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Álvarez-Covarrubias HA, Altaner N, Adolf R, Jurisic M, Horban E, Pellegrini C, Duesmann C, Lachmann M, Thilo C, Syryca F, Klos M, Mayr NP, Rheude T, Renker M, Charitos EI, Schunkert H, Kastrati A, Xhepa E, Won-Keun K, Joner M. Aortic valve calcification volume and prognosis in patients undergoing transcatheter aortic valve implantation. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2025; 78:507-518. [PMID: 39461471 DOI: 10.1016/j.rec.2024.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 10/10/2024] [Indexed: 10/29/2024]
Abstract
INTRODUCTION AND OBJECTIVES It is unknown whether aortic valve calcium volume, as measured by contrast-enhanced computed tomography angiography (angio-CT), is associated with mortality in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to confirm that contrast-enhanced aortic valve calcium correlates with noncontrast-enhanced calcium score and provides useful prognostic information in patients undergoing TAVI. METHODS This retrospective observational study included patients from 2 high-volume TAVI centers in Germany, all of whom underwent high-quality angio-CT prior to TAVI. Calcium volume in contrast-enhanced angio-CT was calculated using 3Mensio software (Pie Medical, The Netherlands), while the calcium score from noncontrast-enhanced angio-CT was obtained using the Syngo.via (Siemens Healthineers, Germany) workstation to validate contrast-enhanced angio-CT values. Calcium volume was dichotomized using the median based on to sex-specific values from contrast-enhanced angio-CT, and the risk associated with increased calcium volume was determined using Cox proportional hazard regression analysis. RESULTS We included 3318 TAVI patients. A good correlation was observed between noncontrast-enhanced and contrast-enhanced angio-CT (r2=0.680; P<.001). The median values for sex-specific contrast-enhanced angio-CT calcium volume were 514 mm3 for women and 1025 mm3 for men. Patients with higher calcium volumes showed lower mortality at 1 year (8.8% vs 12.1%; adjusted HR, 0.86; 95%CI, 0.75-0.98; P=.02) compared with those with lower calcium volumes. CONCLUSIONS Calcium volume in contrast-enhanced angio-CT correlated well with noncontrast-enhanced angio-CT calcium score. Patients with higher calcium volume showed lower mortality at 1 year after TAVI.
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Affiliation(s)
- Héctor A Álvarez-Covarrubias
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Departamento de Cardiología, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro (IMSS), México City, Mexico.
| | - Niklas Altaner
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Rafael Adolf
- Department of Radiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Martin Jurisic
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Elisabeth Horban
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Costanza Pellegrini
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Charlotte Duesmann
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Mark Lachmann
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Thilo
- Department of Cardiology, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Finn Syryca
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Markus Klos
- Department of Cardiology, Medicum Tegernsee, Rottach-Weissach, Germany
| | - N Patrick Mayr
- Institut für Anästhesiologie, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Tobias Rheude
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Matthias Renker
- Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany
| | | | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Erion Xhepa
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Kim Won-Keun
- Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Michael Joner
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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Satomi N, Miyasaka M, Enta Y, Munehisa Y, Toki Y, Nakashima M, Saigan M, Kobayashi Y, Teng Y, Maeda M, Kosuga M, Abe K, Taguri M, Hayatsu Y, Hata M, Tada N. Transcatheter Aortic Valve Replacement for Structural Valve Deterioration After Aortic Valve Neocuspidization. Catheter Cardiovasc Interv 2025. [PMID: 40370003 DOI: 10.1002/ccd.31583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 04/07/2025] [Accepted: 04/28/2025] [Indexed: 05/16/2025]
Abstract
BACKGROUND Evidence on structural valve deterioration (SVD) after aortic valve neocuspidization (AVNeo) remains limited. While transcatheter aortic valve replacement (TAVR) offers a less invasive option, its feasibility is unclear. This study aimed to characterize SVD patients post-AVNeo and to assess TAVR feasibility. METHODS This retrospective study included 11 patients who underwent TAVR for SVD after AVNeo in Sendai Kousei Hospital between June 2017 and August 2024. Four patients with aortic stenosis (AS) and seven with aortic regurgitation (AR) due to SVD were included. RESULTS AS-SVD group showed shorter time interval from AVNeo to TAVR (50.5 [28.3-98.3] vs. 107.0 [97.0-131.0] months, p = 0.04) and smaller aortic annulus area (316.5 [259.8-375.0] vs. 538.0 [440.0-582.0] mm2, p = 0.005) than AR-SVD group. In TAVR, technical success was achieved in 91% of cases. Although coronary obstruction is a concern due to the long leaflet, no case occurred. Misidentification of the basal ring plane caused by the slack cusp resulted in second valve implantation (one case) and new conduction disturbance (two cases) due to deep implantation, and aortic contained rupture (one case) for oversized valve selection. CONCLUSIONS Rapid AS-SVD progression and AR-SVD occurring later than previously reported were observed, highlighting the need for further studies on AVNeo durability. TAVR after AVNeo was feasible. Special precautions for coronary obstruction may be unnecessary. Careful hinge point placement at the boundary between pericardial cusps and the annulus was a key to CT-based basal ring determination in patients after AVNeo.
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Affiliation(s)
- Natsuko Satomi
- Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan
| | - Masaki Miyasaka
- Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan
- Department of Laboratory Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yusuke Enta
- Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan
| | | | - Yusuke Toki
- Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan
| | | | - Makoto Saigan
- Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan
| | - Yuta Kobayashi
- Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan
| | - Yun Teng
- Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan
| | - Manabu Maeda
- Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan
| | - Momo Kosuga
- Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan
| | - Kazuo Abe
- Department of Cardiovascular Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Masataka Taguri
- Department of Health Data Science, Tokyo Medical University, Tokyo, Japan
| | - Yukihiro Hayatsu
- Department of Cardiovascular Surgery, Sendai Kousei Hospital, Miyagi, Japan
| | - Masaki Hata
- Department of Cardiovascular Surgery, Sendai Kousei Hospital, Miyagi, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan
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Kaur S, Nagaraja V, Schoenhagen P, Dabbagh MM, Bazarbashi N, Khubber S, Kaur M, Mohomad G, Verma B, Yun J, Svensson L, Tuzcu M, Popović ZB, Krishnaswamy A, Kapadia S. Outcomes of Cardiac Tamponade Post-Transcatheter Aortic Valve Replacement: Results From a Tertiary Cardiac Center. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2025; 9:100356. [PMID: 40124085 PMCID: PMC11925032 DOI: 10.1016/j.shj.2024.100356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/02/2024] [Accepted: 07/18/2024] [Indexed: 03/25/2025]
Abstract
Background Cardiac tamponade is a rare but potentially lethal complication of transcatheter aortic valve replacement (TAVR). There is paucity of evidence assessing the incidence and outcomes of patients with cardiac tamponade after TAVR. Methods A retrospective review was performed of all patients who underwent TAVR at our institution from January 2013 to January 2019. The clinical characteristics of patients who developed cardiac tamponade in the periprocedural period were compared to the patients who did not develop tamponade. Qualitative and quantitative assessment of aortic annular calcium distribution on cardiac computerized tomography was analyzed. Results Twenty out of 2030 patients (0.9%) developed cardiac tamponade post-TAVR. The mean age of the cohort developing cardiac tamponade was 81.7 years, and 50% of them were men. Most of these were intraprocedural (70%) while the remaining were identified in the postprocedural period. The site of injury resulting in pericardial tamponade was thought to be from the injury to aortic annulus (50%), right ventricle (40%), and left ventricle (10%). Tamponade due to annular or left ventricular trauma was mostly identified intraprocedurally (91%; n = 10 of 11), while patients with tamponade due to presumed right ventricular injury were mostly identified in the postprocedural period (62.5%; n = 5 of 8) (p = 0.009). Conservative management with supportive therapies was employed in 90% of patients with cardiac tamponade, while two patients had cardiac surgery. There was one in-hospital mortality, and another patient died within 30 days of the TAVR procedure. Conclusion The incidence of cardiac tamponade after TAVR (0.9%) was low, and this serious complication can be managed successfully in the majority of patients with streamlined processes in high-volume centers.
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Affiliation(s)
- Simrat Kaur
- Department of Cardiology, Section of Cardiovascular Medicine Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Vinayak Nagaraja
- Department of Interventional Cardiology, Section of Interventional Cardiology, Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Paul Schoenhagen
- Department of Cardiology, Section of Cardiovascular Medicine Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - M. Marwan Dabbagh
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio
| | - Najdat Bazarbashi
- Department of Internal Medicine, University of Maryland Medical Center Baltimore, Maryland
| | - Shameer Khubber
- Department of Cardiology, Section of Cardiovascular Medicine Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Manpreet Kaur
- Department of Cardiology, Section of Cardiovascular Medicine Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gad Mohomad
- Department of Cardiology, Section of Cardiovascular Medicine Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Beni Verma
- Department of Cardiology, Section of Cardiovascular Medicine Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - James Yun
- Department of Cardiovascular Surgery, Section of Cardiovascular Surgery, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars Svensson
- Department of Cardiovascular Surgery, Section of Cardiovascular Surgery, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Murat Tuzcu
- Department of Cardiology, Section of Cardiovascular Medicine Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Zoran B. Popović
- Department of Cardiology, Section of Cardiovascular Medicine Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiology, Section of Cardiovascular Medicine Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir Kapadia
- Department of Cardiology, Section of Cardiovascular Medicine Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Inomata S, Yoshimura T, Tang M, Ichikawa S, Sugimori H. Automatic Aortic Valve Extraction Using Deep Learning with Contrast-Enhanced Cardiac CT Images. J Cardiovasc Dev Dis 2024; 12:3. [PMID: 39852281 PMCID: PMC11766280 DOI: 10.3390/jcdd12010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 12/16/2024] [Accepted: 12/21/2024] [Indexed: 01/26/2025] Open
Abstract
PURPOSE This study evaluates the use of deep learning techniques to automatically extract and delineate the aortic valve annulus region from contrast-enhanced cardiac CT images. Two approaches, namely, segmentation and object detection, were compared to determine their accuracy. MATERIALS AND METHODS A dataset of 32 contrast-enhanced cardiac CT scans was analyzed. The segmentation approach utilized the DeepLabv3+ model, while the object detection approach employed YOLOv2. The dataset was augmented through rotation and scaling, and five-fold cross-validation was applied. The accuracy of both methods was evaluated using the Dice similarity coefficient (DSC), and their performance in estimating the aortic valve annulus area was compared. RESULTS The object detection approach achieved a mean DSC of 0.809, significantly outperforming the segmentation approach, which had a mean DSC of 0.711. Object detection also demonstrated higher precision and recall, with fewer false positives and negatives. The aortic valve annulus area estimation had a mean error of 2.55 mm. CONCLUSIONS Object detection showed superior performance in identifying the aortic valve annulus region, suggesting its potential for clinical application in cardiac imaging. The results highlight the promise of deep learning in improving the accuracy and efficiency of preoperative planning for cardiovascular interventions.
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Affiliation(s)
- Soichiro Inomata
- Graduate School of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan;
| | - Takaaki Yoshimura
- Department of Health Sciences and Technology, Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
- Department of Medical Physics, Hokkaido University Hospital, Sapporo 060-8648, Japan
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo 060-8638, Japan
- Clinical AI Human Resources Development Program, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Minghui Tang
- Clinical AI Human Resources Development Program, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan
- Department of Diagnostic Imaging, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Shota Ichikawa
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Niigata University, Niigata 951-8518, Japan
- Institute for Research Administration, Niigata University, Niigata 950-2181, Japan
| | - Hiroyuki Sugimori
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo 060-8638, Japan
- Clinical AI Human Resources Development Program, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan
- Department of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
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Granot YN, Passaniti G, Prandi FR, Sharma SK, Kini A, Lerakis S. Do we still need intra-procedural TTE during Transcatheter aortic valve replacement? A high volume, single center experience. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 68:1-5. [PMID: 38749898 DOI: 10.1016/j.carrev.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/08/2024] [Accepted: 05/08/2024] [Indexed: 11/26/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has undergone significant advances in recent years, with the development of improved pre-planning tools and devices. These advances have led to a reduction in the rate of paravalvular leak (PVL), a complication that is associated with poor outcomes even when mild. As some centers around the world are moving to solely fluoroscopy-focused implantation, we aimed to describe the clinical impact of intra-procedural transthoracic echocardiography (TTE) during TAVI in a high volume hospital. METHODS Observational study during a 3-month period. A limited TTE examination was performed immediately after deployment to assess the existence of PVL and grade its severity. Complete TTE was performed a day after the procedure. In case of ≥mild PVL after valve deployment, a decision was made according to the severity of the PVL, patient anatomy and extent of annular calcification to preform balloon post-dilation. If done, an additional limited TTE was performed to assess possible complication and the degree of PVL post dilatation. RESULTS 115 patient were included in the study. Intra-procedural TTE identified 16 patients (14 %) with at least mild PVL, three of them with moderate (3 %). Post balloon dilatation was performed in 10 patients (9 % of the cohort) with significant improvement in the degree of PVL. CONCLUSION Intra-procedural TTE immediately after TAVI deployment can accurately identify PVL, allowing operators to perform post balloon dilatation with improvement in early echocardiographic results. Our findings support the routine use of TTE during procedures, without relying solely on fluoroscopy.
