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Garagoli F, Chiabrando JG, Seropian IM, Lombardi M, Agatiello CR, Fernández Recalde ML, Vergallo R, Porto I, Bluro IM. Stroke risk after transcatheter aortic valve replacement in patients with carotid stenosis: A systematic review and meta-analysis. Int J Cardiol 2024; 408:132085. [PMID: 38702030 DOI: 10.1016/j.ijcard.2024.132085] [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: 01/07/2024] [Revised: 04/02/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Stroke is a feared complication of transcatheter aortic valve replacement (TAVR). Patients undergoing TAVR typically have multiple comorbidities, such as carotid artery stenosis (CAS). We conducted the present meta-analysis to determine the risk of stroke and mortality following TAVR in patients with CAS. METHODS We searched PubMed/Medline, Scopus, ScienceDirect, and Cochrane Clinical Trials databases for clinical studies that compared CAS ≥50% and CAS ≥70% versus non-CAS TAVR population. The endpoints included the 30-day incidence of stroke or transient ischemic attack (TIA) and 30-day all-cause of mortality. RESULTS We identified seven studies that included 12,418 patients in the CAS group and 102,316 in the control group. CAS ≥50% was not associated with an increased risk of 30-day stroke or TIA after TAVR [risk ratio (RR): 1.38; 95% confidence interval (95% CI): 0.95-2.02; p = 0.09]. However, patients with CAS ≥70% had an increased risk of stroke or TIA (RR: 1.43; 95% CI: 1.02-2.01; p = 0.04). No difference in 30-day all-cause mortality was observed between CAS ≥50% or CAS ≥70% and control groups (RR: 1.09; 95% CI: 0.79-1.52; p = 0.59 and RR: 1.11; 95% CI: 0.85-1.45; p = 0.43, respectively). CONCLUSIONS CAS ≥70% was associated with an increased risk of stroke or TIA following TAVR compared with patients without CAS.
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Affiliation(s)
- Fernando Garagoli
- Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Juan Guido Chiabrando
- Department of Interventional Cardiology, Sanatorio Anchorena, Buenos Aires, Argentina
| | - Ignacio Miguel Seropian
- Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marco Lombardi
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Largo R. Benzi, 10, 16132 Genova, Italy
| | - Carla Romina Agatiello
- Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Rocco Vergallo
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Largo R. Benzi, 10, 16132 Genova, Italy; Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Italo Porto
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Largo R. Benzi, 10, 16132 Genova, Italy; Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Ignacio Martín Bluro
- Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Zaid S, Atkins MD, Kleiman NS, Reardon MJ, Tang GHL. What's New with TAVR? An Update on Device Technology. Methodist Debakey Cardiovasc J 2023; 19:4-14. [PMID: 37213874 PMCID: PMC10198244 DOI: 10.14797/mdcvj.1230] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 05/23/2023] Open
Abstract
Over the last 20 years, transcatheter aortic valve replacement (TAVR) has revolutionized the management of aortic stenosis and has become the standard of care across the entire spectrum of surgical risk. Expansion of TAVR in treating younger, lower-risk patients with longer life expectancies, and treating earlier in the disease process, has seen a continuous evolution in device technology, with several next-generation transcatheter heart valves developed to minimize procedural complications and improve patient outcomes. This review provides an update on the latest advances in transcatheter delivery systems, devices, and leaflet technology.
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Affiliation(s)
- Syed Zaid
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US
| | - Marvin D. Atkins
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US
| | - Neal S. Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US
| | - Michael J. Reardon
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US
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Bezzeccheri A, Vermeersch P, Verheye S, Wilgenhof A, Willemen Y, Vescovo GM, Scott B, Convens C, Zivelonghi C, Agostoni P. Trends and outcomes in transcatheter aortic valve implantation in Belgium: a 13-year single centre experience. Acta Cardiol 2022; 77:960-969. [PMID: 36326198 DOI: 10.1080/00015385.2022.2130444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has been adopted as an alternative to surgery in severe aortic stenosis treatment, even in low-intermediate risk. The aim of this study is to retrospectively report our single-centre 13-year TAVI experience with emphasis on learning curve, referral indication and trends in outcomes over time. METHODS We included 361 consecutive patients who underwent TAVI from January 2008 to December 2020, grouped according to similar per-year volume of procedures: G1 (2008-2014), G2 (2015-2017) and G3 (2018-2020). RESULTS The number of procedures increased (group size: 59 vs. 106 vs. 196). No major differences were observed in STS-PROM and EuroSCORE-II between groups, despite TAVI in patients with prior surgical revascularisation was mainly performed in G1. Trans-femoral approach raised from 80.8 to 93.4%, while the most common alternative access was trans-subclavian. The pre-dilation rate was higher in G1 with lower prosthesis post-dilation rate. The length of hospital stay decreased in time by 30%. At 30 days a reduction in all-cause mortality, vascular complications, bleedings and para-valvular leak combined with higher rate of permanent pacing were observed over the groups. At 1-year there was no difference in all-cause mortality but over 30% reduction in cardiovascular death (8.5 vs. 7.5 vs. 5.6%). CONCLUSIONS Favourable trends were observed across the groups, with an improvement in periprocedural outcomes and cardiovascular mortality at 1-year. These improvements could depend on increased expertise because mortality reduction was noted only after reaching a significant procedure volume. A trend towards lower risk patients selection was present in our cohort, as previously described worldwide.
