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Thiene G, Rizzo S, Basso C. Bicuspid aortic valve: The most frequent and not so benign congenital heart disease. Cardiovasc Pathol 2024; 70:107604. [PMID: 38253300 DOI: 10.1016/j.carpath.2024.107604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Bicuspid aortic valve (BAV) is the most frequent congenital heart disease, with an incidence of approximately 1%. It can be silent and associated with normal valve function. However, a series of complications, even catastrophic, may occur with time: valve incompetence, valve stenosis by dystrophic calcification, infective endocarditis, progressive dilatation of the ascending aorta, aortic dissection, sudden death. The problem of BAV is not just about the number of semilunar cusps, but also the aortic wall. Severe noninflammatory degenerative changes (elastic fiber fragmentation, smooth muscle cells death, mucoid extracellular matrix accumulation=MEMA) are observed in the aortic wall of BAV patients, with intrinsic weakness accounting for progressive aneurysmal dilatation of the ascending aorta, valve incompetence, and wall dissection. The link between valve and aortic wall pathology finds most probably an explanation in the embryology of the arterial pole since neurocrestal cells play a role in the development of both the ascending aorta, aortic arch, and semilunar valves. The frequent association of adult aortic coarctation and BAV provides evidence for this hypothesis. BAV has a significant genetic component as to require screening of first-degree relatives, as outlined by AHA/ACC 2022 guidelines.
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Affiliation(s)
- Gaetano Thiene
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padova, Italy.
| | - Stefania Rizzo
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padova, Italy
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padova, Italy
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2
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Boiago M, Bellamoli M, De Biase C, Beneduce A, Alonso LG, Laforgia P, Feliachi S, Oliva OA, Dumonteil N, Tchétché D. Three-year clinical outcomes after transcatheter aortic valve implantation in patients with bicuspid aortic disease: Comparison between self-expanding and balloon-expandable valves. Catheter Cardiovasc Interv 2024. [PMID: 38577939 DOI: 10.1002/ccd.31041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/05/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Bicuspid aortic valve (BAV) stenosis is a complex anatomical scenario for transcatheter aortic valve implantation (TAVI). Favorable short-term clinical outcomes have been reported with TAVI in this setting, but long-term data are scarce. METHODS We retrospectively included, in a single-center registry, patients with BAV stenosis who underwent TAVI before 2020. We compared patients treated with self-expanding valves (SEV) versus balloon-expandable valves (BEV). The primary endpoint was a composite of all-cause mortality, stroke and need for aortic valve (AV) reintervention at 3 years. Secondary endpoints included each component of the primary endpoint, cardiovascular mortality, permanent pacemaker implantation (PPI) rate, mean gradient and ≥moderate paravalvular leak (PVL) rate. RESULTS A total of 150 consecutive patients (SEV = 83, BEV = 67) were included. No significant differences were reported between SEV and BEV groups for the primary composite endpoint (SEV 35.9% vs. BEV 32%, p = 0.66), neither for clinical secondary endpoints (all-cause mortality SEV 28.1% vs. BEV 28%, p = 0.988; cardiovascular mortality SEV 14.1% vs. BEV 20%, p = 0.399; stroke SEV 12.5% vs. BEV 6%, p = 0.342; need for AV reintervention SEV 0% vs. BEV 0%; PPI SEV 28.1% vs. BEV 24%, p = 0.620). A lower mean gradient persisted up to 3 years in the SEV group (SEV 8.8 ± 3.8 mmHg vs. BEV 10.7 ± 3.2 mmHg, p = 0.063), while no significant difference was found in the rate of ≥ moderate PVL (SEV 3/30 vs. BEV 0/25, p = 0.242). CONCLUSIONS In this single center registry, we observed favorable 3-year clinical outcomes in nonselected BAV patients treated with different generation devices, without significant differences between patients receiving SEV or BEV.
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Affiliation(s)
- Mauro Boiago
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Michele Bellamoli
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | | | - Pietro Laforgia
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Souehib Feliachi
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Didier Tchétché
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
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3
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Gupta R, Mahmoudi E, Behnoush AH, Malik AH, Mahajan P, Lin M, Bandyopadhyay D, Goel A, Chakraborty S, Aedma SK, Gupta HB, Vyas AV, Combs WG, Mathur M, Yakubov SJ, Patel NC. Clinical outcomes and the impact of valve morphology for transcatheter aortic valve replacement in bicuspid aortic valves: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2023; 102:721-730. [PMID: 37605512 DOI: 10.1002/ccd.30808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/16/2023] [Accepted: 08/13/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Bicuspid aortic valve (BAV) is present in approximately 0.5%-2% of the general population, causing significant aortic stenosis (AS) in 12%-37% of affected individuals. Transcatheter aortic valve replacement (TAVR) is being considered the treatment of choice in patients with symptomatic AS across all risk spectra. AIM Aim Our study aims to compare TAVR outcomes in patients with BAV versus tricuspid aortic valves (TAV). METHODS A comprehensive literature search was performed in PubMed, Web of Science, and Cochrane trials. Studies were included if they included BAV and TAV patients undergoing TAVR with quantitative data available for at least one of our predefined outcomes. Meta-analysis was performed by the random-effects model using Stata software. RESULTS Fifty studies of 203,288 patients were included. BAV patients had increased 30-day all-cause mortality (odds ratio [OR] = 1.23 [1.00-1.50], p = 0.05), in-hospital stroke (OR = 1.39 [1.01-1.93], p = 0.05), in-hospital and 30-day PPI (OR = 1.13 [1.00-1.27], p = 0.04; OR = 1.16 [1.04-1.13], p = 0.01) and in-hospital, 30-day and 1-year aortic regurgitation (AR) (OR = 1.48 [1.19-1.83], p < 0.01; OR = 1.79 [1.26-2.52], p < 0.01; OR = 1.64 [1.03-2.60], p = 0.04). Subgroup analysis on new-generation valves showed a reduced 1-year all-cause mortality (OR = 0.86 [CI = 0.75-0.98], p = 0.03), despite higher in-hospital and 30-day PPI (OR = 0.1.21 [1.04-1.41], p = 0.01; OR = 1.17 [1.05-1.31], p = 0.01) and in-hospital AR (OR = 1.62 [1.14-2.31], p = 0.01) in the BAV group. The quality of included studies was moderate-to-high, and only three analyses presented high heterogeneity. CONCLUSION TAVR is associated with comparable outcomes in patients with BAV and TAV. Careful selection of BAV cases by preprocedural assessment of valve anatomy and burden of calcification, pre- and post-procedural dilation, and implementing newer generations of valves may improve the safety and efficacy of TAVR in BAV patients.
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Affiliation(s)
- Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Elham Mahmoudi
- Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Pranav Mahajan
- Department of Medicine, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Muling Lin
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Dhrubajyoti Bandyopadhyay
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Akshay Goel
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Sandipan Chakraborty
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Surya K Aedma
- Department of Medicine, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Harsh Bala Gupta
- Guru Nanak Dev Hospital, Department of medicine, Government Medical College, Amritsar, Punjab, India
| | - Apurva V Vyas
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - William G Combs
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Moses Mathur
- Heart & Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-Ohio Health, Columbus, Ohio, USA
| | - Nainesh C Patel
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
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4
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Saeed Al-Asad K, Martinez Salazar A, Radwan Y, Wang E, Salam MF, Sabanci R, Saeed M, Halboni A, Al-Abcha A, Abela G. Transcatheter Aortic Valve Replacement in Bicuspid Versus Tricuspid Aortic Valve Stenosis: Meta-Analysis and Systemic Review. Am J Cardiol 2023; 203:105-112. [PMID: 37487404 DOI: 10.1016/j.amjcard.2023.06.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/26/2023]
Abstract
Because of its anatomic and procedural complexities, bicuspid aortic valve (BAV) has been excluded from previous trials investigating transcatheter aortic valve replacement (TAVR). We aimed to compare the clinical outcomes of TAVR in BAV and tricuspid aortic valve patients. We searched the databases systematically from inception until March 2023 for studies that reported the outcomes of TAVR in BAV and tricuspid aortic valve patients. The primary focus was all-cause mortality at 1 year. Additional outcomes included outcomes at 30-day follow-up. Secondary and subgroup analyses were performed on propensity-matched patients, patients at low surgical risk, and based on the type of transcatheter valve type. We included 30 studies with a total of 193,274 patients who underwent TAVR, of which 14,353 patients had BAV stenosis. The rate of 1-year mortality was lower in the BAV group compared with the tricuspid group with the results reaching statistical significance (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.75 to 0.98, p = 0.02). The rate of 30-day stroke, however, was higher in patients with BAV who underwent TAVR (OR 1.24, 95% CI 1.08 to 1.43, p <0.05). Other 30-day clinical outcomes were similar between the 2 groups. Similar outcomes were observed in secondary analysis of matched populations with less mortality and higher rate of stroke in patients with BAV (OR 0.84, 95% CI 0.72 to 0.96, p = 0.01, and OR 1.38, 95% CI 1.09 to 1.75, p <0.05, respectively). Comparing the outcomes for self-expandable and balloon-expandable valves resulted in similar results. Subgroup analysis of low-surgical-risk patients similarly showed lower 1-year mortality in patients with BAV (OR 0.67, 95% CI 0.50 to 0.91, p = 0.01), without difference in 30-day stroke between the 2 groups (OR 1.24, 95% CI 0.83 to 1.88, p = 0.30). In conclusion, this report indicates that TAVR is safe and feasible in patients with BAV, including patients at low surgical risk. The higher rate of 30-day stroke, however, warrants caution when pursuing TAVR in this population. More studies, specifically randomized trials, are still warranted to further assess the safety and the long-term outcomes in this group.
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Affiliation(s)
- Khalid Saeed Al-Asad
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan.
| | | | - Yasser Radwan
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - Enhua Wang
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - Mohammad Fahad Salam
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - Rand Sabanci
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - Moiz Saeed
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - Adnan Halboni
- Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | | | - George Abela
- Department of Cardiology, Michigan State University, East Lansing, Michigan
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5
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Xiong TY, Ali WB, Feng Y, Hayashida K, Jilaihawi H, Latib A, Lee MKY, Leon MB, Makkar RR, Modine T, Naber C, Peng Y, Piazza N, Reardon MJ, Redwood S, Seth A, Sondergaard L, Tay E, Tchetche D, Yin WH, Chen M, Prendergast B, Mylotte D. Transcatheter aortic valve implantation in patients with bicuspid valve morphology: a roadmap towards standardization. Nat Rev Cardiol 2023; 20:52-67. [PMID: 35726019 DOI: 10.1038/s41569-022-00734-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 02/08/2023]
Abstract
Indications for transcatheter aortic valve implantation (TAVI) have expanded in many countries to include patients with aortic stenosis who are at low surgical risk, and a similar expansion to this cohort is anticipated elsewhere in the world, together with an increase in the proportion of patients with bicuspid aortic valve (BAV) morphology as the age of the patients being treated decreases. To date, patients with BAV have been excluded from major randomized trials of TAVI owing to anatomical considerations. As a consequence, BAV has been a relative contraindication to the use of TAVI in international guidelines. Although clinical experience and observational data are accumulating, BAV presents numerous anatomical challenges for successful TAVI, despite advances in device design. Furthermore, in those with BAV, substantial geographical variation exists in patient characteristics, clinical approach and procedural strategy. Therefore, in this Roadmap article, we summarize the existing evidence and provide consensus recommendations from an international group of experts on the application of TAVI in patients with BAV in advance of the anticipated growth in the use of this procedure in this challenging cohort of patients.
