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Abbas AE, Madanat L, Khalili H, Mando R, Kheyrbek M, Chandra R, Niroula S, Hanson I, Dixon S, Renard B, Bloomingdale R, Cami E, Pridham B, Altshuler J, Kindzelski B, Fazzalari F, Shannon F, Vivacqua A. Aortic Regurgitation, Time to Aortic Valve Reintervention, and Mortality in Degenerated Trifecta Versus Non-Trifecta Bioprosthesis. Am J Cardiol 2024; 220:49-55. [PMID: 38580038 DOI: 10.1016/j.amjcard.2024.03.033] [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: 01/17/2024] [Revised: 03/04/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
On July 31, 2023, the Trifecta valve was withdrawn from the market after concerns regarding early (≤5 years) structural valve deterioration (SVD), mainly as aortic regurgitation (AR). Our aim was to determine the timing, mechanism, and impact of bioprosthetic SVD in patients who underwent redo aortic valve replacement (redo-AVR) with either redo-SAVR or valve-in-valve transcatheter aortic valve replacement (TAVR) using Trifecta versus other bioprosthetic valves. Patients who underwent redo-AVR for SVD at our institution were categorized into 2 groups based on the valve type: Trifecta versus non-Trifecta. Multivariate Cox proportional hazard model and Kaplan-Meier curves were used to compare mortality. A total of 171 patients were included; 58 (34%) had previous SAVR with a Trifecta valve and 113 (66%) with non-Trifecta valve. A total of 103 patients (60%) underwent valve-in-valve TAVR and 68 redo-SAVR (40%). The age, gender, and Society of Thoracic Surgeons score were similar between Trifecta and non-Trifecta groups. In patients with bioprosthetic valves requiring redo-AVR, Trifecta valves had an earlier onset of greater than moderate AR (4.5 vs 11.9 years, p <0.001) and earlier time to redo-AVR (5.5 vs 12 years, p <0.001). AR was more common as the mechanism of SVD in Trifecta versus non-Trifecta valves (55.2% vs 30.1%, p = 0.006). All-cause adjusted mortality from index SAVR was higher in the Trifecta than in non-Trifecta group (hazard ratio 4.1, 95% confidence interval 1.5 to 11.5, p = 0.007). In conclusion, compared with non-Trifecta valves, Trifecta valves exhibit early SVD primarily as AR and progress rapidly to significant SVD requiring redo-AVR. Mortality is significantly higher with Trifecta than in non-Trifecta valves, potentially impacting the results of SAVR versus TAVR studies.
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Affiliation(s)
- Amr E Abbas
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan.
| | - Luai Madanat
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan
| | - Houman Khalili
- Department of Cardiovascular Medicine. Florida Atlantic University and Memorial Cardiovascular Institute, Hollywood, Florida
| | - Ramy Mando
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan
| | - Mazhed Kheyrbek
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan
| | - Rohit Chandra
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan
| | - Shailesh Niroula
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan
| | - Ivan Hanson
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Simon Dixon
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Brian Renard
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Richard Bloomingdale
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Elvis Cami
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Brittany Pridham
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan
| | - Jeffrey Altshuler
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Bogdan Kindzelski
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Franco Fazzalari
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Francis Shannon
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Alessandro Vivacqua
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
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Ahmad D, Yousef S, Kliner D, Brown JA, Serna-Gallegos D, Toma C, Makani A, West D, Wang Y, Thoma FW, Sultan I. Outcomes of Valve-in-Valve Transcatheter Aortic Valve Replacement. Am J Cardiol 2024; 215:1-7. [PMID: 38232811 DOI: 10.1016/j.amjcard.2023.12.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/23/2023] [Accepted: 12/27/2023] [Indexed: 01/19/2024]
