Journal of Clinical Medicine

Editorial

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3 pages, 182 KiB

Open AccessEditorial

Device Selection for Transcatheter Aortic Valve Implantation

by Camille Granger and Paul Guedeney

J. Clin. Med. 2023, 12(1), 284; https://doi.org/10.3390/jcm12010284 - 29 Dec 2022

Cited by 1 | Viewed by 860

Abstract

Twenty years after the first implantation by Alain Cribier and his team, transcatheter aortic valve implantation (TAVI) has demonstrated its efficacy and safety in patients with symptomatic severe aortic stenosis with high, intermediate, and even low surgical risk [...] Full article

(This article belongs to the Special Issue Aortic Valve Replacement: Ongoing Issues and Challenges)

Research

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11 pages, 282 KiB

Open AccessArticle

Embolic Protection with the TriGuard 3 System in Nonagenarian Patients Undergoing Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

by Alexander Lind, Rolf Alexander Jánosi, Matthias Totzeck, Arjang Ruhparwar, Tienush Rassaf and Fadi Al-Rashid

J. Clin. Med. 2022, 11(7), 2003; https://doi.org/10.3390/jcm11072003 - 02 Apr 2022

Cited by 4 | Viewed by 1737

Abstract

Background: Transcatheter aortic valve replacement (TAVR) improves the survival and life quality of nonagenarian patients with aortic stenosis. Stroke remains one of the most worrisome complications following TAVR. Cerebral embolic protection devices (CEPDs) may reduce neurological complications after TAVR. This study evaluated the [...] Read more.

Background: Transcatheter aortic valve replacement (TAVR) improves the survival and life quality of nonagenarian patients with aortic stenosis. Stroke remains one of the most worrisome complications following TAVR. Cerebral embolic protection devices (CEPDs) may reduce neurological complications after TAVR. This study evaluated the safety and efficacy of CEPDs during TAVR in nonagenarian patients. Methods: Between January 2018 and October 2021, 869 patients underwent transfemoral TAVR (TF-TAVR) at our center. Of these, 51 (5.9%) patients were older than ninety years. In 33 consecutive nonagenarian patients, TF-TAVR was implanted without CEPDs using balloon-expandable valves (BEVs) and self-expandable valves (SEVs). Eighteen consecutive nonagenarians underwent TF-TAVR using a CEPD (CP group). Follow up period was in-hospital or 30 days after the procedure, respectively. Results: Minor access site complications occurred in two patients (3.9%) and were not CEPD-associated. Postinterventional delirium occurred in nine patients (17.6%). Periprocedural minor non-disabling stroke and delirium occurred in ten patients (19.6%). Periprocedural major fatal stroke occurred in two patients in the BEV group (3.9%). Two patients in the BEV group died due to postinterventional pneumonia with sepsis. The mortality rate was 7.8%. The results did not differ between the groups. Conclusions: Age alone is no longer a contraindication for TAVR. CEPD using the Triguard 3 system in nonagenarian TAVR patients was feasible and safe and did not increase access site complications. Full article

(This article belongs to the Special Issue Aortic Valve Replacement: Ongoing Issues and Challenges)

12 pages, 446 KiB

Open AccessArticle

Acute Kidney Injury Following Transcatheter Aortic Valve Implantation: Association with Contrast Media Dosage and Contrast Media Based Risk Predication Models

by Doron Sudarsky, Yarden Drutin, Fabio Kusniec, Liza Grosman-Rimon, Ala Lubovich, Wadia Kinany, Evgeni Hazanov, Michael Gelbstein, Edo Y. Birati and Ibrahim Marai

J. Clin. Med. 2022, 11(5), 1181; https://doi.org/10.3390/jcm11051181 - 23 Feb 2022

Cited by 4 | Viewed by 1812

Abstract

The effect of contrast media (CM), delivered prior to- and during transcatheter aortic valve implantation (TAVI), on kidney function, following the procedure, is debatable. Consequently, the performance of CM-based, acute kidney injury (AKI) risk prediction models is also questionable. We retrospectively studied 210 [...] Read more.

