1
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Parma R, Joner M, Saia F, Cuisset T, Delgado V, Rodes-Cabau J, Modine T, Van Belle E, Fovino LN, Landes U, Abdel-Wahab M, Zamorano JL, Eden M, Cademartiri F, Skipirzepa JN, Kurucova J, Greinert D, Bramlage P, Tarantini G. Procedural and clinical outcomes of patients undergoing a TAVI in TAVI procedure: Rationale and design of the multicentre, prospective, observational ReTAVI registry. Eur J Clin Invest 2024:e14241. [PMID: 38767226 DOI: 10.1111/eci.14241] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is increasingly being used in younger patients and those with lower peri-procedural risk, meaning more patients will live long enough to experience structural valve deterioration (SVD) of the bioprosthesis, indicating repeated TAVI. Experience of repeated TAVI-transcatheter heart valve (THV) implantation into an index THV is limited. This registry aims to assess the peri-procedural and short-term safety, efficacy and durability of repeated TAVI. METHODS The ReTAVI Prospective observational registry is an investigator-initiated, multicentre, international, prospective registry of patients undergoing repeated TAVI using balloon-expandable SAPIEN prosthesis to evaluate procedural and short-term safety, efficacy and durability as well as anatomical and procedural factors associated with optimal results. The registry will enrol at least 150 patients across 60 high-volume centres. Patients must be ≥18 years old, have had procedural success with their first TAVI, have index THV device failure, intend to undergo repeated TAVI and be considered suitable candidates by their local Heart Team. All patients will undergo a 30-day and 12-month follow-up. The estimated study completion is 2025. CONCLUSIONS The registry will collect pre-, peri-, postoperative and 12-months data on patients undergoing repeated TAVI procedures with THVs for failure of the index THV and determine VARC-3-defined efficacy and safety at 30 days and functional outcome at 12 months. The registry will expand existing data sets and identify patient characteristics/indicators related to complications and clinical benefits for patients with symptomatic severe calcific degenerative aortic stenosis.
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Affiliation(s)
- Radoslaw Parma
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Michael Joner
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Policlinico S. Orsola-Malpighia, University Hospital of Bologn, Bologna, Italy
| | - Thomas Cuisset
- Département de Cardiologie, Centre Hospitalier Universitaire de Timone, Marseille, France
- Aix Marseille Université, INSERM, INRA, C2VN & Faculté de Médecine, Marseille, France
| | - Victoria Delgado
- Department of Cardiology, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Josep Rodes-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Québec, Canada
| | - Thomas Modine
- Department of Cardiology, Hopital Haut Levêque-Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Eric Van Belle
- Interventional Cardiology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Uri Landes
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - Mohamed Abdel-Wahab
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Matthias Eden
- Heidelberg University Clinic, Department Internal Medicine III (Cardiology, Angiology, Pneumology), Heidelberg, Germany
| | | | - Joanna Nawara Skipirzepa
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Daniel Greinert
- IPPMed-Institute for Pharmacology and Preventive Medicine GmbH, Cloppenburg, Germany
| | - Peter Bramlage
- IPPMed-Institute for Pharmacology and Preventive Medicine GmbH, Cloppenburg, Germany
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
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2
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Meier D, Grant D, Frawley C, Akodad M, Landes U, Khokhar AA, Dudek D, George I, Rinaldi MJ, Kim WK, Yakubov SJ, Sorajja P, Tarantini G, Wood DA, Webb JG, Sellers SL, Sathananthan J. Redo-TAVI with the ACURATE neo2 and Prime XL for balloon-expandable transcatheter heart valve failure. EUROINTERVENTION 2024; 20:e376-e388. [PMID: 38506739 PMCID: PMC10941669 DOI: 10.4244/eij-d-23-00783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/06/2023] [Indexed: 03/21/2024]
Abstract
BACKGROUND There are limited data regarding treatment for failed balloon-expandable transcatheter heart valves (THVs) in redo-transcatheter aortic valve implantation (TAVI). AIMS We aimed to assess THV performance, neoskirt height and expansion when performing redo-TAVI with the ACURATE platform inside a SAPIEN 3 (S3) compared to redo-TAVI with an S3 in an S3. METHODS Redo-TAVI was performed on the bench using each available size of the S3, the ACURATE neo2 (ACn2) and the next-generation ACURATE Prime XL (AC XL) implanted at 2 different depths within 20 mm/23 mm/26 mm/29 mm S3s serving as the "failed" index THV. Hydrodynamic testing was performed to assess THV function. Multimodality assessment was performed using photography, X-ray, microcomputed tomography (micro-CT), and high-speed videos. RESULTS The ACURATE in S3 combinations had favourable hydrodynamic performance compared to the S3 in S3 for all size combinations. In the 20 mm S3, redo-TAVI with the ACn2 had lower gradients compared to the S3 (mean gradient 16.3 mmHg for the ACn2 vs 24.7 mmHg for the 20 mm S3 in 20 mm S3). Pinwheeling was less marked for the ACURATE THVs than for the S3s. On micro-CT, the S3s used for redo-TAVI were underexpanded across all sizes. This was also observed for the ACURATE platform, but to a lesser extent. CONCLUSIONS Redo-TAVI with an ACn2/AC XL within an S3 has favourable hydrodynamic performance and less pinwheeling compared to an S3 in S3. This comes at the price of a taller neoskirt.
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Affiliation(s)
- David Meier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Daire Grant
- Boston Scientific Corporation, Marlborough, MA, USA
| | | | - Mariama Akodad
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Uri Landes
- Edith Wolfson Medical Center, Holon, Israel and Tel-Aviv University, Tel-Aviv, Israel
| | - Arif A Khokhar
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Isaac George
- Division of Cardiothoracic Surgery, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Klinik Heart Center, Bad Nauheim, Germany
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-OhioHealth Hospital, Columbus, OH, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA and Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Giuseppe Tarantini
- Humanitas Research Hospital IRCCS, Rozzano, Italy
- University of Padua Medical School, Padua, Italy
| | - David A Wood
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John G Webb
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie L Sellers
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Boston Scientific Corporation, Marlborough, MA, USA
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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3
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Landes U, Harari E. What should we expect when we explant? EUROINTERVENTION 2024; 20:e115-e116. [PMID: 38224258 PMCID: PMC10786172 DOI: 10.4244/eij-e-23-00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Affiliation(s)
- Uri Landes
- Cardiology Department, Edith Wolfson Medical Center, Tel-Aviv University, Holon, Israel
| | - Emanuel Harari
- Cardiology Department, Assuta Ashdod University Hospital, Ben-Gurion University, Ashdod, Israel
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Danenberg H, Vaknin-Assa H, Makkar R, Virmani R, Manevich L, Codner P, Patel V, Finn AV, Landes U, Rubinshtein R, Bar A, Barnea R, Mezape Y, Teichman E, Eli S, Weisz G, Kornowski R. First-in-human study of the CAPTIS embolic protection system during transcatheter aortic valve replacement. EUROINTERVENTION 2023; 19:e948-e952. [PMID: 37916296 PMCID: PMC10719740 DOI: 10.4244/eij-d-23-00465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Stroke and other clinically significant embolic complications are well documented in the early period following transcatheter aortic valve replacement (TAVR). The CAPTIS device is an embolic protection system, designed to provide neurovascular and systemic protection by deflecting debris away from the brain's circulation, capturing the debris and thus avoiding systemic embolisation. AIMS We aimed to study the safety and feasibility study of the CAPTIS complete cerebral and full-body embolic protection system during TAVR. METHODS A first-in-human study investigated the safety, feasibility and debris capturing ability of CAPTIS during TAVR. Patients were followed for 30 days. The primary endpoints were device safety and cerebrovascular events at 72 hours. RESULTS Twenty patients underwent TAVR using balloon-expandable or self-expanding valve systems. CAPTIS was successfully delivered, positioned, deployed, and retrieved in all cases, and TAVR was successfully completed without device-related complications. No cerebrovascular events were observed. High numbers of debris particles were captured in all patients. CONCLUSIONS The use of the CAPTIS full-body embolic protection system during TAVR was safe, and it captured a substantial number of debris particles. No patient suffered from a cerebrovascular event. A randomised clinical trial is warranted to prove its efficacy.
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Affiliation(s)
- Haim Danenberg
- Wolfson Medical Center, Holon, Israel
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Hana Vaknin-Assa
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | | | | | - Lisa Manevich
- Wolfson Medical Center, Holon, Israel
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Pablo Codner
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Vivek Patel
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Uri Landes
- Wolfson Medical Center, Holon, Israel
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Ronen Rubinshtein
- Wolfson Medical Center, Holon, Israel
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Alon Bar
- Wolfson Medical Center, Holon, Israel
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Rani Barnea
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | | | | | - Sigal Eli
- Filterlex Medical Ltd, Caesarea, Israel
| | - Giora Weisz
- Filterlex Medical Ltd, Caesarea, Israel
- NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Ran Kornowski
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
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5
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Harari E, Landes U. Post-Transcatheter Aortic Valve Implantation paravalvular leak: multiple aetiologies and no panacea. Eur Heart J 2023; 44:4811-4812. [PMID: 37897337 DOI: 10.1093/eurheartj/ehad696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2023] Open
Affiliation(s)
- Emanuel Harari
- Department of Cardiology, Assuta Ashdod University Hospital, Ben-Gurion University, Ashdod, Israel
| | - Uri Landes
- Department of Cardiology, Edith Wolfson Medical Center, Ha-Lokhamim St 62, Holon 5822012, Israel and Tel-Aviv University, Tel Aviv 6997801, Israel
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6
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Meier D, Landes U, Sondergaard L, De Backer O, Lutter G, Puehler T, Akodad M, Tzimas G, Blanke P, Payne GW, Lai A, Gill H, Wood DA, Webb JG, Sellers SL, Sathananthan J. Redo-TAVI with SAPIEN 3 in SAPIEN XT or SAPIEN 3 - impact of pre- and post-dilatation on final THV expansion. EUROINTERVENTION 2023; 19:757-765. [PMID: 37519190 PMCID: PMC10654765 DOI: 10.4244/eij-d-23-00308] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/18/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND When a balloon-expandable transcatheter heart valve (THV) is chosen to treat a failed balloon-expandable THV, there is a risk of underexpansion with a potential impact on performance. AIMS We aimed to assess the impact of pre- and post-dilatation on the expansion of balloon-expandable THVs after redo-transcatheter aortic valve implantation (TAVI). METHODS Redo-TAVI was performed on the bench with a 23 mm SAPIEN 3 (S3) implanted within a 23 mm SAPIEN XT (SXT) or a 23 mm S3, both of which served as the "failed" THVs. Pre- and/or post-dilatation was performed using a 23 mm non-compliant TRUE balloon. Expansion of the index and redo-THVs were assessed before and after pre-/post-dilatation using microcomputed tomography (micro-CT), and THV hydrodynamic testing was conducted. RESULTS Without pre- or post-dilatation, the S3 was underexpanded, for all combinations, particularly in the mid-portion of the THV (18.6 mm and 19.7 mm representing 81% and 86% of the nominal diameter inside the SXT and S3, respectively). Pre- and post-dilatation had an additive effect on diameter expansion of the redo-THV, which remained constrained in most combinations. The only combination to achieve nominal expansion was the S3 in S3 when both pre- and post-dilatation were performed. The S3 remained underexpanded inside the SXT despite pre- and post-dilatation (93% in the mid-portion). Improved redo-THV expansion was accompanied by 2.7 mm (12%) overexpansion of the index THV. While all samples had acceptable hydrodynamic performance, the underexpanded samples had worse leaflet pinwheeling. CONCLUSIONS When performing redo-TAVI with a 23 mm S3 inside a 23 mm SXT or S3, only the S3 in S3 with the use of pre- and post-dilatation reached full expansion. This underlines the importance of CT assessment of THV expansion and the role of pre-/post-dilatation.
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Affiliation(s)
- David Meier
- Centre for Cardiovascular Innovation, St Paul's Hospital, Vancouver, BC, Canada and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Vancouver, BC, Canada and Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Uri Landes
- Edith Wolfson Medical Center, Holon, Israel
- Rabin Medical Center, Petah Tikva, Israel and Tel Aviv University, Tel Aviv, Israel
| | | | - Ole De Backer
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Georg Lutter
- DZHK (German Centre for Cardiovascular Research), partner site Kiel/Hamburg/Lübeck, Kiel Germany
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holsten, Campus Kiel, Kiel, Germany
| | - Thomas Puehler
- DZHK (German Centre for Cardiovascular Research), partner site Kiel/Hamburg/Lübeck, Kiel Germany
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holsten, Campus Kiel, Kiel, Germany
| | - Mariama Akodad
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Georgios Tzimas
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Geoffrey W Payne
- University of Northern British Columbia, Prince George, BC, Canada
| | - Althea Lai
- Cardiovascular Translational Laboratory, Vancouver, BC, Canada and Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Hacina Gill
- Cardiovascular Translational Laboratory, Vancouver, BC, Canada and Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, St Paul's Hospital, Vancouver, BC, Canada and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St Paul's Hospital, Vancouver, BC, Canada and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie L Sellers
- Centre for Cardiovascular Innovation, St Paul's Hospital, Vancouver, BC, Canada and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Vancouver, BC, Canada and Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul's Hospital, Vancouver, BC, Canada and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Vancouver, BC, Canada and Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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7
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De Backer O, Sathananthan J, Landes U, Danenberg HD, Webb J, Sondergaard L. Redo-TAVI with a balloon-expandable valve and the impact of index transcatheter aortic valve design. EUROINTERVENTION 2023; 19:714-716. [PMID: 37994094 PMCID: PMC10654766 DOI: 10.4244/eij-d-23-00363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/10/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Uri Landes
- Edith Wolfson Medical Center, Holon, Israel and Tel-Aviv University, Tel Aviv, Israel
| | - Haim D Danenberg
- Edith Wolfson Medical Center, Holon, Israel and Tel-Aviv University, Tel Aviv, Israel
| | - John Webb
- St. Paul's Hospital, Vancouver, BC, Canada
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8
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Zaid S, Bapat VN, Sathananthan J, Landes U, De Backer O, Tarantini G, Grubb KJ, Kaneko T, Khalique OK, Jilaihawi H, Fukui M, Madhavan M, Cangut B, Harrington K, Thourani VH, Makkar RR, Leon MB, Mack MJ, Tang GHL. Challenges and Future Directions in Redo Aortic Valve Reintervention After Transcatheter Aortic Valve Replacement Failure. Circ Cardiovasc Interv 2023; 16:e012966. [PMID: 37988437 DOI: 10.1161/circinterventions.123.012966] [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] [Indexed: 11/23/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is increasingly being performed in younger and lower surgical risk patients. Reintervention for failed transcatheter heart valves will likely increase in the future as younger patients are expected to outlive the initial bioprosthesis. While redo-TAVR has emerged as an attractive and less invasive alternative to surgical explantation (TAVR-explant) to treat transcatheter heart valve failure, it may not be feasible in all patients due to the risk of coronary obstruction and impaired coronary access. Conversely, TAVR-explant can be offered to most patients who are surgical candidates, but the reported outcomes have shown high mortality and morbidity. This review provides the latest evidence, current challenges, and future directions on redo-TAVR and TAVR-explant for transcatheter heart valve failure, to guide aortic valve reintervention and facilitate patients' lifetime management of aortic stenosis.
