Figure 7 - uploaded by Paul Schoenhagen
Content may be subject to copyright.
Mitral Annular Calcification: CT allows precise localization of mitral annular calcification. The impact of mitral annular calcification remains unclear
Source publication
Transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI) has emerged as an attractive treatment strategy for the treatment of patients with severe symptomatic aortic stenosis (AS), particularly those who are inoperable or at high risk for surgical aortic valve replacement. Several multicentre registries and ra...
Similar publications
Sirs:A 74-year-old male patient presented with decompensated heart failure. Diagnostic work-up revealed a failed St. Jude Medical Trifecta 23-mm bioprosthesis implanted 3 years earlier featuring severe central aortic regurgitation and mildly elevated transaortic gradients (Fig. 1a, b). Relevant comorbidities included a history of concomitant aorto-...
Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis and pre‐procedure planning relies heavily on advanced imaging. Multidetector computed tomography angiography, the “TAVR CT,” facilitates essential planning steps of measuring the aortic root for valve sizing and feasibility and assessment of potential acc...
Transaortic (TAo) transcatheter aortic valve implantation (TAVI) is an alternative approach in patients considered to be at high risk for classical open surgery with poor peripheral vessel access. The purpose of this study was to determine the feasibility of using TAo access for TAVI procedures employing the Edwards SAPIEN transcatheter heart valve...
Aims:
Transcatheter mitral valve-in-ring (TMVIR) implantation with transcatheter heart valve (THV) prostheses can be performed in patients with recurrent mitral regurgitation (MR) following annuloplasty. However, an oval configuration and sometimes the rigidity of surgical rings can often lead to suboptimal THV expansion, resulting in considerable...
Background: Valve-in-Valve transcatheter aortic valve implantation (ViV-TAVI) is a growing alternative for redo-surgery in patients with degenerated surgical valves. To our knowledge, data are lacking on the determinants on ViV-TAVI procedural success in patients with degenerated surgical valves.
Methods: All consecutive patients undergoing ViV-TA...
Citations
... 4 This signals an overall poor prognosis of TAVR-IE, highlighting the importance of management of these complex patients in centers with a dedicated, experienced multidisciplinary heart valve team. 11 Our study has some important limitations. Generalizability of the results is limited by the retrospective design and relatively small sample size of our study. ...
Background
Transcatheter aortic valve replacement–associated infective endocarditis (TAVR-IE) is a relatively rare complication of TAVR. Little is known about the characteristics of early, intermediate, and late-onset TAVR-IE.
Methods
We studied the risk factors, microbiological patterns, and diagnostic and treatment strategies in patients with early (<60 days), intermediate (60-365 days), and late-onset (>1 year) TAVR-IE.
Results
Ten out of 494 definite cases of prosthetic valve IE between 2007 and 2019 were confirmed to have TAVR-IE from the IE registry at our center. The mean age was 78.1 ± 13.7 years, with 50% being female. The mean Society of Thoracic Surgeons risk score was 7.8 ± 5.7. Most (60%) TAVR-IE cases had an intermediate onset, with Staphylococcus aureus being the most common organism (66.6%). 18-fluorodeoxyglucose positron emission tomography aided in diagnosis of TAVR-IE in 20% of cases. Mortality due to IE was observed in 40% of cases. Most of the patients underwent conservative management, and 37.5% survived over a mean follow-up of 709 ± 453 days. Two patients underwent surgery, of whom one died on day 30 postoperatively from sepsis. Mortality due to IE occurred in 25% of cases in the early and intermediate-onset groups, while there was 100% mortality in the late-onset group.
Conclusions
In a single-center cohort, most TAVR-IE cases had an intermediate onset, with Staphylococcus aureus being the most common organism. Understanding timing of TAVR-IE may have important prognostic implications.
... It has been proposed that said endangerment can be avoided by utilizing pledgeted sutures on the accessory leaflet, from exterior of the sinus of Valsalva to superior of the aortic annulus [74]. TAVR/TAVI carries with it its own risks [75]: most notably stroke which generally occurs in the immediate postprocedural period [76]; other less severe complications include paravalvular AR, conduction disturbances (particularly new-onset left bundle branch blockage), and least of all vascular complications [75]. ...
