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Transcatheter Aortic Valve Implantation (TAVI)

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A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Cardiac Surgery".

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 32931

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Special Issue Editors

Prof. Dr. Enrico Ferrari

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Guest Editor

Cardiac Surgery Department, Cardiocentro Ticino Institute, Via Tesserete 48, CH-6900 Lugano, Switzerland
Interests: transcatheter heart valve procedures; minimally invasive cardiac surgery; myocardial protection; development of new transcatheter technologies; transcatheter aortic root replacement (TARR) procedures
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Francesco Maisano

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Cardiac Surgery Department, San Raffaele Hospital, via Olgettina 60, 20132 Milano, Italy
Interests: cardiovascular surgery; valve disease; transcatheter interventions

Dr. Sergio Berti

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Fondazione C.N.R. Reg. Toscana G. Monasterio, Ospedale del Cuore, 54100 Massa, Italy
Interests: interventional cardiology; TAVI; transcatheter mitral repair; STEMI; NSTEMI; transcatheter tricuspid repair; LAA closure
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Over the last ten years, transcatheter aortic valve implantation (TAVI) has become an important minimally invasive approach that represents an alternative to standard open-heart cardiac surgery for patients at high surgical risk and suffering from severe symptomatic aortic valve stenosis. Based on the results of the most recent clinical trials, this new technology is even additionally recommended for use in patients with an intermediate risk profile and, therefore, the population of patients potentially treatable with a TAVI device is continuing to grow in western countries. Modern cardiac imaging, the computational tools for the 3D imaging analysis of cardiac and vascular structures, and the use of fusion technologies during TAVI procedures have become important key factors for the success of TAVI procedures. Similarly, the evolution of TAVI devices has helped in improving the hemodynamic results, simplifying the procedural steps and lowering the rate of post-TAVI vascular injury, paravalvular leak, and permanent pacemaker implantation. The aim of the present Special Issue is to provide a clear and modern overview on contemporary trends in TAVI and describe, with technical details and clinical data, the latest results and technologies in use during TAVI and valve-in-valve procedures. By reading this Special Issue, modern cardiologists and cardiac surgeons involved in TAVI-dedicated heart teams should easily improve their knowledge by learning about the latest trends in TAVI as presented by experts in the field.

Prof. Dr. Enrico Ferrari
Prof. Dr. Francesco Maisano
Dr. Sergio Berti
Guest Editors

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Keywords

aortic valve
transcatheter aortic valve procedures
transcatheter devices
aortic valve stenosis
paravalvular leak
access sites for TAVI

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Published Papers (12 papers)

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Research

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10 pages, 552 KiB

Open AccessArticle

Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular Disease

by Enrico Ferrari, Alberto Pozzoli, Catherine Klersy, Francesca Toto, Tiziano Torre, Tiziano Cassina, Giovanni Pedrazzini and Stefanos Demertzis

