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Ashraf H, Patel M, Armas ISD, Jumean M. Ventriculo-arterial uncoupling with an impella assisted HVAD: The p-D LVAD. Catheter Cardiovasc Interv 2024. [PMID: 38648353 DOI: 10.1002/ccd.31043] [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: 09/17/2023] [Revised: 03/06/2024] [Accepted: 03/31/2024] [Indexed: 04/25/2024]
Abstract
This paper presents the novel use of a temporary percutaneous ventricular assist device (pVAD) in a 51-year-old man with an implanted durable left ventricular assist device (d-LVAD). The pre-existing left ventricular assist device was unable to successfully unload the left ventricle, and the addition of the temporary pVAD achieved successful unloading as well as a decrease in pulmonary artery pressures without compromising the function of the right ventricle allowing safe UNOS listing for orthotopic heart transplantation.
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Affiliation(s)
- Hassan Ashraf
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Manish Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ismael Salas De Armas
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Marwan Jumean
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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2
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Nesta M, Bruno P, d'Acierno EM, Cutrone G, Rovere G, Burzotta F, Trani C, Romagnoli E, Aurigemma C, Infusino F, Locorotondo G, Chiariello GA, Cammertoni F, Grandinetti M, Pavone N, Massetti M. Unrecognized Hole in the Aortic Stenosis Heart: Acquired Gerbode Defect Detected During Pretransfemoral Aortic Valve Implantation Evaluation. Circ Cardiovasc Imaging 2024:e016151. [PMID: 38602112 DOI: 10.1161/circimaging.123.016151] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Marialisa Nesta
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
| | - Piergiorgio Bruno
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
| | - Edoardo Maria d'Acierno
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
| | - Gessica Cutrone
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
| | - Giuseppe Rovere
- Division of Radiology, Department of Diagnostical Imaging, Catholic University of the Sacred Heart, Rome, Italy. (G.R.)
| | - Francesco Burzotta
- Division of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (F.B., C.T., E.R., C.A., F.I., G.L.)
| | - Carlo Trani
- Division of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (F.B., C.T., E.R., C.A., F.I., G.L.)
| | - Enrico Romagnoli
- Division of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (F.B., C.T., E.R., C.A., F.I., G.L.)
| | - Cristina Aurigemma
- Division of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (F.B., C.T., E.R., C.A., F.I., G.L.)
| | - Fabio Infusino
- Division of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (F.B., C.T., E.R., C.A., F.I., G.L.)
| | - Gabriella Locorotondo
- Division of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (F.B., C.T., E.R., C.A., F.I., G.L.)
| | - Giovanni A Chiariello
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
| | - Federico Cammertoni
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
| | - Maria Grandinetti
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
| | - Natalia Pavone
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
| | - Massimo Massetti
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
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3
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Biancari F, Mäkikallio T. Hospital racial composition and outcomes after transcatheter and surgical aortic valve replacement. Catheter Cardiovasc Interv 2024; 103:828-829. [PMID: 38549462 DOI: 10.1002/ccd.31022] [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: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
Key points
Racial/ethnic cardiovascular disparities have been demonstrated in optimal cardiovascular health.
Racial residential segregation may be a cause of disparities in health.
Early outcomes after aortic valve replacement are worse in hospitals treating a larger proportion of non‐White patients.
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Affiliation(s)
- Fausto Biancari
- Department of Medicine, South Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Timo Mäkikallio
- Department of Medicine, South Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
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4
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Yamashita Y, Sicouri S, Torregrossa G, Gray WA, Sutter FP, Ramlawi B. Hybrid robotic-assisted coronary revascularization and transcatheter aortic valve replacement: a single-center experience. J Invasive Cardiol 2024. [PMID: 38446024 DOI: 10.25270/jic/23.00308] [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] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVES The efficacy of hybrid robotic-assisted coronary artery bypass grafting (CABG) and transcatheter aortic valve replacement (TAVR) for coronary and aortic valve disease is poorly reported. Herein, we report our experience with this hybrid approach. METHODS Between January 2018 and June 2022, 10 (7 male, 3 female) patients with a mean age of 81 years underwent the hybrid procedure. Coronary revascularization was performed prior to TAVR with robotic-assisted left internal mammary artery-to-left anterior descending (LAD) bypass grafting for left main or proximal LAD lesions with or without multivessel disease with or without hybrid percutaneous coronary intervention (PCI). RESULTS Five patients had left main disease, and 5 had proximal LAD disease with or without multivessel disease. All patients tolerated the robotic-assisted CABG procedure well; 9 patients were extubated in the operating room and all patients were ambulatory on postoperative day 1. Five patients underwent hybrid PCI for non-LAD lesions. TAVR was subsequently performed at intervals ranging from 3 days to 5 months after CABG. One patient with end-stage renal disease on hemodialysis required hospitalization for heart failure during the interval period. The 1-year mortality rate was 0%, and 3 patients died during late follow-up (24-43 months). CONCLUSIONS This innovative, less invasive approach demonstrates the potential for early recovery in appropriately selected patients with complex coronary and aortic valve disease with promising mid-term outcomes.
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Affiliation(s)
- Yoshiyuki Yamashita
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA
| | - William A Gray
- Department of Interventional Cardiology, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA
| | - Francis P Sutter
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA; Department of Cardiothoracic Surgery, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA
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5
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Notenboom ML, Van Hoof L, Schuermans A, Takkenberg JJM, Rega FR, Taverne YJHJ. Aortic Valve Embryology, Mechanobiology, and Second Messenger Pathways: Implications for Clinical Practice. J Cardiovasc Dev Dis 2024; 11:49. [PMID: 38392263 PMCID: PMC10888685 DOI: 10.3390/jcdd11020049] [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: 12/24/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
During the Renaissance, Leonardo Da Vinci was the first person to successfully detail the anatomy of the aortic root and its adjacent structures. Ever since, novel insights into morphology, function, and their interplay have accumulated, resulting in advanced knowledge on the complex functional characteristics of the aortic valve (AV) and root. This has shifted our vision from the AV as being a static structure towards that of a dynamic interconnected apparatus within the aortic root as a functional unit, exhibiting a complex interplay with adjacent structures via both humoral and mechanical stimuli. This paradigm shift has stimulated surgical treatment strategies of valvular disease that seek to recapitulate healthy AV function, whereby AV disease can no longer be seen as an isolated morphological pathology which needs to be replaced. As prostheses still cannot reproduce the complexity of human nature, treatment of diseased AVs, whether stenotic or insufficient, has tremendously evolved, with a similar shift towards treatments options that are more hemodynamically centered, such as the Ross procedure and valve-conserving surgery. Native AV and root components allow for an efficient Venturi effect over the valve to allow for optimal opening during the cardiac cycle, while also alleviating the left ventricle. Next to that, several receptors are present on native AV leaflets, enabling messenger pathways based on their interaction with blood and other shear-stress-related stimuli. Many of these physiological and hemodynamical processes are under-acknowledged but may hold important clues for innovative treatment strategies, or as potential novel targets for therapeutic agents that halt or reverse the process of valve degeneration. A structured overview of these pathways and their implications for cardiothoracic surgeons and cardiologists is lacking. As such, we provide an overview on embryology, hemodynamics, and messenger pathways of the healthy and diseased AV and its implications for clinical practice, by relating this knowledge to current treatment alternatives and clinical decision making.
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Affiliation(s)
- Maximiliaan L Notenboom
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Lucas Van Hoof
- Department of Cardiac Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Art Schuermans
- Department of Cardiac Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Filip R Rega
- Department of Cardiac Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
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Vasankari S, Mahlamäki V, Hartikainen J, Vasankari V, Tokola K, Vähä-Ypyä H, Anttila V, Husu P, Sievänen H, Vasankari T, Halonen J. Elective Cardiac Procedure Patients Have Low Preoperative Cardiorespiratory Fitness. Int J Sports Med 2024; 45:63-70. [PMID: 37640058 PMCID: PMC10776211 DOI: 10.1055/a-2161-4137] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 08/28/2023] [Indexed: 08/31/2023]
Abstract
Preoperative cardiorespiratory fitness may influence the recovery after cardiac procedure. The aim of this study was to investigate the cardiorespiratory fitness of patients scheduled for elective cardiac procedures, using a six-minute walk test, and compare the results with a population-based sample of Finnish adults. Patients (n=234) awaiting percutaneous coronary intervention or coronary angiography, coronary artery bypass grafting, aortic valve replacement or mitral valve surgery performed the six-minute walk test. VO2max was calculated based on the walk test. The patients were compared to a population-based sample of 60-69-year-old Finnish adults from the FinFit2017 study. The mean six-minute walk test distances (meters) and VO2max (ml/kg/min) of the patient groups were: 452±73 and 24.3±6.9 (coronary artery bypass grafting), 499±84 and 27.6±7.2 (aortic valve replacement), 496±85 and 27.4±7.3 (mitral valve surgery), and 519±90 and 27.3±6.9 (percutaneous coronary intervention or coronary angiography). The population-based sample had significantly greater walk test distance (623±81) and VO2max (31.7±6.1) than the four patient groups (all p-values<0.001). All patient groups had lower cardiorespiratory fitness than the reference population of 60-69-year-old Finnish adults. Particularly the coronary artery bypass grafting group had a low cardiorespiratory fitness, and therefore might be prone to complications and challenging rehabilitation after the operation.
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Affiliation(s)
- Sini Vasankari
- Clinical Medicine, University of Turku Faculty of Medicine, Turku,
Finland
| | - Visa Mahlamäki
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Juha Hartikainen
- Heart Center, Kuopio University Hospital, Kuopio, Finland
- Clinical Medicine, University of Eastern Finland – Kuopio
Campus, Kuopio, Finland
| | - Ville Vasankari
- Neurosurgery, Helsinki University Central Hospital, Helsinki,
Finland
| | - Kari Tokola
- UKK Institute, UKK Institute, Tampere, Finland
| | | | - Vesa Anttila
- Heart Center, TYKS Turku University Hospital, Turku,
Finland
| | | | | | - Tommi Vasankari
- UKK Institute, UKK Institute, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere,
Finland
| | - Jari Halonen
- Heart Center, Kuopio University Hospital, Kuopio, Finland
- Clinical Medicine, University of Eastern Finland – Kuopio
Campus, Kuopio, Finland
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Akao K, Imamura T, Tanaka S, Onoda H, Ushijima R, Sobajima M, Fukuda N, Ueno H, Kinugawa K. Prognostic Implication of Intestinal Wall Edema in Patients with Aortic Stenosis Receiving Trans-Catheter Aortic Valve Replacement. J Clin Med 2023; 12:7658. [PMID: 38137728 PMCID: PMC10744330 DOI: 10.3390/jcm12247658] [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: 11/06/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND A recently proposed mechanism, the intestinal-cardiovascular relationship, serves as a framework to elucidate the interplay between these two systems. In our investigation, we assessed the prognostic implications of colon wall thickness, a marker correlated with intestinal congestion and dysfunction, in patients diagnosed with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). METHODS Patients diagnosed with severe aortic stenosis who underwent TAVR at our institution during the period spanning 2015 to 2022 were retrospectively enrolled. As part of the institutional protocol, patients underwent abdominal computed tomography upon admission, preceding TAVR. Our analysis aimed to assess the influence of colon wall thickness on the occurrence of either all-cause mortality or readmission due to heart failure within a two-year period. RESULTS A total of 345 patients were included. The median age was 85 (82, 88) years, and 99 patients were male. Baseline colon wall thickness was distributed widely, with a median value of 2.2 (2.0, 2.5) mm. Patients with thicker colon walls tended to have lower pulmonary artery pulsatility index values, indicating more impaired right ventricular function and more advanced malnutrition. A thicker colon wall was independently associated with 2-year death or heart failure readmission with a hazard ratio of 2.02 (95% confidence interval 1.01-14.07), adjusted for hemoglobin, age, and plasma B-type natriuretic peptide levels (p = 0.049), and significantly stratified the primary endpoint at a cutoff of 2.7 mm (25% versus 10%, p = 0.005). CONCLUSIONS Our initial observation revealed that a thicker baseline colon wall correlated with increased rates of mid-term mortality and readmission due to heart failure subsequent to TAVR. Developing a comprehensive understanding of the underlying causality necessitates further in-depth investigations through subsequent studies.
