Device Selection in Patients with Borderline Size Aortic Valve Annulus Undergoing Transcatheter Aortic Valve Implantation

Abstract Transcatheter heart valve (THV) selection for transcatheter aortic valve implantation (TAVI) is crucial to achieve procedural success. Borderline aortic annulus size (BAAS), which allows a choice between two consecutive valve sizes, is a common challenge during device selection. In the present study, we evaluated TAVI outcomes in patients with BAAS according to THV size selection. We performed a retrospective study including patients with severe aortic stenosis (AS) and BAAS, measured by multidetector computed tomography (MDCT), undergoing TAVI with self-expandable (SE) or balloon-expandable (BE) THV from the Israeli multicenter TAVI registry. TAVI outcomes were assessed according to the Valve Academic Research Consortium-2 (VARC-2). Out of 2,352 patients with MDCT measurements, 598 patients with BAAS as defined for at least one THV type were included in the study. In BAAS patients treated with SE-THV, larger THV selection was associated with lower rate of paravalvular leak (PVL), compared to smaller THV (45.3% vs. 64.5%; pv = 0.0038). Regarding BE-THV, larger valve selection was associated with lower post-procedural transvalvular gradients compared to smaller THV (mean gradient: 9.9 ± 3.7mmHg vs. 12.5 ± 7.2mmHg; p = 0.019). Of note, rates of mortality, left bundle branch block, permanent pacemaker implantation, stroke, annular rupture and/or coronary occlusion did not differ between groups. BAAS is common among patients undergoing TAVI. Selection of a larger THV in these patients is associated with lower rates of PVL and better hemodynamic profile in patients implanted with SE and BE-THV, respectively, with no effect on procedural complications.

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

Clinical Research in Cardiology ◽

10.1007/s00392-021-01882-3 ◽

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

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Real-time observation of a high-echoic mass in the left ventricle during transcatheter aortic valve implantation: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa392 ◽

2020 ◽

Author(s):

Akiko Masumoto ◽

Takeshi Kitai ◽

Mitsuhiko Ota ◽

Kitae Kim ◽

Natsuhiko Ehara ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Cerebral Arteries ◽

Transoesophageal Echocardiography ◽

Transcatheter Aortic Valve ◽

Transcatheter Heart Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background Increasing number of symptomatic patients with severe aortic stenosis is treated with transcatheter aortic valve implantation (TAVI). Stroke is one of the most serious complications of TAVI, and the majority of cerebral events in patients undergoing TAVI have an embolic origin. Case summary A 90-year-old female underwent trans-femoral TAVI for symptomatic severe aortic stenosis. Just before the implantation of the transcatheter heart valve (THV), transoesophageal echocardiography (TOE) showed a mobile, high-echoic mass attached to the THV, which gradually enlarged to 26 mm, then spontaneously detached from the THV and flowed up the ascending aorta, disappearing from the TOE field of. After the procedure, the patient presented with ischaemic stroke. The patient’s stroke was thought to have resulted from the embolism migrating to the distal cerebral arteries. Discussion The detailed images acquired with TOE during TAVI enabled the prompt identification of the unusual intracardiac mass.

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The Wattson temporary pacing guidewire for transcatheter heart valve implantation

Future Cardiology ◽

10.2217/fca-2021-0105 ◽

2021 ◽

Author(s):

James Carey ◽

Anthony Buckley ◽

Stephen O'Connor ◽

Mark Hensey

Keyword(s):

Aortic Valve ◽

Heart Valve ◽

Transcatheter Aortic Valve Implantation ◽

Pacemaker Implantation ◽

Left Ventricular ◽

Temporary Pacing ◽

Transcatheter Aortic Valve ◽

Transcatheter Heart Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Transcatheter aortic valve implantation and implantation of other transcatheter heart valves, generally requires insertion of a temporary venous pacemaker. Implantation of a temporary venous pacemaker adds complexity, time and risk to the procedure. Guidewire modification to allow pacing is increasingly popular, however it requires technical expertise and provides unipolar pacing resulting in high thresholds and potential capture loss. The Wattson temporary pacing guidewire is a novel device which offers guidewire support for valve delivery and concomitant bipolar pacing. It may offer a safe and effective solution to guidewire pacing for transcatheter aortic valve implantation and other transcatheter heart valve implantations. Herein, we review the literature surrounding left ventricular guidewire pacing along with the features and clinical data of the Wattson wire.

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Echocardiographic and clinical factors related to paravalvular leak incidence in low-gradient severe aortic stenosis patients post-transcatheter aortic valve implantation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeu288 ◽

2014 ◽

Vol 16 (5) ◽

pp. 558-563 ◽

Cited By ~ 4

Author(s):

C. Chrysohoou ◽

S. S. Hayek ◽

N. Spilias ◽

S. Lerakis

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Paravalvular Leak ◽

Clinical Factors ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

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Impact of Mitral Regurgitation on Clinical Outcomes After Transcatheter Aortic Valve Implantation

Interventional Cardiology Review ◽

10.15420/icr.2016.11.01.54 ◽

2016 ◽

Vol 11 (1) ◽

pp. 54

Author(s):

Crochan J O’Sullivan ◽

◽

...

