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Percutaneous aortic valve replacement

Federico M Asch, Mani A Vannan, Siddharth Singh, Bijoy Khandheria, Stephen H Little, Dominic J Allocco, Ian T Meredith, Ted E Feldman, Michael J Reardon, Neil J Weissman
BACKGROUND : Comparative echocardiographic data on transcatheter aortic valve replacement systems from randomized trials are limited. The REPRISE III trial (Repositionable Percutaneous Replacement of Stenotic Aortic Valve through Implantation of Lotus Valve System - Randomized Clinical Evaluation) is a multicenter, randomized comparison of a mechanically expanded (Lotus) versus self-expanding (CoreValve) transcatheter aortic valve replacement device. This analysis rigorously assesses Doppler-derived valve hemodynamics and the impact on outcomes at 1 year in patients with extreme/high surgical risk treated with Lotus and CoreValve from REPRISE III...
March 12, 2018: Circulation
Michael Gottlieb, Brit Long, Alex Koyfman
INTRODUCTION: Aortic stenosis is a common condition among older adults that can be associated with dangerous outcomes, due to both the disease itself and its influence on other conditions. OBJECTIVE: This review provides an evidence-based summary of the current emergency department (ED) evaluation and management of aortic stenosis. DISCUSSION: Aortic stenosis refers to significant narrowing of the aortic valve and can be caused by calcific disease, congenital causes, or rheumatic valvular disease...
March 7, 2018: Journal of Emergency Medicine
Kashish Goel, Mackram F Eleid
PURPOSE OF REVIEW: This review will summarize the growing importance of diagnosing and managing paravalvular leak associated with surgical and transcatheter valves. RECENT FINDINGS: The burden of paravalvular leak is increasing; however, advanced imaging techniques and high degree of clinical suspicion are required for diagnosis and management. The latest data from pivotal clinical trials in the field of transcatheter aortic valve replacement suggest that any paravalvular leak greater than mild was associated with worse clinical outcomes...
March 6, 2018: Current Cardiology Reports
Konstantinos V Voudris, Peter Petropulos, Panagiotis Karyofillis, Konstantinos Charitakis
PURPOSE OF REVIEW: Transcatheter aortic valve replacement (TAVR) has become an established therapy for patients with symptomatic severe aortic stenosis (AS). As the number of patients referred for TAVR increases, so does the prevalence of untreated obstructive coronary artery disease (CAD) in the population under evaluation. Despite the high prevalence of CAD in patients treated with TAVR, the management strategy of concomitant CAD in these patients remains an area of considerable uncertainty...
March 6, 2018: Current Treatment Options in Cardiovascular Medicine
Giorgia M Bosi, Claudio Capelli, Mun Hong Cheang, Nicola Delahunty, Michael Mullen, Andrew M Taylor, Silvia Schievano
Patient-specific computational models are an established tool to support device development and test under clinically relevant boundary conditions. Potentially, such models could be used to aid the clinical decision-making process for percutaneous valve selection; however, their adoption in clinical practice is still limited to individual cases. To be fully informative, they should include patient-specific data on both anatomy and mechanics of the implantation site. In this work, fourteen patient-specific computational models for transcatheter aortic valve replacement (TAVR) with balloon-expandable Sapien XT devices were retrospectively developed to tune the material parameters of the implantation site mechanical model for the average TAVR population...
February 20, 2018: Journal of Biomechanics
Shamir R Mehta, Kevin R Bainey, Warren J Cantor, Marie Lordkipanidzé, Guillaume Marquis-Gravel, Simon D Robinson, Matthew Sibbald, Derek Y So, Graham C Wong, Joseph G Abunassar, Margaret L Ackman, Alan D Bell, Raymond Cartier, James D Douketis, Patrick R Lawler, Michael S McMurtry, Jacob A Udell, Sean van Diepen, Subodh Verma, G B John Mancini, John A Cairns, Jean-François Tanguay
Antiplatelet therapy (APT) has become an important tool in the treatment and prevention of atherosclerotic events, particularly those associated with coronary artery disease. A large evidence base has evolved regarding the relationship between APT prescription in various clinical contexts and risk/benefit relationships. The Guidelines Committee of the Canadian Cardiovascular Society and Canadian Association of Interventional Cardiology publishes regular updates of its recommendations, taking into consideration the most recent clinical evidence...
