Journal of Clinical Medicine

Editorial

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3 pages, 161 KiB

Open AccessEditorial

The Treatment of Aortic Valve Stenosis in Intermediate and Low-Risk Patients—When, How and Where

by Flavio L. Ribichini and Valeria Ferrero

J. Clin. Med. 2022, 11(4), 1073; https://doi.org/10.3390/jcm11041073 - 18 Feb 2022

Cited by 3 | Viewed by 1021

Abstract

Until now, treatment of severe aortic stenosis (AS) is recommended after the disease becomes symptomatic or causes “silent” damages such as myocardial dysfunction [...] Full article

(This article belongs to the Special Issue Surgical or Transcatheter Aortic Valve Replacement in Intermediate-Risk Patients)

Research

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11 pages, 811 KiB

Open AccessArticle

Balloon-Expandable versus Self-Expandable Valves in Transcatheter Aortic Valve Implantation: Complications and Outcomes from a Large International Patient Cohort

by Astrid C. van Nieuwkerk, Raquel B Santos, Leire Andraka, Didier Tchetche, Fabio S. de Brito, Marco Barbanti, Ran Kornowski, Azeem Latib, Augusto D’Onofrio, Flavio Ribichini, Francisco Ten, Nicolas Dumonteil, Jan Baan, Jan J. Piek, Alexandre Abizaid, Samantha Sartori, Paola D’Errigo, Giuseppe Tarantini, Mattia Lunardi, Katia Orvin, Matteo Pagnesi, Juan Manuel Nogales-Asensio, Angie Ghattas, George Dangas, Roxana Mehran and Ronak Delewi Show full author list Hide full author list

J. Clin. Med. 2021, 10(17), 4005; https://doi.org/10.3390/jcm10174005 - 04 Sep 2021

Cited by 7 | Viewed by 2417

Abstract

Background: Both balloon-expandable (BE) and self-expandable (SE) valves for transcatheter aortic valve implantation (TAVI) are broadly used in clinical practice. However, adequately powered randomized controlled trials comparing these two valve designs are lacking. Methods: The CENTER-study included 12,381 patients undergoing transfemoral TAVI. Patients [...] Read more.

Background: Both balloon-expandable (BE) and self-expandable (SE) valves for transcatheter aortic valve implantation (TAVI) are broadly used in clinical practice. However, adequately powered randomized controlled trials comparing these two valve designs are lacking. Methods: The CENTER-study included 12,381 patients undergoing transfemoral TAVI. Patients undergoing TAVI with a BE-valve (n = 4096) were compared to patients undergoing TAVI with an SE-valve (n = 4096) after propensity score matching. Clinical outcomes including one-year mortality and stroke rates were assessed. Results: In the matched population of n = 5410 patients, the mean age was 81 ± 3 years, 60% was female, and the STS-PROM predicted 30-day mortality was 6.2% (IQR 4.0–12.4). One-year mortality was not different between patients treated with BE- or SE-valves (BE: 16.4% vs. SE: 17.0%, Relative Risk 1.04, 95%CI 0.02–1.21, p = 0.57). One-year stroke rates were also comparable (BE: 4.9% vs. SE: 5.3%, RR 1.09, 95%CI 0.86–1.37, p = 0.48). Conclusion: This study suggests that one-year mortality and stroke rates were comparable in patients with severe aortic valve stenosis undergoing TAVI with either BE or SE-valves. Full article

(This article belongs to the Special Issue Surgical or Transcatheter Aortic Valve Replacement in Intermediate-Risk Patients)

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12 pages, 12929 KiB

Open AccessArticle

Real World Performance Evaluation of Transcatheter Aortic Valve Implantation

by Gabriele Pesarini, Gabriele Venturi, Domenico Tavella, Leonardo Gottin, Mattia Lunardi, Elena Mirandola, Francesco Onorati, Giuseppe Faggian and Flavio Ribichini

J. Clin. Med. 2021, 10(9), 1890; https://doi.org/10.3390/jcm10091890 - 27 Apr 2021

Cited by 5 | Viewed by 1696

Abstract

Background: The aim of this research is to describe the performance over time of transcatheter aortic valve implantations (TAVIs) in a high-volume center with a contemporary, real-world population. Methods: Patients referred for TAVIs at the University Hospital of Verona were prospectively enrolled. By [...] Read more.

