Issue Special Focus: Transcatheter Aortic Valve Replacement
Impact of Ascending Aorta Dilation on Mid-Term Outcome After Transcatheter Aortic Valve Implantation
Marco B. Ancona, MD*; Francesco Moroni, MD*; Alaide Chieffo, MD; Andrea Spangaro, MD; Francesco Federico, MD; Luca A. Ferri, MD; Barbara Bellini, MD; Mauro Carlino, MD; Vittorio Romano, RT; Anna Palmisano, MD; Valeria Nicoletti, MD; Antonio Esposito, MD; Nicola Buzzatti, MD; Eustachio Agricola, MD; Francesco Ancona, MD; Lorenzo Azzalini, MD, PhD, MSc; Matteo Montorfano, MD *Joint first authors
Severe aortic stenosis is often associated with ascending aorta dilation (AAD). AAD is amenable to surgical correction combined with aortic valve replacement. TAVI might represent a valid therapeutic option in these patients when AAD correction is not indicated. Our study aim was to examine the impact of concomitant AAD on early and mid-term outcomes after TAVI for symptomatic severe aortic stenosis.
Impact of Repositioning During Transcatheter Aortic Valve Replacement on Embolized Debris
Julia Seeger, MD; Maria Romero, MD; Carolin Schuh; Renu Virmani, MD; Jochen Wöhrle, MD
Use of the dual-filter cerebral embolic protection (CEP) device has been linked to a lower stroke rate in patients undergoing transfemoral TAVR. Captured debris is found in almost every filter. The impact of repositioning on number and area of captured debris has not been studied; therefore, we analyzed the filters from patients who underwent transfemoral TAVR with double-filter CEP device, and compared captured debris in TAVRs with versus without repositioning.
Feasibility of Transfemoral Aortic Valve Implantation in Patients With Aortic Disease and Simultaneous or Sequential Endovascular Aortic Repair
Polykarpos C. Patsalis, MD; Sultan Alotaibi, MD; Alexander Wolf, MD; Werner Scholtz, MD; Axel Kloppe, MD; Björn Plicht, MD; Thomas Buck, MD; Peter Lukas Haldenwang, MD; Justus Thomas Strauch, MD; Volkmar Nicolas, MD; Volker Rudolph, MD; Andreas Mügge, MD; Christoph K. Naber, MD
The transfemoral approach for TAVI is associated with a significant survival benefit for intermediate and high-risk patients. Due to the increased procedural risk, many operators avoid transfemoral TAVI in patients with aortic disease. Moreover, significant peri-interventional device interaction may occur in patients with previous endovascular aortic repair (EVAR). We evaluated the feasibility of transfemoral TAVI in patients with aortic disease in combination with simultaneous or sequential EVAR.
Early Experience With Embolic Protection Devices During Transcatheter Aortic Valve Replacement
Sotiris C. Stamou, MD; Kayla Polcari, BS; Ahmed Abdallah, MD; Taylor James, BS; Mark Rothenberg, MD; George Daniel, MD; Marcos A. Nores, MD
Embolic protection devices (EPDs) have been employed to combat the risk of cerebrovascular events during TAVR. The use of EPD has been shown in some studies to decrease periprocedural stroke incidence when compared with non-EPD TAVR. Our study compared the postoperative outcomes of TAVR with versus without EPD.
Comparison of TransFemoral Transcatheter Aortic Valve Replacement Performed With a Minimally Invasive Simplified Technique: “FAST” Versus a Standard Approach
Grégoire Lefèvre, MD; Arnaud Jégou, MD; Grégoire Dambrin, MD; Fabien Picard, MD; Joseph Anconina, MD; Bruno Pouzet, MD; Laurent Guesnier, MD; Riadh Cheikh Khelifa, MD; Loïc Hilpert, MD; Huy Long Doan, MD; Xavier Favereau, MD
The goal of a simplified strategy for transfemoral TAVR is to reduce the rate of specific complications associated with general anesthesia, second vascular access, use of temporary pacemaker, and length of stay. Our objective was to assess the safety and efficacy of the FAST protocol, which is a new, simplified procedure for transfemoral TAVR.
Increased Rate of Intermediate-Term Valve Failure After TAVR in End-Stage Renal Disease Patients Requiring Maintenance Dialysis
Ashleigh Long, MD, PhD and Paul Mahoney, MD
TAVR has been widely adopted, but outcomes in end-stage renal disease (ESRD) patients on hemodialysis have not been extensively studied. Our objective was to compare TAVR outcomes in ESRD patients with a cohort of non-ESRD patients. Baseline demographics, preoperative risk, hemodynamics, reintervention rates, as well as survival at 30 days, 1 year, and 2 years were examined. In this single-center study, the ESRD TAVR group demonstrated significantly higher rates of need for valvular reintervention at 2 years, as well as higher mortality rates at 30 days, 1 year, and 2 years.
