Yakubov SJ. Clinical Impact of Standardized TAVR Technique and Care Pathway: Insights From the Optimize PRO Study. JACC Cardiovasc Interv 2023; 16:558-570. [PMID: 36922042 DOI: 10.1016/j.jcin.2023.01.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Procedural success and clinical outcomes after transcatheter aortic valve replacement (TAVR) have improved, but residual aortic regurgitation (AR) and new permanent pacemaker implantation (PPI) rates remain variable because of a lack of uniform periprocedural management and implantation. OBJECTIVES The Optimize PRO study evaluates valve performance and procedural outcomes using an "optimized" TAVR care pathway and the cusp overlap technique (COT) in patients receiving the Evolut PRO/PRO+ (Medtronic) self-expanding valves. METHODS Optimize PRO, a nonrandomized, prospective, postmarket study conducted in the United States, Canada, Europe, Middle East, and Australia, is enrolling patients with severe symptomatic aortic stenosis and no pre-existing pacemaker. Sites follow a standardized TAVR care pathway, including early discharge and a conduction disturbance management algorithm, and transfemoral deployment using the COT. RESULTS A total of 400 attempted implants from the United States and Canada comprised the main cohort of this second interim analysis. The mean age was 78.7 ± 6.6 years, and the mean Society of Thoracic Surgeons predictive risk of mortality was 3.0 ± 2.4. The median length of stay was 1 day. There were no instances of moderate or severe AR at discharge. At 30 days, all-cause mortality or stroke was 3.8%, all-cause mortality was 0.8%, disabling stroke was 0.7%, hospital readmission was 10.1%, and cardiovascular rehospitalization was 6.1%. The new PPI rate was 9.8%, 5.8% with 4-step COT compliance. In the multivariable model, right bundle branch block and the depth of the implant increased the risk of PPI, whereas using the 4-step COT lowered 30-day PPI. CONCLUSIONS The use of the TAVR care pathway and COT resulted in favorable clinical outcomes with no moderate or severe AR and low PPI rates at 30 days while facilitating early discharge and reproducible outcomes across various sites and operators. (Optimize PRO; NCT04091048).
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Affiliation(s)
- Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA.
| | - Hemal Gada
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, Pennsylvania, USA; Center for Heart Valve Disease, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Suneet Mittal
- Division of Cardiology and the Snyder Center for Comprehensive Atrial Fibrillation at Valley Health System, Ridgewood, New Jersey, USA
| | - Tamim Nazif
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clínic de Barcelona, Barcelona, Spain
| | - Douglas G W Fraser
- Cardiology Department, Manchester Heart Centre, Central Manchester University Hospitals, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Lang Lin
- Department of Interventional Cardiology, Morton Plant Hospital, Clearwater, Florida, USA; Department of Cardiovascular Surgery, Morton Plant Hospital, Clearwater, Florida, USA
| | - Joshua D Rovin
- Department of Interventional Cardiology, Morton Plant Hospital, Clearwater, Florida, USA; Department of Cardiovascular Surgery, Morton Plant Hospital, Clearwater, Florida, USA
| | - Ramzi Khalil
- Department of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, Pennsylvania, USA; Center for Heart Valve Disease, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Blake Gardner
- Saint George Regional Hospital, St. George, Utah, USA
| | - David Lorenz
- Saint Vincent's Medical Center, Bridgeport, Connecticut, USA
| | - Stanley J Chetcuti
- Department of Interventional Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan, USA; Department of Cardiovascular Surgery, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | - Nainesh C Patel
- Division of Cardiology, Lehigh Valley Health Network/University of South Florida College of Medicine, Allentown, Pennsylvania, USA
| | - James E Harvey
- Department of Cardiovascular Diseases, York Hospital-Wellspan Health System, York, Pennsylvania, USA
| | - Paul Mahoney
- Structural Heart Center, Sentara Heart Hospital, Norfolk, Virginia, USA
| | - Brian Schwartz
- Department of Cardiology, Kettering Medical Center, Dayton, Ohio, USA
| | - Zubair Jafar
- Department of Cardiology, Vassar Brothers Medical Center, Poughkeepsie, New York, USA
| | - John Wang
- Section of Interventional Cardiology, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Srinivasa Potluri
- Department of Interventional Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
| | - Amit N Vora
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, Pennsylvania, USA; Center for Heart Valve Disease, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carlos Sanchez
- Department of Interventional Cardiology, Riverside Methodist-OhioHealth, Columbus, Ohio, USA
| | - Amy Corrigan
- Department of Clinical Research, Medtronic, Minneapolis, Minnesota, USA
| | - Shuzhen Li
- Department of Structural Heart and Aortic Clinical Research and Medical Science, Medtronic, Minneapolis, Minnesota, USA
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-OhioHealth, Columbus, Ohio, USA
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Van Belle E, Delhaye C, Vincent F. When Anatomy Is Small, Does the Design Matter? JACC Cardiovasc Interv 2023; 16:441-443. [PMID: 36858663 DOI: 10.1016/j.jcin.2023.01.004] [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: 12/28/2022] [Accepted: 01/02/2023] [Indexed: 03/03/2023]
Affiliation(s)
- Eric Van Belle
- CHU Lille, Department of Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Coeur Poumon, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France.
