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Litkouhi PN, Rao K, Baer A, Hansen PS, Bhindi R. The safety and feasibility of same day discharge for patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis. Can J Cardiol 2025:S0828-282X(25)00342-3. [PMID: 40383183 DOI: 10.1016/j.cjca.2025.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2024] [Revised: 05/02/2025] [Accepted: 05/11/2025] [Indexed: 05/20/2025] Open
Abstract
BACKGROUND Next day discharge (NDD) after transcatheter aortic valve replacement (TAVR) has been shown to be safe in appropriately selected patients and has since been implemented into clinical practice. As the demand for TAVR grows, improving its accessibility is crucial. Several studies have trialled same day discharge (SDD) after TAVR, but a review has not been performed. METHODS Five databases were searched. Baseline demographics, study characteristics and the assessment criteria used to determine eligibility for SDD were extracted and compared. Proportional meta-analysis was used to compare post-TAVI outcomes between SDD and NDD patients. RESULTS Six studies were included from 1734 screened articles. Of 3519 patients, 318 (9.0%) underwent SDD (mean age 78.2 ± 8.7 years; 59.3% male). Balloon-expanding valves were used in 91.6% of cases, and self-expanding valves in the remaining 8.4%. Patients that underwent SDD experienced lower rates of mortality (OR 0.104, 95% CI: 0.015 - 0.998), all-cause readmission (OR 0.194, 95% CI 0.052 - 0.717), cardiovascular readmissions (OR 0.155, 95% CI 0.026 - 0.971), and new pacemaker requirement (OR 0.167, 95% 0.028 - 0.995) at 30 days after TAVR, compared to patients that underwent NDD. There was no difference in rates of stroke (OR 0.407, 95% CI: 0.015 - 16.694) or major vascular complications (0.0% vs 0.0%). CONCLUSIONS Current evidence supports the safety and feasibility of SDD after elective, transfemoral TAVR in appropriately selected patients. Heterogeneity between eligibility criteria used to select patients for SDD, especially related to conduction disease, poses a barrier to implementation. Further research on self-expanding valves is needed.
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Affiliation(s)
- Princess Neila Litkouhi
- Department of Cardiology, Royal North Shore Hospital, St Leonards, Australia; School of Medicine, University of Sydney, Camperdown, Australia
| | - Karan Rao
- Department of Cardiology, Royal North Shore Hospital, St Leonards, Australia; School of Medicine, University of Sydney, Camperdown, Australia
| | - Alexandra Baer
- Department of Cardiology, Royal North Shore Hospital, St Leonards, Australia
| | - Peter S Hansen
- Department of Cardiology, Royal North Shore Hospital, St Leonards, Australia; School of Medicine, University of Sydney, Camperdown, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, St Leonards, Australia; School of Medicine, University of Sydney, Camperdown, Australia.
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Barbanti M, Costa G, Frittitta V, Dipietro E, Comis A, Calì M, Sammartino S, Deste W, La Rosa L, Garretto V, Inserra C, Cannizzaro MT, Sgroi C, Veroux P, Capodanno D, Tamburino C. A minimalistic approach for transfemoral transcatheter aortic valve implantation therapy: a prospective "real-world" study. Clin Res Cardiol 2025:10.1007/s00392-025-02654-z. [PMID: 40301224 DOI: 10.1007/s00392-025-02654-z] [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: 06/04/2024] [Accepted: 04/15/2025] [Indexed: 05/01/2025]
Abstract
BACKGROUND Optimized pathways for transcatheter aortic valve implantation (TAVI) have been reported over the past decade, but they considered specific devices and selected populations. OBJECTIVES The aim of this study was to assess the safety and efficacy of a comprehensive, minimalistic approach to TAVI utilizing all available devices in all-comers, real-world population. METHODS This is a prospective, single-center, single-arm clinical study. The primary endpoint of the study was a composite of 30-day all-cause mortality, disabling stroke, major bleedings, major vascular complications, stage 3 acute kidney injury (AKI), and permanent pacemaker implantation (PPI). Outcomes were compared to those of an historical cohort of patients undergoing TAVI following a standard approach, by selecting pairs of patients selected through a 1:1 propensity score matching (PSM). A cost analysis of TAVI hospitalization was performed considering costs related to procedural complications and post-procedural length of stay (LoS). RESULTS Between January 2020 and December 2023, a total of 997 patients underwent TAVI following an optimized, minimalistic pathway. Device success was reported in 88.2% patients, with low procedural complications. The primary endpoint occurred in 21.1% of patients. After PSM, TAVI patients following the minimalistic pathway had higher device success (91.4% vs 84.2%, p = 0.004), and lower major vascular complications (4.5% vs. 10.3%, p = 0.004) compared to those following the standard approach. Median LoS was shorter (1.0 day vs. 2.0 days, p < 0.001) and the rate of next-day discharge was higher (46.7% vs. 19.0%, p < 0.001) in patients following the minimalistic pathway, with lower hospitalization costs (median € 2200 vs. 3150; p < 0.001). At 30-day, the primary endpoint was significantly lower in patients following the minimalistic pathway (17.2% vs 23.9%, p = 0.034). CONCLUSIONS The minimalistic TAVI care pathway was associated with favorable outcomes in an unselected, real-world population. The shorter post-procedural LoS of the minimalistic approach led to a significant cost-saving.
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Affiliation(s)
- Marco Barbanti
- Università degli Studi di Enna "Kore", Piazza dell'Università, 94100, Enna, Italy.
| | - Giuliano Costa
- 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
| | - Mariachiara Calì
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Sofia Sammartino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Wanda Deste
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Luigi La Rosa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Valeria Garretto
- Division of Radiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Cristina Inserra
- Division of Radiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Pierfrancesco Veroux
- Division of Vascular Surgery, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
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3
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Forrest JK, Yakubov SJ, Deeb GM, Gada H, Mumtaz MA, Ramlawi B, Bajwa T, Crouch J, Merhi W, Wai Sang SL, Kleiman NS, Petrossian G, Robinson NB, Sorajja P, Iskander A, Berthoumieu P, Tchétché D, Feindel C, Horlick EM, Saito S, Oh JK, Jung Y, Reardon MJ. 5-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis. J Am Coll Cardiol 2025; 85:1523-1532. [PMID: 40158212 DOI: 10.1016/j.jacc.2025.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2025] [Revised: 03/04/2025] [Accepted: 03/05/2025] [Indexed: 04/02/2025]
Abstract
BACKGROUND The Evolut Low Risk trial demonstrated that transcatheter aortic valve replacement (TAVR) was noninferior to surgery for the primary endpoint of all-cause mortality or disabling stroke at 2 years. Outcomes at 5 years have not been reported. OBJECTIVES This study sought to evaluate 5-year clinical and hemodynamic outcomes with TAVR vs surgery in patients from the Evolut Low Risk trial. METHODS We randomly assigned low-risk patients with severe aortic stenosis to TAVR or surgery. The primary endpoint was a composite of all-cause mortality or disabling stroke. Secondary endpoints included clinical, echocardiographic, and quality-of-life outcomes through 5 years. RESULTS A total of 1,414 patients underwent an attempted implant (n = 730 TAVR, n = 684 surgery). The mean age was 74 years (range 51-88 years), and women accounted for 35% of patients. At 5 years the Kaplan-Meier estimate for the primary endpoint of all-cause mortality or disabling stroke was 15.5% for the TAVR group and 16.4% for the surgery group (P = 0.47). The Kaplan-Meier estimates in the TAVR and surgery groups for all-cause mortality were 13.5% and 14.9% (P = 0.39) and for disabling stroke were 3.6% and 4.0% (P = 0.57). Cardiovascular mortality was 7.2% in the TAVR group and 9.3% in the surgery group (P = 0.15). Noncardiovascular mortality in the TAVR group was 6.8% and 6.2% in the surgery group (P = 0.73). A site-level vital status sweep was performed for patients who were lost to follow-up or withdrew from the study. With the addition of these patients, the all-cause mortality rate at 5 years for patients undergoing TAVR was 14.7% and for surgery was 15.2% (P = 0.74). Over 5 years, valve reintervention rate was 3.3% for TAVR and 2.5% for surgery (P = 0.44). A sustained improvement in quality of life was observed in both treatment arms with mean Kansas City Cardiomyopathy Questionnaire summary score of 88.3 ± 15.8 in TAVR and 88.5 ± 15.8 in surgery. CONCLUSIONS At 5 years, patients with severe aortic stenosis who were treated with either TAVR or surgery had comparable rates of all-cause mortality or disabling stroke. Valve durability and performance were excellent in both arms. This midterm evaluation reinforces the position of TAVR as noninferior to surgery in patients with severe aortic stenosis at low surgical risk (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients; NCT02701283).
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Affiliation(s)
- John K Forrest
- Yale University School of Medicine, New Haven, Connecticut, USA.
| | | | - G Michael Deeb
- University of Michigan Health Systems University Hospital, Ann Arbor, Michigan, USA
| | - Hemal Gada
- University of Pittsburgh Medical Center, Harrisburg, Pennsylvania, USA
| | - Mubashir A Mumtaz
- University of Pittsburgh Medical Center, Harrisburg, Pennsylvania, USA
| | - Basel Ramlawi
- Lankenau Heart Institute, Philadelphia, Pennsylvania, USA
| | - Tanvir Bajwa
- Aurora St Luke's Medical Center, Milwaukee, Wisconsin, USA
| | - John Crouch
- Aurora St Luke's Medical Center, Milwaukee, Wisconsin, USA
| | | | | | - Neal S Kleiman
- Houston Methodist-DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | | - Paul Sorajja
- Minneapolis Heart Institute-Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Ayman Iskander
- Saint Joseph's Hospital Health Center, Syracuse, New York, USA
| | | | | | | | - Eric M Horlick
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shigeru Saito
- Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Jae K Oh
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Michael J Reardon
- Houston Methodist-DeBakey Heart and Vascular Center, Houston, Texas, USA
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4
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Bansal A, Puri R, Yun J, Krishnaswamy A, Jilaihawi H, Makkar R, Kapadia SR. Management of complications after valvular interventions. EUROINTERVENTION 2025; 21:e390-e410. [PMID: 40259838 PMCID: PMC11995294 DOI: 10.4244/eij-d-24-00066] [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: 01/23/2024] [Accepted: 11/04/2024] [Indexed: 04/23/2025]
Abstract
Transcatheter valve interventions have transformed the outcomes of patients with valvular heart disease who are at high risk for surgery. With the increasing utilisation and expansion of transcatheter valve interventions, it is of utmost importance to be familiar with their potential complications and their subsequent management, especially given the relative infrequency of many of these issues in contemporary practice. Herein, we present a state-of-the-art review article focusing on the complications, their prevention, and treatment following transcatheter aortic valve implantation, mitral transcatheter edge-to-edge repair, and transcatheter mitral valve replacement.
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Affiliation(s)
- Agam Bansal
- Department of Cardiovascular Medicine, 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
| | - James Yun
- 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
| | - Hasan Jilaihawi
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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5
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Triwiyanto T, Luthfiyah S. Letter to the Editor: Proposal: Bold New Indications for Transcatheter Pulmonary Flow Restrictors. Pediatr Cardiol 2025:10.1007/s00246-025-03868-8. [PMID: 40232362 DOI: 10.1007/s00246-025-03868-8] [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: 03/26/2025] [Accepted: 04/10/2025] [Indexed: 04/16/2025]
Affiliation(s)
- Triwiyanto Triwiyanto
- Department of Medical Electronics Technology, Poltekkes Kemenkes Surabaya, Surabaya, Indonesia.
| | - Sari Luthfiyah
- Department of Nursing, Poltekkes Kemenkes Surabaya, Surabaya, Indonesia
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6
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Litkouhi PN, Rao K, Baer A, Hansen PS, Bhindi R. Aortic Valve and Left Ventricular Outflow Tract Calcium Distribution and Conduction Outcomes After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2025; 9:100389. [PMID: 40321309 PMCID: PMC12047526 DOI: 10.1016/j.shj.2024.100389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 11/03/2024] [Accepted: 11/07/2024] [Indexed: 05/08/2025]
Abstract
Permanent pacemaker implantation (PPMI) is an important complication following transcatheter aortic valve replacement (TAVR). The influence of valvular and subvalvular calcium and its distribution between aortic leaflets on the risk of PPMI following TAVR remains unclear. We performed a systematic review of the aortic valve complex (AVC) calcium by leaflet, left ventricular outflow tract (LVOT) calcium by leaflet, total AVC calcium, total LVOT calcium, and mitral annular calcium and its association with post-TAVR atrioventricular block, left bundle branch block, and new PPMI. The search strategy included five databases identifying 893 articles. A total of 34 studies with 11,528 patients were included for qualitative analysis, and seven studies totaling 1056 patients were suitable for quantitative analysis. On meta-analysis, left coronary cusp calcium and right coronary cusp calcium were significant predictors of PPMI, while noncoronary cusp (NCC) calcium was not predictive (left coronary cusp: mean difference: 21.05 mm3, 95% CI: 5.92-36.19, p < 0.001; right coronary cusp: mean difference: 46.02 mm3, 95% CI: 1.84-90.21, p = 0.04, and NCC: mean difference: 0.19 mm3, 95% CI: -0.32 to 0.50, p = 0.10). On qualitative review, LVOT calcium in the NCC region was the leaflet most commonly predictive of post-TAVR conduction outcomes. Total AVC, total LVOT calcium, and mitral annular calcium had no convincing association with post-TAVR conduction outcomes. The distribution of calcium rather than its total volume was associated with post-TAVR conduction abnormalities. Heterogeneity in methodology and implantation techniques between studies limits the clinical significance of these findings.
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Affiliation(s)
- Princess Neila Litkouhi
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Medicine, University of Sydney, Camperdown, Australia
| | - Karan Rao
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Medicine, University of Sydney, Camperdown, Australia
| | - Alexandra Baer
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Peter S. Hansen
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Medicine, University of Sydney, Camperdown, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Medicine, University of Sydney, Camperdown, Australia
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7
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Mas-Peiro S, Lhermusier T, Urena M, Nombela-Franco L, Vilalta V, Muñoz-Garcia A, Amat-Santos I, Atienza F, Kleiman N, Chamandi C, Serra V, Deyell MW, Campelo-Parada F, Mondoly P, Suc G, Canadas-Godoy V, Fernandez-Nofrerias E, Castrodeza J, Elizaga J, Baudinaud P, Francisco Pascual J, Webb JG, Pelletier-Beaumont E, Philippon F, Rodés-Cabau J. Late arrhythmic burden in patients with left bundle branch block after TAVR with the Evolut valve. Europace 2025; 27:euaf057. [PMID: 40103312 PMCID: PMC11983392 DOI: 10.1093/europace/euaf057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2024] [Revised: 03/04/2025] [Accepted: 03/06/2025] [Indexed: 03/20/2025] Open
Abstract
AIMS Arrhythmic burden after discharge in patients with new-onset persistent left bundle branch block (NOP-LBBB) following transcatheter aortic valve replacement (TAVR) with Evolut devices remains largely unknown. The aim of this study is to assess the incidence and type of arrhythmias at 2-year follow-up in patients with NOP-LBBB post-TAVR. METHODS AND RESULTS This is a prospective multicentre study including 88 patients with LBBB persisting for ≥3 days post-implantation. Before discharge, an implantable loop recorder (REVEAL XT/LINQ) was implanted; patients had continuous monitoring for 2 years. Arrhythmic events were adjudicated in a central core lab. Of the arrhythmic events, 411 were detected in 58 patients [65.9%; 2 (1-4) events per patient]. Symptoms were reported in 12/58 (20.7%), and therapy was changed in 25/58 (43.1%). There were 101 bradyarrhythmic events in 33 patients [35 high-grade atrioventricular block (HAVB) and 66 severe bradycardia]. The HAVB incidence was higher in the early (4-week) phase and remained stable over time, whereas severe bradycardia increased after 1 year. Permanent pacemaker was required in 11 (12.5%) patients (6.8% and 5.7% in the first and second year, respectively). There were 310 tachyarrhythmic events in 29 patients (120 AF/AFL, 111 AT, 72 SVT, 6 NSVT, and 1 VT); its incidence decreased throughout the 2 years. New AF/AFL episodes occurred in 20/69 patients [29%; symptomatic in 2/20 (10%)]. CONCLUSION Patients with NOP-LBBB post-TAVR with Evolut devices exhibited a high burden of late arrhythmias, with events occurring in two-thirds of patients and leading to treatment changes in about half of them. These data should inform future studies on cardiac monitoring devices for follow-up and treatment optimization in this challenging population.
