Impact of Left Ventricular Outflow Tract Calcification on Procedural Outcomes After Transcatheter Aortic Valve Replacement

Okuno, Taishi; Asami, Masahiko; Heg, Dik; Lanz, Jonas; Praz, Fabien; Hagemeyer, Daniel; Brugger, Nicolas; Gräni, Christoph; Huber, Adrian Thomas; Spirito, Alessandro; Räber, Lorenz; Stortecky, Stefan; Windecker, Stephan; Pilgrim, Thomas

doi:10.1016/j.jcin.2020.04.015

Cited by 78 publications

(75 citation statements)

References 19 publications

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“…Therefore, although clinical assessments have shown improvements (increased EF, www.nature.com/scientificreports/ decreased aortic valve pressure gradient and decreased NYHA classification), geometrical alterations at the left ventricular outflow tract after TAVR could increase the risk of thrombus formation. Indeed, a recent study showed that left ventricular outflow tract calcification increases the risk of annular rupture and residual aortic regurgitation 131 . Therefore, despite the improvements of clinical parameters, our results depicting the details of local hemodynamics in this patient might partially explain how TAVR could adversely increase the risk of LVOT calcification and subsequent long-term complications.…”

Section: Discussionmentioning

confidence: 99%

Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework

Khodaei

Henstock

Sadeghi

et al. 2021

Sci Rep

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One of the most common acute and chronic cardiovascular disease conditions is aortic stenosis, a disease in which the aortic valve is damaged and can no longer function properly. Moreover, aortic stenosis commonly exists in combination with other conditions causing so many patients suffer from the most general and fundamentally challenging condition: complex valvular, ventricular and vascular disease (C3VD). Transcatheter aortic valve replacement (TAVR) is a new less invasive intervention and is a growing alternative for patients with aortic stenosis. Although blood flow quantification is critical for accurate and early diagnosis of C3VD in both pre and post-TAVR, proper diagnostic methods are still lacking because the fluid-dynamics methods that can be used as engines of new diagnostic tools are not well developed yet. Despite remarkable advances in medical imaging, imaging on its own is not enough to quantify the blood flow effectively. Moreover, understanding of C3VD in both pre and post-TAVR and its progression has been hindered by the absence of a proper non-invasive tool for the assessment of the cardiovascular function. To enable the development of new non-invasive diagnostic methods, we developed an innovative image-based patient-specific computational fluid dynamics framework for patients with C3VD who undergo TAVR to quantify metrics of: (1) global circulatory function; (2) global cardiac function as well as (3) local cardiac fluid dynamics. This framework is based on an innovative non-invasive Doppler-based patient-specific lumped-parameter algorithm and a 3-D strongly-coupled fluid-solid interaction. We validated the framework against clinical cardiac catheterization and Doppler echocardiographic measurements and demonstrated its diagnostic utility by providing novel analyses and interpretations of clinical data in eleven C3VD patients in pre and post-TAVR status. Our findings position this framework as a promising new non-invasive diagnostic tool that can provide blood flow metrics while posing no risk to the patient. The diagnostic information, that the framework can provide, is vitally needed to improve clinical outcomes, to assess patient risk and to plan treatment.

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Section: Discussionmentioning

confidence: 99%

Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework

Khodaei

Henstock

Sadeghi

et al. 2021

Sci Rep

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“…Basic measurements were made in accordance with a current expert consensus document 20 . Calcium volume in the aortic valve complex and mitral valve complex were measured as previously described 19,21 . Ascending aorta length is defined in the presented study as the distance at which the line drawn perpendicular to the aortic valve annulus plane hits the ascending aortic wall ( Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

Deep Learning-based Prediction of Early Cerebrovascular Events after Transcatheter Aortic Valve Replacement

Okuno

Overtchouk

Asami

et al. 2021

Preprint

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Background: Cerebrovascular events (CVE) are one of the most feared complications of transcatheter aortic valve replacement (TAVR). CVE appear difficult to predict due to their multifactorial origin incompletely explained by clinical predictors. We aimed to build a deep learning-based predictive tool for TAVR-related CVE. Methods: Integrated clinical and imaging characteristics from consecutive patients enrolled into a prospective TAVR registry were analysed. CVE comprised any strokes and transient ischemic attacks. Predictive variables were selected by recursive feature reduction to train an autoencoder predictive model. Area under the curve (AUC) represented the model`s performance to predict 30-day CVE. Results: Among 2,279 patients included between 2007 and 2019, both clinical and imaging data were available in 1,492 patients. Median age was 83 years and STS score was 4.6%. Acute (<24 hours) and subacute (day 2-30) CVE occurred in 19 (1.3%) and 36 (2.4%) patients, respectively. The occurrence of CVE was associated with an increased risk of death (HR [95%CI]: 2.62 [1.82-3.78]). The constructed predictive model uses less than 107 clinical and imaging variables and has an AUC of 0.79 (0.65-0.93). Conclusions: TAVR-related CVE can be estimated using a deep learning-based predictive algorithm. The model was implemented online for broad usage. (https://www.welcome.alviss.ai/#/cvecalculator).

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“…Heavy LVOT calcium should lead to the use of a self-expanding valve, while patients with extra-large annular size may benefit from a balloon-expandable valve. 15,16 Intraprocedurally, MAC alone is not an absolute indication for TTE, however a deeper level of sedation may be necessary for TEE, which increases the risk of hemodynamic and airway compromise. Rates of these complications will increase with longer procedure times and certain patient characteristics.…”

Section: Considerations For Imaging Modalitymentioning

confidence: 99%

Contemporary Practice of Echocardiography in Transcatheter Aortic Valve Replacement

Pospishil

Nampi

Neuburger

2022

Journal of Cardiothoracic and Vascular Anesthesia

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Impact of Left Ventricular Outflow Tract Calcification on Procedural Outcomes After Transcatheter Aortic Valve Replacement

Cited by 78 publications

References 19 publications

Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework

Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework

Deep Learning-based Prediction of Early Cerebrovascular Events after Transcatheter Aortic Valve Replacement

Contemporary Practice of Echocardiography in Transcatheter Aortic Valve Replacement

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