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Didagelos M, Ninios V, Kakderis C, Lakkas L, Kouparanis A, Nikas D, Naka KK, Rammos A, Zegkos T, Kamperidis V, Ninios I, Evangelou S, Tsalikakis DG, Michalis L, Ziakas A. Transcatheter Aortic Valve Implantation with the Portico Valve: 2-Year Outcomes of a Multicenter, Real-World Registry. Life (Basel) 2023; 13:1785. [PMID: 37629642 PMCID: PMC10455265 DOI: 10.3390/life13081785] [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: 07/04/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION The self-expanding, resheathable, repositionable transcatheter aortic heart valve Portico is being used successfully for transcatheter aortic valve implantation procedures (TAVI) in patients with severe aortic stenosis. The aim of this study was to evaluate outcomes at 2 years after TAVI with the Portico valve. METHODS Multicenter registry of clinical, echocardiographic and survival data from consecutive patients treated with the Portico TAVI system (Abbott, Chicago, IL, USA) in three cath labs in Northern Greece and Epirus during 2017-2020. The primary end point was all-cause mortality at 24 months. Secondary end points included procedural outcomes (efficacy and safety) and echocardiographic measurements. RESULTS A total of 90 patients (81 ± 6 years, 50% females, mean age 81 ± 6 years) were included in the registry. The indication for implantation was severe, symptomatic aortic stenosis (NYHA III, IV) in eighty-two (91.1%) and degeneration of a prosthetic aortic valve in eight (8.9%) patients. All patients were categorized as high surgical risk (mean Logistic Euroscore 25.9 ± 10, Euroscore II 7.7 ± 4.4 and STS score 10.8 ± 8.9). The procedure was performed transfemorally in all patients, under general anesthesia in 95.6%, under TOE guidance in 21.1%, with native valve predilatation in 46.7%, and the "resheath" option was used in 31.1% of the cases. The implantation was successful in 97.8% and there was a need for a second valve in 2.2% of the cases. Complications included permanent pacemaker implantation (16.7%), access cite complications (15.6%), arrythmias (23.3%), paravalvular leak (moderate 7.8%, severe 1.1%), acute kidney injury (7.8%), no strokes and one death during the procedure. Aortic valve peak velocity, peak and mean pressure gradients, were significantly reduced after the procedure. All-cause mortality at 1, 12 and 24 months was 4.4%, 6.7% and 7.8%, respectively. CONCLUSIONS TAVI with the Portico system comprises an effective and safe solution for the management of severe, symptomatic aortic stenosis in high-risk surgical patients.
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Affiliation(s)
- Matthaios Didagelos
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece
| | - Vlasis Ninios
- 2nd Cardiology Department, Interbalkan Medical Center, 55535 Thessaloniki, Greece
| | - Charalampos Kakderis
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece
| | - Lampros Lakkas
- 2nd Cardiology Department, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Antonios Kouparanis
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece
| | - Dimitrios Nikas
- 2nd Cardiology Department, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Katerina K. Naka
- 2nd Cardiology Department, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Aidonis Rammos
- 2nd Cardiology Department, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Thomas Zegkos
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece
| | - Vasileios Kamperidis
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece
| | - Ilias Ninios
- 2nd Cardiology Department, Interbalkan Medical Center, 55535 Thessaloniki, Greece
| | - Sotirios Evangelou
- 2nd Cardiology Department, Interbalkan Medical Center, 55535 Thessaloniki, Greece
| | - Dimitrios G. Tsalikakis
- Department of Informatics and Telecommunications Engineering, University of Western Macedonia, 50100 Kozani, Greece
| | - Lampros Michalis
- 2nd Cardiology Department, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Antonios Ziakas
- 1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece
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Lemarchand L, Boulmier D, Leurent G, Bedossa M, Sharobeem S, Bakhti A, Le Breton H, Auffret V. Conductive disturbances in the transcatheter aortic valve implantation setting: An appraisal of current knowledge and unmet needs. Arch Cardiovasc Dis 2023; 116:419-425. [PMID: 37328391 DOI: 10.1016/j.acvd.2023.05.004] [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: 02/01/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 06/18/2023]
Abstract
New-onset conduction disturbances, including left bundle branch block and permanent pacemaker implantation, remain a major issue after transcatheter aortic valve implantation. Preprocedural risk assessment in current practice is most often limited to evaluation of the baseline electrocardiogram, whereas it may benefit from a multimodal approach, including ambulatory electrocardiogram monitoring and multidetector computed tomography. Physicians may encounter equivocal situations during the hospital phase, and the management of follow-up is not fully defined, despite the publication of several expert consensuses and the inclusion of recommendations regarding the role of electrophysiology studies and postprocedural monitoring in recent guidelines. This review provides an overview of current knowledge and future perspectives regarding the management of new-onset conduction disturbances in the setting of transcatheter aortic valve implantation, from the preprocedural phase to long-term follow-up.
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Affiliation(s)
- Léo Lemarchand
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Dominique Boulmier
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Guillaume Leurent
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Marc Bedossa
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Sam Sharobeem
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Abdelkader Bakhti
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Hervé Le Breton
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France
| | - Vincent Auffret
- Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France.
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Tokuda T, Yamamoto M. Vascular management during transcatheter aortic valve replacement. Cardiovasc Interv Ther 2023; 38:18-27. [PMID: 36447120 DOI: 10.1007/s12928-022-00900-z] [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: 03/16/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022]
Abstract
Transcatheter aortic valve replacement (TAVR), as an alternative to open heart surgery, has been established as the standard therapy for patients with severe aortic valve stenosis. Vascular access management, the first step in a TAVR procedure, should be managed properly. Moreover, the transfemoral and alternatives such as the transaxillary/subclavian, transcarotid, transapical, and transcaval approaches are considered access routes during TAVR. More than 90% of cases can be treated via the transfemoral approach in the current TAVR era, whereas other approaches should be considered in patients in whom the transfemoral approach is not suitable. Vascular complications regardless of access route differences are a specific issue of TAVR caused by the use of large sheaths. With the increased number of TAVR cases, we must manage vascular complications and decrease the morbidity and mortality rates associated with TAVR procedures. Thus, this study aimed to review the vascular complications during TAVR and summarize their prognosis, prevention, and adequate management.
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Affiliation(s)
- Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan.
| | - Masanori Yamamoto
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan. .,Department of Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan. .,Department of Cardiology, Gifu Heart Center, Gifu, Japan.
