scholarly journals 690 Acute post-implantation enlargement of transcatheter self-expandable valve: insights from a single-centre prospective registry

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Salvatore Giordano ◽  
Sabato Sorrentino ◽  
Annalisa Mongiardo ◽  
Antonio Bellantoni ◽  
Fabiola Boccuto ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Regression Model ◽  
Time Course ◽  
Distal Segment ◽  
Significant Degree ◽  
Diameter Ratio ◽  
Proximal Segment ◽  
Minimum Diameter ◽  
Transcatheter Aortic Valve ◽  
Valve Implantation

Abstract Aims Transcatheter implantation of a balloon-expandable aortic valve is associated with an acute stent recoil . Conversely, the acute effects of nitinol-based stent frame- self expandable valve on post-deployment dimensions have not been reported. Accordingly, the aim of this study was to assess the occurrence and degree of acute prosthetic dimension changes after Evolute R valve implantation. Methods A total of 58 consecutive patients undergoing transcatheter aortic valve intervention (TAVI) with a widely used nitinol based self-expandable device (Evolute R, Medtronic, Minneapolis, USA) were included in this study. We measured valve diameters at three different sections: a) distal (aortic) level, b) central (annulus) level, and c) proximal (ventricular) level. Valve expansion was calculated as the difference between the diameters calculated immediately after valve deployment (A) and at the end of the procedure (B). The absolute and relative acute stent recoil were defined as B-A and (B-A)/B*100, respectively. A linear regression model was performed to test the association between the degree of valve extension, with baseline, as well as procedural characteristics. Results Final stent diameters were significantly higher compared to those achieved immediately after valve implantation in proximal (20.87±3.20 mm versus 20.37±3.27 mm, P <0.001), central (19.58±1.63 mm versus 19.12±1.75 mm, P <0.001) as well as distal (26.99±1.53 mm versus 26.41±1.57 mm, P <0.001) segments. The mean absolute and relative enlargement of the valve was respectively 0.50±0.51 mm and 2.48±2.57% in the proximal, 0.46±0.57 mm and 2.39±2.96% in the central and 0.58±0.59 mm and 2.14±2.14% in the distal segment. Among baseline and procedural characteristics assessed in the logistic regression model no association was observed between pre-dilation and valve expansion across all the segments (proximal: r2=0.004, P=0.885, central: r2=0.004, P=0.637, and distal r2=0.05, P=0.10). Of interest, post dilation affected only the expansion of the central segment (r2=0.241, P<0.001), while no association was observed for the proximal (r2=0.059, P=0.065) and distal (r2=0.0002, P=0.916) parts. The expansion of the proximal segment was associated with higher maximum/minimum diameter ratio measured by CT (r2=0.08, P=0.045), while no association was observed for the central (r2= 0.020; P=0.992) and distal (r2=1.111, P=0.683) segments. Conclusions This is the first study that documented a significant degree of post-deployment recoil of the Evolute R self-expandable valve, that was consistent across all the segments. The stent-valve expansion of the proximal segment was associated with a greater annulus dissymmetry reported by the maximum and minimum diameter ratio assessed by CT scan. However, further studies are required to assess the short and long-term time-course of self-expandable valve enlargement and the clinical relevance of this finding.

scholarly journals Computed tomography for the prediction of structural valve deterioration in patients undergoing transcatheter aortic valve implantation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Guglielmo ◽  
L Fusini ◽  
M Muratori ◽  
G Tamborini ◽  
V Mantegazza ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Maximum Diameter ◽  
Minimum Diameter ◽  
Female Sex ◽  
Transcatheter Aortic Valve ◽  
Structural Valve Deterioration ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Funding Acknowledgements Type of funding sources: None. Background  Computed tomography (CT) provides excellent anatomy assessment of the aortic annulus (AoA) and is currently routinely utilized for pre-procedural planning of transcatheter aortic valve implantation (TAVI). This study sought to investigate if geometrical characteristics of the AoA determined by CT may represent predictors of structural valve deterioration (SVD) in patients undergoing transcatheter aortic implantation (TAVI) with balloon-expandable valves. Methods AoA maximum diameter (Dmax), minimum diameter (Dmin), and area were assessed using pre-procedural CT in patients undergoing TAVI in our Institution.  SVD was identified with transthoracic echocardiography at 5.9 ± 1.7 follow-up years. Results 124 consecutive patients (mean age: 79 ± 7 years old; female: 61%) were retrospectively enrolled. AoA Dmax, Dmin and area were significantly smaller in patients with SVD compared to patients without SVD (27.1 ± 2.8 mm vs 25.6 ± 2.2 mm, p = 0.012; 21.8 ± 2.1 mm vs 20.5 ± 2.1 mm, p = 0.001 and 467 ± 88 mm2 vs 419 ± 77 mm2  p = 0.002 respectively). At univariate analysis, female sex, body surface area, the use of a -23 mm prosthetic valve a Dmax <27.1 mm and a Dmin < 19.9 mm were all variables independently associated with SVD whereas at multivariate analysis, only Dmin <19.9 mm (OR = 2.873, 95% CI: 1.191-6.929, p = 0.019) and female sex (OR = 2.659, 95% CI: 1.095-6.458, p = 0.031)  were independent predictors of SVD. Conclusions Female sex and AoA Dmin < 19.9 mm are associated to SVD in patients undergoing TAVI with balloon explandable valves. Abstract Figure.

