P3381Quantification of hypo-attenuated leaflet thickening after transcatheter aortic valve implantation - clinical relevance of HALT volume

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Karady ◽  
A Apor ◽  
A I Nagy ◽  
M Kolossvary ◽  
B Szilveszter ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Clinical Relevance ◽  
Brain Mri ◽  
Ischemic Brain ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Hypo-attenuated leaflet thickening (HALT) is a recently recognized phenomenon following transcatheter aortic valve implantation (TAVI) and there is no consensus over the standardized assessment of HALT and its clinical relevance is poorly understood. We sought to determine the predictors and clinical significance of HALT volume. Methods Patients, who previously underwent TAVI between 2011 and 2016 were prospectively enrolled in the RETORIC (Rule out Transcatheter Aortic Valve Thrombosis with Post Implantation Computed Tomography) study, a single-center observational study. At inclusion cardiac computed tomography angiography (CTA), transthoracic echocardiography (TTE) and brain magnetic resonance imaging (MRI) was performed. HALT was volumetrically quantified on cardiac CTA images by segmenting the inner volume of the TAVI frame at the level of the leaflets and applying a threshold of −200 to 200 Hounsfield units. We evaluated the clinical predictors of HALT volume, and its association with ischemic brain MRI lesions (recent and chronic large vessel ischemic focuses, microbleed/microembolization, white matter or small vessel disease) and all-cause mortality. Results In total, we analyzed 111 patients with CoreValve bioprosthesis (56.7% female, mean age 80.3±7.4 years). A median of 19 [IQR: 11–29] months passed between TAVI procedure and enrollment. The mean HALT volume was 111.0±163.4 mm3. Current malignant disease, prosthesis implantation depth measured on CTA images acquired at inclusion, and aortic mean gradient and aortic valve area evaluated on TTE images at inclusion predicted HALT volume by univariate analysis (all p<0.05). After multivariate adjustment, aortic mean gradient remained a significant predictor of HALT volume (beta-coefficient: 11.5, 95% CI: 5.0–18.0; p<0.001). HALT volume was not associated with ischemic brain MRI lesions (all p>0.05) and did not predict all-cause mortality (median follow-up: 20 months [IQR: 18–23]; HR: 1.0; 95% CI: 1.0–1.0; p=0.15). Volumetric quantification of HALT. Conclusion Aortic mean gradient was the only predictor independently associated with HALT volume. Our results suggest that TAVI valve function is negatively affected by HALT volume, however, we found no association of HALT volume with cerebrovascular ischemic lesions or increased risk for all-cause mortality.

scholarly journals Impact of left atrial strain assessed with feature-tracking computed tomography on long-term mortality after transcatheter aortic valve implantation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Hirasawa ◽  
G K Singh ◽  
J H Kuneman ◽  
N Ajmone Marsan ◽  
V Delgado ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Atrial ◽  
Feature Tracking ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Aortic stenosis (AS) induces left atrial (LA) remodeling through the increase of left ventricular (LV) filling pressure. Peak left atrial longitudinal strain (PALS) has been proposed as a prognostic marker in patients with AS. Novel feature-tracking (FT) software allows to assess LA strain from multidetector computed tomography (MDCT) dataset. Purpose To investigate the association between PALS using FT MDCT and moratlity in patients who underwent transcatheter aortic valve implantation (TAVI). Methods A total of 369 Patients (mean 80±7 years, 51% male) who underwent preprocedual MDCT before TAVI and had suitable data for measureing PALS using dedicated FT software were included. Patients were classified into 4 groups according to PALS quartiles; PALS more than 19.3% (Q1), 19.3% or less to more than 15.0% (Q2), 15.0% or less to more than 9.1% (Q3), and 9.1% or less (Q4). The primary outcome was all-caurse mortality. Results During median follow-up of 45 [22 - 68] months, 124 patients (34%) were died. On multivariable Cox regression analysis, PALS is an independently associated with all-cause mortality (HR: 0.958 [95% CI: 0.925–0.993], P=0.006). Kaplan-Meier analysis showed the worse outcome of the quatile with more impaired PALS (Logrank P&lt;0.001). Compared to Q1, Q3 and Q4 had higher risk of mortality after TAVI (HR: 2.475 [95% CI: 1.411–4.340] for Q3, HR: 3.253 [95% CI: 1.878–5.633] for Q4). Conclusion In this retrospective study, PALS measured with FT MDCT was strongly associated with all-cause mortality after TAVI. LA functial assessment using MDCT may have a importan role for risk stratification in patients referred to TAVI. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): ESC research grant 2018 K-M curve according to PALS quartiles

scholarly journals The ACURATE neo2 valve system for transcatheter aortic valve implantation: 30-day and 1-year outcomes

