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Transcatheter heart valve implantation

Sarah E Motta, Emanuela S Fioretta, Petra E Dijkman, Valentina Lintas, Luc Behr, Simon P Hoerstrup, Maximilian Y Emmert
Tissue-engineered heart valves with self-repair and regeneration properties may overcome the problem of long-term degeneration of currently used artificial prostheses. The aim of this study was the development and in vivo proof-of-concept of next-generation off-the-shelf tissue-engineered sinus valve (TESV) for transcatheter pulmonary valve replacement (TPVR). Transcatheter implantation of off-the-shelf TESVs was performed in a translational sheep model for up to 16 weeks. Transapical delivery of TESVs was successful and showed good acute and short-term performance (up to 8 weeks), which then worsened over time most likely due to a non-optimized in vitro valve design...
March 20, 2018: Journal of Cardiovascular Translational Research
Lenard Conradi, Michael Hilker, Jörg Kempfert, Jochen Börgermann, Hendrik Treede, David M Holzhey, Holger Schröfel, Won-Keun Kim, Ulrich Schaefer, Thomas Walther
OBJECTIVES: We assessed the safety and efficacy of a novel low-profile, 22-Fr transapical delivery system together with the ACURATE neo™ resheathable transcatheter heart valve. METHODS: This prospective, single-arm, multicentre study enrolled 60 patients with severe symptomatic aortic stenosis and high surgical risk ineligible for transfemoral access. Primary end points were 6-month mortality and procedural success. RESULTS: The mean age of patients was 79...
March 14, 2018: European Journal of Cardio-thoracic Surgery
Costanza Pellegrini, Oliver Husser, Won-Keun Kim, Andreas Holzamer, Thomas Walther, Tobias Rheude, Nicola Patrick Mayr, Teresa Trenkwalder, Michael Joner, Jonathan Michel, Fabian Chaustre, Adnan Kastrati, Heribert Schunkert, Christof Burgdorf, Michael Hilker, Helge Möllmann, Christian Hengstenberg
INTRODUCTION AND OBJECTIVES: The incidence of permanent pacemaker implantation (PPI) and new conduction abnormalities (CA) with the ACURATE neo (Symetis S.A., Eclubens, Switzerland) has not been studied in detail. We aimed to analyze their predictors, evaluating patient- and device-related factors, including implantation depth and device-to-annulus ratio (DAR). METHODS: Two analyses of a multicenter population were performed: new PPI in pacemaker-naive patients (n = 283), and PPI/new-CA in patients without prior CA or pacemaker (n = 232)...
March 15, 2018: Revista Española de Cardiología
Niklas Schofer, Florian Deuschl, Gerhard Schön, Moritz Seiffert, Matthias Linder, Andreas Schaefer, Johannes Schirmer, Edith Lubos, Hermann Reichenspurner, Stefan Blankenberg, Lenard Conradi, Ulrich Schäfer
BACKGROUND: The balloon-expandable Sapien 3 (Edwards Lifesciences, Irvine, CA, USA) and the mechanically-expandable Lotus valve (Boston Scientific, Marlborough, MA, USA) are established devices for transcatheter aortic valve implantation. We sought to compare both transcatheter heart valves (THV) under consideration of the extent of THV landing zone calcification. METHODS: This retrospective analysis includes consecutive patients with severe aortic stenosis treated with Sapien 3 (S3; n=212) or Lotus (n=61) THV via transfemoral access...
March 13, 2018: Journal of Cardiology
Rafael Arboleda Salazar, Jane Heggie, Piotr Wolski, Eric Horlick, Mark Osten, Massimiliano Meineri
BACKGROUND: Twenty percent of patients born with congenital heart disease present with right ventricular outflow tract abnormalities. These patients require multiple surgical procedures in their lifetime. Transcatheter pulmonary valve replacement (TPVR) has become a viable alternative to conventional pulmonary valve and right ventricular outflow tract surgery in pediatric and adult populations. In this retrospective review, we analyze the perioperative management of adult patients who underwent TPVR in our center...
March 14, 2018: Anesthesia and Analgesia
Shumpei Mori, Justin T Tretter, Takayoshi Toba, Yu Izawa, Natsuko Tahara, Tatsuya Nishii, Shinsuke Shimoyama, Hidekazu Tanaka, Toshiro Shinke, Ken-Ichi Hirata, Diane E Spicer, Farhood Saremi, Robert H Anderson
Introduction Knowledge of the anatomy of the membranous septum, as a surrogate to the location of the atrioventricular conduction axis, is a prerequisite for those undertaking transcatheter implantation of the aortic valve (TAVI). Equally important is its relationship of the virtual basal ring. This feature, however, has yet to be adequately described in the living heart. Materials and Methods We analyzed computed tomographic angiographic datasets from 107 candidates (84.1 ± 5.2 years, 68% women) for TAVI...