Keyword(s):

Aortic Valve ◽

Mitral Regurgitation ◽

Clinical Outcomes ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Transcatheter Heart Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Severe aortic stenosis (AS) and mitral regurgitation (MR) are the two most common valvular lesions referred for surgical intervention in Europe and frequently co-exist. In patients with both severe AS and significant MR referred for surgical aortic valve replacement (SAVR), a concomitant mitral valve intervention is typically performed if the MR is severe, despite the higher associated perioperative risk. The management of moderate MR among SAVR patients is controversial and depends on a number of factors including MR aetiology (i.e., organic versus functional MR), feasibility of repair and patient risk profile. Moderate or severe MR is present in up to one-third of patients undergoing transcatheter aortic valve implantation (TAVI), is mainly of functional aetiology and is typically left untreated. Although data are conflicting, a growing body of evidence suggests that significant MR exerts an adverse effect on both short- and long-term clinical outcomes after TAVI. Moderate or severe MR improves in just over half of patients following TAVI and recent data suggest MR is more likely to improve among patients receiving a balloon-expandable as compared with a self-expandable transcatheter heart valve.

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Transcatheter aortic valve implantation in decompensated aortic stenosis within the same hospital admission: early clinical experience

Open Heart ◽

10.1136/openhrt-2018-000827 ◽

2018 ◽

Vol 5 (2) ◽

pp. e000827 ◽

Cited By ~ 3

Author(s):

Mahmoud Abdelaziz ◽

Saib Khogali ◽

James M Cotton ◽

Antonella Meralgia ◽

Maciej Matuszewski ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Hospital Admission ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Paravalvular Leak ◽

Hospital Death ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

ObjectiveSevere decompensated aortic valve stenosis is associated with noticeable reduction in survival. Until recently the options for such patients were either high-risk surgery or percutaneous balloon valvuloplasty and medical therapy which does not add any survival benefits and associated with high rate of complications. We present our experience in the use of transcatheter aortic valve implantation (TAVI) in patients with decompensated severe aortic stenosis requiring urgent intervention in the same hospital admission.MethodsIn this observational study, all patients who were admitted with decompensated severe aortic stenosis were enrolled. Elective patients were excluded from the study. Perioperative records were analysed and clinical, echocardiographic and survival data were presented.Results76 patients with a mean age of 81±6 years were enrolled. All patients presented with New York Heart Association (NYHA) IV status. Femoral approach was performed in 86.8%. Median postoperative hospital stay was 6 days and intensive care unit admission rate was 15%. At follow-up, 61.8% of patients were in NYHA status I/II. Moderate or more paravalvular leak occurred in 5.2% of patients. Permanent pacemaker was required in 14.4% of patients. The incidence of in-hospital death was 2.6%. Kaplan-Meier analysis indicated a survival rate of 81% at 1 year.ConclusionsUrgent in-hospital TAVI is feasible as the first-line treatment in decompensated severe aortic stenosis. In our cohort, it showed to be safe and achieved satisfactory survival rates and symptom control.

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Transcatheter aortic valve implantation in low-risk patients: is it too early?

Heart ◽

10.1136/heartjnl-2018-314248 ◽

2019 ◽

Vol 105 (Suppl 2) ◽

pp. s51-s56

Author(s):

Miguel Sousa Uva

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Pacemaker Implantation ◽

Vascular Complications ◽

Low Risk ◽

Paravalvular Leak ◽

Transcatheter Aortic Valve ◽

Risk Patients ◽

Aortic Valve Implantation ◽

Valve Implantation

The median age of patients treated by transcatheter aortic valve implantation (TAVI) is falling across Europe, and low-risk patients with severe aortic stenosis (AS) represent 80% of patients with severe AS undergoing surgical aortic valve replacement (SAVR). There are few data for TAVI in low-risk patients, but there are four ongoing randomised trials of SAVR versus TAVI. The key issues relate to pacemaker implantation rates and the associated potential longer term deleterious effects, and the need to minimise vascular complications and paravalvular leak. Valve leaflet thrombosis and paucity of data on valve durability remain a concern. Given the higher incidence of bicuspid aortic valves in younger patients, outcomes of TAVI in this setting need clarification and are discussed.

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Advancements in Transcatheter Aortic Valve Implantation: A Focused Update

Medicina ◽

10.3390/medicina57070711 ◽

2021 ◽

Vol 57 (7) ◽

pp. 711

Author(s):

Niccolò Ciardetti ◽

Francesca Ciatti ◽

Giulia Nardi ◽

Francesca Maria Di Muro ◽

Pierluigi Demola ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Pacemaker Implantation ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Transcatheter aortic valve implantation (TAVI) has become the leading technique for aortic valve replacement in symptomatic patients with severe aortic stenosis with conventional surgical aortic valve replacement (SAVR) now limited to patients younger than 65–75 years due to a combination of unsuitable anatomies (calcified raphae in bicuspid valves, coexistent aneurysm of the ascending aorta) and concerns on the absence of long-term data on TAVI durability. This incredible rise is linked to technological evolutions combined with increased operator experience, which led to procedural refinements and, accordingly, to better outcomes. The article describes the main and newest technical improvements, allowing an extension of the indications (valve-in-valve procedures, intravascular lithotripsy for severely calcified iliac vessels), and a reduction of complications (stroke, pacemaker implantation, aortic regurgitation).

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