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Holzamer A, Bedogni F, van Wyk P, Barwad P, Protasiewicz M, Ielasi A, Nombela-Franco L, Seidler T, Hilker M. Performance of the 32 mm Myval transcatheter heart valve for treatment of aortic stenosis in patients with extremely large aortic annuli in real-world scenario: First global, multicenter experience. Catheter Cardiovasc Interv 2023; 102:1364-1375. [PMID: 37698335 DOI: 10.1002/ccd.30820] [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: 07/05/2022] [Revised: 08/03/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Extremely large aortic valve anatomy is one of the remaining limitations leading to exclusion of patients for transcatheter aortic valve replacement (TAVR). AIMS The newly approved Myval 32 mm device is designed for use in aortic annulus areas up to 840 mm2 . Here we want to share the initial worldwide experience with the device. METHODS AND RESULTS Retrospective data were collected from 10 patients with aortic stenosis and very large annular anatomy (mean area 765.5 mm2 ), who underwent implantation with 32 mm Myval transcatheter heart valve at eight centers. Valve Academic Research Consortium-2 device success was achieved in all cases. Mild paravalvular leak was observed in three patients and two patients required new pacemaker implantation. One patient experienced retroperitoneal hemorrhage caused by the contralateral 6 F sheath and required surgical revision. No device-related complications, stroke, or death from any cause occurred within the 30-day follow-up period. In a studied cohort of 2219 consecutive TAVR-screened patients from a central European site, only 0.27% of patients showed larger anatomy than covered by the 32 mm Myval device by instructions for use without off-label use of overexpansion. This rate was significantly higher for the 34 mm Evolut Pro (1.8%) and 29 mm Sapien 3 (2.1%) devices. CONCLUSIONS The Myval 32 mm prosthesis showed promising initial results in a cohort of patients who previously had to be excluded from TAVR. It is desirable that all future TAVR systems accommodate larger anatomy to allow optimal treatment of all patients.
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Affiliation(s)
| | | | - Pieter van Wyk
- Department of Cardiology, Netcare Sunninghill Hospital, Sunninghill, South Africa
| | - Parag Barwad
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | | | - Tim Seidler
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Michael Hilker
- University of Regensburg Medical Center, Regensburg, Germany
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Tabrizi NS, Ramadan R, Musuku SR, Shapeton AD. Diastolic Left Main Coronary Artery Flow Reversal. J Cardiothorac Vasc Anesth 2023; 37:2674-2677. [PMID: 37349188 DOI: 10.1053/j.jvca.2023.06.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/19/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023]
Abstract
In patients undergoing percutaneous cardiac interventions, perioperative transesophageal echocardiography is used routinely, often revealing an unusual pathology that was not previously detected with transthoracic echocardiography. In this e-challenge, the authors present a patient undergoing percutaneous transcatheter aortic valve replacement, with preprocedural transesophageal echocardiography revealing an abnormal color Doppler signal near the left main coronary artery during diastole.
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Affiliation(s)
| | - Ronnie Ramadan
- Georgia Heart Institute, Northeast Georgia Health System, Gainesville, GA
| | | | - Alexander D Shapeton
- Veterans Affairs Boston Healthcare System, Department of Anesthesia, Critical Care and Pain Medicine, and Tufts University School of Medicine, Boston, MA
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Barrett CD, Nickel A, Rosenberg MA, Ream K, Tzou WS, Aleong R, Tumolo A, Garg L, Zipse M, West JJ, Varosy P, Sandhu A. PRIME score for prediction of permanent pacemaker implantation after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2023; 102:1357-1363. [PMID: 37735946 DOI: 10.1002/ccd.30845] [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: 12/19/2022] [Revised: 05/02/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES We sought to produce a simple scoring system that can be applied at clinical visits before transcatheter aortic valve replacement (TAVR) to stratify the risk of permanent pacemaker (PPM) after the procedure. BACKGROUND Atrioventricular block is a known complication of TAVR. Current models for predicting the risk of PPM after TAVR are not designed to be applied clinically to assist with preprocedural planning. METHODS Patients undergoing TAVR at the University of Colorado were split into a training cohort for the development of a predictive model, and a testing cohort for model validation. Stepwise and binary logistic regressions were performed on the training cohort to produce a predictive model. Beta coefficients from the binary logistic regression were used to create a simple scoring system for predicting the need for PPM implantation. Scores were then applied to the validation cohort to assess predictive accuracy. RESULTS Patients undergoing TAVR from 2013 to 2019 were analyzed: with 483 included in the training cohort and 123 included in the validation cohort. The need for a pacemaker was associated with five preprocedure variables in the training cohort: PR interval > 200 ms, Right bundle branch block, valve-In-valve procedure, prior Myocardial infarction, and self-Expandable valve. The PRIME score was developed using these clinical features, and was highly accurate for predicting PPM in both the training and model validation cohorts (area under the curve 0.804 and 0.830 in the model training and validation cohorts, respectively). CONCLUSIONS The PRIME score is a simple and accurate preprocedural tool for predicting the need for PPM implantation after TAVR.
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Affiliation(s)
| | - Andrew Nickel
- University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | | | - Karen Ream
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Wendy S Tzou
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Ryan Aleong
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Alexis Tumolo
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Lohit Garg
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Matthew Zipse
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - John J West
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
- Denver Health Medical Center, Denver, Colorado, USA
| | - Paul Varosy
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Amneet Sandhu
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
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11
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王 蔚, 孙 泽, 辛 然, 丁 熠, 刘 子, 王 玺, 王 晶, 单 冬, 刘 长. [Calcification distributional density of the aortic-valvular complex is an independent risk factor for conduction block following self-expanding transcatheter aortic valve replacement]. Nan Fang Yi Ke Da Xue Xue Bao 2023; 43:1901-1908. [PMID: 38081608 PMCID: PMC10713467 DOI: 10.12122/j.issn.1673-4254.2023.11.10] [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] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To evaluate the effect of calcification distributional density in different regions of aortic-valvular complex (AVC) on postoperative new-onset conduction block (CB) following transcatheter aortic valve replacement (TAVR) using self-expandable valves (SEV) made in China. METHODS From January, 2016 to December, 2022, 73 patients with severe aortic valve stenosis received Venus-A prosthetic valve replacement using SEV made in China, and postoperative new-onset CB occurred in 18 (24.7%) of the patients. The baseline data, imaging and intervention- related data were compared were between the patients with CB and those without CB. Univariate and multivariate logistic regression analysis was used for investigating the independent risk factors for new- onset CB after TAVR, and the predictive performance of these risk factors was evaluated using receiver operating characteristic (ROC) curve and DeLong test. RESULTS Compared with those with CB, the patients experiencing postoperative new-onset CB had a greater implantation depth (6.77±2.45 mm vs 5.11±3.28 mm, P=0.027), a smaller difference between the membranous septum length and the implantation depth (MSID) (0.68±3.49 mm vs 2.82±3.88 mm, P= 0.036), and a higher calcification distributional density of the left coronary sinus (LCS) in the device landing zone (DLZ) (P= 0.026). Multivariate logistic analysis revealed that DLZ-LCS calcification distributional density and MSID were independent risk (protective) factors for new-onset CB following TAVR. ROC curve analysis showed that the AUC of MSID and DLZ-LCS calcification distributional density was 0.775 and 0.716, respectively, and their combination had had a significantly higher AUC of 0.890 (P=0.041 and 0.027, respectively). CONCLUSION The DLZ-LCS calcification distributional density is an independent risk factor for new-onset CB following TAVR using SEV. The conduction complications following TAVR can be effectively predicted using this calcification indicator combined with MSID.
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Affiliation(s)
- 蔚然 王
- 中国人民解放军总医院第一医学中心心内科,北京 100853Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - 泽瑜 孙
- 中国人民解放军总医院第六医学中心心血管病医学部,北京 100048Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
- 南开大学医学院,天津 300071School of Medicine, Nankai University, Tianjin 300071, China
| | - 然 辛
- 中国人民解放军总医院第六医学中心心血管病医学部,北京 100048Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
- 南开大学医学院,天津 300071School of Medicine, Nankai University, Tianjin 300071, China
| | - 熠璞 丁
- 中国人民解放军总医院第六医学中心心血管病医学部,北京 100048Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
- 南开大学医学院,天津 300071School of Medicine, Nankai University, Tianjin 300071, China
| | - 子暖 刘
- 中国人民解放军总医院第六医学中心心血管病医学部,北京 100048Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
- 南开大学医学院,天津 300071School of Medicine, Nankai University, Tianjin 300071, China
| | - 玺 王
- 中国人民解放军总医院第六医学中心心血管病医学部,北京 100048Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - 晶 王
- 中国人民解放军总医院第六医学中心心血管病医学部,北京 100048Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - 冬凯 单
- 中国人民解放军总医院第六医学中心心血管病医学部,北京 100048Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - 长福 刘
- 中国人民解放军总医院第六医学中心心血管病医学部,北京 100048Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
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Evans MA, Walsh K. Clonal Hematopoiesis and Transcatheter Aortic Valve Replacement: A Fatal Connection. JACC Basic Transl Sci 2023; 8:1436-1438. [PMID: 38093748 PMCID: PMC10714164 DOI: 10.1016/j.jacbts.2023.06.007] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Megan A. Evans
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Kenneth Walsh
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Pribadi A, Siddiq A, Nugrahani AD, Santoso DPJ. Case Report: 5 Cases of Variant Hypoplastic Left Heart Syndrome Diagnosed on Prenatal Fetal Ultrasound. Am J Case Rep 2023; 24:e940871. [PMID: 37880936 PMCID: PMC10616901 DOI: 10.12659/ajcr.940871] [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: 04/22/2023] [Revised: 09/12/2023] [Accepted: 08/18/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Hypoplastic left heart syndrome (HLHS) is a complex left-sided obstructive congenital cardiac condition with several variants. This report is of 5 cases with varying morphology of HLHS diagnosed by fetal prenatal ultrasound at the 4-chamber view (4CV) level. CASE REPORT Five cases were referred by obstetrics and gynecology specialists with preliminary information on visible congenital abnormalities in the third trimester. Fetal echocardiography showed that several morphological variants of HLHS were found. The patient in the first case had the most frequently found variant; this variation is usually linked to mitral valve stenosis (MVS). The second case had the characteristic of mitral valve atresia (MVA), and as a consequence, blood flow was not visible in this variant and the left ventricle (LV) was not clear or not adequately visualized by ultrasound. In the third case, the patient suffered from severe MVS and perhaps a small aorta. Uni-atrial conditions were described in the third case. In the fourth case, the patient had a narrow LV, MVA, ventricular septal defect, nearly united atrium, and tricuspid regurgitation. The fifth case was a case of HLHS with congenital diaphragmatic hernia. Further, 4 out of 5 of the cases were associated with widening of the cisterna magna and Dandy Walker syndrome-associated posterior fossa disorder malformations. The overall maternal age was over 35 years old in 4 cases. Karyotyping examination was not performed in all cases. CONCLUSIONS The role of ultrasound is very important in determining the diagnosis and the degree of development of hypoplastic LV. However, visualization at the 4CV level can detect abnormalities found in the LV.
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Andreeva A, Coti I, Werner P, Scherzer S, Kocher A, Laufer G, Andreas M. Aortic Valve Replacement in Adult Patients with Decellularized Homografts: A Single-Center Experience. J Clin Med 2023; 12:6713. [PMID: 37959179 PMCID: PMC10650916 DOI: 10.3390/jcm12216713] [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: 09/01/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND decellularized aortic homografts (DAH) represent a promising alternative for aortic valve replacement in young adults due to their low immunogenicity and thrombogenicity. Herein, we report our midterm, single-center experience in adult patients with non-frozen DAH from corlife. METHODS safety, durability, and hemodynamic performance were evaluated according to current guidelines in all consecutive patients who had received a DAH at our center since 03/2016. RESULTS seventy-three (mean age 47 ± 11 years, 68.4% (n = 50) male) patients were enrolled. The mean diameter of the implanted DAH was 24 ± 2 mm. Mean follow-up was 36 ± 27 months, with a maximum follow-up of 85 months and cumulative follow-up of 215 years. No cases of stenosis were observed, in four (5.5%) cases moderate aortic regurgitation occurred, but no reintervention was required. No cases of early mortality, non-structural dysfunction, reoperation, valve endocarditis, or thrombosis were observed. Freedom from bleeding and thromboembolic events was 100%; freedom from re-intervention was 100%; survival was 98.6% (n = 72). CONCLUSIONS early and mid-term results showed low mortality and 100% freedom from reoperation, thromboembolic events, and bleeding at our center. However, in order for this novel approach to be established as a valid alternative to aortic valve replacement in young patients, long-term data are required.
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Affiliation(s)
- Alexandra Andreeva
- Department of Cardiac Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; (I.C.); (P.W.); (S.S.); (A.K.); (G.L.); (M.A.)