Background: The aim of this research is to describe the performance over time of transcatheter aortic valve implantations (TAVIs) in a high-volume center with a contemporary, real-world population. Methods: Patients referred for TAVIs at the University Hospital of Verona were prospectively enrolled. By cumulative sum failures analysis (CUSUM), procedural-control curves for standardized combined endpoints—as defined by the Valve Academic Research Consortium-2 (VARC-2)—were calculated and analyzed over time. Acceptable and unacceptable limits were derived from recent studies on TAVI in intermediate and low-risk patients to fit the higher required standards for current indications. Results: A total of 910 patients were included. Baseline risk scores significantly reduced over time. Complete procedural control was obtained after approximately 125 and 190 cases for device success and early safety standardized combined endpoints, respectively. High risk patients (STS ≥ 8) had poorer outcomes, especially in terms of VARC-2 clinical efficacy, and required a higher case load to maintain in-control and proficient procedures. Clinically relevant single endpoints were all influenced by operator’s experience as well. Conclusions: Quality-control analysis for contemporary TAVI interventions based on standardized endpoints suggests the need for relevant operator’s experience to achieve and maintain optimal clinical results, especially in higher-risk subjects. Full article

(This article belongs to the Special Issue Surgical or Transcatheter Aortic Valve Replacement in Intermediate-Risk Patients)

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Review

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23 pages, 1134 KiB

Open AccessReview

Diagnostic Work-Up of the Aortic Patient: An Integrated Approach toward the Best Therapeutic Option

by Michele Pighi, Davide Giovannini, Roberto Scarsini and Nicolo Piazza

J. Clin. Med. 2021, 10(21), 5120; https://doi.org/10.3390/jcm10215120 - 31 Oct 2021

Cited by 3 | Viewed by 2176

Abstract

Aortic stenosis (AS) is the most common valvular heart disease. In the last decade, transcatheter aortic valve implantation (TAVI) has become the standard of care for symptomatic patients at high surgical risk. Recently, indications to TAVI have also been extended to the low [...] Read more.

Aortic stenosis (AS) is the most common valvular heart disease. In the last decade, transcatheter aortic valve implantation (TAVI) has become the standard of care for symptomatic patients at high surgical risk. Recently, indications to TAVI have also been extended to the low surgical risk and intermediate surgical risk populations. Consequently, in this setting, some aspects acquire greater relevance: surgical risk evaluation, clinical assessment, multimodality imaging of the valve, and management of coronary artery disease. Moreover, future issues such as coronary artery re-access and valve-in-valve interventions should be considered in the valve selection process. This review aims to summarize the principal aspects of a multidimensional (multidisciplinary) and comprehensive preprocedural work-up. The Heart Team is at the center of the decision-making process of the management of aortic valve disease and bears responsibility for offering each patient a tailored approach based on an individual evaluation of technical aspects together with the risks and benefits of each modality. Considering the progressive expansion in TAVI indication and technological progress, the role of a work-up and multidisciplinary Heart Team will be even more relevant. Full article

(This article belongs to the Special Issue Surgical or Transcatheter Aortic Valve Replacement in Intermediate-Risk Patients)

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13 pages, 1068 KiB

Open AccessReview

Durability of Transcatheter Heart Valves: Standardized Definitions and Available Data

by Ines Richter, Holger Thiele and Mohamed Abdel-Wahab

J. Clin. Med. 2021, 10(18), 4180; https://doi.org/10.3390/jcm10184180 - 16 Sep 2021

Cited by 2 | Viewed by 1777

Abstract

Transcatheter aortic valve replacement is a well-established alternative to surgical aortic valve replacement in high-risk patients with severe symptomatic aortic stenosis. Currently, this technique is shifting towards younger patient groups with intermediate- and low-risk profile, which raises the question about long-term durability. Despite [...] Read more.

Transcatheter aortic valve replacement is a well-established alternative to surgical aortic valve replacement in high-risk patients with severe symptomatic aortic stenosis. Currently, this technique is shifting towards younger patient groups with intermediate- and low-risk profile, which raises the question about long-term durability. Despite acceptable results up to 5 years, little is currently known about valve performance beyond 5 years. Since valve deterioration, thrombosis and endocarditis seem to be the main factors affecting valve durability, precise and widely accepted definitions of these parameters were stated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in 2017, followed by the Valve in Valve International Data (VIVID) group definitions in 2018 and the Valve Academic Research Consortium 3 (VARC-3) definitions in 2021. Until the introduction of these definitions, interstudy comparisons were difficult due to missing uniformity. Since the release of these recommendations, an increasing number of studies have reported their data on long-term durability using these new criteria. The aim of the present article is to discuss the current definitions on bioprosthetic valve durability, and to summarize the available data on long-term durability of transcatheter aortic valves. Full article

(This article belongs to the Special Issue Surgical or Transcatheter Aortic Valve Replacement in Intermediate-Risk Patients)

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11 pages, 23316 KiB

Open AccessReview

Neurocognitive Status after Aortic Valve Replacement: Differences between TAVI and Surgery

by Nicholas Aroney, Tiffany Patterson, Christopher Allen, Simon Redwood and Bernard Prendergast

J. Clin. Med. 2021, 10(8), 1789; https://doi.org/10.3390/jcm10081789 - 20 Apr 2021

Cited by 4 | Viewed by 2593

Abstract

Over the past decade, indications for transcatheter aortic valve implantation (TAVI) have progressed rapidly—procedural numbers now exceed those of surgical aortic valve replacement (SAVR) in many countries, and TAVI is now a realistic and attractive alternative to SAVR in low-risk patients. Neurocognitive outcomes [...] Read more.

