TCT-735 Can we Predict Post-Procedural Paravalvular Leak After Edwards Sapien Transcatheter Aortic Valve Implantation? (original) (raw)
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International Journal of Cardiology, 2015
Background: Moderate or severe paravalvular leak (PVL ≥ moderate) after transcatheter aortic valve implantation (TAVI) is associated with poor outcomes. The aim of this study was to assess whether the baseline ejection fraction (EF) affects the impact of PVL on mortality after TAVI. Methods: We analyzed 514 consecutive patients with native severe aortic stenosis who underwent TAVI. Patients were divided into two groups: EF b40% group (n = 84) and EF ≥40% group (n = 430) according to baseline EF. Results: The mean age was 79.5 years and 49% were male. Patients in the EF b40% group were younger and with higher logistic EuroSCORE compared to patients in the EF ≥40% group. Diabetes, coronary artery disease, atrial fibrillation and renal insufficiency were more prevalent in the EF b40% group. Patients in the EF b40% group had more mitral regurgitation. In-hospital mortality was significantly higher in the EF b40% group (8.3% vs. 0.9%, p b 0.0001). PVL ≥ moderate was significantly associated with increased 2-year estimated mortality only in the EF b40% group (65% vs. 20%, log-rank p b 0.0001) whereas no difference was seen in the EF ≥40% group (24% vs. 19%, log-rank p = 0.509). Interaction between PVL ≥ moderate and EF b 40% was statistically significant. Conclusions: The impact of PVL ≥ moderate on mortality after TAVI was significant in the EF b40% group but not in the EF ≥40% group in our study. Even though operators should aim to minimize PVL in all TAVI patients, special attention is required for patients with reduced baseline EF.
Paravalvular leak after TAVI : Short-term results. Data from Polish national POL-TAVI registry
Cardiology Journal, 2013
Background: The authors analyzed data from Polish national POL-TAVI registry in terms of paravalvular leak (PVL) occurrence after transcatheter aortic valve implantation (TAVI) and its impact on clinical outcomes. Methods: A total of 331 patients with severe aortic stenosis underwent TAVI (Edwards Sapien, n = 141; CoreValve, n = 190). The grade of PVL and survival rate were assessed at 6-month follow-up. Results: One hundred and eighty-one (54.7%) patients developed mild PVL, and 22 (6.6%) -moderate PVL after TAVI. No severe PVLs were observed. Occurrence of moderate PVL was device dependent and more frequent in the CoreValve group (p = 0.02). Larger CoreValve device used correlated with the grade of PVL (Spearman: r = 0.19; p = 0.01), but for Edwards Sapien devices this correlation was inverted (Spearman: r = -0.62; p = 0.01). Six-month mortality rate was not significant between patients with no or mild PVL compared to those with moderate PVL (p = 0.12). Conclusions: The PVL occurrence remains a frequent problem after TAVI and is device dependent, more common with Edwards 23 mm valve and 31 mm CoreValve prosthesis. (Cardiol J 2016; 23, 2: 163-168) Logistic EuroScore I [%] 15.7 (9.5-24.8) STS score [%] 5.3 (3.1-11.5) Aortic valve parameters: Pressure gradient max [mm Hg] 80 (65-98) Pressure gradient mean [mm Hg] 50 (40-63) Aortic valve area [cm 2 ] 0.7 (0.6-0.8) Left ventricular ejection fraction [%] 55 (45-60)
International Journal of Cardiology, 2015
Post-interventional paravalvular leakage (PVL) still represents a major problem after transcatheter aortic-valve implantation (TAVI) and has been recently shown to be associated with increased mortality and morbidity . It occurs in 65%-85% of treated patients with the majority being trivial to mild, up to 26% being moderate, and up to 10% being severe . The main reasons for the occurrence of PVL comprise heavily calcified cusps, prosthesis malpositioning, and/or annulusprosthesis size mismatch . Thus, adequate patient selection and imaging-guided preoperative anatomical assessment of the aortic-root are mandatory. Multi-slice computed-tomography (MSCT) plays an important role for preoperative patient screening. It allows for detailed anatomic-assessment and importantly, it also allows for accurate detection, localization and quantification of aortic-valve calcification. In this study, using standardized preoperative MSCT, we evaluate the impact of aortic-valve calcification and its distribution on the occurrence of post-procedural PVL.
2018
Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with severe symptomatic aortic stenosis (AS) considered inoperable or at high surgical risk. More recently, TAVI has been performed also to lower risk patients based on the Heart Team decision. Few studies have studied interaction between surgical risk categories and outcomes. Aim of the study To analyze safety and efficacy (VARC-2 defined) TAVI treated patients as function of different preoperative risk. To assess independent predictors of death. Methods Four-hundred-eighty-two patients who underwent TAVI in our center between 2007 and 2017 were included in the study. According to Society of Thoracic Surgeons (STS) score and to other parameters, all the patients were retrospectively stratified into 4 groups: prohibitive (contraindications to aortic valve replacement, n = 124), high (STS > 8, n = 131), intermediate (4 ≤ STS ≤ 8, n = 112) and low (STS < 4, n = 115) risk. Early, 1-year ...
