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Transcatheter aortic valve implantation - Top 30 Publications

Predictors of Persistent Tricuspid Regurgitation After Transcatheter Aortic Valve Replacement in Patients With Baseline Tricuspid Regurgitation.

This study sought to analyze outcomes in patients with moderate-severe tricuspid regurgitation (TR) undergoing transcatheter aortic valve replacement (TAVR). The consequences of uncorrected significant TR in patients undergoing TAVR remain undefined.

Transcatheter aortic valve replacement in the setting of left atrial appendage thrombus.

Left atrial appendage thrombus (LAT) was an exclusion criterion in the seminal transcatheter aortic valve replacement (TAVR) trials; however, such patients do undergo TAVR in the 'real-world' setting. This study sought to analyse outcomes after TAVR in patients with LAT or spontaneous echo contrast (SEC).

Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation.

The fusion of 3D anatomical models derived from high-fidelity pre-interventional computed tomography angiography (CTA), and x-ray (XR) fluoroscopy to facilitate anatomical guidance is of huge interest for complex cardiac interventions like TAVI procedures with cerebral protection. Co-registration of CTA and XR has been introduced either based on additional intraoperative non-/contrast-enhanced cone-beam computed tomography (CBCT) or two separate aortograms. With the related increase of radiation exposure and/or contrast agent (CA) dose, a potential additional risk for the patient is introduced. Here, we propose a modified co-registration approach making use of arteriograms of the iliofemoral arteries, routinely performed during the femoral puncture and sheath introduction. On-the-fly refinement of the co-registration during the on-going procedure enables accurate co-registration without any additional angiograms, thus reducing CA, XR dose and procedure time, while simultaneously improving operator confidence and procedure safety.

Three-Year Survival Comparison Between Transcatheter and Surgical Aortic Valve Replacement for Intermediate- and Low-Risk Patients.

Transcatheter aortic valve implantation is a suitable therapeutic intervention for patients deemed inoperable or high risk for surgical aortic valve replacement. Current investigations question whether it is a suitable alternative to surgery for intermediate- and low-risk patients. The following meta-analysis presents a comparison between transcatheter versus surgical aortic valve replacement in patients that are intermediate and low risk for surgery. Articles were collected via an electronic search using Google Scholar and PubMed. Articles of interest included studies comparing the survival of intermediate- and low-risk patients undergoing transcatheter aortic valve implantation to those undergoing surgical aortic valve replacement. Primary end points included 1-, 2-, and 3-year survival. Secondary end points included postintervention thromboembolic events, stroke, transient ischemic attacks, major vascular complications, permanent pacemaker implantation, life-threatening bleeding, acute kidney injury, atrial fibrillation, and moderate-to-severe aortic regurgitation. Six studies met the criteria for the meta-analysis. One- and two-year survival comparisons showed no difference between the two interventions. Surgical aortic valve replacement, however, presented with favorable 3-year survival compared with the transcatheter approach. Transcatheter aortic valve implantation had more major vascular complications, permanent pacemaker implantation, and moderate-to-severe aortic regurgitation rates compared with surgery. Surgical aortic valve replacement presented more life-threatening bleeding, acute kidney injury, and atrial fibrillation compared with a transcatheter approach. There was no statistical difference between the two approaches in terms of thromboembolic events, strokes, or transient ischemic attack rates. Surgical aortic valve replacement presents favorable 3-year survival rates compared with transcatheter aortic valve implantation.

Evolving trends in aortic valve replacement: A statewide experience.

Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for the treatment of aortic stenosis in patients at intermediate, high, and extreme risk for mortality from SAVR. We examined recent trends in aortic valve replacement (AVR) in Michigan.

Mechanolytic management of transcatheter aortic valve thrombosis.

Data on the incidence, characteristics, and treatment of thrombosis of a transcatheter aortic valve implantation (TAVI) implant are scarce. We report a challenging case of a TAVI thrombosis occurring 6 months after the procedure. Initial anticoagulation using low-molecular-weight heparin followed by thrombolytic therapy failed to both relieve symptoms and alleviate thrombosis. However, the condition of the patient deteriorated rapidly, necessitating the use of balloon valvuloplasty followed by low-dose thrombolysis. The uniqueness of the case can be summarized as follows: (1) first report of balloon valvuloplasty to manage a case of TAVI thrombosis; (2) thrombolytic therapy after balloon valvuloplasty was successful to further reduce gradient from valve thrombosis.

Do CTA measurements of annular diameter, perimeter and area result in different TAVI prosthesis sizes?