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Affiliation(s)
- Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | | | - Martin B Leon
- Columbia University Medical Center, New York, NY, USA
| | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Thomas Modine
- Department of Heart Valve Therapy, CHU Bordeaux, Bordeaux, France.,IHU Lyric, Bordeaux-, Pessac, France.,Shanghai Jiaotong University, Shanghai, China
| | - Christoph Naber
- Department of Cardiology, Klinikum Wilhelmshaven, Wilhelmshaven, Germany
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Nicolo Piazza
- Division of Cardiology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, TX, USA
| | - Simon Redwood
- Department of Cardiology, St Thomas' Hospital, London, UK
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi, India
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Edgar Tay
- National University Heart Center, National University of Singapore, Singapore, Singapore
| | - Didier Tchetche
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Wei-Hsian Yin
- Heart Center, ChengHsin General Hospital, Taipei, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Bernard Prendergast
- Department of Cardiology, St Thomas' Hospital, London, UK. .,Cleveland Clinic London, London, UK.
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, National University of Ireland, Galway, Ireland.
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6
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Kusner JJ, Brown JY, Gleason TG, Edelman ER. The Natural History of Bicuspid Aortic Valve Disease. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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7
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Saji M, Highchi R, Iguchi N, Takamisawa I, Shimizu J, Shimokawa T, Nanasato M, Takayama M, Isobe M. Combination Use of Inoue-Balloon and Self-Expandable Transcatheter Valves in Managing Aortic Stenosis Not Amenable to Balloon-Expandable Valves. Int Heart J 2022; 63:843-851. [DOI: 10.1536/ihj.22-220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Mike Saji
- Department of Cardiology, Sakakibara Heart Institute
| | | | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute
| | | | - Jun Shimizu
- Department of Anesthesiology, Sakakibara Heart Institute
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
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8
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Zghouzi M, Osman H, Ullah W, Suleiman AR, Razvi P, Abdalrazzak M, Rabbat F, Alraiyes M, Sattar Y, Bagur R, Paul T, Matetic A, Mamas MA, Lakkis N, Alraies MC. Safety and efficacy of transcatheter aortic valve implantation in stenotic bicuspid aortic valve compared to tricuspid aortic valve: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2022; 20:581-588. [PMID: 35770517 DOI: 10.1080/14779072.2022.2094368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has emerged as a safe and effective alternative to surgical replacement for tricuspid aortic valve (TAV) stenosis. However, utilization of TAVI for aortic stenosis in bicuspid aortic valve (BAV) compared to TAV remains controversial. METHODS We queried online databases with various keywords to identify relevant articles. We compared major cardiovascular events and procedural outcomes using a random effect model to calculate odds ratios (OR). RESULTS We included a total of 22 studies comprising 189,693 patients (BAV 12,669 vs. TAV 177,024). In the pooled analysis, there were no difference in TAVI for BAV vs. TAV for all-cause mortality, cardiovascular mortality, myocardial infarction (MI), vascular complications, acute kidney injury (AKI), coronary occlusion, annulus rupture, and reintervention/reoperation between the groups. The incidence of stroke (OR 1.24; 95% CI 1.1-1.39), paravalvular leak (PVLR) (OR 1.42; 95% CI 1.26-1.61), and the need for pacemaker (OR 1.15; 95% CI 1.06-1.26) was less in the TAV group compared to the BAV group, while incidence of life-threatening bleeding was higher in the TAV group. Subgroup analysis mirrored pooled outcomes except for all-cause mortality. CONCLUSION The use of TAVI for the treatment of aortic stenosis in selective BAV appears to be safe and effective.
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Affiliation(s)
- Mohamed Zghouzi
- Department of Internal Medicine, Detroit Medical Center, Detroit, MI, USA
| | - Heba Osman
- Department of Internal Medicine, Detroit Medical Center, Detroit, MI, USA
| | - Waqas Ullah
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Parveen Razvi
- Department of Internal Medicine, Detroit Medical Center, Detroit, MI, USA
| | - Mukhlis Abdalrazzak
- Division of Cardiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Firas Rabbat
- Division of Cardiolog, Internal medicine, Baptist hospital, Miami, FL, USA
| | - Mowaffak Alraiyes
- Division of Cardiology, Vernon Hills High School, Vernon Hills, IL, USA
| | - Yasar Sattar
- Division of cardiology, West Virginia University, Morgantown, WV, USA
| | - Rodrigo Bagur
- Division of Cardiology, London Health Sciences Centre, Western University, London, ON, Canada
| | - Timir Paul
- Department of Medical Education, University of Tennessee at Nashville, Nashville, TN, USA
| | - Andrija Matetic
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Nasser Lakkis
- Division of cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - M Chadi Alraies
- Division of cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, USA
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9
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Esposito G, Kumar N, Pugliese F, Sayers M, Chow AW, Kennon S, Ozkor M, Mathur A, Baumbach A, Lloyd G, Mullen A, Cook A, Mullen M, Patel KP. Predictors of post-TAVI conduction abnormalities in patients with bicuspid aortic valves. Open Heart 2022; 9:openhrt-2022-001995. [PMID: 35790318 PMCID: PMC9258482 DOI: 10.1136/openhrt-2022-001995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/06/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study evaluates predictors of conduction abnormalities (CA) following transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valves (BAV). BACKGROUND TAVI is associated with CA that commonly necessitate a permanent pacemaker. Predictors of CA are well established among patients with tricuspid aortic valves but not in those with BAV. METHODS This is a single-centre, retrospective, observational study of patients with BAV treated with TAVI. Pre-TAVI ECG and CT scans and procedural characteristics were evaluated in 58 patients with BAV. CA were defined as a composite of high-degree atrioventricular block, new left bundle branch block with a QRS >150 ms or PR >240 ms and right bundle branch block with new PR prolongation or change in axis. Predictors of CA were identified using regression analysis and optimum cut-off values determined using area under the receiver operating characteristic curve analysis. RESULTS CA occurred in 35% of patients. Bioprosthesis implantation depth, the difference between membranous septum (MS) length and implantation depth (δMSID) and device landing zone (DLZ) calcification adjacent to the MS were identified as univariate predictors of CA. The optimum cut-off for δMSID was 1.25 mm. Using this cut-off, low δMSID and DLZ calcification adjacent to MS predicted CA, adjusted OR 8.79, 95% CI 1.88 to 41.00; p=0.01. Eccentricity of the aortic valve annulus, type of BAV and valve calcium quantity and distribution did not predict CA. CONCLUSIONS In BAV patients undergoing TAVI, short δMSID and DLZ calcification adjacent to MS are associated with an increased risk of CA.
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Affiliation(s)
- Giulia Esposito
- King's College London Faculty of Life Sciences and Medicine, London, UK.,Cardiology, Barts Health NHS Trust, London, UK
| | - Niraj Kumar
- Cardiology, Barts Health NHS Trust, London, UK.,University College London Institute of Cardiovascular Science, London, UK
| | - Francesca Pugliese
- Cardiology, Barts Health NHS Trust, London, UK.,Centre for Advanced Cardiovascular Imaging, Queen Mary University William Harvey Research Institute, London, UK
| | - Max Sayers
- Cardiology, Barts Health NHS Trust, London, UK
| | | | | | - Mick Ozkor
- Cardiology, Barts Health NHS Trust, London, UK
| | - Anthony Mathur
- Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicine and Devices, Queen Mary University William Harvey Research Institute, London, UK
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, Queen Mary University William Harvey Research Institute, London, UK.,Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Guy Lloyd
- Cardiology, Barts Health NHS Trust, London, UK
| | - Aigerim Mullen
- University College London Institute of Cardiovascular Science, London, UK
| | - Andrew Cook
- University College London Institute of Cardiovascular Science, London, UK
| | | | - Kush P Patel
- Cardiology, Barts Health NHS Trust, London, UK .,University College London Institute of Cardiovascular Science, London, UK
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10
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Lee YT, Yin WH, Tsao TP, Lee KC, Hsiung MC, Tzeng YH, Wei J. The Presence of Calcified Raphe Is an Independent Predictor of Adverse Long-Term Clinical Outcomes in Patients With Bicuspid Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement. Front Cardiovasc Med 2022; 9:767906. [PMID: 35497985 PMCID: PMC9043529 DOI: 10.3389/fcvm.2022.767906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/10/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Current guidelines recommend that transcatheter aortic valve replacement (TAVR) for bicuspid aortic valve (BAV) with aortic stenosis (AS) should only be performed in selected patients. However, we consider it even more crucial to identify what the really important factors are while determining long-term outcomes in patients with BAV undergoing TAVR, which is precisely the aim of this study. Methods We retrospectively evaluated consecutive patients who underwent TAVR with balloon-expandable Sapien XT or Sapien 3 valves (Edwards Lifesciences, Irvine, CA) for the treatment of severe bicuspid AS. The primary end points were major adverse cardiac and cerebral events (MACCE), that is, mortality, non-fatal myocardial infarction (MI), disabling stroke, valve failure needing reintervention, or clinically relevant valve thrombosis during follow-up. Results A total of 56 patients who underwent TAVR with Sapien XT (n = 20) or Sapien 3 (n = 36) were included. The device and procedural success rates were similar between the two TAVR valves; however, the newer-generation Sapien 3 yielded a trend toward better long-term clinical outcomes than the early-generation Sapien XT did (MACCE rates 35 vs. 11%, p = 0.071). In the multivariate Cox proportional hazards analyses, the presence of calcified raphe > 4 mm was the only independent predictor of long-term MACCE (hazard ratio: 6.76; 95% confidence interval: 1.21–37.67, p = 0.029). Conclusion TAVR performed by a skilled heart team, while using newer-generation balloon-expandable Sapien 3 valve, may yield better long-term clinical outcomes compared to TAVR using early-generation Sapien XT valve. Moreover, the presence of calcified raphe >4 mm is an independent determinant of adverse clinical outcomes.