Abstract
Structural valve degeneration is increasingly seen given the higher rates of bioprosthetic heart valve use for surgical and transcatheter aortic valve replacement (TAVR). Valve-in-valve TAVR (VIV-TAVR) is an attractive alternate for patients who are otherwise at high risk for reoperative surgery. We compared patients who underwent VIV-TAVR and native valve TAVR through a retrospective analysis of our institutional transcatheter valve therapy (TVT) database from 2013 to 2022. Patients who underwent either a native valve TAVR or VIV-TAVR were included. VIV-TAVR was defined as TAVR in patients who underwent a previous surgical aortic valve replacement. Kaplan-Meier survival analysis was used to obtain survival estimates. A Cox proportional hazards regression model was used for the multivariable analysis of mortality. A total of 3,532 patients underwent TAVR, of whom 198 (5.6%) underwent VIV-TAVR. Patients in the VIV-TAVR cohort were younger than patients who underwent native valve TAVR (79.5 vs 84 years, p <0.001), with comparable number of women and a higher Society of Thoracic Surgeons risk score (6.28 vs 4.46, p <0.001). The VIV-TAVR cohort had a higher incidence of major vascular complications (2.5% vs 0.8%, p = 0.008) but lower incidence of permanent pacemaker placement (2.5% vs 8.1%, p = 0.004). The incidence of stroke was comparable between the groups (VIV-TAVR 2.5% vs native TAVR 2.4%, p = 0.911). The 30-day readmission rates (VIV-TAVR 7.1% vs native TAVR 9%, p = 0.348), as well as in-hospital (VIV-TAVR 2% vs native TAVR 1.4%, p = 0.46), and overall (VIV-TAVR 26.3% vs native TAVR 30.8%, p = 0.18) mortality at a follow-up of 1.8 years (0.83 to 3.5) were comparable between the groups. The survival estimates were also comparable between the groups (log-rank p = 0.27). On multivariable Cox regression analysis, VIV-TAVR was associated with decreased hazards of death (hazard ratio 0.68 [0.5 to 0.9], p = 0.02). In conclusion, VIV-TAVR is a feasible and safe strategy for high-risk patients with bioprosthetic valve failure. There may be potentially higher short-term morbidity with VIV-TAVR, with no overt impact on survival.
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Affiliation(s)
- Danial Ahmad
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dustin Kliner
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Catalin Toma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amber Makani
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David West
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yisi Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd W Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Golzarian H, Thiel A, Hempfling G, Otto M, Otto T, Shappell E, Racer L, Martz D, Recker‐Herman CM, Laird A, Cole WC, Sirak J, Patel SM. Severe aortic insufficiency-induced cardiogenic shock treated with left atrial VA-ECMO and emergent valve-in-valve TAVR. ESC Heart Fail 2023; 10:3718-3724. [PMID: 37890858 PMCID: PMC10682863 DOI: 10.1002/ehf2.14561] [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] [Received: 02/01/2023] [Revised: 09/05/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
Conventional venoarterial extracorporeal membrane oxygenation (VA-ECMO) places a functional afterload burden on the left ventricle. In the setting of acute severe aortic insufficiency-induced cardiogenic shock, the utility of VA-ECMO in combination with a failing valve may result in catastrophic haemodynamic consequences. This challenge is compounded when the culprit is a failing surgical bioprosthetic valve. We present a case of severe rapid-onset bioprosthetic aortic insufficiency-induced cardiogenic shock successfully resuscitated with left atrial VA-ECMO promptly followed by emergent percutaneous valve-in-valve transaortic valve replacement. We discuss the logistics, implications, and associated haemodynamic manifestations in utilizing this strategy for such disease processes.