Clinical Physiology and Functional Imaging, 2014
Background and Aims Transcatheter aortic valve implantation (TAVI) is an established method for the treatment of high-risk patients with aortic stenosis (AS). The beneficial effects of TAVI in cardiac hemodynamics have been described in recent studies, but those investigations were mostly performed after an interval of more than 6 months following aortic valve implantation. The aim of this study is to investigate the acute and short-term alterations in hemodynamic conditions using the echocardiography outcomes in patients undergoing TAVI. Methods and Results A total of 60 patients (26 males, 34 females; age 84Á7 AE 5Á8) who underwent TAVI with CoreValve system were included in the study. Echocardiography was performed before hospital discharge and at 3 months follow-up. As expected, TAVI was associated with an immediate significant improvement in aortic valve area (AVA) (from 0Á64 AE 0Á16 cm 2 to 1Á67 AE 0Á41 cm 2 , P-value<0Á001) and mean gradient (from 51Á9 AE 15Á4 mmHg to 8Á8 AE 3Á8 mmHg, P-value<0Á001). At 3-month follow-up, systolic LV function was augmented (EF: 50 AE 14% to 54 AE 11%, Pvalue = 0Á024). Left ventricle (LV) mass and left atrium (LA) volume were significantly reduced (LV mass index from 126Á5 AE 30Á5 g m À2 to 102Á4 AE 32Á4 g m À2 ; LA index from 42Á9 AE 17Á3 ml m À2 to 33Á6 AE 10Á6 ml m À2 ; P-value<0Á001 for both). Furthermore, a decrement in systolic pulmonary artery pressure (SPAP) from 47Á5 AE 13Á5 mmHg to 42Á5 AE 11Á2 mmHg, P-value = 0Á02 was also observed. Despite the high incidence of paravalvular regurgitation (PVR) (80%), most of the patients presented mild or trace PVR and no significant progress of the regurgitation grade was seen after 3 months. Conclusion This study demonstrates that the beneficial effects of TAVI in cardiac function and hemodynamics occur already after a short period following aortic valve implantation.
Revista Brasileira de cardiologia invasiva, 2012
background: One third of the elderly population with symptomatic calcified aortic stenosis cannot undergo surgery due to their high operative risk. The transcatheter aortic-valve implantation (TAVI) has emerged as an alternative therapy for this group of patients. Methods: All patients submitted to TAVI from November 2008 to April 2012 were included in our study. We report the baseline clinical characteristics, procedural data, hospital outcomes and clinical follow-up of this population. Definitions were based on the Valve Academic Research Consortium criteria. Results: TAVI was performed in 23 patients, with 79 ± 6.7 years of age, and 56% were female. The EuroSCORE was 20.4 ± 11.1%. The CoreValve ® prosthesis was used in 19 patients (82.6%) and the Edwards SAPIEN™ valve was used in the remaining ones. Procedure success rate was 96%. The mean follow-up was 22 ± 12.8 months, with 6 deaths (26.1%) in this period, 3 of which were observed in the first 30 days (13%) and other 2 (21.7%) by the end of the first year. One patient had a transient ischemic attack during hospitalization (4.3%), but there were no episodes of stroke or myocardial infarction in the periprocedural period or in the follow-up. The composite safety endpoint at 30 days was observed in 5 patients (21.7%) and the composite efficacy endpoint at 12 months was 78.3%. Conclusions: The results of this study demonstrate that TAVI is an attractive procedure for
Cardiovascular ultrasound, 2016
To make assessment of paravalvular aortic leakage (PVL) after transcatheter aortic valve implantation (TAVI) more uniform the second Valve Academic Research Consortium (VARC) recently updated the echocardiographic criteria for mild, moderate and severe PVL. In the VARC recommendation the assessment of the circumferential extent of PVL in the short-axis view is considered critical. In this paper we will discuss our observational data on the limitations and difficulties of this particular view, that may potentially result in overestimation or underestimation of PVL severity.
CARDIAC SURGERY Risk factors for paravalvular leak after transcatheter aortic valve implantation
Polish Journal of Cardio-Thoracic Surgery, 2015
Badania wykazały, że przezcewnikowa implantacja zastawki aortalnej (transcatheter aortic valve implantation-TAVI) wydłuża przeżycie w grupie chorych z ciężką stenozą aortalną, u których zabieg chirurgiczny obarczony jest zbyt dużym ryzykiem operacyjnym i nie może być wykonany. Jednym z najczęstszych powikłań po TAVI jest przeciek okołozastawkowy, który istotnie wpływa na rokowanie krótko-i długoterminowe u pacjentów poddanych temu zabiegowi. W pracy przeanalizowano najważniejsze czynniki anatomiczne i proceduralne, które wpływają na występowanie tego powikłania po TAVI.
Risk factors for paravalvular leak after transcatheter aortic valve implantation
Polish journal of cardio-thoracic surgery
Many studies have shown that transcatheter aortic valve implantation (TAVI) improves outcomes in patients with severe aortic stenosis in whom a classical surgical procedure cannot be performed due to the high risk. As one of the most frequent periprocedural complications of TAVI, paravalvular leak significantly affects the short- and long-term prognosis for patients undergoing implantation. In this paper, we analyze the most significant anatomical and procedural predictors of paravalvular leak after TAVI.