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Moldovan H, Popescu BŞ, Nechifor E, Badea A, Ciomaga I, Nica C, Zaharia O, Gheorghiță D, Broască M, Diaconu C, Parasca C, Chioncel O, Iliescu VA. Rare Cause of Severe Mitral Regurgitation after TAVI: Case Report and Literature Review. Medicina (B Aires) 2022; 58:medicina58040464. [PMID: 35454303 PMCID: PMC9031139 DOI: 10.3390/medicina58040464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022] Open
Abstract
Pre-procedure mitral regurgitation (MR) is a frequent coexistent finding in patients undergoing transcatheter aortic valve replacement (TAVR), and most of them (up to 55%) experience a significant improvement in MR after the procedure. Although seldom described, mitral valve perforation after TAVR is a potentially serious complication that physicians should be aware of, as moderate or severe MR in TAVR recipients is associated with a high early mortality rate. We herein describe the case of a 65-year-old man presenting with worsening heart failure symptoms 5 months after TAVR due to an intraprocedural anterior mitral leaflet perforation and discuss the diagnostic process and therapeutic course of the case. Furthermore, we draw attention to the essential role of echocardiography in the management of TAVR procedures, taking into account its ability in detecting early complications, and emphasize the value of CT as a main determinant to predict long-term MR improvement after TAVR and to assess the potential candidates for double valve repair with percutaneous techniques.
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Affiliation(s)
- Horațiu Moldovan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.Z.); (C.D.); (O.C.); (V.A.I.)
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
- Correspondence: (H.M.); (D.G.)
| | - Bogdan-Ştefan Popescu
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
| | - Elena Nechifor
- Sanador Clinical Hospital, 011038 Bucharest, Romania; (E.N.); (I.C.)
| | - Aida Badea
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
| | - Irina Ciomaga
- Sanador Clinical Hospital, 011038 Bucharest, Romania; (E.N.); (I.C.)
| | - Claudia Nica
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
| | - Ondin Zaharia
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.Z.); (C.D.); (O.C.); (V.A.I.)
- ”Prof. Dr. Theodor Burghele” Clinical Hospital, 061344 Bucharest, Romania
| | - Daniela Gheorghiță
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania
- Correspondence: (H.M.); (D.G.)
| | - Marian Broască
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
| | - Camelia Diaconu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.Z.); (C.D.); (O.C.); (V.A.I.)
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
| | - Cătălina Parasca
- “Prof. Dr. C.C. Iliescu” Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
| | - Ovidiu Chioncel
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.Z.); (C.D.); (O.C.); (V.A.I.)
- “Prof. Dr. C.C. Iliescu” Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.Z.); (C.D.); (O.C.); (V.A.I.)
- “Prof. Dr. C.C. Iliescu” Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
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Dominici C, Salsano A, Nenna A, Spadaccio C, Barbato R, Mariscalco G, Santini F, Bashir M, El-Dean Z, Chello M. Higher preoperative left atrial volume index predicts lack of mitral regurgitation improvement after transcatheter aortic valve replacement. J Cardiovasc Med (Hagerstown) 2020; 21:383-390. [PMID: 32243341 DOI: 10.2459/jcm.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Moderate-to-severe mitral regurgitation is present in 20-35% of patients undergoing transcatheter aortic valve replacement (TAVR) and the current literature lacks simple echocardiographic parameters, which can predict post-TAVR changes in mitral regurgitation. The aim of this study is to investigate the echocardiographic predictors of improvement or worsening of mitral regurgitation in patients undergoing TAVR with moderate-to-severe mitral regurgitation. METHODS This retrospective study included 113 patients who underwent TAVR with preoperative mitral regurgitation grade at least 2. Patients with concomitant coronary artery disease requiring treatment were excluded. Mitral regurgitation was related to the annular dilatation or tethering mechanism in all patients. Preoperative and postoperative echocardiographies were compared in terms of mitral regurgitation and other commonly measured parameters. RESULTS After TAVR, a reduction in mitral regurgitation was observed in 62.8% of cases. On the basis of the difference between postoperative and preoperative echocardiograms, 71 patients had improved mitral regurgitation, whereas 42 patients had stable or worsened mitral regurgitation. After analyzing preoperative echocardiographic parameters with regard to this group difference, left atrial volume index (LAVI) was the only variable that was different between groups (33.4 ± 4.8 ml/m in improved mitral regurgitation vs. 39.8 ± 3.0 ml/m in not improved mitral regurgitation, P < 0.001). In a multivariable logistic regression model, a LAVI increase was associated with lack of an acute reduction in mitral regurgitation (odds ratio = 1.41, P < 0.001) after adjustment for age and preoperative serum creatinine. CONCLUSION Higher preoperative LAVI is a determinant predictor of lack of an acute reduction in mitral regurgitation after TAVR, and LAVI could be used as a stratifying tool to tailor the treatment strategy and the timing of the procedures. However, validation of these results and long-term outcomes are warranted to support those conclusions.
