|
1
|
Sava RI, Garot P, Benamer H, Gall E, Pezel T, Djebbar M, Sayah N, Meier D, Tzimas G, Garot J, Leclercq F, Akodad M. Redo-Transcatheter Aortic Valve Replacement Procedural Optimization and Patient Selection: From Bench to Clinical Practice. J Clin Med 2025; 14:2770. [PMID: 40283600 PMCID: PMC12027932 DOI: 10.3390/jcm14082770] [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: 03/06/2025] [Revised: 04/10/2025] [Accepted: 04/11/2025] [Indexed: 04/29/2025] Open
Abstract
With recent guidelines expanding transcatheter aortic valve replacement (TAVR) to younger patients, indications for redo-TAVR will also likely increase. When compared with TAVR, redo-TAVR is a rare and novel procedure. Current clinical data derived from registries suggest excellent safety, with low rates of 30-day and 1-year mortality following redo-TAVR. Proper understanding of data from bench studies regarding optimal valve configurations, of patient anatomy and of the technical properties of transcatheter heart valves (THV) is essential for patient selection and procedural success. Lifetime management of redo-TAVR should start before the index procedure, as the choice of the index THV has a major impact on the feasibility of redo-TAVR. Procedural optimization by adequate valve sizing, commissural alignment and adequate implant depth of both index and redo-THV are critical determinants of optimal hemodynamics for maximized valve longevity, as well as lifelong coronary access.
Collapse
Affiliation(s)
- Ruxandra I. Sava
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France; (R.I.S.); (P.G.); (H.B.); (E.G.); (M.D.); (N.S.); (J.G.)
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France; (R.I.S.); (P.G.); (H.B.); (E.G.); (M.D.); (N.S.); (J.G.)
| | - Hakim Benamer
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France; (R.I.S.); (P.G.); (H.B.); (E.G.); (M.D.); (N.S.); (J.G.)
| | - Emmanuel Gall
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France; (R.I.S.); (P.G.); (H.B.); (E.G.); (M.D.); (N.S.); (J.G.)
- Department of Cardiology, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), Université Paris-Cité, 75013 Paris, France;
| | - Théo Pezel
- Department of Cardiology, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), Université Paris-Cité, 75013 Paris, France;
| | - Morad Djebbar
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France; (R.I.S.); (P.G.); (H.B.); (E.G.); (M.D.); (N.S.); (J.G.)
| | - Neila Sayah
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France; (R.I.S.); (P.G.); (H.B.); (E.G.); (M.D.); (N.S.); (J.G.)
| | - David Meier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, 1005 Lausanne, Switzerland; (D.M.); (G.T.)
| | - Georgios Tzimas
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, 1005 Lausanne, Switzerland; (D.M.); (G.T.)
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France; (R.I.S.); (P.G.); (H.B.); (E.G.); (M.D.); (N.S.); (J.G.)
| | | | - Mariama Akodad
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France; (R.I.S.); (P.G.); (H.B.); (E.G.); (M.D.); (N.S.); (J.G.)