The effect of contrast media (CM), delivered prior to- and during transcatheter aortic valve implantation (TAVI), on kidney function, following the procedure, is debatable. Consequently, the performance of CM-based, acute kidney injury (AKI) risk prediction models is also questionable. We retrospectively studied 210 patients that underwent TAVI. We recorded the dose of CM used prior and during TAVI, calculated the results of different AKI risk assessment models containing a CM module, and tested their association with AKI after the procedure. AKI was diagnosed in 38 patients (18.1%). The baseline estimated glomerular filtration rate (eGFR) was lower in the AKI+ group compared to AKI− group (51 ± 19.3 versus 64.5 ± 19 mL/min/1.73 mr², respectively). While the dose of CM delivered prior to TAVI, during TAVI or the cumulative amount of both did not differ between the groups, the results of all tested risk models were higher in AKI+ patients. However, by multivariable analysis, only eGFR had a consistent independent association with AKI. We suggest that the dose of CM delivered prior or during TAVI is not associated with AKI and that the predictive power of CM based AKI risk models is, in all probability, limited to eGFR alone. Full article

(This article belongs to the Special Issue Aortic Valve Replacement: Ongoing Issues and Challenges)

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11 pages, 657 KiB

Open AccessArticle

Short- and Mid-Term Outcomes in Patients Deemed Inoperable Undergoing Transapical and Transfemoral TAVR with an STS-PROM below Four Percent

by Verena Veulemans, Katharina Hellhammer, Armin Borhan Azad, Shouheng Goh, Christian Drake, Oliver Maier, Kerstin Piayda, Amin Polzin, Arash Mehdiani, Christian Jung, Ralf Westenfeld, Malte Kelm, Artur Lichtenberg and Tobias Zeus

J. Clin. Med. 2021, 10(13), 2993; https://doi.org/10.3390/jcm10132993 - 05 Jul 2021

Cited by 1 | Viewed by 1730

Abstract

Transapical (TA) TAVR is known to be associated with increased mortality and vascular complications compared with transfemoral (TF) TAVR in high-risk and inoperable patients. However, safe alternative access methods remain crucial. We aimed to (1) evaluate the 30-day and 1-year outcomes comparing TA [...] Read more.

Transapical (TA) TAVR is known to be associated with increased mortality and vascular complications compared with transfemoral (TF) TAVR in high-risk and inoperable patients. However, safe alternative access methods remain crucial. We aimed to (1) evaluate the 30-day and 1-year outcomes comparing TA and TF TAVR in patients with an STS-PROM of <4% deemed inoperable and (2) determine dependent and independent predictors for all-cause one-year mortality. Data were collected from a single-center registry consisting of 340 eligible patients. One-to-one propensity score matching was performed (n = 50 TA, n = 50 TF). Primary endpoints were all-cause mortality, stroke, and major bleeding. Predictors for all-cause one-year mortality were evaluated. Thirty-day mortality (TF vs. TA: 0.0% vs. 4.0%; p = 0.153) was comparable in both cohorts. One-year all-cause mortality was twice as high in TA patients (TF vs. TA: 10.0% vs. 20.0%, p logrank = 0.165, HR 2.10). Cerebrovascular events and major bleeding during one-year follow-up were similar. The multivariate analysis identified hemoglobin <12 g/dL at admission and dual antiplatelet therapy as strong predictors for one-year mortality. Although femoral access is the primary access with favorable 30-day and 1-year results, transapical access was successful for patients unsuitable for TF TAVR, showing acceptable short- and mid-term results in inoperable patients with low-risk profiles. Full article

(This article belongs to the Special Issue Aortic Valve Replacement: Ongoing Issues and Challenges)

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Review

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15 pages, 910 KiB

Open AccessReview

Unmet Needs in TAVR: Conduction Disturbances and Management of Coronary Artery Disease

by Vincent Auffret, Carine Ridard, Nadia Salerno and Sabato Sorrentino

J. Clin. Med. 2022, 11(21), 6256; https://doi.org/10.3390/jcm11216256 - 24 Oct 2022

Cited by 5 | Viewed by 1551

Abstract

Over the past two decades, transcatheter aortic valve replacement (TAVR) swiftly evolved from a disrupting technology towards mainstream therapy in the field of severe symptomatic aortic stenosis. A series of randomized evaluations established its role in treating severe aortic stenosis patients across all [...] Read more.

