1
|
Dal Piaz MR, Pires LT, Herrera JCU, Labat ALB, Cividanes FR, Spina GS, Palma JH, Tarasoutchi F. Mitral re-valve-in-valve as a new perspective for high-risk patients with prosthetic valve dysfunction: case reports. Eur Heart J Case Rep 2023; 7:ytad579. [PMID: 38130861 PMCID: PMC10734623 DOI: 10.1093/ehjcr/ytad579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
Background Mitral valve diseases are a common medical condition, and surgery is the most used therapeutic approach. The need for less invasive interventions led to the development of transcatheter valve implantation in high-risk patients. However, the treatment to the dysfunctions of these prosthetic valves is still uncertain, and the yield and safety of repeated transcatheter valve implantations remain unclear. Cases summary A 69-year-old Caucasian woman with three previous mitral valve procedures performed due to rheumatic valve disease (currently with a biological prosthetic mitral valve) and a 76-year-old Latin woman with previous liver transplantation (due to metabolic-associated fatty liver disease) and biological mitral prosthesis due to mitral valve prolapse with severe regurgitation underwent mitral valve-in-valve (ViV) transcatheter implantation at the time of dysfunction of their surgical prostheses. Later, these patients developed prosthetic valve dysfunction and clinical worsening, requiring another invasive procedure. Due to maintained high-risk status and unfavourable clinical conditions for surgery, re-valve-in-valve (re-ViV) was performed. Discussion Valve-in-valve transcatheter mitral valve implantation was approved in 2017, and, since then, it has been used in several countries, mainly in high-risk patients. Nevertheless, these prosthetic valves may complicate with stenosis or regurgitation, demanding reinterventions. Although there are favourable data for mitral ViV, re-ViV still lacks robust data to support its performance, with only case reports in the literature so far. It is possible that in high-risk patients, there is a greater benefit from re-ViV when compared with the surgical strategy. However, this hypothesis must be studied in future controlled trials.
Collapse
Affiliation(s)
- Matheus Ramos Dal Piaz
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil
| | - Lucas Tachotti Pires
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil
| | - Jonathan Cayo Urdiales Herrera
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil
| | - André Luis Bezerra Labat
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil
| | - Felipe Reale Cividanes
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil
| | - Guilherme Sobreira Spina
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil
| | - José Honório Palma
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil
| | - Flávio Tarasoutchi
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil
| |
Collapse
|
2
|
Muñoz-Rodríguez R, Bosa-Ojeda F, Yanes-Bowden G, Lacalzada-Almeida J. Transcatheter Aortic Valve Implantation in a Patient With Degenerated Aortic Homograft and Anomalous Right Coronary Artery Originating From Left Aortic Sinus. CASE (Phila) 2023; 7:405-408. [PMID: 37970479 PMCID: PMC10635884 DOI: 10.1016/j.case.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
•Aortic root homograft shows lower infection rates but may lead to reintervention. •TAVI is a feasible and safe option to avoid open surgery in high-risk patients. •Anatomic planning guided by advanced imaging techniques is essential.
Collapse
Affiliation(s)
- Rebeca Muñoz-Rodríguez
- Cardiology Department, University Hospital of the Canary Islands, San Cristóbal de la Laguna, Spain
| | - Francisco Bosa-Ojeda
- Cardiology Department, University Hospital of the Canary Islands, San Cristóbal de la Laguna, Spain
| | - Geoffrey Yanes-Bowden
- Cardiology Department, University Hospital of the Canary Islands, San Cristóbal de la Laguna, Spain
| | - Juan Lacalzada-Almeida
- Cardiology Department, University Hospital of the Canary Islands, San Cristóbal de la Laguna, Spain
| |
Collapse
|
3
|
Koliastasis L, Doundoulakis I, Rychter J, Zembala M, Ninios V, Ninios I, Evangelou S, Katsimagklis G, Mastrokostopoulos A, Moraitis S, Komporozos C, Hamilos M, Skalidis E, Syrseloudis D, Pagkalidou E, Benetos G, Latsios G, Drakopoulou M, Synetos A, Aggeli K, Tousoulis D, Tsioufis K, Toutouzas K. Transcatheter aortic valve implantation with self-expanding valves and the impact of balloon predilatation: the DIRECT II trial. Hellenic J Cardiol 2023:S1109-9666(23)00187-2. [PMID: 37778638 DOI: 10.1016/j.hjc.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/23/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023] Open
Affiliation(s)
- Leonidas Koliastasis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece.
| | - Ioannis Doundoulakis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Jan Rychter
- Silesian Center for Heart Diseases, Zabrze, Poland
| | | | - Vlasis Ninios
- Second Department of Cardiology, Interbalkan medical center, Thessaloniki, Greece
| | - Ilias Ninios
- Second Department of Cardiology, Interbalkan medical center, Thessaloniki, Greece
| | - Sotirios Evangelou
- Second Department of Cardiology, Interbalkan medical center, Thessaloniki, Greece
| | | | | | - Sotiris Moraitis
- Department of Cardiology, Naval Hospital of Athens, Athens, Greece
| | | | - Michalis Hamilos
- Department of Cardiology, University Hospital of Heraklion, Crete, Greece
| | - Emmanouil Skalidis
- Department of Cardiology, University Hospital of Heraklion, Crete, Greece
| | - Dimitris Syrseloudis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Eirini Pagkalidou
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Benetos
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Georgios Latsios
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Maria Drakopoulou
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Andreas Synetos
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Konstantina Aggeli
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| |
Collapse
|
4
|
Petrou P. The economics of TAVI: A systematic review. Int J Cardiol Heart Vasc 2023; 44:101173. [PMID: 36747880 PMCID: PMC9898648 DOI: 10.1016/j.ijcha.2023.101173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/27/2023]
Abstract
Objective The scope of this systematic review is to update the existing body of evidence regarding the cost-effectiveness of transcatheter aortic valve implantation, stratified across all risk categories, and to assess their methodological quality. Methods A systematic review was performed including published cost-effectiveness analyses of heart valve implantations. The quality was assessed with the Quality of Health Economics Tool. Results We identified 33 economic evaluations of transcatheter aortic heart valve implantations. Results were not consistent, ranging from dominant to dominating. Moreover, the models were sensitive to an array of variables. The methodological quality of the studies was good. Conclusion This systematic review led to inconclusive and inconsistent results pertinent to the economic profile of TAVI technology. It also highlighted areas which merit further research regarding the pillars of cost-effectiveness analysis such as modeling, the extrapolation of available data and the uncertainty of the evidence. A thorough assessment of the patient should proceed any decision-making.