Incorrect prosthesis size has direct impact on patient outcome after transcatheter aortic valve implantation (TAVI) procedure. Currently, annular diameter, area or perimeter may be used for prosthesis size selection. The aim was to evaluate whether the use different annular dimensions would result in the selection of different prosthesis sizes, when assessed in the same TAVI-candidate during the same phase of a cardiac cycle. Fifty consecutive TAVI-candidates underwent retrospectively ECG-gated computed tomography angiography (CTA). Aortic root dimensions were assessed in the 20% phase of the R-R interval. Annular short diameter, perimeter and area were used to select the prosthesis size, based on the industry recommendations for a self-expandable (Medtronic CoreValve; MCV) and balloon-expandable (Edwards Sapien XT Valve; ESV) valve. Complete agreement on selected prosthesis size amongst all three annular dimensions was observed in 62% (31/50; ESV) and 30% (15/50; MCV). Short aortic annulus measurement resulted in a smaller prosthesis size in 20% (10/50; ESV) and in 60% of cases (30/50; MCV) compared to the size suggested by both annular perimeter and area. In 18% (9/50; ESV) and 10% of cases (5/50; MCV) a larger prosthesis would have been selected based on annular perimeter compared to annular diameter and area. Prosthesis size derived from area was always in agreement with at least one other parameter in all cases. Aortic annulus area appears to be the most robust parameter for TAVI-prosthesis size selection, regardless of the specific prosthesis size. Short aortic annulus diameter may underestimate the prosthesis size, while use of annular perimeter may lead to size overestimation in some cases.

Comprehensive Echocardiographic Assessment of Normal Transcatheter Valve Function.

This study aims to establish parameters for identifying normal function for each of the 3 iterations of balloon-expandable valves and 2 iterations of self-expanding valves.

Rate of Progression of Aortic Stenosis and its Impact on Outcomes in Patients With Radiation-Associated Cardiac Disease: A Matched Cohort Study.

The aim of this study was to study differences in progression of aortic stenosis (AS) in patients with mediastinal radiotherapy (XRT)-associated moderate AS versus a matched cohort during the same time frame, and to ascertain need for aortic valve replacement (AVR) and longer-term survival.

Transcatheter Aortic Valve Replacement on an Aortic Mechanical Valve.

Real-Time Detection of an Acute Cerebral Thrombotic Occlusion During a Transcatheter Valve Intervention.

Transcatheter Aortic Valve Replacement in a Patient with Dextrocardia and Situs Inversus Totalis.

This report presents the case of an 82 year old male with known dextrocardia and situs inversus totalis who developed increasing dyspnea on exertion and was diagnosed with severe aortic stenosis. Transcatheter aortic valve replacement was decided upon requiring deviation from standard techniques for patients with normal anatomy and left-sided aortic arch. We describe two technical differences required for patients with dextrocardia and right-sided aortic arch which facilitate transcatheter aortic valve replacement in this patient group. Dextrocardia is a condition in which there is abnormal embryological looping of the heart such that it is a mirror-image of the usual anatomy. It occurs in less than 1 in 10,000 births and it may be associated with either situs solitus, in which the rest of the organs of the body are in their normal anatomic position, or situs inversus totalis in which all of the body's organs are in a mirror-image position. Although dextrocardia is associated with other congenital cardiac anomalies as well as Kartagener's syndrome it does not usually impair physiology itself thereby allowing many patients to live a normal lifespan.

Transcatheter Mitral Valve-in-Valve and Valve-in-Ring Replacement in High-Risk Surgical Patients: Feasibility, Safety, and Longitudinal Outcomes in a Single-Center Experience.

Transcatheter mitral valve-in-valve (TMVIV) or valve-in-ring (TMVIR) replacement has shown early promise in patients deemed poor surgical candidates as a less invasive alternative to conventional reoperative mitral valve (MV) replacement.

Minimally Invasive Direct Access Balloon-Expandable Transcatheter Mitral Valve Replacement for Extensive Mitral Annular Calcification after Transcatheter Aortic Valve Replacement.

Mitral annular calcification can pose a formidable surgical challenge in the setting of mitral valve replacement for mitral stenosis. Although there are reports of transapical valve-in-valve transcatheter mitral valve replacement in the setting of degenerated bioprosthetic mitral valve replacement, there is less experience with transcatheter mitral valve replacement for mitral annular calcification. This report describes a patient who previously received a transcatheter aortic valve replacement and then subsequently underwent a minimally invasive right thoracotomy for transcatheter mitral valve replacement with a successful result. We discuss technical pearls and operative considerations based on an extensive experience with minimally invasive valve surgery from a right mini-thoracotomy.

