scholarly journals 5 Year Outcomes of Patients With Aortic Structural Valve Deterioration Treated With Transcatheter Valve in Valve – A Single Center Prospective Registry

2021 ◽  
Vol 8 ◽  
Author(s):  
Nili Schamroth Pravda ◽  
Ran Kornowski ◽  
Amos Levi ◽  
Guy Witberg ◽  
Uri Landes ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Functional Class ◽  
Nyha Functional Class ◽  
Transcatheter Aortic Valve ◽  
Structural Valve Deterioration ◽  
Valve In Valve ◽  
One Year ◽  
Valve Pathology

The Valve-in-Valve (ViV) technique is an established alternative for the treatment of structural bioprosthetic valve deterioration (SVD). Data describing the intermediate term follow up of patients treated with this approach is scarce. We report on our intermediate-term outcomes of patients with SVD in the Aortic position treated with ViV. Included were patients with symptomatic SVD in the aortic position valve who were treated by Valve in valve transcatheter aortic valve implantation (ViV-TAVI) during the years 2010-2019 in our center. Three main outcomes were examined during the follow up period: NYHA functional class, ViV-TAVI hemodynamic per echocardiography, and mortality. Our cohort consisted of 85 patients (mean age 78.8 ± 8.9 years). The indications for aortic ViV were: SVD isolated aortic stenosis in 37.6%, SVD isolated aortic regurgitation in 42.2% and combined valve pathology in 20.0%. Self-expandable and balloon-expandable devices were used in 73 (85.9%) and 12 (14.1%), respectively. Average follow up was 3.7 ± 2.4 years. 95 and 91% of patients were in NYHA functional class I/II at 1 and 5 year follow up respectively. At one year, the mean trans-aortic valve pressure was 15 ± 9 mmHg and rates of ≥ moderate aortic regurgitation were 3.7%. Mortality at one year was 8.6% (95% CI 2.3–14.4) and 31% (95% CI 16.5–42.5) at 5 years. ViV in the aortic position offers an effective and durable treatment option for patient with SVD, with low rates of all-cause mortality, excellent hemodynamic and improved functional capacity at intermediate follow up.

scholarly journals Long term outcomes of patients with aortic structural valve deterioration treated with transcatheter valve in valve implantation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
N Schamroth Pravda ◽  
P Codner ◽  
H Vaknin Assa ◽  
G Vitberg ◽  
L Perl ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Functional Class ◽  
Nyha Functional Class ◽  
Long Term Follow Up ◽  
Valve In Valve ◽  
One Year ◽  
Valve Implantation

Abstract Introduction The Valve-in-Valve (ViV) technique is an established alternative for the treatment of structural bioprosthetic valve deterioration (SVD). Data describing the long term follow up of patients treated with this approach is scarce. We report on our long-term follow up outcomes of patients with SVD in the Aortic position treated with ViV. Methods Included were patients with symptomatic SVD in the aortic position valve who were treated by Valve in valve transcatheter aortic valve implantation (ViV-TAVI) during the years 20102019 in our center. Three main outcomes were examined during follow up: NYHA functional class, hemodynamic of the VIV-TAVI per echocardiography, and overall mortality. Results Our cohort consisted of 84 patients (mean age 78.8±8.9 years). The indications for aortic ViV were: SVD isolated aortic stenosis in 37.6%, SVD isolated aortic regurgitation in 42.2% and combined valve pathology in 20.0%. Self-expandable and balloon-expandable devices were used in 73 (85.9%) and 12 (14.1%), respectively. Average time of follow up was 3.74±2.4 years. 95% and 91% of patients were in NYHA functional class I/II at 1 and 5 year follow up respectively. At one year the mean trans-aortic valve pressure was 15.3±9.3 and rates of ≥ moderate aortic regurgitation were 3.7%. Survival was 91.4% (95% CI 85.6–97.7) at one year and 79.5% (95% CI 70.2–90.0) at 3 years. Conclusion ViV in the aortic position offers an effective and durable treatment option for patient with SVD, with low rates of all-cause mortality, excellent hemodynamic and improved functional capacity at 3 years follow up. FUNDunding Acknowledgement Type of funding sources: None. NYHA functional class over follow up

scholarly journals First-in-Human Use of the Next-generation ProtEmbo Cerebral Embolic Protection System During Transcatheter Aortic Valve-in-valve Implantation

