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Percutaneous aortic valve replacement

Mark A Groh, Ivan Diaz, Alan M Johnson, Stephen W Ely, Oliver A Binns, Gerard L Champsaur
BACKGROUND: Patients at intermediate risk (IR) according to The Society of Thoracic Surgeons risk score are today frequently oriented toward the transfemoral aortic valve replacement (TAVR) option. Our goal was to evaluate the best treatment strategies for IR patients with severe aortic stenosis. METHODS: Of a consecutive series of 1,144 surgical aortic valve replacements (AVRs) performed in our institution between 2008 and 2014, we reviewed the early and late outcomes of two different groups: a low-risk (LR) group of 470 patients, and an IR group of 620...
October 15, 2016: Annals of Thoracic Surgery
Tomo Ando, Alexandros Briasoulis, Anthony A Holmes, Hisato Takagi, David P Slovut
BACKGROUND: The transfemoral (TF) approach has become the preferred approach for transcatheter aortic valve replacement (TAVR) because of its low risk profile. However, the relative safety of the percutaneous approach (PC) compared to surgical cut-down (SC) remains unclear. Our aim was to compare the outcomes between PC versus SC access in patients undergoing TF-TAVR using a meta-analysis. METHODS: We conducted a systematic electronic database search for studies reporting major and minor vascular complications (VC), major and minor bleeding, and perioperative all-cause mortality, in PC versus SC TF-TAVR cases...
October 3, 2016: Journal of Cardiac Surgery
Uri Landes, Alexander Sagie, Ran Kornowski
Sutureless aortic bioprostheses (SAB) are increasingly being used to provide shorter cross-clamp time. Valve-in-valve transcatheter aortic valve replacement (VIV-A) is shown to be effective and safe in the vast majority of patients with degenerated bioprosthetics, yet its' use in SAB failure is infrequent. We present a case of balloon-expandable VIV-A in an 80-year-old woman who suffered severe symptomatic aortic regurgitation in a failed Perceval S 21-mm valve. Computed tomography scan demonstrated a deformed valve...
October 3, 2016: Catheterization and Cardiovascular Interventions
James R McCarthy, T Sloane Guy
Mitral valve dysfunction can seriously impair patients' lives and may require valve repair or replacement. Surgery can be performed using techniques including sternotomy; right thoracotomy with or without robot assistance; and the totally endoscopic robotic technique, which requires percutaneous techniques, femoral cannulation, and endovascular aortic cross-clamping. The totally endoscopic robotic technique has been facilitated by minimally invasive surgical techniques, the evolution of endoscopic techniques, and the development of surgical robots...
October 2016: AORN Journal
Kevin Phan, Joshua M Haswell, Joshua Xu, Yusuf Assem, Stephanie L Mick, Samir R Kapadia, Anson Cheung, Frederick S Ling, Tristan D Yan, Vakhtang Tchantchaleishvili
De novo progressive aortic insufficiency (AI) is a side effect frequently related to prolonged support with continuous-flow left ventricular assist devices (CF-LVAD). Its progression can result in recurrent clinical heart failure symptoms and significantly increased mortality. Recently, percutaneous intervention methods such as transcatheter aortic valve replacement (TAVR) and percutaneous occluder devices have emerged, However, given the very scarce global experience with these approaches, evidence in the literature is lacking...
September 22, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Vikas Singh, Alex P Rodriguez, Badal Thakkar, Nileshkumar J Patel, Abhijit Ghatak, Apurva O Badheka, Carlos E Alfonso, Eduardo de Marchena, Rahul Sakhuja, Ignacio Inglessis-Azuaje, Igor Palacios, Mauricio G Cohen, Sammy Elmariah, William W O'Neill
Transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) has emerged as a less-invasive therapeutic option for high surgical risk patients with aortic stenosis and coronary artery disease. The aim of this study was to determine the outcomes of TAVR when performed with PCI during the same hospitalization. We identified patients using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes from the Nationwide Inpatient Sample between the years 2011 and 2013...
August 30, 2016: American Journal of Cardiology
Ditte Dencker, Mikkel Taudorf, N H Vincent Luk, Michael B Nielsen, Klaus F Kofoed, Torben V Schroeder, Lars Søndergaard, Lars Lönn, Ole De Backer
Vascular access and closure remain a challenge in transcatheter aortic valve replacement (TAVR). This single-center study aimed to report the incidence, predictive factors, and clinical outcomes of access-related vascular injury and subsequent vascular intervention. During a 30-month period, 365 patients underwent TAVR and 333 patients (94%) were treated by true percutaneous transfemoral approach. Of this latter group, 83 patients (25%) had an access-related vascular injury that was managed by the use of a covered self-expanding stent (n = 49), balloon angioplasty (n = 33), or by surgical intervention (n = 1)...