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Affiliation(s)
- Silvia Mas-Peiro
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City, Quebec, Canada G1V4G5
| | - Thibault Lhermusier
- Department of Cardiology, Hôpital Universitaire de Toulouse, Toulouse, France
| | - Marina Urena
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Victoria Vilalta
- Department of Cardiology, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Ignacio Amat-Santos
- Department of Cardiology, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Felipe Atienza
- Department of Cardiology, Hospital Gregorio Marañón, Madrid, Spain
| | - Neal Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | | | - Vicenç Serra
- Department of Cardiology, Hospital Universitari Vall d’Hebron, CIBER-CV, Barcelona, Spain
| | - Marc W Deyell
- Department of Cardiology, St Paul’s Hospital, Vancouver, Canada
| | | | - Pierre Mondoly
- Department of Cardiology, Hôpital Universitaire de Toulouse, Toulouse, France
| | - Gaspard Suc
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | | | | | - Javier Castrodeza
- Department of Cardiology, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Jaime Elizaga
- Department of Cardiology, Hospital Gregorio Marañón, Madrid, Spain
| | - Pierre Baudinaud
- Department of Cardiology, Hôpital Européen George Pompidou, Paris, France
| | | | - John G Webb
- Department of Cardiology, St Paul’s Hospital, Vancouver, Canada
| | - Emilie Pelletier-Beaumont
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City, Quebec, Canada G1V4G5
| | - François Philippon
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City, Quebec, Canada G1V4G5
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City, Quebec, Canada G1V4G5
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8
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Lee YT, Tsao TP, Lee KC, Lin HC, Liu CT, Hsiung MC, Yin WH, Wei J. Predictors of permanent pacemaker requirement in aortic stenosis patients undergoing self-expanding valve transcatheter aortic valve replacement using the cusp overlap technique. Front Cardiovasc Med 2025; 12:1486375. [PMID: 40041167 PMCID: PMC11876403 DOI: 10.3389/fcvm.2025.1486375] [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: 09/04/2024] [Accepted: 02/03/2025] [Indexed: 03/06/2025] Open
Abstract
Introduction Since TAVR was approved for lower-risk aortic stenosis (AS) patients, managing post-implantation conduction disturbances has become crucial, especially with self-expanding heart valves (SEV). This study aims to identify risk factors for conduction disturbances in such patients using a specific fluoroscopic cusp overlap (COL) technique. Methods This retrospective study analyzed AS patients who underwent TAVR with SEV from 2019 to 2022, excluding those needing pacemakers or valve-in-valve procedures. Patients were grouped by conventional (CON) and COL techniques, with outcomes monitored using Valve Academic Research Consortium (VARC)-2 criteria. Results In this cohort study of 114 patients, 17 were excluded due to pre-existing pacemakers. Forty-seven received SEVs using COL, and 50 with CON techniques. The COL group showed a significant reduction in new LBBB (27.7% vs. 46%, p = 0.006) and PPI rates (4.3% vs. 18%, p = 0.033) compared to the CON group. Deeper implantation depth below the non-coronary cusp (NCC) and left coronary cusp (LCC) was linked to an increased risk of conduction disturbances. Multivariate analysis identified smaller left ventricular outflow tract diameter, shorter membranous septum length, and greater pre-releasing implantation depth below the LCC as predictors of future PPI risk. Conclusion The use of the COL technique significantly reduces the risk of newly developed conduction disturbances after SEV TAVR. Keeping SEV implantation depth within 1 mm of the membranous septum length and maintaining an implantation depth of <6 mm below the LCC before final release further minimizes the risk of PPI.
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Affiliation(s)
- Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Department of Exercise and Health Science, National Taipei University of Nursing and Healthy Science, Taipei, Taiwan
| | - Tien-Ping Tsao
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Chen Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Huan-Chiu Lin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Ting Liu
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | | | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
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9
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Van Mieghem NM, Windecker S, Manoharan G, Lancellotti P, Tamburino C, Kornowski R, Thiele H, Danenberg H, Fiorina C, Scholtz W, Brecker S, Ruge H, Opdahl A, Amoroso G, Bedogni F, Petronio AS, Nickenig G, Harnath A, Kempfert J, Oh JK, Eisenberg RE, Grube E. Three-Year Outcomes With a Supra-Annular, Self-Expanding Bioprosthesis and a Pericardial Wrap-The FORWARD PRO Study. Catheter Cardiovasc Interv 2025; 105:577-587. [PMID: 39686582 PMCID: PMC11831722 DOI: 10.1002/ccd.31335] [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: 04/23/2024] [Revised: 09/24/2024] [Accepted: 11/22/2024] [Indexed: 12/18/2024]
Abstract
BACKGROUND The self-expanding, supra-annular Evolut valve is an established platform for Transcatheter Aortic Valve Implantation (TAVI). Evolut PRO introduced an outer sealing wrap to mitigate paravalvular leakage. We evaluated the 3-year clinical outcomes and valve performance of the Evolut PRO in standard clinical practice for severe aortic stenosis (AS) patients at intermediate or higher risk for surgery. METHODS The FORWARD PRO prospective, single-arm, multicentre, post-market clinical study enrolled 638 patients with native aortic valve stenosis or failed surgical bioprosthetic aortic valve undergoing TAVI, at intermediate or high risk, with the Evolut PRO valve. Clinical and serial echocardiographic outcomes were followed-up for 3 years. RESULTS TAVI using Evolut PRO was attempted in 629 AS patients (implanted in 97%) (mean age 81.7 years; STS PROM score, 4.7%). At 3 years all-cause mortality was 25.0%, disabling stroke 6.5% (all-cause mortality or disabling stroke, 28.5%) and rate of new permanent pacemaker implantation 24.7%. Excellent valve haemodynamics were maintained (mean gradient 8.8 ± 4.7 mm Hg; mean effective orifice area 2.0 ± 0.5 cm2) at 3 years. In a paired analysis of patients with ≥ mild paravalvular leakage (PVL) at discharge, more than two-thirds demonstrated improved PVL at 3 years. Patients with ≥ mild PVL at discharge had higher median total calcium volume than those with no/trace PVL (p < 0.001). CONCLUSIONS In clinical practice TAVI with the Evolut PRO valve is associated with favorable clinical outcomes and excellent haemodynamic performance out to 3 years. The observation of improvements in PVL over time warrants further research.
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Affiliation(s)
- Nicolas M. Van Mieghem
- Department of CardiologyCardiovascular Institute, Erasmus University Medical Center RotterdamRotterdamThe Netherlands
| | - Stephan Windecker
- Department of Cardiology, InselspitalBern University HospitalBernSwitzerland
| | - Ganesh Manoharan
- Department of CardiologyRegional Health Centre, Royal Victoria HospitalBelfastUK
| | | | - Corrado Tamburino
- Cardiothoracic, Transplantation and Vascular Surgery DepartmentAzienda Policlinico‐Vittorio Emanuele, Universita di CataniaCataniaItaly
| | - Ran Kornowski
- Cardiology DivisionRabin Medical CenterPetach TikvaIsrael
| | - Holger Thiele
- Department of Internal Medicine, CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Haim Danenberg
- Interventional CardiologyWolfson Medical CenterTel AvivIsrael
| | - Claudia Fiorina
- Cardiothoracic DepartmentSpedali Civili di BresciaBresciaItaly
| | - Werner Scholtz
- Clinic for General and Interventional Cardiology, AngiologyHerz‐ und Diabeteszentrum Nordrhein‐Westfalen, Universitätsklinik der Ruhr‐Universität BochumBad OeynhausenGermany
| | | | - Hendrik Ruge
- Department of Cardiovascular SurgeryDeutsches Herzzentrum MünchenMunichGermany
| | - Anders Opdahl
- Department of CardiologyOslo University Hospital RikshospitaletOsloNorway
| | | | - Francesco Bedogni
- Clinical Cardiology, Inverventional Cardiology and Coronary Intesive Care UnitsIRCCS Policlinico San DonatoMilanItaly
| | | | | | - Axel Harnath
- Cardiology DepartmentSana Heart CenterCottbusGermany
| | - Joerg Kempfert
- Department of Cardiothoracic and Vascular SurgeryGerman Heart Institute Charité BerlinBerlinGermany
| | - Jae K. Oh
- Echocardiography Core LaboratoryMayo ClinicRochesterMinnesotaUSA
| | | | - Eberhard Grube
- Center of Innovative Interventions in CardiologyUniversity Hospital BonnBonnGermany
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10
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Chen M, Liu X, Zhou Y, Chen Y, Feng Y, Boatman SV, Wang J. 30-Day Transcatheter Aortic Valve Replacement Outcomes in Severe Symptomatic Aortic Stenosis Chinese Patients. JACC. ASIA 2025; 5:318-321. [PMID: 39967225 PMCID: PMC11840230 DOI: 10.1016/j.jacasi.2024.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 10/02/2024] [Accepted: 10/18/2024] [Indexed: 02/20/2025]
Affiliation(s)
- Mao Chen
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xianbao Liu
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Yujie Zhou
- Department of Cardiology, Anzhen Hospital of the Capital University of Medical Science, Beijing, People's Republic of China
| | - Yundai Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yuan Feng
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | | | - Jianan Wang
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.
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11
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Yashima F, Yamamoto M, Shirai S, Tada N, Naganuma T, Yamawaki M, Yamanaka F, Mizutani K, Noguchi M, Ueno H, Takagi K, Ohno Y, Izumo M, Nishina H, Suzuyama H, Yamasaki K, Nishioka K, Hachinohe D, Fuku Y, Otsuka T, Asami M, Watanabe Y, Hayashida K. Initial Findings Concerning the Latest Self-Expandable Evolut FX Valve: A Report Using OCEAN-TAVI Registry Data. Am J Cardiol 2025; 235:59-66. [PMID: 39461400 DOI: 10.1016/j.amjcard.2024.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 10/02/2024] [Accepted: 10/14/2024] [Indexed: 10/29/2024]
Abstract
Data concerning the clinical effect of the latest-generation self-expandable transcatheter heart valve (Evolut FX) remain limited. We aimed to assess the in-hospital outcomes of 3 bioprosthetic valves (Evolut EPO, PRO+, and FX). We analyzed data from a Japanese multicenter registry involving 634 consecutive patients who underwent transcatheter aortic valve replacement with Evolut FX up until October 2023. Patients who underwent transcatheter aortic valve replacement with Evolut EPO between 2018 and 2020 (n = 1,128), and those with Evolut EPO+ between 2020 and 2023 (n = 1,696) served as the control groups. The exclusion criteria comprised patients on dialysis with a history of infective endocarditis or with insufficient data. Unmatched comparisons among the 3 valves were conducted, followed by a propensity score-matched comparison between Evolut EPO+ and FX. In the unmatched cohort, among the Evolut EPO, PRO+, and FX groups, all vascular complications (7.8% vs 5.2% vs 4.5%, respectively, p <0.01) and new pacemaker implantation rates (11.2% vs 6.1% vs 7.7%, respectively, p <0.01) differed significantly. In the propensity score-matched analysis, the rate of all bleeding events was significantly higher in the Evolut EPO+ group (11.0%) than in the FX group (7.0%) (p = 0.02), whereas all vascular complications (4.6% vs 4.6%, respectively, p = 1.00) and new pacemaker implantation (5.9% vs 7.6%, respectively, p = 0.28) rates were comparable. The incidence of stroke in the FX group was approximately half that of the EP+ group (3.7% vs 1.9%, p = 0.095), without statistical significance. In conclusion, compared with the Evolut EPO+, Evolut FX was associated with a lower incidence of in-hospital bleeding complications and may reduce the incidence of in-hospital stroke.
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Affiliation(s)
- Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan.
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan; Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kazuki Mizutani
- Division of Cardiology, Department of Medicine, Kindai University, Osaka, Japan
| | - Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Hiroshi Ueno
- Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, National Cerebral and Cardiovascular Center, Oasaka, Japan
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Masaki Izumo
- Department of Cardiology, St Marianna University School of Medicine, Tokyo, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Hiroto Suzuyama
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Kazumasa Yamasaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Kenji Nishioka
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Daisuke Hachinohe
- Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Yasushi Fuku
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan; Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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12
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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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13
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Bagur R, Chu MWA, Kabali C, Ordoñez S, Husain AS, Yoon SH, Palma Dallan LA, Alosail A, Althekrallah J, Valdis M, Teefy P, Diamantouros P, Webb JG, Attizzani GF. Readmissions after next-day discharge following transcatheter aortic valve implantation. EUROINTERVENTION 2024; 20:e1505-e1519. [PMID: 39676548 DOI: 10.4244/eij-d-24-00514] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2024]
Abstract
BACKGROUND No data compare newer-generation transcatheter heart valves (THVs) in terms of next-day discharge (NDD) following transfemoral (TF) transcatheter aortic valve implantation (TAVI). AIMS We aimed to evaluate the safety of NDD in unselected patients who received ACURATE (neo/neo2), Evolut (PRO/PRO+/FX) and the SAPIEN (3/Ultra) THVs. METHODS This multicentre registry included patients who underwent TF-TAVI without a preprocedural permanent pacemaker implantation (PPI) and were discharged the next day without a new PPI. The primary endpoint was unplanned readmissions at 30 days. Multinomial gradient-boosted inverse probability of treatment-weighted (IPTW) propensity scores (stage 1) followed by the modified Poisson regression (stage 2) approach were used to compare the average effects of the THVs on the primary outcome. RESULTS A total of 963 all-comer patients (ACURATE=264, Evolut=306, and SAPIEN=393) were included in this study. ACURATE patients were older (p<0.001) and included a greater proportion of females (p<0.001), whereas Evolut patients had a higher risk profile as assessed by the Society of Thoracic Surgeons score (p=0.01). There were no differences between the groups in terms of right or left bundle branch block (p=0.75). At 30 days, the overall readmission rate was 8%, and there were no differences in cardiac (ACURATE 4.6% vs Evolut 4.2% vs SAPIEN 3.1%; p=0.56) or non-cardiac readmissions (ACURATE 4.6% vs Evolut 3.3% vs SAPIEN 4.6%; p=0.64). Readmission for new PPI was 2.7%, 1.0% and 1.8% (p=0.32) and for heart failure (HF) was 1.5%, 2.0% and 1.3% (p=0.76) in ACURATE, Evolut and SAPIEN patients, respectively. The IPTW propensity score model followed by modified Poisson regression indicate that, using ACURATE as the reference, no significant differences were found in 30-day readmissions (relative risk [RR] 0.76, 95% confidence interval [CI]: 0.38-1.52; p=0.38 for Evolut and RR 0.74, 95% CI: 0.44-1.22; p=0.28 for SAPIEN). CONCLUSIONS In pacemaker-naïve patients undergoing TF-TAVI with newer-generation THVs, NDD was not associated with a negative impact on overall 30-day readmissions, cardiac or non-cardiac readmissions, readmissions for PPI or HF after discharge, or mortality, regardless of the type of THV.