Over the past two decades, transcatheter aortic valve replacement (TAVR) swiftly evolved from a disrupting technology towards mainstream therapy in the field of severe symptomatic aortic stenosis. A series of randomized evaluations established its role in treating severe aortic stenosis patients across all surgical risk categories, paving the way for an extension of its indications to younger low-risk patients with a longer life expectancy. Therefore, managing comorbidities and limiting procedural complications, which may affect long-term outcomes, is of paramount importance. Among those, new-onset conduction disturbances and concomitant coronary artery disease remain two of the most debated issues. In the present review, we will discuss the incidence, prognostic impact, and unmet needs of patients with post-TAVR new-onset conduction disturbances and the ongoing challenges posed by the management of concomitant coronary artery disease. Full article

(This article belongs to the Special Issue Aortic Valve Replacement: Ongoing Issues and Challenges)

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18 pages, 1139 KiB

Open AccessReview

Evolving Devices and Material in Transcatheter Aortic Valve Replacement: What to Use and for Whom

by Mauro Chiarito, Alessandro Spirito, Johny Nicolas, Alexandra Selberg, Giulio Stefanini, Antonio Colombo, Bernhard Reimers, Annapoorna Kini, Samin K. Sharma, George D. Dangas and Roxana Mehran

J. Clin. Med. 2022, 11(15), 4445; https://doi.org/10.3390/jcm11154445 - 30 Jul 2022

Cited by 4 | Viewed by 5406

Abstract

Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, providing a viable alternative to surgical aortic valve replacement (SAVR) for patients deemed to be at prohibitive surgical risk, but also for selected patients at intermediate or low surgical risk. Nonetheless, [...] Read more.

Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, providing a viable alternative to surgical aortic valve replacement (SAVR) for patients deemed to be at prohibitive surgical risk, but also for selected patients at intermediate or low surgical risk. Nonetheless, there still exist uncertainties regarding the optimal management of patients undergoing TAVR. The selection of the optimal bioprosthetic valve for each patient represents one of the most challenging dilemmas for clinicians, given the large number of currently available devices. Limited follow-up data from landmark clinical trials comparing TAVR with SAVR, coupled with the typically elderly and frail population of patients undergoing TAVR, has led to inconclusive data on valve durability. Recommendations about the use of one device over another in given each patient’s clinical and procedural characteristics are largely based on expert consensus. This review aims to evaluate the available evidence on the performance of different devices in the presence of specific clinical and anatomic features, with a focus on patient, procedural, and device features that have demonstrated a relevant impact on the risk of poor hemodynamic valve performance and adverse clinical events. Full article

(This article belongs to the Special Issue Aortic Valve Replacement: Ongoing Issues and Challenges)

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19 pages, 2253 KiB

Open AccessReview

Evolving Indications of Transcatheter Aortic Valve Replacement—Where Are We Now, and Where Are We Going

by Jules Mesnier, Vassili Panagides, Jorge Nuche and Josep Rodés-Cabau

J. Clin. Med. 2022, 11(11), 3090; https://doi.org/10.3390/jcm11113090 - 30 May 2022

Cited by 13 | Viewed by 4218

Abstract

Indications for transcatheter aortic valve replacement (TAVR) have steadily increased over the last decade since the first trials including inoperable or very high risk patients. Thus, TAVR is now the most common treatment of aortic valve stenosis in elderly patients (vs. surgical aortic [...] Read more.