2021 ◽  
Vol 16 (Supplement 1) ◽  
pp. 1-4
Author(s):  
Dariusz Jagielak ◽  
Radoslaw Targonski ◽  
Dariusz Ciecwierz
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Aortic Regurgitation ◽  
Heart Valve ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Valve In Valve ◽  
Human Use ◽  
Valve Implantation

Cerebral embolic protection (CEP) devices aim to reduce the risk of periprocedural cerebrovascular events during transcatheter aortic valve implantation (TAVI). Here, the authors describe the first-in-human experience with the ProtEmbo Cerebral Protection System (Protembis), a next-generation CEP device, during TAVI. This case is part of a larger European trial evaluating the safety and performance of this device. After deployment of the ProtEmbo in the aortic arch, a first transcatheter heart valve was implanted. Despite postdilatation, moderate to severe aortic regurgitation persisted. The operating team decided to perform a valve-in-valve procedure using a second transcatheter heart valve. The ProtEmbo demonstrated good coverage of all three head vessels and no interaction with TAVI catheters in the aortic arch throughout the entire procedure. No adverse events were observed during hospitalisation or follow-up, and there was a significant reduction in aortic regurgitation at follow-up echocardiography. Despite a challenging overall procedure with presumably high embolic burden, diffusion-weighted MRI at follow-up showed a low number (n=3) and volume (156 mm3) of new hyperintense lesions. The first-in-human use of the ProtEmbo was safe and feasible, despite a challenging TAVI valve-in-valve procedure.

A valve-in-valve transcatheter aortic valve implantation with commissural alignment using advanced imaging reconstruction: a case report

2020 ◽  
Vol 3 (10) ◽  
pp. 01-05
Author(s):  
Marco Angelillis
Keyword(s):  
Aortic Valve ◽  
Severe Aortic Stenosis ◽  
Coronary Intervention ◽  
Easy Access ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Structural Valve Deterioration ◽  
Valve In Valve ◽  
Transcatheter Valve ◽  
Valve Implantation

Transcatheter valve in valve (ViV) implantation actually represents a valid alternative to surgical reinterventions in patients with previous surgical aortic valve replacement (AVR). In patients less than 80 years old, it is crucial to correctly position the new valve leaving a feasible and easy access to coronary ostia, both for future percutaneous coronary intervention (PCI) than for a future possible TAVinTAV procedure. We report a 71 year old man with prior AVR presented with structural valve deterioration (SVD) leading to severe aortic stenosis. In order to guarantee comfortable coronary access we aligned, the commissures of the new percutaneous valve with the ones of the surgical bioprothesis by reconstructing the headframes of the surgical bioprosthesis with computer tomography (CT) and fluoro-CT.

4307Lung ultrasound in stable ambulatory chronic heart failure patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Domingo ◽  
L Conangla ◽  
J Lupon ◽  
M De Antonio ◽  
P Moliner ◽  
...  
Keyword(s):  
Cox Regression ◽  
Functional Class ◽  
Class Iii ◽  
Nyha Functional Class ◽  
End Point ◽  
Ambulatory Patients ◽  
Beta Coefficient ◽  
One Year ◽  
B Lines