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Affiliation(s)
- Rodrigo Bagur
- Heart Team, London Health Sciences Centre, Western University, London, ON, Canada
| | - Michael W A Chu
- Heart Team, London Health Sciences Centre, Western University, London, ON, Canada
| | - Conrad Kabali
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Santiago Ordoñez
- Heart Team, London Health Sciences Centre, Western University, London, ON, Canada
| | - Ali S Husain
- Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Sung-Han Yoon
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Luis A Palma Dallan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Abdulmajeed Alosail
- Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jasem Althekrallah
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mathew Valdis
- Heart Team, London Health Sciences Centre, Western University, London, ON, Canada
| | - Patrick Teefy
- Heart Team, London Health Sciences Centre, Western University, London, ON, Canada
| | | | - John G Webb
- Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Guilherme F Attizzani
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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14
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Rodés-Cabau J, Nombela-Franco L, Muntané-Carol G, Veiga G, Regueiro A, Nazif T, Serra V, Asmarats L, Ribeiro HB, Latib A, Poulin A, Cheema AN, Jiménez-Quevedo P, Gomez-Hospital JA, Ongay AG, Gabani R, Arzamendi D, Brener M, Calabuig A, Scotti A, Gelain MAS, Labinaz M, Cepas-Guillén P, Nuche J, Côté M, Del Portillo JH, Philippon F. Prospective validation of a prespecified algorithm for the management of conduction disturbances after transcatheter aortic valve replacement: The PROMOTE study. Heart Rhythm 2024:S1547-5271(24)03692-0. [PMID: 39694306 DOI: 10.1016/j.hrthm.2024.12.019] [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: 10/13/2024] [Revised: 12/01/2024] [Accepted: 12/07/2024] [Indexed: 12/20/2024]
Abstract
BACKGROUND There is a large variability in the management of conduction disturbances (CDs) after transcatheter aortic valve replacement (TAVR). OBJECTIVE This study aimed to validate a prespecified algorithm for managing CDs in patients undergoing TAVR. METHODS This was a prospective multicenter study including consecutive patients without prior pacemaker undergoing TAVR. Patients were stratified in different groups according to the presence of prior right bundle branch block (RBBB) and the occurrence of CDs during the procedure: no prior RBBB and no CDs (group NCD), prior RBBB and no CDs (group RBBB-NCD), and occurrence of CDs (group CD). A management algorithm was prespecified for each group. Permanent pacemaker (PPM) and mortality (overall, sudden cardiac death) at 30 days were the primary end points. RESULTS A total of 2110 TAVR recipients were included. Patients were distributed in NCD (32.0%), RBBB-NCD (5.1%), and CD (62.9%) groups. A total of 329 patients (15.6%) received a PPM at 30 days, with a PPM rate of 5.5%, 15.9%, and 20.7% in the NCD, RBBB-NCD, and CD groups, respectively (P < .001). The PPM rate was 17.4% and 57.2% in patients with procedural new-onset left bundle branch block and high-degree atrioventricular block/complete heart block, respectively. There were no differences in 30-day all-cause mortality and sudden cardiac death between groups (NCD group, 1.2% and 0.2%; RBBB-NCD group, 0% and 0%; CD group, 0.7% and 0.1%; P = .45 and P = .99 for all-cause mortality and sudden cardiac death, respectively). CONCLUSION A prespecified strategy for the management of CDs in contemporary TAVR recipients was feasible and safe, with no increased mortality and an extremely low rate of sudden cardiac death in patients with CDs. However, PPM rates remained high, and continued efforts for preventing the occurrence of CDs are warranted.
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Affiliation(s)
- Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
| | - Luis Nombela-Franco
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Gabriela Veiga
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Ander Regueiro
- Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Tamim Nazif
- Columbia University Irving Medical Center, New York, New York
| | | | - Lluis Asmarats
- Hospital Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Barcelona, Spain
| | | | | | - Anthony Poulin
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Asim N Cheema
- Southlake Regional Health Center, Toronto, Ontario, Canada
| | - Pilar Jiménez-Quevedo
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Aritz Gil Ongay
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Rami Gabani
- Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Dabit Arzamendi
- Hospital Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Barcelona, Spain
| | - Michael Brener
- Columbia University Irving Medical Center, New York, New York
| | | | | | | | | | - Pedro Cepas-Guillén
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jorge Nuche
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Melanie Côté
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Juan H Del Portillo
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
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15
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Costa G, Sammartino S. Is next-day discharge after uncomplicated transcatheter aortic valve implantation the new standard of care? EUROINTERVENTION 2024; 20:e1488-e1489. [PMID: 39676549 DOI: 10.4244/eij-e-24-00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2024]
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16
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Webb JG, Millar K. Editorial: Decreasing pacemaker implantation rates with Evolut supra-annular transcatheter aortic valves. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 69:10-11. [PMID: 39054173 DOI: 10.1016/j.carrev.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024]
Affiliation(s)
- John G Webb
- From the Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, BC, Canada.
| | - Kevin Millar
- From the Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, BC, Canada
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17
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Harvey JE, Puri R, Grubb KJ, Yakubov SJ, Mahoney PD, Gada H, Coylewright M, Poulin MF, Chetcuti SJ, Sorajja P, Rovin JD, Eisenberg R, Reardon MJ. Decreasing pacemaker implantation rates with Evolut supra-annular transcatheter aortic valves in a large real-world registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 69:1-9. [PMID: 38871537 DOI: 10.1016/j.carrev.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/29/2024] [Accepted: 05/17/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Permanent pacemaker implantation (PPI) rates following transcatheter aortic valve replacement (TAVR) remain a concern. We assessed the PPI rates over time in patients implanted with an Evolut supra-annular, self-expanding transcatheter valve from the US STS/ACC TVT Registry. METHODS Patients who underwent TAVR with an Evolut R, Evolut PRO or Evolut PRO+ valve between July 2018 (Q3) and June 2021 (Q2) were included. PPI rates were reported by calendar quarter. In-hospital PPI rates were reported as proportions and 30-day rates as Kaplan-Meier estimates. A Cox regression model was used to determine potential predictors of a new PPI within 30 days of the TAVR procedure. RESULTS From July 2018 to June 2021, 54,014 TAVR procedures were performed using Evolut valves. Mean age was 79.3 ± 8.8 years and 49.2 % were male. The 30-day PPI rate was 16.6 % in 2018 (Q3) and 10.8 % in 2021 (Q2, 34.9 % decrease, p < 0.001 for trend across all quarters). The in-hospital PPI rate decreased by 40.1 %; from 14.7 % in 2018 (Q3) to 8.8 % in 2021 (Q2) (p < 0.001 for trend across all quarters). Significant predictors of a new PPI within 30 days included a baseline conduction defect, history of atrial fibrillation, home oxygen, and diabetes mellitus. CONCLUSION From 2018 to 2021, TAVR with an Evolut transcatheter heart valve in over 50,000 patients showed a significant decreasing trend in the rates of in-hospital and 30-day PPI, representing the lowest rate of PPI in any large real-world registry of Evolut. During the same evaluated period, high device success and shorter length of stay was also observed.
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Affiliation(s)
- James E Harvey
- WellSpan York Hospital, 1001 S George Street, York, PA 17403, USA.
| | - Rishi Puri
- Cleveland Clinic, 2049 East 100(th) Street, Cleveland, OH 44195, USA.
| | - Kendra J Grubb
- Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA.
| | - Steven J Yakubov
- Riverside Methodist-Ohio Health, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Paul D Mahoney
- Sentara Healthcare, 600 Gresham Drive, Suite 8630A, Norfolk, VA 23507, USA
| | - Hemal Gada
- University of Pittsburgh-Pinnacle, 1000 N Front Street, Wormleysburg, PA 17043, USA
| | - Megan Coylewright
- Erlanger Heart and Lung Institute, 979 E 3rd Street, C-520, Chattanooga, TN 37403, USA.
| | - Marie-France Poulin
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - Stanley J Chetcuti
- University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Paul Sorajja
- Minneapolis Heart Institute-Abbott-Northwestern Hospital, 920 E 28th Street, Suite 100, Minneapolis, MN 55404, USA.
| | - Joshua D Rovin
- Morton Plant Hospital, 55 Pinellas St #320, Clearwater, FL 33756, USA.
| | - Ruth Eisenberg
- Medtronic, 8200 Coral Sea Street, Mounds View, MN 55112, USA.
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St #1401, Houston, TX, USA.
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18
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Guthoff H, Abdel-Wahab M, Kim WK, Witberg G, Wienemann H, Thurow M, Shamekhi J, Eckel C, von der Heide I, Veulemans V, Landt M, Barbanti M, Finkelstein A, Schewel J, Van Mieghem N, Adrichem R, Toggweiler S, Rheude T, Nombela-Franco L, Amat-Santos IJ, Ruile P, Estévez-Loureiro R, Bunc M, Branca L, De Backer O, Tarantini G, Mylotte D, Arzamendi D, Pauly M, Bleiziffer S, Renker M, Al-Kassou B, Möllmann H, Ludwig S, Zeus T, Tamburino C, Schmidt T, Rück A, von Stein P, Thiele H, Abdelhafez A, Adam M, Baldus S, Rudolph T, Mauri V. Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2024; 17:2626-2635. [PMID: 39603776 DOI: 10.1016/j.jcin.2024.08.041] [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: 03/04/2024] [Revised: 07/21/2024] [Accepted: 08/27/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND Prosthesis-patient mismatch after transcatheter aortic valve replacement (TAVR) can be measured echocardiographically (measured prosthesis-patient mismatch [PPMm]) or predicted (predicted prosthesis-patient mismatch [PPMp]) using published effective orifice area (EOA) reference values. However, the clinical implications of PPM post-TAVR remain unclear. OBJECTIVES This study aimed to elucidate the prevalence of PPMm and PPMp post-TAVR and their impact on mortality in a large international cohort. METHODS The IMPPACT TAVR (Impact of Measured or Predicted Prosthesis-pAtient mismatCh after TAVR) registry included 38,808 TAVR patients from 26 international centers. Valve Academic Research Consortium 3 criteria were used to define prosthesis-patient mismatch severity. EOA was determined echocardiographically (PPMm) or predicted (PPMp) based on core lab-derived EOA reference values. The primary endpoint was 2-year all-cause mortality. RESULTS The prevalence of PPMp (moderate: 6.8%, severe: 0.6%) was significantly lower than that of PPMm (moderate: 20.7%, severe: 4.3%; P < 0.001) with negligible correlation between the 2 methods (Kendall's tau c correlation coefficient: 0.063; P < 0.001). In unadjusted analyses, severe PPMm adversely influenced 2-year survival (HR: 1.22; 95% CI: 1.02-1.45; P = 0.027), whereas severe PPMp was not associated with outcomes (HR: 0.81; 95% CI: 0.55-1.19; P = 0.291). After adjusting for confounders, neither PPMm nor PPMp had a significant effect on 2-year all-cause mortality. CONCLUSIONS PPMm and PPMp were associated with different patient characteristics, with PPMm tending toward worse (especially low flow) and PPMp toward better (especially women) survival. After adjusting for confounders, neither PPMm nor PPMp significantly affected 2-year all-cause mortality. Hence, valve selection should not solely be based on hemodynamics but rather on a holistic approach, including patient and procedural specifics.
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Affiliation(s)
- Henning Guthoff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site RhineMain, Bad Nauheim, Germany
| | - Guy Witberg
- Division of Cardiology, Rabin Medical Center, Petah-Tikva, Israel
| | - Hendrik Wienemann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Maria Thurow
- Department of Statistics, Technical University Dortmund University, Dortmund, Germany
| | - Jasmin Shamekhi
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Clemens Eckel
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Ina von der Heide
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Verena Veulemans
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | | | | | - Jury Schewel
- Department of Cardiology, Marienkrankenhaus Hamburg, Hamburg, Germany; Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Nicolas Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rik Adrichem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Tobias Rheude
- Department of Cardiovascular Disease, German Heart Center Munich, Munich, Germany
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Ignacio J Amat-Santos
- Centro de Investigación Biomédica en Red - Enfermedades Cardiovasculares, Madrid, Spain; Cardiology Department, University Clinic Hospital, Valladolid, Spain
| | - Philipp Ruile
- Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Matjaz Bunc
- University Clinical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Luca Branca
- Cardiovascular Department, Spedali Civili, Brescia, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Dabit Arzamendi
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Barcelona, Spain
| | - Markus Pauly
- Department of Statistics, Technical University Dortmund University, Dortmund, Germany
| | - Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Matthias Renker
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site RhineMain, Bad Nauheim, Germany
| | - Baravan Al-Kassou
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Tobias Zeus
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | | | - Tobias Schmidt
- Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Andreas Rück
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - Philipp von Stein
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ahmed Abdelhafez
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Matti Adam
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Stephan Baldus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Tanja 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
| | - Victor Mauri
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany.
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19
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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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20
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Blackman DJ, Ryschon AM, Barnett S, Garner AM, Forrest JK, Reardon MR, Pietzsch JB. Cost-effectiveness of TAVI in the United Kingdom: a long-term analysis based on 4-year data from the Evolut Low Risk Trial. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-024-01739-2. [PMID: 39579244 DOI: 10.1007/s10198-024-01739-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 11/07/2024] [Indexed: 11/25/2024]
Abstract
BACKGROUND The cost-effectiveness of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) has previously been reported across the spectrum of surgical mortality risk. We present an updated analysis specific to the UK based on 4-year data from the Evolut Low Risk Trial, which showed a maintained numerical survival benefit with TAVI. METHODS A decision-analytic Markov model was used to project outcomes and costs over a lifetime horizon. Adverse events and utilities were modeled based on 4-year trial data. Beyond 4 years, no difference in long-term survival between TAVR and SAVR was assumed. Costs were informed by NHS England reference costs and reflect resource utilization in the UK TAVI Trial, with costs and effects discounted at 3.5% p.a. The lifetime incremental cost-effectiveness ratio (ICER) was evaluated against the established £20,000-£ 30,000 per QALY cost-effectiveness threshold. Extensive sensitivity and scenario analyses were performed, including comparison to prior results based on 12-month data. RESULTS TAVI improved survival by 0.41 life years and added 0.28 QALYs at incremental cost of £5,021, resulting in a lifetime ICER of £17,883 per QALY gained. 57.5% and 85.3% of probabilistic sensitivity analysis simulations were cost-effective at the £20,000 and £30,000 per QALY thresholds. Use of 4- vs. 1-year trial data markedly improved lifetime cost-effectiveness. CONCLUSION Recent 4-year follow-up data from the Evolut Low Risk trial suggest TAVI adds meaningful patient benefit over lifetime and can be expected to be a cost-effective intervention compared to SAVR for low surgical risk patients in a UK setting.
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Affiliation(s)
- Daniel J Blackman
- Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, West Yorkshire, England
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21
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Gupta T, Malaisrie SC, Batchelor W, Boudoulas KD, Davidson L, Ibebuogu UN, Kpodonu J, Singh R, Sultan I, Theriot M, Reardon MJ, Leon MB, Grubb KJ. Decision-Making Approach to the Treatment of Young and Low-Risk Patients With Aortic Stenosis. JACC Cardiovasc Interv 2024; 17:2455-2471. [PMID: 39537269 DOI: 10.1016/j.jcin.2024.08.032] [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: 06/06/2024] [Revised: 08/16/2024] [Accepted: 08/27/2024] [Indexed: 11/16/2024]
Abstract
Over a decade of randomized controlled trial data demonstrate excellent outcomes with transcatheter aortic valve replacement or surgical aortic valve replacement for patients with symptomatic severe aortic stenosis regardless of surgical risk. The 2020 American College of Cardiology/American Heart Association guidelines recommend both options for low-risk AS patients aged 65 to 80 years. However, the fastest growing population of patients receiving transcatheter aortic valve replacement in the United States is <65 years old, with little data to support the practice. The American College of Cardiology's Cardiac Surgery Team Section Leadership and Interventional Cardiology Councils, a multidisciplinary collaboration of cardiologists and cardiac surgeons, sought to summarize the relevant data into a decision-making tool for heart valve teams. A literature review was completed, and guidelines, randomized controlled trials, and large observational studies were summarized into a pragmatic decision-making approach to treating young and low-risk patients with AS.