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Affiliation(s)
- Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Wei-Hsian Yin
| | - Tien-Ping Tsao
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Chen Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
| | | | - Yun-Hsuan Tzeng
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Medical Imaging, Health Management Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
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11
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Zhang Y, Xiong TY, Li YM, Yao YJ, He JJ, Yang HR, Zhu ZK, Chen F, Ou Y, Wang X, Liu Q, Li X, Li YJ, Liao YB, Huang FY, Zhao ZG, Li Q, Wei X, Peng Y, He S, Wei JF, Zhou WX, Zheng MX, Bao Y, Zhou X, Tang H, Meng W, Feng Y, Chen M. Patients With Bicuspid Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:794850. [PMID: 35369357 PMCID: PMC8965870 DOI: 10.3389/fcvm.2022.794850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/07/2022] [Indexed: 01/10/2023] Open
Abstract
Objective We sought to conduct a systematic review and meta-analysis of clinical adverse events in patients undergoing transcatheter aortic valve replacement (TAVR) with bicuspid aortic valve (BAV) vs. tricuspid aortic valve (TAV) anatomy and the efficacy of balloon-expandable (BE) vs. self-expanding (SE) valves in the BAV population. Comparisons aforementioned will be made stratified into early- and new-generation devices. Differences of prosthetic geometry on CT between patients with BAV and TAV were presented. In addition, BAV morphological presentations in included studies were summarized. Method Observational studies and a randomized controlled trial of patients with BAV undergoing TAVR were included according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Results A total of 43 studies were included in the final analysis. In patients undergoing TAVR, type 1 BAV was the most common phenotype and type 2 BAV accounted for the least. Significant higher risks of conversion to surgical aortic valve replacement (SAVR), the need of a second valve, a moderate or severe paravalvular leakage (PVL), device failure, acute kidney injury (AKI), and stroke were observed in patients with BAV than in patients with TAV during hospitalization. BAV had a higher risk of new permanent pacemaker implantation (PPI) both at hospitalization and a 30-day follow-up. Risk of 1-year mortality was significantly lower in patients with BAV than that with TAV [odds ratio (OR) = 0.85, 95% CI 0.75–0.97, p = 0.01]. BE transcatheter heart valves (THVs) had higher risks of annular rupture but a lower risk of the need of a second valve and a new PPI than SE THVs. Moreover, BE THV was less expanded and more elliptical in BAV than in TAV. In general, the rates of clinical adverse events were lower in new-generation THVs than in early-generation THVs in both BAV and TAV. Conclusions Despite higher risks of conversion to SAVR, the need of a second valve, moderate or severe PVL, device failure, AKI, stroke, and new PPI, TAVR seems to be a viable option for selected patients with severe bicuspid aortic stenosis (AS), which demonstrated a potential benefit of 1-year survival, especially among lower surgical risk population using new-generation devices. Larger randomized studies are needed to guide patient selection and verified the durable performance of THVs in the BAV population.
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Affiliation(s)
- Yi Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi-Ming Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi-Jun Yao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing-Jing He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hao-Ran Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhong-Kai Zhu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanweixiang Ou
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi-Jian Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fang-Yang Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhen-Gang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Sen He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jia-Fu Wei
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wen-Xia Zhou
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming-Xia Zheng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Bao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuan Zhou
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Tang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Meng
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Yuan Feng
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Mao Chen
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12
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OUP accepted manuscript. Eur Heart J 2022; 43:2729-2750. [DOI: 10.1093/eurheartj/ehac105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/22/2022] [Accepted: 02/01/2022] [Indexed: 11/12/2022] Open
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Montalto C, Sticchi A, Crimi G, Laricchia A, Khokhar AA, Giannini F, Reimers B, Colombo A, Latib A, Waksman R, Mangieri A. Outcomes After Transcatheter Aortic Valve Replacement in Bicuspid Versus Tricuspid Anatomy: A Systematic Review and Meta-Analysis. JACC Cardiovasc Interv 2021; 14:2144-2155. [PMID: 34620393 DOI: 10.1016/j.jcin.2021.07.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of this study was to compare the feasibility, safety, and clinical outcomes of transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV) stenosis. BACKGROUND At present, limited observational data exist supporting TAVR in the context of bicuspid anatomy. METHODS Primary endpoints were 1-year survival and device success. Secondary endpoints included moderate to severe paravalvular leak (PVL) and a composite endpoint of periprocedural complications; incidence rates of individual procedural endpoints were also explored individually. RESULTS In the main analysis, 17 studies and 181,433 patients undergoing TAVR were included, of whom 6,669 (0.27%) had BAV. A secondary analysis of 7,071 matched subjects with similar baseline characteristics was also performed. Device success and 1-year survival rates were similar between subjects with BAV and those with TAV (97% vs 94% [P = 0.55] and 91.3% vs 90.8% [P = 0.22], respectively). In patients with BAV, a trend toward a higher risk for periprocedural complications was observed in our main analysis (risk ratio [RR]: 1.12; 95% CI: 0.99-1.27; P = 0.07) but not in the matched population secondary analysis (RR: 1.00; 95% CI: 0.81-1.24; P = 0.99). The risk for moderate to severe PVL was higher in subjects with BAV (RR: 1.42; 95% CI: 1.29-1.58; P < 0.0001) as well as the incidence of cerebral ischemic events (2.4% vs 1.6%; P = 0.015) and of annular rupture (0.3% vs 0.02%; P = 0.014) in matched subjects. CONCLUSIONS TAVR is a feasible option among selected patients with BAV anatomy, but the higher rates of moderate to severe PVL, annular rupture, and cerebral ischemic events observed in the BAV group warrant caution and further evidence.
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Affiliation(s)
- Claudio Montalto
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Oxford Heart Center, Oxford University Hospital NHS Trust, Oxford, United Kingdom
| | - Alessandro Sticchi
- Centro per la Lotta Contro l'Infarto Foundation, Rome, Italy; Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Gabriele Crimi
- Cardio-Thoraco-Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Arif A Khokhar
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Azeem Latib
- Montefiore Medical Center, New York, New York, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy.
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Choosing Between Transcatheter Aortic Valve Replacement and Surgery in the Low-Risk Transcatheter Aortic Valve Replacement Era. Interv Cardiol Clin 2021; 10:413-422. [PMID: 34593105 DOI: 10.1016/j.iccl.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The landmark results of the low surgical risk pivotal transcatheter aortic valve replacement (TAVR) trials fueled speculation that the role of surgical aortic valve replacement (SAVR) would be limited in the future. Instead, the field has pivoted away from reductive surgical risk stratification toward understanding the complex interplay of anatomy, timing, and surgical risk to optimize the lifetime management of aortic stenosis. In this review, we systematically explore the subtleties that influence the choice between TAVR and surgery in the low-risk TAVR era.
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Santos-Martínez S, Amat-Santos IJ. New Challenging Scenarios in Transcatheter Aortic Valve Implantation: Valve-in-valve, Bicuspid and Native Aortic Regurgitation. Eur Cardiol 2021; 16:e29. [PMID: 34512800 PMCID: PMC8422266 DOI: 10.15420/ecr.2021.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/14/2021] [Indexed: 01/10/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is the most frequently performed structural technique in the field of interventional cardiology. Initially, this procedure was only used in patients with severe symptomatic aortic stenosis and prohibitive risk. Now, barely one decade after its introduction, TAVI indications extend to low- and intermediate-risk patients. Despite these advances, several challenging scenarios are still on the periphery of the evidence base for TAVI. These include valve-in-valve procedures, lower-risk patients with bicuspid aortic valve and the treatment of pure aortic regurgitation. Whereas the valve-in-valve indication has expanded rapidly, evidence for the use of TAVI compared with conventional surgery for bicuspid aortic valve is limited, including the best choice of device should TAVI be used. Evidence for TAVI in pure aortic regurgitation is still anecdotal because of suboptimal outcomes. Operators worldwide have described variations in the TAVI procedural technique to achieve commissural alignment and to minimise the rate of pacemaker use through cusp overlap implantation. In light of the potential clinical benefits, this may also be an area of further development. This review aims to discuss the current evidence available supporting the use of TAVI for these new indications.
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Affiliation(s)
- Sandra Santos-Martínez
- CIBERCV, Cardiology Department, University Clinic Hospital of Valladolid Valladolid, Spain
| | - Ignacio J Amat-Santos
- CIBERCV, Cardiology Department, University Clinic Hospital of Valladolid Valladolid, Spain
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16
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Gorla R, Casenghi M, Finotello A, De Marco F, Morganti S, Regazzoli D, Bianchi G, Acerbi E, Popolo Rubbio A, Brambilla N, Testa L, Castriota F, Auricchio F, Reimers B, Bedogni F. Outcome of transcatheter aortic valve replacement in bicuspid aortic valve stenosis with new-generation devices. Interact Cardiovasc Thorac Surg 2021; 32:20-28. [PMID: 33201993 DOI: 10.1093/icvts/ivaa231] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/05/2020] [Accepted: 09/03/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To compare device success and paravalvular leak rates of 3 new-generation transcatheter aortic valve replacement devices in patients with bicuspid aortic valve stenosis and to test their biomechanical performance in a computer-based simulation model of aortic root with increasing ellipticity. METHODS This retrospective multicentre study included 56 bicuspid aortic valve patients undergoing transcatheter aortic valve replacement with new-generation devices: Lotus/Lotus Edge (N = 15; 27%), Evolut-R (N = 20; 36%) and ACURATE neo (N = 21; 37%). Three virtual simulation models of aortic root with increasing index of eccentricity (0-0.25-0.5) were implemented. Stress distribution, stent-root contact area and paravalvular orifice area were computed. RESULTS Device success was achieved in 43/56 patients (77%) with comparable rates among Lotus (87%), Evolut-R (60%) and ACURATE neo (86%; P = 0.085). Moderate paravalvular leak rate was significantly lower in the Lotus group as compared to Evolut-R group (0% vs 30%; P = 0.027) and comparable to the ACURATE neo group (0% vs 10%; P = 0.33). By index of eccentricity = 0.5, Lotus showed a uniform and symmetric pattern of stress distribution with absent paravalvular orifice area, ACURATE neo showed a mild asymmetry with small paravalvular orifice area (1.1 mm2), whereas a severely asymmetric pattern was evident with Evolut-R, resulting in a large paravalvular orifice area (12.0 mm2). CONCLUSIONS Transcatheter aortic valve replacement in bicuspid aortic valve patients with new-generation devices showed comparable device success rates. Lotus showed moderate paravalvular leak rate comparable to that of ACURATE neo and significantly lower than Evolut-R. On simulation, Lotus and ACURATE neo showed optimal adaptability to elliptic anatomies as compared to Evolut-R.
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Affiliation(s)
- Riccardo Gorla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Matteo Casenghi
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alice Finotello
- Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Simone Morganti
- Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Damiano Regazzoli
- Department of Clinical and Interventional Cardiology, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Giovanni Bianchi
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Elena Acerbi
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Antonio Popolo Rubbio
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Nedy Brambilla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Fausto Castriota
- Department of Clinical and Interventional Cardiology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Bernhard Reimers
- Department of Clinical and Interventional Cardiology, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Feasibility and effectiveness of transcatheter aortic valve implantation in adults with congenital heart disease. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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18
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Kumar K, Simpson TF, Akhavein R, Rajotte K, Weller S, Fuss C, Song HK, Golwala H, Zahr F, Chadderdon SM. Hemodynamic and Conduction System Outcomes in Sievers Type 0 and Sievers Type 1 Bicuspid Aortic Valves Post Transcatheter Aortic Valve Replacement. STRUCTURAL HEART 2021. [DOI: 10.1080/24748706.2021.1883782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Boccalini S, Bons LR, van den Hoven AT, van den Bosch AE, Krestin GP, Roos-Hesselink J, Budde RPJ. Bicuspid aortic valve annulus: assessment of geometry and size changes during the cardiac cycle as measured with a standardized method to define the annular plane. Eur Radiol 2021; 31:8116-8129. [PMID: 33895857 PMCID: PMC8523432 DOI: 10.1007/s00330-021-07916-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/11/2021] [Accepted: 03/19/2021] [Indexed: 12/02/2022]
Abstract
Purpose Bicuspid aortic valve (BAV) is a complex malformation affecting not merely the aortic valve. However, little is known regarding the dynamic physiology of the aortic annulus in these patients and whether it is similar to tricuspid aortic valves (TAV). Determining the BAV annular plane is more challenging than for TAV. Our aim was to present a standardized methodology to determine BAV annulus and investigate its changes in shape and dimensions during the cardiac cycle. Methods BAV patients were prospectively included and underwent an ECG-gated cardiac CTA. The annulus plane was manually identified on reconstructions at 5% intervals of the cardiac cycle with a new standardized method for different BAV types. Based on semi-automatically defined contours, maximum and minimum diameter, area, area-derived diameter, perimeter, asymmetry ratio (AR), and relative area were calculated. Differences of dynamic annular parameters were assessed also per BAV type. Results Of the 55 patients included (38.4 ± 13.3 years; 58% males), 38 had BAV Sievers type 1, 10 type 0, and 7 type 2. The minimum diameter, perimeter, area, and area-derived diameter were significantly higher in systole than in diastole with a relative change of 13.7%, 4.8%, 13.7%, and 7.2% respectively (all p < 0.001). The AR was ≥ 1.1 in all phases, indicating an elliptic shape, with more pronounced flattening in diastole (p < 0.001). Different BAV types showed comparable dynamic changes. Conclusions BAV annulus undergo significant changes in shape during the cardiac cycle with a wider area in systole and a more elliptic conformation in diastole regardless of valve type. Key Points • A refined method for the identification of the annulus plane on CT scans of patients with bicuspid aortic valves, tailored for the specific anatomy of each valve type, is proposed. • The annulus of patients with bicuspid aortic valves undergoes significant changes during the cardiac cycle with a wider area and more circular shape in systole regardless of valve type. • As compared to previously published data, the bicuspid aortic valve annulus has physiological dynamics similar to that encountered in tricuspid valves but with overall larger dimensions. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07916-8.