Collapse
Affiliation(s)
- Panagiotis Petrou
- University of Nicosia, School of Sciences and Engineering, Pharmacy School, Pharmacoepidemiology-Pharmacovigilance, Nicosia, Cyprus,University of Nicosia, Department of Life and Health Sciences, School of Sciences and Engineering, Pharmacoepidemiology-Pharmacovigilance, Nicosia, Cyprus
| |
Collapse
|
5
|
Baikoussis NG, Alexopoulou-Prounia L, Limperiadis D. Severe aortic valve stenosis in low-risk elderly patients, which is the role of surgery. Interact Cardiovasc Thorac Surg 2023; 36:6988034. [PMID: 36802265 PMCID: PMC9881609 DOI: 10.1093/icvts/ivac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Affiliation(s)
| | - Loukia Alexopoulou-Prounia
- Corresponding author. Cardiac Surgery Department, Ippokrateio General Hospital of Athens, 114 Vasilissis Sofias Avenue, Athens 11527, Greece. Tel: +30-6986680123; e-mail: (L. Alexopoulou-Prounia)
| | | |
Collapse
|
6
|
Kelly J, Han JJ, Li RH, Szeto WY. Explant of a transcatheter valve-in-transcatheter valve with pericardial patch repair of the aortic root. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 36598345 DOI: 10.1510/mmcts.2022.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Surgically explanting a failed transcatheter aortic valve can be challenging due to substantial neoendothelialization and may require concomitant and often unanticipated repairs of the aortic root and ascending aorta. We describe the explant of a failed transcatheter aortic valve-in-transcatheter aortic valve with surgical aortic valve replacement and pericardial patch repair of the aortic root. This case report illustrates that appropriate patient selection is essential for transcatheter aortic valve replacement, especially as transcatheter technology expands to lower-risk and younger patients.
Collapse
Affiliation(s)
- John Kelly
- Division of Cardiovascular Surgery Hospital of the University of Pennsylvania 3400 Spruce St Philadelphia, PA, 19146 United States of America
| | - Jason J Han
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert H Li
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
7
|
Kerbel T, Mach M, Bartunek A, Coti I, Bartko PE, Andreas M. Off-label transapical beating-heart transcatheter mitral valve replacement in severe mitral annular calcification. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 36331192 DOI: 10.1510/mmcts.2022.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The recent CE mark approval of a novel transapical transcatheter beating-heart replacement system, anchored by an apical pad, expanded the therapeutic options for patients with a significantly diseased mitral valve who are not eligible for conventional surgery. However, this self-expandable bioprosthesis is-despite promising data from the first European real-world experience-not approved for patients with severe mitral annular calcification. In this video tutorial, we provide a step-by-step description of an off-label transapical mitral valve replacement in a patient with severe degenerative mitral valve disease and limited alternative treatment options.
Collapse
Affiliation(s)
- Tillmann Kerbel
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Markus Mach
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Anna Bartunek
- Division of Cardiothoracic and Vascular Anesthesia, Medical University of Vienna, Austria
| | - Iuliana Coti
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Philipp E Bartko
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
8
|
Faim D, Silva PV, Zunzunegui JL, Puga L, Francisco A, Rodrigues D, Pires A. Simultaneous transcatheter pulmonary and tricuspid valve-in-ring implantation. Cardiol Young 2022; 32:1013-5. [PMID: 34689853 DOI: 10.1017/S1047951121004339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report on a 50-year-old female patient, with several severe comorbidities and high-surgical risk, in whom we successfully performed a simultaneous transcatheter pulmonary and tricuspid valve-in-ring implantation to treat both bioprosthetic pulmonary valve dysfunction and native torrential tricuspid valve regurgitation, the latter previously managed with a Carpentier annuloplasty ring.
Collapse
|
9
|
Van Praet KM, Nersesian G, Kukucka M, Heil E, Kofler M, Falk V, Kempfert J, Klein C, Unbehaun A. Percutaneous transseptal transcatheter mitral valve-in-valve implantation under endovascular cerebral protection. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 35467091 DOI: 10.1510/mmcts.2022.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Various interventional and minimally invasive surgical approaches are currently available for the treatment of mitral valve pathologies. However, only a few of these options are applicable in patients with previously operated on mitral valves. In this case report, we provide detailed insight into the step-by-step guidance of a percutaneous transseptal transcatheter mitral valve-in-valve implant under cerebral protection in a patient with a deteriorated surgically implanted mitral bioprosthesis.
