scholarly journals Pharmacodynamic Effect of Clopidogrel in Patients Undergoing Transcatheter Aortic Valve Implantation

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Petr Tousek ◽  
Viktor Kocka ◽  
Jakub Sulzenko ◽  
Frantisek Bednar ◽  
Hana Linkova ◽  
...  
Keyword(s):  
Platelet Reactivity ◽  
Point Of Care ◽  
Bolus Administration ◽  
Antiplatelet Treatment ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
Medtronic Corevalve ◽  
Valve Implantation ◽  
Dual Antiplatelet Treatment

The aim of this study was to analyze periprocedural and mid-term effect of clopidogrel on platelet function using the VerifyNow P2Y12point-of-care assay in patients undergoing TAVI. Platelet reactivity was measured at the beginning of the procedure after 300 mg clopidogrel bolus administration and during the follow-up (at 1 month after the procedure) in 52 patients undergoing TAVI using the Medtronic CoreValve prosthesis (Medtronic CoreValve). A cutoff value of 240 PRU was used to identify nonresponders to clopidogrel treatment with high residual platelet reactivity (HRPR). Baseline HRPR was identified in 80% of patients and in 72% of patients during 6-month follow-up. There was no significant difference in the pharmacodynamic effects of clopidogrel on platelet reactivity from baseline to 6-months follow-up (297±57vs.275±62;P=0.058). Ischemic event occurred only in 3 patients (5.8%) from the study group. In conclusion, majority of patients undergoing TAVI had high residual platelet reactivity after pretreatment with 300 mg of clopidogrel and during the 6-month follow-up at dual antiplatelet treatment. The noneffectiveness of clopidogrel in the TAVI population raises the question of the routine use of dual antiplatelet treatment in this setting.

scholarly journals P964 Assessment of long-term durability of transcatheter implanted aortic valves - structural and nonstructural deteriorations in 5 years follow-up

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H Linkova ◽  
R Petr ◽  
E Paskova ◽  
V Kocka ◽  
P Tousek
Keyword(s):  
Young Patients ◽  
Transcatheter Aortic Valve ◽  
Clinical Complications ◽  
Structural Deterioration ◽  
Significant Difference ◽  
Before And After ◽  
Echocardiographic Examination ◽  
Valve Implantation

Abstract Introduction Transcatheter aortic valve implantation (TAVI) is the method of choice for patient with a significant stenosis (AS) who are contraindicated for cardio-surgical procedure. Medium – term results of TAVI are comparable with results observed for surgical replacements. There is limited knowledge of structural, nonstructural and clinical complications in five years follow-up which could contribute to TAVI indication for implantation in young patients. Goal. The aim of this study is to assess structural and non-structural deterioration of TAVI prosthesis by echocardiography and clinical evaluation at 5 years follow-up. Methods By the end of 2013, 112 patients were implanted TAVI in our center( average age, 80,4 ± 7,2 y, 53(47% ) males. All patients underwent both clinical and echocardiographic examination once a year and underwent native CT after five year. We analysed mortality, structural and non- structural deteriorations, and standard echocardiographic parameters before and after implantation, and at 5 years follow-up. Results 5-years mortality was 58%. There was not a statistically significant difference in age between the patients who survive and who died (80,2 ±7,3 vs 80,6 ± 7,3 p = 0.77) ,they had similar logistic EUROSCORE (17,0 ± 12,4 vs 16,9 ± 15,0, p = 0,96) and EF 53,8 ± 11,1 vs 52,3 ± 11,7,p= 0,51) before the procedure. 48 patients underwent the five years follow –up. Only one patient had to undergo reTAVI due to the earlier prosthetic degeneration. The average EOA was 1,88 ± 0,33 cm2), the average V max. after five years was 1,8 ± 0,4 m/s, PG max 13,6 ± 6,2 mm Hg a PG mean 8 ± 3,6 mm Hg ( no significant increase in time),Post procedural paravalvular regurgitation ≥ 2/4 appeared in 14 % patients. Twenty –three patients underwent CT scan which resulted in Agaston score O on TAVI replacement in 19(83 %) patients. Conclusion After 5 years follow-up, low rates of structural and nonstructural deterioration after TAVI were noted, suggesting good long- term durability.