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Kim WK, Charitos E. Prosthesis Type-Associated Risk of Subclinical Leaflet Thrombosis. JACC Cardiovasc Interv 2022; 15:676. [PMID: 35331461 DOI: 10.1016/j.jcin.2022.01.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/27/2022]
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Appa H, Park K, Bezuidenhout D, van Breda B, de Jongh B, de Villiers J, Chacko R, Scherman J, Ofoegbu C, Swanevelder J, Cousins M, Human P, Smith R, Vogt F, Podesser BK, Schmitz C, Conradi L, Treede H, Schröfel H, Fischlein T, Grabenwöger M, Luo X, Coombes H, Matskeplishvili S, Williams DF, Zilla P. The Technological Basis of a Balloon-Expandable TAVR System: Non-occlusive Deployment, Anchorage in the Absence of Calcification and Polymer Leaflets. Front Cardiovasc Med 2022; 9:791949. [PMID: 35310972 PMCID: PMC8928444 DOI: 10.3389/fcvm.2022.791949] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/18/2022] [Indexed: 12/14/2022] Open
Abstract
Leaflet durability and costs restrict contemporary trans-catheter aortic valve replacement (TAVR) largely to elderly patients in affluent countries. TAVR that are easily deployable, avoid secondary procedures and are also suitable for younger patients and non-calcific aortic regurgitation (AR) would significantly expand their global reach. Recognizing the reduced need for post-implantation pacemakers in balloon-expandable (BE) TAVR and the recent advances with potentially superior leaflet materials, a trans-catheter BE-system was developed that allows tactile, non-occlusive deployment without rapid pacing, direct attachment of both bioprosthetic and polymer leaflets onto a shape-stabilized scallop and anchorage achieved by plastic deformation even in the absence of calcification. Three sizes were developed from nickel-cobalt-chromium MP35N alloy tubes: Small/23 mm, Medium/26 mm and Large/29 mm. Crimp-diameters of valves with both bioprosthetic (sandwich-crosslinked decellularized pericardium) and polymer leaflets (triblock polyurethane combining siloxane and carbonate segments) match those of modern clinically used BE TAVR. Balloon expansion favors the wing-structures of the stent thereby creating supra-annular anchors whose diameter exceeds the outer diameter at the waist level by a quarter. In the pulse duplicator, polymer and bioprosthetic TAVR showed equivalent fluid dynamics with excellent EOA, pressure gradients and regurgitation volumes. Post-deployment fatigue resistance surpassed ISO requirements. The radial force of the helical deployment balloon at different filling pressures resulted in a fully developed anchorage profile of the valves from two thirds of their maximum deployment diameter onwards. By combining a unique balloon-expandable TAVR system that also caters for non-calcific AR with polymer leaflets, a powerful, potentially disruptive technology for heart valve disease has been incorporated into a TAVR that addresses global needs. While fulfilling key prerequisites for expanding the scope of TAVR to the vast number of patients of low- to middle income countries living with rheumatic heart disease the system may eventually also bring hope to patients of high-income countries presently excluded from TAVR for being too young.
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Affiliation(s)
- Harish Appa
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Kenneth Park
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Deon Bezuidenhout
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
| | - Braden van Breda
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Bruce de Jongh
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Jandré de Villiers
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Reno Chacko
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Jacques Scherman
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
- Chris Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Chima Ofoegbu
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
- Chris Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Justiaan Swanevelder
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Michael Cousins
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Paul Human
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
- Chris Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Robin Smith
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Ferdinand Vogt
- Deparment of Cardiac Surgery, Artemed Clinic Munich South, Munich, Germany
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Bruno K. Podesser
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Christoph Schmitz
- Auto Tissue Berlin, Berlin, Germany
- Department of Cardiac Surgery, University of Munich, Munich, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Hendrik Treede
- Department of Cardiac and Vascular Surgery, University Hospital, Mainz, Germany
| | - Holger Schröfel
- Department of Cardiovascular Surgery, University Heart Center, Freiburg, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Vienna North Hospital, Vienna, Austria
| | - Xinjin Luo
- Department of Cardiac Sugery, Fu Wai Hospital, Peking Union Medical College, Beijing, China
| | - Heather Coombes
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | | | - David F. Williams
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
- Wake Forest Institute of Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Peter Zilla
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
- Chris Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
- Cape Heart Centre, University of Cape Town, Cape Town, South Africa
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Mach M, Okutucu S, Kerbel T, Arjomand A, Fatihoglu SG, Werner P, Simon P, Andreas M. Vascular Complications in TAVR: Incidence, Clinical Impact, and Management. J Clin Med 2021; 10:jcm10215046. [PMID: 34768565 PMCID: PMC8584339 DOI: 10.3390/jcm10215046] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/23/2021] [Accepted: 10/24/2021] [Indexed: 12/12/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has replaced surgical aortic valve replacement as the new gold standard in elderly patients with severe aortic valve stenosis. However, alongside this novel approach, new complications emerged that require swift diagnosis and adequate management. Vascular access marks the first step in a TAVR procedure. There are several possible access sites available for TAVR, including the transfemoral approach as well as transaxillary/subclavian, transcarotid, transapical, and transcaval. Most cases are primarily performed through a transfemoral approach, while other access routes are mainly conducted in patients not suitable for transfemoral TAVR. As vascular access is achieved primarily by large bore sheaths, vascular complications are one of the major concerns during TAVR. With rising numbers of TAVR being performed, the focus on prevention and successful management of vascular complications will be of paramount importance to lower morbidity and mortality of the procedures. Herein, we aimed to review the most common vascular complications associated with TAVR and summarize their diagnosis, management, and prevention of vascular complications in TAVR.
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Affiliation(s)
- Markus Mach
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
- Correspondence: ; Tel.: +43-1-40400-52620
| | - Sercan Okutucu
- Department of Cardiology, Memorial Ankara Hospital, 06520 Ankara, Turkey;
| | - Tillmann Kerbel
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
| | - Aref Arjomand
- Department of Cardiology, St. John of God Hospital, Geelong, VIC 3220, Australia;
| | | | - Paul Werner
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
| | - Paul Simon
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
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Chen S, Chau KH, Nazif TM. The incidence and impact of cardiac conduction disturbances after transcatheter aortic valve replacement. Ann Cardiothorac Surg 2020; 9:452-467. [PMID: 33312903 PMCID: PMC7724062 DOI: 10.21037/acs-2020-av-23] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/21/2020] [Indexed: 12/29/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has developed into an established therapy for patients with severe aortic stenosis (AS) across the spectrum of surgical risk. Despite improvements in transcatheter heart valve (THV) technologies and procedural techniques, cardiac conduction disturbances, including high degree atrioventricular block (AVB) requiring permanent pacemaker (PPM) implantation and new-onset left bundle branch block (LBBB), remain frequent complications. TAVR-related conduction disturbances occur due to injury to the conduction system from interactions with interventional equipment and the transcatheter valve stent frame. Risk factors for post-TAVR conduction disturbances have been identified and include clinical characteristics, baseline electrocardiogram findings (right bundle branch block), anatomic factors, and potentially modifiable procedural factors (type of transcatheter valve, depth of implantation, over-sizing). New-onset LBBB and PPM implantation after TAVR have been shown to be associated with adverse long-term clinical outcomes, including mortality and heart failure hospitalization. These clinical consequences are likely to be of increasing importance as TAVR is utilized in younger and lower risk population. This review provides an updated overview of the literature regarding the incidence, predictors, and clinical outcomes of TAVR-related conduction disturbances, as well as proposed strategies for the management of this frequent clinical challenge.