... It has been proposed that said endangerment can be avoided by utilizing pledgeted sutures on the accessory leaflet, from exterior of the sinus of Valsalva to superior of the aortic annulus [74]. TAVR/TAVI carries with it its own risks [75]: most notably stroke which generally occurs in the immediate postprocedural period [76]; other less severe complications include paravalvular AR, conduction disturbances (particularly new-onset left bundle branch blockage), and least of all vascular complications [75]. ...
Quadricuspid aortic valve (QAV) is a congenital heart anomaly in which the aortic valve has four cusps of various size possibilities, as opposed to the three symmetrical cusps generally observed. This cardiac valvular abnormality is rarely identified, with an estimated incidence rate of 0.013% to 0.043%, although recent technological advancements in diagnostics have contributed to an increase in detection. Historically, it had been typically encountered during open heart surgery or postmortem; however, it is presently diagnosed primarily via ultrasound echocardiography, and could go undetected unless specifically considered. It was first reported by Babington in 1847, and since then approximately 300 cases have been published. This condition is sporadically associated with additional congenital cardiovascular defects, with coronary artery irregularities being the most common. In more than half of published QAV incidences it has led to the progressive development of aortic regurgitation (AR) usually sans aortic stenosis, particularly amongst elderly patients, often requiring surgical intervention after 50 years of age. A fifth of total instances, but two-thirds of instances with AR, warrant surgery seldom amidst complications, with reconstructive tricuspidization preferred over valve replacement.
... The indication for treatment of AS is accomplished by a multidisciplinary Heart Team, who considers the risk/ benefit ratio of SAVR and TAVI based on the patient on the whole, including comorbidities, perioperative mortality risk, clinical status and frailty at presentation, imaging parameters, the status of the access routes and mode of anaesthesia 12 (Fig. 1). ...
Non-invasive cardiovascular imaging owns a pivotal role in the preoperative assessment of patients for transcatheter aortic valve implantation (TAVI), providing a wide range of crucial information to select the patients who will benefit the most and have the procedure done safely.
Although advanced cardiac imaging with cardiac computed tomography is routinely used for a detailed anatomic assessment before TAVI, echocardiography remains the first imaging modality to assess aortic stenosis severity and to provide essential functional information.
This document results from the collaboration between the Italian Society of Cardiology (SIC) and the Italian Society of Medical and Interventional Radiology (SIRM), aiming to produce an updated consensus statement about the pre-procedural imaging assessment in patient for TAVI. The writing committee is composed of radiologists and cardiologists, experts in the field of cardiac imaging and structural heart diseases.
Part 1 of the document, after a brief overview of the clinical indication and basic technical aspects of TAVI, will focus on the role of echocardiography in TAVI pre-procedural planning.
... Regarding long-term mortality, non-cardiac comorbidities (such as anemia, liver disease, chronic obstructive pulmonary disease (COPD), chronic kidney disease) seem to be more important [2,10]. Pre-procedural full echocardiographic assessment of patients with AS candidate for TAVI or surgery should be performed to identify anatomical and functional detailed features of the aortic valve, ascending aorta and LV [11][12][13]. Importantly, lack of knowledge does still exist about the role of right ventricular (RV) dysfunction. Given its particular position and shape, cardiovascular magnetic resonance (CMR) is the gold standard to evaluate RV volumes, mass and function, but it has limited availability [14][15][16]. ...
Aim:
To evaluate the long-term prognostic significance of right ventricular (RV) deformation and RV-arterial coupling in a cohort of patients with heart failure (HF) due to severe aortic stenosis (AS) candidate for trans-catheter aortic valve implantation (TAVI).