One-year echocardiographic outcomes of transcatheter aortic valve implantation with or without predilatation of the aortic valve: insights from the multicenter, randomized DIRECT trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Karmpalioti ◽  
G Benetos ◽  
M Drakopoulou ◽  
M Xanthopoulou ◽  
K Stathogiannis ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Funding Source ◽  
Aortic Valve Area ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation

Abstract Introduction Transcatheter aortic valve implantation (TAVI) has become the standard of care for high-risk and inoperable surgical patients and a valid alternative in intermediate-risk patients with severe aortic stenosis.The DIRECT trial (Predilatation in Transcatheter Aortic Valve Implantation Trial) was a multicenter, randomized, clinical trial designed to evaluate the safety and efficacy of TAVI with or without balloon aortic valvuloplasty (BAV) in patients with symptomatic, severe aortic valve stenosis. Purpose To compare the one year echocardiographic findings among patients, who underwent TAVI using a self-expanding valve with or without BAV. Methods A total of 171 patients with severe aortic stenosis were randomly assigned at 4 tertiary centers to undergo TAVI with the use of self-expanding prostheses with (pre-BAV) or without pre-dilatation (no-BAV). Follow up transthoracic echocardiography was performed 1 year after TAVI. Results Of 171 patients, 86 patients were randomized to pre-BAV group and 85 to no-BAV group. One year echocardiographic follow up was available in 146 patients. In one year follow up there was no significant difference between pre-BAV and no-BAV group in aortic valve area (1.84±0.39cm2 vs. 1.85±0.44cm2, p=0.79), peak aortic valve gradient (15.95±9.97 mmHg vs. 14.51±6.60 mmHg, p=0.35), mean aortic valve gradient (8.37±5.01 mmHg vs. 7.99±4.04 mmHg, p=0.64), aortic valve peak velocity (1.90±0.51 m/s vs. 1.80±0.42m/s, p=0.24), ejection fraction (54.19±8.36% vs. 53.19±9.58%, p=0.52) and pulmonary artery systolic pressure (41.86±14.34 mmHg vs. 40.71±12.40 mmHg, p=0.64). The incidence of moderate or severe paravalvular regurgitation (PVL) in 1 year follow up was 6.2% without significant difference between the 2 study groups (5.7% in the no-BAV group vs. 6.6% in the pre-BAV group, p=0.83). Conclusions Direct transcatheter aortic valve implantation has no impact on one-year prosthesis function and PVL in patients undergoing TAVI with self-expanding valve Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic

P3722Platelet reactivity changes following transcatheter aortic valve implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Z Ostojic ◽  
J Samardzic ◽  
V Reskovic Luksic ◽  
S Pavasovic ◽  
B Skoric ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Time Course ◽  
Platelet Reactivity ◽  
Transcatheter Aortic Valve ◽  
Heparin Administration ◽  
Number Of Patients ◽  
Significant Difference ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Introduction Although recent studies described changes in platelet reactivity (PR) in days following transcatheter aortic valve implantation (TAVI), precise time course and duration of these changes have not been fully investigated. Purpose To investigate PR changes during and after TAVI. Methods Study included 42 consecutive patients with severe and symptomatic aortic stenosis undergoing TAVI procedure in our institution. Patients' clinical characteristics were collected from medical records. All patients who did not have chronic dual antiplatelet therapy received loading dose of aspirin and clopidogrel (300 mg) one day before the procedure followed by their standard maintenance doses for next three months. PR was measured in six time points: just before induction of anaesthesia (T1), after heparin administration (T2), at the end of procedure (T3), and on 3rd, 6th and 30th postoperative day (T4–6). PR was measured using impedance aggregometer (Multiplate® analyzer, Roche, Munich, Germany) in response to three platelet aggregation agonists: arachidonic acid (ASPItest), ADP (ADPtest) and thrombin receptor activating peptide-6 (TRAPtest). Results Mean patient age was 82.1 years with majority of patients being male 57.1% (N=24). Mean valve area and mean transvalvular gradient prior to procedure were 0.71±0.21 cm2 and 49.1±18.7 mmHg, respectively. All patients underwent successful TAVI procedure using either self-expandable (N=25, 59.5%) or balloon-expandable valve. Two patients (4.7%) underwent transapical TAVI, while transfemoral approach was used in all other patients. Mean postimplantation gradient was 10.2±7.1 mmHg. Mean PR on T1 was 24.3±23.1 U for ASPItest, 41.6±26.5 U for ADPtest and 90.1±33.3 U for TRAPtest. There was no significant difference in PR on T2. However, on T3, ignificant reduction of PR in all 3 tests was observed (ASPI 9.4±10.1 U (p=0.001), ADP 23.1±15.0 U (p<0.001) and TRAP 64.5±27.3 U (p<0.001)). Lowest PR values for all tests were reached on T4, after which incline in PR has been observed. On T5, value of ASPItest reached levels not significantly different to those on T1 (15.1±17.2 U, p=0.13), while ADPtest and TRAPtest remained significantly lower (27.3±18.5 U, p=0.007 and 68.6±33.2 U, p=0.003, respectively). All PR values returned to initial levels on T6 (figure 1). Conclusions Our results show that successful TAVI procedure induces transient decrease in PR regardless of the platelet activation pathway. These findings add new knowledge in understanding complexed relations in intravascular milieu following TAVI. Further research on a larger number of patients is needed to confirm and asses clinical significance of these results. Acknowledgement/Funding Croatian Science Foundation

scholarly journals Coagulation derangement and risk factors for valve thrombosis following transcatheter aortic valve implantation

