Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients

Popma, Jeffrey J.; Deeb, G. Michael; Yakubov, Steven J.; Mumtaz, Mubashir; Gada, Hemal; O’Hair, Daniel; Bajwa, Tanvir; Heiser, John; Merhi, William; Kleiman, Neal S.; Askew, Judah; Sorajja, Paul; Rovin, Joshua D.; Chetcuti, Stanley; Adams, David H.; Teirstein, Paul S.; Zorn, George L.; Forrest, John K.; Tchétché, Didier; Resar, Jon R.; Walton, Antony; Piazza, Nicolò; Ramlawi, Basel; Robinson, N. Bryce; Petrossian, George; Gleason, Thomas G.; Oh, Jae K.; Boulware, Michael J.; Qiao, Hongyan; Mugglin, Andrew S.; Reardon, Michael J.

doi:10.1056/nejmoa1816885

Cited by 2,676 publications

(1,843 citation statements)

References 21 publications

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“…Indeed in a recent study by Arnold et al, 23 using noninvasive epicardial electrocardiographic imaging, it was shown that HBP was more effective at delivering ventricular resynchronization and produced greater acute hemodynamic benefit as compared to biventricular pacing. In the recent context of the Partner III 5 and Evolut low risk trials, 4 which included patients with lower risk, the search for better pacing solutions in this population has therefore become crucial. In this context, direct left bundle branch pacing might be considered a promising pacing option as it has the potential to correct LBBB with higher success rates and lower pacing thresholds as compared to His bundle pacing 24,25 …”

Section: Discussionmentioning

confidence: 99%

“…Transcatheter aortic valve replacement (TAVR) is an effective catheter‐based treatment for severe aortic valve stenosis. Large registries and randomized trials have proved its effectiveness in patients at low, intermediate, or high surgical risks 1–6 . Unfortunately, atrioventricular block (AVB) and new left bundle branch block (new LBBB), resulting from encroachment of the conduction system by the aortic valve prosthesis, are frequent complications that could mitigate the advantage of TAVR.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of His‐bundle pacing in patients with conduction disorders following transcatheter aortic valve replacement

Pooter

Gauthey

Calle

et al. 2020

Cardiovasc electrophysiol

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Background Conduction disorders requiring permanent pacemaker implantation occur frequently after transcatheter aortic valve replacement (TAVR). This multicenter study explored the feasibility and safety of His bundle pacing (HBP) in TAVR patients with a pacemaker indication to correct a TAVR‐induced left bundle branch block (LBBB). Methods Patients qualifying for a permanent pacemaker implant after TAVR were planned for HBP implant. HBP was performed using the Select Secure (3830; Medtronic) pacing lead, delivered through a fixed curve or deflectable sheath (C315HIS or C304; Medtronic). Successful HBP was defined as selective or nonselective HBP, irrespective of LBB recruitment. Successful LBBB correction was defined as selective or nonselective HBP resulting in paced QRS morphology similar to pre‐TAVR QRS and paced QRS duration (QRSd) less than 120 milliseconds with thresholds less than 3.0 V at 1.0‐millisecond pulse width. Results The study enrolled 16 patients requiring a permanent pacemaker after TAVR (age 85 ± 4 years, 31% female, all LBBB; QRSd: 161 ± 14 milliseconds). Capture of the His bundle was achieved in 13 of 16 (81%) patients. HBP with LBBB correction was achieved in 11 of 16 (69%) and QRSd narrowed from 162 ± 14 to 99 ± 13 milliseconds and 134 ± 7 milliseconds during S‐HBP and NS‐HBP, respectively (P = .005). At implantation, mean threshold for LBBB correction was 1.9 ± 1.1 V at 1.0 millisecond. Thresholds remained stable at 11 ± 4 months follow‐up (1.8 ± 0.9 V at 1.0 millisecond, P = .231 for comparison with implant thresholds). During HBP implant, one temporary complete atrioventricular block occurred. Conclusion Permanent HBP is feasible in the majority of patients with TAVR requiring a permanent pacemaker with the potential to correct a TAVR‐induced LBBB with acceptable pacing thresholds.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Feasibility of His‐bundle pacing in patients with conduction disorders following transcatheter aortic valve replacement