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Affiliation(s)
- Andrea Bezzeccheri
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.,Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Paul Vermeersch
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Adriaan Wilgenhof
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Yannick Willemen
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | | | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carl Convens
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
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Hameed I, Oakley CT, Hameed NUF, Jiang Y, Naeem N, Morsi M, Ahmed A, Amabile A, Hirji S, Truong QA, Gaudino M, Kaneko T, Salemi A. Peripheral access size evaluation in transfemoral transcatheter aortic valve replacement. J Card Surg 2022; 37:801-807. [PMID: 35137971 DOI: 10.1111/jocs.16293] [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: 12/03/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM Peripheral access vessel dimensions in the general patient population screened for transcatheter aortic valve replacement (TAVR) can offer insight into the indications for pre-TAVR computed tomography angiography (CTA) assessment. We seek to determine peripheral access vessel sizes in patients screened for TAVR and association with patient characteristics. MATERIALS AND METHODS All patients with severe, symptomatic aortic stenosis screened for TAVR at a high-volume center from April 2012 to March 2019 were retrospectively reviewed. For each patient, contrast-enhanced CTA was used to determine the minimal luminal diameters (MLDs) of the transfemoral access vessels, as measured between the inguinal ligament and the deep femoral artery for the femoral artery, and proximal to the inguinal ligament for the external and common iliac arteries, respectively. Paired and independent samples t-tests were used to compare means and regression analyses were performed to determine factors associated with MLD. RESULTS A total of 1049 screened patients were included of which 826 (78.7%) underwent TAVR and 551 (52.5%) were male. The mean age was 80.6 (±9.6) years and the mean body mass index (BMI) was 26.7 (±5.9) kg/m2 . About 152 (14.5%) had peripheral vascular disease and 153 (14.6%) had chronic kidney disease. The mean (±2 standard deviations) MLDs of the right and left femoral arteries were 7.73 mm (4.68-10.78) and 7.68 mm (4.63-10.72), respectively. Male sex and BMI were associated with larger average femoral MLD while hyperlipidemia, hypertension, smoking, peripheral vascular disease, and coronary artery disease were inversely associated. CONCLUSION Most patients screened for TAVR have minimum peripheral access vessel sizes exceeding the recommended minimum access route diameters of modern transcatheter heart valves. As sheath sizes decrease, clinicians must carefully judge patient individual risk factors to determine whether a pre-TAVR CTA assessing peripheral access vessel dimensions and anatomical contraindications is indicated. Larger studies and randomized controlled trials are required to compare the outcomes of TAVR with and without preoperative CTA.
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Affiliation(s)
- Irbaz Hameed
- Division of Cardiothoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christian T Oakley
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - N U F Hameed
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Yuan Jiang
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Nyla Naeem
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Mahmoud Morsi
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Adham Ahmed
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Andrea Amabile
- Division of Cardiothoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sameer Hirji
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Quynh A Truong
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Arash Salemi
- Department of Cardiothoracic Surgery, Robert Wood Johnson/Barnabas Health, West Orange, New Jersey, USA
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Santangelo G, Ielasi A, Pellicano M, Latib A, Tespili M, Donatelli F. An Update on New Generation Transcatheter Aortic Valves and Delivery Systems. J Clin Med 2022; 11:jcm11030499. [PMID: 35159952 PMCID: PMC8837046 DOI: 10.3390/jcm11030499] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/30/2021] [Accepted: 01/15/2022] [Indexed: 12/15/2022] Open
Abstract
Over the last 15 years, the management of aortic valve disease has been changed by transcatheter aortic valve replacement, which has become the standard of care across the entire spectrum of surgical risk. As a result of continuous evolution of this technique, several next-generation transcatheter heart valves (THVs) have been developed to minimize procedural complications and improve patient outcomes. This review aims to provide an update on the new generation THVs and delivery systems.
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Affiliation(s)
- Gloria Santangelo
- San Paolo Hospital, Division of Cardiology, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy;
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, Via Faravelli 16, 20149 Milan, Italy; (M.P.); (M.T.)
- Correspondence:
| | - Mariano Pellicano
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, Via Faravelli 16, 20149 Milan, Italy; (M.P.); (M.T.)
| | - Azeem Latib
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 210th Street, Bronx, NY 10467, USA;
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, Via Faravelli 16, 20149 Milan, Italy; (M.P.); (M.T.)