J. Cardiovasc. Dev. Dis. 2022, 9(12), 422; https://doi.org/10.3390/jcdd9120422 - 28 Nov 2022

Viewed by 1791

Abstract

Objective: Transcatheter aortic valve replacement (TAVR) through alternative access routes is indicated in patients with severe aortic valve stenosis and diseased peripheral arteries. We analysed and compared the outcome of patients undergoing transapical (TA) and direct transaortic (TAO) TAVR procedures. Methods: Preoperative characteristics, procedural details, and thirty-day outcome of patients undergoing transapical (TA-TAVR group) and direct transaortic (TAO-TAVR group) TAVR procedures were prospectively collected and retrospectively analysed. Results: From March 2012 to March 2022, 81 TA and 82 TAO-TAVR (total: 163 cases) were performed with balloon-expanding (n = 120; 73.6%) and self-expandable (n = 43; 26.4%) valves. The mean age was 79.7 ± 6.2 and 81.9 ± 6.7 years for the TA- and TAO-TAVR groups, respectively (p = 0.032). Females were more represented in the TAO-TAVR group (56% vs. 32%; p = 0.003) while TA-TAVR patients showed a higher prevalence of previous vascular surgery (20% vs. 6%; p = 0.01), previous cardiac surgery (51% vs. 3.6%; p < 0.001), and porcelain aorta (22% vs. 5%; p = 0.001). The mean ejection fraction was 49.0 ± 14.6% (TA) and 53.5 ± 12.2% (TAO) (p = 0.035) while mean gradients were 35.6 ± 13.2 mmHg (TA) and 40.4 ± 16.1 mmHg (TAO) (p = 0.045). The median EuroSCORE-II was 5.0% (IQR: 3.0–11.0) and 3.9% (IQR: 2.5–5.4) for the TA- and TAO-TAVR groups, respectively (p = 0.005). The procedural time was shorter for TA procedures (97 min (IQR: 882–118) vs. 102 min (IQR: 88–129); p = 0.133). Mortality at day 30 was 6% in both groups (p = 1.000); the permanent pacemaker implantation rate was similar (8.6% vs. 9.7%; p = 1.000), and hospital stay was shorter for the TAO group (8 days (IQR: 6–11) vs. 10 days (IQR: 7–13); p = 0.025). Conclusions: Our results show that transapical and direct transaortic TAVR in high-risk patients with diseased peripheral arteries provide satisfactory clinical results with similar thirty-day outcomes. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI))

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9 pages, 969 KiB

Open AccessArticle

A New Definition of Thrombocytopenia Following Transcatheter Aortic Valve Implantation: Incidence, Outcome, and Predictors

by Francesco Pollari, Stine Horna, Magnus Rottmann, Christian Langhammer, Thomas Bertsch and Theodor Fischlein

J. Cardiovasc. Dev. Dis. 2022, 9(11), 388; https://doi.org/10.3390/jcdd9110388 - 9 Nov 2022

Cited by 1 | Viewed by 2219

Abstract

Background: The aim of this study was to assess the incidence, outcomes, and risk factors associated with thrombocytopenia following TAVI according to a corrected platelet count (CPC), to avoid the bias of hemodilution/concentration. Methods: We analyzed patients who underwent TAVI in our center between 2009 and 2018. The study population were divided into three groups: none (NT), mild (MT), and severe (ST) postoperative thrombocytopenia. Primary outcomes were bleedings, length of hospital stay, and mortality. A multivariate logistic regression was performed to assess risk factors for ST. Results: A total of 907 patients were included in the analysis. MT was observed in 28.1% and ST in 2.6% of all patients. The following clinical outcomes were recorded: incidence of life-threatening and major bleeding (NT = 14.2%, MT = 20.8%, ST = 58.3%), the median length of hospital stay (NT = 8, MT = 10, ST = 14 days), in-hospital mortality (NT = 3.9%, MT = 6.3%, ST = 16.7%), and the overall significance in comparison with NT (p < 0.05). The logistic regression showed ST was associated with preoperative CPC, transapical access, diabetes mellitus, and the critical preoperative state. Conclusions: Worse clinical outcomes are associated with both MT and ST after TAVI. In particular, ST is associated with higher in-hospital and 30-day mortality. Management of modifiable baseline and procedural variables may improve this outcome. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI))

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16 pages, 4475 KiB

Open AccessArticle

Prosthetic Valve Function after Aortic Valve Replacement for Severe Aortic Stenosis by Transcatheter Procedure versus Surgery

by Shunsuke Saito, Toshimi Sairenchi, Shotaro Hirota, Ken Niitsuma, Shohei Yokoyama, Yasuyuki Kanno, Yuta Kanazawa, Masahiro Tezuka, Yusuke Takei, Go Tsuchiya, Taisuke Konishi, Ikuko Shibasaki, Koji Ogata, Osamu Monta, Yasushi Tsutsumi and Hirotsugu Fukuda