Collapse
Affiliation(s)
- Karel M Van Praet
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Gaik Nersesian
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Marian Kukucka
- Institute for Anesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Emanuel Heil
- Department of Internal Medicine - Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Department of Cardiovascular Surgery, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Department of Health Sciences and Technology, Institute of Translational Medicine, Swiss Federal Institute of Technology, Translational Cardiovascular Technologies, Zurich, Switzerland
| | - Joerg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Christoph Klein
- Department of Internal Medicine - Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| |
Collapse
|
10
|
Van Praet KM, Nersesian G, Kukucka M, Heil E, Kofler M, Falk V, Klein C, Kempfert J, Unbehaun A. Transcatheter aortic valve-in-valve implantation under cerebral protection in a patient with a deteriorated 19-mm rapid-deployment bioprosthetic valve. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 35377972 DOI: 10.1510/mmcts.2022.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The introduction of transcatheter aortic valve implantation (TAVI) has dramatically improved the treatment of valvular pathologies in high-risk patients. Additionally, transcatheter aortic valve implantation can be successfully applied in patients with deteriorated surgical bioprosthetic valves, representing an attractive alternative to a redo operation. Valve-in-valve transcatheter aortic valve implantations can be especially challenging in patients with a small-diameter prosthesis and patient-prosthesis mismatch. Bioprosthetic valve fracturing or bioprosthetic valve remodeling can be used to increase the valvular opening area and additionally reduce the transvalvular gradients in patients having an aortic valve implant. In this case report, we provide detailed insight and step-by-step guidance for transcatheter aortic valve-in-valve implantation with bioprosthetic valve fracturing/bioprosthetic valve remodeling under cerebral protection in a patient with a deteriorated 19-mm surgically implanted bioprosthesis.
Collapse
Affiliation(s)
- Karel M Van Praet
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
| | - Gaik Nersesian
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Marian Kukucka
- Institute for Anesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Emanuel Heil
- Institute for Anesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
- Department of Cardiovascular Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
- Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Christoph Klein
- Department of Internal Medicine – Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Joerg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
| |
Collapse
|
11
|
Jensen RV, Jensen JK, Christiansen EH, Tang M, Nielsen JC, Terkelsen CJ. Two case reports of transcatheter valve-in-valve implantation of Sapien 3 and MyVal in degenerated biological tricuspid prosthesis valves. Eur Heart J Case Rep 2022; 6:ytac131. [PMID: 35434509 PMCID: PMC9007432 DOI: 10.1093/ehjcr/ytac131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/31/2021] [Accepted: 03/18/2022] [Indexed: 11/12/2022]
Abstract
Background Patients with severe tricuspid valve stenosis or dysfunction following degeneration of biological valve prosthesis in tricuspid position are complex, have substantial comorbidity, and very high surgical risk. Case summary We report two cases with transcatheter tricuspid valve-in-valve implantation in patients with degenerated tricuspid bioprosthesis with transfemoral and transjugular access with Sapien 3 valve and MyVal, respectively. Discussion In patients with high surgical risk, transcatheter tricuspid valve implantation is a good alternative. Careful consideration of optimal access site, device size, and delivery system is paramount. This case report demonstrates technically feasible and safe transcatheter valve-in-valve implantantion in tricuspid position and highlights the importance of meticulous procedure planning.
Collapse
Affiliation(s)
- Rebekka Vibjerg Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jesper Khedri Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Evald Høj Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Mariann Tang
- Department of Thoracic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| |
Collapse
|
12
|
Menahem S, Roberts PA, Tanous D. Melody valve insertion for relief of "Tricuspid" stenosis in an unbalanced atrioventricular septal defect. Cardiol Young 2022; 32:135-7. [PMID: 34183082 DOI: 10.1017/S1047951121002419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A Melody valve was successfully placed across a very stenotic right-sided component of a common atrioventricular valve because of ongoing troublesome arrhythmias in a young woman with an unbalanced atrioventricular septal defect, a very dilated right atrium and a hypoplastic right ventricle. Four years later, she remains well.
Collapse
|
13
|
Lux A, Veenstra LF, Kats S, Dohmen W, Maessen JG, van 't Hof AWJ, Maesen B. Urgent transcatheter aortic valve implantation in an all-comer population: a single-centre experience. BMC Cardiovasc Disord 2021; 21:550. [PMID: 34798815 PMCID: PMC8603591 DOI: 10.1186/s12872-021-02347-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/30/2021] [Indexed: 01/04/2023] Open
Abstract
Background When compared with older reports of untreated symptomatic aortic valve stenosis (AoS), urgent transcatheter aortic valve implantation (u-TAVI) seems to improve mortality rates. We performed a single centre, retrospective cohort analysis to characterize our u-TAVI population and to identify potential predictors of worse outcomes. Methods We performed a retrospective analysis of 631 consecutive TAVI patients between 2013 and 2018. Of these patients, 53 were categorized as u-TAVI. Data was collected from the local electronic database. Results Urgent patients had more often a severely decreased left ventricular ejection fraction (LVEF < 30%) and increased creatinine levels (115.5 [88–147] vs 94.5 [78–116] mmol/l; p = 0.001). Urgent patients were hospitalised for 18 [10–28] days before and discharged 6 [4–9] days after the implantation. The incidence of peri-procedural complications and apical implantations was comparable among the study groups. Urgent patients had higher in-hospital (11.3% vs 3.1%; p = 0.011) and 1-year mortality rates (28.2% vs 8.5%, p < 0.001). An increased risk of one-year mortality was associated with urgency (HR 3.5; p < 0.001), apical access (HR 1.9; p = 0.016) and cerebrovascular complications (HR 4.3; p = 0.002). Within the urgent group, the length of pre-hospital admission was the only significant predictor of 1-year mortality (HR 1.037/day; p = 0.003). Conclusions Compared to elective procedures, u-TAVI led to increased mortality and comparable complication rates. This detrimental effect is most likely related to the length of pre-procedural hospitalisation of urgent patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02347-1.
