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Cerebral Embolic Protection for Transcatheter Aortic Valve Replacement—Present Status and Perspective

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (25 July 2019)

Special Issue Editors

Prof. Dr. Jochen Wöhrle

E-Mail Website
Guest Editor
Head of Department of Cardiology and Intensive Care, Medical Campus Lake Constance, 88048 Friedrichshafen, Germany
Interests: transfemoral aortic valve implantation; stroke; cerebral embolic protection; coronary artery disease; structural heart disease; mitral regurgitation; patent foramen ovale; left atrial appendage
Special Issues, Collections and Topics in MDPI journals
Dr. Antonio Miceli

E-Mail Website
Guest Editor
1. Minimally Invasive Cardiac Surgery Department, Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Via Faravelli 16, Milan, Italy
2. Bristol Heart Institute, University of Bristol, Bristol, UK
Interests: minimally invasive cardiac surgery; IABP; renal dysfunction in cardiac surgery; OPCAB; database; preoperative risk stratification

Special Issue Information

Dear Colleagues,

Stroke is a major complication. Transcatheter aortic valve replacement (TAVR) is associated with a substantial risk of stroke, increasing the acute and long-term morbidity and mortality. Cerebral embolic protection with different devices has been linked to a reduction in the size and number of new ischemic cerebral lesions documented by magnetic resonance imaging. In addition, large meta-analyses have supported the idea that TAVR with the use of cerebral embolic protection may be associated with a reduction in clinical stroke. However, the definition of stroke substantially differs between trials and is largely dependent on the neurological assessment. In addition, no risk criteria have been reported so far. This Special Issue addresses the present status of cerebral embolic protection during TAVR and will provide a future perspective. We kindly invite scientific groups dedicated to reducing the risk of stroke during TAVR by technical or pharmacological treatment strategies to submit their manuscript. In addition, we want to address groups studying clinical and imaging criteria for stroke assessment and experts to provide their future perspectives addressing this important topic.

Prof. Dr. Jochen Wöhrle
Dr. Antonio Miceli
Guest Editors

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Keywords

  • Transcatheter aortic valve replacement
  • Stroke
  • Cerebral embolic protection
  • Filter
  • Magnetic resonance imaging
  • Aortic stenosis
  • Vascular access
  • Complications
  • Safety

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Published Papers (3 papers)

