Long-term Transcatheter Aortic Valve Durability

Costa, Giuliano; Criscione, Enrico; Todaro, Denise; Tamburino, Corrado; Barbanti, Marco

doi:10.15420/icr.2019.4.2

Cited by 31 publications

(21 citation statements)

References 55 publications

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“…The recent results of the PARTNER 3 71 and Medtronic Corevalve Low Risk trial 73 have significantly altered clinical practice, with TAVR becoming the standard of care for many patients. Yet, it has been simultaneously pointed out that the long-term durability of TAVR due to SVD is currently unclear 74 . In our study, we provided evidence that both clinical grade SAVR and TAVR valves (as well our laboratory-manufactured valves) are similarly subject to glycation and HSA incorporation both in vivo and in vitro.…”

Section: Discussionmentioning

confidence: 99%

Glycation and Serum Albumin Infiltration Contribute to the Structural Degeneration of Bioprosthetic Heart Valves

Frasca

Xue

Kossar

et al. 2020

Preprint

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Background: Bioprosthetic heart valves (BHV) are widely used to treat heart valve disease but are fundamentally limited by structural valve degeneration (SVD). Non-calcific mechanisms of SVD entirely account for approximately 30% of SVD cases and contribute to calcific SVD but remain understudied. Glycation mechanisms have not been previously associated with SVD, despite being established as degenerative in collagenous native tissues. Objectives:To determine whether blood component infiltration-based glycation and concomitant human serum albumin (HSA) deposition contribute mechanistically to SVD.Methods: Immunohistochemistry (IHC) was used to identify advanced glycation end-products (AGEs) and serum albumin accumulation in 45 aortic valve BHV explanted due to SVD, glutaraldehyde-treated bovine pericardium (BP) incubated in vitro in glyoxal and HSA, and rat subcutaneous BP implants. Structural impacts of glycation-related mechanisms were evaluated by second harmonic generation (SHG) collagen imaging. Hydrodynamic effects of valve glycation and concomitant HSA exposure were studied with an ISO-5840-compliant pulse duplicator system using surgical grade BHV.Results: All 45 clinical explants and in vitro-incubated BP demonstrated accumulated AGE and HSA compared to un-implanted, un-exposed BHV. SHG revealed instigation of collagen malalignment similar to that in SVD explants by glycation and HSA infiltration. Rat subdermal explants also showed AGE and serum albumin accumulation. Pulse duplication demonstrated significantly reduced orifice area and increased pressure gradient and peak fluid velocity following glyoxal and HSA incubations. Conclusions:Glycation and concomitant HSA infiltration occur in clinical BHV and contribute to structural and functional degeneration of leaflet tissue, thus representing novel, interacting mechanisms of BHV SVD.

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Section: Discussionmentioning

confidence: 99%

Glycation and Serum Albumin Infiltration Contribute to the Structural Degeneration of Bioprosthetic Heart Valves

Frasca

Xue

Kossar

et al. 2020

Preprint

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“…The standardized definitions of structural valve degeneration by the European Association of Percutaneous Cardiovascular Intervention, the European Society of Cardiology, the European Association for Cardio-Thoracic Surgery, and the Valve-in-Valve International Data registry have resulted in increased uniformity in the evaluations of structural valve durability. 7 In a 2018 study, the incidence of clinically relevant transcatheter valve degeneration after ViV TAVI for degenerated surgical bioprosthesis was 3% at up to 5-year follow-up. Meanwhile, the incidence of subclinical transcatheter valve degeneration was 15.1%.…”

Section: Discussionmentioning

confidence: 99%

Balloon Expandable Transcatheter Aortic Valve Implantation in Failing Self-Expandable Transcatheter Valve in Degenerated Surgical Bioprosthesis: Valve-in-Valve-in-Valve Implantation for the Treatment of Early Degenerative Prosthetic Insufficiency

Subahi

Alhusain

Ajmal

et al. 2021

TOJ

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Background: Transcatheter aortic valve implantation (TAVI) has emerged as the standard of care for patients with severe aortic stenosis who are at high surgical risk. However, transcatheter valves can degenerate, and redo TAVI has been reported after surgical aortic valve implantation and post initial TAVI. Case Report: We describe the case of a 70-year-old male who presented with decompensated heart failure secondary to severe prosthetic valve insufficiency. The patient had a history of distant triple coronary artery bypass surgery in 2004, surgical ascending aortic aneurysm repair and stentless aortic valve replacement in 2012, and transcatheter CoreValve (Medtronic) implantation in 2015 for the failing stentless aortic valve. In 2019, the patient presented with heart failure symptoms. A 29-mm SAPIEN 3 valve (Edwards Lifesciences) was implanted for the third time (valve-in-valve-in-valve) with excellent clinical and echocardiographic results and no evidence of coronary obstruction. Conclusion: Early (<5 years) bioprosthetic valve insufficiency after initial valve-in-valve implantation can be successfully treated with a second TAVI.

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“…Meta-analyses in surgical bioprosthetic valves have shown SVD begins 8 years after implantation, with further substantial increased SVD after 10 years [ 74 ]. The incidence of SVD after TAVR varies in the literature, from <5% to 10% at 1 year, 12–20% at 5 years, and approximately 13–23% at 8 years [ 74 – 76 ]. Other sources of BVF include nonstructural valve dysfunction, valve thrombosis, and endocarditis.…”

Section: Challenges Facing Tavr In Low-risk Patientsmentioning

confidence: 99%

TAVR: A Review of Current Practices and Considerations in Low-Risk Patients

Spears

Al-Saiegh

Goldberg

et al. 2020

Journal of Interventional Cardiology

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Transcatheter aortic valve replacement (TAVR) is an established treatment for severe, symptomatic, aortic stenosis (AS) in patients of all risk categories and now comprises 12.5% of all aortic valve replacements. TAVR is a less invasive alternative to traditional surgical aortic valve replacement (SAVR), with equivalent or superior outcomes. The use of TAVR has increased rapidly. The success and increase in use of TAVR are a result of advances in technology, greater operator experience, and improved outcomes. Indications have recently expanded to include patients considered to be at low risk for SAVR. While TAVR outcomes have improved, remaining challenges include the management of coexistent coronary artery disease, prevention of periprocedural stroke, and issue of durability. These issues are even more relevant for low-risk, younger patients.

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Long-term Transcatheter Aortic Valve Durability

Cited by 31 publications

References 55 publications

Glycation and Serum Albumin Infiltration Contribute to the Structural Degeneration of Bioprosthetic Heart Valves

Glycation and Serum Albumin Infiltration Contribute to the Structural Degeneration of Bioprosthetic Heart Valves

Balloon Expandable Transcatheter Aortic Valve Implantation in Failing Self-Expandable Transcatheter Valve in Degenerated Surgical Bioprosthesis: Valve-in-Valve-in-Valve Implantation for the Treatment of Early Degenerative Prosthetic Insufficiency

TAVR: A Review of Current Practices and Considerations in Low-Risk Patients

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