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Sundström E, Laudato M. Machine Learning-Based Segmentation of the Thoracic Aorta with Congenital Valve Disease Using MRI. Bioengineering (Basel) 2023; 10:1216. [PMID: 37892946 PMCID: PMC10604748 DOI: 10.3390/bioengineering10101216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/21/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Subjects with bicuspid aortic valves (BAV) are at risk of developing valve dysfunction and need regular clinical imaging surveillance. Management of BAV involves manual and time-consuming segmentation of the aorta for assessing left ventricular function, jet velocity, gradient, shear stress, and valve area with aortic valve stenosis. This paper aims to employ machine learning-based (ML) segmentation as a potential for improved BAV assessment and reducing manual bias. The focus is on quantifying the relationship between valve morphology and vortical structures, and analyzing how valve morphology influences the aorta's susceptibility to shear stress that may lead to valve incompetence. The ML-based segmentation that is employed is trained on whole-body Computed Tomography (CT). Magnetic Resonance Imaging (MRI) is acquired from six subjects, three with tricuspid aortic valves (TAV) and three functionally BAV, with right-left leaflet fusion. These are used for segmentation of the cardiovascular system and delineation of four-dimensional phase-contrast magnetic resonance imaging (4D-PCMRI) for quantification of vortical structures and wall shear stress. The ML-based segmentation model exhibits a high Dice score (0.86) for the heart organ, indicating a robust segmentation. However, the Dice score for the thoracic aorta is comparatively poor (0.72). It is found that wall shear stress is predominantly symmetric in TAVs. BAVs exhibit highly asymmetric wall shear stress, with the region opposite the fused coronary leaflets experiencing elevated tangential wall shear stress. This is due to the higher tangential velocity explained by helical flow, proximally of the sinutubal junction of the ascending aorta. ML-based segmentation not only reduces the runtime of assessing the hemodynamic effectiveness, but also identifies the significance of the tangential wall shear stress in addition to the axial wall shear stress that may lead to the progression of valve incompetence in BAVs, which could guide potential adjustments in surgical interventions.
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Affiliation(s)
- Elias Sundström
- Department of Engineering Mechanics, FLOW Research Center, KTH Royal Institute of Technology, Teknikringen 8, 10044 Stockholm, Sweden
| | - Marco Laudato
- Department of Engineering Mechanics, FLOW Research Center, KTH Royal Institute of Technology, Teknikringen 8, 10044 Stockholm, Sweden
- Department of Engineering Mechanics, The Marcus Wallenberg Laboratory for Sound and Vibration Research, KTH Royal Institute of Technology, Teknikringen 8, 10044 Stockholm, Sweden
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16
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Matkovic M, Aleksic N, Bilbija I, Antic A, Lazovic JM, Cubrilo M, Milojevic A, Zivkovic I, Putnik S. Clinical Impact of Patient-Prosthesis Mismatch After Aortic Valve Replacement With a Mechanical or Biological Prosthesis. Tex Heart Inst J 2023; 50:e228048. [PMID: 37867308 PMCID: PMC10658167 DOI: 10.14503/thij-22-8048] [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: 10/24/2023]
Abstract
BACKGROUND Patient-prosthesis mismatch (PPM) may impair functional capacity and survival after aortic valve replacement. This study aimed to investigate the impact of PPM on long-term survival and quality of life after mechanical and biological aortic valve replacement. METHODS This study included 595 consecutive patients who had undergone isolated aortic valve replacement. Patients were divided into 2 groups according to prosthesis type. The baseline and operative characteristics, survival rates, complications, and quality of life of the groups with and without PPM were compared for up to 6 years. The PPM calculation was performed using the effective orifice area value provided by the manufacturer divided by the patient's body surface area. RESULTS The moderate to severe PPM rates were 69.8% and 3.7% after biological and mechanical prosthesis implantation, respectively. Mean survival for patients in the biological group who had PPM was statistically significantly shorter (50.2 months [95% CI, 45.2-55.3]) than for patients in the biological group without PPM (60.1 months [95% CI, 55.7-64.4]; P = .04). In the mechanical prosthesis group, there was no difference in mean survival between the subgroup with PPM (66.6 months [95% CI, 58.3-74.9]) and the subgroup without PPM (64.9 months [95% CI, 62.6-67.2]; P = .50). A quality-of-life questionnaire's scores did not differ between the groups. CONCLUSION Mismatch is common after biological valve implantation and statistically significantly affects long-term survival and quality of life. If the risk of PPM after implantation of a biological prosthesis is suspected, adopting strategies to avoid PPM at the time of surgery is warranted.
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Affiliation(s)
- Milos Matkovic
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nemanja Aleksic
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ilija Bilbija
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Antic
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - Jelena Milin Lazovic
- Department for Biostatistics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko Cubrilo
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Igor Zivkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Svetozar Putnik
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Mizutani H, Fujimoto N, Saihara K, Ishida M, Sakuma H, Dohi K. Long-term Consequence of Mediastinal Radiation Therapy for Thymoma on Cardiovascular System Confirmed by Cardiovascular Imaging. Circ Cardiovasc Imaging 2023; 16:e015653. [PMID: 37772413 DOI: 10.1161/circimaging.123.015653] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Affiliation(s)
- Hana Mizutani
- Department of Cardiology and Nephrology (H.M., N.F., K.D.), Mie University Graduate School of Medicine, Tsu, Japan
| | - Naoki Fujimoto
- Department of Cardiology and Nephrology (H.M., N.F., K.D.), Mie University Graduate School of Medicine, Tsu, Japan
| | - Kazushi Saihara
- Department of Radiology (K.S., M.I., H.S.), Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaki Ishida
- Department of Radiology (K.S., M.I., H.S.), Mie University Graduate School of Medicine, Tsu, Japan
| | - Hajime Sakuma
- Department of Radiology (K.S., M.I., H.S.), Mie University Graduate School of Medicine, Tsu, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology (H.M., N.F., K.D.), Mie University Graduate School of Medicine, Tsu, Japan
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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
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Beaver T, Bavaria JE, Griffith B, Svensson LG, Pibarot P, Borger MA, Sharaf OM, Heimansohn DA, Thourani VH, Blackstone EH, Puskas JD. Seven-year outcomes following aortic valve replacement with a novel tissue bioprosthesis. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00873-5. [PMID: 37778503 DOI: 10.1016/j.jtcvs.2023.09.047] [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: 07/09/2023] [Revised: 09/07/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE As bioprosthetic aortic valve replacement (AVR) extends to younger cohorts, tissue durability is of paramount importance. We report 7-year outcomes from an AVR bioprosthesis utilizing novel tissue. METHODS This was an international investigational device exemption trial for novel AVR with annual follow-up and a subset re-consented at 5 years for extended 10-year follow-up. Safety end points and echocardiographic measurements were adjudicated by an independent clinical events committee and by a dedicated core laboratory, respectively. RESULTS Between January 2013 and March 2016, 689 patients underwent AVR with the study valve. Mean age was 66.9 ± 11.6 years, Society of Thoracic Surgeons risk score was 2.0% ± 1.8%, and 74.3% of patients were New York Heart Association functional class II and III. Five-year follow-up was completed by 512 patients, and 225 re-consented for extended follow-up. Follow-up duration was 5.3 ± 2.2 years (3665.6 patient-years), and 194 and 195 patients completed 6- and 7-year follow-ups, respectively. One-, 5-, and 7-year freedom from all-cause mortality was 97.7%, 89.4%, and 85.4%, respectively. Freedom from structural valve deterioration at 7 years was 99.3%. At 7 years, effective orifice area and mean gradients were 1.82 ± 0.57 cm2 (n = 153), and 9.4 ± 4.5 mm Hg (n = 157), respectively. At 7 years, predominantly none (96.8% [152 out of 157]) or trivial/trace (2.5% [4 out of 157]) paravalvular regurgitation and none (84.7% [133 out of 157]) or trivial/trace (11.5% [18 out of 157]) transvalvular regurgitation were observed. CONCLUSIONS We report the longest surgical AVR follow-up with novel tissue in an investigational device exemption trial utilizing an independent clinical events committee and an echocardiography core laboratory. This tissue demonstrates excellent outcomes through 7 years and is the benchmark for future surgical and transcatheter prostheses.
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Affiliation(s)
- Thomas Beaver
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Fla.
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Bartley Griffith
- Department of Surgery, University of Maryland Medical Center, Baltimore, Md
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Philippe Pibarot
- Department of Cardiology, Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada
| | - Michael A Borger
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Omar M Sharaf
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Fla
| | | | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY
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Vázquez DJL, López GA, Guzmán MQ, Cancelo AV, Leal FR, Rios XF, Esteban PP, Fernandez JS, Santos RC, Rodriguez JMV. Prognostic impact of coronary lesions and its revascularization in a 5-year follow-up after the TAVI procedure. Catheter Cardiovasc Interv 2023; 102:513-520. [PMID: 37471716 DOI: 10.1002/ccd.30767] [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: 04/29/2023] [Revised: 06/14/2023] [Accepted: 07/08/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) is a common finding in patients undergoing transcatheter aortic valve implantation (TAVI). However, its prognostic significance and its management remains controversial. AIMS This study sought to determine whether the presence of CAD, its complexity, and angiography-guided percutaneous coronary intervention (PCI) are associated with outcomes after TAVI. METHODS All patients undergoing TAVI at a tertiary referral center between 2008 and 2018 were included in a prospective observational study. Baseline SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score (SS) and a residual SS after PCI were calculated. The endpoints on the 5 year follow-up were all-cause mortality and a composite of mayor cardiovascular adverse events (MACE). RESULTS In 379 patients, the presence of CAD and its complexity were not significantly associated with worse 5-year survival after TAVI, with a mortality for SS0 of 45%; for SS 1-22 of 36.5% (HR 0.77; 95% CI 0.53-1.11, p = 0.15) and for SS > 22 of 42.1% (HR 1.24; 95% CI 0.59-2.63, p = 0.57). Regarding the combined event of MACE, there were also no statistically significant differences between patients with CAD and without CAD (56.8% in patients without CAD and 54.9% in patients with CAD; HR 1.06; 95% CI 0.79-1.43, p = 0.7). Angiography-guided PCI or completeness of revascularization was not associated with different outcomes. CONCLUSIONS In the present analysis, neither the presence nor the extent of CAD, nor the degree of revascularization, was associated with a prognostic impact in patients undergoing TAVI at 5-year follow-up.
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Affiliation(s)
- Domingo José López Vázquez
- Department of Interventional Cardiology, Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Guillermo Aldama López
- Department of Interventional Cardiology, Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Martin Quintas Guzmán
- Department of Clinical Cardiology, Cardiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ariana Varela Cancelo
- Department of Clinical Cardiology, Cardiology, Complexo Hospitalario Universitario Ferrol (CHUF), A Coruña, Spain
| | - Fernando Rebollal Leal
- Department of Interventional Cardiology, Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Xacobe Flores Rios
- Department of Interventional Cardiology, Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Pablo Piñón Esteban
- Department of Interventional Cardiology, Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Jorge Salgado Fernandez
- Department of Interventional Cardiology, Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Ramón Calviño Santos
- Department of Interventional Cardiology, Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - José Manuel Vázquez Rodriguez
- Department of Interventional Cardiology, Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
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Cuko B, Baudo M, Ternacle J, Leroux L, Modine T. One-Stage Transcatheter Aortic Valve Implantation and Transcatheter Edge-to-Edge Tricuspid Valve Repair for Double Valve Dysfunction in a High-Risk Patient. Cureus 2023; 15:e45648. [PMID: 37868418 PMCID: PMC10590086 DOI: 10.7759/cureus.45648] [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] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
A 75-year-old female patient was referred to our institution for severe symptomatic low-flow low-gradient aortic valve stenosis and tricuspid valve regurgitation (TR) associated with heart failure. After multidisciplinary discussion, the patient was scheduled for one-stage totally percutaneous treatment of her valve lesions by transcatheter aortic valve implantation (TAVI) and transcatheter edge-to-edge tricuspid valve repair (TEER) through transfemoral access. The patient had an uneventful hospital stay and was discharged home on the third postoperative day. During the following 24 months, the patient did well with regression of her heart failure signs and symptoms.