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Affiliation(s)
- Tanush Gupta
- Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - S Chris Malaisrie
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Wayne Batchelor
- Inova Schar Heart and Vascular Institute, Falls Church, Virginia, USA
| | | | - Laura Davidson
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Uzoma N Ibebuogu
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jacques Kpodonu
- Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ramesh Singh
- Inova Schar Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Center for Heart Valve Disease, University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Misty Theriot
- Lake Charles Memorial Hospital Heart & Vascular Center, Lake Charles, Louisiana, USA
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Martin B Leon
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
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22
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Modine T, Tchétché D, Van Mieghem NM, Deeb GM, Chetcuti SJ, Yakubov SJ, Sorajja P, Gada H, Mumtaz M, Ramlawi B, Bajwa T, Crouch J, Teirstein PS, Kleiman NS, Iskander A, Bagur R, Chu MW, Berthoumieu P, Sudre A, Adrichem R, Ito S, Huang J, Popma JJ, Forrest JK, Reardon MJ. Three-Year Outcomes Following TAVR in Younger (<75 Years) Low-Surgical-Risk Severe Aortic Stenosis Patients. Circ Cardiovasc Interv 2024; 17:e014018. [PMID: 39421943 PMCID: PMC11573113 DOI: 10.1161/circinterventions.124.014018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/31/2024] [Indexed: 10/19/2024]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis, but data are limited on younger, low-risk patients. This analysis compares outcomes in low-surgical-risk patients aged <75 years receiving TAVR versus surgery. METHODS The Evolut Low Risk Trial randomized 1414 low-risk patients to treatment with a supra-annular, self-expanding TAVR or surgery. We compared rates of all-cause mortality or disabling stroke, associated clinical outcomes, and bioprosthetic valve performance at 3 years between TAVR and surgery patients aged <75 years. RESULTS In patients <75 years, 352 were randomized to TAVR and 351 to surgery. Mean age was 69.1±4.0 years (minimum 51 and maximum 74); Society of Thoracic Surgeons Predicted Risk of Mortality was 1.7±0.6%. At 3 years, all-cause mortality or disabling stroke for TAVR was 5.7% and 8.0% for surgery (P=0.241). Although there was no difference between TAVR and surgery in all-cause mortality, the incidence of disabling stroke was lower with TAVR (0.6%) than surgery (2.9%; P=0.019), while surgery was associated with a lower incidence of pacemaker implantation (7.1%) compared with TAVR (21.0%; P<0.001). Valve reintervention rates (TAVR 1.5%, surgery 1.5%, P=0.962) were low in both groups. Valve performance was significantly better with TAVR than surgery with lower mean aortic gradients (P<0.001) and lower rates of severe prosthesis-patient mismatch (P<0.001). Rates of valve thrombosis and endocarditis were similar between groups. There were no significant differences in rates of residual ≥moderate paravalvular regurgitation. CONCLUSIONS Low-risk patients <75 years treated with supra-annular, self-expanding TAVR had comparable 3-year all-cause mortality and lower disabling stroke compared with patients treated with surgery. There was significantly better valve performance in patients treated with TAVR. REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT02701283.
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Affiliation(s)
- Thomas Modine
- Centre Hospitalier Universitaire de Bordeaux, L’Unité Médico-Chirurgicale des Valvulopathies, Chirurgie Cardiaque, Université de Bordeaux, France (T.M.)
| | | | - Nicolas M. Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, the Netherlands (N.M.V.M., R.A.)
| | - G. Michael Deeb
- Department of Cardiac Surgery and Division of Interventional Cardiology (G.M.D.), Michigan Medicine Health Systems – University Hospital, Ann Arbor, MI
| | - Stanley J. Chetcuti
- Department of Internal Medicine and Division of Cardiovascular Medicine (S.J.C.), Michigan Medicine Health Systems – University Hospital, Ann Arbor, MI
| | - Steven J. Yakubov
- Department of Cardiology, Ohio Health Riverside Methodist Hospital, Columbus (S.J.Y.)
| | - Paul Sorajja
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (P.S.)
| | - Hemal Gada
- Department of Interventional Cardiology and Cardiothoracic Surgery, University of Pittsburgh Medical Center, Moffitt Heart/Pinnacle Health, Harrisburg, PA (H.G., M.M.)
| | - Mubashir Mumtaz
- Department of Interventional Cardiology and Cardiothoracic Surgery, University of Pittsburgh Medical Center, Moffitt Heart/Pinnacle Health, Harrisburg, PA (H.G., M.M.)
| | - Basel Ramlawi
- Cardiothoracic Surgery, Lankenau Heart Institute, Wynnewood, PA (B.R.)
| | - Tanvir Bajwa
- Department of Interventional Cardiology and Cardiothoracic Surgery, Aurora Health Care, Aurora St. Luke’s Medical Center, Milwaukee, WI (T.B., J.C.)
| | - John Crouch
- Department of Interventional Cardiology and Cardiothoracic Surgery, Aurora Health Care, Aurora St. Luke’s Medical Center, Milwaukee, WI (T.B., J.C.)
| | - Paul S. Teirstein
- Department of Interventional Cardiology, Scripps Clinic, Scripps Prebys Cardiovascular Institute, La Jolla, CA (P.S.T.)
| | - Neal S. Kleiman
- Department of Interventional Cardiology and Cardiothoracic Surgery, Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K., M.J.R.)
| | - Ayman Iskander
- Saint Joseph’s Hospital Health Center, Syracuse, NY (A.I.)
| | - Rodrigo Bagur
- London Health Sciences Centre – University Campus, Ontario, Canada (R.B., M.W.A.C.)
| | - Michael W.A. Chu
- London Health Sciences Centre – University Campus, Ontario, Canada (R.B., M.W.A.C.)
| | | | - Arnaud Sudre
- Centre Hospitalier Régional Universitaire de Lille, France (A.S.)
| | - Rik Adrichem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, the Netherlands (N.M.V.M., R.A.)
| | - Saki Ito
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, MN (S.I.)
| | - Jian Huang
- Medtronic, Mounds View, MN (J.H., J.J.P.)
| | | | - John K. Forrest
- Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, CT (J.K.F.)
| | - Michael J. Reardon
- Department of Interventional Cardiology and Cardiothoracic Surgery, Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K., M.J.R.)
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23
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Grubb KJ, Tom SK, Xie J, Kalra K, Camaj A. Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement in Bicuspid Aortic Valve Stenosis-We Need a Well-Designed Randomized Control Trial. J Clin Med 2024; 13:6565. [PMID: 39518704 PMCID: PMC11546600 DOI: 10.3390/jcm13216565] [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: 10/12/2024] [Revised: 10/28/2024] [Accepted: 10/29/2024] [Indexed: 11/16/2024] Open
Abstract
Bicuspid aortic stenosis is a common pathology, typically seen in patients a decade younger than those with tricuspid valves. Surgical aortic valve replacement has been the mainstay treatment for bicuspid disease, especially considering the prevalence of concomitant aortic aneurysmal pathology. Transcatheter aortic valve replacement has shown equivalent results in bicuspid compared to tricuspid pathology in highly selected patient populations in single-arm registries and observational studies. For older patients with favorable bicuspid pathology, TAVR is reasonable. However, as younger patients with longer life expectancy are now being treated with TAVR, what is "best" is a question only answered by a well-designed randomized controlled trial. Herein, we describe the current evidence for treating bicuspid aortic stenosis and provide a framework for future trials. Yet, the question of equipoise remains, and who will we enroll?
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Affiliation(s)
- Kendra J. Grubb
- Division of Cardiothoracic Surgery, School of Medicine, Emory University, Atlanta, GA 30308, USA;
| | - Stephanie K. Tom
- Department of Surgery, Emory University School of Medicine, Atlanta, GA 30308, USA;
| | - Joe Xie
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30308, USA; (J.X.); (A.C.)
| | - Kanika Kalra
- Division of Cardiothoracic Surgery, School of Medicine, Emory University, Atlanta, GA 30308, USA;
| | - Anton Camaj
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30308, USA; (J.X.); (A.C.)
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24
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Bajwa T, Attizzani GF, Gada H, Chetcuti SJ, Williams MR, Ahmed M, Petrossian GA, Saybolt MD, Allaqaband SQ, Merhi WM, Stoler RC, Bezerra H, Mahoney P, Wu W, Jumper R, Lambrecht L, Tang GHL. Use and performance of the evolut FX transcatheter aortic valve system. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 67:1-7. [PMID: 38599918 DOI: 10.1016/j.carrev.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The next generation supra-annular, self-expanding Evolut FX transcatheter aortic valve (TAV) system was designed to improve catheter deliverability, provide stable and symmetric valve deployment, and assess commissural alignment during the procedure. The impact of these modifications has not been clinically evaluated. METHODS Procedural information was collected by survey in 2 Stages: Stage I comprised 23 centers with extensive experience with Evolut TAV systems, and Stage II comprised an additional 46 centers with a broad range of balloon- and self-expanding system experience. Operators were to compare the experience with the Evolut FX to the predicate Evolut PRO+ system. RESULTS There were 285 cases during Stage I from June 24 to August 12, 2022, and 254 cases during Stage II from August 15 to September 11, 2022. Overall, the cusp overlap technique was used in 88.6 %, and commissural alignment was achieved in 96.1 % of these cases. Compared to implanter's previous experience with the Evolut PRO+ system, less resistance was noted with the Evolut FX system: in 83.0 % of cases during vascular insertion, in 84.7 % of cases while tracking through the vasculature, in 84.4 % of cases while traversing over the arch, and 76.1 % of cases in advancing across the valve. Better symmetry of valve depth was observed in 423 of 525 cases (80.6 %). CONCLUSION Evolut FX system design modifications translated into improvements in catheter deliverability, deployment symmetry and stability, and commissural alignment as assessed by experienced self-expanding and balloon expandable operators.
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Affiliation(s)
- Tanvir Bajwa
- Advocate Aurora Health Care, 2801 W. Kinnickinnic River Parkway,Milwaukee, WI 53215, United States of America.
| | - Guilherme F Attizzani
- University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States of America.
| | - Hemal Gada
- University of Pittsburgh-Pinnacle, 1000 N Front Street, Wormleysburg, PA 17043, United States of America
| | - Stanley J Chetcuti
- University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, United States of America.
| | - Mathew R Williams
- New York University - Langone Health, 530 1st Ave. Suite 9V, New York, NY 10016, United States of America.
| | - Mustafa Ahmed
- University of Alabama Medicine, 2000 6th Avenue South, Floor 4, Birmingham, AL 35233, United States of America.
| | - George A Petrossian
- Saint Francis Hospital, Vizza Pavilion, 100 Port Washington Blvd Ste G04, Roslyn, NY 11576, United States of America
| | - Matthew D Saybolt
- Jersey Shore University Medical Center, 1945 NJ-33, Neptune Township, NJ 07753, United States of America
| | - Suhail Q Allaqaband
- Advocate Aurora Health Care, 2801 W. Kinnickinnic River Parkway,Milwaukee, WI 53215, United States of America.
| | - William M Merhi
- Spectrum Health Hospitals, 743 E Beltline Ave NE, Grand Rapids, MI 49525, United States of America.
| | - Robert C Stoler
- Baylor Scott & White Heart and Vascular Hospital at Baylor Scott & White University Medical Center, 621 N Hall St #500, Dallas, TX 75226, United States of America.
| | - Hiram Bezerra
- Tampa General Hospital, University of South Florida; 2 Tampa General Circle, Tampa, FL 33606, United States of America.
| | - Paul Mahoney
- Sentara Norfolk General Hospital, 600 Gresham Dr Ste 8630A, Norfolk, VA 23507, United States of America
| | - Willis Wu
- Rex Hospital, 2800 Blue Ridge Rd Suite 201, Raleigh, NC 27607, United States of America.
| | - Robert Jumper
- St. Vincent's Medical Center, 115 Technology Dr UNIT C300, Trumbull, CT 06611, United States of America.
| | - Larry Lambrecht
- Medtronic, 8200 Coral Sea St., Mounds View, MN 55112, United States of America.
| | - Gilbert H L Tang
- Mount Sinai Health System, 1190 5th Ave, New York, NY 10029, United States of America
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Goel SS, Aoun J, Reardon MJ. Editorial: Going from Evolut PRO+ to Evolut FX: A step in the right direction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 67:8-9. [PMID: 38714398 DOI: 10.1016/j.carrev.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Sachin S Goel
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States of America
| | - Joe Aoun
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States of America
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States of America.
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26
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Álvarez-Velasco R, Almendárez M, Alperi A, Antuña P, del Valle R, Morís C, Pascual I. [The role of implant projection in optimizing transcatheter aortic valve implantation]. REC: INTERVENTIONAL CARDIOLOGY 2024; 6:332-339. [PMID: 40417347 PMCID: PMC12097345 DOI: 10.24875/recic.m24000476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/25/2024] [Indexed: 05/27/2025] Open
Abstract
Severe aortic stenosis is the most frequent valve condition requiring surgery, and its incidence is increasing yearly. Transcatheter aortic valve implantation (TAVI) is the first-line treatment for patients at all levels of surgical risk. Nevertheless, modifications to the procedure often appear to improve clinical outcomes. A major concern after TAVI is the higher rate of permanent pacemaker implantation (PPMI) compared with surgical valve replacement. Optimal implantation depth is crucial to reduce the burden of PPMI without causing serious complications such as valve embolization. The classic implantation technique, where the 3 cusps are aligned in the same plane, has been modified to a cusp overlap projection by isolating the noncoronary cusp and superimposing the left and right cusps. This simple modification provides optimal visualization during deployment and helps to achieve the desired implant depth to reduce conduction disturbances and PPMI. Another limitation after TAVI is coronary reaccess due to the frame of the transcatheter valve obstructing the coronary ostia. Commissural alignment of the prostheses with the native valve may facilitate selective cannulation of the coronary arteries after this procedure. This review will discuss the techniques and supporting evidence for these modifications to the deployment and implant projection methods, and how they can improve TAVI outcomes.