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Affiliation(s)
- Hafez Golzarian
- Internal Medicine Residency ProgramMercy Health—St. Rita's Medical CenterLimaOHUSA
| | - Arielle Thiel
- Structural Heart and Intervention CenterMercy Health—St. Rita's Medical Center730 West Market Street, 2K TowerLimaOH45801USA
| | - Gerri Hempfling
- Structural Heart and Intervention CenterMercy Health—St. Rita's Medical Center730 West Market Street, 2K TowerLimaOH45801USA
| | - Michael Otto
- Cardiothoracic SurgeryMercy Health—St. Rita's Medical CenterLimaOHUSA
| | - Todd Otto
- Cardiothoracic SurgeryMercy Health—St. Rita's Medical CenterLimaOHUSA
| | - Emily Shappell
- Structural Heart and Intervention CenterMercy Health—St. Rita's Medical Center730 West Market Street, 2K TowerLimaOH45801USA
| | - Lisa Racer
- Structural Heart and Intervention CenterMercy Health—St. Rita's Medical Center730 West Market Street, 2K TowerLimaOH45801USA
| | - Denise Martz
- Structural Heart and Intervention CenterMercy Health—St. Rita's Medical Center730 West Market Street, 2K TowerLimaOH45801USA
| | | | - Amanda Laird
- Department of Critical CareMercy Health—St. Rita's Medical CenterLimaOHUSA
| | - William C. Cole
- Department of Critical CareMercy Health—St. Rita's Medical CenterLimaOHUSA
| | - John Sirak
- Cardiothoracic SurgeryMercy Health—St. Rita's Medical CenterLimaOHUSA
| | - Sandeep M. Patel
- Structural Heart and Intervention CenterMercy Health—St. Rita's Medical Center730 West Market Street, 2K TowerLimaOH45801USA
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Dokollari A, Torregrossa G, Sicouri S, Cameli M, Mandoli GE, Kjelstrom S, Prifti E, Veshti A, Bonacchi M, Gelsomino S. Long-term prognosis in patients undergoing redo-isolated aortic valve replacement. Future Cardiol 2023; 19:685-694. [PMID: 38078413 DOI: 10.2217/fca-2023-0050] [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: 12/18/2023] Open
Abstract
Aim: To evaluate clinical outcomes after redo aortic valve replacement (AVR) with sutured valves, versus valve-in-valve transcatheter aortic valve replacement (ViV-TAVR), versus sutureless valves. Methods: We identified 113 consecutive patients undergoing redo AVR with either ViV-TAVR, redo-sutured and redo-sutureless valves between August 2010 to March 2020. Heart-team made the decision whether patient should undergo redo-sutureless versus ViV-TAVR, versus redo-sutured AVR. Results: Preoperatively, redo-sutured (n = 57), ViV-TAVR (n = 31) and redo-sutureless (n = 25) patients were compared. Postoperatively, after propensity-adjustment analysis, the redo surgical aortic valve replacement group had a higher incidence of new postoperative atrial fibrillation (POAF; p = 0.04) compared with redo-sutureless group. Follow-up outcomes analysis did not show differences among groups. Conclusion: Patients undergoing redo-sutureless AVR experienced a higher incidence of POAF compared with patients undergoing redo-sutured.
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Affiliation(s)
- Aleksander Dokollari
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiac Surgery Department, St. Boniface Hospital, University of Manitoba, Winnipeg M3B1W7, Canada
| | | | - Serge Sicouri
- Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University Hospital of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University Hospital of Siena, Siena, Italy
| | | | - Edvin Prifti
- Division of Cardiac Surgery University Hospital Center "Mother Teresa" Tirana Albania
| | - Altin Veshti
- Division of Cardiac Surgery University Hospital Center "Mother Teresa" Tirana Albania
| | - Massimo Bonacchi
- Department of Experimental & Clinical Medicine, University of Florence, Firenze, Italy
| | - Sandro Gelsomino
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands
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Galhardo A, Avvedimento M, Mengi S, Rodés-Cabau J. Redo-TAVR: Essential Concepts, Updated Data and Current Gaps in Evidence. J Clin Med 2023; 12:4788. [PMID: 37510906 PMCID: PMC10381270 DOI: 10.3390/jcm12144788] [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: 05/01/2023] [Revised: 07/02/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Within the last two decades, transcatheter aortic valve replacement (TAVR) has transformed the treatment strategy for symptomatic severe aortic stenosis (AS), representing a less invasive alternative to traditional open-chest surgery. With time, advances in device features, imaging planning, and implantation techniques have contributed to an improvement in safety as well as a reduction in procedural complications. This has led to the expansion of TAVR to lower-risk patients, where TAVR has shown favorable outcomes compared to surgical aortic valve replacement (SAVR). As TAVR expands to younger and lower-risk patients with longer life expectancies, the need for reintervention for failing transcatheter heart valves is expected to increase. Redo-TAVR has gained increasing relevance in the lifetime management of AS as one of the treatment strategies available for structural valve dysfunction (SVD). However, some issues are associated with this approach, including coronary re-access and the risk of coronary obstruction. In this review, we provide essential concepts to properly select candidates for Redo-TAVR, updated data on clinical outcomes and complication rates, and current gaps in evidence.