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Research

14 pages, 1872 KiB  
Article
Remote Ischemic Preconditioning Neither Improves Survival nor Reduces Myocardial or Kidney Injury in Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI)
by Mandy Flechsig, Tobias F. Ruf, Willi Troeger, Stephan Wiedemann, Silvio Quick, Karim Ibrahim, Christian Pfluecke, Akram Youssef, Krunoslav M. Sveric, Robert Winzer, Frank R. Heinzel, Axel Linke, Ruth H. Strasser, Kun Zhang and Felix M. Heidrich
J. Clin. Med. 2020, 9(1), 160; https://doi.org/10.3390/jcm9010160 - 7 Jan 2020
Cited by 6 | Viewed by 2844
Abstract
Background: Peri-interventional myocardial injury occurs frequently during transcatheter aortic valve implantation (TAVI). We assessed the effect of remote ischemic preconditioning (RIPC) on myocardial injury, acute kidney injury (AKIN) and 6-month mortality in patients undergoing TAVI. Methods: We performed a prospective single-center controlled trial. [...] Read more.
Background: Peri-interventional myocardial injury occurs frequently during transcatheter aortic valve implantation (TAVI). We assessed the effect of remote ischemic preconditioning (RIPC) on myocardial injury, acute kidney injury (AKIN) and 6-month mortality in patients undergoing TAVI. Methods: We performed a prospective single-center controlled trial. Sixty-six patients treated with RIPC prior to TAVI were enrolled in the study and were matched to a control group by propensity-score. RIPC was applied to the upper extremity using a conventional tourniquet. Myocardial injury was assessed using high-sensitive troponin-T (hsTnT), and kidney injury was assessed using serum creatinine levels. Data were compared with the Wilcoxon-Rank and McNemar tests. Mortality was analysed with the log-rank test. Results: TAVI led to a significant rise of hsTnT across all patients (p < 0.001). No significant inter-group difference in maximum troponin release or areas-under-the-curve was detected. Medtronic CoreValve and Edwards Sapien valves showed similar peri-interventional troponin kinetics and patients receiving neither valve did benefit from RIPC. AKIN occurred in one RIPC patient and four non-RIPC patients (p = 0.250). No significant difference in 6-month mortality was observed. No adverse events related to RIPC were recorded. Conclusion: Our data do not show a beneficial role of RIPC in TAVI patients for cardio- or renoprotection, or improved survival. Full article
(This article belongs to the Special Issue Cerebral Embolic Protection for Transcatheter Aortic Valve Replacement—Present Status and Perspective)
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11 pages, 645 KiB  
Article
Prediction of One-Year Mortality Based upon A New Staged Mortality Risk Model in Patients with Aortic Stenosis Undergoing Transcatheter Valve Replacement
by Verena Veulemans, Amin Polzin, Oliver Maier, Kathrin Klein, Georg Wolff, Katharina Hellhammer, Shazia Afzal, Kerstin Piayda, Christian Jung, Ralf Westenfeld, Alexander Blehm, Artur Lichtenberg, Malte Kelm and Tobias Zeus
J. Clin. Med. 2019, 8(10), 1642; https://doi.org/10.3390/jcm8101642 - 8 Oct 2019
Cited by 2 | Viewed by 2159
Abstract
Background: In-depth knowledge about potential predictors of mortality in transcatheter aortic valve replacement (TAVR) is still warranted. Currently used risk stratification models for TAVR often fail to reach a holistic approach. We, therefore, aimed to create a new staged risk model for 1-year [...] Read more.
Background: In-depth knowledge about potential predictors of mortality in transcatheter aortic valve replacement (TAVR) is still warranted. Currently used risk stratification models for TAVR often fail to reach a holistic approach. We, therefore, aimed to create a new staged risk model for 1-year mortality including several new categories including (a) AS-entities (b) cardiopulmonary hemodynamics (c) comorbidities, and (d) different access routes. Methods: 737 transfemoral (TF) TAVR (84.3%) and 137 transapical (TA) TAVR (15.7%) patients were included. Predictors of 1-year mortality were assessed according to the aforementioned categories. Results: Over-all 1-year mortality (n = 100, 11.4%) was significantly higher in the TA TAVR group (TF vs. TA TAVR: 10.0% vs. 18.9 %; p = 0.0050*). By multivariate cox-regression analysis, a three-staged model was created in patients with fulfilled categories (TF TAVR: n = 655, 88,9%; TA TAVR: n = 117, 85.4%). Patients in “stage 2” showed 1.7-fold (HR 1.67; CI 1.07–2.60; p = 0.024*) and patients in “stage 3” 3.5-fold (HR 3.45; CI 1.97–6.05; p < 0.0001*) enhanced risk to die within 1 year. Mortality increased with every stage and reached the highest rates of 42.5% in “stage 3” (plogrank < 0.0001*), even when old- and new-generation devices (plogrank = n.s) were sub-specified. Conclusions: This new staged mortality risk model had incremental value for prediction of 1-year mortality after TAVR independently from the TAVR-era. Full article
(This article belongs to the Special Issue Cerebral Embolic Protection for Transcatheter Aortic Valve Replacement—Present Status and Perspective)
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12 pages, 1058 KiB  
Article
Transcatheter Aortic Valve Replacement Is Associated with Less Oxidative Stress and Faster Recovery of Antioxidant Capacity than Surgical Aortic Valve Replacement
by Anna Komosa, Bartłomiej Perek, Piotr Rzymski, Maciej Lesiak, Jolanta M. Siller-Matula, Marek Grygier, Mateusz Puślecki, Marcin Misterski, Anna Olasińska-Wiśniewska, Mariola Ropacka-Lesiak, Zbigniew Krasiński, Przemysław Niedzielski, Tatiana Mularek-Kubzdela and Barbara Poniedziałek
J. Clin. Med. 2019, 8(9), 1364; https://doi.org/10.3390/jcm8091364 - 2 Sep 2019
Cited by 9 | Viewed by 2715
Abstract
The objective of this study was to compare oxidative stress indices in 24 patients (mean ± SD age 71 ± 13 years) undergoing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR). Serum total antioxidant capacity (TAC), copper/zinc ratio (Cu/Zn), activity [...] Read more.
The objective of this study was to compare oxidative stress indices in 24 patients (mean ± SD age 71 ± 13 years) undergoing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR). Serum total antioxidant capacity (TAC), copper/zinc ratio (Cu/Zn), activity of lactate dehydrogenase (LDH), and thiobarbituric acid reactive substances (TBARS) were assessed at four different time-points: pre-procedure, immediately post-procedure, and one day and two days after the procedure. All oxidative stress parameters were comparable in both groups pre-procedure. TAC decreased significantly when assessed immediately after procedures in both groups (p < 0.001); however, the magnitude of the reduction was more pronounced after SAVR (88% decrease from baseline: 1.8 ± 0.1 vs. 0.2 ± 0.03 mM) compared to TAVR procedures (53% decrease from baseline: 1.9 ± 0.1 vs. 1.0 ± 0.1 mM; p < 0.001). TAC returned to baseline two days after TAVR in all patients, but was still reduced by 55% two days after SAVR. In concordance, TBARS levels and Cu/Zn ratio increased significantly with maximum levels immediately after procedures in both groups (p < 0.001), but the magnitude of the increase was significantly higher in SAVR compared to TAVR (TBARS: 3.93 ± 0.61 µM vs. 1.25 ± 0.30 µM, p = 0.015; Cu/Zn ratio: 2.33 ± 0.11 vs. 1.80 ± 0.12; p < 0.001). Two days after the procedure, TBARS levels and the Cu/Zn ratio returned to baseline after TAVR, with no full recovery after SAVR. TAVR is associated with a lesser redox imbalance and faster recovery of antioxidant capacity compared to SAVR. Full article
(This article belongs to the Special Issue Cerebral Embolic Protection for Transcatheter Aortic Valve Replacement—Present Status and Perspective)
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