| | - Cédric Delhaye
- CHU Lille, Department of Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Coeur Poumon, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
| | - Flavien Vincent
- CHU Lille, Department of Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Coeur Poumon, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
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48
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Yoon SH, Galo J, Amoah JK, Dallan LAP, Tsushima T, Motairek IK, Rajagopalan V, Hager AM, Galloway BR, Palovich G, Ukaigwe A, Rushing G, Pelletier M, Filby S, Baeza C, Attizzani GF. Permanent Pacemaker Insertion Reduction and Optimized Temporary Pacemaker Management After Contemporary Transcatheter Aortic Valve Implantation With Self-Expanding Valves (from the Pristine TAVI Study). Am J Cardiol 2023; 189:1-10. [PMID: 36481373 DOI: 10.1016/j.amjcard.2022.11.026] [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: 06/13/2022] [Revised: 10/07/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022]
Abstract
Permanent pacemaker implantation (PPMI) reduction and optimal management of newly acquired conduction disturbances after transcatheter aortic valve implantation (TAVI) are crucial. We sought to evaluate the relation between transcatheter heart valve (THV) implantation depth and baseline and newly acquired conduction disturbances on PPMI after TAVI. This study included 1,026 consecutive patients with severe symptomatic aortic stenosis (mean age 79.7 ± 8.4 years; 47.4% female) who underwent TAVI with the newer-generation self-expanding THVs Primary outcomes were early and late PPMI defined as the need for PPMI during the index admission and between discharge and 30 days, respectively. Early and late PPMI was required for 115 (11.2%) and 21 patients (2.0%), respectively. Early PPMI rates decreased from 26.7% in 2015 and 2016 to 5.7% in 2021, and so did the mean THV depth from 4.4 ± 2.4 mm to 1.8 ± 1.6 mm. Receiver operator characteristics curve analyses showed THV depth had significant discriminatory value for early and late PPMI with cutoff values of 3.0 and 2.2 mm, respectively. Rates of early and late PPMI were significantly lower for patients with shallower compared with deeper implantations (5.1% vs 22.6% and 0.4% vs 4.1%, p <0.001 for both, respectively). Furthermore, rates of early PPMI were lower with shallower implantations in patients with new left bundle branch block after TAVI (2.4% vs 15.9%; p <0.001) and those with baseline right bundle branch block (7.5% vs 29.6%; p = 0.017). Lower rates of PPMI with shallower THV implantation were consistently observed, including in patients with baseline and newly acquired conduction disturbances. Our findings might help optimize the management of a temporary pacemaker after TAVI.
