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Transcatheter aortic valve implantation - Top 30 Publications

Transient left anterior and septal fascicular blocks after self-expandable percutaneous transcatheter aortic valve implantation.

Transcatheter aortic valve implantation (TAVI) is indicated in severe symptomatic aortic stenosis, when there is intermediate-high surgical risk, or a condition considered inoperable, as in the case of "porcelain aorta" that could turn clamping or cannulation of the ascending aorta hazardous in open-heart surgery. Among the complications of this less invasive procedure, intraventricular conduction disorders subsequent to the procedure stand out. TAVI causes worsening of intraventricular dromotropic disorders in more than 75% of the cases, with the presence of preexisting right bundle branch block and first-degree atrioventricular block, deep prosthesis implant, male gender, size of the aortic annulus smaller than the prosthesis, and porcelain aorta being predictive of requirement for permanent pacemaker implant.

Contrast-Zero Transcatheter Aortic Valve Replacement for Patients With Severe Renal Dysfunction: A Single-Center Experience.

Patient-Prosthesis Mismatch After Aortic Valve Intervention: Another Win for Transcatheter Aortic Valve Replacement.

Incidence, Predictors, and Clinical Impact of Prosthesis-Patient Mismatch Following Transcatheter Aortic Valve Replacement in Asian Patients: The OCEAN-TAVI Registry.

The authors sought to investigate the prevalence, risk factors, and mid-term mortality in Asian patients with prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR).

Trends and Outcomes of Transcatheter Aortic Valve Implantation (TAVI) in Korea: the Results of the First Cohort of Korean TAVI Registry.

There has been no nation-wide data on the outcomes of transcatheter aortic valve implantation (TAVI) after commercialization of TAVI in Korea. We report clinical features and outcomes of the first cohort of TAVI performed from Jun 2015 to Jun 2017 in Korea.

Acute torrential mitral regurgitation during transcatheter aortic valve replacement: a case report.

Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to aortic valve replacement. However, critical cardiovascular collapse can occur during the procedure for various reasons.

The role of antiplatelet drug resistance in subclinical leaflet thrombosis following transcatheter aortic valve replacement.

Surgical Aortic Valve Replacement in Octogenerians in the Era of Transcatheter Aortic Valve Replacement.

The hospital mortality rate in >80-year-old patients undergoing surgical aortic valve replacement (SAVR) is reportedly satisfactory, but how such patients' functional status both at discharge and during the postoperative hospitalization period might affect their quality of life and medical costs remains unclear.Methods and Results:The adverse events of 161 patients aged >80 years who underwent SAVR with or without coronary artery bypass grafting were retrospectively investigated. Adverse events were defined as hospital death, a long hospital stay (>60 days) attributable to major complications or requirement for rehabilitation, or a depressed status at discharge (modified Rankin scale score >4). A total of 18.6% of patients developed adverse events, and their hospital mortality rate was 4.3%. Logistic regression analysis revealed that a perfusion time >3 h (P=0.0331; odds ratio, 2.685) and EuroSCORE II >10% (P<0.0001; odds ratio, 8.232) were significant risk factors for adverse events. The average medical cost was approximately 1.5-fold higher in patients with adverse events (¥8,360,880 vs. ¥5,234,660, P=0.0016).

Transcatheter Aortic Valve Replacement: Efficiency and Safety Improvements With Progressive Experience and Improved Technology.

Transcatheter aortic valve replacement is now commercially available for intermediate-risk, high-risk, or inoperable patients with severe aortic stenosis. In this study, we investigated change in the safety and efficiency of the transcatheter aortic valve replacement procedure at our institution and patient outcomes comparing our first 100, second 100, and last 100 patients.

Transcaval Valve-in-Valve-in-Valve Aortic Valve Replacement for Bioprosthetic Valve Degeneration.

A 74-year-old man presented with progressive dyspnea on exertion. History included peripheral arterial disease and coronary artery bypass grafting with aortic valve replacement 12 years ago. Subsequently, the surgical valve developed severe stenosis and moderate insufficiency. He underwent a transapical valve-in-valve transcatheter aortic valve replacement 5 years before presentation. This second valve developed a mean gradient of 66 mm Hg with mild insufficiency. The patient was treated with a third aortic valve using an alternative transcaval approach, significantly alleviating his symptoms.

Predictors of paravalvular regurgitation and permanent pacemaker implantation after TAVR with a next-generation self-expanding device.

To identify predictors of paravalvular regurgitation (PVR) and permanent pacemaker implantation (PPI) following TAVR with a next-generation self-expanding device.

Fibrous composite material for textile heart valve design: in vitro assessment.

