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Flores-Umanzor E, Alshehri B, Keshvara R, Wilson W, Osten M, Benson L, Abrahamyan L, Horlick E. Transcatheter-Based Interventions for Tetralogy of Fallot Across All Age Groups. JACC Cardiovasc Interv 2024; 17:1079-1090. [PMID: 38749587 DOI: 10.1016/j.jcin.2024.02.009] [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: 11/07/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 05/26/2024]
Abstract
Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease. Palliative procedures, either surgical or transcatheter, aim to improve oxygen saturation, affording definitive procedures at a later stage. Transcatheter interventions have been used before and after surgical palliative or definitive repair in children and adults. This review aims to provide an overview of the different catheter-based interventions for TOF across all age groups, with an emphasis on palliative interventions, such as patent arterial duct stenting, right ventricular outflow tract stenting, or balloon pulmonary valvuloplasty in infants and children and transcatheter pulmonary valve replacement in adults with repaired TOF, including the available options for a large, dilated native right ventricular outflow tract.
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Affiliation(s)
- Eduardo Flores-Umanzor
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Cardiology Department, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Bandar Alshehri
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Rajesh Keshvara
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - William Wilson
- Royal Melbourne Hospital Cardiology, Parkville, Victoria, Australia
| | - Mark Osten
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Lee Benson
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; The Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children, The Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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Stinis CT, Abbas AE, Teirstein P, Makkar RR, Chung CJ, Iyer V, Généreux P, Kipperman RM, Harrison JK, Hughes GC, Lyons JM, Rahman A, Kakouros N, Walker J, Roberts DK, Huang PH, Kar B, Dhoble A, Logsdon DP, Khanna PK, Aragon J, McCabe JM. Real-World Outcomes for the Fifth-Generation Balloon Expandable Transcatheter Heart Valve in the United States. JACC Cardiovasc Interv 2024; 17:1032-1044. [PMID: 38456883 DOI: 10.1016/j.jcin.2024.02.015] [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: 01/17/2024] [Revised: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The fifth-generation SAPIEN 3 Ultra Resilia valve (S3UR) incorporates several design changes as compared with its predecessors, the SAPIEN 3 (S3) and SAPIEN 3 Ultra (S3U) valves, including bovine leaflets treated with a novel process intended to reduce structural valve deterioration via calcification, as well as a taller external skirt on the 29-mm valve size to reduce paravalvular leak (PVL). The clinical performance of S3UR compared with S3 and S3U in a large patient population has not been previously reported. OBJECTIVES The aim of this study was to compare S3UR to S3/S3U for procedural, in-hospital, and 30-day clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR). METHODS Patients enrolled in the STS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) Registry between January 1, 2021, and June 30, 2023, who underwent TAVR with S3UR or S3U/S3 valve platforms were propensity-matched and evaluated for procedural, in-hospital, and 30-day clinical and echocardiographic outcomes. RESULTS 10,314 S3UR patients were propensity matched with 10,314 patients among 150,539 S3U/S3 patients. At 30 days, there were no statistically significant differences in death, stroke, or bleeding, but a numerically higher hospital readmission rate in the S3UR cohort (8.5% vs 7.7%; P = 0.04). At discharge, S3UR patients exhibited significantly lower mean gradients (9.2 ± 4.6 mm Hg vs 12.0 ± 5.7 mm Hg; P < 0.0001) and larger aortic valve area (2.1 ± 0.7 cm2 vs 1.9 ± 0.6 cm2; P < 0.0001) than patients treated with S3/S3U. The 29-mm valve size exhibited significant reduction in mild PVL (5.3% vs 9.4%; P < 0.0001). CONCLUSIONS S3UR TAVR is associated with lower mean gradients and lower rates of PVL than earlier generations of balloon expandable transcatheter heart valve platforms.