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Affiliation(s)
- Shmuel Chen
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Katherine H Chau
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Tamim M Nazif
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
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Poulis N, Zaytseva P, Gähwiler EKN, Motta SE, Fioretta ES, Cesarovic N, Falk V, Hoerstrup SP, Emmert MY. Tissue engineered heart valves for transcatheter aortic valve implantation: current state, challenges, and future developments. Expert Rev Cardiovasc Ther 2020; 18:681-696. [DOI: 10.1080/14779072.2020.1792777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Nikolaos Poulis
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Polina Zaytseva
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Eric K. N. Gähwiler
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Sarah E. Motta
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | | | - Nikola Cesarovic
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center of Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Simon P. Hoerstrup
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Maximilian Y. Emmert
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
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Renker M, Kim WK. Choice of transcatheter heart valve: should we select the device according to each patient's characteristics or should it be "one valve fits all"? ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:961. [PMID: 32953761 PMCID: PMC7475391 DOI: 10.21037/atm.2020.04.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Since its introduction at the beginning of the century, transcatheter aortic valve replacement (TAVR) has implicated a paradigm shift in the treatment of patients with symptomatic aortic valve stenosis. The past years have brought about major improvements of procedural outcomes owing to advances in imaging and patient selection, global experience, and device technology. Whereas in the early stages of TAVR, only two different devices with limited sizes and access options were used, currently a variety of different transcatheter heart valves (THVs) are available. This has expanded the spectrum of patients that can be treated with TAVR and has allowed for sophisticated device selection tailored to the patients' individual anatomy and comorbidities. The big question is whether such a customized device selection is really necessary-or is there one valve type that fits all patients? With this question in mind, the authors provide an overview of contemporary THVs, including technical specifications and clinical data, that help us to understand the potential value of a differential use of THVs.
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Affiliation(s)
- Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany.,Department of Cardiology, University of Giessen, Giessen, Germany
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Mas-Peiro S, Fichtlscherer S, Walther C, Vasa-Nicotera M. Current issues in transcatheter aortic valve replacement. J Thorac Dis 2020; 12:1665-1680. [PMID: 32395310 PMCID: PMC7212163 DOI: 10.21037/jtd.2020.01.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aortic stenosis is the most common valvular disease worldwide. With transcatheter aortic valve replacement (TAVR) being increasingly expanded to lower-risk populations, several challenging issues remain to be solved. The present review aims at discussing modern approaches to such issues as well as the current status of TAVR. TAVR has undergone several developments in the recent years: an increased use of transfemoral access, the development of prostheses in order to adapt to challenging anatomies, improved delivery systems with repositioning features, and outer skirts aiming at reducing paravalvular leak. The indication of TAVR is increasingly being expanded to patients with lower surgical risk. The main clinical trials supporting such expansion are reviewed and the latest data on low-risk patients are discussed. A number of challenges need still to be addressed and are also reviewed in this paper: the need for updated international guidelines including the latest evidence; a reduction of main complications such as permanent pacemaker implantation, paravalvular leak, and stroke (and its potential prevention by using anti-embolic protection devices); the appropriate role of TAVR in patients with concomitant cardiac ischemic disease; and durability of bio-prosthetic implanted valves. Finally, the future perspectives for TAVR use and next device developments are discussed.
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Affiliation(s)
- Silvia Mas-Peiro
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Claudia Walther
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
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Alperi Garcia A, Muntané-Carol G, Junquera L, del Val D, Faroux L, Philippon F, Rodés-Cabau J. Can we reduce conduction disturbances following transcatheter aortic valve replacement? Expert Rev Med Devices 2020; 17:309-322. [DOI: 10.1080/17434440.2020.1741349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Lucia Junquera
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - David del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Laurent Faroux
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - François Philippon
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
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Schäfer U, Kempfert J, Verheye S, Maisano F, Thiele H, Landt M, Haude M, Rudolph TK, Ince H, Kische S, Treede H, Tonino P, Conradi L. Safety and Performance Outcomes of a Self-Expanding Transcatheter Aortic Heart Valve: The BIOVALVE Trials. JACC Cardiovasc Interv 2020; 13:157-166. [PMID: 31629751 DOI: 10.1016/j.jcin.2019.07.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/20/2019] [Accepted: 07/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to assess the safety and performance of a newly introduced transfemoral self-expanding supra-annular transcatheter heart valve. BACKGROUND Transcatheter aortic valve replacement has become an established procedure, and newer transcatheter heart valves aim to supplement the current armamentarium. METHODS BIOVALVE-I is a prospective, single-center feasibility study enrolling 13 high-risk patients with severe aortic stenosis, and BIOVALVE-II is a multicenter pilot study enrolling a further 55 patients under the same protocol. RESULTS Patients' mean age was 82.4 ± 5.3 years, 57.4% had concomitant coronary artery disease, 50.0% had renal insufficiency stage ≥3, 32.4% had diabetes mellitus, 29.4% had current anemia, 19.1% had chronic obstructive pulmonary disease, 19.1% were frail, and 17.6% had prior cerebrovascular events. The primary endpoint, early safety according to the Valve Academic Research Consortium-2 guidelines, was observed in 13 patients (19.1%). One patient (1.5%) died through 30 days of a noncardiac cause, and 4 patients (7.8%) died through 180 days. Disabling stroke occurred at 30 days in 1 patient (1.5%) and at 180 days in 2 patients (3.2%). New permanent pacemakers up to 30 days were implanted in 9 patients (13.4%). Two patients (3.8%) had moderate or severe paravalvular leakage at 30 days and 4 (9.1%) at 6 months, mean effective orifice area was 2.0 ± 0.4 cm2 and 1.9 ± 0.5 cm2, and mean gradient was 6.4 mm Hg at 30 days and 6 months. CONCLUSIONS Clinical outcomes with the Biovalve self-expanding transcatheter heart valve were similar to those seen in other first-in-human studies with first-generation devices for severe aortic stenosis.
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Affiliation(s)
- Ulrich Schäfer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Stefan Verheye
- Interventional Cardiology, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Francesco Maisano
- Division of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Martin Landt
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Michael Haude
- Medical Clinic I Städtische Kliniken Neuss Lukaskrankenhaus, Neuss, Germany
| | - Tanja K Rudolph
- Clinic for Cardiology, Angiology, and Pneumology and Intensive Care Medicine, Heart Center of the University Clinic Cologne, Cologne, Germany
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany; Department of Cardiology, Universitätsmedizin Rostock, Rostock, Germany
| | - Stephan Kische
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany; Department of Cardiology, Universitätsmedizin Rostock, Rostock, Germany
| | - Hendrik Treede
- Department of Cardiac Surgery, Mid-German Heart Centre, University Hospital Halle, Halle, Germany
| | - Pim Tonino
- Department of Cardiology, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
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Kefer J, Maes F, Renkin J, Kautbally S, De Meester C, Delacour M, Pouleur AC. Resheathing of self-expanding bioprosthesis: Impact on procedural results, clinical outcome and prosthetic valve durability after transcatheter aortic valve implantation. IJC HEART & VASCULATURE 2020; 26:100462. [PMID: 31921975 PMCID: PMC6948261 DOI: 10.1016/j.ijcha.2019.100462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/20/2019] [Accepted: 12/20/2019] [Indexed: 01/08/2023]
Abstract
To resheath a SEV doesn’t increase the procedural risk of TAVI. To resheath a SEV doesn’t impair the clinical outcome of patients. The resheath has no negative impact on the acute prosthetic valve function. Resheathing manœuvre has no deleterious effect on the prosthetic valve durability at short term follow-up.