With over 150,000 implantations performed over the world, transcatheter aortic valve replacement (TAVR) has become a surgical technique, which largely competes with open surgery valve replacement for an increasing number of patients. The success of the procedure favors the research toward synthetic valve leaflet materials as an alternative to biological tissues, whose durability remains unknown. In particular, fibrous constructions have recently proven to be durable in vivo over a 6-month period of time in animal sheep models. Exaggerated fibrotic tissue formation remains, however, a critical issue to be addressed. This work investigates the design of a composite fibrous construction combining a woven polyethylene terephthalate (PET) layer and a non-woven PET mat, which are expected to provide, respectively, strength and appropriate topography toward limited fibrotic tissue ingrowth. For this purpose, a specific equipment has been developed to produce non-woven PET mats made from fibers with small diameter. These mats were assembled with woven PET substrates using various assembling techniques in order to obtain hybrid fibrous constructions. The physical and mechanical properties of the obtained materials were assessed and valve samples were manufactured to be tested in vitro for hydrodynamic performances. The results show that the composite fibrous construction is characterized by properties suitable for the valve leaflet function, but the durability of the assembling is however limited under accelerated cyclic loading.

Combined carotid endarterectomy and transcatheter aortic valve replacement: Technique and outcomes.

Stroke and transient ischemic attack after transcatheter aortic valve replacement results in significantly higher morbidity and mortality. Severe carotid artery disease may be a contributing factor to this increased risk. We report our technique and outcomes of combined carotid endarterectomy (CEA) with transcatheter aortic valve replacement (TAVR).

Comparison of in-hospital outcomes between octogenarians and nonagenarians undergoing transcatheter aortic valve replacement: a propensity matched analysis.

Aortic valve stenosis (AS) is very common in the elderly patients above 80 years. Transcatheter aortic valve replacement (TAVR) in such patients is being increasingly performed. This study sought to assess in-hospital outcome differences between octogenarians and nonagenarians and predictors of mortality in nonagenarians undergoing TAVR with severe AS.

Transcatheter Mitral Valve-In-Valve Dislocation: A Rescue Strategy.

In the TAVR (transcatheter aortic valve replacement) era, trans-apical valve-in-valve mitral valve implantation (TA-MVI) is considered an alternative treatment for high risk patients with degenerated mitral bioprosthesis. We report an unusual strategy to remedy to a potentially fatal complication as the mitral prosthesis migration into the aortic arch. The dislocated prosthesis was successfully stabilized in the aortic arch with a bare aortic stent, ensuring an adequate perfusion of epiaortic vessels.

Large dissecting intramural haematoma of the oesophagus and stomach and major gastro-oesophageal bleeding after transoesophageal echocardiography during transcatheter aortic valve replacement procedures.

Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: An updated meta-analysis.

A dynamic model based approach to motion and deformation tracking of prosthetic valves from biplane x-ray images.

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure in which a prosthetic heart valve is placed and expanded within a defective aortic valve. The device placement is commonly performed using two-dimensional fluoroscopic imaging. Within this work, we propose a novel technique to track the motion and deformation of the prosthetic valve in three dimensions based on biplane fluoroscopic image sequences.

Systemic inflammatory response syndromes in the era of interventional cardiology.

Systemic inflammatory response syndrome (SIRS), initially reported after cardiovascular surgery, has been described after various interventional cardiology procedures, including endovascular/thoracic aortic repair (EVAR/TEVAR), implantation of heart rhythm devices, percutaneous coronary intervention (PCI), electrophysiology procedures (EP), and transcatheter aortic valve implantation (TAVI). In these settings, a comprehensive understanding of the triggers, pathogenesis as well as a common diagnostic/therapeutic algorithm is lacking and will be discussed in this review. SIRS occurs in 40% and 50% of patients undergoing TEVAR/EVAR and TAVI respectively; it affects 0.1% of patients undergoing implantation of heart rhythm devices. Prevalence is unknown after PCI or EP. Clinical presentation includes fever, dyspnoea/tachypnoea, tachycardia, weakness, chest pain and pericardial/pleural effusion. Several triggers can be identified, related to implanted devices, biomaterial, and procedural aspects (prolonged hypotension, aneurysm thrombus manipulation, active fixation atrial leads, coronary microembolization, balloon dilatation/stent implantantation, contrast medium, coronary/myocardial microperforation). Nonetheless, these triggers share three main pathogenic pathways leading to SIRS clinical manifestations: leucocytes activation, endothelial injury/activation, and myocardial/pericardial injury. Therapy consists of non-steroidal agents, with corticosteroids as second-line treatment in non-responders. Although a benign evolution is reported after implantation of heart rhythm devices, PCI and EP, major adverse events may occur after EVAR/TEVAR and TAVI at short- and mid-term follow up.

Transitional care post TAVI: A pilot initiative focused on bridging gaps and improving outcomes.

Interventions focused on ensuring safe transitions for patients from hospital to home can assist in providing continuity of care, preventing readmissions, and reducing duplication of services. Patients undergoing a Transcatheter Aortic Valve Implantation (TAVI) procedure are often frail, elderly, and have multiple co-morbidities. A pilot initiative evaluating transitional care strategies through telephone follow up was implemented in a tertiary centre with the aim to identify gaps and intervene, preventing re-admission and improving patient outcomes. TAVI patients or caregivers were contacted at 3 days and 30 days post discharge by an Advanced Practice Nurse (APN). Telephone follow up centered on best practices for transitional care. Outcomes revealed fluid balance monitoring, medication management, and feelings of anxiety and depression post TAVI were the most frequent areas requiring intervention. Findings from this initiative reinforce the need to establish consistent processes that support elderly patient populations during potentially vulnerable points in the care trajectory.

