EFFECT OF ASCENDING AORTA SIZE IN TRANSCATHETER AORTIC VALVE PERFORMANCE: COMPARISON BETWEEN EVOLUT R AND SAPIEN 3

This study presents a case of a successful severed femoral sheath recapture during transfemoral transcatheter aortic valve replacement (TAVR). During skin tunneling with a scalpel, the discontinuity of the femoral sheath occurred. Grasping of the distal sheath with the surgical hemostat was attempted unsuccessfully. A proximal part of the severed sheath was removed and Medtronic Sentrant introducer sheath (14 French) was then placed over the existing Confida wire which permanently remained in position, followed by the introduction of the Amplatz Left 2 (AL2) catheter which pushed the severed sheath in the ascending aorta over the Confida wire. The crucial maneuver was the entanglement of the severed sheath in the aortic non-coronary cusp which allowed for its entrapment by the AL2 catheter. This allowed for the coronary guidewire BMW Universal (0.014”) placement and a slow balloon retrieval (SeQuent NEO 2.5 x 25 mm) of the severed sheath into the introducer sheath. The guidewire/balloon catheter was then exchanged for the support wire (0.035”) followed by the removal of the introducer sheath, AL2 catheter and the severed sheath. In conclusion, sheath severing is a complex accidental event during TAVR, which can be solved by intra-aortic recapture and retraction.

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Real-World Experience With the SAPIEN 3 Ultra Transcatheter Heart Valve: A Propensity-Matched Analysis From the United States

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.121.010543 ◽

2021 ◽

Vol 14 (9) ◽

Author(s):

Tamim M. Nazif ◽

Thomas J. Cahill ◽

David Daniels ◽

James M. McCabe ◽

Mark Reisman ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Clinical Outcomes ◽

Valve Replacement ◽

Heart Valve ◽

Transcatheter Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Transcatheter Heart Valve ◽

Sapien 3 ◽

Transcatheter Valve

Background: Paravalvular regurgitation (PVR) after transcatheter aortic valve replacement is associated with adverse clinical outcomes. The SAPIEN 3 Ultra (Ultra) is a new generation balloon-expandable transcatheter heart valve with a modified external skirt that is designed to reduce PVR, but reports of clinical and echocardiographic outcomes are limited. The aim of this study was to compare short-term outcomes of patients undergoing transcatheter aortic valve replacement with the Ultra and the original SAPIEN 3 (S3) transcatheter heart valve in a large national registry. Methods: Data from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry was used to compare patients who underwent elective, transfemoral transcatheter aortic valve replacement with the Ultra or S3 transcatheter heart valve. Clinical and echocardiographic outcomes were analyzed in a propensity-matched cohort at discharge and 30 days. Results: Patients who underwent transcatheter aortic valve replacement with Ultra (N=1324) from January 2019 to February 2020 were propensity score–matched with patients treated with S3 (N=32 982) during the same period, resulting in 1324 matched pairs. There was no difference in the rate of device success between patients treated with Ultra and S3 (97.1% versus 98.0%, P =0.11). At hospital discharge, PVR was significantly reduced with Ultra compared with S3, with mild PVR in 9.0% versus 13.9% and moderate or greater PVR in 0.1% versus 0.4% (overall P <0.01). At 30 days, there were no differences between Ultra and S3 recipients in the rates of all-cause mortality or stroke (1.8% versus 2.8%, P =0.10), major vascular complications (1.1% versus 1.0%, P =0.84), or permanent pacemaker implantation (6.4% versus 6.2%, P =0.81). Conclusions: In this propensity-matched analysis from the Transcatheter Valve Therapy Registry, the Ultra transcatheter heart valve was associated with similar procedural and 30-day clinical outcomes, but reduced incidence of PVR, compared with S3. The clinical benefit of less PVR should be evaluated in longer-term studies.

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One-stage off pump combined transapical aortic valve replacement and ascending aorta endografting

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa301 ◽

2020 ◽

Cited By ~ 1

Author(s):

Gino Gerosa ◽

Giorgia Cibin ◽

Michele Antonello ◽

Augusto D’Onofrio

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Ascending Aorta ◽

Off Pump ◽

Stent Grafting ◽

Transcatheter Aortic Valve ◽

Custom Made ◽

Risk Patients

Abstract An 84-year-old patient was referred for severe symptomatic aortic valve stenosis and focal chronic dissection of the ascending aorta. After multidisciplinary discussion, the patient was scheduled for combined transapical transcatheter aortic valve replacement and ascending aorta stent-grafting. The procedure was performed with a balloon aortic valvuloplasty followed by a custom-made stent graft implantation into the ascending aorta and then by balloon-expandable transapical transcatheter aortic valve replacement. The patient had an uneventful hospital stay. In conclusion, in selected high-risk patients, transapical combined ascending aorta stent-grafting and transcatheter aortic valve replacement are feasible and safe.

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Comparing the Procedural and Clinical Outcomes of Sapien XT and Sapien 3 Valves in Transcatheter Aortic Valve Replacement in Korean Patients

Korean Circulation Journal ◽

10.4070/kcj.2020.0061 ◽

2020 ◽

Vol 50 (10) ◽

pp. 907 ◽

Cited By ~ 1

Author(s):

Hyungdon Kook ◽

Duck Hyun Jang ◽

Kyung-Sook Yang ◽

Hyung Joon Joo ◽

Jae Hyoung Park ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Clinical Outcomes ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Korean Patients ◽

Transcatheter Aortic Valve ◽

Sapien 3

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Numerical models for assessing the risk of leaflet thrombosis post-transcatheter aortic valve-in-valve implantation

Royal Society Open Science ◽

10.1098/rsos.201838 ◽

2020 ◽

Vol 7 (12) ◽

pp. 201838

Author(s):

Romina Plitman Mayo ◽

Halit Yaakobovich ◽

Ariel Finkelstein ◽

Shawn C. Shadden ◽

Gil Marom

Keyword(s):

High Risk ◽

Aortic Valve ◽

Numerical Models ◽

Aortic Valves ◽

Transcatheter Aortic Valve ◽

Edwards Sapien ◽

Valve In Valve ◽

Sapien 3 ◽

Valve Implantation ◽

Numerical Approaches

Leaflet thrombosis has been suggested as the reason for the reduced leaflet motion in cases of hypoattenuated leaflet thickening of bioprosthetic aortic valves. This work aimed to estimate the risk of leaflet thrombosis in two post-valve-in-valve (ViV) configurations, using five different numerical approaches. Realistic ViV configurations were calculated by modelling the deployments of the latest version of transcatheter aortic valve devices (Medtronic Evolut PRO, Edwards SAPIEN 3) in the surgical Sorin Mitroflow. Computational fluid dynamics simulations of blood flow followed the dry models. Lagrangian and Eulerian measures of near-wall stagnation were implemented by particle and concentration tracking, respectively, to estimate the thrombogenicity and to predict the risk locations. Most of the numerical approaches indicate a higher leaflet thrombosis risk in the Edwards SAPIEN 3 device because of its intra-annular implantation. The Eulerian approaches estimated high-risk locations in agreement with the wall sheer stress (WSS) separation points. On the other hand, the Lagrangian approaches predicted high-risk locations at the proximal regions of the leaflets matching the low WSS magnitude regions of both transcatheter aortic valve implantation models and reported clinical and experimental data. The proposed methods can help optimizing future designs of transcatheter aortic valves with minimal thrombotic risks.

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