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Affiliation(s)
- Besart Cuko
- Department of Cardiology and Cardiovascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux, FRA
| | - Massimo Baudo
- Cardiac Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, ITA
| | - Julien Ternacle
- Department of Cardiology and Cardiovascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Bordeaux, FRA
| | - Lionel Leroux
- Department of Cardiology and Cardiovascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux, FRA
| | - Thomas Modine
- Department of Cardiology and Cardiovascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux, FRA
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22
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Halder V, Mishra A, Ghosh S, Singh H, Barwad P, Thingnam SK, Dutta ARS, Harunal M. Effectiveness and Safety of the Ozaki Procedure for Aortic Valve Disease in Pediatric Patients: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e45269. [PMID: 37846270 PMCID: PMC10576845 DOI: 10.7759/cureus.45269] [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] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
The surgical treatment options for pediatric aortic valve disease are limited and have debatable long-term durability. In the current situation, the Ross procedure is considered in children for aortic valve disease(s). It is a complex surgical procedure with the risk of neo-aortic dilatation, converting a single valve disease into double valve disease, and associated with future re-interventions. Conversely, the Ozaki procedure has shown promising results in adults. Thus, the present study aimed to provide comparative evidence on the effectiveness and safety of the Ozaki versus Ross procedure for pediatric patients by performing a meta-analytic comparison of reporting outcomes. A total of 15 relevant articles were downloaded and among them, seven articles (one prospective study, five retrospective studies, and one case series) were used in the analysis. Primary outcomes such as physiological laminar flow pattern and hemodynamic parameters, and secondary outcomes such as hospital stays, adverse effects, mortality, and numbers of re-intervention(s) were measured in the meta-analysis. There were no significant differences in the age of patients between children who underwent the Ozaki procedure and those who underwent the Ross procedure at the time of surgeries. The Ozaki procedure is a good solution to an aortic problem(s) similar to the Ross procedure. Unlike the Ross procedure, the Ozaki procedure has restored a physiological laminar flow pattern in the short-term follow-up without the bi-valvular disease. Mean hospital stays (p = 0.048), mean follow-up (p = 0.02), adverse effects (p = 0.02), death, and numbers of re-intervention(s) of children who underwent the Ozaki procedure were fewer than those who underwent the Ross procedure. The time required for re-intervention(s) is higher for children who underwent the Ozaki procedure than those who underwent the Ross procedure. None of the procedures, including the Ozaki procedure for aortic valve disease(s), has significant effects on hemodynamic parameters and the frequent death rate of children after surgeries. Based on our analysis, we may suggest the Ozaki procedure for aortic valve disease surgery in children.
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Affiliation(s)
- Vikram Halder
- Department of Cardiothoracic Surgery, U. N. Mehta Institute of Cardiology & Research Centre, Gujarat, IND
| | - Amit Mishra
- Department of Cardiothoracic Surgery, U. N. Mehta Institute of Cardiology & Research Centre, Ahmedabad, IND
| | - Soumitra Ghosh
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Harkant Singh
- Department of Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Parag Barwad
- Department of Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Shyam K Thingnam
- Department of Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Aduri Raja S Dutta
- Department of Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Maruti Harunal
- Department of Cardiothoracic Surgery/Congenital Heart Disease, U. N. Mehta Institute of Cardiology & Research Centre, Ahmedabad, IND
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Thatcher K, Mattern CR, Chaparro D, Goveas V, McDermott MR, Fulton J, Hutcheson JD, Hoffmann BR, Lincoln J. Temporal Progression of Aortic Valve Pathogenesis in a Mouse Model of Osteogenesis Imperfecta. J Cardiovasc Dev Dis 2023; 10:355. [PMID: 37623368 PMCID: PMC10455328 DOI: 10.3390/jcdd10080355] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
Organization of extracellular matrix (ECM) components, including collagens, proteoglycans, and elastin, is essential for maintaining the structure and function of heart valves throughout life. Mutations in ECM genes cause connective tissue disorders, including Osteogenesis Imperfecta (OI), and progressive debilitating heart valve dysfunction is common in these patients. Despite this, effective treatment options are limited to end-stage interventions. Mice with a homozygous frameshift mutation in col1a2 serve as a murine model of OI (oim/oim), and therefore, they were used in this study to examine the pathobiology of aortic valve (AoV) disease in this patient population at structural, functional, and molecular levels. Temporal echocardiography of oim/oim mice revealed AoV dysfunction by the late stages of disease in 12-month-old mice. However, structural and proteomic changes were apparent much earlier, at 3 months of age, and were associated with disturbances in ECM homeostasis primarily related to collagen and proteoglycan abnormalities and disorganization. Together, findings from this study provide insights into the underpinnings of late onset AoV dysfunction in connective tissue disease patients that can be used for the development of mechanistic-based therapies administered early to halt progression, thereby avoiding late-stage surgical intervention.
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Affiliation(s)
- Kaitlyn Thatcher
- Department of Pediatrics, Division of Pediatric Cardiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (K.T.); (C.R.M.); (V.G.)
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI 53226, USA
| | - Carol R. Mattern
- Department of Pediatrics, Division of Pediatric Cardiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (K.T.); (C.R.M.); (V.G.)
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI 53226, USA
| | - Daniel Chaparro
- Department of Biomedical Engineering, Florida International University, Miami, FL 33174, USA; (D.C.); (J.D.H.)
| | - Veronica Goveas
- Department of Pediatrics, Division of Pediatric Cardiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (K.T.); (C.R.M.); (V.G.)
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI 53226, USA
| | - Michael R. McDermott
- Center for Cardiovascular Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205, USA; (M.R.M.); (J.F.)
| | - Jessica Fulton
- Center for Cardiovascular Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205, USA; (M.R.M.); (J.F.)
| | - Joshua D. Hutcheson
- Department of Biomedical Engineering, Florida International University, Miami, FL 33174, USA; (D.C.); (J.D.H.)
| | - Brian R. Hoffmann
- Mass Spectrometry and Protein Chemistry, Protein Sciences, The Jackson Laboratory, Bar Harbor, ME 04609, USA;
| | - Joy Lincoln
- Department of Pediatrics, Division of Pediatric Cardiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (K.T.); (C.R.M.); (V.G.)
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI 53226, USA
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24
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Akao K, Imamura T, Tanaka S, Onoda H, Ushijima R, Sobajima M, Fukuda N, Ueno H, Kinugawa K. Prognostic Impact of Modified H2FPEF Score in Patients Receiving Trans-Catheter Aortic Valve Replacement. J Clin Med 2023; 12:5396. [PMID: 37629434 PMCID: PMC10455783 DOI: 10.3390/jcm12165396] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/01/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND H2FPEF is a recently introduced score for the diagnosis of heart failure with preserved ejection fraction (HFpEF). Many patients with severe aortic stenosis have clinical/subclinical HFpEF and have worsening heart failure even after trans-catheter aortic valve replacement (TAVR). We investigated the prognostic impact of the H2FPEF score in TAVR candidates. METHODS Patients undergoing TAVR procedures at a single academic center between 2015 and 2022 were included. The H2FPEF score was calculated using baseline characteristics before TAVR. The prognostic impact of the score on the post-TAVR composite endpoint, consisting of all-cause death and heart failure readmissions during the 2-year observation period, was evaluated. RESULTS A total of 244 patients (median age 86 years, 70 males) were included. The median value of H2FPEF score was 3 (2, 4). The score was significantly associated with the primary outcome with a hazard ratio of 1.33 (95% confidence interval 1.02-1.74, p = 0.036). We constructed a modified H2FPEF score by adjusting cutoffs of several items for better prognostic stratification (i.e., age and body mass index). A modified score had a higher area under the curve than the original one (0.65 vs. 0.59, p = 0.028) and was independently associated with the primary outcome with an adjusted hazard ratio of 1.22 (95% confidence interval 1.01-1.49, p = 0.047). CONCLUSIONS A modified H2FPEF score, which was originally developed to diagnose the presence of HFpEF, could be used to risk-stratify elderly patients receiving TAVR. The clinical utility of this score should be validated in future studies.
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Kavsur R, Schaefer C, Stumpf MJ, Weber M, Sugiura A, Becher MU, Zimmer S, Nickenig G, Schahab N. Carotid Stiffness After Transcatheter Aortic Valve Replacement. Angiology 2023:33197231195647. [PMID: 37571920 DOI: 10.1177/00033197231195647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
The present study aimed to analyze common carotid artery strain properties in patients (n = 59) with severe aortic valve stenosis who underwent transcatheter aortic valve replacement (TAVR). Arterial compliance of the common carotid artery was assessed by ultrasound speckle-tracking before and after TAVR. For sub-analysis the study cohort was divided according to aortic valve area <.75 cm2 (n = 30) vs ≥.75 cm2 (n = 29). Comparison of pre- and post-procedural strain variables showed an improvement in median radial velocity (P < .0001), radial displacement (P = .007), circumferential strain (P = .004), radial strain rate (P = .023), and circumferential strain rate (P < .0001), while the increase of radial strain showed a trend (P = .082). Analysis of aortic valve area revealed an inverse correlation between aortic valve area and the differences (post-procedural-pre-procedural values) for radial strain rate, and circumferential strain. Moreover, sub-analysis revealed that the increase of carotid strain variables before and after TAVR were more pronounced in the sub-group of aortic valve area .75 vs ≥.75 cm2. TAVR led to a reduction of arterial wall stiffness of the common carotid artery assessed by ultrasound speckle-tracking. The decrease of arterial wall stiffness after TAVR was more pronounced in more severe aortic valve stenosis.
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Affiliation(s)
- Refik Kavsur
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Christian Schaefer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Max Jonathan Stumpf
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Nadjib Schahab
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
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26
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Rogers MA, Tarantini G, Veulemans V. Editorial: Case reports in heart valve disease: 2022. Front Cardiovasc Med 2023; 10:1260522. [PMID: 37600043 PMCID: PMC10434232 DOI: 10.3389/fcvm.2023.1260522] [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: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Verena Veulemans
- Department of Cardiology, Pulmonology, and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany
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27
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Zoni D, Cresce GD, Hinna-Danesi T, Benvegnù L, Poddi S, Gallo M, Sella M, Salvador L. Endoscopic aortic valve surgery in isolated and concomitant procedures. Interdiscip Cardiovasc Thorac Surg 2023:ivad101. [PMID: 37326963 PMCID: PMC10371047 DOI: 10.1093/icvts/ivad101] [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] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/23/2023] [Accepted: 06/14/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To evaluate early outcomes of endoscopic aortic valve replacement and risks of concomitant procedures done through the same working port. METHODS At our institution we performed a data analysis of 342 consecutive patients (from July 2013 to May 2021) that underwent endoscopic aortic valve replacement with or without associated major procedure. Pre-operative, intraoperative, post-operative data were evaluated. Subsequently we perform a comparative analysis between the isolated and concomitant surgery group. The surgical access was a 3-4 cm working port in the second right intercostal space and 3 additional 5 mm mini-ports for the introduction of the thoracoscope, the transthoracic clamp and the vent line. Cardiopulmonary by-pass was achieved through peripheral cannulation. RESULTS 105 patients (30.7%) underwent combined procedure: 2 coronary artery bypass (1.9%), 21 ascending aorta replacement (19.6%), 41 mitral surgery (38.3%), 16 mitral and tricuspid surgery (15%), 25 other procedure (27%). Death occurred in 1 patient (0.4%) in the isolated group versus 2 patients (1.9%) in the combined group (p = 0.175). Seven strokes were observed, 4 in isolated procedures (1.7%) and 3 in the concomitant ones (2.85%) (p = 0.481). Surgical revision for bleeding was performed always through the same access in 13 patients (5.4%) versus 11 patients (10.4%) (p = 0.096). Pace maker implantation was necessary in 5 patients (2.1%) versus 8 patients (7,6%) (p = 0.014). Median intubation time was 5 [2] hours versus 6 [8] (p < 0.080). CONCLUSIONS Through a single working port made for endoscopic aortic valve replacement a concomitant procedure may be done without affecting in-hospital mortality and post-operative stroke rate.
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Affiliation(s)
- Daniele Zoni
- Division of Cardiac Surgery, S. Bortolo Hospital, Vicenza, Italy
| | | | | | - Luciana Benvegnù
- Division of Cardiac Surgery, S. Bortolo Hospital, Vicenza, Italy
| | - Salvatore Poddi
- Division of Cardiac Surgery, S. Bortolo Hospital, Vicenza, Italy
| | - Michele Gallo
- Cardiovascular & Thoracic Surgery Department, University of Louisville, Louisville, (KY, ), USA
| | - Massimo Sella
- Division of Cardiac Surgery, S. Bortolo Hospital, Vicenza, Italy
| | - Loris Salvador
- Division of Cardiac Surgery, S. Bortolo Hospital, Vicenza, Italy
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28
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Li X, Simakov S, Liu Y, Liu T, Wang Y, Liang F. The Influence of Aortic Valve Disease on Coronary Hemodynamics: A Computational Model-Based Study. Bioengineering (Basel) 2023; 10:709. [PMID: 37370640 DOI: 10.3390/bioengineering10060709] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/31/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Aortic valve disease (AVD) often coexists with coronary artery disease (CAD), but whether and how the two diseases are correlated remains poorly understood. In this study, a zero-three dimensional (0-3D) multi-scale modeling method was developed to integrate coronary artery hemodynamics, aortic valve dynamics, coronary flow autoregulation mechanism, and systemic hemodynamics into a unique model system, thereby yielding a mathematical tool for quantifying the influences of aortic valve stenosis (AS) and aortic valve regurgitation (AR) on hemodynamics in large coronary arteries. The model was applied to simulate blood flows in six patient-specific left anterior descending coronary arteries (LADs) under various aortic valve conditions (i.e., control (free of AVD), AS, and AR). Obtained results showed that the space-averaged oscillatory shear index (SA-OSI) was significantly higher under the AS condition but lower under the AR condition in comparison with the control condition. Relatively, the overall magnitude of wall shear stress was less affected by AVD. Further data analysis revealed that AS induced the increase in OSI in LADs mainly through its role in augmenting the low-frequency components of coronary flow waveform. These findings imply that AS might increase the risk or progression of CAD by deteriorating the hemodynamic environment in coronary arteries.
