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Ahmad D, Sá MP, Kliner D, Serna-Gallegos D, Toma C, Makani A, West D, Wang Y, Thoma F, Ogami T, Hasan I, Sultan I. Transcatheter aortic valve replacement in small aortic annuli: A propensity-matched comparison between intra-annular self-expanding valves and balloon-expandable valves. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2025:S1553-8389(25)00237-4. [PMID: 40368734 DOI: 10.1016/j.carrev.2025.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Revised: 04/17/2025] [Accepted: 05/05/2025] [Indexed: 05/16/2025]
Abstract
BACKGROUND Specific transcatheter aortic valve replacement (TAVR) valve superiority is not established in the small aortic annulus (SAA) population. We sought to compare clinical and echocardiographic characteristics between patients with a SAA who underwent TAVR with either intra-annular self-expanding valves (SEV) or balloon-expandable valves (BEV). METHODS This was an observational, retrospective analysis (2013-2023). SAA was defined as an aortic annulus diameter < 23 mm (maximum) and annulus area ≤ 430 mm2. Unmatched and propensity-score matched (PSM) populations were compared. RESULTS We identified 663 patients with SAA who underwent TAVR with SEV (n = 106) or BEV (n = 557). The PSM cohort (96 pairs) was predominantly female (90.6 % and 87.5 %) with a median age of 82.5 and 81.0 years. No statistically significant differences were observed in VARC-3 outcomes (periprocedural mortality, technical success, device success, clinical efficacy). Higher rates of residual mean gradients >20 mmHg were seen in the BEV group at 30 days (SEV 2.1 % vs BEV 21.9 %, P < 0.001) as well as lower median values of indexed effective orifice area (SEV 0.9 vs 0.6 cm2/m2). Severe PPM was also more common in the BEV group (SEV 5.2 % vs BEV 21.9 %, P = 0.002). At 2 years, differences in the rates of all-cause death (SE 11.9 % vs BE 17.1 %, Plog-rank = 0.6794) and stroke (SEV 3.4 % vs BEV 10.2 %, P = 0.7055) were not statistically significant. CONCLUSIONS Intra-annular SEV presented better hemodynamics compared to BEV; however, survival and incidence of stroke were comparable between the groups at 2 years. Potential risk of nonstructural valve deterioration with BEV needs further investigation with longer follow-up.
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Affiliation(s)
- Danial Ahmad
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America; UPMC Heart and Vascular Institute, Pittsburgh, PA, United States of America
| | - Michel Pompeu Sá
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America; UPMC Heart and Vascular Institute, Pittsburgh, PA, United States of America
| | - Dustin Kliner
- UPMC Heart and Vascular Institute, Pittsburgh, PA, United States of America
| | - Derek Serna-Gallegos
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America; UPMC Heart and Vascular Institute, Pittsburgh, PA, United States of America
| | - Catalin Toma
- UPMC Heart and Vascular Institute, Pittsburgh, PA, United States of America
| | - Amber Makani
- UPMC Heart and Vascular Institute, Pittsburgh, PA, United States of America
| | - David West
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America; UPMC Heart and Vascular Institute, Pittsburgh, PA, United States of America
| | - Yisi Wang
- UPMC Heart and Vascular Institute, Pittsburgh, PA, United States of America
| | - Floyd Thoma
- UPMC Heart and Vascular Institute, Pittsburgh, PA, United States of America
| | - Takuya Ogami
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Irsa Hasan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America; UPMC Heart and Vascular Institute, Pittsburgh, PA, United States of America.
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Barbanti M, Costa G, Windecker S, Maisano F, Laterra G, Leipsic J, Blanke P, Bapat VN, Leon MB, Webb JG. Bicuspid aortic valve disease: advancements and challenges of transcatheter aortic valve implantation. Eur Heart J 2025:ehaf307. [PMID: 40343748 DOI: 10.1093/eurheartj/ehaf307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 01/19/2025] [Accepted: 04/17/2025] [Indexed: 05/11/2025] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of patients with severe aortic stenosis (AS). Initially developed for patients with tricuspid aortic valve (TAV) anatomy, the procedural success and expanding indications of TAVI have spurred interest in its application to more complex aortic valve anatomies, such as the bicuspid aortic valve (BAV). The growing interest in this specific sub-set of patients with AS is driven by the recent extension of TAVI indications to younger individuals, who exhibit a notably higher incidence of bicuspid anatomy compared with older populations. Bicuspid aortic valves present distinct anatomical and pathological complexities that pose significant challenges to the conventional TAVI approach. These include asymmetric calcification, aortic root dilation (also known as BAV aortopathy), and variations in cusp fusion patterns, which can affect valve deployment, transcatheter heart valve sealing, and long-term durability. Despite these challenges, advancements in imaging techniques, valve design, and procedural strategies have led to increased adoption of TAVI in BAV patients. However, surgical aortic valve replacement still retains a more prominent role in this group compared with patients with TAVs. This preference is partly due to the exclusion of BAV patients from almost all previous randomized controlled trials, which limits the available evidence supporting the use of TAVI in this unique cohort. This state-of-the-art review aims to provide a comprehensive overview of the current landscape of TAVI in BAV patients, including an analysis of anatomical considerations and procedural pitfalls, as well as outcomes' improvements with new device iterations. It will also explore clinical data, tackling the risks, benefits, and the evolving role of TAVI in this unique patient cohort.
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Affiliation(s)
- Marco Barbanti
- Department of Medicine and Surgery, Università degli Studi di Enna Kore, Piazza dell'Università, 94100 Enna, Italy
- Division of Cardiology, Umberto I Hospital, ASP 4 of Enna, Contrada Ferrante, 94100 Enna, Italy
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Polilcinico 'G. Rodolico-San Marco, Catania, Italy
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Francesco Maisano
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia Laterra
- Department of Medicine and Surgery, Università degli Studi di Enna Kore, Piazza dell'Università, 94100 Enna, Italy
- Division of Cardiology, Umberto I Hospital, ASP 4 of Enna, Contrada Ferrante, 94100 Enna, Italy
| | - Jonathon Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vinayak N Bapat
- Department of Cardiac Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, 800 E 28th St, MN 55407 Minneapolis, MN, USA
| | - Martin B Leon
- Department of Internal Medicine, Columbia University and Cardiovascular Research Foundation, New York City, NY, USA
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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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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Valvo R, Popolo Rubbio A, Sisinni A, Squillace M, Bedogni F, Testa L. Platform Selection for Patients Undergoing Transcatheter Aortic Valve Replacement: A Practical Approach. Catheter Cardiovasc Interv 2025; 105:1042-1055. [PMID: 39853899 DOI: 10.1002/ccd.31420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 12/19/2024] [Accepted: 01/12/2025] [Indexed: 01/26/2025]
Abstract
Transfemoral transcatheter aortic valve Replacement (TAVR) has become the standard therapy for patients with severe aortic stenosis in patients over 75 years old in Europe or 65 years old in the United States, regardless of the surgical risk. Furthermore, iterations of existing transcatheter aortic valves (TAVs), as well as devices with novel concepts, have provided substantial improvements with respect to the limitations of previous-generation devices. Hence, treatment of a broader spectrum of patients has become feasible, and a sophisticated selection of the appropriate TAV tailored to patients' anatomy and comorbidities is now possible. Anatomy, patient characteristics, and operator experience must all inform proper device selection. This review describes the features and performance of the current generation of TAVs with the aim of providing a practical approach for clinicians when selecting the appropriate TAV for a specific patient.
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Costa G, Pilgrim T, Saia F, Ribichini FL, Gandolfo C, Latib A, Webb JG, Abdel-Wahab M, Mylotte D, Barbanti M, Opera-Tavi FT. Balloon-expandable SAPIEN 3 Ultra valve in intermediate sizing zones: insights from the OPERA-TAVI registry. EUROINTERVENTION 2025; 21:e282-e284. [PMID: 40028731 PMCID: PMC11849532 DOI: 10.4244/eij-d-24-00741] [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: 08/13/2024] [Accepted: 10/31/2024] [Indexed: 03/05/2025]
Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Thomas Pilgrim
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - Francesco Saia
- Cardiovascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | | | - Caterina Gandolfo
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John G Webb
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Darren Mylotte
- Department of Cardiology, University Hospital, University of Galway, Galway, Ireland
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Saad M, Seoudy H, Bramlage K, Bramlage P, Voran JC, Puehler T, Lutter G, Allali A, Landt M, Frank J, Bisht O, Salem M, Wienemann H, Adam M, Zeus T, Veulemans V, Bleiziffer S, Rudolph TK, Frank D. Transcatheter aortic valve replacement in heavily calcified aortic valve stenosis: a multicenter comparison. Clin Res Cardiol 2025; 114:405-415. [PMID: 40063121 PMCID: PMC11913988 DOI: 10.1007/s00392-025-02611-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/24/2024] [Accepted: 01/24/2025] [Indexed: 03/18/2025]
Abstract
BACKGROUND Heavy calcifications in severe aortic stenosis (AS) pose a major challenge in patients undergoing transcatheter aortic valve replacement (TAVR). Only a few studies have addressed the performance of different transcatheter heart valves (THV) in this subgroup of patients. OBJECTIVES We aimed to investigate the outcomes of the self-expanding Medtronic CoreValve Evolut valve frame and the balloon-expandable Edwards SAPIEN-3/3 Ultra THV in this challenging patient population. MATERIALS AND METHODS This was a multicenter registry including a total of 1513 patients with heavily calcified AS undergoing TAVR. The primary endpoint was the incidence and degree of paravalvular leak (PVL) after TAVR. Secondary endpoints were post-implant hemodynamics as well as clinical endpoints according to the VARC-3 definitions. RESULTS The CoreValve Evolut R but not the Evolut PRO showed significantly higher rates of PVL compared to the SAPIEN-3/3 Ultra (44.8% vs. 29.5% for mild PVL, p < 0.001), while there was no significant difference in ≥ moderate PVL between both groups (p = 0.399). The CoreValve Evolut R and Evolut PRO showed superior THV hemodynamics compared to the SAPIEN-3/3 Ultra group. These findings were confirmed in a propensity score-matched analysis. There were no significant differences regarding short-term outcomes including permanent pacemaker implantation and all-cause mortality between the three groups. CONCLUSION In patients with severely calcified AS, both CoreValve Evolut PRO and SAPIEN-3/3 Ultra THV showed lower rates of PVL than the CoreValve Evolut R. The self-expanding CoreValve platform had superior post-implant hemodynamics than the SAPIEN-3/3 Ultra system.
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Affiliation(s)
- M Saad
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, 24105, Kiel, Germany.
| | - H Seoudy
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, 24105, Kiel, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - K Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - P Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - J C Voran
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, 24105, Kiel, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - T Puehler
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
- Department of Cardiac and Vascular Surgery, University Clinical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - G Lutter
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
- Department of Cardiac and Vascular Surgery, University Clinical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - A Allali
- Department of Cardiac and Vascular Surgery, University Clinical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - M Landt
- Heart Center Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - J Frank
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, 24105, Kiel, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - O Bisht
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, 24105, Kiel, Germany
| | - M Salem
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, 24105, Kiel, Germany
| | - H Wienemann
- Klinik III für Innere Medizin-Kardiologie, Herzzentrum der Universität Köln, Kerpener Str. 62, 50937, Köln, Germany
| | - M Adam
- Klinik III für Innere Medizin-Kardiologie, Herzzentrum der Universität Köln, Kerpener Str. 62, 50937, Köln, Germany
| | - T Zeus
- Klinik für Kardiologie, Pneumologie & Angiologie, Universitätsklinikum Düsseldorf, 40225, Düsseldorf, Germany
| | - V Veulemans
- Klinik für Kardiologie, Pneumologie & Angiologie, Universitätsklinikum Düsseldorf, 40225, Düsseldorf, Germany
| | - S Bleiziffer
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, 32545, Bad Oeynhausen, Germany
| | - T K Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, 32545, Bad Oeynhausen, Germany
| | - D Frank
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, 24105, Kiel, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
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Nakase M, Tomii D, Maznyczka A, Heg D, Okuno T, Samim D, Stortecky S, Lanz J, Reineke D, Windecker S, Pilgrim T. Five-year outcomes with self-expanding versus balloon-expandable TAVI in patients with left ventricular systolic dysfunction. Am Heart J 2025; 280:18-29. [PMID: 39536846 DOI: 10.1016/j.ahj.2024.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 10/22/2024] [Accepted: 10/26/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND The importance of transcatheter heart valve (THV) design on clinical outcome in patients with aortic stenosis (AS) and left ventricular (LV) systolic dysfunction remains unknown. OBJECTIVES We aimed to compare 5-year outcomes of patients with severe AS and reduced LV ejection fraction (LVEF), undergoing transcatheter aortic valve implantation (TAVI) with balloon-expandable vs. self-expanding THVs. METHODS In a retrospective analysis from the Bern TAVI registry, patients with LVEF <50% who underwent TAVI with either balloon-expandable or self-expanding THVs were included. A 1:1 propensity-score matching was performed to account for baseline differences between groups. RESULTS A total of 759 patients were included between August 2007 and December 2022, and propensity-score matching resulted in 134 pairs. Technical success was achieved in over 85% of patients, and was similar in both groups. Self-expanding THVs were associated with a lower mean transvalvular gradient (7.1 ± 3.7 mmHg vs. 9.9 ± 4.3 mmHg; P < .001) and a higher incidence of ≥mild-to-moderate paravalvular regurgitation (36.3% vs. 11.3%; P < .001) compared to balloon-expandable THVs. At 5 years, patients treated with a self-expanding THV had higher all-cause mortality than those with a balloon-expandable THV (67.8% vs. 55.8%, HRadjusted: 1.44; 95% CI: 1.02-2.03; P = .037). There were no significant differences in other clinical outcomes up to 5 years between groups. CONCLUSIONS In the setting of LV systolic dysfunction, patients treated with a self-expanding THV had higher risk of 5-year mortality compared to patients treated with a balloon-expandable THV. CLINICAL TRIAL REGISTRATION https://www. CLINICALTRIALS gov. NCT01368250.
