Paravalvular leak after transcatheter aortic valve implantation (TAVI): Short-term results. Data from Polish national POL-TAVI registry

Kleczyński, Paweł; Zasada, Wojciech; Bagieński, Maciej; Rzeszutko, Łukasz; Sorysz, Danuta; Sobczyński, Robert; Trębacz, Jarosław; Kapelak, B; Zembala, Marian; Dudek, Dariusz

doi:10.5603/cj.a2015.0071

Cited by 16 publications

(14 citation statements)

References 15 publications

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“…This rate was quite similar to that reported in previous studies with a post-dilation rate of 30% to 38% after implantation of self-expanding prostheses and 28% to 41% for balloon-expandable valves [15,17,23,24,26]. PD might be associated with a higher rate of cardiovascular complications, conduction disturbances, annulus rupture, coronary obstruction, and cerebral embolism leading to stroke [1,4]. These findings were not confirmed in our study because no differences in cardiovascular complications such as coronary obstruction, stroke, and death were observed.…”

Section: Discussionsupporting

confidence: 74%

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Impact of post-dilatation on the reduction of paravalvular leak and mortality after transcatheter aortic valve implantation

Kleczyński¹,

Dziewierz²,

Daniec³

et al. 2017

Kardiol Pol

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A b s t r a c tBackground: Post-implantation paravalvular leak (PVL) remains a significant complication of transcatheter aortic valve implantation (TAVI). More importantly, its occurrence may impact long-term mortality. Aim:We sought to evaluate the effects of balloon post-dilatation (PD) on the reduction of PVL and mortality in patients undergoing TAVI.Methods: A total of 101 consecutive patients undergoing TAVI were enrolled. Angiography, echocardiography, and the aortic regurgitation index (ARI) were used to assess the severity of PVL before and after balloon PD. Patients were divided into two groups based whether or not PD after TAVI was performed. Reduction of PVL, change of ARI, and clinical outcomes were assessed.Results: Balloon post-dilatation was performed in 23 (22.8%) patients. In 95.6%, PVL reduction was successful (no or mild PVL). PD increased the ARI from 23.4% (22.4-24.0) to 27.1% (26.1-28.3); p < 0.001. Thirty-day mortality rate was 14.1% in the PD (-) group vs. 0.0% in the PD (+) group; p = 0.07. One-year mortality (21.8% vs. 4.3%, p = 0.97) and procedural stroke rate (7.7% vs. 8.7%, p = 0.99) were not different between the groups. Conclusions:Balloon post-dilatation may be a safe and effective technique to reduce moderate to severe PVL after TAVI.

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Section: Discussionsupporting

confidence: 74%

“…TAVI improves survival and quality of life in inoperable patients as compared to medical treatment of severe AS [1][2][3]. However, post-implantation paravalvular leak (PVL) remains a significant TAVI-related complication [4]. Importantly, the presence of PVL may worsen clinical outcomes of patients undergoing TAVI [5].…”

Section: Introductionmentioning

confidence: 99%

Impact of post-dilatation on the reduction of paravalvular leak and mortality after transcatheter aortic valve implantation

Kleczyński¹,

Dziewierz²,

Daniec³

et al. 2017

Kardiol Pol

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“…Finally, all models failed in being able to accurately classify patients into high or non-high risk categories, however the simplest one (ACEF) was closest to reach statistical significance. Furthermore, univariate analysis of baseline and periprocedural characteristics identified 3 factors that occurred significantly more often in patients with an endpoint: MR grade ≥ 3, GFR < 30 mL/min/1.73 m 2 and AR post-TAVI grade ≥ 3 -findings consistent with previously published observations [19][20][21][22][23].…”

Section: Discussionsupporting

confidence: 81%

Outcome prediction following transcatheter aortic valve implantation: Multiple risk scores comparison

et al. 2016

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p = 0.59; EuroSCORE II, AUC 0.59; p = 0.23; STS, AUC 0.55; p = 0.52; ACEF, AUC 0.54; p = 0.69; Ambler's, AUC 0.54; p = 0.70; OBSERVANT, AUC 0.597; p = 0.21; SURTAVI, AUC 0.535; p = 0.65. SURTAVI model was calibrated best in high-risk patients showing coherence between expected and observed mortality (10.8% vs. 9.4%, p = 0.982). ACEF demonstrated best classification accuracy (17.5% vs. 6.9%, p = 0.053, respectively). Conclusions: None of the investigated risk scales proved to be optimal in predicting 30-day mortality in unselected, real-life population with aortic stenosis referred to TAVI. This data supports primary role of heart team in decision process of selecting patients for TAVI. (Cardiol J 2016; 23, 2: 169-177)

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“…A biological prosthesis implanted in a native aortic position provides and almost physiological gradient across the valve, and thus may restore peripheral arterial blood by reducing the afterload. In our cohort of patients, no significant paravalvular leak was observed after the procedure, which may have an impact on peripheral blood flow and mortality . After TAVI, high outflow resistance caused by a reduction in the valve orifice area while opening is diminished.…”

Section: Discussionmentioning

confidence: 62%

Transcatheter aortic valve implantation improves carotid and vertebral arterial blood flow in patients with severe aortic stenosis: practical role of orthostatic stress test

Kleczyński

Dimitrow

Dziewierz

et al. 2017

Clinical Cardiology

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Background There are no data on the impact of transcatheter aortic valve implantation (TAVI) on carotid and vertebral arterial blood flow. Our aim was to assess the effects of the orthostatic stress test on carotid and vertebral artery blood flow in patients with severe aortic stenosis (AS) undergoing TAVI. Hypothesis TAVI may have beneficial effect on carotid and vertebral artery flow in patients with severe aortic stenosis. Methods Thirty carefully selected patients with severe AS undergoing TAVI were enrolled. Peak systolic blood‐flow velocity and end‐diastolic velocity in the common carotid artery, internal carotid artery, and vertebral artery, as well as spectral analysis of flow pattern with time‐averaged maximum velocity (centimeters per second), time‐averaged mean velocity (centimeters per second), and flow volume (milliliters per minute) on both sides were measured by duplex ultrasound. Measurements were performed in the supine position and at 1 to 2 minutes after the assumption of the standing position at baseline and 3 months after TAVI. Results All duplex ultrasound parameters assessed in the supine position have significantly improved in patients after TAVI as compared to baseline (P < 0.001 for all). The orthostatic stress test induced decrease of carotid and vertebral arterial flow velocities in AS patients before and after TAVI. However, the drop in velocities and flow volume was numerically lower after TAVI. Conclusions TAVI may have some beneficial effect on extracranial artery blood flow by minimalization of its decrease as a response to orthostatic stress.

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Paravalvular leak after transcatheter aortic valve implantation (TAVI): Short-term results. Data from Polish national POL-TAVI registry

Cited by 16 publications

References 15 publications

Impact of post-dilatation on the reduction of paravalvular leak and mortality after transcatheter aortic valve implantation

Impact of post-dilatation on the reduction of paravalvular leak and mortality after transcatheter aortic valve implantation

Outcome prediction following transcatheter aortic valve implantation: Multiple risk scores comparison

Transcatheter aortic valve implantation improves carotid and vertebral arterial blood flow in patients with severe aortic stenosis: practical role of orthostatic stress test

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