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Affiliation(s)
- Curtiss T Stinis
- Division of Cardiology, Scripps Clinic, La Jolla, California, USA.
| | - Amr E Abbas
- Corewell Health East, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Paul Teirstein
- Division of Cardiology, Scripps Clinic, La Jolla, California, USA
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Christine J Chung
- University of Washington Medical Center, Department of Medicine, Division of Cardiology, Seattle, Washington, USA
| | - Vijay Iyer
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, New York, USA
| | - Philippe Généreux
- Gagnon Cardiovascular Institute at Morristown Medical Center, Morristown, New Jersey, USA
| | - Robert M Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - John K Harrison
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | - G Chad Hughes
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | | | - Ayaz Rahman
- Cardiology Associates of East Tennessee, Knoxville, Tennessee, USA
| | - Nikolaos Kakouros
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Jennifer Walker
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, North Carolina, USA
| | | | | | - Biswajit Kar
- Division of Cardiology, Department of Internal Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Abhijeet Dhoble
- Division of Cardiology, Department of Internal Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | | | | | - Joseph Aragon
- Santa Barbara Cottage Hospital, Santa Barbara, California, USA
| | - James M McCabe
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
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Šolc AJ, Línková H, Toušek P. Transcatheter aortic valve durability, predictors of bioprosthetic valve dysfunction, longer-term outcomes - a review. Expert Rev Med Devices 2024; 21:15-26. [PMID: 38032186 DOI: 10.1080/17434440.2023.2288275] [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: 09/08/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) is one of the most significant inventions in cardiology, as it provides a viable minimally invasive treatment option for patients with aortic stenosis, the most common valvular disease in the developed world and one with a poor prognosis when left untreated. Using data available to date, this review aims to discuss and identify possible predictors of TAVI valve durability - an essential requirement for the device's wide-spread use, especially in younger patients. AREAS COVERED This article explores the main causes of bioprosthetic valve dysfunction (BVD) based on pathophysiology and available data, and reviews possible predictors of BVD including prosthesis-related, procedure-related, and patient-related factors. An emphasis is made on affectable predictors, which could potentially be targeted with prevention management and improve valve durability. A literature search of online medical databases was conducted using relevant key words and dates; significant clinical trials were identified. A brief overview of important randomized controlled trials with mid to long-term follow-up is included in this article. EXPERT OPINION Identifying modifiable predictors of valve dysfunction presents an opportunity to enhance and predict valve durability - a necessity as patients with longer life-expectancies are being considered for the procedure.
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Affiliation(s)
- Abigail Johanna Šolc
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Cardiology, University Hospital Kralovské Vinohrady, Prague, Czech Republic
| | - Hana Línková
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Cardiology, University Hospital Kralovské Vinohrady, Prague, Czech Republic
| | - Petr Toušek
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
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Gorla R, Tua L, D'Errigo P, Barbanti M, Biancari F, Tarantini G, Badoni G, Ussia GP, Ranucci M, Bedogni F, Baglio G, Rosato S. Incidence and predictors of 30-day and 6-month stroke after TAVR: Insights from the multicenter OBSERVANT II study. Catheter Cardiovasc Interv 2023; 102:1122-1131. [PMID: 37794734 DOI: 10.1002/ccd.30848] [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: 05/21/2023] [Revised: 09/13/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The incidence and predictors of 30-day stroke after transcatheter aortic valve replacement (TAVR) were derived from early studies investigating first-generation devices. The incidence of 6-month stroke and its related predictors are unknown. AIMS To investigate the incidence and to identify procedural and patient-related predictors of 30-day and 6-month stroke after TAVR. METHODS Data from 2753 consecutive patients with severe aortic stenosis undergoing TAVR were obtained from the OBSERVANT-II study, an observational, prospective, multicenter cohort study. The study endpoints were symptomatic 30-day and 6-month stroke after TAVR. RESULTS The occurrence of a 30-day and 6-month stroke was low (1.3% and 2.4%, respectively) but with significant impact on survival. Aortic valve predilatation (odds ratio [OR]: 2.28, 95% confidence interval [CI]: 1.12-4.65, p = 0.023), diabetes (OR: 3.10, 95% CI: 1.56-6.18, p = 0.001), and left ventricle ejection fraction < 50% (OR: 2.15, 95% CI: 1.04-4.47, p = 0.04) were independent predictors of 30-day stroke, whereas diabetes (sub-distribution hazard ratio [SHR]: 2.07, 95% CI: 1.25-3.42, p = 0.004), pre-existing neurological dysfunction (SHR: 3.92, 95% CI: 1.54-10, p = 0.004), bicuspid valve (SHR: 4.75, 95% CI: 1.44-15.7, p = 0.011), and critical status (SHR: 3.05, 95% CI: 1.21-7.72, p = 0.018) were predictive of 6-month stroke. Conversely, antiplatelet therapy and anticoagulation were protective factors at both 30 days and 6 months. CONCLUSIONS Stroke after TAVR was rare. Predilatation was the only procedural factor predictive of 30-day stroke, whereas the remaining were patient-related risk factors, suggesting appropriate risk stratification preoperatively.
