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Journal of the American College of... Jan 2022
Topics: Aortic Valve; Aortic Valve Stenosis; Humans; Transcatheter Aortic Valve Replacement
PubMed: 35027109
DOI: 10.1016/j.jacc.2021.10.039 -
JACC. Cardiovascular Interventions Dec 2021
Topics: Aortic Valve; Aortic Valve Stenosis; Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 34774480
DOI: 10.1016/j.jcin.2021.09.007 -
Journal of the American Heart... Jul 2020
Topics: Aortic Valve; Aortic Valve Stenosis; Coronary Angiography; Humans; Transcatheter Aortic Valve Replacement
PubMed: 32578467
DOI: 10.1161/JAHA.120.017409 -
JACC. Cardiovascular Imaging Feb 2020
Topics: Aortic Valve Stenosis; Humans; Stroke Volume; Systole; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 31005529
DOI: 10.1016/j.jcmg.2019.03.010 -
Archives of Cardiovascular Diseases Mar 2020Until recently, transcatheter aortic valve implantation was restricted to high-risk and inoperable patients. The updated 2017 European Society of Cardiology Guidelines... (Review)
Review
Until recently, transcatheter aortic valve implantation was restricted to high-risk and inoperable patients. The updated 2017 European Society of Cardiology Guidelines has widened the indication to include intermediate-risk patients, based on two recently published trials (PARTNER 2 and SURTAVI). Moreover, two other recent trials (PARTNER 3 and EVOLUT LOW RISK) have demonstrated similar results with transcatheter aortic valve implantation in low-risk patients. Thus, extension of transcatheter aortic valve implantation to younger patients, who are currently treated by surgical aortic valve replacement, raises the crucial question of bioprosthesis durability. In this translational review, we propose to produce a state-of-the-art overview of the durability of transcatheter aortic valve implantation by integrating knowledge of the basic science of bioprosthesis degeneration (pathophysiology and biomarkers). After summarising the new definition of structural valve deterioration, we will present what is known about the pathophysiology of aortic stenosis and bioprosthesis degeneration. Next, we will consider how to identify a population at risk of early degeneration, and how basic science with the help of biomarkers could identify and predict structural valve deterioration. Finally, we will present data on the differences in durability of transcatheter aortic valve implantation compared with surgical aortic valve replacement.
Topics: Animals; Aortic Valve; Aortic Valve Stenosis; Bioprosthesis; Heart Valve Prosthesis; Hemodynamics; Humans; Prosthesis Design; Prosthesis Failure; Risk Factors; Time Factors; Transcatheter Aortic Valve Replacement; Translational Research, Biomedical; Treatment Outcome
PubMed: 32113816
DOI: 10.1016/j.acvd.2019.11.007 -
JACC. Cardiovascular Interventions Sep 2021
Topics: Aortic Valve; Aortic Valve Stenosis; Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 34556270
DOI: 10.1016/j.jcin.2021.07.021 -
Open Heart Sep 2020Balloon aortic valvuloplasty (BAV) remains a treatment option for the selected patients with severe aortic stenosis. We examined clinical outcomes and predictors of...
BACKGROUND
Balloon aortic valvuloplasty (BAV) remains a treatment option for the selected patients with severe aortic stenosis. We examined clinical outcomes and predictors of prognosis in patients undergoing BAV for severe aortic stenosis.
METHODS
We identified all patients undergoing BAV from January 2010 to March 2018 (n=167) at a single transcatheter aortic valve implantation (TAVI) centre. Patient demographics, investigations, subsequent interventions and clinical outcomes were obtained from electronic health records.
RESULTS
Patients undergoing BAV were elderly (median age 80, IQR 73-86 years) and half (n=87, 52%) were male. All-cause mortality at 30 days and 12 months was 11% and 43%, respectively. Reduce ejection fraction (EF 30%-50%: HR 1.76, 95% CI 1.05 to 2.94; EF <30%: HR 1.90, 95% CI 1.12 to 3.20) was the only independent predictor at baseline of overall mortality. Median survival was 212 (IQR 54-490) days from the index procedure. Mortality at 1 year was lowest in patients who subsequently underwent TAVI or SAVR but high among those who had no further interventions or those who had a repeat BAV (14%, 19%, 60%, 89% respectively, log-rank p<0.001).
CONCLUSION
BAV as a bridge to definitive aortic valve intervention in carefully selected patients offers acceptable outcomes. These contemporary observational findings demonstrate the ongoing potential utility of BAV in the TAVI era.
