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Mohammadi NSH, Tavakoli K, Taebi M, Zafari A, Riahi M, Molaei MM, Farooqi MA, Khanipour R, Karvane HB, Shahrzad S, Vaseghi M, Lakkirrddy GR, Mattumpuram J, Tzeis S, Jenab Y, Hosseini K. Comparative Prognostic Value of Risk Factors for Predicting Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Systematic Review and Network Meta-Analysis. Am J Cardiol 2025:S0002-9149(25)00296-6. [PMID: 40348046 DOI: 10.1016/j.amjcard.2025.05.009] [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: 03/10/2025] [Revised: 04/29/2025] [Accepted: 05/03/2025] [Indexed: 05/14/2025]
Abstract
This study compares the prognostic value of risk factors for Permanent pacemaker implantation (PPI) following transcatheter aortic valve replacement (TAVR). PubMed, Embase, Scopus, and Cochrane Library databases were searched until November 2024 for studies reporting PPI incidence within 30 days post-TAVR. A random-effect model was used to pool risk ratios (RR) and standardized mean differences (SDM) for binary and continuous risk factors. Network meta-analysis estimated pooled risk differences (ΔRR) for binary predictors with male sex as the reference. Significant predictors were ranked based on their surface under the cumulative ranking curve (SUCRA) values. A total of 108 studies comprising 77,538 patients (14,560 requiring PPI) were included. Male sex (RR: 1.13), baseline atrial fibrillation (AF) (RR: 1.12), 2nd degree Mobitz I (RR: 5.16) and Mobitz II (RR: 2.30) atrioventricular blocks (AVB), 3rd degree AVB (RR: 13.46), left anterior (LAHB) (RR: 1.79) and posterior hemiblocks (LPHB) (RR: 2.57), bifascicular block (RR: 2.34), right bundle branch block (RBBB) (RR: 3.20) and intraprocedural AVB (RR: 4.15) were identified as predictors for PPI post-TAVR. The risk of PPI was higher with self-expandable valves (RR: 1.79), subclavian access (RR: 1.75), and 29 mm prostheses (RR: 1.33) compared to balloon-expandable valves, transfemoral access, and 23 mm prostheses. Network meta-analysis ranked 3rd degree AVB (SUCRA <0.01), Mobitz I AVB (SUCRA: 0.14), Mobitz II AVB (SUCRA: 0.33), intraprocedural AVB (SUCRA: 0.42), bifascicular block (SUCRA: 0.48), RBBB (SUCRA: 0.49) and LPHB (SUCRA: 0.54) as major predictors of PPI in descending order of significance. In conclusion, clinicians should closely monitor conduction abnormalities as key predictors of PPI following TAVR. Additionally, other risk factors such as subclavian access, self-expanding implantation, AF, large prosthesis diameter, and male sex should not be overlooked.
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Affiliation(s)
- Negin Sadat Hosseini Mohammadi
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kiarash Tavakoli
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Morvarid Taebi
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Zafari
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mobina Riahi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Ramtin Khanipour
- Department of Internal Medicine, HCA Florida Bayonet Point Hospital - University of South Florida
| | - Houshang Bavandpour Karvane
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soraya Shahrzad
- Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marmar Vaseghi
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, CA, USA
| | | | - Jishanth Mattumpuram
- Division of Cardiology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, Hygeia Group, Athens, Greece
| | - Yaser Jenab
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Tanner R, Gilhooley S, Power D, Tang GH, Kini AS, Sharma SK. Coronary Artery Disease and Transcatheter Aortic Valve Replacement. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2025; 4:102574. [PMID: 40308232 PMCID: PMC12038282 DOI: 10.1016/j.jscai.2025.102574] [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: 10/16/2024] [Revised: 10/27/2024] [Accepted: 01/10/2025] [Indexed: 05/02/2025]
Abstract
Concomitant coronary artery disease (CAD) and severe aortic stenosis (AS) are frequently encountered in patients evaluated for transcatheter aortic valve replacement (TAVR). Invasive coronary angiography remains the mainstay for anatomical assessment of CAD, whereas coronary computed tomography angiography may be used in patients with a low pretest probability of CAD. Adjunctive functional evaluation of coronary lesions has proven safe in the presence of AS, but uncertainty remains over the impact of AS on the results of functional testing. For patients with CAD, revascularization of significant lesions (≥90% stenosis, fractional flow reserve ≤0.80) is associated with improved clinical outcomes compared to medical therapy. However, the optimal timing of percutaneous coronary intervention (PCI) remains unclear with no clear benefit to revascularization in advance of TAVR. When planning post-TAVR PCI, careful consideration should be given to the type of valve implanted, with short-frame valves having more favorable coronary access after TAVR. Planning for future coronary access is particularly relevant for patients who have either unrevascularized obstructive coronary lesions or unknown coronary anatomy in advance of TAVR. Moreover, post-TAVR PCI will likely increase, given the younger age profile of patients being treated and the trend to defer revascularization until after valve replacement.