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Affiliation(s)
- Xuanyu Li
- Department of Engineering Mechanics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Sergey Simakov
- Marchuk Institute of Numerical Mathematics of the Russian Academy of Sciences, Moscow 119991, Russia
| | - Youjun Liu
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing 100124, China
| | - Taiwei Liu
- Department of Engineering Mechanics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yue Wang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Fuyou Liang
- Department of Engineering Mechanics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
- State Key Laboratory of Ocean Engineering, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
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29
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Imamura T, Fujioka H, Ushijima R, Sobajima M, Fukuda N, Ueno H, Kinugawa K. Prognostic Impact of Psoas Muscle Mass Index following Trans-Catheter Aortic Valve Replacement. J Clin Med 2023; 12:3943. [PMID: 37373637 DOI: 10.3390/jcm12123943] [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: 05/03/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Psoas muscle mass is a recently featured index of sarcopenia, which has a negative prognostic impact in patients with a variety of diseases. We investigated the prognostic impact of baseline psoas muscle mass in patients receiving a trans-catheter aortic valve replacement (TAVR). METHODS Patients who received TAVR at our center between 2015 and 2022 were included. Patients received computer tomography imaging upon admission as an institutional protocol, and psoas muscle mass was measured, which was indexed by body surface area. Patients were followed for four years or until January 2023. The prognostic impact of psoas muscle mass index on 4-year mortality following index discharge was evaluated. RESULTS A total of 322 patients (85 years, 95 male) were included. Median psoas muscle mass index at baseline was 10.9 (9.0, 13.5) × 10 cm3/m2. A lower psoas muscle mass index tended to be associated with several index of malnutrition and sarcopenia. A psoas muscle mass index was independently associated with 4-year mortality with an adjusted hazard ratio of 0.88 (95% confidence interval 0.79-0.99, p = 0.044). Patients with lower psoas muscle mass index (below the statistically calculated cutoff of 10.7 × 10 cm3/m2, N = 152) had significantly higher cumulative 4-year mortality compared with others (32% versus 13%, p = 0.008). CONCLUSIONS A lower psoas muscle mass index, which is a recently featured objective marker of sarcopenia, was associated with mid-term mortality following TAVR in the elderly cohort with severe aortic stenosis. The measurement of psoas muscle mass index prior to TAVR could have clinical implications for shared decision-making among patients, their relatives, and clinicians.
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Affiliation(s)
- Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Hayato Fujioka
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Ryuichi Ushijima
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Mitsuo Sobajima
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Nobuyuki Fukuda
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Hiroshi Ueno
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
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30
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Nappi F, Nenna A, Spadaccio C, Avtaar Singh SS, Almazil A, Acar C. The Use of the Cryopreserved Aortic Homograft for Aortic Valve Replacement: Is It Still an Option? J Cardiovasc Dev Dis 2023; 10:248. [PMID: 37367413 DOI: 10.3390/jcdd10060248] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/01/2023] [Revised: 05/28/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
The indications for cryopreserved allografts in aortic valve replacement are still debatable. We aim to identify factors influencing early and long-term durability of the aortic homograft and to define subgroups of patients with an improved long-term quality of life, survival, and freedom from structural valve degeneration (SVD). We evaluated our series of 210 patients who underwent allograft implantation with a retrospective cohort study design over a period of 20 years. Endpoints were overall mortality, cardiac mortality related to SVD, the incidence of SVD, reoperation, and a composite endpoint comprising major adverse cardiac and cerebrovascular events (MACCEs), which includes cardiac death both related and not related to SVD, subsequent aortic valve surgery, new or recurrent infection of implanted allograft, recurrent aortic regurgitation, rehospitalization for heart failure, an increase in New York Heart Association (NYHA) class of ≥1, or cerebrovascular events. The primary indication for surgery was endocarditis (48%), which was also a predisposing factor for increased cardiac mortality. Overall mortality was 32.4% with a 27% incidence of SVD and mortality associated with SVD of 13.8%. Reoperation occurred in 33.8% and MACCEs in 54.8%. Long-term NYHA functional class and echocardiographic parameters improved over time. Statistical analysis demonstrated that root replacement technique and adult age were protective factors for SVD. We found no statistically significant difference in the clinical outcomes analyzed between women of childbearing age who had children after surgery and the rest of the women. The cryopreserved allograft is still a valid option in aortic valve replacement, providing acceptable durability and clinical outcomes with optimal hemodynamic performance. SVD is influenced by the implantation technique. Women of childbearing age might have additional benefits from this procedure.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint Denis, France
| | - Antonio Nenna
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Cristiano Spadaccio
- Cardiothoracic Surgery, Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool FY3 8NP, UK
| | | | - Almothana Almazil
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint Denis, France
| | - Christophe Acar
- Department of Cardiothoracic Surgery, Hôpital Pitié-Salpêtrière, Boulevard de Hôpital 47-83, 75013 Paris, France
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31
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Solli CN, Chamat-Hedemand S, Elming H, Ngo A, Kjaer L, Skov V, Sørensen AL, Ellervik C, Hasselbalch H, Bruun NE. High JAK2V617F variant allele frequency is associated with coronary artery but not aortic valve calcifications in patients with Philadelphia-negative myeloproliferative neoplasms. Eur J Haematol 2023. [PMID: 37286366 DOI: 10.1111/ejh.14019] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) have a higher burden of cardiac calcifications compared to the general population. It is not known whether the JAK2V617F mutation is associated with increased cardiac calcification. AIM To investigate if a higher JAK2V617F variant allele frequency (VAF) is associated with severe coronary atherosclerosis and the presence of aortic valve calcification (AVC). METHODS Patients with MPNs were examined by cardiac computer tomography to establish coronary artery calcium score (CACS) and AVC score. The first VAF after diagnosis was registered. Severe coronary atherosclerosis was defined as a CACS >400 and AVC was defined as an AVC score >0. RESULTS Among 161 patients, 137 were JAK2V617F mutation-positive, with a median VAF of 26% (interquartile range 12%-52%). A VAF in the upper quartile range was associated with a CACS >400 [odds ratio (OR) 15.96, 95% confidence interval [CI] 2.13-119.53, p = .0070], after adjustment for cardiovascular risk factors and MPN subtype. An association was not found for the presence of AVC (OR 2.30, 95% CI 0.47-11.33, p = 0.31). CONCLUSION In patients with MPNs, there is a significant association between having a VAF in the upper quartile (>52%), and severe coronary atherosclerosis, defined as a CACS >400. The presence of AVC is not associated with VAF.
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Affiliation(s)
- Camilla Nordheim Solli
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sandra Chamat-Hedemand
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Elming
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Anh Ngo
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Lasse Kjaer
- Department of Haematology, Zealand University Hospital, Roskilde, Denmark
| | - Vibe Skov
- Department of Haematology, Zealand University Hospital, Roskilde, Denmark
| | | | - Christina Ellervik
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Data Support, Sorø, Denmark
| | - Hans Hasselbalch
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Haematology, Zealand University Hospital, Roskilde, Denmark
| | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences Aalborg University, Aalborg, Denmark
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32
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Anastasakis E, Grosomianidis V, Tossios P, Charaf A, Sarsam MAI, Karapanagiotidis GT. Cor triatriatum dexter as an incidental finding due to symptomatic bicuspid aortic valve stenosis. Perfusion 2023:2676591231182584. [PMID: 37279771 DOI: 10.1177/02676591231182584] [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: 06/08/2023]
Abstract
Cor triatriatum is a rare congenital heart defect in which a thin, fibro-muscular membrane divides the left or right atrium into two chambers resulting in a triatrial heart. Subdivision of the left atrium named cor triatriatum sinister (CTS), is the more common form, whereas the right atrial equivalent called cor triatriatum dexter (CTD) is rarer. They account for up to 0.4% and 0.025% of the burden of congenital heart disease respectively. We present the case of CTD found incidentally with transthoracic echocardiography for a patient who underwent aortic valve replacement for symptomatic bicuspid aortic valve stenosis.
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Affiliation(s)
- Evangelos Anastasakis
- St George's University of London, London, UK
- Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | | | | | - Adnan Charaf
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Mazin A I Sarsam
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Georgios T Karapanagiotidis
- AHEPAUniversity Hospital, Thessaloniki, Greece
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
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Bociański M, Puślecki M, Olasińska-Wiśniewska A, Perek B, Stefaniak S, Buczkowski P, Jemielity M. A comparative study of minimally invasive aortic valve replacement with sutureless biological versus mechanical prostheses. Kardiochir Torakochirurgia Pol 2023; 20:77-82. [PMID: 37564970 PMCID: PMC10410630 DOI: 10.5114/kitp.2023.129542] [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] [Received: 03/07/2023] [Accepted: 06/25/2023] [Indexed: 08/12/2023]
Abstract
Introduction The ministernotomy approach with sutureless aortic bioprosthesis may provide an attractive and safe option for aortic valve disease patients. Aim To assess the early and mid-term outcomes of minimally invasive aortic valve replacement (miniAVR) with sutureless vs. standard prostheses. Material and methods The study involved 76 consecutive patients (51 males and 25 females) with mean age of 63.2 years who were treated with miniAVR between 2015 and 2022. They were divided into 2 subgroups: group I (n = 40) subjects with sutureless bioprostheses and group II (n = 36) with standard prostheses implanted. Early and mid-term outcomes were evaluated. A probability of survival was estimated by means of the Kaplan-Meier method. Results No conversion to complete sternotomy was necessary. The median (minimum; maximum) aorta cross clamping and cardio-pulmonary bypass times were 49 (27; 84) and 70 (40; 188) minutes in group I whereas 69 (50; 103) and 95 (69; 170) minutes in group II, respectively (p < 0.001). In-hospital mortality was 5.0% (n = 2) and 2.8% (n = 1) in group I vs. II, respectively (ns). Permanent ICD implantation was performed in 8 (20.0%) in group I and in 3 (8.3%) subjects in group II. In the discharge echocardiography, the function of all prostheses was correct. Five-year probability of survival was much lower in group I (0.75 ±0.10) than in group II (0.94 ±0.04). No wound infection or sternum instability was noted. Conclusions Intraoperative advantages of miniAVR procedures for aortic valve patients with sutureless bioprostheses do not translate directly into improved early and middle-term outcomes.
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Affiliation(s)
- Michał Bociański
- Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Mateusz Puślecki
- Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
- Department of Medical Rescue, Chair of Rescue Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Olasińska-Wiśniewska
- Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Sebastian Stefaniak
- Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Buczkowski
- Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
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Imamura T, Narang N, Onoda H, Tanaka S, Ushijima R, Sobajima M, Fukuda N, Ueno H, Kinugawa K. Negative Prognostic Impact of Mineralocorticoid Receptor Antagonist in Elderly Patients Receiving TAVR. J Clin Med 2023; 12:3742. [PMID: 37297936 PMCID: PMC10253895 DOI: 10.3390/jcm12113742] [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: 03/13/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Background: Morbidity and mortality following trans-catheter aortic valve replacement (TAVR) remain high. Renin-angiotensin system inhibitors improve clinical outcomes in the cohort studied in this work. However, post-TAVR prognostic impact of mineralocorticoid receptor antagonist (MRA), another neuro-hormonal blocker, remains uncertain. Here, we hypothesized that MRA was associated with improved clinical outcomes in elderly patients with severe aortic stenosis receiving TAVR. METHODS Consecutive patients who received TAVR at our institute between 2015 and 2022 were considered for inclusion. Propensity score matching analysis was performed to match pre-procedural baseline characteristics between those with and without MRA. The prognostic impact of MRA use on the composite primary endpoint consisting of all-cause death and heart failure during the 2-year observational period following index discharge was evaluated. RESULTS Among 352 patients who received TAVR, 112 patients (median 86 years, 31 men) were included, consisting of baseline-matched 56 patients with MRA and 56 patients without MRA. Following TAVR, patients with MRA had more impaired renal function compared with no MRA group. Following index discharge, serum potassium tended to increase, and renal function tended to decline in patients with MRA. Patients with MRA had a higher cumulative incidence of the primary endpoints during a two-year observational period (30% versus 8%, p = 0.022). CONCLUSIONS Routine prescription of MRA might not be recommended in elderly patients with severe aortic stenosis receiving TAVR, given its negative prognostic impact. Optimal patient selection for MRA administration in this cohort needs further study.
