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Aortic stenosis TAVR

W Toppen, W Suh, O Aksoy, P Benharash, C Bowles, R J Shemin, M Kwon
OBJECTIVE: With the introduction of the latest generation Sapien 3 transcatheter aortic valve, there has been a reduction in the usage of transapical (TA) approach for TAVRs in many centers. However, despite the smaller sheath size and more stream-lined delivery system, vascular complications continue to occur, especially in patients with peripheral vascular disease. Thus, our institution has maintained a stringent TA protocol aiming to prevent these complications. We hypothesize that this protocol has helped to reduce vascular complications and improve outcomes at our institution even in the Sapien 3 era...
March 6, 2018: Seminars in Thoracic and Cardiovascular Surgery
Amnon Eitan, Julian Witt, Jan Stripling, Timo Haselbach, Friedrich-Christian Rieß, Joachim Schofer
BACKGROUND: Evolut-R 34 mm (received CE mark in January 2017) and Sapien-3 29 mm are the only options for transcatheter aortic valve replacement (TAVR) in patients with annulus ≥26 mm. We compared the short-term outcomes of these valves in these patients. METHODS: Data was collected prospectively from consecutive patients with severe aortic stenosis and annulus diameter larger than 26 mm treated by femoral approach TAVR. RESULTS: Between February 1, 2014 to August 19, 2017 Sapien-3 29 mm was implanted in 55 and Evolut-R 34 mm in 37 consecutive patients...
March 9, 2018: Catheterization and Cardiovascular Interventions
Gabby Elbaz-Greener, Shannon Masih, Jiming Fang, Dennis T Ko, Sandra B Lauck, John G Webb, Brahmajee K Nallamothu, Harindra C Wijeysundera
Background -Trans-catheter aortic valve replacement (TAVR) represents a paradigm shift in the therapeutic options for patients with severe aortic stenosis. However, rapid and exponential growth in TAVR demand may overwhelm capacity, translating to inadequate access and prolonged wait-times. Our objective was to evaluate temporal trends in TAVR wait-times and the associated clinical consequences. Methods -In this population-based study in Ontario, Canada, we identified all TAVR referrals from April 1st, 2010 to March 31st, 2016...
March 6, 2018: Circulation
Konstantinos V Voudris, Peter Petropulos, Panagiotis Karyofillis, Konstantinos Charitakis
PURPOSE OF REVIEW: Transcatheter aortic valve replacement (TAVR) has become an established therapy for patients with symptomatic severe aortic stenosis (AS). As the number of patients referred for TAVR increases, so does the prevalence of untreated obstructive coronary artery disease (CAD) in the population under evaluation. Despite the high prevalence of CAD in patients treated with TAVR, the management strategy of concomitant CAD in these patients remains an area of considerable uncertainty...
March 6, 2018: Current Treatment Options in Cardiovascular Medicine
Fenton H McCarthy, Sreekanth Vemulapalli, Zhuokai Li, Vinod Thourani, Roland A Matsouaka, Nimesh D Desai, Ajay Kirtane, Saif Anwaruddin, Matthew L Williams, Jay Giri, Prashanth Vallabhajosyula, Robert H Li, Howard C Herrmann, Joseph E Bavaria, Wilson Y Szeto
BACKGROUND: The purpose of this study is to evaluate the association of tricuspid regurgitation (TR) severity with outcomes after transcatheter aortic valve replacement (TAVR). METHODS: We analyzed data from 34,576 patients who underwent TAVR at 365 US hospitals from November 2011 through March 2015 submitted to The Society of Thoracic Surgeon/American College of Cardiology Transcatheter Valve Therapy Registry. We examined unadjusted mortality and heart failure readmission stratified by degree of preoperative TR and used multivariable models for 1-year mortality and heart failure readmission...
March 2, 2018: Annals of Thoracic Surgery
Masahiko Asami, Jonas Lanz, Stefan Stortecky, Lorenz Räber, Anna Franzone, Dik Heg, Lukas Hunziker, Eva Roost, George Cm Siontis, Marco Valgimigli, Stephan Windecker, Thomas Pilgrim
OBJECTIVES: This study sought to determine the impact of left ventricular (LV) diastolic dysfunction (LVDD) on clinical outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: LV hypertrophy in response to afterload increase promotes the development of LVDD and represents an early stage in the progression to valvular heart failure. METHODS: In a consecutive cohort of 777 aortic stenosis patients undergoing TAVR, LVDD was categorized according to the latest guidelines...
February 24, 2018: JACC. Cardiovascular Interventions
Anat Berkovitch, Victor Guetta, Israel M Barbash, Noam Fink, Ehud Regev, Elad Maor, Yotam Vered, Yoni Grossman, Arwa Younis, Rafael Kuperstein, Micha Feinberg, Elad Asher, Amit Segev, Paul Fefer
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is now the treatment of choice for high-surgical risk patients with symptomatic aortic stenosis. Little is known regarding the outcome of TAVR in patients with previous malignancy. METHODS: We investigated 477 patients who underwent TAVR in a tertiary medical center. Subjects were divided into two groups according to malignancy status: no history of malignancy (n = 386) and positive history of malignancy (n = 91)...