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Affiliation(s)
- Sara Boccalini
- Department of Radiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Lidia R Bons
- Department of Cardiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Allard T van den Hoven
- Department of Cardiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Jolien Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Cardiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
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20
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Majmundar M, Kumar A, Doshi R, Shah P, Arora S, Shariff M, Adalja D, Visco F, Amin H, Vallabhajosyula S, Gullapalli N, Kapadia SR, Kalra A, Panaich SS. Meta-Analysis of Transcatheter Aortic Valve Implantation in Patients With Stenotic Bicuspid Versus Tricuspid Aortic Valve. Am J Cardiol 2021; 145:102-110. [PMID: 33460604 DOI: 10.1016/j.amjcard.2020.12.085] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/28/2020] [Accepted: 12/31/2020] [Indexed: 01/10/2023]
Abstract
Most of the trials investigating the role of transcatheter aortic valve implantation (TAVI) across various strata of risk categories have excluded patients with bicuspid aortic stenosis (BAS) due to its anatomical complexities. The aim of this study was to perform a meta-analysis with meta-regression of studies comparing clinical, procedural, and after-procedural echocardiographic outcomes in BAS versus tricuspid aortic stenosis (TAS) patients who underwent TAVI. We searched the PubMed and Cochrane databases for relevant articles from the inception of the database to October 2019. Continuous and categorical variables were pooled using inverse variance and Mantel-Haenszel method, respectively, using the random-effect model. To rate the certainty of evidence for each outcome, we used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. Nineteen articles were included in the final analysis. There was no difference in the risk of 30-day mortality, 1-year mortality, 30-day cardiovascular mortality, major and/or life-threatening bleeding, major vascular complications, acute kidney injury, permanent pacemaker implantation, device success, annular rupture, after-procedural aortic valve area, and mean pressure gradient between the 2 groups. BAS patients who underwent TAVI had a higher risk of 30-day stroke, conversion to surgery, need for second valve implantation, and moderate to severe paravalvular leak. In conclusion, the present meta-analysis supports the feasibility of TAVI in surgically ineligible patients with BAS. However, the incidence of certain procedural complications such as stroke, conversion to surgery, second valve implantation, and paravalvular leak is higher among BAS patients compared with TAS patients, which must be discussed with the patient during the decision-making process.
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21
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Saad M, Seoudy H, Frank D. Challenging Anatomies for TAVR-Bicuspid and Beyond. Front Cardiovasc Med 2021; 8:654554. [PMID: 33928138 PMCID: PMC8076502 DOI: 10.3389/fcvm.2021.654554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022] Open
Abstract
Transcatheter aortic valve replacement has emerged as the standard treatment for the majority of patients with symptomatic aortic stenosis. As transcatheter aortic valve replacement expands to patients across all risk groups, optimal patient selection strategies and device implantation techniques become increasingly important. A significant number of patients referred for transcatheter aortic valve replacement present with challenging anatomies and clinical indications that had been historically considered a contraindication for transcatheter aortic valve replacement. This article aims to highlight and discuss some of the potential obstacles that are encountered in clinical practice with a particular emphasis on bicuspid aortic valve disease.
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Affiliation(s)
- Mohammed Saad
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
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22
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Westin O, Lauridsen MD, Kristensen SL, Køber L, Torp-Pedersen C, Gislason G, Søndergaard L, Maurer MS, Leicht BP, Gustafsson F, Fosbøl EL. The association of prior carpal tunnel syndrome surgery with adverse cardiovascular outcomes and long-term mortality after aortic valve replacement. IJC HEART & VASCULATURE 2021; 33:100741. [PMID: 33732868 PMCID: PMC7944045 DOI: 10.1016/j.ijcha.2021.100741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 11/23/2022]
Abstract
AIMS Patients undergoing aortic valve replacement (AVR) for severe aortic stenosis have a 6-16% prevalence of occult cardiac amyloidosis. Carpal tunnel syndrome (CTS) is common in cardiac amyloidosis, but whether prior CTS surgery has a prognostic impact in patients undergoing AVR is unknown. This study examined the association between prior CTS surgery and adverse cardiovascular outcomes in patients treated with AVR. METHODS AND RESULTS Using Danish nationwide registries, we retrospectively identified patients undergoing first-time AVR from 2005 to 2018, examining the association between previous CTS and adverse cardiovascular outcomes the following 5 years after the AVR procedure. Cumulative incidence functions and adjusted Cox proportional hazard models were used to assess differences. Among 19,211 patients undergoing AVR, 2.5% (n = 472) had prior CTS surgery. Patients in the CTS-cohort were significantly older (median age 75.7 [IQR 68.1-82.3] vs 73.7 [IQR 66.0-79.6]), more often female and had more comorbidities. Prior CTS surgery was not associated with differences in hospitalization for heart failure (11.2% [95% CI 8.3-14.7] vs 9.4% [95% CI 9.0-9.9]), atrial fibrillation (11.1% [95% CI 8.2-14.5] vs 11.2% [95% CI 10.8-11.7]) or pacemaker implantation (6.2% [95% CI 4.0-9.0] vs 5.1% [95% CI 4.8-5.5]). The 5-year mortality (32.8% [27.6-38.0] vs 25.2% [24.5-25.9]) was higher in the CTS-cohort. CTS was significantly associated with increased 5-year mortality (HR 1.27 [1.05-1.53]) in crude models, however, after multivariable adjustment prior CTS surgery was not associated with adverse cardiovascular outcomes. CONCLUSION Previous CTS surgery was not associated with increased risk for adverse cardiovascular outcomes after AVR.
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Affiliation(s)
- Oscar Westin
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - Marie D. Lauridsen
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | | | - Lars Køber
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | | | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Søndergaard
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - Mathew S. Maurer
- Columbia University Irving Medical Center, New York, NY, United States
| | | | - Finn Gustafsson
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - Emil L. Fosbøl
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
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Comparison of the results of transcatheter aortic valve implantation in patients with bicuspid and tricuspid aortic valve. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:82-92. [PMID: 33868422 PMCID: PMC8039923 DOI: 10.5114/aic.2021.104773] [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: 10/08/2020] [Accepted: 02/13/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Indications for transcatheter aortic valve implantation (TAVI) are constantly expanding, including younger patients. Bicuspid aortic valves (BAV) often occur in this group. In order to achieve optimal treatment results in younger patients, it is necessary to develop an effective method for selecting the size of implanted valves. Aim To compare the results of TAVI with use of a self-expanding prosthesis in patients with a BAV and a tricuspid aortic valve (TAV) with valve selection based on annular sizing. Material and methods The diagnosis of BAV and TAV and measurements (annular sizing) were based on multi-slice computed tomography scans. Eighty-three patients received a self-expanding CoreValve or Evolut R prosthesis. In group I (BAV) there were 21 (25.3%) patients and in group II (TAV) there were 62 (74.7%) patients. Results The groups did not differ in terms of baseline clinical characteristics. Device success was achieved in 16 (76.2%) and 55 (88.7%) (p = NS) in group I and II respectively. Composite endpoints: early safety occurred in 5 (23.8%) and 11 (17.7%) patients (p =NS) in group I and II respectively; clinical efficacy occurred in 10 (47.6%) and 28 (45.2%) patients (p = NS) in group I and II respectively. 30-day mortality was 4.8% vs 9.7%, 1-year mortality was 28.6% vs 17.7% (p = NS) in group I and II respectively. Conclusions TAVI in patients with severe aortic stenosis and BAV is as effective as in patients with TAV using self-expanding prostheses if the valve selection is based on annular sizing.
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Vincent F, Ternacle J, Denimal T, Shen M, Redfors B, Delhaye C, Simonato M, Debry N, Verdier B, Shahim B, Pamart T, Spillemaeker H, Schurtz G, Pontana F, Thourani VH, Pibarot P, Van Belle E. Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Stenosis. Circulation 2021; 143:1043-1061. [PMID: 33683945 DOI: 10.1161/circulationaha.120.048048] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
After 15 years of successive randomized, controlled trials, indications for transcatheter aortic valve replacement (TAVR) are rapidly expanding. In the coming years, this procedure could become the first line treatment for patients with a symptomatic severe aortic stenosis and a tricuspid aortic valve anatomy. However, randomized, controlled trials have excluded bicuspid aortic valve (BAV), which is the most frequent congenital heart disease occurring in 1% to 2% of the total population and representing at least 25% of patients 80 years of age or older referred for aortic valve replacement. The use of a less invasive transcatheter therapy in this elderly population became rapidly attractive, and approximately 10% of patients currently undergoing TAVR have a BAV. The U.S. Food and Drug Administration and the "European Conformity" have approved TAVR for low-risk patients regardless of the aortic valve anatomy whereas international guidelines recommend surgical replacement in BAV populations. Given this progressive expansion of TAVR toward younger and lower-risk patients, heart teams are encountering BAV patients more frequently, while the ability of this therapy to treat such a challenging anatomy remains uncertain. This review will address the singularity of BAV anatomy and associated technical challenges for the TAVR procedure. We will examine and summarize available clinical evidence and highlight critical knowledge gaps regarding TAVR utilization in BAV patients. We will provide a comprehensive overview of the role of computed tomography scans in the diagnosis, and classification of BAV and TAVR procedure planning. Overall, we will offer an integrated framework for understanding the current role of TAVR in the treatment of bicuspid aortic stenosis and for guiding physicians in clinical decision-making.
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Affiliation(s)
- Flavien Vincent
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.).,Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- European Genomic Institute for Diabetes, F-59000 Lille, France (F.V., E.VB.).,Clinical Trials Center, Cardiovascular Research Foundation, New York (F.V., B.R., M. Simonato).,Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (F.V., J.T., M. Shen, P.P.)
| | - Julien Ternacle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (F.V., J.T., M. Shen, P.P.).,Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France (J.T.)
| | - Tom Denimal
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.)
| | - Mylène Shen
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (F.V., J.T., M. Shen, P.P.)
| | - Bjorn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York (F.V., B.R., M. Simonato)
| | - Cédric Delhaye
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.)
| | - Matheus Simonato
- Clinical Trials Center, Cardiovascular Research Foundation, New York (F.V., B.R., M. Simonato)
| | - Nicolas Debry
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.)
| | - Basile Verdier
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.)
| | - Bahira Shahim
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.)
| | - Thibault Pamart
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.)
| | - Hugues Spillemaeker
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.)
| | - Guillaume Schurtz
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.)
| | | | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA (V.H.T.)
