scholarly journals Brain Injury after Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis

2020 ◽  
Author(s):  
Jiaqi Fan ◽  
Xian Fang ◽  
Chunhui Liu ◽  
Gangjie Zhu ◽  
Cody R. Hou ◽  
...  
Keyword(s):  
Brain Injury ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Cerebral Arteries ◽  
Lesion Volume ◽  
Tricuspid Aortic Valve ◽  
Transcatheter Aortic Valve ◽  
Middle Cerebral Arteries

AbstractBackgroundsThe risk of brain injury in bicuspid aortic valve (BAV) patients following transcatheter aortic valve replacement (TAVR) is currently unknown.Methods and ResultsA total of 204 consecutive severe aortic stenosis patients who underwent TAVR were enrolled. 83 (40.7%) patients were BAV patients and the other 121 patients were tricuspid aortic valve (TAV) patients. All patients received diffusion-weighted magnetic resonance imaging (DW-MRI) at baseline, 2 to 7 days after TAVR. Mean ages (mean ± SD: 75.8 ± 6.7 years vs. 78.9 ± 6.6 years, p = 0.004) and STS scores (6.0 ± 3.7 vs. 7.1 ± 4.2, p = 0.044) of the BAV and TAV patients were significantly different, while the stroke rates (2.4% vs. 1.7%, p = 0.704) were comparable between two groups. BAV patients were associated with higher number of new lesions (5.69 ± 6.22 vs. 3.50 ± 4.16, p = 0.008), total lesion volume [median(interquartile range): 290(70-930) mm3 vs. 140(35-480) mm3, p = 0.008], and the volume per lesion [70.0(45.0-115.0) mm3 vs. 57.5(24.5-93.0) mm3, p = 0.037] in DW-MRI. Moreover, the proportion of patients with lesions larger than 1cm3 (28.6% vs. 10.9%, p = 0.005) and the number of new lesions in the middle cerebral arteries zone (1.46 ± 2.07 vs. 0.98 ± 1.84, p = 0.039) and intermediate zone between the anterior cerebral and middle cerebral arteries (ACA/MCA) (1.07 ± 1.68 vs. 0.50 ± 1.05, p = 0.007), and between the vertebral artery and basilar artery (VA/BA) (1.01 ± 1.35 vs. 0.77 ± 1.44, p = 0.033) were higher in BAV patients than in TAV patients.ConclusionsBAV patients may encounter more severe brain injuries not only due to greater number of lesions but also due to larger lesion size, especially in the ACA/MCA, MCA and VA/BA lesions zone.

scholarly journals Prevalence of permanent pacemaker implantation after conventional aortic valve replacement—a propensity-matched analysis in patients with a bicuspid or tricuspid aortic valve: a benchmark for transcatheter aortic valve replacement

2020 ◽  
Vol 58 (1) ◽  
pp. 130-137 ◽  
Author(s):  
Josephina Haunschild ◽  
Martin Misfeld ◽  
Thomas Schroeter ◽  
Frank Lindemann ◽  
Piroze Davierwala ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Tricuspid Aortic Valve ◽  
Permanent Pacemaker Implantation ◽  
Transcatheter Aortic Valve

