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Transcatheter Valve Replacement

V Lintas, E S Fioretta, S E Motta, P E Dijkman, M Pensalfini, E Mazza, E Caliskan, H Rodriguez, M Lipiski, M Sauer, N Cesarovic, S P Hoerstrup, M Y Emmert
Transcatheter aortic valve replacement (TAVR) is being extended to younger patients. However, TAVR-compatible bioprostheses are based on xenogeneic materials with limited durability. Off-the-shelf tissue-engineered heart valves (TEHVs) with remodeling capacity may overcome the shortcomings of current TAVR devices. Here, we develop for the first time a TEHV for TAVR, based on human cell-derived extracellular matrix and integrated into a state-of-the-art stent for TAVR. The TEHVs, characterized by a dense acellular collagenous matrix, demonstrated in vitro functionality under aortic pressure conditions (n = 4)...
August 13, 2018: Journal of Cardiovascular Translational Research
Sasha Still, Molly Szerlip, Michael Mack
PURPOSE OF REVIEW: To determine what influences patients and physicians to choose between transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) in intermediate-surgical-risk patients with severe, symptomatic aortic stenosis. RECENT FINDINGS: Advances in transcatheter valve technology, techniques, and trials demonstrating non-inferiority compared to surgical aortic valve replacement (SAVR) have led to expanded eligibility of transcatheter aortic valve replacement (TAVR) to both intermediate-risk patients in clinical practice and low-risk patients in pivotal trials...
August 9, 2018: Current Cardiology Reports
Chirag Bavishi, Dhaval Kolte, Paul C Gordon, J Dawn Abbott
Severe aortic stenosis (AS) and heart failure (HF) represent an important and high-risk group of patients who are often referred for transcatheter aortic valve replacement (TAVR) due to high risk for surgical intervention. Thus far, randomized controlled trials have shown comparable outcomes between TAVR and surgical aortic valve replacement in patients with severe AS and heart failure with reduced ejection fraction. In the current review, we will discuss (1) the pathophysiology of HF in patients with severe AS, (2) role of imaging modalities in management, (3) role of biomarkers of HF on prognosis, (4) impact of other valvular heart diseases, (5) evidence from the contemporary trials on the role of TAVR in patients with severe AS and HF, and (6) future directions and research...
August 9, 2018: Heart Failure Reviews
Chalak Berzingi, Vinay Badhwar, Fahad Alqahtani, Sami Aljohani, Zakeih Chaker, Mohamad Alkhouli
Background: Early experience with transcatheter mitral valve replacement (TMVR) highlighted several investigational challenges related to this novel therapy. Conclusive randomised clinical trials in the field may, therefore, be years ahead. In the interim, contemporary outcomes of isolated surgical bioprosthetic mitral valve replacement (MVR) can be used as a benchmark for the emerging TMVR therapies. Methods: We used the nationwide inpatient sample to examine recent trends and outcomes of surgical bioprosthetic MVR for mitral regurgitation (isolated and combined)...
2018: Open Heart
Ibrahim Sultan, Arturo Cardounel, Islam Abdelkarim, Arman Kilic, Andrew D Althouse, Michael S Sharbaugh, Aman Gupta, Jeff Xu, Miho Fukui, Marc A Simon, John T Schindler, Joon S Lee, Thomas G Gleason, João L Cavalcante
OBJECTIVES: To evaluate the prognostic value of the ratio between tricuspid annular plane systolic excursion (TAPSE)-pulmonary artery systolic pressure (PASP) as a determinant of right ventricular to pulmonary artery (RV-PA) coupling in patients undergoing transcatheter aortic valve replacement (TAVI). BACKGROUND: RV function and pulmonary hypertension (PH) are both prognostically important in patients receiving TAVI. RV-PA coupling has been shown to be prognostic important in patients with heart failure but not previously evaluated in TAVI patients...
August 9, 2018: Heart: Official Journal of the British Cardiac Society
Tamim M Nazif, Shmuel Chen, Susheel K Kodali
No abstract text is available yet for this article.
