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Benjamin MM, Rabbat MG. Artificial Intelligence in Transcatheter Aortic Valve Replacement: Its Current Role and Ongoing Challenges. Diagnostics (Basel) 2024; 14:261. [PMID: 38337777 PMCID: PMC10855497 DOI: 10.3390/diagnostics14030261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a viable alternative to surgical aortic valve replacement, as accumulating clinical evidence has demonstrated its safety and efficacy. TAVR indications have expanded beyond high-risk or inoperable patients to include intermediate and low-risk patients with severe aortic stenosis. Artificial intelligence (AI) is revolutionizing the field of cardiology, aiding in the interpretation of medical imaging and developing risk models for at-risk individuals and those with cardiac disease. This article explores the growing role of AI in TAVR procedures and assesses its potential impact, with particular focus on its ability to improve patient selection, procedural planning, post-implantation monitoring and contribute to optimized patient outcomes. In addition, current challenges and future directions in AI implementation are highlighted.
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Affiliation(s)
- Mina M. Benjamin
- Division of Cardiovascular Medicine, SSM—Saint Louis University Hospital, Saint Louis University, Saint Louis, MO 63104, USA
| | - Mark G. Rabbat
- Department of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL 60153, USA;
- Department of Cardiology, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA
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2
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Howard T, Prasada S, Cremer P, Jaber W, Harb S. Apical defect following Tendyne valve placement. J Nucl Cardiol 2022; 29:2045-2047. [PMID: 33211303 DOI: 10.1007/s12350-020-02440-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Travis Howard
- Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, OH, USA.
| | - Sameer Prasada
- Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, OH, USA
| | - Paul Cremer
- Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, OH, USA
| | - Wael Jaber
- Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, OH, USA
| | - Serge Harb
- Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, OH, USA
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3
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Transcatheter Mitral Valve Replacement in High-Surgical Risk Patients: A Single-Center Experience and Outcome. J Interv Cardiol 2022; 2022:6587036. [PMID: 35847236 PMCID: PMC9242753 DOI: 10.1155/2022/6587036] [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: 08/01/2021] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022] Open
Abstract
Background Re-operative mitral valve (MV) replacement is a high-risk procedure, therefore, transcatheter MV replacement (TMVR) is a promising therapeutic option. Aim In this study, we aimed to evaluate the feasibility and safety of TMVR in patients with high surgical risk with degenerated mitral bioprostheses (TMViV), failed surgical rings (TMViR), and mitral annular calcification (TMViMAC). Methods This is a retrospective cohort study that enrolled patients with high surgical risk who underwent TMVR from February 2017 to September 2020. The TMVR procedure was performed using Edwards SAPIEN-3 valves through the transseptal approach. Results Sixty-four patients aged 62.7 ± 16.1 years with an STS score of 9.2 ± 3.7% underwent TMVR [35 (55%) TMViV, 16 (25%) TMViR, and 13 (20%) TMViMAC]. Mitral stenosis was more frequent in TMViV, mitral regurgitation was more frequent in TMViR, and combined mitral stenosis and regurgitation were more frequent in TMViMAC (P < 0.05). The MV gradient was 14.3 ± 5.3 mmHg and the MV area was 1.5±0.6 cm2. The 29 mm valve was frequently used in TMViV and TMViMAC, while the 23 mm valve was frequently used in TMViR (P=0.003∗). The procedural and fluoroscopy times were 58.7 ± 8.9 and 41.1 ± 8.2 minutes, respectively. Technical success was reported in 62 (98.4%) patients; 1 TMViR patient experienced valve embolization and salvage surgery, and 1 TMViMAC patient experienced slight valve malposition. At 3 months, 2 (3.1%) patients showed valve thrombosis (treated with anticoagulation), and 1 (1.6%) patient developed a paravalvular leak (underwent surgical MV replacement). At 6 months, 3 (4.7%) patients showed valve degeneration (underwent surgical MV replacement). Throughout follow-up, no patient exhibited mortality. Conclusions TMVR is a feasible and safe approach in patients with high surgical risk. TMViV and TMViR are reasonable as the first treatment approaches, and TMViMAC seems encouraging.
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4
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Overhoff D, Ansari U, Hohneck A, Tülümen E, Rudic B, Kuschyk J, Lossnitzer D, Baumann S, Froelich MF, Waldeck S, Akin I, Borggrefe M, Schoenberg SO, Papavassiliu T. Prediction of cardiac events with non-contrast magnetic resonance feature tracking in patients with ischaemic cardiomyopathy. ESC Heart Fail 2021; 9:574-584. [PMID: 34818694 PMCID: PMC8788051 DOI: 10.1002/ehf2.13712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/24/2021] [Accepted: 10/31/2021] [Indexed: 11/23/2022] Open
Abstract
Aims The aim of this study was to evaluate the prognostic value of feature tracking (FT) derived cardiac magnetic resonance (CMR) strain parameters of the left ventricle (LV)/right ventricle (RV) in ischaemic cardiomyopathy (ICM) patients treated with an implantable cardioverter‐defibrillator (ICD). Current guidelines suggest a LV‐ejection fraction ≤35% as major criterion for ICD implantation in ICM, but this is a poor predictor for arrhythmic events. Supplementary parameters are missing. Methods and results Ischaemic cardiomyopathy patients (n = 242), who underwent CMR imaging prior to primary and secondary implantation of ICD, were classified depending on EF ≤ 35% (n = 188) or >35% (n = 54). FT parameters were derived from steady‐state free precession cine views using dedicated software. The primary endpoint was a composite of cardiovascular mortality (CVM) and/or appropriate ICD therapy. There were no significant differences in FT‐function or LV‐/RV‐function parameters in patients with an EF ≤ 35% correlating to the primary endpoint. In patients with EF > 35%, standard CMR functional parameters, such as LV‐EF, did not reveal significant differences. However, significant differences in most FT parameters correlating to the primary endpoint were observed in this subgroup. LV‐GLS (left ventricular‐global longitudinal strain) and RV‐GRS (right ventricular‐global radial strain) revealed the best diagnostic performance in ROC curve analysis. The combination of LV‐GLS and RV‐GRS showed a sensitivity of 85% and a specificity of 76% for the prediction of future events. Conclusions The impact of FT derived measurements in the risk stratification of patients with ICM depends on LV function. The combination of LV‐GLS/RV‐GRS seems to be a predictor of cardiovascular mortality and/or appropriate ICD therapy in patients with EF > 35%.
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Affiliation(s)
- Daniel Overhoff
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.,Department of Radiology and Neuroradiology, German Federal Armed Forces Central Hospital, Koblenz, Germany
| | - Uzair Ansari
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Anna Hohneck
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Erol Tülümen
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany
| | - Boris Rudic
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany
| | - Jürgen Kuschyk
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany
| | - Dirk Lossnitzer
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Stefan Baumann
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Stephan Waldeck
- Department of Radiology and Neuroradiology, German Federal Armed Forces Central Hospital, Koblenz, Germany
| | - Ibrahim Akin
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Stefan O Schoenberg
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Theano Papavassiliu
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
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5
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Joseph KM, Nyman C. Mitral Valve Annuloplasty Failure and Percutaneous Treatment Options. Curr Cardiol Rep 2021; 23:140. [PMID: 34410525 DOI: 10.1007/s11886-021-01574-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Mitral valve repair is a common surgical procedure for both primary and secondary mitral regurgitation. With operations performed earlier in disease progression and increased patient longevity, the need for a repeat intervention is not infrequent. With the associated risks of reoperation and patient comorbidities, percutaneous techniques for acute or delayed failure after ring annuloplasty are emerging. RECENT FINDINGS Current commercially available devices, used in "off-label" ways, such as the MitraClip, may be effective in repairing recurrent mitral regurgitation after annuloplasty. Similarly, a valve-in-ring transcatheter mitral valve replacement can be considered in patients at high risk for surgical reoperation. These procedures are not without risk, for example, resultant mitral stenosis in the setting of edge-to-edge repair or left ventricular outflow tract (LVOT) obstruction with valve-in-ring transcatheter mitral valve replacement. Newer devices are emerging to permit more options for this subset of patients, which include transcatheter valves that are specifically designed for the mitral position. Undoubtedly, surgical reoperation has increased risk as compared to primary operation. Though percutaneous options are evolving, use in this patient population is currently limited to "off-label" use and is also associated with procedural complexities and risk. It is prudent for cardiologists, surgeons, and anesthesiologists to weigh risks, benefits, and limitations when considering patients for surgical reoperation, percutaneous repair, or transcatheter replacement after failed mitral annuloplasty.