| | - Francesco Donatelli
- Department of Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, University of Milan, Via Faravelli 16, 20149 Milan, Italy;
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Pontone G, Marano R, Agricola E, Alushi B, Bartorelli A, Cameli M, Carrabba N, Esposito A, Faletti R, Francone M, Galea N, Golino P, Guglielmo M, Palmisano A, Petronio S, Petullà M, Pradella S, Ribichini F, Romeo F, Russo V, Scandura S, Schicchi N, Spaccarotella C, Tomai F, Centonze M, indolfi C. Recommendations in pre-procedural imaging assessment for transcatheter aortic valve implantation intervention. J Cardiovasc Med (Hagerstown) 2022; 23:216-227. [DOI: 10.2459/jcm.0000000000001293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Aidietis A, Srimahachota S, Dabrowski M, Bilkis V, Buddhari W, Cheung GSH, Nair RK, Mussayev AA, Mattummal S, Chandra P, Mahajan AU, Chmielak Z, Govindan SC, Jose J, Hiremath MS, Chandra S, Shetty R, Mohanan S, John JF, Mehrotra S, Søndergaard L. 30-Day and 1-Year Outcomes With HYDRA Self-Expanding Transcatheter Aortic Valve: The Hydra CE Study. JACC Cardiovasc Interv 2022; 15:93-104. [PMID: 34991828 DOI: 10.1016/j.jcin.2021.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/17/2021] [Accepted: 09/07/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study sought to evaluate the 30-day and 1-year safety and performance of the Hydra transcatheter aortic valve (THV) (in the treatment of symptomatic severe aortic stenosis in patients at high or extreme surgical risk. BACKGROUND The Hydra THV is a novel repositionable self-expanding system with supra-annular bovine pericardial leaflets. METHODS The Hydra CE study was a premarket, prospective, multicenter, single-arm study conducted across 18 study centers in Europe and Asia-Pacific countries. The primary endpoint was all-cause mortality at 30 days. All endpoints were adjudicated by an independent clinical events committee. RESULTS A total of 157 patients (79.2 ± 7.1 years of age, 58.6% female; Society of Thoracic Surgeons score 4.7 ± 3.4%) were enrolled. Successful implantation was achieved in 94.3% cases. At 30 days, there were 11 (7.0%) deaths, including 9 (5.7%) cardiovascular deaths, of which 5 (3.2%) were device related. At 1 year, there were 23 (14.6%) deaths, including 13 (8.3%) cardiovascular deaths. At 30 days, there were significant improvement of effective orifice area (from 0.7 ± 0.2 cm2 to 1.9 ± 0.6 cm2) and mean aortic valve gradient (from 49.5 ± 18.5 mm Hg to 8.1 ± 3.7 mm Hg), which were sustained up to 1 year. Moderate or severe paravalvular leak was observed in 6.3% of patients at 30 days and 6.9% of patients at 1 year. The rate of new permanent pacemaker implantation was 11.7% at 30 days and 12.4% at 1 year. CONCLUSIONS The Hydra CE study demonstrated that transcatheter aortic valve replacement with Hydra THV offered favorable efficacy at 1 year, providing large effective orifice area and low transvalvular gradient as well as acceptable complication rates with regard to new permanent pacemaker and paravalvular leak. (A Clinical Evaluation of the HYDRA Self Expanding Transcatheter Aortic Valve; NCT02434263).
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Affiliation(s)
- Audrius Aidietis
- Cardiology and Angiology Centre, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Suphot Srimahachota
- Cardiac Center and Division of Cardiovascular Disease, Department of Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Vaildas Bilkis
- Cardiology and Angiology Centre, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Wacin Buddhari
- Cardiac Center and Division of Cardiovascular Disease, Department of Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | - Gary S H Cheung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR
| | - Rajesh K Nair
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Abdurashid A Mussayev
- Catheterization Laboratory, National Research Center for Cardiac Surgery, Astana, Kazakhstan
| | - Shafeeq Mattummal
- Department of Adult Cardiology, ASTER MIMS Hospital, Kozhikode, India
| | - Praveen Chandra
- Division of Interventional Cardiology, Medanta The Medicity Hospital, Gurgaon, India
| | - Ajay U Mahajan
- Department of Cardiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, India
| | - Zbigniew Chmielak
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Sajeev C Govindan
- Department of Cardiology, Government Medical College, Calicut, India
| | - John Jose
- Department of Cardiology, Cardiology Unit 2, Christian Medical College Hospital, Vellore, India
| | | | - Sharad Chandra
- Department of Cardiology (Lari Heart Center), King George's Medical University, Lucknow, India
| | - Ranjan Shetty
- Department of Cardiology, Manipal Hospital, Bengaluru, India
| | - Sandeep Mohanan
- KMCT Heart Institute, KMCT Medical College Hospital, Kozhikode, India
| | - John F John
- Department of Cardiology, Baby Memorial Hospital, Calicut, India
| | - Sanjay Mehrotra
- Department of Cardiology, NH Institute of Cardiac Sciences, Bangalore, India
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Werner N, Renker M, Dörr O, Bauer T, Nef H, Choi YH, Hamm CW, Zahn R, Kim WK. Anatomical suitability and off-label use of contemporary transcatheter heart valves. Int J Cardiol 2021; 350:96-103. [PMID: 34979147 DOI: 10.1016/j.ijcard.2021.12.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite excellent procedural results in a broad clinical population, certain anatomical or clinical conditions are still challenging for transcatheter aortic valve replacement (TAVI). Whether the adherence to the instructions for use (IFU) or the use of a clinically suitable device is a prerequisite for procedural success has not been well characterized. AIMS The anatomical and clinical suitability of new-generation transcatheter heart valves (THV) was evaluated in an all-comers population (n = 540) at a high-volume center. METHODS Conformity with anatomical IFU criteria was evaluated in each implanted THV. In addition, the suitability of the implanted THV was verified in each case according to clinical and anatomical criteria, which had been previously defined according to the results of an international survey including 20 renowned TAVI operators. Furthermore, criteria of clinical suitability and adherence to IFU of each THV were applied to the overall cohort to analyze the proportion of patients in whom the use of the respective THV would have been judged to be unsuitable or off-label. RESULTS An off-label use of THV based on anatomical considerations was found in 20% of all procedures, whereas the implantation of a THV deemed to be clinically unsuitable was noted in 16.3% of all procedures. Clinical suitability and conformity with IFU were present to a varying extent across the THV systems. Neither clinical suitability, nor conformity with IFU were associated with device failure or periprocedural mortality. On multivariable analysis, aortic tortuosity, mean transaortic gradient and ascending aorta diameter were identified as independent predictors of device failure (VARC-3). CONCLUSIONS Off-label TAVI and the use of clinically unsuitable THVs were common, but did not affect procedural outcomes. The variety of clinical and anatomical coverage of the different THV systems emphasizes the importance of an individualized THV selection.