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Affiliation(s)
- Riccardo Gorla
- Department of Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Lorenzo Tua
- Department of Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Cardiology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Paola D'Errigo
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Fausto Biancari
- Department of Medicine, South Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gabriella Badoni
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Marco Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco Bedogni
- Department of Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - Stefano Rosato
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
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Monizzi G, Olivares P, Makmur G, Fabbiocchi F, Grancini L, Mastrangelo A, Ferrari C, Galli S, Montorsi P, Bartorelli AL. Conduction disorders after transcatheter aortic valve implantation: A comparison between SAPIEN 3 and SAPIEN 3 Ultra balloon-expandable valves. Front Cardiovasc Med 2022; 9:922696. [DOI: 10.3389/fcvm.2022.922696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
BackgroundConduction disorders (CD) are the most common complications after Transcatheter Aortic Valve Implantation (TAVI). The last generation of Edwards balloon expandable valves, the SAPIEN 3 Ultra (S3U), is provided with an external sealing skirt that aims to further reduce paravalvular leakage (PVL) compared to SAPIEN 3 (S3) and could potentially lead to higher CD rate. We sought to investigate the rate of new-onset CD in patients undergoing TAVI with the S3 or S3U valve.MethodsWe included 582 consecutive patients undergoing TAVI in a single high-volume Center. Patients with previously implanted pacemaker and Valve in valve procedures were excluded. CD rate was evaluated early after implantation and at discharge.ResultsNo significant difference in the overall CD rate was found between S3 and S3U patients both immediately after the procedure (S3 45.5% vs. S3U 41.8%, p = 0.575) and at discharge (S3 30.4% vs. S3U 35.6%, p = 0.348) with low rate of permanent pacemaker implantation (S3 6.3% vs. S3U 5.5%, p = 0.749). No significant differences were found also in patients with pre-existing atrial fibrillation (S3 8.2% vs. S3U 5%, p = 0.648). A significantly lower rate of PVL was found with S3U compared to S3 (S3 42% vs. S3U 26%, p = 0.007). According to the manufacturer’s guidelines we confirmed that S3U were implanted in a significantly higher position compared to S3 (S3 4.89 ± 1.57 mm vs. S3U 4.47 ± 1.36 mm, p = 0.001).ConclusionNo significant difference in the rate of CD, including the need for PPM implantation, was found in patients undergoing TAVI with the S3 compared to S3U. Moreover, S3U significantly reduced the PVL rate.
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Peverill W, Chu MWA, Diamantouros P, Bagur R. Transcatheter Balloon-Expandable Valve-in-Valve to Treat Severe Paravalvular Leak Secondary to ACURATE- neo Self-expanding Prosthesis-Annulus Mismatch. CJC Open 2021; 3:1320-1322. [PMID: 34888515 PMCID: PMC8636236 DOI: 10.1016/j.cjco.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/10/2021] [Indexed: 10/28/2022] Open
Abstract
A 75-year-old male with severe symptomatic aortic stenosis underwent transcatheter aortic valve implantation with a Large (27-mm) ACURATE-neo transcatheter aortic valve, complicated by severe paravalvular leak. He developed rapid and progressive worsening heart failure. Reanalysis of the computed tomography images suggested evidence of prosthesis-annulus mismatch. Therefore, a redo transcatheter aortic valve implantation utilizing a 29-mm SAPIEN 3 transcatheter aortic valve was performed. This case illustrates the importance of proper valve sizing to avoid paravalvular leak, and how to safely cross an ACURATE-neo valve to avoid catheter entangling.