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Affiliation(s)
- Yoav Niv Granot
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Giulia Passaniti
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Francesca Romana Prandi
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Samin K Sharma
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Annapoorna Kini
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Stamatios Lerakis
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Hashemifard A, Fatouraee N, Nabaei M. Nature of aortic annulus: Influence of annulus dynamic on the aortic valve hemodynamics. Comput Biol Med 2024; 181:109037. [PMID: 39168015 DOI: 10.1016/j.compbiomed.2024.109037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 07/30/2024] [Accepted: 08/15/2024] [Indexed: 08/23/2024]
Abstract
Accurate imaging reports of the aortic valve indicate that the diameter of the aortic annulus changes regularly during a cardiac cycle. Most of these studies aim to demonstrate the proper method for estimating the aortic annulus diameter before performing TAVR surgery, revealing that the aortic annulus is dynamic and not constant throughout the cardiac cycle. This raises the question of how fixing the aortic annulus might affect valve function, which is a question that still needs to be addressed. Therefore, the present study seeks to address this question and elucidate the dynamic impact of the aortic annulus on aortic valve hemodynamics. Two computational models based on this hypothesis were created and solved, and then their results were compared. Both models are identical, except for the intrinsic dynamic nature of the aortic annulus. One model consists of the dynamic behavior, and the other simulates a fixed annulus, resembling the effect of a TAVR operation, SAVR, or any phenomenon that eliminates the dynamic nature of the annulus. Our research findings indicate that the dynamic nature of the annulus enhances blood flow (+2.7 %), increases mean velocity (+11.9) and kinetic energy density (+34 %), prolongs momentum retention during systole, stabilizes the flow jet at the end of systole, reduces the required pressure to keep the leaflets open (-40.9 % at 0.3s), and sustains ventricular pressure superiority (+9.4 %) over the aorta for a longer duration (+17.7 % of systole), a crucial factor in preventing backflow during aortic valve closure. Based on these results, more attention should be paid to the dynamic nature of the annulus.
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Affiliation(s)
- Alireza Hashemifard
- Biological Fluid Dynamics Research Laboratory, Biomedical Engineering Department, َAmirkabir University of Technology, 350 Hafez Ave, Valiasr Square, P.O.Box 159163-4311, Tehran, 1591634311, Iran(1)
| | - Nasser Fatouraee
- Biological Fluid Dynamics Research Laboratory, Biomedical Engineering Department, َAmirkabir University of Technology, 350 Hafez Ave, Valiasr Square, P.O.Box 159163-4311, Tehran, 1591634311, Iran(1).
| | - Malikeh Nabaei
- Biological Fluid Dynamics Research Laboratory, Biomedical Engineering Department, َAmirkabir University of Technology, 350 Hafez Ave, Valiasr Square, P.O.Box 159163-4311, Tehran, 1591634311, Iran(1)
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Choi JY. Enhancing cardiology imaging: usability and implications of aortic annulus sizing software in transcatheter aortic valve replacement planning. J Cardiovasc Imaging 2024; 32:20. [PMID: 39098901 PMCID: PMC11299346 DOI: 10.1186/s44348-024-00016-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/04/2024] [Indexed: 08/06/2024] Open
Affiliation(s)
- Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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Piekarski F, Rohner M, Monsefi N, Bakhtiary F, Velten M. Anesthesia for Minimal Invasive Cardiac Surgery: The Bonn Heart Center Protocol. J Clin Med 2024; 13:3939. [PMID: 38999504 PMCID: PMC11242163 DOI: 10.3390/jcm13133939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 06/29/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
The development and adoption of minimally invasive techniques has revolutionized various surgical disciplines and has also been introduced into cardiac surgery, offering patients less invasive options with reduced trauma and faster recovery time compared to traditional open-heart procedures with sternotomy. This article provides a comprehensive overview of the anesthesiologic management for minimally invasive cardiac surgery (MICS), focusing on preoperative assessment, intraoperative anesthesia techniques, and postoperative care protocols. Anesthesia induction and airway management strategies are tailored to each patient's needs, with meticulous attention to maintaining hemodynamic stability and ensuring adequate ventilation. Intraoperative monitoring, including transesophageal echocardiography (TEE), processed EEG monitoring, and near-infrared spectroscopy (NIRS), facilitates real-time assessment of cardiac and cerebral perfusion, as well as function, optimizing patient safety and improving outcomes. The peripheral cannulation techniques for cardiopulmonary bypass (CPB) initiation are described, highlighting the importance of cannula placement to minimize tissue as well as vessel trauma and optimize perfusion. This article also discusses specific MICS procedures, detailing anesthetic considerations and surgical techniques. The perioperative care of patients undergoing MICS requires a multidisciplinary approach including surgeons, perfusionists, and anesthesiologists adhering to standardized treatment protocols and pathways. By leveraging advanced monitoring techniques and tailored anesthetic protocols, clinicians can optimize patient outcomes and promote early extubation and enhanced recovery.
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Affiliation(s)
- Florian Piekarski
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, 53127 Bonn, Germany; (M.R.); (M.V.)
| | - Marc Rohner
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, 53127 Bonn, Germany; (M.R.); (M.V.)
| | - Nadejda Monsefi
- Department of Cardiac Surgery, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, 53127 Bonn, Germany; (N.M.); (F.B.)
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, 53127 Bonn, Germany; (N.M.); (F.B.)
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, 53127 Bonn, Germany; (M.R.); (M.V.)
- Department of Anesthesiology and Pain Management, Division of Cardiovascular and Thoracic Anesthesiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Sharkey A, Khan AA, Yunus R, Rehman T, Bu Y, Saeed S, Matyal R, Mahmood F. Misidentification of the True Aortic Annulus With 2-dimensional Echocardiography: A Critical Appraisal Using 3-Dimensional Imaging. J Cardiothorac Vasc Anesth 2024; 38:1460-1466. [PMID: 38580474 DOI: 10.1053/j.jvca.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/25/2024] [Accepted: 03/03/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES This study aimed to evaluate the accuracy of identifying the true aortic valve (AV) annulus using 2-dimensional (2D) echocardiography, with the goal of highlighting potential misidentification issues in clinical practice. DESIGN An observational study employing 3-dimensional (3D) datasets to generate 2D images of the AV annulus for analysis. SETTING The study was conducted in an academic medical center. PARTICIPANTS Three-dimensional transesophageal echocardiography datasets were obtained from 11 patients with normal AV and aortic root anatomies undergoing coronary artery bypass surgery. Attending anesthesiologists certified by the National Board of Echocardiography (NBE) were approached subsequently to participate in this study. INTERVENTIONS Two images per patient were generated from 3D datasets, reflecting the mid-esophageal long-axis view of the AV, a true AV annulus image, and an off-axis image. A survey was distributed to NBE-certified perioperative echocardiographers across 12 academic institutions to identify the true AV annulus from these images. MEASUREMENTS AND MAIN RESULTS The survey, completed by 45 qualified respondents, revealed a significant misidentification rate of the true AV annulus, with only 36.8% of responses correctly identifying it. The rate of correct identification varied across image sets, with 44.4% of participants unable to correctly identify any true AV annulus image. CONCLUSIONS The study highlighted the limitations of 2D echocardiography in accurately identifying the true AV annulus in complex 3D structures like the aortic root. The findings suggest a need for greater reliance on advanced imaging modalities, such as 3D echocardiography, to improve accuracy in clinical practice.
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Affiliation(s)
- Aidan Sharkey
- Department of Anesthesia, Critical Care and Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA.
| | - Adnan A Khan
- Department of Anesthesia, Critical Care and Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Rayaan Yunus
- Department of Anesthesia, Critical Care and Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Taha Rehman
- Department of Anesthesia, Critical Care and Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Yifan Bu
- Department of Anesthesia, Critical Care and Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Shirin Saeed
- Department of Anesthesia, Critical Care and Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
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10
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Langenbach IL, Langenbach MC, Mayrhofer T, Foldyna B, Maintz D, Klein K, Wienemann H, Krug KB, Hellmich M, Adam M, Naehle CP. Reduction of contrast medium for transcatheter aortic valve replacement planning using a spectral detector CT: a prospective clinical trial. Eur Radiol 2024; 34:4089-4099. [PMID: 37979008 PMCID: PMC11166752 DOI: 10.1007/s00330-023-10403-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/25/2023] [Accepted: 09/17/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION This study investigated the use of dual-energy spectral detector computed tomography (CT) and virtual monoenergetic imaging (VMI) reconstructions in pre-interventional transcatheter aortic valve replacement (TAVR) planning. We aimed to determine the minimum required contrast medium (CM) amount to maintain diagnostic CT imaging quality for TAVR planning. METHODS In this prospective clinical trial, TAVR candidates received a standardized dual-layer spectral detector CT protocol. The CM amount (Iohexol 350 mg iodine/mL, standardized flow rate 3 mL/s) was reduced systematically after 15 patients by 10 mL, starting at 60 mL (institutional standard). We evaluated standard, and 40- and 60-keV VMI reconstructions. For image quality, we measured signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and diameters in multiple vessel sections (i.e., aortic annulus: diameter, perimeter, area; aorta/arteries: minimal diameter). Mixed regression models (MRM), including interaction terms and clinical characteristics, were used for comparison. RESULTS Sixty consecutive patients (mean age, 79.4 ± 7.5 years; 28 females, 46.7%) were included. In pre-TAVR CT, the CM reduction to 40 mL is possible without affecting the image quality (MRM: SNR: -1.1, p = 0.726; CNR: 0.0, p = 0.999). VMI 40-keV reconstructions showed better results than standard reconstructions with significantly higher SNR (+ 6.04, p < 0.001). Reduction to 30 mL CM resulted in a significant loss of quality (MRM: SNR: -12.9, p < 0.001; CNR: -13.9, p < 0.001), regardless of the reconstruction. Across the reconstructions, we observed no differences in the metric evaluation (p > 0.914). CONCLUSION Among TAVR candidates undergoing pre-interventional CT at a dual-layer spectral detector system, applying 40 mL CM is sufficient to maintain diagnostic image quality. VMI 40-keV reconstructions improve the vessel attenuation and are recommended for evaluation. CLINICAL RELEVANCE STATEMENT Contrast medium reduction to 40 mL in pre-interventional transcatheter aortic valve replacement CT using dual-energy CT maintains image quality, while 40-keV virtual monoenergetic imaging reconstructions enhance vessel attenuation. These results offer valuable recommendations for interventional transcatheter aortic valve replacement evaluation and potentially improve nephroprotection in patients with compromised renal function. KEY POINTS • Patients undergoing transcatheter aortic valve replacement (TAVR), requiring pre-interventional CT, are often multimorbid with impaired renal function. • Using a spectral detector dual-layer CT, contrast medium reduction to 40 mL is feasible, maintaining diagnostic image quality. • The additional application of virtual monoenergetic image reconstructions with 40 keV improves vessel attenuation significantly in clinical practice.
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Affiliation(s)
- Isabel L Langenbach
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany.
| | - Marcel C Langenbach
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Thomas Mayrhofer
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
- School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Borek Foldyna
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Konstantin Klein
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Hendrik Wienemann
- Clinic III for Internal Medicine, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Kathrin B Krug
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Medical Faculty, University of Cologne, Cologne, Germany
| | - Matti Adam
- Clinic III for Internal Medicine, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
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11
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de Agustin JA, Pozo Osinalde E, Olmos C, Mahia Casado P, Marcos-Alberca P, Luaces M, Gomez de Diego JJ, Nombela-Franco L, Jimenez-Quevedo P, Tirado-Conte G, Collado Yurrita L, Fernandez-Ortiz A, Perez-Villacastin J. Current Usefulness of Transesophageal Echocardiography in Patients Undergoing Transcatheter Aortic Valve Replacement. J Clin Med 2023; 12:7748. [PMID: 38137816 PMCID: PMC10743683 DOI: 10.3390/jcm12247748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
This review article describes in depth the current usefulness of transesophageal echocardiography in patients who undergo transcatheter aortic valve replacement. Pre-intervention, 3D-transesophageal echocardiography allows us to accurately evaluate the aortic valve morphology and to measure the valve annulus, helping us to choose the appropriate size of the prosthesis, especially useful in cases where the computed tomography is not of adequate quality. Although it is not currently used routinely during the intervention, it remains essential in those cases of greater complexity, such as for patients with greater calcification and bicuspid valve, mechanical mitral prosthesis, and "valve in valve" procedures. Three-dimensional transesophageal echocardiography is the best technique to detect and quantify paravalvular regurgitation, a fundamental aspect to decide whether immediate valve postdilation is needed. It also allows to detect early any immediate complications such as cardiac tamponade, aortic hematoma or dissection, migration of the prosthesis, malfunction of the prosthetic leaflets, or the appearance of segmental contractility disorders due to compromise of the coronary arteries ostium. Transesophageal echocardiography is also very useful in follow-up, to check the proper functioning of the prosthesis and to rule out complications such as thrombosis of the leaflets, endocarditis, or prosthetic degeneration.
