Evolution of Transcatheter Aortic Valve Replacement

Bourantas, Christos V.; Serruys, Patrick W.

doi:10.1161/circresaha.114.302292

Cited by 69 publications

(39 citation statements)

References 149 publications

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“…It has been shown that high stress and bending moment regions in stented bioprostheses correlate with regions of mechanical damage (Ferrans et al, 1978;Sacks, 2001;Sacks and Schoen, 2002). Although TAV manufacturers use a similar biologic leaflets as surgical bioprostheses and therefore it would be expected to degenerate via similar mechanisms, TAV design and implantation configuration are substantially different than surgical bioprostheses (Bourantas and Serruys, 2014;Rodes-Cabau, 2012). Unlike surgical valves, the degree of TAV expansion varies from patient to patient, and depends upon annulus size and specific calcified valve geometry (Delgado et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Leaflet stress and strain distributions following incomplete transcatheter aortic valve expansion

Abbasi

Azadani

2015

Journal of Biomechanics

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Section: Introductionmentioning

confidence: 99%

Leaflet stress and strain distributions following incomplete transcatheter aortic valve expansion

Abbasi

Azadani

2015

Journal of Biomechanics

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“…Although evolving device technologies and greater experiences are associated with improved outcomes, accurate device deployment is crucial to achieve better outcomes. Increased aortic angulation, also referred to as a horizontal aorta, poses technical challenges during self‐expanding (SE) TAVI . Two studies demonstrated that increased aortic angulation was associated with increased post‐procedural PVR and lower rates of device success following SE TAVI .…”

Section: Discussionmentioning

confidence: 99%

Anatomic and procedural associations of transcatheter heart valve displacement following Evolut R implantation

Hachinohe

Latib

Laricchia

et al. 2018

Cathet Cardio Intervent

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Objectives This study aimed to predict the displacement of self‐expanding transcatheter heart valves (THV) during final deployment. Background Accurate device positioning during transcatheter aortic valve implantation (TAVI) is crucial for optimal results. Methods At our institution, 103 patients who underwent transfemoral TAVI with Evolut R were retrospectively identified. Multiple linear regression models were created, and a predictor equation was built to quantify the factors that may affect THV behavior. Results Multiple linear regression analysis for THV displacement on the left coronary cusp (LCC) identified the angle between the THV and the ascending aorta (ATA), predilation, and less operator experience as independent predictors of upward displacement, whereas estimated glomerular filtration rate (eGFR) was inversely related with THV behavior (95% confidence interval: 0.219 to 0.340, 0.447 to 2.092, 0.165 to 1.757, and −0.053 to −0.011, respectively). Predictors of THV displacement on the noncoronary cusp side could not be identified using this model. Conclusions The ATA at the point of recapture, predilation, and less operator experience were independent predictors of upward displacement of THV on the LCC side. eGFR was an independent predictor of THV downward displacement on the LCC side. Of them, the ATA was the strongest predictor. Physicians may need to adjust this angle adequately before deployment to achieve the appropriate position.

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“…The incidence of cerebral ischemic lesions visible on diffusion weighted magnetic resonance imaging after TAVR ranges from 68% to 84% . Although most of these lesions are asymptomatic, potential etiologies include ischemia caused by hemodynamic instability or rapid ventricular pacing during valve insertion, aortic dissection, NOAF, or emboli . Calcific lesions on the aortic valve can embolize during valvuloplasty or during placement or manipulation of the valve .…”

Section: Pharmacologic Considerations For Patients Undergoing Tavrmentioning

confidence: 99%

Medication Management of Patients Undergoing Transcatheter Aortic Valve Replacement

2017

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Aortic stenosis (AS) is the most common form of valvular heart disease. A detailed diagnostic workup is necessary to promptly stage and classify disease severity to determine optimal management. Medical therapy and valvuloplasty are options that fail to delay or reverse disease progression. Surgical aortic valve replacement (SAVR) is curative but has significant limitations for some patient populations. A newer option, transcatheter aortic valve replacement (TAVR), has become more widely available to patients with intermediate‐ or high‐operative risk. Periprocedural medication management is imperative for successful valve implantation and to minimize adverse events. Stroke remains one of the most common complications of TAVR and is associated with increased mortality. Thus, intra‐ and postprocedural antithrombotic therapy is required, although the regimen that best minimizes thromboembolic events and bleeding complications has yet to be defined. Patients undergoing TAVR with comorbid conditions requiring oral anticoagulation or individuals who develop subvalvular thromboses pose unique challenges. Antiplatelet and anticoagulant therapy should be carefully balanced. This article summarizes key literature supporting the pharmacologic management of patients receiving TAVR.

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Evolution of Transcatheter Aortic Valve Replacement

Cited by 69 publications

References 149 publications

Leaflet stress and strain distributions following incomplete transcatheter aortic valve expansion

Leaflet stress and strain distributions following incomplete transcatheter aortic valve expansion

Anatomic and procedural associations of transcatheter heart valve displacement following Evolut R implantation

Medication Management of Patients Undergoing Transcatheter Aortic Valve Replacement

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