scholarly journals The Impact of Aortic Valvular Calcium on Transcatheter Heart Valve Distortion

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Akihiro Nakajima ◽  
Toru Naganuma ◽  
Haruhito Yuki ◽  
Hirokazu Onishi ◽  
Tatsuya Amano ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Heart Valve ◽  
Severe Aortic Stenosis ◽  
Calcium Score ◽  
Paravalvular Leak ◽  
Transcatheter Heart Valve ◽  
The Difference ◽  
The Impact ◽  
The Relationship

Objectives. To investigate the relationship between the eccentric calcification of aortic valve and transcatheter heart valve (THV) distortion and the impact of THV distortion on echo parameters and clinical outcomes. Background. The effects of eccentric calcification of the aortic valve on the THV distortion and the relationship between THV distortion and clinical impact were not fully understood. Methods. Patients with symptomatic severe aortic stenosis who were undergoing THV implantation were enrolled. Patients underwent preprocedural, postprocedural multislice computed tomography (MSCT), and follow-up transthoracic echocardiogram (TTE). Delta calcium score (ΔCS) is defined as the difference between the maximum and minimal calcium scores of the three cusps, while valve distortion score (VDS) is defined as the difference between the longest and shortest stent frame, as obtained using MSCT. Patients were divided into two groups according to ΔCS: “noneccentric calcification group” and “eccentric calcification group.” Results. A total of 118 patients were enrolled (59 patients in noneccentric and 59 in eccentric calcification groups). VDS was significantly lower in the noneccentric calcification group than in the eccentric calcification group (1.31 ± 0.82 mm vs. 1.73 ± 0.76 mm, p = 0.004 ). VDS was not associated with the degree of paravalvular leak (PVL) and aortic valvular mean pressure gradient (AVPG) at 30-day and 1-year follow-up TTE and the cumulative rates of all-cause death and rehospitalization at 2-year clinical follow-up. Conclusions. Eccentric valvular calcification was associated with longitudinal THV distortion. However, THV distortion was not associated with PVL, AVPG, and adverse clinical events during midterm follow-up.

scholarly journals Aortic valve function post-replacement of severe aortic stenosis by transcatheter procedure versus surgery: a systematic review and metanalysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Charbel Abi Khalil ◽  
Barbara Ignatiuk ◽  
Guliz Erdem ◽  
Hiam Chemaitelly ◽  
Fabio Barilli ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Randomized Clinical Trials ◽  
Severe Aortic Stenosis ◽  
Paravalvular Leak ◽  
Effective Orifice Area ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Heart Valve

AbstractTranscatheter aortic valve replacement (TAVR) has shown to reduce mortality compared to surgical aortic valve replacement (sAVR). However, it is unknown which procedure is associated with better post-procedural valvular function. We conducted a meta-analysis of randomized clinical trials that compared TAVR to sAVR for at least 2 years. The primary outcome was post-procedural patient-prosthesis-mismatch (PPM). Secondary outcomes were post-procedural and 2-year: effective orifice area (EOA), paravalvular gradient (PVG) and moderate/severe paravalvular leak (PVL). We identified 6 trials with a total of 7022 participants with severe aortic stenosis. TAVR was associated with 37% (95% CI [0.51–0.78) mean RR reduction of post-procedural PPM, a decrease that was not affected by the surgical risk at inclusion, neither by the transcatheter heart valve system. Postprocedural changes in gradient and EOA were also in favor of TAVR as there was a pooled mean difference decrease of 0.56 (95% CI [0.73–0.38]) in gradient and an increase of 0.47 (95% CI [0.38–0.56]) in EOA. Additionally, self-expandable valves were associated with a higher decrease in gradient than balloon ones (beta = 0.38; 95% CI [0.12–0.64]). However, TAVR was associated with a higher risk of moderate/severe PVL (pooled RR: 9.54, 95% CI [5.53–16.46]). All results were sustainable at 2 years.

scholarly journals Numerical Parametric Study of Paravalvular Leak Following a Transcatheter Aortic Valve Deployment Into a Patient-Specific Aortic Root