Transcatheter or surgical treatment of severe aortic stenosis and coronary artery disease: A comparative analysis from the Italian OBSERVANT study.

To assess clinical outcomes of patients with concomitant severe aortic stenosis (AS) and coronary artery disease (CAD) who underwent transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) or surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG).

Patterns of solid particle embolization during transcatheter aortic valve implantation and correlation with aortic valve calcification.

To evaluate solid embolization during transcatheter aortic valve implantation (TAVI) and correlate this with aortic valve calcification.

Oral anti-Xa anticoagulation after trans-aortic valve implantation for aortic stenosis: The randomized ATLANTIS trial.

Antithrombotic treatment regimen following transcatheter aortic valve replacement (TAVR) is not evidence-based. Apixaban, a non-vitamin K direct anticoagulant (NOAC) was shown to be superior to VKA and superior to aspirin to prevent cardioembolic stroke in non-valvular atrial fibrillation. It may have the potential to reduce TAVR-related thrombotic complications including subclinical valve thrombosis along with a better safety than the standard of care.

Utility of an additive frailty tests index score for mortality risk assessment following transcatheter aortic valve replacement.

The impact of frailty assessment on outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear. Our aim was to evaluate the individual effect of each frailty test and the utility of an additive frailty index score on short- and long-term survival following TAVR.

Future Technology of Mitral Valve Repair and Replacement for Mitral Valve Disease.

Mitral regurgitation is the most common valvular disease and significant (moderate/severe) mitral regurgitation is found in 2.3% of the population older than 65 years. New transcatheter minimally invasive technologies are being developed to address mitral valve disease in patients deemed too high a risk for conventional open-heart surgery. There are several features of the mitral valve (saddle-shaped noncalcified annulus with irregular leaflet geometry) that make a transcatheter approach to repair or replacing the valve more challenging compared with the aortic valve. Several devices are under investigation for transcatheter mitral valve replacement, and also for mitral valve repair targeting the mitral valve leaflets, chordae tendinae, and mitral annulus. The MitraClip device is the only Food and Drug Administration-approved device to treat mitral regurgitation by targeting the mitral leaflets. There are eight minimally invasive devices being studied in humans that target the mitral annulus, and at least two devices being studied in animal models. There are 5 devices in clinical trials for minimally invasive approaches targeting the chordae tendinae. More than 10 different transcatheter mitral valves are in various stages of development and clinical trials. These transcatheter mitral valves can be delivered either through a transseptal, transapical, transaortic, or left atriotomy approach. It seems likely that transcatheter treatment approaches to mitral valve disease will become more common, at least in the sick and elderly patient population.

Advanced Chronic Kidney Disease: Relationship to Outcomes Post TAVR, A Meta-Analysis.

Chronic kidney (CKD) is associated with worse outcomes in high-surgical risk patients undergoing transcatheter aortic valve replacement (TAVR). However, it is unclear whether this relationship is apparent in lower surgical risk patients. Herein we sought to analyze existing literature to assess whether or not advanced CKD is associated with increased mortality, or a greater incidence of adverse events (specifically major stroke, bleeding and vascular complications).

Comparing outcomes after Transcatheter aortic valve replacement in patients with stenotic bicuspid and tricuspid aortic valve: A systematic review and meta-analysis.

Transcatheter aortic valve replacement (TAVR) has become an alternative treatment to surgery in patients with severe aortic stenosis (AS). However, patients with Bicuspid aortic stenosis (BiAV) are usually excluded from major TAVR studies. The aim of this study is to reexamine the current evidence of TAVR in patients with severe AS and BiAV comparing to tricuspid aortic valve (TriAV).

Sub-acute leaflet thrombosis: a reversible cause of aortic stenosis.

A 77 year old male underwent elective bioprosthetic aortic valve replacement (23mm Carpentier-Edwards Perimount MagnaEase) for severe aortic stenosis. His pre-discharge transthoracic echocardiogram (TTE) was normal. He presented 9 days after surgery with dyspnoea and fever. He was in sinus rhythm. Blood cultures were taken and he was commenced on empirical antibiotics for possible infective endocarditis (subsequently all negative). Repeat TTE showed a well-seated prosthesis without regurgitation but elevated gradients (peak / mean gradients 49 / 22 mmHg respectively). Transoesophageal echocardiography (TOE) revealed marked thickening of the leaflets, without obvious vegetations. The patient was diagnosed with subacute prosthetic valve thrombosis and was anticoagulated with apixaban. He underwent repeat TOE 3 months later, which demonstrated thin, mobile valve leaflets with normalized transprosthetic gradients. Thrombosis of a bioprosthetic valve is usually diagnosed in the early postoperative period, when endothelialisation of the suture zone is incomplete. Although previously considered rare, a recent observational study using cardiac CT imaging found an incidence of 4% (5/138) and 13% (101/752) in patients with surgical and transcatheter valves respectively. Anticoagulation therapy - and not anti-platelet drugs - was associated with successful prevention and treatment of subclinical leaflet thrombosis. Indeed, American guidelines on valvular heart disease give a Class IIb recommendation for a period (3-6 months) of formal anticoagulation after bioprosthetic AVR. Patients with established risk factors, including atrial fibrillation and a history of thromboembolic event, may have most to benefit from a brief period of routine post-operative anticoagulation.

