Long-Term Outcomes and Valve Performance in Patients Undergoing Transcatheter Aortic Valve Implantation

Stathogiannis, Konstantinos; Synetos, Αndreas; Latsios, George; Καρανάσος, Αντώνιος; Trantalis, George; Toskas, P; Drakopoulou, Maria; Xanthopoulou, Maria; Karmpalioti, Maria; Simopoulou, Chryssa; Σουλαϊδόπουλος, Στέργιος; Oikonomou, G; Benetos, Georgios; Tsalamandris, Sotirios; Kosmas, Elias; Voudris, Vasilis; Mastrokostopoulos, Antonios; Katsimagklis, George; Halvatsiotis, Panagiotis; Deftereos, Spyridon; Tsioufis, Costas; Toutouzas, Konstantinos

doi:10.1016/j.amjcard.2021.02.006

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…balloon-expandable and self-expandable prostheses, when compared to surgical prostheses. [15][16][17][18][19] In addition, a costeffectiveness study showed a slight economic advantage for TAVI in the medium-term follow-up. 16 However, for younger patients (below 70 years), we still do not have consistent data for the durability of TAVI prostheses compared to surgical prostheses.…”

Section: Le Bihan Et Al Transcatheter Aortic Valve Implantationmentioning

confidence: 99%

“…Quando se trata do primeiro ponto, estudos preliminares mostraram desfechos semelhantes quanto à degeneração estrutural, tanto para as próteses balão expansíveis quanto para as autoexpansíveis, quando comparadas às próteses cirúrgicas. 15 - 19 Além disso, um estudo de custo efetividade mostrou discreta vantagem econômica para o TAVI, no acompanhamento em médio prazo. 16 Entretanto, para pacientes mais jovens (abaixo de 70 anos), ainda não temos dados consistentes para a durabilidade das próteses TAVI frente às cirúrgicas.…”

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Implante Transcateter de Valva Aórtica: O Que já Aconteceu e o que Ainda está Por Vir

Bihan¹,

Barretto²,

Mathias³

2023

Arquivos Brasileiros De Cardiologia

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Section: Le Bihan Et Al Transcatheter Aortic Valve Implantationmentioning

confidence: 99%

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Implante Transcateter de Valva Aórtica: O Que já Aconteceu e o que Ainda está Por Vir

Bihan¹,

Barretto²,

Mathias³

2023

Arquivos Brasileiros De Cardiologia

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“…Although long-term data on SVD in TAVI patients is scarce, there is evidence that there is a similar rate of SVD in surgical and TAVI patients at five years [ 73 ]. Registry data show low rates of SVD even after five years [ 74 , 75 ]. The NOTION trial—the first randomized trial on bioprosthetic valve durability in patients with low surgical risk of mortality—even showed a lower rate of SVD in TAVI compared to surgical patients at 8 years (13.9% vs. 28.3%; p = 0.0017) and the risk of bioprosthetic valve failure was similar (8.7% vs. 10.5%; p = 0.61) [ 76 ].…”

Section: Valvementioning

confidence: 99%

Technical Aspects and Development of Transcatheter Aortic Valve Implantation

Steblovnik¹,

Bunc²

2022

JCDD

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Aortic stenosis is the most common valve disease requiring surgery or percutaneous treatment. Since the first-in-man implantation in 2002 we have witnessed incredible progress in transcatheter aortic valve implantation (TAVI). In this article, we review the technical aspects of TAVI development with a look at the future. Durability, low thrombogenicity, good hydrodynamics, biocompatibility, low catheter profile, and deployment stability are the attributes of an ideal TAVI device. Two main design types exist—balloon-expandable and self-expanding prostheses. Balloon-expandable prostheses use a cobalt-chromium alloy frame providing high radial strength and radiopacity, while the self-expanding prostheses use a nickel-titanium (Nitinol) alloy frame, which expands to its original shape once unsheathed and heated to the body temperature. The valve is sewn onto the frame and consists of the porcine or bovine pericardium, which is specially treated to prevent calcinations and prolong durability. The lower part of the frame can be covered by polyethylene terephthalate fabric or a pericardial skirt, providing better sealing between the frame and aortic annulus. The main future challenges lie in achieving lower rates of paravalvular leaks and new pacemaker implantations following the procedure, lower delivery system profiles, more precise positioning, longer durability, and a good hemodynamic profile. Patient-specific design and the use of autologous tissue might solve these issues.

