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Bansal M, Kasliwal R. Role of Echocardiography in Guiding Transcatheter Aortic and Mitral Valve Replacement. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2022. [DOI: 10.4103/jiae.jiae_45_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Coccia M. Evolution of technology in replacement of heart valves: Transcatheter aortic valves, a revolution for management of valvular heart diseases. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Meddahi-Pelle A, Pavon-Djavid G, Chakfe N, Heim F. How yarn orientation limits fibrotic tissue ingrowth in a woven polyester heart valve scaffold: a case report. BIOMED ENG-BIOMED TE 2021; 66:225-230. [PMID: 32739902 DOI: 10.1515/bmt-2020-0137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/16/2020] [Indexed: 11/15/2022]
Abstract
Transcatheter Aortic Valve Implantation (TAVI) has become today a popular alternative technique to surgical valve replacement for critical patients. However, with only six years follow up on average, little is known about the long-term durability of transcatheter implanted biological tissue. Moreover, the high cost of tissue harvesting and chemical treatment procedures favor the development of alternative synthetic valve leaflet materials. In that context, thin, strong and flexible woven fibrous constructions could be considered as interesting candidates. However, the interaction of textile material with living tissue should be comparable to biological tissue, and the Foreign Body Reaction (FBR) in particular should be controlled. Actually, the porosity of textile materials tends to induce exaggerated tissue ingrowth which may prevent the implants from remaining flexible. The purpose of this preliminary animal case study is to investigate the influence of the valve leaflet yarn orientation on the fibrotic tissue ingrowth. For that purpose the in vivo performances of 45° inclined yarn woven valve leaflets implanted in juvenile sheep model were assessed after three months implantation. Results bring out that in the frame of this case study the development of fibrosis is limited with a woven fabric valve obtained from 45° inclined yarns.
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Affiliation(s)
- Anne Meddahi-Pelle
- INSERM U1148, Laboratory for Vascular Translational Science, Université Sorbonne Paris Nord, Villetaneuse, France
| | - Graciela Pavon-Djavid
- INSERM U1148, Laboratory for Vascular Translational Science, Université Sorbonne Paris Nord, Villetaneuse, France
| | - Nabil Chakfe
- GEPROVAS, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Frederic Heim
- Laboratoire de Physique et Mécanique Textiles (LPMT), ENSISA, Mulhouse, France
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Ammar A, Hassan Rizvi SN, Saghir T, Khan N, Akhtar P, Mengal N, Sial JA, Qamar N. Pakistan Following Foot Prints of Developed World in Structural Interventions: Experience of Transcatheter Aortic Valve Implantation Reported First Time. Cureus 2020; 12:e11497. [PMID: 33354443 PMCID: PMC7744204 DOI: 10.7759/cureus.11497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to evaluate the safety and efficacy of transcatheter aortic valve implantation (TAVI) program in a Tertiary care hospital in Karachi, Pakistan. Methodology This study was conducted by interventional cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Karachi from July 2015 to February 2020. All patients of severe aortic stenosis (AS) who underwent TAVI were included. Baseline characteristics, in-hospital course and one-month follow-up data were collected. Results This study included 100 consecutive patients with severe AS undergoing TAVI. Sixty-three (63.0%) patients were males and the mean age was 67.38 ± 10.73 years. Eighty-five (85%) patients were in the New York Heart Association (NYHA) class III-IV. Aortic valve mean gradient was 51.33±10.47 mmHg and 50% of patients had bicuspid aortic valves. Core valve was implanted in 86 (86%) and evolute-R aortic valve was implanted in 14 (14%) patients. TAVI was successfully done in 94% of patients. Post-deployment aortic valve mean gradient was 5.33±4.13 mmHg. Major vascular access site complications were noted in 14% and atrioventricular (AV) blocks were seen in 22% of cases. There was a significant difference in symptoms of patients before and after the procedure. Overall, eight (8%) patients expired during hospital stay. At one-month follow-up, 76% of patients were found to have no limitation of physical activities. Conclusions Results of this study showed that TAVI is a safe procedure in these high-risk patients and is an alternative to surgery for AS patients in the region.