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (F.V., J.T., M. Shen, P.P.)
| | - Eric Van Belle
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases (F.V., T.D., C.D., N.D., B.V., B.S., T.P., H.S., G.S., E.VB.).,Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- European Genomic Institute for Diabetes, F-59000 Lille, France (F.V., E.VB.)
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Jung JH, Kim HK, Park JB, Lee SP, Koo BK, Kim YJ, Kim HS, Sohn DW. Progression of ascending aortopathy may not occur after transcatheter aortic valve replacement in severe bicuspid aortic stenosis. Korean J Intern Med 2021; 36:332-341. [PMID: 31408927 PMCID: PMC7969055 DOI: 10.3904/kjim.2019.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/16/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND/AIMS We evaluated changes in the ascending aorta dimension post-transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BiAV) and tricuspid aortic valve (TAV) patients. METHODS Patients with severe aortic stenosis undergoing TAVR at Seoul National University Hospital were consecutively recruited. Patients with less than 12 months' follow-up and/or with an ascending aorta size larger than 50 mm were excluded. The ascending aorta size was measured on a parasternal long axis view using transthoracic echocardiography. RESULTS Among the 67 patients who were included (age: 76.5 ± 6.5 years; male: 52.2%; AV area: 0.67 ± 0.15 cm2), 19 (28.4%) had BiAV; 48 (71.6%) had TAV. The median (interquartile ranges) follow-up duration was 398 days (361 to 451). BiAV patients were younger (73.2 ± 7.2 vs. 77.8 ± 5.8, p = 0.008), and had lower incidences of chronic renal disease (5.3% vs. 35.4%, p = 0.014) and history of coronary intervention (15.8% vs. 50.0%, p = 0.013), than TAV patients. On pre-procedural echocardiography, the ascending aorta dimensions in BiAV patients were larger than those in TAV patients (40.5 ± 3.8 mm vs. 35.9 ± 4.2 mm, p < 0.005). The ascending aorta dimension changed minimally during follow-up; post-TAVR, the ascending aorta's growth rate was -0.11 ± 1.9 and 0.26 ± 1.8 mm/yr in patients with BiAV and TAV, respectively (p = 0.50). Progression of the ascending aorta's dimension postTAVR was not clinically significant in BiAV patients. CONCLUSION The concern about the progression of aortopathy in BiAV patients post-TAVR may not be a clinical issue. This should be confirmed in studies with a larger population and with a longer follow-up duration.
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Affiliation(s)
- Ji-Hyun Jung
- Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Correspondence to Hyung-Kwan Kim, M.D. Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-0243 Fax: +82-2-766-8904 E-mail:
| | - Jun-Bean Park
- Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bon-Kwon Koo
- Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yong-Jin Kim
- Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyo-Soo Kim
- Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dae-Won Sohn
- Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Sá MPBO, Simonato M, Van den Eynde J, Cavalcanti LRP, Alsagheir A, Tzani A, Fovino LN, Kampaktsis PN, Gallo M, Laforgia PL, Ruhparwar A, Weymann A, Hirji SA, Kaneko T, H L Tang G. Balloon versus self-expandable transcatheter aortic valve implantation for bicuspid aortic valve stenosis: A meta-analysis of observational studies. Catheter Cardiovasc Interv 2021; 98:E746-E757. [PMID: 33555107 DOI: 10.1002/ccd.29538] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/15/2020] [Accepted: 01/17/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is a rising trend for transcatheter aortic valve implantation (TAVI) in bicuspid aortic stenosis patients. Data on the use of self-expandable (SEV) vs. balloon-expandable (BEV) valves in these patients are scarce. Therefore, we systematically compared clinical outcomes in bicuspid aortic stenosis patients treated with SEV and BEV. METHODS Data were extracted from PubMed/MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, Google Scholar and reference lists of relevant articles. Eight studies published from 2013 to 2020 including a total of 1,080 patients (BEV: n = 620; SEV: n = 460) were selected. Primary endpoints were procedural, 30-day and 1-year mortality. Secondary endpoints were new pacemaker implantation, annular rupture, coronary obstruction, moderate-to-severe paravalvular leak, need of second valve, stroke and acute kidney injury. RESULTS We found no statistically significant difference in mortality between patients treated with BEV vs. SEV during index procedure, at 30 days and at 1 year. BEVs showed a statistically significant higher risk of annulus rupture (2.5%) in comparison with SEV (0%) (OR 5.81 [95% CI, 3.78-8.92], p < .001). New generation BEVs were also associated with significantly less paravalvular leak when compared to new generation SEVs (OR 0.08 [95% CI, 0.02-0.35], p = .001). CONCLUSIONS This meta-analysis of observational studies of TAVI for bicuspid valves, showed no difference in short- and mid-term TAVI mortality with BEVs and SEVs. BEVs presented a higher risk of annular rupture in comparison with SEV.
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Affiliation(s)
- Michel Pompeu B O Sá
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco-PROCAPE, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Matheus Simonato
- Division of Cardiac Surgery, Escola Paulista de Medicina-UNIFESP, São Paulo, São Paulo, Brazil
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Luiz Rafael P Cavalcanti
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco-PROCAPE, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Ali Alsagheir
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Division of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Aspasia Tzani
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Michele Gallo
- Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Pietro L Laforgia
- I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Sameer A Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, New York, USA
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Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, Komiya T, Shibata T, Seo Y, Daimon M, Takanashi S, Tanaka H, Nakatani S, Ninami H, Nishi H, Hayashida K, Yaku H, Yamaguchi J, Yamamoto K, Watanabe H, Abe Y, Amaki M, Amano M, Obase K, Tabata M, Miura T, Miyake M, Murata M, Watanabe N, Akasaka T, Okita Y, Kimura T, Sawa Y, Yoshida K. JCS/JSCS/JATS/JSVS 2020 Guidelines on the Management of Valvular Heart Disease. Circ J 2020; 84:2037-2119. [DOI: 10.1253/circj.cj-20-0135] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kiyoyuki Eishi
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women’s Medical University Hospital
| | - Takeshi Arita
- Division of Cardiovascular Medicine Heart & Neuro-Vascular Center, Fukuoka Wajiro
| | - Yutaka Otsuji
- Department of Cardiology, Hospital of University of Occupational and Environmental Health
| | - Takashi Kunihara
- Department of Cardiac Surgery, The Jikei University School of Medicine
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Postgraduate of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- Department of Clinical Laboratory/Cardiology, The University of Tokyo Hospital
| | | | | | - Satoshi Nakatani
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Hiroshi Ninami
- Department of Cardiac Surgery, Tokyo Women’s Medical University
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center
| | | | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | | | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | | | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kikuko Obase
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Takashi Miura
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Mitsushige Murata
- Department of Laboratory Medicine, Tokai University Hachioji Hospital
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Takatsuki Hospital
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Kiyoshi Yoshida
- Department of Cardiology, Sakakibara Heart Institute of Okayama
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Sá MPBO, Simonato M, Van den Eynde J, Cavalcanti LRP, Roever L, Bisleri G, Dokollari A, Dvir D, Zhigalov K, Ruhparwar A, Weymann A. Asymptomatic severe aortic stenosis, bicuspid aortic valves and moderate aortic stenosis in heart failure: New indications for transcatheter aortic valve implantation. Trends Cardiovasc Med 2020; 31:435-445. [PMID: 33065313 DOI: 10.1016/j.tcm.2020.10.002] [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] [Received: 07/19/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 11/15/2022]
Abstract
Aortic stenosis (AS) remains one of the most common valvular heart diseases, with enormous impact on patient survival. Over the past years, transcatheter aortic valve implantation (TAVI) has become a reality worldwide, offering a less invasive method to treat AS. Apart from the classical indications for aortic valve disease, recent studies tried to address unanswered questions for TAVI - asymptomatic severe AS, bicuspid aortic valves and moderate AS in patients with heart failure. This review discusses the rationale of those possible indications, pitfalls and current evidence in the medical literature.
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Affiliation(s)
- Michel Pompeu B O Sá
- Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, University of Pernambuco, Pernambuco, Brazil
| | - Matheus Simonato
- Division of Cardiac Surgery, Escola Paulista de Medicina - UNIFESP, São Paulo, Brazil
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, and Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Luiz Rafael P Cavalcanti
- Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, University of Pernambuco, Pernambuco, Brazil
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Minas Gerais, Brazil
| | | | | | - Danny Dvir
- Division of Cardiology, University of Washington, Washington, United States of America
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Essen, Germany
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Annular versus supra-annular sizing for transcatheter aortic valve replacement in bicuspid aortic valve disease. J Cardiovasc Comput Tomogr 2020; 14:407-413. [DOI: 10.1016/j.jcct.2020.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/19/2019] [Accepted: 01/23/2020] [Indexed: 11/21/2022]
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Yoon SH, Kim WK, Dhoble A, Milhorini Pio S, Babaliaros V, Jilaihawi H, Pilgrim T, De Backer O, Bleiziffer S, Vincent F, Shmidt T, Butter C, Kamioka N, Eschenbach L, Renker M, Asami M, Lazkani M, Fujita B, Birs A, Barbanti M, Pershad A, Landes U, Oldemeyer B, Kitamura M, Oakley L, Ochiai T, Chakravarty T, Nakamura M, Ruile P, Deuschl F, Berman D, Modine T, Ensminger S, Kornowski R, Lange R, McCabe JM, Williams MR, Whisenant B, Delgado V, Windecker S, Van Belle E, Sondergaard L, Chevalier B, Mack M, Bax JJ, Leon MB, Makkar RR. Bicuspid Aortic Valve Morphology and Outcomes After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 76:1018-1030. [DOI: 10.1016/j.jacc.2020.07.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/09/2020] [Accepted: 07/02/2020] [Indexed: 11/24/2022]
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Haunschild J, Misfeld M, Schroeter T, Lindemann F, Davierwala P, von Aspern K, Spampinato RA, Weiss S, Borger MA, Etz CD. Prevalence of permanent pacemaker implantation after conventional aortic valve replacement—a propensity-matched analysis in patients with a bicuspid or tricuspid aortic valve: a benchmark for transcatheter aortic valve replacement. Eur J Cardiothorac Surg 2020; 58:130-137. [DOI: 10.1093/ejcts/ezaa053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 01/24/2020] [Accepted: 01/29/2020] [Indexed: 12/13/2022] Open
Abstract
Abstract
OBJECTIVES
Elective treatment of aortic valve disease by transcatheter aortic valve replacement (TAVR) is becoming increasingly popular, even in patients with low risk and intermediate risk. Even patients with a bicuspid aortic valve (BAV) are increasingly considered eligible for TAVR. Permanent pacemaker implantation (PMI) is a known—frequently understated—complication of TAVR affecting 9–15% of TAVR patients with a potentially significant impact on longevity and quality of life. BAV patients are affected by the highest PMI rates, although they are frequently younger compared to their tricuspid peers. The aim of the study is to report benchmark data—from a high-volume centre (with a competitive TAVR programme) on PMI after isolated surgical aortic valve replacement (SAVR) in patients with BAV and tricuspid aortic valve (TAV).
