Outcomes and complications of transcatheter aortic valve replacement using a balloon expandable valve according to the Valve Academic Research Consortium (VARC) guidelines

2011 ◽  
Vol 7 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Ronen Gurvitch ◽  
Stefan Toggweiler ◽  
Alexander Willson ◽  
Namal Wijesinghe ◽  
Anson Cheung ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Academic Research ◽  
Transcatheter Aortic Valve ◽  
Research Consortium

scholarly journals Comparison between Surgical Access and Percutaneous Closure Device in 787 Patients Undergoing Transcatheter Aortic Valve Replacement

2021 ◽  
Vol 10 (7) ◽  
pp. 1344
Author(s):  
Dennis Eckner ◽  
Francesco Pollari ◽  
Giuseppe Santarpino ◽  
Jürgen Jessl ◽  
Johannes Schwab ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Academic Research ◽  
Peripheral Artery ◽  
Transcatheter Aortic Valve ◽  
Surgical Access ◽  
Artery Disease ◽  
Research Consortium

Background: The vascular access in transcatheter aortic valve replacement (TAVR) was initially dominated by a surgical approach. Meanwhile, percutaneous closure systems became a well-established alternative. The aim of this study was to compare the clinical outcome between the two approaches. Methods: In this retrospective study, we observed 787 patients undergoing a TAVR-Procedure between 2013 and 2019. Of those, 338 patients were treated with surgical access and 449 with the Perclose ProGlide™-System (Abbott, Chicago, IL, USA). According to the Bleeding Academic Research Consortium (BARC) and Valve Academic Research Consortium (VARC) criteria, the primary combined endpoints were defined. Results: Overall hospital mortality was 2.8% with no significant difference between surgical (3.8%) and percutaneous (2.2%) access (p = 0.182). Major vascular complications or bleeding defined as the primary combined endpoint was not significantly different in either group (Surgical group 5.3%, ProGlide group 5.1%, p = 0.899). In the ProGlide group, women with pre-existing peripheral artery disease (PAD) were significantly more often affected by a vascular complication (p = 0.001 for female sex and p = 0.03 for PAD). Conclusions: We were able to show that the use of both accesses is safe. However, the surgical access route should also be considered in case of peripheral artery disease.

Aortic Angulation Does Not Impact Outcomes in Self-Expandable or Balloon-Expandable Transcatheter Aortic Valve Replacement

Cardiology ◽  
2018 ◽  
Vol 140 (2) ◽  
pp. 96-102
Author(s):  
Adham Elmously ◽  
Katherine D. Gray ◽  
Quynh A. Truong ◽  
Aaron Burshtein ◽  
S. Chiu Wong ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Academic Research ◽  
Multivariate Logistic Regression Analysis ◽  
Tertiary Referral Center ◽  
Transcatheter Aortic Valve ◽  
Wide Range

Objectives: The role of aortic angulation in attenuating procedural success in balloon-expandable (BE) and self-expandable (SE) transcatheter aortic valve replacement (TAVR) has been controversial. Methods: We retrospectively assessed patients undergoing SE and BE TAVR who had an aortic angle measured on multidetector computed tomography at a single tertiary referral center. The primary outcome was device success, measured per the Valve Academic Research Consortium-2 criteria. Clinical outcomes at 30 days (including mortality) were also assessed. Results: A total of 251 patients were identified; 182 patients received a BE valve and 69 patients an SE valve. The median aortic angle was 46.8° (range 24.4–70°) in the BE group and 43.3° (range 20–71°) in the SE group. In multivariate logistic regression analysis, aortic angulation did not affect device success. Mortality at 30 days and 12 months and postprocedural clinical outcomes were similarly not associated with aortic angulation. Conclusion: In this cohort of patients undergoing BE and SE TAVR over a wide range of aortic angles, we found no associations between angle and device success or any other clinical metrics. Increased aortic angulation does not adversely affect outcomes in BE or SE TAVR.

Transcatheter Aortic Valve Replacement for a Degenerated Transcatheter Valve—A Single Center Experience

2021 ◽  
Author(s):  
Magdalena Erlebach ◽  
Hendrik Ruge ◽  
Ruediger Lange
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Academic Research ◽  
Vascular Complication ◽  
Complication Rates ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Transcatheter Valve

Abstract Background The transcatheter valve-in-valve treatment (TAV-in-TAV) of degenerated transcatheter aortic valves is becoming more relevant, as the use of transcatheter aortic valve replacement (TAVR) increases. We report our experience with TAV-in-TAV in patients with a degenerated transcatheter heart valve (THV). Methods We retrospectively analyzed prospectively collected data from our designated TAVR database. Intraprocedural and intrahospital outcomes were reported. Results Ten patients out of a total of 3,144 TAVR implantations since 2007 presented with a degenerated THV, among those six with an Edwards Sapien XT (Edwards Lifesciences, Irvine, California, United States) valve, treated with a Medtronic Evolut R (Medtronic, Dublin, Ireland) valve. Four patients had severe stenosis, one pure insufficiency, and five combined stenosis and insufficiency. Average time between initial implantation and re-intervention was 6.8 ± 1.3 years. The mean preoperative maximum and mean gradients were 54.2 ± 14.8 mm Hg and 31.6 ± 9.9 mm Hg, respectively. Nine patients underwent transfemoral and one patient underwent transaortic TAV-in-TAV. Mean procedural time was 86.2 ± 51.5 minutes. Post-implantation, the maximum and mean gradients decreased to 18 ± 6.9 mm Hg and 8.4 ± 3.2 mm Hg (16 ± 8 mm Hg and 6.4 ± 1.7 mm Hg in the Evolut-in-Sapien subgroup), respectively. The valve area increased from 0.98 ± 0.28 mm Hg to 1.72 ± 0.32 mm Hg (0.8 ± 0.07 mm Hg to 1.9 ± 0.16 mm Hg in the Evolut-in-Sapien subgroup). Two patients experienced a vascular complication. No further Valve Academic Research Consortium-2 criteria complications occurred during hospitalization. Conclusion TAV-in-TAV resulted in low procedural and peri-procedural complication rates. In particular, the usage of a supra-annular valve resulted in excellent hemodynamic results. Larger studies are required to validate this observational data and to establish a protocol for this procedure.