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Affiliation(s)
- Rut Álvarez-Velasco
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, EspañaÁrea del CorazónHospital Universitario Central de AsturiasOviedoEspaña
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, EspañaInstituto de Investigación Sanitaria del Principado de AsturiasInstituto de Investigación Sanitaria del Principado de AsturiasOviedoEspaña
| | - Marcel Almendárez
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, EspañaÁrea del CorazónHospital Universitario Central de AsturiasOviedoEspaña
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, EspañaInstituto de Investigación Sanitaria del Principado de AsturiasInstituto de Investigación Sanitaria del Principado de AsturiasOviedoEspaña
| | - Alberto Alperi
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, EspañaÁrea del CorazónHospital Universitario Central de AsturiasOviedoEspaña
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, EspañaInstituto de Investigación Sanitaria del Principado de AsturiasInstituto de Investigación Sanitaria del Principado de AsturiasOviedoEspaña
| | - Paula Antuña
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, EspañaÁrea del CorazónHospital Universitario Central de AsturiasOviedoEspaña
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, EspañaInstituto de Investigación Sanitaria del Principado de AsturiasInstituto de Investigación Sanitaria del Principado de AsturiasOviedoEspaña
| | - Raquel del Valle
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, EspañaÁrea del CorazónHospital Universitario Central de AsturiasOviedoEspaña
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, EspañaInstituto de Investigación Sanitaria del Principado de AsturiasInstituto de Investigación Sanitaria del Principado de AsturiasOviedoEspaña
| | - Cesar Morís
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, EspañaÁrea del CorazónHospital Universitario Central de AsturiasOviedoEspaña
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, EspañaInstituto de Investigación Sanitaria del Principado de AsturiasInstituto de Investigación Sanitaria del Principado de AsturiasOviedoEspaña
- Facultad de Medicina, Universidad de Oviedo, Oviedo, Asturias, EspañaFacultad de MedicinaUniversidad de OviedoOviedoEspaña
| | - Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, EspañaÁrea del CorazónHospital Universitario Central de AsturiasOviedoEspaña
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, EspañaInstituto de Investigación Sanitaria del Principado de AsturiasInstituto de Investigación Sanitaria del Principado de AsturiasOviedoEspaña
- Facultad de Medicina, Universidad de Oviedo, Oviedo, Asturias, EspañaFacultad de MedicinaUniversidad de OviedoOviedoEspaña
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Aoun J, Kharsa C, Reardon M, Kleiman N, Chang SM, Atkins M, Faza NN, Little SH, Goel SS. Transcatheter Aortic Valve Implantation Using the Evolut FX+ Platform With Optimal Diamond-Coronary Alignment. JACC Case Rep 2024; 29:102506. [PMID: 39359513 PMCID: PMC11442345 DOI: 10.1016/j.jaccas.2024.102506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/11/2024] [Accepted: 07/17/2024] [Indexed: 10/04/2024]
Abstract
We present one of the inaugural transcatheter aortic valve implantation procedures using the latest Medtronic platform, Evolut FX+. Successful coronary angiography was achieved within 28 seconds and 1 minute 49 seconds for the left and right coronary arteries, respectively. Postoperative cardiac computed tomography scan demonstrated optimal commissural and diamond-coronary alignment.
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Affiliation(s)
- Joe Aoun
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Chloe Kharsa
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Michael Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Neal Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Su Min Chang
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Marvin Atkins
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Nadeen N Faza
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Stephen H Little
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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28
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Di Pietro G, Improta R, De Filippo O, Bruno F, Birtolo LI, Tocci M, Fabris T, Saade W, Colantonio R, Celli P, Sardella G, Esposito G, Tarantini G, Mancone M, D'Ascenzo F. Transcatheter Aortic Valve Replacement in Low Surgical Risk Patients: An Updated Metanalysis of Extended Follow-Up Randomized Controlled Trials. Am J Cardiol 2024; 224:56-64. [PMID: 38729335 DOI: 10.1016/j.amjcard.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/03/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
The long-term safety and effectiveness of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in low surgical risk has not been evaluated in a pooled analysis. An electronic database search was conducted for randomized controlled trials with a maximal 5 years clinical and echocardiographic follow-up including low surgical risk patients who underwent TAVR or SAVR. We calculated odds ratio (OR) and 95% confidence intervals (CIs) using a random-effects model. Subgroups analysis was performed for permanent pacemaker implantation and paravalvular leaks. Three randomized controlled trials were included with a total of 2,611 low surgical risk patients (Society of Thoracic Surgeons score <4%). Compared with SAVR, the TAVR group had similar rates of all-cause mortality (OR 0.94,95% CI 0.65 to 1.37, p = 0.75) and disabling stroke (OR 0.84, 95% CI 0.52 to 1.36, p = 0.48). No significant differences were registered in the TAVR group in terms of major cardiovascular events (OR 0.96, 95% CI 0.67 to 1.38, p = 0.83), myocardial infarction (OR 0.69, 95% CI 0.34 to 1.40, p = 0.31), valve thrombosis (OR 3.11, 95% CI 0.29 to 33.47, p = 0.35), endocarditis (OR 0.71,95% CI 0.35 to 1.48, p = 0.36), aortic valve reintervention (OR 0.93, 95% CI 0.52 to 1.66, p = 0.80), and rehospitalization (OR 0.80, 95% CI 0.52 to 1.02, p = 0.07) compared with SAVR. However, TAVR patients had a higher risk of paravalvular leaks (OR 8.21, 95% CI 4.18 to 16.14, p <0.00001), but lower rates of new-onset atrial fibrillation (OR 0.27,95% CI 0.17 to 0.30, p <0.0001). The rates of permanent pacemaker implantation were comparable from 1 year up to a maximum of 5 years (OR 1.32, 95% CI 0.88 to 1.97, p = 0.18). Lastly, TAVR had a greater effective orifice area (0.10 cm2/m2, 95% CI 0.05 to 0.15, p = 0.0001), but similar transvalvular mean gradients (0.60, 95% CI 3.94 to 2.73, p = 0.72). In conclusion, TAVR patients had similar long-term outcomes compared with SAVR, except for an elevated risk of paravalvular leaks in the TAVR group and increased rates of atrial fibrillation in the SAVR cohort.
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Affiliation(s)
- Gianluca Di Pietro
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy; Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
| | - Riccardo Improta
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy; Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
| | - Ovidio De Filippo
- Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
| | - Francesco Bruno
- Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Marco Tocci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Tommaso Fabris
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Wael Saade
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Riccardo Colantonio
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Paola Celli
- Department of General and Specialistic Surgery "Paride Stefanini", "Sapienza" University of Rome, Rome, Italy
| | - Gennaro Sardella
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy.
| | - Fabrizio D'Ascenzo
- Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
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Zahr F, Ramlawi B, Reardon MJ, Deeb GM, Yakubov SJ, Song HK, Kleiman NS, Chetcuti SJ, Gada H, Mumtaz M, Leung S, Merhi W, Rovin JD, DeFrain M, Muppala M, Kauten J, Rajagopal V, Huang J, Ito S, Forrest JK. 3-Year Outcomes From the Evolut Low Risk TAVR Bicuspid Study. JACC Cardiovasc Interv 2024; 17:1667-1675. [PMID: 39048253 DOI: 10.1016/j.jcin.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Outcomes from transcatheter aortic valve replacement (TAVR) in low-surgical risk patients with bicuspid aortic stenosis beyond 2 years are limited. OBJECTIVES This study aimed to evaluate 3-year clinical and echocardiographic outcomes from the Evolut Low Risk Bicuspid Study. METHODS The Evolut Low Risk Bicuspid Study is a prospective, multicenter, single-arm study conducted in 25 U.S. CENTERS Patients with severe aortic stenosis at low surgical risk with bicuspid aortic valve anatomy (all subtypes) underwent TAVR with a self-expanding, supra-annular Evolut R or PRO (Medtronic) bioprosthesis. An independent clinical events committee adjudicated all deaths and endpoint-related adverse events, and a central echocardiographic core laboratory assessed hemodynamic endpoints. RESULTS An attempted implant was performed in 150 patients from December 2018 to October 2019. The mean age was 70.3 ± 5.5 years, 48% (72/150) of the patients were women, and the mean Society of Thoracic Surgeons Predicted Risk of Mortality score was 1.3% (Q1-Q3: 0.9%-1.7%). Sievers type 1 was the dominant bicuspid morphology (90.7%, 136/150). The Kaplan-Meier rates of all-cause mortality or disabling stroke were 1.3% (95% CI: 0.3%-5.3%) at 1 year, 3.4% (95% CI: 1.4%-8.1%) at 2 years, and 4.1% (95% CI: 1.6%-10.7%) at 3 years. The incidence of new permanent pacemaker implantation was 19.4% (95% CI: 12.4%-29.6%) at 3 years. There were no instances of moderate or severe paravalvular aortic regurgitation at 2 and 3 years after TAVR. CONCLUSIONS The 3-year results from the Evolut Low Risk Bicuspid Study demonstrate low rates of all-cause mortality or disabling stroke and favorable hemodynamic performance.
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Affiliation(s)
- Firas Zahr
- Oregon Health & Science University, Portland, Oregon, USA.
| | - Basel Ramlawi
- Lankenau Heart Institute, Philadelphia, Pennsylvania, USA
| | | | - G Michael Deeb
- University of Michigan Health Systems, University Hospital, Ann Arbor, Michigan, USA
| | | | - Howard K Song
- Oregon Health & Science University, Portland, Oregon, USA
| | - Neal S Kleiman
- Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Stanley J Chetcuti
- University of Michigan Health Systems, University Hospital, Ann Arbor, Michigan, USA
| | - Hemal Gada
- University of Pittsburgh Medical Center, Harrisburg, Pennsylvania, USA
| | - Mubashir Mumtaz
- University of Pittsburgh Medical Center, Harrisburg, Pennsylvania, USA
| | | | - William Merhi
- Corewell Health Hospitals, Grand Rapids, Michigan, USA
| | | | | | | | | | | | | | - Saki Ito
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - John K Forrest
- Yale University School of Medicine, New Haven, Connecticut, USA
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30
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Leung Wai Sang S, Weissman C, Parker J, Timek T, Willekes C, Fanning J. Contemporary outcomes of surgical aortic valve replacement in patients referred for a transcatheter approach. Int J Cardiol 2024; 407:132004. [PMID: 38561110 DOI: 10.1016/j.ijcard.2024.132004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES The purpose of this study is to examine which patients referred to our structural valve clinic for potential transcatheter aortic valve replacement (TAVR) are receiving surgical aortic valve replacement (SAVR) whether due to unsuitable anatomy for TAVR versus other reasons. METHODS Individuals referred for TAVR from January 2019 to March 2022, who ultimately underwent SAVR were examined, retrospectively. Patients were divided into 2 surgical groups: TAVR was technically unsuitable (SAVR-TU) and those in which TAVR was technically feasible (SAVR-TF). RESULTS 215 patients referred for TAVR underwent SAVR with 61 (28.4%) patients in the SAVR-TU group and 154 (71.6%) in the SAVR-TF group. The SAVR-TU group were more commonly female (52.5% vs 23.4%, p < 0.0001), had a higher incidence of stroke at baseline (9.8% vs 2.0%, p = 0.017) were frailer (5-m gait 5.2 s vs 4.7 s, p = 0.0035), and had a higher Society of Thoracic Surgery risk score (2.2 vs 1.7, p = 0.04). In the SAVR-TU group, unsuitability for TAVR was due to inadequate aortic root anatomy (86.9%), and poor peripheral access (6.6%). In the SAVR-TF group, the most common reasons for SAVR referral were concomitant coronary artery disease (42.9%), bicuspid aortic valve disease (16.9%), and concomitant aortic aneurysm (10.4%). Overall, in-hospital mortality was 1.4% with no difference between both groups. One-year survival was 96.7%. CONCLUSION Despite a higher trend of aortic stenosis being treated with TAVR, higher risk patients unsuitable for TAVR can have SAVR with excellent outcomes. Moreover, patients with AS and concomitant other pathology should be evaluated for cardiac surgery.
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Affiliation(s)
- Stephane Leung Wai Sang
- Meijer Heart and Vascular Institute, Division of Cardiothoracic Surgery, Corewell Health West, Grand Rapids, MI, United States of America; College of Human Medicine, Michigan State University, Grand Rapids, MI, United States of America.
| | - Caleb Weissman
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States of America
| | - Jessica Parker
- Meijer Heart and Vascular Institute, Division of Cardiothoracic Surgery, Corewell Health West, Grand Rapids, MI, United States of America
| | - Tomasz Timek
- Meijer Heart and Vascular Institute, Division of Cardiothoracic Surgery, Corewell Health West, Grand Rapids, MI, United States of America; College of Human Medicine, Michigan State University, Grand Rapids, MI, United States of America
| | - Charles Willekes
- Meijer Heart and Vascular Institute, Division of Cardiothoracic Surgery, Corewell Health West, Grand Rapids, MI, United States of America; College of Human Medicine, Michigan State University, Grand Rapids, MI, United States of America
| | - Justin Fanning
- Meijer Heart and Vascular Institute, Division of Cardiothoracic Surgery, Corewell Health West, Grand Rapids, MI, United States of America; College of Human Medicine, Michigan State University, Grand Rapids, MI, United States of America
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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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32
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Sultan I, Reardon MJ, Søndergaard L, Chehab B, Smith D, Walton AS, Worthley SG, Manoharan G, Yong G, Jilaihawi H, Asch F, Bates N, Fontana GP. Predictors and Trends of New Permanent Pacemaker Implantation: A Subanalysis of the International Navitor IDE Study. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2024; 8:100293. [PMID: 39100579 PMCID: PMC11294828 DOI: 10.1016/j.shj.2024.100293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 08/06/2024]
Abstract
Background The Navitor Investigational Device Exemption (IDE) study is a prospective, multicenter, global study assessing the safety and effectiveness of the Navitor valve in a population with severe, symptomatic aortic stenosis who are at high and extreme surgical risk. The impact of pre-existing conduction abnormalities and implantation technique on new permanent pacemaker implantation (PPI) for the Navitor platform is not fully understood. Therefore, the goal of this analysis was to investigate the associations between patient and procedural factors and the 30-day new PPI rate. Methods A total of 260 patients who underwent implantation of a Navitor valve in the Navitor IDE study were reviewed. Patients with preprocedural permanent pacemakers (n = 28) were excluded. Baseline risk factors were assessed for statistical significance. Multivariable logistic regression analyses were performed to identify independent predictors of new PPI. Results Mean age of the pacemaker-naïve population was 83.3 ± 5.2 years, 58.6% were female, average Society of Thoracic Surgeons score was 3.8% ± 1.9%, median frailty score was 1 (interquartile range 1, 2), and 17.7% were deemed at extreme surgical risk. Pre-existing first-degree atrioventricular block and right bundle branch block significantly increased the risk of new PPI postimplantation, whereas left bundle branch block did not. Membranous septum length in relation to noncoronary cusp implant depth was a significant predictor of new PPI, with higher rates of new PPI observed when noncoronary cusp implant depth exceeded membranous septum length. Analysis of implant depth alone revealed deeper implants were associated with a higher rate of new PPI, regardless of patient baseline conduction abnormality. Conclusions The 30-day rate of new PPI in the Navitor IDE study is associated with patient pre-existing baseline conduction disturbances and implantation depth.
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Affiliation(s)
- Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael J. Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Lars Søndergaard
- Structural Heart Medical Affairs, Abbott Medical, Santa Clara, California, USA
| | - Bassem Chehab
- Department of Cardiology, Ascension Via Christi Hospital, University of Kansas, Wichita, Kansas, USA
| | - Dave Smith
- Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Antony S. Walton
- Department of Interventional Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Stephen G. Worthley
- Department of Cardiology, Macquarie University Hospital, Macquarie Park, New South Wales, Australia
| | - Ganesh Manoharan
- Regional Cardiology Centre, Royal Victoria Hospital, Belfast, UK
| | - Gerald Yong
- Department of Cardiology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Hasan Jilaihawi
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Federico Asch
- Cardiovascular Core Labs, MedStar Health Research Institute and Georgetown University, Washington, District of Columbia, USA
| | - Nicholas Bates
- Structural Heart Clinical Affairs, Abbott Medical, St. Paul, Minnesota, USA
| | - Gregory P. Fontana
- Cardiovascular Institute, Hospital Corporation of America, Los Robles Regional Medical Center, Thousand Oaks, California, USA
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Esteves V, de Andrade PB, Zukowski CN, Araujo E, Bezerra CG, Oliveira AD, de Melo EP, Gama G, Cantarelli R, Mattos LAPE, Tedeschi A, Loures VA, Vahle V, Silva GBG, Rati MAN, Lopes AC, Fé NDM, Alves G, Tavares SC, Kreimer S, Tebet M, Maia F, de Oliveira MS, Fonseca A, Camiletti A, de Albuquerque DC, de Souza OF. Temporal Trends in Transcatheter Aortic Valve Implantation: 10-Year Analysis of the TAVIDOR Registry. Arq Bras Cardiol 2024; 121:e20230467. [PMID: 38896588 PMCID: PMC11164433 DOI: 10.36660/abc.20230467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/18/2023] [Accepted: 03/13/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has established itself as the preferential strategy to approach severe aortic stenosis. Information on procedural improvements and nationwide results obtained with the technique throughout the past decade are unknown. OBJECTIVES To assess the temporal variation of the demographic profile, procedural characteristics, and in-hospital outcomes of patients undergoing TAVI procedures at the Rede D'Or São Luiz. METHODS Observational registry comprising 29 national institutions, comparing the characteristics of the TAVI procedures performed from 2012 to 2017 (Group 1) to those performed from 2018 to 2023 (Group 2). The statistical significance level adopted was p < 0.05. RESULTS This study assessed 661 patients, 95 in Group 1 and 566 in Group 2, with a mean age of 81.1 years. Group 1 patients had a higher prevalence of New York Heart Association functional class III or IV and STS risk score > 8%. In addition, they more often underwent general anesthesia, transesophageal echocardiographic monitoring, and access through femoral dissection. Group 2 patients had a higher success rate of the TAVI procedure (95.4% versus 89.5%; p = 0.018), lower mortality (3.9% versus 11.6%; p = 0.004), and less often needed permanent pacemaker implantation (8.5% versus 17.9%; p = 0.008). CONCLUSIONS The 10-year temporal trends analysis of the TAVIDOR Registry shows a reduction in patients' clinical complexity over time. Furthermore, the advance to minimalistic implantation techniques, added to the technological evolution of the devices, may have contributed to the favorable outcomes observed among those whose implantation occurred in the last 5 years studied.
