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Paravalvular leak

Federico M Asch, Mani A Vannan, Siddharth Singh, Bijoy Khandheria, Stephen H Little, Dominic J Allocco, Ian T Meredith, Ted E Feldman, Michael J Reardon, Neil J Weissman
BACKGROUND : Comparative echocardiographic data on transcatheter aortic valve replacement systems from randomized trials are limited. The REPRISE III trial (Repositionable Percutaneous Replacement of Stenotic Aortic Valve through Implantation of Lotus Valve System - Randomized Clinical Evaluation) is a multicenter, randomized comparison of a mechanically expanded (Lotus) versus self-expanding (CoreValve) transcatheter aortic valve replacement device. This analysis rigorously assesses Doppler-derived valve hemodynamics and the impact on outcomes at 1 year in patients with extreme/high surgical risk treated with Lotus and CoreValve from REPRISE III...
March 12, 2018: Circulation
Kashish Goel, Mackram F Eleid
PURPOSE OF REVIEW: This review will summarize the growing importance of diagnosing and managing paravalvular leak associated with surgical and transcatheter valves. RECENT FINDINGS: The burden of paravalvular leak is increasing; however, advanced imaging techniques and high degree of clinical suspicion are required for diagnosis and management. The latest data from pivotal clinical trials in the field of transcatheter aortic valve replacement suggest that any paravalvular leak greater than mild was associated with worse clinical outcomes...
March 6, 2018: Current Cardiology Reports
Gilbert H L Tang, Syed Zaid, Samuel R Schnittman, Hasan Ahmad, Ryan Kaple, Cenap Undemir, Tanya Dutta, Angelica Poniros, Joanne Bennett, Cheng Feng, Martin Cohen, Steven L Lansman
AIMS: Paravalvular leak(PVL) remains an important issue in TAVI. The Edwards Sapien3(S3) valve has reduced PVL but up to one-third of patients remain with mild leak. Our study aims to identify predictors of mild PVL after TAVI with S3 valve. METHODS AND RESULTS: From 10/2015 to 5/2017, 122 consecutive patients underwent S3 TAVI for symptomatic severe aortic stenosis. 33 patients with mild PVL on transthoracic echocardiography at 30-day follow-up were compared to 89 with none/trace PVL...
February 27, 2018: EuroIntervention
Tian-Yuan Xiong, Giuseppe Martucci, Hind Alosaimi, Nicolo Piazza
No abstract text is available yet for this article.
February 20, 2018: EuroIntervention
Yang Liu, Shiqiang Yu, Lanlan Li, Xiaofeng Li, Jian Yang
No abstract text is available yet for this article.
February 20, 2018: Journal of Cardiac Surgery
Timothy Lee, Alexander J C Mittnacht, Shinobu Itagaki, Allan Stewart
Sutureless aortic valves are increasingly used for aortic valve replacement (AVR) with excellent outcomes. Implantation requires device expansion in a subannular position within the native aortic root. We report a patient with severe aortic stenosis who received a Perceval sutureless AVR (LivaNova, London, United Kingdom), resulting in a competent prosthesis with an absence of paravalvular leak and aortic regurgitation. However, this implantation resulted in the exacerbation of mitral regurgitation. The sutureless valve required explantation, and a traditional sutured valve was subsequently implanted, which returned the mitral regurgitation to baseline...
March 2018: Annals of Thoracic Surgery
Massimo Meco, Andrea Montisci, Antonio Miceli, Paolo Panisi, Francesco Donatelli, Silvia Cirri, Matteo Ferrarini, Antonio Lio, Mattia Glauber
BACKGROUND: Aortic stenosis is the most common valvular disease and has a dismal prognosis without surgical treatment. The aim of this meta-analysis was to quantitatively assess the comparative effectiveness of the Perceval (LivaNova) valve versus conventional aortic bioprostheses. METHODS AND RESULTS: A total of 6 comparative studies were identified, including 639 and 760 patients who underwent, respectively, aortic valve replacement with the Perceval sutureless valve (P group) and with a conventional bioprosthesis (C group)...
February 16, 2018: Journal of the American Heart Association
Axel Linke, David Holzhey, Helge Möllmann, Ganesh Manoharan, Ulrich Schäfer, Christian Frerker, Stephen G Worthley, A J van Boven, Simon Redwood, Jan Kovac, Christian Butter, Lars Søndergaard, Alexander Lauten, Gerhard Schymik, Thomas Walther
BACKGROUND: The aim of the Portico TAVI (transcatheter aortic valve implantation) system study was to evaluate outcomes ≤1 year after implantation of a novel resheathable, self-expanding TAVI system in a multicenter patient population with severe aortic stenosis (AS). METHODS AND RESULTS: High-risk patients (n=222) with symptomatic severe AS (mean age, 83.0±4.6 years; 74.3% women) were enrolled across 12 centers in Europe and Australia. The study's primary end point was all-cause mortality at 30 days...
