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1.
Michael Gotzmann MD Michael Lindstaedt MD Waldemar Bojara MD Aydan Ewers MD Andreas Mügge MD 《Catheterization and cardiovascular interventions》2012,79(5):693-701
Background : Low‐flow, low‐gradient aortic stenosis is associated with relevant postoperative mortality whereas conservative management results in dismal prognosis. We present the initial experience of low‐flow, low‐gradient aortic stenosis treated with transcatheter aortic valve implantation (TAVI). Methods : From June 2008 to December 2010 167 consecutive patients with native severe aortic stenosis and an excessive operative risk underwent TAVI. Of these, 15 patients presented with low‐flow, low‐gradient aortic stenosis (aortic valve area < 1 cm2, left ventricular (LV) ejection fraction < 40%, aortic mean gradient < 40 mm Hg). The CoreValve prosthesis 18‐F‐generation (Medtronic, Minneapolis, Minnesota) was inserted retrograde. Clinical follow‐up and echocardiography were performed 6 months after procedure. Results : Patients with low‐flow, low‐gradient aortic stenosis (mean LV ejection fraction 32 ± 6%, mean aortic gradient 27 ± 7 mm Hg) had higher all‐cause mortality 6 months after TAVI compared to patients without low‐flow, low‐gradient aortic stenosis (33% vs. 13%, P = 0.037). In the surviving 10 patients with low‐flow, low‐gradient aortic stenosis, LV ejection fraction increased (34 ± 6% before vs. 46 ± 11% 6 months after TAVI, p = 0.005) and more distance covered in the 6‐minute walk test (218 ± 102 meters before vs. 288 ± 129 meters 6 months after TAVI, p = 0.038). Conclusion : Our study suggests that TAVI is feasible in patients with severe co‐morbidities and low‐flow, low‐gradient aortic stenosis. Within the first 6 months after treatment all‐cause mortality was considerable high, but the surviving patients showed symptomatic benefit and significant improvement of myocardial function and exercise capacity. © 2011 Wiley Periodicals, Inc. 相似文献
2.
Jean‐Bernard Masson MD May Lee MSc Robert H. Boone MD Abdullah Al Ali MD Saad Al Bugami MD Jaap Hamburger MD PhD G.B. John Mancini MD Jian Ye MD Anson Cheung MD Karin H. Humphries PhD David Wood MD Fabian Nietlispach MD John G. Webb MD 《Catheterization and cardiovascular interventions》2010,76(2):165-173
Background: Coronary artery disease (CAD) negatively impacts prognosis of patients undergoing surgical aortic valve replacement and revascularization is generally recommended at the time of surgery. Implications of CAD and preprocedural revascularization in the setting of transcatheter aortic valve implantation (TAVI) are not known. Method: Patients who underwent successful TAVI from January 2005 to December 2007 were retrospectively divided into five groups according to the extent of CAD assessed with the Duke Myocardial Jeopardy Score: no CAD, CAD with DMJS 0, 2, 4, and ≥6. Study endpoints included 30‐day and 1‐year survival, evolution of symptoms, left ventricular ejection fraction (LVEF), and mitral regurgitation (MR) and need of revascularization during follow‐up. Results: One hundred and thirty‐six patients were included, among which 104 (76.5%) had coexisting CAD. Thirty‐day mortality in the five study groups was respectively 6.3, 14.6, 7.1, 5.6, and 17.7% with no statistically significant difference between groups (P = 0.56). Overall survival rate at one year was 77.9% (95% CL: 70.9, 84.9) with no difference between groups (P = 0.63). Symptoms, LVEF, and MR all significantly improved in the first month after TAVI, but the extent of improvement did not differ between groups (P > 0.08). Revascularization after TAVI was uncommon. Conclusion: The presence of CAD or nonrevascularized myocardium was not associated with an increased risk of adverse events in this initial cohort. On the basis of these early results, complete revascularization may not constitute a prerequisite of TAVI. This conclusion will require re‐assessment as experience accrues in patients with extensive CAD. © 2010 Wiley‐Liss, Inc. 相似文献
3.
