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Planning tavi

Yu Horiuchi, Mika Izumo, Takayoshi Kusuhara, Motoi Yokozuka, Takeshi Taketani, Kengo Tanabe
This report describes an elderly severe aortic stenosis (AS) patient, who had a history of coronary artery bypass grafting and endovascular repair for an abdominal aortic aneurysm (AAA). Type II endoleak with enlargement of AAA was diagnosed and ligation of inferior mesenteric artery (IMA) was recommended. Because aortic valve replacement (AVR) was high risk, we planned transcatheter aortic valve implantation (TAVI). Considering risks of IMA ligation under dual antiplatelet therapy, increased blood pressure after TAVI, and general anesthesia, we performed combined TAVI and IMA ligation...
September 7, 2016: Cardiovascular Intervention and Therapeutics
Takanari Fujita, Naritatsu Saito, Kenji Minakata, Masao Imai, Kazuhiro Yamazaki, Takeshi Kimura
An 82-year-old woman with severe aortic stenosis was referred. She had previously undergone mitral valve replacement. We planned transcatheter aortic valve implantation (TAVI) with transfemoral approach. We planned to use the Safari-dedicated TAVI guidewire. No studies have reported clinical application of the dedicated TAVI guidewire in a patient with the previous mitral valve replacement. Thus, we conducted a simulation using a three-dimensional heart model to confirm the safety of the procedure. The procedure was successful without any complications...
August 27, 2016: Cardiovascular Intervention and Therapeutics
Shunsuke Matsumoto, Yoshitake Yamada, Masahiro Hashimoto, Teppei Okamura, Minoru Yamada, Fumiaki Yashima, Kentaro Hayashida, Keiichi Fukuda, Masahiro Jinzaki
OBJECTIVES: To evaluate the effectiveness of CT before TAVI using variable helical pitch (VHP) scanning and its diagnostic performance for coronary artery disease (CAD). METHODS: Sixty patients (84.4 ± 4.6 years) scheduled for TAVI underwent CT using VHP scanning with the contrast material (CM) volume calculated as scanning time × weight [kg] × 0.06 mL. Retrospective electrocardiography (ECG)-gated scanning was utilized to examine the thorax, and non-ECG-gated scanning of the abdomen immediately followed...
August 25, 2016: European Radiology
Jaya Chandrasekhar, Roxana Mehran
As more patients become eligible for transcatheter aortic valve implantation (TAVI), resource allocation and early discharge planning require careful consideration. TAVI centers must develop locally appropriate and systematic strategies to facilitate early discharge and seamless post-discharge care. While ongoing studies examine pacing requirements post-TAVI, trials comparing general anesthesia and monitored analgesia care are desired. Future technologies for co-registration of computed tomography with fluoroscopy may reduce the need for intra-operative transesophageal echo and general anesthesia...
January 1, 2016: Catheterization and Cardiovascular Interventions
Alice Wielandner, Dietrich Beitzke, Ruediger Schernthaner, Florian Wolf, Christina Langenberger, Alfred Stadler, Christian Loewe
OBJECTIVE: To compare electrocardiographic (ECG)-triggered high-pitch (HP) dual-source CT angiography (CTA) with non-ECG-triggered HP CTA of the aorta, particularly the ascending aorta, with regard to image quality, motion artefacts, contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR) and radiation dose. METHODS: 59 consecutive patients who had been referred for CTA for known or suspected aortic disease, previous aortic intervention or planned transapical or transfemoral aortic valve implantation were prospectively included...
June 27, 2016: British Journal of Radiology
Birgid Gonska, Julia Seeger, Christoph Rodewald, Dominik Scharnbeck, Wolfgang Rottbauer, Jochen Wöhrle
BACKGROUND: Surgical aortic bioprosthetic valves deteriorate 10 to 20 years after operation. Valve-in-valve implantation with first generation transcatheter aortic valve implantation (TAVI) devices has shown to be feasible. We report a first case series with the new Edwards Sapien 3 valve for transfemoral aortic valve-in-valve implantation. METHODS AND RESULTS: Nine patients underwent valve-in-valve-TAVI with the Edward Sapien 3 valve. Seven patients presented with severe aortic stenosis and two patients with severe aortic insufficiency of surgical aortic bioprosthesis...
May 3, 2016: Catheterization and Cardiovascular Interventions
Amira F Hussien, Jean Jeudy, Seth J Kligerman, Charles S White
BACKGROUND: Many older patients with aortic stenosis are excluded from surgical intervention due to multiple comorbidities. For these patients, transcatheter aortic valve implantation (TAVI) is a viable treatment alternative. Cardiothoracic computed tomography (CT) provides detailed anatomic assessment of the aortic root structures for patient selection, preprocedural planning, and intraoperative decision-making; however, nonaortic incidental findings are frequently detected. The prevalence and clinical significance of these findings have not been well described...
