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By Alessandro Iadanza Interventional Cardiologist at Siena University Hospital
Philippe Généreux, Gregg W Stone, Patrick T O'Gara, Guillaume Marquis-Gravel, Björn Redfors, Gennaro Giustino, Philippe Pibarot, Jeroen J Bax, Robert O Bonow, Martin B Leon
Aortic stenosis (AS) is one of the most common valvular diseases encountered in clinical practice. Current guidelines recommend aortic valve replacement (AVR) when the aortic valve is severely stenotic and the patient is symptomatic; however, a substantial proportion of patients with severe AS are asymptomatic at the time of first diagnosis. Although specific morphological valve features, exercise testing, stress imaging, and biomarkers can help to identify patients with asymptomatic severe AS who may benefit from early AVR, the optimal management of these patients remains uncertain and controversial...
May 17, 2016: Journal of the American College of Cardiology
Seung-Pyo Lee, Whal Lee, Joo Myung Lee, Eun-Ah Park, Hyung-Kwan Kim, Yong-Jin Kim, Dae-Won Sohn
PURPOSE: To assess whether native T1 mapping provides noninvasive estimation of diffuse myocardial fibrosis and whether it correlates with subclinical myocardial dysfunction in asymptomatic patients with aortic stenosis (AS). MATERIALS AND METHODS: The local institutional review board approved the study, and all patients gave informed consent. Eighty asymptomatic patients with moderate or severe AS and normal left ventricular (LV) ejection fraction (mean age, 67 years; range, 31-81 years) and 15 sex-matched control subjects (mean age, 33 years; range, 23-41 years) were prospectively enrolled...
February 2015: Radiology
Yusuke Watanabe, Thierry Lefèvre, Takahide Arai, Kentaro Hayashida, Erik Bouvier, Thomas Hovasse, Mauro Romano, Bernard Chevalier, Philippe Garot, Patrick Donzeau-Gouge, Arnaud Farge, Bertrand Cormier, Marie-Claude Morice
BACKGROUND: Postprocedural paravalvular leak (PVL) ≥ 2 has been shown to be associated with worse outcomes after transcatheter aortic valve implantation (TAVI). This study sought to identify predictive factors of postprocedural PVL ≥ 2 after TAVI with the Edwards valve. METHODS AND RESULTS: A total of 176 patients with Edwards TAVI (aged 83.4 ± 7.4 years, Logistic EuroSCORE [the Logistic European System for Cardiac Operative Risk Evaluation] 18...
July 2015: Catheterization and Cardiovascular Interventions
Mohammad Abdelghani, Osama I I Soliman, Carl Schultz, Alec Vahanian, Patrick W Serruys
Paravalvular leakage (PVL) is an important complication of transcatheter aortic valve implantation (TAVI). It contributed to the erosion of the clinical benefits of TAVI and confidence of its adoption as a default therapy in low surgical-risk patients. Newer TAVI technologies are provided with effective paravalvular sealing as well as retrieval/reposition mechanisms that are believed to considerably lower the risk of PVL. Meanwhile, developments in timely detection and accurate quantitation of PVL remain lagging behind those technological advances...
September 7, 2016: European Heart Journal
Philippe Généreux, Stuart J Head, Rebecca Hahn, Benoit Daneault, Susheel Kodali, Mathew R Williams, Nicolas M van Mieghem, Maria C Alu, Patrick W Serruys, A Pieter Kappetein, Martin B Leon
Paravalvular leak (PVL) is a frequent complication of transcatheter aortic valve replacement (TAVR) and is seen at a much higher rate after TAVR than after conventional surgical aortic valve replacement. Recent reports indicating that PVL may be correlated with increased late mortality have raised concerns. However, the heterogeneity of methods for assessing and quantifying PVL, and lack of consistency in the timing of such assessments, is a hindrance to understanding its true prevalence, severity, and effect...
March 19, 2013: Journal of the American College of Cardiology
Fabian Nietlispach, Francesco Maisano, Paul Sorajja, Martin B Leon, Charanjit Rihal, Ted Feldman
Paravalvular leak (PVL) occurs after both surgical and transcatheter valve replacement/implantation. It can lead to haemolysis, heart failure and may increase the risk of endocarditis. Percutaneous closure has significantly less morbidity than re-operation and is therefore often the therapy of choice. Percutaneous PVL closure can make an important difference for patients and can improve patient prognosis. These procedures can be intricate and larger case series and research is needed to further develop and improve these procedures...
May 8, 2016: European Heart Journal
Gianluca Lucchese, Nicholas Montarello, Vinayak Bapat
Transcatheter aortic valve implantation (TAVI) is now routinely performed to treat inoperable and high-risk patients with severe aortic stenosis (AS). Transapical or transaortic approaches are alternative routes used when peripheral accesses are unsuitable.Correct placement of the device is achieved with the help of an angiography performed with a pigtail catheter to identify the deployment view. However, in patients with severe vascular disease, placement of a pigtail catheter may not be possible.We report a modified single-puncture technique, whereby a single access point is used to perform both angiography and TAVI by using visible calcification landmarks as reference points...