August 13, 2018: JACC. Cardiovascular Interventions
Antonio Mangieri, Giuseppe Lanzillo, Letizia Bertoldi, Richard J Jabbour, Damiano Regazzoli, Marco B Ancona, Akihito Tanaka, Satoru Mitomo, Stefano Garducci, Claudio Montalto, Matteo Pagnesi, Francesco Giannini, Manuela Giglio, Matteo Montorfano, Alaide Chieffo, Josep Rodès-Cabau, Fabrizio Monaco, Gabriele Paglino, Paolo Della Bella, Antonio Colombo, Azeem Latib
OBJECTIVES: This study sought to determine predictors of advanced conduction disturbances requiring late (≥48 h) permanent pacemaker replacement (PPM) after transcatheter aortic valve replacement (TAVR). METHODS: Data of consecutive patients were identified by retrospective review of a TAVR database of a single center in Milan, Italy, between October 2007 and July 2015. We defined delta PR (ΔPR) and delta QRS (ΔQRS) interval as the difference between the last PR and QRS length available 48 h after TAVR and the baseline PR and QRS length...
August 13, 2018: JACC. Cardiovascular Interventions
Troels H Jørgensen, Ole De Backer, Thomas A Gerds, Gintautas Bieliauskas, Jesper H Svendsen, Lars Søndergaard
OBJECTIVES: The aim of this study was to use a 12-lead electrocardiogram obtained immediately post-transcatheter aortic valve replacement (TAVR) to identify predictors of late high-degree conduction defect (HD-CD) within 30 days after TAVR. BACKGROUND: There are limited data on risk factors for the development of late HD-CD and the need to retain the temporary pacemaker after TAVR. METHODS: A single-center study was conducted including 467 consecutive patients, without pre-procedural pacemakers, undergoing TAVR...
August 13, 2018: JACC. Cardiovascular Interventions
Homam Ibrahim, Matthew T Rondina, Neal S Kleiman
Since the approval of the first transcatheter aortic valve replacement (TAVR) device in 2011, this technology has undergone substantial enhancements and exponential growth. However, valve thrombosis and residual paravalvular leaks (PVL) are among the challenges that require further investigation. Recently, monitoring von Willebrand factor (vWF) multimers has emerged as a tool to help evaluate the severity of PVL after TAVR. Following TAVR, vWF large multimers recovery have been documented. The role of large vWF multimers recovery and their interactions with platelets, and the endothelium have not been entirely elucidated...
July 30, 2018: Thrombosis Research
Heath Sl Adams, Srikkumar Ashokkumar, Andrew Newcomb, Andrew I MacIsaac, Robert J Whitbourn, Sonny Palmer
Severe aortic stenosis (AS) is the most common form of valvular heart disease in the developed world with a rising prevalence due to an ageing Australian population. Transcatheter aortic valve implantation (TAVI) offers a less invasive option for the treatment of severe AS with evidence supporting of TAVI compared to medical therapy in inoperable patients, and superior to surgical aortic valve replacement (SAVR) in high-risk patients. Equal outcomes have been observed in all-comer intermediate risk populations...
August 8, 2018: Internal Medicine Journal
Kuldeep Shah, Zakeih Chaker, Tatiana Busu, Vinay Badhwar, Fahad Alqahtani, Muhammad Alvi, Amelia Adcock, Mohamad Alkhouli
Stroke is one of the most feared complications of aortic valve replacement. Although the outcomes of transcatheter aortic valve implantation (TAVI) improved substantially over time, concerns remained about a potentially higher incidence of stroke with TAVI compared with surgical replacement (SAVR). However, comparative data are sparse. We performed a meta-analysis comparing the incidence of stroke among patients undergoing TAVI versus SAVR. Of the 5067 studies screened, 28 eligible studies (22 propensity-score matched studies and 6 randomized trials) were analyzed...
July 5, 2018: American Journal of Cardiology
Dominik Rath, Meinrad Gawaz
Catheter-based interventions have revolutionized treatment of both coronary artery disease and aortic valve disease. Yet, these procedures are accompanied by thromboembolic and bleeding complications. Antiplatelet agents and anticoagulants with tolerable risk of bleeding complications are required to protect from recurrent thromboembolic events. Although guidelines for antithrombotic treatment in patients undergoing percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR) are available, scarce evidence exists regarding therapeutic recommendations for patients at high risk for thromboembolic events or major bleeding...
August 8, 2018: Hämostaseologie
Hyungdon Kook, Cheol Woong Yu, Seung Hun Lee, Haim Danenberg, Seong Mi Park
No abstract text is available yet for this article.
June 14, 2018: Korean Circulation Journal
Morgan Marino, Craig J Lilie, William C Culp, Shawn R Schepel, Jason C Tippett
OBJECTIVE: Describe the change in intraoperative transcatheter aortic valve replacement (TAVR) care by examining the utilization of transesophageal echocardiography (TEE) versus transthoracic echocardiography (TTE) and general anesthesia (GA) versus conscious sedation (CS) over time. DESIGN: Retrospective, observational. SETTING: A university, single, high-volume TAVR center. PARTICIPANTS: Patients who underwent TAVR...