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Affiliation(s)
- Syed Zaid
- Division of Cardiology, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX (S.Z.)
| | - Vinayak N Bapat
- Cardiothoracic Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (V.N.B., M.F.)
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.S.)
| | - Uri Landes
- Department of Cardiology, Edith Wolfson Medical Center, Tel-Aviv University, Holon, Israel (U.L.)
| | - Ole De Backer
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark (O.D.B.)
| | | | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (K.J.G.)
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (T.K.)
| | - Omar K Khalique
- DeMatteis Cardiovascular Institute; Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY (O.K.K.)
| | - Hasan Jilaihawi
- Division of Cardiology, Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, CA (H.J., R.R.M.)
| | - Miho Fukui
- Cardiothoracic Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (V.N.B., M.F.)
| | - Mahesh Madhavan
- Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY (M.M, M.B.L.)
| | - Busra Cangut
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY (B.C., G.H.L.T.)
| | - Katherine Harrington
- Department of Cardiothoracic Surgery, Baylor, Scott and White the Heart Hospital, Plano, TX (K.H., M.J.M.)
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA (V.H.T.)
| | - Raj R Makkar
- Division of Cardiology, Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, CA (H.J., R.R.M.)
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY (M.M, M.B.L.)
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor, Scott and White the Heart Hospital, Plano, TX (K.H., M.J.M.)
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY (B.C., G.H.L.T.)
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9
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Akuka A, Landes U, Manevich L, Rubinshtein R, Danenberg HD. Coronary Embolism After Transcatheter Aortic Valve Replacement-Case Series and Review of Literature. Am J Cardiol 2023; 205:234-240. [PMID: 37611416 DOI: 10.1016/j.amjcard.2023.07.137] [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: 06/22/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 08/25/2023]
Abstract
Periprocedural systemic embolism is a well-documented complication of transcatheter aortic valve replacement (TAVR). Although the most focus was given to cerebral embolism (which remains unpredictable, difficult to prevent, and a source of increased morbidity and mortality after TAVR), coronary embolism remains less investigated and potentially overlooked. This study provides a case series of 3 patients diagnosed with coronary embolism after TAVR in our institution over a 2-year period (3 of 297 cases, 1%) and a systematic literature review (4 studies; 19 case reports). Overall, coronary embolism associated with TAVR is frequently characterized by proximal vessel occlusion causing ST-elevation myocardial infarction and hemodynamic instability with lower mortality in the acute phase as compared with late coronary embolism. However, it often presents with distal vessel occlusion and minor symptoms that may be overlooked in the periprocedural period. In conclusion, we suggest that TAVR-associated coronary embolism has a much higher prevalence than previously documented. Further studies are warranted to properly assess the prevalence and impact of this phenomenon.
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Affiliation(s)
- Aviram Akuka
- Department of Cardiology, Wolfson Medical Center, Holon, Israel; School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Uri Landes
- Department of Cardiology, Wolfson Medical Center, Holon, Israel; School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Lisa Manevich
- Department of Cardiology, Wolfson Medical Center, Holon, Israel; School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ronen Rubinshtein
- Department of Cardiology, Wolfson Medical Center, Holon, Israel; School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Haim D Danenberg
- Department of Cardiology, Wolfson Medical Center, Holon, Israel; School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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10
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Akodad M, Meier D, Sellers S, de Backer O, Mylotte D, Landes U, Frawley C, Lynch L, Tang GHL, Sondergaard L, Wood DA, Webb JG, Sathananthan J. A bench study of balloon-expandable valves for the treatment of self-expanding valve failure. EUROINTERVENTION 2023; 19:93-102. [PMID: 36621917 PMCID: PMC10174185 DOI: 10.4244/eij-d-22-00769] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/08/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Coronary obstruction and access are concerns in patients undergoing redo transcatheter aortic valve implantation (TAVI). AIMS We sought to assess the neoskirt height, leaflet overhang, leaflet deflection,and transcatheter heart valve (THV) expansion and performance, at 2 different implant depths, of the SAPIEN 3 Ultra (S3U) within the ACURATE neo2 (ACn2) THV. METHODS An in vitro study was performed with a 23 mm S3U deployed within a small (S) ACn2 and a 26 mm S3U deployed within a medium (M) and a large (L) ACn2. The S3U outflow was positioned at the top of the ACn2 crown (low implant) and at the base of the commissural post of the ACn2 (high implant). Testing was performed under physiological conditions as per ISO-5840-3 standard. RESULTS The neoskirt height was shorter when the S3U outflow was positioned at a low implantation depth (S: 9.6 mm, M: 12.2 mm, L: 13.8 mm vs S: 15.2 mm, M: 15.1 mm, L: 17.8 mm ACn2 for high implants). Hydrodynamic performance was acceptable for all configurations. Leaflet overhang was <50% for all configurations except the low implant of the 26 mm S3U in the L ACn2 (77.6%). There was a gap from the side of the neoskirt to the outer border of the THV frame which was >2 mm for all configurations. The S3U was underexpanded for all configurations, and the achieved area was 77.9%-92.9% of the expected nominal area. CONCLUSIONS Redo TAVI with an S3U within an ACn2 has favourable hydrodynamics and moderate leaflet overhang. Importantly, the design of the ACn2 results in a neoskirt that is not deflected all the way to the outer dimensions of the THV, hence creating a space that facilitates coronary flow and access.
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Affiliation(s)
- Mariama Akodad
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, BC, Canada
- Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques-Cartier, Ramsay Santé, Massy, France
| | - David Meier
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, BC, Canada
| | - Stephanie Sellers
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, BC, Canada
| | - Ole de Backer
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Darren Mylotte
- Department of Cardiology, National University of Ireland, Galway, (NUIG), Galway, Ireland
| | - Uri Landes
- Edith Wolfson Medical Center, Holon, Israel and Tel-Aviv University, Tel-Aviv, Israel
| | | | - Lisa Lynch
- Boston Scientific Corporation, Marlborough, MA, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Lars Sondergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David A Wood
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, BC, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, BC, Canada
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11
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Landes U, Hochstadt A, Manevich L, Webb JG, Sathananthan J, Sievert H, Piayda K, Leon MB, Nazif TM, Blusztein D, Hildick-Smith D, Pavitt C, Thiele H, Abdel-Wahab M, Van Mieghem NM, Adrichem R, Sondergaard L, De Backer O, Makkar RR, Koren O, Pilgrim T, Okuno T, Kornowski R, Codner P, Finkelstein A, Loewenstein I, Barbash I, Sharon A, De Marco F, Montorfano M, Buzzatti N, Latib A, Scotti A, Kim WK, Hamm C, Nombela Franco L, Mangieri A, Schoels WH, Barbanti M, Bunc M, Akodad M, Rubinshtein R, Danenberg H. Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation: prognostic implications. Eur Heart J 2023; 44:1331-1339. [PMID: 36883599 DOI: 10.1093/eurheartj/ehad146] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 10/20/2022] [Revised: 02/15/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND AND AIMS Paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) is associated with increased morbidity and mortality. The effect of transcatheter interventions to treat PVR after the index TAVI was investigated. METHODS A registry of consecutive patients who underwent transcatheter intervention for ≥ moderate PVR after the index TAVI at 22 centers. Principal outcomes were residual aortic regurgitation (AR) and mortality at 1 year after PVR treatment. RESULTS A total of 201 patients were identified: 87 (43%) underwent redo-TAVI, 79 (39%) plug closure and 35 (18%) balloon valvuloplasty. Median TAVI-to-re-intervention time was 207 (35; 765) days. The failed valve was self-expanding in 129 (63.9%) patients. Most frequent devices utilized were a Sapien 3 valve for redo-TAVI (55, 64%), an AVP II as plug (33, 42%) and a True balloon for valvuloplasty (20, 56%). At 30 days, AR ≥ moderate persisted in 33 (17.4%) patients: 8 (9.9%) after redo-TAVI, 18 (25.9%) after plug and 7 (21.9%) after valvuloplasty (p=0.036). Overall mortality was 10 (5.0%) at 30 days and 29 (14.4%) at 1 year: 0, 8 (10.1%) and 2 (5.7%) at 30 days (p=0.010); and 11 (12.6%), 14 (17.7%) and 4 (11.4%) at 1 year (p=0.418), after redo-TAVI, plug and valvuloplasty, respectively. Regardless of treatment strategy, patients in whom AR was reduced to ≤ mild had lower mortality at 1 year compared to those with AR persisting ≥ moderate [11 (8.0%) vs. 6 (21.4%); p=0.007]. CONCLUSIONS This study describes the efficacy of transcatheter treatments for PVR after TAVI. Patients in whom PVR was successfully reduced had better prognosis. The selection of patients and optimal PVR treatment modality require further investigation.
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Affiliation(s)
- Uri Landes
- Edith Wolfson Medical Center, Holon, and Tel-Aviv University, Israel
| | - Aviram Hochstadt
- Edith Wolfson Medical Center, Holon, and Tel-Aviv University, Israel
| | - Lisa Manevich
- Edith Wolfson Medical Center, Holon, and Tel-Aviv University, Israel
| | - John G Webb
- Centre for Cardiovascular Innovation Centre for Heart Valve Innovation St Paul's and Vancouver General Hospital Vancouver, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation Centre for Heart Valve Innovation St Paul's and Vancouver General Hospital Vancouver, Canada
| | | | | | - Martin B Leon
- Columbia University Medical Center, New York, NY, USA
| | - Tamim M Nazif
- Columbia University Medical Center, New York, NY, USA
| | | | | | - Chris Pavitt
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | - Rik Adrichem
- Erasmus university medical center, Rotterdam, Netherlands
| | | | - Ole De Backer
- Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Raj R Makkar
- Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, California, USA
| | - Ofir Koren
- Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, California, USA
| | | | | | | | - Pablo Codner
- Rabin medical center, Tel-Aviv University, Israel
| | | | | | - Israel Barbash
- The Heart and Vascular Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Amir Sharon
- The Heart and Vascular Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Matteo Montorfano
- Interventional Cardiology Unit IRCCS San Raffaele Sientific Insitute, Milan, Italy
| | - Nicola Buzzatti
- Interventional Cardiology Unit IRCCS San Raffaele Sientific Insitute, Milan, Italy
| | - Azeem Latib
- Montefiore Medical Center, New York, NY, USA
| | | | | | | | - Luis Nombela Franco
- Cardiovascular Institute. Hospital Clínico San Carlos. IdISSC. Madrid, Spain
| | - Antonio Mangieri
- Invasive Cardiology, Humanitas Clinical and Research Center, IRCCS and department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Matjaz Bunc
- University Medical Centre Ljubljana, Slovenia
| | - Myriama Akodad
- Ramsay Santé, Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Massy, France
| | - Ronen Rubinshtein
- Edith Wolfson Medical Center, Holon, and Tel-Aviv University, Israel
| | - Haim Danenberg
- Edith Wolfson Medical Center, Holon, and Tel-Aviv University, Israel
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12
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Manevich L, Landes U, Gluzman Y, Welt M, Rubinshtein R, Danenberg HD. Thoracic Aorta Perforation Treated Conservatively After TAVR in a Patient With Extremely Tortuous Aorta. JACC Case Rep 2023; 5:101691. [PMID: 36523949 PMCID: PMC9745652 DOI: 10.1016/j.jaccas.2022.101691] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/05/2022] [Indexed: 06/17/2023]
Abstract
Aortic perforation is a rare complication of transcatheter aortic valve replacement associated with grim outcomes. Tortuous and calcified aortas increase the risk of aortic trauma and perforation. We report a case in which, despite massive thoracic bleeding, avoidance of thoracic aortic surgery resulted in clinical recovery. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Lisa Manevich
- Address for correspondence: Dr Lisa Manevich, Department of Cardiology, E. Wolfson Medical Center, Holon and Tel-Aviv University, Tel-Aviv 5822012, Israel.
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13
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Akodad M, Sathananthan J, Tzimas G, Salcudean H, Hensey M, Gulsin GS, Meier D, Anthony Chuang MY, Chatfield AG, Landes U, Blanke P, Sondergaard L, Payne GW, Lutter G, Puehler T, Wood DA, Webb JG, Leipsic JA, Sellers SL. Multimodality Imaging to Assess Leaflet Height in Mitral Bioprosthetic Valves: Implications for Mitral Valve-in-Valve Procedure. JACC Cardiovasc Imaging 2022; 15:1663-1665. [PMID: 36075626 DOI: 10.1016/j.jcmg.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 10/07/2021] [Revised: 12/23/2021] [Accepted: 01/06/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Mariama Akodad
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Georgios Tzimas
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Hannah Salcudean
- Cardiovascular Translational Laboratory, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mark Hensey
- Department of Cardiology, St James's Hospital, Dublin, Ireland
| | - Gaurav S Gulsin
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - David Meier
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ming-Yu Anthony Chuang
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew G Chatfield
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Uri Landes
- Department of Cardiology, Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Philipp Blanke
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Lars Sondergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Geoffrey W Payne
- Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Georg Lutter
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany; Department of Cardiac and Vascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Thomas Puehler
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany; Department of Cardiac and Vascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, Kiel, Germany
| | - David A Wood
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon A Leipsic
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie L Sellers
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, St. Paul's Hospital, Vancouver, British Columbia, Canada.