Methods:
The study is a retrospective analysis of 56 patients undergoing echocardiography before TAVI execution. RV function was defined by tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), peak systolic myocardial velocity by tissue Doppler imaging (RVSm) and RV longitudinal strain (RVLS). RV-arterial coupling were defined as TAPSE and RVLS normalized for systolic pulmonary artery pressure (sPAP) to obtain afterload-independent parameters: TAPSE/sPAP and RVLS/sPAP, respectively. All-cause mortality was the primary endpoint of survival analysis; composite of death and hospitalization for HF was the secondary endpoint.
Results:
All patients underwent TAVI from femoral access. Mean age was 81.6±6.3 years and left ventricular ejection fraction was preserved in most patients (51±15%). At 10 years, using Cox regression analysis adjusted for the parameters related to prognosis at univariate analysis, we found that only pre-procedural RVLS was independently associated with all-cause mortality (aHR 1.53, 95% CI 1.10-2.12, P=0.011). RVLS (aHR 7.542, 95% CI 1.325-42.921, P=0.023), sPAP (aHR 1.421, 95% CI 1.045-1.932, P=0.025), TAPSE/sPAP (aHR 4.977, 95% CI 5.425-21.99, P=0.044) and RVLS/sPAP (aHR 2.333, 95% CI 3.9677-12.999, P=0.046) were independently associated with the secondary endpoint.
Conclusions:
Among patients with HF due to severe AS undergoing TAVI, deformation imaging (i.e., RVLS) and RV-arterial coupling (i.e., TAPSE/sPAP and RVLS/sPAP) provide better risk stratification at long-term follow up of 10 years than other RV echocardiographic parameters.
... T ranscatheter valve replacement has altered the therapeutic landscape for individuals with native and post-operative stenosis or regurgitation of the aortic, pulmonary, mitral, and tricuspid valves (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). In recent reports of data from the international VIVID registry (Valve-in-Valve International Database Registry), it was shown that transcatheter tricuspid valve (TV) implantation after prior surgical repair or bioprosthetic valve replacement can be performed successfully and safely, with good short-term outcomes in most patients (6)(7)(8). ...
Background:
Transcatheter aortic and pulmonary valves have been used to treat stenosis or regurgitation after prior surgical tricuspid valve (TV) replacement or repair. Little is known about intermediate-term valve-related outcomes after transcatheter tricuspid valve replacement (TTVR), including valve function, thrombus, and endocarditis.
Objectives:
The authors sought to evaluate mid-term outcomes in a large cohort of patients who underwent TTVR after surgical TV repair or replacement, with a focus on valve-related outcomes.
Methods:
Patients who underwent TTVR after prior surgical TV replacement or repair were collected through an international registry. Time-related outcomes were modeled and risk factors assessed.
Results:
Data were collected for 306 patients who underwent TTVR from 2008 through 2017 at 80 centers; 52 patients (17%) had a prior history of endocarditis. Patients were followed for a median of 15.9 months after implantation (0.1 to 90 months), with 64% of patients estimated to be alive without TV reintervention or a valve-related event at 3 years. The cumulative 3-year incidence of death, reintervention, and valve-related adverse outcomes (endocarditis, thrombosis, or significant dysfunction) were 17%, 12%, and 8%, respectively. Endocarditis was diagnosed in 8 patients 2 to 29 months after TTVR, for an annualized incidence rate of 1.5% per patient-year (95% confidence interval: 0.45% to 2.5%). An additional 8 patients were diagnosed with clinically relevant valve thrombosis, 3 in the short term, 2 within 2 months, and 3 beyond 6 months. Only 2 of these 8 patients received anticoagulant therapy before thrombus detection (p = 0.13 vs. patients without thrombus). Prior endocarditis was not a risk factor for reintervention, endocarditis, or valve thrombosis, and there was no difference in valve-related outcomes according to TTVR valve type.
Conclusions:
TV dysfunction, endocarditis, and leaflet thrombosis were uncommon after TTVR. Patients with prior endocarditis were not at higher risk for endocarditis or other adverse outcomes after TTVR, and endocarditis occurred with similar frequency in different valve types. Though rare, leaflet thrombosis is an important adverse outcome, and further study is necessary to determine the appropriate level of prophylactic therapy after TTVR.
