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tavi and mitral regurgitation

A Schmermund, J Eckert, S N Schelle, H Eggebrecht
For the treatment of structural heart disease, current options in the catheterization laboratory include MitraClip® implantation for treating severe mitral regurgitation, transcatheter aortic valve implantation (TAVI), closure of a patent foramen ovale (PFO) and occlusion of the left atrial appendage (LAA). These treatment options are based on a precise diagnosis provided by modern cardiac imaging, which is indispensable for treatment recommendations. Its importance for supporting the invasive procedures in the catheterization laboratory is less well known...
September 19, 2016: Herz
Francesco Saia, Carolina Moretti, Gianni Dall'Ara, Cristina Ciuca, Nevio Taglieri, Alessandra Berardini, Pamela Gallo, Marina Cannizzo, Matteo Chiarabelli, Niccolò Ramponi, Linda Taffani, Maria Letizia Bacchi-Reggiani, Cinzia Marrozzini, Claudio Rapezzi, Antonio Marzocchi
BACKGROUND: Whilst the majority of the patients with severe aortic stenosis can be directly addressed to surgical aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI), in some instances additional information may be needed to complete the diagnostic workout. We evaluated the role of balloon aortic valvuloplasty (BAV) as a bridge-to-decision (BTD) in selected high-risk patients. METHODS: Between 2007 and 2012, the heart team in our Institution required BTD BAV in 202 patients...
September 2016: Journal of Geriatric Cardiology: JGC
Asife Sahinarslan, Francesco Vecchio, Philip MacCarthy, Rafal Dworakowski, Ranjit Deshpande, Olaf Wendler, Mark Monaghan
BACKGROUND: The aim of this study was to investigate the echocardiographic features of functional mitral regurgitation (MR) in patients with aortic stenosis (AS) pre- and post-trans catheter aortic valve implantation (TAVI). METHODS: The study subjects consisted of 79 patients with severe AS, who underwent TAVI. The echocardiographic parameters related to MR severity prior to TAVI and the change in these parameters and MR severity within one month after implantation were retrospectively evaluated...
July 2016: Acta Cardiol Sin
S Yücel, H Ince, S Kische, M A Sherif, H Bushnaq, A Bärisch, A Öner
The demographic changes in society lead to an increasing number of patients with aortic valve stenosis and mitral regurgitation. Simultaneously the higher age of patients is associated with an increase in multimorbidity with a high surgical risk so that they cannot be referred to surgery. Besides the current gold standard of surgery, minimally invasive therapeutic options are increasingly becoming established for these patients. For the differentiated indications and therapeutic success, a multidisciplinary heart team assumes an important role...
August 2016: Herz
Y Tayyareci, R Dworakowski, P Kogoj, J Reiken, C Kenny, P MacCarthy, O Wendler, M J Monaghan
OBJECTIVE: To assess the impact of mitral geometry, left ventricular (LV) remodelling and global LV afterload on mitral regurgitation (MR) after trans-catheter aortic valve implantation (TAVI). METHODS: In this study, 60 patients who underwent TAVI were evaluated by 3D echocardiography at baseline, 1 month and 6 months after procedure. The proportional change in MR following TAVI was determined by examining the percentage change in vena contracta (VC) at 6 months...
September 2016: Echo Research and Practice
Nestoras Papadopoulos, Ali El-Sayed Ahmad, Marlene Thudt, Stephan Fichtlscherer, Patrick Meybohm, Christian Reyher, Anton Moritz, Andreas Zierer
BACKGROUND: The aim of the current study is to report our experience with fast-track treatment of patients undergoing transapical transcatheter aortic valve implantation (TA-TAVI) and to determine perioperative predictors for fast-track protocol failure. METHODS: Being one of the pioneering centers to start performing TA-TAVI back in 2005, we routinely included patients undergoing this procedure into our fast-track management program since 2008. Between January 2008 and June 2013, 207 consecutive high-risk patients (mean age 79 ± 7 years, mean Log...
2016: Journal of Cardiothoracic Surgery
Isabel Baldizon, Andres Espinoza, Thomas Kuntze, Evaldas Girdauskas
Some patients who underwent previous mitral valve surgery experience bioprosthetic valve degeneration or recurrent mitral valve regurgitation, and the transcatheter valve-in-valve or valve-in-ring procedure is a promising therapeutic option. Early thrombotic complications have been recently reported in 0.6-0.8% of TAVI prostheses implanted in aortic position. To the best of our knowledge, this article reports on the first case of thrombotic transcatheter mitral valve dysfunction which occurred on oral anticoagulation with Coumadin in combination with antiplatelet therapy...