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Affiliation(s)
- Richard Tanner
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Cardiology, Mater Private Network, Cork, Ireland
| | - Sean Gilhooley
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David Power
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gilbert H.L. Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York
| | - Annapoorna S. Kini
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K. Sharma
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
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Hirsch JR, Mascarenhas L, Kayani WT, Denktas AE, Khalid MU, Liu J. Management of Acute Coronary Syndrome in Patients With Transcatheter Aortic Valve Replacement: A Review. Catheter Cardiovasc Interv 2025; 105:959-969. [PMID: 39806924 DOI: 10.1002/ccd.31394] [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: 11/23/2024] [Accepted: 12/22/2024] [Indexed: 01/16/2025]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a viable treatment option for patients with severe aortic stenosis among all risk subsets. As TAVR use becomes more prevalent and patients live longer with their transcatheter valve, an increasing number of these patients can be expected to present with ACS. Overall, there is a paucity of high-quality data detailing incidence, pathophysiology, and management of ACS in this subset. While most ACS cases post-TAVR are Type II myocardial infarctions (MI), the incidence of Type I MI and ST-elevation myocardial infarction is not negligible. Additionally, ACS in TAVR patients is associated with poor outcomes. While medical management is similar in this cohort to non-TAVR patients, procedural issues pose a unique challenge, especially as related to coronary access in the presence of valve prosthesis. Despite the proven benefit of invasive therapies in the management of ACS in non-TAVR patients, administrative databases suggest a lower utilization of invasive therapies in this cohort, which may highlight a disparity in care and potential for improvement. In this review, we summarize available data regarding the incidence, pathophysiology, and management of ACS in TAVR patients as well as strategies for coronary access post-TAVR.
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Affiliation(s)
- Joshua R Hirsch
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - Waleed T Kayani
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Ali E Denktas
- Department of Medicine, Michael E DeBakey Veteran's Affairs Medical Center, Houston, Texas, USA
| | - Mirza U Khalid
- Department of Medicine, Michael E DeBakey Veteran's Affairs Medical Center, Houston, Texas, USA
| | - Jing Liu
- Department of Medicine, Michael E DeBakey Veteran's Affairs Medical Center, Houston, Texas, USA
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Onishi K, Mizutani K, Soejima N, Fujita K, Yasuda M, Ueno M, Sakaguchi G, Nakazawa G. High implantation of a balloon-expandable valve above the left ventricular outflow calcification improves the prosthetic valve function without increasing complications: a case series. Eur Heart J Case Rep 2025; 9:ytaf007. [PMID: 39877479 PMCID: PMC11772999 DOI: 10.1093/ehjcr/ytaf007] [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: 04/15/2024] [Revised: 09/14/2024] [Accepted: 01/06/2025] [Indexed: 01/31/2025]
Abstract
Background The initial outcomes of transcatheter aortic valve replacement in patients with left ventricular outflow tract calcification are poor. Furthermore, balloon-expandable transcatheter aortic valve replacement is associated with an increased risk of annular rupture, and self-expandable transcatheter aortic valve replacement is associated with worse post-operative residual paravalvular leakage grades. Therefore, developing an optimal method for transcatheter aortic valve replacement for patients with left ventricular outflow tract calcification is desirable. Case summary We present two cases of successful balloon-expandable transcatheter aortic valve replacement, wherein the transcatheter heart valve was implanted above the left ventricular outflow tract calcification to avoid annular rupture and paravalvular leakage, and one case each of balloon-expandable and self-expandable transcatheter aortic valve replacements, wherein the transcatheter heart valve was implanted at a normal height. Although annular rupture did not occur in any of the cases, more-than-mild paravalvular leakage persisted post-operatively in cases where the transcatheter heart valve was placed at a normal height. Discussion Annular rupture is more likely to occur in areas with high calcification at the joint than in noncalcified areas. Furthermore, the greater the calcification in the landing zone of the transcatheter heart valve, the more the paravalvular leakage persists. Therefore, high implantation of transcatheter heart valves above the left ventricular outflow tract calcification can be an effective method to avoid annular rupture and paravalvular leakage.