《Revista portuguesa de cardiologia》2022,41(8):621-631
BackgroundSome studies suggest that patients with low flow low gradient (LF-LG) aortic stenosis (AS) may achieve worse results after undergoing transcatheter aortic valve implantation (TAVI).PurposeTo compare outcomes between LF-LG AS and high gradient (HG) AS patients submitted to TAVI.MethodsInclusion of 480 consecutive patients who underwent TAVI between 2008 and 2020 at a single tertiary center. Patients were divided into high gradient AS and LF-LG AS; and baseline characteristics and outcomes after the procedure were collected and compared between groups.ResultsPatients with LF-LG AS had worse baseline characteristics, with higher Society of Thoracic Surgeons score (p=0.008), New Euroscore II (p<0.0001), and NT pro-natriuretic peptide B (p=0.001), more frequent left ventricular ejection fraction (LVEF) <40% (p<0.0001), coronary artery disease (p<0.0001), including previous myocardial infarction (p=0.002) and coronary artery bypass graft (p<0.0001), poor vascular accesses (p=0.026) and periprocedural angioplasty (p=0.038). In a multivariate analysis, adjusted to differences in baseline characteristics, LF-LG AS was associated with worse functional class at one year (p=0.023) and in the long-term (p=0.004) and with heart failure hospitalizations at one year and in the long-term (p=0.001 and p<0.0001). In a sub-analysis including only patients with LF-LG AS, those with LVEF <40% had the worst outcomes, with more global (p=0.035) and cardiovascular (p=0.038) mortality.ConclusionPatients with LF-LG AS have worse short and long-term outcomes, even when adjusted for baseline characteristic differences. The sub-group of patients with LVEF <40% have the most ominous global outcomes. 相似文献
4.
Apostolos Tzikas MD Nicolo Piazza MD Bas M. van Dalen MD Carl Schultz MD PhD Marcel L. Geleijnse MD PhD Robert‐Jan van Geuns MD PhD Tjebbe W. Galema MD Rutger‐Jan Nuis MSc Amber Otten MSc Juan‐Luis Gutierrez‐Chico MD PhD Patrick W. Serruys MD PhD Peter P. de Jaegere MD PhD 《Catheterization and cardiovascular interventions》2010,75(1):43-49
Objectives : To assess the acute and intermediate changes in mitral regurgitation (MR) severity after transcatheter aortic valve implantation (TAVI) with the CoreValve Revalving SystemTM (CRS). Background : Following surgical aortic valve replacement, improvement in MR is reported in 27–82% of the patients. The changes in MR severity following CRS implantation are unknown. Methods : Transthoracic echocardiography was performed in 79 consecutive patients before and after treatment, and at the first outpatient visit. Left ventricular dimensions and ejection fraction (LVEF), left atrial (LA) size, and aortic gradient were measured. MR was assessed by color flow mapping and was graded as none, mild, moderate, or severe. It was defined as organic or functional. The depth of CRS implantation was measured by angiography. Results : Post‐treatment, the mean gradient decreased from 48 ± 16 mm Hg to 9 ± 5 mm Hg (P < 0.0001). There was no significant change in the left ventricular dimensions, LA size, and LVEF. MR pretreatment was mild, moderate, or severe in 57%, 18%, and 1% of the patients, respectively. It was defined as organic in 27 patients (36%) and functional in 27 patients (36%). The degree of MR remained unchanged in 61% of the patients, improved in 17%, and worsened in 22%. MR improvement was associated with a lower baseline LVEF (P = 0.02). There was no association between the changes in MR severity and the depth of CRS implantation. Conclusions : Most patients who underwent TAVI had some degree of MR. Overall there was no change in the degree of MR post‐treatment. Patients in whom MR improved had a lower LVEF at baseline. © 2009 Wiley‐Liss, Inc. 相似文献
5.
