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Oversized heart valve replacement

Nicolaj C Hansson, Jonathon Leipsic, Francesca Pugliese, Henning R Andersen, Alexia Rossi, Matheus Simonato, Kaare T Jensen, Evald H Christiansen, Christian J Terkelsen, Philipp Blanke, Mariann Tang, Lars R Krusell, Kaj-Erik Klaaborg, Kim Terp, Simon Kennon, Danny Dvir, Hans Erik Bøtker, John Webb, Bjarne L Nørgaard
OBJECTIVES: We sought to determine the impact of aortic root calcium on the risk of significant paravalvular regurgitation (sPAR) in transcatheter aortic valve replacement (TAVR). METHODS: In 302 consecutive patients from 3 centers, aortic root calcium was quantified volumetrically on pre-TAVR multidetector computed tomography (MDCT) in three regions: 1) the aortic valve region, 2) the overall left ventricular outflow tract (LVOT) and 3) the upper LVOT. Transcathether heart valve (THV) oversizing was calculated as (THV nominal area/MDCT annular area-1) × 100...
February 15, 2018: Journal of Cardiovascular Computed Tomography
Giuseppe Petrone, Panagiotis Theodoropoulos, Prakash P Punjabi
BACKGROUND AND AIM OF THE STUDY: Mitral valve repair (MVr) in rheumatic heart disease (RHD) remains challenging. The present authors' surgical experience of MVr in 56 patients with RHD operated in between January 2011 and September 2014 is reported. METHODS: Among the patients (mean age 32 ± 11 years), 11 were in NYHA functional class II, 32 in class III, and seven in class IV. An adequate or oversized autologous pericardial patch was sutured to extend the coaptating edge of both the anterior leaflet (in 18 patients) and the posterior leaflet (in 30 patients)...
November 2016: Journal of Heart Valve Disease
María Sol Cabrera, Cees W J Oomens, Frank P T Baaijens
A proper interpretation of the forces developed during stent crimping and deployment is of paramount importance for a better understanding of the requirements for successful heart valve replacement. The present study combines experimental and computational methods to assess the performance of a nitinol stent for tissue-engineered heart valve implantation. To validate the stent model, the mechanical response to parallel plate compression and radial crimping was evaluated experimentally. Finite element simulations showed good agreement with the experimental findings...
April 2017: Journal of the Mechanical Behavior of Biomedical Materials
Osama I I Soliman, Nahid El Faquir, Ben Ren, Ernest Spitzer, Lennart van Gils, Hans Jonker, Marcel L Geleijnse, Gerrit-Anne van Es, Jan G Tijssen, Nicolas M van Mieghem, Peter P T de Jaegere
Aims: The Lotus and SAPIEN3 are second-generation transcatheter heart valves, which are designed to minimize paravalvular aortic regurgitation (PAR) after transcatheter aortic valve replacement (TAVR). We sought to compare both devices for valve performance and with emphasis on PAR by independent core laboratory analysis. Methods and results: A total of 162 (79 Lotus and 83 SAPIEN3) consecutive patients (51% female, 80 ± 8 years, Logistic EuroSCORE 14.8 ± 9...
February 1, 2018: European Heart Journal Cardiovascular Imaging
Grzegorz Smolka, Piotr Pysz, Michał Kozłowski, Marek Jasiński, Radosław Gocoł, Tomasz Roleder, Agnieszka Kargul, Andrzej Ochała, Wojciech Wojakowski
INTRODUCTION: Transcatheter paravalvular leak closure (TPVLC) has become an established treatment option but is mostly performed with off-label use of different non-dedicated occluders. The first one specifically designed for TPVLC is the paravalvular leak device (PLD - Occlutech). AIM: We present initial short-term results of a prospective registry intended to assess the safety and efficacy of TPVLC with PLD. MATERIAL AND METHODS: We screened patients with paravalvular leak (PVL) after surgical valve replacement (SVR)...
2016: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
Ramón Rodríguez-Olivares, Lennart van Gils, Nahid El Faquir, Zouhair Rahhab, Luigi F M Di Martino, Sander van Weenen, John de Vries, Tjebbe W Galema, Marcel L Geleijnse, Ricardo P J Budde, Eric Boersma, Peter P de Jaegere, Nicolas M Van Mieghem
BACKGROUND: The interaction of left ventricular outflow tract (LVOT) and transcatheter heart valve (THV) is complex and may be device design specific. We sought to study LVOT characteristics and its relation with permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR). METHODS: We studied 302 patients with a median age of 81years [75-84]. Computed tomography was used to assess LVOT in terms of amount of calcium, perimeter and device size relative to LVOT...
