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Meier D, Grant D, Frawley C, Akodad M, Landes U, Khokhar AA, Dudek D, George I, Rinaldi MJ, Kim WK, Yakubov SJ, Sorajja P, Tarantini G, Wood DA, Webb JG, Sellers SL, Sathananthan J. Redo-TAVI with the ACURATE neo2 and Prime XL for balloon-expandable transcatheter heart valve failure. EUROINTERVENTION 2024; 20:e376-e388. [PMID: 38506739 PMCID: PMC10941669 DOI: 10.4244/eij-d-23-00783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/06/2023] [Indexed: 03/21/2024]
Abstract
BACKGROUND There are limited data regarding treatment for failed balloon-expandable transcatheter heart valves (THVs) in redo-transcatheter aortic valve implantation (TAVI). AIMS We aimed to assess THV performance, neoskirt height and expansion when performing redo-TAVI with the ACURATE platform inside a SAPIEN 3 (S3) compared to redo-TAVI with an S3 in an S3. METHODS Redo-TAVI was performed on the bench using each available size of the S3, the ACURATE neo2 (ACn2) and the next-generation ACURATE Prime XL (AC XL) implanted at 2 different depths within 20 mm/23 mm/26 mm/29 mm S3s serving as the "failed" index THV. Hydrodynamic testing was performed to assess THV function. Multimodality assessment was performed using photography, X-ray, microcomputed tomography (micro-CT), and high-speed videos. RESULTS The ACURATE in S3 combinations had favourable hydrodynamic performance compared to the S3 in S3 for all size combinations. In the 20 mm S3, redo-TAVI with the ACn2 had lower gradients compared to the S3 (mean gradient 16.3 mmHg for the ACn2 vs 24.7 mmHg for the 20 mm S3 in 20 mm S3). Pinwheeling was less marked for the ACURATE THVs than for the S3s. On micro-CT, the S3s used for redo-TAVI were underexpanded across all sizes. This was also observed for the ACURATE platform, but to a lesser extent. CONCLUSIONS Redo-TAVI with an ACn2/AC XL within an S3 has favourable hydrodynamic performance and less pinwheeling compared to an S3 in S3. This comes at the price of a taller neoskirt.
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Affiliation(s)
- David Meier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Daire Grant
- Boston Scientific Corporation, Marlborough, MA, USA
| | | | - Mariama Akodad
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Uri Landes
- Edith Wolfson Medical Center, Holon, Israel and Tel-Aviv University, Tel-Aviv, Israel
| | - Arif A Khokhar
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Isaac George
- Division of Cardiothoracic Surgery, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Klinik Heart Center, Bad Nauheim, Germany
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-OhioHealth Hospital, Columbus, OH, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA and Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Giuseppe Tarantini
- Humanitas Research Hospital IRCCS, Rozzano, Italy
- University of Padua Medical School, Padua, Italy
| | - David A Wood
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John G Webb
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie L Sellers
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Boston Scientific Corporation, Marlborough, MA, USA
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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2
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Hayek A, Prieur C, Dürrleman N, Chatelain Q, Ibrahim R, Asgar A, Modine T, Ben Ali W. Clinical considerations and challenges in TAV-in-TAV procedures. Front Cardiovasc Med 2024; 11:1334871. [PMID: 38440208 PMCID: PMC10910030 DOI: 10.3389/fcvm.2024.1334871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/24/2024] [Indexed: 03/06/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a viable treatment for aortic valve disease, including low-risk patients. However, as TAVR usage increases, concerns about long-term durability and the potential for addition interventions have arisen. Transcatheter aortic valve (TAV)-in-TAV procedures have shown promise in selected patients in numerous registries, offering a less morbid alternative to TAVR explantation. In this review, the authors aimed to comprehensively review the experience surrounding TAV-in-TAV, summarize available data, discuss pre-procedural planning, highlight associated challenges, emphasize the importance of coronary obstruction assessment and provide insights into the future of this technique.
