Hemodynamic Valve Deterioration After Transcatheter Aortic Valve Replacement

КАРДИОЛОГИЯ УЗБЕКИСТАНА, Journal Year: 2025, Volume and Issue: 18(1), P. 72 - 85

Published: Jan. 1, 2025

Reports on the durability of transcatheter aortic valve replacement (TAVR) prostheses are scarce and confounded by varying definitions competing risks death. The authors sought to determine incidence, predictors, clinical outcomes hemodynamic deterioration (HVD) according Valve Academic Research Consortium 3 definition after TAVR. We analyzed consecutive patients undergoing TAVR in prospective Bern TAVI (Transcatheter Aortic Implantation) registry between August 2007 June 2022 for incidence predictors HVD performed case control-matching compare HVD. A total 2,403 eligible (mean age 81.8 ± 6.2 years, median Society Thoracic Surgeons Predicted Risk Mortality score 3.8% [Q1-Q3: 2.4%-6.0%]) were included had a duration follow-up 376 days (Q1-Q3: 365-1,825 days). cumulative moderate or severe was 2.2% (95% CI: 1.6%-3.1%), 10.8% 9.2%-12.7%), 25.6% 17.5%-36.5%) at 1, 5, 10 respectively. complex calcium volume (HR: 1.81; 95% 1.11-2.97; P = 0.018), residual regurgitation discharge 1.87; 1.34-2.60; < 0.001), treatment with oral anticoagulants 1.78; 1.00-3.15; 0.048) independent In control-matched cohort (HVD, n 155, no-HVD, 600), similar yearly rates all-cause cardiovascular mortality, infective endocarditis, but higher repeat intervention (rate ratio [RR]: 4.81 [95% 1.74-13.26]; 0.001). occurred up 1 4 throughout 10-year post-TAVR associated 5-fold increase risk reintervention.

Language: Английский

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Transcatheter or Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis and Small Aortic Annulus: A Randomized Clinical Trial

Circulation, Journal Year: 2023, Volume and Issue: 149(9), P. 644 - 655

Published: Oct. 26, 2023

The optimal treatment in patients with severe aortic stenosis and small annulus (SAA) remains to be determined. This study aimed compare the hemodynamic clinical outcomes between transcatheter valve replacement (TAVR) surgical (SAVR) a SAA.

Language: Английский

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Durability of transcatheter aortic valve implantation

EuroIntervention, Journal Year: 2024, Volume and Issue: 20(14), P. e845 - e864

Published: July 1, 2024

Transcatheter aortic valve implantation (TAVI) is now utilised as a less invasive alternative to surgical replacement (SAVR) across the whole spectrum of risk. Long-term durability bioprosthetic valves has become key goal TAVI this procedure considered for younger and lower-risk populations. The purpose article present state-of-the-art overview on definition, aetiology, risk factors, mechanisms, diagnosis, clinical impact, management dysfunction (BVD) failure (BVF) following with comparative perspective versus SAVR. Structural deterioration (SVD) main factor limiting used or SAVR, but non-structural BVD, such prosthesis-patient mismatch paravalvular regurgitation, well thrombosis endocarditis may also lead BVF. incidence BVF related SVD other causes low (<5%) at midterm (5- 8-year) follow-up compares favourably that long-term data randomised trials conducted first generations transcatheter heart suggest similar in SAVR 10 years, these suffer from major survivorship bias, will need be confirmed by analysis low-risk years.

Language: Английский

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A Guide to Transcatheter Aortic Valve Design and Systematic Planning for a Redo-TAV (TAV-in-TAV) Procedure

КАРДИОЛОГИЯ УЗБЕКИСТАНА, Journal Year: 2024, Volume and Issue: 17(14), P. 1631 - 1651

Published: July 1, 2024

Language: Английский

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Valve Thrombosis Following Transcatheter Aortic Valve Replacement: State‐of‐the‐Art Review

Catheterization and Cardiovascular Interventions, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 5, 2025

Transcatheter aortic valve replacement (TAVR) is a well-established treatment for severe stenosis, especially in patients over 75 or those at high surgical risk. While these prosthetic valves have lower thrombogenic profile than mechanical heart valves, leaflet thrombosis transcatheter (TAV) occurs an estimated 5%-40% of cases. Most TAV thromboses are subclinical and can be detected via cardiac computed tomography (CCT), which reveals hypo-attenuating thickening reduced motion asymptomatic without elevated transprosthetic gradients on echocardiography. The mechanisms behind involve local triggers, patient predisposing factors, device procedure-related aspects. ideal antithrombotic therapy post-TAVR depends individual characteristics, balancing bleeding risks with the need oral anticoagulants. Data optimal management routine use CT limited. anticoagulation effectively resolves clinically significant prosthesis thrombosis, its benefit cases unclear. There ongoing debate about whether precedes clinical making follow-up after implantation uncertain. This article aims to provide comprehensive review, summarizing current data incidence TAVR underlying mechanisms, imaging diagnosis, strategies, preventive measures, long-term follow-up.

