Low risk TAVR: Long- term considerations and appropriate patient selection

Price, Justin; Bob‐Manuel, Tamunoinemi; Aymond, Josh; Amoran, Olayiwola; Almusawi, Hussain; Kelly, Jayna; Okor, Ivana; Okoro, Kelechukwu U.; Ramee, Stephen R.; Tafur, José D.

doi:10.1016/j.pcad.2020.04.002

Cited by 8 publications

(3 citation statements)

References 40 publications

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“…Although providing excellent short-term results, post-TAVI-associated 1–5 year mortality varies widely between 8.3% and 67.8% according to patients' risk profiles ( 5 – 7 ). This calls for a detailed examination of patient-related factors that have an impact on long-term survival ( 8 ). Among these, right ventricular (RV) dysfunction and pulmonary hypertension have been shown to have a negative prognostic impact after TAVI ( 9 – 11 ).…”

Section: Introductionmentioning

confidence: 99%

Right ventricle to pulmonary artery coupling after transcatheter aortic valve implantation—Determinant factors and prognostic impact

Parasca

Călin

Cadil

et al. 2023

Front. Cardiovasc. Med.

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IntroductionRight ventricular (RV) dysfunction and pulmonary hypertension (PH) have been previously associated with unfavorable outcomes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI), but little is known about the effect of right ventricle (RV) to pulmonary artery (PA) coupling. Our study aimed to evaluate the determinant factors and the prognostic value of RV-PA coupling in patients undergoing TAVI.MethodsOne hundred sixty consecutive patients with severe AS were prospectively enrolled, between September 2018 and May 2020. They underwent a comprehensive echocardiogram before and 30 days after TAVI, including speckle tracking echocardiography (STE) for myocardial deformation analysis of the left ventricle (LV), left atrium (LA), and RV function. Complete data on myocardial deformation was available in 132 patients (76.6 ± 7.5 years, 52.5% men) who formed the final study population. The ratio of RV free wall longitudinal strain (RV-FWLS) to PA systolic pressure (PASP) was used as an estimate of RV-PA coupling. Patients were analyzed according to baseline RV-FWLS/PASP cut-off point, determined through time-dependent ROC curve analysis, as follows: normal RV-PA coupling group (RV-FWLS/PASP ≥0.63, n = 65) and impaired RV-PA coupling group (RV-FWLS/PASP < 0.63, n = 67).ResultsA significant improvement of RV-PA coupling was observed early after TAVI (0.75 ± 0.3 vs. 0.64 ± 0.3 before TAVI, p < 0.001), mainly due to PASP decrease (p < 0.001). LA global longitudinal strain (LA-GLS) is an independent predictor of RV-PA coupling impairment before and after TAVI (OR = 0.837, p < 0.001, OR = 0.848, p < 0.001, respectively), while RV diameter is an independent predictor of persistent RV-PA coupling impairment after TAVI (OR = 1.174, p = 0.002). Impaired RV-PA coupling was associated with a worse survival rate (66.3% vs. 94.9%, p-value < 0.001) and emerged as an independent predictor of mortality (HR = 5.97, CI = 1.44–24.8, p = 0.014) and of the composite endpoint of death and rehospitalization (HR = 4.14, CI = 1.37–12.5, p = 0.012).ConclusionOur results confirm that relief of aortic valve obstruction has beneficial effects on the baseline RV-PA coupling, and they occur early after TAVI. Despite significant improvement in LV, LA, and RV function after TAVI, RV-PA coupling remains impaired in some patients, it is mainly related to persistent pulmonary hypertension and is associated with adverse outcomes.

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Section: Introductionmentioning

confidence: 99%

Right ventricle to pulmonary artery coupling after transcatheter aortic valve implantation—Determinant factors and prognostic impact

Parasca

Călin

Cadil

et al. 2023

Front. Cardiovasc. Med.

