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Aortic paravalvular leak

Claudia Fiorina, Giuseppe Bruschi, Luca Testa, Marco De Carlo, Federico De Marco, Giuseppe Coletti, Stefano Bonardelli, Marianna Adamo, Salvatore Curello, Giovanni Scioti, Paolo Panisi, Francesco Bedogni, Anna S Petronio, Federica Ettori
BACKGROUND: About one-third of candidates for transcatheter aortic valve implantation (TAVI) suffer from severe peripheral artery disease, making the routine femoral approach difficult or impossible. Aim was to compare the trans-axillary (TAx) and the trans-aortic (TAo) route for TAVI with Medtronic CoreValve Revalving System (CRS). METHODS: 242 (23%) out of 1049 consecutive TAVI with 18F CRS were treated in 4 high-volume Italian Centre through TAx (61%) and TAo (39%)...
October 4, 2016: Journal of Cardiovascular Surgery
Pranav Loyalka, Angelo Nascimbene, Michael Schechter, Marija Petrovic, Ajay Sundara Raman, Igor D Gregoric, Biswajit Kar
INTRODUCTION: Transcatheter aortic valve implantation (TAVI) in patients with degenerated bioprosthetic aortic valve has been successfully performed as an alternative to surgery. We describe our initial experience of valve-in-valve TAVI in five patients, using new generation Edwards Sapien 3 transcatheter heart valves implanted into degenerated 19 mm bioprosthetic valves. 20-mm Edwards S3 valves were offered for compassionate use. All patients had significant aortic valve stenosis. METHODS AND RESULTS: The main vascular access was achieved and pre-closed with two Proglide closure devices in one patient and Prostar closure devices in four patients...
October 3, 2016: Catheterization and Cardiovascular Interventions
Rodrigo Bagur, Patrick J Teefy, Bob Kiaii, Pantelis Diamantouros, Michael W A Chu
BACKGROUND: Transcatheter aortic valve implantation (TAVI) has become a therapeutic alternative for patients presenting with severe symptomatic aortic stenosis and considered at high-surgical risk. Paravalvular leak (PVL), conduction disorders, and coronary obstruction remain unresolved procedure-related complications. The aim of this manuscript was to report the first North American experience with the ACURATE-neo(TM) aortic bioprosthesis and its ACURATE-TF(TM) delivery system (Symetis S...
September 28, 2016: Catheterization and Cardiovascular Interventions
A A Sakrana, M M Nasr, G A Ashamallah, R A Abuelatta, H A Naeim, M E Tahlawi
AIM: To investigate the determinants of paravalvular leak (PVL) occurring after transcatheter aortic valve implantation (TAVI). MATERIALS AND METHODS: One hundred and eight patients with severe symptomatic aortic stenosis (mean age 75.5±11.8 years, 72.2% male) underwent contrast-enhanced electrocardiogram (ECG)-gated multidetector computed tomography (MDCT) then successful TAVI. The following parameters were determined in the late systolic phase: annular and left ventricular outflow tract (LVOT) diameters, annular perimeter, ellipticity index, annular area, indexed annular area, LVOT perimeter, annulus/LVOT perimeter difference ratio, the LVOT to ascending aorta angle (< LVOT-AO)...
November 2016: Clinical Radiology
Sung-Han Yoon, Thierry Lefèvre, Jung-Ming Ahn, Gidon Y Perlman, Danny Dvir, Azeem Latib, Marco Barbanti, Florian Deuschl, Ole De Backer, Philipp Blanke, Thomas Modine, Gregor Pache, Franz-Josef Neumann, Philipp Ruile, Takahide Arai, Yohei Ohno, Hidehiro Kaneko, Edgar Tay, Niklas Schofer, Erik W Holy, Ngai H V Luk, Gerald Yong, Qingsheng Lu, William K F Kong, Jimmy Hon, Hsien-Li Kao, Michael Lee, Wei-Hsian Yin, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Hyo-Soo Kim, Christian Butter, Omar K Khalique, Ulrich Schaefer, Fabian Nietlispach, Susheel K Kodali, Martin B Leon, Jian Ye, Bernard Chevalier, Jonathon Leipsic, Victoria Delgado, Jeroen J Bax, Corrado Tamburino, Antonio Colombo, Lars Søndergaard, John G Webb, Seung-Jung Park
BACKGROUND: Few studies have evaluated the clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS). Particularly, limited data exist comparing the results of TAVR with new-generation devices versus early-generation devices. OBJECTIVES: This study sought to evaluate the clinical outcomes of TAVR for bicuspid AS with early- and new-generation devices. METHODS: The Bicuspid TAVR Registry is an international multicenter study enrolling consecutive patients with bicuspid AS undergoing TAVR between April 2005 and May 2015...