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Affiliation(s)
- Kara M Joseph
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Charles Nyman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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6
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Jin XY, Petrou M, Hu JT, Nicol ED, Pepper JR. Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic valve replacement. Front Med 2021; 15:416-437. [PMID: 34047933 DOI: 10.1007/s11684-021-0852-7] [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: 10/17/2020] [Accepted: 02/20/2021] [Indexed: 11/26/2022]
Abstract
Over the last half century, surgical aortic valve replacement (SAVR) has evolved to offer a durable and efficient valve haemodynamically, with low procedural complications that allows favourable remodelling of left ventricular (LV) structure and function. The latter has become more challenging among elderly patients, particularly following trans-catheter aortic valve implantation (TAVI). Precise understanding of myocardial adaptation to pressure and volume overloading and its responses to valve surgery requires comprehensive assessments from aortic valve energy loss, valvular-vascular impedance to myocardial activation, force-velocity relationship, and myocardial strain. LV hypertrophy and myocardial fibrosis remains as the structural and morphological focus in this endeavour. Early intervention in asymptomatic aortic stenosis or regurgitation along with individualised management of hypertension and atrial fibrillation is likely to improve patient outcome. Physiological pacing via the His-Purkinje system for conduction abnormalities, further reduction in para-valvular aortic regurgitation along with therapy of angiotensin receptor blockade will improve patient outcome by facilitating hypertrophy regression, LV coordinate contraction, and global vascular function. TAVI leaflet thromboses require anticoagulation while impaired access to coronary ostia risks future TAVI-in-TAVI or coronary interventions. Until comparable long-term durability and the resolution of TAVI related complications become available, SAVR remains the first choice for lower risk younger patients.
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Affiliation(s)
- Xu Yu Jin
- Surgical Echo-Cardiology Services, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK.
- Cardiac Surgical Physiology and Genomics Group, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK.
| | - Mario Petrou
- Department of Cardiac Surgery, Royal Brompton Hospital, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Jiang Ting Hu
- Cardiac Surgical Physiology and Genomics Group, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Ed D Nicol
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
- Department of Cardiology, Royal Brompton Hospital, London, SW3 6NP, UK
| | - John R Pepper
- Department of Cardiac Surgery, Royal Brompton Hospital, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
- NIHR Imperial Biomedical Research Centre, London, W2 1NY, UK
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7
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Shariya MA, Ustyuzhanin DV, Lepilin PM, Imaev TE, Komlev AE, Belyaevskaya AA, Ternovoy SK. [Role of magnetic resonance imaging in patients with aortic stenosis before and after replacement of the valve]. TERAPEVT ARKH 2020; 92:70-76. [PMID: 33346434 DOI: 10.26442/00403660.2020.09.000657] [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: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022]
Abstract
Risk stratification among patients with aortic stenosis remains inadequate, and there is a clinical need for the correct identification of high-risk patients who would benefit from aortic valve intervention before developing left ventricular decompensation. Since the publication of the results of the PARTNER study, transcatheter aortic valve implantation (TAVI) has become the method of choice for aortic valve stenosis in inoperable patients and is a real alternative to conventional surgical replacement of the aortic valve in high-risk patients. In planning TAVI and postoperative monitoring of a patient from imaging methods, the leading role is played by echocardiography and multispiral computed tomography. However, in recent years, the interest of researchers in the use of magnetic resonance imaging in this category of patients has increased. The review article examines the potential role of magnetic resonance imaging in patients with aortic stenosis before and after TAVI.
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Affiliation(s)
- M A Shariya
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
| | - D V Ustyuzhanin
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
| | - P M Lepilin
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
| | - T E Imaev
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
| | - A E Komlev
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
| | - A A Belyaevskaya
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
| | - S K Ternovoy
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology.,Sechenov First Moscow State Medical University (Sechenov University)
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8
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Simonetto F, Purita PAM, Malerba M, Barbierato M, Pascotto A, Mangino D, Zanchettin C, Tarantini G, Gerosa G, D'Onofrio A, Cernetti C, Favero L, Daniotti A, Minniti G, Caprioglio F, Erente G, Hinna Danesi T, Frigo AC, Ronco F. Surgical redo versus transseptal or transapical transcatheter mitral valve‐in‐valve implantation for failed mitral valve bioprosthesis. Catheter Cardiovasc Interv 2020; 97:714-722. [DOI: 10.1002/ccd.29324] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/31/2020] [Accepted: 09/28/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Federico Simonetto
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science Ospedale dell'Angelo Venice Italy
| | - Paola A. M. Purita
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science Ospedale dell'Angelo Venice Italy
- Cardiology Division Ospedale Civile di Mirano Mirano Italy
| | | | - Marco Barbierato
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science Ospedale dell'Angelo Venice Italy
| | - Andrea Pascotto
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science Ospedale dell'Angelo Venice Italy
| | - Domenico Mangino
- Cardiac Surgery, Department of Cardiothoracic and Vascular Science Ospedale dell'Angelo Venice Italy
| | - Chiara Zanchettin
- Cardiac Surgery, Department of Cardiothoracic and Vascular Science Ospedale dell'Angelo Venice Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health University of Padua Padua Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health University of Padua Padua Italy
| | - Augusto D'Onofrio
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health University of Padua Padua Italy
| | - Carlo Cernetti
- Department of Cardiology Ca' Foncello Hospital Treviso Italy
| | - Luca Favero
- Department of Cardiology Ca' Foncello Hospital Treviso Italy
| | | | | | | | | | | | - Anna Chiara Frigo
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health University of Padua Padua Italy
| | - Federico Ronco
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science Ospedale dell'Angelo Venice Italy
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Lu H, Muller O, Eeckhout E, Monney P, Roguelov C, Marcucci C, Meziani A, Kirsch M. TAVI : une revue de la littérature des voies alternatives à l’accès trans-fémoral. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.lpmfor.2020.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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10
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Overtchouk P, Piazza N, Granada JF, Modine T. Predictors of adverse outcomes after transcatheter mitral valve replacement. Expert Rev Cardiovasc Ther 2019; 17:625-632. [PMID: 31403364 DOI: 10.1080/14779072.2019.1653186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Transcatheter mitral valve replacement (TMVR) is still a recent technology with numerous unknowns but also great promises. The risk of complications reported in observational studies have limited its adoption by interventional cardiology and surgical communities. Areas covered: Some of the major setbacks of TMVR are complications related to the devices and those related to the pathway. Device-related complications include left ventricle outflow tract (LVOT) obstruction, transcatheter heart valve (THV) dislocation or embolization, thrombosis, and stroke. The transapical approach currently remains the main pathway for TMVR but is associated with high risk of major bleeding and residual apical myocardial scarring. Complication prediction and prevention seem possible. Device-related complication prediction is based on pre-operative imaging including multi-slice computed tomography with 3-dimensional reconstructions and echocardiography which allow LVOT obstruction prediction and appropriate sizing aiming at avoiding dislocation. Industry should aim at the development of transfemoral delivery systems. Nevertheless, several recent feasibility observational studies suggested acceptable safety and efficacy of transcatheter mitral valve replacement. Expert opinion: TMVR complications and transapical delivery are some of the main setbacks which need to be addressed for TMVR to be adopted for broad clinical use.
