Percutaneous and Minimally Invasive Valve Procedures

Rosengart, Todd K.; Feldman, Ted; Borger, Michael A.; Vassiliades, Thomas A.; Gillinov, A. Marc; Hoercher, Katherine J.; Vahanian, Alec; Bonow, Robert O.; O’Neill, William

doi:10.1161/circulationaha.107.188525

Cited by 175 publications

(40 citation statements)

References 91 publications

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“…Nesse grupo, a abordagem por cateter tem elevada chance de sucesso e pode oferecer mortalidade inferior àquela esperada com o tratamento cirúrgico. 7,[10][11][12]15 O risco cirúrgico pode ser estimado por diversos escores. Os mais empregados são o EuroSCORE 16 e o STS 17 , validados em centros europeus e americanos, respectivamente.…”

Section: Seleção De Pacientesunclassified

Racional e desenho do registro brasileiro de implante de bioprótese aórtica por cateter

Júnior¹,

Siqueira²,

Sarmento‐Leite³

et al. 2011

Rev. Bras. Cardiol. Invasiva

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RESUMOIntrodução: A substituição cirúrgica da valva aórtica é o tratamento de eleição para pacientes com estenose aórtica acentuada. Entretanto, o risco cirúrgico aumenta expressivamente com o avançar da idade e com a associação de comorbidades. Recentemente, iniciou-se a experiência com o implante por cateter de biopróteses aórticas no Brasil. Justifica-se, portanto, a criação de um registro nacional para conhecimento dos resultados desse tipo de procedimento em nosso meio. Descrevemos o racional e o desenho do Registro Brasileiro de Implante de Bioprótese Aórtica por Cateter. Métodos: Trata-se de um registro multicêntrico, prospectivo, que incluirá 200 pacientes portadores de estenose valvar aórtica sintomática de alto risco cirúrgico submetidos a implante por cateter de bioprótese valvular aórtica em centros brasileiros. O desfecho primário do estudo é a mortalidade por qualquer causa aos 30 dias, 12 meses e 24 meses. Os desfechos secundários avaliados incluem, entre outros: 1) sucesso técnico do implante da bioprótese; 2) mortalidade cardiovascular aos 30 dias, 12 meses e 24 meses; 3) desfecho combinado de segurança aos 30 dias; e 4) desfecho combinado de eficácia aos 12 meses e 24 meses. Conclusões: A análise dos resultados desse registro ABSTRACT Rationale and Design of the Brazilian TranscatheterAortic Valve Implantation Registry

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Section: Seleção De Pacientesunclassified

Racional e desenho do registro brasileiro de implante de bioprótese aórtica por cateter

Júnior¹,

Siqueira²,

Sarmento‐Leite³

et al. 2011

Rev. Bras. Cardiol. Invasiva

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“…At this point in time, it is important for professional societies to critically review the available TAVI techniques and their results, as well as propose recommendations for their use, development in clinical practice, and further research. 9,10 On the 18 -19th of November 2007, a committee of experts, including EACTS and ESC representatives, met. The consensus reached is summarized in the current document, which was approved first by the committee members and subsequently by the board of both professional societies involved.…”

Section: Preamblementioning

confidence: 99%

Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Vahanian¹,

Alfieri²,

Al‐Attar³

et al. 2008

EuroIntervention

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183

104

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AimsTo critically review the available transcatheter aortic valve implantation techniques and their results, as well as propose recommendations for their use and development. Methods and resultsA committee of experts including European Association of Cardio-Thoracic Surgery and European Society of Cardiology representatives met to reach a consensus based on the analysis of the available data obtained with transcatheter aortic valve implantation and their own experience. The evidence suggests that this technique is feasible and provides haemodynamic and clinical improvement for up to 2 years in patients with severe symptomatic aortic stenosis at high risk or with contraindications for surgery. Questions remain mainly concerning safety and long-term durability, which have to be assessed. Surgeons and cardiologists working as a team should select candidates, perform the procedure, and assess the results. Today, the use of this technique should be restricted to high-risk patients or those with contraindications for surgery. However, this may be extended to lower risk patients if the initial promise holds to be true after careful evaluation.

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“…Although these procedures can be performed in cardiac catheterization suites, a recent expert panel suggested that they are best performed in a hybrid operating theatre with fixed fluoroscopic imaging. 9 A hybrid operating theatre ensures sterility and the ability to rapidly convert to a conventional surgical approach during unforeseen complications, while maintaining the fluoroscopic capabilities of a catheterization laboratory.…”

Section: Techniques Used In Valve Implantationmentioning

confidence: 99%

Transcatheter heart-valve replacement: update

Chu¹,

Borger²,

Mohr³

et al. 2010

Canadian Medical Association Journal

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Key points• Transcatheter valve replacement offers patients less invasive heart-valve therapy, with lower morbidity and mortality, and quicker recovery. A dedicated team is essential for the success of this program.• The procedure can be performed for the aortic and pulmonic valves.• Minimally invasive techniques enable valve implantation, as well as repeat valve replacement, without the need for cardiopulmonary bypass or sternotomy.Previously published at www.cmaj.caReview replacement is considered high risk. 6 Certain conditions, such as a highly calcified (i.e., "porcelain") aorta, mediastinal irradiation, liver cirrhosis or a need for reoperation with patent bypass grafts, may lower the threshold of risk for transcatheter valves, because of the well-recognized increased risks associated with these conditions in conventional surgery.Transcatheter therapy is usually not offered to patients with asymptomatic aortic stenosis or patients with a life expectancy of less than one year. Although most patients will have a suitably sized aortic annulus (as assessed by echocardiography), patients with a large aortic annulus are not currently candidates for transcatheter aortic valve implantation because of a limited selection of prosthetic sizes. Our current indications and contraindications for transcatheter aortic valve implantation are detailed further in Box 1. An ongoing randomized clinical trial in Europe and North America is expected to further delineate the optimal patient groups for transfemoral and transapical aortic valve therapy. 7 Transcatheter pulmonic valve replacement is indicated in patients with congenital, symptomatic pulmonary valve stenosis or insufficiency who have previously undergone right ventricular outflow tract reconstruction, usually for tetralogy of Fallot. The most common indication is homograft stenosis with calcification. Most patients are young (in contrast to transcatheter aortic valve patients), but have undergone multiple previous operations and are therefore deemed to be at increased risk with conventional surgery. Preoperative workupA history and physical examination, as well as routine preoperative blood work, 12-lead electrocardiography, and chest radiography, are performed initially to assess the patient's candidacy for transcatheter valve therapy. Transthoracic echocardiography defines the character and severity of the aortic stenosis. However, transesophageal echocardiography is often necessary to better delineate the calcification pattern and accurately measure the aortic annulus and root diameters. Currently, limitation in the sizes of prostheses require patients to have a specific aortic annulus diameter for proper stent deployment and seating (Box 1). To decrease the risk of paravalvular leak, the implanted prosthesis is slightly oversized. Because of the advanced age of the patients, coronary angiography is performed. Computed tomography is also recommended for all patients to define the distances between the aortic annulus and the coronary ostia, to minimize risks of cor...

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Percutaneous and Minimally Invasive Valve Procedures

Cited by 175 publications

References 91 publications

Racional e desenho do registro brasileiro de implante de bioprótese aórtica por cateter

Racional e desenho do registro brasileiro de implante de bioprótese aórtica por cateter

Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Transcatheter heart-valve replacement: update

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