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Affiliation(s)
- Jose Alberto de Agustin
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Eduardo Pozo Osinalde
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Carmen Olmos
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Patricia Mahia Casado
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Pedro Marcos-Alberca
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - María Luaces
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Jose Juan Gomez de Diego
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (G.T.-C.); (A.F.-O.); (J.P.-V.)
| | - Pilar Jimenez-Quevedo
- Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (G.T.-C.); (A.F.-O.); (J.P.-V.)
| | - Gabriela Tirado-Conte
- Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (G.T.-C.); (A.F.-O.); (J.P.-V.)
| | | | - Antonio Fernandez-Ortiz
- Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (G.T.-C.); (A.F.-O.); (J.P.-V.)
| | - Julian Perez-Villacastin
- Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (G.T.-C.); (A.F.-O.); (J.P.-V.)
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12
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Yao J, Bosi GM, Palombi A, Burriesci G, Wurdemann H. Compliant Aortic Annulus Sizing With Different Elliptical Ratios Through a Valvuloplasty Balloon Catheter. IEEE Trans Biomed Eng 2023; 70:3469-3479. [PMID: 37363848 DOI: 10.1109/tbme.2023.3289300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Aortic stenos (AS) is a heart valve disease that commonly affects the elderly. Transcatheter aortic valve implantation is a minimally invasive treatment that allows to replace the function of the diseased native valve with a prosthetic device, relying on catheters for device implantation. According to the current clinical guidelines, the choice of the implanted device is based on preoperative sizing determined by image-based technology. However, this assessment faces inherent limitations that can lead to sub-optimal sizing of the prosthesis; in turn, this can cause major post-operative complications like aortic regurgitation or cardiac electrical signal disruption. METHOD By utilizing balloon pressure and volume data, this article proposes an intra-operative method for determining the dimension of the aortic annulus which takes into account its compliance and geometric irregularity. The intra-balloon pressure-volume curves were obtained using an Automated Balloon Inflation Device operating a commercially available valvuloplasty balloon catheter. A sizing algorithm to estimate the dimensions of the annulus was integrated via a validated analytical model and a numerical model for balloon free-inflation. Tests were performed on circular and elliptical idealised aortic phantoms. RESULTS Experimental results confirm that the pressure-volume data processed with the sizing algorithm can be used to determine the circular annular diameter for all tissue rigidities. CONCLUSION The measurement of stiffer elliptical annulus phantoms shows good accuracy and high repeatability. SIGNIFICANCE This work represents substantial progress toward improving the selection of TAVI devices by using balloon catheters to improve the sizing of compliant aortic annuli with complex geometry.
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13
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Black GB, Kim JH, Vitter S, Ibrahim R, Lisko JC, Perdoncin E, Shekiladze N, Gleason PT, Grubb KJ, Greenbaum AB, Devireddy CM, Guyton RA, Leshnower B, Merchant FM, El-Chami M, Westerman SB, Shah AD, Leon AR, Lloyd MS, Babaliaros VC, Kiani S. Prospective validation of a risk score to predict pacemaker implantation after transcatheter aortic valve replacement. J Cardiovasc Electrophysiol 2023; 34:2225-2232. [PMID: 37702135 DOI: 10.1111/jce.16061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/25/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION The need for pacemaker is a common complication after transcatheter aortic valve replacement (TAVR). We previously described the Emory Risk Score (ERS) to predict the need for new pacemaker implant (PPM) after TAVR. Metrics included in the score are a history of syncope, pre-existing RBBB, QRS duration ≥140 ms, and prosthesis oversizing ≥16%. To prospectively validate the previously described risk score. METHODS We prospectively evaluated all patients without pre-existing pacemakers, ICD, or pre-existing indications for pacing undergoing TAVR with the Edwards SAPIEN 3 prosthesis at our institution from March 2019 to December 2020 (n = 661). Patients were scored prospectively; however, results were blinded from clinical decision-making. The primary endpoint was PPM at 30 days after TAVR. Performance of the ERS was evaluated using logistic regression, a calibration curve to prior performance, and receiver operating characteristic (ROC) analysis. RESULTS A total of 48 patients (7.3%) had PPM after TAVR. A higher ERS predicted an increased likelihood of PPM (OR 2.61, 95% CI: 2.05-3.25 per point, p < 0.001). There was good correlation between observed and expected values on the calibration curve (slope = 1.04, calibration at large = 0.001). The area under the ROC curve was 0.81 (95% CI [0.74-0.88], p < 0.001). CONCLUSIONS The ERS prospectively predicted the need for PPM in a serial, real-world cohort of patients undergoing TAVR with a balloon-expandable prosthesis, confirming findings previously described in retrospective cohorts. Notably, the prospective performance of the score was comparable with that of the initial cohorts. The risk score could serve as a framework for preprocedural risk stratification for PPM after TAVR.
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Affiliation(s)
- George B Black
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joshua H Kim
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sophie Vitter
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rand Ibrahim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John C Lisko
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Emily Perdoncin
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nikoloz Shekiladze
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patrick T Gleason
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kendra J Grubb
- Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Adam B Greenbaum
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chandan M Devireddy
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert A Guyton
- Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bradley Leshnower
- Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Faisal M Merchant
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mikhael El-Chami
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stacy B Westerman
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anand D Shah
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Angel R Leon
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael S Lloyd
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasilis C Babaliaros
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Soroosh Kiani
- Department of Medicine, Division of Cardiology, UMass Chan Medical School, Worcester, Massachusetts, USA
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14
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Dweck MR, Loganath K, Bing R, Treibel TA, McCann GP, Newby DE, Leipsic J, Fraccaro C, Paolisso P, Cosyns B, Habib G, Cavalcante J, Donal E, Lancellotti P, Clavel MA, Otto CM, Pibarot P. Multi-modality imaging in aortic stenosis: an EACVI clinical consensus document. Eur Heart J Cardiovasc Imaging 2023; 24:1430-1443. [PMID: 37395329 DOI: 10.1093/ehjci/jead153] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023] Open
Abstract
In this EACVI clinical scientific update, we will explore the current use of multi-modality imaging in the diagnosis, risk stratification, and follow-up of patients with aortic stenosis, with a particular focus on recent developments and future directions. Echocardiography is and will likely remain the key method of diagnosis and surveillance of aortic stenosis providing detailed assessments of valve haemodynamics and the cardiac remodelling response. Computed tomography (CT) is already widely used in the planning of transcutaneous aortic valve implantation. We anticipate its increased use as an anatomical adjudicator to clarify disease severity in patients with discordant echocardiographic measurements. CT calcium scoring is currently used for this purpose; however, contrast CT techniques are emerging that allow identification of both calcific and fibrotic valve thickening. Additionally, improved assessments of myocardial decompensation with echocardiography, cardiac magnetic resonance, and CT will become more commonplace in our routine assessment of aortic stenosis. Underpinning all of this will be widespread application of artificial intelligence. In combination, we believe this new era of multi-modality imaging in aortic stenosis will improve the diagnosis, follow-up, and timing of intervention in aortic stenosis as well as potentially accelerate the development of the novel pharmacological treatments required for this disease.
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Affiliation(s)
- Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Krithika Loganath
- Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Rong Bing
- Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Thomas A Treibel
- Barts Heart Centre, Bart's Health NHS Trust, W Smithfield, EC1A 7BE, London, UK
- University College London Institute of Cardiovascular Science, 62 Huntley St, WC1E 6DD, London, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, University Rd, Leicester LE1 7RH, UK
- The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Jonathon Leipsic
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, 1081 Burrard St Room 166, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Science and Public Health, Via Giustiniani, 2 - 35128, Padua, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan 164, 9300 Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, 80125 Naples, Italy
| | - Bernard Cosyns
- Department of Cardiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - João Cavalcante
- Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th St, Minneapolis, MN 55407, USA
| | - Erwan Donal
- Cardiology and CIC, Université Rennes, 2 Rue Henri Le Guilloux, 35033 Rennes, France
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Corso Giuseppe Garibaldi, 11, 48022 Lugo RA, Italy
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada
- Faculté de Médecine-Département de Médecine, Université Laval, Ferdinand Vandry Pavillon, 1050 Av. de la Médecine, Québec City, Quebec G1V 0A6, Canada
| | - Catherine M Otto
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, 4333 Brooklyn Ave NE Box 359458, Seattle, WA 98195-9458, USA
| | - Phillipe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada
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15
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Massie C, Parent M, Berthelot-Richer M, Kouz R, Palisaitis D, Le V, Poulin F. Automated and semi-automated 3D echocardiographic software for aortic annulus sizing in transcatheter aortic valve implantation helps bridge the gap between expert and novice operators. Int J Cardiovasc Imaging 2023; 39:1707-1717. [PMID: 37572176 PMCID: PMC10520092 DOI: 10.1007/s10554-023-02885-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/24/2023] [Indexed: 08/14/2023]
Abstract
3D-transesophageal echocardiography (3D-TEE) is an alternative to multidetector row computed tomography (MDCT) for aortic annulus (AoA) sizing in preparation for Transcatheter aortic valve implantation (TAVI). We aim to evaluate how the fully automated (auto) and semi-automated (SA) TEE methods perform compared to conventional manual TEE method and the gold standard MDCT for annulus sizing both in expert and novice operators. In this prospective cohort study, eighty-nine patients with severe aortic stenosis underwent multimodality imaging with 3D-TEE and MDCT. Annular measurements were collected by expert echocardiographers using 3D auto, SA and manual methods and compared to MDCT. A novice in the field of echocardiography retrospectively measured the AoA for all patients using the same methods. TEE measurements, independently of the method used, had good to very good agreement to MDCT. They significantly underestimated aortic annular area and circumference vs. MDCT with the auto method underestimating it the most and the manual method the least (6.5% and 1.3% respectively for area and circumference). For experts, the manual TEE method offered the least systematic bias while the SA method had narrower limits of agreement (LOA). For the novice operator, SA method provided the least bias and narrower LOA vs. MDCT. There is good agreement between novice and experts for all 3 TEE methods but better agreement with auto and SA methods as opposed to manual one. Our study supports the use of 3D-TEE as a complementary method to MDCT for aortic annular sizing. The newer auto and SA software, that requires minimal operator intervention, is an easy to use, reliable and reproducible tool for aortic annulus sizing for experienced operators, and especially less experienced ones.
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Affiliation(s)
- Charles Massie
- Hôpital du Sacré-Cœur de Montréal, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
| | - Martine Parent
- Hôpital du Sacré-Cœur de Montréal, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
| | - Maxime Berthelot-Richer
- Hôpital du Sacré-Cœur de Montréal, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
- Hôtel Dieu de Québec, Quebec, QC, Canada
| | - Rémi Kouz
- Hôpital du Sacré-Cœur de Montréal, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
| | - Donald Palisaitis
- Hôpital du Sacré-Cœur de Montréal, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
| | - Viet Le
- Hôpital du Sacré-Cœur de Montréal, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
| | - Frédéric Poulin
- Hôpital du Sacré-Cœur de Montréal, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada.
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16
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Postolache A, Sperlongano S, Lancellotti P. TAVI after More Than 20 Years. J Clin Med 2023; 12:5645. [PMID: 37685712 PMCID: PMC10489114 DOI: 10.3390/jcm12175645] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
It has been more than 20 years since the first in man transcatheter aortic valve intervention (TAVI), and during this period we have witnessed an impressive evolution of this technique, with an extension of its use from non-operable patients to high-, intermediate- and even low-risk patients with aortic stenosis, and with a decrease in the incidence of complications. In this review, we discuss the evaluation of patients before TAVI, the procedure and the changes it has seen over time, and we present the current main complications and challenges of TAVI.