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001496
Author(s):  
Tiffany Patterson ◽  
Harriet Hurrell ◽  
Jack Lee ◽  
Giulia Esposito ◽  
Utkarsh Dutta ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Reference Range ◽  
Multivariable Analysis ◽  
Single Centre ◽  
Transcatheter Aortic Valve ◽  
Coagulation Testing ◽  
Valve Thrombosis ◽  
Valve Implantation ◽  
Transfemoral Tavi

AimsDurability of transcatheter aortic valve implantation (TAVI) is key to its expansion. We sought to identify incidence of valve thrombosis and predictors of valve thrombosis in our single centre with associated coagulation testing pre-TAVI and post-TAVI.Methods and resultsThis single-centre observational study comprised patients undergoing transfemoral TAVI discussed in the Heart Team meeting . Patients were followed up with echocardiography at 120 days to identify incidence of elevated transvalvular gradient and multivariable analysis was performed to identify factors associated with an increased odds of developing valve thrombosis. In addition, 11 patients underwent baseline, day 1 and day 120 post-TAVI coagulation testing. Between August 2017 and August 2019, 437 consecutive patients underwent transfemoral TAVI. Of these patients, 207/437 (47.4%) had 3-month follow-up echo data available and were analysed. Of these patients, 26/207 (12.6%) had elevated transvalvular gradients. These patients tended to be younger (80±14 vs 83±6 years; p=0.047) with a lower ejection fraction (49±13 vs 54%±11%; p=0.021), with a greater proportion of the population experiencing atrial fibrillation (14/21, 54% vs 68/181, 38%; p=0.067). Following multivariable analysis, there remained a trend towards higher eccentricity index associated with elevated gradients. Baseline (pre-TAVI) elevation of thrombin antithrombin levels (56±63; reference range 1.0–4.1 ng/L) and PF 1+2 (791±632; reference range 69–229 ng/mL) normalised at 120 days post-TAVIConclusionThis study demonstrated that in the cohort of patients undergoing transfemoral TAVI in our centre: younger age, poor ejection fraction, atrial fibrillation and increased baseline eccentricity of the aortic valve annulus were present to a greater extent in patients exhibiting elevated transvalvular gradients at 3-month follow-up. Further work is required to delineate the extent of coagulation derangement and confirm predictors of thrombosis.

scholarly journals The Usefulness of [18F]F-Fluorodeoxyglucose and [18F]F-Sodium Fluoride Positron Emission Tomography Imaging in the Assessment of Early-Stage Aortic Valve Degeneration after Transcatheter Aortic Valve Implantation (TAVI)—Protocol Description and Preliminary Results

