scholarly journals Transcatheter aortic valve implantation in patients with a small aortic annulus: performance of supra-, intra- and infra-annular transcatheter heart valves

2021 ◽  
Author(s):  
Lisa Voigtländer ◽  
Won-Keun Kim ◽  
Victor Mauri ◽  
Alina Goßling ◽  
Matthias Renker ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Aortic Annulus ◽  
Transcatheter Aortic Valve ◽  
Small Aortic Annulus ◽  
Number Of Patients ◽  
Transcatheter Heart Valve ◽  
Increased Risk ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background A small aortic annulus is associated with increased risk of prosthesis–patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI). Whether specific transcatheter heart valve (THV) designs yield superior hemodynamic performance in these small anatomies remains unclear. Methods Data from 8411 consecutive patients treated with TAVI from May 2012 to April 2019 at four German centers were retrospectively evaluated. A small aortic annulus was defined as multidetector computed tomography-derived annulus area < 400 mm2. TAVI was performed with a balloon-expanding intra-annular (Sapien-3, n = 288), self-expanding intra-annular (Portico, n = 110), self-expanding supra-annular (Evolut, n = 179 and Acurate-Neo, n = 428) and mechanically expanding infra-annular (Lotus, n = 64) THV according to local practice. PPM was defined as indexed effective orifice area ≤ 0.85cm2/m2. Results A small annulus was found in 1069 (12.7%) patients. PPM was detected in 38.3% overall with a higher prevalence after implantation of a balloon-expanding intra-annular or mechanically expanding infra-annular THV compared to self-expanding intra- and supra-annular THV. Multivariable analysis linked self-expanding THV (Evolut: Odds ratio [OR] 0.341, Acurate-Neo: OR 0.436, Portico: OR 0.291), postdilatation (OR 0.648) and age (OR 0.968) to lower rates of PPM, while aortic valve calcification was associated with an increased risk (OR 1.001). Paravalvular regurgitation > mild was more frequent after TAVI with self-expanding THV (p = 0.04). Conclusion In this large contemporary multicenter patient population, a substantial number of patients with a small aortic anatomy were left with PPM after TAVI. Self-expanding supra- and intra-annular THV demonstrated superior hemodynamics in these patients at risk, however at the cost of higher rates of residual paravalvular regurgitation. Graphic abstract

scholarly journals Real-time observation of a high-echoic mass in the left ventricle during transcatheter aortic valve implantation: a case report

2020 ◽  
Author(s):  
Akiko Masumoto ◽  
Takeshi Kitai ◽  
Mitsuhiko Ota ◽  
Kitae Kim ◽  
Natsuhiko Ehara ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Cerebral Arteries ◽  
Transoesophageal Echocardiography ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Increasing number of symptomatic patients with severe aortic stenosis is treated with transcatheter aortic valve implantation (TAVI). Stroke is one of the most serious complications of TAVI, and the majority of cerebral events in patients undergoing TAVI have an embolic origin. Case summary A 90-year-old female underwent trans-femoral TAVI for symptomatic severe aortic stenosis. Just before the implantation of the transcatheter heart valve (THV), transoesophageal echocardiography (TOE) showed a mobile, high-echoic mass attached to the THV, which gradually enlarged to 26 mm, then spontaneously detached from the THV and flowed up the ascending aorta, disappearing from the TOE field of. After the procedure, the patient presented with ischaemic stroke. The patient’s stroke was thought to have resulted from the embolism migrating to the distal cerebral arteries. Discussion The detailed images acquired with TOE during TAVI enabled the prompt identification of the unusual intracardiac mass.

scholarly journals TRANSCATHETER AORTIC VALVE IMPLANTATION FOR PATIENTS WITH ELLIPTICAL AORTIC ANNULUS

2013 ◽  
Vol 61 (10) ◽  
pp. E1994
Author(s):  
Kentaro Hayashida ◽  
Erik Bouvier ◽  
Thierry Lefèvre ◽  
Bernard Chevalier ◽  
Thomas Hovasse ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Aortic Annulus ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

The Wattson temporary pacing guidewire for transcatheter heart valve implantation

2021 ◽  
Author(s):  
James Carey ◽  
Anthony Buckley ◽  
Stephen O'Connor ◽  
Mark Hensey
Keyword(s):  
Aortic Valve ◽  
Heart Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Temporary Pacing ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation and implantation of other transcatheter heart valves, generally requires insertion of a temporary venous pacemaker. Implantation of a temporary venous pacemaker adds complexity, time and risk to the procedure. Guidewire modification to allow pacing is increasingly popular, however it requires technical expertise and provides unipolar pacing resulting in high thresholds and potential capture loss. The Wattson temporary pacing guidewire is a novel device which offers guidewire support for valve delivery and concomitant bipolar pacing. It may offer a safe and effective solution to guidewire pacing for transcatheter aortic valve implantation and other transcatheter heart valve implantations. Herein, we review the literature surrounding left ventricular guidewire pacing along with the features and clinical data of the Wattson wire.

scholarly journals Experiência Inicial de um Programa de TAVI: Análise da Decisão Anestésica e sua Evolução

2019 ◽  
Vol 32 (2) ◽  
pp. 126
Author(s):  
Ana Margarida Martins ◽  
Maria Lurdes Castro ◽  
Isabel Fragata
Keyword(s):  
Aortic Valve ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Transcatheter Aortic Valve Implantation ◽  
Anesthetic Technique ◽  
Less Invasive ◽  
Transcatheter Aortic Valve ◽  
Number Of Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Introduction: Transcatheter aortic valve implantation is a less invasive option for aortic valve replacement. The number of transcatheter aortic valve implantations under local anesthesia with sedation has been increasing as the team’s experience increases and less invasive accesses are used. The aim of this study is to describe the evolution of the anesthetic technique in patients undergoing transcatheter aortic valve implantation at our center over the years, as which was compared. Material and Methods: Retrospective study in 149 consecutive patients undergoing transcatheter aortic valve implantation in Hospital Santa Marta (January 2010 to December 2016). Data was collected from the periprocedural records of patients. Patients were stratified according to anesthetic technique. Results: From our patients’ sample, 57.0% were female, with median age 82 [58 - 95] years. Most patients underwent general anesthesia (68.5%). In the local anesthesia with sedation group there was a shorter duration of the procedure (120; [60 - 285] vs 155 [30 - 360]) and a lower number of patients requiring administration of vasopressors (61.8% vs 28.3%) – p < 0.05. There were no differences regarding length of hospital stay (9 [4 - 59] vs 10 [3 - 87]), periprocedural complications (66.0% vs 72.5%), readmission rate (4.3% vs 3.9%) or 30-days (2.1% vs 4.9%) and 1-year mortality (6.4% vs 7.8%) – p > 0.05. There was an increasing number of transcatheter aortic valve implantations performed under local anesthesia with sedation over the years.Discussion: The choice of anesthetic technique depends on the patient’s characteristics, experience and preference of the team.Conclusion: Local anesthesia with sedation seems to be associated with similar results as general anesthesia. The increase in the number of transcatheter aortic valve implantations under local anesthesia with sedation seems to follow the trend of lower invasiveness of the procedure.

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