Pooter

Gauthey

Calle

et al. 2020

Cardiovasc electrophysiol

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“…Transcatheter aortic valve replacement (TAVR) has evolved as the mainstay of treatment for aortic stenosis (AS). With proven noninferiority or even superiority to surgery among elderly AS patients in different risk categories, [1][2][3][4][5][6][7] TAVR has been increasingly used in younger and lower risk groups. With the anticipated downshifting of patients' age, bicuspid aortic valve (BAV) disease will be an increasingly common condition for TAVR operators, 8 as has already been reflected in the TAVR experience in China, where the mean age of patients undergoing TAVR is roughly 75 years and the incidence of BAV is approximately 50%.…”

Section: Introductionmentioning

confidence: 99%

Reshaping bicuspid aortic valve stenosis with an hourglass‐shaped balloon for transcatheter aortic valve replacement: A pilot study

Zhang

Feng

Liao

et al. 2020

Cathet Cardio Intervent

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Objectives We evaluated the safety and usefulness of preparatory anatomical reshaping with a geometric hourglass‐shaped balloon to optimize transcatheter aortic valve replacement (TAVR) outcomes in bicuspid aortic valve (BAV) stenosis. Background TAVR has been increasingly performed for BAV stenosis; however, technical challenges remain. Procedural results are suboptimal given unfavorable valvular anatomies. Methods Eligible patients with BAV stenosis were enrolled to undergo aortic valve predilatation with the hourglass‐shaped TAV8 balloon before TAVR using the self‐expandable Venus A‐Valve. Procedural details and outcomes were compared to a sequential group of patients with BAV who underwent TAVR with the same device following preparatory dilatation using a cylindrical balloon. Results A total of 22 patients were enrolled in the TAV8 group and 53 were included in the control group. Valve downsizing was less common in the TAV8 group (36.4 vs. 67.9%; p = .012). Stable valve release and optimal implant depth were consistently achieved in the TAV8 group with no requirement for a second valve (0 vs. 17.0%; p = .039) and with higher device success rates (100.0 vs 77.4%; p = .014). Residual aortic regurgitation graded as ≥mild was less common in the TAV8 group (13.6 vs 45.3%; p = .009). Mortality was similar (0 vs. 3.8%; p = 1); no major/disabling stroke or conversion to open‐heart surgery was seen in either group within 30 days. Conclusions Compared with standard cylindrical balloon valvuloplasty, preparatory reshaping with the hourglass‐shaped balloon before self‐expandable TAVR in BAV was associated with significantly better procedural results and may encourage more promising outcomes.

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“…As the management of health, time, and beauty is increasingly important in the current era, it is foreseeable that transcatheter aortic valve replacement (TAVR) will become in the early future the first choice for all patients with severe aortic stenosis. Indeed, TAVR is already superior to surgical aortic valve replacement (SAVR) with regard to several clinical aspects, primarily lower invasiveness (including physical—then psychological—stigmata), disabling stroke, acute kidney injury, hospitalization duration, and faster return to full performances . Some technical aspects, also, that is, patient–prosthesis mismatch, are already better dealt with transcatheter aortic valve implantation (TAVI), and the rate of significant residual paravalvular leak (PVL) has become very low with the new TAVI prostheses with sealing fabric, especially balloon‐expandable ones …”

mentioning

confidence: 99%

“…Currently, the only drawback of TAVR as compared with SAVR is a higher incidence of permanent pacemaker implantation (PPI), notably with self‐expandable valves (SEV) . In this issue of Catheterization and Cardiovascular Interventions , Oleja and colleagues provide important information regarding strategies for reducing the need for PPI after TAVR.…”

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confidence: 99%

Choose to fly higher rather than pacing around

Musumeci

Aranzulla

2020

Cathet Cardio Intervent

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Key Points Pre‐existing right bundle branch block and the depth of the prosthesis in the left ventricle are predictors of permanent pacemaker implantation (PPI) following transcatheter aortic valve replacement. The recapturable capability of the Evolut R system allows higher and more precise valve implantation and this was associated with halved incidence of PPI as compared with the CoreValve. Larger studies are needed to assess the feasibility of systematic very high implantation (depth in the left ventricle outflow tract ≤3 mm) of the Evolut R and the associated rate of PPI.

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Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients

Cited by 2,676 publications

References 21 publications

Feasibility of His‐bundle pacing in patients with conduction disorders following transcatheter aortic valve replacement

Feasibility of His‐bundle pacing in patients with conduction disorders following transcatheter aortic valve replacement

Reshaping bicuspid aortic valve stenosis with an hourglass‐shaped balloon for transcatheter aortic valve replacement: A pilot study

Choose to fly higher rather than pacing around

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