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Affiliation(s)
- Adriana Postolache
- Cardiology Department, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, 4000 Liège, Belgium;
| | - Simona Sperlongano
- Devision of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi VanVitelli, 80131 Naples, Italy;
| | - Patrizio Lancellotti
- Cardiology Department, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, 4000 Liège, Belgium;
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17
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Lebehn M, Vahl T, Kampaktsis P, Hahn RT. Contemporary Evaluation and Clinical Treatment Options for Aortic Regurgitation. J Cardiovasc Dev Dis 2023; 10:364. [PMID: 37754793 PMCID: PMC10532324 DOI: 10.3390/jcdd10090364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
Aortic regurgitation (AR) is the third most frequent form of valvular disease and has increasing prevalence with age. This will be of increasing clinical importance with the advancing age of populations around the globe. An understanding of the various etiologies and mechanisms leading to AR requires a detailed understanding of the structure of the aortic valve and aortic root. While acute and chronic AR may share a similar etiology, their hemodynamic impact on the left ventricle (LV) and management are very different. Recent studies suggest current guideline recommendations for chronic disease may result in late intervention and suboptimal outcomes. Accurate quantitation of ventricular size and function, as well as grading of the severity of regurgitation, requires a multiparametric and multimodality imaging approach with an understanding of the strengths and weaknesses of each metric. Echocardiography remains the primary imaging modality for diagnosis with supplemental information provided by computed tomography (CT) and cardiac magnetic resonance imaging (CMR). Emerging transcatheter therapies may allow the treatment of patients at high risk for surgery, although novel methods to assess AR severity and its impact on LV size and function may improve the timing and outcomes of surgical intervention.
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Affiliation(s)
- Mark Lebehn
- Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Torsten Vahl
- Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
- Cardiovascular Research Foundation, New York, NY 10019, USA
| | - Polydoros Kampaktsis
- Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Rebecca T. Hahn
- Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
- Cardiovascular Research Foundation, New York, NY 10019, USA
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Hervas GC, Cisnal AF, Garcia-Blas S, Minana G, Valero E, Sanchis J, Moratal D. A Software Tool for the Measurement of the Aortic Annulus Area by Means of Computed Tomography Image Analysis for the Planning of Transcatheter Aortic Valve Replacement (TAVR). ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083767 DOI: 10.1109/embc40787.2023.10341020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Cardiovascular diseases (CVD) are the leading cause of death globally, being the heart valve complications one of the five most common heart problems. The aim of this study is the development of a MATLAB-based software tool to obtain several measurements derived from the aortic annulus for the planning of transcatheter aortic valve replacement (TAVR). The proposed software tool utilizes computed tomography (CT) images to reconstruct a volume of the patient. This virtual volume is rotated to situate the images in the plane which cuts the most basal points of the three aortic valve cusps, namely the aortic annulus, and obtain the required measurements. Nevertheless, the computer-user interaction will be entirely based on 2-dimension techniques to reduce both the complexity of the app and the computational load. The program was validated in CT images of 10 subjects with diagnosed aortic stenosis. A comparison of the results with the measurements used in the real clinical practice showed no significant differences between both methods.Clinical Relevance- The resulting computer tool provides significant information about the diseased aortic valve. This will allow clinicians to select the right prosthetic heart valve. It represents a cheaper and less complex alternative to sophisticated software tools which are currently being used to plan the intervention.
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Yang T, Zhu G, Cai L, Yeo JH, Mao Y, Yang J. A benchmark study of convolutional neural networks in fully automatic segmentation of aortic root. Front Bioeng Biotechnol 2023; 11:1171868. [PMID: 37397959 PMCID: PMC10311214 DOI: 10.3389/fbioe.2023.1171868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023] Open
Abstract
Recent clinical studies have suggested that introducing 3D patient-specific aortic root models into the pre-operative assessment procedure of transcatheter aortic valve replacement (TAVR) would reduce the incident rate of peri-operative complications. Tradition manual segmentation is labor-intensive and low-efficient, which cannot meet the clinical demands of processing large data volumes. Recent developments in machine learning provided a viable way for accurate and efficient medical image segmentation for 3D patient-specific models automatically. This study quantitively evaluated the auto segmentation quality and efficiency of the four popular segmentation-dedicated three-dimensional (3D) convolutional neural network (CNN) architectures, including 3D UNet, VNet, 3D Res-UNet and SegResNet. All the CNNs were implemented in PyTorch platform, and low-dose CTA image sets of 98 anonymized patients were retrospectively selected from the database for training and testing of the CNNs. The results showed that despite all four 3D CNNs having similar recall, Dice similarity coefficient (DSC), and Jaccard index on the segmentation of the aortic root, the Hausdorff distance (HD) of the segmentation results from 3D Res-UNet is 8.56 ± 2.28, which is only 9.8% higher than that of VNet, but 25.5% and 86.4% lower than that of 3D UNet and SegResNet, respectively. In addition, 3D Res-UNet and VNet also performed better in the 3D deviation location of interest analysis focusing on the aortic valve and the bottom of the aortic root. Although 3D Res-UNet and VNet are evenly matched in the aspect of classical segmentation quality evaluation metrics and 3D deviation location of interest analysis, 3D Res-UNet is the most efficient CNN architecture with an average segmentation time of 0.10 ± 0.04 s, which is 91.2%, 95.3% and 64.3% faster than 3D UNet, VNet and SegResNet, respectively. The results from this study suggested that 3D Res-UNet is a suitable candidate for accurate and fast automatic aortic root segmentation for pre-operative assessment of TAVR.
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Affiliation(s)
- Tingting Yang
- School of Energy and Power Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Guangyu Zhu
- School of Energy and Power Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Li Cai
- School of Mathematics and Statistics, Northwestern Polytechnical University, Xi’an, China
| | - Joon Hock Yeo
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Yu Mao
- Department of Cardiac Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Jian Yang
- Department of Cardiac Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
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20
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Angellotti D, Manzo R, Castiello DS, Immobile Molaro M, Mariani A, Iapicca C, Nappa D, Simonetti F, Avvedimento M, Leone A, Canonico ME, Spaccarotella CAM, Franzone A, Ilardi F, Esposito G, Piccolo R. Hemodynamic Performance of Transcatheter Aortic Valves: A Comprehensive Review. Diagnostics (Basel) 2023; 13:diagnostics13101731. [PMID: 37238215 DOI: 10.3390/diagnostics13101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a widely adopted treatment option for patients with severe aortic stenosis. Its popularity has grown significantly in recent years due to advancements in technology and imaging. As TAVI use is increasingly expanded to younger patients, the need for long-term assessment and durability becomes paramount. This review aims to provide an overview of the diagnostic tools to evaluate the hemodynamic performance of aortic prosthesis, with a special focus on the comparison between transcatheter and surgical aortic valves and between self-expandable and balloon-expandable valves. Moreover, the discussion will encompass how cardiovascular imaging can effectively detect long-term structural valve deterioration.
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Affiliation(s)
- Domenico Angellotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | | | | | - Andrea Mariani
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Cristina Iapicca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Dalila Nappa
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Fiorenzo Simonetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Mario Enrico Canonico
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | | | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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21
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Kusner JJ, Brown JY, Gleason TG, Edelman ER. The Natural History of Bicuspid Aortic Valve Disease. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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22
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Lasso A, Herz C, Nam H, Cianciulli A, Pieper S, Drouin S, Pinter C, St-Onge S, Vigil C, Ching S, Sunderland K, Fichtinger G, Kikinis R, Jolley MA. SlicerHeart: An open-source computing platform for cardiac image analysis and modeling. Front Cardiovasc Med 2022; 9:886549. [PMID: 36148054 PMCID: PMC9485637 DOI: 10.3389/fcvm.2022.886549] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
Cardiovascular disease is a significant cause of morbidity and mortality in the developed world. 3D imaging of the heart's structure is critical to the understanding and treatment of cardiovascular disease. However, open-source tools for image analysis of cardiac images, particularly 3D echocardiographic (3DE) data, are limited. We describe the rationale, development, implementation, and application of SlicerHeart, a cardiac-focused toolkit for image analysis built upon 3D Slicer, an open-source image computing platform. We designed and implemented multiple Python scripted modules within 3D Slicer to import, register, and view 3DE data, including new code to volume render and crop 3DE. In addition, we developed dedicated workflows for the modeling and quantitative analysis of multi-modality image-derived heart models, including heart valves. Finally, we created and integrated new functionality to facilitate the planning of cardiac interventions and surgery. We demonstrate application of SlicerHeart to a diverse range of cardiovascular modeling and simulation including volume rendering of 3DE images, mitral valve modeling, transcatheter device modeling, and planning of complex surgical intervention such as cardiac baffle creation. SlicerHeart is an evolving open-source image processing platform based on 3D Slicer initiated to support the investigation and treatment of congenital heart disease. The technology in SlicerHeart provides a robust foundation for 3D image-based investigation in cardiovascular medicine.
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Affiliation(s)
- Andras Lasso
- Laboratory for Percutaneous Surgery, School of Computing, Queen's University, Kingston, ON, Canada
| | - Christian Herz
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Hannah Nam
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Alana Cianciulli
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Simon Drouin
- Software and Information Technology Engineering, École de Technologie Supérieure, Montreal, QC, Canada
| | | | - Samuelle St-Onge
- Software and Information Technology Engineering, École de Technologie Supérieure, Montreal, QC, Canada
| | - Chad Vigil
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Stephen Ching
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kyle Sunderland
- Laboratory for Percutaneous Surgery, School of Computing, Queen's University, Kingston, ON, Canada
| | - Gabor Fichtinger
- Laboratory for Percutaneous Surgery, School of Computing, Queen's University, Kingston, ON, Canada
| | - Ron Kikinis
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Matthew A. Jolley
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States,Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States,*Correspondence: Matthew A. Jolley
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Boissonnet CP, Wisner JN, Giorgi MA, Carosella L, Brescacin Castillejo C, Pissinis J, Guetta JN. Temporal Trends in Self-Expandable Transcatheter Aortic Valve Replacement in South America: A Systematic Review and Meta-Analysis. Value Health Reg Issues 2022; 30:148-160. [DOI: 10.1016/j.vhri.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 11/24/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
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Abstract
Purpose of Review This review summarizes current data supporting a minimalist TAVR approach and identifies the need for additional study to optimize TAVR care. The authors discuss future directions of the TAVR landscape and how this necessitates evolution of minimalist care pathways. Recent Findings Transcatheter aortic valve replacement (TAVR) has become a mainstay in the treatment of aortic stenosis since the initial procedure in 2002. Recently, attention has shifted to TAVR optimization and the minimalist approach with a focus on minimizing procedural sedation, protocolization of perioperative management, and prioritization on early discharge. This approach has been shown to be safe and reduce procedure time, length of stay, and overall cost for hospital systems. Summary The minimalist care pathway avoids general anesthesia, shortens procedure time and length of stay, and reduces cost without changing mortality or readmission rates at 30 days. A variety of protocols have been proposed without a clear consensus on specific components or patient eligibility. There is a continued need for data regarding patient risk stratification, valve selection, and discharge strategy as TAVR becomes increasingly common.
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Preoperative TAVR Planning: How to Do It. J Clin Med 2022; 11:jcm11092582. [PMID: 35566708 PMCID: PMC9101424 DOI: 10.3390/jcm11092582] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/25/2022] [Accepted: 03/15/2022] [Indexed: 02/06/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a well-established treatment option for patients with severe symptomatic aortic stenosis (AS) whose procedural efficacy and safety have been continuously improving. Appropriate preprocedural planning, including aortic valve annulus measurements, transcatheter heart valve choice, and possible procedural complication anticipation is mandatory to a successful procedure. The gold standard for preoperative planning is still to perform a multi-detector computed angiotomography (MDCT), which provides all the information required. Nonetheless, 3D echocardiography and magnet resonance imaging (MRI) are great alternatives for some patients. In this article, we provide an updated comprehensive review, focusing on preoperative TAVR planning and the standard steps required to do it properly.