August 1, 2016: International Journal of Cardiology
Samaneh Ghazanfari, Anita Driessen-Mol, Simon P Hoerstrup, Frank P T Baaijens, Carlijn V C Bouten
The use of valved stents for minimally invasive replacement of semilunar heart valves is expected to change the extracellular matrix and mechanical function of the native artery and may thus impair long-term functionality of the implant. Here we investigate the impact of the stent on matrix remodeling of the pulmonary artery in a sheep model, focusing on matrix composition and collagen (re)orientation of the host tissue. Ovine native pulmonary arteries were harvested 8 (n = 2), 16 (n = 4) and 24 (n = 2) weeks after transapical implantation of self-expandable stented heart valves...
2016: Cells, Tissues, Organs
Oliver Husser, Costanza Pellegrini, Thorsten Kessler, Christof Burgdorf, Hannah Thaller, N Patrick Mayr, Albert M Kasel, Adnan Kastrati, Heribert Schunkert, Christian Hengstenberg
OBJECTIVES: This study investigates the influence of implantation depth and prosthesis oversizing on conduction abnormalities (CA) and permanent pacemaker implantation (PPI) after SAPIEN 3 (Edwards Lifesciences, Irvine, California) implantation. BACKGROUND: CA and PPIs are frequent complications after transcatheter aortic valve replacement with a next-generation balloon-expandable transcatheter heart valve (SAPIEN 3). The potential underlying mechanisms are incompletely understood...
February 8, 2016: JACC. Cardiovascular Interventions
John S Tan, Jonathon Leipsic, Gidon Perlman, Dion Stub, Danny Dvir, Nicolaj C Hansson, Bjarne L Norgaard, Philipp Blanke, Anson Cheung, Jian Ye, Christopher R Thompson, Robert R Moss, Sandra Lauck, David Wood, John Webb
OBJECTIVES: The aim of this study was to evaluate a strategy of intentional underexpansion of excessively oversized balloon-expandable transcatheter heart valves (THVs) in terms of clinical outcomes, valve function, and frame durability at 1 year. BACKGROUND: Transcatheter aortic valve replacement requires the selection of an optimally sized THV to ensure paravalvular sealing and fixation without risking annular injury. However, some patients have "borderline" annular dimensions that require choosing between a THV that may be too small or another that may be too large...
November 2015: JACC. Cardiovascular Interventions
Barbara E Stähli, Thi Dan Linh Nguyen-Kim, Cathérine Gebhard, Ladina Erhart, Thomas Frauenfelder, Felix C Tanner, Volkmar Falk, Ulf Landmesser, Fabian Nietlispach, Thomas F Lüscher, Willibald Maier, Ronald K Binder
BACKGROUND AND AIM OF THE STUDY: The study aim was to investigate prosthesis-specific predictors for paravalvular aortic regurgitation (PAR) in self-expandable versus balloon-expandable transcatheter heart valves (THVs). PAR is frequently observed after transcatheter aortic valve replacement (TAVR). As self-expandable and balloon-expandable THVs engage differently with the native aortic valve structures, factors that impact PAR may differ between the prosthesis types. METHODS: A total of 137 TAVR patients who underwent pre-procedural multidetector computed tomography and post-procedural transthoracic echocardiography were studied...
January 2015: Journal of Heart Valve Disease
Nicolaj C Hansson, Bjarne L Nørgaard, Marco Barbanti, Niels Erik Nielsen, Tae-Hyun Yang, Corrado Tamburino, Danny Dvir, Hasan Jilaihawi, Phillip Blanke, Raj R Makkar, Azeem Latib, Antonio Colombo, Giuseppe Tarantini, Rekha Raju, David Wood, Henning R Andersen, Henrique B Ribeiro, Samir Kapadia, James Min, Gudrun Feuchtner, Ronen Gurvitch, Faisal Alqoofi, Marc Pelletier, Gian Paolo Ussia, Massimo Napodano, Fabio Sandoli de Brito, Susheel Kodali, Gregor Pache, Sergio J Canovas, Adam Berger, Darra Murphy, Lars G Svensson, Josep Rodés-Cabau, Martin B Leon, John G Webb, Jonathon Leipsic
BACKGROUND: A detailed assessment of calcium within the aortic root may provide important additional information regarding the risk of aortic root injury during transcatheter heart valve replacement (TAVR). OBJECTIVE: We sought to delineate the effect of calcium volume and distribution on aortic root injury during TAVR. METHODS: Thirty-three patients experiencing aortic root injury during TAVR with a balloon-expandable valve were compared with a control group of 153 consecutive TAVR patients without aortic root injury (as assessed by post-TAVR multidetector CT)...