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Affiliation(s)
- Nicolas Werner
- Sana Klinikum Offenbach, Department of Cardiology, Offenbach, Germany
| | - Matthias Renker
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Oliver Dörr
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Justus-Liebig University of Giessen and Marburg, Department of Cardiology, Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Timm Bauer
- Sana Klinikum Offenbach, Department of Cardiology, Offenbach, Germany; Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Holger Nef
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Justus-Liebig University of Giessen and Marburg, Department of Cardiology, Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Yeong-Hoon Choi
- Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Christian W Hamm
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Justus-Liebig University of Giessen and Marburg, Department of Cardiology, Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Ralf Zahn
- Herzzentrum Ludwigshafen, Department of Cardiology, Ludwigshafen, Germany
| | - Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; Justus-Liebig University of Giessen and Marburg, Department of Cardiology, Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany.
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9
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Gorla R, Casenghi M, Finotello A, De Marco F, Morganti S, Regazzoli D, Bianchi G, Acerbi E, Popolo Rubbio A, Brambilla N, Testa L, Castriota F, Auricchio F, Reimers B, Bedogni F. Outcome of transcatheter aortic valve replacement in bicuspid aortic valve stenosis with new-generation devices. Interact Cardiovasc Thorac Surg 2021; 32:20-28. [PMID: 33201993 DOI: 10.1093/icvts/ivaa231] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/05/2020] [Accepted: 09/03/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To compare device success and paravalvular leak rates of 3 new-generation transcatheter aortic valve replacement devices in patients with bicuspid aortic valve stenosis and to test their biomechanical performance in a computer-based simulation model of aortic root with increasing ellipticity. METHODS This retrospective multicentre study included 56 bicuspid aortic valve patients undergoing transcatheter aortic valve replacement with new-generation devices: Lotus/Lotus Edge (N = 15; 27%), Evolut-R (N = 20; 36%) and ACURATE neo (N = 21; 37%). Three virtual simulation models of aortic root with increasing index of eccentricity (0-0.25-0.5) were implemented. Stress distribution, stent-root contact area and paravalvular orifice area were computed. RESULTS Device success was achieved in 43/56 patients (77%) with comparable rates among Lotus (87%), Evolut-R (60%) and ACURATE neo (86%; P = 0.085). Moderate paravalvular leak rate was significantly lower in the Lotus group as compared to Evolut-R group (0% vs 30%; P = 0.027) and comparable to the ACURATE neo group (0% vs 10%; P = 0.33). By index of eccentricity = 0.5, Lotus showed a uniform and symmetric pattern of stress distribution with absent paravalvular orifice area, ACURATE neo showed a mild asymmetry with small paravalvular orifice area (1.1 mm2), whereas a severely asymmetric pattern was evident with Evolut-R, resulting in a large paravalvular orifice area (12.0 mm2). CONCLUSIONS Transcatheter aortic valve replacement in bicuspid aortic valve patients with new-generation devices showed comparable device success rates. Lotus showed moderate paravalvular leak rate comparable to that of ACURATE neo and significantly lower than Evolut-R. On simulation, Lotus and ACURATE neo showed optimal adaptability to elliptic anatomies as compared to Evolut-R.
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Affiliation(s)
- Riccardo Gorla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Matteo Casenghi
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alice Finotello
- Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Simone Morganti
- Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Damiano Regazzoli
- Department of Clinical and Interventional Cardiology, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Giovanni Bianchi
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Elena Acerbi
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Antonio Popolo Rubbio
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Nedy Brambilla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Fausto Castriota
- Department of Clinical and Interventional Cardiology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Bernhard Reimers
- Department of Clinical and Interventional Cardiology, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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10
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Kawashima H, Serruys PW, Mylotte D, Rosseel L, Amat-Santos IJ, Rao RS, Onuma Y, Wijns W, Abdel-Wahab M, Baumbach A, Soliman O. Operator preference and determinants of size selection when additional intermediate-size aortic transcatheter heart valves are made available. Int J Cardiol 2021; 338:168-173. [PMID: 34147554 DOI: 10.1016/j.ijcard.2021.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/22/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Appropriate size selection of transcatheter heart valves (THVs) is fundamental to reduce transcatheter aortic valve implantation (TAVI) related complications, particularly paravalvular aortic regurgitation, new permanent pacemaker implantation, and annular rupture. We sought to investigate the frequency of operator selection of intermediate-size balloon-expandable Myval THVs (Meril Life Sciences Pvt. Ltd., India) for TAVI in a real-world dataset. METHODS In this retrospective survey of patients treated with TAVI using the Myval THV, 20, 23, 26, and 29 mm are conventional-size THVs, 21.5, 24.5 and 27.5 mm are intermediate-size THVs, and 30.5 and 32 mm are extra-large THVs. Operator size selection for implantation was based on multislice computed tomography (MSCT) derived aortic-root dimensions. RESULTS A total of 1115 patients underwent Myval THV implantation in 27 countries worldwide. The Myval intermediate-size THVs were used in 468 (42.0%) patients. MSCT data were available in 562 patients. There was no statistical difference between the Intermediate/Upsized and Appropriately sized groups or Intermediate/Downsized and Appropriately sized groups in terms of different variables measured with MSCT except for annular dimensions and degree of calcification. CONCLUSIONS Intermediate-size Myval balloon-expandable THVs are used in nearly half of all cases in contemporary real-world TAVI practice, addressing the unmet need of TAVI operators for a more calibrated THV choice. Our hypothesis should be tested in randomized prospective studies currently initiated in Europe, including clinical outcomes of patients treated with both conventional- and intermediate-size THVs.
