Paravalvular Leak After Transcatheter Aortic Valve Replacement

Généreux, Philippe; Head, Stuart J.; Hahn, Rebecca T.; Daneault, Benoit; Kodali, Susheel; Williams, Mathew; Mieghem, Nicolás M. Van; Alu, Maria; Serruys, Patrick W.; Kappetein, Arie Pieter; Leon, Martin B.

doi:10.1016/j.jacc.2012.08.1039

Cited by 380 publications

(93 citation statements)

References 87 publications

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“…PAR is frequently observed after TAVI 20 and is associated with worse survival in patients with moderate to severe PAR. 21 Whether mild PAR is an independent mortality predictor, as suggested by a previous study, 22 is a matter of controversy.…”

Section: Paravalvular Regurgitationmentioning

confidence: 99%

Procedural Results and Clinical Outcomes of Transcatheter Aortic Valve Implantation in Switzerland

Binder¹,

Stortecky²,

Heg³

et al. 2015

Circ: Cardiovascular Interventions

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Section: Paravalvular Regurgitationmentioning

confidence: 99%

Procedural Results and Clinical Outcomes of Transcatheter Aortic Valve Implantation in Switzerland

Binder¹,

Stortecky²,

Heg³

et al. 2015

Circ: Cardiovascular Interventions

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“…7 Wiegerinck et al 5 provide useful insight into this cohort of patients. They demonstrate that patients with aortic regurgitation post TAVR do not benefit from the favorable improvement in coronary flow reserve realized in the TAVR patients who are not complicated by postprocedural aortic regurgitation.…”

Section: Aortic Regurgitation Post Tavrmentioning

confidence: 99%

Demystifying Complex Coronary Hemodynamics in Patients Undergoing Transcatheter Aortic Valve Replacement

Sen

Davies

2015

Circ: Cardiovascular Interventions

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T ranscatheter aortic valve replacement (TAVR) has revolutionized the treatment of patients with severe aortic stenosis who are at high risk for traditional surgical intervention.1,2 As the technology matures and experience grows, the applicability of TAVR to lower risk populations is likely and is already being explored. 3 These patients often present with chest pain or exertional dyspnoea in the context of varying degrees of coronary artery disease. An understanding of how the aortic valve affects coronary hemodynamics is becoming increasingly clinically relevant in determining how to manage this coexisting coronary disease. See Article by Wiegerinck et alCreating a model of aortic stenosis is challenging. The pressure loading of the ventricle and coronary arteries varies according to the location of the stenosis. Stenosis at the level of the aortic valve is anatomically below coronary artery inflow; this results in increased afterload of the left ventricle but reduces coronary perfusion pressure. Relief of the stenosis therefore results in an acute reduction in left ventricular enddiastolic pressure, and in most cases, it results in an increase in coronary perfusion. This differs from the traditional systemic hypertension model often generated experimentally in animal models in which a restrictive band is placed around the aorta. 4 In such cases, the stenosis is positioned in the aorta distal to coronary artery inflow; this results in an increase in both left ventricular end-diastolic pressure and coronary perfusion. After removal of the aortic band, both left ventricular end-diastolic pressure and coronary perfusion fall; as a result, the traditional banding model cannot be used to make inferences on the acute effect of relieving aortic stenosis on coronary hemodynamics.The development of TAVR therefore provides a unique model to delineate the coronary hemodynamics of patients with aortic stenosis. In addition to being a model of true aortic stenosis, it permits easy access to the coronaries before and after the procedure for rapid hemodynamic assessment. Previously, TAVR had been performed under general anesthesia, and whilst recently, conscious sedation is increasingly used. Conscious sedation avoids the potentially confounding effect of a general anesthetic, which can manipulate myocardial preload and after-load, and therefore, it may provide a better model to study the effect of severe aortic stenosis on coronary artery hemodynamics.In this issue of Circulation: Cardiovascular Interventions, Wiegerinck et al 5 use the TAVR model to determine how relief of aortic stenosis alters coronary hemodynamics. In a study of 27 patents with aortic stenosis and 28 control patients without aortic stenosis, detailed assessment of coronary flow and microvascular resistance was performed at rest and after intracoronary adenosine administration pre and post TAVR.They demonstrate that in the cohort of patients with no aortic regurgitation post TAVR, hyperemic flow, coronary flow reserve, and hyperemic microvascular resist...

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“…Clinical performance of established TAVP increases constantly, leading to an extension of the therapy from high risk to intermediate risk patients [4]. Nevertheless, in particular regurgitation of TAVP remains the major threatening complication [5] and is associated with dramatically increased 1-year mortality [6].…”

Section: Introductionmentioning

confidence: 99%

Impact of aortic root geometry on hydrody-namic performance of transcatheter aortic valve prostheses

Kaule

Pfensig

Ott

et al. 2017

Current Directions in Biomedical Engineering

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Assessment of hydrodynamic performance of transcatheter aortic valve prostheses (TAVP) in vitro is essentially in the fields of development and approval of novel implants. For the prediction of clinical performance, in vitro testing of TAVP allows for benchmarking of different devices, likewise. In addition to the implant itself, also the testing environment has a crucial influence on leaflet dynamics and quantitative test results like effective orifice area (EOA) or aortic regurgitation.Therefore, within the current study we developed simplified physiological and pathophysiological vessel models of the aortic root as a tool for in vitro hydrodynamic testing of TAVP in idealized and worst case conditions. We used 3D printing and silicone cast molding for manufacturing of aortic root models with variable degree of stenosis. Design of aortic roots with normal, mild and severe stenosis was developed according to Reul et al. For manufacturing of tripartite casting molds, a 3D printer was used. Both outer mold parts and the mold core were manufactured from polylactide filament and water soluble polyvinylalcohol filament, respectively. In vitro hydrodynamic performance testing of an exemplary commercially available TAVP implanted in different aortic root models was conducted according to DIN EN ISO 5840-3:2013, using a pulse duplicator system.Manufactured aortic root models were highly transparent, dimensionally stable and therefore suitable for hydrodynamic testing of TAVP. Both, EOA and regurgitant fraction increased with increasing degree of stenosis from 1.6 ± 0.1 cm² to 1.8 ± 0.1 cm² and 8.6 ± 6.5% to 20.2 ± 4.2% (n = 30 cycles), respectively.We successfully developed a testing environment enabling sophisticated evaluation of hydrodynamic performance of TAVR in pathophysiological worst case conditions.

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Paravalvular Leak After Transcatheter Aortic Valve Replacement

Cited by 380 publications

References 87 publications

Procedural Results and Clinical Outcomes of Transcatheter Aortic Valve Implantation in Switzerland

Procedural Results and Clinical Outcomes of Transcatheter Aortic Valve Implantation in Switzerland

Demystifying Complex Coronary Hemodynamics in Patients Undergoing Transcatheter Aortic Valve Replacement

Impact of aortic root geometry on hydrody-namic performance of transcatheter aortic valve prostheses

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