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Affiliation(s)
- Masaaki Nakase
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daijiro Tomii
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annette Maznyczka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dik Heg
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Taishi Okuno
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daryoush Samim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Patel KP, Baumbach A. TAVR and Strokes: Are Aortic Atheromas Part of the Story? JACC. ASIA 2025; 5:270-272. [PMID: 39967217 PMCID: PMC11840227 DOI: 10.1016/j.jacasi.2024.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 11/14/2024] [Indexed: 02/20/2025]
Affiliation(s)
- Kush P Patel
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Andreas Baumbach
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
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9
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Costa G, Barbanti M, Rosato S, Tarantini G, Tamburino C, Biancari F, Badoni G, Santoro G, Baiocchi M, Baglio G, D'Errigo P. Five-Year Multiple Comparison of Transcatheter Aortic Valves: Insights From the OBSERVANT II study. Can J Cardiol 2025; 41:264-271. [PMID: 39617051 DOI: 10.1016/j.cjca.2024.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 09/30/2024] [Accepted: 10/26/2024] [Indexed: 12/29/2024] Open
Abstract
BACKGROUND Head-to-head comparisons of second and third generations of transcatheter heart valves (THVs) are mostly limited to 2-arm studies and to mid-term follow-up. The aim of this study was to simultaneously compare clinical outcomes of transcatheter aortic valve replacement (TAVR) with 4 different THVs at 5 years. METHODS Patients undergoing transfemoral TAVR with 4 second-generation THV platforms and enrolled in the multicentre prospective OBSERVANT II study from December 2016 to September 2018 were compared according to the THV received. Outcomes were adjudicated through a linkage with administrative databases and adjusted by means of inverse propensity of treatment weighting (IPTW) based on propensity score. The primary end points were death from any cause and major adverse cardiac and cerebrovascular events (MACCE) at 5 years. Cumulative rates were reported consecutively for Evolut R/Pro, Sapien 3, Acurate Neo, and Portico groups. RESULTS A total of 2493 patients were considered. The median age was 83 years and median EuroSCORE 2 was 4.9%. After IPTW adjustment, the rates of all-cause death (53.6%, 46.7%, 50.5%, and 46.3%; P = 0.06) and MACCE (57.2%, 51.2%, 54.4%, and 50.6%; P = 0.08) did not differ among the groups at 5 years. The rate of rehospitalisation for heart failure (HF) (33.9%, 27.0%, 31.6%, 33.7%; P = 0.02) was significantly lower for Sapien 3 at 5 years. CONCLUSIONS Data from real-world practice showed sustained and similar effectiveness of TAVR considering all the available THVs up to 5 years, but Sapien 3 showed a lower rate of rehospitalisation for HF.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, AOU Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Marco Barbanti
- Università degli Studi di Enna "Kore," Enna, Italy; Division of Cardiology, Umberto I Hospital, ASP 4 di Enna, Enna, Italy.
| | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Giuseppe Tarantini
- Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Corrado Tamburino
- Division of Cardiology, AOU Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Fausto Biancari
- Department of Medicine, South Karelja Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Gabriella Badoni
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Gennaro Santoro
- Fondazione "G. Monasterio" CNR/Regione Toscana per la Ricerca Medica e la Sanità Pubblica, Massa, Italy
| | - Massimo Baiocchi
- Anestesia e Rianimazione Dipartimento Cardiotoracovascolare, IRCSS Policlinico S Orsola, Università degli Studi di Bologna, Bologna, Italy
| | - Giovanni Baglio
- Italian National Agency for Regional Health Care Services, Rome, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
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Sá MP, Ahmad D, Wang Y, Thoma F, Makani A, Kliner D, Toma C, West D, Serna-Gallegos D, Sultan I. Supra-Annular Versus Intra-Annular Self-Expanding Valves in Small Aortic Annulus: A Propensity Score-Matched Study. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2025; 9:100334. [PMID: 40017835 PMCID: PMC11864141 DOI: 10.1016/j.shj.2024.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 03/01/2025]
Abstract
Background Transcatheter aortic valve replacement (TAVR) with self-expanding valves (SEVs) may have different outcomes with supra-annular valves (SAVs) or intra-annular valves (IAVs) in patients with small aortic annuli (SAA), but this topic remains underexplored. We aimed to evaluate outcomes between different SEVs, namely SAVs (CoreValve/Evolut R/PRO/PRO+/FX) vs. IAVs (Portico/Navitor). Methods Single-center data with patients with SAA (maximum diameter <23 mm) who underwent TAVR from 2013 to 2023 with SEVs, followed by 1:1 propensity score matching (PSM). Results We obtained 86 PSM pairs with median age of 83.0 years (SAVs) and 82.0 years (IAVs), with women representing 77.6% of the PSM cohort. After TAVR, we did not find statistically significant differences for the following outcomes: Valve Academic Research Consortium-3 periprocedural mortality, technical success, device success, clinical efficacy, and rates of paravalvular leak were not statistically significantly different, but we found higher rates of permanent pacemaker implantation in the IAV group (1.2 vs. 8.1%; p = 0.029). Despite the larger indexed effective orifice area with SAVs (median 1.0 vs. 0.8 cm2/m2, p = 0.001), we did not find statistically significant differences between the groups in terms of residual mean gradients >20 mmHg (0.0 vs. 2.3%, p = 0.155), and severe prosthesis-patient mismatch (2.3 vs. 5.8%, p = 0.390). No statistically significant difference was observed in survival (log-rank p = 0.950) and stroke (p = 0.6547) between patients who received SAVs and IAVs. For patients with SAA, TAVR with SEV devices is safe. Conclusions IAVs and SAVs are associated with comparable device performance in terms of hemodynamic structural and nonstructural dysfunction. Randomized data are needed to validate these findings and guide informed device selection.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Danial Ahmad
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Yisi Wang
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Floyd Thoma
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amber Makani
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Interventional Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dustin Kliner
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Interventional Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Catalin Toma
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Interventional Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David West
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Derek Serna-Gallegos
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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11
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Kroon HG, Hokken T, van Wiechen M, Ooms JFW, van Gils L, Kardys I, Daemen J, De Jaegere PPT, Nuis RJ, Van Mieghem NM. Conduction dynamics over time after transcatheter aortic valve replacement: An expert review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2025; 70:92-102. [PMID: 39299841 DOI: 10.1016/j.carrev.2024.08.005] [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: 04/15/2024] [Revised: 07/27/2024] [Accepted: 08/13/2024] [Indexed: 09/22/2024]
Abstract
New conduction disorders remain a frequent complication in current transcatheter aortic valve replacement (TAVR) era. Left bundle branch block (LBBB) occurs early in about 20-30 % of TAVR-patients, persists at 1 month in about 35-45 % of cases and will likely remain thereafter. Third-degree atrioventricular block (AV3B) affects approximately 15 % of patients. Pacemaker dependency gradually decreases throughout follow-up and approximately 25-35 % of patients remain pacemaker dependent at one year. We aimed to review what is currently known about the dynamics of acquired conduction disorders, including extraction of predictors, and how to interpret these dynamics in light of an early discharge policy.
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Affiliation(s)
- Herbert G Kroon
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Thijmen Hokken
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Maarten van Wiechen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Joris F W Ooms
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lennart van Gils
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter P T De Jaegere
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rutger-Jan Nuis
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
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12
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Gonzálvez-García A, Cepas-Guillén P, Ternacle J, Urena M, Alperi A, Cheema AN, Veiga-Fernández G, Nombela-Franco L, Vilalta V, Esposito G, Campelo-Parada F, Idolfi C, Del Trigo M, Muñoz-García A, Maneiro N, Asmarats L, Regueiro A, Del Val D, Serra V, Auffret V, Jonveaux M, Bonnet G, Mesnier J, Gaspard S, Avanzas P, Rezaei E, Fradejas-Sastre V, Tirado-Conte G, Fernández-Nofrerías E, Franzone A, Guitteny T, Sorrentino S, Oteo JF, Díez-Delhoyo F, Gutiérrez-Alonso L, Vidal P, Alfonso F, Monastyrski A, Nolf M, Pelletier-Beaumont E, Avvedimento M, Rodés-Cabau J. Early safety after TAVR according to VARC-3 criteria: incidence, predictors, and clinical impact. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00363-3. [PMID: 39722415 DOI: 10.1016/j.rec.2024.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 12/09/2024] [Indexed: 12/28/2024]
Abstract
INTRODUCTION AND OBJECTIVES The Valve Academic Research Consortium (VARC)-3 definition of the early safety (ES) composite endpoint after transcatheter aortic valve replacement (TAVR) lacks clinical validation. The aim of this study was to determine the incidence, predictors, and clinical impact of ES after TAVR as defined by VARC-3 criteria. METHODS We performed a multicenter study including 10 078 patients with severe aortic stenosis undergoing transarterial TAVR. According to VARC-3 criteria, ES at 30 days was defined as freedom from all-cause mortality, stroke, VARC type 2-4 bleeding, major vascular, access-related, or cardiac structural complications, acute kidney injury stages 3-4, moderate or severe aortic regurgitation, new permanent pacemaker implantation, and surgery or intervention related to the device. Baseline, procedural, and follow-up data were prospectively collected in a dedicated database. RESULTS ES was achieved in 6598 patients (65.5%). The main factors associated with a lack of ES were the occurrence of type 2-4 bleeding (18.9%), and new pacemaker implantation (13.6%). Advanced age, peripheral artery disease, chronic kidney disease, and balloon postdilation were associated with an increased risk of no-ES (P<.01 for all). Failure to achieve ES was associated with higher all-cause mortality up to 1-year after TAVR (HR, 3.17; 95%CI, 2.76-3.65; P<.001). CONCLUSIONS VARC-3 ES was not achieved in up to one-third of contemporary TAVR patients, which was associated with worse mid-term outcomes. The factors associated with increased risk were advanced age, baseline comorbidities, and some procedural features (postdilation). These findings highlight the importance of continued efforts to minimize the risk of TAVR-related procedural complications.
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Affiliation(s)
- Ariana Gonzálvez-García
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain. https://x.com/@ari_gonzalvez
| | - Pedro Cepas-Guillén
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. https://x.com/@pedro_cepas
| | - Julien Ternacle
- Département de Cardiologie, Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, Bordeaux, France
| | - Marina Urena
- Département de Cardiologie(,) Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alberto Alperi
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Asim N Cheema
- Cardiology Department, Southlake Regional Health Centre Newmarket, Ontario, Canada
| | - Gabriela Veiga-Fernández
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - Luis Nombela-Franco
- Servicio de Cardiología, Instituto Cardiovascular Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Victoria Vilalta
- Servicio de Cardiología, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Giovanni Esposito
- Dipartimento di Scienze Biomediche Avanzate, Università di Napoli Federico II, Naples, Italy
| | | | - Ciro Idolfi
- Dipartimento di Cardiologia, Università di 'Magna Graecia', Catanzaro, Italy
| | - María Del Trigo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Nicolás Maneiro
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis Asmarats
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ander Regueiro
- Servei de Cardiologia, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - David Del Val
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain
| | - Vicenç Serra
- Servicio de Cardiología, Hospital Univesitario Vall d'Hebron, Barcelona, Spain
| | - Vincent Auffret
- Département de Cardiologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Melchior Jonveaux
- Département de Cardiologie, Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, Bordeaux, France
| | - Guillaume Bonnet
- Département de Cardiologie, Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, Bordeaux, France
| | - Jules Mesnier
- Département de Cardiologie(,) Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Suc Gaspard
- Département de Cardiologie(,) Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pablo Avanzas
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Effat Rezaei
- Cardiology Department, Southlake Regional Health Centre Newmarket, Ontario, Canada
| | - Víctor Fradejas-Sastre
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - Gabriela Tirado-Conte
- Servicio de Cardiología, Instituto Cardiovascular Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Anna Franzone
- Dipartimento di Scienze Biomediche Avanzate, Università di Napoli Federico II, Naples, Italy
| | - Thibaut Guitteny
- Département de Cardiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sabato Sorrentino
- Dipartimento di Cardiologia, Università di 'Magna Graecia', Catanzaro, Italy
| | - Juan Francisco Oteo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Felipe Díez-Delhoyo
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Pablo Vidal
- Servei de Cardiologia, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain
| | - Andrea Monastyrski
- Servicio de Cardiología, Hospital Univesitario Vall d'Hebron, Barcelona, Spain
| | - Maxime Nolf
- Département de Cardiologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Emilie Pelletier-Beaumont
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Marisa Avvedimento
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. https://x.com/@MAvvedimento
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Department of Research and Innovation, Clínic Barcelona, Barcelona, Spain.