March 2018: Journal of Invasive Cardiology
Holger Eggebrecht, Kurt Bestehorn, Tienush Rassaf, Maike Bestehorn, Thomas Voigtländer, Eckhard Fleck, Volker Schächinger, Axel Schmermund, Rajendra H Mehta
AIMS: Randomised trials comparing transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) have included mainly elderly patients >80 years. The authors investigated comparative in-hospital outcomes of younger patients <75 years undergoing transfemoral (TF) TAVR or isolated SAVR. METHODS AND RESULTS: A total of 6,972 patients aged 65-74 years undergoing TF-TAVR or SAVR between 2013 and 2014 were identified from the observational German Quality Assurance Registry on Aortic Valve Replacement (AQUA), which comprises all TAVR and SAVR procedures performed in Germany...
February 27, 2018: EuroIntervention
Brent Klinkhammer
Background: A history of coronary artery bypass graft (CABG) is a common compelling indication for transcatheter aortic valve replacement (TAVR). However, there is little data on how these patients compare to other TAVR patients. In this study, the short and long-term outcomes of these TAVR patients after CABG are defined. Methods: A retrospective chart review case-control study of 337 consecutive patients who underwent a TAVR for severe aortic stenosis at Sanford Health in Fargo ND was performed to determine if a history of prior CABG was associated with worse outcomes after TAVR as compared to a TAVR cohort without a history of CABG...
February 2018: Cardiology Research
Jun-Bean Park, In-Chang Hwang, Whal Lee, Jung-Kyu Han, Chi-Hoon Kim, Seung-Pyo Lee, Han-Mo Yang, Eun-Ah Park, Hyung-Kwan Kim, Paul T L Chiam, Yong-Jin Kim, Bon-Kwon Koo, Dae-Won Sohn, Hyuk Ahn, Joon-Won Kang, Seung-Jung Park, Hyo-Soo Kim
BACKGROUND: Limited data exist regarding the impact of aortic valve calcification (AVC) eccentricity on the risk of paravalvular regurgitation (PVR) and response to balloon post-dilation (BPD) after transcatheter aortic valve replacement (TAVR). We investigated the prognostic value of AVC eccentricity in predicting the risk of PVR and response to BPD in patients undergoing TAVR. METHODS: We analyzed 85 patients with severe aortic stenosis who underwent self-expandable TAVR (43 women; 77...
December 27, 2017: International Journal of Cardiology
África Duque Santos, Andrés Reyes Valdivia, Pablo Gallo González, Eduardo González Ferrer, Julia Ocaña Guaita, Claudio Gandarias Zúñiga
PURPOSE: To report a case of rupture of the descending aorta after aortic migration during transcatheter aortic valve replacement (TAVR). CASE REPORT: An 85 year-old man with a severe and symptomatic aortic stenosis underwent elective TAVR, which complicated with embolization into the ascending aorta. While repositioning into the descending aorta the procedure complicated with aortic rupture. The patient required urgent thoracic intra-valve stent graft implantation (TEVAR)...
February 15, 2018: Annals of Vascular Surgery
Periklis A Davlouros, Virginia C Mplani, Ioanna Koniari, Grigorios Tsigkas, George Hahalis
Transcatheter aortic valve implantation (TAVR) has emerged as an alternative, rapidly evolving treatment option for patients with severe aortic stenosis and high surgical risk. Stroke is a devastating complication being confined mainly in the periprocedural and 30-day period following TAVR, with a lower and relatively constant frequency thereafter. Early stroke is mainly due to debris embolization during the procedure, whereas later events are associated with patient specific factors. Despite the fact that the rate of clinical stroke has been constantly decreasing compared to initial TAVR experience, modern neuro-imaging with MRI suggests that new ischemic lesions post-TAVR are almost universal...
January 2018: Journal of Geriatric Cardiology: JGC
Tsigkas Grigorios, Despotopoulos Stefanos, Makris Athanasios, Koniari Ioanna, Armylagos Stylianos, Davlouros Periklis, Hahalis George
Aortic stenosis (AS) is the most common type of valvular heart disease in the elderly. Surgical aortic valve replacement (SAVR) has been the standard practice for treating severe, symptomatic AS, but recently new treatment options have emerged. Transcatheter aortic valve replacement (TAVR) is now an established treatment option in patients at high surgical risk. In this review, we focus on recent developments and compare the two treatment methods in specific populations in terms of efficacy and safety (e.g...
January 2018: Journal of Geriatric Cardiology: JGC
Jennifer M Burg, Nora F Fino, Frederick A Tibayan, Victor Rodriguez, Jaishankar Raman, Firas Zahr, Howard K Song
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is changing the treatment of aortic stenosis. We compared cost and clinical outcomes of TAVR versus surgical aortic valve repair (SAVR) in the real-world setting since US TAVR approval in 2012. METHODS: The Nationwide Inpatient Sample (NIS) dataset was analyzed by quarter (Jun 2012- Dec 2014). Patients (>65yo) undergoing TAVR or SAVR were identified and risk stratified based on APR-DRG Mortality risk score...