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26
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Risk of conduction disturbances following different transcatheter aortic valve prostheses: the role of aortic valve calcifications. J Geriatr Cardiol 2022; 19:167-176. [PMID: 35464642 PMCID: PMC9002082 DOI: 10.11909/j.issn.1671-5411.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To assess the impact of prosthesis choice and aortic valve calcifications on the occurrence of conduction disturbances after transcatheter aortic valve implantation (TAVI). METHODS We retrospectively analyzed the preoperative clinical characteristics, electrocardiograms, contrast-enhanced multidetector computed tomography scans and procedural strategies of patients who underwent TAVI in our center between January 2012 and June 2017. Quantification of calcium volume was performed for each aortic cusp above (aortic valve) and below (left ventricular outflow tract, LVOT) the basal plane. Multivariate analysis was performed to evaluate risk factors for the onset of new bundle branch block (BBB), transient and permanent atrioventricular block (tAVB, pAVB). RESULTS A total of 569 patients were included in the study. Six different prostheses were implanted (Edwards Sapien XT, n = 162; Edwards Sapien 3, n = 240; Medtronic CoreValve, n = 27; Medtronic CoreValve Evolut R, n = 21; Symetis Acurate, n = 56; Symetis Acurate neo, n = 63). The logistic regression analysis for BBB showed association with baseline left anterior hemiblock. The logistic regression for tAVB, found the prior valvuloplasty and the balloon post-dilatation associated with the outcome. Baseline left and right BBB, degree of oversizing, and LVOT calcification beneath the non-coronary cusp were associated with pAVB. Neither the prosthesis model, nor the use of a self-expandable prosthesis showed statistical significance with the above-mentioned outcomes on univariate analysis. CONCLUSIONS LVOT calcification beneath the non-coronary cusp, baseline left anterior hemiblock, right BBB, balloon post-dilatation, prior valvuloplasty and oversizing are independently associated with postprocedural conduction disturbances after TAVI. Use of a self-expandable prosthesis may show a lower incidence of AVB, if applied in lower calcified aortic valves.
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27
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Recommendations in pre-procedural imaging assessment for TAVI intervention: SIC-SIRM position paper part 2 (CT and MR angiography, standard medical reporting, future perspectives). LA RADIOLOGIA MEDICA 2022; 127:277-293. [PMID: 35129758 DOI: 10.1007/s11547-021-01434-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
Non-invasive cardiovascular imaging owns a pivotal role in the preoperative assessment of patient candidates 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. This document has been developed by a joined group of experts of the Italian Society of Cardiology and the Italian Society of Medical and Interventional Radiology and aims to produce an updated consensus statement about the pre-procedural imaging assessment in candidate patients for TAVI intervention. The writing committee consisted of members and experts of both societies who worked jointly to develop a more integrated approach in the field of cardiac and vascular radiology. Part 2 of the document will cover CT and MR angiography, standard medical reporting, and future perspectives.
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Tsuda D, Mori S, Izawa Y, Toh H, Suzuki M, Takahashi Y, Toba T, Fujiwara S, Tanaka H, Watanabe Y, Kono AK, Hirata KI. Diversity and determinants of the sigmoid septum and its impact on morphology of the outflow tract as revealed using cardiac computed tomography. Echocardiography 2022; 39:248-259. [PMID: 35038184 DOI: 10.1111/echo.15298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/27/2021] [Accepted: 01/01/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The sigmoid septum has been generally evaluated subjectively and qualitatively, without detailed examination of its diversity, impact on the morphology of the left ventricular outflow tract (LVOT), and anatomical background. METHODS We enrolled 100 patients without any background cardiac diseases (67.5 ± 12.8 years old; 43% women) who underwent cardiac computed tomography. Basal septal morphology was evaluated using antero-superior and medial bulging angles (bidirectional angulation of the basal septum relative to the LVOT). The eccentricity index of the LVOT, area narrowing ratio (LVOT/virtual basal ring area), aortic-to-left ventricular axial angle (angulation of the aortic root relative to the left ventricle), and wedged height (non-coronary aortic sinus to inferior epicardium distance) were also quantified. RESULTS The antero-superior bulging, medial bulging, aortic-to-left ventricular axial angles, LVOT eccentricity index, area narrowing ratio, and wedged height were 76° ± 17°, 166° ± 27°, 127° ± 9°, 1.8 ± 0.5, 1.0 ± 0.2, and 41.2 ± 9.1 mm, respectively. Both bulging angles were correlated with each other and contributed to the narrowing and deformation of the LVOT. Angulated aortic root was not correlated with either bidirectional septal bulge or LVOT narrowing. Clockwise rotation of the aortic root rotation was an independent predictor of prominent antero-superior septal bulge. Deeper aortic wedging was a common independent predictor of bidirectional septal bulge. CONCLUSIONS The extent of septal bulge varies in normal hearts. Along with deep aortic wedging, the bidirectional bulge of the basal septum deforms and narrows the LVOT without affecting the virtual basal ring morphology.
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Affiliation(s)
- Daisuke Tsuda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Toh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masataka Suzuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yu Takahashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sei Fujiwara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiaki Watanabe
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi K Kono
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Westermann D, Ludwig S, Kalbacher D, Spink C, Linder M, Bhadra OD, Nikorowitsch J, Waldschmidt L, Demal T, Voigtländer L, Schaefer A, Seiffert M, Pecha S, Schofer N, Greenbaum AB, Reichenspurner H, Blankenberg S, Conradi L, Schirmer J. Prevention of coronary obstruction in patients at risk undergoing transcatheter aortic valve implantation: the Hamburg BASILICA experience. Clin Res Cardiol 2021; 110:1900-1911. [PMID: 34156524 PMCID: PMC8639537 DOI: 10.1007/s00392-021-01881-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to assess the clinical outcome of the bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary obstruction (BASILICA) technique in a single-center patient cohort considered at high or prohibitive risk of transcatheter aortic valve implantation (TAVI)-induced coronary obstruction. METHODS Between October 2019 and January 2021, a total of 15 consecutive patients (age 81.0 [78.1, 84.4] years; 53.3% female; EuroSCORE II 10.6 [6.3, 14.8] %) underwent BASILICA procedure prior to TAVI at our institution. Indications for TAVI were degeneration of stented (n = 12, 80.0%) or stentless (n = 1, 6.7%) bioprosthetic aortic valves, or calcific stenosis of native aortic valves (n = 2, 13.3%), respectively. Individual risk of TAVI-induced coronary obstruction was assessed by pre-procedural computed tomography analysis. Procedural and 30-day outcomes were documented in accordance with Valve Academic Research Consortium (VARC)-2 criteria. RESULTS BASILICA was attempted for single left coronary cusp in 12 patients (80.0%), for single right coronary cusp in 2 patients (13.3%), and for both cusps in 1 patient (6.7%), respectively. The procedure was feasible in 13 patients (86.7%) resulting in effective prevention of coronary obstruction, whilst TAVI was performed without prior successful bioprosthetic leaflet laceration in two patients (13.3%). In one of these patients (6.7%), additional chimney stenting immediately after TAVI was performed. No all-cause deaths or strokes were documented after 30 days. CONCLUSION The BASILICA technique appears to be a feasible, safe and effective concept to avoid iatrogenic coronary artery obstruction during TAVI in both native and bioprosthetic valves of patients at high or prohibitive risk. ClinicalTrials.gov Identifier: NCT04227002 (Hamburg AoRtic Valve cOhoRt).
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Affiliation(s)
- Dirk Westermann
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany.
| | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
| | - Clemens Spink
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Linder
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Oliver D Bhadra
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Julius Nikorowitsch
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lara Waldschmidt
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Till Demal
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lisa Voigtländer
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
| | - Simon Pecha
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, USA
| | - Hermann Reichenspurner
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
| | - Lenard Conradi
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
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Singh S, Rutkowski PS, Dyachkov A, Iyer VS, Pourafkari L, Nader ND. A discrepancy between CT angiography and transesophageal echocardiographic measurements of the annular size affect long-term survival following trans-catheter aortic valve replacement. J Cardiovasc Thorac Res 2021; 13:208-215. [PMID: 34630968 PMCID: PMC8493236 DOI: 10.34172/jcvtr.2021.39] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/18/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction: Accurate measurement of the aortic valve annulus is critical for proper valve sizing for the transcatheter aortic valve replacement (TAVR) procedure. While computed tomography angiography (CTA) is the widely-accepted standard, two-dimensional (2D) and three-dimensional(3D) transesophageal echocardiography (TEE) is commonly performed to measure the size of the aortic valve and to verify appropriate seating of prostheses. Methods: Patients undergoing TAVR between 2013-2015 were examined. 2D- and 3D-TEEmeasurements were compared to CTA taken as standard. Patients were followed for at least one year. The presence and effect of discrepancy (defined as a difference of more than 10%) between CTA and TEE measurements on survival were examined. Results: One hundred eighty-five patients (70 men) were included. 2D- and 3D-TEE measurements underestimated the annulus size by -1.49 and -1.32 mm, respectively. Discrepancies > 10% between TEE and CTA methods in estimating the aortic annulus size were associated with a decrease in post implant survival. The peak pressure gradient across the aortic prosthesis measured one year after the implant was higher in patients with an initial discrepancy between 3D-TEE and CTA measurements. In a multivariate cox-regression model, the discrepancy between CTA and 2D-TEE readings and the smaller size of the aortic annular area were the predictors of long-term survival. Conclusion: Both 2D and 3D-TEE underestimate the aortic annulus measurements compared to CTA, with 2D-TEE being relatively more precise than 3D-TEE technology. The presence of a discrepancy between echocardiographic and CTA measurements of the aortic annulus is associated with a lower survival rate.
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Affiliation(s)
- Siddarth Singh
- Department of Anesthesiology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Piotr S Rutkowski
- Department of Anesthesiology, University at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Alexey Dyachkov
- Department of Anesthesiology, Geisinger Medical Center, Danville, PA, USA
| | - Vijay S Iyer
- Gates Vascular Institute, Interventional Cardiology, University at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Leili Pourafkari
- Catholic Health System, University at Buffalo Jacob's School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Nader D Nader
- Department of Anesthesiology, University at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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31
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Chen M, Michel J, Kasel AM. Application of Balloon-Expandable Transcatheter Heart Valve in Bicuspid Aortic Valve. JACC. ASIA 2021; 1:147-161. [PMID: 36338163 PMCID: PMC9627836 DOI: 10.1016/j.jacasi.2021.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 06/16/2023]
Abstract
Bicuspid aortic valve (BAV) remains challenging in transcatheter aortic valve replacement (TAVR) because of unfavorable anatomy. New-generation balloon-expandable valve (BEV) appears to be a valid alternative to surgery, especially in some Asian countries with a higher prevalence of BAV. This tutorial review summarizes current thinking about how to plan and implant BEV in BAVs using versatile techniques. First, the authors depict the main morphological characteristics of BAVs and their effects on the TAVR procedure. Next, the authors provide preprocedural analysis on sizing, obtaining the optimal deployment projection, and how to simplify valve-crossing. Finally, the authors provide step-by-step guidance on how to deploy the BEVs with evolved iterations in terms of specific anatomies, calcified annulus, and giant annulus.
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Key Words
- AV, aortic valve
- BAV, bicuspid aortic valve
- BEV, balloon-expandable valve
- MDCT, multidetector computed tomography
- ODP, optimal deployment projection
- PVL, paravalvular leak
- SEV, self-expanding valve
- TAV, tricuspid aortic valve
- TAVR, transcatheter aortic valve replacement
- THV, transcatheter heart valve
- aortic stenosis
- balloon-expandable valve
- bicuspid aortic valve
- transcatheter aortic valve replacement
- transcatheter heart valve
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Affiliation(s)
- Mi Chen
- Department of Cardiac Surgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jonathan Michel
- Department of Cardiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Albert Markus Kasel
- Department of Cardiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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32
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Izawa Y, Mori S, Tretter JT, Quintessenza JA, Toh H, Toba T, Watanabe Y, Kono AK, Okada K, Hirata KI. Normative Aortic Valvar Measurements in Adults Using Cardiac Computed Tomography - A Potential Guide to Further Sophisticate Aortic Valve-Sparing Surgery. Circ J 2021; 85:1059-1067. [PMID: 33408304 DOI: 10.1253/circj.cj-20-0938] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A thorough understanding of the anatomy of the aortic valve is necessary for aortic valve-sparing surgery. Normal valvar dimensions and their relationships in the living heart, however, have yet to be fully investigated in a 3-dimensional fashion. METHODS AND RESULTS In total, 123 consecutive patients (66±12 years, Men 63%) who underwent coronary computed tomographic angiography were enrolled. Mid-diastolic morphology of the aortic roots, including height of the interleaflet triangles, geometric height, free margin length of each leaflet, effective height, and coaptation length were measured using multiplanar reconstruction images. Average height of the interleaflet triangle, geometric height, free margin length, effective height, and the coaptation length were 17.3±1.8, 14.7±1.3, 32.6±3.6, 8.6±1.4, and 3.2±0.8 mm, respectively. The right coronary aortic leaflet displayed the longest free margin length and shortest geometric height. Geometric height, free margin length, and effective height showed positive correlations with aortic root dimensions. Coaptation length, however, remained constant regardless of aortic root dimensions. CONCLUSIONS Diversities, as well as characteristic relationships among each value involving the aortic root, were identified using living-heart datasets. The aortic leaflets demonstrated compensatory elongation along with aortic root dilatation to maintain constant coaptation length. These measurements will serve as the standard value for revealing the underlying mechanism of aortic regurgitation to plan optimal aortic valve-sparing surgery.