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13
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Hioki H, Yamamoto M, Shirai S, Ohno Y, Yashima F, Naganuma T, Yamawaki M, Watanabe Y, Yamanaka F, Mizutani K, Ryuzaki T, Noguchi M, Izumo M, Takagi K, Asami M, Ueno H, Nishina H, Otsuka T, Suzuyama H, Yamasaki K, Nishioka K, Hachinohe D, Fuku Y, Hayashida K. Valve Performance Between Latest-Generation Balloon-Expandable and Self-Expandable Transcatheter Heart Valves in a Small Aortic Annulus. JACC Cardiovasc Interv 2024; 17:2612-2622. [PMID: 39603775 DOI: 10.1016/j.jcin.2024.08.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 08/04/2024] [Accepted: 08/27/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) using a self-expandable valve (SEV) promotes better hemodynamics compared with a balloon-expandable valve (BEV) in a small aortic annulus (SAA). OBJECTIVES The authors sought to compare hemodynamic properties and clinical outcomes between the latest-generation BEV and SEV after TAVR for SAA. METHODS We retrospectively analyzed 1,227 patients undergoing TAVR for aortic stenosis with SAA, defined as an annulus area ≤430 mm2, using the BEV (SAPIEN3 Ultra RESILIA, Edwards Lifesciences) and SEV (Evolut FX, Medtronic). The impact of valve design on severe prosthesis-patient mismatch, aortic valve mean pressure gradient ≥20 mm Hg, paravalvular leakage (PVL) ≥ mild, new permanent pacemaker implantation (PMI), and modified VARC-3 device success at discharge was evaluated using logistic regression and propensity score analysis. RESULTS Of 1,227 patients, 798 (65.0%) underwent TAVR with BEV implantation. TAVR using BEV had a relatively higher rate of severe prosthesis-patient mismatch (OR: 1.74; 95% CI: 0.54-5.62) and significantly higher incidence of mean pressure gradient ≥20 mm Hg (OR: 2.05; 95% CI: 0.91-4.62) than that using SEV. By contrast, the BEV showed significantly lower incidence of PVL ≥ mild (OR: 0.19; 95% CI: 0.14-0.26), and new PMI (OR: 0.53; 95% CI: 0.33-0.86). The rate of device success was comparable between the BEV and the SEV. These results were confirmed by propensity score analysis. CONCLUSIONS In TAVR for SAA, SEV demonstrated better hemodynamics than the latest BEV, whereas the latest BEV had lower incidences of PVL ≥ mild and new PMI than the SEV.
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Affiliation(s)
- Hirofumi Hioki
- Department of Cardiology, IMS Tokyo Katsushika General Hospital, Tokyo, 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
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Tsurumi, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Toshinobu Ryuzaki
- Division of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Ichikawa Medical Center, Urayasu, Japan
| | - Masaki Izumo
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kensuke Takagi
- Department of Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan; Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Hiroto Suzuyama
- Department of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Kazumasa Yamasaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Hokkaido, Japan
| | - Kenji Nishioka
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Daisuke Hachinohe
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
| | - Kentaro Hayashida
- Division of Cardiology, Keio University School of Medicine, Tokyo, Japan
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14
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Nuche J, Ellenbogen KA, Mittal S, Windecker S, Benavent C, Philippon F, Rodés-Cabau J. Conduction Disturbances After Transcatheter Aortic Valve Replacement: An Update on Epidemiology, Preventive Strategies, and Management. JACC Cardiovasc Interv 2024; 17:2575-2595. [PMID: 39603774 DOI: 10.1016/j.jcin.2024.07.032] [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: 05/22/2024] [Revised: 07/15/2024] [Accepted: 07/23/2024] [Indexed: 11/29/2024]
Abstract
Conduction disturbances (CDs) are common after transcatheter aortic valve replacement. Continuous improvements in preprocedural planification, implant techniques, and device design have markedly reduced periprocedural complications. However, CDs rate remains in the double-digit range. Because CDs after TAVR are associated with poorer outcomes, seeking a reduction in their occurrence is paramount. Several nonmodifiable and modifiable factors are associated with an increased risk of CDs. Previous right bundle branch block has been shown to have a strong association with pacemaker implant after TAVR. Among the modifiable factors, a lower implantation depth seems to be associated with a higher risk of CDs, and several implant strategies aiming to obtain a higher implant depth have shown promising results. This literature review provides a detailed description of updated evidence about the epidemiology, impact, and preventive and management strategies of CDs after TAVR. Also, based on these updated data, a fast-track protocol CDs management is proposed.
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Affiliation(s)
- Jorge Nuche
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria 12 de Octubre, Madrid, Spain; Consorcio de Investigación Biomédica en Red-Cardiovascular, Madrid, Spain
| | | | - Suneet Mittal
- Valley Hospital and the Snyder Center for Comprehensive Atrial Fibrillation, Paramus, New Jersey, USA
| | - Stephan Windecker
- Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carla Benavent
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clinic de Barcelona, Barcelona, Spain.
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15
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Patel KP, Rathod KS, Lansky AJ, Prendergast B, Kharbanda RK, Mathur A, Perry R, Baumbach A. Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Replacement: A Review. Stroke 2024; 55:2754-2764. [PMID: 39371005 DOI: 10.1161/strokeaha.124.047149] [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] [Indexed: 10/08/2024]
Abstract
Cerebrovascular events (CVEs) are a dreaded complication of transcatheter aortic valve replacement (TAVR). They are associated with significant mortality, morbidity, and reduced quality of life and impose a significant burden to health care systems. Although the rates of clinical stroke have reduced since the advent of TAVR, it remains an important complication, particularly as TAVR is increasingly utilized. CVE may occur at the time of the TAVR, as a direct consequence of the procedure, or may occur later, related to thrombosis of the prosthetic valve, atrial fibrillation, and other comorbidities. Imaging of the brain has revealed a high prevalence of subclinical cerebral infarcts (68%-98%) associated with the TAVR procedure. Although their clinical significance has not been fully established, clinically evident CVE ranges between 3% and 5% in patients considered at high operative risk to between 1% and 3% in low operative risk patients. Periprocedural CVEs are largely the result of embolization of the thrombus and tissue derived from the valve, vasculature, or myocardium. Cerebral embolic protection devices have been studied in multiple trials, with some evidence supporting a reduction in new cerebral lesion volume, number, and potentially disabling strokes. However, thus far, there is no robust evidence that they reduce the overall stroke rate. The number and severity of comorbidities, in particular, new-onset atrial fibrillation, are associated with CVEs. Valve thrombosis diagnosed using computed tomography as areas of hypoattenuated leaflet thickening has been identified in 10% to 15% of patients. This is a dynamic process associated with an increase in CVEs, but that resolves with anticoagulation or sometimes without it. Routine use of anticoagulation compared with a single antiplatelet agent is associated with an increased risk of bleeding, without any additional alleviation in risk of thromboembolism. Future studies to improve risk stratification could facilitate the tailoring of preventive therapies to patients at high risk of CVE, who stand to gain the most benefit.
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Affiliation(s)
- Kush P Patel
- Institute of Cardiovascular Science, University College London, UK (K.P.P.)
- Barts Heart Centre, St Bartholomew's Hospital, London, UK (K.P.P., K.S.R., A.M., A.B.)
| | - Krishnaraj S Rathod
- Barts Heart Centre, St Bartholomew's Hospital, London, UK (K.P.P., K.S.R., A.M., A.B.)
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK (K.S.R., A.M., A.B.)
| | | | - Bernard Prendergast
- Cleveland Clinic London, UK (B.P., A.B.)
- St Thomas' Hospital, London, UK (B.P.)
| | - Rajesh K Kharbanda
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK (R.K.K.)
| | - Anthony Mathur
- Barts Heart Centre, St Bartholomew's Hospital, London, UK (K.P.P., K.S.R., A.M., A.B.)
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK (K.S.R., A.M., A.B.)
- National Institute of Health and Care Research (NINR) Barts Biomedical Research Centre, Queen Mary University of London, UK (A.M., A.B.)
| | - Richard Perry
- University College London, Queen Square Institute of Neurology and the National Hospital for Neurology & Neurosurgery, UK (R.P.)
| | - Andreas Baumbach
- Barts Heart Centre, St Bartholomew's Hospital, London, UK (K.P.P., K.S.R., A.M., A.B.)
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK (K.S.R., A.M., A.B.)
- Cleveland Clinic London, UK (B.P., A.B.)
- National Institute of Health and Care Research (NINR) Barts Biomedical Research Centre, Queen Mary University of London, UK (A.M., A.B.)
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16
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Yamashita Y, Sicouri S, Baudo M, Dokollari A, Ridwan K, Rodriguez R, Goldman S, Ramlawi B. Early clinical and hemodynamic outcomes of balloon-expandable versus self-expanding transcatheter aortic valve replacement in patients with large aortic annulus: a study-level meta-analysis. Indian J Thorac Cardiovasc Surg 2024; 40:696-706. [PMID: 39416329 PMCID: PMC11473460 DOI: 10.1007/s12055-024-01770-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 10/19/2024] Open
Abstract
Purpose This study aimed to compare early clinical and hemodynamic outcomes of transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis and large aortic annulus using either balloon-expandable valves (BEVs) or self-expanding valves (SEVs). Methods A comprehensive search of PubMed, Scopus, and the Cochrane Central Register of Controlled Trials was conducted through September 10, 2023, to perform a meta-analysis comparing the clinical outcomes of BEV versus SEV for large aortic annulus (annulus perimeter ≥ 80 mm). Results Seven studies (one propensity-matched study and six observational studies) met our eligibility criteria, including a total of 2167 patients (BEV, 1521; SEV, 646). The rates of procedural stroke (pooled odds ratio 0.55, 95% confidence interval 0.32-0.98), valve embolization (0.11, 0.05-0.24), need for second valve implantation (0.21, 0.17-0.26), permanent pacemaker implantation (0.43, 0.28-0.67), and aortic regurgitation ≥ moderate (0.23, 0.08-0.68) were significantly lower in the BEV group. Conversely, postoperative transvalvular gradient was significantly lower in the SEV group (pooled standard mean difference 0.55, 0.12-0.98). Subgroup analysis with newer-generation valves also showed significant differences in the need for second valve implantation and permanent pacemaker implantation, as well as aortic regurgitation ≥ moderate, favoring BEVs. Conclusions BEV provides better early outcomes in TAVR for large aortic annulus in terms of lower rates of stroke, valve embolization, need for second valve, permanent pacemaker implantation, and aortic regurgitation ≥ moderate. Conversely, SEV provides a better transvalvular gradient in the early period after TAVR. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-024-01770-1.
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Affiliation(s)
- Yoshiyuki Yamashita
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, 100E Lancaster Ave., Wynnewood, PA 19096 USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, 100E Lancaster Ave., Wynnewood, PA 19096 USA
| | - Massimo Baudo
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, 100E Lancaster Ave., Wynnewood, PA 19096 USA
| | - Aleksander Dokollari
- Department of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB Canada
| | - Khalid Ridwan
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA USA
| | - Roberto Rodriguez
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA USA
| | - Scott Goldman
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA USA
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, 100E Lancaster Ave., Wynnewood, PA 19096 USA
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA USA
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17
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Husain A, Jelisejevas J, Chatfield A, Akodad M, Lauck SB, Achtem L, Tang E, Zaky F, Blanke P, Leipsic J, Sellers SL, Ye J, Cheung A, Moss R, Wood D, Boone R, Meier D, Sathananthan J, Webb JG. An Optimized Assessment Pathway for Remote Patients: The Vancouver Facilitated Transcatheter Aortic Valve Implantation Program. CJC Open 2024; 6:1220-1226. [PMID: 39525335 PMCID: PMC11544281 DOI: 10.1016/j.cjco.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/01/2024] [Indexed: 11/16/2024] Open
Abstract
Background Novel pathways are needed to accommodate the increasing demand for transcatheter aortic valve implantation (TAVI) and ensure equitable access. A single Vancouver Facilitated TAVI program (VFTP) based at St. Paul's and Vancouver General Hospitals was established to streamline the assessment of remote patients with severe aortic stenosis using virtual technologies. Methods Remote patients with severe aortic stenosis who expressed difficulties traveling to complete their pre-TAVI workup were included and received prospective follow-up. Clinical and echocardiographic parameters were reported per the Valve Academic Research Consortium 3. Results Between December 2020 and March 2023, a total of 56 remote patients were included in the VFTP. The mean patient age was 79.7 ± 9.1 years. A total of 55 patients (98%) passed the screening for candidacy; 45 patients (80%) were found suitable for transfemoral TAVI, 5 patients (9%) were directed toward surgical aortic valve replacement; 3 (5%) underwent alternative-access TAVI; and 2 patients (4%) were assigned to a watchful waiting strategy. No inpatient mortality, stroke, or major bleeding occurred in the transfemoral TAVI group, and the median hospital stay was 1 day (interquartile range, 1-2 days; range, 1-24 days). Two patients had an access-closure failure requiring surgical intervention; 1 patient had tamponade; and 4 patients had complete heart block requiring permanent pacemaker implantation. No hospital readmission had occurred at 30 days. Conclusions A simplified assessment pathway to assess TAVI candidacy using virtual technologies is safe and feasible. The VFTP potentially can increase access to TAVI and reduce inequity in TAVI care.
