Trends in Isolated Surgical Aortic Valve Replacement According to Hospital-Based Transcatheter Aortic Valve Replacement Volumes

Kundi, Harun; Strom, Jordan B.; Valsdottir, Linda R.; Elmariah, Sammy; Popma, Jeffrey J.; Shen, Changyu; Yeh, Robert W.

doi:10.1016/j.jcin.2018.07.002

Cited by 67 publications

(52 citation statements)

References 18 publications

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“…Though the surge of TAVR has led to a reduction in isolated SAVR volume, SAVR is still an option for low-risk patients. 1,5,6,12 It is the low risk/younger patients that are more likely to need a valve reintervention during their lifetime. Hence, shared decision making between the patient and heart team is essential in patients with high-risk anatomy to discuss all options for lifetime management.…”

Section: Discussionmentioning

confidence: 99%

Preoperative multidetector computed tomography for isolated surgical aortic valve replacement: Planning for future transcatheter options

et al. 2020

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Background: Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has become a valuable option in patients with bioprosthetic failure. However, potential issues with ViV TAVR may occur in patients with high-risk anatomy for coronary obstruction and patients with baseline smaller bioprosthetic valves at risk for patient prosthesis mismatch. The purpose of this study was, therefore, to use preoperative electrocardiography-gated, multidetector computed tomography (MDCT) in patients undergoing isolated surgical aortic valve replacement (SAVR) to (1) identify which would be high risk for coronary occlusion with ViV TAVR, and (2) predict intraoperative SAVR sizing. Methods: Among 223 patients from our institutions' database that underwent SAVR for aortic insufficiency (AI) or aortic stenosis (AS) between January 2012 and January 2020, 48 patients had MDCT imaging before surgery (AI; n = 31, AS; n = 17). Of all patients, 67% (n = 32) were bicuspid morphology. Results: With the use of virtual valve implantation, all patients with AI and bicuspid AS had feasible anatomy for ViV TAVR, while 38% of patients with tricuspid AS were high risk for coronary obstruction. There was a strong correlation between actual valve size implanted and preoperative MDCT measurements using annulus average diameter, area, and/or perimeter. Conclusion: Preoperative MDCT in patients undergoing SAVR is a useful tool for lifetime management, particularly in patients with tricuspid AS. Decisions for surgical management may change based on MDCT's ability to predict intraoperative SAVR size and determine which patients may be high-risk candidates for future ViV TAVR due to coronary artery obstruction.

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Section: Discussionmentioning

confidence: 99%

Preoperative multidetector computed tomography for isolated surgical aortic valve replacement: Planning for future transcatheter options

et al. 2020

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“…Though the surge of TAVR has led to a reduction in isolated SAVR volume, SAVR is still an option for low-risk patients. (1,9) It is the low risk/younger patients that are more likely to need a valve re-intervention during their lifetime. Hence, shared decision making between the patient and heart team is essential in patients with high risk anatomy to discuss all options for lifetime management.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Multi-Detector Computed Tomography for Isolated Surgical Aortic Valve Replacement; Planning for Future Transcatheter Options

Basman

Seetharam

Johnson³

et al. 2020

Preprint

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Background: Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has become a valuable option in patients with bioprosthetic failure. However, potential issues with ViV TAVR may occur in patients with high risk anatomy for coronary obstruction and patients with baseline smaller bioprosthetic valves at risk for patient prosthesis mismatch. The purpose of this study was therefore to use preoperative electrocardiography (ECG)-gated, multidetector computed tomography (MDCT) in patients undergoing isolated surgical aortic valve replacement (SAVR) to 1) identify which would be high risk for coronary occlusion with ViV TAVR, and 2) predict intraoperative SAVR sizing. Methods: Among 223 patients from our institutions' database that underwent SAVR for aortic insufficiency (AI) or aortic stenosis (AS) between January 2012 and January 2020, 48 patients had MDCT imaging prior to surgery (AI; n=31, AS; n=17). Of all patients, 67% (n=32) were bicuspid morphology. Results: With the use of virtual valve implantation, all patients with AI and bicuspid AS had feasible anatomy for ViV TAVR, while 38% of patients with tricuspid AS were high risk for coronary obstruction. There was a strong correlation between actual valve size implanted and preoperative MDCT measurements using annulus average diameter, area and/or perimeter. Conclusion: Preoperative MDCT in patients undergoing SAVR is a useful tool for lifetime management, particularly in patients with tricuspid AS. Decisions for surgical management may change based on MDCT's ability to predict intraoperative SAVR size and determine which patients may be high risk candidates for future ViV TAVR due to coronary artery obstruction.

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“…Transcatheter aortic valve replacement (TAVR) is increasingly considered the standard of care in patients with symptomatic aortic stenosis across the spectrum of surgical risk provided there has been an evaluation by the Heart Team and consideration of anatomic and comorbid conditions 1‐5 . In light of patient preference for TAVR, as well as several randomized‐controlled trials showing similar short and midterm outcomes across spectrums of risk, TAVR has now eclipsed surgical aortic valve replacement (SAVR) worldwide as the predominant treatment for severe aortic stenosis 6,7 …”

Section: Introductionmentioning

confidence: 99%

Bioprosthetic valve oversizing is associated with increased risk of valve thrombosis following TAVR

Simpson

Tuohy

Rajotte

et al. 2020

Cathet Cardio Intervent

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Background Hypoattenuating leaflet thickening (HALT), the radiographic manifestation of transcatheter heart valve thrombosis, is commonly identified following transcatheter aortic valve replacement (TAVR) and associated with increased risk of stroke and structural valve deterioration. While anticoagulation effectively resolves HALT, routine use remains controversial. We aimed to identify hemodynamic, anatomic, and comorbid predictors of HALT. Methods We evaluated consecutive patients with severe aortic stenosis who underwent TAVR with Edwards SAPIEN 3 bioprosthesis at a single center between June 1, 2018 and October 30, 2019. Patients on anticoagulation and those receiving valve‐in‐valve were excluded. Clinically driven computed tomography (CT) imaging was performed to assess for HALT at the discretion of the treating valve team. Results A total of 78 patients with a mean age of 78 ± 10 years and STS risk score 5.5 ± 3.3% were analyzed. HALT was identified in 11 (14.1%) patients. Compared to controls, those with HALT had smaller annular areas, 435 ± 57 mm2 vs. 489 ± 79 mm2 (p = .032), but received comparable size valves. In multivariate regression, valve oversizing by more than 20% was associated with increased risk of HALT, OR 23.5, 95% CI 2.5–223, (p = .006). After initiation of anticoagulation, patients with HALT had similar rates of stroke, major bleeding, and all‐cause mortality out to an average of 243 days. Conclusions In this pragmatic study of patients undergoing TAVR with SAPIEN 3 valves, we report the novel finding that oversizing by more than 20% was independently associated with increased risk of HALT. These findings warrant confirmation in larger and prospective trials.

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Trends in Isolated Surgical Aortic Valve Replacement According to Hospital-Based Transcatheter Aortic Valve Replacement Volumes

Cited by 67 publications

References 18 publications

Preoperative multidetector computed tomography for isolated surgical aortic valve replacement: Planning for future transcatheter options

Preoperative multidetector computed tomography for isolated surgical aortic valve replacement: Planning for future transcatheter options

Preoperative Multi-Detector Computed Tomography for Isolated Surgical Aortic Valve Replacement; Planning for Future Transcatheter Options

Bioprosthetic valve oversizing is associated with increased risk of valve thrombosis following TAVR

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