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Affiliation(s)
- Pavel Overtchouk
- Department of Cardiology, University Hospital of Bern , Bern , Switzerland.,Interventional cardiology, McGill University Health Centre , Montréal , Canada
| | - Nicolo Piazza
- Interventional cardiology, McGill University Health Centre , Montréal , Canada
| | - Juan F Granada
- Cardiovascular Research Foundation, Columbia University Medical Center, CRF Skirball Center for Innovation , New York , NY , USA
| | - Thomas Modine
- Cardiology and Cardiovascular Surgery Department, Heart Valve Center, Institut Cœur Poumon CHU de Lille , Lille , France.,Cardiovascular Surgery, Jioa Tong university , Shanghai , China
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11
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Modine T, Overtchouk P. Catheter-based innovations in mitral valve surgery. Eur J Cardiothorac Surg 2019; 56:429-432. [DOI: 10.1093/ejcts/ezz164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Thomas Modine
- Jioa Tong University, Shanghai, China
- Heart Valve Center, Institut Cœur-Poumon, Service de Chirurgie Cardiovasculaire, Hôpital Cardiologique, Centre Hospitalier et Universitaire de Lille, Lille, France
| | - Pavel Overtchouk
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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12
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Al-Hijji MA, Zack CJ, Nkomo VT, Pislaru SV, Pellikka PA, Reeder GS, Greason KL, Rihal CS, Eleid MF. Left ventricular remodeling and function after transapical versus transfemoral transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 94:738-744. [PMID: 30688003 DOI: 10.1002/ccd.28074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/02/2018] [Accepted: 12/26/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND The effect of utilizing transapical (TA) access for transcatheter aortic valve replacement (TAVR) on cardiac function has not been well studied. AIMS The aim of this retrospective study is to determine the direct effects of TA access for TAVR on myocardial function parameters and their correlation with 4-year survival. METHODS Three hundred and thirty propensity matched patients, who underwent TAVR using Sapien valve (Edwards Lifesciences Corp, Irvine, CA) between February 15, 2012 and June 17, 2016 (115 TA and 115 transfemoral [TF] routes) were studied. The pre- and 1 month post-TAVR echocardiographic features of both groups were compared. The 4-year survival in both groups was analyzed. RESULTS Baseline clinical characteristics, diastolic function parameters, left ventricular (LV) chamber size, and ejection fraction were similar between matched TA and TF groups. At 1 month following TAVR, there was a significant increase in stroke volume index (SVI) in both TA (mean increase 7 cm3 /m2 ; P = 0.03) and TF groups (mean increase 7 cm3 /m2 ; P < 0.001). Left ventricular ejection fraction (LVEF) significantly increased post TF TAVR (mean increase 2%; P = 0.008), but no significant increase was observed post TA TAVR (mean increase 1%; P = 0.27). Both groups had significant improvement in aortic valve (AV) hemodynamics post-TAVR (P < 0.001). Overall, there were no significant differences in the mean change of SVI, LVEF, or left ventricular end diastolic dimensions (LVEDDs) post TA versus TF TAVR. There was no significant difference in 4-year survival in the TF compared to TA group (49% vs 50%, P = 0.43). CONCLUSION Both TA and TF TAVR were equally associated with favorable changes in LV SVI and AV hemodynamics in 30 days. TA TAVR patients had similar 4 year survival to propensity matched TF TAVR; therefore, TA TAVR remains an acceptable alternative access route in patients not amenable to TF TAVR.
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Affiliation(s)
- Mohammed A Al-Hijji
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Chad J Zack
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Vuyisile T Nkomo
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Sorin V Pislaru
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Patricia A Pellikka
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Guy S Reeder
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Kevin L Greason
- Division of Cardiothoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Charanjit S Rihal
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Mackram F Eleid
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
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13
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Imnadze G, Hofmann S, Billion M, Ferdosi A, Kowalski M, Smith KH, Deutsch C, Bramlage P, Warnecke H, Franz N. Transapical transcatheter aortic valve implantation in patients with a low ejection fraction. Interact Cardiovasc Thorac Surg 2019; 26:224-229. [PMID: 29049741 DOI: 10.1093/icvts/ivx315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/21/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES It may be expected that patients with left ventricular dysfunction may be at greater risk of complications after transcatheter aortic valve implantation (TAVI) via transapical (TA) access compared with via transfemoral (TF) access. There is a lack of data comparing the outcomes of TAVI using TA and TF access in patients with a reduced left ventricular ejection fraction (EF). METHODS This is a retrospective analysis of data from a high-volume heart centre in Germany. TAVI access route assignment was based on a 'best for TF' approach, where only patients who met a strict set of criteria underwent TF-TAVI, with the remainder receiving TA-TAVI. For this analysis, patients were included if they had a pre-TAVI EF of ≤ 40%. Early mortality and late (1-year) mortality were compared through multivariate logistic regression. RESULTS A total of 342 patients in the registry had an EF of ≤ 40%, of which 74.9% underwent TA-TAVI and 25.1% underwent TF-TAVI. Higher proportions of the TA group presented with certain comorbidities, and their logistic EuroSCORE and Society of Thoracic Surgeons (STS) risk scores were higher than in the TF group. At 1 year, TA access was associated with greater mortality in the univariate analysis (odd ratio 2.43; 95% confidence interval 1.04-5.69). However, after multivariate adjustment, no significant differences were found in either 30-day or 1-year mortality rates. CONCLUSIONS The data suggest that, for patients with a reduced EF, TA-TAVI is not associated with a poorer outcome compared with TF-TAVI. Therefore, TA access should not be discounted based on the presence of left ventricular dysfunction alone.
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Affiliation(s)
- Guram Imnadze
- Institut für Gesundheitsforschung und Bildung, Universität Osnabrück, Osnabrück, Germany.,Department of Cardiology, Klinikum Osnabrück, Am Finkenhügel 1, Osnabrück, Germany
| | - Steffen Hofmann
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Michael Billion
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Abbas Ferdosi
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Marek Kowalski
- Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Katherine H Smith
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Henning Warnecke
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany.,Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Norbert Franz
- Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany.,University Witten-Herdecke, Witten, Germany
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14
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Deng MD, Wei X, Zhang XL, Li XD, Liu GY, Zhu D, Guo YQ, Tang H. Changes in left ventricular function in patients with aortic regurgitation 12 months after transapical transcatheter aortic valve implantation. Int J Cardiovasc Imaging 2018; 35:99-105. [PMID: 30264363 DOI: 10.1007/s10554-018-1445-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/17/2018] [Indexed: 02/05/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is an established treatment for high surgical risk aortic stenosis patients; in recent years, it has also been used in patients with pure/dominant aortic regurgitation (AR). This study aimed to determine the impact of transapical TAVI on left ventricle myocardial mechanics in AR patients. Thirty AR patients (70% men; mean age, 72.8 ± 4.3 years) were enrolled. Conventional echocardiography was performed on all patients before and 12 months after TAVI. Three-dimensional speckle tracking was accomplished in 20 AR patients for the evaluation of global longitudinal strain, global circumferential strain, twist, torsion, apical rotation and basal rotation. Preoperative left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), twist, torsion and apical rotation were impaired in AR patients compared with controls. Mean left ventricular (LV) end-diastolic diameter (from 62.9 ± 7.3 to 52.0 ± 6.8 mm, p < 0.001), LV end-diastolic volume (from 199.4 ± 55.0 to 130.1 ± 48.9 mL, p < 0.001), and LV mass index (179.8 ± 52.2-134.4 ± 42.5 g/m2, p = 0.001) decreased 12 months after TAVI. Interestingly, GLS (from - 17.2 ± 3.2 to - 18.9 ± 3.7, p = 0.007) and GCS (from - 23.9 ± 4.9 to - 25.7 ± 5.0, p = 0.008) improved significantly, but LVEF did not significantly improve. In terms of the rotational mechanics, twist, rotation and basal rotation remained almost unchanged, whereas apical rotation (from 7.4 ± 4.0 to 5.5 ± 3.9, p = 0.009) was significantly impaired after transapical TAVI. Our results indicate that LV function was improved in terms of myocardial deformation but worsened in terms of apical rotation 12 months after TAVI in AR patients. Three-dimensional speckle tracking echocardiography appears to be a sensitive method for detecting subtle cardiac remodeling after TAVI.
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Affiliation(s)
- Ming-Dan Deng
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao-Ling Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao-Dong Li
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Gu-Yue Liu
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Da Zhu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ying-Qiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Tang
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China.