J. Cardiovasc. Dev. Dis. 2022, 9(10), 355; https://doi.org/10.3390/jcdd9100355 - 16 Oct 2022

Cited by 2 | Viewed by 2424

Abstract

Background This study compared the clinical outcomes of transcatheter (TAVR) and surgical (SAVR) aortic valve replacements, focusing on postoperative valvular performance assessed by echocardiography. Method and Results A total of 425 patients who underwent TAVR (230 patients) or SAVR (195 patients) were included. Postoperative effective orifice area index (EOAI) was higher in the TAVR group (1.27 ± 0.35 cm²/m²) than in the SAVR group (1.06 ± 0.27 cm²/m², p < 0.001), and patient–prosthesis mismatch (PPM) was more frequent in the SAVR group (22.6%) than in the TAVR group (8.7%, p < 0.001). Mild or greater paravalvular leakage (PVL) was more frequent in the TAVR group (21.3%) than in the SAVR group (0%, p < 0.001). Moreover, there was no difference in freedom from all-cause death, stroke, or rehospitalization between the groups. Patients with moderate or greater PPM (EOAI < 0.85 cm²/m²) had lower freedom from composite events than those without this PPM criterion (p = 0.008). Patients with mild or greater PVL also had lower freedom from composite events than those without this PVL criterion (p = 0.017). Conclusions Postoperative valvular performance of TAVR was superior to that of SAVR in terms of EOAI. This merit was counterbalanced by the significantly lower rates of PVL in patients who underwent SAVR. The overall clinical outcomes were similar between the study groups. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI))

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11 pages, 1303 KiB

Open AccessArticle

Comparison of Suture-Based and Collagen-Based Vascular Closure Devices for Large Bore Arteriotomies—A Meta-Analysis of Bleeding and Vascular Outcomes

by Sumit Sohal, Sheetal Vasundara Mathai, Sanjana Nagraj, Krishna Kurpad, Kandarp Suthar, Harsh Mehta, Komaldeep Kaur, Najam Wasty, Sergio Waxman, Marc Cohen, Gautam K. Visveswaran and Rajiv Tayal

J. Cardiovasc. Dev. Dis. 2022, 9(10), 331; https://doi.org/10.3390/jcdd9100331 - 30 Sep 2022

Cited by 7 | Viewed by 2524

Abstract

Background: Large bore access procedures rely on vascular closure devices to minimize access site complications. Suture-based vascular closure devices (S-VCD) such as ProGlide and ProStar XL have been readily used, but recently, newer generation collagen-based vascular closure devices (C-VCD) such as MANTA have been introduced. Data on comparisons of these devices are limited. Methods: PubMed, Scopus and Cochrane were searched for articles on vascular closure devices using keywords, (“Vascular closure devices” OR “MANTA” OR “ProStar XL” OR “ProGlide”) AND (“outcomes”) that resulted in a total of 875 studies. Studies were included if bleeding or vascular complications as defined by Valve Academic Research Consortium-2 were compared between the two types of VCDs. The event level data were pooled across trials to calculate the Odds Ratio (OR) with 95% CI, and analysis was done with Review Manager 5.4 using random effects model. Results: Pooled analyses from these nine studies resulted in a total of 3410 patients, out of which 2855 were available for analysis. A total of 1229 received C-VCD and 1626 received S- VCD. Among the patients who received C-VCD, the bleeding complications (major and minor) were similar to patients who received S-VCD ((OR: 0.70 (0.35–1.39), p = 0.31, I² = 55%), OR: 0.92 (0.53–1.61), p = 0.77, I² = 65%)). The vascular complications (major and minor) in patients who received C-VCD were also similar to patients who received S-VCD ((OR: 1.01 (0.48–2.12), p = 0.98, I² = 52%), (OR: 0.90 (0.62–1.30), p = 0.56, I² = 35%)). Conclusions: Bleeding and vascular complications after large bore arteriotomy closure with collagen-based vascular closure devices are similar to suture-based vascular closure devices. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI))

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10 pages, 522 KiB

Open AccessEditor’s ChoiceArticle

Short-Term Atrioventricular Dysfunction Recovery after Post-TAVI Pacemaker Implantation

by Gaetano Pinnacchio, Eleonora Ruscio, Erica Rocco, Carlo Trani, Francesco Burzotta, Cristina Aurigemma, Enrico Romagnoli, Roberto Scacciavillani, Maria Lucia Narducci, Gianluigi Bencardino, Francesco Perna, Francesco Raffaele Spera, Gianluca Comerci, Antonio Bisignani and Gemma Pelargonio