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Affiliation(s)
- William Peverill
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Michael W A Chu
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Pantelis Diamantouros
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
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Lorenzoni V, Barbieri G, Saia F, Meucci F, Martinelli GL, Cerillo AG, Berti S, Candolfi P, Turchetti G. The cost-effectiveness of transcatheter aortic valve implantation: exploring the Italian National Health System perspective and different patient risk groups. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1349-1363. [PMID: 34019220 PMCID: PMC8558181 DOI: 10.1007/s10198-021-01314-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 04/28/2021] [Indexed: 05/09/2023]
Abstract
OBJECTIVES To assess the cost-effectiveness (CE) of transcatheter aortic valve implantation (TAVI) in Italy, considering patient groups with different surgical risk. METHODS A Markov model with a 1-month cycle length, comprising eight different health states, defined by the New York Heart Association functional classes (NYHA I-IV), with and without stroke plus death, was used to estimate the CE of TAVI for intermediate-, high-risk and inoperable patients considering surgical aortic valve replacement or medical treatment as comparators according to the patient group. The Italian National Health System perspective and 15-year time horizon were considered. In the base-case analysis, effectiveness data were retrieved from published efficacy data and total direct costs (euros) were estimated from national tariffs. A scenario analysis considering a micro-costing approach to estimate procedural costs was also considered. The incremental cost-effectiveness ratio (ICER) was expressed both in terms of costs per life years gained (LYG) and costs per quality adjusted life years (QALY). All outcomes and costs were discounted at 3% per annum. Univariate and probabilistic sensitivity analyses (PSA) were performed to assess robustness of results. RESULTS Over a 15-year time horizon, the higher acquisition costs for TAVI were partially offset in all risk groups because of its effectiveness and safety profile. ICERs were €8338/QALY, €11,209/QALY and €10,133/QALY, respectively, for intermediate-, high-risk and inoperable patients. ICER values were slightly higher in the scenario analysis. PSA suggested consistency of results. CONCLUSIONS TAVI would be considered cost-effective at frequently cited willingness-to-pay thresholds; further studies could clarify the CE of TAVI in real-life scenarios.
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Affiliation(s)
- V Lorenzoni
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - G Barbieri
- Edwards Lifesciences Italia S.p.A, Milan, Italy
| | - F Saia
- Cardio-Thoracic-Vascular Department, RCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - F Meucci
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - G L Martinelli
- Department of Cardiac Surgery, IRCCS MultiMedica Sesto San Giovanni, Milano, Italy
| | - A G Cerillo
- Division of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | - S Berti
- Fondazione C.N.R Regione Toscana G. Monasterio, Massa, Italy
| | - P Candolfi
- Edwards Lifesciences S.A., Nyon, Switzerland
| | - G Turchetti
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
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Medranda GA, Rogers T. Risk and Mitigation of Coronary Obstruction in Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2021; 10:481-490. [PMID: 34593111 DOI: 10.1016/j.iccl.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Acute coronary artery occlusion is a rare but devastating complication of transcatheter aortic valve replacement. Coronary obstruction is angiographic evidence of a new-partial or complete-obstruction of a coronary artery. Key factors identifying patients at risk are aortic root anatomy, type of aortic valve, and type of transcatheter heart valve. Techniques to prevent coronary obstruction include intentional leaflet laceration. If acute coronary obstruction does occur, bailout stenting can be challenging and conversion to emergent open heart surgery may be required, both of which are associated with high morbidity and mortality.