March 2018: Canadian Journal of Cardiology
Ryan Azarrafiy, Felipe N Albuquerque, Roger G Carrillo, Mauricio G Cohen
Aortic annular rupture is one of the most feared complications of transcatheter aortic valve replacement (TAVR). This complication often presents as sudden cardiac tamponade with hypotension and requires urgent intervention. The traditional rescue strategy for such cases is emergency surgical intervention, yet the mortality remains high considering most patients who undergo TAVR are not candidates for open heart surgery. As such, there is a need for percutaneous alternatives to treat this critical complication...
February 22, 2018: Catheterization and Cardiovascular Interventions
Tian-Yuan Xiong, Giuseppe Martucci, Hind Alosaimi, Nicolo Piazza
No abstract text is available yet for this article.
February 20, 2018: EuroIntervention
Iris M van Hagen, Sara A Thorne, Nasser Taha, Ghada Youssef, Amro Elnagar, Harald Gabriel, Yahia ElRakshy, Bernard Iung, Mark R Johnson, Roger Hall, Jolien W Roos-Hesselink
BACKGROUND: Cardiac disease is 1 of the major causes of maternal mortality. We studied pregnancy outcomes in women with rheumatic mitral valve disease. METHODS: The Registry of Pregnancy and Cardiac Disease is an international prospective registry, and consecutive pregnant women with cardiac disease were included. Pregnancy outcomes in all women with rheumatic mitral valve disease and no prepregnancy valve replacement is described in the present study (n=390). A maternal cardiac event was defined as cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, and hospitalization for other cardiac reasons or cardiac intervention...
February 20, 2018: Circulation
Kevin D Accola, W Randolph Chitwood, Mubashir A Mumtaz, Glenn R Barnhart
PURPOSE: Rapid deployment/sutureless aortic valve replacement is aimed at minimizing the invasiveness of surgical aortic valve replacement. We describe the implantation techniques of a new rapid deployment aortic valve, focusing on its unique and challenging features. DESCRIPTION: The EDWARDS INTUITY Elite aortic valve (Edwards Lifesciences, Irvine, CA) represents a hybrid between the surgical PERIMOUNT Magna Ease (Edwards Lifesciences) pericardial valve, but with advanced features of the percutaneous SAPIEN valve system (Edwards Lifesciences)...
March 2018: Annals of Thoracic Surgery
Tarun Chakravarty, Justin Cox, Yigal Abramowitz, David Lange, Masaki Miyasaka, Suhail Dohad, Wen Cheng, Raj R Makkar
No abstract text is available yet for this article.
February 2018: Circulation. Cardiovascular Interventions
Ahmed Kheiwa, Punag Divanji, Vaikom S Mahadevan
Right ventricular outflow tract (RVOT) dysfunction is a common hemodynamic challenge for adults with congenital heart disease (ACHD), including patients with repaired tetralogy of Fallot (TOF), truncus arteriosus (TA), and those who have undergone the Ross procedure for congenital aortic stenosis and the Rastelli repair for transposition of great vessels. Pulmonary valve replacement (PVR) has become one of the most common procedures performed for ACHD patients. Areas covered: Given the advances in transcatheter technology, we conducted a detailed review of the available studies addressing the indications for PVR, historical background, evolving technology, procedural aspects, and the future direction, with an emphasis on ACHD patients...
March 2018: Expert Review of Cardiovascular Therapy
Nicholas S Clarke, Howaida El-Said, John J Lamberti, Raghav A Murthy
Percutaneous therapies for congenital heart disease have been evolving rapidly despite limited investment from industry. The Melody transcatheter pulmonary valve (Medtronic, Inc, Minneapolis, MN USA) replacement therapy represents an important advancement in this arena. It has been approved in the United States for use in the pulmonary position, on a Humanitarian Device Exemption status. Off-label use of the Melody transcatheter pulmonary valve has extended to the mitral, pulmonary, and aortic valves, especially in previously implanted valves with prosthetic valve degeneration...