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Affiliation(s)
- Carmelo Dominici
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome
| | - Antonio Salsano
- Department of Cardiac Surgery, University of Genoa, Genoa, Italy
| | - Antonio Nenna
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome
| | | | - Raffaele Barbato
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome
| | - Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, UK
| | | | - Mohamad Bashir
- Department of Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Zein El-Dean
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, UK
| | - Massimo Chello
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome
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Caballero A, Mao W, McKay R, Sun W. The Impact of Self-Expandable Transcatheter Aortic Valve Replacement on Concomitant Functional Mitral Regurgitation: A Comprehensive Engineering Analysis. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2020; 4:179-191. [PMID: 33728393 DOI: 10.1080/24748706.2020.1740365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Mitral regurgitation (MR) is present in a large proportion of patients who undergo transcatheter aortic valve replacement (TAVR). However, existing clinical data on the impact of TAVR on early post-procedural MR severity are contradictory. Using a comprehensive computational engineering methodology, this study aimed to evaluate quantitatively the structural and hemodynamic impact of TAVR on aortic-mitral continuity and MR severity in a rigorously developed and validated patient-specific left heart (LH) computer model with aortic stenosis and concomitant functional MR. Methods TAVR procedure was virtually simulated using a self-expandable valve (SEV) at three implantation heights. Pre- and post-TAVR LH dynamics as well as intra-operative biomechanics were analyzed. Results No significant differences in early MR improvement (<10%) were noted at the three implantation depths when compared to the pre-TAVR state. The high deployment model resulted in the highest stress in the native aortic leaflets, lowest stent-tissue contact force, highest aortic-mitral angle, and highest MR reduction for this patient case. When comparing SEV vs. balloon-expandable valve (BEV) performance at an optimal implantation height, the SEV gave a higher regurgitant volume ⋅ than the pre-TAVR model (40.49 vs 37.59 ml), while the BEV model gave the lowest regurgitant volume (33.84 vs 37.59 ml). Conclusions Contact force, aortic-mitral angle, and valve annuli compression were identified as possible mechanistic parameters that may suggest avenues for acute MR improvement. Albeit a single patient parametric study, it is our hope that such detailed engineering analysis could shed some light into the underlying biomechanical mechanisms of TAVR impact on MR.
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Affiliation(s)
- Andrés Caballero
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Wenbin Mao
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Raymond McKay
- Division of Cardiology, The Hartford Hospital, Hartford, Connecticut, USA
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
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Valvo R, Criscione E, Reddavid C, Barbanti M. Early detection of transcatheter heart valve dysfunction. Expert Rev Cardiovasc Ther 2019; 17:863-872. [PMID: 31829050 DOI: 10.1080/14779072.2019.1703673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: Transcatheter aortic valve implantation therapy is spreading rapidly, representing the standard of care in inoperable and high-risk patients, and a valid alternative in intermediate- and low-risk patients with severe symptomatic aortic stenosis. In this subset, the development and validation of noninvasive, quantitative, in vivo imaging modality, to monitor possible valve dysfunction is mandatory, in order to plan timely therapeutic interventions before the onset of symptoms.Areas covered: The implantation of transcatheter heart valves (THV) is increasing rapidly. As a consequence, THV dysfunction will become a major cause of cardiovascular morbidity after TAVI. Emergency repeat aortic valve replacement surgery is associated with a high rate of mortality compared with elective repeat surgery. In this context, early detection of THV dysfunction is therefore highly desirable. The review aims to examine the different diagnostic method to early detect THV dysfunction.Expert opinion: Most promising innovations in the diagnosis of early detection of THV dysfunction are evaluated, and the future outlook is explored. Waiting for upcoming evidence about the utility of CT, CMR, and PET on early detection of THV dysfunction, tailoring echocardiogram follow-up based on patients' characteristics is the desirable approach.