2021 ◽  
Author(s):  
Helge Möllmann ◽  
David M. Holzhey ◽  
Michael Hilker ◽  
Stefan Toggweiler ◽  
Ulrich Schäfer ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Pacemaker Implantation ◽  
Paravalvular Leak ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Valve Thrombosis ◽  
Aortic Valve Implantation ◽  
And Performance ◽  
Valve Implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) has become standard treatment for elderly patients with symptomatic severe aortic valve stenosis. The ACURATE neo AS study evaluates 30-day and 1-year clinical and hemodynamic outcomes in patients treated with the ACURATE neo2 valve. Methods The primary endpoint of this single-arm multicenter study is 30-day all-cause mortality. Other key endpoints include device performance, echocardiographic measures assessed by an independent core laboratory, and VARC-2 clinical efficacy and safety endpoints through 12 months. Results The study enrolled 120 patients (mean age 82.1 ± 4.0 years; 67.5% female, mean baseline STS score 4.8 ± 3.8%). The VARC-2 composite safety endpoint at 30 days occurred in 13.3% of patients. All-cause mortality was 3.3% at 30 days and 11.9% at 1 year. The 30-day stroke rate was 2.5% (disabling stroke 1.7%); there were no new strokes between 30 days and 12 months. The rate of permanent pacemaker implantation was 15.0% (18/120) at 30 days and 17.8% (21/120) at 1 year. No patients required re-intervention for valve-related dysfunction and there were no cases of valve thrombosis or endocarditis. Patients demonstrated significant improvement in mean aortic valve gradient (baseline 38.9 ± 13.1 mmHg, 1 year 7.8 ± 3.5 mmHg; P < 0.001 in a paired analysis). In the overall population, paravalvular leak was evaluated at 1 year as none/trace in 60.5%, mild in 37.0%, and moderate in 2.5%; no patients had severe PVL. Conclusions One-year outcomes from the ACURATE neo AS study support the safety and performance of TAVI with the ACURATE neo2 valve. Graphic Abstract

New onset left bundle branch block after transcatheter aortic valve implantation and the effect on long-term survival – a UK wide experience

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.S Arri ◽  
A Myat ◽  
I Malik ◽  
N Curzen ◽  
A Baumbach ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Bundle Branch Block ◽  
Left Ventricular ◽  
Bundle Branch Block ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
New Onset

Abstract Introduction New onset left bundle branch block (LBBB) is the most common conduction disturbance associated with transcatheter aortic valve implantation (TAVI). It has been shown to adversely affect cardiac function and increase re-hospitalisation, although its impact on mortality remains contentious. Methods We conducted an observational cohort analysis of all TAVI procedures performed by 13 heart teams in the United Kingdom from inception of their structural programmes until 31st July 2013. The primary outcome was 1-year all-cause mortality. Secondary outcomes included left ventricular ejection fraction (LVEF) at 30 days and need for a post-TAVI permanent pacemaker (PPM). Results 1785 patients were eligible for inclusion to the study. The primary analysis cohort was composed of 1409 patients with complete electrocardiographic (ECG) data pre- and post-TAVI. Pre-existing LBBB was present in 200 (14.2%) patients. New LBBB occurred in 323 (22.9%) patients post TAVI, which resolved in 99 (7%) patients prior to discharge. A balloon-expandable device was implanted in 968 (69%) patients, whilst 421 (30%) patients received a self-expandable valve. New LBBB was observed in 120 (12.4%) and 192 (45.6%) patients receiving a balloon- or self-expandable prosthesis respectively. Overall 1-year all-cause mortality post TAVI was 18.7%. New onset LBBB was not associated with an increase in 1-year all-cause mortality (p=0.416). Factors that were associated with mortality included an increasing logistic EuroScore (p=0.05), history of previous balloon aortic valvuloplasty (p=0.001), renal impairment (p=0.003), previous myocardial infarction with pre-existing LBBB (p=0.028) and atrial fibrillation (p=0.039). Lower baseline peak and mean AV gradients were also associated with greater mortality at 1 year (p=0.001), likely reflecting underlying left ventricular dysfunction. In the majority of patients, LVEF remained unchanged following TAVI. Interestingly, the presence or absence of new onset LBBB did not affect LVEF improvement at 30 days. 10% of patients required a PPM post TAVI. Predictors of PPM included new LBBB (OR 2.6, p&lt;0.001), pre-TAVI left ventricular systolic impairment (OR 1.2, p=0.037), a self-expandable device (p&lt;0.001), and pre-existing RBBB (OR 4.0, p&lt;0.001). Conclusions These findings suggest that new onset LBBB post TAVI does not increase mortality at 1 year or adversely affect LVEF at 30 days. Funding Acknowledgement Type of funding source: None

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