Background New transcatheter aortic valves were recently developed, enabling to resheath and reposition the prosthesis. The aim of the present study was to investigate whether the resheath manoeuvre did not impair the outcome of patients and the bioprosthesis durability after transcatheter aortic valve implantation (TAVI). Methods and results On the 346 consecutive patients (84 ± 7 yrs-old, mean STS 6.7 ± 5%) undergoing a transfemoral TAVI in our institution since January 2008, 170 patients were implanted using a self-expanding valve (SEV). Among those, 39 (Group 1) required resheathing to achieve a successful implantation, while 131 did not require it (Group 2, N = 131). A balloon-expanding valve (BEV) was used in 176 patients (Group 3). Baseline characteristics were similar between groups. Device success was 98%, the rate of in-hospital death was 2%, and the number of procedural complications was similarly low, with no significant difference between groups. The follow-up was complete in 337 of 338 patients undergoing a successful TAVI (781 patients-year). Kaplan-Meier analysis showed that overall survival was 80 ± 2% and 42 ± 3% at 1 and 5 years respectively, with no difference between groups. On multivariate analysis, acute kidney injury, post-dilatation, pulmonary hypertension, porcelain aorta and STS score, but not resheath, were independant predictors of death after TAVI. The annual event rate of structural valve deterioration was 0.6% patients-year, and similar between groups. Conclusions Our study shows that SEV resheath did not impair the procedural results, the outcome of patients nor the valve durability at short term after TAVI.
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Affiliation(s)
- Joelle Kefer
- Cliniques Universitaires Saint-Luc, Division of Cardiology and Intitut de Recherche Experimentale en Cardiologie (IREC), Brussels, Belgium
| | - Frederic Maes
- Cliniques Universitaires Saint-Luc, Division of Cardiology and Intitut de Recherche Experimentale en Cardiologie (IREC), Brussels, Belgium
| | - Jean Renkin
- Cliniques Universitaires Saint-Luc, Division of Cardiology and Intitut de Recherche Experimentale en Cardiologie (IREC), Brussels, Belgium
| | - Shakeel Kautbally
- Cliniques Universitaires Saint-Luc, Division of Cardiology and Intitut de Recherche Experimentale en Cardiologie (IREC), Brussels, Belgium
| | | | - Marine Delacour
- Cliniques Universitaires Saint-Luc, Division of Cardiology and Intitut de Recherche Experimentale en Cardiologie (IREC), Brussels, Belgium
| | - Anne-Catherine Pouleur
- Cliniques Universitaires Saint-Luc, Division of Cardiology and Intitut de Recherche Experimentale en Cardiologie (IREC), Brussels, Belgium
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14
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Husser O, Pellegrini C, Kim WK, Holzamer A, Pilgrim T, Toggweiler S, Schäfer U, Blumenstein J, Deuschl F, Rheude T, Joner M, Hilker M, Hengstenberg C, Möllmann H. Transcatheter Valve SELECTion in Patients With Right Bundle Branch Block and Impact on Pacemaker Implantations. JACC Cardiovasc Interv 2019; 12:1781-1793. [DOI: 10.1016/j.jcin.2019.05.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/06/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
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15
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Schäfer A, Conradi L, Schäfer U, Blankenberg S, Reichenspurner H. TAVI für alle. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2019. [DOI: 10.1007/s00398-018-0265-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Reichenspurner H, Schaefer A, Schäfer U, Tchétché D, Linke A, Spence MS, Søndergaard L, LeBreton H, Schymik G, Abdel-Wahab M, Leipsic J, Walters DL, Worthley S, Kasel M, Windecker S. Self-Expanding Transcatheter Aortic Valve System for Symptomatic High-Risk Patients With Severe Aortic Stenosis. J Am Coll Cardiol 2019; 70:3127-3136. [PMID: 29268926 DOI: 10.1016/j.jacc.2017.10.060] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/15/2017] [Accepted: 10/17/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The CENTERA transcatheter heart valve (THV) is a low-profile, self-expanding nitinol valve made from bovine pericardial tissue that is 14-F compatible with a motorized delivery system allowing for repositionability. OBJECTIVES The pivotal study evaluated safety and efficacy of this THV in high-surgical-risk study patients with severe symptomatic aortic stenosis. METHODS Implantations were completed in 23 centers. Clinical and echocardiographic outcomes were assessed at baseline, discharge, and 30 days. Major events were adjudicated by an independent clinical events committee. Echocardiograms and computed tomography scans were reviewed by core laboratories. The primary endpoint was all-cause mortality at 30 days. RESULTS Between March 25, 2015 and July 5, 2016, 203 patients with severe symptomatic aortic stenosis and increased surgical risk, as determined by the heart team, were treated by transfemoral THV implantation (age 82.7 ± 5.5 years, 67.5% female, 68.0% New York Heart Association functional class III/IV). At 30 days, mortality was 1%, disabling stroke occurred in 2.5% of patients, and New York Heart Association functional class I/II was observed in 93.0% of patients. Effective orifice area increased from 0.71 ± 0.20 cm2 to 1.88 ± 0.43 cm2 (p < 0.001). Mean aortic transvalvular gradient decreased from 40.5 ± 13.2 mm Hg to 7.2 ± 2.8 mm Hg at 30 days post-procedure (p < 0.001). Paravalvular aortic regurgitation at 30 days was moderate or higher in 0.6% of patients. A new permanent pacemaker was implanted in 4.5% of patients receiving the THV (4.9% for patients at risk). CONCLUSIONS The herein described THV is safe and effective at 30 days with low mortality, significant improvements in hemodynamic outcomes, and low incidence of adverse events. Of particular interest is the low incidence of permanent pacemaker implantations. (Safety and Performance Study of the Edwards CENTERA-EU Self-Expanding Transcatheter Heart Valve [CENTERA-2]; NCT02458560).