Indications for transcatheter aortic valve replacement (TAVR) have steadily increased over the last decade since the first trials including inoperable or very high risk patients. Thus, TAVR is now the most common treatment of aortic valve stenosis in elderly patients (vs. surgical aortic valve replacement -SAVR-). In this review, we summarize the current indications of TAVR and explore future directions in which TAVR indications can expand. Full article

(This article belongs to the Special Issue Aortic Valve Replacement: Ongoing Issues and Challenges)

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9 pages, 794 KiB

Open AccessReview

Simplified TAVR Procedure: How Far Is It Possible to Go?

by Florence Leclercq, Pierre Alain Meunier, Thomas Gandet, Jean-Christophe Macia, Delphine Delseny, Philippe Gaudard, Marc Mourad, Laurent Schmutz, Pierre Robert, François Roubille, Guillaume Cayla and Mariama Akodad

J. Clin. Med. 2022, 11(10), 2793; https://doi.org/10.3390/jcm11102793 - 16 May 2022

Cited by 6 | Viewed by 2752

Abstract

Increasing operators’ experience and improvement of the technique have resulted in a drastic reduction in complications following transcatheter aortic valve replacement (TAVR) in patients with lower surgical risk. In parallel, the procedure was considerably simplified, with a routine default approach including local anesthesia [...] Read more.

Increasing operators’ experience and improvement of the technique have resulted in a drastic reduction in complications following transcatheter aortic valve replacement (TAVR) in patients with lower surgical risk. In parallel, the procedure was considerably simplified, with a routine default approach including local anesthesia in the catheterization laboratory, percutaneous femoral approach, radial artery as the secondary access, prosthesis implantation without predilatation, left ventricle wire pacing and early discharge. Thus, the “simplified” TAVR adopted in most centers nowadays is a real revolution of the technique. However, simplified TAVR must be accompanied upstream by a rigorous selection of patients who can benefit from a minimalist procedure in order to guarantee its safety. The minimalist strategy must not become dogmatic and careful pre-, per- and post-procedural evaluation of patients with well-defined protocols guarantee optimal care following TAVR. This review aims to evaluate the benefits and limits of the simplified TAVR procedure in a current and future vision. Full article

(This article belongs to the Special Issue Aortic Valve Replacement: Ongoing Issues and Challenges)

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27 pages, 2954 KiB

Open AccessReview

Antithrombotic Therapy Following Transcatheter Aortic Valve Replacement

by Camille Granger, Paul Guedeney and Jean-Philippe Collet

J. Clin. Med. 2022, 11(8), 2190; https://doi.org/10.3390/jcm11082190 - 14 Apr 2022

Cited by 5 | Viewed by 4875

Abstract

Due to a large technical improvement in the past decade, transcatheter aortic valve replacement (TAVR) has expanded to lower-surgical-risk patients with symptomatic and severe aortic stenosis. While mortality rates related to TAVR are decreasing, the prognosis of patients is still impacted by ischemic [...] Read more.

Due to a large technical improvement in the past decade, transcatheter aortic valve replacement (TAVR) has expanded to lower-surgical-risk patients with symptomatic and severe aortic stenosis. While mortality rates related to TAVR are decreasing, the prognosis of patients is still impacted by ischemic and bleeding complications, and defining the optimal antithrombotic regimen remains a priority. Recent randomized control trials reported lower bleeding rates with an equivalent risk in ischemic outcomes with single antiplatelet therapy (SAPT) when compared to dual antiplatelet therapy (DAPT) in patients without an underlying indication for anticoagulation. In patients requiring lifelong oral anticoagulation (OAC), the association of OAC plus antiplatelet therapy leads to a higher risk of bleeding events with no advantages on mortality or ischemic outcomes. Considering these data, guidelines have recently been updated and now recommend SAPT and OAC alone for TAVR patients without and with a long-term indication for anticoagulation. Whether a direct oral anticoagulant or vitamin K antagonist provides better outcomes in patients in need of anticoagulation remains uncertain, as recent trials showed a similar impact on ischemic and bleeding outcomes with apixaban but higher gastrointestinal bleeding with edoxaban. This review aims to summarize the most recently published data in the field, as well as describe unresolved issues. Full article

(This article belongs to the Special Issue Aortic Valve Replacement: Ongoing Issues and Challenges)

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