Safety and effectiveness of the novel Myval Octacor transcatheter heart valve in severe, symptomatic aortic valve stenosis - A real-world Indian experience (The OCTACOR India Study)

PURPOSE

To evaluate the safety and effectiveness of the novel, next-generation Myval Octacor - Transcatheter Heart Valve (THV) in patients with severe, symptomatic, native aortic stenosis (AS).

METHODS

This multicenter, real-world observational registry included 123 patients with severe symptomatic AS, across 16 Indian centers who underwent treatment with the novel Myval Octacor THV. Study endpoints included all-cause mortality, all stroke, acute kidney injury (AKI), major vascular complications, moderate or severe paravalvular leakage (PVL) and new permanent pacemaker implantation (PPI) until 30 days follow-up.

RESULTS

Of the 123 patients (average age 70.07 ± 8.33 years), 37.4 % (n = 46) were female and 39.84 % presented with bicuspid valves. The technical success rate of the procedure was 100 % and the device success rate at 30 days was 98.4 %. At 30 days (n = 123) after the procedure, the overall mortality was 1.6 %. AKI occurred in 1.6 % of patients and there was no incidence of stroke, bleeding (types 3 and 4), and major vascular complications. In an analysis of 31 patients whose echocardiographic parameters were available across all timepoints, there were significant improvements in the mean pressure gradient (54.31 ± 18.19 mmHg vs. 10.42 ± 4.24 mmHg; p < 0.0001) and effective orifice area (0.66 ± 0.21 cm2 vs. 1.80 ± 0.44 cm2; p < 0.0001) from baseline to the 30-day follow-up. None of the patients experienced severe PVL, while moderate PVL was observed in two patients (1.6 %).

CONCLUSIONS

Early outcomes of the next-generation, novel Myval Octacor THV proved its safety and effectiveness in the treatment of severe AS.

Identification of the novel HLA-DPB1*1461:01 allele in three individuals from Southern India

HLA-DPB1*1461:01 differs from DPB1*02:01:02:01 in exon 2, codon 51 CTG > CGG a Leucine to Arginine replacement.

Angiographic quantification of aortic regurgitation following myval octacor implantation; independent core lab adjudication

BACKGROUND

The balloon expandable Myval transcatheter heart valve (THV) showed encouraging results regarding residual aortic regurgitation (AR) from multiple observational studies. The newly designed Myval Octacor has been introduced recently, aiming for a reduction in AR and improved performance.

OBJECTIVES

The focus of this study is to report the incidence of AR using the validated quantitative Videodensitometry angiography technology (qLVOT-AR%) in the first in human use of the Myval Octacor THV system.

METHODOLOGY

We report on the first in human use of the Myval Octacor THV system in 125 patients in 18 Indian centres. Independent retrospective analysis of the final aortograms following implantation of the Myval Octacor was performed using the CAAS-A-Valve software. AR is reported as a regurgitation fraction. The previously validated cutoff values have been used to identify ≥moderate AR (RF% >17%), mild (6% < RF% ≤17%), and none or trace AR (RF% ≤ 6%).

RESULTS

Final aortogram was analysable for 103 patients (84.4%) among the 122 available aortograms. 64 (62%) patients, had tricuspid aortic valve (TAV), 38 (37%) with bicuspid AV (BAV), and one with unicuspid AV. The median absolute RF% was 2% [1, 6], moderate or more AR incidence was 1.9%, mild AR in 20.4%, and none or trace AR in 77.7%. The two cases with RF% >17% were in the BAV group.

CONCLUSION

The initial results of Myval Octacor using quantitative angiography-derived regurgitation fraction demonstrated a favourable outcome regarding residual AR, possibly due to improved device design. Results must be confirmed in a larger randomised study, including other imaging modalities.