2018 ◽  
Vol 140 (10) ◽  
Author(s):  
Wenbin Mao ◽  
Qian Wang ◽  
Susheel Kodali ◽  
Wei Sun
Keyword(s):  
Aortic Valve ◽  
Computational Model ◽  
Aortic Root ◽  
Paravalvular Leak ◽  
Patient Specific ◽  
Fe Method ◽  
Transcatheter Aortic Valve ◽  
Operative Planning ◽  
The Difference ◽  
The Impact

Paravalvular leak (PVL) is a relatively frequent complication after transcatheter aortic valve replacement (TAVR) with increased mortality. Currently, there is no effective method to pre-operatively predict and prevent PVL. In this study, we developed a computational model to predict the severity of PVL after TAVR. Nonlinear finite element (FE) method was used to simulate a self-expandable CoreValve deployment into a patient-specific aortic root, specified with human material properties of aortic tissues. Subsequently, computational fluid dynamics (CFD) simulations were performed using the post-TAVR geometries from the FE simulation, and a parametric investigation of the impact of the transcatheter aortic valve (TAV) skirt shape, TAV orientation, and deployment height on PVL was conducted. The predicted PVL was in good agreement with the echocardiography data. Due to the scallop shape of CoreValve skirt, the difference of PVL due to TAV orientation can be as large as 40%. Although the stent thickness is small compared to the aortic annulus size, we found that inappropriate modeling of it can lead to an underestimation of PVL up to 10 ml/beat. Moreover, the deployment height could significantly alter the extent and the distribution of regurgitant jets, which results in a change of leaking volume up to 70%. Further investigation in a large cohort of patients is warranted to verify the accuracy of our model. This study demonstrated that a rigorously developed patient-specific computational model can provide useful insights into underlying mechanisms causing PVL and potentially assist in pre-operative planning for TAVR to minimize PVL.

Abstract 11653: The Qualitative Grading of Aortic Valve Calcification in Severe Aortic Stenosis is Weakly Associated With Aortic Valve Weight and is Gender Dependent

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Dragos Alexandru ◽  
Florentina Petillo ◽  
Simcha Pollack ◽  
Nathaniel Reichek ◽  
Eddy Barasch
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Pearson Correlation ◽  
Calcium Score ◽  
Aortic Valve Calcification ◽  
Test Analysis ◽  
Valve Calcification ◽  
Exact Test ◽  
The Difference

Background: In severe aortic stenosis (AS), qualitative estimation of aortic valve calcification (AVC) burden by echocardiography has diagnostic and prognostic value. Hypothesis: there is a weak association between a qualitative calcium score (QCS) by TEE and AV weight in severe AS. Methods: Between 2010-2014, of 719 pts who underwent surgical AVR for isolated severe AS, QCS was feasible in 483 (67%): mean age 76.7 ± 9.5 yrs, 59% males, EF 56 ±12%, AVAi 0.35 ±0.09 cm2/m2, AVW 2.45 ± 0.09 g, QCS 3.5± 0.57, 11% bicuspid valves . AVC was determined using short- and long-axis views and graded as mild (1) localized, small, nondense calcifications to severe (4) extensive thickening and calcification of all cusps. TEEs were done on the day of surgery and excised valves were weighed. Independent t-test, Fisher’s exact test, analysis of variance, and Pearson correlation were done as appropriate. Results: Intraclass correlations for intra and interobserver variability were 0.76 and 0.53 , respectively.The association between indices of AS severity and AVC burden, is stronger for AVW than for QCS (table).19 pts had QCS = 2, 183 = 3 and 280 = 4. A QCS of 2 to 4 corresponded to an AVW of 1 to 6 g. The correlation between QCS and AVW was 0.11, p=.01, and 0.09, p =.04 when controlling for age, sex and BSA. QCS-AVW association was gender dependent : for females (196), who had a lower severity of stenosis, r=0.23, p=0.001, for males (286), r=0.02, p=.68 with p =.02 for the difference. Conclusions: 1. In severe AS, QCS by TEE has limited reliability with no relationship with AVW in males and a weak one in females. 2. The utilization of QCS in severe AS even when employing TEE is weakly associated with total AVC burden and should probably be replaced by quantitative objective non- echocardiographic methods.