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14
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Landes U, Richter I, Danenberg H, Kornowski R, Sathananthan J, De Backer O, Søndergaard L, Abdel-Wahab M, Yoon SH, Makkar RR, Thiele H, Kim WK, Hamm C, Buzzatti N, Montorfano M, Ludwig S, Schofer N, Voigtlaender L, Guerrero M, El Sabbagh A, Rodés-Cabau J, Mesnier J, Okuno T, Pilgrim T, Fiorina C, Colombo A, Mangieri A, Eltchaninoff H, Nombela-Franco L, Van Wiechen MP, Van Mieghem NM, Tchétché D, Schoels WH, Kullmer M, Barbanti M, Tamburino C, Sinning JM, Al-Kassou B, Perlman GY, Ielasi A, Fraccaro C, Tarantini G, De Marco F, Witberg G, Redwood SR, Lisko JC, Babaliaros VC, Laine M, Nerla R, Finkelstein A, Eitan A, Jaffe R, Ruile P, Neumann FJ, Piazza N, Sievert H, Sievert K, Russo M, Andreas M, Bunc M, Latib A, Bruoha S, Godfrey R, Hildick-Smith D, Barbash I, Segev A, Maurovich-Horvat P, Szilveszter B, Spargias K, Aravadinos D, Nazif TM, Leon MB, Webb JG. Outcomes of Redo Transcatheter Aortic Valve Replacement According to the Initial and Subsequent Valve Type. JACC Cardiovasc Interv 2022; 15:1543-1554. [DOI: 10.1016/j.jcin.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 10/17/2022]
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15
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Meier D, Akodad M, Landes U, Barlow AM, Chatfield AG, Lai A, Tzimas G, Tang GH, Puehler T, Lutter G, Leipsic JA, Søndergaard L, Wood DA, Webb JG, Sellers SL, Sathananthan J. Coronary Access Following Redo TAVR. JACC Cardiovasc Interv 2022; 15:1519-1531. [DOI: 10.1016/j.jcin.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/18/2022] [Accepted: 05/03/2022] [Indexed: 10/17/2022]
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16
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Witberg G, Landes U, Talmor-Barkan Y, Richter I, Barbanti M, Valvo R, De Backer O, Ooms JF, Islas F, Marroquin L, Sedaghat A, Sugiura A, Masiero G, Armario X, Fiorina C, Arzamendi D, Santos-Martinez S, Fernández-Vázquez F, Baz JA, Steblovnik K, Mauri V, Adam M, Merdler I, Hein M, Ruile P, Codner P, Grasso C, Branca L, Estévez-Loureiro R, Benito-González T, Amat-Santos IJ, Mylotte D, Bunc M, Tarantini G, Nombela-Franco L, Søndergaard L, Van Mieghem NM, Finkelstein A, Kornowski R. Center Valve Preference and Outcomes of Transcatheter Aortic Valve Replacement: Insights From the AMTRAC Registry. JACC Cardiovasc Interv 2022; 15:1266-1274. [PMID: 35738747 DOI: 10.1016/j.jcin.2022.05.004] [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: 01/18/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Data on outcomes of transcatheter aortic valve replacement (TAVR) using balloon-expandable valves (BEVs) or self-expandable valves (SEVs) as well as the impact of center valve preference on these outcomes are limited. OBJECTIVES The aim of this study was to compare outcomes of TAVR procedures using third-generation BEVs and SEVs stratified by center valve preference. METHODS In a multicenter registry (n = 17), 13 centers exhibited valve preference (66.6%-90% of volume) and were included. Outcomes were compared between BEVs and SEVs stratified by center valve preference. RESULTS In total, 7,528 TAVR procedures (3,854 with SEVs and 3,674 with BEVs) were included. The mean age was 81 years, and the mean Society of Thoracic Surgeons score was 5.2. Baseline characteristics were similar between BEVs and SEVs. Need for pacemaker implantation was higher with SEVs at BEV- and SEV-dominant centers (17.8% vs 9.3% [P < 0.001] and 12.7% vs 10.0% [P = 0.036], respectively; HR: 1.51; P for interaction = 0.021), risk for cerebrovascular accident was higher with SEVs at BEV-dominant but not SEV-dominant centers (3.6% vs 1.1% [P < 0.001] and 2.2% vs 1.4% [P = 0.162]; HR: 2.08; P for interaction < 0.01). Aortic regurgitation greater than mild was more frequent with SEVs at BEV-dominant centers and similar with BEVs regardless of center dominance (5.2% vs 2.8% [P < 0.001] and 3.4% vs 3.7% [P = 0.504], respectively). Two-year mortality was higher with SEVs at BEV-dominant centers but not at SEV-dominant centers (21.9% vs 16.9% [P = 0.021] and 16.8% vs 16.5% [P = 0.642], respectively; HR: 1.20; P for interaction = 0.032). CONCLUSIONS Periprocedural outcomes, aortic regurgitation greater than mild, and 2-year mortality are worse when TAVR is performed using SEVs at BEV-dominant centers. Outcomes are similar regardless of valve type at SEV-dominant centers. The present results stress the need to account for this factor when comparing BEV and SEV outcomes. (The Aortic+Mitral Transcatheter [AMTRAC] Valve Registry; NCT04031274).
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Uri Landes
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Cardiology, Wolfson Medical Center, Holon, Israel
| | - Yeela Talmor-Barkan
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilan Richter
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Marco Barbanti
- Division of Cardiology, University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, University of Catania, Catania, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joris F Ooms
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fabian Islas
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Luis Marroquin
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | | | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Xavier Armario
- Department of Cardiology, Galway University Hospital, and National University of Ireland Galway, Galway, Ireland
| | | | - Dabit Arzamendi
- Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain
| | | | | | - Jose A Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Klemen Steblovnik
- Department of Cardiology, University Medical Center, Ljubljana, Slovenia
| | - Victor Mauri
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Germany
| | - Ilan Merdler
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Carmelo Grasso
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Cardiology, Wolfson Medical Center, Holon, Israel
| | - Luca Branca
- Cardiovascular Department, Spedali Civili, Brescia, Italy
| | | | | | | | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, and National University of Ireland Galway, Galway, Ireland
| | - Matjaz Bunc
- Department of Cardiology, University Medical Center, Ljubljana, Slovenia
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ariel Finkelstein
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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17
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Landes U, Morelli O, Danenberg H, Sathananthan J, Backer OD, Sondergaard L, Abdel-Wahab M, Yoon SH, Makkar RR, Thiele H, Kim WK, Hamm C, Guerrero M, Rodés-Cabau J, Okuno T, Pilgrim T, Mangieri A, Van Mieghem NM, Tchétché D, Schoels WH, Barbanti M, Sinning JM, Ielasi A, Tarantini G, De Marco F, Finkelstein A, Sievert H, Andreas M, Latib A, Godfrey R, Hildick-Smith D, Manevich L, Kornowski R, Nazif TM, Leon MB, Webb JG. Transcatheter aortic valve-in-valve implantation to treat aortic Para-valvular regurgitation after TAVI. Int J Cardiol 2022; 364:31-34. [PMID: 35700856 DOI: 10.1016/j.ijcard.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Para-valvular regurgitation (PVR) after transcatheter aortic valve (TAV) implantation is associated with increased mortality. Redo-TAVI may be applied to treat PVR, yet with unknown efficacy. We thought to assess redo-TAVI efficacy in reducing PVR using the Redo-TAVI registry (45 centers; 600 TAV-in-TAV cases). METHODS Patients were excluded if redo-TAVI was done urgently (N = 253), for isolated TAV stenosis (N = 107) or if regurgitation location at presentation remained undetermined (N = 123). The study group of patients with PVR (N = 70) were compared against patients with intra-valvular regurgitation (IVR) (N = 41). Echocardiographic examinations of 67 (60%) patients were reassessed in a core-lab for data accuracy validation. RESULTS Core-lab examination validated the jet location in 66 (98.5%) patients. At 30 days, the rate of residual AR ≥ moderate was 7 (10%) in the PVR cohort vs. 1 (2.4%) in the IVR cohort, p = 0.137. The rate of procedural success was 53 (75.7%) vs. 33 (80.5%), p = 0.561; procedural safety 51 (72.8%) vs. 31 (75.6%), p = 0.727; and mortality 2 (2.9%) vs. 1 (2.4%), p = 0.896 at 30 days and 7 (18.6%) vs. 2 (11.5%), p = 0.671 at 1 year, respectively. Of patients with residual PVR ≥ moderate at 30 days, 5/7 occurred after implanting balloon-expandable in self-expanding TAV and 2/7 after balloon-expandable in balloon-expandable TAV. CONCLUSIONS This study puts in perspective redo-TAVI efficacy and limitations to treat PVR after TAVI. Patient selection for this and other therapies for PVR needs further investigation.
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Affiliation(s)
- Uri Landes
- Edith Wolfson Medical Center, Holon, and Tel-Aviv University, Israel..
| | - Olga Morelli
- Rabin medical center, Tel-Aviv University, Israel
| | - Haim Danenberg
- Edith Wolfson Medical Center, Holon, and Tel-Aviv University, Israel
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation Centre for Heart Valve Innovation St Paul's and Vancouver General Hospital Vancouver, Canada
| | - Ole De Backer
- Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | | | - Sung-Han Yoon
- Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California., United States of America
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California., United States of America
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | | | - Antonio Mangieri
- Invasive Cardiology, Humanitas Clinical and Research Center, IRCCS and department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | | | | | - Marco Barbanti
- A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | | | | | | | | | | | | | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Azeem Latib
- Montefiore Medical Center, New York, NY, USA
| | - Rebecca Godfrey
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Lisa Manevich
- Edith Wolfson Medical Center, Holon, and Tel-Aviv University, Israel
| | | | - Tamim M Nazif
- Columbia University Medical Center, New York, NY, USA
| | - Martin B Leon
- Columbia University Medical Center, New York, NY, USA
| | - John G Webb
- Centre for Cardiovascular Innovation Centre for Heart Valve Innovation St Paul's and Vancouver General Hospital Vancouver, Canada
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18
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Witberg G, Landes U, Codner P, Barbanti M, Valvo R, De Backer O, Ooms JF, McInerney A, Masiero G, Werner P, Armario X, Fiorina C, Arzamendi D, Santos-Martinez S, Baz JA, Steblovnik K, Mauri V, Adam M, Merdler I, Hein M, Ruile P, Russo M, Musumeci F, Sedaghat A, Sugiura A, Grasso C, Branca L, Estévez-Loureiro R, Amat-Santos IJ, Mylotte D, Andreas M, Bunc M, Tarantini G, Nombela-Franco L, Søndergaard L, Van Mieghem NM, Finkelstein A, Kornowski R. Clinical outcomes of transcatheter aortic valve implantation in patients younger than 70 years rejected for surgery: the AMTRAC registry. EUROINTERVENTION 2022; 17:1289-1297. [PMID: 34673502 PMCID: PMC9743236 DOI: 10.4244/eij-d-21-00613] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The mean age of transcatheter aortic valve implantation (TAVI) patients is steadily decreasing. AIMS The aim of the study was to describe the characteristics, the indications for and the outcomes of TAVI in patients <70 years old. METHODS All patients undergoing TAVI (n=8,626) from the 18 participating centres between January 2007 and June 2020 were stratified by age (</>70). For patients <70, the indications for TAVI were extracted from Heart Team discussions and the baseline characteristics and mortality were compared between the two groups. RESULTS Overall, 640 (7.4%) patients were <70 (9.1% during 2018-2020, p<0.001); the mean age was 65.0±2.3 years. The younger patients were more often male, with bicuspid valves or needing valve-in-valve procedures. They had a higher prevalence of lung disease and diabetes. In 80.7% of cases, the Heart Team estimated an increased surgical risk and TAVI was selected, reflected by an STS score >4% in 20.4%. Five-year mortality was similar (29.4 vs 29.8%, HR 0.95, p=0.432) in the <70 and >70 groups. In the <70 group, mortality was higher for those referred for TAVI due to an increased surgical risk compared to those referred for other reasons (31.6 vs 24.5%, HR 1.23, p=0.021). Mortality was similar regardless of the STS stratum in patients judged by the Heart Team to be at increased surgical risk (32.6 vs 30.4%, HR 0.98, p=0.715). CONCLUSIONS Use of TAVI in patients <70 is becoming more frequent. The main reason for choosing TAVI is due to an increased surgical risk not adequately represented by the STS score. The outcomes for these patients are similar to those for older TAVI patients. Dedicated trials of TAVI/SAVR in younger patients are needed to guide decisions concerning expansion of TAVI indications. ((ClinicalTrials.gov: NCT04031274).
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Affiliation(s)
- Guy Witberg
- Division of Cardiology, Rabin Medical Centre, Petah-Tikva, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Landes
- Division of Cardiology, Rabin Medical Centre, Petah-Tikva, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pablo Codner
- Division of Cardiology, Rabin Medical Centre, Petah-Tikva, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marco Barbanti
- Division of Cardiology, University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, University of Catania, Catania, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joris F Ooms
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Angela McInerney
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Paul Werner
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Xavier Armario
- Department of Cardiology, University Hospital Galway, National University of Ireland, Galway, Ireland
| | | | - Dabit Arzamendi
- Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain
| | | | - Jose A Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Klemen Steblovnik
- Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | - Victor Mauri
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Matti Adam
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ilan Merdler
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | | | | | | | - Carmelo Grasso
- Division of Cardiology, University of Catania, Catania, Italy
| | - Luca Branca
- Cardiovascular Department, Spedali Civili, Brescia, Italy
| | | | | | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Martin Andreas
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Matjaž Bunc
- Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ariel Finkelstein
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ran Kornowski
- Division of Cardiology, Rabin Medical Centre, Petah-Tikva, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Levi A, Kheifets M, Bental T, Perl L, Codner P, Witberg G, Talmor-Barkan Y, Landes U, Samara A, Greenberg G, Erez A, Vaknin-Assa H, Kornowski R. Biodegradable polymer drug-eluting stents versus durable polymer drug-eluting stents for percutaneous coronary intervention: a contemporary registry-based analysis. Coron Artery Dis 2022; 33:105-113. [PMID: 34074911 DOI: 10.1097/mca.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS We aimed to compare the long-term outcomes of patients undergoing percutaneous coronary intervention (PCI) with biodegradable polymer drug-eluting stents (BP-DES) versus durable polymer drug-eluting stents (DP-DES). METHODS AND RESULTS Among 11 517 PCIs with second-generation DES performed in our institution between 2007 and 2019, we identified 8042 procedures performed using DP-DES and 3475 using BP-DES. The primary outcome was target lesion failure, the composite target lesion revascularization (TLR), target vessel myocardial infarction and death. Propensity score matching was used to create a well-balanced cohort. Mean follow-up was 4.8 years. Of the 3413 matched pairs, 21% were females, and the mean age was 66 years. At 1 year, the primary outcome occurred in 8.3% patients versus 7.1% (P = 0.07), and TLR rate was 3% versus 2% (P = 0.006) in patients with DP-DES and BP-DES respectively. Within 5 years, the primary outcome occurred in 23.1% versus 23.4% (P = 0.44), and the rate of TLR was 7.2% versus 6.5% (P = 0.07) in patients with DP-DES and BP-DES, respectively. CONCLUSION Similar rates of the composite outcome were observed throughout the entire follow-up. Target lesion revascularization rates were lower in the BP-DES group at 1-year but equalized within 5 years.
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Affiliation(s)
- Amos Levi
- Department of Cardiology, Rabin Medical Center, Petach Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Akodad M, Sellers S, Landes U, Meier D, Tang GHL, Gada H, Rogers T, Caskey M, Rutkin B, Puri R, Rovin J, Leipsic J, Sondergaard L, Grubb KJ, Gleason P, Garde K, Tadros H, Teodoru S, Wood DA, Webb JG, Sathananthan J. Balloon-Expandable Valve for Treatment of Evolut Valve Failure: Implications on Neoskirt Height and Leaflet Overhang. JACC Cardiovasc Interv 2022; 15:368-377. [PMID: 35210043 DOI: 10.1016/j.jcin.2021.12.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [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: 10/04/2021] [Revised: 11/26/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study sought to determine the degree of Evolut (Medtronic) leaflet pinning, diameter expansion, leaflet overhang, and performance at different implant depths of the balloon-expandable Sapien 3 (S3, Edwards Lifesciences LLC) transcatheter heart valve (THV) within the Evolut THV. BACKGROUND Preservation of coronary access and flow is a major factor when considering the treatment of failed Evolut THVs. METHODS An in vitro study was performed with 20-, 23-, 26-, and 29-mm S3 THVs deployed within 23-, 26-, 29-, and 34-mm Evolut R THVs, respectively. The S3 outflow was positioned at various depths at node 4, 5, and 6 of the Evolut R. Neoskirt height, leaflet overhang, performance, and Evolut R valve housing diameter expansion were assessed under physiological conditions as per ISO 5840-3 standard. RESULTS The neoskirt height for the Evolut R was shorter when the S3 outflow was positioned at node 4 compared with node 6 (node 4 height for 23 mm = 16.3 mm, 26 mm = 17.1 mm, 29 mm = 18.3 mm, and 34 mm = 19.9 mm vs node 6 height for 23 mm = 23.9 mm, 26 mm = 23.4 mm, 29 mm = 24.7 mm, and 34 mm = 27 mm Evolut R). All configurations exhibited acceptable hydrodynamic performance irrespective of the degree of leaflet overhang, except the 29-mm S3 implanted in 34-mm Evolut R at node 4 (regurgitant fraction >20%). The valve housing radius of the index Evolut R increased when the S3 was implanted, with the increase ranging from 0 to 2.5 mm. CONCLUSIONS Placement of the S3 at a lower implant position within an index Evolut R reduces the neoskirt height with no significant compromise to S3 valve function despite a higher degree of leaflet overhang. Low S3 implantation may facilitate future coronary access after redo transcatheter aortic valve replacement.