September 2015: Journal of Cardiovascular Computed Tomography
Vlad Ciobotaru, Eric Maupas, Nicolas Dürrleman, Jean-Marc Boulenc, Augustin Borton, Pénélope Pujadas-Berthault, Philippe Rioux, Antoine Maubon
AIMS: Paravalvular regurgitation (PAR) remains a serious complication after trans-catheter aortic valve replacement (TAVR). Multidetector computed tomography (MDCT)-based measurements of the aortic basal virtual ring (BVR) are considered the gold standard for trans-catheter heart valve (THV) sizing. However, the real anatomic aortic annulus is a 3-dimensional structure. To compare measurement of 3D-anatomic annulus with BVR and secondly to assess independent predictive parameters that may impact on PAR > mild post-TAVR (PAR+)...
January 2016: European Heart Journal Cardiovascular Imaging
Nicolas M Van Mieghem, Nahid El Faquir, Zouhair Rahhab, Ramón Rodríguez-Olivares, Jeroen Wilschut, Mohamed Ouhlous, Tjebbe W Galema, Marcel L Geleijnse, Arie-Pieter Kappetein, Marguerite E I Schipper, Peter P de Jaegere
OBJECTIVES: The aim of this study was to identify variables associated with tissue fragment embolization during transcatheter aortic valve replacement (TAVR). BACKGROUND: Brain magnetic resonance imaging and transcranial Doppler studies have revealed that cerebrovascular embolization occurs frequently during TAVR. Embolized material may be r thrombotic, tissue derived, or catheter (foreign material) fragments. METHODS: A total of 81 patients underwent TAVR with a dual filter-based embolic protection device (Montage Dual Filter System, Claret Medical, Inc...
April 27, 2015: JACC. Cardiovascular Interventions
Tae-Hyun Yang, John G Webb, Philipp Blanke, Danny Dvir, Nicolaj C Hansson, Bjarne L Nørgaard, Christopher R Thompson, Martyn Thomas, Olaf Wendler, Alec Vahanian, Dominique Himbert, Susheel K Kodali, Rebecca T Hahn, Vinod H Thourani, Gerhard Schymik, Bruce Precious, Adam Berger, David A Wood, Philippe Pibarot, Josep Rodés-Cabau, Wael A Jaber, Martin B Leon, Thomas Walther, Jonathon Leipsic
OBJECTIVES: This study sought to compare the influence of the extent of multidetector computed tomography (MDCT) area oversizing on the incidence of paravalvular aortic regurgitation (PAR) between the Sapien 3 and the Sapien XT transcatheter heart valve (THV) to define a new MDCT sizing guideline suitable for the Sapien 3 platform. BACKGROUND: The inverse relationship of PAR occurrence and oversizing has been demonstrated for the Sapien XT but the incidence of PAR with comparable oversizing with the Sapien 3 is not known...
March 2015: JACC. Cardiovascular Interventions
Christian Neukamm, Harald L Lindberg, Kirsti Try, Gaute Døhlen, Gunnar Norgård
OBJECTIVES: From a population of 90 patients after pulmonary valve replacement with a biological valve (Carpentier-Edwards Perimount valve), 56 of 80 available patients were examined five years after surgery. BACKGROUND: Pulmonary valve replacement is needed in many patients with congenital heart disease. Homografts have limited availability and predictable degeneration, and mechanical valves require anticoagulation. No superiority of one kind of pulmonary valve replacement has been shown...