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Affiliation(s)
- Ali Ammar
- Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Syed N Hassan Rizvi
- Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Tahir Saghir
- Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Naveedullah Khan
- Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Parveen Akhtar
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Naeem Mengal
- Cardiology/Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Jawaid A Sial
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Nadeem Qamar
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
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Heim F. Heart valves from polymeric fibers: potential and limits. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:586-595. [DOI: 10.23736/s0021-9509.20.11604-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fanous EJ, Mukku RB, Dave P, Aksoy O, Yang EH, Benharash P, Press MC, Rabbani AB, Aboulhosn JA, Rafique AM. Paravalvular Leak Assessment: Challenges in Assessing Severity and Interventional Approaches. Curr Cardiol Rep 2020; 22:166. [PMID: 33037927 DOI: 10.1007/s11886-020-01418-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW With increasing use of prosthetic valves to treat degenerative valvular heart disease (VHD) in an aging population, the incidence and adverse consequences of paravalvular leaks (PVL) are better recognized. The present work aims to provide a cohesive review of the available literature in order to better guide the evaluation and management of PVL. RECENT FINDINGS Despite gains in operator experience and design innovation, significant PVL remains a significant complication that may present with congestive heart failure and/or hemolytic anemia. To date, clear consensus or guidelines on the evaluation and management of PVL remain lacking. Although the evolution of transcatheter valve therapies has had a tremendous impact on the management of patients with VHD, the limitations and complications of such techniques, including PVL, present further challenges. Incidence of PVL, graded as moderate or greater, ranges from 4 to 7.4% in surgical and transcatheter valve replacements, respectively. Improved imaging modalities and the advent of novel surgical and percutaneous therapies have undoubtedly yielded a better understanding of PVL including its anatomical location, mechanism, severity, and treatment options. Echocardiography, used in conjunction with cardiac computed tomography and cardiac magnetic resonance, provides essential details for diagnosis and management of PVL. Transcatheter intervention has become a favored approach in lieu of surgical intervention in select patients after previous surgical or percutaneous valve replacement. PVL treatment with vascular plugs, balloon post-dilation, and the valve-in-valve methods have shown technical success with promising clinical outcomes in appropriately selected patients.
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Affiliation(s)
- Elias J Fanous
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Roy B Mukku
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Olcay Aksoy
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Eric H Yang
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peyman Benharash
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Marcella Calfon Press
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amir B Rabbani
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jamil A Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Center Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Asim M Rafique
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Tripathi B, Nerusu LA, Sawant AC, Atti L, Sharma P, Pershad A. Transcatheter Aortic Valve Implantation Readmissions in the Current Era (from the National Readmission Database). Am J Cardiol 2020; 130:115-122. [PMID: 32665132 DOI: 10.1016/j.amjcard.2020.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has become the mainstream treatment for severe aortic stenosis. Despite improvement in device iteration and operator experience rigorous outcome data outside the scope of clinical trials is lacking. Nationwide readmission database 2016 and 2017 was utilized to identify the study population. International Classification of Disease,10th edition codes were used to identify TAVI admissions. Outcomes of interest were the 90-day readmission pattern and in hospital complications of the TAVI procedure. A total of 73,784 TAVI related index admissions were identified in the Nationwide Readmission Database in 2016 to 2017. Forty four percent of patients undergoing TAVI in that timeframe were discharged within 48 hours of their procedure. 16,343 patients (22.2%) were readmitted within 90 days after discharge. Major cardiac co-morbidities like heart failure were prevalent more often in the group of patients that were readmitted within 90 days. Noncardiac causes however accounted for two thirds of these readmissions. The median time to 90-day readmission was 31 days. Multivariate analysis showed that nonagenarians, patients undergoing transapical TAVI, and patients with a higher comorbidity burden were more likely to be readmitted within 90 days. In conclusion, almost half of TAVI patients in the US are discharged within 48 hours after their procedure and 20% of all TAVI patients are readmitted within 90 days. Most readmissions are due to noncardiac causes.