Collapse
Affiliation(s)
- Arpad Lux
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands. .,Department of Cardiology, Zuyderland Medical Centrum, Heerlen, The Netherlands.
| | - Leo F Veenstra
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Suzanne Kats
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Wim Dohmen
- Business Information Management, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,Cardiovascular Reasearch Institute Maastricht University, Maastricht, The Netherlands
| | - Arnoud W J van 't Hof
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Cardiovascular Reasearch Institute Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Centrum, Heerlen, The Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,Cardiovascular Reasearch Institute Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
14
|
Akyüz AR, Konuş AH, Çırakoğlu ÖF, Şahin S, Kul S, Korkmaz L. First experiences with a new balloon-expandable Myval transcatheter aortic valve: a preliminary study. Herz 2021; 47:449-455. [PMID: 34643745 PMCID: PMC8512594 DOI: 10.1007/s00059-021-05069-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 08/02/2021] [Accepted: 09/12/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND In the present article, we present our first experiences with a new type of balloon-expandable Myval valve (Meril Life Sciences, Gujarat, India). MATERIALS AND METHODS A total of 25 consecutive patients who underwent transcatheter aortic valve implantation (TAVI) from June 2020 to November 2020 were included in the study. RESULTS The mean age of the study population was 83 (75-87) years; 17 (68%) were female, and 20 (80%) had hypertension. The Society of Thoracic Surgeons (STS) score of the group was 5.4% ± 3.5%. TAVI was performed via the transfemoral route on all patients. In 19 (76%) cases, we started the procedure without predilation. In two (10.5%) cases performed without predilation, the prosthesis did not pass the native valve. We had to implant the valve from the descending aorta in one (4%) patient. We used Prostar XL (Abbott Vascular, Santa Clara, CA, USA) for six (24%) patients and ProGlide (Abbott Vascular) for 19 (76%) patients for vascular closure. Two (8%) in-hospital deaths occurred in our study but there were no deaths in the 30-day and 90-day follow-up. Vascular complications were observed in one (4%) patient. None of the patients in our study had severe paravalvular leak (PVL), while two (8%) patients had moderate PVL. A permanent pacemaker (PPM) was required in two (8%) patients for the indication of complete atrioventricular block. The mean hospital stay for the whole group was 4 (3-7) days. CONCLUSION Based on our experiences, the new balloon-expandable valve Myval is easy to use, efficient, and has only a few negligible drawbacks such as the need for predilation of the sheath. While shaft flexibility may have advantages in some situations including in very tortuous arteries, it may cause some difficulties in alignment of the valves.
Collapse
Affiliation(s)
- Ali Rıza Akyüz
- Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Trabzon, Turkey.
| | - Ali Hakan Konuş
- Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Trabzon, Turkey
| | - Ömer Faruk Çırakoğlu
- Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Trabzon, Turkey
| | - Sinan Şahin
- Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Trabzon, Turkey
| | - Selim Kul
- Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Trabzon, Turkey
| | - Levent Korkmaz
- Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Trabzon, Turkey
| |
Collapse
|
15
|
Nara Y, Watanabe Y, Kataoka A, Nakashima M, Hioki H, Kawashima H, Nagura F, Kozuma K, Yashima F, Shirai S, Tada N, Yamawaki M, Naganuma T, Yamanaka F, Ueno H, Tabata M, Mizutani K, Takagi K, Yamamoto M, Hayashida K. Balloon post-dilatation improves long-term valve performance after balloon-expandable valve implantation. Cardiovasc Revasc Med 2021; 37:15-22. [PMID: 34175251 DOI: 10.1016/j.carrev.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The impact of balloon post-dilatation (BPD) on short- and long-term valve performance after Sapien 3 (S3) implantation is unknown. This study aimed to evaluate the impact of balloon post-dilatation (BPD) on short- and long-term valve performance after the implantation of S3. METHODS A total of 846 patients implanted with S3 from the OCEAN-TAVI registry were included in this study. The patients were divided into BPD and non-BPD groups. The clinical outcomes and valve functions were compared. RESULTS The BPD group included 173 (20.4%) patients and the non-BPD group comprised 673 (79.6%) patients. The prosthesis-patient mismatch (PPM) rates were significantly lower in the BPD group than in the non-BPD group before and after propensity score matching at in-hospital follow-up (before matching: 12 [7.1%] vs. 108 [16.3%], p = 0.002; after matching: 8 [6.3%] vs. 19 [14.8%], p = 0.027) and at 1-year follow-up (before matching: 14 [12.5%] vs. 112 [23.6%], p = 0.010; after matching: 9 [10.5%] vs. 19 [22.1%], p = 0.039). The rates of acute kidney injury, cardiac tamponade, and in-hospital cardiovascular death were significantly higher in the BPD group than in the non-BPD group (acute kidney injury: 22 [12.7%] vs. 33 [4.9%], p < 0.001; cardiac tamponade: 3 [1.7%] vs. 2 [0.3%], p = 0.028; in-hospital cardiovascular death: 4 [2.3%] vs. 3 [0.4%], p = 0.016). After matching, these clinical outcomes were similar between the BPD and non-BPD groups. CONCLUSIONS The BPD group demonstrated better short- and long-term valve performance. Caution is needed to avoid procedure-related complications in patients undergoing BPD.