February 8, 2018: Journal of Cardiovascular Surgery
Samuel Latham, Tamunoinemi Bob-Manuel, Arindam Sharma, Amit Nanda, Devareshi Ardeshna, Rami N Khouzam
Aortic stenosis (AS) is a common cause of valvular heart disease with heavy disease burden in elderly patients. It is present in almost 7% of patients older than 65. The mortality rate increases significantly once it becomes symptomatic with average life expectancy of around 1-year. Symptoms include angina, syncope, or heart failure. This requires either surgical or transcutaneous replacement. Transcutaneous aortic valve replacement (TAVR) use has increased in recent years from high risk patients to now even including intermediate risk patients...
January 2018: Annals of Translational Medicine
Tamunoinemi Bob-Manuel, Arindam Sharma, Amit Nanda, Devarshi Ardeshna, William Paul Skelton, Rami N Khouzam
Racial disparities in transcatheter aortic valve replacement (TAVR) implantation results from several factors, including socioeconomic disparities, inherent biases in healthcare provision, fewer referrals to specialists and language barriers in some minority populations. In this review article, we discuss the current data on the racial disparities in TAVR, explore the prevalence of aortic stenosis in different demographics in the United States and we proffer practical solutions to these problems.
January 2018: Annals of Translational Medicine
Xianbao Liu, Yuxin He, Qifeng Zhu, Feng Gao, Wei He, Lei Yu, Qijing Zhou, Minjian Kong, Jian'an Wang
OBJECTIVES: To explore assessment of supra-annular structure for self-expanding transcatheter heart valve (THV) size selection in patients with bicuspid aortic stenosis (AS). BACKGROUND: Annulus-based device selection from CT measurement is the standard sizing strategy for tricuspid aortic valve before transcatheter aortic valve replacement (TAVR). Because of supra-annular deformity, device selection for bicuspid AS has not been systemically studied. METHODS: Twelve patients with bicuspid AS who underwent TAVR with self-expanding THVs were included in this study...
February 5, 2018: Catheterization and Cardiovascular Interventions
Pablo Codner, Daniel Pugliese, Rémi Kouz, Amisha Patel, Cheng-Han Chen, Juan Terre, Kyle M Eudaley, Tamim Nazif, Torsten P Vahl, Isaac George, Omar K Khalique, Rebecca T Hahn, Martin B Leon, Susheel Kodali, Michael Borger
BACKGROUND: Transcatheter aortic valve replacement (TAVR) provides therapy for patients with severe aortic stenosis at extreme, high, or intermediate surgical risk. Transfemoral access has been the preferred access route; however, this approach is not suitable for many TAVR candidates. A suprasternal approach may allow for earlier ambulation and shorter hospital stay as compared with other, nontransfemoral approaches. METHODS: A total of 11 patients with unsuitable transfemoral access underwent suprasternal TAVR...
February 1, 2018: Annals of Thoracic Surgery
Ronald M Lazar, Marykathryn A Pavol, Tobias Bormann, Michael G Dwyer, Carlye Kraemer, Roseann White, Robert Zivadinov, Jeffrey C Wertheimer, Angelika Thöne-Otto, Lisa D Ravdin, Richard Naugle, Dawn Mechanic-Hamilton, William S Garmoe, Anthony Y Stringer, Heidi A Bender, Samir R Kapadia, Susheel Kodali, Alexander Ghanem, Axel Linke, Roxana Mehran, Renu Virmani, Tamim Nazif, Azin Parhizgar, Martin B Leon
OBJECTIVES: The authors sought to determine baseline neurocognition before transcatheter aortic valve replacement (TAVR) and its correlations with pre-TAVR brain imaging. BACKGROUND: TAVR studies have not shown a correlation between diffusion-weighted image changes and neurocognition. The authors wanted to determine the extent to which there was already impairment at baseline that correlated with cerebrovascular disease. METHODS: SENTINEL (Cerebral Protection in Transcatheter Aortic Valve Replacement) trial patients had cognitive assessments of attention, processing speed, executive function, and verbal and visual memory...
January 27, 2018: JACC. Cardiovascular Interventions
Christine Pacheco, Christine Henri, Jessica Forcillo, Anita W Asgar
Aortic stenosis (AS), 1 of the most common valve diseases in developed countries, carries a poor prognosis if left untreated. Transcatheter aortic valve replacement (TAVR) has become the standard of care for high-risk and inoperable patients with severe aortic stenosis (AS). Women represent a significant proportion of patients with severe AS and demonstrate specific clinical, anatomic, and pathophysiological features that are evident both before and after valve replacement. In this review, we discuss these features as well as the outcomes of women undergoing TAVR for AS...
November 11, 2017: Canadian Journal of Cardiology
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