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Affiliation(s)
- Mariama Akodad
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - Stephanie Sellers
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - Uri Landes
- Edith Wolfson Medical Center, Holon, Israel; Tel-Aviv University, Tel-Aviv, Israel
| | - David Meier
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Hemal Gada
- Department of Cardiothoracic Surgery, Pinnacle Health, Harrisburg, Pennsylvania, USA
| | - Toby Rogers
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Michael Caskey
- Department of Cardiovascular Surgery, Abrazo Arizona Heart Hospital, Phoenix, Arizona, USA
| | - Bruce Rutkin
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joshua Rovin
- Department of Cardiovascular and Thoracic Surgery, Morton Plant Hospital, BayCare Health System, Clearwater, Florida, USA
| | - Jonathon Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - Lars Sondergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patrick Gleason
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Kshitija Garde
- Research and Development, Structural Heart & Aortic, Medtronic, Santa Ana, California, USA
| | - Hatem Tadros
- Research and Development, Structural Heart & Aortic, Medtronic, Santa Ana, California, USA
| | - Sebastian Teodoru
- Research and Development, Structural Heart & Aortic, Medtronic, Santa Ana, California, USA
| | - David A Wood
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada.
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21
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Moscarella E, Mangieri A, Giannini F, Tchetchè D, Kim WK, Sinning JM, Landes U, Kornowski R, Backer OD, Nickenig G, Biase CD, Soendergaard L, Marco FD, Bedogni F, Ancona M, Montorfano M, Regazzoli D, Stefanini G, Toggweiler S, Tamburino C, Immè S, Tarantini G, Sievert H, Schaefer U, Kempfert J, Woehrle J, Latib A, Calabrò P, Medda M, Tespili M, Colombo A, Ielasi A. 90 Annular size and interaction with trans-catheter aortic valves for the treatment of severe bicuspid aortic valve stenosis: insights from the beat registry. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Transcatheter aortic valve replacement (TAVR) is safe and feasible in patients with bicuspid aortic valve (BAV), but whether annular size may influence TAVR results in BAV patients remains unclear. We aimed at evaluating the impact of aortic annular size on procedural and clinical outcomes of BAV patients undergoing TAVR, as well as potential interactions between annular dimension and trans-catheter heart valve (THV) type [balloon-expandable (BEV) vs. self-expanding (SEV)].
Methods and results
BEAT is a multicentre registry of consecutive BAV stenosis undergoing TAVR. For this sub-study patients were classified according to annular dimension in small-annulus (area < 400 mm2 or perimeter <72 mm), medium-annulus (area ≥ 400 and < 575 mm2, perimeter ≥72 mm and< 85 mm), large-annulus (area ≥575 mm2 or perimeter ≥85 mm). Primary endpoint was Valve Academic Research Consortium-2 (VARC-2) device success. 45(15.5%) patients had small, 132(45.3%) medium, and 114(39.2%) large annuli. Compared with other groups, patients with large annuli were more frequently male, at younger age, had higher body mass index, larger aortic valve area, higher rate of moderate-severe calcification, lower mean trans-aortic valve gradient and lower left ventricular ejection fraction. In large-annuli SEVs were associated with a lower VARC-2 device success (75.9% vs. 90.6%, P = 0.049) driven by a higher rate of paravalvular valvular leak (PVL) compared to BEVs (20.7% vs. 1.2%, P < 0.001). However, no differences in clinical outcomes were observed according to annular size nor THV type.
Conclusions
TAVR in BAV patients is feasible irrespective of annular size. However in patients with large aortic annulus SEVs were associated with a significantly higher rate of PVLs compared to BEVs.
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22
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Moscarella E, Mangieri A, Giannini F, Tchetchè D, Kim WK, Sinning JM, Landes U, Kornowski R, De Backer O, Nickenig G, De Biase C, Søndergaard L, De Marco F, Bedogni F, Ancona M, Montorfano M, Regazzoli D, Stefanini G, Toggweiler S, Tamburino C, Immè S, Tarantini G, Sievert H, Schäfer U, Kempfert J, Wöehrle J, Latib A, Calabrò P, Medda M, Tespili M, Colombo A, Ielasi A. Annular size and interaction with trans-catheter aortic valves for treatment of severe bicuspid aortic valve stenosis: Insights from the BEAT registry. Int J Cardiol 2021; 349:31-38. [PMID: 34843819 DOI: 10.1016/j.ijcard.2021.11.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/15/2021] [Accepted: 11/24/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is safe and feasible in patients with bicuspid aortic valve (BAV), but whether annular size may influence TAVR results in BAV patients remains unclear. We aimed at evaluating the impact of aortic annular size on procedural and clinical outcomes of BAV patients undergoing TAVR, as well as potential interactions between annular dimension and trans-catheter heart valve (THV) type (balloon-expandable (BEV) vs. self-expanding (SEV). METHODS BEAT is a multicenter registry of consecutive BAV stenosis undergoing TAVR. For this sub-study patients were classified according to annular dimension in small-annulus (area < 400 mm2 or perimeter <72 mm), medium-annulus (area ≥ 400 and < 575 mm2, perimeter ≥72 mm and< 85 mm), large-annulus (area ≥ 575 mm2 or perimeter ≥85 mm). Primary endpoint was Valve Academic Research Consortium-2 (VARC-2) device success. RESULTS 45(15.5%) patients had small, 132(45.3%) medium, and 114(39.2%) large annuli. Compared with other groups, patients with large annuli were more frequently male, younger, with higher body mass index, larger aortic valve area, higher rate of moderate-severe calcification, lower mean trans-aortic valve gradient and lower left ventricular ejection fraction. In large-annuli SEVs were associated with a lower VARC-2 device success (75.9% vs. 90.6%, p = 0.049) driven by a higher rate of paravalvular valvular leak (PVL) compared to BEVs (20.7% vs. 1.2%, p < 0.001). However, no differences in clinical outcomes were observed according to annular size nor THV type. CONCLUSIONS TAVR in BAV patients is feasible irrespective of annular size. However in patients with large aortic annulus SEVs were associated with a significantly higher rate of PVLs compared to BEVs.
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Affiliation(s)
- Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Francesco Giannini
- Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
| | | | - Uri Landes
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ole De Backer
- The Heart Center-Rigshospitalet, Copenhagen, Denmark
| | - Georg Nickenig
- Cardiology Department, University Hospital Bonn, Bonn, Germany
| | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | | | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | | | - Corrado Tamburino
- Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy
| | | | | | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, United Kingdom
| | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, NY, United States of America; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Massimo Medda
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Antonio Colombo
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France; EMO GVM Centro Cuore Columbus, Milan, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy.
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Ielasi A, Moscarella E, Mangieri A, Giannini F, Tchetche D, Kim WK, Sinning JM, Landes U, Kornowski R, de Backer O, Nickenig G, de Biase C, Sondergaard L, de Marco F, Bedogni F, Ancona M, Montorfano M, Regazzoli D, Stefanini G, Toggweiler S, Tamburino C, Immè S, Tarantini G, Sievert H, Schaefer U, Kempfert J, Latib A, Calabrò P, Medda M, Tespili M, Colombo A. TCT-235 Annular Size and Its Interaction With Self-Expandable Versus Balloon-Expandable Transcatheter Heart Valves for the Treatment of Patients With Severe Bicuspid Aortic Valve Stenosis: Insights from the BEAT Registry. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Akodad M, Sellers S, Gulsin GS, Tzimas G, Landes U, Chatfield AG, Chuang A, Meier D, Leipsic J, Blanke P, Ye J, Cheung A, Wood DA, Khan JM, Webb JG, Sathananthan J. Leaflet and Neoskirt Height in Transcatheter Heart Valves: Implications for Repeat Procedures and Coronary Access. JACC Cardiovasc Interv 2021; 14:2298-2300. [PMID: 34600879 DOI: 10.1016/j.jcin.2021.07.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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] [Received: 06/16/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Mariama Akodad
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Sellers
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Gaurav S Gulsin
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Georgios Tzimas
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Uri Landes
- Department of Cardiology, Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Andrew G Chatfield
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Chuang
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Meier
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon Leipsic
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Philippe Blanke
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Jian Ye
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anson Cheung
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - John G Webb
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, St. Paul's Hospital, Vancouver, British Columbia, Canada.
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Schamroth Pravda N, Codner P, Vaknin Assa H, Vitberg G, Perl L, Shapira Y, Levi A, Mishaev R, Talmor Barkan Y, Sharoni R, Hamdan A, Landes U, Kornowski R. Long term outcomes of patients with aortic structural valve deterioration treated with transcatheter valve in valve implantation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The Valve-in-Valve (ViV) technique is an established alternative for the treatment of structural bioprosthetic valve deterioration (SVD). Data describing the long term follow up of patients treated with this approach is scarce. We report on our long-term follow up outcomes of patients with SVD in the Aortic position treated with ViV.
Methods
Included were patients with symptomatic SVD in the aortic position valve who were treated by Valve in valve transcatheter aortic valve implantation (ViV-TAVI) during the years 20102019 in our center. Three main outcomes were examined during follow up: NYHA functional class, hemodynamic of the VIV-TAVI per echocardiography, and overall mortality.
Results
Our cohort consisted of 84 patients (mean age 78.8±8.9 years). The indications for aortic ViV were: SVD isolated aortic stenosis in 37.6%, SVD isolated aortic regurgitation in 42.2% and combined valve pathology in 20.0%. Self-expandable and balloon-expandable devices were used in 73 (85.9%) and 12 (14.1%), respectively. Average time of follow up was 3.74±2.4 years. 95% and 91% of patients were in NYHA functional class I/II at 1 and 5 year follow up respectively. At one year the mean trans-aortic valve pressure was 15.3±9.3 and rates of ≥ moderate aortic regurgitation were 3.7%. Survival was 91.4% (95% CI 85.6–97.7) at one year and 79.5% (95% CI 70.2–90.0) at 3 years.
Conclusion
ViV in the aortic position offers an effective and durable treatment option for patient with SVD, with low rates of all-cause mortality, excellent hemodynamic and improved functional capacity at 3 years follow up.
Funding Acknowledgement
Type of funding sources: None. NYHA functional class over follow up
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Affiliation(s)
| | - P Codner
- Rabin Medical Center, Petah Tikva, Israel
| | | | - G Vitberg
- Rabin Medical Center, Petah Tikva, Israel
| | - L Perl
- Rabin Medical Center, Petah Tikva, Israel
| | - Y Shapira
- Rabin Medical Center, Petah Tikva, Israel
| | - A Levi
- Rabin Medical Center, Petah Tikva, Israel
| | - R Mishaev
- Tel Aviv University, Sackler Medical School, Tel Aviv, Israel
| | | | - R Sharoni
- Rabin Medical Center, Petah Tikva, Israel
| | - A Hamdan
- Rabin Medical Center, Petah Tikva, Israel
| | - U Landes
- Rabin Medical Center, Petah Tikva, Israel
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26
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Kheifets M, Levi A, Bental T, Perl L, Codner P, Wittberg G, Talmor-Barkan Y, Landes U, Samara A, Greenberg G, Erez A, Vaknin-Assa H, Kornowski R. Biodegradable polymer drug eluting stents versus durable polymer drug eluting stents for percutaneous coronary intervention. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Invasive angiography with subsequent revascularization is a widely used treatment method in patients with coronary heart disease. Although biodegradable polymer drug eluting stents (BP-DES) have been used for almost a decade now, clinical trials regarding their long-term outcomes are both sparse and inconsistent. We aimed to compare the long-term outcomes of patients undergoing percutaneous coronary intervention (PCI) with BP-DES versus durable polymer drug eluting stents (DP-DES).
Methods
Among 11,517 PCIs with second generation drug eluting stents preformed in our institution between 2007 and 2019, we identified 8042 procedures performed using DP-DES and 3475 using BP-DES. The primary outcome was the composite of all-cause mortality, recurrent myocardial infarction (re-MI), target vessel revascularization (TVR) and coronary artery bypass grafting (CABG). Propensity score matching was used to create a well-balanced cohort.
Results
Mean follow up was 4.8 years. Of the 3,413 matched pairs, 21% were females, and the mean age was 66. At one year, the primary outcome occurred in 9.6% patients versus 8.3% (p=0.05), and TVR rate was 4.1% versus 3% (p=0.005) in patients with DP-DES and BP-DES respectively. Within 5 years, the primary outcome occurred in in 24.9% versus 24.8% (p=0.83), and the rate of TVR was 9.8% versus 9.1% (p=0.07) in patients with DP-DES and BP-DES respectively.
Conclusions
Similar rates of the composite outcome were observed throughout the entire follow-up. TVR rates were lower in the DP-DES group at 1-year but equalized within 5 years.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Kheifets
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - A Levi
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - T Bental
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - L Perl
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - P Codner
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - G Wittberg
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | | | - U Landes
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - A Samara
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - G Greenberg
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - A Erez
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - H Vaknin-Assa
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - R Kornowski
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
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27
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Schamroth Pravda N, Kornowski R, Levi A, Witberg G, Landes U, Perl L, Shapira Y, Orvin K, Mishaev R, Talmor Barkan Y, Hamdan A, Sharoni R, Vaknin Assa H, Codner P. 5 Year Outcomes of Patients With Aortic Structural Valve Deterioration Treated With Transcatheter Valve in Valve - A Single Center Prospective Registry. Front Cardiovasc Med 2021; 8:713341. [PMID: 34568456 PMCID: PMC8458695 DOI: 10.3389/fcvm.2021.713341] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/17/2021] [Indexed: 12/03/2022] Open
Abstract
The Valve-in-Valve (ViV) technique is an established alternative for the treatment of structural bioprosthetic valve deterioration (SVD). Data describing the intermediate term follow up of patients treated with this approach is scarce. We report on our intermediate-term outcomes of patients with SVD in the Aortic position treated with ViV. Included were patients with symptomatic SVD in the aortic position valve who were treated by Valve in valve transcatheter aortic valve implantation (ViV-TAVI) during the years 2010-2019 in our center. Three main outcomes were examined during the follow up period: NYHA functional class, ViV-TAVI hemodynamic per echocardiography, and mortality. Our cohort consisted of 85 patients (mean age 78.8 ± 8.9 years). The indications for aortic ViV were: SVD isolated aortic stenosis in 37.6%, SVD isolated aortic regurgitation in 42.2% and combined valve pathology in 20.0%. Self-expandable and balloon-expandable devices were used in 73 (85.9%) and 12 (14.1%), respectively. Average follow up was 3.7 ± 2.4 years. 95 and 91% of patients were in NYHA functional class I/II at 1 and 5 year follow up respectively. At one year, the mean trans-aortic valve pressure was 15 ± 9 mmHg and rates of ≥ moderate aortic regurgitation were 3.7%. Mortality at one year was 8.6% (95% CI 2.3–14.4) and 31% (95% CI 16.5–42.5) at 5 years. ViV in the aortic position offers an effective and durable treatment option for patient with SVD, with low rates of all-cause mortality, excellent hemodynamic and improved functional capacity at intermediate follow up.