September 13, 2016: Journal of the American College of Cardiology
Patrick A Calvert, David B Northridge, Iqbal S Malik, Leonard Shapiro, Peter Ludman, Shakeel A Qureshi, Michael Mullen, Robert Henderson, Mark Turner, Martin Been, Kevin P Walsh, Ivan Casserly, Lindsay Morrison, Nicola L Walker, John Thomson, Mark S Spence, Vaikom S Mahadevan, Angela Hoye, Philip A MacCarthy, Matthew J Daniels, Paul Clift, William R Davies, Philip D Adamson, Gareth Morgan, Suneil K Aggarwal, Yasmin Ismail, Julian O M Ormerod, Habib R Khan, Sujay Subash Chandran, Joseph de Giovanni, Bushra S Rana, Oliver Ormerod, David Hildick-Smith
BACKGROUND: Paravalvular leak (PVL) occurs in 5% to 17% of patients following surgical valve replacement. Percutaneous device closure represents an alternative to repeat surgery. METHODS: All UK and Ireland centers undertaking percutaneous PVL closure submitted data to the UK PVL Registry. Data were analyzed for association with death and major adverse cardiovascular events (MACE) at follow-up. RESULTS: Three hundred eight PVL closure procedures were attempted in 259 patients in 20 centers (2004-2015)...
September 27, 2016: Circulation
Sathish Chikkabyrappa, Doff B McElhinney, Muhamed Saric
We report a rare case of progressive left ventricular outflow tract (LVOT) obstruction after percutaneous device closure of a mechanical prosthetic mitral valve (MV) paravalvular leak (PVL) in the region of aortomitral curtain in a patient who also had small mechanical aortic valve prosthesis with patient-prosthesis mismatch.
August 30, 2016: Echocardiography
Candice Y Lee, Joshua K Wong, Ronald E Ross, David C Liu, Kamal R Khabbaz, Angelo J Martellaro, Heather R Gorea, Jude S Sauer, Peter A Knight
OBJECTIVE: Prostheses attachment is critical in aortic valve replacement surgery, yet reliable prosthetic security remains a challenge. Accurate techniques to analyze prosthetic fixation pressures may enable the use of fewer sutures while reducing the risk of paravalvular leaks (PVL). METHODS: Customized digital thin film pressure transducers were sutured between aortic annulus models and 21-mm bioprosthetic valves with 15 × 4-mm, 12 × 4-mm, or 9 × 6-mm-wide pledgeted mattress sutures...
August 25, 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Ganesh Manoharan, Axel Linke, Helge Moellmann, Simon Redwood, Christian Frerker, Jan Kovac, Thomas Walther
AIMS: The aim of this study was to evaluate the safety and performance of the resheathable and repositionable St. Jude Medical Portico self-expanding transfemoral TAVI system. METHODS AND RESULTS: This prospective, single-arm, multicentre study evaluated the 18 Fr Portico system with either a 23 or a 25 mm valve. Patient follow-up was at 30, 90, 180 days and one year. Results up to 30 days are presented. Adverse events were categorised by VARC definitions and adjudicated by an independent events committee...
August 20, 2016: EuroIntervention
Julius I Ejiofor, Maroun Yammine, Morgan T Harloff, Siobhan McGurk, Jochen D Muehlschlegel, Prem S Shekar, Lawrence H Cohn, Pinak Shah, Tsuyoshi Kaneko
BACKGROUND: Bioprosthetic aortic valve use has increased steadily according to The Society of Thoracic Surgeons (STS) database analyses. One of the momentums toward this trend is the future utilization of transcatheter valve-in-valve (TViV) techniques when bioprosthetic valves fail. We compared the results of reoperative TViV to surgical aortic valve replacement (SAVR) for degenerated bioprosthetic valves. METHODS: From January 2002 to January 2015, we identified 91 patients with degenerated bioprosthetic valves who underwent isolated AVR (SAVR n = 69, TViV n = 22)...