Collapse
Affiliation(s)
- Yugo Nara
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan.
| | - Akihisa Kataoka
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Makoto Nakashima
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Hirofumi Hioki
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Hideyuki Kawashima
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Fukuko Nagura
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Ken Kozuma
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Norio Tada
- Department of Cardiovascular Center, Sendai Kosei Hospital, Miyagi, Japan
| | - Masahiro Yamawaki
- Department of Cardiovascular Medicine, Yokohama City Eastern Hospital, Kanagawa, Japan
| | - Toru Naganuma
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Futoshi Yamanaka
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroshi Ueno
- The Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Minoru Tabata
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | - Masanori Yamamoto
- Division of Cardiovascular Medicine, Toyohashi Heart Center and Nagoya Heart Center, Aichi, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
16
|
Weber J, Bond K, Flanagan J, Passick M, Petillo F, Pollack S, Robinson N, Petrossian G, Cao JJ, Barasch E. The Prognostic Value of Left Atrial Global Longitudinal Strain and Left Atrial Phasic Volumes in Patients Undergoing Transcatheter Valve Implantation for Severe Aortic Stenosis. Cardiology 2021; 146:489-500. [PMID: 33752215 DOI: 10.1159/000514665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/24/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The changes and the prognostic implications of left atrial (LA) volumes (LAV), LA function, and vascular load in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) are less known. METHODS We enrolled 150 symptomatic patients (mean age 82 ± 8 years, 58% female, and pre-TAVI aortic valve area 0.40 ± 0.19 cm/m2) with severe AS who underwent 2D transthoracic echocardiography and 2D speckle tracking echocardiography at average 21 ± 35 days before and 171 ± 217 days after TAVI. The end point was a composite of new onset of atrial fibrillation, hospitalization for heart failure and all-cause death (major adverse cardiac events [MACE]). RESULTS After TAVI, indexed maximal LA volume and minimum volume of the LA decreased by 2.1 ± 10 mL/m2 and 1.6 ± 7 mL/m2 (p = 0.032 and p = 0.011, respectively), LA function index increased by 6.8 ± 11 units (p < 0.001), and LA stiffness decreased by 0.38 ± 2.0 (p = 0.05). No other changes in the LA phasic volumes, emptying fractions, and vascular load were noted. Post-TAVI, both left atrial and ventricular global peak longitudinal strain improved by about 6% (p = 0.01 and 0.02, respectively). MACE was reached by 37 (25%) patients after a median follow-up period of 172 days (interquartile range, 20-727). In multivariable models, MACE was associated with both pre- and post-TAVI LA global peak longitudinal strain (hazard ratio [HR] 0.75, CI 0.59-0.97; and HR 0.77, CI 0.60-1.00, per 5 percentage point units, respectively), pre-TAVI LV global endocardial longitudinal strain (HR 1.37, CI 1.02-1.83 per 5 percentage point units), and with most of the LA phasic volumes. CONCLUSION Within 6 months after TAVI, there is reverse LA remodeling and an improvement in LA reservoir function. Pre- and post-TAVI indices of LA function and volume remain independently associated with MACE. Larger studies enrolling a greater diversity of patients may provide sufficient evidence for the utilization of these imaging biomarkers in clinical practice.
Collapse
Affiliation(s)
- Jonathan Weber
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Kristine Bond
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Joseph Flanagan
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Michael Passick
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Florentina Petillo
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Simcha Pollack
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Newell Robinson
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - George Petrossian
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - J Jane Cao
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA.,Health Sciences Center, Stony Brook University, Stony Brook, New York, USA
| | - Eddy Barasch
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA, .,Health Sciences Center, Stony Brook University, Stony Brook, New York, USA,
| |
Collapse
|
17
|
Tayal R, Sohal S, Okoh A, Wasty N, Waxman S, Salemi A. Intravascular Lithotripsy Enabled Transfemoral Transcatheter Aortic Valve Implantation via Percutaneous Axillary Access Approach. Cardiovasc Revasc Med 2021; 28S:89-93. [PMID: 33358548 DOI: 10.1016/j.carrev.2020.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/15/2020] [Indexed: 11/23/2022]
Abstract
Transfemoral (TF) access for transcatheter aortic valve implantation (TAVI) is the most commonly used site, however its use may be limited by prohibitive peripheral arterial disease. Although a number of alternative access techniques have been well described, each has been shown to be associated with increased risks when compared to a TF approach. Recently, planned treatment of iliofemoral artery disease using intravascular lithotripsy (IVL) has emerged as a means of preserving TF access. Ipsilateral or contralateral femoral artery access has been routinely used to perform IVL but its use may be limited in certain conditions. Here we describe the novel technique of using percutaneous axillary artery access to perform IVL of iliofemoral artery to facilitate its use for large bore access. We present a 78-year-old high surgical risk female with severe aortic stenosis who was found to have a prior stent in the contralateral iliac artery protruding into the aorta which limited a traditional 'up and over' approach, and thus axillary artery access was used to perform IVL. This is the first case in literature to describe the use of percutaneous axillary access to perform IVL of the iliac and common femoral artery to facilitate TF TAVI. Based on our previous experience we feel this technique holds promise for a routine use when use of other access sites is limited.