Abstract OBJECTIVES Elective treatment of aortic valve disease by transcatheter aortic valve replacement (TAVR) is becoming increasingly popular, even in patients with low risk and intermediate risk. Even patients with a bicuspid aortic valve (BAV) are increasingly considered eligible for TAVR. Permanent pacemaker implantation (PMI) is a known—frequently understated—complication of TAVR affecting 9–15% of TAVR patients with a potentially significant impact on longevity and quality of life. BAV patients are affected by the highest PMI rates, although they are frequently younger compared to their tricuspid peers. The aim of the study is to report benchmark data—from a high-volume centre (with a competitive TAVR programme) on PMI after isolated surgical aortic valve replacement (SAVR) in patients with BAV and tricuspid aortic valve (TAV). METHODS We performed a retrospective single-centre analysis on 4154 patients receiving isolated SAVRs (w/o concomitant procedures), between 2000 and 2019, of whom 1108 had BAV (27%). PMI rate and early- and long-term outcomes were analysed. For better comparability of these demographically unequal cohorts, 1:1 nearest neighbour matching was performed. RESULTS At the time of SAVR, BAV patients were on average 10 years younger than their TAV peers (59.7 ± 12 vs 69.3 ± 9; P < 0.001) and had less comorbidities; all relevant characteristics were equally balanced after statistical matching. Overall PMI rate was significantly higher in BAV patients (5.4% vs 3.8%; P = 0.03). BAV required PMI exclusively (100%) and TAV required predominately (96%) for persistent postoperative high-degree atrioventricular block. After matching, the PMI rate was similar (5.1% vs 4.4%, P = 0.5). In-hospital mortality in the matched cohort was 1% in both groups. Long-term survival was more favourable in BAV patients (94% vs 90% in TAV at 5 years; 89% vs 82% in TAV at 9 years; P = 0.013). CONCLUSIONS With SAVR, the overall incidence of PMI among BAV patients seems significantly higher; however, after propensity matching, no difference in PMI rates between BAV and TAV is evident. The PMI rate was remarkably lower among BAV patients after SAVR compared to the reported incidence after TAVR.

scholarly journals Rationale and design of the ADAPT-TAVR trial: a randomised comparison of edoxaban and dual antiplatelet therapy for prevention of leaflet thrombosis and cerebral embolisation after transcatheter aortic valve replacement

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e042587
Author(s):  
Hanbit Park ◽  
Do-Yoon Kang ◽  
Jung-Min Ahn ◽  
Kyung Won Kim ◽  
Anthony Y T Wong ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Antiplatelet Therapy ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Dual Antiplatelet Therapy ◽  
Medical Center ◽  
Lesion Volume ◽  
Study Drug Administration ◽  
Transcatheter Aortic Valve

IntroductionOptimal antithrombotic strategy following transcatheter aortic valve replacement (TAVR) is still unknown. We hypothesised that the direct factor Xa inhibitor edoxaban can potentially prevent subclinical leaflet thrombosis and cerebral embolisation compared with conventional dual antiplatelet therapy (DAPT) in patients undergoing TAVR.Methods and analysisThe ADAPT-TAVR trial is an international, multicentre, randomised, open-label, superiority trial comparing edoxaban-based strategy and DAPT strategy in patients without an indication for oral anticoagulation who underwent successful TAVR. A total of 220 patients are randomised (1:1 ratio), 1–7 days after successful TAVR, to receive either edoxaban (60 mg daily or 30 mg daily if patients had dose-reduction criteria) or DAPT using aspirin (100 mg daily) plus clopidogrel (75 mg daily) for 6 months. The primary endpoint was an incidence of leaflet thrombosis on four-dimensional, volume-rendered cardiac CT imaging at 6 months post-TAVR. The key secondary endpoints were the number of new lesions and new lesion volume on brain diffusion-weighted MRI and the changes in neurological and neurocognitive function assessment between immediate post-TAVR and 6 months of study drug administration. Detailed clinical information on thromboembolic and bleeding events were also assessed.Ethics and disseminationEthic approval has been obtained from the Ethics Committee/Institutional Review Board of Asan Medical Center (approval number: 2017–1317) and this trial is also approved by National Institute of Food and Drug Safety Evaluation of Republic of Korea (approval number: 31511). Results of this study will be disseminated in scientific publication in reputed journals.Trial registration numberNCT03284827.

Epidemiology of infective endocarditis in transcatheter aortic valve replacement: systemic review and meta-analysis

2020 ◽  
Vol 21 (10) ◽  
pp. 790-801 ◽  
Author(s):  
Narut Prasitlumkum ◽  
Wasawat Vutthikraivit ◽  
Sittinun Thangjui ◽  
Thiratest Leesutipornchai ◽  
Jakrin Kewcharoen ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Meta Analysis ◽  
Systemic Review ◽  
Transcatheter Aortic Valve
Sign in / Sign up

Export Citation Format

Share Document