J. Cardiovasc. Dev. Dis. 2022, 9(10), 324; https://doi.org/10.3390/jcdd9100324 - 24 Sep 2022

Cited by 1 | Viewed by 2924

Abstract

Permanent pacemaker implantation (PPI) represents a frequent complication after transcatheter aortic valve implantation (TAVI) due to atrio-ventricular (AV) node injury. Predictors of early AV function recovery were investigated. We analyzed 50 consecutive patients (82 ± 6 years, 58% males, EuroSCORE: 7.8 ± 3.3%, STS mortality score: 5 ± 2.8%). Pacemaker interrogations within 4–6 weeks from PPI were performed to collect data on AV conduction. The most common indication of PPI was persistent third-degree (44%)/high-degree (20%) AV block/atrial fibrillation (AF) with slow ventricular conduction (16%) after TAVI. At follow-up, 13 patients (26%) recovered AV conduction (i.e., sinus rhythm with stable 1:1 AV conduction/AF with a mean ventricular response >50 bpm, associated with a long-term ventricular pacing percentage < 5%). At multivariate analysis, complete atrio-ventricular block independently predicted pacemaker dependency at follow-up (p = 0.019). Patients with persistent AV dysfunction showed a significant AV conduction time prolongation after TAVI (PR interval from 207 ± 50 to 230 ± 51, p = 0.02; QRS interval from 124 ± 23 to 147 ± 16, p < 0.01) compared to patients with recovery, in whom AV conduction parameters remained unchanged. Several patients receiving PPI after TAVI have recovery of AV conduction within a few weeks. Longer observation periods prior to PPI might be justified, and algorithms to minimize ventricular pacing should be utilized whenever possible. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI))

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10 pages, 734 KiB

Open AccessArticle

30-Day Outcomes after Surgical or Transapical Aortic Valve Replacement in Symptomatic Aortic Regurgitation

by Minjian Kong, Ze Hong, Xianbao Liu, Xian Zhu, Jianan Wang and Aiqiang Dong

J. Cardiovasc. Dev. Dis. 2022, 9(7), 224; https://doi.org/10.3390/jcdd9070224 - 14 Jul 2022

Cited by 3 | Viewed by 1858

Abstract

Background: We aimed to analyze the short-term clinical outcomes of transapical aortic valve replacement (TA-TAVR) compared with surgical aortic valve replacement (SAVR) in symptomatic aortic regurgitation (AR) patients to draw preliminary conclusions about the advantages and disadvantages of TA-TAVR compared with SAVR and to provide evidence for future use of TA-TAVR in AR patients. Method: From September 2016 to September 2021, 69 patients undergoing TA-TAVR with J-valve implantation and 42 patients undergoing SAVR at the Second Hospital of Zhejiang University School of Medicine were analyzed for clinical data and 30-day follow-up outcomes to analyze and compare the differences in clinical endpoints between the two procedures. Results: At 30-day follow-up, there were no significant differences in mortality or neurological events between the two groups before and after the PSM. In secondary endpoints there were significant differences between the pre-match TAVR and SAVR groups, such as the incidence of paravalvular leaks (33.8% vs. 4.8%, p < 0.05), which also remained after the PSM (37.5% vs. 0, p < 0.05). In addition, the incidence of major bleeding was 7.4% in the TAVR group and 26.2% in the SAVR group before matching (p < 0.05). After matching, the statistical difference still remained. In longitudinal comparison, significant improvements in postoperative cardiac ultrasound indices and NYHA classification occurred in both groups. Conclusion: The TA-TAVR approach is safe and reliable, with similar clinical efficacy to SAVR, and has advantages in bleeding rate and speed of recovery. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI))

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13 pages, 677 KiB

Open AccessEditor’s ChoiceArticle

Serum and Vascular Stiffness Biomarkers Associated with the Severity of Degenerative Aortic Valve Stenosis and Cardiovascular Outcomes

by Jakub Baran, Łukasz Niewiara, Jakub Podolec, Mateusz Siedliński, Ewelina Józefczuk, Anna Bernacik, Rafał Badacz, Tadeusz Przewłocki, Piotr Pieniążek, Krzysztof Żmudka, Jacek Legutko and Anna Kabłak-Ziembicka