scholarly journals Von Willebrand Factor As a Biological Sensor of Blood Flow in Percutaneous Cardiac Procedures

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 474-474
Author(s):  
Antoine Rauch ◽  
Eric Van Belle ◽  
André Vincentelli ◽  
Paulette Legendre ◽  
Emmanuelle Jeanpierre ◽  
...  
Keyword(s):  
Shear Stress ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Time Course ◽  
Rabbit Model ◽  
Loss Recovery ◽  
Transcatheter Aortic Valve ◽  
Acute Changes ◽  
Valve Implantation ◽  
Von Willebrand

Abstract Background: Acquired deficiency of von Willebrand Factor (VWF) characterized by a quantitative loss of high molecular weight (HMW) multimers of VWF is associated with cardiovascular disorders such as aortic stenosis. It has been shown that HMW-multimers defect is usually corrected after surgical aortic valve replacement. However, the initial time course of loss/recovery of VWF HMW-multimers following acute changes in blood flow in-vivo has not yet been studied. We hypothesized that recovery of HMW-multimers could occur within minutes following correction of the underlying "high shear" condition and as such could be used to monitor acute changes in flow induced by cardiac interventions. We further investigated the potential underlying mechanisms. Methods: We investigated the time course of HMW-multimers loss/recovery in an animal model of instantaneous and reversible aortic stenosis (AS) specifically developed for that purpose. This model allowed the evaluation, in the same rabbit, of the dynamic time course of loss and recovery of HMW-multimers. We further investigated the time course of HMW-multimers loss/recovery and its related bedside whole blood assessment (PFA-100 analyzer) in 28 patients included in the WITAVI (Willebrand-TAVI) registry and undergoing 1) implantation of an axial-continuous-flow-LVAD (HeartMate-IIÒ, n=8) and 2) transcatheter aortic valve procedures, either BAV (n=10) or TAVI (n=10). VWF antigen (VWF:Ag) and VWF propeptide (VWFpp) levels were measured by ELISA. VWF multimeric analysis was performed as previously described in patients and newly developed for rabbits. PFA-CADP was assessed by platelet-function analyzer PFA-100® using ADP cartridges. Results: In the rabbit model, induction of aortic stenosis was associated with a HMW-multimers defect (normalized ratio = 0.74±0.07; p<0.01 versus no stenosis). Partial recovery of HMW-multimers (0.89±0.12 versus AS baseline; p<0.01) occurred within 5 minutes of stenosis reversion. Thirty minutes after reversion, a complete recovery of HMW-multimers was observed (0.98±0.10). In patients with AS (n=18) a VWF HMW-multimers defect was observed at baseline (0.50±0.18). Among patients with AS, those treated with TAVI experienced an acute decrease in shear stress (4.47±0.41 m.s-1 to 1.81±0.43 m.s-1, p<0.0001, n=10) after treatment while those undergoing BAV alone experienced a modest improvement in shear stress conditions (4.47±0.25m.s-1 to 3.88±0.65m.s-1; p=0.03, n=8). In patients undergoing TAVI (n=10), similar to what was observed in the rabbit model, recovery of HMW-multimers defect was observed within minutes of valve implantation (p<0.001, Table1). By contrast, in patients undergoing BAV (n=8) no recovery of HMW-multimers defect was observed (p=0.21,Table1). A potential role of the vascular endothelium in the HMW-multimers recovery was also evaluated by measuring the VWFpp levels during TAVI and BAV procedures. In TAVI procedures, VWFppsignificantly increased 5 minutes after valve implantation, and further after 30 and 180 minutes when compared to baseline. In BAV procedures, VWFpp did not increase significantly overtime. The time course of PFA-CADP time mimicked the recovery of HMW-multimers defect both in TAVI in patients, in whom a rapid correction of PFA-CADP was observed (p<0.001, Table1), and BAV patients, in whom no correction was observed (p=0.69;Table1). Results are expressed as mean±SD, p values are for overall time course comparison (repeated Anova). Abstract 474. Table Transcatheter aortic valve implantion (TAVI, n=10) Balloon Aortic Valvuloplasty (BAV, n=8) T0 T5 T30 T180 p T0 T5 T30 T180 p HMW-multimers (ratio vs NP) 0.47(±0.14) 0.87(±0.24) 0.93(±0.17) 0.99(±0.16) <0.001 0.52(±0.21) 0.58(±0.20) 0.66(±0.25) 0.63(±0.10) ns VWFpp (UI/dL) 168(±71) 195(±63) 215(±100) 429(±195) p<0.01 256(±121) 234(±106) 290(±96) 275(±136) ns PFA-CT ADP (sec) 252(±68) 193(±51) 116(±40) 94(±26) <0.001 201(±46) 212(±61) 204(±71) 219(±76) ns Conclusion: These results demonstrate that variations in the multimeric pattern of VWF are highly dynamic, occurring within minutes of changes in shear stress status. They further demonstrate that VWF multimeric pattern changes could be used in clinical practice as a tool to monitor the quality of the result of percutaneous aortic valve procedures procedures using a bedside analyzer. Disclosures No relevant conflicts of interest to declare.