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Affiliation(s)
- Attílio Galhardo
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC G1V 4G5, Canada
| | - Marisa Avvedimento
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC G1V 4G5, Canada
| | - Siddhartha Mengi
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC G1V 4G5, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC G1V 4G5, Canada
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Arjomandi Rad A, Naruka V, Vardanyan R, Salmasi MY, Tasoudis PT, Kendall S, Casula R, Athanasiou T. Renal outcomes in valve-in-valve transcatheter versus redo surgical aortic valve replacement: A systematic review and meta-analysis. J Card Surg 2022; 37:3743-3753. [PMID: 36040611 PMCID: PMC9804591 DOI: 10.1111/jocs.16890] [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: 02/17/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Postoperative acute kidney injury (AKI) and the requirement for renal replacement therapy (RRT) remain common and significant complications of both transcatheter valve-in-valve aortic valve replacement (ViV-TAVR) and redo surgical aortic valve replacement (SAVR). Nevertheless, the understanding of renal outcomes in the population undergoing either redo SAVR or ViV-TAVR remains controversial. METHODS A systematic database search with meta-analysis was conducted of comparative original articles of ViV-TAVR versus redo SAVR in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to September 2021. Primary outcomes were AKI and RRT. Secondary outcomes were stroke, major bleeding, pacemaker implantation rate, operative mortality, and 30-day mortality. RESULTS Our search yielded 5435 relevant studies. Eighteen studies met the inclusion criteria with a total of 11,198 patients. We found ViV-TAVR to be associated with lower rates of AKI, postoperative RRT, major bleeding, pacemaker implantation, operative mortality, and 30-day mortality. No significant difference was observed in terms of stroke rate. The mean incidence of AKI in ViV-TAVR was 6.95% (±6%) and in redo SAVR was 15.2% (±9.6%). For RRT, our data showed that VIV-TAVR to be 1.48% (±1.46%) and redo SAVR to be 8.54% (±8.06%). CONCLUSION Renoprotective strategies should be put into place to prevent and reduce AKI incidence regardless of the treatment modality. Patients undergoing re-intervention for the aortic valve constitute a high-risk and frail population in which ViV-TAVR demonstrated it might be a feasible option for carefully selected patients. Long-term follow-up data and randomized control trials will be needed to evaluate mortality and morbidity outcomes between these 2 treatments.
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Affiliation(s)
| | - Vinci Naruka
- Department of Cardiothoracic Surgery, Imperial College NHS TrustHammersmith HospitalLondonUK
| | - Robert Vardanyan
- Department of Medicine, Imperial College LondonFaculty of MedicineLondonUK
| | | | | | - Simon Kendall
- Department of Cardiothoracic SurgeryJames Cook University HospitalMiddlesboroughUK
| | - Roberto Casula
- Department of Cardiothoracic Surgery, Imperial College NHS TrustHammersmith HospitalLondonUK
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Imperial College NHS TrustHammersmith HospitalLondonUK,Department of Surgery and CancerImperial College LondonLondonUK
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Affiliation(s)
- Marco Spaziano
- Division of Cardiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Jeremy Y Levett
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Nicolo Piazza
- Division of Cardiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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