The impact of pain on the course of ADL functioning in patients with dementia

2020 ◽  
Author(s):  
Annelore H van Dalen-Kok ◽  
Marjoleine J C Pieper ◽  
Margot W M de Waal ◽  
Jenny T van der Steen ◽  
Erik J A Scherder ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Score ◽  
Nursing Home Residents ◽  
Linear Regression Models ◽  
Dutch Version ◽  
The Difference ◽  
Item Scores ◽  
The Impact ◽  
The Relationship

Abstract Background Understanding if and how pain influences activities of daily living (ADL) in dementia is essential to improving pain management and ADL functioning. This study examined the relationship between the course of pain and change in ADL functioning, both generally and regarding specific ADL functions. Methods Participants were Dutch nursing home residents (n = 229) with advanced dementia. ADL functioning was assessed with the Katz ADL scale, and pain with the Dutch version of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-D). Changes of PACSLAC-D and Katz ADL scores were computed based on the difference in scores between baseline, 3-month and 6-month follow-up. Multivariate linear regression models were used to assess the relationships between change in pain score, change in total ADL score and specific ADL item scores during follow-up. Results At baseline, residents had a median ADL score of 18 (interquartile range 13–22, range 6–24) and 48% of the residents were in pain (PACSLAC-D ≥ 4). Residents with pain were more ADL dependent than residents without pain. A change in pain score within the first 3 months was a significant predictor for a decline in ADL functioning over the 6-month follow-up (B = 0.10, SE = 0.05, P = 0.045), and specifically, a decline on the items ‘transferring’ over the 6-month follow-up and ‘feeding’ during the first 3 months of follow-up. Conclusions Pain is associated with ADL functioning cross-sectionally, and a change in pain score predicts a decline in ADL functioning, independent of dementia severity. Awareness of (changes in) ADL activities is clearly important and might result in both improved recognition of pain and improved pain management.

scholarly journals First-in-Human Use of the Next-generation ProtEmbo Cerebral Embolic Protection System During Transcatheter Aortic Valve-in-valve Implantation

2021 ◽  
Vol 16 (Supplement 1) ◽  
pp. 1-4
Author(s):  
Dariusz Jagielak ◽  
Radoslaw Targonski ◽  
Dariusz Ciecwierz
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Aortic Regurgitation ◽  
Heart Valve ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Valve In Valve ◽  
Human Use ◽  
Valve Implantation

Cerebral embolic protection (CEP) devices aim to reduce the risk of periprocedural cerebrovascular events during transcatheter aortic valve implantation (TAVI). Here, the authors describe the first-in-human experience with the ProtEmbo Cerebral Protection System (Protembis), a next-generation CEP device, during TAVI. This case is part of a larger European trial evaluating the safety and performance of this device. After deployment of the ProtEmbo in the aortic arch, a first transcatheter heart valve was implanted. Despite postdilatation, moderate to severe aortic regurgitation persisted. The operating team decided to perform a valve-in-valve procedure using a second transcatheter heart valve. The ProtEmbo demonstrated good coverage of all three head vessels and no interaction with TAVI catheters in the aortic arch throughout the entire procedure. No adverse events were observed during hospitalisation or follow-up, and there was a significant reduction in aortic regurgitation at follow-up echocardiography. Despite a challenging overall procedure with presumably high embolic burden, diffusion-weighted MRI at follow-up showed a low number (n=3) and volume (156 mm3) of new hyperintense lesions. The first-in-human use of the ProtEmbo was safe and feasible, despite a challenging TAVI valve-in-valve procedure.