Carotid Disease and Stroke After Transcatheter Aortic Valve Replacement.

Stroke and Cardiovascular Outcomes in Patients With Carotid Disease Undergoing Transcatheter Aortic Valve Replacement.

Stroke is a serious complication of both transcatheter aortic valve replacement (TAVR) and carotid artery disease (CD). The implications of CD in patients undergoing TAVR are unclear.

Percutaneous access versus surgical cut down for TAVR: Where do we go from here?

Transcatheter aortic valve replacement is now the standard of care for severe symptomatic aortic stenosis patients who are at high-surgical risk. Percutaneous approach without a surgical cut down has been increasingly adapted by some centers in USA. Percutaneous approach seems to be associated with shorter hospital stay, similar short and late vascular complications, less disabling stroke, similar mortality as well as significantly less hospital cost. However, this technique also requires operators to be able to manage any vascular complications using advanced endovascular interventions to achieve complete hemostasis.

Transcatheter treatment of aortic regurgitation: Still enigmatic.

In the thirty patients with aortic regurgitation in the Jupiter Postmarket Registry, initial device success of JenaValve implantation showed a high success rate of >95% with a device success rate of ∼89%. At one year transvalvar aortic gradients were an acceptable ∼13 mm Hg. Aortic regurgitation in patients in the Jupiter Postmarket Registry continued to be reduced at one-year follow-up with no/trace aortic regurgitation in 50% (though numbers are small). Patients with aortic regurgitation constitute a small number (∼10-15%) of patients with symptomatic aortic valve disease, and follow-up numbers in the Jupiter Postmarket Registry are small (30 patients) with one year echo data in only 23 patients, making broad conclusions about JenaValve results for patients with aortic regurgitation problematic.

Inadvertent pacemaker lead dislodgement.

Transcatheter aortic valve implantation (TAVI) has become an established treatment option for aortic valve stenosis in patients with a high risk for conventional surgical valve replacement. A well-known complication is the development of conduction abnormalities. In the case of a new third degree atrio-ventricular block the complication can be life-threatening and permanent pacing is needed. Often these patients have a venous sheath placed in the jugular vein for the perioperative period. We report a case of inadvertent dislodgement of a permanent pacemaker lead after removal of a preoperatively placed venous sheath in a TAVI patient. This article is protected by copyright. All rights reserved.

Successful Coronary Protection during TAVI in Heavily Calcified Aortic Leaflets in Patient with Short and Low Left Coronary System.

Transcatheter aortic valve replacement has been recently approved for patients who are high or intermediate risk for surgical aortic valve replacement. The procedure is associated with several known complications including coronary related complications. Coronary obstruction is rare but disastrous complication, and it is associated with a high mortality rate. Coronary protection technique has emerged as a preemptive technique to avoid this complication. We present a case of successful coronary protection during TAVR in severely calcified left cusp in patient with short and low left ostium.

Aortic valve anatomy and outcomes after transcatheter aortic valve implantation in bicuspid aortic valves.

Aortic stenosis (AS) in bicuspid aortic valve (BAV) remains a challenge for transcatheter aortic valve implantation (TAVI). BAV is a condition encountered in young adults as well as elderly patients. Frequently we face in clinical practice elderly patients with BAV and severe AS, but there is little evidence concerning TAVI in this population. The aim of our study was to compare anatomic features and outcomes of bicuspid and tricuspid patients with AS undergoing TAVI.

Role of T2 mapping in left ventricular reverse remodeling after TAVR.

Patients with severe aortic stenosis (AS) are subjected to left ventricular hypertrophy (LVH) with increasing morbidity and mortality. Transcatheter aortic valve replacement (TAVR) induces reverse left ventricular remodeling which can be monitored by cardiovascular magnetic resonance (CMR). CMR is able to analyze myocardial tissue properties by magnetic relaxation times (parametric CMR). The objective of this study was to study myocardial T2 relaxation in reverse ventricular remodeling after TAVR.