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Sharma SK, Rao RS, Chandra P, Goel PK, Bharadwaj P, Joseph G, Jose J, Mahajan AU, Mehrotra S, Sengottovelu G, Ajit Kumar VK, Manjunath CN, Abhaichand RK, Sethi R, Seth A. First-in-human evaluation of a novel balloon-expandable transcatheter heart valve in patients with severe symptomatic native aortic stenosis: the MyVal-1 study. EUROINTERVENTION 2020; 16:421-429. [DOI: 10.4244/eij-d-19-00413] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sharma SK, Rao RS, Chopra M, Sonawane A, Jose J, Sengottuvelu G. Myval transcatheter heart valve system in the treatment of severe symptomatic aortic stenosis. Future Cardiol 2020; 17:73-80. [PMID: 32628046 DOI: 10.2217/fca-2020-0020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The transcatheter aortic valve replacement (TAVR) is an established treatment for patients with severe symptomatic aortic stenosis (AS) at prohibitive risk for surgery. It is an alternative treatment to surgical aortic valve replacement in patients with AS at intermediate- and high-surgical risk. Although regulatory authorities extend the indications of TAVR to treat patients at low-surgical risk, the limitations of earlier-generation transcatheter heart valve (THV) systems accelerate the development of improved newer generation of THV systems. Myval™ THV (Meril Life Sciences Pvt. Ltd., Vapi, Gujarat, India) is a newer-generation, balloon-expandable TAVR system with features that facilitate accurate positioning of the bioprosthetic valve and favorable procedural and clinical outcomes. This review summarizes existing preclinical and clinical data on Myval THV for the intervention of symptomatic native AS and lays out the plan for future research program.
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Affiliation(s)
- Samin K Sharma
- Director of Clinical and Interventional Cardiology and Dean of International Clinical Affiliations, Mount Sinai Health System, NY, USA
| | - Ravinder S Rao
- Department of Cardiology, Eternal Heart Care Centre & Research Institute Pvt. Ltd., Jaipur, Rajasthan 302017, India
| | - Manik Chopra
- Department of Cardiology, Narayana Multispeciality Hospital, Ahmedabad, Gujarat 380023, India
| | - Anmol Sonawane
- Department of Cardiology, Breach Candy Hospital, Mumbai, Maharashtra 400026, India
| | - John Jose
- Department of Cardiology, Christian Medical College & Hospital, Vellore, Tamil Nadu 632002, India
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Mäkikallio T, Jalava MP, Husso A, Virtanen M, Laakso T, Ahvenvaara T, Tauriainen T, Maaranen P, Kinnunen EM, Dahlbacka S, Jaakkola J, Airaksinen J, Anttila V, Savontaus M, Laine M, Juvonen T, Valtola A, Raivio P, Eskola M, Niemelä M, Biancari F. Ten-year experience with transcatheter and surgical aortic valve replacement in Finland. Ann Med 2019; 51:270-279. [PMID: 31112060 PMCID: PMC7880078 DOI: 10.1080/07853890.2019.1614657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Aim: We investigated the outcomes of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in Finland during the last decade. Methods: The nationwide FinnValve registry included data from 6463 patients who underwent TAVR or SAVR with a bioprosthesis for aortic stenosis from 2008 to 2017. Results: The annual number of treated patients increased three-fold during the study period. Thirty-day mortality declined from 4.8% to 1.2% for TAVR (p = .011) and from 4.1% to 1.8% for SAVR (p = .048). Two-year survival improved from 71.4% to 83.9% for TAVR (p < .001) and from 87.2% to 91.6% for SAVR (p = .006). During the study period, a significant reduction in moderate-to-severe paravalvular regurgitation was observed among TAVR patients and a reduction of the rate of acute kidney injury was observed among both SAVR and TAVR patients. Similarly, the rate of red blood cell transfusion and severe bleeding decreased significantly among SAVR and TAVR patients. Hospital stay declined from 10.4 ± 8.4 to 3.7 ± 3.4 days after TAVR (p < .001) and from 9.0 ± 5.9 to 7.8 ± 5.1 days after SAVR (p < .001). Conclusions: In Finland, the introduction of TAVR has led to an increase in the invasive treatment of severe aortic stenosis, which was accompanied by improved early outcomes after both SAVR and TAVR. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03385915 Key Messages This study demonstrated that the introduction of transcatheter aortic valve replacement has led to its widespread use as an invasive treatment for severe aortic stenosis. Early and 2-year survival after transcatheter and surgical aortic valve replacement has improved during past decade. Transcatheter aortic valve replacement has fulfilled its previously unmet clinical needs and has surpassed surgical aortic valve replacement as the most common invasive treatment for aortic stenosis.