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Affiliation(s)
- Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Justin T Tretter
- The Heart Institute, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - James A Quintessenza
- The Heart Institute, Cincinnati Children's Hospital Medical Center
- Kentucky Children's Hospital, University of Kentucky, UK Healthcare
| | - Hiroyuki Toh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Yoshiaki Watanabe
- Department of Radiology, Kobe University Graduate School of Medicine
| | - Atsushi K Kono
- Department of Radiology, Kobe University Graduate School of Medicine
| | - Kenji Okada
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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33
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Librera M, Carlomagno G, Paolillo S, Romano M, Antonini-Canterin F, D'Alto M, De Martino G, Briguori C. Two-Dimensional Transesophageal Echocardiography Assessment of the Major Aortic Annulus Diameter in Patients Undergoing Transcatheter Aortic Valve Replacement. J Cardiovasc Echogr 2021; 31:23-28. [PMID: 34221882 PMCID: PMC8230165 DOI: 10.4103/jcecho.jcecho_110_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/27/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Multidetector computed tomography (MDCT) is the gold standard in annulus sizing before transcatheter aortic valve replacement (TAVR). However, MDCT has limited applicability in specific subgroups of patients, such as those with atrial fibrillation and chronic kidney disease. Two-dimensional transesophageal echocardiography (2DTEE) has traditionally been limited to the long-axis measurement of the anteroposterior diameter of the aortic annulus. We describe a new 2DTEE approach for the measurement of the major diameter of the aortic annulus. Methods: Seventy-six patients with symptomatic severe aortic valve stenosis and high surgical risk underwent MDCT and 2DTEE before TAVR. A modified five-chamber view was used to measure the major aortic annulus diameter. This was obtained starting from a mid-esophageal four chamber and retracting the TEE probe up until the left ventricular outflow tract and the left and noncoronary aortic cusps were visualized: major aortic annulus diameter was measured as the distance between their insertion points in systole. Results: Major aortic annulus diameters measured at 2DTEE showed good correlation with MDCT diameter (r = 0.79; P < 0.001) and perimeter (r = 0.87; P < 0.0001). Using factsheet-derived sizing criteria, 2DTEE alone would have allowed accurate sizing in 75% of patients, with 21% of oversizing predominantly with smaller annuli. Conclusions: We describe a new method for 2DTEE measurement of the major aortic annulus diameter; this approach is simple, correlates with MDCT, and allows adequate TAVR sizing in most patients. These findings may help in the assessment of patients with contraindications to or inadequate MDCT images.
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Affiliation(s)
| | | | | | - Maurizio Romano
- Radiology Unit, Mediterranea Cardiocentro, Naples, Italy.,Institute on Biostructures and Bioimages, CNR, Naples, Italy
| | | | - Michele D'Alto
- "L. Vanvitelli" University, Monaldi Hospital, Naples, Italy
| | | | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
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34
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Boccalini S, Bons LR, van den Hoven AT, van den Bosch AE, Krestin GP, Roos-Hesselink J, Budde RPJ. Bicuspid aortic valve annulus: assessment of geometry and size changes during the cardiac cycle as measured with a standardized method to define the annular plane. Eur Radiol 2021; 31:8116-8129. [PMID: 33895857 PMCID: PMC8523432 DOI: 10.1007/s00330-021-07916-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/11/2021] [Accepted: 03/19/2021] [Indexed: 12/02/2022]
Abstract
Purpose Bicuspid aortic valve (BAV) is a complex malformation affecting not merely the aortic valve. However, little is known regarding the dynamic physiology of the aortic annulus in these patients and whether it is similar to tricuspid aortic valves (TAV). Determining the BAV annular plane is more challenging than for TAV. Our aim was to present a standardized methodology to determine BAV annulus and investigate its changes in shape and dimensions during the cardiac cycle. Methods BAV patients were prospectively included and underwent an ECG-gated cardiac CTA. The annulus plane was manually identified on reconstructions at 5% intervals of the cardiac cycle with a new standardized method for different BAV types. Based on semi-automatically defined contours, maximum and minimum diameter, area, area-derived diameter, perimeter, asymmetry ratio (AR), and relative area were calculated. Differences of dynamic annular parameters were assessed also per BAV type. Results Of the 55 patients included (38.4 ± 13.3 years; 58% males), 38 had BAV Sievers type 1, 10 type 0, and 7 type 2. The minimum diameter, perimeter, area, and area-derived diameter were significantly higher in systole than in diastole with a relative change of 13.7%, 4.8%, 13.7%, and 7.2% respectively (all p < 0.001). The AR was ≥ 1.1 in all phases, indicating an elliptic shape, with more pronounced flattening in diastole (p < 0.001). Different BAV types showed comparable dynamic changes. Conclusions BAV annulus undergo significant changes in shape during the cardiac cycle with a wider area in systole and a more elliptic conformation in diastole regardless of valve type. Key Points • A refined method for the identification of the annulus plane on CT scans of patients with bicuspid aortic valves, tailored for the specific anatomy of each valve type, is proposed. • The annulus of patients with bicuspid aortic valves undergoes significant changes during the cardiac cycle with a wider area and more circular shape in systole regardless of valve type. • As compared to previously published data, the bicuspid aortic valve annulus has physiological dynamics similar to that encountered in tricuspid valves but with overall larger dimensions. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07916-8.
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Affiliation(s)
- Sara Boccalini
- Department of Radiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Lidia R Bons
- Department of Cardiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Allard T van den Hoven
- Department of Cardiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Jolien Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Cardiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
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35
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Lind AY, Totzeck M, Rassaf T, Jánosi RA. [Aortic stenosis - Selection of the appropriate TAVR patient]. MMW Fortschr Med 2021; 163:46-53. [PMID: 33844225 DOI: 10.1007/s15006-021-9714-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alexander Y Lind
- Klinik für Kardiologie und Angiologie, Westdeutsches Herz- und Gefäßzentrum,, UniversitätDuisburg-Essen, Hufelandstraße 55, D-45147, Essen, Germany
| | - Matthias Totzeck
- - Klinik f. Kardiologie u. Angilogie -, Westdt.Herz- u. Gefäßzentrum\/Univ.-Klinikum Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Tienush Rassaf
- - Universitätsklinikum Essen -, Westdt. Herz- u. Gefäßzentrum\/Klinik f. Kardiologie, Hufelandstr. 55, 45122, Essen, Germany
| | - R Alexander Jánosi
- Klinik für Kardiologie und Angiologie, Westdeutsches Herz- und Gefäßzentrum, Universität Duisburg-Essen, Hufelandstraße 55, D-45147, Essen, Germany
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36
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Di Bacco L, Rosati F, Folliguet T, Petruccelli RD, Concistrè G, Santarpino G, Di Bartolomeo R, Bisleri G, Fischlein TJ, Muneretto C. Sutureless aortic valves in elderly patients with aortic stenosis and intermediate-risk profile. J Cardiovasc Med (Hagerstown) 2021; 22:297-304. [PMID: 33633045 DOI: 10.2459/jcm.0000000000001120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS Sutureless valves became an alternative to standard bioprostheses, allowing surgeons to significantly reduce cross-clamping and extracorporeal circulation times, with a potential positive impact on major postoperative complications. The aim of this European multicentre study was to evaluate the safety and efficacy of sutureless valves in patients with an intermediate-risk profile undergoing aortic valve replacement (AVR). METHODS We investigated early and mid-term outcomes of 518 elderly patients with aortic stenosis at intermediate-risk profile (mean STS Score 6.1 ± 2%) undergoing AVR with sutureless aortic valve. Primary endpoints were 30-day mortality and freedom from all-cause death at follow-up. The secondary endpoint was survival freedom from MACCEs [all-cause death, stroke/transitory ischemic attack (TIA), bleeding, myocardial infarction, aortic regurgitation Grade II, endocarditis, reintervention and pacemaker implant; VARC 1--2 criteria]. RESULTS Sutureless valve implantation was successfully performed in 508 patients, with a procedural success rate of 98.1% (508/518) as per VARC criteria. Concomitant myocardial revascularization [coronary artery bypass grafting (CABG)] was performed in 74 out of 518 patients (14.3%). In-hospital mortality was 1.9% (10/518). Postoperative complications included revision for bleeding (23/518; 4.4%), prolonged intubation more than 48h (4/518; 0.7%), acute renal failure (14/518; 2.7%), stroke/TIA (11/518; 2.1%), pacemaker implantation (26/518; 5.1%) and aortic regurgitation more than Grade II (7/518; 1.4%). At 48-month follow-up, Kaplan-Meier overall survival and freedom from MACCEs in patients receiving isolated AVR were 83.7% [95% confidence interval (95% CI): 81.1-86.3] and 78.4% (95% CI: 75.5-81.4), respectively, while in patients with concomitant CABG, Kaplan-Meier overall survival and freedom from MACCEs were 82.3% (95% CI: 73.3-91.3) and 79.1% (95% CI: 69.9-88.3), respectively. CONCLUSION The use of sutureless aortic valves in elderly patients with an intermediate-risk profile provided excellent early and mid-term outcomes, providing a reliable tool in patients undergoing surgical AVR in this specific subset of population. These preliminary data need to be investigated with a TAVI control-group in further studies.
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Affiliation(s)
- Lorenzo Di Bacco
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Fabrizio Rosati
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | | | - Rocco D Petruccelli
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | | | - Giuseppe Santarpino
- Città di Lecce Hospital, GVM Care and Research, Lecce, Italy
- Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | | | - Gianluigi Bisleri
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | | | - Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
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37
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Mangieri A, Laricchia A, Montalto C, Palena ML, Fisicaro A, Cereda A, Sticchi A, Latib A, Giannini F, Khokhar AA, Colombo A. Patient selection, procedural planning and interventional guidance for transcatheter aortic valve intervention. Minerva Cardiol Angiol 2021; 69:671-683. [PMID: 33703862 DOI: 10.23736/s2724-5683.21.05573-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is an established treatment for severe aortic stenosis across a broad spectrum of patient risk profiles. Pre-procedural planning using multislice computed tomography (MSCT) is a fundamental component to ensure acute and long-term procedural success. MSCT can establish the procedural feasibility, the type vascular of approach as well as the device which is more likely to give a good result. Moreover, MSCT is a key tool to estimate the risk of potentially life-threatening complications. In this review, the role of MSCT for pre-procedural TAVR planning will be discussed providing a panoramic overview of the key elements that should be considered when performing TAVR. Additionally, the adjunctive role of fluoroscopy and echocardiography to plan and guide a TAVR procedure will also be discussed.
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Affiliation(s)
- Antonio Mangieri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy -
| | - Alessandra Laricchia
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mariano L Palena
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Andrea Fisicaro
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alberto Cereda
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alessandro Sticchi
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Francesco Giannini
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Arif A Khokhar
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Antonio Colombo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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Self-navigated versus navigator-gated 3D MRI sequence for non-enhanced aortic root measurement in transcatheter aortic valve implantation. Eur J Radiol 2021; 137:109573. [PMID: 33578090 DOI: 10.1016/j.ejrad.2021.109573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/27/2020] [Accepted: 01/22/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To prospectively compare image-quality, reliability and graft sizing of a prototype self-navigated and a navigator-gated non-contrast three dimensional (3D) whole-heart magnetic-resonance-angiography (MRA) sequence with computed-tomography-angiography (CTA) for planning transcatheter-aortic-valve-implantation (TAVI). METHODS Self- and navigator-gated 1.5 T MRA were performed in 27 patients (aged 83 ± 5 years, 41 % male) for aortic root sizing and coronary ostia height measurements; 15 (56 %) patients underwent additional CTA. Subjective-image quality was graded on a 4-point Likert scale, objective MRA image-quality was assessed by signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Continuous MRA and CTA measurements were analyzed with regression and Bland-Altman analysis, valve sizing by kappa statistics. RESULTS Median image-quality as rated by two observers was 1.5 [interquartile range (IQR) 1-3] for self-navigated MRA and 1 [IQR 1-2] for navigator-gated MRA (p = 0.059). SNR and CNR were comparable between MRA sequences (p = 0.471 and 0.445, respectively). Acquisition time was shorter for self-navigated MRA compared to navigator-gated MRA (5.5 ± 1 min vs, 6.5 ± 2 min, p = 0.029). Inter-observer correlation of aortic root measurements was high to very high for both self- and navigator-gated MRA (r = 0.75 to 0.94 and r = 0.85 to 0.96, respectively, all p < 0.0001). Theoretical prosthetic valve sizing of self-navigated MRA and CTA was equivalent (κ = 1). However, in four patients (15 %) one coronary ostium each (right coronary artery 3, left main artery 1) was not clearly definable on self-navigated MRA. CONCLUSION Self-navigated MRA enables aortic annulus TAVI measurements without significant difference to navigator-gated MRA at shortened acquisition time. Prosthesis sizing by self-navigated MRA measurements is equivalent to navigator-gated MRA and CTA-based choice.
