Transcatheter aortic valve implantation in bicuspid anatomy

Zhang, Zhengang; Jilaihawi, Hasan; Feng, Yuan; Chen, Mao

doi:10.1038/nrcardio.2014.161

Cited by 61 publications

(42 citation statements)

References 49 publications

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“…Yousef et al (27) and Mylotte et al (26) separately reported the rates of paravalvular leak of 2+ or greater as 30.8% and 28.4% respectively. TAVI used in Asian patients with bicuspid valve stenosis has yielded satisfactory outcomes when compared to Western patients (29,30). China reported unusually high prevalence of bicuspid aortic valve in Chinese patients with severe aortic valve stenosis and these patients were associated with high leaflet calcium burden.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter aortic valve implantation in Asia

Hon

Tay

2017

Ann. Cardiothorac. Surg.

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The use of transcatheter aortic valve implantation (TAVI) to treat severe symptomatic aortic valve stenosis has increased exponentially in the last decade. This rapid expansion was seen predominantly in Western developed nations and has been fuelled by favorable results reported from a plethora of well-publicized randomized controlled trials, large retrospective series and national registries. Now, TAVI has become the standard of care for inoperable patients and an alternative to open surgery in patients who are at intermediate to high risk for open surgery. Notwithstanding these positive results, Asia has been relatively slow to adopt this technology despite a potentially large patient pool. Unique features of Asian medical environments and differences in Asian anatomy affecting TAVI uptake in Asia will be discussed. This article serves to outline the various challenging aspects of disseminating TAVI in Asian countries.

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Section: Discussionmentioning

confidence: 99%

Transcatheter aortic valve implantation in Asia

Hon

Tay

2017

Ann. Cardiothorac. Surg.

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“…Recent multicentre Bic-AV registry revealed that the rate of procedural success rate was relative high (89.5%) and survival was similar to that in patients with a tricuspid AV who undergo TAVI. Nevertheless, moderate or severe AR and aortic dissection seem to occur more frequently (28.3%) in patients with Bic-AV than tricuspid aortic valve [11]. However, it is notable that in a small TEE series valve expansion appeared relatively circular on in all cases, suggesting that a Bic-AV does not necessarily preclude symmetric expansion of a balloon-expandable valve with sufficient radial strength.…”

Section: Tavi In Bicuspid Aortic Valve (Bic-av)mentioning

confidence: 81%

Update on current TAVI technology, indications, screening, and outcomes

Halapas

Chrissoheris

Bouboulis

et al. 2016

Continuing Cardiol Educ

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Transcatheter aortic valve replacement (TAVI) is an established treatment for inoperable patients or patients at high surgical risk with severe aortic stenosis. Herein, we illustrate the key design features of the main new generation devices that are entering contemporary clinical practice, the labeled and off-labeled indications, the basic principles of screening process, and the clinical outcomes of the TAVI procedure.Answer questions and earn CME: https://wileyhealthlearning.com/Activity2/ 4193543/Activity.aspx TAVI New TechnologyDespite growing experience with transcatheter aortic valve replacement (TAVI) the first-generation devices were associated with several limitations such as: valve malpositioning, vascular complications, paravalvular regurgitation (PVR), and conduction disorders [1,2]. Several new generation TAVI devices (Table 1), aimed at addressing these issues. Medtronic Evolut-R TMThe Evolut-R TM is the new iteration of the Medtronic CoreValve â (MCV), ( Figure 1A). Several key features of the MCV have been preserved, namely the trileaflet porcine pericardial tissue, the supra-annular position of the valve leaflets, the self-expanding nitinol stent frame and the architecture in three levels of function: inflow portion with a high radial force for anchoring within the aortic annulus, mid portion with a constrained structure for preservation of the coronary flow, and outflow portion with a high hoop strength for coaxiality with the aortic root. However, the new generation Evolut-R TM presents several improvements namely:) the inflow portion is wider and more cylindrical providing a flatter landing zone to ensure maximum over-sizing within the full target implant depth range, (iii) the geometry of the distal diamond cell of the inflow portion has been modified with a slightly asymmetric configuration and extended length for better conformability and consistent radial force across a range of annulus sizes, (iv) the distal skirt has been extended with a scalloped design creating a longer landing zone for better sealing, (v) the prosthesis is fully repositionable and retrievable before final detachment of the hooks (up to three times) and, (vi) the 14 Fr profile of the delivery system (true outer diameter 18 Fr), with the option of proceeding to sheath-less procedures reduces the rate of vascular complications. At the moment the device is available in three sizes (23, 26, and 29 mm) covering aortic annuli from 18 to 26 mm. In addition, whereas positioning of the actual MCV can be sometimes challenging, the 1:1 ratio applied to the handle and prosthesis unsheathing-resheathing response aims at ª 2016 Hellenic College of Cardiology

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“…Careful navigation and deflection of the TAVI system away from walls of the aortic arch and the ascending aorta during catheter passage is recommended in these high-risk patients. -Conduction abnormalities: an asymmetrical calcium distribution, with deposits located in the noncoronary cusp or valve oversizing, compared to an elliptical BAV orifice, increase the risk of new pacemaker implantation [36]. Current registry data provide guidance for the transcatheter treatment of this challenging group of patients.…”

Section: Bicuspid Aortic Valvementioning

confidence: 99%