scholarly journals P1476 Percutaneous paravalvular leak closure after transcatheter aortic valve replacement expedited with multimodality imaging

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
O Ozden Tok ◽  
M Abdelnabi ◽  
G Bingol ◽  
A Almaghraby ◽  
O Goktekin ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Multimodality Imaging ◽  
Imaging Modality ◽  
Paravalvular Leak ◽  
Integrated Analysis ◽  
Aortic Valve Area ◽  
Transcatheter Aortic Valve

Abstract A 75-year-old male admitted to our hospital with decompansated heart failure symptoms. He had a history of 3 vessel coronary artery bypass grafting 10 years ago and a 29 mm Evolut R bioprosthetic transcatheter aortic valve replacement (TAVR) history 2 months ago. His physical examination revealed a 3/6 diastolic murmur on the aortic valve area. We performed a transeosophagel echocardiography (TOE) as the transthoracic echocardiography (TTE) images were not so clear and didn’t guide enough for the procedure . TOE showed a severe paravalvular leak . After we found out from his medical reports that postprocedural ad-hoc post dilatation was performed but didn’t work, we decided to close this paravalvular leak percutanaously . According to TOE, the paravalvular leak was at 12 o’clock position. We identified the corresponding location of the leak on previous CT images which was scanned pre-TAVR for selection of the valve size and planning of the procedure. We recognized that the leak location was corresponding to a very calcified part of the aortic annulus and the reason of the severe PVL seemed to be due to this nodular extensive calcification. We planned the procedure according to TOE-CT integrated analysis and selected the optimal flouroscopic viewing angle.The defect was found and crossed in 20 seconds after the wire passed through arcus aorta.The selected VSD Occluder(No:12) was deployed precisely by extending the device throughout the defect. Succesful complete closure was confirmed with TOE. In the past 1o years, TAVR has become the treatment of choice for patients with severe aortic stenosis with a higher operative risk. Different studies have depicted a higher incidence of PVR in patients who undergo TAVR compared to SAVR. Percutaneous postTAVR PVL closure is a technically challenging procedure. Echocardiography remains the primary imaging modality for assessing PVR immediately following TAVR. Finding and crossing the PVL defect is one of the most difficult and time-consuming parts of the procedure. The reason of this difficulty can be different anatomies, bad quality imaging and lack of common language between interventional cardiologist and cardiac imaging expert. To facilitate this part of the procedure integration of echocardiograohy and CT and finding the best angulation for flouroscopy seems to be quite promising. Abstract P1476 Figure. Step by step approach to PostTAVR

scholarly journals Multimodality imaging derived energy loss index and outcome after transcatheter aortic valve replacement

2020 ◽  
Vol 21 (10) ◽  
pp. 1092-1102 ◽  
Author(s):  
Erik W Holy ◽  
Thi Dan Linh Nguyen-Kim ◽  
Lisa Hoffelner ◽  
Daniel Stocker ◽  
Thomas Stadler ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Energy Loss ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Multimodality Imaging ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
Transcatheter Aortic Valve ◽  
Loss Index

Abstract Aims  To assess whether the combination of transthoracic echocardiography (TTE) and multidetector computed tomography (MDCT) data affects the grading of aortic stenosis (AS) severity under consideration of the energy loss index (ELI) in patients undergoing transcatheter aortic valve replacement (TAVR). Methods and results  Multimodality imaging was performed in 197 patients with symptomatic severe AS undergoing TAVR at the University Hospital Zurich, Switzerland. Fusion aortic valve area index (fusion AVAi) assessed by integrating MDCT derived planimetric left ventricular outflow tract area into the continuity equation was significantly larger as compared to conventional AVAi (0.41 ± 0.1 vs. 0.51 ± 0.1 cm2/m2; P < 0.01). A total of 62 patients (31.4%) were reclassified from severe to moderate AS with fusion AVAi being >0.6 cm2/m2. ELI was obtained for conventional AVAi and fusion AVAi based on sinotubular junction area determined by TTE (ELILTL 0.47 ± 0.1 cm2/m2; fusion ELILTL 0.60 ± 0.1 cm2/m2) and MDCT (ELIMDCT 0.48 ± 0.1 cm2/m2; fusion ELIMDCT 0.61 ± 0.05 cm2/m2). When ELI was calculated with fusion AVAi the effective orifice area was >0.6 cm2/m2 in 85 patients (43.1%). Survival rate 3 years after TAVR was higher in patients reclassified to moderate AS according to multimodality imaging derived ELI (78.8% vs. 67%; P = 0.01). Conclusion  Multimodality imaging derived ELI reclassifies AS severity in 43% undergoing TAVR and predicts mid-term outcome.