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Affiliation(s)
- Timo Mäkikallio
- a Department of Internal Medicine , Oulu University Hospital , Oulu , Finland
| | - Maina P Jalava
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | | | - Marko Virtanen
- d Heart Hospital , Tampere University Hospital , Tampere , Finland
| | - Teemu Laakso
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Tuomas Ahvenvaara
- f Department of Surgery , Oulu University Hospital and University of Oulu , Finland
| | - Tuomas Tauriainen
- f Department of Surgery , Oulu University Hospital and University of Oulu , Finland
| | - Pasi Maaranen
- d Heart Hospital , Tampere University Hospital , Tampere , Finland
| | | | | | - Jussi Jaakkola
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Juhani Airaksinen
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Vesa Anttila
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Mikko Savontaus
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Mika Laine
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Tatu Juvonen
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Antti Valtola
- c Heart Center , Kuopio University Hospital , Kuopio , Finland
| | - Peter Raivio
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Markku Eskola
- d Heart Hospital , Tampere University Hospital , Tampere , Finland
| | - Matti Niemelä
- a Department of Internal Medicine , Oulu University Hospital , Oulu , Finland
| | - Fausto Biancari
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland.,f Department of Surgery , Oulu University Hospital and University of Oulu , Finland.,g Department of Surgery , University of Turku, Turku , Finland
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Novel pharmacological targets for calcific aortic valve disease: Prevention and treatments. Pharmacol Res 2018; 136:74-82. [DOI: 10.1016/j.phrs.2018.08.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 12/24/2022]
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Goeddel LA, Serini J, Steyn JW, Evans AS, Dwarakanath S, Ramakrishna H, Augoustides J, Brady MB. Transcatheter Aortic Valve Replacements: Current Trends and Future Directions. Semin Cardiothorac Vasc Anesth 2018; 23:282-292. [PMID: 29871563 DOI: 10.1177/1089253218779389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Since the 1960s when the first aortic surgical aortic valve replacement (SAVR) was performed, continuous growth in the field of valvular technology has occurred. Although SAVR remains a lifesaving procedure, minimally invasive transcatheter aortic valve replacement has revolutionized and expanded aortic valve replacement to patients who were not previously SAVR candidates, increasing their quality of life and survival. Since its introduction in the United States in 2011, the technology and practice have rapidly expanded. Hybrid techniques have been developed that combine surgical access to the vasculature with valvular deployment over transcatheter systems. This literature review aims to describe the differences between the current available valve technologies, review approaches to surgical technique, discuss anesthetic considerations, and look forward to future directions, trends, and challenges.
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Affiliation(s)
- Lee A Goeddel
- 1 Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | | | - Adam S Evans
- 3 Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Goeddel LA, Abernathy JH, Brady MB. An Anesthesiologist's Guide to the 2017 American College of Cardiology Expert Consensus Decision Pathway for Transcatheter Aortic Valve Replacement in the Management of Adults with Aortic Stenosis. J Cardiothorac Vasc Anesth 2018; 33:263-273. [PMID: 29935802 DOI: 10.1053/j.jvca.2018.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Lee Andrew Goeddel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
| | - James H Abernathy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Mary B Brady
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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