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15
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Okada A, Kanzaki H, Amaki M, Kataoka Y, Miyamoto K, Hamatani Y, Fujino M, Takahama H, Hasegawa T, Shimahara Y, Morita Y, Sugano Y, Kusano K, Ohnishi Y, Fujita T, Kobayashi J, Anzai T, Yasuda S. Successful Treatment of Mitral Regurgitation after Transapical Transcatheter Aortic Valve Implantation by Percutaneous Edge-to-edge Mitral Valve Repair (MitraClip ®) -The First Combination Therapy Performed in Japan. Intern Med 2018; 57:1105-1109. [PMID: 29269670 PMCID: PMC5938500 DOI: 10.2169/internalmedicine.9663-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 75-year old man with a history of inferior myocardial infarction was admitted with symptoms of progressive heart failure 3 months after undergoing transapical transcatheter aortic valve implantation (TAVI). Echocardiography revealed severe mitral regurgitation (MR) caused by posterior leaflet tethering, without traumatic injury of the mitral valve or chordae. The patient was successfully treated by percutaneous edge-to-edge mitral valve repair (MitraClip®). This case highlights the role of MitraClip® in high-risk patients suffering from MR, and suggests that apical contractile loss or adhesion caused by apical puncture and suturing in transapical TAVI may be one of the mechanisms of worsening MR.
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Affiliation(s)
- Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Yasuhiro Hamatani
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Hiroyuki Takahama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Takuya Hasegawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Yusuke Shimahara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Japan
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center, Japan
| | - Yasuo Sugano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
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16
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Per-Ventricular Insertion of Melody Valve-in-Valve in the Neoaortic Position in a Single-Ventricle Patient. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:56-59. [DOI: 10.1097/imi.0000000000000458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Percutaneous therapies for congenital heart disease have been evolving rapidly despite limited investment from industry. The Melody transcatheter pulmonary valve (Medtronic, Inc, Minneapolis, MN USA) replacement therapy represents an important advancement in this arena. It has been approved in the United States for use in the pulmonary position, on a Humanitarian Device Exemption status. Off-label use of the Melody transcatheter pulmonary valve has extended to the mitral, pulmonary, and aortic valves, especially in previously implanted valves with prosthetic valve degeneration. The single-ventricle patient poses additional challenges. However, there exists one report in the English literature of a patient undergoing Melody transcatheter neoaortic valve replacement after the patient developed severe neoaortic regurgitation after Fontan palliation. Here, we describe a patient with hypoplastic left heart syndrome, palliated with a Norwood modified Blalock-Taussig shunt, with a progressively regurgitant quadricusp neoaortic valve who underwent bioprosthetic valve replacement. There was early prosthetic valve degeneration after a year of bioprosthesis implantation. As he was declined for transplantation, he underwent successful perventricular Melody valve-in-valve replacement.
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17
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Abstract
Transcatheter aortic valve implantation (TAVI) is currently performed through an alternative access in 15% of patients. The transapical access is progressively being abandoned as a result of its invasiveness and poor outcomes. Existing data does not allow TAVI operators to favour one access over another - between transcarotid, trans-subclavian and transaortic - because all have specific strengths and weaknesses. The percutaneous trans-subclavian access might become the main surgery-free alternative access, although further research is needed regarding its safety. Moreover, the difficult learning curve might compromise its adoption. The transcaval access is at an experimental stage and requires the development of dedicated cavo-aortic crossing techniques and closure devices.
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Affiliation(s)
- Pavel Overtchouk
- Centre Hospitalier Regional et Universitaire de Lille Lille, France
| | - Thomas Modine
- Centre Hospitalier Regional et Universitaire de Lille Lille, France
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18
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Clarke NS, El-Said H, Lamberti JJ, Murthy RA. Per-Ventricular Insertion of Melody Valve-in-Valve in the Neoaortic Position in a Single-Ventricle Patient. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nicholas S. Clarke
- Division of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Howaida El-Said
- The Division of Pediatric Cardiology, Rady Children's Hospital, University of California, San Diego, CA USA
| | - John J. Lamberti
- Division of Pediatric Cardiothoracic Surgery, Rady Children's Hospital, University of California, San Diego, CA USA
| | - Raghav A. Murthy
- Division of Pediatric Cardiothoracic Surgery, Rady Children's Hospital, University of California, San Diego, CA USA
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19
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Asthana N, Mantha A, Yang EH, Suh W, Aksoy O, Shemin RJ, Vorobiof G, Benharash P. Myocardial functional changes in transfemoral versus transapical aortic valve replacement. J Surg Res 2018; 221:304-310. [DOI: 10.1016/j.jss.2017.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 07/19/2017] [Accepted: 08/16/2017] [Indexed: 10/18/2022]
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20
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Kiser AC, Caranasos TG, Peterson MD, Holzhey DM, Kiefer P, Wiley Nifong L, Borger MA. Suprasternal Transcatheter Aortic Valve Replacement in Patients with Marginal Femoral Access. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andy C. Kiser
- East Carolina Heart Institute, East Carolina University, Greenville, NC USA
| | - Thomas G. Caranasos
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Mark D. Peterson
- St. Michael's Hospital, University of Toronto, Toronto, ON Canada
| | | | | | - L. Wiley Nifong
- East Carolina Heart Institute, East Carolina University, Greenville, NC USA
| | - Michael A. Borger
- Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University, New York, NY USA
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21
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Suprasternal Transcatheter Aortic Valve Replacement in Patients with Marginal Femoral Access. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:1-4. [DOI: 10.1097/imi.0000000000000462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective Recently, the PARTNER 2A trial reported results of transcatheter aortic valve replacement versus surgical aortic valve replacement in 2032 intermediate-risk patients at 2 years. Two hundred thirty-six patients (24%) required an access route other than transfemoral. Compared with transfemoral and surgical aortic valve replacement, nontransfemoral transcatheter aortic valve replacement was associated with a numerically higher rate of death and disabling stroke at 30 days. This underscores the need for a better alternative surgical approach for patients with marginal femoral access. We reviewed our multicenter experience with minimally invasive suprasternal transcatheter aortic valve replacement. Methods Consecutive patients with symptomatic severe aortic stenosis at high or intermediate risk for surgical aortic valve replacement underwent suprasternal transcatheter aortic valve replacement. A commercially available transcatheter heart valve was deployed under fluoroscopic guidance through the innominate artery or ascending aorta. Using a 3-cm skin incision just above the sternal notch, the Aegis Transit System (Aegis Surgical Ltd, Galway, Ireland) provided illuminated access to the mediastinum without bone disruption. Through a purse-string suture placed in the innominate artery or ascending aorta, transcatheter aortic valve replacement proceeded similarly to the direct aortic approach. Results Thirty patients at six medical centers successfully underwent suprasternal transcatheter aortic valve replacement. Implanted valves included 2 CoreValve and 12 Evolut-R (Medtronic, Inc, Minneapolis, MN USA), as well as 10 SAPIEN 3 and 6 SAPIEN XT (Edwards Lifesciences, Corp, Irvine, CA USA) with sizes ranging from 23 to 31 mm. Median procedure time was 90 minutes and median hospital stay was 4 days. Postoperatively, new permanent pacemaker (n = 3) was the most common Vascular Academic Research Consortium 2 complication. Conclusions These data demonstrate the early clinical feasibility of suprasternal transcatheter aortic valve replacement. Key advantages of this approach include direct access to the innominate artery and ascending aorta, precise sheath control, and confident arterial closure. Additional experience is warranted to confirm these favorable results.
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22
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Elmariah S, Fearon WF, Inglessis I, Vlahakes GJ, Lindman BR, Alu MC, Crowley A, Kodali S, Leon MB, Svensson L, Pibarot P, Hahn RT, Thourani VH, Palacios IF, Miller DC, Douglas PS, Passeri JJ. Transapical Transcatheter Aortic Valve Replacement Is Associated With Increased Cardiac Mortality in Patients With Left Ventricular Dysfunction. JACC Cardiovasc Interv 2017; 10:2414-2422. [DOI: 10.1016/j.jcin.2017.09.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/24/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
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23
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Al-Hawwas M, Marmagkiolis K, Mehta JL. The Impact of Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement on Left Ventricular Remodeling. Am J Cardiol 2017; 120:1198-1202. [PMID: 28823482 DOI: 10.1016/j.amjcard.2017.06.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/01/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) appears to be equivalent to surgical aortic valve replacement (SAVR) with regard to clinical end points in high-risk and intermediate risk patients. Major landmark trials, such as Placement of Aortic Transcatheter Valves (PARTNER) trials 1 and 2 and US CoreValve show similar hemodynamic responses and left ventricular remodeling after both procedures. Real-life nonrandomized studies, however, suggest that TAVI may result in a somewhat better hemodynamic response and, therefore, a more favorable left ventricular remodeling than after SAVR for the first few years of follow-up. Further, there are fewer cases of prosthesis patient mismatch and more cases of paravalvular leak and conduction system abnormalities that affect the left ventricular remodeling process with TAVI than with SAVR. Overall, TAVI may be considered superior to SAVR in high-risk patients whose clinical outcome depends on a favorable remodeling process.