May 2016: Journal of Thoracic Imaging
Shun Saito, Hisanari Ishii
An 80-year-old woman with severe aortic stenosis was planned to undergo transcatheter aortic valve implantation (TAVI) under general anesthesia. Due to severe stenosis of the femoral arteries, the left iliac artery was cut down and a 16 F Edwards SAPIEN Expandable Sheath (eSheath : Edwards Lifesciences, Irvine, CA) was inserted into the artery smoothly. After balloon aortic valvuloplasty (BAV), an artificial valve was tried to deploy but stuck in the middle of eSheath. Suddenly regional saturation of oxygen (rSO2) at the ipsilateral foot decreased steeply without other significant hemodynamic instabilities...
February 2016: Masui. the Japanese Journal of Anesthesiology
Daniel O Bittner, Martin Arnold, Lutz Klinghammer, Annika Schuhbaeck, Michaela M Hell, Gerd Muschiol, Soeren Gauss, Michael Lell, Michael Uder, Udo Hoffmann, Stephan Achenbach, Mohamed Marwan
OBJECTIVES: Chronic renal failure is common in patients referred for transcatheter aortic valve implantation (TAVI). CT angiography is recommended and provides crucial information prior to TAVI. We evaluated the feasibility of a reduced contrast volume protocol for pre-procedural CT imaging. METHODS: Forty consecutive patients were examined with prospectively ECG-triggered high-pitch spiral acquisition using a novel third-generation dual-source CT system; 38 ml contrast agent was used...
March 19, 2016: European Radiology
Sveeta Badiani, Sanjeev Bhattacharyya, Guy Lloyd
Aortic stenosis (AS) is the most common primary valve disorder in the elderly with an increasing prevalence; transcatheter aortic valve implantation (TAVI) has become an accepted alternative to surgical aortic valve replacement (AVR) in the high risk or inoperable patient. Appropriate selection of patients for TAVI is crucial and requires a multidisciplinary approach including cardiothoracic surgeons, interventional cardiologists, anaesthetists, imaging experts and specialist nurses. Multimodality imaging including echocardiography, CT and MRI plays a pivotal role in the selection and planning process; however, echocardiography remains the primary imaging modality used for patient selection, intra-procedural guidance, post-procedural assessment and long-term follow-up...
April 2016: Current Cardiology Reports
Abhishek Chaturvedi, Susan K Hobbs, Fred S Ling, Apeksha Chaturvedi, Peter Knight
Transcatheter Aortic Valve Implantation (TAVI) is increasingly being used in patients with severe aortic stenosis who are not candidates for surgery. ECG-gated CT angiography (CTA) plays an important role in the preoperative planning for these devices. As the number of patients undergoing these procedures increases, a subset of patients is being recognized who have contraindications to iodinated contrast medium, either due to a prior severe allergic type reaction or poor renal function. Another subgroup of patients with low flow and low gradient aortic stenosis is being recognized that are usually assessed for severity of aortic stenosis by stress echocardiography...
April 2016: Insights Into Imaging
Orly Goitein, Elio Di Segni, Yael Eshet, Victor Guetta, Amit Segev, Eyal Nahum, Ehud Raanani, Eli Konen, Ashraf Hamdan
UNLABELLED: Background: Trans-cathetervalve implantation (TAVI) is a non- surgical alternative for patients with severe aortic stenosis (AS). Pre-procedural computed tomography angiography (CTA) allows accurate "road mapping," aortic annulus sizing and the detection of incidental findings. OBJECTIVES: To document the prevalence of non-valvular extracardiac findings on CTA prior to TAVI and the impact of these findings on the procedure. METHODS: Ninety AS patients underwent CTA as part of pre-TAVI planning...
December 2015: Israel Medical Association Journal: IMAJ
Mohamed Marwan, Stephan Achenbach
Catheter-based aortic valve implantation is increasingly being performed in high-risk patients with symptomatic aortic valve stenosis. For successful planning of the procedure, CT has been shown to provide crucial information concerning the aortic root as well as the peripheral access vessels. This article illustrates the increasing role of CT before transcatheter aortic valve implantation.
February 2016: Current Cardiology Reports
S Morganti, N Brambilla, A S Petronio, A Reali, F Bedogni, F Auricchio
Prosthesis positioning in transcatheter aortic valve implantation procedures represents a crucial aspect for procedure success as demonstrated by many recent studies on this topic. Possible complications, device performance, and, consequently, also long-term durability are highly affected by the adopted prosthesis placement strategy. In the present work, we develop a computational finite element model able to predict device-specific and patient-specific replacement procedure outcomes, which may help medical operators to plan and choose the optimal implantation strategy...