April 2016: Interactive Cardiovascular and Thoracic Surgery
Peter Wenaweser, Fabien Praz, Stefan Stortecky
Aortic stenosis is the most common valvular heart disease in Western industrial countries (including Switzerland) with a prevalence of about 5% in the population aged 75 and over. If left untreated, symptomatic patients have a rate of death of more than 50% within 2 years. As a result of age and elevated surgical risk, an important proportion of elderly patients are not referred to surgery. Thus, the introduction of transcatheter aortic valve implantation (TAVI) in 2002 has initiated a paradigm shift in the treatment of patients with symptomatic, severe aortic stenosis...
2016: Swiss Medical Weekly
Richard Fojt, Zuzana Moťovská, Petr Budera, Marek Malý, Zbyněk Straka
BACKGROUND: Significant aortic stenosis (AS) is frequently associated with mitral regurgitation (MR) of varying degrees. We sought to assess the change in MR grade after the aortic valve procedure, to find predictors of MR improvement and finally to determine the prognostic impact of persistent MR. METHODS: We retrospectively analyzed a group of 101 AS patients who underwent aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI) at our institution between January 2007 and March 2014 and who presented with MR grade 2 or higher on preoperative echocardiogram - 35 patients underwent an isolated AVR, 18 underwent TAVI, and the rest underwent a combined procedure, which included coronary artery bypass grafting...
June 2016: Journal of Cardiology
Piotr Szymański, Tomasz Hryniewiecki, Maciej Dąbrowski, Danuta Sorysz, Janusz Kochman, Jan Jastrzębski, Tomasz Kukulski, Marian Zembala
OBJECTIVE: To analyse the impact of postprocedural mitral regurgitation (MR), in an interaction with aortic regurgitation (AR), on mortality following transcatheter aortic valve implantation (TAVI). METHODS: To assess the interaction between MR and AR, we compared the survival rate of patients (i) without both significant MR and AR versus (ii) those with either significant MR or significant AR versus (iii) with significant MR and AR, all postprocedure. 381 participants of the Polish Transcatheter Aortic Valve Implantation Registry (166 males (43...
May 2016: Heart: Official Journal of the British Cardiac Society
Leor Perl, Mordehay Vaturi, Abid Assali, Alexander Sagie, Adaya Weissler-Snir, Pablo Codner, Katia Orvin, Hana Vaknin-Assa, Yaron Shapira, Ran Kornowski
BACKGROUND AND AIM OF THE STUDY: In patients with aortic stenosis, mitral regurgitation (MR) is a common finding. Little is known regarding outcomes of MR in patients undergoing transcatheter aortic valve implantation (TAVI). The study aim was to characterize the short- and mid-term impact of the TAVI procedure on MR grade. METHODS: A total of 261 patients (59% females; mean age 82.1 +/- 6.9 years) undergoing TAVI was assessed for rates of significant MR and the severity of MR at baseline, and at one month and six months after the procedure...
July 2015: Journal of Heart Valve Disease
Ignacio J Amat-Santos, Carlos Cortés, Luis H Varela-Falcón
AIM: We aimed to illustrate the physiopathology of anterior mitral leaflet perforation after TAVI in patients suffering from infective endocarditis (IE). METHODS AND RESULTS: The first known case of balloon-expandable transapical case from our series suffering from this complication was reported. In addition, a systematic electronic search of all published cases reporting both entities was performed. Five transfemoral cases have been published to the date, all males with mean age of 79...
January 17, 2016: Catheterization and Cardiovascular Interventions
G Lutter, D Frank
Approximately 30 % of patients suffering from severe valvular heart disease, such as mitral valve regurgitation are non-compliant to the gold standard of minimally invasive surgery, reconstruction or valve replacement. The number of these mostly old patients with severe comorbidities is increasing; therefore, transcatheter interventions have been developed to address an unmet clinical need and may be an alternative therapeutic option to the reference standard. Apart from the successful MitraClip therapy, alternative transcatheter reconstruction technologies are being developed...
February 2016: Herz
Kirsten Boerlage-van Dijk, Esther M A Wiegerinck, Takuro Takama, Karel T Koch, M Marije Vis, Bas A J M de Mol, Jan J Piek, Berto J Bouma, Jan Baan
BACKGROUND: Current data about the impact of concomitant mitral regurgitation (MR) on outcome in patients who undergo transcatheter aortic valve implantation (TAVI) are conflicting. Our purpose was to analyze the clinical course of MR and to assess the influence of MR on survival and clinical status after TAVI. METHODS: We included 375 consecutive patients who underwent TAVI. MR grade and NYHA class were determined before TAVI and at follow-up. RESULTS: In total 171 patients (46%) had MR grade ≥ 2 at baseline and of these 29% improved to MR grade ≤ 1 after TAVI...
