An Advanced Heart Team Model: Can It Be Adapted to Africa?

В статье представлены современные взгляды на ведение пациентов с сердечно-сосудистой и онкологической патологиями. Обозначены наиболее спорные вопросы по проблемам подготовки пациентов с сердечно-сосудистой патологией к некардиологическим (онкологическим) оперативным вмешательствам. Обсуждены существующие ограничения в диагностике, профилактике и лечении кардиотоксичности химиотерапии при лечении злокачественных образований. Представлены перспективы научных исследований, направленных на оценку единых механизмов развития сердечно- сосудистых и онкологических заболеваний.

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Valve-in-valve transcatheter aortic valve implantation with fracturing of a failed small surgical aortic bioprosthesis: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa356 ◽

2020 ◽

Author(s):

Matjaz Bunc ◽

Miha Cercek ◽

Tomaz Podlesnikar ◽

Simon Terseglav ◽

Klemen Steblovnik

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Ex Vivo ◽

Bioprosthetic Valve ◽

Heart Team ◽

Transcatheter Aortic Valve ◽

Patient Prosthesis Mismatch ◽

Valve In Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background Failure of a small surgical aortic bioprosthesis represents a challenging clinical scenario with valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) often resulting in patient-prosthesis mismatch. Bioprosthetic valve fracture (BVF) performed as a part of the ViV TAVI has recently emerged as an alternative approach with certain types of surgical bioprostheses. Case summary An 81-year-old woman with a history of three surgical aortic valve procedures presented with heart failure. Aortic bioprosthesis degeneration with severe stenosis and moderate regurgitation was found. The patient was deemed a high-risk surgical candidate and the heart team decided that ViV TAVI was the preferred treatment option. Due to the very small 19 mm stented surgical aortic bioprosthesis Mitroflow 19 mm (Sorin Group, Italy) we decided to perform BVF as a part of ViV TAVI to prevent patient-prosthesis mismatch. Since this was the first BVF procedure in our centre, an ex vivo BVF of the same kind of bioprosthetic valve was performed first. Subsequently, successful BVF with implantation of Evolut R 23 mm (Medtronic, USA) self-expandable transcatheter valve was performed. Excellent haemodynamic result was achieved and no periprocedural complications were present. The patient had an immediate major improvement in clinical status and remains asymptomatic after 6 months. Discussion Bioprosthetic valve fracture together with ViV TAVI is a safe and effective emerging technique for treatment of small surgical aortic bioprosthesis failure. Bioprosthetic valve fracture allows marked oversizing of implanted self-expandable transcatheter aortic valves, leading to excellent haemodynamic and clinical results. An ex vivo BVF can serve as an important preparatory step when introducing the new method.

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Left atrial functional assessment and mortality in patients with severe aortic stenosis with sinus rhythm

Cardiovascular Ultrasound ◽

10.1186/s12947-020-00231-0 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

João Ferreira ◽

Valdirene Gonçalves ◽

Patrícia Marques-Alves ◽

Rui Martins ◽

Sílvia Monteiro ◽

...

Keyword(s):

Aortic Valve ◽

Left Atrial ◽

Primary Outcome ◽

Severe Aortic Stenosis ◽

Heart Team ◽

Pump Function ◽

Volumetric Assessment ◽

All Cause Mortality ◽

Echocardiography Laboratory

Abstract Background Aortic valve stenosis (AS) is the most common primary valvular heart disease leading to surgical or percutaneous aortic valve replacement (AVR) in Europe and its prevalence keeps growing. While other risk factors in severe AS are well documented, little is known about the prognostic value of left atrial (LA) function in AS. Our aim is to clarify the relationship between LA function measured at severe AS diagnosis (evaluated by means of volumetric assessment) and all-cause mortality during follow-up. Methods We retrospectively evaluated patients diagnosed with severe AS for the first time at our echocardiography laboratory. We evaluated LA reservoir, conduit and pump function by measuring LA volumes at different timings of cardiac cycle. Treatment strategy was decided according to heart team consensus and patient decision. We divided patients into groups according to terciles of LA reservoir, conduit and pump function. Primary outcome was defined by the occurrence of all-cause mortality during follow-up. Results A total of 408 patients were included in the analysis, with a median follow-up time of 45 months (interquartile range 54 months). 57.9% of patients underwent AVR and 44.9% of patients registered the primary outcome during follow-up. Left atrial emptying fraction (LAEF) was the best LA functional parameter and the best overall parameter in discriminating primary outcome (AUC 0.845, 95%CI 0.81–0.88, P < 0.001). After adjustment for clinical, demographic and echocardiographic variables, cumulative survival of patients with LAEF < 37% and LAEF 37 to 53% relative to patients with LAEF ≥54% remained significantly lower (HR 13.91, 95%CI 6.20–31.19, P < 0.001 and HR 3.40, 95%CI 1.57–7.37, P = 0.002, respectively). After adjustment for AVR, excess risk of LAEF < 37% and LAEF 37 to 53% relative to LAEF ≥54% remained significant (HR 11.71, 95%CI 5.20–26.40, P < 0.001 and HR 3.59, 95%CI 1.65–7.78, P = 0.001, respectively). Conclusions In patients with a first diagnosis of severe AS, LA function, evaluated by means of volumetric assessment, is an independent predictor of all-cause mortality and a more potent predictor of death compared to classical severity parameters. These data can be useful to identify high-risk patients who might benefit of AVR.