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Affiliation(s)
- Vinicius Esteves
- Rede D’Or São LuizSão PauloSPBrasilRede D’Or São Luiz, São Paulo, SP – Brasil
| | - Pedro Beraldo de Andrade
- Rede D’Or São LuizSão PauloSPBrasilRede D’Or São Luiz, São Paulo, SP – Brasil
- Santa Casa de Misericórdia de MaríliaMaríliaSPBrasilSanta Casa de Misericórdia de Marília – Cardiologia Invasiva, Marília, SP – Brasil
| | - Cleverson Neves Zukowski
- Hospital Copa D’OrRio de JaneiroRJ BrasilHospital Copa D’Or, Rio de Janeiro, RJ – Brasil
- Hospital Quinta D’OrRio de JaneiroRJBrasilHospital Quinta D’Or, Rio de Janeiro, RJ – Brasil
| | - Edmur Araujo
- Hospital do Coração do BrasilBrasíliaRJBrasilHospital do Coração do Brasil, Brasília, RJ – Brasil
| | - Cristiano Guedes Bezerra
- Universidade Federal da BahiaSalvadorBABrasilUniversidade Federal da Bahia – Hemodinâmica e Cardiologia Intervencionista, Salvador, BA – Brasil
| | | | | | - Gustavo Gama
- UDI HospitalSão LuísMABrasilUDI Hospital, São Luís, MA – Brasil
| | - Rodrigo Cantarelli
- Hospital Memorial São JoséRecifePEBrasilHospital Memorial São José, Recife, PE – Brasil
| | | | - Angelo Tedeschi
- Rede D’Or São LuizRio de JaneiroRJBrasilRede D’Or São Luiz, Rio de Janeiro, RJ – Brasil
| | - Vitor Alves Loures
- Hospital São Luiz Anália FrancoSão PauloSPBrasilHospital São Luiz Anália Franco, São Paulo, SP – Brasil
| | - Vitor Vahle
- Hospital São LucasAracajuSEBrasilHospital São Lucas, Aracaju, SE – Brasil
| | | | | | - Augusto Celso Lopes
- Hospital Monte KlinikumFortalezaCEBrasilHospital Monte Klinikum, Fortaleza, CE – Brasil
| | - Nilson de Moura Fé
- Hospital São CarlosFortalezaCEBrasilHospital São Carlos, Fortaleza, CE – Brasil
| | - Gustavo Alves
- Rede D’Or São LuizRio de JaneiroRJBrasilRede D’Or São Luiz, Rio de Janeiro, RJ – Brasil
| | | | - Sergio Kreimer
- Hospital e Maternidade BrasilSanto AndréSPBrasilHospital e Maternidade Brasil, Santo André, SP – Brasil
| | - Marden Tebet
- Rede D’Or São LuizSão PauloSPBrasilRede D’Or São Luiz, São Paulo, SP – Brasil
| | - Felipe Maia
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ – Brasil
| | - Maurício Sales de Oliveira
- Hospital Copa D’OrRio de JaneiroRJ BrasilHospital Copa D’Or, Rio de Janeiro, RJ – Brasil
- Hospital Quinta D’OrRio de JaneiroRJBrasilHospital Quinta D’Or, Rio de Janeiro, RJ – Brasil
| | - Alberto Fonseca
- Hospital do Coração do BrasilBrasíliaRJBrasilHospital do Coração do Brasil, Brasília, RJ – Brasil
| | - Angelina Camiletti
- Rede D’Or São LuizSão PauloSPBrasilRede D’Or São Luiz, São Paulo, SP – Brasil
| | - Denilson Campos de Albuquerque
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ – Brasil
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Batchelor WB, Sanchez CE, Sorajja P, Harvey JE, Galper BZ, Kini A, Keegan P, Grubb KJ, Eisenberg R, Rogers T. Temporal Trends, Outcomes, and Predictors of Next-Day Discharge and Readmission Following Uncomplicated Evolut Transcatheter Aortic Valve Replacement: A Propensity Score-Matched Analysis. J Am Heart Assoc 2024; 13:e033846. [PMID: 38639328 PMCID: PMC11179905 DOI: 10.1161/jaha.123.033846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/23/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Next-day discharge (NDD) outcomes following uncomplicated self-expanding transcatheter aortic valve replacement have not been studied. Here, we compare readmission rates and clinical outcomes in NDD versus non-NDD transcatheter aortic valve replacement with Evolut. METHODS AND RESULTS Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry patients (n=29 597) undergoing elective transcatheter aortic valve replacement with self-expanding supra-annular valves (Evolut R, PRO, and PRO+) from July 2019 to June 2021 were stratified by postprocedure length of stay: ≤1 day (NDD) versus >1 day (non-NDD). Propensity score matching was used to compare risk adjusted 30-day readmission rates and 1-year outcomes in NDD versus non-NDD, and multivariable regression to determine predictors of NDD and readmission. Between the first and last calendar quarter, the rate of NDD increased from 45.4% to 62.1% and median length of stay decreased from 2 days to 1. Propensity score matching produced relatively well-matched NDD and non-NDD cohorts (n=10 549 each). After matching, NDD was associated with lower 30-day readmission rates (6.3% versus 8.4%; P<0.001) and 1-year adverse outcomes (death, 7.0% versus 9.3%; life threatening/major bleeding, 1.6% versus 3.4%; new permanent pacemaker implantation/implantable cardioverter-defibrillator, 3.6 versus 11.0%; [all P<0.001]). Predictors of NDD included non-Hispanic ethnicity, preexisting permanent pacemaker implantation/implantable cardioverter-defibrillator, and previous surgical aortic valve replacement. CONCLUSIONS Most patients undergoing uncomplicated self-expanding Evolut transcatheter aortic valve replacement are discharged the next day. This study found that NDD can be predicted from baseline patient characteristics and was associated with favorable 30-day and 1-year outcomes, including low rates of permanent pacemaker implantation and readmission.
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Affiliation(s)
| | | | - Paul Sorajja
- Valve Science CenterMinneapolis Heart Institute Foundation, Abbott Northwestern HospitalMinneapolisMNUSA
| | | | | | - Anapoorna Kini
- Division of CardiologyMount Sinai Medical CenterNew YorkNYUSA
| | - Patricia Keegan
- Division of Cardiology, Emory Structural Heart and Valve CenterEmory University Hospital MidtownAtlantaGAUSA
| | - Kendra J. Grubb
- Division of Cardiothoracic Surgery, Emory Structural Heart and Valve CenterEmory University Hospital MidtownAtlantaGAUSA
| | | | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital CenterWashingtonDCUSA
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Grubb KJ, Lisko JC, O'Hair D, Merhi W, Forrest JK, Mahoney P, Van Mieghem NM, Windecker S, Yakubov SJ, Williams MR, Chetcuti SJ, Deeb GM, Kleiman NS, Althouse AD, Reardon MJ. Reinterventions After CoreValve/Evolut Transcatheter or Surgical Aortic Valve Replacement for Treatment of Severe Aortic Stenosis. JACC Cardiovasc Interv 2024; 17:1007-1016. [PMID: 38573257 DOI: 10.1016/j.jcin.2024.01.292] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/26/2023] [Accepted: 01/20/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Data on valve reintervention after transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) are limited. OBJECTIVES The authors compared the 5-year incidence of valve reintervention after self-expanding CoreValve/Evolut TAVR vs SAVR. METHODS Pooled data from CoreValve and Evolut R/PRO (Medtronic) randomized trials and single-arm studies encompassed 5,925 TAVR (4,478 CoreValve and 1,447 Evolut R/PRO) and 1,832 SAVR patients. Reinterventions were categorized by indication, timing, and treatment. The cumulative incidence of reintervention was compared between TAVR vs SAVR, Evolut vs CoreValve, and Evolut vs SAVR. RESULTS There were 99 reinterventions (80 TAVR and 19 SAVR). The cumulative incidence of reintervention through 5 years was higher with TAVR vs SAVR (2.2% vs 1.5%; P = 0.017), with differences observed early (≤1 year; adjusted subdistribution HR: 3.50; 95% CI: 1.53-8.02) but not from >1 to 5 years (adjusted subdistribution HR: 1.05; 95% CI: 0.48-2.28). The most common reason for reintervention was paravalvular regurgitation after TAVR and endocarditis after SAVR. Evolut had a significantly lower incidence of reintervention than CoreValve (0.9% vs 1.6%; P = 0.006) at 5 years with differences observed early (adjusted subdistribution HR: 0.30; 95% CI: 0.12-0.73) but not from >1 to 5 years (adjusted subdistribution HR: 0.61; 95% CI: 0.21-1.74). The 5-year incidence of reintervention was similar for Evolut vs SAVR (0.9% vs 1.5%; P = 0.41). CONCLUSIONS A low incidence of reintervention was observed for CoreValve/Evolut R/PRO and SAVR through 5 years. Reintervention occurred most often at ≤1 year for TAVR and >1 year for SAVR. Most early reinterventions were with the first-generation CoreValve and managed percutaneously. Reinterventions were more common following CoreValve TAVR compared with Evolut TAVR or SAVR.
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Affiliation(s)
- Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA.
| | - John C Lisko
- Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Daniel O'Hair
- Cardiovascular Service Line, Boulder Community Health, Boulder, Colorado, USA
| | - William Merhi
- Department of Interventional Cardiology, Corewell Health, Grand Rapids, Michigan, USA; Department of Cardiothoracic Surgery, Corewell Health, Grand Rapids, Michigan, USA
| | - John K Forrest
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Paul Mahoney
- University of Pittsburgh Medical Center Harrisburg, Harrisburg, Pennsylvania, USA
| | | | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | | | - Stanley J Chetcuti
- University of Michigan Health Systems-University Hospital, Ann Arbor, Michigan, USA
| | - G Michael Deeb
- University of Michigan Health Systems-University Hospital, Ann Arbor, Michigan, USA
| | - Neal S Kleiman
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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36
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Elkoumy A, Rück A, Abdel-Wahab M, Thiele H, Rudolph TK, Wolf A, Wambach JM, De Backer O, Sondergaard L, Hengstenberg C, Abdelshafy M, Arsang-Jang S, Elzomor H, Laine M, Bjursten H, Götberg M, Wykrzykowska JJ, Mohamed SK, Pellegrini C, Rheude T, Toggweiler S, Saleh N, Meduri CU, Kim WK, Soliman O. ACURATE neo2 Transcatheter aortic valve implantation without balloon aortic valvuloplasty - direct ACURATE neo2. Int J Cardiol 2024; 400:131792. [PMID: 38244892 DOI: 10.1016/j.ijcard.2024.131792] [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: 10/31/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND ACURATE neo2 (Neo2) implantation is performed after systematic Balloon Aortic Valvuloplasty (BAV) in most patients. No reports exist about the feasibility and safety of direct Neo2 transcatheter aortic valve implantation (TAVI) in comparison to the standard practice. AIM We aimed to identify the patients' baseline anatomical characteristics, procedural, and early post-procedural outcomes in patients treated using Neo2 with and without BAV. METHODOLOGY This is a retrospective multicentre analysis of 499 patients with severe aortic stenosis who underwent TAVI using Neo2. The comparison was done according to the performance or omission of BAV. Echocardiography and computed tomography were analysed by an independent Core Lab. Propensity score matching (PSM) was performed based on the annular diameter and AV calcium volume, which identified 84 matched pairs. RESULTS Among the cohort included, 391 (78%) patients received BAV (BAV-yes) and 108 (22%) were not attempted (BAV-no or Direct TAVI). Patients in BAV-no cohort had smaller annular diameter (22.6 vs 23.4 mm; p < 0.001) and lower calcium volume (163 vs 581 mm3; p < 0.001) compared to BAV-yes cohort. In the matched cohort, VARC-3 device technical success was similar (95%) and all other outcome measures were statistically comparable between cohorts. CONCLUSION Direct TAVI using ACURATEneo2 without pre-TAVI balloon aortic valvuloplasty in patients with mild or less valve calcifications might be feasible and associated with comparable early outcomes compared to patients with similar anatomical features undergoing systematic balloon valvuloplasty.
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Affiliation(s)
- Ahmed Elkoumy
- Discipline of Cardiology, Saolta, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, Galway, Ireland; Islamic Center of Cardiology, Al-Azhar University, Nasr City, Cairo, Egypt
| | - Andreas Rück
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Tanja K Rudolph
- Heart and Diabetes Center Nordrhine Westphalia, Department of General and Interventional Cardiology/Angiology, Bad Oeynhausen, Ruhr-University Bochum, Germany
| | - Alexander Wolf
- Department of Cardiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus, Essen, Germany
| | - Jan Martin Wambach
- Department of Cardiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus, Essen, Germany
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Mahmoud Abdelshafy
- Discipline of Cardiology, Saolta, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, Galway, Ireland; Department of Cardiology, Al-Azhar University Hospitals, Cairo, Egypt
| | - Shahram Arsang-Jang
- Discipline of Cardiology, Saolta, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
| | - Hesham Elzomor
- Discipline of Cardiology, Saolta, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, Galway, Ireland
| | - Mika Laine
- Department of Cardiology, Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Lund University, Skåne University Hospital, Lund, Sweden
| | - Matthias Götberg
- Department of Cardiology, Clinical Sciences. Lund University, Skåne University Hospital, Lund, Sweden
| | - Joanna J Wykrzykowska
- Interventional Cardiology, Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Sameh K Mohamed
- Discipline of Cardiology, Saolta, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, Galway, Ireland
| | - Costanza Pellegrini
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Stefan Toggweiler
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital|LUKS, Lucerne, Switzerland
| | - Nawzad Saleh
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | | | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart, and Lung Centre, Bad Nauheim, Germany
| | - Osama Soliman
- Discipline of Cardiology, Saolta, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland.