Abstract Background The role of lung ultrasound (LUS) in diagnosis and response to diuretic treatment of patients with acute HF has been widely studied, but less is known about its value in chronic HF. Purpose To assess the prognostic value of LUS in a cohort of chronic HF stable ambulatory patients and to explore the relationship of LUS findings with clinical data, such as NYHA functional class, left ventricular ejection fraction (LVEF) and NTproBNP. Methods Consecutive stable ambulatory patients who attended a scheduled follow-up visit in a HF clinic were included. LUS were performed with a pocket device and examined 4 chest areas per side (two anterior and two lateral). Scans were analysed offline by two investigators blinded to clinical data, who evaluated the number of B-lines of each area. The addition number of B-lines of each area and the quartiles of such addition were used for the analyses. The primary outcome end-point was the composite of all-cause death or hospitalization due to HF at one year. Linear regression and Cox regression analyses were performed. Results Five-hundred seventy-seven patients were included between July 2016 and July 2017 (age 69±12 years, 72% men). The main HF aetiology was ischemic heart disease (43%) followed by dilated cardiomyopathy (20%). Median HF duration was 79 months (Q1-Q3 38–144). Mean LVEF was 45%±13 (mean LVEF when admitted at the Unit 34%±13). Most patients were in NYHA functional class II (70%), 13% were in class I and 17% in class III. Median NTproBNP was 722 ng/L (Q1-Q3 262–1760). Mean number of B-lines was 5±6 (Q1, 0; Q2, 1–3; Q3, 4–7; Q4, ≥8). The number of B-lines was associated with age (beta-coefficient 0.11, p<0.001), NYHA functional class (beta-coefficient 1.75, p<0.001), and logNTproBNP (beta-coefficient 1.40, p<0.001). Mean number of B-lines according to NYHA functional class was: class I, 3.5±6; class II, 4.9±6; and class III, 7.1±7. During the one year follow-up 47 patients suffered the primary end-point. In total there were 24 HF related hospitalizations and 26 deaths. In Cox regression analysis, Q4 of B-lines showed a double risk of suffering the primary end-point (HR 2.13 [95% CI 1.18–3.84], p=0.01). However, statistically significance was not maintained for LUS results in the multivariable analysis when age, NYHA functional class and logNTproBNP were included in the model, although a 38% increase in the risk of suffering the primary end-point for Q4 was observed (HR 1.38 [95% CI 0.75–2.54], p=0.31). Conclusion In outpatients with stable chronic HF, the number of B-lines detected in LUS was associated with age, NYHA functional class and NTproBNP. Patients having ≥8 B-lines had a significant double risk of HF related hospitalization or all-cause death at one year. However, when strongly powerful prognostic variables such as NYHA class and NTproBNP were included in the model LUS did not retain an independent prognostic role.

scholarly journals Transcatheter aortic valve implantation for severe aortic regurgitation in a patient with end-stage respiratory failure

2020 ◽  
Vol 26 (1) ◽  
pp. 58-70
Author(s):  
Aleksandra Cherneva ◽  
Zoran Stankov ◽  
Naidenka Zlatareva ◽  
Iveta Tasheva ◽  
Georgi Dobrev ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Functional Class ◽  
Severe Aortic Regurgitation ◽  
Transcatheter Aortic Valve ◽  
History Of ◽  
And Migration ◽  
End Stage ◽  
Valve Implantation

We report a case of a high-risk 73-year–old patient with a combined aortic valve disease with predominant severe, symptomatic aortic regurgitation and a history of an end-stage respiratory failure with prohibitive surgical risk who was successfully treated using a minimalist approach to implant off-label а self-expandable Medtronic Evolut R prosthesis. This case report demonstrates that the self-expandable prosthesis Medtronic Evolut R might be implanted without tissue damage and migration in a moderate-calcified tricuspid aortic valve with predominant regurgitation and mild stenosis with satisfactory hemodynamic results and improvement in functional class heart failure in a patient with concomitant severe respiratory failure.

4069From first in man transcatheter aortic valve implantation, a 15-year experience