... On the other hand, while the influence of various complications on prolonged hospitalization have been extensively studied, [8][9][10] it is not yet known, if a certain antibiotic prophylactic regimen is directly associated with post TAVR complications and duration of hospitalization. This also includes the risk of antibiotic related diarrhea or Clostridium difficile infection. ...
Background
To date, there are no guidelines recommending a specific prophylactic antibiotic treatment in transcatheter aortic valve replacement (TAVR). The aim of this study is to evaluate clinical data after TAVR with different periprocedural antibiotic regimens.
Methods
In May 2015 the institutional rules for periprocedural antibiotic prophylaxis were changed from 3 days to 1 day. Thus, a total of 450 consecutive TAVR patients between February 2014 and June 2016 were classified into two intention‐to‐treat groups: patients receiving a 1‐day Cefuroxime prophylaxis (N = 225); patients receiving a 3‐day Cefuroxime prophylaxis (N = 225).
Results
One‐day Cefuroxime regimen was not associated with shorter hospitalization (3‐day Cefuroxime 9 ± 4.7 vs 1‐day Cefuroxime 8.9 ± 4.0; P = 0.87). Incidence of diarrhea (26.2% vs 18.2%; P = 0.04) and Clostridium difficile infections (4% vs 0.4%; P = 0.01) were significantly higher in the 3‐day group. No endocarditis was registered after 1 year follow‐up. There was no difference in 30‐day overall mortality rate, major vascular complications, bleeding complications, pacemaker‐implantation rate, paravalvular regurgitation, or acute kidney injury between patients groups.
Conclusion
Three‐day Cefuroxime prophylaxis does not seem to be advantageous compared to a shorter 1‐day regimen, but even shows a significantly higher incidence of diarrhea and Clostridium difficile infection.
... 4 Various risk factors have been identified for heart block following TAVI, including age, male sex, left ventricular ejection fraction, left ventricular outflow tract diameter, mitral annular calcium, access route, implantation depth, balloon predilatation, valve size, atrial fibrillation, and preexisting conduction abnormalities. 5,6 However, the significance of each of these factors varies widely from study to study and can be confounded by the various types of valves currently being implanted. ...
Transcatheter aortic valve implantation (TAVI) is growing in utilization in the USA, and atrioventricular heart block is a common complication of the procedure. In patients with conduction system changes following TAVI, there are no clear guidelines for permanent pacing, leading to difficult clinical decisions on how long to leave temporary transvenous pacemakers in place. The aim of our study was to determine whether changes in electrocardiogram characteristics could predict the need for permanent pacing. A retrospective analysis was conducted of 209 consecutive TAVI patients seen from January 2012 to December 2015 at Baylor Heart and Vascular Hospital, Dallas. The baseline characteristics were similar between those who received a permanent pacemaker (PPM) within 7 days of the procedure (21.1%) and those who did not (78.9%); of those who did receive a PPM, 79.5% were implanted for complete heart block. The median (range) percentage change in the sum of QRS and PR was significantly higher in those who received a PPM (20.2%) than those who did not (7.1%) (P = 0.004). Using the percentage change in the sum of QRS and PR to predict PPM, the area under the curve was found to be 0.69. The optimal cutpoint was found to be 18.9% (sensitivity = 0.63, specificity = 0.73). Our study suggests that delay in the conduction system immediately following TAVI predicts the need for permanent pacing.
... In 2002, the first transcatheter aortic valve implantation (TAVI) was performed providing a feasible alternative for high-risk patients [2,3]. Since then, around 100,000 successful TAVI procedures have been reported with outcomes comparable to conventional aortic valve surgery [4][5][6][7][8][9]. For TAVI, several alternative approaches have been developed, such as transapical, subclavian, direct aortic, or transcaval route. ...
