STS-ACC TVT Registry of Transcatheter Aortic Valve Replacement

Carroll, John D.; Mack, Michael J.; Vemulapalli, Sreekanth; Herrmann, Howard C.; Gleason, Thomas G.; Hanzel, George; Deeb, G. Michael; Thourani, Vinod H.; Cohen, David J.; Desai, Nimesh D.; Kirtane, Ajay J.; Fitzgerald, Susan; Michaels, Joan; Krohn, Carole; Masoudi, Frederick A.; Brindis, Ralph G.; Bavaria, Joseph E.

doi:10.1016/j.jacc.2020.09.595

Cited by 548 publications

(298 citation statements)

References 14 publications

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“…Transcatheter aortic valve implantation (TAVI) in patients suffering from aortic stenosis has achieved excellent clinical results in a wide range of patients since its introduction in 2002; originally performed on inoperable patients, it has been progressively implemented in patients at lower risk over the last years, so that the latest American College of Cardiology/American Heart Association guidelines recently surpassed the surgical risk-based decision making for treatment selection in patients with aortic stenosis (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Clinical and Technical Challenges of Prosthesis–Patient Mismatch After Transcatheter Aortic Valve Implantation

Fazzari¹,

Cannata²,

Sánchez³

et al. 2021

Front. Cardiovasc. Med.

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Prosthesis–patient mismatch (PPM) is present when the effective area of a prosthetic valve inserted into a patient is inferior to that of a normal human valve; the hemodynamic consequence of a valve too small compared with the size of the patient's body is the generation of higher than expected transprosthetic gradients. Despite evidence of increased risk of short- and long-term mortality and of structural valve degeneration in patients with PPM after surgical aortic valve replacement, its clinical impact in patients subject to transcatheter aortic valve implantation (TAVI) is yet unclear. We aim to review and update on the definition and incidence of PPM after TAVI, and its prognostic implications in the overall population and in higher-risk subgroups, such as small aortic annuli or valve-in-valve procedures. Last, we will focus on the armamentarium available in order to reduce risk of PPM when planning a TAVI procedure.

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Section: Introductionmentioning

confidence: 99%

Clinical and Technical Challenges of Prosthesis–Patient Mismatch After Transcatheter Aortic Valve Implantation

Fazzari¹,

Cannata²,

Sánchez³

et al. 2021

Front. Cardiovasc. Med.

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“…In the last few years TAVI indication moved to the intermediate [5] , [6] and low-risk population [7] , [8] , [9] , [10] . However, since AS in its most common etiology is a degenerative senile, the majority of patients undergoing TAVI in the recent past was represented by elderly (mostly over 75 years old) both in clinical trials and in real world scenarios [11] , [12] , [13] , [14] .…”

Section: Introductionmentioning

confidence: 99%

Patients younger than 70 undergoing transcatheter aortic valve implantation: Procedural outcomes and mid-term survival

Ancona

Toscano

Moroni

et al. 2021

IJC Heart & Vasculature

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Introduction Based on recent data, the indication for transcatheter aortic valve implantation (TAVI) is expanding to individuals at lower surgical risk, who are generally younger than subjects historically treated for severe aortic stenosis. Indeed, younger patients have traditionally been under-represented in current TAVI literature. The aim of the present study is to report about clinical features, procedural outcomes and mid-term outcomes of patients younger than 70 who underwent TAVI in a single high-volume center. Materials and methods Consecutive patients younger than 70 years of age who underwent TAVI for severe, symptomatic aortic stenosis between 2007 and 2019 at a single, tertiary referral center have been included in this retrospective study. Procedural and mid-term outcomes were analyzed, comparing 1st generation with 2nd generation devices. Results Between 2007 and 2019, 1740 TAVI procedures were performed in our center. Among these, one hundred twenty-nine (7.4%) patients were younger than 70 years at the time of the intervention and were included in the present analysis. Fifty-eight patients (45%) were implanted with a 1st generation prosthesis while seventy-one patients (55%) were implanted with a 2nd generation device. Reasons which lead to a transcatheter approach in this population were: previous CABG (27.9%); porcelain aorta (24%); severe left ventricular systolic dysfunction (21.7%); prior chest radiation (19.4%); severe lung disease (8.5%); hemodynamic instability (7.0%); advanced liver disease (4.6%) and active cancer (3.9%). Overall device success rate was 89%, with no differences among 1st and 2nd generation devices. Threeyears all-cause mortality was 34%, with no difference among the two groups. Low incidence of aortic-valve re-intervention was observed at mid-term follow-up (late valve re-intervention = 2.3%). Conclusions TAVI in young patient with appropriate indication for intervention is a safe procedure, associated with low rate of in hospital mortality and low rate of severe complications both with 1st and with 2nd generation devices. When considering long term durability, more data are needed; in our case series long-term follow up shows a good survival and also an extremely low rate of valve re-intervention.

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“…In fact, annual TAVR volume, for the first time in 2019, exceeded the total number of surgical AVR procedures. [1][2][3][4] At least in part to make the surgical approach more palatable to patient preference compared with TAVR, access through smaller, less invasive hemisternotomy or right thoracotomy incisions has increased, with excellent outcomes. 5 Sutureless or rapid deployment valves have been developed ostensibly to simplify the process of surgical AVR and further facilitate more frequent implantation via these less invasive approaches.…”

mentioning

confidence: 99%

Commentary: How long it takes is not as important as how long it lasts

Paone

2022

The Journal of Thoracic and Cardiovascular Surgery

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Transcatheter aortic valve replacement (TAVR) has been approved for patients with severe aortic stenosis at all levels of risk, and is now performed in more than 700 centers. In fact, annual TAVR volume, for the first time in 2019, exceeded the total number of surgical AVR procedures. [1][2][3][4] At least in part to make the surgical approach more palatable to patient preference compared with TAVR, access through smaller, less invasive hemisternotomy or right thoracotomy incisions has increased, with excellent outcomes. 5 Sutureless or rapid deployment valves have been developed ostensibly to simplify the process of surgical AVR and further facilitate more frequent implantation via these less invasive approaches. 6,7 Unlike with TAVR, the native valve leaflets are removed and the annulus is decalcified, presumably allowing more precise positioning and annular coaptation under vision. Cardiopulmonary bypass and crossclamp times have been approximately 30 minutes shorter than generally seen when implanting stented devices, although whether this difference, for AVR alone or with concomitant procedures, is clinically significant is uncertain. Early hemodynamic performance seems good, especially in smaller valve sizes, perhaps obviating need for annular enlargement procedures in some. 8 Fischlein and colleagues 9 report midterm outcomes at mean follow-up of 3.8 years from 658 patients enrolled to receive the Perceval sutureless valve (LivaNova, PLC, London, United Kingdom) in the multicenter European Cavalier Trial between 2010 and 2013. With mean age of

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STS-ACC TVT Registry of Transcatheter Aortic Valve Replacement

Cited by 548 publications

References 14 publications

Clinical and Technical Challenges of Prosthesis–Patient Mismatch After Transcatheter Aortic Valve Implantation

Clinical and Technical Challenges of Prosthesis–Patient Mismatch After Transcatheter Aortic Valve Implantation

Patients younger than 70 undergoing transcatheter aortic valve implantation: Procedural outcomes and mid-term survival

Commentary: How long it takes is not as important as how long it lasts

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