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24
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Cardiovascular magnetic resonance feature tracking in small animals - a preliminary study on reproducibility and sample size calculation. BMC Med Imaging 2017; 17:51. [PMID: 28835220 PMCID: PMC5569535 DOI: 10.1186/s12880-017-0223-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 08/17/2017] [Indexed: 11/10/2022] Open
Abstract
Background Cardiovascular magnetic resonance feature tracking (CMR-FT) is a novel tissue tracking technique developed for noninvasive assessment of myocardial motion and deformation. This preliminary study aimed to evaluate the observer’s reproducibility of CMR-FT in a small animal (mouse) model and define sample size calculation for future trials. Methods Six C57BL/6 J mice were selected from the ongoing experimental mouse model onsite and underwent CMR with a 3 Tesla small animal MRI scanner. Myocardial deformation was analyzed using dedicated software (TomTec, Germany) by two observers. Left ventricular (LV) longitudinal, circumferential and radial strain (EllLAX, EccSAX and ErrSAX) were calculated. To assess intra-observer agreement data analysis was repeated after 4 weeks. The sample size required to detect a relative change in strain was calculated. Results In general, EccSAX and EllLAX demonstrated highest inter-observer reproducibility (ICC 0.79 (0.46–0.91) and 0.73 (0.56–0.83) EccSAX and EllLAX respectively). In contrast, at the intra-observer level EllLAX was more reproducible than EccSAX (ICC 0.83 (0.73–0.90) and 0.74 (0.49–0.87) EllLAX and EccSAX respectively). The reproducibility of ErrSAX was weak at both observer levels. Preliminary sample size calculation showed that a small study sample (e.g. ten animals to detect a relative 10% change in EccSAX) could be sufficient to detect changes if parameter variability is low. Conclusions This pilot study demonstrates good to excellent inter- and intra-observer reproducibility of CMR-FT technique in small animal model. The most reproducible measures are global circumferential and global longitudinal strain, whereas reproducibility of radial strain is weak. Furthermore, sample size calculation demonstrates that a small number of animals could be sufficient for future trials.
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25
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Podlesnikar T, Delgado V, Bax JJ. Cardiovascular magnetic resonance imaging to assess myocardial fibrosis in valvular heart disease. Int J Cardiovasc Imaging 2017. [PMID: 28642994 PMCID: PMC5797565 DOI: 10.1007/s10554-017-1195-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The left ventricular (LV) remodeling process associated with significant valvular heart disease (VHD) is characterized by an increase of myocardial interstitial space with deposition of collagen and loss of myofibers. These changes occur before LV systolic function deteriorates or the patient develops symptoms. Cardiovascular magnetic resonance (CMR) permits assessment of reactive fibrosis, with the use of T1 mapping techniques, and replacement fibrosis, with the use of late gadolinium contrast enhancement. In addition, functional consequences of these structural changes can be evaluated with myocardial tagging and feature tracking CMR, which assess the active deformation (strain) of the LV myocardium. Several studies have demonstrated that CMR techniques may be more sensitive than the conventional measures (LV ejection fraction or LV dimensions) to detect these structural and functional changes in patients with severe left-sided VHD and have shown that myocardial fibrosis may not be reversible after valve surgery. More important, the presence of myocardial fibrosis has been associated with lesser improvement in clinical symptoms and recovery of LV systolic function. Whether assessment of myocardial fibrosis may better select the patients with severe left-sided VHD who may benefit from surgery in terms of LV function and clinical symptoms improvement needs to be demonstrated in prospective studies. The present review article summarizes the current status of CMR techniques to assess myocardial fibrosis and appraises the current evidence on the use of these techniques for risk stratification of patients with severe aortic stenosis or regurgitation and mitral regurgitation.
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Affiliation(s)
- Tomaz Podlesnikar
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2 2333 ZA, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2 2333 ZA, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2 2333 ZA, Leiden, The Netherlands.
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26
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Dobson LE, Musa TA, Uddin A, Fairbairn TA, Bebb OJ, Swoboda PP, Haaf P, Foley J, Garg P, Fent GJ, Malkin CJ, Blackman DJ, Plein S, Greenwood JP. The impact of trans-catheter aortic valve replacement induced left-bundle branch block on cardiac reverse remodeling. J Cardiovasc Magn Reson 2017; 19:22. [PMID: 28222749 PMCID: PMC5320804 DOI: 10.1186/s12968-017-0335-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/02/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Left bundle branch block (LBBB) is common following trans-catheter aortic valve replacement (TAVR) and has been linked to increased mortality, although whether this is related to less favourable cardiac reverse remodeling is unclear. The aim of the study was to investigate the impact of TAVR induced LBBB on cardiac reverse remodeling. METHODS 48 patients undergoing TAVR for severe aortic stenosis were evaluated. 24 patients with new LBBB (LBBB-T) following TAVR were matched with 24 patients with a narrow post-procedure QRS (nQRS). Patients underwent cardiovascular magnetic resonance (CMR) prior to and 6 m post-TAVR. Measured cardiac reverse remodeling parameters included left ventricular (LV) size, ejection fraction (LVEF) and global longitudinal strain (GLS). Inter- and intra-ventricular dyssynchrony were determined using time to peak radial strain derived from CMR Feature Tracking. RESULTS In the LBBB-T group there was an increase in QRS duration from 96 ± 14 to 151 ± 12 ms (P < 0.001) leading to inter- and intra-ventricular dyssynchrony (inter: LBBB-T 130 ± 73 vs nQRS 23 ± 86 ms, p < 0.001; intra: LBBB-T 118 ± 103 vs. nQRS 13 ± 106 ms, p = 0.001). Change in indexed LV end-systolic volume (LVESVi), LVEF and GLS was significantly different between the two groups (LVESVi: nQRS -7.9 ± 14.0 vs. LBBB-T -0.6 ± 10.2 ml/m2, p = 0.02, LVEF: nQRS +4.6 ± 7.8 vs LBBB-T -2.1 ± 6.9%, p = 0.002; GLS: nQRS -2.1 ± 3.6 vs. LBBB-T +0.2 ± 3.2%, p = 0.024). There was a significant correlation between change in QRS and change in LVEF (r = -0.434, p = 0.002) and between change in QRS and change in GLS (r = 0.462, p = 0.001). Post-procedure QRS duration was an independent predictor of change in LVEF and GLS at 6 months. CONCLUSION TAVR-induced LBBB is associated with less favourable cardiac reverse remodeling at medium term follow up. In view of this, every effort should be made to prevent TAVR-induced LBBB, especially as TAVR is now being extended to a younger, lower risk population.
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Affiliation(s)
- Laura E. Dobson
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Tarique A. Musa
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Timothy A. Fairbairn
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Owen J. Bebb
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Peter P. Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Philip Haaf
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - James Foley
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Graham J. Fent
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | | | - Daniel J. Blackman
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
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27
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Claus P, Omar AMS, Pedrizzetti G, Sengupta PP, Nagel E. Tissue Tracking Technology for Assessing Cardiac Mechanics: Principles, Normal Values, and Clinical Applications. JACC Cardiovasc Imaging 2016; 8:1444-1460. [PMID: 26699113 DOI: 10.1016/j.jcmg.2015.11.001] [Citation(s) in RCA: 302] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/06/2015] [Indexed: 02/06/2023]
Abstract
Tissue tracking technologies such as speckle tracking echocardiography and feature tracking cardiac magnetic resonance have enhanced the noninvasive assessment of myocardial deformation in clinical research and clinical practice. The widespread enthusiasm for using tissue tracking techniques in research and clinical practice stems from the ready applicability of these technologies to routine echocardiographic or cardiac magnetic resonance images. The technology is common to both modalities, and derived parameters to describe myocardial mechanics are the similar, albeit with different accuracies. We provide an overview of the normal values and reproducibility of the clinically applicable parameters, together with their clinical validation. The use of these technologies in different clinical scenarios, and the additive value to current imaging diagnostics are discussed.