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Affiliation(s)
- Sung-Han Yoon
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jason Galo
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Joseph Kofi Amoah
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Luis Augusto Palma Dallan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Takahiro Tsushima
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Issam Kamel Motairek
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Varun Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Ann Marie Hager
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Brett R Galloway
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Gregory Palovich
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Anene Ukaigwe
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Gregory Rushing
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Mark Pelletier
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Steven Filby
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Cristian Baeza
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Guilherme F Attizzani
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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49
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Wang X, Wong I, Bajoras V, Vanhaverbeke M, Nuyens P, Bieliauskas G, Jørgensen TH, Chen M, De Backer O, Sondergaard L. Impact of implantation technique on conduction disturbances for TAVR with the self-expanding portico/navitor valve. Catheter Cardiovasc Interv 2023; 101:431-441. [PMID: 36542648 DOI: 10.1002/ccd.30517] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/06/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Use of a right-left (R-L) cusp overlap view for transcatheter aortic valve replacement (TAVR) with self-expanding valves has recently been proposed aiming to reduce permanent pacemaker implantation (PPMI). An objective, data-driven explanation for this observation is missing. AIMS To assess the impact of different implantation techniques on the risk of PPMI following TAVR with the Portico/NavitorTM transcatheter heart valve (THV; Abbott). METHODS A TAVR-population treated with Portico/NavitorTM had the THV implanted in a right versus left anterior oblique (RAO/LAO) fluoroscopic view with no parallax in the delivery system. The impact of these different implantation views on the spatial relationship between THV and native aortic annulus and the risk of conduction disturbances and PPMI after TAVR was studied. RESULTS A total of 366 matched TAVR patients were studied: 183 in the RAO group and 183 in the LAO group. The degree of aortic annulus plane tilt was significantly smaller in the RAO versus LAO group (median: 0° vs. 23°, p < 0.001), with no plane tilt in 105 out of 183 cases (57.3%) in the RAO group. At 30 days after TAVR, the overall PPMI and guideline-directed PPMI rates were 12.6% versus 18.0% (p = 0.15) and 8.2% versus 15.3% (p = 0.04) in the RAO versus LAO group, respectively. CONCLUSIONS Use of a R-L cusp overlap (RAO-caudal) view for implantation of the Portico/NavitorTM valve results in less tilt of the native aortic annulus plane and a clear trend toward a lower 30-day PPMI rate as compared to TAVR using the conventional LAO implantation view.
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Affiliation(s)
- Xi Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ivan Wong
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vilhelmas Bajoras
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Philippe Nuyens
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gintautas Bieliauskas
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Sondergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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50
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Sá MP, Van den Eynde J, Jacquemyn X, Erten O, Dokollari A, Sicouri S, Ramlawi B. Cusp-overlap versus coplanar view in transcatheter aortic valve implantation with self-expandable valves: A meta-analysis of comparative studies. Catheter Cardiovasc Interv 2023; 101:639-650. [PMID: 36655511 DOI: 10.1002/ccd.30562] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/04/2022] [Accepted: 01/08/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Permanent pacemaker implantation (PPI) is a common complication after transcatheter aortic valve implantation (TAVI). The cusp-overlap view (COV) was adopted to reduce PPI risk after TAVI with self-expandable valves (SEVs); however, the evidence remains scarce. We performed a systematic review with meta-analysis comparing COV and the standard coplanar view (CPV) technique to evaluate their effectiveness and safety. METHODS Following the PRISMA statement, data were extracted from studies published by August 2022 and found in PubMed/MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, and Google Scholar. The primary outcome of interest was post-procedural PPI and the secondary outcomes were new left bundle branch block (LBBB), moderate/severe paravalvular leak (PVL), valve dislocation (pop-out); need of second transcatheter heart valve, 30-day mortality, stroke, conversion to surgery, coronary obstruction, implantation depth (mm), and post-TAVI mean gradients (mmHg). RESULTS Eleven studies met our eligibility criteria and included 1464 patients in the COV group and 1743 patients in the CPV group. Patients who underwent TAVI with COV had lower risk of PPI (odds ratio 0.48; 95% confidence interval [CI] 0.33-0.70; p = 0.001) and higher implantation depths with COV (mean difference -0.83; 95% CI -1.2 to -0.45; p < 0.001). We did not observe any statistically significant differences in the rates of new LBBB, moderate/severe PVL, valve dislocation, need of second transcatheter heart valve, 30-day mortality, stroke, conversion to surgery, coronary obstruction, and post-TAVI mean gradients (mmHg). CONCLUSION In TAVI with SEVs, the application of COV is associated with lower risk of PPI compared with the standard CPV without increasing risk for adverse outcomes.
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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
| | | | - Xander Jacquemyn
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Ozgun Erten
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Aleksander Dokollari
- 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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