P3722Platelet reactivity changes following transcatheter aortic valve implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Z Ostojic ◽  
J Samardzic ◽  
V Reskovic Luksic ◽  
S Pavasovic ◽  
B Skoric ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Time Course ◽  
Platelet Reactivity ◽  
Transcatheter Aortic Valve ◽  
Heparin Administration ◽  
Number Of Patients ◽  
Significant Difference ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Introduction Although recent studies described changes in platelet reactivity (PR) in days following transcatheter aortic valve implantation (TAVI), precise time course and duration of these changes have not been fully investigated. Purpose To investigate PR changes during and after TAVI. Methods Study included 42 consecutive patients with severe and symptomatic aortic stenosis undergoing TAVI procedure in our institution. Patients' clinical characteristics were collected from medical records. All patients who did not have chronic dual antiplatelet therapy received loading dose of aspirin and clopidogrel (300 mg) one day before the procedure followed by their standard maintenance doses for next three months. PR was measured in six time points: just before induction of anaesthesia (T1), after heparin administration (T2), at the end of procedure (T3), and on 3rd, 6th and 30th postoperative day (T4–6). PR was measured using impedance aggregometer (Multiplate® analyzer, Roche, Munich, Germany) in response to three platelet aggregation agonists: arachidonic acid (ASPItest), ADP (ADPtest) and thrombin receptor activating peptide-6 (TRAPtest). Results Mean patient age was 82.1 years with majority of patients being male 57.1% (N=24). Mean valve area and mean transvalvular gradient prior to procedure were 0.71±0.21 cm2 and 49.1±18.7 mmHg, respectively. All patients underwent successful TAVI procedure using either self-expandable (N=25, 59.5%) or balloon-expandable valve. Two patients (4.7%) underwent transapical TAVI, while transfemoral approach was used in all other patients. Mean postimplantation gradient was 10.2±7.1 mmHg. Mean PR on T1 was 24.3±23.1 U for ASPItest, 41.6±26.5 U for ADPtest and 90.1±33.3 U for TRAPtest. There was no significant difference in PR on T2. However, on T3, ignificant reduction of PR in all 3 tests was observed (ASPI 9.4±10.1 U (p=0.001), ADP 23.1±15.0 U (p<0.001) and TRAP 64.5±27.3 U (p<0.001)). Lowest PR values for all tests were reached on T4, after which incline in PR has been observed. On T5, value of ASPItest reached levels not significantly different to those on T1 (15.1±17.2 U, p=0.13), while ADPtest and TRAPtest remained significantly lower (27.3±18.5 U, p=0.007 and 68.6±33.2 U, p=0.003, respectively). All PR values returned to initial levels on T6 (figure 1). Conclusions Our results show that successful TAVI procedure induces transient decrease in PR regardless of the platelet activation pathway. These findings add new knowledge in understanding complexed relations in intravascular milieu following TAVI. Further research on a larger number of patients is needed to confirm and asses clinical significance of these results. Acknowledgement/Funding Croatian Science Foundation

Sign in / Sign up

Export Citation Format

Share Document