2021 ◽  
Vol 10 (3) ◽  
pp. 431
Author(s):  
Danuta Sorysz ◽  
Rafał Januszek ◽  
Anna Sowa-Staszczak ◽  
Anna Grochowska ◽  
Marta Opalińska ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Emission Tomography ◽  
Effective Orifice Area ◽  
Orifice Area ◽  
Transcatheter Aortic Valve ◽  
Positron Emission ◽  
Pet Ct ◽  
Transvalvular Gradient ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) is now a well-established treatment for severe aortic stenosis. As the number of procedures and indications increase, the age of patients decreases. However, their durability and factors accelerating the process of degeneration are not well-known. The aim of the study was to verify the possibility of using [18F]F-sodium fluoride ([18F]F-NaF) and [18F]F-fluorodeoxyglucose ([18F]F-FDG) positron emission tomography/computed tomography (PET/CT) in assessing the intensity of TAVI valve degenerative processes. In 73 TAVI patients, transthoracic echocardiography (TTE) at initial (before TAVI), baseline (after TAVI), and during follow-up, as well as transesophageal echocardiography (TEE) and PET/CT, were performed using [18F]F-NaF and [18F]F-FDG at the six-month follow-up (FU) visit as a part of a two-year FU period. The morphology of TAVI valve leaflets were assessed in TEE, transvalvular gradients and effective orifice area (EOA) in TTE. Calcium scores and PET tracer activity were counted. We assessed the relationship between [18F]F-NaF and [18F]F-FDG PET/CT uptake at the 6 = month FU with selected indices e.g.,: transvalvular gradient, valve type, EOA and insufficiency grade at following time points after the TAVI procedure. We present the preliminary PET/CT ([18F]F-NaF, [18F]F-FDG) results at the six-month follow-up period as are part of an ongoing study, which will last two years FU. We enrolled 73 TAVI patients with the mean age of 82.49 ± 7.11 years. A significant decrease in transvalvular gradient and increase of effective orifice area and left ventricle ejection fraction were observed. At six months, FU valve thrombosis was diagnosed in four patients, while 7.6% of patients refused planned controls due to the COVID-19 pandemic. We noticed significant correlations between valve types, EOA and transaortic valve gradients, as well as [18F]F-NaF and [18F]F-FDG uptake in PET/CT. PET/CT imaging with the use of [18F]F-FDG and [18F]F-NaF is intended to be feasible, and it practically allows the standardized uptake value (SUV) to differentiate the area containing the TAVI leaflets from the SUV directly adjacent to the ring calcifications and the calcified native leaflets. This could become the seed for future detection and evaluation capabilities regarding the progression of even early degenerative lesions to the TAVI valve, expressed as local leaflet inflammation and microcalcifications.

Safety and Efficacy of Different Antithrombotic Strategies After Transcatheter Aortic Valve Implantation: A Network Meta-Analysis

2021 ◽  
Author(s):  
Eliano Pio Navarese ◽  
Leonardo Grisafi ◽  
Enrico Spinoni ◽  
Marco Giovanni Mennuni ◽  
Andrea Rognoni ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Antiplatelet Therapy ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Transcatheter Aortic Valve ◽  
Safety Endpoint ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Background. The optimal pharmacological therapy after transcatheter aortic valve implantation (TAVI) remains uncertain. We compared efficacy and safety of various antiplatelet and anticoagulant approaches after TAVI by a network meta-analysis. Methods. A total of 14 studies (both observational and randomized) were considered, with 24,119 patients included. Primary safety endpoint was the incidence of any bleeding complications during follow-up. Secondary safety endpoint was major bleeding. Efficacy endpoints were stroke, myocardial infarction and cardiovascular mortality. A frequentist network meta-analysis was conducted with a random-effects model. The following strategies were compared: dual antiplatelet therapy (DAPT), single antiplatelet therapy (SAPT), oral anticoagulation (OAC), OAC+SAPT. Mean follow-up was 15 months. Results. In comparison to DAPT, SAPT was associated with a 44% risk reduction of any bleeding (OR, 0.56 [95% CI, 0.39-0.80]). SAPT was ranked as the safest strategy for the prevention of any bleeding (P-score, 0.704), followed by OAC alone (P-score, 0.476) and DAPT (P-score, 0.437). Consistent results were observed for major bleeding. The incidence of cardiovascular death and secondary ischemic endpoints did not differ among the tested antithrombotic approaches. In patients with indication for long-term anticoagulation, OAC alone showed similar rates of stroke (OR 0.92 [95% CI 0.41-2.05], p=0.83) and reduced occurrence of any bleeding (OR 0.49 [95% CI 0.37-0.66], p<0.01) vs OAC+SAPT. Conclusions. The present network meta-analysis supports after TAVI the use of SAPT in patients without indication for OAC and OAC alone in those needing long-term anticoagulation.