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Affiliation(s)
- Hideyuki Kawashima
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland; Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland; CÚRAM, the SFI Research Centre for Medical Devices, Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
| | - Darren Mylotte
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland
| | - Liesbeth Rosseel
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland
| | | | | | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland
| | - William Wijns
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Baumbach
- William Harvey Research Institute, Queen Mary University of London, and Barts Heart Centre, London, United Kingdom
| | - Osama Soliman
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland; CÚRAM, the SFI Research Centre for Medical Devices, Galway, Ireland
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11
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Oh JK, Lee SH, Lee SA, Kang DY, Lee S, Kim HJ, Ahn JM, Kim JB, Park DW, Song JM, Choo SJ, Kang DH, Song JK, Park SJ, Kim DH. Prognostic impact of left ventricular mass regression after transcatheter aortic valve replacement in patients with left ventricular hypertrophy. Int J Cardiol 2021; 332:60-66. [PMID: 33781852 DOI: 10.1016/j.ijcard.2021.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/23/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Paravalvular regurgitation (PVR) has been known to be the primary determinant of poor left ventricular (LV) mass regression after transcatheter aortic valve replacement (TAVR). However, the incidence of significant PVR has been reduced considerably as TAVR technology evolved rapidly. This study aimed to investigate the time course and impact of LV mass index (LVMi) regression on long-term clinical outcomes in severe aortic stenosis (AS) patients without significant PVR after TAVR. METHODS Of 412 patients who underwent TAVR, 146 who had LV hypertrophy (LVMi ≥115 g/m2 for men and ≥ 95 g/m2 for women) at baseline and were alive at one year after TAVR were enrolled. The primary outcome was cardiovascular deaths and the impact of LVMi regression on clinical outcomes were examined. The patients with significant PVR were excluded. RESULTS During a median follow-up of 40 months (interquartile range, 26-58 months), 9 (6.2%) cardiovascular deaths, 21 (14.4%) all-cause deaths, and 9 (6.2%) hospitalizations occurred. In the multivariable analysis, the percentage change of LVMi was an independent predictor of cardiovascular deaths (adjusted hazard ratio [HR], 1.03; 95% confidential interval [CI], 1.01-1.05; P = 0.010), and composite outcome of cardiovascular deaths and rehospitalization for heart failure (adjusted HR, 1.02; 95% CI, 1.00-1.04; P = 0.022). Baseline LVMi, eccentric hypertrophy, and TAVR-induced left bundle branch block were independently associated with LVMi regression. CONCLUSIONS In patients with severe AS who received successful TAVR without significant PVR, the degree of LVMi regression is an independent predictor of postoperative outcomes after TAVR.
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Affiliation(s)
- Jin Kyung Oh
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Sun Hack Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Seung-Ah Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sahmin Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Min Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Kwan Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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12
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Ebelt H, Goetze S, Weida A, Offhaus A. Impact of ultrasound contrast agent during transoesophageal echocardiography on the sizing of the left atrial appendage. Open Heart 2021; 8:openhrt-2020-001403. [PMID: 33757976 PMCID: PMC7993222 DOI: 10.1136/openhrt-2020-001403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/19/2020] [Accepted: 03/09/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Interventional closure of the left atrial appendage closure (LAAC) has been established as an alternative treatment in patients with atrial fibrillation (AF) and an increased risk of stroke. So far it is unknown whether the use of ultrasound contrast agent (UCA) would influence the correct sizing of the LAA and thereby have an impact on device selection during interventional LAAC. METHODS Between January 2017 and April 2018, 223 transoesophageal echocardiography (TOE) examinations were prospectively performed in adult patients with non-valvular AF (Impact of the use of ultrasound contrast agent on the detection of thrombi in the left atrial appendage during transesophageal echocardiography (CONDOR) study). LAA was examined both with and without the use of UCA. The following measurements were taken at 0o, 45o, 90o and 135o: diameter of LAA ostium, maximal depth of the LAA, maximal available depth of the LAA orthogonal to the ostial plane and area of the LAA. RESULTS The use of UCA had no relevant influence on the size determination of the LAA. Additionally, Bland-Altman blots demonstrate a high degree of correlation between the measurements with and without UCA with no evidence for a systematic effect arising from the use of UCA. When comparing the measurements of two independent investigators, the use of UCA rather leads to a higher variability than to an improved precision. DISCUSSION Despite the fact that the use of UCA during TOE leads to an improved rule out of thrombi, our study shows that there is no advantageous effect of UCA on the size determination of the LAA and should therefore not be used for this purpose.