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Affiliation(s)
- Kyohei Onishi
- Division of Cardiology, Department of Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511, Japan
| | - Kazuki Mizutani
- Division of Cardiology, Department of Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511, Japan
| | - Naoko Soejima
- Division of Cardiology, Department of Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511, Japan
| | - Kosuke Fujita
- Division of Cardiology, Department of Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511, Japan
| | - Masakazu Yasuda
- Division of Cardiology, Sakurabashi Watanabe Hospital, 4-3-51 nakanoshima kita-ku, Osaka 530-0005, Japan
| | - Masafumi Ueno
- Division of Cardiology, Department of Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511, Japan
| | - Genichi Sakaguchi
- Division of Cardiovascular Surgery, Department of Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511, Japan
| | - Gaku Nakazawa
- Division of Cardiology, Department of Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511, Japan
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Yasuda M, Mizutani K, Onishi K, Onishi N, Fujita K, Ueno M, Okamura A, Iwanaga Y, Sakaguchi G, Nakazawa G. Hemodynamic effect of supra-annular implantation of SAPIEN 3 balloon expandable valve. Cardiovasc Interv Ther 2025; 40:133-143. [PMID: 39240505 PMCID: PMC11723897 DOI: 10.1007/s12928-024-01040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 08/19/2024] [Indexed: 09/07/2024]
Abstract
The hemodynamic impact of the implantation depth for balloon-expandable valves is under-investigated, especially with higher implantation techniques. We assessed the hemodynamic performance of supra-annular SAPIEN 3 valve implantation. This retrospective study involved consecutive patients who underwent transcatheter aortic valve replacement (TAVR) using the SAPIEN 3. The device implantation depth and transcatheter heart valve (THV) leaflet-nadir position were angiographically analyzed, and supra-annular implantation was defined as a higher leaflet-nadir position than the original annular line. The Doppler hemodynamic status was evaluated at patient discharge. Among 184 patients, 120 (65%) underwent supra-annular implantation, and their mean implantation depth was significantly lower than that of intra-annular implantation (1.1 vs. 5.2 mm, p < 0.001). No patients developed valve embolization or coronary occlusion, and none required the TAV-in-TAV procedure. Two (1.6%) patients in the supra-annular implantation group had a mild or greater paravalvular leak. Echocardiography demonstrated that supra-annular implantation had better hemodynamic performance, showing a larger indexed effective orifice area (iEOA) compared with intra-annular implantation (1.09 vs. 0.97 cm2/m2, p < 0.01). There was a weak but negative correlation between the implantation depth and iEOA (r = - 0.27, p < 0.01). Moderate or severe prosthesis-patient mismatch (PPM) was found in 35.9% of the intra-annular group and 9.2% of supra-annular of the supra-annular group (p < 0.01). In the multivariable analysis, supra-annular implantation was an independent predictor of better THV function (iEOA > 0.85). Supra-annular SAPIEN 3 implantation provides beneficial hemodynamic effects and reduces the PPM risk.
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Affiliation(s)
- Masakazu Yasuda
- Division of Cardiology, Sakurabashi Watanabe Advanced Healthcare Hospital, OSAKA, Japan
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, OSAKA, Japan
| | - Kazuki Mizutani
- Department of Cardiology, Sapporo Cardio vascular Clinic, 8-1, Kita 49 jyo, Higashi 16 jyo, Higashi-ku, Sapporo, 007-0849, Japan.
| | - Kyohei Onishi
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, OSAKA, Japan
| | - Naoko Onishi
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, OSAKA, Japan
| | - Kosuke Fujita
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, OSAKA, Japan
| | - Masafumi Ueno
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, OSAKA, Japan
| | - Atsushi Okamura
- Division of Cardiology, Sakurabashi Watanabe Advanced Healthcare Hospital, OSAKA, Japan
| | - Yoshitaka Iwanaga
- Division of Cardiology, Sakurabashi Watanabe Advanced Healthcare Hospital, OSAKA, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kindai University Faculty of Medicine, OSAKA, Japan
| | - Gaku Nakazawa
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, OSAKA, Japan
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6
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Rao K, Baer A, Bapat VN, Piazza N, Hansen P, Prendergast B, Bhindi R. Lifetime management considerations to optimise transcatheter aortic valve implantation: a practical guide. EUROINTERVENTION 2024; 20:e1493-e1504. [PMID: 39676551 PMCID: PMC11626398 DOI: 10.4244/eij-d-24-00332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/30/2024] [Indexed: 12/17/2024]
Abstract
Transcatheter aortic valve implantation (TAVI) is a safe and effective procedure for the treatment of aortic stenosis. With the recently broadened indications, there is a larger cohort of patients likely to outlive their first transcatheter heart valve (THV). This review discusses relevant lifetime planning considerations, focusing on the utility of preprocedural computed tomography imaging to help implanters future-proof their patients who are likely to outlive their first valve. The initial priority is to optimise the index procedure by maximising THV haemodynamic function and durability. This involves maximising the effective orifice area, minimising the risk of new pacemaker implantation, reducing paravalvular regurgitation, and preventing coronary obstruction and annular rupture. In patients requiring a second valve procedure, a significant proportion will require a TAVI-in-TAVI, and implanters should consider the key priorities for a redo procedure, including the increased risks of patient-prosthesis mismatch and conduction abnormalities, promoting coronary reaccessibility, and preventing coronary obstruction and sinus sequestration. Careful planning can identify potential hurdles as well as predict the feasibility and likely outcomes of redo-TAVI, to help individualise care over the lifetime of each patient.