October 15, 2016: American Journal of Cardiology
Riccardo Cappato, Robert Welsh
The vast clinical research programme for the direct, oral factor Xa inhibitor rivaroxaban has generated a wealth of data since the first rivaroxaban approval in 2008 for the prevention of venous thromboembolism (VTE) in patients undergoing elective hip or knee replacement surgery. While rivaroxaban is widely used across a spectrum of seven indications, there is continuous commitment to investigating its wider benefits in new indications and attempts to refine current evidence. Key data from recently completed randomised controlled trials (RCTs) have shown that rivaroxaban is a feasible anticoagulation option for patients with non-valvular atrial fibrillation (NVAF) undergoing cardioversion or catheter ablation...
September 28, 2016: Thrombosis and Haemostasis
Erin A Woods, Margaret L Ackman, Michelle M Graham, Sheri L Koshman, Rosaleen M Boswell, Arden R Barry
BACKGROUND: Current guidelines recommend triple antithrombotic therapy (TAT), defined as acetylsalicylic acid (ASA), clopidogrel, and warfarin, for patients with nonvalvular atrial fibrillation who have undergone percutaneous coronary intervention with stent implantation. The choice of anticoagulant/antiplatelet therapy in this population is ambiguous and complex, and prescribing patterns are not well documented. OBJECTIVE: To characterize local prescribing patterns for anticoagulant/antiplatelet therapy after percutaneous coronary intervention in patients with nonvalvular atrial fibrillation...
July 2016: Canadian Journal of Hospital Pharmacy
James Roy, Con Manganas, George Youssef, David Rees
Valve complications following coronary angiography and percutaneous coronary interventions are rare. We report a case of an aortic valve laceration following cardiac catheterization and percutaneous coronary intervention, which required surgical valve replacement.
September 12, 2016: Journal of Cardiac Surgery
Kazuaki Okuyama, Tarun Chakravarty, Raj R Makkar
Left ventricular pseudoaneurysm (LVP) formation is a rare but potentially life-threatening complication of transapical transcatheter aortic valve replacement (TAVR). Conventionally, a pseudoaneurysm has been treated surgically; however, improved transcatheter technique and device technology have made a percutaneous closure of LVP an increasingly viable option, especially in a patient unfavorable for surgery. A TAVR candidate is most likely at increased surgical-risk or inoperable. Therefore a percutaneous closure can be a reasonable strategy for LVP, but its experience following this emerging aortic valve procedure remains limited...
September 13, 2016: Catheterization and Cardiovascular Interventions
Patrick A Calvert, David B Northridge, Iqbal S Malik, Leonard Shapiro, Peter Ludman, Shakeel A Qureshi, Michael Mullen, Robert Henderson, Mark Turner, Martin Been, Kevin P Walsh, Ivan Casserly, Lindsay Morrison, Nicola L Walker, John Thomson, Mark S Spence, Vaikom S Mahadevan, Angela Hoye, Philip A MacCarthy, Matthew J Daniels, Paul Clift, William R Davies, Philip D Adamson, Gareth Morgan, Suneil K Aggarwal, Yasmin Ismail, Julian O M Ormerod, Habib R Khan, Sujay Subash Chandran, Joseph de Giovanni, Bushra S Rana, Oliver Ormerod, David Hildick-Smith
BACKGROUND: Paravalvular leak (PVL) occurs in 5% to 17% of patients following surgical valve replacement. Percutaneous device closure represents an alternative to repeat surgery. METHODS: All UK and Ireland centers undertaking percutaneous PVL closure submitted data to the UK PVL Registry. Data were analyzed for association with death and major adverse cardiovascular events (MACE) at follow-up. RESULTS: Three hundred eight PVL closure procedures were attempted in 259 patients in 20 centers (2004-2015)...
September 27, 2016: Circulation
Claire Bouleti, Marion Chauvet, Guillaume Franchineau, Dominique Himbert, Bernard Iung, Benjamin Alos, Eric Brochet, Marina Urena, Walid Ghodbane, Phalla Ou, Sophie Provenchere, Patrick Nataf, Alec Vahanian
OBJECTIVES: Transcatheter aortic valve implantation (TAVI) has reoriented the treatment of aortic stenosis (AS) for high-risk patients. Little is known about late outcome after TAVI, surgical aortic valve replacement (AVR) or medical treatment in a single centre. We report patients' characteristics, early and 6-year survival rates after the three therapeutic strategies, and the evolution over time. We also analysed predictive factors of mortality after TAVI or surgical AVR. METHODS: Between October 2006 and December 2010, 478 high-risk consecutive patients were referred for severe symptomatic AS...
August 30, 2016: European Journal of Cardio-thoracic Surgery
Daisy C Nieto
This report describes the case of a 61-year-old woman who presented with dyspnea, aortic stenosis, and coronary artery disease-typical side effects of radiation therapy for Hodgkin lymphoma. A poor candidate for surgery, she underwent successful high-risk percutaneous coronary intervention and subsequent transcatheter aortic valve replacement. This report highlights some of the cardiovascular-specific sequelae of radiation therapy for cancer treatment; in addition, possible directions for future investigations are discussed...