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Affiliation(s)
- Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Nikhil Narang
- Advocate Christ Medical Center, Oak Lawn, IL 60453, USA
| | - Hiroshi Onoda
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Shuhei Tanaka
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Ryuichi Ushijima
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Mitsuo Sobajima
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Nobuyuki Fukuda
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Hiroshi Ueno
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
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Reed A, Bajwa S, Schuh S, Mikhael M. Incidental Perforation of Aortic Valve Leaflet Found on Presentation of Cardiogenic Shock. Cureus 2023; 15:e39476. [PMID: 37362500 PMCID: PMC10290443 DOI: 10.7759/cureus.39476] [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] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Aortic regurgitation (AR) is grouped into acute or chronic AR. Acute AR, unlike chronic AR, can manifest with significant hemodynamic compromise. Acute AR is typically due to endocarditis or aortic dissection, and less commonly due to blunt trauma or iatrogenic causes. We present a patient with cardiogenic shock due to severe acute AR from anterior leaflet perforation without an identifiable rheumatologic or infectious etiology.
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Affiliation(s)
- Austin Reed
- Internal Medicine, University of Missouri, Columbia, USA
| | - Suhaib Bajwa
- Internal Medicine, University of Missouri, Columbia, USA
| | - Shelby Schuh
- Internal Medicine, University of Missouri, Columbia, USA
| | - Mary Mikhael
- Internal Medicine, University of Missouri, Columbia, USA
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Chang S, Yong MS, Stroebel A, Hughes I, Scuffham P, He C. A contemporary evaluation of surgical aortic valve replacement outcomes and temporal trends. ANZ J Surg 2023. [PMID: 37088919 DOI: 10.1111/ans.18486] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Given the ageing population and uptake of transcatheter approaches for treating aortic stenosis (AS), a renewed evaluation of outcomes after surgical aortic valve replacement (SAVR) is warranted. With guidelines recommending age-based indications for surgical and transcatheter approaches, this study critically evaluates outcomes in age-based subgroups, with the aim to refine management of AS in the elderly, where there is often no clear consensus. METHODS Six hundred and thirteen consecutive patients who underwent SAVR in an Australian tertiary cardiac centre between 1 June 2014 and 13 January 2022 were retrospectively analysed. Of these, 70.31% were <75 years (Group 1) and 29.69% were ≥75 years (Group 2). Groups were compared with respect to early and long-term outcomes. Logistic regression, Kaplan-Meier survival estimates and Cox proportional hazards regression were performed for all patients and an AS-specific sub-group. RESULTS Patients aged ≥75 years were more likely to be female and have hypercholesterolemia, hypertension, and pre-existing arrhythmia (P < 0.001). Group 1 experienced a higher incidence of renal failure compared with Group 2, in the overall cohort and AS-specific subgroup (P = 0.02). The incidence of stroke was similar between groups, in the overall cohort (P = 0.22) and the AS-specific subgroup (P = 0.32). Age ≥ 75 was not found to be an independent predictor of 30-day, 1-year or 5-year mortality. Temporal trends revealed low consistently low complication rates. CONCLUSIONS Elderly patients should not be denied surgery based on age, despite guideline-driven age-based recommendations.
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Affiliation(s)
- Shantel Chang
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Matthew S Yong
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Andrie Stroebel
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Ian Hughes
- Office for Research Governance, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Paul Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Cheng He
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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Petersen J, Iqbal S, Gedeon N, Kloth B, Pecha S, Yildirim Y, Eschenhagen T, Reichenspurner H, Christ T, Girdauskas E. Valvular Cardiomyopathy in Aortic Valve Regurgitation Correlates with Myocardial Fibrosis. J Clin Med 2023; 12:jcm12082915. [PMID: 37109251 PMCID: PMC10145654 DOI: 10.3390/jcm12082915] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/30/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Objective: At the tissue level, disruption of the extracellular matrix network leads to irreversible cardiac fibrosis, which contributes to myocardial dysfunction. At the myocyte level, downregulation of beta-adrenoceptors (beta-AR) reduces adaptation to increased workload. The aim of our study was to analyse the correlation between myocardial fibrosis and beta-AR sensitivity in patients with aortic valve (AV) disease. Methods: A total of 92 consecutive patients who underwent elective AV surgery between 2017-2019 were included in our study (51 with aortic regurgitation (AR-group); 41 with aortic stenosis (AS-group) and left ventricular (LV) biopsies were obtained intraoperatively. In vitro force contractility testing was performed by measuring beta-AR sensitivity (-log EC50[ISO]). In parallel, a quantitative analysis of myocardial fibrosis burden was performed. Results: Mean age at the time of AV surgery was not statistically different in both groups (AR: 53.3 ± 15.3 years vs. AS: 58.7 ± 17.0 years; p = 0.116). The LV end-diastolic diameter was significantly enlarged in the AR-group when compared to the AS-group (59.4 ± 15.6 vs. 39.7 ± 21.2; p < 0.001). Analysis of beta-AR sensitivity (AR: -6.769 vs. AS: -6.659; p = 0.316) and myocardial fibrosis (AR: 8.9% vs. AS: 11.3%; p = 0.284) showed no significant differences between patients with AS and AR. There was no correlation between myocardial fibrosis and beta-AR sensitivity in the whole study cohort (R = 0.1987; p = 0.100) or in the AS-subgroup (R = 0.009; p = 0.960). However, significant correlation of fibrosis and beta-AR sensitivity was seen in AR-patients (R = 0.363; p = 0.023). Conclusion: More severe myocardial fibrosis was associated with reduced beta-AR sensitivity in patients presenting with AR but not with AS. Therefore, our results suggest that in patients with AR, cellular myocardial dysfunction is present and correlates with the extent of myocardial fibrosis in the myocardium.
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Affiliation(s)
- Johannes Petersen
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
| | - Shahria Iqbal
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Naomi Gedeon
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Benjamin Kloth
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
- Department of Cardiothoracic Surgery, Augsburg University Hospital, 86156 Augsburg, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
| | - Yalin Yildirim
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Thomas Eschenhagen
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
| | - Torsten Christ
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
- Department of Cardiothoracic Surgery, Augsburg University Hospital, 86156 Augsburg, Germany
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Gollmann-Tepeköylü C, Graber M, Hirsch J, Mair S, Naschberger A, Pölzl L, Nägele F, Kirchmair E, Degenhart G, Demetz E, Hilbe R, Chen HY, Engert JC, Böhm A, Franz N, Lobenwein D, Lener D, Fuchs C, Weihs A, Töchterle S, Vogel GF, Schweiger V, Eder J, Pietschmann P, Seifert M, Kronenberg F, Coassin S, Blumer M, Hackl H, Meyer D, Feuchtner G, Kirchmair R, Troppmair J, Krane M, Weiss G, Tsimikas S, Thanassoulis G, Grimm M, Rupp B, Huber LA, Zhang SY, Casanova JL, Tancevski I, Holfeld J. Toll-Like Receptor 3 Mediates Aortic Stenosis Through a Conserved Mechanism of Calcification. Circulation 2023; 147:1518-1533. [PMID: 37013819 DOI: 10.1161/circulationaha.122.063481] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Calcific aortic valve disease (CAVD) is characterized by a phenotypic switch of valvular interstitial cells to bone-forming cells. Toll-like receptors (TLRs) are evolutionarily conserved pattern recognition receptors at the interface between innate immunity and tissue repair. Type I interferons (IFNs) are not only crucial for an adequate antiviral response but also implicated in bone formation. We hypothesized that the accumulation of endogenous TLR3 ligands in the valvular leaflets may promote the generation of osteoblast-like cells through enhanced type I IFN signaling. METHODS Human valvular interstitial cells isolated from aortic valves were challenged with mechanical strain or synthetic TLR3 agonists and analyzed for bone formation, gene expression profiles, and IFN signaling pathways. Different inhibitors were used to delineate the engaged signaling pathways. Moreover, we screened a variety of potential lipids and proteoglycans known to accumulate in CAVD lesions as potential TLR3 ligands. Ligand-receptor interactions were characterized by in silico modeling and verified through immunoprecipitation experiments. Biglycan (Bgn), Tlr3, and IFN-α/β receptor alpha chain (Ifnar1)-deficient mice and a specific zebrafish model were used to study the implication of the byglycan (BGN)-TLR3-IFN axis in both CAVD and bone formation in vivo. Two large-scale cohorts (GERA [Genetic Epidemiology Research on Adult Health and Aging], n=55 192 with 3469 aortic stenosis cases; UK Biobank, n=257 231 with 2213 aortic stenosis cases) were examined for genetic variation at genes implicated in BGN-TLR3-IFN signaling associating with CAVD in humans. RESULTS Here, we identify TLR3 as a central molecular regulator of calcification in valvular interstitial cells and unravel BGN as a new endogenous agonist of TLR3. Posttranslational BGN maturation by xylosyltransferase 1 (XYLT1) is required for TLR3 activation. Moreover, BGN induces the transdifferentiation of valvular interstitial cells into bone-forming osteoblasts through the TLR3-dependent induction of type I IFNs. It is intriguing that Bgn-/-, Tlr3-/-, and Ifnar1-/- mice are protected against CAVD and display impaired bone formation. Meta-analysis of 2 large-scale cohorts with >300 000 individuals reveals that genetic variation at loci relevant to the XYLT1-BGN-TLR3-interferon-α/β receptor alpha chain (IFNAR) 1 pathway is associated with CAVD in humans. CONCLUSIONS This study identifies the BGN-TLR3-IFNAR1 axis as an evolutionarily conserved pathway governing calcification of the aortic valve and reveals a potential therapeutic target to prevent CAVD.
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Affiliation(s)
- Can Gollmann-Tepeköylü
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria. (C.G.-T., M.G, J.H., S.M., L.P., F.N., E.K., N.F., D. Lobenwein, V.S., J.E., M.G., J.H.)
| | - Michael Graber
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria. (C.G.-T., M.G, J.H., S.M., L.P., F.N., E.K., N.F., D. Lobenwein, V.S., J.E., M.G., J.H.)
| | - Jakob Hirsch
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria. (C.G.-T., M.G, J.H., S.M., L.P., F.N., E.K., N.F., D. Lobenwein, V.S., J.E., M.G., J.H.)
| | - Sophia Mair
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria. (C.G.-T., M.G, J.H., S.M., L.P., F.N., E.K., N.F., D. Lobenwein, V.S., J.E., M.G., J.H.)
| | - Andreas Naschberger
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, Austria. (A.N., F.K., S.C., B.R.)
- Division of Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, Thuwal4 Saudi Arabia (A.N.)
| | - Leo Pölzl
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria. (C.G.-T., M.G, J.H., S.M., L.P., F.N., E.K., N.F., D. Lobenwein, V.S., J.E., M.G., J.H.)
| | - Felix Nägele
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria. (C.G.-T., M.G, J.H., S.M., L.P., F.N., E.K., N.F., D. Lobenwein, V.S., J.E., M.G., J.H.)
| | - Elke Kirchmair
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria. (C.G.-T., M.G, J.H., S.M., L.P., F.N., E.K., N.F., D. Lobenwein, V.S., J.E., M.G., J.H.)
| | - Gerald Degenhart
- Department of Radiology, Core Facility for Micro-CT, Medical University of Innsbruck, Austria. (G.D., G..F.)
| | - Egon Demetz
- Department of Internal Medicine III, Medical University of Innsbruck, Austria. (E.D., R.H., A.B., D. Lener, M.S., R.K., G.W., I.T.)
| | - Richard Hilbe
- Department of Internal Medicine III, Medical University of Innsbruck, Austria. (E.D., R.H., A.B., D. Lener, M.S., R.K., G.W., I.T.)
| | - Hao-Yu Chen
- Preventive and Genomic Cardiology, McGill University Health Centre Research Institute, Montreal, Quebec, Canada (J.C.E., H.-Y.C., G.T.)
| | - James C Engert
- Preventive and Genomic Cardiology, McGill University Health Centre Research Institute, Montreal, Quebec, Canada (J.C.E., H.-Y.C., G.T.)
| | - Anna Böhm
- Department of Internal Medicine III, Medical University of Innsbruck, Austria. (E.D., R.H., A.B., D. Lener, M.S., R.K., G.W., I.T.)
| | - Nadja Franz
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria. (C.G.-T., M.G, J.H., S.M., L.P., F.N., E.K., N.F., D. Lobenwein, V.S., J.E., M.G., J.H.)
| | - Daniela Lobenwein
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria. (C.G.-T., M.G, J.H., S.M., L.P., F.N., E.K., N.F., D. Lobenwein, V.S., J.E., M.G., J.H.)
| | - Daniela Lener
- Department of Internal Medicine III, Medical University of Innsbruck, Austria. (E.D., R.H., A.B., D. Lener, M.S., R.K., G.W., I.T.)
| | - Christiane Fuchs
- Department Life Science Engineering, University of Applied Sciences Technikum Wien, Vienna, Austria. (C.F., A.W.)
| | - Anna Weihs
- Department Life Science Engineering, University of Applied Sciences Technikum Wien, Vienna, Austria. (C.F., A.W.)