METHODS
We performed a retrospective single-centre analysis on 4154 patients receiving isolated SAVRs (w/o concomitant procedures), between 2000 and 2019, of whom 1108 had BAV (27%). PMI rate and early- and long-term outcomes were analysed. For better comparability of these demographically unequal cohorts, 1:1 nearest neighbour matching was performed.
RESULTS
At the time of SAVR, BAV patients were on average 10 years younger than their TAV peers (59.7 ± 12 vs 69.3 ± 9; P < 0.001) and had less comorbidities; all relevant characteristics were equally balanced after statistical matching. Overall PMI rate was significantly higher in BAV patients (5.4% vs 3.8%; P = 0.03). BAV required PMI exclusively (100%) and TAV required predominately (96%) for persistent postoperative high-degree atrioventricular block. After matching, the PMI rate was similar (5.1% vs 4.4%, P = 0.5). In-hospital mortality in the matched cohort was 1% in both groups. Long-term survival was more favourable in BAV patients (94% vs 90% in TAV at 5 years; 89% vs 82% in TAV at 9 years; P = 0.013).
CONCLUSIONS
With SAVR, the overall incidence of PMI among BAV patients seems significantly higher; however, after propensity matching, no difference in PMI rates between BAV and TAV is evident. The PMI rate was remarkably lower among BAV patients after SAVR compared to the reported incidence after TAVR.
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Affiliation(s)
- Josephina Haunschild
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Martin Misfeld
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Thomas Schroeter
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Frank Lindemann
- Department of Electrophysiology, Leipzig Heart Center, Leipzig, Germany
| | - Piroze Davierwala
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | | | - Ricardo A Spampinato
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Stefan Weiss
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Christian D Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
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Pasta S, Cannata S, Gentile G, Di Giuseppe M, Cosentino F, Pasta F, Agnese V, Bellavia D, Raffa GM, Pilato M, Gandolfo C. Simulation study of transcatheter heart valve implantation in patients with stenotic bicuspid aortic valve. Med Biol Eng Comput 2020; 58:815-829. [DOI: 10.1007/s11517-020-02138-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 01/22/2020] [Indexed: 12/19/2022]
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Quintana RA, Monlezun D, Davogustto G, Saenz H, Lugo Baruqui D, Denktas AE, Jneid H, Paniagua D. Network Analysis of Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement for Stenotic Bicuspid Aortic Valves According to Valve Type. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1076-1085. [PMID: 31980400 DOI: 10.1016/j.carrev.2020.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND It is currently unknown if outcomes after transcatheter aortic valve replacement (TAVR) differ according to the prosthetic valve deployed in patients with bicuspid aortic valves (BAV). OBJECTIVES This study evaluated valve-specific outcomes post-TAVR in patients with BAV. METHODS Literature search was performed using the Cochrane databases, PubMed, ClinicalTrials, SCOPUS and EMBASE databases from inception until July 2018. We computed risk ratios and their 95% confidence intervals for all outcomes of interest. For each outcome, the data were pooled using a multivariate random-effects meta-analysis including multiple treatment as well as direct and indirect comparisons. RESULTS Ten studies enrolling a total of 1547 BAV patients undergoing TAVR using 6 different prosthetic valve types were analyzed. There were no significant differences in 30-day all-cause mortality, life-threatening bleeding and device success among the diverse prosthetic valve types implanted. However, 2nd generation balloon-expandable valves had consistently lower risk of moderate-to-severe prosthetic valve regurgitation. CONCLUSION In patients with BAV, there were no significant differences in 30-day all-cause mortality after TAVR among the various prosthetic valve types.
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Affiliation(s)
- Raymundo A Quintana
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Dominique Monlezun
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Giovanni Davogustto
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Humberto Saenz
- Division of Geriatrics, Department of Internal Medicine, University of California San Diego, San Diego, CA, USA.
| | - Diego Lugo Baruqui
- Department of Internal Medicine, Mount Sinai Medical Center, Miami, FL, USA
| | - Ali E Denktas
- Division of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, TX, USA.
| | - Hani Jneid
- Division of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, TX, USA.
| | - David Paniagua
- Division of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, TX, USA.
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Ueshima D, Nai Fovino L, Brener SJ, Fabris T, Scotti A, Barioli A, Giacoppo D, Pavei A, Fraccaro C, Napodano M, Tarantini G. Transcatheter aortic valve replacement for bicuspid aortic valve stenosis with first- and new-generation bioprostheses: A systematic review and meta-analysis. Int J Cardiol 2020; 298:76-82. [DOI: 10.1016/j.ijcard.2019.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 01/10/2023]
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Yucel-Finn A, Nicol E, Leipsic JA, Weir-McCall JR. CT in planning transcatheter aortic valve implantation procedures and risk assessment. Clin Radiol 2019; 76:73.e1-73.e19. [PMID: 31883615 DOI: 10.1016/j.crad.2019.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/13/2019] [Indexed: 12/31/2022]
Abstract
For surgical aortic valve replacement, the Society of Thoracic Surgeons score (STSS) is the reference standard for the prediction of operative risk. In transcatheter aortic valve implantation (TAVI) though, where the procedure itself is minimally invasive, the traditional risk assessment is supplemented by CTA. Through a consistent approach to the acquisition of high-quality images and the standardised reporting of annular measurements and adverse root and vascular features, patients at risk of complications can be identified. In turn, this may allow for a personalised procedural approach and treatment strategies devised to potentially reduce or mitigate this risk. This article provides a systematic and standardised approach to pre-procedural work-up with computed tomography angiography (CTA) and explores the current state of evidence and future areas of development in this rapidly developing field.
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Affiliation(s)
| | - E Nicol
- Royal Brompton Hospital, London, UK
| | - J A Leipsic
- St Paul's Hospital, Vancouver, British Columbia, Canada
| | - J R Weir-McCall
- Royal Papworth Hospital, Cambridge, UK; University of Cambridge School of Clinical Medicine, Cambridge, UK.
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36
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Ng VG, Hahn RT, Nazif TM. Planning for Success: Pre-procedural Evaluation for Transcatheter Aortic Valve Replacement. Cardiol Clin 2019; 38:103-113. [PMID: 31753169 DOI: 10.1016/j.ccl.2019.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Vivian G Ng
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY 10032, USA
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY 10032, USA
| | - Tamim M Nazif
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY 10032, USA.
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Sathananthan J, Hensey M, Landes U, Alkhodair A, Saiduddin A, Sellers S, Cheung A, Lauck S, Blanke P, Leipsic J, Ye J, Wood DA, Webb JG. Long-Term Durability of Transcatheter Heart Valves: Insights From Bench Testing to 25 Years. JACC Cardiovasc Interv 2019; 13:235-249. [PMID: 31575516 DOI: 10.1016/j.jcin.2019.07.049] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/03/2019] [Accepted: 07/30/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study assessed the long-term durability of nominally deployed transcatheter heart valves (THV) to 1 billion cycles (equivalent to 25 years) and non-nominal (overexpansion, underexpansion, and elliptical) THV deployments to 200 million cycles (equivalent to 5 years) with accelerated wear testing. BACKGROUND The long-term durability of THVs is currently unknown. As transcatheter aortic valve replacement expands to lower-risk patients, durability will be of increasing importance. METHODS SAPIEN 3 THVs, sized 20, 23, 26, and 29 mm were assessed. Nominally deployed THVs underwent hydrodynamic performance and mechanical durability as assessed with accelerated wear testing to 1 billion cycles. Magna Ease surgical valves were used as comparators. Durability of non-nominal THV deployments was tested to 200 million cycles. Valves were tested to International Standards Organization 5840:2013 standard. RESULTS THV durability was excellent for both the nominal and non-nominal THV deployments to 1 billion and 200 million cycles, respectively. At 1 billion cycles the regurgitant fraction for the 20-, 23-, 26-, and 29-mm SAPIEN 3 was 0.92 ± 0.47%, 1.29 ± 0.04%, 1.73 ± 0.46%, and 2.47 ± 0.15%, respectively. There was also excellent durability in the comparator Magna Ease valves. The regurgitant fraction of non-nominal overexpanded (20 mm, 4.36 ± 0.53; 23 mm, 7.68 ± 1.39; 26 mm, 6.80 ± 1.17; 29 mm, 9.00 ± 0.37), underexpanded (20 mm, 3.06 ± 0.28; 23 mm, 4.46 ± 0.45; 26 mm, 7.72 ± 0.48; 29 mm, 8.65 ± 2.01), and elliptical (20 mm, 3.30 ± 0.38; 23 mm, 6.13 ± 0.94; 26 mm, 6.77 ± 1.22; 29 mm, 8.72 ± 0.24) THVs were excellent at 200 million cycles. CONCLUSIONS Nominal SAPIEN 3 THVs demonstrated excellent durability, to an equivalent of 25-years wear. THV durability was similar to the comparator surgical valves tested. Non-nominal (overexpansion, underexpansion, and elliptical) THV deployments also had excellent durability to an equivalent of 5 years wear.
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Affiliation(s)
- Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Mark Hensey
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Uri Landes
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Abdullah Alkhodair
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | | | | | - Anson Cheung
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Sandra Lauck
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jonathon Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - David A Wood
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
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Takaoka H, Kitahara H, Ota J, Suzuki-Eguchi N, Sasaki H, Mori N, Takahashi M, Iida Y, Matsuura K, Nakayama T, Matsumiya G, Kobayashi Y. Utility of computed tomography in cases of aortic valve stenosis before and after transcatheter aortic valve implantation. Cardiovasc Interv Ther 2019; 35:72-84. [PMID: 31512054 DOI: 10.1007/s12928-019-00618-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/29/2019] [Indexed: 01/04/2023]
Abstract
Trans-catheter aortic valve implantation (TAVI) has been recognized as a useful treatment for patients with severe aortic valve stenosis, particularly those with moderate to high risks of open heart surgery. A thorough evaluation of the aortic valve complex, including the size or presence of calcifications of the leaflets and annulus, is important for the selection of appropriate candidates, artificial valve types and approach. Echocardiography is useful for the precise evaluation of aortic valve stenosis severity and aortic valve complex morphology, but it is not useful to evaluate three-dimensional aortic valve anatomy and pathway for the catheter of aortic valve implantation. Electrocardiography (ECG)-gating computed tomography (CT) has recently been recognized as a useful modality for evaluating significant coronary artery stenosis because of its higher spatial and temporal resolution and diagnostic accuracy based on recent studies. ECG-gating CT is also useful for evaluating aortic valve complex morphology, including calcifications and whole aorta and iliac arteries, as the access route of catheter in TAVI. TAVI candidates, who are at high risk of open surgery, tend to be old and require anti-platelet after TAVI; therefore CT, is also useful for screening for non-cardiac diseases including malignant tumors just before TAVI. Therefore, here we introduce the utility of cardiac and whole body CT in cases of severe aortic valve stenosis before and after TAVI.
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Affiliation(s)
- Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Inohana 1-8-1, Cuo-ku, Chiba, Japan.
