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Transcatheter Valve Replacement

Andres M Pineda, J Kevin Harrison, Neal S Kleiman, Michael J Reardon, John V Conte, Daniel P O'Hair, Stanley J Chetcuti, Jian Huang, Steven J Yakubov, Jeffrey J Popma, Nirat Beohar
OBJECTIVES: To assess the treatment effect of TAVR versus SAVR on clinical outcomes to 3 years in patients stratified by chronic kidney disease (CKD) by retrospectively studying patients randomized to TAVR or SAVR. BACKGROUND: The impact of CKD on mid-term outcomes of patients undergoing TAVR versus SAVR is unclear. METHODS: Patients randomized to TAVR or SAVR in the CoreValve US Pivotal High Risk Trial were retrospectively stratified by eGFR: none/mild or moderate/severe CKD...
October 20, 2018: Catheterization and Cardiovascular Interventions
Eric L Pierce, Keshav Kohli, Beatrice Ncho, Vahid Sadri, Charles H Bloodworth, Fiona E Mangan, Ajit P Yoganathan
Transcatheter mitral valve (TMV) replacement technology has great clinical potential for surgically inoperable patients suffering from mitral regurgitation. An important goal for robust TMV design is maximizing the likelihood of achieving a geometry post-implant that facilitates optimal performance. To support this goal, improved understanding of the annular forces that oppose TMV radial expansion is necessary. In Part II of this study, novel circular and D-shaped Radial Expansion Force Transducers (C-REFT and D-REFT) were developed and employed in porcine hearts (N = 12), to detect the forces required to radially expand the mitral annulus to discrete oversizing levels...
October 17, 2018: Annals of Biomedical Engineering
Eric L Pierce, Vahid Sadri, Beatrice Ncho, Keshav Kohli, Siddhi Shah, Ajit P Yoganathan
While transcatheter mitral valve (TMV) replacement technology has great clinical potential for surgically inoperable patients suffering from mitral regurgitation, no TMV has yet achieved regulatory approval. The diversity of devices currently under development reflects a lack of consensus regarding optimal design approaches. In Part I of this two-part study, a test system was developed for the quantification of paravalvular leakage (PVL) following deployment of a TMV or TMV-like device in pressurized, explanted porcine hearts (N = 7)...
October 17, 2018: Annals of Biomedical Engineering
Adelaide De Vecchi, David Marlevi, David A Nordsletten, Ioannis Ntalas, Jonathon Leipsic, Vinayak Bapat, Ronak Rajani, Steven A Niederer
Left ventricular outflow tract (LVOT) obstruction is a relatively common consequence of transcatheter mitral valve replacement (TMVR). Although LVOT obstruction is associated with heart failure and adverse remodelling, its effects upon left ventricular hemodynamics remain poorly characterised. This study uses validated computational models to identify the LVOT obstruction degree that causes significant changes in ventricular hemodynamics after TMVR. Seven TMVR patients underwent personalised flow simulations based on pre-procedural imaging data...
October 19, 2018: Scientific Reports
Yoav Hammer, Uri Landes, Oren Zusman, Ran Kornowski, Guy Witberg, Katia Orvin, Amos Levi, Pablo Codner, Hanna Vaknin-Assa, Mithal Nassar, Gideon Shafir, Abid Assali, Ashraf Hamdan
BACKGROUND: Transfemoral Transcatheter Aortic Valve Replacement (TAVR) carries a risk of Vascular Complications (VCs) at the access site. The currently used measures for assessing the risk for VCs are not accurate enough, and sometimes fail to predict them. We therefore aimed to examine whether Iliofemoral artery lumen volume (IFV) assessment with 3-dimensional computed tomography (CT) predicts VCs after transfemoral TAVR. METHODS: We identified 45/560 trans-femoral TAVR patients with VC, then performed nearest neighbor 1:1 matching for patients with no VC, matching for age, sex, TAVR year, valve size and type, closure-device, sheath size and peripheral vascular disease...
October 13, 2018: Journal of Cardiovascular Computed Tomography
Johannes Patzelt, Miriam Ulrich, Annika Becker, Karin A L Müller, Rezo Jorbenadze, Michal Droppa, Wenzhong Zhang, Sarah Mandel, Lisa Habel, Henning Lausberg, Janine Pöss, Tobias Geisler, Oliver Borst, Peter Rosenberger, Christian Schlensak, Meinrad Gawaz, Jürgen Schreieck, Peter Seizer, Harald F Langer
BACKGROUND: Patients after transcatheter aortic valve replacement (TAVR) and persistent severe mitral regurgitation (MR) are increasingly treated with percutaneous edge-to-edge mitral valve repair (PMVR). The impact of a former TAVR on PMVR procedures is not clear. METHODS AND RESULTS: We retrospectively analyzed 332 patients undergoing PMVR using the MitraClip system with respect to procedural and clinical outcome. 21 of these 332 patients underwent TAVR before PMVR...