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Affiliation(s)
- Ali Husain
- Centre for Cardiovascular Innovation, St Paul’s Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julius Jelisejevas
- Centre for Cardiovascular Innovation, St Paul’s Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Chatfield
- Centre for Cardiovascular Innovation, St Paul’s Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mariama Akodad
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Sandra B. Lauck
- Centre for Cardiovascular Innovation, St Paul’s Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie Achtem
- Centre for Cardiovascular Innovation, St Paul’s Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erin Tang
- Centre for Cardiovascular Innovation, St Paul’s Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fady Zaky
- Centre for Cardiovascular Innovation, St Paul’s Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Centre for Cardiovascular Innovation, St Paul’s Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Leipsic
- Centre for Cardiovascular Innovation, St Paul’s Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie L. Sellers
- Centre for Cardiovascular Innovation, St Paul’s Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada
| | - Jian Ye
- Division of Cardiac Surgery, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anson Cheung
- Division of Cardiac Surgery, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Moss
- Centre for Cardiovascular Innovation, St Paul’s Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Wood
- Centre for Cardiovascular Innovation, St Paul’s Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Robert Boone
- Centre for Cardiovascular Innovation, St Paul’s Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Meier
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul’s Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada
| | - John G. Webb
- Centre for Cardiovascular Innovation, St Paul’s Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada
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18
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Isogai T, Spilias N, Bakhtadze B, Sabbak N, Denby KJ, Layoun H, Agrawal A, Shekhar S, Yun JJ, Puri R, Harb SC, Reed GW, Krishnaswamy A, Kapadia SR. Outcomes and treatment strategy of transcatheter aortic valve replacement with balloon-expandable valve in borderline-size annulus. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 66:6-14. [PMID: 38641438 DOI: 10.1016/j.carrev.2024.03.030] [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: 03/23/2024] [Accepted: 03/27/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Candidates for transcatheter aortic valve replacement (TAVR) occasionally have a "borderline-size" aortic annulus between 2 transcatheter heart valve sizes, based on the manufacturer's sizing chart. Data on TAVR outcomes in such patients are limited. METHODS We retrospectively reviewed 1816 patients who underwent transfemoral-TAVR with balloon-expandable valve (BEV) at our institution between 2016 and 2020. We divided patients into borderline and non-borderline groups based on computed tomography-derived annular measurements and compared outcomes. Furthermore, we analyzed procedural characteristics and compared outcomes between the smaller- and larger-valve strategies in patients with borderline-size annulus. RESULTS During a median follow-up of 23.3 months, there was no significant difference between the borderline (n = 310, 17.0 %) and non-borderline (n = 1506) groups in mortality (17.3 % vs. 19.5 %; hazard ratio [HR] = 0.86 [95% CI = 0.62-1.20], p = 0.39), major adverse cardiac/cerebrovascular events (MACCE: death/myocardial infarction/stroke, 21.2 % vs. 21.5 %; HR = 0.97 [0.71-1.32], p = 0.85), paravalvular leak (PVL: mild 21.8 % vs. 20.6 %, p = 0.81; moderate 0 % vs. 1.2 %; p = 0.37), or mean gradient (12.9 ± 5.8 vs. 12.6 ± 5.2 mmHg, p = 0.69) at 1 year. There was no significant difference between the larger-(n = 113) and smaller-valve(n = 197) subgroups in mortality (23.7 % vs. 15.2 %; HR = 1.57 [0.89-2.77], p = 0.12), MACCE (28.1 % vs. 18.4 %; HR = 1.52 [0.91-2.54], p = 0.11), mild PVL (13.3 % vs. 25.9 %; p = 0.12), or mean gradient (12.3 ± 4.5 vs. 13.6 ± 5.3 mmHg, p = 0.16); however, the rate of permanent pacemaker implantation (PPI) was higher in the larger-valve subgroup (15.9 % vs. 2.6 %, p < 0.001). CONCLUSION Borderline-size annulus is not associated with higher risk of adverse outcomes after BEV-TAVR. However, the larger-valve strategy for borderline-size annulus is associated with higher PPI risk, suggesting a greater risk of injury to the conduction system.
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Affiliation(s)
- Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nikolaos Spilias
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Beka Bakhtadze
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nabil Sabbak
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kara J Denby
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James J Yun
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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19
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Nuis RJ, van den Dorpel M, Adrichem R, Daemen J, Van Mieghem N. Conduction Abnormalities after Transcatheter Aortic Valve Implantation: Incidence, Impact and Management Using CT Data Interpretation. Interv Cardiol 2024; 19:e12. [PMID: 39221063 PMCID: PMC11363062 DOI: 10.15420/icr.2024.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/09/2024] [Indexed: 09/04/2024] Open
Abstract
The demonstrated safety and effectiveness of transcatheter aortic valve implantation (TAVI) among low surgical risk patients opened the road to its application in younger low-risk patients. However, the occurrence of conduction abnormalities and need for permanent pacemaker implantation remains a frequent problem associated with adverse outcomes. The clinical implications may become greater when TAVI shifts towards younger populations, highlighting the need for comprehensive strategies to address this issue. Beyond currently available clinical and electrocardiographic predictors, patient-specific anatomical assessment of the aortic root using multi-sliced CT (MSCT) imaging can refine risk stratification. Moreover, leveraging MSCT data for computational 3D simulations to predict device-anatomy interactions may help guide procedural strategy to mitigate conduction abnormalities. The aims of this review are to summarise the incidence and clinical impact of new left bundle branch block and permanent pacemaker implantation post-TAVI using contemporary transcatheter heart valves; and highlight the value of MSCT data interpretation to improve the management of this complication.
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Affiliation(s)
- Rutger-Jan Nuis
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Mark van den Dorpel
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Rik Adrichem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Nicolas Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
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20
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Guo Y, Liu X, Li R, Ng S, Liu Q, Wang L, Hu P, Ren K, Jiang J, Fan J, He Y, Zhu Q, Lin X, Li H, Wang J. Comparison of downsizing strategy (HANGZHOU Solution) and standard annulus sizing strategy in type 0 bicuspid aortic stenosis patients undergoing transcatheter aortic valve replacement: Rationale and design of a randomized clinical trial. Am Heart J 2024; 274:65-74. [PMID: 38701961 DOI: 10.1016/j.ahj.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/21/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND There has not been a consensus on the prothesis sizing strategy in type 0 bicuspid aortic stenosis (AS) patients undergoing transcatheter aortic valve replacement (TAVR). Modifications to standard annular sizing strategies might be required due to the distinct anatomical characteristics. We have devised a downsizing strategy for TAVR using a self-expanding valve specifically for patients with type 0 bicuspid AS. The primary aim of this study is to compare the safety and efficacy of downsizing strategy with the Standard Annulus Sizing Strategy in TAVR for patients with type 0 bicuspid AS. TRIAL DESIGN It is a prospective, multi-center, superiority, single-blinded, randomized controlled trial comparing the Down Sizing and Standard Annulus Sizing Strategy in patients with type 0 bicuspid aortic stenosis undergoing transcatheter aortic valve replacement. Eligible participants will include patients with severe type 0 bicuspid AS, as defined by criteria such as mean gradient across aortic valve ≥40 mmHg, peak aortic jet velocity ≥4.0 m/s, aortic valve area (AVA) ≤1.0 cm², or AVA index ≤0.6 cm2/m2. These patients will be randomly assigned, in a 1:1 ratio, to either the Down Sizing Strategy group or the Standard Sizing Strategy group. In the Down Sizing Strategy group, a valve one size smaller will be implanted if the "waist sign" manifests along with less than mild regurgitation during balloon pre-dilatation. The primary end point of the study is a composite of VARC-3 defined device success, absence of both permanent pacemaker implantation due to high-degree atrioventricular block and new-onset complete left bundle branch block. CONCLUSION This study will compare the safety and efficacy of Down Sizing Strategy with the Standard Annulus Sizing Strategy and provide valuable insights into the optimal approach for sizing in TAVR patients with type 0 bicuspid AS. We hypothesize that the Down Sizing Strategy will demonstrate superiority when compared to the Standard Annulus Sizing Strategy. (Down Sizing Strategy (HANGZHOU Solution) vs Standard Sizing Strategy TAVR in Bicuspid Aortic Stenosis (Type 0) (TAILOR-TAVR), NCT05511792).
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Affiliation(s)
- Yuchao Guo
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China; Research Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzhou 310053, China
| | - Ranxi Li
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Stella Ng
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Qiong Liu
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Lihan Wang
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Po Hu
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Kaida Ren
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Jubo Jiang
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Jiaqi Fan
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Yuxin He
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Qifeng Zhu
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Xinping Lin
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Huajun Li
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China
| | - Jian'an Wang
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou 310009, China; Research Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzhou 310053, China.
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21
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Bharucha AH, Kanyal R, Mullen M, Patel K, Smith D, Shome J, Blackman DJ, Aktaa S, Williams PD, Khogali S, Dworakowski R, Eskandari M, Byrne J, MacCarthy P. Transcatheter Aortic Valve Replacement With the Navitor System: Real-World United Kingdom Experience. Am J Cardiol 2024; 222:23-28. [PMID: 38692400 DOI: 10.1016/j.amjcard.2024.04.036] [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: 02/04/2024] [Revised: 04/05/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024]
Abstract
The Navitor transcatheter heart valve (THV) is the latest iteration of the Portico self-expanding valve system. Early prospective studies have shown promising outcomes, however, there is a lack of complementary 'real-world' data. This study aimed to assess early safety and efficacy outcomes of the Navitor THV using registry data from 6 high-volume United Kingdom transcatheter aortic valve replacement (TAVR) centers. Demographic, procedural, and in-hospital outcome data were retrieved from 6 United Kingdom centers. The primary safety end point was 30-day mortality. Primary efficacy end points were procedural success, mean aortic gradient, and ≥moderate paravalvular leak. Secondary end points included rates of new permanent pacemaker implantation, stroke, and vascular injury. A total of 574 patients (mean age 83.4 years; 54.5% female) underwent Navitor TAVR between January 2020 and May 2023. The 30-day mortality in this patient cohort was 1.6%. Procedural success was 98.1%, mean echo-derived gradient post-TAVR was 7.7 ± 4.8 mm Hg (95% confidence interval [CI] 7.2 to 8.3, p <0.001) and 5.1% of patients had ≥moderate paravalvular leak (sample proportion estimate [p̂] = 0.051, 95% CI [0.035, 0.073], p <0.001). New permanent pacemaker implantation to discharge was required in 11% (p̂ = 0.119, 95% CI 0.088 to 0.158, p <0.001), stroke occurred in 1.2% of patients (p̂ = 0.017, 95% CI 0.006 to 0.036, p <0.001) and significant vascular injury in 1.6% (p̂ = 0.014, 95% CI 0.005 to 0.032, p <0.001). In conclusion, early procedural outcomes with Navitor TAVR compare favorably to new-generation THVs. Procedural success was high with a low incidence of complications.
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Affiliation(s)
- Apurva H Bharucha
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Ritesh Kanyal
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Michael Mullen
- Department of Cardiology, Barts Health NHS Trust, London, United Kingdom
| | - Kush Patel
- Department of Cardiology, Barts Health NHS Trust, London, United Kingdom
| | - David Smith
- Department of Cardiology, Morriston Cardiac Centre, Swansea, United Kingdom
| | - Joy Shome
- Department of Cardiology, Morriston Cardiac Centre, Swansea, United Kingdom
| | - Daniel J Blackman
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Suleman Aktaa
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Paul D Williams
- Department of Cardiology, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Saib Khogali
- Department of Cardiology, New Cross Hospital, Wolverhampton, United Kingdom
| | - Rafal Dworakowski
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Mehdi Eskandari
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Jonathan Byrne
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital, London, United Kingdom.