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Affiliation(s)
- Ahmad Hayek
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
- Department of Interventional Cardiology, Hospices Civils de Lyon, Lyon, France
| | - Cyril Prieur
- Department of Interventional Cardiology, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Dürrleman
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Quentin Chatelain
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Reda Ibrahim
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Anita Asgar
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Thomas Modine
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
| | - Walid Ben Ali
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
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Mauler-Wittwer S, Giannakopoulos G, Arcens M, Noble S. Degenerated Transcatheter Aortic Valve Replacement: Investigation and Management Options. Can J Cardiol 2024; 40:300-312. [PMID: 38072363 DOI: 10.1016/j.cjca.2023.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 01/16/2024] Open
Abstract
With the expansion of transcatheter aortic valve replacement (TAVR) to younger and lower-surgical-risk patients, many younger and less comorbid patients will be treated with TAVR and are expected to have a life expectancy that will exceed the durability of their transcatheter heart valve. Consequently, the number of patients requiring reintervention will undoubtedly increase in the near future. Redo-TAVR and TAVR explantation followed by surgical aortic valve replacement are the different therapeutic options in the event of bioprosthetic valve failure and the need for reintervention. Patients often anticipate being able to benefit from a redo-TAVR in the event of bioprosthetic valve failure after TAVR, despite the lack of long-term data and the risk of unfavourable anatomy. Our understanding of the feasibility of redo-TAVR is constantly improving thanks to bench test studies and growing worldwide experience. However, much remains unknown. In clinical practice, one of the heart team's objectives is to anticipate the need to reaccess the coronary arteries and implant a second or even a third valve when life expectancy may exceed the durability of the transcatheter heart valve. In this review, we address key definitions in the diagnosis of structural valve deterioration and bioprosthetic valve failure, as well as patient selection and procedural planning for redo-TAVR to reduce periprocedural risk, optimise hemodynamic performance, and maintain coronary access. We describe the bench testing and literature in the redo-TAVR and TAVR explantation fields.
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Affiliation(s)
| | | | - Marc Arcens
- Structural Heart Unit, University Hospital of Geneva, Geneva, Switzerland
| | - Stéphane Noble
- Structural Heart Unit, University Hospital of Geneva, Geneva, Switzerland.
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Meier D, Tzimas G, Akodad M, Fournier S, Leipsic JA, Blanke P, Wood DA, Sellers SL, Webb JG, Sathananthan J. TAVR in TAVR: Where Are We in 2023 for Management of Failed TAVR Valves? Curr Cardiol Rep 2023; 25:1425-1431. [PMID: 37815660 DOI: 10.1007/s11886-023-01959-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE OF REVIEW As TAVR is increasingly performed on younger patients with a longer life expectancy, the number of redo-TAVR procedures is likely to increase in the coming years. Limited data is currently available on this sometimes challenging procedure. We provide a summary of currently published literature on management of patients with a failed transcatheter aortic valve. RECENT FINDINGS Recent registry data have increased the clinical knowledge on redo-TAVR. Additionally, numerous bench studies have provided valuable insights into the technical aspects of redo-TAVR with various combinations of valve types. Redo-TAVR can be performed safely in selected cases with a high procedural success and good short-term outcomes. However, at present, the procedure remains relatively infrequent and many patients are not eligible. Bench testing can be useful to understand important concepts such as valve expansion, neoskirt, leaflet overhang, and leaflet deflection as well as their potential clinical implications.
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Affiliation(s)
- David Meier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, Canada
| | - Georgios Tzimas
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mariama Akodad
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques-Cartier, Massy, France
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jonathon A Leipsic
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Philipp Blanke
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Stephanie L Sellers
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, Canada.
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, Canada.