Intra-procedural monitoring protocol using routine transthoracic echocardiography with backup trans-oesophageal probe in transcatheter aortic valve replacement: a single centre experience

2019 ◽  
Vol 21 (1) ◽  
pp. 85-92 ◽  
Author(s):  
S Stella ◽  
F Melillo ◽  
C Capogrosso ◽  
A Fisicaro ◽  
F Ancona ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transthoracic Echocardiography ◽  
Transcatheter Aortic Valve Replacement ◽  
Imaging Modality ◽  
Paravalvular Leak ◽  
Haemodynamic Instability ◽  
Delay In Diagnosis ◽  
Transcatheter Aortic Valve

Abstract Aim The aim of this study is to describe our 9-year experience in transcatheter aortic valve replacement (TAVR) using transthoracic echocardiography (TTE) as a routine intra-procedural imaging modality with trans-oesophageal echocardiography (TEE) as a backup. Methods and results From January 2008 to December 2017, 1218 patients underwent transfemoral TAVR at our Institution. Except the first 20 cases, all procedures have been performed under conscious sedation, with fluoroscopic guidance and TTE imaging monitoring. Once the TTE resulted suboptimal for final result assessment or a complication was either suspected or identified on TTE, TEE evaluation was promptly performed under general anaesthesia. Only 24 (1.9%) cases required a switch to TEE: 6 cases for suboptimal TTE prosthetic valve leak (PVL) quantification; 12 cases for haemodynamic instability; 2 cases for pericardial effusion without haemodynamic instability; 4 cases for urgent TAVR. The 30-days and 1-year all-cause mortality were 2.1% and 10.2%, respectively. Cardiac mortality at 30-days and 1-year follow-up were 0.6% and 4.1%, respectively. Intra-procedural and pre-discharge TT evaluation showed good agreement for PVL quantification (k agreement: 0.827, P = 0.005). Conclusion TTE monitoring seems a reasonable imaging tool for TAVR intra-procedural monitoring without delay in diagnosis of complications and a reliable paravalvular leak assessment. However, TEE is undoubtedly essential in identifying the exact mechanism in most of the complications.

True-severe stenosis in paradoxical low-flow low-gradient aortic stenosis: outcomes after transcatheter aortic valve replacement

2021 ◽  
Author(s):  
Taishi Okuno ◽  
Noé Corpataux ◽  
Giancarlo Spano ◽  
Christoph Gräni ◽  
Dik Heg ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Functional Status ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Low Flow ◽  
Aortic Valve Area ◽  
High Gradient ◽  
Transcatheter Aortic Valve

