Multicenter Evaluation of Edwards SAPIEN Positioning During Transcatheter Aortic Valve Implantation With Correlates for Device Movement During Final Deployment

Dvir, Danny; Lavi, Ifat; Eltchaninoff, Hélène; Himbert, Dominique; Almagor, Yaron; Descoutures, Fleur; Vahanian, Alec; Tron, Christophe; Cribier, Alain; Kornowski, Ran

doi:10.1016/j.jcin.2012.03.005

Cited by 39 publications

(33 citation statements)

References 18 publications

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“…Fluoroscopy has shown that the device-center upper movement during final deployment was (on average) 2.0 ± 1.43 mm (range -1.3 to 4.6 mm), with shortening of the device due to asymmetrical upward movement of the ventricular edge of THV by 3.2 ± 1.4 mm and the upper (aortic) edge by only 0.75 ± 1.50 mm (67). The optimal final THV deployment position resulted in 17% of the THV below the base of the aortic sinuses (determined by pigtail catheter position or aortography); this translated to 33% of the valve below the sinuses during the final pacing run.…”

Section: Complicationsmentioning

confidence: 99%

“…Although operator-independent motion of the balloon-expandable valve is usually predictable and has been well described for the first generation and second generation balloon-expandable valves (67), there is rarely an unexpected extreme motion of the valve. Embolization of the valve into the aorta may itself result in aortic trauma, but if not, intentional repositioning of the valve into the descending aorta beyond the great arteries (Figure 34) may be necessary before attempted deployment of a second valve at the aortic annulus.…”

Section: Complicationsmentioning

confidence: 99%

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Echocardiographic Imaging of Procedural Complications During Balloon-Expandable Transcatheter Aortic Valve Replacement

Hahn

Kodali

Tuzcu

et al. 2015

JACC: Cardiovascular Imaging

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Transcatheter aortic valve replacement (TAVR) using a balloon-expandable valve is an accepted alternative to surgical replacement for severe, symptomatic aortic stenosis in high risk or inoperable patients. Intraprocedural transesophageal echocardiography (TEE) offers real-time imaging guidance throughout the procedure and allows for rapid and accurate assessment of complications and procedural results. The value of intraprocedural TEE for TAVR will likely increase in the future as this procedure is performed in lower surgical risk patients, who also have lower risk for general anesthesia, but a greater expectation of optimal results with lower morbidity and mortality. This imaging compendium from the PARTNER (Placement of Aortic Transcatheter Valves) trials is intended to be a comprehensive compilation of intraprocedural complications imaged by intraprocedural TEE and diagnostic tools to anticipate and/or prevent their occurrence.

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Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Echocardiographic Imaging of Procedural Complications During Balloon-Expandable Transcatheter Aortic Valve Replacement

Hahn

Kodali

Tuzcu

et al. 2015

JACC: Cardiovascular Imaging

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“…Considerably high implantation may result in paravalvular regurgitation, coronary flow obstruction and device embolisation into the thoracic aorta [10, 60]. …”

Section: Post-implantation Imagingmentioning

confidence: 99%

Imaging in Transcatheter Aortic Valve Replacement (TAVR): role of the radiologist

et al. 2014

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BackgroundTranscatheter aortic valve replacement (TAVR) is a novel technique developed in the last decade to treat severe aortic stenosis in patients who are non-surgical candidates because of multiple comorbidities.MethodsSince the technique is performed using a transvascular approach, pre-procedural assessment of the aortic valve apparatus, ascending aorta and vascular access is of paramount importance for both appropriate patient selection and correct device selection. This assessment is performed by a multi-disciplinary team with radiology being an integral and important part.ResultsAmong imaging modalities, there is growing scientific evidence supporting the crucial role of MDCT in the assessment of the aortic valve apparatus, suitability of the iliofemoral or alternative pathway, and determination of appropriate coaxial angles. MDCT also plays an important role in post-procedure imaging in the assessment of valve integrity and position.ConclusionThis review outlines the principal aspects of TAVR, the multidisciplinary approach and utilisation of different imaging modalities, as well as a step-by-step approach to MDCT acquisition protocols, reconstruction techniques, pre-procedure measurements and post-procedure assessment.Teaching Points• TAVR is a new technique to treat severe aortic stenosis in high-risk and nonsurgical candidates.• MDCT assessment of the aortic annulus is important for appropriate patient and device selection.• Multidisciplinary approach is required for patient selection, procedure planning and performance.• MDCT is required for assessment of the aortic root, iliofemoral or alternative vascular pathway.

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“…Unlike SAVR in which the valve is directly sutured to the aortic annulus, in TAVR the valve is ‘anchored’ only by contact and friction forces between the native root and the deployed stent. Because the deployment position is based on angiographic imaging and is performed during heart pacing, a possible suboptimal location can cause longitudinal shift of the prosthesis during the balloon inflation (10), and thus lead to procedural failure. The deployed valve may be susceptible to migration, where the prosthetic valve dislocates toward either the LV cavity (11) or the aorta (12).…”

Section: Introductionmentioning

confidence: 99%

Effect of Balloon‐Expandable Transcatheter Aortic Valve Replacement Positioning: A Patient‐Specific Numerical Model

Bianchi¹,

Marom²,

Ghosh³

et al. 2016

Artificial Organs

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Transcatheter aortic valve replacement (TAVR) has emerged as a life-saving and effective alternative to surgical valve replacement in high-risk, elderly patients with severe calcific aortic stenosis. Despite its early promise, certain limitations and adverse events, such as suboptimal placement and valve migration, have been reported. In the present study, we aim to evaluate the effect of various TAVR deployment locations on the procedural outcome by assessing the risk for valve migration. The deployment of a balloon-expandable Edwards SAPIEN valve was simulated via finite element analysis in a patient-specific calcified aortic root, which was reconstructed from CT scans of a retrospective case of valve migration. The deployment location was parametrized in three configurations and the anchorage was quantitatively assessed based on the contact between the stent and the native valve during the deployment and recoil phases. The proximal deployment led to lower contact area between the native leaflets and the stent which poses higher risk for valve migration. The distal and midway positions resulted in comparable outcomes, with the former providing a slightly better anchorage. The approach presented might be used as a predictive tool for procedural planning in order to prevent prosthesis migration and achieve better clinical outcomes.

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Multicenter Evaluation of Edwards SAPIEN Positioning During Transcatheter Aortic Valve Implantation With Correlates for Device Movement During Final Deployment

Cited by 39 publications

References 18 publications

Echocardiographic Imaging of Procedural Complications During Balloon-Expandable Transcatheter Aortic Valve Replacement

Echocardiographic Imaging of Procedural Complications During Balloon-Expandable Transcatheter Aortic Valve Replacement

Imaging in Transcatheter Aortic Valve Replacement (TAVR): role of the radiologist

Effect of Balloon‐Expandable Transcatheter Aortic Valve Replacement Positioning: A Patient‐Specific Numerical Model

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