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“…Over the last decade, transcatheter aortic valve implantation (TAVI) has been established as the primary treatment option for individuals with severe symptomatic aortic stenosis with increased surgical risk, and is steadily gaining traction as a valid alternative to conventional surgery in lower-surgical-risk patients [ 1 , 2 , 3 ]. The combination of considerable progress in transcatheter techniques and devices, along with the accumulating experience of operators have contributed to the minimization of periprocedural complications and have led to a dramatic improvement in TAVI short- and long-term outcomes [ 4 , 5 , 6 , 7 , 8 , 9 ]. Given the emerging expansion of indications for the minimally invasive, percutaneous repair of aortic stenosis, the challenge remains to identify those patients that are more likely to benefit from TAVI, as well as objective features that may be predictive of a less favorable prognosis.…”

Section: Introductionmentioning

confidence: 99%

The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT Trial

Drakopoulou

Oikonomou

Karmpalioti

et al. 2023

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Background: The presence of an electrocardiographic (ECG) strain pattern—among other ECG features—has been shown to be predictive of adverse cardiovascular outcomes in asymptomatic patients with aortic stenosis. However, data evaluating its impact on symptomatic patients undergoing TAVI are scarce. Therefore, we tried to investigate the prognostic impact of baseline ECG strain pattern on clinical outcomes after TAVI. Methods: A sub-group of patients of the randomized DIRECT (Pre-dilatation in Transcatheter Aortic Valve Implantation Trial) trial with severe aortic stenosis who underwent TAVI with a self-expanding valve in one single center were consecutively enrolled. Patients were categorized into two groups according to the presence of ECG strain. Left ventricular strain was defined as the presence of ≥1 mm convex ST-segment depression with asymmetrical T-wave inversion in leads V5 to V6 on the baseline 12-lead ECG. Patients were excluded if they had paced rhythm or left bundle branch block at baseline. Multivariate Cox proportional hazard regression models were generated to assess the impact on outcomes. The primary clinical endpoint was all-cause mortality at 1 year after TAVI. Results: Of the 119 patients screened, 5 patients were excluded due to left bundle branch block. Among the 114 included patients (mean age: 80.8 ± 7), 37 patients (32.5%) had strain pattern on pre-TAVI ECG, while 77 patients (67.5%) did not exhibit an ECG strain pattern. No differences in baseline characteristics were found between the two groups. At 1 year, seven patients reached the primary clinical endpoint, with patients in the strain group demonstrating significantly higher mortality in Kaplan–Meier plots compared to patients without left ventricular strain (five vs. two, log-rank p = 0.022). There was no difference between the strain and no strain group regarding the performance of pre-dilatation (21 vs. 33, chi-square p = 0.164). In the multivariate analysis, left ventricular strain was found to be an independent predictor of all-cause mortality after TAVI [Exp(B): 12.2, 95% Confidence Intervals (CI): 1.4–101.9]. Conclusion: Left ventricular ECG strain is an independent predictor of all-cause mortality after TAVI. Thus, baseline ECG characteristics may aid in risk-stratifying patients scheduled for TAVI.

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Long-Term Outcomes and Valve Performance in Patients Undergoing Transcatheter Aortic Valve Implantation

Cited by 6 publications

References 23 publications

Implante Transcateter de Valva Aórtica: O Que já Aconteceu e o que Ainda está Por Vir

Implante Transcateter de Valva Aórtica: O Que já Aconteceu e o que Ainda está Por Vir

Technical Aspects and Development of Transcatheter Aortic Valve Implantation

The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT Trial

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