Abstract 13349: Long Term (4 Years) Clinical and Echocardiographic Results of Transcatheter Self-expanding Medtronic Corevalve Device in Patients With Aortic Stenosis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Vassilis Voudris ◽  
Sofia Thomopoulou ◽  
Manolis Vavuranakis ◽  
Maria Kariori ◽  
Christos Stefopoulos ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
The Self ◽  
Paravalvular Leak ◽  
Categorical Variables ◽  
Aortic Valve Area ◽  
Medtronic Corevalve

Introduction: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement for patients (pts) with severe aortic stenosis considered inoperable or at high operative risk. However, little is known about long-term outcomes following TAVI. In this study we assessed the 4-year clinical and echocardiographic outcomes of pts undergoing TAVI with the self expanding Medtronic CoreValve prosthesis. Methods: The 4-year outcomes following successful TAVI with the self-expanding aortic valve device (Medtronic CoreValve) were evaluated in 60 pts (mean age 79+6 years, male 47 %, Logistic Euroscore 28.43+10.93%). Principal outcome measures were death from any cause. An echocardiograpic examination was performed at prespecified intervals of 6 and 12 months, and every year afterwards. Categorical variables were compared using X2 test, and continuous variables using t test. Survival curves were also constructed. Results: All cause mortality at 1, 2, 3, and 4 years was 16.7%, 28.3%, 30%, and 40% respectively. Mean aortic valve gradient decreased from 50.96+18.6 mm Hg pre to 9.22+ 4.6 mm Hg after TAVI (P<0.001) and remained at 15.69+6.3 mm Hg at 4 years (p for post-TAVI trend <0.01). Mean aortic valve area increased from 0.66+ 0.14 cm2 pre to 1.87+0.33 cm2 after TAVI (p<0.001) and remained at 1.23+ 0.25 cm2 at 4 years (p for post-TAVI trend <0.01). Paravalvular leak (minimal to moderate) was observed in 61% of pts post-TAVI; however, there was no case of progression to severe regurgitation at 4 years follow-up. Conclusions: TAVI with the Medtronic CoreValve prosthesis is associated with sustained clinical and functional cardiovascular benefits in inoperable or high-risk patients with symptomatic aortic stenosis up to 4-year follow-up.

scholarly journals Asymptomatic Patients with Severe Aortic Stenosis and the Impact of Intervention

2021 ◽  
Vol 8 (4) ◽  
pp. 35
Author(s):  
Mevlüt Çelik ◽  
Milan Milojevic ◽  
Andras P. Durko ◽  
Frans B. S. Oei ◽  
Edris A. F. Mahtab ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Survival Rates ◽  
Aortic Valve Area ◽  
Term Survival ◽  
Asymptomatic Patients ◽  
History Of ◽  
The Impact

Objectives the exact timing of aortic valve replacement (AVR) in asymptomatic patients with severe aortic stenosis (AS) remains a matter of debate. Therefore, we described the natural history of asymptomatic patients with severe AS, and the effect of AVR on long-term survival. Methods: Asymptomatic patients who were found to have severe AS between June 2006 and May 2009 were included. Severe aortic stenosis was defined as peak aortic jet velocity Vmax ≥ 4.0 m/s or aortic valve area (AVA) ≤ 1 cm2. Development of symptoms, the incidence of AVR, and all-cause mortality were assessed. Results: A total of 59 asymptomatic patients with severe AS were followed, with a mean follow-up of 8.9 ± 0.4 years. A total of 51 (86.4%) patients developed AS related symptoms, and subsequently 46 patients underwent AVR. The mean 1-year, 2-year, 5-year, and 10-year overall survival rates were higher in patients receiving AVR compared to those who did not undergo AVR during follow-up (100%, 93.5%, 89.1%, and 69.4%, versus 92.3%, 84.6%, 65.8%, and 28.2%, respectively; p < 0.001). Asymptomatic patients with severe AS receiving AVR during follow-up showed an incremental benefit in survival of up to 31.9 months compared to conservatively managed patients (p = 0.002). Conclusions: The majority of asymptomatic patients turn symptomatic during follow-up. AVR during follow-up is associated with better survival in asymptomatic severe AS patients.

scholarly journals Device Selection in Patients with Borderline Size Aortic Valve Annulus Undergoing Transcatheter Aortic Valve Implantation