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39
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Michel JM, Hashorva D, Kretschmer A, Alvarez-Covarrubias HA, Mayr NP, Pellegrini C, Rheude T, Frangieh AH, Giacoppo D, Kastrati A, Schunkert H, Xhepa E, Joner M, Kasel AM. Evaluation of a Low-Dose Radiation Protocol During Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 139:71-78. [PMID: 33190811 DOI: 10.1016/j.amjcard.2020.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
We aimed to evaluate the efficacy and safety of a low-dose imaging protocol to reduce intraprocedural radiation during transcatheter aortic valve implantation (TAVI). Observational analysis: 802 transfemoral TAVI patients receiving balloon-expandable devices ≥23 mm at a high-volume centre. After propensity score matching, a standard-dose group (SD, n = 333) treated between January 2014 and February 2016 was compared with a low-dose group (LD, n = 333) treated between August 2017 and March 2019 after departmental uptake of a low-dose imaging protocol (reduced field size, high table height, use of "fluoro save," 3.75 frames/second acquisition, increased filtering). Primary end point was dose-area product (DAP). Secondary safety end points were VARC-2 device success and a composite of in-hospital complications. The LD protocol was associated with lower DAP (4.64 [2.93, 8.42] vs 22.73 [12.31, 34.58] Gy⋅cm2, p <0.001) and fluoroscopy time (10.4 [8.1, 13.9] vs 11.5 [9.1, 15.3] minutes, p = 0.001). Contrast use was higher in the LD group (LD 110 [94, 130] vs SD 100 [80, 135] milliliters, p = 0.042). Device success (LD 88.3% vs SD 91.3%, p = 0.25), and the composite end point (LD 8.1% vs SD 11.4%, p = 0.19) were similar. In multivariate analysis, the low-dose protocol was associated with a 19.8 Gy⋅cm2 reduction in procedural DAP (p <0.001). In conclusion, compared with standard imaging, a low-dose protocol for TAVI significantly reduced radiation dose without compromising outcomes.
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40
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The Impact of Aortic Valvular Calcium on Transcatheter Heart Valve Distortion. J Interv Cardiol 2021; 2021:8829906. [PMID: 33500684 PMCID: PMC7803404 DOI: 10.1155/2021/8829906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/10/2020] [Accepted: 12/26/2020] [Indexed: 12/01/2022] Open
Abstract
Objectives To investigate the relationship between the eccentric calcification of aortic valve and transcatheter heart valve (THV) distortion and the impact of THV distortion on echo parameters and clinical outcomes. Background The effects of eccentric calcification of the aortic valve on the THV distortion and the relationship between THV distortion and clinical impact were not fully understood. Methods Patients with symptomatic severe aortic stenosis who were undergoing THV implantation were enrolled. Patients underwent preprocedural, postprocedural multislice computed tomography (MSCT), and follow-up transthoracic echocardiogram (TTE). Delta calcium score (ΔCS) is defined as the difference between the maximum and minimal calcium scores of the three cusps, while valve distortion score (VDS) is defined as the difference between the longest and shortest stent frame, as obtained using MSCT. Patients were divided into two groups according to ΔCS: “noneccentric calcification group” and “eccentric calcification group.” Results A total of 118 patients were enrolled (59 patients in noneccentric and 59 in eccentric calcification groups). VDS was significantly lower in the noneccentric calcification group than in the eccentric calcification group (1.31 ± 0.82 mm vs. 1.73 ± 0.76 mm, p=0.004). VDS was not associated with the degree of paravalvular leak (PVL) and aortic valvular mean pressure gradient (AVPG) at 30-day and 1-year follow-up TTE and the cumulative rates of all-cause death and rehospitalization at 2-year clinical follow-up. Conclusions Eccentric valvular calcification was associated with longitudinal THV distortion. However, THV distortion was not associated with PVL, AVPG, and adverse clinical events during midterm follow-up.
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Azriff Basri A, Zuber M, Illyani Basri E, Shukri Zakaria M, Fazli Abd Aziz A, Tamagawa M, Arifin Ahmad K. Fluid-Structure Interaction in Problems of Patient Specific Transcatheter Aortic Valve Implantation with and Without Paravalvular Leakage Complication. FLUID DYNAMICS & MATERIALS PROCESSING 2021; 17:531-553. [DOI: 10.32604/fdmp.2021.010925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Noothout JMH, De Vos BD, Wolterink JM, Postma EM, Smeets PAM, Takx RAP, Leiner T, Viergever MA, Isgum I. Deep Learning-Based Regression and Classification for Automatic Landmark Localization in Medical Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:4011-4022. [PMID: 32746142 DOI: 10.1109/tmi.2020.3009002] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In this study, we propose a fast and accurate method to automatically localize anatomical landmarks in medical images. We employ a global-to-local localization approach using fully convolutional neural networks (FCNNs). First, a global FCNN localizes multiple landmarks through the analysis of image patches, performing regression and classification simultaneously. In regression, displacement vectors pointing from the center of image patches towards landmark locations are determined. In classification, presence of landmarks of interest in the patch is established. Global landmark locations are obtained by averaging the predicted displacement vectors, where the contribution of each displacement vector is weighted by the posterior classification probability of the patch that it is pointing from. Subsequently, for each landmark localized with global localization, local analysis is performed. Specialized FCNNs refine the global landmark locations by analyzing local sub-images in a similar manner, i.e. by performing regression and classification simultaneously and combining the results. Evaluation was performed through localization of 8 anatomical landmarks in CCTA scans, 2 landmarks in olfactory MR scans, and 19 landmarks in cephalometric X-rays. We demonstrate that the method performs similarly to a second observer and is able to localize landmarks in a diverse set of medical images, differing in image modality, image dimensionality, and anatomical coverage.
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Abd Alamir M, Nazir S, Alani A, Golub I, Gilchrist IC, Aslam F, Dhawan P, Changal K, Ostra C, Soni R, Elzanaty A, Budoff M. Multidetector computed tomography in transcatheter aortic valve replacement: an update on technological developments and clinical applications. Expert Rev Cardiovasc Ther 2020; 18:709-722. [PMID: 33063552 DOI: 10.1080/14779072.2020.1837624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of patients with underlying sever aortic valve stenosis across all spectrum of the disease. CT imaging is so crucial to the pre procedural planning, to incorporate the information from the CT imaging in the decision making intraprocedurally and to predict and identity the post procedural complications.Areas covered: In this article, we review available studies on CT role in TAVR procedure and provide update on the technological developments and clinical applications.Expert opinion: CT imaging, with its high resolution, and in particular its utilization in aortic annular measurements, bicuspid aortic valve assessment, hypoattenuated leaflet thickening and valve in valve therapy proved to be the ideal approach to study the mechanisms of aortic stenosis, detection of high-risk anatomy, more accurate risk stratification and thus to allow a personalized catheter based intervention of the affected patients.
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Affiliation(s)
- Moshrik Abd Alamir
- Department of Cardiology, Stony Brook University Hospital, Health Sciences Tower , Stony Brook, NY, USA
| | - Salik Nazir
- Department of Cardiology, University of Toledo , Toledo, OH, USA
| | - Anas Alani
- Loma Linda University , Loma Linda, CA, USA
| | - Ilana Golub
- Department of Cardiology, Lundquist Institute , Torrance, CA, USA
| | - Ian C Gilchrist
- Department of Cardiology, Stony Brook University Hospital, Health Sciences Tower , Stony Brook, NY, USA
| | - Faisal Aslam
- Department of Cardiology, Stony Brook University Hospital, Health Sciences Tower , Stony Brook, NY, USA
| | - Puneet Dhawan
- David Geffen School of Medicine at UCLA, Department of Surgery, Los Angeles County Harbor-UCLA Medical Center , Torrance, CA, USA
| | - Khalid Changal
- Department of Cardiology, University of Toledo , Toledo, OH, USA
| | - Carson Ostra
- Department of Cardiology, University of Toledo , Toledo, OH, USA
| | - Ronak Soni
- Department of Cardiology, University of Toledo , Toledo, OH, USA
| | - Ahmad Elzanaty
- Department of Cardiology, University of Toledo , Toledo, OH, USA
| | - Matthew Budoff
- Department of Cardiology, Lundquist Institute , Torrance, CA, USA
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Pasala TKR, Jelnin V, Sahyoun C, Dudiy Y, Ruiz CE. Hinge point-based annular plane with abnormal aortic cusps in transcatheter aortic valve replacement. EUROINTERVENTION 2020; 16:549-553. [PMID: 32364500 DOI: 10.4244/eij-d-19-00760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A virtual aortic annular plane that is built using the three hinge points, known as the hinge point-based annular plane (HPAP), is routinely used during transcatheter aortic valve replacement (TAVR). Abnormal aortic cusps (AAC) with unequal length and size influence the relationship of the HPAP to the aortic root axis significantly and pose challenges to valve deployment, leading to paravalvular leak and valve embolisation. Obtaining a centreline-based aortic annular plane in addition may help to understand valve deployment behaviour in AAC better.
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Affiliation(s)
- Tilak K R Pasala
- Structural and Congenital Heart Center, Hackensack University Medical Center, Hackensack, NJ, USA
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Efficacy of preoperative electrocardiographic-gated computed tomography in predicting the accurate aortic annulus diameter in surgical aortic valve replacement. Gen Thorac Cardiovasc Surg 2020; 69:466-471. [PMID: 32865765 DOI: 10.1007/s11748-020-01469-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Electrocardiographic (ECG)-gated computed tomography (CT) can be used to determine which valve and size should be used in transcatheter aortic valve replacement (TAVR). It is beneficial to predict the accurate annulus diameter in surgical aortic valve replacement (SAVR), which can help in determining the surgical strategy. We aimed to compare the predicted aortic annulus size with the actual annulus size measured intraoperatively and to examine its validity. METHODS A total of 88 patients underwent isolated or concomitant SAVR in 2018 at our hospital. The study population consisted of 45 patients who underwent preoperative CT assessment and intraoperative measurement. The perimeter- and area-derived diameters at the level of basal attachments were determined using CT, and the lower value among the two was defined as the predicted aortic annulus (CTpredict). The predicted aortic annulus (TTEpredict) was measured by transthoracic echography in the parasternal long-axis view. An actual-sized ball sizer was inserted into the annulus intraoperatively. True annulus size was determined as the labeled size that just fits on the annulus, and labeled size plus 1 mm was determined as one that passes through the annulus. RESULTS There was better agreement with minimal bias between CTpredict and true annulus size as demonstrated in the Bland-Altman analysis with an intraclass correlation coefficient of 0.796 compared with TTEpredict. CONCLUSION ECG-gated CT is also helpful in predicting the annulus diameter even in patients undergoing SAVR. This has important clinical implications for planning SAVR, including the surgical approach.
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Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement: From Computed Tomography to BASILICA. JACC Cardiovasc Interv 2020; 12:1197-1216. [PMID: 31272666 DOI: 10.1016/j.jcin.2019.04.052] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 11/24/2022]
Abstract
Coronary artery obstruction is an uncommon but devastating complication of transcatheter aortic valve replacement (TAVR). Computed tomography appears to be a sensitive but nonspecific predictor of coronary artery obstruction. Transcatheter approaches to prevent and treat coronary artery obstruction, such as "snorkel" stenting, are unsatisfactory because of serious early and late ischemic complications. Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR (BASILICA) is an early-stage transcatheter procedure to prevent coronary artery obstruction. It works by splitting the native or bioprosthetic leaflets so that they splay after TAVR and preserve coronary artery inflow. Because of the paucity of suitable alternatives, there is interest in the BASILICA technique despite its infancy. This tutorial review summarizes current thinking about how to predict and prevent coronary artery obstruction using BASILICA. First, the authors depict the main pathophysiological mechanisms of TAVR-associated coronary artery obstruction, along with the factors thought to contribute to coronary obstruction. Next, the authors provide a step-by-step guide to analyzing pre-procedural computed tomographic findings to assess obstruction risk and, if desirable, to plan BASILICA. Next, the authors describe the mechanisms underlying transcatheter electrosurgery. Finally, they provide step-by-step guidance on how to perform the procedure, along with a required equipment list.