February 2018: Circulation. Cardiovascular Interventions
Norihiko Kamioka, Frank Corrigan, Jose Miguel Iturbe, Hope Caughron, Stamatios Lerakis, Vinod Thourani, Peter Block, Robert Guyton, Vasilis Babaliaros
No abstract text is available yet for this article.
February 12, 2018: JACC. Cardiovascular Interventions
Li Hongxin, Guo Wenbin, Hai-Zhou Zhang, Fei Liang, Gui-Dao Yuan, Zeeshan Farhaj, Jun Zhang
BACKGROUND: The current approaches of transcatheter closure of mitral paravalvular leak (MPVL) have different drawbacks. The challenges come from transseptal puncture, accessing the MPVL site, and the absence of dedicated delivery systems. This study introduces a novel peratrial approach for device closure of different locations of MPVLs using a probe-assisted delivery system under three-dimensional transesophageal echocardiography. METHODS: A 4.0 cm minithoracotomy incision was made in the fourth right interspaces...
February 2, 2018: Annals of Thoracic Surgery
Omar Zibdeh, Ian Bugg, Shriyam Patel, Gina Twine, Jonathan Unsworth-White
OBJECTIVES: We performed a prospective randomized study comparing the clinical performance of the Carpentier-Edwards supra-annular valve (CE-SAV) (Edwards Lifesciences, Irvine, CA, USA) and the newer Mosaic (Medtronic Corporation, Minneapolis, MN, USA) porcine bioprostheses in the aortic position over a 10-year period. METHODS: Between January 2001 and March 2005, 398 patients undergoing bioprosthetic aortic valve replacement were randomized to receive either the CE-SAV (n = 193) or the Mosaic (n = 205) prosthesis...
February 1, 2018: European Journal of Cardio-thoracic Surgery
Joseph L Blackshear
Gastrointestinal bleeding with severe aortic stenosis was originally described in the 1950s by Heyde, although for years, the association was debated. Further discovery of mechanisms and the ubiquity and severity of acquired von Willebrand syndrome in the left ventricular assist device therapy have removed any doubts. At this time, gastrointestinal bleeding from intestinal angiodysplasia in patients with turbulence-related proteolysis of the highest molecular weight multimers of von Willebrand factor is now known to occur in patients with aortic stenosis, and also subaortic obstruction and associated mitral insufficiency in hypertrophic cardiomyopathy, isolated mitral and aortic insufficiency, endocarditis, and in patients with prosthetic valve dysfunction, either from stenosis or insufficiency...
February 3, 2018: Current Treatment Options in Cardiovascular Medicine
Minoru Tabata
The left ventricular apex has excellent accessibility to the aortic valve, mitral valve, left ventricular outflow tract and thoracic aorta. Although the number of transapical approach in transcatheter aortic valve replacement has been decreasing in recent years, it is still a useful option for patients with very poor peripheral vascular access. The apex has been chosen as a primary access site for many devices of transcatheter mitral valve repair/replacement and mitral valve-in-valve procedures. Additionally, the transapical approach has been used for other transcatheter cardiovascular interventions such as paravalvular leak repair after mitral or aortic valve replacement, pseudoaneurysm repair of the left ventricular outflow tract, and thoracic endovascular aortic repair...
January 25, 2018: General Thoracic and Cardiovascular Surgery
Jose Alberto de Agustin, Pilar Jimenez-Quevedo, Luis Nombela-Franco, Jose Juan Gomez de Diego, Leopoldo Pérez de Isla
No abstract text is available yet for this article.
January 18, 2018: European Heart Journal Cardiovascular Imaging
Abdallah El Sabbagh, Mackram F Eleid, Jane M Matsumoto, Nandan S Anavekar, Mohammed A Al-Hijji, Sameh M Said, Vuyisile T Nkomo, David R Holmes, Charanjit S Rihal, Thomas A Foley
INTRODUCTION: Three-dimensional (3D) prototyping is a novel technology which can be used to plan and guide complex procedures such as transcatheter mitral valve replacement (TMVR). METHODS: Eight patients with severe mitral annular calcification (MAC) underwent TMVR. 3D digital models with digital balloon expandable valves were created from pre-procedure CT scans using dedicated software. Five models were printed. These models were used to assess prosthesis sizing, anchoring, expansion, paravalvular gaps, left ventricular outflow tract (LVOT) obstruction, and other potential procedure pitfalls...
