1
|
Knol W, Wahadat A, Roos-Hesselink J, Tanis W, Hirsch A, Van Mieghem N, Bogers A, Budde R. Diagnosis and management of coronary artery disease in early surgical treatment of acute infective endocarditis of the aortic valve. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The need to routinely screen for coronary artery disease (CAD) in asymptomatic patients undergoing surgery for acute aortic valve infective endocarditis (IE) is debated. There is concern about the risk of embolization during invasive coronary angiography (ICA), especially in patients with vegetations. Coronary computed tomography angiography (cCTA) is a non-invasive alternative.
Purpose
To evaluate the prevalence of CAD in patients with acute aortic valve IE, the safety and feasibility of ICA and cCTA for diagnosis of CAD, and CAD related postoperative outcomes.
Methods
In this single center retrospective cohort study, all patients with acute infective aortic valve endocarditis between 2009–2019 undergoing surgery were selected. Outcomes were embolization after preoperative ICA, in-hospital mortality, perioperative myocardial infarction or unplanned revascularization.
Results
159 patients (mean age 58±15, 81% male) underwent surgery. No CAD screening was done in 46/145, a cCTA was performed in 54/145 patients and an ICA in 52/145 patients. In 1 of the 52 patients undergoing preoperative ICA a cerebral embolism occurred. cCTA was not assessable on a patient level in 2 patients and 7 patients underwent both cCTA and ICA. Significant CAD was found in about 20% of patients both after cCTA and ICA. Even though just a minority of patients with CAD was treated with concomitant CABG, only 1 patient with known but untreated CAD needed unplanned revascularization postoperatively. The rate of perioperative myocardial infarction or unplanned revascularization in patients not screened for CAD was 5% (3 patients).
Conclusion
In patients with acute aortic valve IE the prevalence of CAD is low (14%). The risk of embolism after preoperative ICA is not negligible and should be carefully weighed against the estimated risk of CAD-related perioperative complications. cCTA might serve as a gatekeeper for ICA in many patients with acute aortic IE.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- W.G Knol
- Erasmus University Medical Centre, Cardiothoracic Surgery, Rotterdam, Netherlands (The)
| | - A.W Wahadat
- Erasmus University Medical Centre, Cardiology, Rotterdam, Netherlands (The)
| | - J.W Roos-Hesselink
- Erasmus University Medical Centre, Cardiology, Rotterdam, Netherlands (The)
| | - W Tanis
- Haga Hospital, Cardiology, Den Haag, Netherlands (The)
| | - A Hirsch
- Erasmus University Medical Centre, Cardiology, Rotterdam, Netherlands (The)
| | - N.M Van Mieghem
- Erasmus University Medical Centre, Interventional Cardiology, Rotterdam, Netherlands (The)
| | - A.J.J.C Bogers
- Erasmus University Medical Centre, Cardiothoracic Surgery, Rotterdam, Netherlands (The)
| | - R.P.J Budde
- Erasmus University Medical Centre, Radiology, Rotterdam, Netherlands (The)
| |
Collapse
|
2
|
Armario X, Rosseel L, Banning A, Khogali S, Blackman D, Abdel-Wahab M, Tchetche D, Hildick-Smith D, Van Mieghem N, Spence M, Frerker C, Nickenig G, Pilgrim T, Sondergaard L, Mylotte D. Transcatheter aortic valve implantation with the LOTUS Edge system: early European experience. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
To evaluate the clinical outcomes of transcatheter aortic valve implantation (TAVI) with the recently commercialised LOTUS EdgeTM system.
Methods and results
We performed a multicentre, single-arm, retrospective registry to generate early information on patients undergoing TAVI with the LOTUS EdgeTM system following its commercial release in July 2019. Novel features of this second-generation device include increased flexibility of the delivery catheter, enhanced visualisation of the locking mechanism and the depth guard technology to reduce left ventricular outflow tract interaction and, potentially, reduce the risk of permanent pacemaker (PPM) implantation. All endpoints were defined according to the VARC-2 definitions and were reported by the treating site.
A total of 286 consecutive patients from 18 participating centres were included. The mean age and STS score were 81.2±6.9 years and 5.2±5.4%, respectively. Most procedures were performed under local anaesthesia (97.2%) via transfemoral access (98.6%).