Midterm outcome of transcatheter versus surgical aortic valve replacement in low to intermediate risk patients: A meta-analysis of randomized controlled trials.

Current guidelines recommend transcatheter aortic valve replacement (TAVR) in patients with severe symptomatic aortic stenosis (AS) who are not suitable for conventional surgical aortic valve replacement (SAVR). In light of the recent trend in performing TAVR in patients with lower risk profile, we assessed the midterm outcome comparing TAVR and SAVR for the treatment of patients with severe AS at low to intermediate risk.

Predictors of 1-year mortality after transcatheter aortic valve replacement.

To identify variables predictive of increased mortality within 1 year of transcatheter aortic valve replacement (TAVR).

Realistic Vascular Replicator for TAVR Procedures.

Transcatheter aortic valve replacement (TAVR) is an over-the-wire procedure for treatment of severe aortic stenosis (AS). TAVR valves are conventionally tested using simplified left heart simulators (LHS). While those provide baseline performance reliably, their aortic root geometries are far from the anatomical in situ configuration, often overestimating the valves' performance. We report on a novel benchtop patient-specific arterial replicator designed for testing TAVR and training interventional cardiologists in the procedure. The Replicator is an accurate model of the human upper body vasculature for training physicians in percutaneous interventions. It comprises of fully-automated Windkessel mechanism to recreate physiological flow conditions. Calcified aortic valve models were fabricated and incorporated into the Replicator, then tested for performing TAVR procedure by an experienced cardiologist using the Inovare valve. EOA, pressures, and angiograms were monitored pre- and post-TAVR. A St. Jude mechanical valve was tested as a reference that is less affected by the AS anatomy. Results in the Replicator of both valves were compared to the performance in a commercial ISO-compliant LHS. The AS anatomy in the Replicator resulted in a significant decrease of the TAVR valve performance relative to the simplified LHS, with EOA and transvalvular pressures comparable to clinical data. Minor change was seen in the mechanical valve performance. The Replicator showed to be an effective platform for TAVR testing. Unlike a simplified geometric anatomy LHS, it conservatively provides clinically-relevant outcomes and complement it. The Replicator can be most valuable for testing new valves under challenging patient anatomies, physicians training, and procedural planning.

Transcatheter valve interventions in heart failure: new answers to old questions.

Heart failure (HF) is often associated with different valve diseases, predominantly functional mitral and tricuspid regurgitation. However, the association between HF and aortic stenosis, particularly low-flow low-gradient aortic stenosis, is not infrequent. Severe mitral and tricuspid regurgitations, as well as aortic stenosis, in HF patients worsen prognosis and left ventricular dilatation and induce further reduction in left ventricular ejection fraction. Transcatheter edge-to-edge mitral and tricuspid valve repair and transcatheter aortic valve implantation could be an important therapeutic option with a satisfactory long-term outcome in HF patients with comorbidities and even in patients with severely depressed ejection fraction.

Risk factors and outcome of postoperative delirium after transcatheter aortic valve replacement.

POD is associated with a worse postoperative course in patients after cardiac surgery, but its incidence and effects after TAVR are not well-understood. The aim of the present study was to analyze incidence, risk factors, and in-hospital outcomes of postoperative delirium (POD) after transfemoral (TF-AVR) and transapical (TA-AVR) transcatheter aortic valve replacement (TAVR) in a nationwide cohort.

Transcatheter Aortic Valve Replacement in Low-Flow Aortic Stenosis: Treat the Flow or Treat the Patient?

Predictors of Mortality and Symptomatic Outcome of Patients With Low-Flow Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement.

Impaired left ventricular (LV) ejection fraction is a common finding in patients with aortic stenosis and serves as a predictor of morbidity and mortality after transcatheter aortic valve replacement. However, conflicting data on the most accurate measure for LV function exist. We wanted to examine the impact of LV ejection fraction, mean pressure gradient, and stroke volume index on the outcome of patients treated by transcatheter aortic valve replacement.

Comparison of adverse event and device problem rates for transcatheter aortic valve replacement and Mitraclip procedures as reported by the Transcatheter Valve Therapy Registry and the Food and Drug Administration postmarket surveillance data.

Although outcomes data on transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (Mitraclip) are available via the Transcatheter Valve Therapy (TVT) registry, dissemination of TVT data is often delayed. The Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) system collects postmarket outcomes data in public medical device reports. We used natural language processing to compare the event rates for TAVR and Mitraclip in the TVT registry and from MAUDE data.

Complications after transcatheter aortic valve implantation using transfemoral and transapical approach in general anaesthesia.

Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure used to treat degenerative heart valve disease. The implantation requires a highly specific and interdisciplinary management approach. Currently, TAVI is performed with the patient under local or general anaesthesia.

Successful rotational atherectomy for abdominal aortic stenosis with severe calcification in a patient treated with transfemoral transcatheter aortic valve implantation.