March 15, 2018: Clinical Anatomy
Toshinari Onishi, Kaoruko Sengoku, Yasuhiro Ichibori, Isamu Mizote, Koichi Maeda, Toru Kuratani, Yoshiki Sawa, Yasushi Sakata
Transcatheter aortic valve implantation (TAVI) is an effective and less invasive treatment for the increasing population of individuals with severe aortic stenosis (AS). Echocardiography is crucial in the assessment of AS patients from pre- to post-procedure. Transthoracic echocardiography (TTE) may be used to assess patient suitability for TAVI, as well as evaluate the severity of AS, the aortic valve complex, aortic valve morphology, mitral regurgitation (MR), and left ventricular function. Transesophageal echocardiography (TEE) is usually used as an intra-procedural monitoring tool to provide feedback during the procedure, to assess prosthetic valve function, and to detect complications rapidly before and after balloon aortic valvuloplasty (BAV) or transcatheter heart valve (THV) deployment...
February 2018: Cardiovascular Diagnosis and Therapy
Anne-Sophie Zenses, Morgane A Evin, Viktória Stanová, Marie-Annick Clavel, Paul Barragan, Josep Rodés-Cabau, Jean-François Obadia, Philippe Pibarot, Régis Rieu
AIMS: Valve-in-Valve (ViV) procedure has become a valuable alternative for the treatment of failed surgical bioprostheses (BP) in high risk patients. However, in small BPs, the clinical outcomes have been suboptimal due to high post-procedural gradients. We aimed at examining the effect of size and position of the self-expanding transcatheter heart valve (THV) CoreValve on the hemodynamics of ViV within small BPs. METHODS AND RESULTS: Sizes 23 and 26 mm of the CoreValve were implanted in sizes 19 and 21 mm of 3 BP models: Trifecta, Mitroflow and Epic Supra...
March 13, 2018: EuroIntervention
Masao Takahashi, Nicolas Badenco, Jacques Monteau, Estelle Gandjbakhch, Fabrice Extramiana, Marina Urena, Nicole Karam, Eloi Marijon, Vincent Algalarrondo, Emmanuel Teiger, Nicolas Lellouche
OBJECTIVES: This study aimed to assess the impact of pacemaker mode programming on clinical outcomes in patients with high-degree atrioventricular conduction disturbance (AVCD) after transcatheter aortic valve implantation (TAVI). BACKGROUND: Although high-degree AVCD after TAVI can receive pacemaker, recovery of the AVCD is often observed. Specific pacemaker algorithms (AAI-DDD mode switch) are available which favor spontaneous atrioventricular conduction. METHODS: Of 1,621 consecutive multi-center TAVI patients, 269 (16...
March 14, 2018: Catheterization and Cardiovascular Interventions
Simone A Huygens, Lucas M A Goossens, Judith A van Erkelens, Johanna J M Takkenberg, Maureen P M H Rutten-van Mölken
Objective: In the era of limited healthcare budgets, healthcare costs of heart valve implantations need to be considered to inform cost-effectiveness analyses. We aimed to provide age group-specific costs estimates of heart valve implantations, related complications and other healthcare utilisation following the intervention. Methods: We performed retrospective analyses of healthcare costs of patients who had undergone heart valve implantations in 2010-2013 and controls using claims data from Dutch health insurers...
2018: Open Heart
Huan Liu, Ye Yang, Wenshuo Wang, Da Zhu, Lai Wei, Kefang Guo, Weipeng Zhao, Xue Yang, Liming Zhu, Yingqiang Guo, Wei Wang, Chunsheng Wang
OBJECTIVE: To report on the Chinese multicenter study of the J-Valve transcatheter heart valve for treatment of predominant aortic regurgitation. METHODS: Transapical transcatheter aortic valve replacement with the J-Valve for treating high-risk severe aortic regurgitation was performed in 43 patients in 3 Chinese centers. The study was registered with the Chinese Clinical Trial Registry (ChiCTR-OPC-15006354). Procedural results and clinical outcomes up to 1-year were analyzed using Valve Academic Research Consortium 2 criteria...
February 13, 2018: Journal of Thoracic and Cardiovascular Surgery
Evan M Zahn, Jennifer C Chang, Dustin Armer, Ruchira Garg
Current balloon expandable transcatheter valves have limited applicability to patients with "native" right ventricular outflow tracts (RVOT), meaning those who have had previous surgery and are left with large, compliant, irregular RVOT. The Alterra Adaptive PrestentTM is a self-expanding, partially covered stent that was designed to internally reconfigure these types of RVOT, making them suitable for implantation of a commercially available balloon expandable heart valve, the SAPIEN 3. Herein, we describe the first human implant of this device...
March 9, 2018: Catheterization and Cardiovascular Interventions
Mohammad Abdelghani, Robbert J de Winter, Yosuke Miyazaki, Rodrigo Modolo, Hiroki Tateishi, Rafael Cavalcante, Rogério Sarmento-Leite, José A Mangione, Alexandre Abizaid, Osama I I Soliman, Yoshinobu Onuma, Pedro A Lemos, Patrick W Serruys, Fabio S de Brito
OBJECTIVES: To explore the rate, the determinants of success, and the hemodynamic impact of balloon postdilatation (BPD) of self-expanding transcatheter heart valves (SE-THVs) BACKGROUND: BPD is commonly used to optimize valve expansion and reduce paravalvular leakage (PVL) after transcatheter aortic valve implantation (TAVI) without clearly knowing its hemodynamic benefits. METHODS: Patients (n = 307) who received a SE-THV were stratified according to whether a BPD was performed or not...