J. Cardiovasc. Dev. Dis. 2022, 9(6), 193; https://doi.org/10.3390/jcdd9060193 - 17 Jun 2022

Cited by 7 | Viewed by 2703

Abstract

Background: Although degenerative aortic valve stenosis (DAS) is the most prevalent growth-up congestive heart valve disease, still little known about relationships between DAS severity, vascular stiffness (VS), echocardiographic parameters, and serum biomarkers in patients undergoing transcatheter (TAVR) or surgical aortic valve replacement (SAVR). The objective of this study was to identify biomarkers associated with DAS severity, and those that are associated with cardiovascular death (CVD) and episodes of chronic heart failure (CHF) exacerbation. Methods: A total of 137 patients with initially moderate-to-severe DAS were prospectively evaluated for the relationship between DAS severity, baseline VS, and serum biomarkers (uPAR, GDF-15, Gal-3, IL-6Rα, ET-1, PCSK9, RANTES/CCL5, NT-proBNP, and hs-TnT), and were followed-up for 48 months. The prognostic significance of each variable for CVD and CHF risk was measured by hazard ratio of risk (HR), which was calculated by Cox’s proportional hazard model. Results: DAS severity showed correlations with IL-6Rα (r = 0.306, p < 0.001), uPAR (r = 0.184, p = 0.032), and NT-proBNP (r = −0.389, p < 0.001). Levels of ET-1 and Gal-3 were strongly correlated with VS parameters (r = 0.674, p < 0.001; r = 0.724, p < 0.001). Out of 137 patients, 20 were referred to TAVR, 88 to SAVR, and 29 to OMT. In TAVR patients, the highest levels of ET-1, Gal-3, and VS were found as compared to other patients. The highest incidence of CVD was observed in patients who underwent TAVR (35%), compared to SAVR (8%) and OMT (10.3%) (p = 0.004). In a multivariate analysis, ET-1 occurred predictive of CVD risk (HR 25.1, p = 0.047), while Gal-3 > 11.5 ng/mL increased the risk of CHF exacerbation episodes requiring hospital admission by 12%. Conclusions: Our study indicated that ET-1 and Gal-3 levels may be associated with the outcomes in patients with DAS. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI))

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14 pages, 1682 KiB

Open AccessArticle

Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis

by Hendrik Wienemann, Marcel C. Langenbach, Victor Mauri, Maryam Banazadeh, Konstantin Klein, Christopher Hohmann, Samuel Lee, Isabel Breidert, Alexander Hof, Kaveh Eghbalzadeh, Elmar Kuhn, Marcel Halbach, David Maintz, Stephan Baldus, Alexander Bunck and Matti Adam

J. Cardiovasc. Dev. Dis. 2022, 9(4), 116; https://doi.org/10.3390/jcdd9040116 - 14 Apr 2022

Cited by 7 | Viewed by 3707

Abstract

Background: Computed tomography derived Fractional Flow Reserve (CT-FFR) has been shown to decrease the referral rate for invasive coronary angiography (ICA). The purpose of the study was to evaluate the diagnostic performance of CT-FFR compared to hyperemia-free index Resting Full-cycle Ratio (RFR) in patients with relevant aortic stenosis (AS) and intermediate coronary stenosis. Methods: 41 patients with 46 coronary lesions underwent ICA with quantitative coronary angiography (QCA), pressure wire assessment and routine pre-transcatheter aortic valve replacement (TAVR) computed tomography (CT). CT-FFR analysis was performed using prototype on-site software. Results: RFR showed a significant correlation with CT-FFR (Pearson’s correlation, r = 0.632, p < 0.001). On a per-lesion basis, diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR were 82.6% (95% CI 68.6–92.2), 69.6% (95% CI 47.1–86.8), 95.7% (95% CI 78.1–99.9), 94.1% (95% CI 69.8–99.1), and 75.9% (95% CI 62.7–85.4), respectively. The optimal cutoff value of the CT-FFR for RFR ≤ 0.89 prediction was 0.815. The area under the receiver curve showed a larger area under the curve for CT-FFR (0.87; 95% CI 0.75–0.98) compared with CTA stenosis of ≥50% (0.54, 95% CI 0.38–0.71), CTA ≥ 70% (0.72, 95% CI 0.57–0.87) and QCA ≥ 50% (0.67, 95% CI 0.52–0.83). Conclusions: CT-FFR assessed by routine pre-TAVR CT is safe and feasible and shows a significant correlation with RFR in patients with AS. CT-FFR is superior to QCA ≥ 50%, CT ≥ 50% and CT ≥ 70% in assessing the hemodynamic relevance of intermediate coronary lesions. Thus, CT-FFR has the potential to guide revascularization in patients with AS. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI))

