scholarly journals Multidisciplinary transcatheter aortic valve replacement heart team programme improves mortality in aortic stenosis

Open Heart ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e000983 ◽  
Author(s):  
Dylan R Jones ◽  
Derek P Chew ◽  
Matthew J Horsfall ◽  
Anthony Ming-Yu Chuang ◽  
Ajay R Sinhal ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Heart Team ◽  
Mortality Benefit ◽  
Transcatheter Aortic Valve ◽  
Lower Ejection Fraction

ObjectivesTo analyse the effect of the implementation of a transcatheter aortic valve replacement (TAVR) and multidisciplinary heart team programme on mortality in severe aortic stenosis (AS).MethodsA retrospective, observational cohort study was performed using the echocardiography, cardiothoracic surgery and TAVR databases between 1 January 2006 and 31 December 2016. Outcomes were compared between the pre- and post-TAVR programme eras in a tertiary referral centre providing transcatheter and surgical interventions for AS.All-cause mortality within 5 years from diagnosis was determined for 3399 patients with echocardiographically defined severe AS.ResultsOf 3399 patients, there were 210 deaths (6.2%) at 30 days and 1614 deaths (47.5%) at 5 years.Overall, patients diagnosed in the post-TAVR programme era were older, with a lower ejection fraction and more severe AS, but were less comorbid.Among 705 patients undergoing intervention, those in the post-TAVR programme era were older, with a lower ejection fraction and more severe AS but no significant differences in comorbidities.Using an inverse probability weighted cohort and a Cox proportional hazards model, a significant mortality benefit was noted between eras alone (HR=0.86, 95% CI 0.77 to 0.97, p=0.015). When matching for age, comorbidities and valve severity, this benefit was more evident (HR=0.82, 95% CI 0.73 to 0.92, p=0.001).After adjusting for the presence of aortic valve intervention, a significant benefit persisted (HR=0.84, 95% CI 0.75 to 0.95, p=0.005).ConclusionThe implementation of a TAVR programme is associated with a mortality benefit in the population with severe AS, independent of the expansion of access to intervention.

scholarly journals Concomitant Transapical Transcatheter Aortic Valve Replacement and Transapical Balloon Mitral Valvuloplasty to Treat Severe Aortic Stenosis with Severe Mitral Stenosis

2021 ◽  
Vol 24 (4) ◽  
pp. E624-E627
Author(s):  
Peijian ◽  
Jian Liu ◽  
Huiming Guo
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Mitral Stenosis ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Heart Team ◽  
Mitral Valvuloplasty ◽  
Transcatheter Aortic Valve

This paper reports concomitant transapical transcatheter aortic valve replacement (TA-TAVR) and transapical balloon mitral valvuloplasty (TA-BMV) for the first time. A 72-year-old man with a diagnosis of rheumatic severe aortic stenosis with mild insufficiency and rheumatic severe mitral stenosis with mild insufficiency was referred to the Department of Cardiac Surgery of Guangdong Provincial People’s Hospital. After the interdisciplinary discussion in the heart team (cardiac surgeon, cardiologist, anesthesiologist and image specialist), we decided to perform concomitant TAVR and BMV through one transapical approach considering the patient’s preference, NYHA class IV heart failure, and the calculated perioperative risk (Euroscore II 3.74%, STS score for the combined mitral and aortic procedure is not available). No intraoperative or postoperative complications were observed.

scholarly journals More in, better out? Successful valve-in-valve procedure of an iatrogenic ventricular septal defect following transcatheter aortic valve replacement: a case report

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Klaus-Dieter Hönemann ◽  
Steffen Hofmann ◽  
Frank Ritter ◽  
Gerold Mönnig
Keyword(s):  
Aortic Valve ◽  
Ventricular Septal Defect ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Septal Defect ◽  
Left Ventricular ◽  
Heart Team ◽  
Transcatheter Aortic Valve ◽  
Valve In Valve

Abstract Background A rare, but serious, complication following transcatheter aortic valve replacement (TAVR) is the occurrence of an iatrogenic ventricular septal defect (VSD). Case summary We describe a case of an 80-year-old female who was referred with severe aortic stenosis for TAVR. Following thorough evaluation, the heart team consensus was to proceed with implantation via a transapical approach of an ACURATE neo M 25 mm valve (Boston Scientific, Natick, MA, USA). The valve was deployed harnessing transoesophageal echocardiographic (TOE) guidance under rapid pacing with post-dilation. Directly afterwards a very high VSD close to the aortic annulus was detected. As the patient was haemodynamically stable, the procedure was ended. The next day another TOE revealed a shunt volume (left-to-right ventricle) between 50% and 60%. Because the defect was partly located between the stent struts of the ACURATE valve decision was made to fix this leakage with implantation of a further valve and we chose an EVOLUT Pro 29 mm (Medtronic Inc., Minneapolis, MN, USA). The valve-in-valve was implanted 2–3 mm below the lower edge of the first valve, more towards the left ventricular outflow tract (LVOT) with excellent result: VSD was reduced to a very small residual shunt without any hemodynamic relevance. Discussion We suggest that an iatrogenic VSD located near the annulus may be treated percutaneously in a bail-out situation with implantation of a second valve that should be implanted slightly more into the LVOT to cover the VSD.

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