| | - Sonja Töchterle
- Institute of Molecular Biology/CMBI, University of Innsbruck, Austria. (S.T., D.M.)
| | - Georg F Vogel
- Department of Pediatrics/Institute of Cell Biology, Medical University of Innsbruck, Austria. (G.V.F.)
| | - Victor Schweiger
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria. (C.G.-T., M.G, J.H., S.M., L.P., F.N., E.K., N.F., D. Lobenwein, V.S., J.E., M.G., J.H.)
| | - Jonas Eder
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria. (C.G.-T., M.G, J.H., S.M., L.P., F.N., E.K., N.F., D. Lobenwein, V.S., J.E., M.G., J.H.)
| | - Peter Pietschmann
- Division of Cellular and Molecular Pathophysiology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria (P.P.)
| | - Markus Seifert
- Department of Internal Medicine III, Medical University of Innsbruck, Austria. (E.D., R.H., A.B., D. Lener, M.S., R.K., G.W., I.T.)
| | - Florian Kronenberg
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, Austria. (A.N., F.K., S.C., B.R.)
| | - Stefan Coassin
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, Austria. (A.N., F.K., S.C., B.R.)
| | - Michael Blumer
- Institute of Clinical and Functional Anatomy, Innsbruck Medical University, Austria (M.B.)
| | - Hubert Hackl
- Institute of Bioinformatics, Medical University of Innsbruck, Austria. (H.H.)
| | - Dirk Meyer
- Institute of Molecular Biology/CMBI, University of Innsbruck, Austria. (S.T., D.M.)
| | - Gudrun Feuchtner
- Department of Radiology, Core Facility for Micro-CT, Medical University of Innsbruck, Austria. (G.D., G..F.)
| | - Rudolf Kirchmair
- Department of Internal Medicine III, Medical University of Innsbruck, Austria. (E.D., R.H., A.B., D. Lener, M.S., R.K., G.W., I.T.)
| | - Jakob Troppmair
- Daniel Swarovski Research Laboratory, Department of Visceral, Transplant and Thoracic Surgery, University of Innsbruck, Austria. (J.T.)
| | - Markus Krane
- Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University Munich, Germany (M.K.)
| | - Günther Weiss
- Department of Internal Medicine III, Medical University of Innsbruck, Austria. (E.D., R.H., A.B., D. Lener, M.S., R.K., G.W., I.T.)
| | - Sotirios Tsimikas
- Division of Cardiovascular Diseases, University of California, San Diego, La Jolla (S.T.)
| | - George Thanassoulis
- Preventive and Genomic Cardiology, McGill University Health Centre Research Institute, Montreal, Quebec, Canada (J.C.E., H.-Y.C., G.T.)
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria. (C.G.-T., M.G, J.H., S.M., L.P., F.N., E.K., N.F., D. Lobenwein, V.S., J.E., M.G., J.H.)
| | - Bernhard Rupp
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, Austria. (A.N., F.K., S.C., B.R.)
| | - Lukas A Huber
- Institute of Cell Biology, Medical University of Innsbruck, Austria. (L.A.H.)
- Austrian Drug Screening Institute, ADSI, Innsbruck (L.A.H.)
| | - Shen-Ying Zhang
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY (S.-Y.Z., J.-L.C.)
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France (S.-Y.Z., J.-L.C.)
- University of Paris, Imagine Institute, France (S.-Y.Z., J.-L.C.)
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY (S.-Y.Z., J.-L.C.)
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France (S.-Y.Z., J.-L.C.)
- University of Paris, Imagine Institute, France (S.-Y.Z., J.-L.C.)
- Howard Hughes Medical Institute, New York, NY (J.-L.C.)
| | - Ivan Tancevski
- Department of Internal Medicine III, Medical University of Innsbruck, Austria. (E.D., R.H., A.B., D. Lener, M.S., R.K., G.W., I.T.)
| | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria. (C.G.-T., M.G, J.H., S.M., L.P., F.N., E.K., N.F., D. Lobenwein, V.S., J.E., M.G., J.H.)
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Fukuhara S, Nguyen CTN, Kim KM, Yang B, Ailawadi G, Patel HJ, Deeb GM. Aortic valve reintervention after transcatheter aortic valve replacement. J Thorac Cardiovasc Surg 2023; 165:1321-1332.e4. [PMID: 34364682 DOI: 10.1016/j.jtcvs.2021.03.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/04/2020] [Revised: 02/27/2021] [Accepted: 03/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite the rapid adoption of transcatheter aortic valve replacement (TAVR), there are scant data regarding aortic valve reintervention after initial TAVR. METHODS Between 2011 and 2019, 1487 patients underwent a TAVR at the University of Michigan. Among these, 24 (1.6%) patients required an aortic valve reintervention. Additionally, 4 patients who received a TAVR at another institution underwent a valve reintervention at our institution. We retrospectively reviewed these 28 patients. RESULTS The median age was 72 years, 36% were female and 86% of implanted TAVR devices were self-expandable. The leading indications for reintervention were structural valve degeneration (39%) and paravalvular leak (36%). The cumulative incidence of aortic valve reintervention was 4.6% at 8 years. Most (71%) were deemed unsuitable for repeat TAVR because of the need for concurrent cardiac procedures (50%), unfavorable anatomy (45%), or endocarditis (10%). TAVR valve explant was associated with frequent concurrent procedures, consisting of aortic repair (35%), mitral repair/replacement (35%), tricuspid repair (25%), and coronary artery bypass graft (20%). Seventy-one percent of aortic procedures were unplanned but proved necessary because of severe adhesion of the devices to the contacting tissue. There were 3 (15%) in-hospital mortalities in the TAVR valve explant group, whereas there was no mortality in the repeat TAVR group. CONCLUSIONS Repeat TAVR procedure was frequently not feasible because of unfavorable anatomy and/or the need for concurrent cardiac procedures. Careful assessment of TAVR procedure repeatability should be weighed at the initial TAVR workup especially in younger patients who are expected to require a valve reintervention.
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Affiliation(s)
- Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
| | | | - Karen M Kim
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Bo Yang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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Massussi M, Adamo M, Rosati F, Chizzola G, Metra M, Tarantini G. Coronary artery disease and TAVI: Current evidence on a recurrent issue. Catheter Cardiovasc Interv 2023; 101:1154-1160. [PMID: 36994903 DOI: 10.1002/ccd.30653] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/13/2023] [Accepted: 03/19/2023] [Indexed: 03/31/2023]
Abstract
Coronary artery disease (CAD) is a frequent finding in patients with aortic stenosis (AS). Concomitant coronary artery bypass and aortic valve replacement is considered the gold standard treatment in surgical candidates. However, limited evidence is available regarding the role of coronary revascularization in patients undergoing transcatheter aortic valve implantation (TAVI). How to evaluate CAD severity in patients with AS, whether percutaneous coronary intervention (PCI) needs to be performed and what is the timing for revascularization to minimize procedural risks, remains matters of debate. The aim of this review is to summarize epidemiology, diagnostic tools and possible options for CAD management in patients undergoing TAVI with specific focus on the pros and the cons of the different timing of PCI.
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Affiliation(s)
- Mauro Massussi
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Fabrizio Rosati
- Division of Cardiac Surgery, ASST Spedali Civili Brescia, Brescia, Italy
| | - Giuliano Chizzola
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
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Imamura T, Narang N, Ushijima R, Sobajima M, Fukuda N, Ueno H, Kinugawa K. Prognostic Impact of Baseline Six-Minute Walk Distance following Trans-Catheter Aortic Valve Replacement. J Clin Med 2023; 12:2504. [PMID: 37048588 PMCID: PMC10094885 DOI: 10.3390/jcm12072504] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The six-minute walk test is a practical tool for assessing functional capacity in patients with a variety of etiologies including pulmonary disease and heart failure. Six-minute walk distance (6MWD) is associated with mortality and morbidity in patients with a variety of comorbidities. We aimed to assess the prognostic impact of baseline 6MWD in patients with severe aortic stenosis undergoing trans-catheter aortic valve replacement (TAVR). METHODS Patients with severe aortic stenosis who underwent a six-minute walk test after index admission and underwent TAVR between 2015 and 2022 were included in this retrospective study. Patients were followed up for two years or until November 2022 following TAVR. The impact of baseline 6MWD on the primary composite outcome, defined as all-cause death and all-cause readmission during the 2-year observation period following index discharge, was assessed. RESULTS A total of 299 patients (median age 86 years old, 85 men) were included. They received a 6-min walk test prior to TAVR, underwent successful TAVR procedures, and were discharged alive. The median baseline 6MWD was 204 (143, 282) meters. Shorter baseline 6MWD was associated with higher cumulative incidence of the primary outcome with an adjusted hazard ratio of 0.76 (95% confidence interval 0.58-1.01, p = 0.055) with a cutoff 6MWD of 178 m during the 2-year observation period after index discharge. CONCLUSIONS Overall, functional capacity was impaired in the elderly patients with severe aortic stenosis prior to TAVR. Patients with severe aortic stenosis having shorter baseline 6MWD tended to have higher rates of morbidity and mortality after successful TAVR. The clinical implication of aggressive cardiac rehabilitation to improve patients' functional capacity and 6MWD-guided optimal patient selection remain the future concerns.
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Affiliation(s)
- Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Nikhil Narang
- Advocate Christ Medical Center, Oak Lawn, IL 60453, USA
| | - Ryuichi Ushijima
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Mitsuo Sobajima
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Nobuyuki Fukuda
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Hiroshi Ueno
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
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Mack MJ, Adams DH. Avoidance of Patient Prosthesis Mismatch After Aortic Valve Replacement: Have We Been Too Aggressive? J Am Coll Cardiol 2023; 81:976-978. [PMID: 36889876 DOI: 10.1016/j.jacc.2023.01.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 03/08/2023]
Affiliation(s)
- Michael J Mack
- Baylor Scott & White Research Institute, Plano, Texas, USA.
| | - David H Adams
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, New York, USA
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Dismorr M, Glaser N, Franco-Cereceda A, Sartipy U. Effect of Prosthesis-Patient Mismatch on Long-Term Clinical Outcomes After Bioprosthetic Aortic Valve Replacement. J Am Coll Cardiol 2023; 81:964-975. [PMID: 36889875 DOI: 10.1016/j.jacc.2022.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 09/07/2022] [Revised: 11/29/2022] [Accepted: 12/21/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND Prosthesis-patient mismatch (PPM) is common following surgical aortic valve replacement (SAVR). OBJECTIVES The purpose of this study was to quantify the impact of PPM on all-cause mortality, heart failure hospitalization, and reintervention following bioprosthetic SAVR. METHODS This observational nationwide cohort study from SWEDEHEART (Swedish Web system for Enhancement and Development of Evidence based care in Heart disease Evaluated According to Recommended Therapies) and other national registers included all patients who underwent primary bioprosthetic SAVR in Sweden from 2003 to 2018. PPM was defined according to the Valve Academic Research Consortium 3 criteria. Outcomes were all-cause mortality, heart failure hospitalization, and aortic valve reintervention. Regression standardization was used to account for intergroup differences and to estimate cumulative incidence differences. RESULTS We included 16,423 patients (no PPM: 7,377 [45%]; moderate PPM: 8,502 [52%]; and severe PPM: 544 [3%]). After regression standardization, the cumulative incidence of all-cause mortality at 10 years was 43% (95% CI: 24%-44%) in the no PPM group compared with 45% (95% CI: 43%-46%) and 48% (95% CI: 44%-51%) in the moderate and severe PPM groups, respectively. The survival difference at 10 years was 4.6% (95% CI: 0.7%-8.5%) and 1.7% (95% CI: 0.1%-3.3%) in no vs severe PPM and no vs moderate PPM, respectively. The difference in heart failure hospitalization at 10 years was 6.0% (95% CI: 2.2%-9.7%) in severe vs no PPM. There was no difference in aortic valve reintervention in patients with or without PPM. CONCLUSIONS Increasing grades of PPM were associated with long-term mortality, and severe PPM was associated with increased heart failure. Moderate PPM was common, but the clinical significance may be negligible because the absolute risk differences in clinical outcomes were small.