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Avinee ◽  
E Durand ◽  
T Levesque ◽  
P Y Litzler ◽  
J N Dacher ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Transcatheter Aortic Valve ◽  
Kaplan Meier ◽  
Transcatheter Heart Valve ◽  
Structural Valve Deterioration ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Since the first-in-man transcatheter aortic valve implantation (TAVI) performed in 2002, the number of procedures has dramatically increased. However, long-term data regarding outcome and valve durability remain poor. Purpose We aimed to evaluate the evolution of 30-day outcomes over years and long-term mortality and valve durability after TAVI. Methods All consecutive patients presenting with severe symptomatic aortic stenosis treated by TAVI in our center were included prospectively. Clinical and echocardiographic follow-up was performed at 30 days and annually thereafter. Survival curves were constructed using Kaplan-Meier analysis. We also evaluated valve durability according to the European standardized definition of structural valve deterioration. Results Between 2002 and 2018, 1530 consecutive patients underwent TAVI including 1285 (84.0%) patients via a femoral approach. A balloon-expandable transcatheter heart valve was predominantly used (1421 patients; 92.9%). The annual transfemoral approach rate increased progressively to reach 93.3%. Age of patients remained stable over time with a global mean age of 83.7±6.5 years old. Logistic EuroSCORE decreased from 49.2±8.2% to 14.3±8.6% (p<0.0001). Thirty-day mortality dramatically decreased below 3% since 2015 and was 0% in 2018. Similarly, major vascular complications decreased from 50.0% in the first year to less than 1% since 2017 (p=0.001). The length of hospital-stay progressively shortened up to a median of 2 days in 2018. The Kaplan-Meier survival estimation was 82.3%, 60.3%, 33.0%; 11.7% and 8.9% respectively at 1, 3, 5, 8 and 10 years. On long-term follow-up the mean aortic gradient remained unchanged (Figure), and only five patients presented a severe prosthetic valve deterioration. Among them, four patients successfully benefited from a valve in valve TAVI procedure. The competing risk analysis at 10 years estimates risk for severe and moderate-or-severe valve deterioration of 1.9±0.9% and 4.3±1.3% respectively. TEE mean transaortic gradient Conclusions Long-term (up to 10 years) follow-up of our large pioneer series of patients treated by TAVI shows a dramatic improvement of outcomes and no warning signs of valve deterioration suggesting very encouraging valve durability, using predominantly, a balloon expandable prosthesis. Further studies are warranted to study valve durability after TAVI before extension to lower risk patients.

Transthoracic Echocardiography to Assess Aortic Regurgitation after TAVR: A Comparison with Periprocedural Transesophageal Echocardiography

Cardiology ◽  
2016 ◽  
Vol 137 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Alexandra Goncalves ◽  
Charles Nyman ◽  
David R. Okada ◽  
Avinainder Singh ◽  
Jeffrey Swanson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Transesophageal Echocardiography ◽  
Aortic Regurgitation ◽  
Transthoracic Echocardiography ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Overall Mortality

Background: We aimed to compare periprocedural transesophageal echocardiography (TEE) with postprocedural transthoracic echocardiography (TTE) for the diagnosis of aortic regurgitation (AR). Methods and Results: TEE and TTE images of 163 transcatheter aortic valve replacement (TAVR) patients (mean age 81 ± 8 years; 56% men) were reviewed separately and blinded to each other as well as to all clinical data. The median time between TEE during TAVR (TEE/TAVR) and TTE was 4 days (IQR 2-10 days). After TAVR, 48% of the patients had at least trace AR by TEE, 56% by angiography and 67% by TTE. The majority of AR was paravalvular (78%). More patients were classified with mild-to-moderate AR by TTE than by TEE (44 vs. 22%, p < 0.01). When examining the 46 patients with AR by TTE which was not at TEE/TAVR, both systolic and diastolic blood pressure (SBP and DBP) were significantly higher during TTE than during TEE (mean ΔSBP = 9 ± 4 mm Hg and mean ΔDBP = 6 ± 2 mm Hg, p < 0.01 for both). No differences in BP between TEE and TTE were found among patients with no AR or among those who had AR in both studies. At a median follow-up of 185 days (IQR 39-424 days), the overall mortality was 17%, but this was not associated with the presence of AR on TTE or TEE. Conclusions: Patients' hemodynamic conditions may result in underdiagnosis of paravalvular regurgitation in periprocedural TEE. Our findings suggest that a postprocedural evaluation for AR by TTE could serve as a reasonable alternative to TEE for the evaluation of AR.

Valve-in-Valve TAVR: State-of-the-Art Review

2019 ◽  
Vol 14 (4) ◽  
pp. 299-310 ◽  
Author(s):  
J. James Edelman ◽  
Jaffar M. Khan ◽  
Toby Rogers ◽  
Christian Shults ◽  
Lowell F. Satler ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
State Of The Art ◽  
Native Valve ◽  
Reoperative Surgery ◽  
Transcatheter Aortic Valve ◽  
Structural Valve Deterioration ◽  
Valve In Valve ◽  
Coronary Obstruction

An increasing number of surgically implanted bioprostheses will require re-intervention for structural valve deterioration. Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become an alternative to reoperative surgery, currently approved for high-risk and inoperable patients. Challenges to the technique include higher rates of prosthesis–patient mismatch and coronary obstruction, compared to native valve TAVR. Herein, we review results of ViV TAVR and novel techniques to overcome the aforementioned challenges.

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