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Sugiyama Y, Miyashita H, Yokoyama H, Ochiai T, Shishido K, Jalanko M, Yamanaka F, Vähäsilta T, Saito S, Laine M, Moriyama N. Risk Assessment of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation in Patients With Preexisting Right Bundle Branch Block. Am J Cardiol 2024; 213:151-160. [PMID: 38103766 DOI: 10.1016/j.amjcard.2023.12.004] [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: 10/04/2023] [Revised: 11/16/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
Preexisting right bundle branch block (RBBB) is the strongest predictor for permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI). However, the risk assessment for new PPI and effective procedural strategy for preventing new PPI in patients with preexisting RBBB are still unclear. This study stratified the new PPI risk after TAVI and investigated the impact of implantation strategy in a preexisting RBBB cohort. We analyzed 237 patients with preexisting RBBB who underwent TAVI. The primary endpoint was the incidence of new PPI. Multivariate analyses investigating predictors for new PPI were performed. The overall PPI rate was 33.3%. Significant baseline predictors for new PPI were combination of RBBB, left anterior or posterior fascicular block, and first-degree atrioventricular block (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.09 to 5.04), high calcium volume of noncoronary cusp (OR 2.08, 95% CI 1.05 to 4.10), and membranous septum (MS) length <2 mm (OR 2.02, 95% CI 1.09 to 3.75) in the univariate analysis and MS length <2 mm (OR 2.25, 95% CI 1.06 to 4.82) in the multivariate analysis. On the multivariate analysis including procedural variables, predilatation (OR 2.41, 95% CI 1.01 to 5.83), self-expanding valves (Corevalve, Evolut R, and Evolut Pro/Pro+; Medtronic Inc., Minneapolis, Minnesota) or mechanical expanding valves (Lotus/Lotus Edge; Boston Scientifics, Marlborough, Massachusetts) (OR 3.00, 95% CI 1.31 to 6.91), and implantation depth > MS length (OR 4.27, 95% CI 1.81 to 10.08) were significantly associated with new PPI. The incidence of new PPI increased according to the number of baseline predictors (0: 20.9%, 1: 34.3%, and ≥2: 52.0%) and procedural predictors (0: 3.7%, 1: 20.9%, 2: 40.5%, and 3: 60.0%). New PPI risk in a preexisting RBBB subset could be stratified by baseline factors. Device selection and implantation strategy considering MS length could prevent new PPI even in these high-risk population.
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Affiliation(s)
- Yoichi Sugiyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan; Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
| | - Hirokazu Miyashita
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan.
| | - Hiroaki Yokoyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Tomoki Ochiai
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Koki Shishido
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Mikko Jalanko
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
| | - Futoshi Yamanaka
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Tommi Vähäsilta
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
| | - Shigeru Saito
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Mika Laine
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
| | - Noriaki Moriyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
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38
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Sá MP, Serna-Gallegos D, Sultan I. Reducing the Burden of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation: Cusp Overlap, Implantation Depth, and Membranous Septum Length. Am J Cardiol 2024; 213:184-185. [PMID: 38181861 DOI: 10.1016/j.amjcard.2023.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 12/24/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Cardiothoracic Surgery, UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Derek Serna-Gallegos
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Cardiothoracic Surgery, UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Cardiothoracic Surgery, UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Tom S, Lisko J, Grubb KJ. How to Assess the Feasibility of a Second Transcatheter Aortic Valve Replacement When the First Valve Fails. Tex Heart Inst J 2024; 51:e238301. [PMID: 38349041 DOI: 10.14503/thij-23-8301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Affiliation(s)
- Stephanie Tom
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - John Lisko
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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40
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Vora AN, Gada H, Manandhar P, Kosinski A, Kirtane A, Nazif T, Reardon M, Kodali S, Cohen DJ, Thourani V, Sherwood M, Julien H, Vemulapalli S. National Variability in Pacemaker Implantation Rate Following TAVR: Insights From the STS/ACC TVT Registry. JACC Cardiovasc Interv 2024; 17:391-401. [PMID: 38355267 DOI: 10.1016/j.jcin.2023.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Although permanent pacemaker (PPM) implantation is a common complication of transcatheter aortic valve replacement (TAVR), hospital variation and change in PPM implantation rates are ill defined. OBJECTIVES The aim of this study was to determine hospital-level variation and temporal trends in the rate of PPM implantation following TAVR. METHODS Using the American College of Cardiology/Society of Thoracic Surgeons TVT (Transcatheter Valve Therapy) Registry, temporal changes in variation of in-hospital and 30-day PPM implantation were determined among 184,452 TAVR procedures across 653 sites performed from 2016 to 2020. The variation in PPM implantation adjusted for valve type by annualized TAVR volume was determined, and characteristics of sites below, within, and above the 95% boundary were identified. A series of stepwise multivariable hierarchical models were then fit, and the median OR was used to measure variation in pacemaker rates among sites. RESULTS From 2016 to 2020, the overall rate of PPM implantation was 11.3%, with wide variation across sites (range: 0%-36.4%); rates trended lower over time. Adjusted for annualized volume, there were 34 sites with PPM implantation rates above the 95th percentile CI and 28 with rates below, with wide variation among the remaining sites. After adjusting for patient-level covariates, there was variation among sites in the probability of PPM implantation (median OR: 1.39; 95% CI: 1.35-1.43, P < 0.001); although some of the variation was explained by the addition of valve type, residual variation in PPM implantation rates persisted in additional models incorporating site-level covariates (annualized volume, region, teaching status, hospital beds, etc). CONCLUSIONS Although PPM implantation rates have decreased over time, substantial site-level variation remains even after accounting for observed patient characteristics and site-level factors. As there are numerous outlier sites both above and below the 95% confidence limit, dissemination of best practices from high-performing sites to low-performing sites and guideline-based education may be important quality improvement initiatives to reduce rates of this common complication.
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Affiliation(s)
- Amit N Vora
- UPMC Pinnacle Heart and Vascular Institute, Harrisburg, Pennsylvania, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA; Yale University School of Medicine, New Haven, CT.
| | - Hemal Gada
- UPMC Pinnacle Heart and Vascular Institute, Harrisburg, Pennsylvania, USA
| | - Pratik Manandhar
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrezej Kosinski
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Ajay Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Tamim Nazif
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michael Reardon
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Susheel Kodali
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | | | | | | | - Howard Julien
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
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Grubb KJ, Yakubov SJ, Nazif TM, Mittal S, Gada H, Fraser DG, Rovin JD, Khalil R, Pyo RT, Sharma SK, Ahmed M, Huang J, Rodes-Cabau J. Management of Postprocedural Conduction Disturbances Using a Prespecified Algorithm in the Optimize PRO Study. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101066. [PMID: 39131970 PMCID: PMC11307950 DOI: 10.1016/j.jscai.2023.101066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 08/13/2024]
Abstract
Background Lack of standardization in posttranscatheter aortic valve replacement (TAVR) conduction disturbance (CD) identification and treatment may affect permanent pacemaker implantation (PPI) rates and clinical outcomes. The safety and efficacy of a standardized TAVR CD algorithm has not been analyzed. This study analyzes the Optimize PRO post-TAVR CD management algorithm with Evolut PRO/PRO+ valves. Methods Optimize PRO is a prospective, postmarket study implementing 2 strategies to reduce pacemaker rates: TAVR with cusp overlap technique and a post-TAVR CD algorithm. The 2-hour postprocedural electrocardiogram (ECG) stratified patients to early discharge in the absence of new ECG changes or to CD algorithms for (1) ECG changes with preexisting right or left bundle branch block (LBBB), interventricular conduction delay or first-degree atrioventricular block, (2) new LBBB, or (3) high-degree atrioventricular block (HAVB). Results The interim analysis of the CD cohort consisted of 125/400 TAVR recipients. In the CD cohort, the 30-day new PPI rate was higher (28.1% vs 1.5%; P <.001), and 60 (48%) patients were discharged with a 30-day continuous ECG monitor. At 30 days, 90% of patients discharged with a monitor did not require PPI. Clinical outcomes, including mortality, stroke, bleeding, and reintervention, were similar in patients with and without CDs. No patient experienced sudden cardiac death. Conclusions Effective management of CDs using a standard algorithm following Evolut TAVR provides similar 30-day safety outcomes to patients without CDs who undergo routine next day discharge. The CD algorithm may provide an effective strategy to recognize arrhythmias early, improve PPI utilization, and facilitate safe monitoring of patients after discharge.
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Affiliation(s)
- Kendra J. Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Steven J. Yakubov
- Department of Interventional Cardiology, Riverside Methodist-OhioHealth, Columbus, Ohio
| | - Tamim M. Nazif
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Suneet Mittal
- Division of Cardiology and the Snyder Center for Comprehensive Atrial Fibrillation at Valley Health System, Ridgewood, New Jersey
| | - Hemal Gada
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleyburg, Pennsylvania
| | - Douglas G.W. Fraser
- UK Manchester Heart Centre Central Manchester University Hospitals Cardiology Department, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Joshua D. Rovin
- Department of Interventional Cardiology, Morton Plant Hospital, Clearwater, Florida
| | - Ramzi Khalil
- Department of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Robert T. Pyo
- Department of Interventional Cardiology, State University of New York at Stony Brook, Stony Brook, New York
| | - Samin K. Sharma
- Department of Interventional Cardiology, Mount Sinai Hospital, New York, New York
| | - Mustafa Ahmed
- Department of Interventional Cardiology, University of Alabama at Birmingham Medicine, Birmingham, Alabama
| | | | - Josep Rodes-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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Stephan T, Krohn-Grimberghe M, von Lindeiner genannt von Wildau A, Buck C, Baumhardt M, Mörike J, Gonska B, Rottbauer W, Buckert D. Cusp-overlap view reduces conduction disturbances and permanent pacemaker implantation after transcatheter aortic valve replacement even with balloon-expandable and mechanically-expandable heart valves. Front Cardiovasc Med 2023; 10:1269833. [PMID: 38107259 PMCID: PMC10722163 DOI: 10.3389/fcvm.2023.1269833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Background Conduction disturbances demanding permanent pacemaker implantation (PPI) remain a common complication after transcatheter aortic valve replacement (TAVR). Optimization of the implantation depth (ID) by introducing the cusp-overlap projection (COP) technique led to a reduced rate of PPI when self-expanding valves were used. Objectives The aim of the present study was to determine if using the novel COP view is applicable for all types of TAVR prosthesis and results in a higher ID and reduced incidence of new conduction disturbances and PPI. Methods In this prospective case-control study 586 consecutive patients undergoing TAVR with either balloon-expandable Edwards SAPIEN S3 (n = 280; 47.8%), or mechanically expandable Boston LOTUS Edge heart valve prostheses (n = 306; 52.2%) were included. ID as well as rates of periprocedural PPI and left bundle branch block (LBBB) were compared between the conventional three-cusp coplanar (TCC) projection and the COP view for implantation. Results Of 586 patients, 282 (48.1%) underwent TAVR using COP, whereas in 304 patients (51.9%) the TCC view was applied. Using COP a significantly higher ID was achieved in Edwards SAPIEN S3 TAVR procedures (ID mean difference -1.0 mm, 95%-CI -1.9 to -0.1 mm; P = 0.029), whereas the final platform position did not differ significantly between both techniques when a Boston LOTUS Edge valve was used (ID mean difference -0.1 mm, 95%-CI -1.1 to +0.9 mm; P = 0.890). In Edwards SAPIEN S3 valves, higher ID was associated with a numerically lower post-procedural PPI incidence (4.9% vs. 7.3%; P = 0.464). Moreover, ID was significantly deeper in patients requiring PPI post TAVR compared to those without PPI [8.7 mm (6.8-10.6 mm) vs. 6.5 mm (6.1-7.0 mm); P = 0.005]. In Boston LOTUS Edge devices, COP view significantly decreased the incidence of LBBB post procedure (28.1% vs. 47.9%; P < 0.001), while PPI rates were similar in both groups (21.6% vs. 25.7%; P = 0.396). Conclusion The present study demonstrates the safety, efficacy and reproducibility of the cusp-overlap view even in balloon-expandable and mechanically-expandable TAVR procedures. Application of COP leads to significantly less LBBB in repositionable Boston LOTUS Edge valves and a numerically lower PPI rate in Edwards SAPIEN S3 valves post TAVR compared to the standard TCC projection. The results should encourage to apply the COP view more widely in clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Dominik Buckert
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
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Halapas A, Koliastasis L, Doundoulakis I, Antoniou CK, Stefanadis C, Tsiachris D. Transcatheter Aortic Valve Implantation and Conduction Disturbances: Focus on Clinical Implications. J Cardiovasc Dev Dis 2023; 10:469. [PMID: 37998527 PMCID: PMC10672026 DOI: 10.3390/jcdd10110469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is an established alternative to surgery in patients with symptomatic severe aortic stenosis and has expanded its indications to even low-surgical-risk patients. Conduction abnormalities (CA) and permanent pacemaker (PPM) implantations remain a relatively common finding post TAVI due to the close proximity of the conduction system to the aortic root. New onset left bundle branch block (LBBB) and high-grade atrioventricular block are the most commonly reported CA post TAVI. The overall rate of PPM implantation post TAVI varies and is related to pre- and intra-procedural factors. Therefore, when screening patients for TAVI, Heart Teams should take under consideration the various anatomical, pathophysiological and procedural conditions that predispose to CA and PPM requirement after the procedure. This is particularly important as TAVI is being offered to younger patients with longer life-expectancy. Herein, we highlight the incidence, predictors, impact and management of CA in patients undergoing TAVI.
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Affiliation(s)
- Antonios Halapas
- Department of Interventional Cardiologist and THV Program, Athens Medical Center, 11526 Athens, Greece;
| | - Leonidas Koliastasis
- Department of Cardiology, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium;
| | - Ioannis Doundoulakis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (C.-K.A.); (D.T.)
- Athens Heart Centre, Athens Medical Centre, 11526 Athens, Greece;
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (C.-K.A.); (D.T.)
- Athens Heart Centre, Athens Medical Centre, 11526 Athens, Greece;
| | | | - Dimitrios Tsiachris
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (C.-K.A.); (D.T.)
- Athens Heart Centre, Athens Medical Centre, 11526 Athens, Greece;
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Merdler I, Case B, Bhogal S, Reddy PK, Sawant V, Zhang C, Ali S, Ben-Dor I, Satler LF, Rogers T, Waksman R. Early experience with the Evolut FX self-expanding valve vs. Evolut PRO+ for patients with aortic stenosis undergoing TAVR. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 56:1-6. [PMID: 37453813 DOI: 10.1016/j.carrev.2023.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/03/2023] [Accepted: 06/03/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The Evolut FX system is the most recent generation of self-expandable transcatheter heart valve (THV) technology. This study aims to report the early experience and outcomes associated with this system. METHODS Our analysis included 200 consecutive patients who underwent transcatheter aortic valve replacement at our center from 2022 to 2023. The first cohort comprised the last 100 patients who received the Evolut PRO+ THV, while the second cohort included the first 100 patients who received the Evolut FX THV. The primary endpoints of the study were defined according to the Valve Academic Research Consortium-3 (VARC-3) criteria, which included technical success (at exit from procedure), device success (at discharge or at 30 days), and early safety (at 30 days). RESULTS The study groups demonstrated no significant differences in baseline characteristics, including co-morbidities, pre-procedural imaging, and echocardiography. VARC-3 technical success rate was 99 % for both valves. The VARC-3 device success rate for the Evolut FX was 92 % compared to 97 % for the Evolut PRO+ (p = 0.12), and VARC-3 early safety rate was 80.1 % for the Evolut PRO+ vs. 81.5 % for the Evolut FX (p = 0.82). The in-hospital permanent pacemaker implantation rate for the Evolut FX was 12 % compared to 9 % for the Evolut PRO+ (p = 0.21). There were no differences in clinical outcomes, such as mortality or stroke, between the two groups. CONCLUSIONS The Evolut FX THV performed well when used for patients with severe aortic stenosis, demonstrating high success with low complication rates when compared to an earlier generation of self-expanding THV.
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Affiliation(s)
- Ilan Merdler
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America; MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Brian Case
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America; MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Sukhdeep Bhogal
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America; MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Pavan K Reddy
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America; MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Vaishnavi Sawant
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America; MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Cheng Zhang
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America; MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Syed Ali
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America; MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Itsik Ben-Dor
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America; MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Lowell F Satler
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America; MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Toby Rogers
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America; MedStar Georgetown University Hospital, Washington, DC, United States of America; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Ron Waksman
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America; MedStar Georgetown University Hospital, Washington, DC, United States of America.
