Role of Imaging in Transcatheter Aortic Valve Replacement

Storz, Corinna; Geisler, Tobias; Notohamiprodjo, Mike; Nikolaou, Konstantin; Bamberg, Fabian

doi:10.1007/s11936-016-0482-6

Cited by 11 publications

(4 citation statements)

References 52 publications

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“…Further investigation is needed to evaluate the relative strengths and limitations of ferumoxytol MRA compared to emerging non-contrast approaches to pre-procedural TAVR imaging. [12–17] …”

Section: Resultsmentioning

confidence: 99%

Ferumoxytol MRA for transcatheter aortic valve replacement planning with renal insufficiency

Kallianos

Henry

Yeghiazarians

et al. 2017

International Journal of Cardiology

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Background Computed tomography angiography (CTA) is the test of choice for pre-procedure imaging of transcatheter aortic valve replacement (TAVR) candidates. The iodinated contrast required, however, increases the risk of renal dysfunction in patients with pre-existing renal failure. Ferumoxytol is a magnetic resonance imaging (MRI) contrast agent that can be used with renal failure. Its long vascular resonance time allows gated MRA sequences that approach CTA in image quality. We present respiratory and cardiac gated MRA enabled by ferumoxytol that can be post-processed in an analogous fashion to CTA. Methods Seven patients with renal failure presenting for TAVR were imaged with respiratory and cardiac gated MRA at 3T using ferumoxtyol for contrast. Aortic annulus, root and peripheral access dimensions were calculated in a fashion identical to that used for CTA. Of these, 6 patients underwent a TAVR procedure and 5 had intraoperative valve assessment with transesophageal echocardiograph (TEE) using standard clinical protocols that employed both two- and three-dimensional techniques. Results Good correlation between MRA aortic annulus measurements and those from TEE were shown in 5 patients with mean annulus area of 392.4 mm2 (290–470 range) versus 374.1 mm2 (285–440 range), with a pairwise correlation coefficient of 0.92, p=0.029. All patients received Sapien valve implants (one 20 mm, three 23 mm, and two 26 mm valves). Access decisions were guided by MRA with no complications. Annulus sizing resulted in no greater than trace/mild aortic regurgitation in all patients. Conclusions Ferumoxytol MRA is a safe alternative to CTA in patients with renal failure for pre-TAVR analysis of the aortic root and peripheral access.

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Section: Resultsmentioning

confidence: 99%

Ferumoxytol MRA for transcatheter aortic valve replacement planning with renal insufficiency

Kallianos

Henry

Yeghiazarians

et al. 2017

International Journal of Cardiology

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“…Thorough planning was crucial to achieving these results. Complications were also minimised by analysing CT measurements to choose the appropriate TAVR system for the patients' anatomical features [26]. The standardization of TAVR procedures (well-trained staff, fixed team members) may have been responsible for our high procedural success with a low complication rate.…”

Section: Discussionmentioning

confidence: 99%

Learning Curve for Starting a Successful Single-Centre TAVR Programme with Multiple Devices: Early and Mid-Term Follow-Up

Magyari,

Kittka,

Goják

et al. 2024

JCM

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We report 30-day, 1-year, and 3-year outcomes for a new TAVR programme that used five different transcatheter heart valve (THV) systems. Methods: From 2014 to 2020, 122 consecutive patients with severe aortic stenosis (AS) received TAVR based on the Heart Team decision. Outcomes were analysed for the whole study population and in addition the first 63 patients (Cohort A, 2014 to 2019) were compared to the last 59 patients (Cohort B, 2019 to 2020). Outcomes included VARC-2 definitions and device performance assessed via transthoracic echocardiography by independent high-volume investigators. Results: The mean patient age was 77.9 ± 6.1 years old, and 48 (39.3%) were male. The mean logistic Euroscore II was 4.2 ± 4.5, and the mean STS score was 6.9 ± 4.68. The systems used were as follows: Medtronic Corevalve Evolute R/PRO (82 patients—67.2%); Abbott Portico (13—10.6%); Boston Scientific Lotus (10—8.2%); Meril Myval (11—9%); and Boston Scientific Neo Accurate (6—5%). Access was transfemoral (95.9% of patients); surgical cut down (18% vs. percutaneous 77.8%); subclavian (n = 2); trans-axillary (n = 2); and direct aorta (n = 1). VARC-2 outcomes were as follows: device success rate 97.5%; stroke rate 1.6%; major vascular complication 3.3%; permanent pacemaker implantation 12.4%. At discharge, the incidences of grade I and II aortic regurgitation were 39.95 and 55.5%, respectively. At one year, all-cause mortality was 7.4% without admissions for valve-related dysfunction. The 3-year all-cause mortality and all-stroke rates were 22.9% and 4.1%, respectively. Between the 1-year and 3-year follow-ups, valve-related dysfunction was detected in three patients; one had THV system endocarditis that led to death. There was a remarkable but statistically non-significant decrease in mortality from Cohort A to Cohort B [four (6.3%) vs. one patient (1.7%), p = 0.195] and major vascular complications occurred at a significantly higher rate in the Cohort B [zero (0%) vs. four (6.8% patient, p = 0.036)]. Overall, we found that using multiple devices was safe and allowed for a learning team to achieve a high device success rate from the beginning (97.5%). Conclusions: TAVR with different THV systems showed acceptable early and mid-term outcomes for survival, technical success, and valve-related adverse events in high-risk patients with significant AS, even in the learning curve phase.

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“…However, in the setting of inadequate peripheral vasculature, vascular complications can be catastrophic, and alternative approaches including subclavian, transaortic, transapical, and transcarotid access are utilized (27)(28)(29)(30)(31). Peripheral CTA is used to determine the adequacy of the peripheral vasculature, with assessment of femoral and iliac artery dimensions, tortuosity, and degree of calcification …”

Section: A B C Dmentioning

confidence: 99%