August 12, 2016: Annals of Thoracic Surgery
H Liu, L Wei, Y Yang, L M Zhu, J Y Zheng, K F Guo, H Luo, W P Zhao, X Yang, Maimaiti Aikebar, C S Wang
OBJECTIVES: To introduce the application of the J-Valve™ system in elderly patients with predominant aortic incompetence without significant valve calcification, and to evaluate its feasibility. METHODS: From April 2014 to July 2015, 33 cases of transapical implantation of J-Valve™ were performed in Department of Cardiac Surgery, Zhongshan Hospital, Fudan University. Sixteen of these patients were diagnosed as predominant aortic incompetence without significant valve calcification...
August 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Takashi Murakami, Hiromichi Fujii, Masanori Sakaguchi, Yosuke Takahashi, Yasuo Suehiro, Shinsuke Nishimura, Yoshito Sakon, Daisuke Yasumizu, Etsuji Sohgawa, Toshihiko Shibata
Transcatheter closure of paravalvular leaks requires precise assessment of the location, size, and shape of the defect. Transesophageal echocardiography plays an important role in this process. We encountered a case of a paravalvular leak at the aortic position after aortic and mitral valve replacement. It was impossible to detect the precise location of the paravalvular leak with transesophageal echocardiography because of an acoustic shadow from the mitral mechanical valve. Intraoperative use of intravascular ultrasound was useful for determining the morphology of the defect and evaluating the procedure during the operation...
August 8, 2016: General Thoracic and Cardiovascular Surgery
Jay D Pal, James M McCabe, Todd Dardas, Gabriel S Aldea, Nahush A Mokadam
The development of new aortic insufficiency after a period of support with a left ventricular assist device can result in progressive heart failure symptoms. Transcatheter aortic valve repair can be an effective treatment in selected patients, but the lack of aortic valve calcification can result in unstable prostheses or paravalvular leak. We describe a technique of deploying a self-expanding CoreValve (Medtronic, Minneapolis, MN, USA) into the aortic annulus, followed by a balloon-expandable SAPIEN-3 (Edwards, Irvine, CA, USA)...
October 2016: Journal of Cardiac Surgery
Marco Hernández-Enríquez, María Ascaso, Xavier Freixa, Elena Sandoval, Giuseppe Giacchi, Salvatore Brugaletta, Victoria Martin-Yuste, Eduard Quintana, Manel Sabaté
We present an 83-year-old woman with history of two aortic valve replacements; 2 years after the last replacement, she developed heart failure and severe paravalvular leak (PVL) was detected. Percutaneous PVL closure was completed with a single Amplatzer Vascular Plug III. Two months later, the patient presented with late coronary obstruction requiring emergent surgical revascularization. To the best of our knowledge, this is the first report of late coronary obstruction after percutaneous PVL closure.
August 2016: Journal of Invasive Cardiology
Mohammad Abdelghani, Ben Ren, Ernest Spitzer, Hiroki Tateishi, Hans Jonker, Marcel L Geleijnse, Jan G Tijssen, Robbert J de Winter, Patrick W J C Serruys, Osama I I Soliman
Paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) is challenging to quantitate. Transthoracic echocardiography (TTE) is the main tool used for the assessment of PVL but is modestly reproducible. We sought to develop a reproducible echocardiographic approach to assess PVL in the post-TAVI setting. Four observers independently analyzed eleven parameters of PVL severity in 50 pre-discharge TTE studies performed after TAVI. The parameters included color-Doppler parameters [jet circumferential extent (CE) and planimetered vena contracta area in the short-axis view and jet breadth and qualitative features in the long-axis views], continuous-wave Doppler parameters [jet velocity time integral (VTI) and pressure half time (PHT)], quantitative Doppler parameters (regurgitation volume and fraction and effective regurgitant orifice area), aortic diastolic flow reversal and valve stent eccentricity...
October 2016: International Journal of Cardiovascular Imaging
Rodrigo Bagur, Bob Kiaii, Patrick J Teefy, Pantelis Diamantouros, Ronit Lavi, Christopher Harle, Mauro Cassese, Michael W A Chu
The Engager aortic bioprosthesis consists of bovine pericardial leaflets mounted on a self-expandable frame with unique anatomic orientation capabilities to engage the aortic valve cusps. We report the initial North American transcatheter aortic valve implantation (TAVI) experience with the Engager device. Transapical TAVI was performed in 4 patients (mean age 80 ± 6 years, Society of Thoracic Surgeons score 5 ± 1%). The valve was anatomically oriented and successfully implanted in all patients. There were no conversions to open operation or major procedure-related adverse events...