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Affiliation(s)
- Piet Claus
- Laboratory for Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Alaa Mabrouk Salem Omar
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Internal Medicine, Medical Division, National Research Centre, Dokki, Cairo, Egypt
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Partho P Sengupta
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eike Nagel
- Institute of Cardiovascular Imaging, Goethe University Frankfurt and German Centre for Cardiovascular Research ([DZHK], partner site Rhine-Main), Frankfurt, Germany.
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Musa TA, Plein S, Greenwood JP. The role of cardiovascular magnetic resonance in the assessment of severe aortic stenosis and in post-procedural evaluation following transcatheter aortic valve implantation and surgical aortic valve replacement. Quant Imaging Med Surg 2016; 6:259-73. [PMID: 27429910 PMCID: PMC4929281 DOI: 10.21037/qims.2016.06.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/02/2016] [Indexed: 01/20/2023]
Abstract
Degenerative aortic stenosis (AS) is the most common valvular disease in the western world with a prevalence expected to double within the next 50 years. International guidelines advocate the use of cardiovascular magnetic resonance (CMR) as an investigative tool, both to guide diagnosis and to direct optimal treatment. CMR is the reference standard for quantifying both left and right ventricular volumes and mass, which is essential to assess the impact of AS upon global cardiac function. Given the ability to image any structure in any plane, CMR offers many other diagnostic strengths including full visualisation of valvular morphology, direct planimetry of orifice area, the quantification of stenotic jets and in particular, accurate quantification of valvular regurgitation. In addition, CMR permits reliable and accurate measurements of the aortic root and arch which can be fundamental to appropriate patient management. There is a growing evidence base to indicate tissue characterisation using CMR provides prognostic information, both in asymptomatic AS patients and those undergoing intervention. Furthermore, a number of current clinical trials will likely raise the importance of CMR in routine patient management. This article will focus on the incremental value of CMR in the assessment of severe AS and the insights it offers following valve replacement.
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Affiliation(s)
- Tarique Al Musa
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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29
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Allahwala UK, Hansen PS, Danson EJ, Straiton N, Sinhal A, Walters DL, Bhindi R. Transcatheter aortic valve implantation: current trends and future directions. Future Cardiol 2015; 12:69-85. [PMID: 26696562 DOI: 10.2217/fca.15.73] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has been increasingly utilized for the treatment of severe symptomatic aortic stenosis in inoperable and high surgical risk patients. Recent advances in valve technology include repositionable scaffolds and smaller delivery systems, as well as improvement in periprocedural imaging. These advances have resulted in reduction of vascular complications, rates of paravalvular aortic regurgitation and periprocedural stroke and improved overall outcomes. Increasingly, TAVI is the preferred treatment for high-risk surgical patients with severe aortic stenosis. Consequently, there is growing interest for the use of TAVI in lower surgical risk patients. Furthermore, the role of TAVI has expanded to include valve-in-valve procedures for the treatment of degenerative bioprosthetic valves and bicuspid aortic valves. Questions remain in regard to the optimal management of concurrent coronary artery disease, strategies to minimize valve leaflet restriction and treatment of conduction abnormalities as well as identifying newer indications for its use.
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Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Peter S Hansen
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Edward J Danson
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Nicola Straiton
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Ajay Sinhal
- Department of Cardiology, Flinders Medical Centre, Adelaide, Australia
| | - Darren L Walters
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
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Kim WK, Liebetrau C, van Linden A, Blumenstein J, Gaede L, Hamm CW, Walther T, Möllmann H. Myocardial injury associated with transcatheter aortic valve implantation (TAVI). Clin Res Cardiol 2015; 105:379-87. [PMID: 26670909 DOI: 10.1007/s00392-015-0949-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as an important treatment option for elderly patients with symptomatic aortic stenosis whose risk is too high or prohibitive for conventional surgery. Despite notable progress during the past decade, continuous efforts directed at further improvement of procedural safety and performance are required, especially considering expanding indications for interventional treatment options among lower-risk populations. One issue that needs to be addressed is myocardial damage, which can frequently be observed after TAVI and has been linked to worse prognosis. Yet, knowledge concerning the underlying mechanisms and clinical impact remains scarce, and further investigation in this field is warranted. In this review, we provide a contemporary summary of the types of myocardial injury associated with TAVI, including access-related injury, mechanical trauma and ischemia, the role of myocardial biomarkers, and the impact on left ventricular function, with emphasis on potential mechanisms and clinical implications.
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Affiliation(s)
- Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany.,Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Arnaud van Linden
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Johannes Blumenstein
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Luise Gaede
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany.,Department of Cardiology, University of Giessen, Giessen, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Helge Möllmann
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany.
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Fröhlich GM, Baxter PD, Malkin CJ, Scott DJA, Moat NE, Hildick-Smith D, Cunningham D, MacCarthy PA, Trivedi U, de Belder MA, Ludman PF, Blackman DJ. Comparative survival after transapical, direct aortic, and subclavian transcatheter aortic valve implantation (data from the UK TAVI registry). Am J Cardiol 2015; 116:1555-9. [PMID: 26409640 DOI: 10.1016/j.amjcard.2015.08.035] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/04/2015] [Accepted: 08/04/2015] [Indexed: 12/20/2022]
Abstract
Many patients have iliofemoral vessel anatomy unsuitable for conventional transfemoral (TF) transcatheter aortic valve implantation (TAVI). Safe and practical alternatives to the TF approach are, therefore, needed. This study compared outcomes of alternative nonfemoral routes, transapical (TA), direct aortic (DA), and subclavian (SC), with standard femoral access. In this retrospective study, data from 3,962 patients in the UK TAVI registry were analyzed. All patients who received TAVI through a femoral, subclavian, TA, or DA approach were eligible for inclusion. The primary outcome measure was survival up to 2 years. Median Logistic EuroSCORE was similar for SC, DA, and TA but significantly lower in the TF cohort (22.1% vs 20.3% vs 21.2% vs 17.0%, respectively, p <0.0001). Estimated 1-year survival rate was similar for TF (84.6 ± 0.7%) and SC (80.5 ± 3%, p = 0.27) but significantly worse for TA (74.7 ± 1.6%, p <0.001) and DA (75.2 ± 3.3%, p <0.001). A Cox proportional hazard model was used to analyze survival up to 2 years. Survival in the SC group was not significantly different from the TF group (hazard ratio [HR] 1.22, 95% confidence interval [CI] 0.88 to 1.70, p = 0.24). In contrast, survival in the TA (HR 1.74, 95% CI 1.43 to 2.11; p <0.001) and DA (HR 1.55, 95% CI 1.13 to 2.14; p <0.01) cohorts was significantly reduced compared with TF. In conclusion, TA and DA TAVI were associated with similar survival, both significantly worse than with the TF route. In contrast, subclavian access was not significantly different from TF and may represent the safest nonfemoral access route for TAVI.
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Affiliation(s)
- Georg M Fröhlich
- Department of Cardiology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Paul D Baxter
- Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, United Kingdom
| | | | - D Julian A Scott
- Department of Vascular Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Neil E Moat
- Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - David Cunningham
- National Institute for Cardiovascular Outcomes Research, University College London, London, United Kingdom
| | - Philip A MacCarthy
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Mark A de Belder
- Department of Cardiology, James Cook University Hospital, Middlesborough, United Kingdom
| | - Peter F Ludman
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Daniel J Blackman
- Department of Cardiology, Leeds Teaching Hospitals, Leeds, United Kingdom.