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Affiliation(s)
- Nili Schamroth Pravda
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Landes
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Shapira
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katia Orvin
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raffael Mishaev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yeela Talmor Barkan
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Sharoni
- Cardio-Thoracic Surgery Department, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin Assa
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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28
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Witberg G, Codner P, Landes U, Barbanti M, Valvo R, De Backer O, Ooms JF, Sievert K, El Sabbagh A, Jimenez-Quevedo P, Brennan PF, Sedaghat A, Masiero G, Werner P, Overtchouk P, Watanabe Y, Montorfano M, Bijjam VR, Hein M, Fiorina C, Arzamendi D, Rodriguez-Gabella T, Fernández-Vázquez F, Baz JA, Laperche C, Grasso C, Branca L, Estévez-Loureiro R, Benito-González T, Amat Santos IJ, Ruile P, Mylotte D, Buzzatti N, Piazza N, Andreas M, Tarantini G, Sinning JM, Spence MS, Nombela-Franco L, Guerrero M, Sievert H, Sondergaard L, Van Mieghem NM, Tchetche D, Webb JG, Kornowski R. Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry. JACC Cardiovasc Interv 2021; 13:2782-2791. [PMID: 33303117 DOI: 10.1016/j.jcin.2020.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 04/23/2020] [Revised: 06/01/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit. BACKGROUND The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging. METHODS This was an international registry of 23 TAVR centers. RESULTS In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05). CONCLUSIONS For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274).
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Landes
- Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Marco Barbanti
- Division of Cardiology, University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, University of Catania, Catania, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joris F Ooms
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Abdallah El Sabbagh
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | | | - Paul F Brennan
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom
| | | | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Paul Werner
- Division of Cardiac Surgery Medical University of Vienna, Vienna, Austria
| | - Pavel Overtchouk
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Matteo Montorfano
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan Italy
| | - Venu Reddy Bijjam
- Department of Cardiology, University Hospital, and National University of Ireland Galway, Galway, Ireland
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Dabit Arzamendi
- Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain
| | | | | | - Jose A Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Clemence Laperche
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Carmelo Grasso
- Division of Cardiology, University of Catania, Catania, Italy
| | - Luca Branca
- Cardiovascular Department, Spedali Civili, Brescia, Italy
| | | | | | | | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Darren Mylotte
- Department of Cardiology, University Hospital, and National University of Ireland Galway, Galway, Ireland
| | - Nicola Buzzatti
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan Italy
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Martin Andreas
- Division of Cardiac Surgery Medical University of Vienna, Vienna, Austria
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | | | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - Luis Nombela-Franco
- Cardiovascular Institute. Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, United Kingdom; University of California San Francisco, San Francisco, California, USA; Yunnan Hospital Fuwai, Kunming, China
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Didier Tchetche
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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29
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Landes U, Witberg G, Sathananthan J, Kim WK, Codner P, Buzzatti N, Montorfano M, Godfrey R, Hildick-Smith D, Fraccaro C, Tarantini G, De Backer O, Sondergaard L, Okuno T, Pilgrim T, Rodés-Cabau J, Jaffe R, Eitan A, Sinning JM, Ielasi A, Eltchaninoff H, Maurovich-Horvat P, Merkely B, Guerrero M, El Sabbagh A, Ruile P, Barbanti M, Redwood SR, Van Mieghem NM, Van Wiechen MPH, Finkelstein A, Bunc M, Leon MB, Kornowski R, Webb JG. Incidence, Causes, and Outcomes Associated With Urgent Implantation of a Supplementary Valve During Transcatheter Aortic Valve Replacement. JAMA Cardiol 2021; 6:936-944. [PMID: 34009236 DOI: 10.1001/jamacardio.2021.1145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Transcatheter aortic valve replacement (TAVR) failure is often managed by an urgent implantation of a supplementary valve during the procedure (2-valve TAVR [2V-TAVR]). Little is known about the factors associated with or sequelae of 2V-TAVR. Objective To examine the incidence, causes, and outcomes of 2V-TAVR. Design, Setting, and Participants A retrospective cohort study was performed using data from an international registry of 21 298 TAVR procedures performed from January 1, 2014, through February 28, 2019. Among the 21 298 patients undergoing TAVR, 223 patients (1.0%) undergoing 2V-TAVR were identified. Patient-level data were available for all the patients undergoing 2V-TAVR and for 12 052 patients (56.6%) undergoing 1V-TAVR. After excluding patients with missing 30-day follow-up or data inconsistencies, 213 2V-TAVR and 10 010 1V-TAVR patients were studied. The 2V-TAVR patients were compared against control TAVR patients undergoing a 1-valve TAVR (1V-TAVR) using 1:4 17 propensity score matching. Final analysis included 1065 (213:852) patients. Exposures Urgent implantation of a supplementary valve during TAVR. Main Outcomes and Measures Mortality at 30 days and 1 year. Results The 213 patients undergoing 2V-TAVR had similar age (mean [SD], 81.3 [0.5] years) and sex (110 [51.6%] female) as the 10 010 patients undergoing 1V-TAVR (mean [SD] age, 81.2 [0.5] years; 110 [51.6%] female). The 2V-TAVR incidence decreased from 2.9% in 2014 to 1.0% in 2018 and was similar between repositionable and nonrepositionable valves. Bicuspid aortic valve (odds ratio [OR], 2.20; 95% CI, 1.17-4.15; P = .02), aortic regurgitation of moderate or greater severity (OR, 2.02; 95% CI, 1.49-2.73; P < .001), atrial fibrillation (OR, 1.43; 95% CI, 1.07-1.93; P = .02), alternative access (OR, 2.59; 95% CI, 1.72-3.89; P < .001), early-generation valve (OR, 2.32; 95% CI, 1.69-3.19; P < .001), and self-expandable valve (OR, 1.69; 95% CI, 1.17-2.43; P = .004) were associated with higher 2V-TAVR risk. In 165 patients (80%), the supplementary valve was implanted because of residual aortic regurgitation after primary valve malposition (94 [46.4%] too high and 71 [34.2%] too low). In the matched 2V-TAVR vs 1V-TAVR cohorts, the rate of device success was 147 (70.4%) vs 783 (92.2%) (P < .001), the rate of coronary obstruction was 5 (2.3%) vs 3 (0.4%) (P = .10), stroke rate was 9 (4.6%) vs 13 (1.6%) (P = .09), major bleeding rates were 25 (11.8%) vs 46 (5.5%) (P = .03) and annular rupture rate was 7 (3.3%) vs 3 (0.4%) (P = .03). The hazard ratios for mortality were 2.58 (95% CI, 1.04-6.45; P = .04) at 30 days, 1.45 (95% CI, 0.84-2.51; P = .18) at 1 year, and 1.20 (95% CI, 0.77-1.88; P = .42) at 2 years. Nontransfemoral access and certain periprocedural complications were independently associated with higher risk of death 1 year after 2V-TAVR. Conclusions and Relevance In this cohort study, valve malposition was the most common indication for 2V-TAVR. Incidence decreased over time and was low overall, although patients with a bicuspid or regurgitant aortic valve, nontransfemoral access, and early-generation or self-expandable valve were at higher risk. These findings suggest that compared with 1V-TAVR, 2V-TAVR is associated with high burden of complications and mortality at 30 days but not at 1 year.
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Affiliation(s)
- Uri Landes
- Department of Cardiology, Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Witberg
- Department of Cardiology, Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Janarthanan Sathananthan
- Department of Cardiology, Centres for Heart Valve and Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Nicola Buzzatti
- Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Rebecca Godfrey
- Department of Cardiology, Brighton & Sussex University Hospitals, National Health Service Trust, Brighton, United Kingdom
| | - David Hildick-Smith
- Department of Cardiology, Brighton & Sussex University Hospitals, National Health Service Trust, Brighton, United Kingdom
| | - Chiara Fraccaro
- Department of Cardiology, University Hospital of Padova, Padova, Italy
| | | | - Ole De Backer
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Sondergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Taishi Okuno
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Ronen Jaffe
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Amnon Eitan
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | | | - Alfonso Ielasi
- Department of Cardiology, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Helene Eltchaninoff
- Department of Cardiology, Hospital Center University De Rouen, Normandy University, Rouen, France
| | - Pál Maurovich-Horvat
- Department of Cardiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Bela Merkely
- Department of Cardiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Mayra Guerrero
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota
| | | | - Philipp Ruile
- Department of Cardiology, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Marco Barbanti
- Department of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco," Catania, Italy
| | - Simon R Redwood
- Department of Cardiology, St Thomas' Hospital Campus, London, United Kingdom
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Maarten P H Van Wiechen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ariel Finkelstein
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Department of Cardiology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Matjaz Bunc
- Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | - Martin B Leon
- Department of Cardiology, Columbia University Medical Center, New York, New York
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - John G Webb
- Department of Cardiology, Centres for Heart Valve and Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
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Percy ED, Harloff MT, Hirji S, McGurk S, Yazdchi F, Newell P, Malarczyk A, Sabe A, Landes U, Webb J, Reardon MJ, Thourani VH, Tang GHL, Bapat V, Bhatt D, O'Gara P, Gleason T, Shah P, Kaneko T. Nationally Representative Repeat Transcatheter Aortic Valve Replacement Outcomes: Report From the Centers for Medicare and Medicaid Services. JACC Cardiovasc Interv 2021; 14:1717-1726. [PMID: 34353602 DOI: 10.1016/j.jcin.2021.06.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/01/2021] [Accepted: 06/15/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim of this study was to examine real-world experience with repeat transcatheter aortic valve replacement (TAVR) in a population-based national database. BACKGROUND Repeat TAVR is a growing option in patients requiring reintervention for TAVR. However, large-scale studies with longitudinal follow-up are limited. METHODS All Medicare beneficiaries who underwent TAVR from 2012 to 2017 were included. Outcomes included 30-day and longitudinal mortality and major adverse cardiovascular events, defined as death, stroke, pacemaker insertion, major bleeding, acute kidney injury, or cardiac arrest. Outcomes of repeat TAVR were compared with surgical explantation after TAVR (TAVR explantation) in a matched analysis. RESULTS Of 133,250 patients who underwent TAVR, 617 (0.46%) underwent subsequent repeat TAVR at a median interval of 154 days (interquartile range: 58-537 days). Mortality at 30 days and 1 year was 6.0% and 22.0%, respectively. Rates of 30-day stroke and pacemaker insertion were 1.8% and 4.2%. Mortality at 30 days was lower in those who underwent their first TAVR during the later era (2015-2017) compared with earlier years (2012-2014) (4.6% vs 8.7%; P = 0.049). Repeat TAVR was associated with lower 30-day mortality compared with a matched group undergoing TAVR explantation (6.2% vs 12.3%; P = 0.05), although 1-year mortality was similar (21.0% vs 20.8%; P = 1.000). The incidence of 30-day major adverse cardiovascular events was higher with TAVR explantation compared with repeat TAVR (risk ratio: 2.92; 95% CI: 1.88-4.99; P ≤ 0.001). CONCLUSIONS Repeat TAVR was performed with acceptable 30-day mortality in this high-risk population. Short-term outcomes were superior to surgical explantation, but 1-year outcomes were similar. Repeat TAVR will likely be an important option for aortic valve reintervention after TAVR.
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Affiliation(s)
- Edward D Percy
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Morgan T Harloff
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sameer Hirji
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Siobhan McGurk
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Farhang Yazdchi
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paige Newell
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra Malarczyk
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashraf Sabe
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Uri Landes
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, Texas, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vinayak Bapat
- Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Deepak Bhatt
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick O'Gara
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Gleason
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pinak Shah
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Kim WK, Pellegrini C, Ludwig S, Möllmann H, Leuschner F, Makkar R, Leick J, Amat-Santos IJ, Dörr O, Breitbart P, Jimenez Diaz VA, Dabrowski M, Rudolph T, Avanzas P, Kaur J, Toggweiler S, Kerber S, Ranosch P, Regazzoli D, Frank D, Landes U, Webb J, Barbanti M, Purita P, Pilgrim T, Liska B, Tabata N, Rheude T, Seiffert M, Eckel C, Allali A, Valvo R, Yoon SH, Werner N, Nef H, Choi YH, Hamm CW, Sinning JM. Feasibility of Coronary Access in Patients With Acute Coronary Syndrome and Previous TAVR. JACC Cardiovasc Interv 2021; 14:1578-1590. [PMID: 34294400 DOI: 10.1016/j.jcin.2021.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 03/22/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to characterize the feasibility of coronary angiography (CA) and percutaneous coronary intervention (PCI) in acute settings among patients who have undergone transcatheter aortic valve replacement (TAVR). BACKGROUND Impaired coronary access after TAVR may be challenging and particularly in acute settings could have deleterious consequences. METHODS In this international registry, data from patients with prior TAVR requiring urgent or emergent CA were retrospectively collected. A total of 449 patients from 25 sites with acute coronary syndromes (89.1%) and other acute cardiovascular situations (10.9%) were included. RESULTS Success rates were high for CA of the right coronary artery (98.3%) and left coronary artery (99.3%) and were higher among patients with short stent-frame prostheses (SFPs) than in those with long SFPs for CA of the right coronary artery (99.6% vs 95.9%; P = 0.005) but not for CA of the left coronary artery (99.7% vs 98.7%; P = 0.24). PCI of native coronary arteries was successful in 91.4% of cases and independent of valve type (short SFP 90.4% vs long SFP 93.4%; P = 0.44). Guide engagement failed in 6 patients, of whom 3 underwent emergent coronary artery bypass grafting and another 3 died in the hospital. Among patients requiring revascularization of native vessels, independent predictors of 30-day all-cause mortality were prior diabetes, cardiogenic shock, and failed PCI but not valve type or success of coronary engagement. CONCLUSIONS CA or PCI after TAVR in acute settings is usually successful, but selective coronary engagement may be more challenging in the presence of long SFPs. Among patients requiring PCI, prior diabetes, cardiogenic shock, and failed PCI were predictors of early mortality.