scholarly journals Rate, correlates, and outcomes of hemodynamic valve deterioration after transcatheter aortic valve replacement

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Nitsche ◽  
D M Mutschlechner ◽  
M K Koschutnik ◽  
C D Dona ◽  
V D Dannenberg ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Cox Regression ◽  
Academic Research ◽  
Outcome Analysis ◽  
Aortic Valves ◽  
Transcatheter Aortic Valve ◽  
Hemodynamic Performance

Abstract Objectives Treatment expenditure of transcatheter aortic valve replacement (TAVR) to younger individuals may potentially be limited by valve durability. Long-term hemodynamic performance of transcatheter aortic valves is not well documented. This study sought to determine the incidence, predisposing factors and outcomes of hemodynamic valve deterioration (HVD) after TAVR. Methods Consecutive patients undergoing TAVR between May 2007 and December 2018 (67.0% Sapien, 14.6% Evolut, 6.8% Acurate, 6.8% Portico, 4.8% other) were prospectively studied. Baseline assessment included echocardiography, laboratory, and clinical assessment. Echocardiographic and laboratory follow-up after TAVR was performed prior to discharge, at 3 and 12 months, and yearly thereafter. HVD was defined by Doppler assessment according to Valve Academic Research Consortium 3 criteria as a ≥10 mm Hg increase in mean gradient to ≥20 mm Hg OR worsening of (para-)prosthetic regurgitation ≥1/3 class to ≥moderate. The primary endpoint was the incidence of HVD. All-cause mortality served as secondary endpoint. Multivariate cox regression was used for outcome analysis. Results 649 patients (82.2±6.7 y/o, 55.5% female, EuroSCORE II 4.4±1.0) were analyzed. Among survivors with available echo data from ≥2 follow-ups (n=382), the incidence of HVD was 6.8% (n=26; 4.1% per valve-year), with no difference between valve types. Modes of HVD were stenosis (n=8), regurgitation (n=14), and both (n=4). Median time to HVD was 14.2 months (interquartile range, 9.4 to 35.0 months), and was significantly shorter in patients in the highest age quartile (Q4 vs. Q1–3: log-rank, p<0.01, Figure). Also, increased age was the only factor that independently predisposed for HVD (Q4 vs. Q1–3: adjusted hazard ratio [adj HR]: 2.86, 95% confidence interval [CI]: 1.30–6.30, p<0.01). Following TAVR, 355 patients (54.7%) had died after 64.2±31.9 months. Independent predictors of mortality were (para-)prosthetic regurgitation >mild at discharge (HR: 1.58, 95% CI: 1.21–2.06, p<0.001), male sex (HR: 1.57, 95% CI: 1.24–2.00, p<0.001), baseline NT-proBNP serum levels (graded into quartiles, HR: 1.31, 95% CI: 1.17–1.46, p<0.001), and diabetes (HR: 1.38, 95% CI: 1.08–1.76, p=0.011), but not time-dependent HVD (p>0.05, Figure). Conclusion This study reports good hemodynamic performance of transcatheter aortic valves up to 8 years following intervention. The incidence of HVD, which may develop over time – especially in the elderly –, is low and does not impact survival. Conversely, (para-)prosthetic regurgitation early after TAVR conveys detrimental prognostic implications and needs to be avoided – particularly in younger patients. FUNDunding Acknowledgement Type of funding sources: None. Hemodynamic valve deterioration in TAVR

scholarly journals Durability of Transcatheter Heart Valves: Standardized Definitions and Available Data

2021 ◽  
Vol 10 (18) ◽  
pp. 4180
Author(s):  
Ines Richter ◽  
Holger Thiele ◽  
Mohamed Abdel-Wahab
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Valves ◽  
Academic Research ◽  
Surgical Aortic Valve Replacement ◽  
Factors Affecting ◽  
Transcatheter Aortic Valve ◽  
Research Consortium

Transcatheter aortic valve replacement is a well-established alternative to surgical aortic valve replacement in high-risk patients with severe symptomatic aortic stenosis. Currently, this technique is shifting towards younger patient groups with intermediate- and low-risk profile, which raises the question about long-term durability. Despite acceptable results up to 5 years, little is currently known about valve performance beyond 5 years. Since valve deterioration, thrombosis and endocarditis seem to be the main factors affecting valve durability, precise and widely accepted definitions of these parameters were stated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in 2017, followed by the Valve in Valve International Data (VIVID) group definitions in 2018 and the Valve Academic Research Consortium 3 (VARC-3) definitions in 2021. Until the introduction of these definitions, interstudy comparisons were difficult due to missing uniformity. Since the release of these recommendations, an increasing number of studies have reported their data on long-term durability using these new criteria. The aim of the present article is to discuss the current definitions on bioprosthetic valve durability, and to summarize the available data on long-term durability of transcatheter aortic valves.

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