Language: Английский

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Deformation of Transcatheter Heart Valve Following Valve-in-Valve Transcatheter Aortic Valve Replacement

КАРДИОЛОГИЯ УЗБЕКИСТАНА, Journal Year: 2023, Volume and Issue: 16(5), P. 515 - 526

Published: March 1, 2023

Language: Английский

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Redo-TAVR Feasibility After SAPIEN 3 Stratified by Implant Depth and Commissural Alignment: A CT Simulation Study

Circulation Cardiovascular Interventions, Journal Year: 2024, Volume and Issue: 17(3)

Published: March 1, 2024

BACKGROUND: Redo-transcatheter aortic valve replacement (TAVR) can pin the index transcatheter heart leaflets open leading to sinus sequestration and restricting coronary access. The impact of initial implant depth commissural alignment on redo-TAVR feasibility is unclear. We sought determine access after SAPIEN 3 (S3) TAVR stratified by alignment. METHODS: Consecutive patients with native stenosis were evaluated using multidetector computed tomography. S3 simulations done at depths, sizing per manufacturer recommendation assuming nominal expansion in all cases. Redo-TAVR was deemed unfeasible based valve-to-sinotubular junction distance valve-to-sinus height <2 mm, while neoskirt plane estimated feasibility. RESULTS: Overall, 1900 (mean age, 80.2±8 years; STS-PROM [Society Thoracic Surgeons Predicted Risk Operative Mortality], 3.4%) included. reduced significantly shallower depths (2.3% 80:20 versus 27.5% 100:0, P <0.001). Larger sizes feasibility, but only a 100:0 ( Commissural would render feasible patients, utilization leaflet modification techniques reduce height. Coronary following TAV-in-TAV affected both size. CONCLUSIONS: This study highlights critical depth, alignment, size predicting These findings highlight necessity for individualized preprocedural planning, considering immediate results long-term prospects reintervention as increasingly utilized younger stenosis.

Language: Английский

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Early Detection of Risk of Neo-Sinus Blood Stasis Post-Transcatheter Aortic Valve Replacement Using Personalized Hemodynamic Analysis

Structural Heart, Journal Year: 2023, Volume and Issue: 7(5), P. 100180 - 100180

Published: April 28, 2023

Despite the demonstrated benefits of transcatheter aortic valve replacement (TAVR), subclinical leaflet thrombosis and hypoattenuated thickening are commonly seen as initial indications decreased durability augmented risk transient ischemic attack.We developed a multiscale patient-specific computational framework to quantify metrics global circulatory function, cardiac local fluid dynamics root coronary arteries.Based on our findings, TAVR might be associated with high blood stagnation in neo-sinus region due lack sufficient flow washout during diastole phase (e.g., maximum stasis volume increased by 13, 8, 2.7 fold left cusp, right noncoronary respectively [N = 26]). Moreover, some patients, not ventricle load relief reduced only 1.2 % 26]) diastolic improvement 4.94%, 15.05%, 23.59% anterior descending, circumflex artery, respectively, 26]).The transvalvular pressure gradient amelioration after translate into adequate sinus washout, optimal flow, stress. Noninvasive personalized modeling can facilitate determination most effective revascularization strategy pre-TAVR monitor plaque progression post-TAVR.

Language: Английский

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Frequency, Predictors, and Clinical Impact of Valvular and Perivalvular Thrombus After Transcatheter Aortic Valve Replacement

КАРДИОЛОГИЯ УЗБЕКИСТАНА, Journal Year: 2023, Volume and Issue: 16(24), P. 2967 - 2981

Published: Dec. 1, 2023

Language: Английский

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Feasibility of Redo-Transcatheter Aortic Valve Replacement in Sapien Valves Based on In Vivo Computed Tomography Assessment

Circulation Cardiovascular Interventions, Journal Year: 2023, Volume and Issue: 16(11)

Published: Nov. 1, 2023

Our aim was to assess the feasibility of repeat transcatheter aortic valve (TAV) replacement for degenerated Sapien3 (S3) prostheses by simulating subsequent implantation S3 or Evolut, using in vivo computed tomography-based sizing and impact on coronary patient-prosthesis mismatch risks.

Language: Английский

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