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Inohana 1-8-1, Cuo-ku, Chiba, Japan
| | - Joji Ota
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Noriko Suzuki-Eguchi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Inohana 1-8-1, Cuo-ku, Chiba, Japan
| | - Haruka Sasaki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Inohana 1-8-1, Cuo-ku, Chiba, Japan
| | - Naoto Mori
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Inohana 1-8-1, Cuo-ku, Chiba, Japan
| | - Manami Takahashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Inohana 1-8-1, Cuo-ku, Chiba, Japan
| | - Yasunori Iida
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Kaoru Matsuura
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takashi Nakayama
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Inohana 1-8-1, Cuo-ku, Chiba, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Inohana 1-8-1, Cuo-ku, Chiba, Japan
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Attinger‐Toller A, Bhindi R, Perlman GY, Murdoch D, Weir‐McCall J, Blanke P, Barbanti M, Sathananthan J, Ruile P, Gandolfo C, Saia F, Nietlispach F, Wood D, Leipsic J, Webb JG. Mid‐term outcome in patients with bicuspid aortic valve stenosis following transcatheter aortic valve replacement with a current generation device: A multicenter study. Catheter Cardiovasc Interv 2019; 95:1186-1192. [DOI: 10.1002/ccd.28475] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/24/2019] [Accepted: 08/12/2019] [Indexed: 11/10/2022]
Affiliation(s)
| | - Rahul Bhindi
- Department of CardiologySt. Paul's Hospital, Vancouver British Columbia Canada
| | - Gidon Y. Perlman
- Department of CardiologyHadassah Hebrew University Medical Center Jerusalem Israel
| | - Dale Murdoch
- Department of CardiologySt. Paul's Hospital, Vancouver British Columbia Canada
- Department of CardiologyThe Prince Charles Hospital Brisbane Australia
- School of MedicineUniversity of Queensland Brisbane Australia
| | | | - Philipp Blanke
- Department of CardiologySt. Paul's Hospital, Vancouver British Columbia Canada
| | - Marco Barbanti
- Department of CardiologyFerrarotto Hospital, University of Catania Catania Italy
| | | | - Philipp Ruile
- Department of Cardiology & Angiology IIUniversity Heart Center Freiburg‐Bad Krozingen Germany
| | | | - Francesco Saia
- Cardiovascular DepartmentInstitute of Cardiology, University of Bologna, Policlinico St. Orsola‐Malpighi Bologna Italy
| | | | - David Wood
- Department of CardiologySt. Paul's Hospital, Vancouver British Columbia Canada
| | - Jonathon Leipsic
- Department of CardiologySt. Paul's Hospital, Vancouver British Columbia Canada
| | - John G. Webb
- Department of CardiologySt. Paul's Hospital, Vancouver British Columbia Canada
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Kochman J, Zbroński K, Kołtowski Ł, Parma R, Ochała A, Huczek Z, Rymuza B, Wilimski R, Dąbrowski M, Witkowski A, Scisło P, Grygier M, Lesiak M, Opolski G. Transcatheter aortic valve implantation in patients with bicuspid aortic valve stenosis utilizing the next-generation fully retrievable and repositionable valve system: mid-term results from a prospective multicentre registry. Clin Res Cardiol 2019; 109:570-580. [PMID: 31478072 PMCID: PMC7182541 DOI: 10.1007/s00392-019-01541-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/22/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the outcomes of transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BiAV) stenosis using a mechanically expanded Lotus™ device. The prior experience with first-generation devices showed disappointing results mainly due to increased prevalence of aortic regurgitation (AR) that exceeded those observed in tricuspid stenosis. METHODS AND RESULTS We collected baseline, in-hospital, 30-day and 2-year follow-up data from a prospective, multicentre registry of patients with BiAV undergoing TAVI using Lotus™ valve. Safety and efficacy endpoints were assessed according to VARC-2 criteria. The study group comprised 24 patients. The mean age was 73.5 years and the mean EuroSCORE 2 was 4.35 ± 2.56%. MDCT analysis revealed Type 1 BiAV in 75% of patients. The mean gradient decreased from 60.1 ± 18.3 to 15 ± 6.4 mm Hg, the AVA increased from 0.6 ± 0.19 to 1.7 ± 0.21 cm2. One in-hospital death was observed secondary to aortic perforation. There was no severe AR and the rate of moderate AR equalled 9% at 30 days (n = 2). Device success was achieved in 83% and the 30-day safety endpoint was 17%. In the 2-year follow-up, the overall mortality was 12.5% and the 2-year composite clinical efficacy endpoint was met in 25% of the patients (n = 6) CONCLUSIONS: The TAVI in selected BiAV patients using the Lotus™ is feasible and characterized by encouraging valve performance and mid-term clinical outcomes.
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Affiliation(s)
- Janusz Kochman
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1a, PL, 02-097, Warsaw, Poland
| | - Karol Zbroński
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1a, PL, 02-097, Warsaw, Poland.
| | - Łukasz Kołtowski
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1a, PL, 02-097, Warsaw, Poland
| | | | | | - Zenon Huczek
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1a, PL, 02-097, Warsaw, Poland
| | - Bartosz Rymuza
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1a, PL, 02-097, Warsaw, Poland
| | - Radosław Wilimski
- Department of Cardiac Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Dąbrowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Piotr Scisło
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1a, PL, 02-097, Warsaw, Poland
| | - Marek Grygier
- Department of Cardiology, Poznan University of Medical Science, Poznan, Poland
| | - Maciej Lesiak
- Department of Cardiology, Poznan University of Medical Science, Poznan, Poland
| | - Grzegorz Opolski
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1a, PL, 02-097, Warsaw, Poland
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Alkhalil M, Brennan P, McQuillan C, Jeganathan R, Manoharan G, Owens CG, Spence MS. Flow, Reflected by Stroke Volume Index, Is a Risk Marker in High-Gradient Aortic Stenosis Patients Undergoing Transcatheter Aortic Valve Replacement. Can J Cardiol 2019; 36:112-118. [PMID: 31785992 DOI: 10.1016/j.cjca.2019.08.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/18/2019] [Accepted: 08/21/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Tools are needed to identify patients at increased risk after transcatheter aortic valve replacement (TAVR). Indexed stroke volume (SVi) is an echocardiographic measurement that is used for low-gradient aortic stenosis. We studied whether low SVi is a high-risk marker in patients with high-gradient aortic stenosis (HG-AS) and assessed the relationship between SVi and left ventricle (LV) systolic function in contributing to this risk. METHODS A total of 816 consecutive patients who underwent TAVR were screened, and only patients with HG-AS were included. Low flow (LF) was defined as SVi ≤ 35 mL/m2. The primary endpoint was defined as a combination of all-cause mortality and readmission with heart failure at 1 year. RESULTS Of the 476 patients with HG-AS, 215 (45%) had LF. They had higher N-terminal pro b-type natriuretic peptide (NTproBNP) (2565 [1037-5492] vs 1730 [818-3575], P = 0.006) and smaller indexed valve area (0.30 ± 0.10 vs 0.37 ± 0.10 cm2/m2, P < 0.001) when compared with normal flow patients. The primary endpoint was higher in LF patients (hazard ratio, 1.49; 95% confidence interval, 1.01-2.21; P = 0.045). There were no statistical differences in the individual components of death (13.0% vs 8.9%, P = 0.16) or heart failure (14.9% vs 10.1%, P = 0.12). When stratified according to LV function, low SVi was associated with future adverse events in patients with reduced function (hazard ratio, 3.37; 95% confidence interval, 1.26-8.98; P = 0.015) with comparable clinical outcomes in those with preserved function. LF was an independent predictor of adverse events in the reduced LV function subgroup. CONCLUSIONS SVi can further characterize patients with HG-AS and may help to identify those who are at increased risk after TAVR.
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Affiliation(s)
- Mohammad Alkhalil
- Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom.
| | - Paul Brennan
- Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom
| | - Conor McQuillan
- Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom
| | - Reuben Jeganathan
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, United Kingdom
| | - Ganesh Manoharan
- Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom
| | - Colum G Owens
- Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom
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Yue B, Ye P, Liu B, Chang Z. Fabrication and characterization of a large medical balloon with ultra-high strength. Technol Health Care 2019; 27:129-135. [PMID: 30664516 DOI: 10.3233/thc-181539] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has emerged as a promising treatment strategy for patients with severe symptomatic aortic stenosis (AS). Moreover, characteristics of Chinese patients that are different from those of patients in Western countries, such as a high prevalence of bicuspid aortic valve (BAV), severe calcification, and a small peripheral artery diameter, have been observed. OBJECTIVE A novel large medical balloon with ultra-high strength was fabricated through the blending modification of PA12/TR55. METHODS The mechanical properties, particularly puncture resistance, of large balloons were thoroughly studied, and TR55, a modified nylon pellet with good mechanical properties and excellent compatibility with PA12, was applied to modify PA12. RESULTS Compared with pure PA12, the fabricated PA12/TR55 balloon exhibited a higher bursting pressure, lower compliance, and higher punctures resistance while retaining good processability and excellent biocompatibility. The improved mechanical properties can be attributed to an increase in crystallinity and densification. CONCLUSIONS The PA12/TR55 balloon is suitable for Chinese patients with bicuspid aortic valve and severe calcification and therefore has potential for clinical application in transcatheter aortic valve implantation. Moreover, this blending modification provides a simple but efficient method of solving other problems in cardiac angioplasty or cryoablation in which mechanical reinforcement of balloons may be necessary.
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Biomechanical modeling of transcatheter aortic valve replacement in a stenotic bicuspid aortic valve: deployments and paravalvular leakage. Med Biol Eng Comput 2019; 57:2129-2143. [PMID: 31372826 DOI: 10.1007/s11517-019-02012-y] [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] [Received: 11/26/2018] [Accepted: 07/08/2019] [Indexed: 12/17/2022]
Abstract
Calcific aortic valve disease (CAVD) is characterized by stiffened aortic valve leaflets. Bicuspid aortic valve (BAV) is the most common congenital heart disease. Transcatheter aortic valve replacement (TAVR) is a treatment approach for CAVD where a stent with mounted bioprosthetic valve is deployed on the stenotic valve. Performing TAVR in calcified BAV patients may be associated with post-procedural complications due to the BAV asymmetrical structure. This study aims to develop refined computational models simulating the deployments of Evolut R and PRO TAVR devices in a representative calcified BAV. The paravalvular leakage (PVL) was also calculated by computational fluid dynamics simulations. Computed tomography scan of severely stenotic BAV patient was acquired. The 3D calcium deposits were generated and embedded inside a parametric model of the BAV. Deployments of the Evolut R and PRO inside the calcified BAV were simulated in five bioprosthesis leaflet orientations. The hypothesis of asymmetric and elliptic stent deployment was confirmed. Positioning the bioprosthesis commissures aligned with the native commissures yielded the lowest PVL (15.7 vs. 29.5 mL/beat). The Evolut PRO reduced the PVL in half compared with the Evolut R (15.7 vs. 28.7 mL/beat). The proposed biomechanical computational model could optimize future TAVR treatment in BAV patients. Graphical abstract.