Original Contribution/Transcatheter Aortic Valve Replacement
Surgical Risk Scores Applied to Transcatheter Aortic Valve Implantation: Friends or Foes? Short-Term and Long-Term Outcomes From a Single-Center Registry
Miriam Compagnone, MD; Carolina Moretti, MD; Chiara Marcelli, MD; Nevio Taglieri, MD; Gabriele Ghetti, MD; Anna Corsini, MD; Matteo Bruno, MD; Antonio Giulio Bruno, MD; Matheus Orzalkiewicz, MD; Cinzia Marrozzini, MD; Maria-Letizia Bacchi Reggiani, MSc; Tullio Palmerini, MD; Francesco Saia, MD, PhD
Transcatheter aortic valve implantation (TAVI) is a valid alternative to surgical aortic valve replacement for the treatment of symptomatic aortic stenosis. The EuroScore II, logistic EuroScore, and the STS score are the most commonly applied scores for surgical risk stratification. However, their predictive value for patients undergoing TAVI is still unclear. Our goal was to evaluate the performance of these three scores as predictors of short-term and long-term mortality in patients undergoing TAVI.
Original Contribution/Transcatheter Aortic Valve Replacement
Baseline Predictors of Renal Failure in Transcatheter Aortic Valve Implantation
Melina Langfritz, MD; Mohammady Shahin, MD; Fabian Nietlispach, MD; Maurizio Taramasso, MD; Andrea Denegri, MD; Marco Moccetti, MD; Giovanni Pedrazzini, MD; Tiziano Moccetti, MD; Lukas S. Keller, MD; Frank Ruschitzka, MD; Francesco Maisano, MD; Slayman Obeid, MD
Acute kidney injury (AKI) post TAVI is associated with worsened outcomes. We identify significant baseline predictors of AKI and established a high-risk subgroup (diabetics with chronic kidney disease stage ≥4) within patients enrolled in the multicenter SWISS-TAVI cohort. In this high-risk subgroup, baseline creatinine in combination with amount of contrast agent used were strong risk factors for developing AKI. AKI in non-diabetics was less predictable by baseline characteristics.
Provisional Closure of an Iatrogenic Atrial Septal Defect for Shunt Reversal After Transcatheter Treatment of Tricuspid Regurgitation
Atsushi Sugiura, MD; Marcel Weber, MD; Jan-Malte Sinning, MD; Nikos Werner, MD; Georg Nickenig, MD
We present a patient with severe TR who underwent transcatheter tricuspid valve repair (TTVR) using the MitraClip system, with the development of LR shunt through an iatrogenic ASD. Provisional occlusion of ASD after TTVR should be considered in patients with residual LR shunt and iatrogenic ASD.
Toggle Malapposition and Femoral Subocclusion as a Potential Complication of Manta Closure Device During TAVR
Felipe Díez-Delhoyo, MD; Jaime Elizaga, MD, PhD; Enrique Gutierrez-Ibañes, MD, PhD; Francisco Fernández-Aviles, MD, PhD
A 73-year-old woman with severe aortic stenosis underwent successful TAVR implantation through the right femoral artery. Femoral closure was intended with the new collagen-based 14 Fr Manta device; after apparent successful closure, control angiography showed mobile subocclusive intravascular material protruding from the anterior puncture site to the posterior calcified wall. To the best of our knowledge, this is the first report of this specific complication using the Manta closure device, highlighting the importance of accurate device positioning before collagen deployment.
Acute Hemodynamic Changes Achieved With Successful MitraClip Procedure for Severe Mitral Regurgitation
Michał Świerczewski; Kamil Zieliński; Łukasz Kalińczuk, MD, PhD; Jerzy Pręgowski, MD, PhD; Adam Witkowski, MD, PhD
An 85-year-old, symptomatic man with severe chronic mitral regurgitation MR, left ventricular ejection fraction of 30%, permanent atrial fibrillation, and EuroScore II of 13% qualified for MitraClip procedure. TEE and electrocardiography documented acute hemodynamic changes throughout the procedure.
First Report of Supra-Annular Atrially Placed Bioprosthetic Mitral Valve Leak Closure Through Percutaneous Approach
Ali Z. Zgheib, MD; Walid S. Gharzuddine, MD; Fadi J. Sawaya, MD
An 81-year-old man underwent mitral valve replacement in 2015 for severe calcific mitral stenosis with multiple subsequent hospitalizations for pulmonary edema. TEE in 2019 revealed severe paravalvular regurgitation. This is the first reported case of suprannular atrially placed mitral paravalvular leak closure.
Transcatheter Tricuspid Valve-in-Valve Replacement Via Right Internal Jugular Vein Access in a 39-Year-Old Woman
Puja B. Parikh, MD; Robert Pyo, MD; Kathleen Stergiopoulos, MD, PhD; Jordan Katz, MD; Roger Fan, MD; Igor Izrailtyan, MD; Thomas Bilfinger, MD
Transcatheter tricuspid valve-in-valve replacement via right internal jugular is safe and feasible for failed bioprosthetic valve implantation. Challenging aspects include stiff wire advancement into the pulmonary artery for rail establishment and multiple push-pull manipulations for balloon and valve advancement.
Novel Antegrade Approach to Transcatheter Aortic Valve Paravalvular Leak Closure
Abdallah El Sabbagh, MD; Kashish Goel, MD; Gautam Reddy, MD; Mohammed Al-Hijji, MD; Erin A. Fender, MD; Mackram F. Eleid, MD; Charanjit S. Rihal, MD; Guy S. Reeder, MD
Aortic paravalvular leak (PVL) is a known complication of TAVR. PVL closure using vascular occluder devices can be used, particularly in cases with annular calcification preventing adequate seal; however, delivery of equipment can be challenging in TAVR patients due to interaction with the valve stent. We describe a novel antegrade closure approach to treat transcatheter aortic PVL.