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Affiliation(s)
- Hermann Reichenspurner
- Departments of Cardiovascular Surgery and General and Interventional Cardiology, University Heart Center, Hamburg, Germany.
| | - Andreas Schaefer
- Departments of Cardiovascular Surgery and General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Ulrich Schäfer
- Departments of Cardiovascular Surgery and General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Didier Tchétché
- Cardiologie Générale et Interventionelle, Clinique Pasteur, Toulouse, France
| | - Axel Linke
- Department of Internal Medicine/Cardiology, Heart Center and Leipzig Heart Institute, University of Leipzig, Leipzig, Germany
| | - Mark S Spence
- Cardiology Department, Royal Victoria Hospital, Belfast, United Kingdom
| | | | - Hervé LeBreton
- Centre cardio-pneumologique, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - Gerhard Schymik
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | | | - Jonathon Leipsic
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren L Walters
- Department of Cardiology, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Stephen Worthley
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Markus Kasel
- Department of Cardiology, German Heart Center Munich, Munich, Germany
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital (Inselspital), Bern, Switzerland
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17
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Rahmani B, McGregor C, Byrne G, Burriesci G. A Durable Porcine Pericardial Surgical Bioprosthetic Heart Valve: a Proof of Concept. J Cardiovasc Transl Res 2019; 12:331-337. [PMID: 30756359 PMCID: PMC6707964 DOI: 10.1007/s12265-019-09868-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/22/2019] [Indexed: 11/28/2022]
Abstract
Bioprosthetic leaflets made from animal tissues are used in the majority of surgical and transcatheter cardiac valve replacements. This study develops a new surgical bioprosthesis, using porcine pericardial leaflets. Porcine pericardium was obtained from genetically engineered pigs with a mutation in the GGTA-1 gene (GTKO) and fixed in 0.6% glutaraldehyde, and used to develop a new surgical valve design. The valves underwent in vitro hydrodynamic test in a pulse duplicator and high-cycled accelerated wear testing and were evaluated for acute haemodynamics and thrombogenicity in a juvenile sheep implant study for 48 h. The porcine surgical pericardial heart valves (pSPHVs) exhibited excellent hydrodynamics and reached 200 million cycles of in vitro durability, with no observable damage. Juvenile sheep implants demonstrated normal valve function with no acute thrombogenic response for either material. The pSPHV incorporates a minimalistic construction method using a tissue-to-tissue design to cover the stent. This new design is a proof of concept alternative to the use of bovine pericardium and synthetic fabric in surgical bioprosthetic heart valves.
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Affiliation(s)
- Benyamin Rahmani
- Cardiovascular Engineering Laboratory, UCL Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK.
| | - Christopher McGregor
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Surgery, University of Alabama, Birmingham, AL, USA
| | - Guerard Byrne
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Surgery, University of Alabama, Birmingham, AL, USA
| | - Gaetano Burriesci
- Cardiovascular Engineering Laboratory, UCL Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK.,Ri.MED Foundation, Bioengineering Group, Palermo, Italy
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18
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Predictores de necesidad de marcapasos permanente y alteraciones de la conducción con el implante transcatéter de una nueva válvula aórtica autoexpandible. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.01.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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19
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Taramasso M, Miura M, Gavazzoni M, Andreas M, Saccocci M, Gülmez G, Puri R, Maisano F. The Portico transcatheter aortic valve for the treatment of severe aortic stenosis. Future Cardiol 2019; 15:31-37. [DOI: 10.2217/fca-2018-0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The Portico TAVI system (Abbott Vascular, Santa Clara, CA, USA) has been specifically designed to mitigate some of the complications associated with first-generation valves. Most of the data generated from randomized studies comparing transcatheter aortic valve implantation with surgery stem from reported experiences with first generation transcatheter heart valve devices. The aim of this review is to describe the repositionable and retrievable Portico system and its implantation technique, coupled with our single-center experience and to provide a review of the clinical results reported so far in the literature.
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Affiliation(s)
- Maurizio Taramasso
- Cardiovascular Surgical Department, Heart Valve Clinic, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Mizuki Miura
- Cardiovascular Surgical Department, Heart Valve Clinic, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Mara Gavazzoni
- Cardiovascular Surgical Department, Heart Valve Clinic, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Andreas
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Matteo Saccocci
- Cardiovascular Surgical Department, Heart Valve Clinic, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Gökhan Gülmez
- Cardiovascular Surgical Department, Heart Valve Clinic, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Francesco Maisano
- Cardiovascular Surgical Department, Heart Valve Clinic, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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20
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del Val D, Ferreira-Neto AN, Asmarats L, Maes F, Guimaraes L, Junquera L, Wintzer J, Fischer Q, Barroso de Freitas Ferraz A, Puri R, Rodés-Cabau J. Transcatheter aortic valve replacement: relative safety and efficacy of the procedure with different devices. Expert Rev Med Devices 2018; 16:11-24. [DOI: 10.1080/17434440.2019.1552132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- David del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Lluis Asmarats
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Frédéric Maes
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Lucia Junquera
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Jérome Wintzer
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Quentin Fischer
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Rishi Puri
- Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
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21
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Mas-Peiro S, Weiler H, Papadopoulos N, Zeiher AM, Fichtlscherer S, Vasa-Nicotera M. Post/preprocedural ratio of hemodynamically assessed aortic regurgitation index as a marker for the need for corrective measures during transcatheter valve replacement: A first confirmatory study in patients receiving a new generation transcatheter self-e. Catheter Cardiovasc Interv 2018; 93:532-537. [DOI: 10.1002/ccd.27847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 07/29/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Silvia Mas-Peiro
- Department of Cardiology; University Hospital Frankfurt am Main; Germany
| | - Helge Weiler
- Department of Cardiology; University Hospital Frankfurt am Main; Germany
| | - Nestoras Papadopoulos
- Department of Cardiothoracic Surgery; University Hospital Frankfurt am Main; Germany
| | - Andreas M. Zeiher
- Department of Cardiology; University Hospital Frankfurt am Main; Germany
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22
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Kim U, Blanke P, Windecker S, Kasel AM, Schäfer U, Walters D, Linke A, Le Breton H, Schymik G, Spence MS, Søndergaard L, Abdel-Wahab M, Worthley S, Tchétché D, Reichenspurner H, Ohana M, Sellers SL, Leipsic JA. Computed tomography-based oversizing and incidence of paravalvular aortic regurgitation and permanent pacemaker implantation with a new-generation self-expanding transcatheter heart valve. EUROINTERVENTION 2018; 14:e511-e518. [PMID: 29741486 DOI: 10.4244/eij-d-17-01040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to evaluate the relationship between CT-based annular perimeter oversizing and the incidence of paravalvular aortic regurgitation (PAR) and permanent pacemaker (PPM) implantation in patients treated with the new self-expanding CENTERA transcatheter heart valve (THV) for severe aortic stenosis. METHODS AND RESULTS One hundred and ninety-eight patients in the CENTERA-EU trial were stratified a priori into four groups based on the perimeter oversizing (2.5-10%, 10-15%, 15-20% and >20%). PAR at 30 days was moderate or higher in 0.6% of patients. The frequency of PPM implantation was 4.9%. The mean perimeter oversizing was 16.2±5.6%. For patients with a perimeter oversizing >10%, an inverse relationship between oversizing and ≥mild PAR was observed (43.3% for 10-15% oversizing; 37.7%, 15-20%; 33.3%, >20%). No association between oversizing and effective orifice area was observed. The optimal cut-off value of perimeter oversizing for the prediction of ≥mild PAR was 15.9% (AUC 0.718, 95% CI: 0.576, 0.860). No annular ruptures were observed. CONCLUSIONS The CENTERA THV appears to have a wide range of sizing tolerance. The degree of oversizing to mitigate PAR is relatively low compared to other self-expanding transcatheter devices. There appears to be no compromise between occurrence of PAR and PPM across this wide range of oversizing.