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Affiliation(s)
- Giorgio A Medranda
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B1, Washington, DC 20010, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B1, Washington, DC 20010, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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Bui HT, Khair N, Yeats B, Gooden S, James SP, Dasi LP. Transcatheter Heart Valves: A Biomaterials Perspective. Adv Healthc Mater 2021; 10:e2100115. [PMID: 34038627 DOI: 10.1002/adhm.202100115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/23/2021] [Indexed: 11/11/2022]
Abstract
Heart valve disease is prevalent throughout the world, and the number of heart valve replacements is expected to increase rapidly in the coming years. Transcatheter heart valve replacement (THVR) provides a safe and minimally invasive means for heart valve replacement in high-risk patients. The latest clinical data demonstrates that THVR is a practical solution for low-risk patients. Despite these promising results, there is no long-term (>20 years) durability data on transcatheter heart valves (THVs), raising concerns about material degeneration and long-term performance. This review presents a detailed account of the materials development for THVRs. It provides a brief overview of THVR, the native valve properties, the criteria for an ideal THV, and how these devices are tested. A comprehensive review of materials and their applications in THVR, including how these materials are fabricated, prepared, and assembled into THVs is presented, followed by a discussion of current and future THVR biomaterial trends. The field of THVR is proliferating, and this review serves as a guide for understanding the development of THVs from a materials science and engineering perspective.
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Affiliation(s)
- Hieu T. Bui
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Nipa Khair
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Breandan Yeats
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Shelley Gooden
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Susan P. James
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
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Five-Year Survival of Transcatheter Aortic Valve Implantation in High-Risk Patients. Heart Lung Circ 2021; 30:1901-1909. [PMID: 34217583 DOI: 10.1016/j.hlc.2021.05.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/11/2021] [Accepted: 05/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although transcatheter aortic valve implantation (TAVI) has become the standard treatment for severe aortic stenosis in high-risk patients in Australia, there is still limited data on long term survival. METHODS All patients undergoing TAVI at a single tertiary institution between September 2009 and December 2015 were included. The primary outcome was survival, by linkage of patients with the National Death Index of the Australian Institute of Health and Welfare. Post-procedure data and echocardiographic measurements were retrospectively analysed for all patients. RESULTS A total of 186 patients were included. It was a high-risk patient population (mean EuroSCORE 31.5±20.5, mean age 83.0±8.2 years). Valve prostheses used were Edwards SAPIEN (ES) (Edwards, Irvine, CA, USA) in 16.1%, Edwards SAPIEN XT (ESXT) in 74.2%, and Medtronic CoreValve (MCV) (Medtronic, Minneapolis, MN, USA) in 9.7%. Median survival time for the entire cohort was 68.2 months (95% Confidence Interval [CI]; Lower Limit [LL] 58.0 months, Upper Limit [UL] not defined). The 2- and 5-year estimates of survival were 85% (LL 80%, UL 90%) and 56% (LL 48%, UL 66%), respectively. There was no statistically significant difference in median survival between the ES and ESXT valves, or implantation approach. Survival was greater in patients with creatinine <200 μmol/L compared to >200 μmol/L (68.8 months [LL 61.4, UL n/a] vs 48.0 months [LL 25.5, UL n/a]). Over the study period, there was a statistically significant trend in increasing mean transvalvular gradient (ES: 1.66 mmHg/yr, p=0.0058; ESXT: 2.50 mmHg/yr, p≤0.001) and maximum velocity (ESXT: 0.16 m/s/yr, p=0.004) and decreasing valve area (ESXT: -0.07 cm2/yr, p<0.001). There was substantial attrition of patient echocardiographic follow-up (number of echocardiograms followed up at 5 years=6, number at risk=41). CONCLUSIONS This study has demonstrated acceptable survival in a high-risk cohort of patients undergoing TAVI, with comparable results to larger international experiences. There was a trend for worsening haemodynamics that needs to be monitored. Future studies need to examine patient quality of life and the performance of newer generation prostheses.