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Fukui M, Okada A, Thao KR, Burns MR, Koike H, Wang C, Phichaphop A, Lesser JR, Sorajja P, Cavalcante JL, Bapat VN. Feasibility of Redo-Transcatheter Aortic Valve Replacement in Sapien Valves Based on In Vivo Computed Tomography Assessment. Circ Cardiovasc Interv 2023; 16:e013497. [PMID: 37988440 DOI: 10.1161/circinterventions.123.013497] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND Our aim was to assess the feasibility of repeat transcatheter aortic valve (TAV) replacement for degenerated Sapien3 (S3) prostheses by simulating subsequent implantation of S3 or Evolut, using in vivo computed tomography-based sizing and the impact on coronary and patient-prosthesis mismatch risks. METHODS Computed tomography scans from 356 patients with prior S3 TAV replacement implantation were analyzed. The in vivo sizing for second TAV based on averaged area of 3 levels of outflow, mid (narrowest) and inflow, was compared with in vitro recommendations, that is, same size as index S3 for second S3 and 1 size larger for Evolut. Risks of coronary obstruction and patient-prosthesis mismatch were determined by valve-to-aorta distance and estimated effective orifice area, respectively. RESULTS Overall, the majority of patients (n=328; 92.1%) had underexpanded index S3 with an expansion area of 94% (91%-97%), leading to significant differences in size selection of the second TAV between in vivo and in vitro sizing strategies. Expansion area <89% served as a threshold, resulting in 1 size smaller than the in vitro recommendations were selected in 45 patients (13%) for S3-in-S3 and 13 (4%) for Evolut-in-S3, while the remaining patients followed in vitro recommendations (P<0.01, in vivo versus in vitro sizing). Overall, 57% of total patients for S3-in-S3 simulation and 60% for Evolut-in-S3 were considered low risk for coronary complications. Deep index S3 implantation (odds ratio, 0.76 [interquartile range, 0.67-0.87]; P<0.001) and selecting Evolut as the second TAV (11% risk reduction in intermediate- or high-risk patients) reduced coronary risk. Estimated moderate or severe patient-prosthesis mismatch risk was 21% for S3-in-S3 and 1% for Evolut-in-S3, assuming optimal expansion of the second TAV. CONCLUSIONS Redo-TAV replacement with S3-in-S3 and Evolut-in-S3 could be feasible with low risk to coronaries in ≈60% of patients, while the remaining 40% will be at intermediate or high risk. The feasibility of redo-TAV replacement is influenced by sizing strategy, type of second TAV, native annular anatomy, and implant depth.
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Affiliation(s)
- Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab (M.F., H.K., J.L.C.), Minneapolis Heart Institute Foundation, MN
| | - Atsushi Okada
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
| | - Kiahltone R Thao
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
| | - Marcus R Burns
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.R.B., J.R.L., P.S., J.L.C., V.N.B.)
| | - Hideki Koike
- Cardiovascular Imaging Research Center and Core Lab (M.F., H.K., J.L.C.), Minneapolis Heart Institute Foundation, MN
| | - Cheng Wang
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
| | - Asa Phichaphop
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
| | - John R Lesser
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.R.B., J.R.L., P.S., J.L.C., V.N.B.)
| | - Paul Sorajja
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.R.B., J.R.L., P.S., J.L.C., V.N.B.)
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab (M.F., H.K., J.L.C.), Minneapolis Heart Institute Foundation, MN
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.R.B., J.R.L., P.S., J.L.C., V.N.B.)
| | - Vinayak N Bapat
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.R.B., J.R.L., P.S., J.L.C., V.N.B.)
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Meier D, Tzimas G, Akodad M, Husain A, Dundas J, Jelisejevas J, Cheung A, Sellers SL, Leipsic JA, Blanke P, Wood DA, Sathananthan J, Webb JG. Case Report: Stretching the limits-late valvuloplasty for THV dysfunction following redo mitral valve-in-valve implantation. Front Cardiovasc Med 2023; 10:1288278. [PMID: 38028444 PMCID: PMC10644176 DOI: 10.3389/fcvm.2023.1288278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Late balloon valvuloplasty can be used to treat under-expansion-related transcatheter heart valve (THV) dysfunction. Whether this can be performed following redo-THV implantation is unknown. Herein, we report a case of a 72-year-old male presenting with symptomatic gradient elevation following redo mitral valve-in-valve implantation. The patient was successfully treated with late balloon valvuloplasty with gradient improvement. In conclusion, late valvuloplasty is effective even with several layers of valves. However, larger studies are required to clarify the role of this approach further.
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Affiliation(s)
- David Meier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - Georgios Tzimas
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mariama Akodad
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques-Cartier, Ramsay Santé, Massy, France
| | - Ali Husain
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - James Dundas
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - Julius Jelisejevas
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - Anson Cheung
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - Stephanie L. Sellers
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - Jonathon A. Leipsic
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - Philipp Blanke
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - David A. Wood
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - John G. Webb
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
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