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“…TAVI has evolved to be the standard of care for elderly patients with symptomatic severe AS, with recent research showing benefits across the entire surgical‐risk spectrum 13‐23 . Inspired by the early and ongoing success of TAVI, newer valves and technologies were rapidly introduced incorporating features that could potentially overcome the limitations of earlier devices 24,25 .…”

Section: Discussionmentioning

confidence: 99%

Clinical evaluation of the Hydra self‐expanding transcatheter aortic valve: 6 month results from the GENESIS trial

Chandra¹,

Jose

Mattummal³

et al. 2021

Cathet Cardio Intervent

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Objectives To evaluate the safety and performance of the Hydra transcatheter aortic valve (THV) in the treatment of symptomatic severe aortic stenosis in patients at high or extreme surgical risk. Background The Hydra THV (Vascular Innovations Co. Ltd., Nonthaburi, Thailand) is a novel flexible repositionable self‐expanding system with supra‐annular bovine pericardial leaflets, available in three sizes, covering aortic annuli between 17 and 27 mm. Methods The GENESIS trial was a prospective, multi‐center, single‐arm, 6 month follow‐up study conducted in India. The primary performance endpoint was device success defined as per VARC‐II criteria at 30 days. The primary safety endpoint was all‐cause mortality at 30 days. All endpoints were adjudicated by an independent clinical events committee. Results Forty high‐risk patients (74.5 ± 6.7 years, 60% men; STS Score:5.6 ± 4.2%) were enrolled in 11 centres. Device success was achieved in 92.5%. The effective orifice area improved from 0.7 ± 0.2 to 2.3 ± 0.6 cm2 at 30 days and to 2.2 ± 0.7 cm2 at 6 months (p < .0001). Mean aortic valve gradient decreased from 53.5 ± 18.1 to 8.9 ± 4.9 mmHg at 30 days and to 7.6 ± 2.7 mmHg at 6 months (p < .0001). The rate of new permanent pacemaker implantation was 7.5% at 30 days, and no patient had more than mild paravalvular leak at 6 months. The 30 days and 6 month all‐cause mortality was 10.0 and 17.5%, cardiovascular mortality 7.5 and 7.5%, device‐related mortality 5.0 and 5.0%, respectively. No patients had stroke up to 6 months. Conclusions The GENESIS trial demonstrated high efficacy of the self‐expanding Hydra THV. The cardiovascular mortality rate of 7.5% may partly be explained by the inclusion of some centres with no or limited previous experience in transcatheter aortic valve implantation.

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“…With the advantages of no requirement of thoracotomy, lower risk, and shorter recovery time, THVR has become the development trend of heart valve replacement surgery and brought dawn to elderly patients and other patients who are not suitable for thoracotomy. [85][86][87] Recent studies for artificial heart valve of THVR are mainly focused on the bioprosthetic heart valves (BHVs) and synthetic polymer heart valves based on their characteristics and advantages, and several factors are essential for an ideal artificial heart valve, such as good mechanical properties, good biocompatibility, excellent anticalcification and anticoagulation properties, superior endothelial cell adhesion, great hydrodynamic and fatigue performance, and others. The enhanced material is the key for the development of advanced artificial heart valve and evokes new hopes for the treatment of heart valve disease.…”

Section: Artificial Heart Valvesmentioning

confidence: 99%

Development of Innovative Biomaterials and Devices for the Treatment of Cardiovascular Diseases

Wang

Yang

et al. 2022

Advanced Materials

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Cardiovascular diseases have become the leading cause of death worldwide. The increasing burden of cardiovascular diseases has become a major public health problem and how to carry out efficient and reliable treatment of cardiovascular diseases has become an urgent global problem to be solved. Recently, implantable biomaterials and devices, especially minimally invasive interventional ones, such as vascular stents, artificial heart valves, bioprosthetic cardiac occluders, artificial graft cardiac patches, atrial shunts, and injectable hydrogels against heart failure, have become the most effective means in the treatment of cardiovascular diseases. Herein, an overview of the challenges and research frontier of innovative biomaterials and devices for the treatment of cardiovascular diseases is provided, and their future development directions are discussed.

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Low risk TAVR: Long- term considerations and appropriate patient selection

Cited by 8 publications

References 40 publications

Right ventricle to pulmonary artery coupling after transcatheter aortic valve implantation—Determinant factors and prognostic impact

Right ventricle to pulmonary artery coupling after transcatheter aortic valve implantation—Determinant factors and prognostic impact

Clinical evaluation of the Hydra self‐expanding transcatheter aortic valve: 6 month results from the GENESIS trial

Development of Innovative Biomaterials and Devices for the Treatment of Cardiovascular Diseases

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