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Affiliation(s)
- Karan Rao
- Royal North Shore Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | | | | | - Nicolo Piazza
- McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Peter Hansen
- Royal North Shore Hospital, Sydney, Australia
- North Shore Private Hospital, Sydney, Australia
| | - Bernard Prendergast
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom
- Heart, Thoracic and Vascular Institute, Cleveland Clinic, London, United Kingdom
| | - Ravinay Bhindi
- Royal North Shore Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
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7
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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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8
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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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9
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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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10
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Eckel C, Kim WK, Schlüter J, Renker M, Bargon S, Grothusen C, Elsässer A, Dohmen G, Choi YH, Charitos EI, Hamm CW, Sossalla S, Möllmann H, Blumenstein J. Impact of Accidental High or Low Implantation Depth on Peri-Procedural Outcomes after Implantation with the Self-Expanding ACURATE neo2. J Clin Med 2024; 13:5342. [PMID: 39274553 PMCID: PMC11396697 DOI: 10.3390/jcm13175342] [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: 07/22/2024] [Revised: 08/15/2024] [Accepted: 08/24/2024] [Indexed: 09/16/2024] Open
Abstract
Background: Precise implantation could play a crucial role in the technical success of transcatheter aortic valve replacement (TAVR) for some prostheses. The impact of an accidental implantation depth (ID) outside the recommended range has not been assessed for the ACURATE neo2 (NEO2). Methods: Data from 1839 patients with severe native aortic stenosis treated with the NEO2 prosthesis were evaluated. We compared the results of prostheses implanted in an ID both inside and outside the recommendations. The outcome assessment followed the Valve Academic Research Consortium-3 criteria. Results: Patients were retrospectively divided into high (<3 mm; n = 412), optimal (3-7 mm; n = 1236), and low (>7 mm; n = 169) implantations. Technical success (94.7% vs. 94.7% vs. 91.7%, p = 0.296) and device success were high (90.1% vs. 89.3% vs. 84.6%, p = 0.112) without differences between groups. Rates of relevant paravalvular regurgitation (PVL; >mild or VinV due to PVL) were comparable (1.2% vs. 1.8% vs. 1.2%, p = 0.759). Even when hemodynamics were superior in the high-implantation group, with greater iEOA (1.01 cm2/m2 vs. 0.95 cm2/m2 vs. 0.92 cm2/m2, p < 0.001), spontaneous embolization or after post-dilatation was more common. Low implantation was associated with a higher rate of associated pacemaker implantation (PPI) (6.1% vs. 8.8% vs. 14.8%, p = 0.001). Conclusions: Implantation with the ACURATE neo2 showed excellent hemodynamic results, including low gradients and a small number of relevant PVL, in line with a high technical success rate that was irrespective of the ID. A favorable outcome can also be achieved in accidental low or high positions. Low implantation was associated with a higher rate of associated pacemaker implantation. Deliberately high implantation should be avoided due to the risk of embolization.
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Affiliation(s)
- Clemens Eckel
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- School VI-School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, 26129 Oldenburg, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
- Department of Cardiology, Justus-Liebig University of Giessen, 35390 Giessen, Germany
| | - Judith Schlüter
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | - Sophie Bargon
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Christina Grothusen
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiac Surgery, University of Kiel, 24118 Kiel, Germany
| | - Albrecht Elsässer
- School VI-School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, 26129 Oldenburg, Germany
| | - Guido Dohmen
- Department of Cardiac Surgery, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | | | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
- Department of Cardiology, Justus-Liebig University of Giessen, 35390 Giessen, Germany
| | - Samuel Sossalla
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
- Department of Cardiology, Justus-Liebig University of Giessen, 35390 Giessen, Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Johannes Blumenstein
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- School VI-School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, 26129 Oldenburg, Germany
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11
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Panagides V, Sakka E, Cheneau E, Bouharaoua A, Vicat J, Leude-Vaillant E, Rochas P, Collet F, Giacomoni MP. Prognosis and Predictor Factors of Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement: A Retrospective Analysis of the Post-Transcatheter Aortic Replacement Clairval Hospital Registry. J Clin Med 2024; 13:3050. [PMID: 38892761 PMCID: PMC11173049 DOI: 10.3390/jcm13113050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: Despite procedural improvements, post-transcatheter aortic valve replacement (TAVR) conduction disorders remain high. Analyzing the data from a monocentric TAVR registry, this study aims to determine predictive factors for PPI (primary outcome), the indication for PPI, and long-term outcomes among these patients (secondary outcomes). Methods: Conducted at Clairval Hospital in Marseille, France, this retrospective study included all consecutive patients from June 2012 to June 2019. Clinical, electrocardiographic, echocardiographic, and procedural data were collected, with outcomes assessed annually. Logistic regression identified PPI predictors and survival analyses were performed. Results: Of the 1458 patients initially considered, 1157 patients were included. PPI was needed in 21.5% of patients, primarily for third-degree atrioventricular block (46.4%). Predictor factors for PPI included baseline right bundle branch block (ORadj 2.49, 95% CI 1.44 to 4.30; p = 0.001), longer baseline QRS duration (ORadj 1.01, 95% CI 1.00 to1.02, p = 0.002), and self-expandable valves (ORadj 1.82, 95% CI, 1.09 to 3.03; p = 0.021). Seven-year estimated mortality was higher in PPI (43.3%) vs. non-PPI patients (30.9%) (log rank p = 0.048). PPI was an independent predictive factor of death (ORadj 2.49, 95% CI 1.4 to 4.3; p = 0.002). Conclusions: This study reveals elevated rates of PPI post-TAVR associated with increased mortality. These results underscore the pressing necessity to refine our practices, delineate precise indications, and enhance the long-term prognosis for implanted patients.