August 12, 2016: Thoracic and Cardiovascular Surgeon
Pradeep K Yadav, Marvin H Eng
Patients with low body mass index (<20 kg/m(2) ) undergoing transcatheter aortic valve replacement have higher short- and long-term mortality Low BMI is an important tool to consider in patient screening and prognostication Prospective study is needed to accurately assess the effects of BMI in TAVR patients, to prove or refute the obesity paradox.
July 2016: Catheterization and Cardiovascular Interventions
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
Mehmet Cilingiroglu, Konstantinos Marmagkiolis
Important differences still exist in the management of patients who receive TAVR in Europe and in the USA. Provisional participation of cardiovascular surgeons and imaging cardiologists, use of TEE, general anesthesia with endotracheal intubation, and length of stay are some of the major differences which may define the future of TAVR in the USA. TAVR procedure will most likely be performed without CT surgery presence and with limited echocardiographic imaging guidance in USA in the near future as it is already being done in Europe...
January 1, 2016: Catheterization and Cardiovascular Interventions
Carl L Tommaso
The learning curve for TAVR is determined based on technical (procedural) data from PARTNER-1 Trial The number of cases needed to reach a learning curve for TAVR in PARTNER-1 was 50 for original sites and fell to 25 for late entering sites Analyses such as this is important in developing guidelines for other emerging technologies.
January 1, 2016: Catheterization and Cardiovascular Interventions
Torsten P Vahl, Susheel K Kodali, Martin B Leon
Transcatheter aortic valve replacement (TAVR) has become a safe and effective therapy for patients with severe aortic stenosis (AS). In recent trials, the hemodynamic performance and clinical outcomes of the latest generation of TAVR devices demonstrated at least parity with surgical outcomes in patients of similar risk. Many initial obstacles with TAVR have largely been overcome, including frequent access site complications and concerns about strokes and paravalvular leaks. Using a multidisciplinary heart team approach, patient selection, procedural planning, and device implantation have been refined and optimized such that clinical outcomes are generally predictable and reproducible...
March 29, 2016: Journal of the American College of Cardiology
Neil E Moat
No abstract text is available yet for this article.
April 28, 2016: New England Journal of Medicine
Jan-Malte Sinning, Anja Stundl, Simon Pingel, Marcel Weber, Alexander Sedaghat, Christoph Hammerstingl, Mariuca Vasa-Nicotera, Fritz Mellert, Wolfgang Schiller, Jan Kovac, Armin Welz, Eberhard Grube, Nikos Werner, Georg Nickenig
OBJECTIVES: The aims of this study were to increase the discriminatory value of the aortic regurgitation index (ARI) for the assessment of paravalvular regurgitation (PVR) and to further elucidate the association between aortic regurgitation severity and mortality after transcatheter aortic valve replacement (TAVR). BACKGROUND: Hemodynamic parameters such as the ARI complement predominantly angiographically guided TAVR. However, the ARI depends on several baseline and periprocedural characteristics...
April 11, 2016: JACC. Cardiovascular Interventions
Wisit Cheungpasitporn, Charat Thongprayoon, Kianoush Kashani
Transcatheter aortic valve replacement (TAVR) has now emerged as a viable treatment option for high-risk patients with severe aortic stenosis (AS) who are not suitable candidates for surgical aortic valve replacement (SAVR). Despite encouraging published outcomes, acute kidney injury (AKI) is common and lowers the survival of patients after TAVR. The pathogenesis of AKI after TAVR is multifactorial including TAVR specific factors such as the use of contrast agents, hypotension during rapid pacing, and embolization; preventive measures may include pre-procedural hydration, limitation of contrast dye exposure, and avoidance of intraprocedural hypotension...
2016: Journal of Renal Injury Prevention
Josep Rodés-Cabau, Maurizio Taramasso, Patrick T O'Gara
The assessment and management of tricuspid valve disease have evolved substantially during the past several years. Whereas tricuspid stenosis is uncommon, tricuspid regurgitation is frequently encountered and is most often secondary in nature and caused by annular dilatation and leaflet tethering from adverse right ventricular remodelling in response to any of several disease processes. Non-invasive assessment of tricuspid regurgitation must define its cause and severity; advanced three-dimensional echocardiography, MRI, and CT are gaining in clinical application...
April 1, 2016: Lancet
Sergio Bertazzo, Eileen Gentleman
No abstract text is available yet for this article.
March 18, 2016: European Heart Journal
Philippe Pibarot, Raphael Rosenhek, Patrizio Lancellotti
No abstract text is available yet for this article.
May 2016: European Heart Journal Cardiovascular Imaging
2016-02-08 06:54:55
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