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Pellegrini C, Kim WK, Holzamer A, Walther T, Mayr NP, Michel J, Rheude T, Nuñez J, Kasel AM, Trenkwalder T, Kaess BM, Joner M, Kastrati A, Schunkert H, Hilker M, Möllmann H, Hengstenberg C, Husser O. Evaluación multicéntrica del sobredimensionamiento de la prótesis transcatéter SAPIEN 3. Impacto en el fallo del dispositivo y nuevos implantes de marcapasos. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.05.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Nunes Filho AC, Katz M, Campos CM, Carvalho LA, Siqueira DA, Tumelero RT, Portella AL, Esteves V, Perin MA, Sarmento-Leite R, Lemos Neto PA, Tarasoutchi F, Bezerra HG, de Brito FS. Impacto del daño renal agudo en el seguimiento a corto y a largo plazo tras el implante percutáneo de válvula aórtica. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2017.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Enríquez-Rodríguez E, Amat-Santos IJ, Jiménez-Quevedo P, Martín-Morquecho I, Tirado-Conte G, Pérez-Vizcayno MJ, Gómez de Diego JJ, Arnold R, Aldazábal A, Rojas P, de Agustín A, Del Trigo M, Gutiérrez H, San Román JA, Macaya C, Nombela-Franco L. Comparación de la hemodinámica valvular de la prótesis transcatéter con balón expandible SAPIEN 3 frente a la autoexpandible Evolut R: estudio de casos emparejados. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Multicenter Evaluation of Prosthesis Oversizing of the SAPIEN 3 Transcatheter Heart Valve. Impact on Device Failure and New Pacemaker Implantations. ACTA ACUST UNITED AC 2018; 72:641-648. [PMID: 30017841 DOI: 10.1016/j.rec.2018.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/21/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES A certain degree of prosthesis oversizing (OS) is recommended for the SAPIEN 3 to achieve device success. However, an increase in OS may increase permanent pacemaker implantation (PPI) rates. We therefore investigated the influence of OS on device failure and PPI. METHODS A total of 804 patients were treated with SAPIEN 3 at 3 centers. Multislice computed tomography-derived OS was calculated and analyzed both as a continuous variable and categorized in 5% increments with -4% to 0% as reference. RESULTS Device failure occurred in 8.8% of patients. Median OS was lower in patients with device failure vs those with device success (+4% vs +8%; P=.038). A nonlinear risk pattern was shown for OS with a significantly reduced device failure rate within 4% to +22% of OS. There was no case of paravalvular leakage II+ between +10% to +20% of OS. The overall PPI rate was 16.2% and the median OS was significantly larger in patients with PPI (PPI: +9% vs no PPI: +7%; P = .025), while implantation depth did not vary in patients with vs without PPI (6.9±1.7 mm vs 6.6±1.9 mm; P=.101). The risk of PPI increased with increasing OS and was highest in the 2 highest categories. CONCLUSIONS An increase in OS reduces the risk for device failure but increases the risk for PPI. There was no ideal range of OS to minimize both device failure and PPI.
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Nunes Filho ACB, Katz M, Campos CM, Carvalho LA, Siqueira DA, Tumelero RT, Portella ALF, Esteves V, Perin MA, Sarmento-Leite R, Lemos Neto PA, Tarasoutchi F, Bezerra HG, de Brito FS. Impact of Acute Kidney Injury on Short- and Long-term Outcomes After Transcatheter Aortic Valve Implantation. ACTA ACUST UNITED AC 2018; 72:21-29. [PMID: 29358043 DOI: 10.1016/j.rec.2017.11.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/20/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES Acute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI) and is associated with higher mortality. However, the impact of AKI on long-term outcomes remains controversial. Therefore, we sought to evaluate the impact of AKI on short- and long-term outcomes following TAVI using the Valve Academic Research Consortium 2 criteria. METHODS Consecutive patients (n = 794) with severe aortic stenosis who underwent TAVI were included in a multicenter Brazilian registry. Logistic regression analysis was used to identify predictors of AKI. Four-year outcomes were determined as Kaplan-Meier survival curves, and an adjusted landmark analysis was used to test the impact of AKI on mortality among survivors at 12 months. RESULTS The incidence of AKI after TAVI was 18%. Independent predictors of AKI were age, diabetes mellitus, major or life-threatening bleeding and valve malpositioning. Acute kidney injury was independently associated with higher risk of all-cause death (adjusted HR, 2.8; 95%CI, 2.0-3.9; P < .001) and cardiovascular mortality (adjusted HR, 2.9; 95%CI, 1.9-4.4; P < .001) over the entire follow-up period. However, when considering only survivors at 12 months, there was no difference in both clinical endpoints (adjusted HR, 1.2; 95%CI, 0.5-2.4; P = .71, and HR, 0.7; 95%CI, 0.2-2.1; P = .57, respectively). CONCLUSIONS Acute kidney injury is a frequent complication after TAVI. Older age, diabetes, major or life-threatening bleeding, and valve malpositioning were independent predictors of AKI. Acute kidney injury is associated with worse short- and long-term outcomes. However, the major impact of AKI on mortality is limited to the first year after TAVI.