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Affiliation(s)
- Roberto Valvo
- A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Enrico Criscione
- A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Claudia Reddavid
- A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Marco Barbanti
- A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
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Caballero A, Mao W, McKay R, Sun W. The impact of balloon-expandable transcatheter aortic valve replacement on concomitant mitral regurgitation: a comprehensive computational analysis. J R Soc Interface 2019; 16:20190355. [PMID: 31409236 DOI: 10.1098/rsif.2019.0355] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The aortic and mitral valves function in a reciprocal interdependent fashion. However, the impact of transcatheter aortic valve replacement (TAVR) on the aortic-mitral continuity and severity of mitral regurgitation (MR) are poorly understood. In this study, a comprehensive engineering analysis was performed to investigate the impact of TAVR on MR severity and left heart dynamics in a retrospective patient case who harbours bicuspid aortic valve stenosis and concomitant functional MR. The TAVR procedure was computer simulated using a balloon-expandable valve, and the impact of three implantation heights on aortic-mitral coupling, MR severity and device performance were analysed. The accuracy and predictability of the computer modelling framework were validated with pre- and post-operative echo data. The highest deployment model resulted in higher stresses in the native leaflets, contact radial force and stent recoil, while the midway implantation model gave better haemodynamic performance and MR reduction in this patient case. Although the regurgitant volume decreased (less than 10%) for the three deployment configurations, no significant differences in MR severity improvement and mitral leaflet tethering were found. Acute improvement in MR was (i) due to the mechanical compression of the stent against the aortic-mitral curtain, (ii) due to an immediate drop in the ventricular pressure and transmitral pressure gradient. Albeit a single real clinical case, it is our hope that such detailed engineering computational analysis could shed light on the underlying biomechanical mechanisms of TAVR impact on MR.
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Affiliation(s)
- Andrés Caballero
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Wenbin Mao
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Raymond McKay
- Division of Cardiology, The Hartford Hospital, Hartford, CT, USA
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
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POL-TAVI - Polish Registry of Transcatheter Aortic Valve Implantation - simple tool, great value, rationale and design. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 13:309-315. [PMID: 28096826 PMCID: PMC5233759 DOI: 10.5114/kitp.2016.64870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 12/20/2016] [Indexed: 11/17/2022]
Abstract
Aortic stenosis (AS) is the most common valvular heart disease in adults in Europe and North America. Management of AS patients depends on accurate diagnosis of the cause and stage of the disease process: the first and definitive therapeutic choice for a growing number of elderly patients with symptomatic AS is surgical treatment. In patients not eligible for surgery, transcatheter aortic valve implantation (TAVI) constitutes a safe and effective alternative. As an innovative, costly method of treatment, it requires however careful monitoring of its course, documenting its early and long-term results, and assessment of its safety and medical-economic cost-effectiveness. A medical registry seems to be an excellent tool to perform such analysis. The aim of this paper is to present the design and rationale for creation of the first National Cardiac-Cardiac Surgical Registry of Percutaneous Aortic Valve Treatment POL-TAVI, to describe its genesis and to highlight its key assumptions and aims. Despite its recent beginnings, the POL-TAVI Registry has already demonstrated its value and usability in monitoring and assessment of TAVI procedures, leading to further improvement and development of this new method in Poland. It constitutes an important and valuable tool for patients, the medical community and the payer.
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Sokalskis V, Muraru D, Fraccaro C, Napodano M, D'Onofrio A, Tarantini G, Badano LP. Echocardiographic follow-up after transcatheter aortic valve replacement. Echocardiography 2017; 34:267-278. [PMID: 28052455 DOI: 10.1111/echo.13443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The use of transcatheter aortic valve replacement (TAVR) for high-risk patients with aortic stenosis has rapidly increased during the past years. Accordingly, more and more patients are referred for a follow-up echocardiographic study after TAVR. However, the echocardiographic evaluation of patients who underwent TAVR places specific demands on echocardiographers. Furthermore, TAVR may be associated with new types of complications, which are frequently unrecognized or underestimated due to lack of familiarity with the normal and pathological appearance of TAVR. Therefore, this review summarizes the echocardiographic parameters describing the structural and functional status of bioprostheses used in TAVR, procedures taking into account their peculiar hemodynamics. We also describe the strengths and the limitations of echocardiography and of other imaging modalities in detecting long-term complications of TAVR (eg, infective endocarditis, thrombosis). The aim of this review was to serve as a guide for a structured echocardiographic follow-up of TAVR patients, as well as for the echocardiographic diagnosis of the procedure-associated complications.
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Affiliation(s)
- Vladislavs Sokalskis
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy.,University Heart Center Hamburg, Hamburg, Germany
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
| | - Massimo Napodano
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
| | - Augusto D'Onofrio
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
| | - Luigi Paolo Badano
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
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