Over the past decade, indications for transcatheter aortic valve implantation (TAVI) have progressed rapidly—procedural numbers now exceed those of surgical aortic valve replacement (SAVR) in many countries, and TAVI is now a realistic and attractive alternative to SAVR in low-risk patients. Neurocognitive outcomes after TAVI and SAVR remain an issue and sit firmly under the spotlight as TAVI moves into low-risk cohorts. Cognitive decline and stroke carry a significant burden and predict future functional decline, reduced mobility, poor quality of life and increased mortality. Early TAVI trials used varying neurocognitive definitions, and outcomes differed significantly as a result. Recent international consensus statements defining endpoints following TAVI and SAVR have standardised neurological outcomes and facilitate interpretation and comparison between trials. The latest TAVI and SAVR trials have demonstrated more consistent and favourable neurocognitive outcomes for TAVI patients, and cerebral embolic protection devices offer the prospect of further refinement and improvement. Full article

(This article belongs to the Special Issue Surgical or Transcatheter Aortic Valve Replacement in Intermediate-Risk Patients)

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21 pages, 1614 KiB

Open AccessReview

Aortic Valve Disease and Associated Complex CAD: The Interventional Approach

by Federico Marin, Roberto Scarsini, Rafail A. Kotronias, Dimitrios Terentes-Printzios, Matthew K. Burrage, Jonathan J. H. Bray, Jonathan L. Ciofani, Gabriele Venturi, Michele Pighi, Giovanni L. De Maria and Adrian P. Banning

J. Clin. Med. 2021, 10(5), 946; https://doi.org/10.3390/jcm10050946 - 01 Mar 2021

Cited by 7 | Viewed by 3060

Abstract

Coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis (AS). The management of CAD is a central aspect of the work-up of patients undergoing transcatheter aortic valve implantation (TAVI), but few data are available on this field and the [...] Read more.

Coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis (AS). The management of CAD is a central aspect of the work-up of patients undergoing transcatheter aortic valve implantation (TAVI), but few data are available on this field and the best percutaneous coronary intervention (PCI) practice is yet to be determined. A major challenge is the ability to elucidate the severity of bystander coronary stenosis independently of the severity of aortic valve stenosis and subsequent impact on blood flow. The prognostic role of CAD in patients undergoing TAVI is being still debated and the benefits and the best timing of PCI in this context are currently under evaluation. Additionally, PCI in the setting of advanced AS poses some technical challenges, due to the complex anatomy, risk of hemodynamic instability, and the increased risk of bleeding complications. This review aims to provide a comprehensive synthesis of the available literature on myocardial revascularization in patients with severe AS undergoing TAVI. This work can assist the Heart Team in individualizing decisions about myocardial revascularization, taking into account available diagnostic tools as well as the risks and benefits. Full article

(This article belongs to the Special Issue Surgical or Transcatheter Aortic Valve Replacement in Intermediate-Risk Patients)

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Other

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19 pages, 890 KiB

Open AccessViewpoint

Updates on the Latest Surgical Approach of the Aortic Stenosis

by Lucian Geicu, Olivier Busuttil, Nicolas D’Ostrevy, Mathieu Pernot, Walid Benali, Louis Labrousse and Thomas Modine

J. Clin. Med. 2021, 10(21), 5140; https://doi.org/10.3390/jcm10215140 - 31 Oct 2021

Cited by 1 | Viewed by 2114

Abstract

Over the last twenty years, we marked significant progresses in the field of tissue engineering and the development of new aortic valve structural and delivery systems. These continuous iterations on the field, have completely changed the surgical indications and approaches for AVR. Nowadays, [...] Read more.

Over the last twenty years, we marked significant progresses in the field of tissue engineering and the development of new aortic valve structural and delivery systems. These continuous iterations on the field, have completely changed the surgical indications and approaches for AVR. Nowadays, therapeutic decisions are endorsed by international guidelines; however, new technical advances need a new integrated approach. The clinical scenarios issued from the interaction between the Guidelines and the newest approaches and technologies are regularly on debate by the Heart Team. We will present some of our most encountered situations and the pattern of our therapeutic decisions. To easily navigate through Guidelines and clinical scenarios, we reported in this review a simplified and easy to use Clinical decision-making algorithm that may be a valuable tool in our daily practice. Full article

(This article belongs to the Special Issue Surgical or Transcatheter Aortic Valve Replacement in Intermediate-Risk Patients)

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