Kidney injury and mortality after transcatheter aortic valve implantation in a routine clinical cohort
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Sandra Wilde BA Johannes Schirmer MD Dietmar H. Koschyk MD Lenard Conradi MD Francisco Ojeda Phd Stephan Baldus MD Hermann Reichenspurner MD Stefan Blankenberg MD Hendrik Treede MD Patrick Diemert MD 《Catheterization and cardiovascular interventions》2015,85(3):440-447
6.
Prevalence and predictors of carotid artery stenosis in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation
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Arie Steinvil MD MHA Eran Leshem‐Rubinow MD MHA Yigal Abramowitz MD Yacov Shacham MD Yaron Arbel MD Shmuel Banai MD Natan M. Bornstein MD Ariel Finkelstein MD Amir Halkin MD 《Catheterization and cardiovascular interventions》2014,84(6):1007-1012
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Kentaro Mitsui MD Kensuke Takagi MD PhD Takashi Kakuta MD Teruo Noguchi MD PhD 《Catheterization and cardiovascular interventions》2023,102(7):1259-1262
Valve-in-valve transcatheter aortic valve replacement (valve-in-valve TAVR) increases the risk of coronary obstruction. Although the coronary protection strategy is widely used, the use of the bailout technique after coronary obstruction is limited. Hence, we report a simple bailout technique for coronary obstruction after valve-in-valve TAVR. An 82-year-old woman presented with structural valve deterioration. The left anterior descending coronary artery had 90% stenosis. After TAVR, the prosthetic valve shifted close to the ascending aorta wall, consequently impairing coronary flow. The wire crossed with the Judkins right guiding catheter (JR) reference to the en-face and perpendicular views. Using the guide-extension catheter, the JR contacted the contralateral ascending aorta as a backup catheter. After a balloon was dilated between the prosthetic valve and aorta, JR engaged into the coronary artery with excellent backup. This novel “Whisker pole guiding technique” is useful, even after valve-in-valve TAVR. 相似文献
8.
Blood transfusion is associated with impaired outcome after transcatheter aortic valve implantation
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Ann Christine Terstesse BS Dietmar Koschyk MD Johannes Schirmer MD Renate B. Schnabel MD MSc Sandra Wilde BA Francisco M. Ojeda PhD Hermann Reichenspurner MD PhD Stefan Blankenberg MD Ulrich Schäfer MD Hendrik Treede MD Patrick Diemert MD 《Catheterization and cardiovascular interventions》2015,85(3):460-467
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Atul Bhatia Anil Kumar Ashok Seth M. L. Bhatia Naresh Trehan 《Catheterization and cardiovascular interventions》1993,29(4):296-297
Emergency balloon valvuloplasty was performed in a 42 year old male with critical aortic stenosis, severe congestive heart failure, and shock. Hemodynamic and clinical improvement occurred and he underwent elective aortic valve replacement. Balloon aortic valvuloplasty may provide a “bridge” to aortic valve replacement in patients with critical aortic stenosis and shock. © 1993 Wiley-Liss, Inc. 相似文献
10.
Toshiki Kaihara Takumi Higuma Masaki Izumo Nozomi Kotoku Tomomi Suzuki Haruka Kameshima Yukio Sato Shingo Kuwata Masashi Koga Takanobu Mitarai Mika Watanabe Kazuaki Okuyama Ryo Kamijima Yuki Ishibashi Kihei Yoneyama Yasuhiro Tanabe Tomoo Harada Yoshihiro J. Akashi 《Clinical cardiology》2021,44(8):1089
BackgroundA high frequency of coronary artery disease (CAD) is reported in patients with severe aortic valve stenosis (AS) who undergo transcatheter aortic valve implantation (TAVI). However, the optimal management of CAD in these patients remains unknown.HypothesisWe hypothesis that AS patients with TAVI complicated by CAD have poor prognosis. His study evaluates the prognoses of patients with CAD and severe AS after TAVI.MethodsWe divided 186 patients with severe AS undergoing TAVI into three groups: those with CAD involving the left main coronary (LM) or proximal left anterior descending artery (LAD) lesion (the CAD[LADp] group), those with CAD not involving the LM or a LAD proximal lesion (the CAD[non‐LADp] group), and those without CAD (Non‐CAD group). Clinical outcomes were compared among the three groups.ResultsThe CAD[LADp] group showed a higher incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) and all‐cause mortality than the other two groups (log‐rank p = .001 and p = .008, respectively). Even after adjustment for STS score and percutaneous coronary intervention (PCI) before TAVI, CAD[LADp] remained associated with MACCE and all‐cause mortality. However, PCI for an LM or LAD proximal lesion pre‐TAVI did not reduce the risk of these outcomes.ConclusionsCAD with an LM or LAD proximal lesion is a strong independent predictor of mid‐term MACCEs and all‐cause mortality in patients with severe AS treated with TAVI. PCI before TAVI did not influence the outcomes. 相似文献
11.