February 1, 2016: International Journal of Cardiology
Crochan J O'Sullivan, Peter Wenaweser
Transcatheter aortic valve implantation (TAVI) has revolutionized the management of high-risk or inoperable patients presenting with symptomatic severe aortic stenosis (AS). There are several factors to consider to optimize patient outcomes from TAVI. Before TAVI, patient selection is key and an understanding the effects of common comorbidities on outcomes after TAVI is critical. Some comorbidities share common risk factors with AS (e.g. coronary artery disease), others are directly or indirectly caused or exacerbated by severe AS (e...
December 2015: Expert Review of Cardiovascular Therapy
Hisato Takagi, Takuya Umemoto
BACKGROUND: It remains unclear whether coexisting and untreated mitral regurgitation (MR) affects survival after transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS). To summarize contemporary evidence, we performed the first metaanalysis of adjusted observational studies reporting post-TAVI mortality in patients with various grades of MR. METHODS: MEDLINE and EMBASE were searched until February 2015, with a bibliographic review of secondary sources...
December 2015: Annals of Thoracic Surgery
Giuseppe D'Ancona, Hüseyin Ince, Jasmin Ortak, Yannik Stoeckicht, Stephan Kische
A case is reported of iatrogenic mitral valve chordal rupture occurring during transcatheter aortic valve implantation (TAVI) with an inflatable and repositionable valve (Direct Flow; Direct Flow Medical, Santa Rosa, CA, USA). The specific implantation technique requires initial valve advancement into the left ventricular cavity, valve inflation within the ventricular cavity, and a final finely tuned valve upward pulling through the left ventricular outflow tract until contact with the aortic annulus is achieved...
March 2015: Journal of Heart Valve Disease
Altug Cincin, Kursat Tigen, Ibrahim Sari, Murat Sunbul, Fatih Kartal, Yelda Basaran
Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic option for high-risk aortic stenosis. Malposition of the prosthesis and severe residual aortic regurgitation are known complications of the procedure, which might require a second valve implantation. Although the implantation of a second valve seems to be an effective method, very few data are available describing this technique. Herein is reported a case of iatrogenic chordal rupture in a TAVI procedure which required a second valve implantation due to dislodgment of the first prosthesis...
January 2015: Journal of Heart Valve Disease
Alexander Sedaghat, Fadi Al-Rashid, Jan-Malte Sinning, Daniel Wendt, Matthias Thielmann, Eberhard Grube, Georg Nickenig, Raimund Erbel, Nikos Werner, Philipp Kahlert
BACKGROUND: Transcatheter aortic valve implantation (TAVI) has rapidly evolved to the standard-of-care for inoperable patients with severe, symptomatic aortic valve stenosis, and to an alternative treatment option for high-risk patients. However, the randomized PARTNER trial excluded patients with conditions frequently encountered in daily clinical practice. METHODS: From 2006 to 2011, 467 high-risk patients, who underwent transfemoral TAVI (Edwards Sapien n = 166; Medtronic CoreValve n = 301) at two German centers were divided into a "PARTNER-like" (n = 227) and a "Real-World" cohort (n = 240), based on the original PARTNER trial in- and exclusion criteria...
November 15, 2015: Catheterization and Cardiovascular Interventions
Sakiko Miyazaki, Eustachio Agricola, Vasileios F Panoulas, Massimo Slavich, Gennaro Giustino, Tadashi Miyazaki, Filippo Figini, Azeem Latib, Alaide Chieffo, Matteo Montorfano, Alberto Margonato, Francesco Maisano, Ottavio Alfieri, Antonio Colombo
BACKGROUND: Moderate or severe paravalvular leak (PVL ≥ moderate) after transcatheter aortic valve implantation (TAVI) is associated with poor outcomes. The aim of this study was to assess whether the baseline ejection fraction (EF) affects the impact of PVL on mortality after TAVI. METHODS: We analyzed 514 consecutive patients with native severe aortic stenosis who underwent TAVI. Patients were divided into two groups: EF < 40% group (n = 84) and EF ≥ 40% group (n = 430) according to baseline EF...
2015: International Journal of Cardiology
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