Aortic root volume is associated with contained rupture of the aortic annulus in balloon‐expandable transcatheter aortic valve replacement

Reinöhl, Jochen; Psyrakis, Dimitrios; Kaier, Klaus; Kodirov, Sodikdjon A.; Siepe, Matthias; Gutmann, Anja; Mühlen, Constantin von zur; Moser, Martin; Ahrens, Ingo; Pache, Gregor; Zirlik, Andreas; Langer, Mathias; Beyersdorf, Friedhelm; Zehender, Manfred; Bode, Christoph; Blanke, Philipp

doi:10.1002/ccd.26260

Cited by 7 publications

(4 citation statements)

References 21 publications

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“…The relationship between annular area sizing and annular rupture has been previously reported. 19,20 Our exploratory results suggest caution when using SE valves in patients with small annuli; this relationship should be explored further in larger datasets.…”

Section: Discussionmentioning

confidence: 90%

Intrathoracic complications associated with trans‐femoral transcatheter aortic valve replacement: Implications for emergency surgical preparedness

Hodson

Jin

Ring

et al. 2019

Cathet Cardio Intervent

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Background Intrathoracic complications (ITC) requiring emergency surgical intervention occur during transcatheter aortic valve replacement (TAVR). Objectives Characterize the incidence, outcomes and predictors of ITC in a large cohort of transfemoral (TF) TAVR cases over a 5 year period. Methods Retrospective registry and chart review of all nonclinical trial TF‐TAVR patients from seven centers within one hospital system from 2012–2016. ITC were defined as cardiac perforation, new or worsening pericardial effusion/tamponade, annular rupture, thoracic aortic injury, aortic valve dislodgement, and coronary artery occlusion. Procedural and 30‐day outcomes and 1‐year mortality were compared between ITC and no ITC patients. Multivariable logistic regression was used to identify predictors of ITC. Results Over the study period, 1,581 patients had TF‐TAVR and 68 ITC occurred in 46 patients (2.9%). The most common ITCs were pericardial effusion/tamponade (59%), cardiac perforation (33%), and valve dislodgement (33%). ITC rate did not decline over time (rate (95% confidence interval) for 2012 = 0% (0–8.8%), 2013 = 1.3% (0–7.2%), 2014 = 4.4% (2.2–8.0%), 2015 = 3.5% (2.0–5.6%), and 2016 = 2.4% (1.5–3.8%)). ITC patients had worse 1‐year survival (ITC: 60.7% (45.1–73.1%), no ITC: 88.7% (87.0–90.3%); p < .001). The majority of ITC patient deaths occurred within the first 30 days. Multivariable models to predict ITC were not successful. Conclusions ITC did not decline over time in our cohort. Predictors of ITC could not be identified. While these events are rare, they are associated with worse procedural outcomes and mortality. Heart teams should continue to be prepared for emergency intervention.

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Section: Discussionmentioning

confidence: 90%

Intrathoracic complications associated with trans‐femoral transcatheter aortic valve replacement: Implications for emergency surgical preparedness

Hodson

Jin

Ring

et al. 2019

Cathet Cardio Intervent

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“…8 , 24 The mechanisms of regurgitation after implantation of THV are multifactorial as, for example, calcification of the native aortic annulus and left ventricular outflow tract (LVOT) and cover index are well known predicting factors of regurgitation after implantation of a THV. 19 , 26 - 34 …”

Section: Discussionmentioning

confidence: 99%

“…19 If they were not normally distributed, median and inter-quartile range [IQR] were used. Mann-Whitney test was used to compare continuous variables between independent samples.…”

Section: Methodsmentioning

confidence: 99%

The Role of Quantitative Aortographic Assessment of Aortic Regurgitation by Videodensitometry in the Guidance of Transcatheter Aortic Valve Implantation

Miyazaki¹,

Modolo²,

Abdelghani³

et al. 2018

Arquivos Brasileiros De Cardiologia

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BackgroundBalloon post-dilatation (BPD) is often needed for optimizing transcatheter heart valve (THV) implantation, since paravalvular leak (PVL) after transcatheter aortic valve implantation is associated with poor outcome and mortality. Quantitative assessment of PVL severity before and after BPD is mandatory to properly assess PVL, thus improving implantation results and outcomes.ObjectiveTo investigate a quantitative angiographic assessment of aortic regurgitation (AR) by videodensitometry before and after BPD.MethodsVideodensitometric-AR assessments (VD-AR) before and after BPD were analysed in 61 cases.ResultsVD-AR decreased significantly from 24.0[18.0-30.5]% to 12.0[5.5-19.0]% (p < 0.001, a two-tailed p < 0.05 defined the statistical significance). The relative delta of VD-AR after BPD ranged from -100% (improvement) to +40% (deterioration) and its median value was -46.2%. The frequency of improvement, no change, and deterioration were 70% (n = 43), 25% (n = 15) and 5% (n = 3), respectively. Significant AR (VD-AR > 17%) was observed in 47 patients (77%) before and in 19 patients (31%) after BPD.ConclusionsVD-AR after THV implantation provides a quantitative assessment of post-TAVI regurgitation and can help in the decision-making process on performing BPD and in determining its efficacy.

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“…In L. polyphemus , similar to humans, there is a semicircular, semilunar Thebesian valve located between the anterior aorta and the heart (Göpel & Wirkner, ). In invertebrates, whether or not there are comparable age‐dependent changes in both aorta and aortic valve functions as in humans (Reinöhl et al, ) is not precisely addressed. However, the two important and opposing functions of vasculature—vasoconstriction and vasodilatation—are directly or indirectly dependent on the properties of the endothelium (Popov, Ershova, Podtaev, Frick, & Zubareva, ).…”

Section: Introductionmentioning

confidence: 99%

Limulus and heart rhythm

et al. 2018

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Great interest in the comparative physiology of hearts and their functions in Animalia has emerged with classic papers on Limulus polyphemus and mollusks. The recurrent cardiac activity-heart rate-is the most important physiological parameter and when present the kardia (Greek) is vital to the development of entire organs of the organisms in the animal kingdom. Extensive studies devoted to the regulation of cardiac rhythm in invertebrates have revealed that the basics of heart physiology are comparable to mammals. The hearts of invertebrates also beat spontaneously and are supplied with regulatory nerves: either excitatory or inhibitory or both. The distinct nerves and the source of excitation/inhibition at the level of single neurons are described for many invertebrate genera. The vertebrates and a majority of invertebrates have myogenic hearts, whereas the horseshoe crab L. polyphemus and a few other animals have a neurogenic cardiac rhythm. Nevertheless, the myogenic nature of heartbeat is precursor, because the contraction of native and stem-cellderived cardiomyocytes does occur in the absence of any neural elements. Even in L. polyphemus, the heart rhythm is myogenic at embryonic stages.

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Aortic root volume is associated with contained rupture of the aortic annulus in balloon‐expandable transcatheter aortic valve replacement

Cited by 7 publications

References 21 publications

Intrathoracic complications associated with trans‐femoral transcatheter aortic valve replacement: Implications for emergency surgical preparedness

Intrathoracic complications associated with trans‐femoral transcatheter aortic valve replacement: Implications for emergency surgical preparedness

The Role of Quantitative Aortographic Assessment of Aortic Regurgitation by Videodensitometry in the Guidance of Transcatheter Aortic Valve Implantation

Limulus and heart rhythm

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