CARDIAC SURGERY Risk factors for paravalvular leak after transcatheter aortic valve implantation (original) (raw)
Related papers
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)
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.
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.
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.
Kardiologia Polska, 2017
Patients with severe symptomatic aortic stenosis have a poor prognosis with medical management alone, and surgical aortic valve replacement can improve symptoms and survival. In recent years, transcatheter aortic valve implantation (TAVI) has been demonstrated to improve survival in inoperable patients and to be an alternative treatment in patients in whom the risk of surgical morbidity or mortality is high or intermediate. A representative expert committee, summoned by the Association of Cardiovascular Interventions of the Polish Cardiac Society (ACVI) and the Polish Society of Cardio-Thoracic Surgeons, developed this Consensus Statement in transcatheter aortic valve implantation. It endorses the important role of a multidisciplinary "TAVI team" in selecting patients for TAVI and defines operator and institutional requirements fundamental to the establishment of a successful TAVI programme. The article summarises current evidence and provides specific recommendations on organisation and conduct of transcatheter treatment of patients with aortic valve disease in Poland.
Cor et Vasa
Prevalence ischemické choroby srdeční (ICHS) se u všech pacientů se stenózou aortální chlopně (aortic valve stenosis, AVS) pohybuje v rozmezí 30 % až 60 %. Dosud nebyla nalezena jednoznačná shoda ohledně optimálního způsobu léčby ICHS u pacientů s indikací k transkatétrové implantaci aortální chlopně (transcatheter aortic valve implantation, TAVI). Cílem této studie bylo stanovit prevalenci, určit způsob léčby i bezprostřední klinické důsledky ICHS u dané populace, se zvláštním zaměřením na proveditelnost a bezpečnost metody revaskularizace na základě fyziologických parametrů. Metody a výsledky: Do analýzy byly zařazeny retrospektivní údaje o celkem 287 po sobě následujících pacientech indikovaných k TAVI na našem pracovišti. Nemocní s ICHS (123; 43 %) byli rozděleni do tří skupin podle léčebné strategie zvolené operatérem: optimální farmakoterapie (42 z oněch 123; 34 %), preventivní perkutánní koronární intervence (percutaneous coronary intervention, PCI) pro angiografi cky významné koronární léze (34 ze 123; 28 %) a strategie s použitím fyziologických parametrů (47 ze 123; 38 %). V populaci pacientů s ICHS hodnota logistického EuroSCORE dosahovala hodnoty 31 ± 24, přičemž rizikový profi l byl vyšší ve skupině s farmakoterapií. Úspěšnost výkonu při použití TAVI v celé populaci byla 96 %. Klinické výsledky po 30 dnech prokázaly vyšší incidenci závažných kardiovaskulárních příhod (major adverse cardiovascular event, MACE) ve skupinách s optimální farmakoterapií a s preventivní PCI (11,9 %, resp. 5,9 %); ve skupině s použitím fyziologických parametrů nebyly zaznamenány žádné příhody. Závěry: Nejlepší způsob léčby ICHS při TAVI se stále ještě hledá. Přes poměrně omezenou velikost vzorku prokazují naše zjištění proveditelnost a bezpečnost revaskularizační léčby s použitím fyziologických parametrů. Potvrzení našeho zjištění a zhodnocení dlouhodobých klinických důsledků si vyžádá větší studie.
Patients with severe symptomatic aortic stenosis have a poor prognosis with medical management alone, and surgical aortic valve replacement can improve symptoms and survival. In recent years, transcatheter aortic valve implantation (TAVI) has been demonstrated to improve survival in inoperable patients and to be an alternative treatment in patients in whom the risk of surgical morbidity or mortality is high or intermediate. A representative expert committee, summoned by the Association of Cardiovascular Interventions of the Polish Cardiac Society (ACVI) and the Polish Society of Cardio-Thoracic Surgeons, devel-oped this Consensus Statement in transcatheter aortic valve implantation. It endorses the important role of a multi-disciplinary "TAVI team" in selecting patients for TAVI and defines operator and institutional requirements fundamental to the establish-ment of a successful TAVI programme. The article summarises current evidence and provides specific recommendations on organisation and conduct of transcatheter treatment of patients with aortic valve disease in Poland.
