Transapical Transcatheter Aortic Valve Replacement Is Associated With Increased Cardiac Mortality in Patients With Left Ventricular Dysfunction

Abstract High-sensitivity Troponin (hs-Tn) has emerged as a useful marker for patients with myocardial injury or heart failure. However, few studies have compared intermediate and hs-Tn in patients undergoing transcatheter aortic valve replacement (TAVR). Moreover, there remains uncertainty of which thresholds are the most useful for discriminating ventricular dysfunction or outcome. In this study we prospectively enrolled 105 patients with severe aortic stenosis (AS) who underwent TAVR as well as blood sampling for high-sensitivity (hs-TnI) and conventional troponin I (EXL-LOCI and RXL) assessment. Patients underwent comprehensive pre-procedure echocardiography. Ventricular dysfunction was defined using left ventricular mass index (LVMI), LV global longitudinal strain (LVGLS) and LV end-diastolic pressure. The mean age was 84.0 ± 8.7 years old and 60% were male sex with mean transaortic pressure gradient of 50.1 ± 16.0 mmHg and AVA of 0.63 ± 0.19 cm2. When using a threshold of 6 ng/L, 77% had positive hs-TnI while 27% had positive hs-TnI using recommended thresholds (16 ng/L for female and 34 ng/L for male). Troponin levels were higher in the presence of abnormal LV phenotypes. The strongest correlate of troponin was LVMI. During median follow-up of 375 days, 21 patients (20%) died. Lower threshold of hs-TnI and EXL-TnI was more discriminatory for overall mortality (Log-rank P = 0.03 for both), while higher threshold of hs-TnI (p = 0.75) and RXL-TnI were not (p = 0.30). Combining hs-TnI and BNP improved to predict long-term outcome (p = 0.004). In conclusion, hs-TnI levels correlated with the degree of LV dysfunction phenotypes. Furthermore, applying a lower threshold for hs-TnI performed better for outcome prediction than a recommended threshold in patients undergoing TAVR. Combining hs-TnI with BNP helped better risk stratification.

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Transcatheter aortic valve replacement and His bundle pacing in the presence of severe left ventricular dysfunction and left bundle branch block

Journal of Transcatheter Interventions ◽

10.31160/jotci202129a20210006 ◽

2021 ◽

Vol 29 ◽

pp. 1-4

Author(s):

Luiz São Thiago ◽

Luis Luciano ◽

Aline Tscha ◽

Artur Guimarães ◽

Alice Silva ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Bundle Branch Block ◽

Transcatheter Aortic Valve Replacement ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Bundle Branch Block ◽

Transcatheter Aortic Valve

Aortic stenosis is the most prevalent valve disease in developed countries and has high morbidity and mortality after the onset of symptoms. The prevalence of severe aortic stenosis in elderly patients (>75 years) is approximately 3.4%. The transcatheter aortic valve replacement has been employed for approximately 20 years and had robust outcomes published. However, it is a challenging procedure when performed on a patient in cardiogenic shock, caused by severe deterioration of left ventricular function, a condition aggravated in cases of electromechanical dyssynchrony due to left bundle branch block. There is evidence that reestablishing the electrical conduction with a pacemaker implanted directly in the conduction system, in patients with left ventricular dysfunction and dyssynchrony, can significantly improve the systolic function. In this context, the objective of the present study was to present and discuss the particularities and evidence available for treating this complex subgroup of patients.

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EFFECT OF SEVERE LEFT VENTRICULAR DYSFUNCTION ON OUTCOMES AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT VERSUS SURGICAL AORTIC VALVE REPLACEMENT: A PROPENSITY SCORE REGRESSION ANALYSIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)61998-2 ◽

2015 ◽

Vol 65 (10) ◽

pp. A1998

Author(s):

Vinod H. Thourani ◽

Richard C. Gilmore ◽

Jose Condado Contreras ◽

Hanna A. Jensen ◽

Jose Binongo ◽

...

Keyword(s):

Regression Analysis ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Surgical Aortic Valve Replacement ◽

Severe Left Ventricular Dysfunction ◽

Transcatheter Aortic Valve

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Faculty Opinions recommendation of Impact of right ventricular dysfunction and tricuspid regurgitation on outcomes in patients undergoing transcatheter aortic valve replacement.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726847452.793524426 ◽

2016 ◽

Author(s):

John Augoustides

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Right Ventricular ◽

Valve Replacement ◽

Tricuspid Regurgitation ◽

Transcatheter Aortic Valve Replacement ◽

Ventricular Dysfunction ◽

Right Ventricular Dysfunction ◽

Transcatheter Aortic Valve

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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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