2021 ◽  
Author(s):  
Yeela Talmor-Barkan ◽  
Ran Kornowski ◽  
Noam Bar ◽  
Jeremy Ben-Shoshan ◽  
Hanna Vaknin-Assa ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Pacemaker Implantation ◽  
Paravalvular Leak ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Device Selection ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Transcatheter heart valve (THV) selection for transcatheter aortic valve implantation (TAVI) is crucial to achieve procedural success. Borderline aortic annulus size (BAAS), which allows a choice between two consecutive valve sizes, is a common challenge during device selection. In the present study, we evaluated TAVI outcomes in patients with BAAS according to THV size selection. We performed a retrospective study including patients with severe aortic stenosis (AS) and BAAS, measured by multidetector computed tomography (MDCT), undergoing TAVI with self-expandable (SE) or balloon-expandable (BE) THV from the Israeli multicenter TAVI registry. TAVI outcomes were assessed according to the Valve Academic Research Consortium-2 (VARC-2). Out of 2,352 patients with MDCT measurements, 598 patients with BAAS as defined for at least one THV type were included in the study. In BAAS patients treated with SE-THV, larger THV selection was associated with lower rate of paravalvular leak (PVL), compared to smaller THV (45.3% vs. 64.5%; pv = 0.0038). Regarding BE-THV, larger valve selection was associated with lower post-procedural transvalvular gradients compared to smaller THV (mean gradient: 9.9 ± 3.7mmHg vs. 12.5 ± 7.2mmHg; p = 0.019). Of note, rates of mortality, left bundle branch block, permanent pacemaker implantation, stroke, annular rupture and/or coronary occlusion did not differ between groups. BAAS is common among patients undergoing TAVI. Selection of a larger THV in these patients is associated with lower rates of PVL and better hemodynamic profile in patients implanted with SE and BE-THV, respectively, with no effect on procedural complications.

scholarly journals Predictors of paravalvular leak following implantation of the ACURATE neo transcatheter heart valve: the PREDICT PVL study

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001391
Author(s):  
Miriam Brinkert ◽  
Bart De Boeck ◽  
Simon F Staempfli ◽  
Mathias Wolfrum ◽  
Federico Moccetti ◽  
...  
Keyword(s):  
New York ◽  
Heart Valve ◽  
Patient Selection ◽  
Heart Association ◽  
Transoesophageal Echocardiography ◽  
Paravalvular Leak ◽  
Transcatheter Heart Valve ◽  
Implantation Depth ◽  
Coronary Cusp

ObjectivesReport predictors and the natural course of paravalvular leak (PVL) following implantation of the ACURATE neo transcatheter heart valve (THV).BackgroundUnderstanding the mechanisms of PVL may help to improve patient selection, patient outcomes and the design of next-generation THVs.MethodsA total of 30 patients (mean age 81±5 years, 47% women) undergoing transcatheter aortic valve replacement with the ACURATE neo were enrolled in the PREDICT PVL study. The effective regurgitant orifice area (EROA, in mm2) of PVL was assessed by transthoracic and transoesophageal echocardiography before discharge and at 6 months follow-up.ResultsPVL was none/trace in 10 (33%), mild in 18 (60%) and moderate in 2 (7%) patients and occurred in distinct locations with largest EROAs in the area of the left coronary cusp and its adjacent commissures. Independent predictors for EROA were implantation depth (r coefficient −1.9 mm2 per mm implantation depth, p=0.01), leaflet calcification (6.2 mm2 per calcification grade, p=0.03) and THV size L (7.6 mm2 more than size S or M, p=0.01). At 6 months follow-up, EROA decreased by 29% from 13.7±9.7 mm2 to 9.5±7.9 mm2 (p<0.01). Patients with smaller EROAs were more likely to be in New York Heart Association class 1 than patients with larger EROAs (p<0.01).ConclusionsPVL occurred predominantly in the region of the left coronary cusp and decreased by 29% during 6 months of follow-up. Our results underscore the importance of adequate patient selection and optimal implantation depth.

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