Kapak içi kapak içi kapak transkateter aortik valve implantasyonu: Bir matruşka TAVI
Current journal of medical research, 2021
Introduction: After its first definition, transcatheter aortic valve implantation(TAVI). continues to use it in a wide range. High surgical risk patients are still the definitive candidate for TAVI to avoid procedural risks. However, complication events and coping with these events may cause other problems for these TAVI patients. Case: 70-year-old male, severe aortic stenosis and operated coronary bypass surgery was decided for TAVI. After successful TAVI procedure on 2th day, hemodynamic instability and lung oedema occurred. New developing paravlvüler severe aortic regurgitation was observed on echocardiography. And valve dislocation to the left ventricular outflow tract was thought. valve-in-valve TAVI performed but the second valve dislocated to ascending aorta above the desired location. Then a third valve implanted between these two valves and hemodynamic stability was provided. Conclusion: The positioning of the second valve in the valve-in-valve procedure may be difficult and the procedure performed as a solution may result as a complication. In our knowledge, our case is the first presentation of usage of three vales as valve-in-valve-in-valve TAVI procedure. So it must keep in mind that in some situations multiple valve-in-valve procedures can be a management option.
Annals of Cardiac Anaesthesia, 2018
Background: Transcatheter aortic valve implantation (TAVI) is a valid option for patients with severe aortic stenosis judged to be at high surgical risk. For this procedure, there is no agreement on the appropriate type of anesthesia. Sedation offers several advantages, but general anesthesia (GA) leads to less paravalvular leaks (PVLs) probably because of the transesophageal echocardiography (TEE) guidance. The objective was to compare the incidence of PVL among patients receiving conscious sedation (TAVI-S) and patients receiving GA (TAVI-GA). We made the hypothesis that a referral center does not necessitate TAVI-GA to reduce the incidence of moderate-to-severe PVL. Aim: The primary outcome was the incidence of moderate-to-severe PVL at 30 days after the implantation. Design and Setting: This study design was a retrospective observational trial in a university hospital. Methods: The TAVI-S group underwent the procedure under conscious sedation. In the TAVI-GA group, an endotracheal tube and a TEE probe were inserted. After the valve deployment, PVL was assessed by hemodynamic and fluoroscopic measurements in the TAVI-S group. TEE was also used in the TAVI-GA group to evaluate the presence of PVL. When PVL was moderate or severe according to the Valve Academic Research Consortium criteria. Results: TAVI-S and TAVI-GA were accomplished in 168 (67.5%) and 81 (32.5%) patients, respectively. Our results show no difference between the two groups regarding the incidence and grade of PVL. Conclusion: Performing TAVI under GA with TEE guidance is not associated with a lower incidence of moderate and severe PVL.
Journal of Clinical Medicine
Background: A paravalvular leak (PVL) is a complication following valve replacement, which may lead to heart failure and hemolysis. The aim of this study is to investigate whether the clinical outcome after transcatheter PVL closure differs according to the prominent indication of the procedure (symptoms of heart failure or hemolysis). Methods: The data of consecutive patients who had transcatheter treatment for PVL between July 2011 and September 2022 in five Greek centers were analyzed. The primary endpoint was the technical, and clinical success rates with regards to the prominent indication of paravalvular leak closure. The secondary endpoints included the evaluation and comparison of the clinical and technical success in relation to the type of valve that was treated (aortic or mitral) as well as the survival analysis in relation to the closure indication and type of valve that was treated. Results: In total, 60 patients were retrospectively studied (39% men, mean age 69.5 ± 11...