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Affiliation(s)
- Vassili Panagides
- Service de Cardiologie, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (V.P.); (E.S.); (E.C.); (A.B.); (P.R.); (F.C.)
| | - Emna Sakka
- Service de Cardiologie, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (V.P.); (E.S.); (E.C.); (A.B.); (P.R.); (F.C.)
| | - Edouard Cheneau
- Service de Cardiologie, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (V.P.); (E.S.); (E.C.); (A.B.); (P.R.); (F.C.)
| | - Ahmed Bouharaoua
- Service de Cardiologie, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (V.P.); (E.S.); (E.C.); (A.B.); (P.R.); (F.C.)
| | - Jacques Vicat
- Service de Chirurgie Cardiaque, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (J.V.); (E.L.-V.)
| | - Elisabeth Leude-Vaillant
- Service de Chirurgie Cardiaque, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (J.V.); (E.L.-V.)
| | - Philippe Rochas
- Service de Cardiologie, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (V.P.); (E.S.); (E.C.); (A.B.); (P.R.); (F.C.)
| | - Frédéric Collet
- Service de Cardiologie, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (V.P.); (E.S.); (E.C.); (A.B.); (P.R.); (F.C.)
| | - Marie-Paule Giacomoni
- Service de Cardiologie, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (V.P.); (E.S.); (E.C.); (A.B.); (P.R.); (F.C.)
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12
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Chrysostomidis G, Apostolos A, Papanikolaou A, Konstantinou K, Tsigkas G, Koliopoulou A, Chamogeorgakis T. The Application of Precision Medicine in Structural Heart Diseases: A Step towards the Future. J Pers Med 2024; 14:375. [PMID: 38673001 PMCID: PMC11051532 DOI: 10.3390/jpm14040375] [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: 02/07/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
The personalized applications of 3D printing in interventional cardiology and cardiac surgery represent a transformative paradigm in the management of structural heart diseases. This review underscores the pivotal role of 3D printing in enhancing procedural precision, from preoperative planning to procedural simulation, particularly in valvular heart diseases, such as aortic stenosis and mitral regurgitation. The ability to create patient-specific models contributes significantly to predicting and preventing complications like paravalvular leakage, ensuring optimal device selection, and improving outcomes. Additionally, 3D printing extends its impact beyond valvular diseases to tricuspid regurgitation and non-valvular structural heart conditions. The comprehensive synthesis of the existing literature presented here emphasizes the promising trajectory of individualized approaches facilitated by 3D printing, promising a future where tailored interventions based on precise anatomical considerations become standard practice in cardiovascular care.
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Affiliation(s)
- Grigorios Chrysostomidis
- Second Department of Adult Cardiac Surgery—Heart and Lung Transplantation, Onassis Cardiac Surgery Center, 176 74 Athens, Greece; (G.C.); (A.K.); (T.C.)
| | - Anastasios Apostolos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece;
| | - Amalia Papanikolaou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece;
| | - Konstantinos Konstantinou
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London 26504, UK;
| | - Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece;
| | - Antigoni Koliopoulou
- Second Department of Adult Cardiac Surgery—Heart and Lung Transplantation, Onassis Cardiac Surgery Center, 176 74 Athens, Greece; (G.C.); (A.K.); (T.C.)
| | - Themistokles Chamogeorgakis
- Second Department of Adult Cardiac Surgery—Heart and Lung Transplantation, Onassis Cardiac Surgery Center, 176 74 Athens, Greece; (G.C.); (A.K.); (T.C.)