June 30, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Hafiz M Imran, Muhammad Baig, Marjan Mujib, Charles Beale, Arlene Gaw, Loren Stabile, Nishant R Shah, Paul C Gordon, Wen-Chih Wu
Background Referral rates and outcomes of cardiac rehabilitation have not been evaluated in patients with transcatheter aortic valve replacement or compared with surgical aortic valve replacement. Method A retrospective cohort study was conducted in 488 patients who underwent transcatheter aortic valve replacement ( n = 199) and surgical aortic valve replacement ( n = 289) from a university-based statewide transcatheter aortic valve replacement/surgical aortic valve replacement program during 2015-2017...
August 8, 2018: European Journal of Preventive Cardiology
Sabine Meier, Joerg Seeburger, Michael A Borger
Mitral valve (MV) insufficiency, classified as primary and secondary mitral regurgitation (MR), is a common cause of morbidity and mortality. In industrialized countries, degenerative forms are the predominant cause of MR; however, an increasing number of patients present with secondary MR (Iung et al. EHJ 24:1231-1243, 2003). During the last decades, MV surgery experienced substantial advancements. Alain Carpentier pioneered the field of reconstructive valve surgery in the beginning of the 1970s and, since then, a plethora of innovations have led to today's landscape of MV surgery...
August 7, 2018: Current Treatment Options in Cardiovascular Medicine
Omar Alshuwaykh, Michael J Krier
BACKGROUND Heyde syndrome is the association between gastrointestinal (GI) bleeding from arteriovenous malformation (AVM) and aortic stenosis. The aim of this study was to review Heyde syndrome and to discuss the management of this condition. CASE REPORT A 56-year-old female with a history of severe aortic stenosis and recurrent GI bleeding secondary to small bowel AVM, presented for hospital admission with melena and maroon blood in her stool. The patient underwent esophagogastroduodenoscopy with push enteroscopy, full colonoscopy, and mesenteric angiogram with failure to identify any active bleeding sources...
August 7, 2018: American Journal of Case Reports
Joseph Nader, Jean-Michel Paradis, Omar Zainulabdin, François Dagenais, Siamak Mohammadi, Dimitri Kalavrouziotis
The options for reoperation for a dysfunctional mechanical aortic prosthesis in a small aortic root may be limited for high-risk patients. We report a case where transcatheter aortic valve replacement was used through the open aorta on cardiopulmonary bypass in order to minimize operative duration and reduce the risk of prosthesis-patient mismatch in a Jehovah's witness with a failed 17-mm mechanical aortic prosthesis.
August 3, 2018: Annals of Thoracic Surgery
Nikhil Nalluri, Varunsiri Atti, Nileshkumar J Patel, Varun Kumar, Shilpkumar Arora, Sreeram Nalluri, Bhargava Krishna Nelluri, Gregory A Maniatis, Ruben Kandov, Chad Kliger
BACKGROUND: The incidence of patients with previous history of coronary artery bypass grafting (CABG) presenting for aortic valvular replacement has been consistently on the rise. Repeat sternotomy for surgical aortic valve replacement (SAVR) carries an inherent risk of morbidity and mortality when compared to Transcatheter aortic valve replacement (TAVR). METHODS: The Nationwide inpatient sample (NIS) from 2012 to 2014 was queried using the International Classification of Diseases-Ninth edition, Clinical Modification (ICD-9-CM) codes to identify all patients ≥ 18 years with prior CABG who underwent TAVR (35...
August 5, 2018: Catheterization and Cardiovascular Interventions
Tian-Yuan Xiong, Yan-Biao Liao, Yi-Jian Li, Zhen-Gang Zhao, Xin Wei, Jiay-Yu Tsauo, Yuan-Ning Xu, Yuan Feng, Mao Chen
BACKGROUND: Studies of permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) specifically for bicuspid aortic valve (BAV) patients are lacking. We aim to delineate possible aspects that might affect the incidence of PPI in a retrospective cohort of BAV patients treated with early-generation self-expanding devices. METHODS: A total of 80 patients with bicuspid morphology who successfully underwent TAVR by self-expanding devices without prior PPI were included...
August 5, 2018: Journal of Interventional Cardiology
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