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22
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Siddiqui SA, Kazemian S, Gupta T, Patel NK, Sakhuja R, Inglessis I, Jassar A, Langer N, Passeri JJ, Dauerman HL, Elmariah S, Kolte D. Outcomes of Transcatheter Aortic Valve Replacement Using Third-Generation Balloon-Expandable Versus Self-Expanding Valves: A Meta-analysis. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:102146. [PMID: 39131997 PMCID: PMC11308705 DOI: 10.1016/j.jscai.2024.102146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 08/13/2024]
Abstract
Background The choice of transcatheter aortic valve replacement (TAVR) prosthesis is crucial in optimizing short- and long-term outcomes. The objective of this study was to conduct a meta-analysis comparing outcomes of third-generation balloon-expandable valves (BEV) vs self-expanding valves (SEV). Methods Electronic databases were searched from inception to June 2023 for studies comparing third-generation BEV vs SEV. Primary outcome was all-cause mortality. Secondary outcomes included clinical and hemodynamic end points. Random-effects models were used to calculate pooled odds ratios (ORs) or weighted mean differences (WMDs). Results The meta-analysis included 16 studies and 10,174 patients (BEV, 5753 and SEV, 4421). There were no significant differences in 1-year all-cause mortality (OR, 1.15; 95% CI, 0.89-1.48) between third-generation BEV vs SEV. TAVR with third generation BEV was associated with a significantly lower risk of TIA/stroke (OR, 0.62; 95% CI, 0.44-0.87), permanent pacemaker implantation (OR, 0.55; 95% CI, 0.44-0.70), and ≥moderate paravalvular leak (PVL, OR, 0.43; 95% CI, 0.25-0.75), and higher risk of ≥moderate patient-prosthesis mismatch (OR, 3.76; 95% CI, 2.33-6.05), higher mean gradient (WMD, 4.35; 95% CI, 3.63-5.08), and smaller effective orifice area (WMD, -0.30; 95% CI, -0.37 to -0.23), compared with SEV. Conclusion In this meta-analysis, TAVR with third-generation BEV vs SEV was associated with similar all-cause mortality, lower risk of TIA/stroke, permanent pacemaker implantation, and ≥moderate PVL, but higher risk of ≥moderate patient-prosthesis mismatch, higher mean gradient, and smaller effective orifice area. Large, adequately powered randomized trials are needed to evaluate long-term outcomes of TAVR with latest generations of BEV vs SEV.
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Affiliation(s)
| | - Sina Kazemian
- Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Tanush Gupta
- Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont
| | - Nilay K. Patel
- Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Rahul Sakhuja
- Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Ignacio Inglessis
- Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Arminder Jassar
- Harvard Medical School, Boston, Massachusetts
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Nathaniel Langer
- Harvard Medical School, Boston, Massachusetts
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan J. Passeri
- Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Harold L. Dauerman
- Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont
| | - Sammy Elmariah
- Division of Cardiology, University of California, San Francisco, California
| | - Dhaval Kolte
- Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
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23
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Adamo M, Branca L, Pezzola E, Saia F, Pilgrim T, Abdel-Wahab M, Garot P, Gandolfo C, Fiorina C, Sammartino S, Latib A, Santos IA, Mylotte D, De Marco F, De Backer O, Franco LN, Akodad M, Ribichini FL, Bedogni F, Laterra G, Mazzapicchi A, Tomii D, Laforgia P, Cannata S, Scotti A, Fezzi S, Criscione E, Poletti E, Mazzucca M, Valvo R, Lunardi M, Mainardi A, Andreaggi S, Quagliana A, Montarello N, Hennessey B, Mon-Noboa M, Meier D, Sgroi C, Reddavid CM, Strazzieri O, Motta SC, Frittitta V, Dipietro E, Comis A, Melfa C, Cal M, Thiele H, Webb JG, Søndergaard L, Tamburino C, Metra M, Costa G, Barbanti M. Sex-Related Outcomes of Transcatheter Aortic Valve Implantation With Self-Expanding or Balloon-Expandable Valves: Insights from the OPERA-TAVI Registry. Am J Cardiol 2024; 219:60-70. [PMID: 38401656 DOI: 10.1016/j.amjcard.2024.01.028] [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: 10/11/2023] [Revised: 12/30/2023] [Accepted: 01/22/2024] [Indexed: 02/26/2024]
Abstract
Evidence regarding gender-related differences in response to transcatheter aortic valve implantation according to the valve type is lacking. This study aimed to evaluate the impact of gender on the treatment effect of Evolut PRO/PRO+ (PRO) or SAPIEN 3 Ultra (ULTRA) devices on clinical outcomes. The Comparative Analysis of Evolut PRO vs SAPIEN 3 Ultra Valves for Transfemoral Transcatheter Aortic Valve Implantation (OPERA-TAVI) is a multicenter, multinational registry including patients who underwent the latest-iteration PRO or ULTRA implantation. Overall, 1,174 of 1,897 patients were matched based on valve type and compared according to gender, whereas 470 men and 630 women were matched and compared according to valve type. The 30-day and 1-year outcomes were evaluated. In the PRO and ULTRA groups, men had a higher co-morbidity burden, whereas women had smaller aortic root. The 30-day (device success [DS], early safety outcome, permanent pacemaker implantation, patient-prosthesis mismatch, paravalvular regurgitation, bleedings, vascular complications, and all-cause death) and 1-year outcomes (all-cause death, stroke, and heart failure hospitalization) did not differ according to gender in both valve groups. However, the male gender decreased the likelihood of 30-day DS with ULTRA versus PRO (p for interaction = 0.047). A higher risk of 30-day permanent pacemaker implantation and 1-year stroke and a lower risk of patient-prosthesis mismatch was observed in PRO versus ULTRA, regardless of gender. In conclusion, gender did not modify the treatment effect of PRO versus ULTRA on clinical outcomes, except for 30-day DS, which was decreased in men (vs women) who received ULTRA (vs PRO).
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Affiliation(s)
- Marianna Adamo
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
| | - Luca Branca
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Elisa Pezzola
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Saia
- Cardiovascular Department, Policlinico S. Orsola, University of Bologna, Bologna, Italy
| | - Thomas Pilgrim
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Caterina Gandolfo
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta specializzazione (ISMETT), Palermo, Italy
| | - Claudia Fiorina
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Sofia Sammartino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ignacio Amat Santos
- Division of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Darren Mylotte
- Department of Cardiology, University Hospital, University of Galway, Ireland
| | - Federico De Marco
- Interventional Cardiology Department, IRCSS Centro Cardiologico Monzino, Milan, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Mariama Akodad
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Francesco Bedogni
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy
| | | | | | - Daijiro Tomii
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - Pietro Laforgia
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Stefano Cannata
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta specializzazione (ISMETT), Palermo, Italy
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Simone Fezzi
- Department of Cardiology, University Hospital, University of Galway, Ireland
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Enrico Poletti
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Mattia Mazzucca
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Roberto Valvo
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Stefano Andreaggi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Angelo Quagliana
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicholas Montarello
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - David Meier
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | | | - Orazio Strazzieri
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | | | - Valentina Frittitta
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Elena Dipietro
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Alessandro Comis
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Chiara Melfa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Mariachiara Cal
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
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24
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Chiariello GA, Di Mauro M, Pasquini A, Bruno P, Nesta M, Fabiani L, Mazza A, Meloni M, Baldo E, Ponzo M, Ferraro F, Conserva AD, D’Acierno E, Villa E, Trani C, Burzotta F, Massetti M. Progression of the ascending aorta diameter after surgical or transcatheter bicuspid aortic valve replacement. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae100. [PMID: 38775458 PMCID: PMC11142625 DOI: 10.1093/icvts/ivae100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/17/2024] [Accepted: 05/17/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVES Ascending aorta (AA) dilatation in patients with bicuspid aortic valve (AV) is related both to genetic and haemodynamic factors. The aim of this study is to compare late progression of AA dilatation in bicuspid AV patients undergoing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve implantation (TAVI). METHODS Data of 189 consecutive patients who underwent AV replacement for severe bicuspid AV stenosis were prospectively collected. Patients who underwent SAVR were compared to patients who underwent TAVI. Indication to the procedure was validated by the institutional Heart Team. Aortic diameters were evaluated by transthoracic echocardiogram. Differences between preoperative and long-term follow-up AA diameters were compared in the 2 groups. RESULTS Between January 2015 and December 2021, 143 (76%) patients underwent SAVR and 46 (24%) patients underwent TAVI. At 4.6 (standard deviation 1.7) years follow-up, patients in the TAVI group showed significantly lower survival (P = 0.00013) and event-free survival (P < 0.0001). AA diameter progression was lower in surgical compared to transcatheter patients, 0.95 (0.60, 1.30) vs 1.65 (0.67, 2.63) mm, P = 0.02. AA diameter progression indexed for body surface area and height was lower in the surgical group: 0.72 (0.38, 1.05) vs 1.05 (0.39, 1.71) mm/m2, P = 0.02, and 0.59 (0.36, 0.81) vs 1.11 (0.44, 1.78) mm/m, P = 0.001, respectively. At multivariable linear regression analysis transcatheter procedure, baseline aortic diameter and paravalvular leak were significantly associated with increased postoperative AA dilatation. CONCLUSIONS Bicuspid AV patients who underwent SAVR, showed significantly less long-term AA diameter progression than patients who underwent transcatheter procedure.
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Affiliation(s)
- Giovanni Alfonso Chiariello
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Michele Di Mauro
- Heart and Vascular Centre, Cardiovascular Research Institute, CARIM, Maastricht, Netherlands
| | - Annalisa Pasquini
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Marialisa Nesta
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Ludovica Fabiani
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Mazza
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Martina Meloni
- Department of Cardiology, Thoracic and Vascular Sciences, S. Matteo University Hospital, Pavia, Italy
| | | | - Myriana Ponzo
- Department of Cardiology, Cristo Re Hospital, Rome, Italy
| | - Francesco Ferraro
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Davide Conserva
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Edoardo D’Acierno
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Emmanuel Villa
- Department of Cardiovascular Surgery, Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Carlo Trani
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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25
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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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26
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Akhtar KH, Pahuja M, Baber U. Self-expanding or balloon-expandable valve for TAVR in low risk patients: The jury is still out! Int J Cardiol 2024; 397:131619. [PMID: 38036268 DOI: 10.1016/j.ijcard.2023.131619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/26/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Khawaja Hassan Akhtar
- Department of Medicine, Section of Cardiovascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
| | - Mohit Pahuja
- Department of Medicine, Section of Cardiovascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Usman Baber
- Department of Medicine, Section of Cardiovascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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27
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Sa YK, Choi IJ, Chang K, Hwang BH, Chung WB, Lee KY, Choo EH, Kim CJ, Park MW, Choi YS, Park CS, Yoo KD, Jeon DS, Oak MH, Lee J, Kang D. Balloon-Expandable Versus Self-Expandable Valve in Transcatheter Aortic Valve Replacement: A Nation-Wide Study. Am J Cardiol 2024; 213:119-125. [PMID: 38110017 DOI: 10.1016/j.amjcard.2023.12.007] [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: 08/30/2023] [Revised: 11/27/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023]
Abstract
A few studies have reported comparative analysis of clinical outcomes between balloon-expandable valve (BEV) and self-expandable valve (SEV) after transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis using newer-generation devices. However, those reports were mostly limited to short-term outcomes and Western populations. In the present study, data of patients with severe aortic stenosis who underwent TAVR between March 2016 and December 2018 were obtained from the National Health Insurance Service in Korea. The primary end point, defined as all-cause mortality, was compared in BEV (SAPIEN 3, Edwards Lifesciences, Irvine, California) and SEV (Evolut R, Medtronic, Minneapolis, MN) groups using a propensity-score matching analysis. Cumulative event rates of ischemic stroke, repeat procedures, and permanent pacemaker insertion (PPI) were evaluated as secondary outcomes. All events were followed up to a maximum of 3 years. A total of 1,172 patients underwent transfemoral TAVR, of whom 707 (60.3%) were treated with BEV and 452 (38.6%) with SEV. After 1:1 propensity-score matching, the BEV group showed lower all-cause mortality after a median follow-up of 12.0 months (mean: 13.1 ± 9.3 months) based on Cox proportional hazard model analysis (hazard ratio [HR] 0.67, 95% confidence interval [CI] 0.45 to 0.99, p = 0.04). Cumulative incidence of ischemic stroke was not statistically different between the 2 groups (HR 0.68, 95% CI 0.29 to 1.59, p = 0.37). PPI occurred less frequently in the BEV group (HR 0.4, 95% CI 0.25 to 0.64, p < 0.01). Repeat procedures were rare (1 patient in BEV and 2 patients in SEV group). In conclusion, Korean nation-wide data analysis showed that BEV was associated with less all-cause death and incidence of PPI after TAVR than was SEV using a newer-generation device.