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Case report: Buddy wire technique to facilitate atrial septal crossing during transcatheter transseptal mitral valve implantation

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa373 ◽

2020 ◽

Author(s):

Ashvarya Mangla ◽

Ameer Musa ◽

Clifford J Kavinsky ◽

Hussam S Suradi

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Heart Valve ◽

Interatrial Septum ◽

Chronic Obstructive ◽

Mitral Valve Stenosis ◽

Heart Team ◽

Transcatheter Heart Valve ◽

Valve Implantation ◽

Buddy Wire

Abstract Background Transcatheter mitral valve-in-valve implantation (MVIV) has emerged as a viable treatment option in patients at high risk for surgery. Occasionally, despite appropriate puncture location and adequate dilation, difficulty is encountered in advancing the transcatheter heart valve across interatrial septum. Case summary We describe a case of a 79-year-old woman with severe chronic obstructive pulmonary disease (COPD), prior surgical bioprosthetic aortic and mitral valve replacement implanted in 2007, atrial fibrillation, and Group II pulmonary hypertension who presented with progressively worsening heart failure symptoms secondary to severe bioprosthetic mitral valve stenosis and moderate-severe mitral regurgitation. Her symptoms had worsened over several months, with multiple admissions at other institutions with treatment for both COPD exacerbation and heart failure. Transoesophageal echocardiogram demonstrated preserved ejection fraction, normal functioning aortic valve, and dysfunctional mitral prosthesis with severe stenosis (mean gradient 13 mmHg) and moderate-severe regurgitation. After a multi-disciplinary heart team discussion, the patient underwent a transcatheter MVIV implantation. During the case, inability in advancing the transcatheter heart valve (THV) across interatrial septum despite adequate septal balloon pre-dilation was successfully managed with the support of a stiff ‘buddy wire’ anchored in the left upper pulmonary vein using the same septal puncture. The patient tolerated the procedure well and was discharged home. Discussion Operators should be aware of potential strategies to advance the THV when difficulty is encountered in crossing the atrial septum despite adequate septal preparation. One such strategy is the use of stiff ‘buddy wire’ for support which avoids the need for more aggressive septal dilatation.

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More in, better out? Successful valve-in-valve procedure of an iatrogenic ventricular septal defect following transcatheter aortic valve replacement: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab097 ◽

2021 ◽

Vol 5 (5) ◽

Author(s):

Klaus-Dieter Hönemann ◽

Steffen Hofmann ◽

Frank Ritter ◽

Gerold Mönnig

Keyword(s):

Aortic Valve ◽

Ventricular Septal Defect ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Septal Defect ◽

Left Ventricular ◽

Heart Team ◽

Transcatheter Aortic Valve ◽

Valve In Valve

Abstract Background A rare, but serious, complication following transcatheter aortic valve replacement (TAVR) is the occurrence of an iatrogenic ventricular septal defect (VSD). Case summary We describe a case of an 80-year-old female who was referred with severe aortic stenosis for TAVR. Following thorough evaluation, the heart team consensus was to proceed with implantation via a transapical approach of an ACURATE neo M 25 mm valve (Boston Scientific, Natick, MA, USA). The valve was deployed harnessing transoesophageal echocardiographic (TOE) guidance under rapid pacing with post-dilation. Directly afterwards a very high VSD close to the aortic annulus was detected. As the patient was haemodynamically stable, the procedure was ended. The next day another TOE revealed a shunt volume (left-to-right ventricle) between 50% and 60%. Because the defect was partly located between the stent struts of the ACURATE valve decision was made to fix this leakage with implantation of a further valve and we chose an EVOLUT Pro 29 mm (Medtronic Inc., Minneapolis, MN, USA). The valve-in-valve was implanted 2–3 mm below the lower edge of the first valve, more towards the left ventricular outflow tract (LVOT) with excellent result: VSD was reduced to a very small residual shunt without any hemodynamic relevance. Discussion We suggest that an iatrogenic VSD located near the annulus may be treated percutaneously in a bail-out situation with implantation of a second valve that should be implanted slightly more into the LVOT to cover the VSD.