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Affiliation(s)
- Ung Kim
- St. Paul's Hospital, Vancouver, BC, Canada
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23
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Möllmann H, Walther T, Siqueira D, Diemert P, Treede H, Grube E, Nickenig G, Baldus S, Rudolph T, Kuratani T, Sawa Y, Kempfert J, Kim WK, Abizaid A. Transfemoral TAVI using the self-expanding ACURATE neo prosthesis: one-year outcomes of the multicentre "CE-approval cohort". EUROINTERVENTION 2018; 13:e1040-e1046. [PMID: 28804056 DOI: 10.4244/eij-d-17-00187] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to assess the safety and performance of the ACURATE neo transcatheter heart valve and its transfemoral delivery system. METHODS AND RESULTS The prospective, multicentre "CE-approval cohort" consists of a prospective series of the first 89 patients implanted with the ACURATE neo prosthesis. The primary endpoint was all-cause mortality at 30 days. Mean patient age was 83.7±4.4 years and logistic EuroSCORE I was 26.5±7.7%. Procedural success was obtained in 84 patients (94.4%). At 30 days, three patients had died, and two major strokes and one reintervention for a ventricular septal defect occurred, leading to a major adverse cardiac and cerebrovascular event (MACCE) rate of 6.7%. Eight patients (10.3%) received a permanent pacemaker. At one year, 20 patients (22.5%) had died and the MACCE rate was 27%. Effective orifice area was 1.76±0.34 cm2, and mean gradient 7.5±2.8 mmHg. Only three patients (4.5%) had moderate paravalvular regurgitation. NYHA Class III/IV was present in 94.4% of patients at baseline, in 9.9% at 30 days and in 4.5% at one year post procedure. CONCLUSIONS This first-in-human experience with a novel self-expanding heart valve showed low rates of procedural mortality, major stroke and pacemaker implantation, and good performance outcomes.
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Affiliation(s)
- Helge Möllmann
- Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
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24
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Möllmann H, Linke A, Holzhey DM, Walther T, Manoharan G, Schäfer U, Heinz-Kuck K, Van Boven AJ, Redwood SR, Kovac J, Butter C, Søndergaard L, Lauten A, Schymik G, Worthley SG. Implantation and 30-Day Follow-Up on All 4 Valve Sizes Within the Portico Transcatheter Aortic Bioprosthetic Family. JACC Cardiovasc Interv 2018; 10:1538-1547. [PMID: 28797431 DOI: 10.1016/j.jcin.2017.05.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/27/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the short-term safety and performance of the full range of valve sizes offered within the Portico transcatheter aortic valve replacement system. BACKGROUND The Portico transcatheter aortic heart valve is a fully resheathable, repositionable, and self-expanding bioprosthesis designed to achieve optimal valve position and hemodynamic performance and limit conduction disturbances. METHODS Patients (n = 222) with symptomatic (New York Heart Association functional class ≥II) severe aortic stenosis considered by a multidisciplinary heart team to be at high surgical risk were recruited between December 2011 and September 2015 in this prospective, nonrandomized, multicenter study. Patients were implanted with the full range of Portico heart valves (23, 25, 27, and 29 mm) using the transfemoral approach. The primary endpoint was all-cause mortality at 30 days. Secondary endpoints included valve performance, improvement in functional class, and procedural outcomes as defined by Valve Academic Research Consortium criteria. RESULTS A total of 220 patients (mean age 83.0 ± 4.6 years, 74.3% women, mean Society of Thoracic Surgeons score 5.8%) had valves implanted. All resheathing and repositioning attempts (n = 72) were successful. At 30 days, all-cause mortality was 3.6%. Procedural outcomes included disabling (major) stroke (3.2%), major vascular complications (7.2%), and permanent pacemaker implantation (13.5%). Compared with baseline, 75.8% of patients improved by ≥1 New York Heart Association functional class at 30 days. The rate of moderate paravalvular leak was 5.7%, with no severe paravalvular leak reported. No differences in paravalvular leak incidence and severity were observed among valve sizes (p = 0.24). CONCLUSIONS Across all valve sizes, use of the repositionable Portico transcatheter aortic valve replacement system resulted in safe and effective treatment of aortic stenosis in high-risk patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jan Kovac
- Glenfield Hospital, Leicester, United Kingdom
| | | | | | - Alexander Lauten
- Department of Cardiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Gerhard Schymik
- Medical Clinic IV, Department of Cardiology, Municipal Hospital Karlsruhe, Karlsruhe, Germany
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25
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Outcomes with a latest generation self-expandable, intra-annular, re-sheathable transcatheter heart valve system: analysis of patients with impaired left ventricular function and determinants for pacemaker implantation. Clin Res Cardiol 2018; 107:914-923. [DOI: 10.1007/s00392-018-1263-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/24/2018] [Indexed: 01/09/2023]
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26
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Predictors of Need for Permanent Pacemaker Implantation and Conduction Abnormalities With a Novel Self-expanding Transcatheter Heart Valve. ACTA ACUST UNITED AC 2018; 72:145-153. [PMID: 29551701 DOI: 10.1016/j.rec.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/30/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES The incidence of permanent pacemaker implantation (PPI) and new conduction abnormalities (CA) with the ACURATE neo (Symetis S.A., Eclubens, Switzerland) has not been studied in detail. We aimed to analyze their predictors, evaluating patient- and device-related factors, including implantation depth and device-to-annulus ratio (DAR). METHODS Two analyses of a multicenter population were performed: new PPI in pacemaker-naive patients (n = 283), and PPI/new-CA in patients without prior CA or pacemaker (n = 232). RESULTS A new PPI was required in 9.9% of patients, who had a higher body mass index, higher rate of right bundle branch block and bradycardia. Neither implantation depth nor DAR differed in patients with PPI compared with those without. In the multivariable analysis neither DAR (OR, 1.010; 95%CI, 0.967-1.055; P = .7) nor implantation depth (OR, 0.972; 95%CI, 0.743-1.272; P = .8) predicted PPI. Only high body mass index, bradycardia and right bundle branch block persisted as independent predictors. PPI/new-onset CA occurred in 22.8% of patients and was associated with a higher logistic EuroSCORE. Neither implantation depth nor DAR differed in patients with PPI/new-CA vs those without (7.3 ± 1.9 vs 7.1 ± 1.5mm; P = .6 and 41.0 ± 7.9 vs 42.2 ± 10.1%; P = .4). The only predictor of PPI/new-CA was a higher logistic EuroSCORE (OR, 1.039; 95%CI, [1.008-1.071]; P = .013). CONCLUSIONS New PPI and new-onset CA rates were low with the ACURATE neo. These were mainly influenced by patient characteristics and not by device-depending factors.