Collapse
|
18
|
Nunes Ferreira-Neto A, Merten C, Beurich HW, Zachow D, Richardt G, Larose E, Guimaraes L, Pibarot P, Pelletier-Beaumont E, Rodés-Cabau J, Abdel-Wahab M. Hemodynamic performance of the balloon-expandable SAPIEN 3 valve as assessed by cardiac magnetic resonance. Int J Cardiol 2020; 320:128-32. [PMID: 32702409 DOI: 10.1016/j.ijcard.2020.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/13/2020] [Accepted: 07/16/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Scarce data exist on transcatheter heart valve (THV) performance evaluated by cardiac magnetic resonance (CMR) in newer generation THV patients. Furthermore, it has been suggested that echocardiographic evaluation after TAVR may inaccurately assess residual AR in some patients. This study aimed to determine the incidence and severity of aortic regurgitation (AR) assessed by CMR in patients undergoing TAVR with the SAPIEN 3 valve, and evaluate the agreement between CMR and transthoracic echocardiography (TTE) on the assessment of AR severity in such patients. METHODS This multicentric observational study included 146 SAPIEN 3 patients with TTE and CMR within the month following their procedure. According to the CMR regurgitation fraction (RF), AR was considered mild and moderate-severe if the RF was 15-<30% and ≥ 30%, respectively. TTE exams followed VARC-2 recommendations. RESULTS By CMR, SAPIEN 3 recipients displayed a mean RF of 5.0 ± 6.1%, and mild and moderate-severe AR rates of 3.4% and 0.7%, respectively. The agreement between CMR-TTE was modest (weighted κ = 0.2640, p<0.001), due to an overestimation of AR severity by TTE. A historical cohort of 139 SAPIEN XT patients with a post-procedure CMR, displayed a mean RF of 9.6 ± 10.7% and mild and moderate-severe AR rates of 18.7% and 3.6%, respectively (p < .001 vs. SAPIEN 3 group). CONCLUSIONS SAPIEN 3 recipients exhibited very low rates of residual AR by CMR, suggesting a surgical-like performance regarding AR with this newer generation THV. TTE tended to overestimate the severity of AR, particularly among mild AR patients.
Collapse
|
19
|
Pingpoh C, Schroefel H, Franz T, Czerny M, Kreibich M, Moser M, Bode C, Beyersdorf F, Neumann FJ, Hochholzer W, Siepe M. Transcatheter valve-in-valve implantation in degenerated aortic bioprostheses: are patients with small surgical bioprostheses at higher risk for unfavourable mid-term outcomes? Ann Cardiothorac Surg 2020; 9:478-486. [PMID: 33312905 DOI: 10.21037/acs-2020-av-fs-0124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To examine outcomes of valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) according to the inner diameter (ID) of the degenerated aortic valve bioprosthesis. Methods We analyzed survival, stroke, permanent pacemaker (PPM) implantation, paravalvular (PV) leakage, acute kidney injury and vascular complications in fifty-nine patients during a ten-year period. Patients were stratified according to the ID of the indwelling degenerated biological aortic valve (true ID ≤ and >20 mm). Differences in post-procedural transvalvular gradients and hospital re-admissions were analyzed. Results The median age of the small diameter group and large diameter group was eighty-one and eighty years, respectively. Median logistic EuroSCORE I was 23.9% and 26.2% and median Society of Thoracic Surgeons (STS) score was 5.7% and 7.8% for the small and large groups, respectively. Survival, stroke, PPM implantation, PV leakage, acute kidney injury and vascular complications did not reach any statistically significant difference between both groups. Postprocedural transvalvular gradients differed significantly according to the true ID of the degenerated bioprosthetic valve and consequently of the respective TAVI valve. There was a significant difference with regard to hospital readmissions according to the true ID. Conclusions TAVI ViV implantation for aortic bioprostheses with small true IDs of ≤20 mm is associated with comparable mid-term mortality and periprocedural stroke rate compared to implantation into larger bioprostheses. However, the periprocedural and mid-term transvalvular gradients, as well as hospital re-admission rates are significantly higher in the small diameter group.
Collapse
Affiliation(s)
- Clarence Pingpoh
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Holger Schroefel
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Tanja Franz
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Martin Moser
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Willibald Hochholzer
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| |
Collapse
|
20
|
Alushi B, Vathie K, Thiele H, Lauten A. Transcatheter therapies for severe tricuspid regurgitation. Quo vadis? Herz 2020; 46:234-241. [PMID: 32468139 DOI: 10.1007/s00059-020-04941-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/13/2020] [Accepted: 05/04/2020] [Indexed: 11/25/2022]
Abstract
Moderate-to-severe tricuspid regurgitation (TR) is common and is associated with a poor prognosis. To date, most patients are undertreated; therefore, transcatheter options could be clinically impactful in those who are denied surgery. Several transcatheter solutions have been developed that address the problem via leaflet enhancement, annuloplasty, or heterotopic implantation of self-expandable or balloon-expandable valves in the caval veins. A comprehensive patient evaluation, based on multimodality imaging techniques for a better understanding of the valvular pathology and TR mechanism, remains paramount for an appropriate device selection. To date, several trials have shown the feasibility and safety of a multitude of devices in this setting, but data from randomized clinical trials regarding clinical benefit based on hard endpoints are still lacking. Although the optimal patient profile and timing of intervention remain under investigation, data from available studies indicate that an earlier treatment referral, before onset of irreversible right ventricular remodeling, could be beneficial. This review discusses the present landscape and future implications of transcatheter therapies for severe TR.
Collapse
Affiliation(s)
- Brunilda Alushi
- Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany.
- Department of Cardiology, Campus Benjamin Franklin, Charité Medical University Berlin, Berlin, Germany.
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany.
| | - Kourosh Vathie
- Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Alexander Lauten
- Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany
- Department of Cardiology, Campus Benjamin Franklin, Charité Medical University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| |
Collapse
|
21
|
Yeoh J, Dworakowski R, Hill J, Byrne J. A contemporary and complete treatment solution for a high-risk patient with critical aortic stenosis, left ventricular thrombus, severe left ventricular dysfunction, and calcified left main stem disease. Catheter Cardiovasc Interv 2020; 95:851-854. [PMID: 31617327 DOI: 10.1002/ccd.28521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/17/2019] [Accepted: 09/17/2019] [Indexed: 11/11/2022]
Abstract
The combination of severe coronary disease, significant valvular dysfunction and impaired ventricular function pose patients at a very high procedural risk. In addition, the presence of left ventricular thrombus can complicate ventricular instrumentation increasing embolic risk. Contemporary techniques and devices have now become available to overcome these challenges to reduce risk and allow safer, more efficient procedures. We describe the feasibility of using Impella CP™ with cerebral protection to facilitate complete revascularisation and percutaneous valve replacement in a patient with critical aortic stenosis, severe left ventricular (LV) impairment, LV thrombus and a calcified left main stem disease.
