TAVR in 2023: Who Should Not Get It?

Bhogal, Sukhdeep; Rogers, Toby; Aladin, Amer I.; Ben‐Dor, Itsik; Cohen, Jeffrey Е.; Shults, Christian; Wermers, Jason P.; Weissman, Gaby; Satler, Lowell F.; Reardon, Michael J.; Yakubov, Steven J.; Waksman, Ron

doi:10.1016/j.amjcard.2023.01.040

Cited by 7 publications

(3 citation statements)

References 111 publications

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“…Since the first transcatheter delivery of an aortic valve prosthesis by Cribier et al in 2002 [ 3 ], transcatheter aortic valve replacement (TAVR) was introduced as a minimally invasive alternative to surgical aortic valve replacement (SAVR) for patients with severe AS who were deemed to be at high or prohibitive surgical risk [ 4 ]. Although there are emerging issues such as the durability of transcatheter heart valves and long-term TAVR outcomes, indications for TAVR continue to expand to younger, low-risk patients with longer life expectancies [ 5 , 6 ]. As the utilization of TAVR expands with the annual TAVR volume in the United States, surpassing all forms of SAVR [ 7 ], it is imperative to understand the impact of diverse patient characteristics on TAVR outcomes.…”

Section: Introductionmentioning

confidence: 99%

Obesity and Transcatheter Aortic Valve Replacement

Seo,

Kharawala,

Borkowski

et al. 2024

JCDD

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Amidst an aging population and escalating obesity prevalence, elucidating the impact of obesity on transcatheter aortic valve replacement (TAVR) outcomes becomes paramount. The so-called “obesity paradox”—a term denoting the counterintuitive association of obesity, typically a risk factor for cardiovascular diseases, with improved survival outcomes in TAVR patients relative to their leaner or normal-weight counterparts—merits rigorous examination. This review comprehensively investigates the complex relationship between obesity and the clinical outcomes associated with TAVR, with a specific focus on mortality and periprocedural complications. This study aims to deepen our understanding of obesity’s role in TAVR and the underlying mechanisms of the obesity paradox, thereby optimizing management strategies for this patient demographic, tailored to their unique physiological and metabolic profiles.

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Section: Introductionmentioning

confidence: 99%

Obesity and Transcatheter Aortic Valve Replacement

Seo,

Kharawala,

Borkowski

et al. 2024

JCDD

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show abstract

“…Furthermore, the indication for TAVI has expanded toward a larger patient population with lower calculated perioperative risk 1,2 but also to patients with a more complex patient profile. 3 Transfemoral access via the right or left common femoral artery is the predominant access route today, 4,5 despite a high prevalence of peripheral artery disease in TAVI patients. In those patients with inaccessible femoral arteries, alternative access routes have been described.…”

Section: Introductionmentioning

confidence: 99%

The 10 Commandments for Transaxillary TAVI

Sündermann

Dreger

Hinkov

et al. 2023

Innovations�(Phila)

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“…Existing research has expanded TAVR applications in AR, resulting in promising outcomes (4). However, AR patients often lack valvular calcification, reducing anchoring strength and increasing the risk of paravalvular leakage and device dislodgment compared to AS patients (5,6).…”

Section: Introductionmentioning

confidence: 99%

The myth of aortic valve annulus changes in aortic valve disease

Peng,

Hu,

Shu

et al. 2023

Front. Cardiovasc. Med.

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BackgroundThe characteristics of aortic annulus changes in aortic regurgitation (AR) patients are poorly understood, and predictive factors among aortic valve disease are yet to be established.ObjectiveThis study seeks to elucidate the pattern of annular size fluctuations across different cardiac phases in AR patients and to identify predictors for annular enlargement during either systole or diastole in aortic valve diseases.MethodsA retrospective analysis was conducted on 55 patients with severe aortic valve diseases, including 26 patients with aortic stenosis (AS) and 29 with AR, to discern the two groups' contrasting and analogous patterns of annular changes. The patient sample was expanded to 107 to investigate the factors influencing the size of the annulus during different cardiac phases. Based on our findings, patients were then divided into two groups: those with an annulus that is larger during systole (83 patients) and those where the annulus is larger during diastole (24 patients).ResultsTypically, AR patients exhibit a dynamic annulus, with both perimeter and area being largest during mid-systole. These dimensions diminish progressively and then increase again in early diastole, a pattern consistent with observations in AS patients. Among 107 patients, 21% had diastolic enlargement. Systolic measurements would lead to prosthesis undersizing in 17% of these. Male gender and lower systolic annulus minimum relative to body surface area (AnMin index) were predictors of diastolic enlargement, with ROC curve areas of 0.70 and 0.87 for AR and AS, respectively.ConclusionsSystolic measurements are recommended for AR patients. Gender and the AnMin index are significant predictors, particularly potent in AS patients.

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TAVR in 2023: Who Should Not Get It?

Cited by 7 publications

References 111 publications

Obesity and Transcatheter Aortic Valve Replacement

Obesity and Transcatheter Aortic Valve Replacement

The 10 Commandments for Transaxillary TAVI

The myth of aortic valve annulus changes in aortic valve disease

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