Topics: Aged; Aged, 80 and over; Aortic Valve Stenosis; Balloon Valvuloplasty; Female; Hemodynamics; Humans; Male; Recovery of Function; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome
PubMed: 32907920
DOI: 10.1136/openhrt-2020-001330 -
JACC. Cardiovascular Interventions May 2021
Topics: Aortic Valve Stenosis; Cardiac Pacing, Artificial; Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 33958173
DOI: 10.1016/j.jcin.2021.03.053 -
The Canadian Journal of Cardiology Feb 2024With the expansion of transcatheter aortic valve replacement (TAVR) to younger and lower-surgical-risk patients, many younger and less comorbid patients will be treated... (Review)
Review
With the expansion of transcatheter aortic valve replacement (TAVR) to younger and lower-surgical-risk patients, many younger and less comorbid patients will be treated with TAVR and are expected to have a life expectancy that will exceed the durability of their transcatheter heart valve. Consequently, the number of patients requiring reintervention will undoubtedly increase in the near future. Redo-TAVR and TAVR explantation followed by surgical aortic valve replacement are the different therapeutic options in the event of bioprosthetic valve failure and the need for reintervention. Patients often anticipate being able to benefit from a redo-TAVR in the event of bioprosthetic valve failure after TAVR, despite the lack of long-term data and the risk of unfavourable anatomy. Our understanding of the feasibility of redo-TAVR is constantly improving thanks to bench test studies and growing worldwide experience. However, much remains unknown. In clinical practice, one of the heart team's objectives is to anticipate the need to reaccess the coronary arteries and implant a second or even a third valve when life expectancy may exceed the durability of the transcatheter heart valve. In this review, we address key definitions in the diagnosis of structural valve deterioration and bioprosthetic valve failure, as well as patient selection and procedural planning for redo-TAVR to reduce periprocedural risk, optimise hemodynamic performance, and maintain coronary access. We describe the bench testing and literature in the redo-TAVR and TAVR explantation fields.
Topics: Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome; Aortic Valve; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis; Aortic Valve Stenosis; Risk Factors; Bioprosthesis; Prosthesis Design
PubMed: 38072363
DOI: 10.1016/j.cjca.2023.12.002 -
Heart and Vessels Feb 2021Sex- and flow-related aortic valve calcification (AVC) studies are still limited in number, and data on the exact calcium quantity and distribution are scarce....
Sex- and flow-related aortic valve calcification (AVC) studies are still limited in number, and data on the exact calcium quantity and distribution are scarce. Therefore, we aimed to (1) re-define the best threshold of AVC load to distinguish severe from moderate aortic stenosis (AS) in common AS entities and to (2) evaluate differences in the aortic annulus and left ventricular outflow tract (LVOT) calcium load. Nine hundred and thirty-eight patients with contrast-enhanced cardiac MSCT and moderate-to-severe aortic stenosis (AS) were retrospectively enrolled. Patients with severe AS ≤ 1.0 cm (n = 841) were further separated into three AS entities: high gradient (HGAS, n = 370, 44.0%), paradoxical low gradient (pLGAS, n = 333, 39.6%), and classical low gradient (LGAS, n = 138, 16.4%). AVC, leaflet, and LVOT calcification were quantified. Aortic valve calcification scores were highest in severe HGAS, and lower in severe pLGAS and classical LGAS. In all severity and AS entities, the non-coronary cusp (NCC) was the most calcified one. LVOT calcification was consistently comparable between gender and AS entities. Accuracy of logistic regression was the highest in HGAS (male vs. female: AVC > 2156 Agatston units (AU), c-index 0.76; vs. AVC > 1292 AU, c-index 0.85; or AVC density > 406 AU/cm, c-index 0.82; vs. > 259 AU/cm, c-index 0.86; each p < 0.0001*) to diagnose severe AS. AVC could only be used in men to differentiate between severe LGAS and moderate AS. Data from this retrospective analysis indicate that the NCC is subject to pre-dominant degeneration throughout gender, AS severity, and several AS entities. AVC was consistently comparable in severe pLGAS and classical LGAS, but only AVC in severe LGAS could sufficiently distinguish from moderate AS in men. LVOT calcification failed to be a reliable indicator of accelerating AS.
Topics: Aged, 80 and over; Aortic Valve; Aortic Valve Stenosis; Calcinosis; Female; Heart Valve Prosthesis Implantation; Humans; Imaging, Three-Dimensional; Male; Multidetector Computed Tomography; Retrospective Studies; Severity of Illness Index
PubMed: 32894344
DOI: 10.1007/s00380-020-01688-9