August 16, 2016: Journal of Biomechanics
Francesco Burzotta, Roberto Nerla, Carlo Trani
BACKGROUND: The optimal management of cardiogenic shock (CS) occurring in the presence of acute coronary syndromes, severe aortic stenosis, and poor left ventricular function has not been established. Recently, the availability of new assistance devices and techniques has provided novel management opportunities. In particular, when compared with surgical approaches, percutaneous procedures have the advantage of allowing "staged" interventions, in which different steps are planned according to the patient's evolving clinical conditions...
January 2016: Journal of Invasive Cardiology
Gianni Dall'Ara, Francesco Saia, Carolina Moretti, Cinzia Marrozzini, Nevio Taglieri, Barbara Bordoni, Matteo Chiarabelli, Cristina Ciuca, Claudio Rapezzi, Antonio Marzocchi
OBJECTIVES: To evaluate the incidence, treatment, and outcomes of acute aortic regurgitation (ARR) complicating BAV. BACKGROUND: In the transcatheter aortic valve implantation (TAVI) era, there is an increase of percutaneous balloon aortic valvuloplasty (BAV) procedures with different indications. METHODS: From the prospective BAV registry of the University of Bologna, which has enrolled patients between the year 2000 and the present, we selected those who suffered intraprocedural AAR with overt hemodynamic instability...
December 30, 2015: Catheterization and Cardiovascular Interventions
Simon H Sündermann, Michael Gessat, Willibald Maier, Jörg Kempfert, Thomas Frauenfelder, Thi D L Nguyen, Francesco Maisano, Volkmar Falk
OBJECTIVE: We tested the hypothesis that simulated three-dimensional prosthesis overlay procedure planning may support valve selection in transcatheter aortic valve implantation (TAVI) procedures. METHODS: Preoperative multidimensional computed tomography (MDCT) data sets from 81 consecutive TAVI patients were included in the study. A planning tool was developed, which semiautomatically creates a three-dimensional model of the aortic root from these data. Three-dimensional templates of the commonly used TAVI implants are spatially registered with the patient data and presented as graphic overlay...
September 2015: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Kerstin D Piayda, Sameer Gafoor, Stefan Bertog, Mirko Doss, Laura Vaskelyte, Predrag Matic, Jennifer Franke, Ilona Hofmann, Nina Staiger, Markus Reinartz, Horst Sievert
AIMS: To evaluate the safety and feasibility of transcatheter aortic valve implantation (TAVI) via femoral access under local anesthesia only (without concomitant sedation) as the initial strategy. METHODS AND RESULTS: Patients undergoing planned transfemoral TAVI without routine general anesthesia between May 2005 and December 2013 were identified. Baseline characteristics, procedural outcomes, and a 30-day clinical follow-up were obtained. A total of 215 patients underwent TAVI with local anesthesia only as the initial strategy (LA group)...
November 2015: Journal of Invasive Cardiology
José Côté, Sylvie Cossette, Pilar Ramirez-Garcia, Alexandra De Pokomandy, Catherine Worthington, Marie-Pierre Gagnon, Patricia Auger, François Boudreau, Joyal Miranda, Yann-Gaël Guéhéneuc, Cécile Tremblay
BACKGROUND: Long-term use of antiretroviral therapy, normal aging, and presence of certain risk factors are associated with metabolic disorders that predispose persons living with HIV to diabetes and cardiovascular diseases. The emergence and progression of these disorders can be prevented by adopting healthy behaviours. Based on the theory of planned behaviour, the Web-based tailored intervention TAVIE en santé was developed. The aim of this study is to evaluate the effectiveness of TAVIE en santé in order to support people living with HIV in the adoption of health promoting behaviours...
October 12, 2015: BMC Public Health
Yigal Abramowitz, Tarun Chakravarty, Hasan Jilaihawi, Mohammad Kashif, Yoshio Kazuno, Nobuyuki Takahashi, Yoshio Maeno, Mamoo Nakamura, Wen Cheng, Raj R Makkar
AIMS: Coronary protection with guidewires and an undeployed coronary balloon or stent positioned in the coronary artery is a pre-emptive technique to manage coronary obstruction during transcatheter aortic valve implantation (TAVI). We investigated the feasibility and safety of left main (LM) protection during TAVI. METHODS AND RESULTS: Twenty-five out of 623 patients who underwent TAVI at our institute were deemed to be at increased risk of LM compromise mainly due to a low LM ostium height, significant LM disease or a previous bioprosthetic valve...
September 2015: EuroIntervention
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