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Aortic Valve Disease and Associated Complex CAD: The Interventional Approach

Journal of Clinical Medicine ◽

10.3390/jcm10050946 ◽

2021 ◽

Vol 10 (5) ◽

pp. 946

Author(s):

Federico Marin ◽

Roberto Scarsini ◽

Rafail A. Kotronias ◽

Dimitrios Terentes Printzios ◽

Matthew K. Burrage ◽

...

Keyword(s):

Aortic Valve ◽

Severe Aortic Stenosis ◽

Myocardial Revascularization ◽

Coronary Intervention ◽

Hemodynamic Instability ◽

Bleeding Complications ◽

Diagnostic Tools ◽

Heart Team ◽

Complex Anatomy ◽

Increased Risk

Coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis (AS). The management of CAD is a central aspect of the work-up of patients undergoing transcatheter aortic valve implantation (TAVI), but few data are available on this field and the best percutaneous coronary intervention (PCI) practice is yet to be determined. A major challenge is the ability to elucidate the severity of bystander coronary stenosis independently of the severity of aortic valve stenosis and subsequent impact on blood flow. The prognostic role of CAD in patients undergoing TAVI is being still debated and the benefits and the best timing of PCI in this context are currently under evaluation. Additionally, PCI in the setting of advanced AS poses some technical challenges, due to the complex anatomy, risk of hemodynamic instability, and the increased risk of bleeding complications. This review aims to provide a comprehensive synthesis of the available literature on myocardial revascularization in patients with severe AS undergoing TAVI. This work can assist the Heart Team in individualizing decisions about myocardial revascularization, taking into account available diagnostic tools as well as the risks and benefits.

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Transcatheter mitral valve repair: an overview of current and future devices

Open Heart ◽

10.1136/openhrt-2020-001564 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001564

Author(s):

Ole De Backer ◽

Ivan Wong ◽

Maurizio Taramasso ◽

Francesco Maisano ◽

Olaf Franzen ◽

...

Keyword(s):

Clinical Trials ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Mitral Annulus ◽

Therapeutic Strategies ◽

Heart Team ◽

Valve Repair ◽

Careful Patient ◽

Transcatheter Mitral Valve Repair ◽

Tailored Approach

The field of transcatheter mitral valve repair (TMVr) for mitral regurgitation (MR) is rapidly evolving. Besides the well-established transcatheter mitral edge-to-edge repair approach, there is also growing evidence for therapeutic strategies targeting the mitral annulus and mitral valve chordae. A patient-tailored approach, careful patient selection and an experienced interventional team is crucial in order to optimise procedural and clinical outcomes. With further data from ongoing clinical trials to be expected, consensus in the Heart Team is needed to address these complexities and determine the most appropriate TMVr therapy, either single or combined, for patients with severe MR.

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Aortic Valve Neocuspidization Using Autologous Pericardium (Ozaki Procedure): an Alternative to Aortic Valve Replacement in Adult Cardiac Surgery?

Current Anesthesiology Reports ◽

10.1007/s40140-021-00454-5 ◽

2021 ◽

Author(s):

Luca Koechlin ◽

Friedrich S. Eckstein

Keyword(s):

Cardiac Surgery ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Pacemaker Implantation ◽

Unmet Need ◽

Heart Team ◽

Autologous Pericardium ◽

Potential Benefits ◽

Adult Cardiac Surgery

Abstract Purpose of the Review The aim of this article is to describe the technique of aortic valve neocuspidization using autologous pericardium (AVNeo, “OZAKI procedure”) in adult cardiac surgery, to analyze recent findings, and to discuss benefits and limitations of this technique. Recent Findings Potential benefits of this technique include excellent hemodynamic performances, minimal use of foreign material, low rates of permanent pacemaker implantation, and omission of oral anticoagulation. However, data regarding the durability of the procedure are hitherto limited, and the procedure is associated with a higher complexity compared to aortic valve replacement. Summary AVNeo using autologous pericardium in adult cardiac surgery is a promising technique providing several benefits. However, there is a major unmet need for more data, especially regarding long-term durability. Thus, based on currently available data, we recommend careful patient selection within the heart team and shared decision-making with the informed patient.

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