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Affiliation(s)
- Young Kyoung Sa
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ik Jun Choi
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Woo-Baek Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kwan Yong Lee
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Eun-Ho Choo
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Mahn Won Park
- Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yoon Seok Choi
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chul Soo Park
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ki Dong Yoo
- Division of Cardiology, Department of Internal Medicine, St. Vincent Hospital, The Catholic University of Korea, Seoul, Korea
| | - Doo Soo Jeon
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Min-Ho Oak
- College of Pharmacy, Mokpo National University, Muan, Jeonnam, Korea
| | - Jungkuk Lee
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Korea
| | - Dongwoo Kang
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Korea
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28
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Philippon F. Pacemaker Implantation Rate Following TAVR: From Registries to Standard of Care. JACC Cardiovasc Interv 2024; 17:402-404. [PMID: 38355268 DOI: 10.1016/j.jcin.2023.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 02/16/2024]
Affiliation(s)
- François Philippon
- Electrophysiology Division, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada.
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29
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Radulescu CI, Chioncel O, Metra M, Adamo M. Atrial fibrillation before and after transcatheter aortic valve implantation: an intertwine between survival and quality of life. J Cardiovasc Med (Hagerstown) 2024; 25:60-62. [PMID: 38079282 PMCID: PMC10720839 DOI: 10.2459/jcm.0000000000001580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/12/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Crina Ioana Radulescu
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- University of Medicine 'Carol Davila'
| | - Ovidiu Chioncel
- University of Medicine 'Carol Davila'
- Emergency Institute for Cardiovascular Diseases 'Prof C C Iliescu', Bucharest, Romania
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Costa G, Saia F, Pilgrim T, Abdel-Wahab M, Garot P, Sammartino S, Gandolfo C, Branca L, Latib A, Amat-Santos I, Mylotte D, De Marco F, De Backer O, Nombela Franco L, Akodad M, Ribichini FL, Bedogni F, Mazzapicchi A, Tomii D, Laforgia P, Cannata S, Fiorina C, Scotti A, Fezzi S, Criscione E, Poletti E, Mazzucca M, Lunardi M, Mainardi A, Andreaggi S, Quagliana A, Montarello NJ, Hennessey B, Mon-Noboa M, Meier D, Adamo M, Sgroi C, Reddavid CM, Strazzieri O, Crescenzia Motta S, Frittitta V, Dipietro E, Comis A, Melfa C, Calì M, Laterra G, Thiele H, Webb JG, Sondergaard L, Tamburino C, Barbanti M. One-year clinical outcomes of transcatheter aortic valve implantation with the latest iteration of self-expanding or balloonexpandable devices: insights from the OPERA-TAVI registry. EUROINTERVENTION 2024; 20:95-103. [PMID: 37982161 PMCID: PMC10758986 DOI: 10.4244/eij-d-23-00720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/09/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Midterm comparative analyses of the latest iterations of the most used Evolut and SAPIEN platforms for transcatheter aortic valve implantation (TAVI) are lacking. AIMS We aimed to compare 1-year clinical outcomes of TAVI patients receiving Evolut PRO/PRO+ (PRO) or SAPIEN 3 Ultra (ULTRA) devices in current real-world practice. METHODS Among patients enrolled in the OPERA-TAVI registry, patients with complete 1-year follow-up were considered for the purpose of this analysis. One-to-one propensity score matching was used to compare TAVI patients receiving PRO or ULTRA devices. The primary endpoint was a composite of 1-year all-cause death, disabling stroke and rehospitalisation for heart failure. Five prespecified subgroups of patients were considered according to leaflet and left ventricular outflow tract calcifications, annulus dimensions and angulation, and leaflet morphology. RESULTS Among a total of 1,897 patients, 587 matched pairs of patients with similar clinical and anatomical characteristics were compared. The primary composite endpoint did not differ between patients receiving PRO or ULTRA devices (Kaplan-Meier [KM] estimates 14.0% vs 11.9%; log-rank p=0.27). Patients receiving PRO devices had higher rates of 1-year disabling stroke (KM estimates 2.6% vs 0.4%; log-rank p=0.001), predominantly occurring within 30 days after TAVI (1.4% vs 0.0%; p=0.004). Outcomes were consistent across all the prespecified subsets of anatomical scenarios (all pinteraction>0.10). CONCLUSIONS One-year clinical outcomes of patients undergoing transfemoral TAVI and receiving PRO or ULTRA devices in the current clinical practice were similar, but PRO patients had higher rates of disabling stroke. Outcomes did not differ across the different anatomical subsets of the aortic root.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Francesco Saia
- Cardiovascular Department, Policlinico S. Orsola, University of Bologna, Bologna, Italy
| | - Thomas Pilgrim
- Bern University Hospital, Inselspital, Bern, Switzerland
| | | | - Philippe Garot
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Sofia Sammartino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Caterina Gandolfo
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | | | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ignacio Amat-Santos
- Division of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Darren Mylotte
- Department of Cardiology, University Hospital, University of Galway, Ireland
| | - Federico De Marco
- Interventional Cardiology Department, IRCSS Centro Cardiologico Monzino, Milan, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Luis Nombela Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Mariama Akodad
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Francesco Bedogni
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Daijiro Tomii
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - Pietro Laforgia
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Stefano Cannata
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | | | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Simone Fezzi
- Department of Cardiology, University Hospital, University of Galway, Ireland
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Enrico Poletti
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Mattia Mazzucca
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Stefano Andreaggi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Angelo Quagliana
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicholas J Montarello
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Breda Hennessey
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Matias Mon-Noboa
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - David Meier
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Orazio Strazzieri
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Valentina Frittitta
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Elena Dipietro
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Alessandro Comis
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Chiara Melfa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Mariachiara Calì
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Abbott Vascular, Santa Clara, CA, USA
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
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Nuche J, Abbas AE, Serra V, Vilalta V, Nombela-Franco L, Regueiro A, Al-Azizi KM, Iskander A, Conradi L, Forcillo J, Lilly S, Calabuig A, Fernandez-Nofrerias E, Mohammadi S, Giuliani C, Pelletier-Beaumont E, Pibarot P, Rodés-Cabau J. Balloon- vs Self-Expanding Transcatheter Valves for Failed Small Surgical Aortic Bioprostheses: 1-Year Results of the LYTEN Trial. JACC Cardiovasc Interv 2023; 16:2999-3012. [PMID: 37902146 DOI: 10.1016/j.jcin.2023.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/15/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Data comparing valve systems in the valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) field have been obtained from retrospective studies. OBJECTIVES The authors sought to compare the 1-year hemodynamic performance and clinical outcomes between balloon-expandable valves (BEV) SAPIEN 3/ULTRA (Edwards Lifesciences) and self-expanding valves (SEV) Evolut R/PRO/PRO+ (Medtronic) in ViV-TAVR. METHODS Patients with a failed small (≤23 mm) surgical valve undergoing ViV-TAVR were randomized to receive a SEV or a BEV. Patients had a clinical and valve hemodynamic (Doppler echocardiography) evaluation at 1-year follow-up. Study outcomes were defined according to VARC-2/VARC-3 criteria. Intended performance of the valve was defined as mean gradient <20 mm Hg, peak velocity <3 m/s, Doppler velocity index ≥0.25 and less than moderate AR. RESULTS A total of 98 patients underwent ViV-TAVR (46 BEV, 52 SEV). At 1-year follow-up, patients receiving a SEV had a lower mean transaortic gradient (22 ± 8 mm Hg BEV vs 14 ± 7 mm Hg SEV; P < 0.001), and a higher rate of intended valve performance (BEV: 30%, SEV:76%; P < 0.001). There were no cases of greater than mild aortic regurgitation. There were no differences in functional status (NYHA functional class >II, BEV: 7.3%, SEV: 4.1%; P = 0.505) or quality of life (Kansas City Cardiomyopathy Questionnaire, BEV: 77.9 ± 21.2, SEV: 81.8 ± 14.8; P = 0.334). No differences in all-cause mortality (BEV: 6.5%, SEV: 3.8; P = 0.495), heart failure hospitalization (BEV: 6.5%, SEV: 1.9%; P = 0.214), stroke (BEV: 0%, SEV: 1.9%; P = 0.369), myocardial infarction (BEV: 0%, SEV: 1.9%; P = 0.347), or pacemaker implantation (BEV: 2.2%, SEV: 1.9%; P = 0.898) were found. CONCLUSIONS In patients who underwent ViV-TAVR for failed small aortic bioprostheses, those receiving a SEV exhibited a better valve hemodynamic profile at 1-year follow-up. There were no differences between SEV and BEV regarding functional status, quality of life, or clinical outcomes.
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Affiliation(s)
- Jorge Nuche
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Amr E Abbas
- Corewell Health East, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Ander Regueiro
- Clinic Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Karim M Al-Azizi
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | | | | | - Jessica Forcillo
- Centre Hospitalier Universitaire de Montreal, Montreal, Quebec, Canada
| | - Scott Lilly
- OSU Heart and Vascular Research Organization, Richard M Ross Hospital, Columbus, Ohio, USA
| | | | | | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Carlos Giuliani
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Clinic Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain.
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Poletti E, De Backer O, Scotti A, Costa G, Bruno F, Fiorina C, Buzzatti N, Latini A, Rudolph TK, van den Dorpel MMP, Brinkmann C, Patel KP, Panoulas V, Schofer J, Giordano A, Barbanti M, Regazzoli D, Taramasso M, Saia F, Baumbach A, Maisano F, Van Mieghem NM, Søndergaard L, Latib A, Amat Santos IJ, Bedogni F, Testa L. Transcatheter Aortic Valve Replacement for Pure Native Aortic Valve Regurgitation: The PANTHEON International Project. JACC Cardiovasc Interv 2023; 16:1974-1985. [PMID: 37648345 DOI: 10.1016/j.jcin.2023.07.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) in patients with pure severe native aortic valve regurgitation (NAVR) has been associated with suboptimal results. The available evidence concerns mostly outdated transcatheter heart valves (THVs). OBJECTIVES The aim of this study was to investigate the performance of new-generation THVs in patients treated for pure severe NAVR. METHODS The PANTHEON (Performance of Currently Available Transcatheter Aortic Valve Platforms in Inoperable Patients With Pure Aortic Regurgitation of a Native Valve) study retrospectively included patients who underwent TAVR with currently available devices (both self-expanding [SE] and balloon expandable [BE]) for severe NAVR. Technical and device success rates as well as a composite of all-cause mortality and heart failure rehospitalization at 1 year were evaluated. The rate and clinical consequences of acute transcatheter valve embolization or migration (TVEM) were also considered. RESULTS A total of 201 patients were included. Overall technical and device success rates were 83.6% and 76.1%, respectively, and did not differ between SE and BE devices. These figures were due mostly to TVEM occurrence (14.6% vs 16.1%; P = 0.47) and residual moderate or greater aortic regurgitation (9.2% vs 10.1%; P = 0.87). Patients who experienced TVEM compared with those without TVEM had a significantly higher incidence of the composite endpoint at 1 year (25.7% vs 15.8%; P = 0.05). CONCLUSIONS Despite improved THV platforms and techniques, TAVR for pure severe NAVR remains a challenging procedure, with significant risk for TVEM. SE and BE platforms demonstrated comparable performance in this setting. (Performance of Currently Available Transcatheter Aortic Valve Platforms in Inoperable Patients With Pure Aortic Regurgitation of a Native Valve [PANTHEON]; NCT05319171).
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Affiliation(s)
- Enrico Poletti
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Ole De Backer
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Giuliano Costa
- Division of Cardiology, CAST, Azienda Ospedaliero - Universitaria Policlinico G. Rodolico - San Marco, University of Catania, Catania, Italy
| | - Francesco Bruno
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | | | | | - Alessia Latini
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Tanja K Rudolph
- Department for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia Bochum, University Hospital of the Ruhr University, Bad Oeynhausen, Germany
| | - Mark M P van den Dorpel
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - Kush P Patel
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London United Kingdom
| | - Vasileios Panoulas
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Joachim Schofer
- MVZ Department of Structural Heart Disease at St. Georg, Hamburg, Germany
| | - Arturo Giordano
- Cardiovascular Interventional Operative Unit, Presidio Ospedaliero Pineta Grande, Castel Volturno, Caserta, Italy; Operative Unit of Hemodynamics, Casa di Salute Santa Lucia, Naples, Italy
| | | | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Maurizio Taramasso
- HerzZentrum Hirslanden Zurich Clinic of Cardiac Surgery, Zurich, Switzerland
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London United Kingdom
| | | | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Lars Søndergaard
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ignacio J Amat Santos
- Instituto de Ciencias del Corazón, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Francesco Bedogni
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Luca Testa
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, Milan, Italy.