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Affiliation(s)
- Henning Ebelt
- Department of Medicine II, Catholic Hospital, Sankt Johann Nepomuk, Erfurt, Thüringen, Germany
| | - Sarah Goetze
- Department of Medicine II, Catholic Hospital, Sankt Johann Nepomuk, Erfurt, Thüringen, Germany
| | - Anja Weida
- Department of Medicine II, Catholic Hospital, Sankt Johann Nepomuk, Erfurt, Thüringen, Germany
| | - Alexandra Offhaus
- Department of Medicine II, Catholic Hospital, Sankt Johann Nepomuk, Erfurt, Thüringen, Germany
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13
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Short and long-term clinical impact of transcatheter aortic valve implantation in Portugal according to different access routes: Data from the Portuguese National Registry of TAVI. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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14
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Guerreiro C, Ferreira PC, Teles RC, Braga P, Canas da Silva P, Patrício L, Silva JC, Baptista J, de Sousa Almeida M, Gama Ribeiro V, Silva B, Brito J, Infante Oliveira E, Cacela D, Madeira S, Silveira J. Short and long-term clinical impact of transcatheter aortic valve implantation in Portugal according to different access routes: Data from the Portuguese National Registry of TAVI. Rev Port Cardiol 2020; 39:705-717. [PMID: 33261991 DOI: 10.1016/j.repc.2020.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/22/2020] [Accepted: 02/01/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The Portuguese National Registry of Transcatheter Aortic Valve Implantation records prospectively the characteristics and outcomes of transcatheter aortic valve implantation (TAVI) procedures in Portugal. OBJECTIVES To assess the 30-day and one-year outcomes of TAVI procedures in Portugal. METHODS We compared TAVI results according to the principal access used (transfemoral (TF) vs. non-transfemoral (non-TF)). Cumulative survival curves according to access route, other procedural and clinical variables were obtained. The Valve Academic Research Consortium-2 (VARC-2) composite endpoint of early (30-days) safety was assessed. VARC-2 predictors of 30-days and 1-year all-cause mortality were identified. RESULTS Between January 2007 and December 2018, 2346 consecutive patients underwent TAVI (2242 native, 104 valve-in-valve; mean age 81±7 years, 53.2% female, EuroSCORE-II - EuroS-II, 4.3%). Device success was 90.1% and numerically lower for non-TF (87.0%). Thirty-day all-cause mortality was 4.8%, with the TF route rendering a lower mortality rate (4.3% vs. 10.1%, p=0.001) and higher safety endpoint (86.4% vs. 72.6%, p<0.001). The one-year all-cause mortality rate was 11.4%, and was significantly lower for TF patients (10.5% vs. 19.4%, p<0.002). After multivariate analysis, peripheral artery disease, previous percutaneous coronary intervention, left ventricular dysfunction and NYHA class III-IV were independent predictors of 30-day all-cause mortality. At one-year follow-up, NYHA class III-IV, non-TF route and occurrence of life-threatening bleeding predicted mortality. Kaplan-Meier survival analysis of the first year of follow-up shows decreased survival for patients with an EuroS-II>5% (p<0.001) and who underwent non-TF TAVI (p<0.001). CONCLUSION Data from our national real-world registry showed that TAVI was safe and effective. The use of a non-transfemoral approach demonstrated safety in the short term. Long-term prognosis was, however, adversely associated with this route, with comorbidities and the baseline clinical status.
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Affiliation(s)
- Cláudio Guerreiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Pedro Carrilho Ferreira
- Department of Cardiology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Portugal
| | - Rui Campante Teles
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; CEDOC, Nova Medical School, Lisbon, Portugal.