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Affiliation(s)
| | - Marcelo Katz
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Carlos M Campos
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz A Carvalho
- Department of Interventional Cardiology, Hospital Pró-Cardíaco, Rio de Janeiro, Brazil
| | - Dimytri A Siqueira
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Rogério T Tumelero
- Department of Interventional Cardiology, Hospital São Vicente de Paulo, Passo Fundo, Brazil
| | | | - Vinícius Esteves
- Department of Interventional Cardiology, Rede D'OR São Luiz, São Paulo, Brazil
| | - Marco A Perin
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Pedro A Lemos Neto
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Flavio Tarasoutchi
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Hiram G Bezerra
- Cardiac Catheterization Laboratory, UH Cleveland Medical Center, Cleveland, United States
| | - Fábio S de Brito
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Enríquez-Rodríguez E, Amat-Santos IJ, Jiménez-Quevedo P, Martín-Morquecho I, Tirado-Conte G, Pérez-Vizcayno MJ, Gómez de Diego JJ, Arnold R, Aldazábal A, Rojas P, de Agustín A, Del Trigo M, Gutiérrez H, San Román JA, Macaya C, Nombela-Franco L. Comparison of the Hemodynamic Performance of the Balloon-expandable SAPIEN 3 Versus Self-expandable Evolut R Transcatheter Valve: A Case-matched Study. ACTA ACUST UNITED AC 2017; 71:735-742. [PMID: 29191782 DOI: 10.1016/j.rec.2017.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 10/06/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES The SAPIEN 3 (S3) valve and the Medtronic Evolut R (EVR) are second-generation transcatheter valves, designed to further reduce the rate of paravalvular aortic regurgitation (AoR). The aim of this study was to compare the 2 devices in terms of valve performance in a case-matched study with independent echocardiographic analysis. METHODS Of a population of 201 patients who underwent transcatheter aortic valve implantation, 144 patients (S3, n = 80; EVR, n = 64) were matched according to aortic annulus diameter and aortic valve calcium score, as assessed by computed tomography. All echocardiographic examinations collected at baseline and at 1- and 6-month follow-up were centrally analyzed. RESULTS The 2 groups were well balanced in baseline clinical and echocardiographic characteristics. The EVR valve showed a better hemodynamic profile as assessed by peak aortic gradient (EVR 13 ± 7 vs S3 20 ± 10mmHg; P<.001), mean aortic gradient (EVR 7 ± 3 vs S3 11 ± 6mmHg; P<.001), and Doppler velocity index (EVR 0.65±0.15 vs S3 0.51±0.16; P<.001). The rate of moderate-severe or any paravalvular (≥ mild) AoR was higher in the EVR group (11% and 50%) than in the S3 group (2.5% and 21%; P <.05, respectively), with a larger number of paravalvular jets (P <.001). CONCLUSIONS In a case-matched cohort of transcatheter aortic valve implantation patients, the S3 valve was associated with a lower rate of paravalvular AoR but also with a higher residual gradient than the EVR system.
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Affiliation(s)
- Eduardo Enríquez-Rodríguez
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Ignacio J Amat-Santos
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Pilar Jiménez-Quevedo
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Irene Martín-Morquecho
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Gabriela Tirado-Conte
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - María José Pérez-Vizcayno
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - José Juan Gómez de Diego
- Departamento de Imagen Cardiaca, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Roman Arnold
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Andrés Aldazábal
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Paol Rojas
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Alberto de Agustín
- Departamento de Imagen Cardiaca, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - María Del Trigo
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Hipólito Gutiérrez
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José A San Román
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Carlos Macaya
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Luis Nombela-Franco
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
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