Collapse
Affiliation(s)
- Julian Yeoh
- Department of Cardiology, King's College Hospital, London
| | | | - Jonathan Hill
- Department of Cardiology, King's College Hospital, London
| | - Jonathan Byrne
- Department of Cardiology, King's College Hospital, London
| |
Collapse
|
22
|
Cayla G, Schmutz L, Soullier C, Ricci JE, Robert C, Cambon-Viala M, Goger AL, Lattuca B. [Which patient for TAVI in 2019?]. Ann Cardiol Angeiol (Paris) 2019; 68:405-409. [PMID: 31668846 DOI: 10.1016/j.ancard.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
The therapeutic management of aortic stenosis has been drastically changed by the advent of percutaneous valve replacement (TAVI). Since the first implantation, the indications have progressively been extended from the inoperable patient to the patient at low surgical risk. The main objective of this review is to describe the currently recommended main indications of TAVI depending on an individualized assessment of each patient's risk, technical characteristics and anatomical valvular criteria.
Collapse
Affiliation(s)
- G Cayla
- Service de cardiologie, université de Montpellier, CHU de Nîmes, 30029 Nîmes, France.
| | - L Schmutz
- Service de cardiologie, université de Montpellier, CHU de Nîmes, 30029 Nîmes, France
| | - C Soullier
- Service de cardiologie, université de Montpellier, CHU de Nîmes, 30029 Nîmes, France
| | - J E Ricci
- Service de cardiologie, université de Montpellier, CHU de Nîmes, 30029 Nîmes, France
| | - C Robert
- Service de cardiologie, université de Montpellier, CHU de Nîmes, 30029 Nîmes, France
| | - M Cambon-Viala
- Service de cardiologie, université de Montpellier, CHU de Nîmes, 30029 Nîmes, France
| | - A L Goger
- Service de cardiologie, université de Montpellier, CHU de Nîmes, 30029 Nîmes, France
| | - B Lattuca
- Service de cardiologie, université de Montpellier, CHU de Nîmes, 30029 Nîmes, France
| |
Collapse
|
23
|
Bavry AA, Aalaei-Andabili SH, Park KE, Choi CY, Manning Iii EW, Stinson WW. Trend and Outcomes of Direct Transcatheter Aortic Valve Replacement from a Single-Center Experience. Cardiol Ther 2018; 7:191-6. [PMID: 30109506 DOI: 10.1007/s40119-018-0115-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION When transcatheter aortic valve replacement (TAVR) was introduced, pre-implantation balloon aortic valvuloplasty (BAV) was a routine part of the procedure. Smaller device profiles have resulted in selective use of BAV; however, there is a paucity of data about the trend in use of direct TAVR and the safety of this strategy. METHODS All patients who underwent TAVR at a Veterans Affairs Medical Center from September 2013 to November 2016 were included in this retrospective analysis. We reviewed angiography films and verified with procedure reports to assess if direct TAVR was performed. Troponin T was assessed within 72 h after the TAVR. Multivariate analysis examined the association between direct TAVR and periprocedural myocardial infarction (MI) or 1-year mortality. RESULTS Overall, 207 patients were available for analysis. The mean follow-up was 13.3 months. A balloon-expandable valve was used 93.2% of the time, and 35.3% of patients were treated with conscious sedation. Periprocedural MI or 1-year mortality occurred in 12.5% of the direct TAVR group versus 18.3% of the pre-implantation BAV group (p = 0.30). After controlling for potential confounding variables, direct TAVR was not associated with periprocedural MI or 1-year mortality. CONCLUSIONS Direct TAVR appears to be safe and is not associated with periprocedural MI or 1-year mortality. With current generation devices, this strategy can be considered for most patients undergoing TAVR.
Collapse
|
24
|
Zanobini M, Manganiello S, Bonalumi G, Biondi R, Russo M, Mapelli M, Alamanni F, Saccocci M. Emergency transapical mitral valve-in-valve implantation for bioprosthesis failure: transapical implantation of an Edwards Sapien-XT in a dysfunctional mitral bioprosthesis in a critical patient. J Cardiothorac Surg 2017; 12:114. [PMID: 29237501 PMCID: PMC5729393 DOI: 10.1186/s13019-017-0680-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/30/2017] [Indexed: 11/17/2022] Open
Abstract
Background Valve-in-Valve (VIV) Transcatheter Aortic Valve Replacement (TAVR) is now the treatment of choice in high-surgical-risk patients with failing aortic bioprosthesis. Although less performed, VIV-Transcatheter Mitral Valve Replacement (TMVR) is a valid treatment option for selected high-risk patients with degenerated mitral bioprostheses. Several cases of elective ViV- TAVR and -TMVR have been reported but only few were performed in critical hemodynamic conditions. Case presentation We report the case of a patient underwent balloon-expandable transapical mitral valve-in-valve implantation in an emergency setting due to a severe stenosis of a bioprosthesis in mitral position. The procedure was successfully performed, with no residual mitral regurgitation or paravalvular leaks, and uneventful. Conclusion Transcatheter transapical mitral valve-in-valve implantation could represent a feasible and effective strategy even in critical setting.