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Lou Y, Gao Y, Yu Y, Li Y, Xi Z, Swe KNC, Zhou Y, Nie X, Liu W. Efficacy and Safety of Transcatheter vs. Surgical Aortic Valve Replacement in Low-to-Intermediate-Risk Patients: A Meta-Analysis. Front Cardiovasc Med 2020; 7:590975. [PMID: 33304932 PMCID: PMC7701058 DOI: 10.3389/fcvm.2020.590975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/12/2020] [Indexed: 01/07/2023] Open
Abstract
Background: The efficacy and safety of transcatheter aortic-valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR) for low- to intermediate-surgical risk patients remains uninvestigated. Objectives: We aimed to investigate the efficacy and safety of transcatheter aortic-valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR) for low-intermediate surgical risk patients. Methods: PubMed, Cochrane Library, and Embase databases were searched to identify potential references. Only randomized controlled trials (RCTs) or observational studies using propensity score matching were eligible for screening. The primary endpoint was all-cause death. The secondary outcomes were bleeding, stroke, myocardial infarction (MI), and other complications of aortic-valve replacement. In addition, we performed subgroup analysis based on surgical risk and study type. Results: Eight RCTs and 13 observational studies covering 12,467 patients were included in the current meta-analysis. For patients with low-surgical risk, compared with SAVR, TAVR was found to be associated with a lower mortality at a follow-up period of 1 year (odds ratio, OR: 0.66, 95% CI: [0.46, 0.96], P = 0.03). This benefit disappeared when the follow-up was extended to 2 years (OR: 0.89, 95% CI: [0.61, 1.30], P = 0.56). For patients with intermediate-surgical risk, TAVR showed to have similar mortality with SAVR regardless of follow-up period (30-day, 1-year, or 2-year). TAVR could reduce the incidence of bleeding, AF, and AKI. For complications, such as MI and stroke, TAVR exhibited to have similar safety with SAVR. However, TAVR was found to be associated with a higher incidence of reintervention, major vascular complication, paravalvular leak, and PPI. Conclusion: For patients with a low-to-intermediate surgical risk, TAVR has at least an equivalent clinical effect to SAVR for 2 years after the procedure.
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Affiliation(s)
- Yake Lou
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yanan Gao
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ying Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanli Li
- Department of Geriatrics, The Affiliated People's Hospital of Inner Mongolia Medical University, Huhhot, China
| | - Ziwei Xi
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Yujie Zhou
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaomin Nie
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Liu
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Deharo P, Bisson A, Herbert J, Lacour T, Saint Etienne C, Grammatico-Guillon L, Porto A, Collart F, Bourguignon T, Cuisset T, Fauchier L. Impact of Sapien 3 Balloon-Expandable Versus Evolut R Self-Expandable Transcatheter Aortic Valve Implantation in Patients With Aortic Stenosis. Circulation 2020; 141:260-268. [DOI: 10.1161/circulationaha.119.043971] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background:
Two competing transcatheter aortic valve replacement (TAVR) technologies are currently available. Head-to-head comparisons of the relative performances of these 2 devices have been published. However, long-term clinical outcome evaluation remains limited by the number of patients analyzed, in particular, for recent-generation devices.
Methods:
Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients treated with a TAVR device commercialized in France between 2014 and 2018. Propensity score matching was used for the analysis of outcomes during follow-up. The objective of this study was to analyze the outcomes of TAVR according to Sapien 3 balloon-expandable (BE) versus Evolut R self-expanding TAVR technology at a nationwide level in France.
Results:
A total of 31 113 patients treated with either Sapien 3 BE or Evolut R self-expanding TAVR were found in the database. After matching on baseline characteristics, 20 918 patients were analyzed (10 459 in each group with BE or self-expanding valves). During follow-up (mean [SD], 358 [384]; median [interquartile range], 232 [10–599] days), BE TAVR was associated with a lower yearly incidence of all-cause death (relative risk, 0.88; corrected
P
=0.005), cardiovascular death (relative risk, 0.82; corrected
P
=0.002), and rehospitalization for heart failure (relative risk, 0.84; corrected
P
<0.0001). BE TAVR was also associated with lower rates of pacemaker implantation after the procedure (relative risk, 0.72; corrected
P
<0.0001).
Conclusions:
On the basis of the largest cohort available, we observed that Sapien 3 BE valves were associated with lower rates of all-cause death, cardiovascular death, rehospitalization for heart failure, and pacemaker implantation after a TAVR procedure.