| | - Pedro Braga
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Pedro Canas da Silva
- Department of Cardiology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Portugal
| | - Lino Patrício
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Portugal
| | - João Carlos Silva
- Department of Cardiology, Centro Hospitalar Universitário de São João, Portugal
| | - José Baptista
- Department of Cardiology, Hospital dos Lusíadas, Portugal
| | - Manuel de Sousa Almeida
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; CEDOC, Nova Medical School, Lisbon, Portugal
| | - Vasco Gama Ribeiro
- Department of Cardiology, Hospital da Cruz Vermelha Portuguesa, Portugal
| | - Bruno Silva
- Department of Cardiology, Hospital de Nélio Mendonça, Funchal, Portugal
| | - João Brito
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; CEDOC, Nova Medical School, Lisbon, Portugal
| | - Eduardo Infante Oliveira
- Department of Cardiology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Portugal
| | - Duarte Cacela
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Portugal
| | - Sérgio Madeira
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; CEDOC, Nova Medical School, Lisbon, Portugal
| | - João Silveira
- Department of Cardiology, Hospital de Santo António, Centro Hospitalar do Porto, Portugal
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16
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Kim WK, Renker M, Rolf A, Fischer-Rasokat U, Wiedemeyer J, Doss M, Möllmann H, Walther T, Nef H, Hamm CW, Liebetrau C. Annular versus supra-annular sizing for TAVI in bicuspid aortic valve stenosis. EUROINTERVENTION 2019; 15:e231-e238. [DOI: 10.4244/eij-d-19-00236] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Overtchouk P, Prendergast B, Modine T. Why should we extend transcatheter aortic valve implantation to low-risk patients? A comprehensive review. Arch Cardiovasc Dis 2019; 112:354-362. [PMID: 31014990 DOI: 10.1016/j.acvd.2019.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 02/07/2023]
Abstract
Within the past decade, transcatheter aortic valve implantation (TAVI) has become established as the optimal treatment option for elderly, inoperable and high-risk patients with severe aortic stenosis, and is now recommended by international guidelines. Randomized controlled trials have demonstrated the non-inferiority of TAVI to open surgery in intermediate-risk patients and, most recently, in low-risk patients. Further randomized controlled trials are underway, but existing studies have already provided reassuring data in this cohort, and TAVI is offered routinely to younger and lower-risk patients in numerous centers. Improvements in the design of devices and delivery systems, accompanied by increased operator experience, have dramatically improved the safety of the procedure, and further expansion into low-risk groups seems inevitable once concerns about valve durability and device cost have been addressed. In this article, we provide a review of the existing literature, and estimate the clinical impact of TAVI in low-risk patients. Abbreviated title: Why should we extend TAVI to low-risk patients?
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Affiliation(s)
- Pavel Overtchouk
- Department of Cardiology and Cardiovascular Surgery, Centre Hospitalier Regional et Universitaire de Lille, 59000 Lille, France
| | | | - Thomas Modine
- Department of Cardiology and Cardiovascular Surgery, Centre Hospitalier Regional et Universitaire de Lille, 59000 Lille, France.
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18
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Schofer N, Deuschl F, Rübsamen N, Skibowski J, Seiffert M, Voigtländer L, Schaefer A, Schneeberger Y, Schirmer J, Reichenspurner H, Blankenberg S, Conradi L, Schäfer U. Prosthesis-patient mismatch after transcatheter aortic valve implantation: prevalence and prognostic impact with respect to baseline left ventricular function. EUROINTERVENTION 2019; 14:1648-1655. [DOI: 10.4244/eij-d-18-00827] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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19
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Tchetche D, de Biase C, Brochado B, Mastrokostopoulos A. How to Make the TAVI Pathway More Efficient. ACTA ACUST UNITED AC 2019; 14:31-33. [PMID: 30858889 PMCID: PMC6406128 DOI: 10.15420/icr.2018.28.2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has been in use for 16 years. As there has been a rapid expansion in its use, there is a need to optimise TAVI programmes to ensure efficiency. In this article, the authors discuss the reasons why clinicians need to make the TAVI pathway more efficient and describe the most important steps to take from screening to early discharge, including procedural optimisation.
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Affiliation(s)
- Didier Tchetche
- Groupe Cardiovasculaire Interventionnel, Clinique Pasteur Toulouse, France
| | - Chiara de Biase
- Groupe Cardiovasculaire Interventionnel, Clinique Pasteur Toulouse, France
| | - Bruno Brochado
- Groupe Cardiovasculaire Interventionnel, Clinique Pasteur Toulouse, France
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20
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van Wiechen MP, Van Mieghem NM. Maturation from CoreValve ® to Evolut Pro ®: a clinical overview. Future Cardiol 2018; 15:1-8. [PMID: 30565481 DOI: 10.2217/fca-2018-0064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The only curative treatment of aortic stenosis is through surgical or transcatheter aortic valve replacement. Transcatheter aortic valve implantation has evolved from its first in human experience in 2002 and matured to the treatment of first choice of symptomatic severe aortic stenosis in elderly patients with an elevated operative risk. The self-expanding CoreValve® bioprosthesis has been on the forefront of this growing transcatheter aortic valve implantation experience. Over the last decade, various device iterations resulted in the current Evolut PRO® self-expanding valve platform with reduced profile, repositioning/retrievable features and porcine pericardial wrap. Herein we provide a critical appraisal of the consecutive device iterations and highlight the clinical foundation for the use of the self-expanding CoreValve® /Evolut platforms in current clinical practice.