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Fu B, Chen Q, Zhao F, Guo Z, Jiang N, Wang X, Wang W, Han J, Yang L, Zhu Y, Ma Y. Efficacy and safety of transcatheter aortic valve implantation in patients with severe bicuspid aortic stenosis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:873. [PMID: 32793717 DOI: 10.21037/atm-20-4436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Bicuspid aortic valve (BAV) is common congenital malformation, bicuspid aortic stenosis accounts for a substantial proportion of patients with aortic valve stenosis (AS). Bicuspid AS are more likely to have aortic dilatation with slightly less elliptical annuli, which might lead to paravalvular aortic valve regurgitation (AR) and permanent pacemaker implantation (PPM) after TAVI with higher mortality. Our study aims to understand the therapeutic efficacy and safety of transcatheter aortic valve implantation (TAVI) with a supra-annular structure-based sizing strategy in Chinese AS patients with BAV versus tricuspid aortic valve (TAV). Methods Seventy-four consecutive tricuspid AS patients and 44 bicuspid AS patients were included and enrolled in the study for analysis. Both groups underwent TAVI performed using balloon sizing less than mild paravalvular AR to assess the proper prosthesis size. The myocardial function within 1 year postoperative were sequentially evaluated using the New York Heart Association (NYHA) class, and echocardiography measurements. The incidence rates of complications at 30 days and 1 year were analyzed. During the 1-year follow-up, the time of death from any cause or complications in both groups was recorded. Results The study found that the percentage of patients with class III-IV of NYHA dropped after TAVI in both groups, and no significant difference between both groups at 1 year. Compared with the tricuspid AS group patients, Bicuspid group patients had more improvement in mean aortic valve gradient from baseline to 1year (-47.47±13.38 vs. -50.22±19.25 mmHg, P<0.05). There were no significant differences in 30-day and one-year compliance outcomes except a lower incidence of AR at post-procedure and 30 days in the tricuspid AS group as the Bicuspid AS group. There were no statistically significant differences in the time of death from any cause or significant complications between groups. Conclusions TAVI has acceptable therapeutic efficacy and safety and is feasible for AS patients with BAV in China.
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Affiliation(s)
- Bo Fu
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Qingliang Chen
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Feng Zhao
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Zhigang Guo
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Nan Jiang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Xu Wang
- Department of Cardiovascular Surgery, Fuwai Hospital, Beijing, China
| | - Wei Wang
- Department of Cardiovascular Surgery, Fuwai Hospital, Beijing, China
| | - Jiange Han
- Department of Anesthesiology, Tianjin Chest Hospital, Tianjin, China
| | - Li Yang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Yanbo Zhu
- Department of Echocardiography, Tianjin Chest Hospital, Tianjin, China
| | - Yanhe Ma
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China
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Undersizing but overfilling eliminates the gray zones of sizing for transcatheter aortic valve replacement with the balloon-expandable bioprosthesis. IJC HEART & VASCULATURE 2020; 30:100593. [PMID: 32775601 PMCID: PMC7399118 DOI: 10.1016/j.ijcha.2020.100593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/21/2020] [Accepted: 07/13/2020] [Indexed: 11/23/2022]
Abstract
Transcatheter heart valve size selection is still challenging. The overlap between two different prosthesis sizes for borderline annuli remains. Undersizing but overfilling improves sizing in borderline annulus cases. Undersizing but overfilling decreases the postprocedural THV-pressure gradient. Prospective studies are needed considering the TAVR expansion to younger patients. Background Current recommendations for valve size selection are based on multidimensional annular measurements, yet the overlap between two different transcatheter heart valve (THV) sizes remains. We sought to evaluate whether undersizing but overfilling eliminates the gray zones of valve sizing. Methods Data of 246 consecutive patients undergoing transcatheter aortic valve replacement (TAVR) with the balloon-expandable bioprosthesis with either conventional sizing and nominal filling (group 1 (NF-TAVR), n = 154) or undersizing but overfilling under a Less Is More (LIM)-Principle (group 2 (LIM-TAVR), n = 92) were compared. Paravalvular leakage (PVL) was graded angiographically and quantitatively using invasive hemodynamics. Results Annulus rupture (AR) occurred only in group 1 (n = 3). Due to AR adequate evaluation of PVL was possible in 152 patients of group 1. More than mild PVL was found in 13 (8.6%) patients of group 1 and 1 (1.1%) patient of group 2 (p = 0.019). Postdilatation was performed in 31 (20.1%) patients of group 1 and 6 patients (6.5%) of group 2 (p = 0.003). For patients with borderline annulus size in group 1 (n = 35, 22.7%) valve size selection was left to the physiciańs choice resulting in selection of the larger prosthesis in 10 (28.6%). In group 2 all patients with borderline annulus (n = 36, 39.1%) received the smaller prosthesis (LIM-TAVR). The postprocedural mean transvalvular pressure gradient was significantly higher in the NF-TAVR-group (11.7 ± 4 vs. 10.1 ± 3.6 mmHg, p = 0.005). Conclusion LIM-TAVR eliminates the gray zones of sizing and associated PVL, can improve THV-performance, reduce incidence of annular rupture and simplify the procedure especially in borderline cases.
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Armijo G, Tang GH, Kooistra N, Ferreira-Neto AN, Toggweiler S, Amat-Santos IJ, Keller LS, Urena M, Ahmad H, Tafur Soto J, Muñoz-Garcia E, Regueiro A, Leenders GE, Tirado-Conte G, Sengupta A, McInerney A, Couture T, Cuevas Herreros O, Rodriguez-Gabella T, Kini A, Ahmed M, Zaid S, Gonzalo N, Nuñez-Gil IJ, Muñoz-Garcia AJ, Jimenez-Quevedo P, Fernández-Ortiz A, Himbert D, Nietlispach F, Stella P, Dangas GD, Escaned J, Macaya C, Rodés-Cabau J, Nombela-Franco L. Third-Generation Balloon and Self-Expandable Valves for Aortic Stenosis in Large and Extra-Large Aortic Annuli From the TAVR-LARGE Registry. Circ Cardiovasc Interv 2020; 13:e009047. [DOI: 10.1161/circinterventions.120.009047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Currently, 2 third-generation transcatheter valves, 29-mm Sapien-3 and 34-mm Evolut-R (ER), are indicated for large sized aortic annuli. We analyzed short and 1-year performance of these valves in patients with large (area ≥575 mm
2
or perimeter ≥85 mm) and extra-large (≥683 mm
2
or ≥94.2 mm) aortic annuli undergoing transcatheter aortic valve replacement.
Methods:
A total of 833 patients across 12 centers with symptomatic aortic stenosis and large aortic annuli underwent transcatheter aortic valve replacement with 29-mm Sapien-3 (n=640) or 34-mm ER (n=193). Clinical, anatomic, and procedural characteristics were collected, and Valve Academic Research Consortium-2 outcomes were reported.
Results:
Median aortic annulus area and perimeter were 617 mm
2
(591–657) and 89.1 mm (87.0–92.1), respectively (704 mm
2
[689–743] and 96.0 mm [94.5–97.9] in the subgroup of 124 patients with extra-large annuli). Overall device success was 94.3% (Sapien-3, 95.8% and ER, 89.3%;
P
=0.001), with a higher rate of significant paravalvular leak (
P
=0.004), second valve implantation (
P
=0.013), and valve embolization (
P
=0.009) in the ER group. Thirty-day and 1-year mortality was 2.4% and 9.2%, respectively, without differences between groups. Valve hemodynamics were excellent (mean gradient, 8.8±3.6 mm Hg; 3.3% rate of moderate-severe paravalvular leak) in the extra-large annulus, without differences compared with the large annulus group.
Conclusions:
In patients with large and extra-large aortic annuli, transcatheter aortic valve replacement using 29-mm Sapien-3 and 34-mm ER is safe and feasible. Observed differences in clinical outcomes and hemodynamic performance may guide valve choice in this cohort of patients undergoing transcatheter aortic valve replacement.
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Affiliation(s)
- Germán Armijo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Gilbert H.L. Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY (G.H.L.T., A.S.)
| | - Nynke Kooistra
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands (N.K., G.E.L., P.S.)
| | - Alfredo Nunes Ferreira-Neto
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.N.F.-N., T.C., J.R.-C.)
| | - Stefan Toggweiler
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Switzerland (S.T.)
| | - Ignacio J. Amat-Santos
- Department of Cardiology, Instituto de Ciencias del Corazón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Spain (I.J.A.-S., T.R.-G.)
| | - Lukas S. Keller
- Department of Cardiology, University Heart Centre Zurich, Switzerland (L.S.K., O.C.H.)
| | - Marina Urena
- Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, France (M.U., D.H.)
| | - Hasan Ahmad
- Division of Cardiology, Westchester Medical Center, Valhalla, New York, NY (H.A., S.Z.)
| | - Jose Tafur Soto
- Department of Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, LA (J.T.S., M.A.)
| | - Erika Muñoz-Garcia
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Malaga, Spain (E.M.-G., A.J.M.-G.)
| | - Ander Regueiro
- Department of Cardiology, Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, IDIBAPS, Spain (A.R.)
| | - Geert E. Leenders
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands (N.K., G.E.L., P.S.)
| | - Gabriela Tirado-Conte
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Aditya Sengupta
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY (G.H.L.T., A.S.)
| | - Angela McInerney
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Thomas Couture
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.N.F.-N., T.C., J.R.-C.)
| | - Oscar Cuevas Herreros
- Department of Cardiology, University Heart Centre Zurich, Switzerland (L.S.K., O.C.H.)
| | - Tania Rodriguez-Gabella
- Department of Cardiology, Instituto de Ciencias del Corazón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Spain (I.J.A.-S., T.R.-G.)
| | - Annapoorna Kini
- Division of Cardiology, Mount Sinai Medical Center, New York, NY (A.K., G.D.D.)
| | - Mohammed Ahmed
- Department of Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, LA (J.T.S., M.A.)
| | - Syed Zaid
- Division of Cardiology, Westchester Medical Center, Valhalla, New York, NY (H.A., S.Z.)
| | - Nieves Gonzalo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Ivan J. Nuñez-Gil
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Antonio J. Muñoz-Garcia
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Malaga, Spain (E.M.-G., A.J.M.-G.)
| | - Pilar Jimenez-Quevedo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Antonio Fernández-Ortiz
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Dominique Himbert
- Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, France (M.U., D.H.)
| | - Fabian Nietlispach
- Department of Cardiology, Universitz Hospital Zurich and Hirslanden Klinik Im Park, Zurich, Switzerland (F.N.)
| | - Pieter Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands (N.K., G.E.L., P.S.)
| | - George D. Dangas
- Division of Cardiology, Mount Sinai Medical Center, New York, NY (A.K., G.D.D.)
| | - Javier Escaned
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Carlos Macaya
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.N.F.-N., T.C., J.R.-C.)
| | - Luis Nombela-Franco
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
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Veulemans V, Afzal S, Papadopoulos G, Maier O, Kelm M, Zeus T, Hellhammer K. TAVR-related echocardiographic assessment - status quo, challenges and perspectives. Acta Cardiol 2020; 75:275-285. [PMID: 30856056 DOI: 10.1080/00015385.2019.1579979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is an emerging and a well-established procedure for high-risk and inoperable patients worldwide. Recent studies revealed furthermore that TAVR is equal or even superior to surgical valve replacement in intermediate risk patients. Therefore, a successful procedure is not only dependent on precise preprocedural patient selection but also on careful intraprocedural multimodal imaging guidance and adequate postprocedural follow-up. Up to date, 2D/3D transthoracic and/or transoesophageal echocardiography is an easy and goal-oriented tool for periprocedural TAVR-assessment regarding annulus measurements, cardiac function and concomitant valve diseases. Further procedural success is directly related to prevention of severe early and late complications. Thus, a careful intra- and postprocedural echocardiographic guidance is crucial to evaluate prosthetic function, position and its haemodynamic implication and changes in the integrity of the left ventricle during intra- and postprocedural management. We explored the role of echocardiography for pre-, intra- and postprocedural TAVR-assessment, illustrated by cases and possible algorithms, in a comprehensive literature review. Furthermore, we describe the role of fusion imaging, that is, real-time fusion of transoesophageal echocardiography and fluoroscopy (EchoNavigator Release System® I and II) during TAVR.
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Affiliation(s)
- Verena Veulemans
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Duesseldorf, Düsseldorf, Germany
| | - Shazia Afzal
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Duesseldorf, Düsseldorf, Germany
| | - Georgios Papadopoulos
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Duesseldorf, Düsseldorf, Germany
| | - Oliver Maier
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Duesseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Duesseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Duesseldorf, Düsseldorf, Germany
| | - Katharina Hellhammer
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Duesseldorf, Düsseldorf, Germany
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