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13
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Koshy AN, Tang GHL, Khera S, Vinayak M, Berdan M, Gudibendi S, Hooda A, Safi L, Lerakis S, Dangas GD, Sharma SK, Kini AS, Krishnamoorthy P. Redo-TAVR Feasibility After SAPIEN 3 Stratified by Implant Depth and Commissural Alignment: A CT Simulation Study. Circ Cardiovasc Interv 2024; 17:e013766. [PMID: 38502723 DOI: 10.1161/circinterventions.123.013766] [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: 10/27/2023] [Accepted: 01/02/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Redo-transcatheter aortic valve replacement (TAVR) can pin the index transcatheter heart valve leaflets open leading to sinus sequestration and restricting coronary access. The impact of initial implant depth and commissural alignment on redo-TAVR feasibility is unclear. We sought to determine the feasibility of redo-TAVR and coronary access after SAPIEN 3 (S3) TAVR stratified by implant depth and commissural alignment. METHODS Consecutive patients with native valve aortic stenosis were evaluated using multidetector computed tomography. S3 TAVR simulations were done at 3 implant depths, sizing per manufacturer recommendation and assuming nominal expansion in all cases. Redo-TAVR was deemed unfeasible based on valve-to-sinotubular junction distance and valve-to-sinus height <2 mm, while the neoskirt plane of the S3 transcatheter heart valve estimated coronary access feasibility. RESULTS Overall, 1900 patients (mean age, 80.2±8 years; STS-PROM [Society of Thoracic Surgeons Predicted Risk of Operative Mortality], 3.4%) were included. Redo-TAVR feasibility reduced significantly at shallower initial S3 implant depths (2.3% at 80:20 versus 27.5% at 100:0, P<0.001). Larger S3 sizes reduced redo-TAVR feasibility, but only in patients with a 100:0 implant (P<0.001). Commissural alignment would render redo-TAVR feasible in all patients, assuming the utilization of leaflet modification techniques to reduce the neoskirt height. Coronary access following TAV-in-TAV was affected by both index S3 implant depth and size. CONCLUSIONS This study highlights the critical impact of implant depth, commissural alignment, and transcatheter heart valve size in predicting redo-TAVR feasibility. These findings highlight the necessity for individualized preprocedural planning, considering both immediate results and long-term prospects for reintervention as TAVR is increasingly utilized in younger patients with aortic stenosis.
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Affiliation(s)
- Anoop N Koshy
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
- Department of Cardiology, The Royal Melbourne Hospital, Australia (A.N.K.)
- Department of Cardiology and The University of Melbourne, Austin Health, Australia (A.N.K.)
| | - Gilbert H L Tang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York (G.H.L.T., M.B., S.G.)
| | - Sahil Khera
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
| | - Manish Vinayak
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
| | - Megan Berdan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York (G.H.L.T., M.B., S.G.)
| | - Sneha Gudibendi
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York (G.H.L.T., M.B., S.G.)
| | - Amit Hooda
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
| | - Lucy Safi
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
| | - Stamatios Lerakis
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
| | - Annapoorna S Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
| | - Parasuram Krishnamoorthy
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (A.N.K., G.H.L.T., S.K., M.V., M.B., S.G., A.H., L.S., S.L., G.D.D., S.K.S., A.S.K., P.K.)
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14
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Parikh PB, Mack M, Stone GW, Anker SD, Gilchrist IC, Kalogeropoulos AP, Packer M, Skopicki HA, Butler J. Transcatheter aortic valve replacement in heart failure. Eur J Heart Fail 2024; 26:460-470. [PMID: 38297972 DOI: 10.1002/ejhf.3151] [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: 03/27/2023] [Revised: 01/06/2024] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
Patients with severe aortic stenosis (AS) may develop heart failure (HF), the presence of which has traditionally been deemed as a final stage in AS progression with poor outcomes. The use of transcatheter aortic valve replacement (TAVR) has become the preferred therapy for most patients with AS and concomitant HF. With its instant afterload reduction, TAVR offers patients with HF significant haemodynamic benefits, with corresponding changes in left ventricular structure and improved mortality and quality of life. The prognostic covariates and optimal timing of TAVR in patients with less than severe AS remain unclear. The purpose of this review is to describe the association between TAVR and outcomes in patients with HF, particularly in the setting of left ventricular systolic dysfunction, acute HF, and right ventricular systolic dysfunction, and to highlight areas for future research.
