High Post-Procedural Transvalvular Gradient or Delayed Mean Gradient Increase after Transcatheter Aortic Valve Implantation: Incidence, Prognosis and Associated Variables. The FRANCE-2 Registry

Mean Gradient (MG) elevation can be detected immediately after transcatheter aortic valve implantation (TAVI) or secondarily during follow-up. Comparisons and interactions between these two parameters and their impact on outcomes have not previously been investigated. This study aimed to identify incidence, influence on prognosis, and parameters associated with immediate high post-procedural mean transvalvular gradient (PPMG) and delayed mean gradient increase (6 to 12 months after TAVI, DMGI) in the FRANCE 2 (French Aortic National CoreValve and Edwards 2) registry. The registry includes all consecutive symptomatic patients with severe aortic stenosis who have undergone TAVI. Three groups were analyzed: (1) PPMG < 20 mmHg without DMGI > 10 mmHg (control); (2) PPMG < 20 mmHg with DMGI > 10 mmHg (Group 1); and (3) PPMG ≥ 20 mmHg (Group 2). From January 2010 to January 2012, 4201 consecutive patients were prospectively enrolled in the registry. Controls comprised 2078 patients. In Group 1(n = 131 patients), DMGI exceeded 10 mmHg in 5.6%, and was not associated with greater 4-years mortality than in controls (32.6% vs. 40.1%, p = 0.27). In Group 2 (n = 144 patients), PPMG was at least 20 mmHg in 6.1% and was associated with higher 4-year mortality (48.7% versus 40.1%, p = 0.005). A total of two-thirds of the patients with PPMG ≥ 20 mmHg had MG < 20 mmHg at 1 year, with mortality similar to the controls (39.2% vs. 40.1%, p = 0.73). Patients with PPMG > 20 mmHg 1 year post-TAVI had higher 4-years mortality than the general population of the registry, unlike patients with MG normalization.

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Management and Prevention of Vascular Complications Related to Transcatheter Aortic Valve Implantation and Aortic Aneurysm Repair Procedures – A Technical Note

Interventional Cardiology Review ◽

10.15420/icr.2010.5.1.81 ◽

2010 ◽

Vol 5 (1) ◽

pp. 81

Author(s):

Andrea Pacchioni ◽

Dimitris Nikas ◽

Carlo Penzo ◽

Salvatore Saccà ◽

Luca Favero ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Aneurysm ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Vascular Complications ◽

Technical Note ◽

Closure Device ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Transcatheter aortic valve implantation (TAVI) and endovascular aortic repair (EVAR) are increasingly being used as therapeutic options for patients with severe aortic stenosis who are ineligible for surgery and who have aortic aneurysm with suitable anatomical features. These procedures can be associated with severe complications, especially related to vascular access and the use of a large introducer sheath (from 18 to 24 French [Fr]). In this article we describe possible vascular complications emerging during TAVI and EVAR and their appropriate management, beginning with patient selection, the correct way to perform vessel puncture and the use of a vascular closure device, up to the recently proposed cross-over technique, which is thought to minimise the risk of dangerous consequences of vascular damage.

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Faculty Opinions recommendation of Outcomes of patients with severe aortic stenosis at high surgical risk evaluated in a trial of transcatheter aortic valve implantation.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718018801.793478429 ◽

2013 ◽

Author(s):

Wilbert Aronow

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Surgical Risk ◽

Transcatheter Aortic Valve ◽

High Surgical Risk ◽

Aortic Valve Implantation ◽

Valve Implantation

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Predictors of Outcomes of Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis

Zagazig University Medical Journal ◽

10.21608/zumj.2020.19760.1626 ◽

2020 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

mosaad ghanem ◽

Abdelfattah Hassan frere ◽

Manar Elzaky ◽

Hamdy Mahmoud

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Transcatheter Aortic Valve ◽

Predictors Of Outcomes ◽

Aortic Valve Implantation ◽

Valve Implantation

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Transcatheter Aortic Valve Implantation For Inoperable Severe Aortic Stenosis - A Meta-Analysis

Value in Health ◽

10.1016/j.jval.2016.09.1952 ◽

2016 ◽

Vol 19 (7) ◽

pp. A686

Author(s):

AZ Mattos ◽

DA Schroder ◽

V Colpani ◽

LM Restelatto ◽

RA Ribeiro

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Meta Analysis ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

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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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