March 9, 2018: Catheterization and Cardiovascular Interventions
Yoshiaki Takewa, Hirohito Sumikura, Satoru Kishimoto, Noritsugu Naito, Kei Iizuka, Daichi Akiyama, Ryosuke Iwai, Eisuke Tatsumi, Yasuhide Nakayama
Tissue-engineered heart valves (TEHVs) are expected to be viable grafts. However, it is unknown whether they transit their histological structure after implantation. We developed a novel autologous TEHV (named stent biovalve) for transcatheter implantation, using in-body tissue engineering based on a tissue encapsulation phenomenon. In this study, a time-course histological transition of implanted biovalves was investigated in goats. Three types of stent biovalves were prepared by 2 month embedding of plastic molds mounted with metallic stents, in the subcutaneous spaces...
March 5, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Marco Barbanti, Simona Gulino, Giuliano Costa, Corrado Tamburino
Transcatheter aortic valve implantation (TAVI) is now a widely adopted therapy for the treatment of elderly patients with severe aortic stenosis. Improved pre-procedural screening, increased operators' experience and technology advancement have made this technique highly reliable and standardized. Areas covered: The purpose of this review article is to provide an overview of the strategies that can be adopted to optimize the TAVI procedure (pre-interventional work-up and procedural simplification and early discharge)...
March 9, 2018: Expert Review of Cardiovascular Therapy
Mani Arsalan, Won-Keun Kim, Arnaud Van Linden, Christoph Liebetrau, Benjamin D Pollock, Giovanni Filardo, Mathias Renker, Helge Möllmann, Mirko Doss, Ulrich Fischer-Rasokat, Adalbert Skwara, Christian W Hamm, Thomas Walther
OBJECTIVES: Due to increasing clinical experience with transcatheter aortic valve implantation (TAVI) procedures, sophisticated imaging and advanced device technology, TAVI complication rates are low; however, patients requiring conversion to surgery are confronted with an increased mortality risk. In this retrospective study, we evaluated the predictors for conversion and the outcomes of these patients. METHODS: We analysed the records of all patients undergoing TAVI in our centre from 2011 to 2016 and focused on cases that required conversion to sternotomy...
March 1, 2018: European Journal of Cardio-thoracic Surgery
François Huchet, Jean Christian Roussel, Vincent Letocart, Thibaut Manigold
AIMS: TAVR implantation in unicuspid aortic valve has rarely been reported previously, due to the rareness of this morphology. This case tries to bring answers to some challenges we may have to face in TAVR current practice. METHODS AND RESULTS: We describe the case of a cardiogenic shock complicating a pure native regurgitating and non-calcified unicuspid aortic valve, in a 40 years old woman without medical follow up. Conventional treatment options such as valve surgery or heart transplantation were denied due to extreme operative risk and multiple allo-immunizations...
February 27, 2018: EuroIntervention
Evelyn Fennelly, Marcus Lee, Mark Da Costa, Sherif Sultan, Faisal Sharif, Darren Mylotte
Transcatheter aortic valve implantation (TAVI) has emerged as the standard of care for older patients with symptomatic severe aortic stenosis (AS) at high or excessive operative risk. There remain patients that are of such considerable risk that even TAVI can be futile. Such patients present ethical conundrums for institutional heart teams. Herein we present a case of a 90-year-old female patient with symptomatic severe AS and significant comorbidities including diffuse peripheral vascular disease and a large ascending aortic aneurysm...
2018: Case Reports in Cardiology
Guy Achkouty, Nicolas Amabile, Konstantinos Zannis, Aurélie Veugeois, Christophe Caussin
From January 2013 to January 2017, 686 consecutive patients were referred to our centre for transcatheter aortic valve replacement, including 5 subjects with severe aortic regurgitation and acute refractory cardiogenic shock. These patients were contraindicated for surgical treatment by the heart team because of high surgical risk (median logistic EuroSCORE: 74.6/Society of Thoracic Surgeons score: 37.9). The success rate of valve implantation was 100% through transfemoral access with self-expandable devices...
March 2018: Canadian Journal of Cardiology
Andy C Kiser, Thomas G Caranasos, Mark D Peterson, David M Holzhey, Philipp Kiefer, L Wiley Nifong, Michael A Borger
OBJECTIVE: Recently, the PARTNER 2A trial reported results of transcatheter aortic valve replacement versus surgical aortic valve replacement in 2032 intermediate-risk patients at 2 years. Two hundred thirty-six patients (24%) required an access route other than transfemoral. Compared with transfemoral and surgical aortic valve replacement, nontransfemoral transcatheter aortic valve replacement was associated with a numerically higher rate of death and disabling stroke at 30 days. This underscores the need for a better alternative surgical approach for patients with marginal femoral access...
February 17, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
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