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11 pages, 725 KiB

Open AccessEditor’s ChoiceArticle

The Effect of TAVR on Left Ventricular and Left Atrial Mechanics in Patients with Aortic Stenosis

by Malcolm Anastasius, Richard Ro, Michael Gavalas, Neil Patel, Francesca Romana Prandi, Gilbert H. L. Tang, Parasuram Krishnamoorthy, Samin K. Sharma, Annapoorna Kini and Stamatios Lerakis

J. Cardiovasc. Dev. Dis. 2022, 9(2), 35; https://doi.org/10.3390/jcdd9020035 - 21 Jan 2022

Cited by 5 | Viewed by 3126

Abstract

Background. Measures of adverse cardiac remodeling, left ventricular global longitudinal strain (LVGLS) and left atrial (LA) phasic function, are predictive of cardiac events in patients with severe aortic stenosis (AS). How these parameters of cardiac function change following TAVR requires further investigation. Methods. A number of 109 consecutive patients with symptomatic severe AS who were seen in the heart valve clinic between 2014 and 2019 for TAVR were included. All patients underwent echocardiographic assessment prior to and 30 days following TAVR, with LVGLS and LA phasic function evaluation using 2D speckle-tracking echocardiography. Heart failure hospitalization, and death were assessed at 12 months. Results. The mean age of the study cohort was 81 ± 7.3 years. Following TAVR, there was a significant reduction in NYHA class III/IV symptoms [89 (82%) vs. 12 (11%), p < 0.01], and median mean aortic valve gradient [44 mmHg (16) vs. 9 mmHg (7), p < 0.01]. There was no significant change in the median LVEF [62% (13) vs. 62% (6.0), p = 0.2]; however, the LVGLS significantly increased following TAVR [15 ± 3.5% vs. 18 ± 3.3%, p < 0.01]. The median LA reservoir, conduit and contractile function significantly improved following TAVR [22.0% (14.0) vs. 18.0% (14.0) p < 0.01, 8.9% (5.4) vs. 7.8% (4.8) p < 0.01, 12% (11.0) vs. 9.6% (11.0) p < 0.01, respectively]. The incidence of death or heart failure hospitalization at 12 months was low, and occurred in eight patients (7.3%). Conclusions. TAVR results in significant short-term reverse LV and LA remodeling, as shown by improvement in LV GLS and all three components of LA phasic function, despite no change in the LVEF. The findings indicate the possible utility of strain imaging for the assessment of global LV and LA function following TAVR. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI))

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Review

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17 pages, 2778 KiB

Open AccessReview

A Meta-Analysis on the Impact of High BMI in Patients Undergoing Transcatheter Aortic Valve Replacement

by Jiyoung Seo, Weijia Li, Israel Safiriyu, Amrin Kharawala, Sanjana Nagraj, Arooj Tahir, Ioannis Doundoulakis, Leonidas Koliastasis, Saul Rios, Leonidas Palaiodimos and Damianos G. Kokkinidis