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Affiliation(s)
- Puja B Parikh
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA
| | - Michael Mack
- Department of Cardiac Surgery, Baylor Scott & White Health, Plano, TX, USA
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Stefan D Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin, Berlin, Germany
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Ian C Gilchrist
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA
| | | | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Hal A Skopicki
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA
| | - Javed Butler
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
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15
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Higuchi R, Otaki Y, Kanisawa M, Takamisawa I, Nanasato M, Iguchi N, Isobe M. Risk of Sinus Sequestration During Redo Transcatheter Aortic Valve Implantation: The Prevalence, Predictors, and Risk Stratification. Am J Cardiol 2024; 211:1-8. [PMID: 37884114 DOI: 10.1016/j.amjcard.2023.10.058] [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: 08/14/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023]
Abstract
The number of patients who underwent transcatheter aortic valve implantation (TAVI) with the potential for reintervention is steadily increasing; however, there is a risk of sinus sequestration (SS) during a redo TAVI. The prevalence, predictors, and risk stratification of the risk for SS remain uncertain. We analyzed computed tomography acquired from 263 patients who underwent TAVI between 2021 and 2022: balloon-expandable valve (BEV) (71%) and self-expandable valve (SEV) (29%). Patients were considered at risk for SS if they met the following: (1) BEV frame > sinotubular junction (STJ) or SEV neocommissure greater than the STJ and (2) valve-to-STJ <2 mm. The risk of left, right, and any SS in 51%, 50%, and 65%, respectively, did not differ between BEV and SEV. The predictors of any SS were the height of the left and right coronary cusp (odds ratio [OR] 0.81 and 0.71, cutoff 18.6 and 19.2 mm, respectively) and STJ minus the annulus diameter (OR 0.65, cutoff 3.7 mm) in BEV, and STJ diameter (OR 0.47, cutoff 27.6 mm) in SEV. The number of predictors stratified the risk of any SS: low risk with BEV at 0 predictors (14% at risk of SS), intermediate risk at 1 predictor (65%), high risk at 2 or 3 predictors (81% and 95%), and low risk with SEV at 0 predictors (33%) versus high risk at 1 predictor (91%). In conclusion, 2/3 of patients who underwent TAVI were at risk of SS. The height of the coronary cusp and the STJ diameter were associated with and adequately stratified the risk of SS.
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Affiliation(s)
- Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
| | - Yuka Otaki
- Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mitsuru Kanisawa
- Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mitsuaki Isobe
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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16
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Miyawaki N, Ishizu K, Shirai S, Nakano K, Fukushima T, Ko E, Tsuru Y, Tashiro H, Nakamura M, Tabata H, Morofuji T, Morinaga T, Hayashi M, Isotani A, Ohno N, Kakumoto S, Ando K. Assessing Potential Risks of Future Redo Transcatheter Aortic Valve Replacement in Asian Patients. JACC. ASIA 2024; 4:25-39. [PMID: 38222260 PMCID: PMC10782404 DOI: 10.1016/j.jacasi.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/24/2023] [Accepted: 09/03/2023] [Indexed: 01/16/2024]
Abstract
Background In the Asian cohort, data are limited on the risk for coronary obstruction due to sinus of Valsalva (SOV) sequestration in redo transcatheter aortic valve replacement (TAVR) procedures. Objectives The aim of this study was to assess the potential risk for coronary obstruction in simulated redo TAVR in Asian patients. Methods Post-TAVR computed tomographic data from 788 patients who received balloon-expandable (BE) SAPIEN 3 transcatheter aortic valves (TAVs) and 334 patients who received self-expanding (SE) Evolut R or Evolut PRO TAVs were analyzed. The risk for coronary obstruction due to SOV sequestration in redo TAVR, defined as the TAV commissure level above the sinotubular junction (STJ) and a TAV-to-STJ distance <2.0 mm in each coronary sinus, was retrospectively evaluated. Results The potential risks for coronary obstruction due to SOV sequestration at 1 or both coronary arteries were identified in 52.1% of the BE TAV group and 71.3% of the SE TAV group (P < 0.001). After adjusting for multiple covariates, STJ diameter, STJ height, TAV oversizing degree by area, and implantation depth were independently associated with SOV sequestration risk in the BE TAV group, whereas STJ diameter and implantation depth were independently associated with SOV sequestration risk in the SE TAV group. Conclusions Coronary obstruction due to SOV sequestration in redo TAVR may occur in a substantial number of Asian patients. This finding suggests the importance of considering the structural feasibility of future redo TAVR when implanting the first TAV, especially in Asian patients with long life expectancy.