January 23, 2018: Catheterization and Cardiovascular Interventions
John K Forrest, Abeel A Mangi, Jeffrey J Popma, Kamal Khabbaz, Michael J Reardon, Neal S Kleiman, Steven J Yakubov, Daniel Watson, Susheel Kodali, Isaac George, Peter Tadros, George L Zorn, John Brown, Robert Kipperman, Sara Saul, Hongyan Qiao, Jae K Oh, Mathew R Williams
OBJECTIVES: This study sought to evaluate the Medtronic Evolut PRO Transcatheter Aortic Valve System in patients with severe symptomatic aortic stenosis. BACKGROUND: A next-generation self-expanding transcatheter aortic valve was designed with an external pericardial wrap with the intent to reduce paravalvular leak while maintaining the benefits of a low-profile, self-expanding, and repositionable supra-annular valve. METHODS: The Medtronic Evolut PRO Clinical Study included 60 patients undergoing transcatheter aortic valve replacement with the Evolut PRO valve at 8 investigational sites in the United States...
January 22, 2018: JACC. Cardiovascular Interventions
Lennart van Gils, Jochen Wöhrle, David Hildick-Smith, Sabine Bleiziffer, Daniel J Blackman, Mohamed Abdel-Wahab, Ulrich Gerckens, Stephen Brecker, Vinayak Bapat, Thomas Modine, Osama I Soliman, Andrey Nersesov, Dominic Allocco, Volkmar Falk, Nicolas M Van Mieghem
OBJECTIVES: The aim of this post hoc analysis from the RESPOND (Repositionable Lotus Valve System-Post-Market Evaluation of Real World Clinical Outcomes) post-market study was to assess the final implantation depth on the contrast aortogram after Lotus valve (Boston Scientific, Marlborough, Massachusetts) transcatheter aortic valve replacement (TAVR) and to correlate with permanent pacemaker implantation (PPI) and paravalvular leak (PVL). BACKGROUND: Contrast aortography allows for the assessment of implantation depth and PVL during and after TAVR...
January 22, 2018: JACC. Cardiovascular Interventions
Roberto J Cubeddu, Hector J Crespo, Gian M Novaro
Mitral paravalvular leak (PVL) remains a well-known complication after mitral valve replacement. Since the first report over 25 years ago, several catheter-based PVL closure techniques have been described. Most of these comprise of either an antegrade transseptal approach, or a retrograde transaortic or transapical approach. We herein report a novel percutaneous mitral PVL closure technique that was safely and successfully performed after failed attempt using a conventional antegrade approach.
January 13, 2018: Catheterization and Cardiovascular Interventions
Hiroyuki Kawamori, Sung-Han Yoon, Tarun Chakravarty, Yoshio Maeno, Mohammad Kashif, Sharjeel Israr, Yigal Abramowitz, Geeteshwar Mangat, Masaki Miyasaka, Tanya Rami, Yoshio Kazuno, Nobuyuki Takahashi, Hasan Jilaihawi, Mamoo Nakamura, Wen Cheng, John Friedman, Daniel Berman, Rahul Sharma, Raj R Makkar
Aims: We assessed the geometry of transcatheter heart valve (THV) and valve function associated with SAPIEN 3 implantation in patients with bicuspid aortic valve (BAV) stenosis. Methods and results: We included 280 consecutive patients who had a contrast computed tomography (CT) before and after transcatheter aortic valve implantation (TAVI) in our institution. Each THV was assessed by CT at five cross-sectional levels: inflow, annulus, mid, sinus, and outflow. The geometry of THV was assessed for eccentricity (1 - minimum diameter/maximum diameter) and expansion (CT derived external valve area/nominal external valve area)...
January 5, 2018: European Heart Journal Cardiovascular Imaging
Altayyeb Yousef, Zachary MacDonald, Trevor Simard, Juan J Russo, Joshua Feder, Michael V Froeschl, Alexander Dick, Christopher Glover, Ian G Burwash, Azeem Latib, Josep Rodés-Cabau, Marino Labinaz, Benjamin Hibbert
BACKGROUND: Transcatheter aortic valve implantation (TAVI) has become the standard of care for management of high-risk patients with aortic stenosis. Limited data is available regarding the performance of TAVI in patients with native aortic valve regurgitation (NAVR).Methods and Results:We performed a systematic review from 2002 to 2016. The primary outcome was device success as per VARC-2 criteria. Secondary endpoints included procedural complications, and 30-day and 1-year mortality rates...
February 23, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
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