P1136Is there a negative impact of permanent pacemaker implantation in long-term outcomes after transcatheter aortic valve implantation?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T J Carvalho Mendonca ◽  
L Patricio ◽  
M Oliveira ◽  
I Rodrigues ◽  
G Portugal ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Cardiovascular Mortality ◽  
Total Mortality ◽  
Permanent Pacemaker ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Introduction Transcatheter aortic valve implantation (TAVI) is an established treatment in patients (P) with aortic stenosis. Despite the continuous developments of this procedure, high-grade conduction disturbances requiring permanent pacemaker (PPM) implantation is still a major and common complication of TAVI. Furthermore, long-term chronic right ventricular pacing has been associated with negative effects on ventricular function and heart failure (HF). Aim   to evaluate the long-term impact of PPM after TAVI focusing on mortality and HF hospitalization. Methods  We retrospectively examined P who underwent TAVI with a self-expanding valve from 2009 to 2018 at our institution. All P had pre-procedural clinical evaluation, including ECG, cardiac computed tomographic angiography and transthoracic echocardiography. P with previous PPM were excluded. Results  265P (57% male, mean age 81.4 years, 20% with left ventricular ejection fraction &lt;40%) were analysed. Mean STS score and mean Euroscore II were 6.33% and 7.07%, respectively. Mean transvalvular gradient was 52.78 mmHg and mean aortic valve area 0.67 cm2. Forty-seven P (17%) underwent PPM implantation during the first 30 days after TAVI. P requiring PPM had higher prevalence of diabetes mellitus, chronic renal disease, atrial fibrillation and right bundle branch block. During a mean follow-up of 20.3 months, post-TAVI PPM was associated with similar mortality rate (29.8% vs. 25.6%, HR 1.28, 95% CI 0.72-2.29, p = 0.42) and similar cardiovascular mortality (9.8% vs. 6.4%, HR 0.72, 95% CI 0.21-2.4, p = 0.59) compared to P without PPM. There were no significant differences in HF hospitalization (4.9% vs. 2.4%, p = 0.47). Kaplan-Meier curves of total mortality and cardiovascular mortality according to the need for PPM post-TAVI were similar.  Conclusions  In P submitted to TAVI, PPM implantation is a relatively common finding, not associated with higher risk of total mortality, cardiovascular mortality or HF hospitalization in a long-term follow-up.

scholarly journals Incidental abnormal CT scan findings during transcatheter aortic valve implantation assessment: incidence and implications

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000855 ◽  
Author(s):  
Akshay Patel ◽  
Kajan Mahendran ◽  
Michael Collins ◽  
Mahmoud Abdelaziz ◽  
Saib Khogali ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Ct Scan ◽  
Clinical Significance ◽  
Transcatheter Aortic Valve Implantation ◽  
Incidental Findings ◽  
Mortality Data ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
Aortic Valve Implantation ◽  
Valve Implantation

ObjectivesThe aim of this retrospective series is to describe the prevalence and clinical significance of the incidental findings found during pre–transcatheter aortic valve implantation (TAVI) work-up and to ascertain the clinical course of such patients.MethodsConsecutive patients undergoing TAVI from 2013 to 2015 where a TAVI CT assessment was performed (n=138) were included in the study. All incidental findings that were not expected from the patient’s history were discussed at the TAVI multidisciplinary meeting in order to ascertain the clinical significance of said findings and whether they would alter the proposed course of treatment. Mortality data were determined by careful retrospective case note and follow-up appointment analysis.ResultsSeventy-eight patients (57%) were found to have incidental findings on pre-TAVI CT scan. The majority of patients had benign pathology with high incidence in particular of diverticular disease, pleural effusions, gallstones, hiatus hernia and degenerative spinal disease. Vascular pathology such as superior mesenteric, renal and iliac artery stenoses and abdominal aortic aneurysm was detected in seven patients. In terms of long-term mortality data, we found no significant difference between those with incidental findings and those without (p=0.48). Survival as assessed by Kaplan-Meier analysis showed no significant difference between those with and without incidental abnormal CT scan findings (p=0.98).ConclusionsIncidental findings with potential for malignancy are common in an elderly, comorbid population. Ultimately, clinical correlation and prognosis must be swiftly ascertained in order to streamline the patients down the appropriate management pathway while avoiding unnecessary delay for treatment of their aortic stenosis.

scholarly journals A case of percutaneous coronary intervention after transfemoral implantation of a Medtronic CoreValve System™

2015 ◽  
Vol 76 (4) ◽  
Author(s):  
Nicola Corcione ◽  
Paolo Ferraro ◽  
Michele Polimeno ◽  
Stefano Messina ◽  
Vincenzo De Rosa ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Coronary Atherosclerosis ◽  
Aortic Valve Disease ◽  
Coronary Intervention ◽  
Transcatheter Aortic Valve ◽  
Percutaneous Coronary ◽  
Medtronic Corevalve ◽  
Valve Implantation

The association between aortic valve disease and coronary atherosclerosis is common. In the recent era of transcatheter aortic valve implantation there is little experience with coronary artery intervention after valve implantation. We report a case of a 80 year-old male who underwent successful coronary artery intervention few months after a Medtronic CoreValve System ™ percutaneous implantation for severe aortic valve stenosis. Verification of the position of the used wires (crossing from inside the self expanding frame) is of utmost importance before proceeding to coronary intervention. In this case, crossing the aortic valve, coronary angiography and percutaneous coronary intervention were successfully performed. In conclusion, percutaneous coronary intervention in patients with previous Medtronic CoreValve System ™ implantation is feasible and safe.

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