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Takagi H, Hari Y, Kawai N, Kuno T, Ando T. Meta-analysis of transcatheter aortic valve implantation for bicuspid versus tricuspid aortic valves. J Cardiol 2019; 74:40-48. [DOI: 10.1016/j.jjcc.2019.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/23/2019] [Accepted: 03/22/2019] [Indexed: 01/10/2023]
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Hwang IC, Hayashida K, Kim HS. Current Key Issues in Transcatheter Aortic Valve Replacement Undergoing a Paradigm Shift. Circ J 2019; 83:952-962. [PMID: 30956265 DOI: 10.1253/circj.cj-19-0096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As a new technology in the management of valvular heart disease, transcatheter aortic valve replacement (TAVR) has drawn much attention since its emergence. To date, numerous studies have investigated the safety and efficacy of TAVR in patients of various risk profiles with severe aortic stenosis (AS) and demonstrated comparable or superior outcomes of TAVR when compared with surgical aortic valve replacement (SAVR). The favorable outcomes of TAVR in inoperable patients, as well as in high- and intermediate-risk patients, are endorsed in current guidelines, and trials of low-risk patients have shown non-inferior or even superior results of TAVR than for SAVR, suggesting that the clinical indications of TAVR can be expanded to low-risk patients. Moreover, a therapeutic role of TAVR has been suggested in various aortic valve (AV) diseases, such as bicuspid AV, moderate AS with heart failure, aortic regurgitation, and bioprosthetic valve failure. In this review, we summarize the current issues of TAVR in various patient populations and discuss the expanding clinical indications of TAVR, which are driving a major paradigm shift in the management of AV disease.
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Affiliation(s)
- In-Chang Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital.,Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital
| | | | - Hyo-Soo Kim
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital
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Howard C, Picca L, Smith T, Sharif M, Bashir M, Harky A. The bicuspid aortic valve: Is it an immunological disease process? J Card Surg 2019; 34:482-494. [PMID: 31012137 DOI: 10.1111/jocs.14050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 01/03/2023]
Abstract
Bicuspid aortic valves (BAVs) are the most common congenital cardiac condition and are characterized by a structural abnormality whereby the aortic valve is composed of two leaflets instead of being trileaflet. It is linked to an increased risk for a variety of complications of the aorta, many with an immunological pathogenesis. The aim of this study is to review and analyze the literature regarding immunological processes involving BAVs, associated common pathologies, and their incidence in the population. This study will also examine current trends in surgical and therapeutic approaches to treatment and discuss the future direction of BAV treatment.
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Affiliation(s)
- Callum Howard
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Leonardo Picca
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tristan Smith
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Monira Sharif
- Department of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Mohamad Bashir
- Department of Emergency Medicine and Surgery, Macclesfield General Hospital, Macclesfield, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
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Bob-Manuel T, Heckle MR, Ifedili IA, Wang J, Ibebuogu UN. Outcomes of transcatheter aortic valve replacement in bicuspid aortic valve stenosis. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:102. [PMID: 31019952 DOI: 10.21037/atm.2019.02.04] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Due to abnormal valve geometry, patients with bicuspid aortic valve (BAV) have been excluded in many transcatheter aortic valve replacement (TAVR) trials resulting in very limited data with regards to its safety and efficacy. Methods We searched electronic databases including Cochrane Database of Systematic Reviews, MEDLINE and EMBASE for all studies including case series, and original reports published before December 2018 that assessed outcomes following TAVR in BAV stenosis. We also included studies that had patients with TAV for comparison. Pooled effect size was calculated with a random-effect model and weighted for the inverse of variance, to compare outcomes post-TAVR between BAV and TAV. The heterogeneity of effect estimates across the studies was assessed using I2. Publication bias was assessed with funnel plots. Statistical analysis was performed using SPSS version 24 (IBM Corp., SPSS Statistics for Windows, Version 24.0. Armonk, NY.). Results A total of 19 studies describing 1,332 patients with BAV and 3,610 with TAV. There was no significant difference in the30-day mortality between patients with BAV and TAV [odds ratio (OR): 1.18, 95% confidence interval (CI): 0.7-1.7, P=0.41, I2=0]. One-year mortality rate in the BAV population was 13.1% compared to 15.4% in the TAV patients (P=0.75). Patients with BAV had significantly more moderate to severe paravalvular leak (PVL) post TAVR (PVL ≥3) 8.8% vs. 4.2% in TAV patients (OR: 1.478, 95% CI: 1.000-2.184, P=0.050, I2=0. Device success was significantly higher in TAV patients compared to BAV patients 93.5% vs. 87% (OR: 0.63, 95% CI: 0.49-0.86, P=0.003). Conclusions TAVR in patients with BAV is associated with a high incidence of paravalvular regurgitation with a comparable 30-day mortality rate to TAV patients. The use of newer generation valve prosthesis improved outcomes.
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Affiliation(s)
| | - Mark R Heckle
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center/Methodist University Hospital, Memphis, USA
| | - Ikechukwu A Ifedili
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center/Methodist University Hospital, Memphis, USA
| | - Jiajing Wang
- Division of Biostatistics & Epidemiology, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Uzoma N Ibebuogu
- Division of Cardiovascular Diseases, Ochsner Clinic Foundation, New Orleans, USA
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Xu Q, Liu X, Jiang J, He Y, Zhu Q, Gao F, Du F, He W, Cheng J, Kong M, Pu Z, Zhou Q, Gooley R, Wang J. Transcatheter aortic valve replacement in atypical valve anatomy using the Lotus valve : A Chinese single-center experience. Herz 2019; 46:63-70. [PMID: 30694372 PMCID: PMC7862532 DOI: 10.1007/s00059-018-4778-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/28/2018] [Accepted: 12/09/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND In the West, the safety and efficacy of the Lotus valve have been demonstrated; however, data in the Chinese population are still lacking. Few studies have compared the clinical outcomes of transcatheter aortic valve replacement (TAVR) with the Lotus valve in patients with bicuspid or tricuspid aortic valve stenosis. Our aim was to assess TAVR outcomes with the Lotus aortic valve in a Chinese patient cohort. METHODS In total, 23 symptomatic, high-surgical risk patients with severe aortic valve stenosis were enrolled. Among them, nine patients (39%) had bicuspid aortic valves, and three patients had a large annulus dimension. The Lotus valve was successfully implanted in all patients. To facilitate accurate positioning, partial re-sheathing was attempted in ten patients (43.5%), while one patient had a full retrieval. One-year clinical follow-up was completed in all patients. RESULTS There were no deaths, strokes, or major adverse cardiac and cerebrovascular events in 22 of the 23 patients at 30 days; the all-cause mortality rate at 1 year was 4.4% (1 of 23 patients). The mean aortic valve gradient decreased from 51.5 ± 8.8 mm Hg at baseline to 13.4 ± 4.9 mm Hg (p < 0.001) and the valve area increased from 0.6 ± 0.2 cm2 to 1.5 ± 0.4 cm2 (p < 0.001) at 30 days. Paravalvular leakage was absent or mild (22%), and no patient had severe paravalvular leakage. Six patients (26.1%) required a postprocedural pacemaker. There was no difference regarding the procedural and the 1‑year outcomes between patients with bicuspid and tricuspid aortic valve stenosis. CONCLUSION Our single-center experience demonstrated that the Lotus valve is feasible and effective for Chinese patients with aortic valve stenosis, including atypical cases with bicuspid aortic valves or large aortic annulus size.
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Affiliation(s)
- Q Xu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - X Liu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - J Jiang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Y He
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Q Zhu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - F Gao
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - F Du
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - W He
- Department of Anesthesia, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - J Cheng
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - M Kong
- Department of Cardiac Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Z Pu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Q Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - R Gooley
- Monash Cardiovascular Research Centre, Monash University, Victoria, Clayton, Australia
| | - J Wang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China.
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One-Year Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement for Stenotic Bicuspid versus Tricuspid Aortic Valves: A Meta-Analysis and Meta-Regression. J Interv Cardiol 2019; 2019:8947204. [PMID: 31772549 PMCID: PMC6739767 DOI: 10.1155/2019/8947204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/07/2018] [Accepted: 12/03/2018] [Indexed: 01/10/2023] Open
Abstract
Objective To assess 1-year mortality after transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (AS). Background Clinical trials have proven the beneficial effect of TAVR on mortality in patients with tricuspid AS. Individuals with bicuspid AS were excluded from these trials. Methods A meta-analysis using literature search from the Cochrane, PubMed, ClinicalTrials, SCOPUS, and EMBASE databases was conducted to determine the effect of TAVR on 1-year mortality in patients with bicuspid AS. Short-term outcomes that could potentially impact one-year mortality were analyzed. Results After evaluating 380 potential articles, 5 observational studies were selected. A total of 3890 patients treated with TAVR were included: 721 had bicuspid and 3,169 had tricuspid AS. No statistically significant difference between the baseline characteristics of the two groups of patients was seen outside of mean aortic gradient. Our primary endpoint of one-year all-cause mortality revealed 85 deaths in 719 patients (11.82%) with bicuspid AS compared to 467 deaths in 3100 patients (15.06%) with tricuspid AS, with no difference between both groups [relative risk (RR) 1.03; 95% CI 0.70-1.51]. Patients with bicuspid AS were associated with a decrease in device success (RR 0.62; 95% CI 0.45-0.84) and an increase in moderate-to-severe prosthetic valve regurgitation (RR 1.55; 95% CI 1.07-2.22) after TAVR compared to patients with tricuspid AS. The effect of meta-regression coefficients on one-year all-cause mortality was not statistically significant for any patient baseline characteristics. Conclusion When comparing TAVR procedure in tricuspid AS versus bicuspid AS, there was no difference noted in one-year all-cause mortality.
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50
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Tchetche D, de Biase C, van Gils L, Parma R, Ochala A, Lefevre T, Hovasse T, De Backer O, Sondergaard L, Bleiziffer S, Lange R, Kornowski R, Landes U, Norgaard BL, Biasco L, Philippart R, Molina-Martin de Nicolas J, Mylotte D, Lemee C, Dumonteil N, Van Mieghem NM. Bicuspid Aortic Valve Anatomy and Relationship With Devices: The BAVARD Multicenter Registry. Circ Cardiovasc Interv 2019; 12:e007107. [DOI: 10.1161/circinterventions.118.007107] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Didier Tchetche
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France (D.T., C.d.B., R.P., J.M.-M.d.N., N.D.)
| | - Chiara de Biase
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France (D.T., C.d.B., R.P., J.M.-M.d.N., N.D.)
| | - Lennart van Gils
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands (L.v.G., N.M.V.M.)
| | - Radoslaw Parma
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France (D.T., C.d.B., R.P., J.M.-M.d.N., N.D.)
| | - Andrzej Ochala
- 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (R.P., A.O.)
| | - Thierry Lefevre
- Institut cardiovasculaire Paris sud, Hôspital prive Jacques Cartier, Massy, France (T.L., T.H.)
| | - Thomas Hovasse
- Institut cardiovasculaire Paris sud, Hôspital prive Jacques Cartier, Massy, France (T.L., T.H.)
| | - Ole De Backer
- The Heart Center-Rigshospitalet, Copenhagen, Denmark (O.D.B., L.S.)
| | - Lars Sondergaard
- The Heart Center-Rigshospitalet, Copenhagen, Denmark (O.D.B., L.S.)
| | | | | | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petach Tikva, Tel-Aviv University, Israel (R.K., U.L.)
| | - Uri Landes
- Cardiology Department, Rabin Medical Center, Petach Tikva, Tel-Aviv University, Israel (R.K., U.L.)
| | | | - Luigi Biasco
- Centro Cardiotoracico TICINO, Lugano, Switzerland (L.B.)
| | - Raphaël Philippart
- 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland (R.P., A.O.)
| | | | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Ireland (D.M.)
| | | | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France (D.T., C.d.B., R.P., J.M.-M.d.N., N.D.)
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