| |
Collapse
|
|
2
|
Kitamura M, Trejo-Velasco B, Dumpies O, Rotta Detto Loria J, Majunke N, Wilde J, Desch S, Noack T, Thiele H, Abdel-Wahab M. Fluoroscopic Measurement of Commissural Alignment for Self-Expanding Transcatheter Heart Valves. JACC Cardiovasc Interv 2023; 16:1425-1427. [PMID: 37316155 DOI: 10.1016/j.jcin.2023.04.004] [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: 01/19/2023] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 06/16/2023]
|
|
3
|
Akodad M, Meier D, Tzimas G, Leipsic J, Blanke P, Wood DA, Webb JG, Sathananthan J. A Simplified Fluoroscopic Method for Commissural Alignment Assessment With a Balloon-Expandable Transcatheter Heart Valve. JACC: CASE REPORTS 2023; 13:101804. [PMID: 37077758 PMCID: PMC10107037 DOI: 10.1016/j.jaccas.2023.101804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/17/2023] [Accepted: 02/09/2023] [Indexed: 03/29/2023]
Abstract
We sought to assess commissural alignment of the balloon-expandable valve on fluoroscopy. Commissural alignment was defined on fluoroscopy in 20 patients according to alignment of the valve commissural posts in the 3-cusp and the cusp-overlap view and correlated with post-transcatheter aortic valve replacement computed tomography. Agreement was strong between computed tomography and fluoroscopy (weighted Cohen's kappa coefficient: 0.88). (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Mariama Akodad
- Centre for Heart Valve Innovation, St Paul’s and Vancouver General Hospitals, Vancouver, British Columbia, Canada
- Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, Vancouver, British Columbia, Canada
- Division of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - David Meier
- Centre for Heart Valve Innovation, St Paul’s and Vancouver General Hospitals, Vancouver, British Columbia, Canada
- Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, Vancouver, British Columbia, Canada
- Division of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Georgios Tzimas
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A. Wood
- Centre for Heart Valve Innovation, St Paul’s and Vancouver General Hospitals, Vancouver, British Columbia, Canada
- Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, Vancouver, British Columbia, Canada
| | - John G. Webb
- Centre for Heart Valve Innovation, St Paul’s and Vancouver General Hospitals, Vancouver, British Columbia, Canada
- Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St Paul’s and Vancouver General Hospitals, Vancouver, British Columbia, Canada
- Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, Vancouver, British Columbia, Canada
- Address for correspondence: Dr Janarthanan Sathananthan, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada. @J_Sathananthan
| |
Collapse
|
|
4
|
Akodad M, Lounes Y, Meier D, Sanguineti F, Hovasse T, Blanke P, Sathananthan J, Tzimas G, Leipsic J, Wood DA, Webb J, Chevalier B. Transcatheter heart valve commissural alignment: an updated review. Front Cardiovasc Med 2023; 10:1154556. [PMID: 37153454 PMCID: PMC10155866 DOI: 10.3389/fcvm.2023.1154556] [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: 01/30/2023] [Accepted: 03/28/2023] [Indexed: 05/09/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) indications recently extended to lower surgical risk patients with longer life expectancy. Commissural alignment (CA) is one of the emerging concepts and is becoming one of the cornerstones of the TAVR procedure in a patient with increased longevity. Indeed, CA may improve transcatheter heart valve (THV) hemodynamics, future coronary access, and repeatability. The definition of CA has been recently standardized by the ALIGN-TAVR consortium using a four-tier scale based on CT analysis. Progress has been made during the index TAVR procedure to optimize CA, especially with self-expandable platforms. Indeed, specific delivery catheter orientation, THV rotation, and computed-tomography-derived views have been proposed to achieve a reasonable degree of CA. Recent data demonstrate feasibility, safety, and a significant reduction in coronary overlap using these techniques, especially with self-expandable platforms. This review provides an overview of THV CA including assessment methods, alignment techniques during the index TAVR procedure with different THV platforms, the clinical impact of commissural misalignment, and challenging situations for CA.
Collapse
Affiliation(s)
- Mariama Akodad
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Interventional Cardiology Department, Massy, France
- Correspondence: Mariama Akodad
| | - Youcef Lounes
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Vascular Surgery Department, Massy, France
| | - David Meier
- Division of Cardiology and Department of Radiology, Centresfor Heart Valve Innovation and for Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Francesca Sanguineti
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Interventional Cardiology Department, Massy, France
| | - Thomas Hovasse
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Interventional Cardiology Department, Massy, France
| | - Philipp Blanke
- Division of Cardiology and Department of Radiology, Centresfor Heart Valve Innovation and for Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Division of Cardiology and Department of Radiology, Centresfor Heart Valve Innovation and for Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Georgios Tzimas
- Division of Cardiology and Department of Radiology, Centresfor Heart Valve Innovation and for Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Jonathon Leipsic
- Division of Cardiology and Department of Radiology, Centresfor Heart Valve Innovation and for Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - David A. Wood
- Division of Cardiology and Department of Radiology, Centresfor Heart Valve Innovation and for Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - John Webb
- Division of Cardiology and Department of Radiology, Centresfor Heart Valve Innovation and for Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Bernard Chevalier
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Interventional Cardiology Department, Massy, France
| |
Collapse
|
|
5
|
Kapadia SR, Harb SC, Krishnaswamy A. Fluoroscopic Determination of Commissural Alignment for TAVR Valves. JACC Cardiovasc Interv 2022; 15:2384-2386. [PMID: 36121438 DOI: 10.1016/j.jcin.2022.08.050] [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: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|