Transcatheter aortic valve implantation not preceded by balloon valvuloplasty in a patient with increased risk of stroke – a

Abstract Background The importance of concomitant tricuspid regurgitation (TR) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) remains unclear. Objectives To document the prevalence of concomitant TR before and after TAVI, to correlate TR severity after TAVI with clinical outcome, to quantify suitability for transcatheter tricuspid valve interventions (TTVI), and to report clinical outcome in patients eligible for TTVI. Methods In a prospective TAVI registry, the severity of TR at baseline and after TAVI was retrospectively evaluated. Results Among 2,008 eligible patients, 1,659 patients (82.6%) had ≤mild TR, 242 (12.1%) had moderate TR, 57 (2.8%) had severe TR, and 50 (2.5%) had massive TR. More than half of all patients with ≥moderate TR had an improvement of TR severity after TAVI. In contrast to baseline TR, >moderate TR after TAVI was associated with an increased risk of mortality (HRadjusted 1.89; 95% CI 1.03–3.46, HRadjusted 2.11; 95% CI 1.07–4.16, respectively) compared with ≤mild TR. After TAVI, 30 out of 101 patients with baseline ≥severe TR (29.7%) were deemed suitable candidates for TTVI. They had a 2-fold increased risk of mortality between 30 days and 1 year (HRadjusted: 1.97; 95% CI: 1.17–3.31) and a higher risk of persistent heart failure symptoms (RRadjusted: 2.75; 95% CI: 1.75–4.31). Conclusions Severity of TR improved in more than half of all patients after TAVI. More than moderate TR after TAVI was associated with a twofold increased risk of death at one year. Xx% of patients with relevant TR are anatomically suitable for TTVI. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

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Transcatheter aortic valve implantation without prior balloon valvuloplasty is associated with less pronounced markers of myocardial injury

The Journal of Cardiovascular Surgery ◽

10.23736/s0021-9509.18.10651-3 ◽

2020 ◽

Vol 61 (2) ◽

Cited By ~ 1

Author(s):

Moritz Mirna ◽

Bernhard Wernly ◽

Sarah Eder ◽

Michael Lichtenauer ◽

Erika Prinz ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Myocardial Injury ◽

Balloon Valvuloplasty ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

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A case report of a transcarotid transcatheter aortic valve implantation with concomitant carotid endarterectomy

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa379 ◽

2020 ◽

Author(s):

Sherif Sultan ◽

Gordon Pate ◽

Niamh Hynes ◽

Darren Mylotte

Keyword(s):

Aortic Valve ◽

Carotid Endarterectomy ◽

Transcatheter Aortic Valve Implantation ◽

Major Adverse Cardiovascular Events ◽

Aortoiliac Disease ◽

Transcatheter Aortic Valve ◽

Increased Risk ◽

Aortic Valve Implantation ◽

The Right ◽

Valve Implantation

Abstract Background Transcarotid transcatheter aortic valve implantation (TAVI) is a worthwhile substitute in patients who might otherwise be inoperable; however, it is applied in <10% of TAVI cases. In patients with established carotid artery stenosis, the risk of complications is increased with the transcarotid access route. Case summary We report a case of concomitant transcarotid TAVI and carotid endarterectomy (CEA) in a patient with bovine aortic arch and previous complex infrarenal EndoVascular Aortic Repair (EVAR). The integrity and positioning of the previous EVAR endograft was risked by transfemoral access. The right subclavian artery was only 4.5 mm and the left subclavian was totally occluded so transcarotid access was chosen. The patient recovered well, with no neurological deficit and was discharged home after 72 h. He was last seen and was doing well 6 months post-procedure. Discussion In patients with severe aortoiliac disease, or previous aortic endografting, transfemoral access for TAVI can be challenging or even prohibitive. Alternative access sites such as transapical or transaortic are associated with added risk because they carry increased risk of major adverse cardiovascular events, longer intensive care unit and hospital stay, and increased cost. A transcaval approach for TAVI has also been reported but was not suitable for our patient due to prior EVAR. Concomitant TAVI via transcarotid access and CEA can be successful in experienced hands. This case highlights the importance of a team-based approach to complex TAVI cases in high-risk patients with complex vascular access.

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Vahanian A, Himbert D. Transcatheter Aortic Valve Implantation: Could It Be Done Without Prior Balloon Valvuloplasty? J Am Coll Cardiol Intv 2011;4:758–9

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2011.09.008 ◽

2011 ◽

Vol 4 (11) ◽

pp. 1255

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Balloon Valvuloplasty ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

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Clinical and Technical Challenges of Prosthesis–Patient Mismatch After Transcatheter Aortic Valve Implantation

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.670457 ◽

2021 ◽

Vol 8 ◽

Author(s):

Pier Pasquale Leone ◽

Fabio Fazzari ◽

Francesco Cannata ◽

Jorge Sanz-Sanchez ◽

Antonio Mangieri ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Effective Area ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Increased Risk ◽

Normal Human ◽

Valve In Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Prosthesis–patient mismatch (PPM) is present when the effective area of a prosthetic valve inserted into a patient is inferior to that of a normal human valve; the hemodynamic consequence of a valve too small compared with the size of the patient's body is the generation of higher than expected transprosthetic gradients. Despite evidence of increased risk of short- and long-term mortality and of structural valve degeneration in patients with PPM after surgical aortic valve replacement, its clinical impact in patients subject to transcatheter aortic valve implantation (TAVI) is yet unclear. We aim to review and update on the definition and incidence of PPM after TAVI, and its prognostic implications in the overall population and in higher-risk subgroups, such as small aortic annuli or valve-in-valve procedures. Last, we will focus on the armamentarium available in order to reduce risk of PPM when planning a TAVI procedure.

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