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33
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Gada H, Kirtane AJ, Wang K, Lei Y, Magnuson E, Reynolds MR, Williams MR, Kodali S, Vahl TP, Arnold SV, Leon MB, Thourani V, Szeto WY, Cohen DJ. Temporal Trends in Quality of Life Outcomes After Transapical Transcatheter Aortic Valve Replacement: A Placement of AoRTic TraNscathetER Valve (PARTNER) Trial Substudy. Circ Cardiovasc Qual Outcomes 2015; 8:338-46. [PMID: 26058718 DOI: 10.1161/circoutcomes.114.001335] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 05/04/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND In the Placement of AoRTic TraNscathetER Valve (PARTNER) randomized controlled trial (RCT), which represented the first exposure to transapical transcatheter aortic valve replacement (TA-TAVR) for many clinical sites, high-risk patients undergoing TA-TAVR derived similar health-related quality of life (HRQoL) outcomes when compared with surgical aortic valve replacement (SAVR). With increasing experience, it is possible that HRQoL outcomes of TA-TAVR may have improved. METHODS AND RESULTS We evaluated HRQoL outcomes at 1-, 6-, and 12-month follow-ups among 875 patients undergoing TA-TAVR in the PARTNER nonrandomized continued access (NRCA) registry and compared these outcomes with those of the TA-TAVR and SAVR patients in the PARTNER RCT. HRQoL was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Medical Outcomes Study Short-Form 12, and the EuroQoL-5D, with the KCCQ overall summary score serving as the primary end point. The NRCA TA-TAVR and RCT TA-TAVR and SAVR groups were generally similar. The primary outcome, the KCCQ summary score, did not differ between the NRCA TA-TAVR and the RCT TA-TAVR group at any follow-up timepoints, although there were small differences in favor of the NRCA cohort on several KCCQ subscales at 1 month. There were no significant differences in follow-up HRQOL between the NRCA-TAVR and the RCT SAVR cohorts on the KCCQ overall summary scale or any of the disease-specific or generic subscales. CONCLUSIONS Despite greater experience with TA-TAVR in the NRCA registry, HRQoL outcomes remained similar to those of TA-TAVR in the original RCT cohort and no better than those with SAVR. These findings have important implications for patient selection for TAVR when transfemoral access is not an option. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.
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Affiliation(s)
- Hemal Gada
- From the Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ (H.G.); Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K., S.K., T.P.V., M.B.L.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine (K.W., Y.L., E.M., S.V.A., D.J.C.); Lahey Hospital & Medical Center, Burlington, MA and Harvard Clinical Research Institute, Boston, MA (M.R.R.); NYU Langone Medical Center, New York, NY (M.R.W.); Emory University School of Medicine, Atlanta, GA (V.T.); and University of Pennsylvania School of Medicine, Philadelphia (W.Y.S.)
| | - Ajay J Kirtane
- From the Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ (H.G.); Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K., S.K., T.P.V., M.B.L.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine (K.W., Y.L., E.M., S.V.A., D.J.C.); Lahey Hospital & Medical Center, Burlington, MA and Harvard Clinical Research Institute, Boston, MA (M.R.R.); NYU Langone Medical Center, New York, NY (M.R.W.); Emory University School of Medicine, Atlanta, GA (V.T.); and University of Pennsylvania School of Medicine, Philadelphia (W.Y.S.)
| | - Kaijun Wang
- From the Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ (H.G.); Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K., S.K., T.P.V., M.B.L.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine (K.W., Y.L., E.M., S.V.A., D.J.C.); Lahey Hospital & Medical Center, Burlington, MA and Harvard Clinical Research Institute, Boston, MA (M.R.R.); NYU Langone Medical Center, New York, NY (M.R.W.); Emory University School of Medicine, Atlanta, GA (V.T.); and University of Pennsylvania School of Medicine, Philadelphia (W.Y.S.)
| | - Yang Lei
- From the Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ (H.G.); Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K., S.K., T.P.V., M.B.L.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine (K.W., Y.L., E.M., S.V.A., D.J.C.); Lahey Hospital & Medical Center, Burlington, MA and Harvard Clinical Research Institute, Boston, MA (M.R.R.); NYU Langone Medical Center, New York, NY (M.R.W.); Emory University School of Medicine, Atlanta, GA (V.T.); and University of Pennsylvania School of Medicine, Philadelphia (W.Y.S.)
| | - Elizabeth Magnuson
- From the Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ (H.G.); Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K., S.K., T.P.V., M.B.L.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine (K.W., Y.L., E.M., S.V.A., D.J.C.); Lahey Hospital & Medical Center, Burlington, MA and Harvard Clinical Research Institute, Boston, MA (M.R.R.); NYU Langone Medical Center, New York, NY (M.R.W.); Emory University School of Medicine, Atlanta, GA (V.T.); and University of Pennsylvania School of Medicine, Philadelphia (W.Y.S.)
| | - Matthew R Reynolds
- From the Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ (H.G.); Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K., S.K., T.P.V., M.B.L.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine (K.W., Y.L., E.M., S.V.A., D.J.C.); Lahey Hospital & Medical Center, Burlington, MA and Harvard Clinical Research Institute, Boston, MA (M.R.R.); NYU Langone Medical Center, New York, NY (M.R.W.); Emory University School of Medicine, Atlanta, GA (V.T.); and University of Pennsylvania School of Medicine, Philadelphia (W.Y.S.)
| | - Mathew R Williams
- From the Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ (H.G.); Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K., S.K., T.P.V., M.B.L.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine (K.W., Y.L., E.M., S.V.A., D.J.C.); Lahey Hospital & Medical Center, Burlington, MA and Harvard Clinical Research Institute, Boston, MA (M.R.R.); NYU Langone Medical Center, New York, NY (M.R.W.); Emory University School of Medicine, Atlanta, GA (V.T.); and University of Pennsylvania School of Medicine, Philadelphia (W.Y.S.)
| | - Susheel Kodali
- From the Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ (H.G.); Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K., S.K., T.P.V., M.B.L.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine (K.W., Y.L., E.M., S.V.A., D.J.C.); Lahey Hospital & Medical Center, Burlington, MA and Harvard Clinical Research Institute, Boston, MA (M.R.R.); NYU Langone Medical Center, New York, NY (M.R.W.); Emory University School of Medicine, Atlanta, GA (V.T.); and University of Pennsylvania School of Medicine, Philadelphia (W.Y.S.)
| | - Torsten P Vahl
- From the Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ (H.G.); Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K., S.K., T.P.V., M.B.L.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine (K.W., Y.L., E.M., S.V.A., D.J.C.); Lahey Hospital & Medical Center, Burlington, MA and Harvard Clinical Research Institute, Boston, MA (M.R.R.); NYU Langone Medical Center, New York, NY (M.R.W.); Emory University School of Medicine, Atlanta, GA (V.T.); and University of Pennsylvania School of Medicine, Philadelphia (W.Y.S.)
| | - Suzanne V Arnold
- From the Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ (H.G.); Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K., S.K., T.P.V., M.B.L.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine (K.W., Y.L., E.M., S.V.A., D.J.C.); Lahey Hospital & Medical Center, Burlington, MA and Harvard Clinical Research Institute, Boston, MA (M.R.R.); NYU Langone Medical Center, New York, NY (M.R.W.); Emory University School of Medicine, Atlanta, GA (V.T.); and University of Pennsylvania School of Medicine, Philadelphia (W.Y.S.)
| | - Martin B Leon
- From the Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ (H.G.); Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K., S.K., T.P.V., M.B.L.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine (K.W., Y.L., E.M., S.V.A., D.J.C.); Lahey Hospital & Medical Center, Burlington, MA and Harvard Clinical Research Institute, Boston, MA (M.R.R.); NYU Langone Medical Center, New York, NY (M.R.W.); Emory University School of Medicine, Atlanta, GA (V.T.); and University of Pennsylvania School of Medicine, Philadelphia (W.Y.S.)
| | - Vinod Thourani
- From the Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ (H.G.); Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K., S.K., T.P.V., M.B.L.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine (K.W., Y.L., E.M., S.V.A., D.J.C.); Lahey Hospital & Medical Center, Burlington, MA and Harvard Clinical Research Institute, Boston, MA (M.R.R.); NYU Langone Medical Center, New York, NY (M.R.W.); Emory University School of Medicine, Atlanta, GA (V.T.); and University of Pennsylvania School of Medicine, Philadelphia (W.Y.S.)
| | - Wilson Y Szeto
- From the Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ (H.G.); Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K., S.K., T.P.V., M.B.L.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine (K.W., Y.L., E.M., S.V.A., D.J.C.); Lahey Hospital & Medical Center, Burlington, MA and Harvard Clinical Research Institute, Boston, MA (M.R.R.); NYU Langone Medical Center, New York, NY (M.R.W.); Emory University School of Medicine, Atlanta, GA (V.T.); and University of Pennsylvania School of Medicine, Philadelphia (W.Y.S.)
| | - David J Cohen
- From the Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ (H.G.); Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K., S.K., T.P.V., M.B.L.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine (K.W., Y.L., E.M., S.V.A., D.J.C.); Lahey Hospital & Medical Center, Burlington, MA and Harvard Clinical Research Institute, Boston, MA (M.R.R.); NYU Langone Medical Center, New York, NY (M.R.W.); Emory University School of Medicine, Atlanta, GA (V.T.); and University of Pennsylvania School of Medicine, Philadelphia (W.Y.S.).
