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Technical Improvements and Hemodynamic Response during TAVI Implantation: Is It...
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Technical Improvements and Hemodynamic Response during TAVI Implantation: Is It Possible to Have a Tailored Procedure for Each Patient?

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Intensive Care/ Anesthesiology".

Deadline for manuscript submissions: closed (18 July 2021) | Viewed by 10819

Special Issue Editor

Dr. Salvatore Mario Romano

E-Mail Website
Guest Editor
Università degli Studi di Firenze, Florence, Italy
Interests: haemodynamic monitoring; minimally invasive technology in clinical monitoring; arterial and ventricular coupling; anaesthesia and TAVI implantation; intra aortic counterpulsation IABP; ultrafiltration in decompensated patients

Special Issue Information

Dear Colleagues,

Transcatheter aortic valve implantation (TAVI), due to best patient selection, well trained operators and the best technology, is now well established. Nevertheless, the choice for the single patient of the type of valve (depending on anatomical characteristics such as interventricular septum thickness, depth of implantation, impedance of cardiovascular coupling, etc.), the best anesthesia regimen and the effective hemodynamic impact of the implantation at the end of the procedure, remain open questions. In particular, the individual clinical response of patients during TAVI implantation remains to be clarified. That is, how the kind of valve and the response during implantation can allow one to predict some complications such as permanent PM implantation or residual aortic insufficiency, and how much deep sedation in spontaneous breathing or femoral local anesthesia can be taken into account to understand the effective hemodynamic response of the patients at the end of the procedure. 

Dr. Salvatore Mario Romano
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • TAVI implantation depth and membranous septum length
  • Type of aortic valve implantation
  • Sedation TAVI procedure
  • Ventricular-arterial system coupling
  • Elastance arterial system
  • PPM and aortic residual leak in TAVI

Published Papers (4 papers)

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Research

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13 pages, 8177 KiB  
Article
Occurrence and Persistency of Conduction Disturbances during Transcatheter Aortic Valve Implantation
by Thomas T. Poels, Elien B. Engels, Suzanne Kats, Leo Veenstra, Vincent van Ommen, Kevin Vernooy, Jos G. Maessen and Frits W. Prinzen
Medicina 2021, 57(7), 695; https://doi.org/10.3390/medicina57070695 - 07 Jul 2021
Cited by 2 | Viewed by 2381
Abstract
Background and Objectives: Conduction disturbances such as left bundle branch block (LBBB) and complete atrio-ventricular block (cAVB) are relatively frequent complications following trans-catheter aortic valve implantation (TAVI). We investigated the dynamics of these conduction blocks to further understand luxating factors and predictors [...] Read more.
Background and Objectives: Conduction disturbances such as left bundle branch block (LBBB) and complete atrio-ventricular block (cAVB) are relatively frequent complications following trans-catheter aortic valve implantation (TAVI). We investigated the dynamics of these conduction blocks to further understand luxating factors and predictors for their persistency. Materials and Methods: We prospectively included 157 consecutive patients who underwent a TAVI procedure. Electrocardiograms (ECGs) were obtained at specific time points during the TAVI procedure and at follow-up until at least six months post-procedure. Results: Of the 106 patients with a narrow QRS complex (nQRS) before TAVI, ~70% developed LBBB; 28 (26.4%) being classified as super-transient (ST-LBBB), 20 (18.9%) as transient (T-LBBB) and 24 (22.6%) as persistent (P-LBBB). Risk of LBBB was higher for self-expandable (SE) than for balloon-expandable (BE) prostheses and increased with larger implant depth. During the TAVI procedure conduction disturbances showed a dynamic behavior, as illustrated by alternating kinds of blocks in 18 cases. Most LBBBs developed during balloon aortic valvuloplasty (BAV) and at positioning and deployment of the TAVI prosthesis. The incidence of LBBB was not significantly different between patients who did and did not undergo BAV prior to TAVI implantation (65.3% and 74.2%, respectively (p = 0.494)). Progression to cAVB was most frequent for patients with preexisting conduction abnormalities (5/34) patients) and in patients showing ST-LBBB (6/28). Conclusions: During the TAVI procedure, conduction disturbances showed a dynamic behavior with alternating types of block in 18 cases. After a dynamic period of often alternating types of block, most BBBs are reversible while one third persist. Patients with ST-LBBB are most prone to progressing into cAVB. The observation that the incidence of developing LBBB after TAVI is similar with and without BAV suggests that a subgroup of patients has a substrate to develop LBBB regardless of the procedure. Full article
(This article belongs to the Special Issue Technical Improvements and Hemodynamic Response during TAVI Implantation: Is It Possible to Have a Tailored Procedure for Each Patient?)
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13 pages, 2403 KiB  
Article
Effective Distance between Aortic Valve and Conduction System Is an Independent Predictor of Persistent Left Bundle Branch Block during Transcatheter Aortic Valve Implantation
by Thomas T. Poels, Robert Stassen, Suzanne Kats, Leo Veenstra, Vincent van Ommen, Bastiaan Kietselaer, Patrick Houthuizen, Jos G. Maessen and Frits W. Prinzen
Medicina 2021, 57(5), 476; https://doi.org/10.3390/medicina57050476 - 11 May 2021
Cited by 1 | Viewed by 1994
Abstract
Background and objectives: Persistent left bundle branch block (P-LBBB) has been associated with poor clinical outcomes of transcatheter aortic valve implantation (TAVI) procedures. We hypothesized that the distance from the aortic valve to the proximal conduction system, expressed as the effective distance between [...] Read more.
Background and objectives: Persistent left bundle branch block (P-LBBB) has been associated with poor clinical outcomes of transcatheter aortic valve implantation (TAVI) procedures. We hypothesized that the distance from the aortic valve to the proximal conduction system, expressed as the effective distance between the aortic valve and conduction system (EDACS), can predict the occurrence of P-LBBB in patients undergoing a TAVI procedure. Materials and methods: In a retrospective study, data from 269 patients were analyzed. EDACS was determined using two longitudinal CT sections. Results: Sixty-four of the patients developed P-LBBB. EDACS ranged between −3 and +18 mm. EDACS was significantly smaller in P-LBBB than in non-P-LBBB patients (4.6 (2.2–7.1) vs. 8.0 (5.8–10.2) mm, median values (interquartile range); p < 0.05). Receiver operating characteristic analysis showed an area under the curve of 0.78 for predicting P-LBBB based on EDACS. In patients with EDACS of ≤3 mm and >10 mm, the chance of developing P-LBBB was ≥50% and <10%, respectively. Conclusions: A small EDACS increases the risk for the development of P-LBBB during TAVI by a factor of >25. As EDACS can be measured pre-procedurally, it may be a valuable additional factor to weigh the risks of transcatheter and surgical aortic valve replacement. Full article
(This article belongs to the Special Issue Technical Improvements and Hemodynamic Response during TAVI Implantation: Is It Possible to Have a Tailored Procedure for Each Patient?)
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Review