2018: PloS One
Napatt Kanjanahattakij, Pattara Rattanawong, Parasuram Krishnamoorthy, Natee Sirinvaravong, Pakawat Chongsathidkiet, Kamolyut Lapumnuaypol, Jon C George, Christian Witzke, Vincent M Figueredo
OBJECTIVE: This study was done to determine the relationship between pre-procedural anaemia and mortality post transcatheter aortic valve replacement (TAVR). INTRODUCTION: TAVR is now a treatment option for patients with severe aortic stenosis (AS) with high surgical risk. Anaemia is a common comorbidity in the TAVR population. Small studies have suggested that anaemia is associated with worse short-term and long-term mortality in patients who underwent TAVR. However, there are no meta-analyses to further assess this association...
October 17, 2018: Acta Cardiologica
Akiyo Kameyama, Hisakatsu Ito, Daisuke Hibi, Sakiyo Matsui, Masaaki Kawakami, Hiroshi Ueno, Kazuaki Fukahara, Mitsuaki Yamazaki
OBJECTIVE: To determine the relationships between intraoperative hemodynamic parameters and delayed hemodynamic recovery after valve deployment and identify the predictive factors of delayed hemodynamic recovery by focusing on intraoperative hemodynamics in patients with transcatheter aortic valve replacement (TAVR). DESIGN: A retrospective study. SETTING: A single university hospital. PARTICIPANTS: Sixty-four patients who underwent elective TAVR between 2015 and 2017...
August 22, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Gaoyang Guo, Linhe Jin, Wanyu Jin, Liang Chen, Yang Lei, Yunbing Wang
In recent years, the number of heart valve replacements has multiplied with valve diseases because of aging populations and the surge in rheumatic heart disease in young people. Among them, bioprosthetic heart valves (BHVs) have become increasingly popular. Transcatheter aortic valve implantation (TAVI) valve as an emerging BHV has been increasingly applied to patients. However, the current commercially used BHVs treated with glutaraldehyde (Glut) still face the problem of durability. BHVs derived from Glut-treated xenogenetic tissues would undergo structural degeneration and calcification sometimes even as short as less than 10 years...
October 13, 2018: Acta Biomaterialia
Daniel R Obaid, David Smith, Michael Gilbert, Saeed Ashraf, Alexander Chase
BACKGROUND: We evaluated the utility of the HeartNavigator III software (Philips Healthcare, Netherlands) to create a patient specific three-dimensional model using ECG-gated CT images to plan Transcatheter Aortic Valve Replacement (TAVR) in a patient with previous Starr-Edwards mitral prosthesis. METHODS: A patient with a previous Starr-Edwards mitral prosthesis considered too high risk for conventional surgery required TAVR. It was uncertain whether this would be possible whilst avoiding the complication of the aortic prosthesis interacting with the high-profile Starr-Edwards cage and ball valve mechanism...
October 9, 2018: Journal of Cardiovascular Computed Tomography
Ahmed Hosny, Joshua D Dilley, Tatiana Kelil, Moses Mathur, Mason N Dean, James C Weaver, Beth Ripley
BACKGROUND: Successful transcatheter aortic valve replacement (TAVR) requires an understanding of how a prosthetic valve will interact with a patient's anatomy in advance of surgical deployment. To improve this understanding, we developed a benchtop workflow that allows for testing of physical interactions between prosthetic valves and patient-specific aortic root anatomy, including calcified leaflets, prior to actual prosthetic valve placement. METHODS: This was a retrospective study of 30 patients who underwent TAVR at a single high volume center...
October 2, 2018: Journal of Cardiovascular Computed Tomography
Oren M Rotman, Matteo Bianchi, Ram P Ghosh, Brandon Kovarovic, Danny Bluestein
Transcatheter aortic valve replacement (TAVR) has emerged as an effective minimally-invasive alternative to surgical valve replacement in medium- to high-risk, elderly patients with calcific aortic valve disease and severe aortic stenosis. The rapid growth of the TAVR devices market has led to a high variety of designs, each aiming to address persistent complications associated with TAVR valves that may hamper the anticipated expansion of TAVR utility. Areas Covered: Here we outline the challenges and the technical demands that TAVR devices need to address for achieving the desired expansion, and review design aspects of selected, latest generation, TAVR valves of both clinically-used and investigational devices...
October 15, 2018: Expert Review of Medical Devices
Ali Ayaon Albarrán, Ulises Ramírez Valdiris, José Antonio Blázquez González
No abstract text is available yet for this article.
October 10, 2018: Revista Española de Cardiología
Amit Iyengar, Yas Sanaiha, Esteban Aguayo, Young-Ji Seo, Vishal Dobaria, William Toppen, Richard J Shemin, Peyman Benharash
Improvements in technology and operator experience have led to exponential growth of transcatheter aortic valve implantation (TAVI) programs. Late bleeding complications were recently highlighted after TAVI with a high impact on morbidity. The purpose of the present study was to assess the incidence and financial impact of late Gastrointestinal (GI) bleeding after TAVI, and compare with the surgical cohort. Retrospective analysis of the National Readmissions Database was performed from January 2011 to December 2014, and patients who underwent TAVI or surgical aortic valve replacement (SAVR) were identified...