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Affiliation(s)
- Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany; Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany; Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany.
| | - Costanza Pellegrini
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Florian Leuschner
- Department of Medicine III, University of Heidelberg, German Centre for Cardiovascular Research (DZHK), Heidelberg, Germany
| | - Raj Makkar
- Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Jürgen Leick
- Department of Cardiology, Barmherzige Brüder Hospital, Trier, Germany
| | | | - Oliver Dörr
- Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
| | - Philipp Breitbart
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Victor A Jimenez Diaz
- Hospital Alvaro Cunqueiro, Interventional Cardiology Unit, Cardiology Department, University Hospital of Vigo, Vigo, Spain
| | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Tanja Rudolph
- Herz- und Diabeteszentrum NRW, Department of General and Interventional Cardiology and Angiology, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Pablo Avanzas
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Department of Medicine, University of Oviedo, Oviedo, Spain
| | - Jatinderjit Kaur
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | | | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Patrick Ranosch
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | - Derk Frank
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), UKSH University Clinical Center Schleswig-Holstein, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Uri Landes
- Centre for Cardiovascular Innovation, Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - John Webb
- Centre for Cardiovascular Innovation, Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco," Catania, Italy
| | - Paola Purita
- Interventional Cardiology, Department of Cardiacthoracic and Vascular Science, Ospedale dell'Angelo, Venice, Italy
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland
| | - Branislav Liska
- National Cardiovascular Institute, Bratislava, Slovak Republic
| | - Noriaki Tabata
- University Hospital Bonn, Heart Center Bonn, Bonn, Germany
| | - Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Clemens Eckel
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Abdelhakim Allali
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Roberto Valvo
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco," Catania, Italy
| | - Sung-Han Yoon
- Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Nikos Werner
- Department of Cardiology, Barmherzige Brüder Hospital, Trier, Germany
| | - Holger Nef
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany; Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany; Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
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Brinkmann C, Abdel-Wahab M, Bedogni F, Bhadra OD, Charbonnier G, Conradi L, Hildick-Smith D, Kargoli F, Latib A, Van Mieghem NM, Miura M, Mylotte D, Landes U, Pilgrim T, Riess FC, Taramasso M, Tchétché D, Testa L, Thiele H, Webb J, Windecker S, Witt J, Wohlmuth P, Wolf A, Schofer J. Bioprosthetic valve fracture: Predictors of outcome and follow-up. Results from a multicenter study. Catheter Cardiovasc Interv 2021; 98:756-764. [PMID: 33991385 DOI: 10.1002/ccd.29755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/21/2021] [Accepted: 05/03/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate outcome and its predictors of bioprosthetic valve fracture (BVF) in patients undergoing valve-in-valve transcatheter aortic valve replacement (VIV-TAVR). BACKGROUND BVF is feasible and reduces transvalvular gradients in VIV-TAVR-procedures, but follow-up-data and information on factors influencing the outcome are missing. METHODS The 81 cases of BVF-VIV-TAVR were collected from 14 international centers. RESULTS Predominantly transcatheter heart valve (THV) was implanted first, followed by BVF. VARC-2 defined device success was 93%, most failures were attributed to residual high gradients. Mean gradients decreased from 37 ± 13 mmHg to 10.8 ± 5.9 mmHg (p < 0.001). BVF reduced the gradient by 16 mmHg. During follow-up (FU, 281 ± 164 days) mean gradient remained stable (10.8 ± 5.9 mmHg at discharge, 12.4 ± 6.3 mmHg at FU, p = ns). In-hospital major adverse events occurred in 3.7%. Event-free survival at 276 ± 237.6 days was 95.4%. The linear mixed model identified balloon-expandable valves (BEV), Mitroflow surgical valve, stenotic surgical bioprostheses and balloon only 1 mm larger than the true internal diameter of the surgical valve as predictors for higher gradients. CONCLUSIONS BVF is safe and can significantly reduce gradients, which remain stable at FU. BEV, Mitroflow surgical valve, stenotic bioprostheses and balloon larger than the true internal diameter of the surgical valve of only 1 mm are predictors for higher final gradients.
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Affiliation(s)
- Christina Brinkmann
- MVZ Department Structural Heart Disease, Asklepios St. Georg, Hamburg, Germany
| | | | | | - Oliver D Bhadra
- Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg, Germany
| | | | - Lenard Conradi
- Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg, Germany
| | | | - Faraj Kargoli
- Division of Cardiology, Montefiore Medical Center / Albert Einstein College of Medicine, New York, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center / Albert Einstein College of Medicine, New York, USA
| | | | - Mizuki Miura
- Universitäres Herzzentrum, Universitätsspital Zürich, Zürich, Switzerland
| | - Darren Mylotte
- Cardiology Department, Bon Secours Hospital, Galway, Ireland
| | - Uri Landes
- Heart Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Thomas Pilgrim
- Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | | | - Maurizio Taramasso
- Universitäres Herzzentrum, Universitätsspital Zürich, Zürich, Switzerland
| | | | - Luca Testa
- Cardiologica, IRCCS Policlinico San Donato, Milan, Italy
| | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - John Webb
- Heart Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Julian Witt
- Cardiothoracic Surgery, Albertinen Heart Center, Hamburg, Germany
| | | | - Alexander Wolf
- Klinik für Kardiologie, Elisabeth-Krankenhaus Essen, Essen, Germany
| | - Joachim Schofer
- MVZ Department Structural Heart Disease, Asklepios St. Georg, Hamburg, Germany
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Witberg G, Codner P, Landes U, Schwartzenberg S, Barbanti M, Valvo R, De Backer O, Ooms JF, Islas F, Marroquin L, Sedaghat A, Sugiura A, Masiero G, Werner P, Armario X, Fiorina C, Arzamendi D, Santos-Martinez S, Fernández-Vázquez F, Baz JA, Steblovnik K, Mauri V, Adam M, Merdler I, Hein M, Ruile P, Grasso C, Branca L, Estévez-Loureiro R, Benito-González T, Amat-Santos IJ, Mylotte D, Andreas M, Bunc M, Tarantini G, Sinning JM, Nombela-Franco L, Søndergaard L, Van Mieghem NM, Finkelstein A, Kornowski R. Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality. JACC Cardiovasc Interv 2021; 14:1181-1192. [PMID: 33992550 DOI: 10.1016/j.jcin.2021.02.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 12/08/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the impact of residual mitral regurgitation (MR) on mortality in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND MR is common in patients undergoing TAVR. Data on optimal management of patients with significant MR after TAVR are limited. METHODS The registry consisted of 16 TAVR centers (n = 7,303). Outcomes of patients with ≥ moderate versus lesser grade MR after TAVR were compared. RESULTS In 1,983 (27.2%) patients, baseline MR grade was ≥ moderate. MR regressed in 874 (44.1%) patients and persisted in 1,109 (55.9%) after TAVR. Four-year mortality was higher for those with MR persistence, but not for those with MR regression after TAVR, compared with nonsignificant baseline MR (43.8% vs. 35.1% vs. 32.4%; hazard ratio [HR]: 1.38; p = 0.008; HR: 1.02; p = 0.383, respectively). New York Heart Association functional class III to IV after TAVR was more common in those with MR persistence vs. regression (14.4% vs. 3.9%; p < 0.001). In a propensity score-matched cohort (91 patients' pairs), with significant residual MR after TAVR who did or did not undergo staged mitral intervention, staged intervention was associated with a better functional class through 1 year of follow-up (82.4% vs. 33.3% New York Heart Association functional class I or II; p < 0.001), and a numerically lower 4-year mortality, which was not statistically significant (64.6% vs. 37.5%; HR: 1.66; p = 0.097). CONCLUSIONS Risk stratification based on improvement in MR and symptoms after TAVR can identify patients at increased mortality risk after TAVR. These patients may benefit from a staged transcatheter mitral intervention, but this requires further proof from future studies. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter [AMTRAC] Valve Registry [AMTRAC]; NCT04031274).
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Landes
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shmuel Schwartzenberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Marco Barbanti
- Division of Cardiology, University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, University of Catania, Catania, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joris F Ooms
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fabian Islas
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Luis Marroquin
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | | | | | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Paul Werner
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Xavier Armario
- Department of Cardiology, Galway University Hospital, National University of Ireland, Galway, Ireland
| | | | - Dabit Arzamendi
- Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain
| | - Sandra Santos-Martinez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Jose A Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Klemen Steblovnik
- Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | - Victor Mauri
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Germany
| | - Ilan Merdler
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Carmelo Grasso
- Division of Cardiology, University of Catania, Catania, Italy
| | - Luca Branca
- Cardiovascular Department, Spedali Civili, Brescia, Italy
| | | | | | - Ignacio J Amat-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, National University of Ireland, Galway, Ireland
| | - Martin Andreas
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Matjaz Bunc
- Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ariel Finkelstein
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Orvin K, Perl L, Landes U, Dvir D, Webb JG, Stelzmüller ME, Wisser W, Nazif TM, George I, Miura M, Taramasso M, Pilgrim T, Fürholz M, Sinning JM, Nickenig G, Rumer C, Tarantini G, Masiero G, Bunc M, Radsel P, Latib A, Kargoli F, Ielasi A, Medda M, Nombela-Franco L, Vaknin-Assa H, Kornowski R. Percutaneous mechanical circulatory support from the collaborative multicenter Mechanical Unusual Support in TAVI (MUST) Registry. Catheter Cardiovasc Interv 2021; 98:E862-E869. [PMID: 33961729 DOI: 10.1002/ccd.29747] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 02/08/2021] [Accepted: 04/21/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate the use and outcomes of percutaneous mechanical circulatory support (pMCS) utilized during transcatheter aortic valve implantation (TAVI) from high-volume centers. METHODS AND RESULTS Our international multicenter registry including 13 high-volume TAVI centers with 87 patients (76.5 ± 11.8 years, 63.2% men) who underwent TAVI for severe aortic stenosis and required pMCS (75.9% VA-ECMO, 19.5% Impella CP, 4.6% TandemHeart) during the procedure (prior to TAVI 39.1%, emergent rescue 50.6%, following TAVI 10.3%). The procedures were considered high-risk, with 50.6% having severe left ventricular dysfunction, 24.1% biventricular dysfunction, and 32.2% severe pulmonary hypertension. In-hospital and 1-year mortality were 27.5% and 49.4%, respectively. Patients with prophylactic hemodynamic support had lower periprocedural mortality compared to patients with rescue insertion of pMCS (log rank = 0.013) and patients who did not undergo cardiopulmonary resuscitation during the TAVI procedure had better short and long term survival (log rank <0.001 and 0.015, respectively). CONCLUSIONS Given the overall survival rate and low frequency of pMCS-related complications, our study results support the use of pMCS prophylactically or during the course of TAVI (bailout) in order to improve clinical outcomes in high-risk procedures or in case of acute life-threatening hemodynamic collapse.
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Affiliation(s)
- Katia Orvin
- Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Landes
- Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Danny Dvir
- Department of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - John George Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | | | - Wilfried Wisser
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Tamim Michael Nazif
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Isaac George
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Mizuki Miura
- Department of Cardiac Surgery, University Heart Center Zurich, Zurich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiac Surgery, University Heart Center Zurich, Zurich, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Monika Fürholz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan-Malte Sinning
- 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
| | - Chris Rumer
- Department of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Giuseppe Tarantini
- Department of Cardiac, Vascular, Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | - Giulia Masiero
- Department of Cardiac, Vascular, Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | - Matjas Bunc
- Department for Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Peter Radsel
- Department for Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, New York, USA
| | - Faraj Kargoli
- Division of Cardiology, Montefiore Medical Center, New York, New York, USA
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istututo Clinico S. Ambrogio, Milan, Italy
| | - Massimo Medda
- Clinical and Interventional Cardiology Unit, Istututo Clinico S. Ambrogio, Milan, Italy
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Faroux L, Lhermusier T, Vincent F, Nombela-Franco L, Tchétché D, Barbanti M, Abdel-Wahab M, Windecker S, Auffret V, Campanha-Borges DC, Fischer Q, Muñoz-Garcia E, Trillo-Nouche R, Jorgensen T, Serra V, Toggweiler S, Tarantini G, Saia F, Durand E, Donaint P, Gutierrez-Ibanes E, Wijeysundera HC, Veiga G, Patti G, D'Ascenzo F, Moreno R, Hengstenberg C, Chamandi C, Asmarats L, Hernandez-Antolin R, Gomez-Hospital JA, Cordoba-Soriano JG, Landes U, Jimenez-Diaz VA, Cruz-Gonzalez I, Nejjari M, Roubille F, Van Belle É, Armijo G, Siddiqui S, Costa G, Elsaify S, Pilgrim T, le Breton H, Urena M, Muñoz-Garcia AJ, Sondergaard L, Bach-Oller M, Fraccaro C, Eltchaninoff H, Metz D, Tamargo M, Fradejas-Sastre V, Rognoni A, Bruno F, Goliasch G, Santaló-Corcoy M, Jimenez-Mazuecos J, Webb JG, Muntané-Carol G, Paradis JM, Mangieri A, Ribeiro HB, Campelo-Parada F, Rodés-Cabau J. ST-Segment Elevation Myocardial Infarction Following Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2021; 77:2187-2199. [PMID: 33926655 DOI: 10.1016/j.jacc.2021.03.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 01/19/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Among patients with acute coronary syndrome following transcatheter aortic valve replacement (TAVR), those presenting with ST-segment elevation myocardial infarction (STEMI) are at highest risk. OBJECTIVES The goal of this study was to determine the clinical characteristics, management, and outcomes of STEMI after TAVR. METHODS This was a multicenter study including 118 patients presenting with STEMI at a median of 255 days (interquartile range: 9 to 680 days) after TAVR. Procedural features of STEMI after TAVR managed with primary percutaneous coronary intervention (PCI) were compared with all-comer STEMI: 439 non-TAVR patients who had primary PCI within the 2 weeks before and after each post-TAVR STEMI case in 5 participating centers from different countries. RESULTS Median door-to-balloon time was higher in TAVR patients (40 min [interquartile range: 25 to 57 min] vs. 30 min [interquartile range: 25 to 35 min]; p = 0.003). Procedural time, fluoroscopy time, dose-area product, and contrast volume were also higher in TAVR patients (p < 0.01 for all). PCI failure occurred more frequently in patients with previous TAVR (16.5% vs. 3.9%; p < 0.001), including 5 patients in whom the culprit lesion was not revascularized owing to coronary ostia cannulation failure. In-hospital and late (median of 7 months [interquartile range: 1 to 21 months]) mortality rates were 25.4% and 42.4%, respectively (20.6% and 38.2% in primary PCI patients), and estimated glomerular filtration rate <60 ml/min (hazard ratio [HR]: 3.02; 95% confidence interval [CI]: 1.42 to 6.43; p = 0.004), Killip class ≥2 (HR: 2.74; 95% CI: 1.37 to 5.49; p = 0.004), and PCI failure (HR: 3.23; 95% CI: 1.42 to 7.31; p = 0.005) determined an increased risk. CONCLUSIONS STEMI after TAVR was associated with very high in-hospital and mid-term mortality. Longer door-to-balloon times and a higher PCI failure rate were observed in TAVR patients, partially due to coronary access issues specific to the TAVR population, and this was associated with poorer outcomes.
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Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | | | - Flavien Vincent
- CHU Lille, Institut Coeur et Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Marco Barbanti
- A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | | | - Vincent Auffret
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, Rennes, France
| | | | - Quentin Fischer
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Erika Muñoz-Garcia
- Hospital Universitario Virgen de la Victoria, Málaga, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Spain
| | | | | | - Vicens Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Francesco Saia
- Institute of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Eric Durand
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000, Rouen, France
| | - Pierre Donaint
- Centre Hospitalier Universitaire de Reims, Service de Cardiologie, Reims, France
| | | | | | - Gabriela Veiga
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Giuseppe Patti
- Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Science, Citta' della Salute e Della Scienza, University of Turin, Turin, Italy
| | - Raul Moreno
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | | | | | - Uri Landes
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Ignacio Cruz-Gonzalez
- University Hospital Salamanca, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | | | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, INI-CRT, CHU de Montpellier, France
| | - Éric Van Belle
- CHU Lille, Institut Coeur et Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
| | - German Armijo
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Giuliano Costa
- A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Sameh Elsaify
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | - Hervé le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, Rennes, France
| | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Antonio Jesus Muñoz-Garcia
- Hospital Universitario Virgen de la Victoria, Málaga, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Spain
| | | | | | | | - Hélène Eltchaninoff
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000, Rouen, France
| | - Damien Metz
- Centre Hospitalier Universitaire de Reims, Service de Cardiologie, Reims, France
| | | | | | - Andrea Rognoni
- Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Science, Citta' della Salute e Della Scienza, University of Turin, Turin, Italy
| | | | | | | | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Jean-Michal Paradis
- Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Antonio Mangieri
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada; Hospital Clínic de Barcelona, Barcelona, Spain.