August 2016: Texas Heart Institute Journal
Kenta Nakamura, Jonathan J Passeri, Ignacio Inglessis-Azuaje
We report a case of acute aorto-right ventricular fistula following transcatheter bicuspid aortic valve replacement and subsequent percutaneous closure. The diagnosis and treatment of this rare complication is illustrated through multi-modality imaging. We hypothesize that the patient's heavily calcified bicuspid aortic valve anatomy led to asymmetric deployment of the transcatheter aortic valve replacement (TAVR) prosthesis, traumatizing the right sinus of Valsalva at the distal edge of the TAVR stent and ultimately fistulized to the right ventricle...
August 22, 2016: Catheterization and Cardiovascular Interventions
Marzena Daniec, Bartłomiej Nawrotek, Danuta Sorysz, Tomasz Rakowski, Artur Dziewierz, Łukasz Rzeszutko, Paweł Kleczyński, Jarosław Trębacz, Marek Tomala, Krzysztof Żmudka, Dariusz Dudek
OBJECTIVES: This study aimed to evaluate the indications, short- and long-term outcomes of balloon aortic valvuloplasty (BAV) in patients with severe aortic stenosis (AS). METHODS: A cohort of 112 patients with AS underwent 114 BAV procedures between October 2012 and July 2015 in two Polish interventional cardiology centers. Clinical and echocardiographic data were prospectively collected within 1, 6, and 12 months follow-up. RESULTS: BAV was performed as a bridge to TAVI (51...
August 12, 2016: Catheterization and Cardiovascular Interventions
Deepakraj Gajanana, David Wheeler, David Hsi, Richard Kovach, Jon C George
BACKGROUND: Percutaneous balloon aortic valvuloplasty (PBAV) is a palliative therapeutic option for relief of severe aortic stenosis (AS) in patients that are poor surgical or transcatheter aortic valve replacement (TAVR) candidates or as a bridge to definitive therapy. The outcomes following PBAV are highly variable and studies identifying factors that correlate with outcomes are sparse. The purpose of this study was to identify predictors at the time of the index procedures that can predict 1-year survival or need for repeat PBAV...
August 5, 2016: Journal of Interventional Cardiology
Carlos Cortés, Ignacio J Amat-Santos, Luis Nombela-Franco, Antonio J Muñoz-Garcia, Enrique Gutiérrez-Ibanes, José M De La Torre Hernandez, Juan G Córdoba-Soriano, Pilar Jimenez-Quevedo, José M Hernández-García, Ana Gonzalez-Mansilla, Javier Ruano, Jesús Jimenez-Mazuecos, Javier Castrodeza, Javier Tobar, Fabian Islas, Ana Revilla, Rishi Puri, Ana Puerto, Itziar Gómez, Josep Rodés-Cabau, José A San Román
OBJECTIVES: This study sought to analyze the clinical impact of the degree and improvement of mitral regurgitation in TAVR recipients, validate the main imaging determinants of this improvement, and assess the potential candidates for double valve repair with percutaneous techniques. BACKGROUND: Many patients with severe aortic stenosis present with concomitant mitral regurgitation (MR). Cardiac imaging plays a key role in identifying prognostic factors of MR persistence after transcatheter aortic valve replacement (TAVR) and for planning its treatment...
August 8, 2016: JACC. Cardiovascular Interventions
Arpandeep Randhawa, Abhimanyu Saini, Anjali Aggarwal, Tulika Gupta, Uma Nahar Saikia, Manoj Kumar Rohit, Daisy Sahni
Variant origin of left circumflex coronary artery (LCx) from right aortic sinus is a well-recognized coronary variation, usually without any clinical consequences. However, the variant origin and trajectory of the artery may have major implications during percutaneous coronary intervention, coronary artery surgery, aortic and mitral valve replacement procedures. We observed a variant LCx in a heart specimen belonging to 45-year-female with no history of hypertension, diabetes mellitus and coronary artery disease...
August 2, 2016: Surgical and Radiologic Anatomy: SRA
Marco Hernández-Enríquez, María Ascaso, Xavier Freixa, Elena Sandoval, Giuseppe Giacchi, Salvatore Brugaletta, Victoria Martin-Yuste, Eduard Quintana, Manel Sabaté
We present an 83-year-old woman with history of two aortic valve replacements; 2 years after the last replacement, she developed heart failure and severe paravalvular leak (PVL) was detected. Percutaneous PVL closure was completed with a single Amplatzer Vascular Plug III. Two months later, the patient presented with late coronary obstruction requiring emergent surgical revascularization. To the best of our knowledge, this is the first report of late coronary obstruction after percutaneous PVL closure.
August 2016: Journal of Invasive Cardiology
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