October 2014: World Journal for Pediatric & Congenital Heart Surgery
Nikos Werner, Jan-Malte Sinning
Paravalvular aortic regurgitation (AR) negatively affects prognosis following transcatheter aortic valve replacement (TAVR). As transcatheter heart valves (THV) are anchored using a certain degree of oversizing at the level of the aortic annulus, incomplete stent frame expansion because of heavily annular calcifications, suboptimal placement of the prosthesis, and/or annulus-prosthesis size-mismatch can contribute to paravalvular AR with subsequent increased mortality risk. Echocardiography is essential to differentiate between transvalvular and paravalvular AR and to further elucidate the etiology of AR during the procedure...
2014: Circulation Journal: Official Journal of the Japanese Circulation Society
Smita R Jategaonkar, Zisis Dimitriadis, Kavous Hakim-Meibodi, Jan Gummert, Dieter Horstkotte, Werner Scholtz
Transcatheter aortic valve implantation (TAVI) offers a less invasive treatment alternative to surgical aortic valve replacement for high-risk patients. Although the procedure can be performed at low risk, life-threatening complications may arise in single cases during or even months after the procedure. Here, the details are presented of two patients who underwent TAVI by a transfemoral approach with Medtronic CoreValve prostheses and suffered myocardial ischemia months later. The patients' anatomy with small aortic root, narrow sinus of Valsalva and small distance between the annulus base and coronary arteries and/or the relative oversizing of the CoreValve prosthesis with a high positioning may have contributed to this late complication...
November 2013: Journal of Heart Valve Disease
Marco Barbanti, Jonathon Leipsic, Ronald Binder, Danny Dvir, John Tan, Melanie Freeman, Bjarne Norgaard, Nicolaj Hansson, Anson Cheung, Jian Ye, Tae-Hyun Yang, Kasia Maryniak, Rekha Raju, Angus Thompson, Philipp Blanke, Sandra Lauck, David Wood, John Webb
OBJECTIVES: This study sought to assess the clinical outcomes and hemodynamic performance associated with a strategy of underexpanding balloon-expandable transcatheter heart valves (THV) when excessive oversizing is a concern. BACKGROUND: Transcatheter aortic valve replacement depends on the selection of an optimally sized THV. An undersized THV may lead to paravalvular regurgitation, whereas excessive oversizing may lead to annular injury. METHODS: Patients (n = 47) who underwent transcatheter aortic valve replacement with an intentionally underexpanded THV (balloon-filling volume reduced ~10%) were compared with consecutive control patients who had nominal THV balloon deployment (n = 87)...
March 18, 2014: Journal of the American College of Cardiology
Melanie Freeman, John G Webb, Alexander B Willson, Miriam Wheeler, Philipp Blanke, Robert R Moss, Christopher R Thompson, Brad Munt, Bjarne L Norgaard, Tae-Hyun Yang, James K Min, Steen Poulsen, Nicolaj C Hansson, Ronald K Binder, Stefan Toggweiler, Cameron Hague, David A Wood, Philippe Pibarot, Jonathon Leipsic
BACKGROUND: Prosthesis-patient mismatch (PPM) is a predictor of mortality after aortic valve replacement (AVR). OBJECTIVE: We examined whether accurate 3-dimensional annular sizing with multidetector CT (MDCT) is predictive of PPM after transcatheter AVR (TAVR). METHODS: One hundred twenty-eight patients underwent MDCT then TAVR. Moderate PPM was defined as an indexed effective orifice area ≤0.85 cm²/m² and severe ≤0.65 cm²/m². MDCT annular measurements (area, short and long axis) were compared with the size of the selected transcatheter heart valve (THV) to obtain (1) the difference between prosthesis size and CT-measured mean annular diameter and (2) the percentage of undersizing or oversizing (calculated as 100 × [MDCT annular area--THV nominal area]/THV nominal area)...
July 2013: Journal of Cardiovascular Computed Tomography
Denis Berdajs
PURPOSE OF REVIEW: The safety and efficiency of trans catheter aortic valve implantation (TAVI) has been clearly demonstrated. In high-risk patients, the number of procedures is constantly increasing and in western European countries this procedure is employed in more than 30% of isolated aortic valve replacements. The literature, however, focusing on perioperative aortic root (AoR) rupture is rather limited to just a few reports. The aim of this review is to analyze the pathophysiology of AoR rupture during TAVI, stressing the implications of the morphology of the AoR for this devastating complication...
November 2013: Current Opinion in Cardiology
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