Transcatheter aortic valve replacement for symptomatic severe aortic valve regurgitation

Dhillon, Priyanka; Kakouros, Nikolaos; Brecker, Stephen

doi:10.1136/hrt.2009.190421

Cited by 15 publications

(12 citation statements)

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“…Besides some preliminary reports [16][17][18] , literature in this field consists of only one recent registry 6 . In the latter, Roy et al collected cases performed in different countries and without a head-to-head comparison with contemporary patients presenting with AS.…”

Section: Discussionmentioning

confidence: 99%

CoreValve implantation for severe aortic regurgitation: a multicentre registry

et al. 2014

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We sought to evaluate the outcome of transcatheter aortic valve replacement (TAVR) with the CoreValve Revalving System (CRS-TAVR) in inoperable patients presenting with severe aortic regurgitation (AR), compared to in patients treated for severe native aortic stenosis (AS). From October 2008 to January 2013, 1,557 consecutive patients undergoing CRS-TAVR, of whom 26 (1.6%) presented with AR, were prospectively followed. Compared with patients with AS, patients with AR were significantly younger (mean age 73±10 vs. 82±6, p=0.02), more frequently in NYHA Class III/IV (95% vs. 73%, p=0.01) and had a higher incidence of severe pulmonary hypertension (sPAP >60 mmHg, 31% vs. 10%, p=0.007). Log EuroSCORE and STS score were similar. VARC-2-defined device success was lower in the AR group (79% vs. 96%, p=0.006). At one month, patients treated for AR had a higher overall mortality (23% vs. 5.9%; OR 4.22 [3.03-8.28], p<0.001) and cardiac mortality (15.3% vs. 4%, OR 4.01 [2.40-7.66], p<0.001). Results were consistent at 12 months: overall mortality (31% vs. 19%, HR 2.1 [1.5-4.41], p<0.001) and cardiac mortality (19.2% vs. 6%, HR 3.1 [2.09-8.22], p<0.001). CRS-TAVR for AR is associated with a significantly higher mortality compared to CRS-TAVR for AS. Considering the ominous prognosis of these patients when treated medically, TAVR may be a reasonable choice in selected patients. In this regard, conventional risk scores have an inadequate predictive value.

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Section: Discussionmentioning

confidence: 99%

CoreValve implantation for severe aortic regurgitation: a multicentre registry

et al. 2014

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“…Severe aortic regurgitation is one such contraindication, as the pLVAD mechanism increases aortic pressure, which can aggravate aortic insufficiency; this may lead to significant volume loading of the LV and result in dilatation. This may be counteracted with procedures such as surgical or transcatheter aortic valve replacement ( 27 , 28 ), central aortic oversewing ( 28 ), percutaneous transcatheter closure of the aortic valve ( 28 , 29 ) Another relative contraindication is severe aortic valve stenosis, which can complicate placement of the catheter in the LV. Aortic valve stenosis is frequently observed in pLVAD patients, and can result in impaired device function, thromboembolism, poor LV recovery, and infection ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

Noninvasive neurological monitoring to enhance pLVAD-assisted ventricular tachycardia ablation – a Mini review

Potter

Valeriano²,

Buytaert³

et al. 2023

Front. Cardiovasc. Med.

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For critically ill patients, hemodynamic fluctuations can be life-threatening; this is particularly true for patients experiencing cardiac comorbidities. Patients may suffer from problems with heart contractility and rate, vascular tone, and intravascular volume, resulting in hemodynamic instability. Unsurprisingly, hemodynamic support provides a crucial and specific benefit during percutaneous ablation of ventricular tachycardia (VT). Mapping, understanding, and treating the arrhythmia during sustained VT without hemodynamic support is often infeasible due to patient hemodynamic collapse. Substrate mapping in sinus rhythm can be successful for VT ablation, but there are limitations to this approach. Patients with nonischemic cardiomyopathy may present for ablation without exhibiting useful endocardial and/or epicardial substrate-based ablation targets, either due to diffuse extent or a lack of identifiable substrate. This leaves activation mapping during ongoing VT as the only viable diagnostic strategy. By enhancing cardiac output, percutaneous left ventricular assist devices (pLVAD) may facilitate conditions for mapping that would otherwise be incompatible with survival. However, the optimal mean arterial pressure to maintain end-organ perfusion in presence of nonpulsatile flow remains unknown. Near infrared oxygenation monitoring during pLVAD support provides assessment of critical end-organ perfusion during VT, enabling successful mapping and ablation with the continual assurance of adequate brain oxygenation. This focused review provides practical use case scenarios for such an approach, which aims to allow mapping and ablation of ongoing VT while drastically reducing the risk of ischemic brain injury.

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“…Patients with symptomatic severe pure AR have poor prognosis and should be offered surgical aortic valve replacement. When deemed of high surgical risk, it may be considered the benefit of offlabel transcatheter-based therapy [7,11,12], but experience with TAVI for pure AR is limited and has been considered a contraindication for this procedure. The aortic anatomy in native AR patients is often challenging, because they lack annular or leaflet calcification, with the associated risk of insufficient anchoring and valve dislocation [7].…”

Section: Discussionmentioning

confidence: 99%

Sequential Percutaneous Approach for Severe Mitral and Aortic Regurgitation

Guerreiro¹,

Barbosa²,

Almeida³

et al. 2020

Cureus

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Percutaneous approach for valvular heart disease is accepted as a safe and feasible strategy to treat patients considered at high surgical risk with aortic stenosis and mitral regurgitation. Additionally, the growing experience led to the increasing use of transcatheter aortic valve implantation in several indications, such as in pure aortic regurgitation. The authors present the case of a 72-year-old woman with prohibitive surgical risk due to several comorbidities, including a chronic arterial dissection from the right carotid artery to the femoral arteries bilaterally that presented with signs and symptoms of heart failure, having a transthoracic echocardiography that showed severe functional mitral and aortic regurgitation. Combined percutaneous intervention for multivalvular disease in this clinical scenario is challenging, and the reported experience is still scarce and limited to inoperable patients.

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Transcatheter aortic valve replacement for symptomatic severe aortic valve regurgitation

Cited by 15 publications

References 0 publications

CoreValve implantation for severe aortic regurgitation: a multicentre registry

CoreValve implantation for severe aortic regurgitation: a multicentre registry

Noninvasive neurological monitoring to enhance pLVAD-assisted ventricular tachycardia ablation – a Mini review

Sequential Percutaneous Approach for Severe Mitral and Aortic Regurgitation

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