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Landes U, Kornowski R. Same day discharge: How much less is more for TAVR patients? Catheter Cardiovasc Interv 2021; 97:948-949. [PMID: 33851781 DOI: 10.1002/ccd.29658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/14/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Uri Landes
- Department of Cardiology, Rabin Medical Center, Petach Tikva, The Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, The Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Bugani G, Pagnesi M, Tchetchè D, Kim WK, Khokhar A, Sinning JM, Landes U, Kornowski R, Codner P, De Backer O, Nickenig G, Ielasi A, De Biase C, Søndergaard L, De Marco F, Ancona M, Montorfano M, Regazzoli D, Stefanini G, Toggweiler S, Tamburino C, Immè S, Tarantini G, Sievert H, Schäfer U, Kempfert J, Wöehrle J, Tespili M, Laricchia A, Latib A, Giannini F, Colombo A, Mangieri A. Correction to: Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis. Clin Res Cardiol 2021; 110:1692. [PMID: 33755778 DOI: 10.1007/s00392-021-01824-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Giulia Bugani
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Ferrara, Italy
| | | | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Won- Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Arif Khokhar
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy
| | | | - Uri Landes
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Pablo Codner
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ole De Backer
- The Heart Center-Rigshospitalet, Copenhagen, Denmark
| | - Georg Nickenig
- Cardiology Department, University Hospital Bonn, Bonn, Germany
| | | | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | | | - Damiano Regazzoli
- Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulio Stefanini
- Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Corrado Tamburino
- Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy
| | | | | | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, UK
| | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | | | - Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, NY, USA.,Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy.,EMO GVM Centro Cuore Columbus, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy.
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Hammer Y, Talmor-Barkan Y, Abelow A, Orvin K, Aviv Y, Bar N, Levi A, Landes U, Shafir G, Barsheshet A, Vaknin-Assa H, Sagie A, Kornowski R, Hamdan A. Myocardial extracellular volume quantification by computed tomography predicts outcomes in patients with severe aortic stenosis. PLoS One 2021; 16:e0248306. [PMID: 33690718 PMCID: PMC7946277 DOI: 10.1371/journal.pone.0248306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The extent of myocardial fibrosis in patients with severe aortic stenosis might have an important prognostic value. Non-invasive imaging to quantify myocardial fibrosis by measuring extracellular volume fraction might have an important clinical utility prior to aortic valve intervention. METHODS Seventy-five consecutive patients with severe aortic stenosis, and 19 normal subjects were prospectively recruited and underwent pre- and post-contrast computed tomography for estimating myocardial extracellular volume fraction. Serum level of galectin-3 was measured and 2-dimensional echocardiography was performed to characterize the extent of cardiac damage using a recently published aortic stenosis staging classification. RESULTS Extracellular volume fraction was higher in patients with aortic stenosis compared to normal subjects (40.0±11% vs. 21.6±5.6%; respectively, p<0.001). In patients with aortic stenosis, extracellular volume fraction correlated with markers of left ventricular decompensation including New York Heart Association functional class, left atrial volume, staging classification of aortic stenosis and lower left ventricular ejection fraction. Out of 75 patients in the AS group, 49 underwent TAVI, 6 surgical AVR, 2 balloon valvuloplasty, and 18 did not undergo any type of intervention. At 12-months after aortic valve intervention, extracellular volume fraction predicted the combined outcomes of stroke and hospitalization for heart failure with an area under the curve of 0.77 (95% confidence interval: 0.65-0.88). A trend for correlation between serum galectin-3 and extracellular volume was noted. CONCLUSION In patients with severe aortic stenosis undergoing computed tomography before aortic valve intervention, quantification of extracellular volume fraction correlated with functional status and markers of left ventricular decompensation, and predicted the 12-months composite adverse clinical outcomes. Implementation of this novel technique might aid in the risk stratification process before aortic valve interventions.
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Affiliation(s)
- Yoav Hammer
- Department of Cardiology, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yeela Talmor-Barkan
- Department of Cardiology, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Aryeh Abelow
- Department of Cardiology, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katia Orvin
- Department of Cardiology, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Aviv
- Department of Cardiology, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Bar
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Landes
- Department of Cardiology, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Shafir
- Department of Cardiology, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Barsheshet
- Department of Cardiology, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Sagie
- Department of Cardiology, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- * E-mail:
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39
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Sathananthan J, Landes U, Flaction L, Humair A, Delaloye S, Toggweiler S, Søndergaard L, Wood DA, Webb JG. Long-Term Durability of the Next-Generation Acurate neo 2 Transcatheter Heart Valve: Insights From Bench Testing to 25 Years. JACC Cardiovasc Interv 2021; 14:586-588. [PMID: 33663791 DOI: 10.1016/j.jcin.2020.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 10/22/2022]
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40
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Witberg G, Steinmetz T, Landes U, Pistiner Hanit R, Green H, Goldman S, Vaknin-Assa H, Codner P, Perl L, Rozen-Zvi B, Kornowski R. Change in Kidney Function and 2-Year Mortality After Transcatheter Aortic Valve Replacement. JAMA Netw Open 2021; 4:e213296. [PMID: 33769507 PMCID: PMC7998079 DOI: 10.1001/jamanetworkopen.2021.3296] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Chronic kidney disease (CKD) is prevalent in the population of patients undergoing transcatheter aortic valve replacement (TAVR). Data on the association of TAVR with kidney function are scarce, as are data on the relationship between changes in kidney function after TAVR and mortality. OBJECTIVE To describe the changes in kidney function (both periprocedural and at steady state) after TAVR and to explore the association of TAVR with midterm mortality. DESIGN, SETTING, AND PARTICIPANTS This single-center, retrospective cohort study was conducted at a public, tertiary academic medical center, which serves as a regional referral center for valvular heart interventions. Consecutive cases of patients undergoing TAVR from November 5, 2008, to December 31, 2019, were included in the study, with available baseline and post-TAVR data on kidney function. EXPOSURES Steady state (1 month) change in kidney function after TAVR. Significant improvement or deterioration in renal function was defined as a greater than or equal to 10% change in estimated glomerular filtration rate (eGFR). MAIN OUTCOMES AND MEASURES Overall mortality at 2-year follow-up. RESULTS A total of 894 patients (mean [SD] age, 82.2 [7.1] years; 452 women ([51.2%]) were evaluated. A total of 362 patients (40.5%) were treated from 2017 to 2019, 348 patients (38.9%) were treated from 2013 to 2016, and 184 patients (20.5%) were treated from 2008 and 2012. Patients had a mean (SD) Society of Thoracic Surgeons (STS) score of 5.2% (4.0%) and a mean (SD) eGFR of 65.1 (23.1) mL/min/1.73 m2. Acute kidney injury occurred in 115 (11.1%) patients by 48 hours, of whom 73 (63.5%) resolved by discharge. One month after TAVR, eGFR improved by at least 10% in 329 patients (36.8%) and deteriorated by at least 10% in 233 patients (26.1%). Overall, CKD stage remained stable or improved in 720 patients (80.6%), and only 5 patients (0.97%) progressed to stage 5 CKD 1 month after TAVR. A deterioration of 10% or greater in eGFR 1 month after TAVR was associated with a hazard ratio of 2.16 (95% CI, 1.24-5.24; P = .04) at 2-year mortality. Patients who showed CKD status resolution (eGFR improvement to >60 mL/min/1.73 m2 after TAVR) had a similar 2-year mortality to those with baseline eGFR greater than 60 mL/min/1.73 m2 and vice versa. Factors associated with steady state CKD status resolution after TAVR included lower STS score, higher left ventricular ejection fraction, higher baseline eGFR, no acute kidney injury at discharge from the TAVR admission, and lower contrast-eGFR ratio. CONCLUSIONS AND RELEVANCE In this cohort study, kidney outcomes after TAVR were reassuring; greater than 80% of patients showed stable or improved kidney function 1 month after the procedure. Improvement in kidney function was associated with a lower 2-year mortality, whereas deterioration in kidney function was associated with increased mortality. Our data suggest that cardiorenal syndrome was a possible cause of CKD in patients in need of TAVR and that there was potential for improvement in both renal and cardiac function after this procedure.
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Steinmetz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Uri Landes
- Department of Cardiology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Hefziba Green
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Goldman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leor Perl
- Department of Cardiology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Benaya Rozen-Zvi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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41
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Simonato M, Whisenant B, Ribeiro HB, Webb JG, Kornowski R, Guerrero M, Wijeysundera H, Søndergaard L, De Backer O, Villablanca P, Rihal C, Eleid M, Kempfert J, Unbehaun A, Erlebach M, Casselman F, Adam M, Montorfano M, Ancona M, Saia F, Ubben T, Meincke F, Napodano M, Codner P, Schofer J, Pelletier M, Cheung A, Shuvy M, Palma JH, Gaia DF, Duncan A, Hildick-Smith D, Veulemans V, Sinning JM, Arbel Y, Testa L, de Weger A, Eltchaninoff H, Hemery T, Landes U, Tchetche D, Dumonteil N, Rodés-Cabau J, Kim WK, Spargias K, Kourkoveli P, Ben-Yehuda O, Teles RC, Barbanti M, Fiorina C, Thukkani A, Mackensen GB, Jones N, Presbitero P, Petronio AS, Allali A, Champagnac D, Bleiziffer S, Rudolph T, Iadanza A, Salizzoni S, Agrifoglio M, Nombela-Franco L, Bonaros N, Kass M, Bruschi G, Amabile N, Chhatriwalla A, Messina A, Hirji SA, Andreas M, Welsh R, Schoels W, Hellig F, Windecker S, Stortecky S, Maisano F, Stone GW, Dvir D. Transcatheter Mitral Valve Replacement After Surgical Repair or Replacement. Circulation 2021; 143:104-116. [DOI: 10.1161/circulationaha.120.049088] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Mitral valve-in-valve (ViV) and valve-in-ring (ViR) are alternatives to surgical reoperation in patients with recurrent mitral valve failure after previous surgical valve repair or replacement. Our aim was to perform a large-scale analysis examining midterm outcomes after mitral ViV and ViR.
Methods:
Patients undergoing mitral ViV and ViR were enrolled in the Valve-in-Valve International Data Registry. Cases were performed between March 2006 and March 2020. Clinical endpoints are reported according to the Mitral Valve Academic Research Consortium (MVARC) definitions. Significant residual mitral stenosis (MS) was defined as mean gradient ≥10 mm Hg and significant residual mitral regurgitation (MR) as ≥ moderate.
Results:
A total of 1079 patients (857 ViV, 222 ViR; mean age 73.5±12.5 years; 40.8% male) from 90 centers were included. Median STS-PROM score 8.6%; median clinical follow-up 492 days (interquartile range, 76–996); median echocardiographic follow-up for patients that survived 1 year was 772.5 days (interquartile range, 510–1211.75). Four-year Kaplan-Meier survival rate was 62.5% in ViV versus 49.5% for ViR (
P
<0.001). Mean gradient across the mitral valve postprocedure was 5.7±2.8 mm Hg (≥5 mm Hg; 61.4% of patients). Significant residual MS occurred in 8.2% of the ViV and 12.0% of the ViR patients (
P
=0.09). Significant residual MR was more common in ViR patients (16.6% versus 3.1%;
P
<0.001) and was associated with lower survival at 4 years (35.1% versus 61.6%;
P
=0.02). The rates of Mitral Valve Academic Research Consortium–defined device success were low for both procedures (39.4% total; 32.0% ViR versus 41.3% ViV;
P
=0.01), mostly related to having postprocedural mean gradient ≥5 mm Hg. Correlates for residual MS were smaller true internal diameter, younger age, and larger body mass index. The only correlate for residual MR was ViR. Significant residual MS (subhazard ratio, 4.67; 95% CI, 1.74–12.56;
P
=0.002) and significant residual MR (subhazard ratio, 7.88; 95% CI, 2.88–21.53;
P
<0.001) were both independently associated with repeat mitral valve replacement.
Conclusions:
Significant residual MS and/or MR were not infrequent after mitral ViV and ViR procedures and were both associated with a need for repeat valve replacement. Strategies to improve postprocedural hemodynamics in mitral ViV and ViR should be further explored.
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Affiliation(s)
- Matheus Simonato
- The Cardiovascular Research Foundation, New York (M.Simonato, G.W.S., O.B-Y.)
- Escola Paulista de Medicina – Universidade Federal de São Paulo, São Paulo, Brazil (M.Simonato, J.H.P., D.F.G.)
| | | | - Henrique Barbosa Ribeiro
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (H.B.R., J.H.P.)
| | - John G. Webb
- St. Paul’s Hospital, Vancouver, Canada (J.G.W., A.Cheung, U.L.)
| | - Ran Kornowski
- Rabin Medical Center, Petah Tikva, Israel (R.K., P.C.)
| | | | | | | | | | | | | | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Berlin, Germany (J.K., A.U.)
| | - Axel Unbehaun
- Deutsches Herzzentrum Berlin, Berlin, Germany (J.K., A.U.)
| | | | | | | | | | - Marco Ancona
- I.R.C.C.S. Ospedale San Raffaele, Milan, Italy (M.M., M.Ancona)
| | | | - Timm Ubben
- Asklepios Klinik St. Georg, Hamburg, Germany (T.U., F.Meincke)
| | - Felix Meincke
- Asklepios Klinik St. Georg, Hamburg, Germany (T.U., F.Meincke)
| | | | - Pablo Codner
- Rabin Medical Center, Petah Tikva, Israel (R.K., P.C.)
| | | | - Marc Pelletier
- University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH (M.P.)
| | - Anson Cheung
- St. Paul’s Hospital, Vancouver, Canada (J.G.W., A.Cheung, U.L.)
| | - Mony Shuvy
- Hadassah Medical Center, Jerusalem, Israel (M.Shuvy)
| | - José Honório Palma
- Escola Paulista de Medicina – Universidade Federal de São Paulo, São Paulo, Brazil (M.Simonato, J.H.P., D.F.G.)
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (H.B.R., J.H.P.)
| | - Diego Felipe Gaia
- Escola Paulista de Medicina – Universidade Federal de São Paulo, São Paulo, Brazil (M.Simonato, J.H.P., D.F.G.)
| | - Alison Duncan
- The Royal Brompton Hospital, London, United Kingdom (A.D.)
| | | | | | | | - Yaron Arbel
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel (Y.A.)
| | - Luca Testa
- I.R.C.C.S. Policlinico San Donato, Milan, Italy (L.T.)
| | - Arend de Weger
- Leids Universitair Medisch Centrum, Leiden, the Netherlands (A.d.W.)
| | | | | | - Uri Landes
- St. Paul’s Hospital, Vancouver, Canada (J.G.W., A.Cheung, U.L.)
| | | | | | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada (J.R-C.)
| | | | | | | | - Ori Ben-Yehuda
- The Cardiovascular Research Foundation, New York (M.Simonato, G.W.S., O.B-Y.)