J. Cardiovasc. Dev. Dis. 2022, 9(11), 386; https://doi.org/10.3390/jcdd9110386 - 9 Nov 2022

Cited by 6 | Viewed by 2815

Abstract

Background: A paradoxical association of obesity with lower risk of transcatheter aortic valve replacement (TAVR) outcomes has been reported. We aimed to systematically review the literature and compare TAVR-related morbidity and mortality among individuals with overweight or obesity and their peers with normal body mass index (BMI). Methods: PubMed and Embase databases were systematically searched for studies reporting TAVR outcomes in different BMI groups. Separate meta-analyses were conducted for studies reporting hazard ratios (HR) and odds ratios/relative risks. Short- and mid-/long-term outcomes were examined. Results: 26 studies with a total of 74,163 patients were included in our study. Overweight was associated with lower risk of short-term mortality (HR: 0.77; 95% CI: 0.60–0.98) and mid-/long-term mortality (HR: 0.79; 95% CI: 0.70–0.89). Obesity was associated with lower risk for mid-/long-term mortality (HR: 0.79; 95% CI: 0.73–0.86), but no difference was observed in short-term mortality, although a trend was noted (HR: 0.87l 95% CI: 0.74–1.01). Individuals with obesity demonstrated an association with higher odds of major vascular complications (OR: 1.33; 95% CI: 1.05–1.68). Both overweight (OR: 1.16; 95% CI: 1.03–1.30) and obesity (OR: 1.26; 95% CI: 1.06–1.50) were associated with higher likelihood for receiving permanent pacemakers after TAVR. Conclusion: Individuals with overweight and obesity were associated with lower mortality risk compared to those with normal BMI but with higher likelihood of major vascular complications and permanent pacemaker implantation after TAVR. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI))

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18 pages, 2122 KiB

Open AccessEditor’s ChoiceReview

TAVR for All? The Surgical Perspective

by Xiling Zhang, Thomas Puehler, Derk Frank, Janarthanan Sathananthan, Stephanie Sellers, David Meier, Marcus Both, Philipp Blanke, Hatim Seoudy, Mohammed Saad, Oliver J. Müller, Lars Sondergaard and Georg Lutter

J. Cardiovasc. Dev. Dis. 2022, 9(7), 223; https://doi.org/10.3390/jcdd9070223 - 12 Jul 2022

Cited by 3 | Viewed by 3246

Abstract

In spite of the noninferiority of transcatheter aortic valve replacement (TAVR) in high- and intermediate-risk patients, there are still obstacles that need to be overcome before the procedure is further expanded and clinically integrated. The lack of evidence on the long-term durability of the bioprostheses used for TAVR remains of particular concern. In addition, surgery may be preferred over TAVR in patients with bicuspid aortic valve (BAV) or with concomitant pathologies such as other valve diseases (mitral regurgitation/tricuspid regurgitation), aortopathy, and coronary artery disease. In this review, we discuss and summarize relevant data from clinical trials, current trends, and remaining obstacles, and provide our perspective on the indications for the expansion of TAVR. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI))

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Other

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7 pages, 1486 KiB

Open AccessCase Report

Multimodal Imaging of a Chimney-Stenting Procedure Performed Simultaneously with a Transcatheter Aortic Valve Replacement (TAVR) in a Reanimated Human Heart including Post-Implant Analyses

by Michael A. Bielecki, Amanda N. DeVos, Francesco Bianchini and Paul A. Iaizzo

J. Cardiovasc. Dev. Dis. 2022, 9(12), 413; https://doi.org/10.3390/jcdd9120413 - 24 Nov 2022

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Abstract

Transcatheter aortic valve replacement (TAVR) has become a popular treatment option for severe aortic stenosis for patients with a high risk for mortality with surgical aortic valve replacement (SAVR). Coronary artery occlusion (CAO) following the implantation of the device is a potential and sometimes devastating complication of this procedure, that provokes a sudden deterioration of hemodynamic status followed by cardiogenic shock and electrical instability. With patients that present a high risk for coronary obstruction, coronary protection with a chimney stenting technique is an effective strategy that can ensure coronary perfusion during TAVR in case of acute CAO. Utilizing Visible Heart^® methodologies, a human heart was reanimated. A chimney stenting technique was implemented simultaneously with the deployment of a Medtronic Evolut^™ Pro+ valve (Medtronic PLC; Minneapolis, MN, USA). The entire procedure was recorded utilizing endoscopic cameras, fluoroscopy, optical coherence tomography, and echocardiography. In addition to these procedural visualizations, post-procedural micro-computed tomography (micro-CT) was conducted to provide post-implantation imaging with approximately 60-micron resolution. Utilizing these imaging modalities in a reanimated human heart allows for the unique opportunity to collect data for TAVR procedures in real human anatomies for the subsequent educational uses by the physicians treating aortic valvular disease and/or the designers of future TAVR technologies and procedures. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI))

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Transcatheter Aortic Valve Implantation (TAVI)

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