Abstract Aims The ESC/EACTS guidelines propose criteria that determine the likelihood of true-severe aortic stenosis (AS). We aimed to investigate the impact of the guideline-based criteria of the likelihood of true-severe AS in patients with low-flow low-gradient (LFLG) AS with preserved ejection fraction (pEF) on outcomes following transcatheter aortic valve replacement (TAVR). Methods and results In a prospective TAVR registry, LFLG-AS patients with pEF were retrospectively categorized into high (criteria ≥6) and intermediate (criteria <6) likelihood of true-severe AS. Haemodynamic, functional, and clinical outcomes were compared with high-gradient AS patients with pEF. Among 632 eligible patients, 202 fulfilled diagnostic criteria for LFLG-AS. Significant haemodynamic improvement after TAVR was observed in LFLG-AS patients, irrespective of the likelihood. Although >70% of LFLG-AS patients had functional improvement, impaired functional status [New York Heart Association (NYHA III/IV)] persisted more frequently at 1 year in LFLG-AS than in high-gradient AS patients (7.8%), irrespective of the likelihood (high: 17.4%, P = 0.006; intermediate: 21.1%, P < 0.001). All-cause death at 1 year occurred in 6.6% of high-gradient AS patients, 10.9% of LFLG-AS patients with high likelihood [hazard ratio (HR)adj 1.43, 95% confidence interval (CI) 0.68–3.02], and in 7.2% of those with intermediate likelihood (HRadj 0.92, 95% CI 0.39–2.18). Among the criteria, only the absence of aortic valve area ≤0.8 cm2 emerged as an independent predictor of treatment futility, a combined endpoint of all-cause death or NYHA III/IV at 1 year (OR 2.70, 95% CI 1.14–6.25). Conclusion Patients with LFLG-AS with pEF had comparable survival but worse functional status at 1 year than high-gradient AS with pEF, irrespective of the likelihood of true-severe AS. Clinical Trial Registration https://www.clinicaltrials.gov. NCT01368250.

scholarly journals Pathologic confirmation of valve thrombosis detected by four-dimensional computed tomography following valve-in-valve transcatheter aortic valve replacement

2017 ◽  
Vol 2017 (2) ◽  
Author(s):  
Ambarish Gopal ◽  
Nathalia Ribeiro ◽  
John J Squiers ◽  
Elizabeth M Holper ◽  
Michael Black ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Thrombus Formation ◽  
Imaging Modality ◽  
4D Ct ◽  
Transcatheter Aortic Valve ◽  
Valve Thrombosis

A major concern regarding transcatheter aortic valve replacement (TAVR) is leaflet thrombosis. Four-dimensional computed tomography (4D-CT) is the preferred imaging modality to evaluate patients with suspected valve thrombosis. To date, the abnormal findings visualized by 4D-CT suggestive of leaflet thrombosis have lacked pathologic confirmation from a surgically explanted valve in a surviving patient. Herein, we provide pathologic confirmation of thrombus formation following surgical explantation of a thrombosed TAVR prosthesis that was initially identified by 4D-CT. 

scholarly journals Concurrent mechanical haemolytic anaemia and heparin-induced thrombocytopenia following transcatheter aortic valve replacement

2018 ◽  
pp. bcr-2017-224069
Author(s):  
Nathan W Furukawa ◽  
Fernando M Jumalon ◽  
Daniel B Friedman ◽  
Linda R Kelly
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Prothrombin Time ◽  
Valve Replacement ◽  
Haemolytic Anaemia ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Paravalvular Leak ◽  
Heparin Induced Thrombocytopenia ◽  
Transcatheter Aortic Valve

A 78-year-old man with a history of severe aortic stenosis presented with confusion, irregular behaviour and dyspnoea 8 days following transcatheter aortic valve replacement. His exam was consistent with a heart failure exacerbation and he had elevated aminotransferases, bilirubin and prothrombin time suggestive of shock liver. A CT head scan demonstrated a subacute large left temporoparietal infarction. His aminotransferase and prothrombin time levels normalised with diuresis, but his indirect bilirubin remained elevated and he developed anaemia and thrombocytopenia consistent with a haemolytic anaemia. A transthoracic echocardiogram demonstrated a paravalvular leak. His thrombocytopenia continued to worsen prompting testing for antibodies against heparin-PF4 complexes which was positive. A serotonin release assay later returned positive, confirming the diagnosis of heparin-induced thrombocytopenia. This case illustrates that the presence of haemolytic anaemia does not necessarily exclude other causes of thrombocytopenia that may occur concurrently.

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