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Möllmann H, Hengstenberg C, Hilker M, Kerber S, Schäfer U, Rudolph T, Linke A, Franz N, Kuntze T, Nef H, Kappert U, Walther T, Zembala M, Toggweiler S, Kim WK. Real-world experience using the ACURATE neo prosthesis: 30-day outcomes of 1,000 patients enrolled in the SAVI TF registry. EUROINTERVENTION 2018; 13:e1764-e1770. [DOI: 10.4244/eij-d-17-00628] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Toggweiler S, Nissen H, Mogensen B, Cuculi F, Fallesen C, Veien K, Brinkert M, Kobza R, Rück A. Very low pacemaker rate following ACURATE neo transcatheter heart valve implantation. EUROINTERVENTION 2017; 13:1273-1280. [DOI: 10.4244/eij-d-17-00252] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tummala R, Banerjee K, Sankaramangalam K, Mick S, Krishnaswamy A, White J, Fares M, Mehta A, Popovic Z, Svensson LG, Kapadia SR. Clinical and procedural outcomes with the SAPIEN 3 versus the SAPIEN XT prosthetic valves in transcatheter aortic valve replacement: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2017; 92:E149-E158. [DOI: 10.1002/ccd.27398] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/10/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Ramyashree Tummala
- Department of Internal Medicine; St. Vincent Charity Medical Center, An Affiliate of Case Western Reserve University; Cleveland Ohio
| | - Kinjal Banerjee
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | | | - Stephanie Mick
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | | | - Jonathon White
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | - Maan Fares
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | - Anand Mehta
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | - Zoran Popovic
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
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Giannini F, Latib A, Montorfano M, Ruparelia N, Romano V, Longoni M, Ferri L, Jabbour R, Mangieri A, Regazzoli D, Ancona M, Buzzatti N, Azzalini L, Tanaka A, Agricola E, Chieffo A, Alfieri O, Colombo A. A comparison of the fully repositionable and retrievable Boston Lotus and direct flow medical valves for the treatment of severe aortic stenosis: A single center experience. Catheter Cardiovasc Interv 2017; 91:966-974. [PMID: 28941127 DOI: 10.1002/ccd.27319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 08/05/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Second generation transcatheter aortic valve implantation (TAVI) devices have been designed to reduce the rate of paravalvular leak (PVL) and other complications. An important technological advancement has been the ability to fully reposition devices to facilitate optimal implantation depth and position to reduce the likelihood of PVL. OBJECTIVES To compare procedural and 30-day outcomes according to the Valve Academic Research Consortium (VARC)-2 criteria following TAVI with the fully repositionable and retrievable Lotus and DFM devices. METHODS AND RESULTS 175 patients with severe aortic stenosis underwent transfemoral TAVI with the Lotus (n = 60) and DFM (n = 115) valve. Baseline clinical characteristics did not differ between the two groups. All devices were successfully implanted, with one case of valve embolization in the Lotus group. Device success (95 vs. 98.2%, P = 0.89), VARC-defined combined safety (90 vs. 93%, P = 0.48), and clinical efficacy (86.7 vs. 90.4%, P = 0.65) rates at 30-days were similar between Lotus and DFM groups. There was no severe PVL; one patient in both Lotus and DFM group developed moderate PVL after the procedure. The Lotus valve was associated with a higher rate of new pacemaker implantation (37.3 vs. 11.2%, P < 0.001) and a lower mean aortic gradient (9.4 ± 5 vs. 12.3 ± 5, P < 0.001) at 30-days as compared with the DFM valve. CONCLUSIONS In this single-center, retrospective analysis, both Lotus and DFM devices demonstrated excellent device success, safety and efficacy at 30-day follow-up. The DFM valve was associated with minimally higher transvalvular gradients but lower new pacemaker implantation rates when compared to the Lotus valve.
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Affiliation(s)
- Francesco Giannini
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy.,EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy.,EMO-GVM Centro Cuore Columbus, Milan, Italy
| | | | - Neil Ruparelia
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy.,EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Vittorio Romano
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | - Matteo Longoni
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | - Luca Ferri
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | - Richard Jabbour
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | | | | | - Marco Ancona
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | | | | | - Akihito Tanaka
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy.,EMO-GVM Centro Cuore Columbus, Milan, Italy
| | | | - Alaide Chieffo
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | | | - Antonio Colombo
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy.,EMO-GVM Centro Cuore Columbus, Milan, Italy
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Auffret V, Puri R, Urena M, Chamandi C, Rodriguez-Gabella T, Philippon F, Rodés-Cabau J. Conduction Disturbances After Transcatheter Aortic Valve Replacement. Circulation 2017; 136:1049-1069. [DOI: 10.1161/circulationaha.117.028352] [Citation(s) in RCA: 302] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a well-accepted option for treating patients with aortic stenosis at intermediate to high or prohibitive surgical risk. TAVR-related conduction disturbances, mainly new-onset left bundle-branch block and advanced atrioventricular block requiring permanent pacemaker implantation, remain the most common complication of this procedure. Furthermore, improvements in TAVR technology, akin to the increasing experience of operators/centers, have translated to a major reduction in periprocedural complications, yet the incidence of conduction disturbances has remained relatively high, with perhaps an increasing trend over time. Several factors have been associated with a heightened risk of conduction disturbances and permanent pacemaker implantation after TAVR, with prior right bundle-branch block and transcatheter valve type and implantation depth being the most commonly reported. New-onset left bundle-branch block and the need for permanent pacemaker implantation may have a significant detrimental association with patients’ prognosis. Consequently, strategies intended to reduce the risk and to improve the management of such complications are of paramount importance, particularly in an era when TAVR expansion toward treating lower-risk patients is considered inevitable. In this article, we review the available evidence on the incidence, predictive factors, and clinical association of conduction disturbances after TAVR and propose a strategy for the management of these complications.
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Affiliation(s)
- Vincent Auffret
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Rishi Puri
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Marina Urena
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Chekrallah Chamandi
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Tania Rodriguez-Gabella
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - François Philippon
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Josep Rodés-Cabau
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
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Latest-Generation Transcatheter Aortic Valve Replacement Devices and Procedures. Can J Cardiol 2017; 33:1082-1090. [DOI: 10.1016/j.cjca.2017.03.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/26/2017] [Accepted: 03/13/2017] [Indexed: 11/20/2022] Open
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Manoharan G. Impacto de las mejoras tecnológicas del TAVI en el resultado de la intervención: ¿positivo, negativo o neutro? Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2017.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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35
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Schmidt-Salzmann M, Schlüter M, Kuck KH, Frerker C. Update on the significance of postprocedural aortic regurgitation after transcatheter aortic valve replacement on postprocedural prognosis. Future Cardiol 2017; 13:479-490. [PMID: 28832195 DOI: 10.2217/fca-2017-0035] [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] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is an established therapy for patients with aortic stenosis and a high surgical risk. Recent data on intermediate-risk patients will probably enlarge the indication for TAVR. In the beginning of the TAVR era, relevant (>mild) aortic regurgitation (AR) was a common finding after TAVR; it was associated with worse outcome compared with patients without significant AR. To date, several improvements in imaging, grading of severity and treatment have been done and will be discussed in this article. AR after TAVR still is a strong and independent predictor of 1-year mortality and every effort should be made to prohibit its development.