August 29, 2018: American Journal of Cardiology
Patrizia Aruta, Denisa Muraru, Andrada Camelia Guta, Sorina Mihaila, Niccolò Ruozi, Chiara Palermo, Basma Elnagar, Sabino Iliceto, Luigi P Badano
BACKGROUND: Transcatheter mitral valve replacement (TMVR) is a new therapeutic option for high surgical risk patients with mitral regurgitation (MR). Mitral valve (MV) geometry quantification is of paramount importance for success of the procedure and transthoracic 3D echocardiography represents a useful screening tool. Accordingly, we sought to asses MV geometry in patients with functional MR (FMR) that would potentially benefit of TMVR, focusing on the comparison of mitral annulus (MA) geometry between patients with ischemic (IMR) and non ischemic mitral regurgitation (nIMR)...
October 12, 2018: Cardiovascular Ultrasound
Arnav Kumar, Kimi Sato, Kinjal Banerjee, Jyoti Narayanswami, Jorge Betancor, Vivek Menon, Divyanshu Mohananey, Anil Kumar Anumandla, Abhishek C Sawant, Amar Krishnaswamy, E Murat Tuzcu, Wael Jaber, Stephanie Mick, Lars G Svensson, Zoran B Popović, Eugene H Blackstone, Samir R Kapadia
OBJECTIVES: We investigated the hemodynamic durability of the transcatheter aortic valves (TAVs) using the updated Valve Academic Research Consortium-2 (VARC-2) criteria. BACKGROUND: The updated VARC-2 consensus criteria combine flow-dependent and flow-independent echocardiographic parameters for hemodynamic assessment of TAVR. Data on the hemodynamic durability of TAV and clinical risk factors associated with valve hemodynamic deterioration (VHD) are lacking. METHODS: All patients (n = 276) who received TAV between 2006 and 2012 and had ≥2 follow-up echocardiograms were studied...
October 12, 2018: Catheterization and Cardiovascular Interventions
Jun Li, Sandeep M Patel, Fahd Nadeem, Prashanth Thakker, Sadeer Al-Kindi, Rahul Thomas, Amber Makani, John M Hornick, Toral Patel, Jerry Lipinski, Yasuhiro Ichibori, Angela Davis, Alan H Markowitz, Hiram G Bezerra, Daniel I Simon, Marco A Costa, Ankur Kalra, Guilherme F Attizzani
OBJECTIVES: This study reports on the clinical effects of complete vs incompletely revascularized coronary artery disease on transcatheter aortic valve replacement (TAVR). BACKGROUND: There is a high prevalence of active coronary artery disease (CAD) in patients undergoing TAVR but preemptive revascularization remains controversial. METHODS: Patients were categorized into three cohorts: complete revascularization (CR), incomplete revascularization of a major epicardial artery (IR Major), and incomplete revascularization of a minor epicardial artery only (IR Minor)...
October 12, 2018: Catheterization and Cardiovascular Interventions
Chia-Cheng Kuo, Jhih-Yuan Shih, Nan-Chun Wu, Bor-Chih Cheng
Transcatheter heart valve-in-valve implantation in failed surgical bioprosthetic valves has shown promising outcomes, prompting the stepwise expansion of their applications in different clinical scenarios. Recently, there is increased interest in valve-in-valve techniques for the treatment of patients with complex congenital heart disease. Herein, we report a case of successful transapical transcatheter atrioventricular valve-in-valve implantation in a patient with Fontan circulation and dextrocardia. The patient was previously treated with total cavopulmonary connection and atrioventricular valve replacement with recurrent prosthesis dysfunction...
October 11, 2018: Interactive Cardiovascular and Thoracic Surgery
Sahrai Saeed, Eva Gerdts
Hypertension is highly prevalent in aortic stenosis (AS) patients as the prevalence of both disorders increases with age. Hypertension and associated stiffening of the large arteries increase afterload and thereby influence both the transvalvular flow and the remodelling of the aortic root and the left ventricle during AS progression. Area covered: The present review gives an overview on complications of hypertension in AS, how these can be diagnosed, and potentially may be managed. Expert commentary: Hypertension-mediated cardiovascular damage in AS is associated with increased morbidity and a 2-fold higher mortality even in asymptomatic patients, and also limits the symptomatic and survival benefit from valve replacement...
October 12, 2018: Expert Review of Cardiovascular Therapy
Matthew W Sherwood, Amit N Vora
PURPOSE OF REVIEW: This review aims to describe the current evidence and consensus recommendations around antiplatelet and anticoagulant management in three common clinical scenarios in transcatheter aortic valve replacement (TAVR): (1) recent percutaneous coronary intervention (PCI) preceding TAVR, (2) atrial fibrillation (AF) management in patients undergoing TAVR, and (3) bioprosthetic valve thrombosis management in TAVR. RECENT FINDINGS: Several small clinical trials have evaluated the use of single vs...
October 11, 2018: Current Cardiology Reports
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