Successful vascular access, valve delivery and deployment and system retrieval were achieved in 97.6% of cases. 30-day rates of all-cause mortality (2.1%, N=6) and stroke (3.5%, N=10) were acceptable. Disabling, life-threatening or major bleeding occurred in 3.8% and major vascular complications in 2.1%. The incidence of new PPM implantation was 27.1% among all patients and 32.2% among pacemaker-naive patients. After TAVI, the mean transvalvular pressure gradient was 11.9±5.6 mmHg and the mean aortic valve area was 1.9±0.9 cm2. The rate of moderate paravalvular leak was 2.1% with no cases of severe paravalvular leak.
Conclusions
Early experience with the LOTUS EdgeTM system demonstrated acceptable 30-day clinical outcomes with impressively low rates of paravalvular leak. The requirement for new PPM remained high in this early experience. Further study is required to understand if improving operator experience with the device can reduce PPM rates.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- X Armario
- Galway University Hospital, Galway, Ireland
| | - L Rosseel
- Galway University Hospital, Galway, Ireland
| | - A Banning
- John Radcliffe Hospital, Oxford, United Kingdom
| | - S.S Khogali
- New Cross Hospital, Wolverhampton, United Kingdom
| | - D.J Blackman
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | | | | | - N.M Van Mieghem
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - M.S Spence
- Belfast City Hospital Trust, Belfast, United Kingdom
| | - C Frerker
- Cologne University Hospital - Heart Center, Cologne, Germany
| | | | - T Pilgrim
- University of Bern, Bern, Switzerland
| | - L Sondergaard
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - D Mylotte
- Galway University Hospital, Galway, Ireland
| |
Collapse
|
3
|
Chiarito M, Regazzoli D, Cannata F, Pagnesi M, Pagnotta P, Stefanini G, Barbanti M, De Marco F, Adamo M, Van Mieghem N, Kim W, Maisano F, Colombo A, Reimers B, Latib A. Predictors of haemodynamic performance in patients with aortic stenosis and small annulus undergoing TAVI with self-expandable valves. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Small aortic annular size is one of the most important predictor of poor hemodynamic and clinical outcomes in patients treated for aortic stenosis. Post-hoc analyses of pivotal trials showed that transcatheter aortic valve intervention (TAVI) offer better outcomes then surgery in patients with small aortic annulus, especially with self-expandable valves (SEV). However, data about SEVs comparison in this population are limited.
Purpose
Our aim is to assess how valve design and oversizing, with anatomical and echographic features, impact on the hemodynamic performance of SEVs in TAVI patients with small aortic annulus.
Methods
The TAVI SMALL registry enrolled 859 patients with small aortic annulus (CT-scan annular perimeter≤72 mm or area ≤400 mm2) treated for aortic stenosis with currently available SEVs (Evolut R=397; Evolut PRO =84; Acurate Neo=140; Acurate TA= 61; Portico=177) at 9 European centers between 2011 and 2018. We performed multivariable backward logistic regression analyses to identify predictors of high postprocedural mean gradient, moderate-to-severe PPM, and moderate-to-severe para-valvular leak (PVL).
Results
After adjustment for LVEF, we identified annular perimeter and percentage of oversizing as independent predictors of lower post-procedural mean gradient.
Implantation of intra-annular rather than supra-annular bioprosthesis was the only independent predictor of moderate-to-severe PPM.
Predictors of moderate-to-severe PVL are reported in the Table.
Conclusions
Among patients with aortic stenosis and small aortic annulus treated with transcatheter SEVs, use of supra-annular bioproshtesis and oversizing were associated with improved valve performance.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- M Chiarito
- Istituto Clinico Humanitas, Milan, Italy
| | | | - F Cannata
- Istituto Clinico Humanitas, Milan, Italy
| | - M Pagnesi
- San Raffaele Scientific Institute, Milan, Italy
| | | | | | - M Barbanti
- AOU Policlinico - Vittorio Emanuele, Catania, Italy
| | - F De Marco
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - M Adamo
- Civil Hospital of Brescia, Brescia, Italy
| | - N.M Van Mieghem
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - W.K Kim
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - F Maisano
- University of Zurich, Zurich, Switzerland
| | - A Colombo
- EMO-GVM Heart Center Columbus, Milan, Italy
| | - B Reimers
- Istituto Clinico Humanitas, Milan, Italy
| | - A Latib
- Montefiore Medical Center (Bronx), New York, United States of America
| |
Collapse
|