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Affiliation(s)
- Maarten P van Wiechen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
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21
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Dowling C, Firoozi S, Doyle N, Blackman DJ, Malkin CJ, Cunnington MS, Saraf S, Buch MH, Levy R, Chowdhary S, Spence MS, Manoharan G, Owens CG, Brennan PF, Roberts D, More R, Wiper A, Abdelaziz HK, Mylotte D, Neylon A, Martin N, Mercanti F, Dorman S, Panoulas V, Dalby M, Kashyap MN, Kabir T, Kovac J, Kontoprias K, Malik IS, Ghada MW, Sen S, Ruparelia N, Demir OM, Frame A, Uren NG, Anderson R, Rajathurai T, Tapp L, Deegan L, Grech E, Hall I, Neville M, Rampat R, Hildick-Smith D, Mullen M, Kennon S, Chandrala P, Doshi S, Brecker SJ. Initial experience of a large, self-expanding, and fully recapturable transcatheter aortic valve: The UK & Ireland Implanters' registry. Catheter Cardiovasc Interv 2018; 93:751-757. [PMID: 30394657 DOI: 10.1002/ccd.27934] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/04/2018] [Accepted: 09/23/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The UK & Ireland Implanters' registry is a multicenter registry which reports on real-world experience with novel transcatheter heart valves. BACKGROUND The 34 mm Evolut R transcatheter aortic valve is a self-expanding and fully recapturable transcatheter aortic valve, designed to treat patients with a large aortic annulus. METHODS Between January 2017 and April 2018, clinical, procedural and 30-day outcome data were prospectively collected from all patients receiving the 34 mm Evolut R valve across 17 participating centers in the United Kingdom and Ireland. The primary efficacy outcome was the Valve Academic Research Consortium-2(VARC-2)-defined endpoint of device success. The primary safety outcome was the VARC-2-defined composite endpoint of early safety at 30 days. RESULTS A total of 217 patients underwent attempted implant. Mean age was 79.5 ± 8.8 years and Society of Thoracic Surgeons Predicted Risk of Mortality Score 5.2% ± 3.4%. Iliofemoral access was used in 91.2% of patients. Device success was 79.7%. Mean gradient was 7.0 ± 4.6 mmHg and effective orifice area 2.0 ± 0.6 cm2 . Paravalvular regurgitation was more than mild in 7.2%. A new permanent pacemaker was implanted in 15.7%. Early safety was demonstrated in 91.2%. At 30 days, all-cause mortality was 3.2%, stroke 3.7%, and major vascular complication 2.3%. CONCLUSIONS Real-world experience of the 34 mm Evolut R transcatheter aortic valve demonstrated acceptable procedural success, safety, valve function, and incidence of new permanent pacemaker implantation.
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Affiliation(s)
- Cameron Dowling
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Niamh Doyle
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Daniel J Blackman
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | | | | | - Smriti Saraf
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom.,Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Mamta H Buch
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Richard Levy
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Saqib Chowdhary
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Mark S Spence
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - Ganesh Manoharan
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - Colum G Owens
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - Paul F Brennan
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - David Roberts
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Ranjit More
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Andrew Wiper
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Hesham K Abdelaziz
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom.,Cardiovascular Department, Ain Shams University, Cairo, Egypt
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Antoinette Neylon
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Niamh Martin
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Federico Mercanti
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Stephen Dorman
- Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom
| | | | - Miles Dalby
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Mavin N Kashyap
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Tito Kabir
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Jan Kovac
- Biomedical Research Unit, University of Leicester, Leicester, United Kingdom
| | - Kosmas Kontoprias
- Biomedical Research Unit, University of Leicester, Leicester, United Kingdom
| | - Iqbal S Malik
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mikhail W Ghada
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sayan Sen
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neil Ruparelia
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ozan M Demir
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Angela Frame
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neal G Uren
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | | | - Luke Tapp
- Department of Cardiology, University Hospital, Coventry, United Kingdom
| | - Lauren Deegan
- Department of Cardiology, University Hospital, Coventry, United Kingdom
| | - Ever Grech
- Department of Cardiology, Northern General Hospital, Sheffield, United Kingdom
| | - Ian Hall
- Department of Cardiology, Northern General Hospital, Sheffield, United Kingdom
| | - Melanie Neville
- Department of Cardiology, Northern General Hospital, Sheffield, United Kingdom
| | - Rajiv Rampat
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - David Hildick-Smith
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Michael Mullen
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Simon Kennon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Pavan Chandrala
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Sagar Doshi
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
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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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van Gils L, Wöhrle J, Hildick-Smith D, Bleiziffer S, Blackman DJ, Abdel-Wahab M, Gerckens U, Brecker S, Bapat V, Modine T, Soliman OI, Nersesov A, Allocco D, Falk V, Van Mieghem NM. Importance of Contrast Aortography With Lotus Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:119-128. [DOI: 10.1016/j.jcin.2017.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/02/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
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Tamburino C, Barbanti M. Transcatheter aortic valve implantation with a mechanical-expandable device: when perfection is hung on a 'wire'. Eur Heart J 2017; 38:3367-3369. [PMID: 29020379 DOI: 10.1093/eurheartj/ehx375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
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25
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Kilic T, Yilmaz I. Transcatheter aortic valve implantation: a revolution in the therapy of elderly and high-risk patients with severe aortic stenosis. J Geriatr Cardiol 2017; 14:204-217. [PMID: 28408919 PMCID: PMC5387215 DOI: 10.11909/j.issn.1671-5411.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/01/2017] [Accepted: 03/12/2017] [Indexed: 12/18/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) represents a real revolution in the field of interventional cardiology for the treatment of elderly or high-risk surgical patients with severe symptomatic aortic valve stenosis. Today, TAVI seems to play a key and a reliable role in the treatment of intermediate and maybe low-risk patients with severe aortic stenosis. TAVI has also evolved from a complex and hazardous procedure into an effective and safe therapy by the development of new generation devices. This article aims to review the background and future of TAVI, clinical trials and registries with old and new generation TAVI devices and to focus on some open issues related to post-procedural outcomes.
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Affiliation(s)
- Teoman Kilic
- Invasive Cardiology Research and Application Unit, Department of Cardiology, Kocaeli University, Kocaeli, Turkey
| | - Irem Yilmaz
- Department of Cardiology, Kocaeli University, Kocaeli, Turkey
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26
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