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Affiliation(s)
- Michael Dismorr
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Natalie Glaser
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden. https://twitter.com/NatalieGlaser10
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
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Sharma S, Morrison AR. Unlocking the Secrets of Subclinical Calcific Aortic Valve Disease and Heart Failure. Circ Cardiovasc Imaging 2023; 16:e015247. [PMID: 36880377 PMCID: PMC10033395 DOI: 10.1161/circimaging.123.015247] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Sheila Sharma
- Department of Medicine (Section of Cardiovascular Medicine) Providence VA Medical Center, Providence, Rhode Island, 02908, USA
- Department of Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, Rhode Island, 02903, USA
| | - Alan R. Morrison
- Department of Medicine (Section of Cardiovascular Medicine) Providence VA Medical Center, Providence, Rhode Island, 02908, USA
- Department of Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, Rhode Island, 02903, USA
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Curini L, Alushi B, Christopher MR, Baldi S, Di Gloria L, Stefano P, Laganà A, Iannone L, Grubitzsch H, Landmesser U, Ramazzotti M, Niccolai E, Lauten A, Amedei A. The first taxonomic and functional characterization of human CAVD-associated microbiota. Microb Cell 2023; 10:36-48. [PMID: 36789351 PMCID: PMC9896411 DOI: 10.15698/mic2023.02.791] [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] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023]
Abstract
Introduction Calcific aortic valve disease (CAVD) is the most common heart valve disorder, defined by a remodeling multistep process: namely, valve fibrosis with its area narrowing, impaired blood flow, and final calcification phase. Nowadays, the only treatment is the surgical valve replacement. As for other cardiovascular diseases, growing evidence suggest an active role of the immune system in the calcification process that could be modulated by the microbiota. To address this point, we aimed to investigate and characterize, for the first time, the presence of a valve microbiota and associated immune response in human CAVD. Method Calcified aortic valve (CAV) samples from twenty patients (11 from Germany and 9 from Italy) with diagnosis of severe symptomatic CAVD were used to assess the presence of infiltrating T cells, by cloning approach, and to characterize the valve microbiota, by 16S rRNA gene sequencing (NGS). Results We documented the presence of infiltrating T lymphocytes, especially the T helper subset, in CAV samples. Moreover, we found a tissue-associated microbiota in freshly collected CAV samples, which was significantly different in Italian and German patients, suggesting potential correlation with other cardiovascular risk factors. Conclusion The presence of microbiota in inflamed CAV samples represents the right trigger point to explain the valve calcification process, encouraging further studies to explore the potential link between bacteria and adaptive immune response and to define the critical role of local microbiota-immunity axis on CAVD development.
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Affiliation(s)
- Lavinia Curini
- Department of Clinical and Experimental Medicine, University of Florence, 50139 Florence, Italy
| | - Brunilda Alushi
- Department of Cardiology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, and German Centre for Cardiovascular Research (DZHK); Department of Interventional Cardiology, Klinik Vincentinum Augsburg, Germany
| | - Mary Roxana Christopher
- Department of Cardiology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, and German Centre for Cardiovascular Research (DZHK)
| | - Simone Baldi
- Department of Clinical and Experimental Medicine, University of Florence, 50139 Florence, Italy
| | - Leandro Di Gloria
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | | | - Anna Laganà
- Cardiac Surgery, Careggi University Hospital, 50134 Florence, Italy
| | - Luisa Iannone
- Cardiac Surgery, Careggi University Hospital, 50134 Florence, Italy
| | - Herko Grubitzsch
- Berlin Institute of Health; Department of Cardiology, German Heart Centre Berlin (DHZB)
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin and German Centre for Cardiovascular Research (DZHK); Berlin Institute of Health
| | - Matteo Ramazzotti
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Elena Niccolai
- Department of Clinical and Experimental Medicine, University of Florence, 50139 Florence, Italy
| | - Alexander Lauten
- Department of Cardiology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, and German Centre for Cardiovascular Research (DZHK); Department of Interventional Cardiology, Klinik Vincentinum Augsburg, Germany
| | - Amedeo Amedei
- Department of Clinical and Experimental Medicine, University of Florence, 50139 Florence, Italy.
,SOD of Interdisciplinary Internal Medicine, Azienda Ospedaliera Universitaria Careggi (AOUC), 50139 Florence, Italy.
,* Corresponding Author: Amedeo Amedei, Department of Clinical and Experimental Medicine, University of Florence, 50139 Florence, Italy; E-mail:
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Bajoras V, Diečkus L, Wong I, Laurinavičienė A, Davidavičius G, Čėsna S. Transcatheter aortic valve implantation in patients with anomalous coronary artery. Catheter Cardiovasc Interv 2023; 101:485-493. [PMID: 36640415 DOI: 10.1002/ccd.30540] [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: 04/23/2022] [Revised: 11/27/2022] [Accepted: 12/26/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The aim of this review was to analyze literature and provide systematic algorithm to guide decision making during TAVI procedure. BACKGROUND Transcatheter aortic valve implantation (TAVI) is growing in popularity and expanding to younger patients with lower risk profiles. Currently, there is no concise guideline on the management strategy during TAVI in patients with anomalous coronary artery (ACA) anatomy undergoing this procedure. METHODS A systematic search was conducted for relevant case reports of TAVI in patients who had confirmed ACA anatomy. Twenty-four case reports, that met the criteria for this review, were identified and included in the final study size. RESULTS TAVI was successful in 23 out of 24 cases. Half of the cases (12) described performing balloon aortic valvuloplasty (BAV) before TAVI. The majority (15) reported using angiogram Postimplantation. Only one-third of cases (8) reported performing coronary protection (with either wire, wire and stent or wire and balloon). Two-third of case reports (16/24, 67%) mentioned using Edwards SAPIEN balloon expandable transcatheter heart valves (THV). CONCLUSIONS Preprocedural diagnostic imaging tests play important role in determining the ACA anatomy and its relation to the aortic valve. BAV with simultaneous coronary arteries angiography or aortography should be performed before implantation of THV, as it could potentially predict whether the ACA would be compressed. Using at least a coronary wire for ACA protection is recommended in case there is high risk of ACA obstruction. Management strategy should be individualized when performing TAVI in patients with ACA.
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Affiliation(s)
- Vilhelmas Bajoras
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Interventional Cardiology, Vilnius University Hospital Santaros Clinics, Division of Cardiology and Vascular Diseases, Vilnius, Lithuania
| | - Laurynas Diečkus
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ivan Wong
- Division of Cardiology, Queen Elizabeth Hospital, Hong Kong SAR, Hong Kong
| | - Anna Laurinavičienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Giedrius Davidavičius
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Interventional Cardiology, Vilnius University Hospital Santaros Clinics, Division of Cardiology and Vascular Diseases, Vilnius, Lithuania
| | - Sigitas Čėsna
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Interventional Cardiology, Vilnius University Hospital Santaros Clinics, Division of Cardiology and Vascular Diseases, Vilnius, Lithuania
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Giraldo-Grueso M, Bedi RS, Tafur-Soto J, Su J, Spindel SM. Zero to Hero? Reducing the Rate of Acute Kidney Injury in Transcatheter Aortic Valve Replacement: The Low Contrast Approach. Ochsner J 2023; 23:284-288. [PMID: 38143547 PMCID: PMC10741818 DOI: 10.31486/toj.23.0103] [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] [Indexed: 12/26/2023] Open
Abstract
Background: Acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) increases hospital stay, morbidity, and mortality, and the amount of contrast used during the procedure has been linked to the occurrence of AKI. Reducing the amount of contrast used during TAVR is hypothesized to decrease AKI without compromising outcomes. Methods: We conducted a single-institution retrospective analysis of patients who underwent TAVR from 2017 to 2019. Patients receiving ≤20 mL of contrast were labeled as group I, and patients receiving >20 mL of contrast were labeled as group II. Primary endpoints were 30-day mortality, AKI, and early aortic regurgitation. Results: A total of 594 patients met the inclusion and exclusion criteria, with 429 patients (72.2%) included in group I and 165 patients (27.8%) included in group II. Two hundred eighteen patients (50.8%) from group I and 41 patients (24.8%) from group II had preoperative chronic kidney disease stage III or IV. The mean contrast volume was 8.5 ± 6 mL for group I and 33 ± 16 mL for group II (P<0.001). In group I, 13 patients (3.0%) developed AKI, and 6 (1.4%) required hemodialysis. In group II, 9 (5.5%) patients developed AKI, and 1 (0.6%) required hemodialysis. The differences between the 2 groups for AKI and hemodialysis were not statistically significant. Overall, 579 patients (97.5%) had less than moderate aortic regurgitation in the postoperative echocardiogram. Conclusion: Low contrast TAVR is safe and effective and can reduce the incidence of AKI when compared to the standard contrast dose without affecting outcomes such as death and aortic regurgitation.
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Affiliation(s)
| | - Ryan S. Bedi
- Division of Cardiothoracic Surgery, Ochsner Clinic Foundation, New Orleans, LA
| | - Jose Tafur-Soto
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA
| | - Jasmine Su
- University of Massachusetts, Amherst, MA
| | - Stephen M. Spindel
- Division of Cardiothoracic Surgery, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA
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Bingen BO, Al Amri I, Montero-Cabezas JM, van der Kley F. Bail out lithotripsy to treat delayed valve-in-valve TAVR-related coronary obstruction. Catheter Cardiovasc Interv 2023; 101:97-101. [PMID: 36385465 PMCID: PMC10099844 DOI: 10.1002/ccd.30483] [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: 12/29/2021] [Revised: 08/24/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022]
Abstract
Coronary access difficulty and stent compression by the juxtaposed aortic valve leaflet hamper percutaneous management of delayed coronary artery obstruction (CAO) after valve-in-valve (Edwards Sapien 3 in St. Jude Trifecta) transcatheter aortic valve replacement (TAVR). Here, we present a case of delayed post-TAVR CAO treated with intravascular lithotripsy and multistenting to overcome stent compression by the adjacent calcified leaflet.
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Affiliation(s)
- Brian O Bingen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Orzalkiewicz M, Taglieri N, Palmerini T, Saia F. Overinflation of balloon-expandable valves for transcatheter treatment of pure noncalcified native aortic regurgitation: How much oversizing is needed and achievable? Catheter Cardiovasc Interv 2022; 101:481-484. [PMID: 36542666 DOI: 10.1002/ccd.30529] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/12/2022] [Accepted: 12/10/2022] [Indexed: 02/17/2024]
Abstract
Transcatheter aortic valve implantation (TAVI) in noncalcified pure aortic valve regurgitation is challenging as dedicated valves are not widely available. We present a case series of four inoperable patients who underwent compassionate TAVI for this indication at our institution with a balloon-expandable valve. In this context, we analyzed the relevant technical aspects such as the need for larger oversizing of the transcatheter prosthesis and the safety and limits of valve overexpansion.
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Affiliation(s)
| | - Nevio Taglieri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tullio Palmerini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Saia
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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50
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Ferreira R, Rua N, Sena A, Velho TR, Gonçalves J, Junqueira N, Almeida AG, Nobre Â, Pinto F. Sutureless bioprosthesis for aortic valve replacement: Surgical and clinical outcomes. J Card Surg 2022; 37:4774-4782. [PMID: 36335595 PMCID: PMC10099473 DOI: 10.1111/jocs.17113] [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: 06/17/2022] [Revised: 10/15/2022] [Accepted: 10/23/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aortic valve stenosis is the most common adult valve disease in industrialized countries. The aging population and the increase in comorbidities urge the development of safer alternatives to the current surgical treatment. Sutureless bioprosthesis has shown promising results, especially in complex procedures and in patients requiring concomitant surgeries. OBJECTIVES Assess the clinical and hemodynamic performance, safety, and durability of the Perceval® prosthetic valve. METHODS This single-center retrospective longitudinal cohort study collected data from all adult patients with aortic valve disease who underwent aortic valve replacement with a Perceval® prosthetic valve between February 2015 and October 2020. Of the 196 patients included (mean age 77.20 ± 5.08 years; 45.4% female; mean EuroSCORE II 2.91 ± 2.20%), the majority had aortic stenosis. RESULTS Overall mean cross-clamp and cardiopulmonary bypass times were 33.31 ± 14.09 min and 45.55 ± 19.04 min, respectively. Mean intensive care unit and hospital stay were 3.32 ± 3.24 days and 7.70 ± 5.82 days, respectively. Procedural success was 98.99%, as two explants occurred. Four valves were reimplanted due to intraoperative misplacement. Mean transvalvular gradients were 7.82 ± 3.62 mmHg. Pacemaker implantation occurred in 12.8% of patients, new-onset atrial fibrillation in 21.9% and renal replacement support was necessary for 3.1%. Early mortality was 2.0%. We report no structural valve deterioration, strokes, or endocarditis, and one successfully treated valve thrombosis. CONCLUSIONS Our study confirms the excellent clinical and hemodynamic performance and safety of a truly sutureless aortic valve, up to a 5-year follow-up. These results were consistent in isolated and concomitant interventions, solidifying this device as a viable option for the treatment of isolated aortic valve disease.
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Affiliation(s)
- Ricardo Ferreira
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.,Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Nuno Rua
- Faculdade de Ciências Médicas da Universidade da Beira Interior, Covilhã, Portugal
| | - André Sena
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Tiago R Velho
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.,Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - João Gonçalves
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Nádia Junqueira
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Ana G Almeida
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Department of Cardiology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Ângelo Nobre
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.,Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Fausto Pinto
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Department of Cardiology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
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