August 2016: Annals of Thoracic Surgery
Abdurrahman Eksik, Aydin Yildirim, Mehmet Gul, Serkan Aslan, Aydin Rodi Tosu, Ozgur Surgit, Huseyin Altug Cakmak, Muhammet Hulusi Satilmisoglu, Emre Akkaya, Ihsan Bakir
AIMS: The purpose of this study is to assess the electrocardiographic and electrophysiological parameters of conduction abnormalities in patients undergoing trans-catheter aortic valve implantation (TAVI) due to severe aortic valve stenosis. METHODS: The study included 55 patients who underwent TAVI using either the Boston Scientific Lotus (n:25) or Edwards Sapien XT (n:30) prostheses. An electrophysiological study (EPS) was performed in the catheterization room immediately before the initial balloon valvuloplasty and immediately after prosthesis implantation...
July 15, 2016: Pacing and Clinical Electrophysiology: PACE
Rodrigo Bagur, Chun Shing Kwok, Luis Nombela-Franco, Peter F Ludman, Mark A de Belder, Sandro Sponga, Mark Gunning, James Nolan, Pantelis Diamantouros, Patrick J Teefy, Bob Kiaii, Michael W A Chu, Mamas A Mamas
BACKGROUND: Preimplantation balloon aortic valvuloplasty (BAV) is considered a routine procedure during transcatheter aortic valve implantation (TAVI) to facilitate prosthesis implantation and expansion; however, it has been speculated that fewer embolic events and/or less hemodynamic instability may occur if TAVI is performed without preimplantation BAV. The aim of this study was to systematically review the clinical outcomes associated with TAVI undertaken without preimplantation BAV...
June 2016: Journal of the American Heart Association
Stefano Salizzoni, Augusto D'Onofrio, Marco Agrifoglio, Antonio Colombo, Alaide Chieffo, Micaela Cioni, Laura Besola, Tommaso Regesta, Filippo Rapetto, Giuseppe Tarantini, Massimo Napodano, Davide Gabbieri, Francesco Saia, Corrado Tamburino, Flavio Ribichini, Diego Cugola, Marco Aiello, Francesco Sanna, Alessandro Iadanza, Esmeralda Pompei, Pierluigi Stefàno, Antioco Cappai, Alessandro Minati, Mauro Cassese, Gian Luca Martinelli, Andrea Agostinelli, Rosario Fiorilli, Francesco Casilli, Maurizio Reale, Francesco Bedogni, Anna Sonia Petronio, Rosa Alba Mozzillo, Roberto Bonmassari, Carlo Briguori, Armando Liso, Gennaro Sardella, Giuseppe Bruschi, Claudia Fiorina, Claudia Filippini, Claudio Moretti, Maurizio D'Amico, Michele La Torre, Federico Conrotto, Roberto Di Bartolomeo, Gino Gerosa, Mauro Rinaldi
OBJECTIVES: The aim of this multicentre study is to report the clinical experiences of all patients undergoing transcatheter aortic valve implantation (TAVI) with a balloon-expandable device in Italy. METHODS: The Italian Transcatheter balloon-Expandable valve Registry (ITER) is a real-world registry that includes patients who have undergone TAVI with the Sapien (Edwards Lifesciences, Irvine, CA, USA) bioprosthesis in Italy since it became available in clinical practice...
July 12, 2016: European Journal of Cardio-thoracic Surgery
Yuanjia Zhu, Samir Kapadia, Amar Krishnaswamy, Lars G Svensson, Stephanie Mick
Paravalvular leak-related aortic regurgitation after transcatheter aortic valve replacement (TAVR) is a common complication and is associated with increased short- and long-term mortality. However, the impact of isolated central aortic regurgitation is unknown. We report a case of transapical (TA) TAVR with postprocedural central aortic regurgitation, who returned after two years with progression of regurgitation. A reoperative valve-in-valve TA-TAVR was performed.
September 2016: Journal of Cardiac Surgery
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