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Affiliation(s)
| | - Michael Schlüter
- Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany
| | - Christian Frerker
- Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany
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Linke A, Chandrasekhar J, Sartori S, Lefevre T, van Belle E, Schaefer U, Tchetche D, Sardella G, Webb J, Colombo A, Windecker S, Vogel B, Farhan S, Sorrentino S, Sharma M, Snyder C, Asgar A, Dumonteil N, Tamburino C, Hink U, Violini R, Stella P, Bernstein D, Deliargyris E, Hengstenberg C, Baber U, Mehran R, Anthopoulos P, Dangas G. Effect of valve design and anticoagulation strategy on 30-day clinical outcomes in transcatheter aortic valve replacement: Results from the BRAVO 3 randomized trial. Catheter Cardiovasc Interv 2017; 90:1016-1026. [DOI: 10.1002/ccd.27154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/30/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Axel Linke
- Department of Internal Medicine/Cardiology; University of Leipzig, Heart Centre; Germany
| | - Jaya Chandrasekhar
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Samantha Sartori
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Thierry Lefevre
- Division of Cardiology; Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé; Massy France
| | - Eric van Belle
- Department of Cardiology and INSERM UMR 1011; University Hospital, and CHRU Lille; Lille France
| | - Ulrich Schaefer
- Division of Cardiologyy; University Heart Center; Hamburg Germany
- Division of Cardiologyy; Asklepios Clinics St. Georg; Hamburg Germany
| | | | | | - John Webb
- Division of Cardiologyy; St. Paul's Hospital; Vancouver British Columbia Canada
| | | | | | - Birgit Vogel
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Serdar Farhan
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Sabato Sorrentino
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Madhav Sharma
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Clayton Snyder
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Anita Asgar
- Division of Cardiology; Montreal Heart Institute; Montreal Canada
| | | | | | - Ulrich Hink
- Cardiology Department; Johannes Gutenberg University Hospital; Mainz Germany
| | - Roberto Violini
- Division of Cardiology; Azienda Ospedaliera San Camillo-Forlanini di Roma; Italy
| | - Pieter Stella
- Division of Cardiology; University Medical Center Utrecht; The Netherlands
| | - Debra Bernstein
- Division of Cardiology; The Medicines Company; Parsippany New Jersey
| | | | - Christian Hengstenberg
- Division of Cardiology; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance; Munich Germany
- Division of Cardiologyy; Deutsches Herzzentrum München, Technische Universität München; Munich Germany
| | - Usman Baber
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Roxana Mehran
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | | | - George Dangas
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
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Gomes B, Katus HA, Bekeredjian R. Repositionable self-expanding aortic bioprosthesis. Expert Rev Med Devices 2017; 14:565-576. [PMID: 28571486 DOI: 10.1080/17434440.2017.1338136] [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: 10/19/2022]
Abstract
INTRODUCTION Transcatheter aortic valve implantation/replacement (TAVI or TAVR) has been established as a first line therapy in patients with symptomatic severe aortic stenosis (AS) at high or prohibitive surgical risk and as an alternative in elderly patients with intermediate surgical risk. Since its first-in-human procedure in 2002, the past 15-years have shown rapid developments in TAVI technology with the introduction and further improvement of new transcatheter heart valves (THV). Areas covered: There are currently several THV systems available, based on balloon-expandable, self-expandable or other technologies. Some of these are repositionable and retrievable even after partial or full deployment, potentially reducing the risk of malpositioning. The aim of this review is to describe such repositionable self-expandable THV systems. Expert commentary: Repositionability potentially represents a crucial step towards higher safety and efficacy of TAVI. It is unclear if full self-expandability or a combination of self and mechanical expansion will be more advantageous.
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Affiliation(s)
- Bruna Gomes
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
| | - Hugo A Katus
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
| | - Raffi Bekeredjian
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
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Impact of Technological Changes on TAVI Outcomes-For Better, for Worse or No Change? ACTA ACUST UNITED AC 2017; 70:694-695. [PMID: 28395995 DOI: 10.1016/j.rec.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/17/2017] [Indexed: 11/24/2022]
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Aroney C. TAVI or Not TAVI-in Low Risk Patients? That Is the Question. Heart Lung Circ 2017; 26:749-752. [PMID: 28343947 DOI: 10.1016/j.hlc.2017.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Con Aroney
- Cardiology Services, Holy Spirit Northside Hospital, Brisbane, Qld, Australia; Medicine, University of Queensland, Brisbane, Qld, Australia.
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Metaxa S, Ioannou A, Missouris CG. Transcatheter aortic valve implantation: new hope in the management of valvular heart disease. Postgrad Med J 2017; 93:280-288. [PMID: 28104807 DOI: 10.1136/postgradmedj-2016-134554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/19/2016] [Accepted: 12/29/2016] [Indexed: 12/17/2022]
Abstract
Severe calcific aortic stenosis is relatively common, and unless treated with valve replacement it carries an adverse prognosis. A large number of patients, however, are denied surgery due to their advanced age or coexistent medical conditions that increase perioperative cardiovascular risks. Transcatheter aortic valve implantation (TAVI), a technique in which a bioprosthetic valve is inserted via a catheter and implanted within the diseased native aortic valve, is a new therapeutic modality for treatment of older patients with severe symptomatic aortic stenosis and other comorbidities, who have an inherently high surgical risk. This review will provide an overview of the pivotal trials in the development of TAVI; while also investigating important complications and limitations of the procedure and evaluating how new valves are being designed and clinically evaluated, with the ultimate goal of reducing potential complications and expanding the use of TAVI to lower-risk patient cohorts.
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Affiliation(s)
| | | | - Constantinos G Missouris
- Frimley Health NHS Foundation Trust, London, UK.,University of Cyprus Medical School, Nicosia, Cyprus
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Perlman G, Cheung A, Dumont E, Stub D, Dvir D, Del Trigo M, Pelletier M, Alnasser S, Ye J, Wood D, Thompson C, Blanke P, Leipsic J, Seidman M, LeBlanc H, Buller C, Rodés-Cabau J, Webb J. Transcatheter aortic valve replacement with the Portico valve: one-year results of the early Canadian experience. EUROINTERVENTION 2017; 12:1653-1659. [DOI: 10.4244/eij-d-16-00299] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bosmans J, Paelinck B. Transcatheter aortic valve replacement: a further step towards a patient-tailored therapy. EUROINTERVENTION 2016; 12:695-7. [PMID: 27542779 DOI: 10.4244/eijv12i6a112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Johan Bosmans
- Department of Cardiology, Interventional Cardiology, University Hospital Antwerp, Antwerp, Belgium
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