State-of-the-art Structural Interventions in Heart Failure

Park, Jeffrey; Suradi, Hussam

doi:10.15420/cfr.2019.12.2

Cited by 5 publications

(7 citation statements)

References 48 publications

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“…(E) shows an AVP3 being placed across the leak. (F) shows the device being released after confirmation of minimal leak and optimum functionality using echocardiography 46 …”

Section: Available Management Optionsmentioning

confidence: 99%

“…52 Mechanical shows the device being released after confirmation of minimal leak and optimum functionality using echocardiography. 46 valves require life-long anticoagulation therapy and there is also the risk of bleeding, whereas with bioprosthetic valves, life-long anticoagulation therapy is not needed but they are more likely to degenerate and will fail with time. 53 A 2016 study reviewing 460…”

Section: Surgical Managementmentioning

confidence: 99%

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The management of paravalvular leaks post aortic valve replacement

Kananathan¹,

Perera²,

Mohanarajan³

et al. 2022

Journal of Cardiac Surgery

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Background: Paravalvular leak (PVL) is uncommon but can lead to severe complications after surgical or transcatheter aortic valve implantation. Conditions associated with PVLs such as heart failure, hemolysis, and infective endocarditis can lead to catastrophic results if not treated promptly; the therapeutic goals differ according to the presentation. It is vital that PVLs are diagnosed early using various imaging modalities. Different approaches have been studied in managing PVLs; there is an increased interest in the transcatheter aortic valve closure procedure as it is minimally invasive and decreases the occurrence of further reinterventions.Aim: To discuss the classification of PVLs, diagnostic approaches, and available management options.Method: A literature review was performed using 28 studies.Results: This review evaluated the relationship between the time of diagnosis, management of PVL and the resulting outcomes.Discussion: Patients with PVL should be assessed through a multidisciplinary team approach and a patient-selective plan should be in place. Conclusion:Open surgical intervention is reserved for complex cases where minimally invasive techniques cannot be utilized.

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“…(E) shows an AVP3 being placed across the leak. (F) shows the device being released after confirmation of minimal leak and optimum functionality using echocardiography 46 …”

Section: Available Management Optionsmentioning

confidence: 99%

Section: Surgical Managementmentioning

confidence: 99%

The management of paravalvular leaks post aortic valve replacement

Kananathan¹,

Perera²,

Mohanarajan³

et al. 2022

Journal of Cardiac Surgery

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“…Transcatheter pulmonary valve replacement is an alternative to surgery in patients with dysfunctional right ventricle-pulmonary artery conduits or bioprosthetic valves. 68,69 It is also useful in patients who cannot undergo open-heart surgery, such as pregnant women. 70 TTE and TEE remain the first-line imaging modalities for the assessment of transcatheter gradient or evidence of patient prosthesis mismatch.…”

Section: Pulmonary Valvementioning

confidence: 99%

Multimodality Imaging in Valvular Structural Interventions

et al. 2022

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Structural valvular interventions have skyrocketed in the past decade with new devices becoming available and indications for patients who would previously have been deemed inoperable. Furthermore, while echocardiography is the main imaging tool and the first line for patient screening, cardiac magnetic resonance and CT are now essential tools in pre-planning and post-procedural follow-up. This review aims to address imaging modalities and their scope in aortic, mitral and tricuspid structural valvular interventions, including multimodality imaging. Pulmonary valve procedures, which are mostly carried out in patients with congenital problems, are discussed. This article presents a guide on individualised imaging approaches on each of the available interventional procedures.

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“…4 Novel percutaneous therapies may be effective in selected patients but remain understudied in the acute setting and are generally considered a compassionate use indication. 22 Given the complex decision-making required for management of SHD emergencies, referral to a comprehensive valve center with proficiency in both surgical and percutaneous interventions for SHD should be considered. 23 Medical therapy may be definitive in thrombosis of a native or (more commonly) prosthetic valve; when valve thrombosis is suspected or confirmed, a trial of aggressive antithrombotic therapy starting with high-intensity heparin may be effective.…”

Section: General Considerationsmentioning

confidence: 99%

Structural Heart Disease Emergencies

Jentzer

Ternus

Eleid

et al. 2020

J Intensive Care Med

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Structural heart disease (SHD) emergencies include acute deterioration of a stable lesion or development of a new critical lesion. Structural heart disease emergencies can produce heart failure and cardiogenic shock despite preserved systolic function that may not respond to standard medical therapy and typically necessitate surgical or percutaneous intervention. Comprehensive Doppler echocardiography is the initial diagnostic modality of choice to determine the cause and severity of the underlying SHD lesion. Patients with chronic SHD lesions which deteriorate due to intercurrent illness (eg, infection or arrhythmia) may not require urgent intervention, whereas patients with an acute SHD lesion often require definitive therapy. Medical stabilization prior to definitive intervention differs substantially between stenotic lesions (aortic stenosis, mitral stenosis, left ventricular outflow tract obstruction) and regurgitant lesions (aortic regurgitation, mitral regurgitation, ventricular septal defect). Patients with regurgitant lesions typically require aggressive afterload reduction and inotropic support, whereas patients with stenotic lesions may paradoxically require β-blockade and vasoconstrictors. Emergent cardiac surgery for patients with decompensated heart failure or cardiogenic shock carries a substantial mortality risk but may be necessary for patients who are not eligible for catheter-based percutaneous SHD intervention. This review explores initial medical stabilization and subsequent definitive therapy for patients with SHD emergencies.

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State-of-the-art Structural Interventions in Heart Failure

Cited by 5 publications

References 48 publications

The management of paravalvular leaks post aortic valve replacement

The management of paravalvular leaks post aortic valve replacement

Multimodality Imaging in Valvular Structural Interventions

Structural Heart Disease Emergencies

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