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Rogers T, Ratnayaka K, Schenke WH, Sonmez M, Kocaturk O, Mazal JR, Chen MY, Flugelman MY, Troendle JF, Faranesh AZ, Lederman RJ. Fully percutaneous transthoracic left atrial entry and closure as a potential access route for transcatheter mitral valve interventions. Circ Cardiovasc Interv 2015; 8:e002538. [PMID: 26022536 DOI: 10.1161/circinterventions.114.002538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous access for mitral interventions is currently limited to transapical and transseptal routes, both of which have shortcomings. We hypothesized that the left atrium could be accessed directly through the posterior chest wall under imaging guidance. METHODS AND RESULTS We tested percutaneous transthoracic left atrial access in 12 animals (10 pigs and 2 sheep) under real-time magnetic resonance imaging or x-ray fluoroscopy plus C-arm computed tomographic guidance. The pleural space was insufflated with CO2 to displace the lung, an 18F sheath was delivered to the left atrium, and the left atrial port was closed using an off-the-shelf nitinol cardiac occluder. Animals were survived for a minimum of 7 days. The left atrial was accessed, and the port was closed successfully in 12/12 animals. There was no procedural mortality and only 1 hemodynamically insignificant pericardial effusion was observed at follow-up. We also successfully performed the procedure on 3 human cadavers. A simulated trajectory to the left atrium was present in all of 10 human cardiac computed tomographic angiograms analyzed. CONCLUSIONS Percutaneous transthoracic left atrial access is feasible without instrumenting the left ventricular myocardium. In our experience, magnetic resonance imaging offers superb visualization of anatomic structures with the ability to monitor and address complications in real-time, although x-ray guidance seems feasible. Clinical translation seems realistic based on human cardiac computed tomographic analysis and cadaver testing. This technique could provide a direct nonsurgical access route for future transcatheter mitral implantation.
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Affiliation(s)
- Toby Rogers
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - Kanishka Ratnayaka
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - William H Schenke
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - Merdim Sonmez
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - Ozgur Kocaturk
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - Jonathan R Mazal
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - Marcus Y Chen
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - Moshe Y Flugelman
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - James F Troendle
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - Anthony Z Faranesh
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - Robert J Lederman
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.).
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Ropponen J, Vainikka T, Sinisalo J, Rapola J, Laine M, Ihlberg L. Transaortic Transcatheter Aortic Valve Implantation as a Second Choice over the Transapical Access. Scand J Surg 2015; 105:35-41. [PMID: 25854823 DOI: 10.1177/1457496915575832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/27/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS In this report, we present our experience with the transaortic transcatheter aortic valve implantation using the SAPIEN valve. The procedural success, 30-day outcome, and survival up to 2 years are compared with the transapical access performed in patients in our institution. MATERIAL AND METHODS Of a total of 282 transcatheter aortic valve implantation patients, 100 consecutive patients had a non-transfemoral approach. The transaortic and transapical access routes were used in 36 and 64 patients, respectively. The transaortic group had a higher mean logistic EuroSCORE (32.6 vs 25.2, p = 0.021) and more patients with left ventricular ejection fraction less than 40% (33.3% vs 14.1%, p = 0.023). RESULTS The respective technical success rates for the transaortic and transapical groups were 100% and 95.2% (p = NS). There were significantly more perioperative hemodynamic problems necessitating cardiopulmonary resuscitation or mechanical circulatory support in the transapical group (18.8% vs 2.8%, p = 0.023). The transaortic group had a slightly shorter hospital stay (7 vs 8 days, p = 0.018). The 30-day mortality was 8.6% and 10.9% in the transaortic and transapical group, respectively (p = NS). Combined safety outcome was similar in both groups at 30 days. The respective 1-year survival rates for the transaortic and transapical groups were 71.5% and 68.3%, respectively (p = NS). CONCLUSION The trans transcatheter aortic valve implantation is a considerable choice to transapical approach. Despite a higher risk patient cohort, the clinical outcome is at least comparable to the transapical transcatheter aortic valve implantation, and it can be utilized as a second choice for patients with prohibitive iliac-femoral anatomy for transfemoral access.
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Affiliation(s)
- J Ropponen
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - T Vainikka
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - J Sinisalo
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - J Rapola
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - M Laine
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - L Ihlberg
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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Lefèvre T. Cardiac death after TAVR: moving up a notch. J Am Coll Cardiol 2015; 65:449-51. [PMID: 25660922 DOI: 10.1016/j.jacc.2014.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/18/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Générale de Santé, Massy, France.
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Murdock JE, Jensen HA, Thourani VH. Nontransfemoral Approaches to Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2015; 4:95-105. [PMID: 28582125 DOI: 10.1016/j.iccl.2014.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is noninferior to surgical aortic valve replacement in patients with high operative risk and superior to medical treatment in patients deemed unsuitable for surgical intervention. However, up to 30% to 50% of patients screened for this intervention are not candidates for TAVR via the preferred transfemoral route because of severe peripheral arterial disease. Alternative access routes must be considered and include the transapical, transaortic, transsubclavian, and transcarotid approaches. The use of alternative access is predicated on appropriate patient selection as determined by a dedicated multispecialty heart valve team and can lead to excellent outcomes.
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Affiliation(s)
- Jared E Murdock
- Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Structural Heart and Valve Center, Emory University School of Medicine, 550 Peachtree Street Northeast, Atlanta, GA 30308, USA
| | - Hanna A Jensen
- Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Structural Heart and Valve Center, Emory University School of Medicine, 550 Peachtree Street Northeast, Atlanta, GA 30308, USA
| | - Vinod H Thourani
- Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Structural Heart and Valve Center, Emory University School of Medicine, 550 Peachtree Street Northeast, Atlanta, GA 30308, USA.
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Urena M, Webb JG, Eltchaninoff H, Muñoz-García AJ, Bouleti C, Tamburino C, Nombela-Franco L, Nietlispach F, Moris C, Ruel M, Dager AE, Serra V, Cheema AN, Amat-Santos IJ, de Brito FS, Lemos PA, Abizaid A, Sarmento-Leite R, Ribeiro HB, Dumont E, Barbanti M, Durand E, Alonso Briales JH, Himbert D, Vahanian A, Immè S, Garcia E, Maisano F, del Valle R, Benitez LM, García del Blanco B, Gutiérrez H, Perin MA, Siqueira D, Bernardi G, Philippon F, Rodés-Cabau J. Late Cardiac Death in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2015; 65:437-48. [DOI: 10.1016/j.jacc.2014.11.027] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/28/2014] [Accepted: 11/04/2014] [Indexed: 11/29/2022]
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Kiser AC, O'Neill WW, de Marchena E, Stack R, Zarate M, Dager A, Reardon M. Suprasternal direct aortic approach transcatheter aortic valve replacement avoids sternotomy and thoracotomy: first-in-man experience. Eur J Cardiothorac Surg 2015; 48:778-83; discussion 784. [DOI: 10.1093/ejcts/ezu524] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/20/2014] [Indexed: 11/14/2022] Open
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