- University of California San Diego (O.B-Y.)
| | | | - Marco Barbanti
- Università degli Studi di Catania, Catania, Italy (M.B.)
| | | | | | | | - Noah Jones
- Mount Carmel Health System, Columbus, OH (N.J.)
| | | | | | | | | | - Sabine Bleiziffer
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany (S.B.)
| | | | | | - Stefano Salizzoni
- Città della Salute e della Scienza - “Molinette” Hospital, Torino, Italy (S.Salizzoni)
| | | | | | | | - Malek Kass
- University of Manitoba, Winnipeg, Canada (M.K.)
| | | | | | - Adnan Chhatriwalla
- Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.Chhatriwalla)
| | - Antonio Messina
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (A.M.)
| | | | - Martin Andreas
- Medizinische Universität Wien, Vienna, Austria (M.Andreas)
| | | | | | - Farrel Hellig
- Sunninghill Hospital, Johannesburg, South Africa (F.H.)
| | | | | | | | - Gregg W. Stone
- The Cardiovascular Research Foundation, New York (M.Simonato, G.W.S., O.B-Y.)
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.W.S.)
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42
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Bugani G, Pagnesi M, Tchetchè D, Kim WK, Khokhar A, Sinning JM, Landes U, Kornowski R, Codner P, De Backer O, Nickenig G, Ielasi A, De Biase C, Søndergaard L, De Marco F, Ancona M, Montorfano M, Regazzoli D, Stefanini G, Toggweiler S, Tamburino C, Immè S, Tarantini G, Sievert H, Schäfer U, Kempfert J, Wöehrle J, Tespili M, Laricchia A, Latib A, Giannini F, Colombo A, Mangieri A. Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis. Clin Res Cardiol 2021; 110:667-675. [PMID: 33389062 DOI: 10.1007/s00392-020-01793-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/20/2020] [Accepted: 12/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To define the incidence of high residual gradient (HRG) after transcatheter aortic valve replacement (TAVR) in BAVs and their impact on short term outcome and 1-year mortality. BACKGROUND Transcatheter heart valves (THVs) offer good performance in tricuspid aortic valves with low rate of HRG. However, data regarding their performance in bicuspid aortic valves (BAV) are still lacking. METHODS The BEAT (Balloon vs Self-Expandable valve for the treatment of bicuspid Aortic valve sTenosis) registry included 353 consecutive patients who underwent TAVR (Evolut R/PRO or Sapien 3 valves) in BAV between June 2013 and October 2018. The primary endpoint was device unsuccess with post-procedural HRG (mean gradient ≥ 20 mmHg). The secondary endpoint was to identify the predictors of HRG following the procedure. RESULTS Twenty patients (5.6%) showed HRG after TAVR. Patients with HRG presented higher body mass index (BMI) (30.7 ± 9.3 vs. 25.9 ± 4.8; p < 0.0001) and higher baseline aortic mean gradients (57.6 ± 13.4 mmHg vs. 47.7 ± 16.6, p = 0.013) and more often presented with BAV of Sievers type 0 than patients without HRG. At multivariate analysis, BMI [odds ratio (OR) 1.12; 95% confidence interval (CI) 1.05-1.20, p = 0.001] and BAV type 0 (OR 11.31, 95% CI 3.45-37.06, p < 0.0001) were confirmed as independent predictors of high gradient. CONCLUSION HRG following TAVR in BAVs is not negligible and is higher among patients with high BMI and with BAV 0 anatomy.
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Affiliation(s)
- Giulia Bugani
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Ferrara, Italy
| | | | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Won- Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Arif Khokhar
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy
| | | | - Uri Landes
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Pablo Codner
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ole De Backer
- The Heart Center-Rigshospitalet, Copenhagen, Denmark
| | - Georg Nickenig
- Cardiology Department, University Hospital Bonn, Bonn, Germany
| | | | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | | | - Damiano Regazzoli
- Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulio Stefanini
- Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Corrado Tamburino
- Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy
| | | | | | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, UK
| | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | | | - Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, NY, USA.,Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy.,EMO GVM Centro Cuore Columbus, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy.
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43
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Webb J, Landes U, Wood D. A New and Improved Transcatheter Aortic Valve for Routine Use? JACC Cardiovasc Interv 2020; 13:2479-2481. [PMID: 33153564 DOI: 10.1016/j.jcin.2020.07.042] [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] [Received: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 12/01/2022]
Affiliation(s)
- John Webb
- Centre for Heart Valve Innovation and Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada.
| | - Uri Landes
- Centre for Heart Valve Innovation and Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada
| | - David Wood
- Centre for Heart Valve Innovation and Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada
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44
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Ielasi A, Moscarella E, Mangieri A, Tchetche D, Kim W, Pagnesi M, Sinning J, Landes U, Kornowski R, De Backer O, Nickenig G, De Biase C, Sondergaard L, De Marco F, Colombo A. Procedural and clinical outcomes of type 0 versus type 1 bicuspid aortic valve stenosis treated with transcatheter valve replacement: insights from the BEAT international collaborative registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Transcatheter aortic valve replacement (TAVR) is an established therapy for symptomatic severe aortic stenosis. Bicuspid aortic valves (BAV) were generally excluded from randomized trials due to anatomic features that may challenge TAVR (valve morphology, annulus geometry and size and severe calcifications). Nevertheless real-world registries have shown that a consistent number of BAV has been treated with TAVR. Whether BAV phenotype may affect acute or long-term outcomes following TAVR still remains unclear.
Purpose
Evaluate the impact of BAV phenotype on procedural and clinical outcomes after TAVR with new generation valves.
Methods
Patients included in the BEAT (Balloon vs Self-Expandable valve for the treatment of bicuspid Aortic valve sTenosis) registry were classified according to the BAV phenotype. Procedural and clinical outcomes of type 0 (2 cusps, 1 commissure, no raphe) vs type 1 (1 raphe) BAV are here reported. Primary endpoint was post-procedural device success, according to Valve Academic Research Consortium–2 (VARC-2) criteria. Secondary endpoints included procedural complications, rate of permanent pacemaker (PM) implantation and assessment of clinical outcomes at 30-day and 1-year follow-up.
Results
BAV 0 phenotype was present in 25 (7.1%) cases, and BAV 1 in 218 (61.8%). 3 (0.9%) patients with BAV 2 phenotype and 105 (29.8%) patients in whom BAV phenotype was undeterminable were excluded. Baseline characteristics of the two populations were well balanced. Mean STS score tended to be lower in type 0 vs type 1 BAV (3.35% ±1.8 vs 4.5% ± 3.0, p=0.062). Mean transvalvular gradient, aortic valve area (AVA), and left ventricular ejection fraction didn't differ between groups. According to CT findings moderate-severe aortic valve calcifications were less frequently present in type 0 vs type 1 (52% vs 71.1%, p=0.01). TAVR was performed under conscious sedation in most patients (89.7%), no differences were noted in terms of valve type, valve size, pre and postdilation between groups. There was no significant difference in any peri-procedural complication including pericardial tamponade, second valve implantation, valve embolization, annular rupture, aortic dissection, coronary occlusion, conversion to open surgery, and need of PM between groups however VARC-2 success tended to be lower in type 0 BAV versus type 1 (72% vs 86.7%; p=0.07). A higher rate of mean transvalvular gradient>20 mmHg was observed in the type 0 vs type 1 groups (respectively 24% vs 6%, p=0.007), while no differences were reported in the rate of moderate-severe aortic regurgitation. At 30-day and 1-year follow-up we did not find differences in clinical outcomes.
Conclusions
Our study confirms the feasibility of TAVR in both type 0 and type 1 BAV, however despite a lower rate of moderate-severe calcifications, a trend toward a lower VARC device success and a higher rate of mean transvalvular gradient >20 mmHg was observed in type 0 vs type 1 BAV.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Ielasi
- Sant'Ambrogio Clinical Institute, Milan, Italy
| | - E Moscarella
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Cardiology, Caserta, Italy
| | - A Mangieri
- Maria Cecilia Hospital, Cotignola, Italy
| | | | - W Kim
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - M Pagnesi
- IRCCS San Raffaele Hospital, Milan, Italy
| | | | - U Landes
- Rabin Medical Center, Petah Tikva, Israel
| | | | - O De Backer
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - L Sondergaard
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - F De Marco
- IRCCS Polyclinic San Donato, Milan, Italy
| | - A Colombo
- Maria Cecilia Hospital, Cotignola, Italy
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45
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De Backer O, Landes U, Fuchs A, Yoon SH, Mathiassen ON, Sedaghat A, Kim WK, Pilgrim T, Buzzatti N, Ruile P, El Sabbagh A, Barbanti M, Fiorina C, Nombela-Franco L, Steinvil A, Finkelstein A, Montorfano M, Maurovich-Horvat P, Kofoed KF, Blanke P, Bunc M, Neumann FJ, Latib A, Windecker S, Sinning JM, Norgaard BL, Makkar R, Webb JG, Søndergaard L. Coronary Access After TAVR-in-TAVR as Evaluated by Multidetector Computed Tomography. JACC Cardiovasc Interv 2020; 13:2528-2538. [DOI: 10.1016/j.jcin.2020.06.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 11/29/2022]
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46
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Ielasi A, Moscarella E, Mangieri A, Giannini F, Tchetchè D, Kim WK, Sinning JM, Landes U, Kornowski R, De Backer O, Nickenig G, De Biase C, Søndergaard L, De Marco F, Bedogni F, Ancona M, Montorfano M, Regazzoli D, Stefanini G, Toggweiler S, Tamburino C, Immè S, Tarantini G, Sievert H, Schäfer U, Kempfert J, Wöehrle J, Latib A, Calabrò P, Medda M, Tespili M, Colombo A. Procedural and clinical outcomes of type 0 versus type 1 bicuspid aortic valve stenosis undergoing trans-catheter valve replacement with new generation devices: Insight from the BEAT international collaborative registry. Int J Cardiol 2020; 325:109-114. [PMID: 33148461 DOI: 10.1016/j.ijcard.2020.10.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 05/29/2020] [Revised: 10/01/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although bicuspid aortic valve (BAV) is not considered a "sweet spot" to trans-catheter aortic valve replacement (TAVR), a certain number of BAV underwent TAVR. Whether BAV phenotype affects outcomes following TAVR remains debated. We aimed at evaluating the impact of BAV phenotype on procedural and clinical outcomes after TAVR using new generation trans-catheter heart valves (THVs). METHODS patients included in the BEAT registry were classified according to the BAV phenotype revealed at multi-slice computed tomography (MSCT) in type 0 (no raphe) vs. type 1 (1 raphe). Primary end-point was Valve Academic Research Consortium-2 (VARC-2) device success. Secondary end-points included procedural complications, rate of permanent pacemaker implantation, clinical outcomes at 30-day and 1-year. RESULTS Type 0 BAV was present in 25(7.1%) cases, type 1 in 218(61.8%). Baseline characteristics were well balanced between groups. Moderate-severe aortic valve calcifications at MSCT were less frequently present in type 0 vs. type 1 (52%vs.71.1%,p = 0.05). No differences were reported for THV type, size, pre and post-dilation between groups. VARC-2 success tended to be lower in type 0 vs. type 1 BAV (72%vs86.7%;p = 0.07). Higher rate of mean transprosthetic gradient ≥20 mmHg was observed in type 0 vs. type 1 group (24%vs6%,p = 0.007). No differences were reported in the rate of post-TAVR moderate-severe aortic regurgitation and clinical outcomes between groups. CONCLUSIONS Our study confirms TAVR feasibility in both BAV types, however a trend toward a lower VARC-2 device success and a higher rate of mean transprosthetic gradient ≥20 mmHg was observed in type 0 vs. type 1 BAV.
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Affiliation(s)
- Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy, Italy.
| | - Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Mangieri
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Francesco Giannini
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
| | | | - Uri Landes
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ole De Backer
- The Heart Center-Rigshospitalet, Copenhagen, Denmark
| | - Georg Nickenig
- Cardiology Department, University Hospital Bonn, Bonn, Germany
| | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | | | - Damiano Regazzoli
- Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulio Stefanini
- Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Corrado Tamburino
- Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy
| | | | | | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany and Anglia Ruskin University, Chelmsford, United Kingdom
| | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, NY, New York, United States of America; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Massimo Medda
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy, Italy
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy, Italy
| | - Antonio Colombo
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy; EMO GVM Centro Cuore Columbus, Milan, Italy
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47
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Affiliation(s)
- David A. Wood
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Uri Landes
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Yoon SH, Kim WK, Dhoble A, Milhorini Pio S, Babaliaros V, Jilaihawi H, Pilgrim T, De Backer O, Bleiziffer S, Vincent F, Shmidt T, Butter C, Kamioka N, Eschenbach L, Renker M, Asami M, Lazkani M, Fujita B, Birs A, Barbanti M, Pershad A, Landes U, Oldemeyer B, Kitamura M, Oakley L, Ochiai T, Chakravarty T, Nakamura M, Ruile P, Deuschl F, Berman D, Modine T, Ensminger S, Kornowski R, Lange R, McCabe JM, Williams MR, Whisenant B, Delgado V, Windecker S, Van Belle E, Sondergaard L, Chevalier B, Mack M, Bax JJ, Leon MB, Makkar RR. Bicuspid Aortic Valve Morphology and Outcomes After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 76:1018-1030. [DOI: 10.1016/j.jacc.2020.07.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/09/2020] [Accepted: 07/02/2020] [Indexed: 11/24/2022]
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Sathananthan J, Hensey M, Fraser R, Landes U, Blanke P, Hatoum H, Dasi LP, Sedaghat A, Bapat VN, Leipsic J, Søndergaard L, Wood DA, Webb JG. Implications of hydrodynamic testing to guide sizing of self-expanding transcatheter heart valves for valve-in-valve procedures. Catheter Cardiovasc Interv 2020; 96:E332-E340. [PMID: 31647178 DOI: 10.1002/ccd.28537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 09/27/2019] [Indexed: 11/07/2022]
Abstract
AIMS The commonly used valve-in-valve (VIV) app recommends sizing based on dimensions of both the transcatheter heart valve (THV) and bioprosthetic surgical valve. The implications of hydrodynamic testing to guide VIV sizing are poorly understood. This bench study assessed the hydrodynamic performance of different sizes of self-expanding supra-annular THVs in three different surgical aortic bioprostheses at different implantation depths. METHODS A small versus medium ACURATE neo (ACn), and a 26 mm versus 29 mm Evolut R were assessed after VIV implantation in 25 mm Mitroflow, Mosaic, and Magna Ease aortic surgical bioprostheses, at three implantation depths (+2 mm, -2 mm, and -6 mm). RESULTS The medium-sized ACn had lower gradients compared to the small ACn when the THV was implanted high (+2 mm, or -2 mm). The 29 mm Evolut R had lower gradients compared to a 26 mm Evolut R for all implantation depths, except for a depth of -2 mm in the 25 mm Mitroflow. The medium ACn and 29 mm Evolut R had larger effective orifice areas compared to the small ACn and 26 mm Evolut R, respectively. Both Evolut R sizes had acceptable regurgitant fractions (<15%), while both ACn sizes were above the acceptable performance criteria (>15%), at all implantation depths. CONCLUSIONS Use of a larger self-expanding THV was associated with superior hydrodynamic performance if the THV was implanted high. Hydrodynamic testing can provide additional information to the VIV app to help guide VIV sizing.
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Affiliation(s)
- Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Mark Hensey
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | | | - Uri Landes
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Alexander Sedaghat
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | | | - Jonathon Leipsic
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David A Wood
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
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