Collapse
Affiliation(s)
- Marco Zanobini
- Department of Cardiac Surgery, IRCCS - Centro Cardiologico Monzino, Università degli Studi di Milano, Via C. Parea 4, 20138 Milano, Italy
| | - Sabrina Manganiello
- Department of Cardiac Surgery, IRCCS - Centro Cardiologico Monzino, Università degli Studi di Milano, Via C. Parea 4, 20138 Milano, Italy
| | - Giorgia Bonalumi
- Department of Cardiac Surgery, IRCCS - Centro Cardiologico Monzino, Università degli Studi di Milano, Via C. Parea 4, 20138 Milano, Italy
| | - Raoul Biondi
- Department of Cardiac Surgery, IRCCS - Centro Cardiologico Monzino, Università degli Studi di Milano, Via C. Parea 4, 20138 Milano, Italy
| | - Marco Russo
- Department of CardioVascular Surgery, Heart Center - University Hospital of Zurich, Zurich, Switzerland
| | - Massimo Mapelli
- Department of Cardiology -IRCCS - Centro Cardiologico Monzino, Università degli Studi di Milano, Milano, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, IRCCS - Centro Cardiologico Monzino, Università degli Studi di Milano, Via C. Parea 4, 20138 Milano, Italy
| | - Matteo Saccocci
- Department of Cardiac Surgery, IRCCS - Centro Cardiologico Monzino, Università degli Studi di Milano, Via C. Parea 4, 20138 Milano, Italy
- Department of CardioVascular Surgery, Heart Center - University Hospital of Zurich, Zurich, Switzerland
| |
Collapse
|
25
|
Sinning C, Conradi L, Deuschl FG, Schofer N, Hakmi S, Schäfer U. Combined rendezvous approach with the Direct Flow Medical® aortic valve prosthesis to treat aortic and mitral stenosis. Int J Cardiol 2016; 214:284-5. [PMID: 27082772 DOI: 10.1016/j.ijcard.2016.03.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 03/19/2016] [Indexed: 11/24/2022]
|
26
|
Abstract
Transcatheter aortic valve implantation is an accepted and established alternative to surgical aortic valve replacement for patients with severe symptomatic aortic valve stenosis and multiple comorbidities that would make open surgery a high-risk option. It has also evolved as a suitable treatment option for degenerative surgical heart valve disease, with considerable experience in the aortic and mitral positions. To enable a successful procedure, avoiding malposition, valve embolization and coronary obstruction, clinicians should be familiar with the design, fluoroscopic appearances and implantation technique of the degenerated surgical bioprosthetic valve in situ, as well as its compatibility with currently available transcatheter valves.
Collapse
Affiliation(s)
- Alia Noorani
- Department of Cardiothoracic Surgery, St. Thomas' Hospital, London, UK
| | - Rizwan Attia
- Department of Cardiothoracic Surgery, St. Thomas' Hospital, London, UK
| | - Vinayak Bapat
- Department of Cardiothoracic Surgery, St. Thomas' Hospital, London, UK
| |
Collapse
|
27
|
|
28
|
Fishbein GA, Schoen FJ, Fishbein MC. Transcatheter aortic valve implantation: status and challenges. Cardiovasc Pathol 2014; 23:65-70. [PMID: 24183003 DOI: 10.1016/j.carpath.2013.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/19/2013] [Accepted: 10/01/2013] [Indexed: 12/22/2022] Open
Abstract
Calcific aortic valve disease of the elderly is the most prevalent hemodynamically-significant valvular disease, and the most common lesion requiring valve replacement in industrialized countries. Transcatheter aortic valve implantation is a less invasive alternative to classical aortic valve replacement that can provide a therapeutic option for high-risk or inoperable patients with aortic stenosis. These devices must be biocompatible, have excellent hemodynamic performance, be easy to insert, be securely anchored without sutures, and be durable, without increased risk of thrombosis or infection. To date, complications are related to the site of entry for insertion, the site of implantation (aorta, coronary ostia, base of left ventricle), and to the structure and design of the inserted device. However, as with any novel technology unanticipated complications will develop. Goals for future development will be to make the devices more effective, more durable, safer, and easier to implant, so as to further improve outcome for patients with severe aortic stenosis. The pathologist participating in research and development, and examination of excised devices will have a critical role in improving outcome for these patients.
Collapse
|
29
|
Bruschi G, De Marco F, Barosi A, Botta L, Colombo P, Montorsi E, Klugmann S, Martinelli L. Direct-aortic "evolute" self-expanding aortic bioprosthesis implantation. Int J Cardiol 2013; 167:e172-4. [PMID: 23664047 DOI: 10.1016/j.ijcard.2013.04.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 04/12/2013] [Indexed: 11/28/2022]
|
30
|
Asgar AW, Bonan R. Transcatheter Aortic Valve Implantation: Experience with the CoreValve Device. Interv Cardiol Clin 2012; 1:27-36. [PMID: 28582065 DOI: 10.1016/j.iccl.2011.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The field of transcatheter aortic valve implantation has been rapidly evolving. The Medtronic CoreValve first emerged on the landscape in 2004 with initial first human studies, and it is currently being studied in the Pivotal US trial. This article details the current experience with the self-expanding aortic valve with a focus on clinical results and ongoing challenges.
Collapse
Affiliation(s)
- Anita W Asgar
- Montreal Heart Institute, 5000 Belanger, Montreal H1T1C8, Quebec, Canada
| | - Raoul Bonan
- Montreal Heart Institute, 5000 Belanger, Montreal H1T1C8, Quebec, Canada.
| |
Collapse
|