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Li J, Sun Y, Luo S, Zheng S, Chen J, Fu M, Fang Z, Wang Y, Li G, Fan R, Luo J. Transcatheter aortic valve replacement with the VenusA-Pro and VenusA-Plus systems: preliminary experience in China. Front Cardiovasc Med 2023; 10:1169590. [PMID: 37692040 PMCID: PMC10483150 DOI: 10.3389/fcvm.2023.1169590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background The outcomes of transcatheter aortic valve replacement (TAVR) employing the second-generation retrievable VenusA-Pro and VenusA-Plus delivery systems with the self-expanding VenusA-Valve have not been described yet. This study aims to report the outcomes of these two second-generation delivery systems. Methods From January 2022 to April 2023, we prospectively enrolled patients with severe aortic stenosis undergoing TAVR with VenusA-Pro from three centers across China in this first-in-man study and retrospectively identified those undergoing TAVR with VenusA-Plus. All outcomes were reported according to the Valve Academic Research Consortium 3 definition. The primary outcome was 30-day all-cause mortality. Results A total of 156 patients were included, of which 46 underwent TAVR with VenusA-Pro and 110 underwent TAVR with VenusA-Plus. The Society of Thoracic Surgeons median score was 2.1%, bicuspid anatomy prevalence rate was 55.1%, and the mean aortic root calcification volume was 693 mm3. The technical success rate was 91.7%, comparable between the VenusA-Pro and VenusA-Plus groups (87.0% vs. 93.6%, P = 0.169). The 30-day all-cause mortality was 2.6%, similar between the VenusA-Pro and VenusA-Plus groups (2.2% vs. 2.7%, P = 0.842). No myocardial infarction occurred. The incidences of stroke (0.6%), major bleeding (3.8%), major vascular complications (5.1%), acute kidney injury (9.0%), permanent pacemaker implantation (5.1%), new-onset atrial fibrillation (5.8%), and moderate-to-severe paravalvular aortic regurgitation (6.0%) were favorable and comparable between the two groups. The clinical outcomes were similar between the patients with bicuspid and tricuspid aortic valve, except that the incidence of permanent pacemaker implantation was lower in patients with bicuspid anatomy (1.2% vs. 10.6%, P = 0.010). Conclusions The 30-day outcomes of TAVR with VenusA-Pro and VenusA-Plus were favorable and comparable.
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Affiliation(s)
- Jie Li
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Yinghao Sun
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Songyuan Luo
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Shengneng Zheng
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Jiaohua Chen
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Ming Fu
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Zhenfei Fang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yan Wang
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, Xiamen, China
| | - Guang Li
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Ruixin Fan
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Jianfang Luo
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
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Wang B, Mei Z, Ge X, Li Y, Zhou Q, Meng X, An G. Comparison of outcomes of self-expanding versus balloon-expandable valves for transcatheter aortic valve replacement: a meta-analysis of randomized and propensity-matched studies. BMC Cardiovasc Disord 2023; 23:382. [PMID: 37525092 PMCID: PMC10388567 DOI: 10.1186/s12872-023-03397-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/14/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND The postoperative outcomes of transcatheter aortic valve replacement (TAVR) with the new generation of self-expanding valves (SEV) and balloon-expandable valves (BEV) remain uncertain. METHODS We conducted a meta-analysis based on randomized controlled trials (RCTs) and propensity score-matched (PSM) studies to evaluate the performance of the new generation TAVR devices, with a focus on Edwards SAPIEN 3/Ultra BEV, Medtronic Evolut R/PRO SEV, and Boston ACURATE neo SEV. Our primary endpoints were mortality and complications at both 30 days and one year post-operation. RESULTS A total of 4 RCTs and 14 PSM studies were included. Our findings showed no significant difference between SEV and BEV regarding 30-day and 1-year mortality rates. ACURATE SEV required less permanent pacemaker implantation (PPI) at 30-day as compared to SAPIEN BEV, while Evolut SEV required a higher rate of PPI than SAPIEN BEV. The incidence of stroke, major or life-threatening bleeding (MLTB), major vascular complications (MVC), coronary artery obstruction (CAO) and acute kidney injury (AKI) did not differ significantly between the two groups. SEV had a larger effective orifice area (EOA) and lower mean transvalvular gradients (MPG) compared to BEV. However, there was an increased risk of paravalvular leakage (PVL) associated with SEV. CONCLUSIONS In terms of 30-day mortality, stroke, bleeding, MVC, AKI, CAO, and one-year mortality, there was comparability between the two valve types following TAVR. SEV was associated with better hemodynamic outcomes, except for a higher incidence of PVL. Compared to SAPIEN BEV, ACURATE SEV had a lower risk of PPI at 30 days, while Evolut SEV was associated with a higher risk of PPI. These findings underscore the importance of personalized valve selection.
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Affiliation(s)
- Baiqiang Wang
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Zeyuan Mei
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Xiao Ge
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Yunyi Li
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Quan Zhou
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Xiao Meng
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Guipeng An
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China.
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Weferling M, Lan Cheong Wah S, Fischer-Rasokat U, Hain A, Renker M, Charitos EI, Liebetrau C, Treiber J, Choi YH, Hamm CW, Kim WK. Incidence and predictors of hemodynamic compromise due to high-grade AV block after TAVI. Front Cardiovasc Med 2023; 10:1161871. [PMID: 37346284 PMCID: PMC10280067 DOI: 10.3389/fcvm.2023.1161871] [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: 02/08/2023] [Accepted: 05/24/2023] [Indexed: 06/23/2023] Open
Abstract
Background High-grade AV block (HAVB) is the most frequent adverse event after transcatheter aortic valve implantation (TAVI). In rare cases, HAVB is associated with hemodynamic compromise (HC) followed by syncope or application of cardiopulmonary resuscitation (CPR), but data on this severe complication are scarce. The aim of the present study was to investigate the incidence and predictors of HC due to HAVB in patients undergoing TAVI. Methods In this retrospective analysis of 4,602 TAVI cases between 2010 and 2022, 466 developed HAVB. Baseline characteristics and procedural and postprocedural findings were compared for patients with HC versus those without. Univariate and multivariable regression analyses were used to investigate independent predictors of HC. Results Forty-nine of 466 patients (10.5%) had HC due to HAVB after TAVI. Patients with HC had a longer hospital stay [10 (8-13) vs. 13 (9-18) days; p < 0.001], more frequent peripheral artery disease (PAD) (28.6% vs. 15.1%; p = 0.016), and lower hemoglobin levels [11.8 (±) vs. 12.5 (±) g/dl; p = 0.006]. In the HC group, HAVB onset post-TAVI was delayed compared with the non-HC group [2 (1-4) vs. 1 (0-3) days; p < 0.001]. Before HAVB onset, patients in the HC group more frequently developed post-TAVI delirium [18 (4.6%) vs. 11 (25.0%); p < 0.001]. In univariate regression analysis, PAD, hemoglobin, procedural time, contrast agent volume, and post-TAVI delirium were significant predictors of HC. After adjustment, only post-TAVI delirium and contrast agent volume remained independent predictors [OR 3.22 (95% CI: 1.05-9.89); p = 0.042 and OR: 1.01 (95% CI: 1.0-1.01); p = 0.04, respectively]. Conclusion HC due to HAVB after TAVI occurred in over 10% of cases. Development of post-TAVI delirium and contrast agent volume are independent predictors of this severe complication.
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Affiliation(s)
- Maren Weferling
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany
| | | | | | - Andreas Hain
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | | | - Christoph Liebetrau
- Cardioangiological Center Bethanien (CCB), Department of Cardiology, Agaplesion Bethanien Hospital, Frankfurt, Germany
| | - Julia Treiber
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Christian W. Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany
- Department of Cardiology, University Hospital of Giessen, Giessen, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
- Department of Cardiology, University Hospital of Giessen, Giessen, Germany
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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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Iacovelli F, Loizzi F, Cafaro A, Burattini O, Salemme L, Cioppa A, Rizzo F, Palmitessa C, D'Alessandro M, De Feo D, Pucciarelli A, De Cillis E, Pestrichella V, Contegiacomo G, Tesorio T, Bortone AS. Surgical Mortality Risk Scores in Transcatheter Aortic Valve Implantation: Is Their Early Predictive Value Still Strong? J Cardiovasc Dev Dis 2023; 10:244. [PMID: 37367409 DOI: 10.3390/jcdd10060244] [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: 04/27/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Surgical mortality risk scores, even if not properly designed and rarely tested in the transcatheter aortic valve implantation (TAVI) setting, still guide the heart team in managing significant aortic stenosis. METHODS After splitting 1763 consecutive patients retrospectively based on their mortality risk thresholds, the composite endpoint early safety (ES) was adjudicated according to Valve Academic Research Consortium (VARC)-2 and -3 consensus documents. RESULTS ES incidence was higher if VARC-2 rather than VARC-3 defined. Despite only patients showing VARC-2 ES had significantly lower absolute values of all three main risk scores, these last still failed to foresee both VARC-2 and -3 ES in intermediate-risk patients. The receiver operating characteristic analysis also showed a significant correlation, but with poor diagnostic accuracy, among the three scores and only VARC-2 ES; moreover, the absence of VARC-2 ES and low-osmolar contrast media administration were identified as independent predictors of 1-year mortality and absence of VARC-3 ES, respectively. Finally, even a single complication included in the ES definition could significantly affect 1-year mortality. CONCLUSION Currently, the most used mortality risk scores do not have adequate diagnostic accuracy in predicting ES after TAVI. The absence of VARC-2, instead of VARC-3, ES is an independent predictor of 1-year mortality.
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Affiliation(s)
- Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy
- Division of Cardiology, "SS. Annunziata" Hospital, 74121 Taranto, Italy
| | - Francesco Loizzi
- Division of Cardiology, "SS. Annunziata" Hospital, 74121 Taranto, Italy
| | | | - Osvaldo Burattini
- Division of Cardiology, "SS. Annunziata" Hospital, 74121 Taranto, Italy
| | - Luigi Salemme
- Interventional Cardiology Service, "Montevergine" Clinic, GVM Care & Research, 83013 Mercogliano, Italy
| | - Angelo Cioppa
- Interventional Cardiology Service, "Montevergine" Clinic, GVM Care & Research, 83013 Mercogliano, Italy
| | - Francesco Rizzo
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy
| | - Chiara Palmitessa
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy
| | - Maurizio D'Alessandro
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy
| | - Daniele De Feo
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy
| | - Armando Pucciarelli
- Interventional Cardiology Service, "Montevergine" Clinic, GVM Care & Research, 83013 Mercogliano, Italy
| | - Emanuela De Cillis
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy
| | | | - Gaetano Contegiacomo
- Interventional Cardiology Service, "Anthea" Clinic, GVM Care & Research, 70124 Bari, Italy
| | - Tullio Tesorio
- Interventional Cardiology Service, "Montevergine" Clinic, GVM Care & Research, 83013 Mercogliano, Italy
| | - Alessandro Santo Bortone
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy
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38
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Prandi FR, Niv Granot Y, Margonato D, Belli M, Illuminato F, Vinayak M, Barillà F, Romeo F, Tang GHL, Sharma S, Kini A, Lerakis S. Coronary Obstruction during Valve-in-Valve Transcatheter Aortic Valve Replacement: Pre-Procedural Risk Evaluation, Intra-Procedural Monitoring, and Follow-Up. J Cardiovasc Dev Dis 2023; 10:jcdd10050187. [PMID: 37233154 DOI: 10.3390/jcdd10050187] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is emerging as an effective treatment for patients with symptomatically failing bioprosthetic valves and a high prohibitive surgical risk; a longer life expectancy has led to a higher demand for these valve reinterventions due to the increased possibilities of outliving the bioprosthetic valve's durability. Coronary obstruction is the most feared complication of valve-in-valve (ViV) TAVR; it is a rare but life-threatening complication and occurs most frequently at the left coronary artery ostium. Accurate pre-procedural planning, mainly based on cardiac computed tomography, is crucial to determining the feasibility of a ViV TAVR and to assessing the anticipated risk of a coronary obstruction and the eventual need for coronary protection measures. Intraprocedurally, the aortic root and a selective coronary angiography are useful for evaluating the anatomic relationship between the aortic valve and coronary ostia; transesophageal echocardiographic real-time monitoring of the coronary flow with a color Doppler and pulsed-wave Doppler is a valuable tool that allows for a determination of real-time coronary patency and the detection of asymptomatic coronary obstructions. Because of the risk of developing a delayed coronary obstruction, the close postprocedural monitoring of patients at a high risk of developing coronary obstructions is advisable. CT simulations of ViV TAVR, 3D printing models, and fusion imaging represent the future directions that may help provide a personalized lifetime strategy and tailored approach for each patient, potentially minimizing complications and improving outcomes.
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Affiliation(s)
- Francesca Romana Prandi
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Yoav Niv Granot
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Davide Margonato
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Martina Belli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Federica Illuminato
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Manish Vinayak
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Francesco Barillà
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Francesco Romeo
- Faculty of Medicine, Unicamillus-Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Samin Sharma
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Annapoorna Kini
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Stamatios Lerakis
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Barbanti M, Costa G. TAVR Protocolization: The Best Formula to "Optimize" Patient Outcomes. JACC Cardiovasc Interv 2023; 16:571-573. [PMID: 36922043 DOI: 10.1016/j.jcin.2023.01.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy.
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
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40
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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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41
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Tsao AL, Shapeton AD. Requiem for Routine Self-Expanding Transcatheter Aortic Valve Replacement Valves? A Commentary on the Comparative Analysis of Evolut PRO Versus Sapien Ultra Valves for Transfemoral Transcatheter Aortic Valve Implantation Registry. J Cardiothorac Vasc Anesth 2023; 37:849-851. [PMID: 36918340 DOI: 10.1053/j.jvca.2023.02.019] [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: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
Affiliation(s)
- Allison L Tsao
- VA Boston Healthcare System and Harvard Medical School, Boston, MA.