Abstract P1117: Transcriptional Changes In Failing Hearts In A South Asian Cohort Capture Molecular Pathophysiology Underlying Maladaptive Remodelling And Reflect A Consistent Disease Gene Signature

Heart failure (HF) is a leading cause of death worldwide and research focused on human cardiac tissue provides insights into underlying disease mechanisms. In this study, we performed transcriptome analyses on cardiac tissue from 21 South Asian (SA) HF patients and compared them with 21 controls without HF. The aim was to i) probe dysregulated genes and pathways in HF and ii) identify a core HF gene signature conserved across etiologies and ethnicities. Gene set enrichment analyses on dysregulated genes (DGs) showed positive enrichment of Gene Ontology terms for ECM remodelling, immune signalling and negative enrichment of terms like cardiac conduction, muscle contraction reflecting altered molecular signalling and cellular cross-talk in failing hearts. The immune cell signatures among the DGs suggest changes in immune milieu which correlates with altered immune signalling pathways. Although poor concordance in DGs across studies on HF transcriptome is well documented, evidence on stratification potential of select DGs is still preliminary. Using an independent component analysis and a machine learning based workflow, we identified gene signatures from two cohorts (SA, GSE116250) independently. We refined these into a core signature after cross validating their stratification potential and by removing the genes with low potential. The core signature effectively separated HF from control samples in SA, GSE116250 and other cohorts potentially reflecting central elements underlying end stage HF. In summary, the transcriptome analyses from SA HF cohort highlights the pathways reflecting HF pathophysiology and reiterates conserved themes across public HF cohorts.

Heart Failure with Preserved Ejection Fraction: Management Guidelines (From Heart Failure Association of India, Endorsed by Association of Physicians of India)

Heart failure with preserved ejection fraction (HFpEF) accounts for 15-20% of patients with heart failure (HF) in India. Diagnosis is by clinical features supported by biomarkers and echocardiography. Lifestyle modifications, control of risk factors to optimum levels, and treatment of comorbidities are essential in the management of HFpEF. Spironolactone and sacubitril-valsartan [angiotensin receptor neprilysin inhibitor (ARNI)] are beneficial in subsets of HFpEF, especially with lower range of ejection fraction (EF). Sodium-glucose co-transporter-2 inhibitors (SGLT2i)-empagliflozin and dapagliflozin and probably sotagliflozin are the only currently available drugs which have shown benefits in HFpEF, mostly by reducing hospitalizations. The benefit of SGLT2i is evident in both diabetic and nondiabetic subsets.

Oversized donor heart transplantation-clinical experience with an underestimated problem

PURPOSE

Heart transplantation is the definitive treatment for end-stage heart failure. With respect to donor-recipient size matching, the problems with undersized heart transplantation have been widely discussed, but there is a paucity of information on oversized transplants due to the presumed advantage of large hearts. We intend to share our center's experience with oversized heart transplantation and its associated problems which would help to expand the knowledge on oversized cardiac allografts.

METHODS

Patients who underwent isolated heart transplantation at our hospital between March 1, 2008, and March 1, 2020, were included. For adults, a donor-recipient predicted heart mass percentage difference exceeding 30% and for children, a donor-recipient weight ratio < 0.8 and > 2.0 was considered a mismatch. We collected data from the in-patient medical records and analyzed the in-hospital outcomes and survival post-transplant among various other parameters.

RESULTS

Out of the 43 patients included in this study, 32 (74.4%) patients received a matched heart and 11 (25.6%) patients received oversized hearts. None of the patients received an undersized heart. The in-hospital mortality rate of oversized transplants was 18.2% whereas that of matched transplants was 9.4% (p = 0.432). The post-operative characteristics and 1-year survival were comparable between the groups. We encountered problems specific to oversizing in 5 of the 11 patients (45.4%) which are discussed.

CONCLUSION

With the liberalization of donor criteria to overcome organ shortage, oversized heart transplantation poses certain unique challenges, which when efficiently managed offers acceptable outcomes.

Extended-range spectroscopic pH measurement using optimized mixtures of dyes

The spectroscopic technique for pH measurement is a well-established laboratory technique that can give high-accuracy pH values. Recent studies have shown the advantage of this technique over standard potentiometric methods for pH measurements in fresh water and seawater and also at high temperatures and pressures. However, a limitation of the spectroscopic technique is that a single pH dye is sensitive only over a narrow pH range. We have developed optimized dye mixtures that are both sensitive and accurate over a broad pH range. The measurement is robust and simple, requires a minimum of two wavelengths, and is independent of the volume of the dye mixture added. Optimization of the dye mixture formulation to maximize accuracy in a broad range of pH involves varying both the dye type and its mole fraction and also accounting for spectral noise. This technique has been successfully applied for in situ pH measurements of oilfield formation waters.