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10 pages, 345 KiB  
Review
Transcatheter Aortic Valve Implantation in Younger Patients: A New Challenge
by Giacomo Virgili, Salvatore Mario Romano, Renato Valenti, Angela Migliorini, Pierluigi Stefàno, Niccolò Marchionni and Nazario Carrabba
Medicina 2021, 57(9), 883; https://doi.org/10.3390/medicina57090883 - 27 Aug 2021
Cited by 4 | Viewed by 2130
Abstract
The number of aortic stenosis patients in Western countries is increasing, along with better life conditions and expectancies. Presently, the volume of percutaneous transcatheter aortic valve implantations (TAVIs) is incessantly increasing, and has already overcome the surgical replacement procedure volume. According to the [...] Read more.
The number of aortic stenosis patients in Western countries is increasing, along with better life conditions and expectancies. Presently, the volume of percutaneous transcatheter aortic valve implantations (TAVIs) is incessantly increasing, and has already overcome the surgical replacement procedure volume. According to the literature, TAVI is a feasible procedure even among low surgical risk patients, and American guidelines have extended the indications for TAVI, including shifting patient evaluations from high/low STS scores to old/young patients, a “paradigm shift” of aortic stenosis evaluation. As a result, low-risk young (<75 years-old) population management could be the next challenge in cardiology. To manage the life conditions of a 65 year old patient affected by aortic stenosis who is undergoing TAVI, one of the most crucial issue will be bioprosthesis durability and the appropriate intervention to make in cases of valve dysfunction or failure. Full article
(This article belongs to the Special Issue Technical Improvements and Hemodynamic Response during TAVI Implantation: Is It Possible to Have a Tailored Procedure for Each Patient?)
27 pages, 2649 KiB  
Review
Advancements in Transcatheter Aortic Valve Implantation: A Focused Update
by Niccolò Ciardetti, Francesca Ciatti, Giulia Nardi, Francesca Maria Di Muro, Pierluigi Demola, Edoardo Sottili, Miroslava Stolcova, Francesca Ristalli, Alessio Mattesini, Francesco Meucci and Carlo Di Mario
Medicina 2021, 57(7), 711; https://doi.org/10.3390/medicina57070711 - 14 Jul 2021
Cited by 7 | Viewed by 3676
Abstract
Transcatheter aortic valve implantation (TAVI) has become the leading technique for aortic valve replacement in symptomatic patients with severe aortic stenosis with conventional surgical aortic valve replacement (SAVR) now limited to patients younger than 65–75 years due to a combination of unsuitable anatomies [...] Read more.
Transcatheter aortic valve implantation (TAVI) has become the leading technique for aortic valve replacement in symptomatic patients with severe aortic stenosis with conventional surgical aortic valve replacement (SAVR) now limited to patients younger than 65–75 years due to a combination of unsuitable anatomies (calcified raphae in bicuspid valves, coexistent aneurysm of the ascending aorta) and concerns on the absence of long-term data on TAVI durability. This incredible rise is linked to technological evolutions combined with increased operator experience, which led to procedural refinements and, accordingly, to better outcomes. The article describes the main and newest technical improvements, allowing an extension of the indications (valve-in-valve procedures, intravascular lithotripsy for severely calcified iliac vessels), and a reduction of complications (stroke, pacemaker implantation, aortic regurgitation). Full article
(This article belongs to the Special Issue Technical Improvements and Hemodynamic Response during TAVI Implantation: Is It Possible to Have a Tailored Procedure for Each Patient?)
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