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42
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Leone PP, Scotti A, Ho EC, Assafin M, Doolittle J, Chau M, Slipczuk L, Levitus M, Regazzoli D, Mangieri A, Latib A. Prosthesis Tailoring for Patients Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2023; 12:338. [PMID: 36615141 PMCID: PMC9821207 DOI: 10.3390/jcm12010338] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has risen over the past 20 years as a safe and effective alternative to surgical aortic valve replacement for treatment of severe aortic stenosis, and is now a well-established and recommended treatment option in suitable patients irrespective of predicted risk of mortality after surgery. Studies of numerous devices, either newly developed or reiterations of previous prostheses, have been accruing. We hereby review TAVI devices, with a focus on commercially available options, and aim to present a guide for prosthesis tailoring according to patient-related anatomical and clinical factors that may favor particular designs.
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Affiliation(s)
- Pier Pasquale Leone
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Cardiovascular Research Foundation, New York, NY 10019, USA
| | - Edwin C. Ho
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Manaf Assafin
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - James Doolittle
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Mei Chau
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Leandro Slipczuk
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Matthew Levitus
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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43
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Scotti A, Baggio S, Pagnesi M, Barbanti M, Adamo M, Eitan A, Estévez-Loureiro R, Veulemans V, Toggweiler S, Mylotte D, De Marco F, Giannini F, Ferlini M, Naber CK, Buono A, Schofer J, Rottbauer W, Van Mieghem NM, Khogali S, Taramasso M, Pilgrim T, Sinning JM, Zweiker D, Montorfano M, Van der Heyden JAS, Brugaletta S, Ielasi A, Hamm CW, Vanhaverbeke M, Costa G, Massussi M, Alarcón R, Zeus T, Lunardi M, Testa L, Di Ienno L, Lanzillo G, Wolf A, Maffeo D, Ziviello F, Saccocci M, Windecker S, Sedaghat A, Schmidt A, Brouwer J, Regueiro A, Reimers B, Kim WK, Sondergaard L, Colombo A, Mangieri A, Latib A. Temporal Trends and Contemporary Outcomes After Transcatheter Aortic Valve Replacement With Evolut PRO/PRO+ Self-Expanding Valves: Insights From the NEOPRO/NEOPRO-2 Registries. Circ Cardiovasc Interv 2023; 16:e012538. [PMID: 36649387 DOI: 10.1161/circinterventions.122.012538] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND In recent years, transcatheter aortic valve replacement (TAVR) techniques and technology have continuously improved. Data regarding the impact of these advancements on outcomes in large real-world settings are still limited. The aim of this study was to investigate temporal trends and assess contemporary outcomes after TAVR with Evolut PRO/PRO+ supra-annular self-expanding valves. METHODS This study included 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 who underwent transfemoral TAVR with Evolut PRO/PRO+. Procedural dates (August 2017 through November 2021) were stratified in quartiles (Q) and used to investigate temporal trends in TAVR outcomes. Predischarge, 30-day Valve Academic Research Consortium-3 defined, and 1-year outcomes were evaluated. RESULTS In total, 1616 patients from 28 centers were included. Over time, patients had lower Society of Thoracic Surgeon-Predicted Risk of Mortality score (Q1-4, 4.1% [2.8-6.3%], 3.7% [2.6-5.3%], 3.3% [2.4-4.9%], 2.9% [2.2-4.3%]; P<0.001) and more moderate or heavy valve calcification (Q1-4, 80%, 80%, 82%, 88%; P=0.038). Overall Valve Academic Research Consortium-3 technical success was 94.1%, with 30-day and 1-year all-cause mortality of 2.4% and 10%, respectively. Throughout the study period, procedures were associated with higher rates of 30-day device success (Q1-4, 81.2%, 82.2%, 82.0%, 88.0%; Cochran-Armitage P=0.023) and early safety (Q1-4, 66.8%, 67.5%, 74.0%, 77.6%; Cochran-Armitage P<0.001), with fewer permanent pacemaker implantations (Q1-4: 15.3%, 20.0%, 12.1%, 11.6%; Cochran-Armitage P=0.023) and residual mild or greater paravalvular leaks (Q1-4, 50.4%, 42.1%, 36.5%, 35.8%; Cochran-Armitage P<0.001). CONCLUSIONS TAVR with Evolut PRO/PRO+ self-expanding valve is safe and effective. Despite the treatment of heavier calcified anatomies, procedural outcomes are improving over time with less need for pacemaker implantation and less significant paravalvular leaks.
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Affiliation(s)
- Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (A.S., A.L.)
| | - Sara Baggio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (S.B., B.R., A.C., A.M.).,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy (S.B., B.R., A.C., A.M.)
| | - Matteo Pagnesi
- Cardiothoracic Department, ASST Spedali Civili di Brescia University of Brescia, Italy (M.P., M.A., M. Massussi).,Department of Medical Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M.P., M.A., M. Massussi)
| | - Marco Barbanti
- Department of Cardiology, C.A.S.T. Policlinico G. Rodolico, Catania, Italy (M.B., G.C.)
| | - Marianna Adamo
- Cardiothoracic Department, ASST Spedali Civili di Brescia University of Brescia, Italy (M.P., M.A., M. Massussi).,Department of Medical Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M.P., M.A., M. Massussi)
| | - Amnon Eitan
- Department of Cardiology, Carmel Medical Center, Haifa, Israel (A.E.)
| | - Rodrigo Estévez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain (R.E.-L., R.A.)
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Germany (V.V., T.Z.)
| | - Stefan Toggweiler
- Heart Center Lucerne, Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland (S.T.)
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospitals, Ireland (D.M., M.L.)
| | | | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (F.G., L.D.I.)
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (M.F., G.L.)
| | - Christoph K Naber
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Germany (C.K.N., A.W.)
| | - Andrea Buono
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy (A.B., D.M.)
| | - Joachim Schofer
- Department for Percutaneous Treatment of Structural Heart Disease, Albertinen Heart Center, Hamburg, Germany (J.S.).,MVZ Department Structural Heart Disease, Asklepios St Georg Clinic, Hamburg, Germany (J.S.)
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Hospital Ulm, Germany (W.R., S.W.)
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands (N.M.V.M., F.Z.)
| | - Saib Khogali
- Heart and Lung Center, New Cross Hospital, Wolverhampton, UK (S.K.)
| | - Maurizio Taramasso
- Division of Cardiothoracic Surgery, HerzZentrum Hirslanden Zürich, Switzerland (M.T., M.S.)
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (T.P.)
| | - Jan-Malte Sinning
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (J.-M.S., A. Sedaghat)
| | - David Zweiker
- Division of Cardiology, Medical University of Graz, Austria (D.Z., A. Schmidt)
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (M. Montorfano)
| | - Jan A S Van der Heyden
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands (J.A.S.V.d.H., J.B.).,Interventional Cardiology Unit, AZ Sint-Jan Hospital, Bruges, Belgium (J.A.S.V.d.H.)
| | - Salvatore Brugaletta
- Clinic Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.B., A.R.)
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy (A.I.)
| | - Christian W Hamm
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany (C.W.H., W.-K.K.)
| | - Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (M.V., L.S.)
| | - Giuliano Costa
- Department of Cardiology, C.A.S.T. Policlinico G. Rodolico, Catania, Italy (M.B., G.C.)
| | - Mauro Massussi
- Cardiothoracic Department, ASST Spedali Civili di Brescia University of Brescia, Italy (M.P., M.A., M. Massussi).,Department of Medical Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M.P., M.A., M. Massussi)
| | - Robert Alarcón
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain (R.E.-L., R.A.)
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Germany (V.V., T.Z.)
| | - Mattia Lunardi
- Department of Cardiology, Galway University Hospitals, Ireland (D.M., M.L.)
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy (L.T.)
| | - Luca Di Ienno
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (F.G., L.D.I.)
| | - Giuseppe Lanzillo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (M.F., G.L.)
| | - Alexander Wolf
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Germany (C.K.N., A.W.)
| | - Diego Maffeo
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy (A.B., D.M.)
| | - Francesca Ziviello
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands (N.M.V.M., F.Z.)
| | - Matteo Saccocci
- Division of Cardiothoracic Surgery, HerzZentrum Hirslanden Zürich, Switzerland (M.T., M.S.)
| | - Stephan Windecker
- Department of Internal Medicine II, University Hospital Ulm, Germany (W.R., S.W.)
| | - Alexander Sedaghat
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (J.-M.S., A. Sedaghat)
| | - Albrecht Schmidt
- Division of Cardiology, Medical University of Graz, Austria (D.Z., A. Schmidt)
| | - Jorn Brouwer
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands (J.A.S.V.d.H., J.B.)
| | - Ander Regueiro
- Clinic Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.B., A.R.)
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (S.B., B.R., A.C., A.M.).,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy (S.B., B.R., A.C., A.M.)
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany (C.W.H., W.-K.K.)
| | - Lars Sondergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (M.V., L.S.)
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (S.B., B.R., A.C., A.M.).,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy (S.B., B.R., A.C., A.M.)
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (S.B., B.R., A.C., A.M.).,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy (S.B., B.R., A.C., A.M.)
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (A.S., A.L.)
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Tailoring TAVR System Design to Patient Characteristics and Needs: One Type Does Not Fit All. JACC Cardiovasc Interv 2022; 15:2408-2411. [PMID: 36121243 DOI: 10.1016/j.jcin.2022.09.014] [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: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 01/11/2023]
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Ferrari E, Pozzoli A, Klersy C, Toto F, Torre T, Cassina T, Pedrazzini G, Demertzis S. Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular Disease. J Cardiovasc Dev Dis 2022; 9:422. [PMID: 36547419 PMCID: PMC9783693 DOI: 10.3390/jcdd9120422] [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: 10/03/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 11/30/2022] Open
Abstract
Objective: Transcatheter aortic valve replacement (TAVR) through alternative access routes is indicated in patients with severe aortic valve stenosis and diseased peripheral arteries. We analysed and compared the outcome of patients undergoing transapical (TA) and direct transaortic (TAO) TAVR procedures. Methods: Preoperative characteristics, procedural details, and thirty-day outcome of patients undergoing transapical (TA-TAVR group) and direct transaortic (TAO-TAVR group) TAVR procedures were prospectively collected and retrospectively analysed. Results: From March 2012 to March 2022, 81 TA and 82 TAO-TAVR (total: 163 cases) were performed with balloon-expanding (n = 120; 73.6%) and self-expandable (n = 43; 26.4%) valves. The mean age was 79.7 ± 6.2 and 81.9 ± 6.7 years for the TA- and TAO-TAVR groups, respectively (p = 0.032). Females were more represented in the TAO-TAVR group (56% vs. 32%; p = 0.003) while TA-TAVR patients showed a higher prevalence of previous vascular surgery (20% vs. 6%; p = 0.01), previous cardiac surgery (51% vs. 3.6%; p < 0.001), and porcelain aorta (22% vs. 5%; p = 0.001). The mean ejection fraction was 49.0 ± 14.6% (TA) and 53.5 ± 12.2% (TAO) (p = 0.035) while mean gradients were 35.6 ± 13.2 mmHg (TA) and 40.4 ± 16.1 mmHg (TAO) (p = 0.045). The median EuroSCORE-II was 5.0% (IQR: 3.0−11.0) and 3.9% (IQR: 2.5−5.4) for the TA- and TAO-TAVR groups, respectively (p = 0.005). The procedural time was shorter for TA procedures (97 min (IQR: 882−118) vs. 102 min (IQR: 88−129); p = 0.133). Mortality at day 30 was 6% in both groups (p = 1.000); the permanent pacemaker implantation rate was similar (8.6% vs. 9.7%; p = 1.000), and hospital stay was shorter for the TAO group (8 days (IQR: 6−11) vs. 10 days (IQR: 7−13); p = 0.025). Conclusions: Our results show that transapical and direct transaortic TAVR in high-risk patients with diseased peripheral arteries provide satisfactory clinical results with similar thirty-day outcomes.
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Affiliation(s)
- Enrico Ferrari
- Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Biomedical Faculty, University of Italian Switzerland (USI), 6900 Lugano, Switzerland
- School of Medicine, University of Zurich, 8006 Zurich, Switzerland
| | - Alberto Pozzoli
- Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Catherine Klersy
- Clinical Epidemiology & Biostatistics, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Francesca Toto
- Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Tiziano Torre
- Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Tiziano Cassina
- Biomedical Faculty, University of Italian Switzerland (USI), 6900 Lugano, Switzerland
- Cardiac Anaesthesia, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Giovanni Pedrazzini
- Biomedical Faculty, University of Italian Switzerland (USI), 6900 Lugano, Switzerland
- Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Stefanos Demertzis
- Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Biomedical Faculty, University of Italian Switzerland (USI), 6900 Lugano, Switzerland
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