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Affiliation(s)
- Norihisa Miyawaki
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenichi Ishizu
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Nakano
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | | | - Euihong Ko
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yasuo Tsuru
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroaki Tashiro
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Miho Nakamura
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroyuki Tabata
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Toru Morofuji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takashi Morinaga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Masaomi Hayashi
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Akihiro Isotani
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shinichi Kakumoto
- Department of Anesthesiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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17
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Elbadawi A, Dayal Y, Kumbhani DJ. Repeat Transcatheter Aortic Valve Implantation: The Importance of Getting it Right the First Time Round! JACC. ASIA 2024; 4:40-43. [PMID: 38222262 PMCID: PMC10782399 DOI: 10.1016/j.jacasi.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Affiliation(s)
- Ayman Elbadawi
- Christus Good Shepherd Medical Center, Longview, Texas, USA
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18
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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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19
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Fukui M, Okada A, Thao KR, Burns MR, Koike H, Wang C, Phichaphop A, Lesser JR, Sorajja P, Cavalcante JL, Bapat VN. Feasibility of Redo-Transcatheter Aortic Valve Replacement in Sapien Valves Based on In Vivo Computed Tomography Assessment. Circ Cardiovasc Interv 2023; 16:e013497. [PMID: 37988440 DOI: 10.1161/circinterventions.123.013497] [Citation(s) in RCA: 4] [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] [Indexed: 11/23/2023]
Abstract
BACKGROUND Our aim was to assess the feasibility of repeat transcatheter aortic valve (TAV) replacement for degenerated Sapien3 (S3) prostheses by simulating subsequent implantation of S3 or Evolut, using in vivo computed tomography-based sizing and the impact on coronary and patient-prosthesis mismatch risks. METHODS Computed tomography scans from 356 patients with prior S3 TAV replacement implantation were analyzed. The in vivo sizing for second TAV based on averaged area of 3 levels of outflow, mid (narrowest) and inflow, was compared with in vitro recommendations, that is, same size as index S3 for second S3 and 1 size larger for Evolut. Risks of coronary obstruction and patient-prosthesis mismatch were determined by valve-to-aorta distance and estimated effective orifice area, respectively. RESULTS Overall, the majority of patients (n=328; 92.1%) had underexpanded index S3 with an expansion area of 94% (91%-97%), leading to significant differences in size selection of the second TAV between in vivo and in vitro sizing strategies. Expansion area <89% served as a threshold, resulting in 1 size smaller than the in vitro recommendations were selected in 45 patients (13%) for S3-in-S3 and 13 (4%) for Evolut-in-S3, while the remaining patients followed in vitro recommendations (P<0.01, in vivo versus in vitro sizing). Overall, 57% of total patients for S3-in-S3 simulation and 60% for Evolut-in-S3 were considered low risk for coronary complications. Deep index S3 implantation (odds ratio, 0.76 [interquartile range, 0.67-0.87]; P<0.001) and selecting Evolut as the second TAV (11% risk reduction in intermediate- or high-risk patients) reduced coronary risk. Estimated moderate or severe patient-prosthesis mismatch risk was 21% for S3-in-S3 and 1% for Evolut-in-S3, assuming optimal expansion of the second TAV. CONCLUSIONS Redo-TAV replacement with S3-in-S3 and Evolut-in-S3 could be feasible with low risk to coronaries in ≈60% of patients, while the remaining 40% will be at intermediate or high risk. The feasibility of redo-TAV replacement is influenced by sizing strategy, type of second TAV, native annular anatomy, and implant depth.
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Affiliation(s)
- Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab (M.F., H.K., J.L.C.), Minneapolis Heart Institute Foundation, MN
| | - Atsushi Okada
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
| | - Kiahltone R Thao
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
| | - Marcus R Burns
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.R.B., J.R.L., P.S., J.L.C., V.N.B.)
| | - Hideki Koike
- Cardiovascular Imaging Research Center and Core Lab (M.F., H.K., J.L.C.), Minneapolis Heart Institute Foundation, MN
| | - Cheng Wang
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
| | - Asa Phichaphop
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
| | - John R Lesser
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.R.B., J.R.L., P.S., J.L.C., V.N.B.)
| | - Paul Sorajja
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.R.B., J.R.L., P.S., J.L.C., V.N.B.)
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab (M.F., H.K., J.L.C.), Minneapolis Heart Institute Foundation, MN
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.R.B., J.R.L., P.S., J.L.C., V.N.B.)
| | - Vinayak N Bapat
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.R.B., J.R.L., P.S., J.L.C., V.N.B.)
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20
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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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21
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Elbadawi A, Saad M, Kumbhani DJ, Bavry AA. The Impact of Transcatheter Aortic Valve Implantation Height on Clinical Consequences. JACC Cardiovasc Interv 2023; 16:1945. [PMID: 37587605 DOI: 10.1016/j.jcin.2023.06.003] [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: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 08/18/2023]
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22
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Ochiai T, Saito S. Reply: Pacemaker Implantation After TAVR: Searching for the Golden Ratio and the Commentary on the Study Interpretation. JACC Cardiovasc Interv 2023; 16:1947. [PMID: 37587607 DOI: 10.1016/j.jcin.2023.06.040] [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: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 08/18/2023]
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23
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Koliastasis L, Kim WK, Toutouzas K. Pacemaker Implantation After TAVR: Searching for the Golden Ratio. JACC Cardiovasc Interv 2023; 16:1946. [PMID: 37587606 DOI: 10.1016/j.jcin.2023.06.002] [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: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 08/18/2023]
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24
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Mylotte D, Fezzi S. TAVR Roulette: Go High or Go Low. JACC Cardiovasc Interv 2023; 16:1205-1207. [PMID: 37225291 DOI: 10.1016/j.jcin.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Darren Mylotte
- Department of Cardiology, SAOLTA Healthcare Group, Galway University Hospital, Health Service Executive and National University of Ireland Galway, Galway, Ireland.
| | - Simone Fezzi
- Department of Cardiology, SAOLTA Healthcare Group, Galway University Hospital, Health Service Executive and National University of Ireland Galway, Galway, Ireland; The Lambe Institute for Translational Medicine and CURAM, National University of Ireland Galway, Galway, Ireland; Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
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