February 9, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Alfonso Campanile, Guido Tavazzi, Francesco Caprioglio, Fausto Rigo
BACKGROUND: Infective endocarditis (IE) is still a condition with high mortality and morbidity, especially in the elderly, and in patients with prosthetic valves. The concept of "time-to-therapy" plays a key role for the prompt management of IE and related complications, and the currently available multimodality imaging may play a key role in this setting. Myocardial ischemia due to extrinsic coronary compression from an aortic abscess is an extremely rare condition where the optimal therapeutic strategy has not been defined yet...
February 9, 2018: BMC Cardiovascular Disorders
Laura M Seese, Faisal G Bakaeen, Ibrahim Sultan, Danny Chu
Incompletely seated knots (air knots) during surgical aortic valve replacement can be potentially difficult to repair in anatomically challenging areas around the aortic root. This is especially true with mechanical protheses as subvalvular areas are inaccessble once the valve is seated. In this report, we present a novel and simple technique of tightening air knots from within the aortic root without removing the prosthesis. The definitive surgical therapy for aortic valve disease has been in evolution since the advent of cardiopulmonary bypass and the development of aortic valve prostheses...
February 2, 2018: Annals of Thoracic Surgery
Marc Eugène, Marina Urena, Jérémie Abtan, José-Luis Carrasco, Walid Ghodbane, Patrick Nataf, Alec Vahanian, Dominique Himbert
The prognosis of patients with cardiogenic shock (CS) or refractory pulmonary edema because of severe aortic stenosis remains poor. The purpose of this study was to assess the outcomes of rescue percutaneous balloon aortic valvuloplasty (PBAV) in the transcatheter aortic valve implantation (TAVI) era. Patients were consecutively included between 2008 and 2016. CS was defined as ≥1 sign of systemic hypoperfusion and need of catecholamines. Refractory pulmonary edema was defined as not controlled by optimal medical treatment...
December 29, 2017: American Journal of Cardiology
Yong Yang, Xi Li, Mao Chen, Yuan Feng
RATIONALE: Iatrogenic atrial septal defects caused by cardiac surgery are rare complications that are traditionally repaired through reoperations; unfortunately, reoperations are accompanied by high risk and trauma. PATIENT CONCERNS: Herein, we report a rare case of a huge atrial septal defect after mitral and aortic mechanical valve replacement. DIAGNOSES: Transesophageal echocardiography revealed a 20 × 33 mm atrial septal defect with a mainly left-to-right shunt and bidirectional shunt...
December 2017: Medicine (Baltimore)
Yung-Tsai Lee, Wei-Hsian Yin, Ho-Ping Yu, Jeng Wei
Background: Transfemoral (TF) access is associated with lower rates of surgical conversion and mortality compared with non-TF access for transcatheter aortic valve replacement (TAVR). Therefore, efforts should be made to make this procedure even less invasive, allowing more TAVR procedures to be performed through femoral access. We herein describe our single-center experience of using one-stage percutaneous internal endoconduits for TAVR in patients with unfavorable iliac artery anatomy...
January 2018: Acta Cardiologica Sinica
Tuğba Kemaloğlu Öz, Corrado Fiore, Tayfun Gürol, Tufan Şener, Özer Soylu, Bahadır Dağdeviren, Amier Ahmad, Navin C Nanda
The development of an aorto-right ventricular fistula is a rare complication of cardiac surgery. The most common treatment is surgical closure of the fistula, but percutaneous closure of the fistula has become an attractive alternative option. We present a case of successful utilization of live/real time three/four-dimensional transoesophageal echocardiography (3/4DTEE) to select the correct device size for percutaneous closure of an adult patient presenting with an aorto-right ventricular (AO-RV) fistula following aortic valve replacement...
January 18, 2018: Echocardiography
Kenan Yalta, Çağlar Kaya, Yüksel Aksoy, Mustafa Yılmaztepe, Fatih Kardaş
In recent years, transcatheter aortic valve implantation (TAVI) has been considered a novel option for the management of surgically high-risk patients requiring aortic valve replacement. Presently described is a case of acute coronary syndrome (ACS) managed with a challenging primary percutaneous coronary intervention (PCI) shortly after a valve-in-valve TAVI intervention. This case highlights 2 important issues: PCI may be an option for the management of coronary heart disease in patients after TAVI even in the setting of demanding features associated with coronary osteal engagement, and secondly, TAVI may serve as a potential risk factor for future coronary ischemic syndromes, largely due to its potential adverse effects on coronary flow dynamics, etc...
January 2018: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
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