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Affiliation(s)
- Pierre Deharo
- Département de Cardiologie (P.D., T.C.), CHU Timone, Marseille, France
- INSERM, INRA (P.D., F.C., T.C.), Aix Marseille Université, France
- Faculté de Médecine (P.D., F.C., T.C.), Aix Marseille Université, France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine (A.B., J.H., T.L., C.S.E., L.F.), France
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine (A.B., J.H., T.L., C.S.E., L.F.), France
- Service d’information médicale, d’épidémiologie et d’économie de la santé, Unité d’épidémiologie hospitalière régionale (J.H., T.L., L.G.-G.), France
| | - Thibaud Lacour
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine (A.B., J.H., T.L., C.S.E., L.F.), France
- Service d’information médicale, d’épidémiologie et d’économie de la santé, Unité d’épidémiologie hospitalière régionale (J.H., T.L., L.G.-G.), France
| | - Christophe Saint Etienne
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine (A.B., J.H., T.L., C.S.E., L.F.), France
| | - Leslie Grammatico-Guillon
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine (A.B., J.H., T.L., C.S.E., L.F.), France
| | | | - Frederic Collart
- Département de Chirurgie Cardiaque (F.C.), CHU Timone, Marseille, France
- INSERM, INRA (P.D., F.C., T.C.), Aix Marseille Université, France
- Faculté de Médecine (P.D., F.C., T.C.), Aix Marseille Université, France
| | | | - Thomas Cuisset
- Département de Cardiologie (P.D., T.C.), CHU Timone, Marseille, France
- INSERM, INRA (P.D., F.C., T.C.), Aix Marseille Université, France
- Faculté de Médecine (P.D., F.C., T.C.), Aix Marseille Université, France
| | - Laurent Fauchier
- Service d’information médicale, d’épidémiologie et d’économie de la santé, Unité d’épidémiologie hospitalière régionale (J.H., T.L., L.G.-G.), France
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13
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van Baal JWPM, Roszek B, van Elk M, Geertsma RE. Transcatheter aortic valve replacement: clinical safety and performance data. Expert Rev Med Devices 2019; 16:899-911. [PMID: 31564181 DOI: 10.1080/17434440.2019.1674138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Patients with severe aortic stenosis and regurgitation who are inoperable or at high-risk for surgery can be treated with transcatheter aortic valve replacement (TAVR). The aim of this study was to provide a comprehensive overview of the literature of TAVR and reported clinical and performance outcomes. Areas covered: A total of 16 devices, described in 204 articles describing clinical and performance outcomes, were included. The most frequently observed outcome was 30-day mortality, ranging between 0-23%. Other commonly reported clinical outcomes were 30-day stroke, ranging between 0-14.3% and pacemaker implantation, ranging from 0-44.9%. The most common valve performance outcome was aortic valve regurgitation, however, mostly reported at 7 days follow-up. Next to a follow-up period of 30 days, numerous articles reported outcomes at 6 months and 1 year. The numbers of articles describing outcomes with a longer follow-up as well as including intermediate and low-risk patients were limited. Expert commentary: This literature review provided a clear overview of the reported clinical and performance outcomes of TAVR devices. Despite the frequently used VARC-2 definitions, we identified a huge variation across studies. Future studies using standardized definitions of study set-ups and outcomes are essential and might lead to better insights of TAVR.
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Affiliation(s)
- Jantine W P M van Baal
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM) , Bilthoven , the Netherlands
| | - Boris Roszek
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM) , Bilthoven , the Netherlands
| | - Merel van Elk
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM) , Bilthoven , the Netherlands
| | - Robert E Geertsma
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM) , Bilthoven , the Netherlands
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14
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Parma R, Hudziak D, Smolka G, Gocoł R, Ochała A, Wojakowski W. SAPIEN 3 Ultra - Design and procedural features of a new balloon-expandable valve. Cardiol J 2019; 27:194-196. [PMID: 31565790 DOI: 10.5603/cj.a2019.0096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/24/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Radosław Parma
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland, Poland
| | - Damian Hudziak
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland, Ziolowa 45, 40-635 Katowice, Poland
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland, Poland
| | - Radosław Gocoł
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland, Ziolowa 45, 40-635 Katowice, Poland
| | - Andrzej Ochała
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland, Poland.
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