... Since TAVI is a relatively new technique, large-scale studies revealing the major factors contributing to minor and major vascular complications remain scarce. Although several aspects thereof have been addressed, such as patient selection criteria, technical advancements of the bio-prosthetic valve devices (either balloon-expandable e.g., Edward SAPIEN, or self-expandable e.g., Medtronic CoreValve), the issue requires further attention [9,19]. ...
... Despite many improvements to the technique, percutaneous TAVI is still associated with significant risks of minor and major vascular complications. This remains an important issue, as major vascular complications are an independent predictor of short-term mortality [9]. Reports on the incidence of TAVI-related vascular complications vary between 5 and 30% [14,18,25]. ...
Objective
Evaluation of the impact of the sheath diameter on vascular complications and mortality in transfemoral aortic valve implantation.
Method
Between 2012 and 2014, 183 patients underwent the procedure using a sheath diameter of 18–24 F. This collective was divided into two groups: group 1, with a sheath diameter of 18F (G1, n = 94), consisted of patients with 18F Medtronic Sentrant and 18 F Direct Flow sheaths, and group 2 with a sheath diameter of 19–24 F (G2, n = 89) consisted of patients with Edwards expandable e-sheath and Solopath sheaths. Perclose-Proglide® was used as a closure device in all patients.
Results
G1 had significantly more female patients (64.9% vs. 46.1% in G2, p = 0.01) and the average BMI was lower (26 ± 4.5% vs. 27.4 ± 4.7%, p = 0.03). There was no significant difference in the incidence of major and minor vascular complications (G1: 12.8% vs. G2: 12.4%, p = 0.9). 30-day mortality was similar in both groups (G1: 6.4 ± 2.5% [95% CI: 0.88–0.98], G2: 3.7 ± 1.9% [95% CI: 0.92–0.99]. The Kaplan Meier analysis of survival revealed no significant differences either.
Conclusion
The difference in sheath diameter had no effect on either incidence or severity of vascular complications. There was no impact on mortality either.
... More recently, the multidisciplinary team approach has been extended in patient management as a response to manage complex disease states, beyond oncology. In the Cardiology field, the transcatheter aortic valve implantation (TAVI) team is a recent example [1]. In the field of infective endocarditis (IE), in some centers a multidisciplinary approach for evaluating patients with IE is being used for many years in order to improve management and outcomes [2]. ...
... TAVR is a therapeutic option for inoperable or too high-risk patients with severe symptomatic aortic valve stenosis. 73 Often performed transfemorally, TAVR positions an appropriately sized stent/prosthetic valve complex at the aortic valve. TAVR can also be performed using transsubclavian, transaortic (through an anterior right mini-thoracotomy or partial mini-sternotomy), and transapical (through the apex of the left ventricle) approaches. ...
... TAVR can also be performed using transsubclavian, transaortic (through an anterior right mini-thoracotomy or partial mini-sternotomy), and transapical (through the apex of the left ventricle) approaches. 73,74 Although open surgery is still the preferred technique for correcting coarctations in small and growing children, endovascular repair is now a safe and effective alternative in older children and adults. Balloon angioplasty alone has been used but is complicated by high rates of aortic wall injury and recoarctation. ...
... Complications after TAVR include paravalvar leak, which is a gap created when the walls of the valve fail to closely approximate the aortic annulus, resulting in aortic regurgitation. 73 Other complications are coronary ostia obstruction from displaced native aortic valvular calcifications, interference of the anterior mitral leaflet by the aortic valve stent, and prosthetic valve leaflet thrombosis. 81,82 ECG-gated CTA is an ideal method for postprocedural assessment of TAVR valves, as MRI and echocardiography can be limited by metallic artifact. ...
Techniques for repair of the aorta currently include open and endovascular methods, hybrid approaches, minimally-invasive techniques, and aortic branch vessel reimplantation or bypass. Collaboration among radiologists and vascular and cardiothoracic surgeons is essential. An awareness of the various surgical techniques, expected postoperative appearance, and potential complications is essential for radiologists. This review will cover the postoperative appearance of the thoracic aorta with a focus on the ascending aorta. The value of three-dimensional image evaluation will also be emphasized.