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Grubb KJ, Tully A, Tom S. Editorial: TAVR quality improvement with Evolut FX and the role of cusp-overlapping technique. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 56:7-8. [PMID: 37648565 DOI: 10.1016/j.carrev.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA; Structural Heart and Valve Center, Emory University, Atlanta, GA, USA.
| | - Andy Tully
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA; Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
| | - Stephanie Tom
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA; Department of Surgery, Emory University, Atlanta, GA, USA
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Tang GH, Spencer J, Rogers T, Grubb KJ, Gleason P, Gada H, Mahoney P, Dauerman HL, Forrest JK, Reardon MJ, Blanke P, Leipsic JA, Abdel-Wahab M, Attizzani GF, Puri R, Caskey M, Chung CJ, Chen YH, Dudek D, Allen KB, Chhatriwalla AK, Htun WW, Blackman DJ, Tarantini G, Zhingre Sanchez J, Schwartz G, Popma JJ, Sathananthan J. Feasibility of Coronary Access Following Redo-TAVR for Evolut Failure: A Computed Tomography Simulation Study. Circ Cardiovasc Interv 2023; 16:e013238. [PMID: 37988439 PMCID: PMC10653288 DOI: 10.1161/circinterventions.123.013238] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/06/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Coronary accessibility following redo-transcatheter aortic valve replacement (redo-TAVR) is increasingly important, particularly in younger low-risk patients. This study aimed to predict coronary accessibility after simulated Sapien-3 balloon-expandable valve implantation within an Evolut supra-annular, self-expanding valve using pre-TAVR computed tomography (CT) imaging. METHODS A total of 219 pre-TAVR CT scans from the Evolut Low-Risk CT substudy were analyzed. Virtual Evolut and Sapien-3 valves were sized using CT-based diameters. Two initial Evolut implant depths were analyzed, 3 and 5 mm. Coronary accessibility was evaluated for 2 Sapien-3 in Evolut implant positions: Sapien-3 outflow at Evolut node 4 and Evolut node 5. RESULTS With a 3-mm initial Evolut implant depth, suitable coronary access was predicted in 84% of patients with the Sapien-3 outflow at Evolut node 4, and in 31% of cases with the Sapien-3 outflow at Evolut node 5 (P<0.001). Coronary accessibility improved with a 5-mm Evolut implant depth: 97% at node 4 and 65% at node 5 (P<0.001). When comparing 3- to 5-mm Evolut implant depth, sinus sequestration was the lowest with Sapien-3 outflow at Evolut node 4 (13% versus 2%; P<0.001), and the highest at Evolut node 5 (61% versus 32%; P<0.001). CONCLUSIONS Coronary accessibility after Sapien-3 in Evolut redo-TAVR relates to the initial Evolut implant depth, the Sapien-3 outflow position within the Evolut, and the native annular anatomy. This CT-based quantitative analysis may provide useful information to inform and refine individualized preprocedural CT planning of the initial TAVR and guide lifetime management for future coronary access after redo-TAVR. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02701283.
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Affiliation(s)
- Gilbert H.L. Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York (G.H.L.T.)
| | - Julianne Spencer
- Structural Heart & Aortic, Medtronic, Mounds View, MN (J. Spencer, J.Z.S., G.S., J.J.P.)
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC (T.R.)
| | - Kendra J. Grubb
- Division of Cardiothoracic Surgery (K.J.G.), Emory University, Atlanta, GA
- Structural Heart and Valve Center (K.J.G., P.G.), Emory University, Atlanta, GA
| | - Patrick Gleason
- Structural Heart and Valve Center (K.J.G., P.G.), Emory University, Atlanta, GA
- Division of Cardiology (P.G.), Emory University, Atlanta, GA
| | - Hemal Gada
- University of Pittsburgh Medical Center Pinnacle Health, PA (H.G.)
| | | | | | - John K. Forrest
- Division of Cardiology, Yale School of Medicine, New Haven, CT (J.K.F.)
| | | | - Philipp Blanke
- Center for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.A.L.)
| | - Jonathon A. Leipsic
- Center for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.A.L.)
| | | | - Guilherme F. Attizzani
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (G.F.A.)
| | | | | | - Christine J. Chung
- Division of Cardiology, University of Washington Medical Center, Seattle (C.J.C.)
| | - Ying-Hwa Chen
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan (Y.-H.C.)
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Keith B. Allen
- St. Luke’s Mid America Heart Institute, Kansas City, MO (K.B.A., A.K.C.)
| | | | | | - Daniel J. Blackman
- Department of Cardiology, Leeds Teaching Hospitals, Leeds, United Kingdom (D.J.B.)
| | - Giuseppe Tarantini
- Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Italy (G.T.)
| | - Jorge Zhingre Sanchez
- Structural Heart & Aortic, Medtronic, Mounds View, MN (J. Spencer, J.Z.S., G.S., J.J.P.)
| | - Greta Schwartz
- Structural Heart & Aortic, Medtronic, Mounds View, MN (J. Spencer, J.Z.S., G.S., J.J.P.)
| | - Jeffrey J. Popma
- Structural Heart & Aortic, Medtronic, Mounds View, MN (J. Spencer, J.Z.S., G.S., J.J.P.)
| | - Janarthanan Sathananthan
- Center for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (J. Sathananthan)
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Jilaihawi H. Fast Is Fine, But Accuracy Is Everything. JACC Cardiovasc Interv 2023; 16:2018-2020. [PMID: 37480888 DOI: 10.1016/j.jcin.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 07/24/2023]
Affiliation(s)
- Hasan Jilaihawi
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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Abdelshafy M, Elkoumy A, Elzomor H, Abdelghani M, Campbell R, Kennedy C, Kenny Gibson W, Fezzi S, Nolan P, Wagener M, Arsang-Jang S, Mohamed SK, Mostafa M, Shawky I, MacNeill B, McInerney A, Mylotte D, Soliman O. Predictors of Conduction Disturbances Requiring New Permanent Pacemaker Implantation following Transcatheter Aortic Valve Implantation Using the Evolut Series. J Clin Med 2023; 12:4835. [PMID: 37510950 PMCID: PMC10381756 DOI: 10.3390/jcm12144835] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Conduction disturbance requiring a new permanent pacemaker (PPM) after transcatheter aortic valve implantation (TAVI) has traditionally been a common complication. New implantation techniques with self-expanding platforms have reportedly reduced the incidence of PPM. We sought to investigate the predictors of PPM at 30 days after TAVI using Evolut R/PRO/PRO+; (2) Methods: Consecutive patients who underwent TAVI with the Evolut platform between October 2019 and August 2022 at University Hospital Galway, Ireland, were included. Patients who had a prior PPM (n = 10), valve-in-valve procedures (n = 8) or received >1 valve during the index procedure (n = 3) were excluded. Baseline clinical, electrocardiographic (ECG), echocardiographic and multislice computed tomography (MSCT) parameters were analyzed. Pre-TAVI MSCT analysis included membranous septum (MS) length, a semi-quantitative calcification analysis of the aortic valve leaflets, left ventricular outflow tract, and mitral annulus. Furthermore, the implantation depth (ID) was measured from the final aortography. Multivariate binary logistic analysis and receiver operating characteristic (ROC) curve analysis were used to identify independent predictors and the optimal MS and ID cutoff values to predict new PPM requirements, respectively; (3) Results: A total of 129 TAVI patients were included (age = 81.3 ± 5.3 years; 36% female; median EuroSCORE II 3.2 [2.0, 5.4]). Fifteen patients (11.6%) required PPM after 30 days. The patients requiring new PPM at 30 days were more likely to have a lower European System for Cardiac Operative Risk Evaluation II, increased prevalence of right bundle branch block (RBBB) at baseline ECG, have a higher mitral annular calcification severity and have a shorter MS on preprocedural MSCT analysis, and have a ID, as shown on the final aortogram. From the multivariate analysis, pre-TAVI RBBB, MS length, and ID were shown to be predictors of new PPM. An MS length of <2.85 mm (AUC = 0.85, 95%CI: (0.77, 0.93)) and ID of >3.99 mm (area under the curve (AUC) = 0.79, (95% confidence interval (CI): (0.68, 0.90)) were found to be the optimal cut-offs for predicting new PPM requirements; (4) Conclusions: Membranous septum length and implantation depth were found to be independent predictors of new PPM post-TAVI with the Evolut platform. Patient-specific implantation depth could be used to mitigate the requirement for new PPM.
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Affiliation(s)
- Mahmoud Abdelshafy
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
- CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; (S.A.-J.); (S.K.M.)
- Department of Cardiology, Al-Azhar University, Cairo 11311, Egypt; (M.A.); (M.M.); (I.S.)
| | - Ahmed Elkoumy
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
- CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; (S.A.-J.); (S.K.M.)
- Islamic Center of Cardiology and Cardiac Surgery, Al-Azhar University, Cairo 11651, Egypt
| | - Hesham Elzomor
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
- CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; (S.A.-J.); (S.K.M.)
- Islamic Center of Cardiology and Cardiac Surgery, Al-Azhar University, Cairo 11651, Egypt
| | - Mohammad Abdelghani
- Department of Cardiology, Al-Azhar University, Cairo 11311, Egypt; (M.A.); (M.M.); (I.S.)
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Ruth Campbell
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
| | - Ciara Kennedy
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
| | - William Kenny Gibson
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
| | - Simone Fezzi
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
| | - Philip Nolan
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
| | - Max Wagener
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
| | - Shahram Arsang-Jang
- CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; (S.A.-J.); (S.K.M.)
- Discipline of Medicine, Clinical Science Institute, University of Galway, H91 YR71 Galway, Ireland
| | - Sameh K. Mohamed
- CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; (S.A.-J.); (S.K.M.)
| | - Mansour Mostafa
- Department of Cardiology, Al-Azhar University, Cairo 11311, Egypt; (M.A.); (M.M.); (I.S.)
| | - Islam Shawky
- Department of Cardiology, Al-Azhar University, Cairo 11311, Egypt; (M.A.); (M.M.); (I.S.)
| | - Briain MacNeill
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
| | - Angela McInerney
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
| | - Darren Mylotte
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
- Discipline of Medicine, Clinical Science Institute, University of Galway, H91 YR71 Galway, Ireland
| | - Osama Soliman
- Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland; (M.A.); (A.E.); (H.E.); (R.C.); (C.K.); (W.K.G.); (S.F.); (P.N.); (M.W.); (B.M.); (A.M.)
- CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; (S.A.-J.); (S.K.M.)
- CÚRAM Centre for Medical Devices, H91 TK33 Galway, Ireland
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Grubb KJ, Shekiladze N, Spencer J, Perdoncin E, Tang GHL, Xie J, Lisko J, Sanchez JZ, Lucas LM, Sathananthan J, Rogers T, Deeb GM, Fukuhara S, Blanke P, Leipsic JA, Forrest JK, Reardon MJ, Gleason P. Feasibility of redo-TAVI in self-expanding Evolut valves: a CT analysis from the Evolut Low Risk Trial substudy. EUROINTERVENTION 2023; 19:e330-e339. [PMID: 37067193 PMCID: PMC10333920 DOI: 10.4244/eij-d-22-01125] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/08/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation in an existing transcatheter valve (redo-TAVI) pins the index valve leaflets in the open position (neoskirt), which can cause coronary flow compromise and limit access. Whether anatomy may preclude redo-TAVI in self-expanding Evolut valves is unknown. AIMS We aimed to evaluate the anatomical feasibility of redo-TAVI by simulating implantation of a balloon-expandable SAPIEN 3 (S3) within an Evolut or an Evolut within an Evolut. METHODS A total of 204 post-TAVI computed tomography (CT) scans from the Evolut Low Risk CT substudy were analysed. Five redo-TAVI positions were evaluated: S3-in-Evolut inflow-to-inflow, S3 outflow at Evolut nodes 4, 5, and 6, and Evolut-in-Evolut inflow-to-inflow. Univariable modelling identified pre-TAVI clinical characteristics, CT anatomical parameters, and procedural variables associated with coronary flow compromise using the neoskirt height and post-TAVI aortic root dimensions. RESULTS The risk of coronary flow compromise was lowest when the S3 outflow was at Evolut node 4 (20%) and highest when at Evolut node 6 (75%). The highest likelihood of preserving coronary accessibility occurred with the S3 outflow at Evolut node 4. Female sex and higher body mass index were associated with a higher risk of coronary flow compromise, as were a smaller annulus diameter, lower sinus of Valsalva height and width, shorter coronary height, smaller sinotubular junction diameter, and shallower Evolut implant depth. CONCLUSIONS The feasibility of redo-TAVI after Evolut failure is multifactorial and relates to the native annular anatomy, as well as the implantation depth of the index and second bioprostheses. Placement of an S3 at a lower Evolut position may reduce the risk of coronary flow compromise while preserving coronary access. CLINICALTRIALS gov: NCT02701283.
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Affiliation(s)
- Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
| | - Nikoloz Shekiladze
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
| | - Julianne Spencer
- Research and Development, Structural Heart & Aortic, Medtronic, Mounds View, MN, USA
| | - Emily Perdoncin
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Joe Xie
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
| | - John Lisko
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
| | - Jorge Zhingre Sanchez
- Research and Development, Structural Heart & Aortic, Medtronic, Mounds View, MN, USA
| | | | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, D.C., USA
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jonathon A Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John K Forrest
- Section of Cardiology, Yale School of Medicine, New Haven, CT, USA
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist, Houston, TX, USA
| | - Patrick Gleason
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
- Division of Cardiology, Emory University, Atlanta, GA, USA
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Elkoumy A, Mylotte D, Elzomor H, McInerney A, Soliman O. Emerging transcatheter heart valve technologies for severe aortic stenosis. Expert Rev Med Devices 2023; 20:1065-1077. [PMID: 37933200 DOI: 10.1080/17434440.2023.2277229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) is the standard of care for selected patients with severe aortic stenosis, irrespective of the surgical risk. Over the last two decades of TAVI practice, multiple limitations were identified. In addition, the extension of TAVI into a wider patient spectrum created new challenges. AREAS COVERED This review provides an overview of emerging transcatheter heart valves (THVs) beyond the approved contemporary THVs for the treatment of aortic stenosis. EXPERT OPINION The incidence of degenerative aortic stenosis is expected to increase with more aging of the population. Therefore, TAVI needs to meet this increase in the number of patients indicated for aortic valve replacement alongside a wide and complex anatomical variability. An increasing number of Aortic THVs are available in the market. This includes upgraded iterations of contemporary devices and innovative devices developed by emerging manufacturers. The new devices aim for the reduction or elimination of undesirable outcomes like paravalvular leakage and conduction disturbances requiring permanent pacemaker implantation. Alternatively, emerging THVs should provide feasibility regarding yet unproven TAVI indications like Bicuspid aortic valve, aortic regurgitation, or very large anatomy. Furthermore, some of the emerging THVs are designed to tackle the long-term durability issue of biological valves.
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Affiliation(s)
- Ahmed Elkoumy
- Department of Cardiology, Saolta Group, Galway University Hospital, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
- Islamic Center of Cardiology, Al-Azhar University, Nasr City, Cairo, Egypt
| | - Darren Mylotte
- Department of Cardiology, Saolta Group, Galway University Hospital, Galway, Ireland
| | - Hesham Elzomor
- Department of Cardiology, Saolta Group, Galway University Hospital, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
| | - Angela McInerney
- Department of Cardiology, Saolta Group, Galway University Hospital, Galway, Ireland
| | - Osama Soliman
- Department of Cardiology, Saolta Group, Galway University Hospital, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
- Euro Heart Foundation, Rotterdam, The Netherlands
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