Luca Testa MD PhD Guido Gelpi MD Francesco Bedogni MD 《Catheterization and cardiovascular interventions》2013,82(4):E621-E625
We hereby present the case of a patient with severe aortic stenosis who underwent in her previous medical history a mitral valve replacement with a mechanical valve (Omnicarbon 27), and progressively developed a severe aortic stenosis. This patient was judged inoperable and then scheduled for CoreValve Revalving System implantation. Despite a good positioning of the CoreValve, an acute, severe mitral regurgitation developed soon after implantation as a consequence of the impaired movement of the mitral prosthesis leaflet. A condition of cardiogenic shock quickly developed. A good mitral prosthesis function was restored disengaging the CoreValve from the aortic annulus. After few months, the patients underwent successful Edwards‐Sapien valve implantation through the Corevalve. This case strongly demonstrates how much a careful evaluation of the features of the mitral prosthesis and patient anatomy is crucial to select which specific transcatheter bioprosthesis would better perform. © 2013 Wiley Periodicals, Inc. 相似文献
12.
Prognostic significance of aortic valve gradient in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement
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Guy Witberg MD Arik Finkelstein MD Issi Barbash MD Abid Assali MD Yaron Shapira MD Amit Segev MD Amir Halkin MD Paul Fefer MD Jeremy Ben‐Shoshan MD Maayan Konigstein MD Alexander Sagie MD Victor Guetta MD Ran Kornowski MD Alon Barsheshet MD 《Catheterization and cardiovascular interventions》2017,90(7):1175-1182
13.
Jean‐Michel Paradis MD Isaac George MD Susheel Kodali MD 《Catheterization and cardiovascular interventions》2013,82(3):E262-E265
We report the case of an 81‐year‐old woman with symptomatic severe aortic stenosis, extremely significant peripheral arterial disease, and obstructive coronary artery disease who underwent percutaneous coronary intervention via a transaxillary conduit immediately before a trans‐apical transcatheter aortic valve replacement performed with a transfemoral device. After deployment of the transcatheter heart valve, there was a left main coronary obstruction and the patient required an emergent PCI. This multifaceted case clearly underlines the importance of a well functioning heart team including the interventional cardiologist, the cardiovascular surgeon, and the echocardiographer. © 2013 Wiley Periodicals, Inc. 相似文献
14.
Access closure is a key element to successful retrograde percutaneous transfemoral transcatheter aortic valve implantation. It requires large-bore femoral arterial access (18Fr-28Fr) which most operators manage with surgical access and closure under general anesthesia. We report a case example of how, using our center's peripheral interventional experience, we have developed a simple five step technique to achieve hemostasis percutaneously. 相似文献
15.
Peter Haworth MBBS MRCP Miles Behan DM MRCP Muhammed Khawaja MBBS MRCP Nevil Hutchinson FRCA Adam de Belder MD FRCP Uday Trivedi FRCS Jean Claude Laborde MD David Hildick‐Smith MD MRCP 《Catheterization and cardiovascular interventions》2010,76(5):751-756
Background : Transcatheter aortic valve implantation (TAVI) is a new treatment strategy for patients with symptomatic aortic stenosis who are high risk for traditional surgical aortic valve replacement. The incidence of conduction system abnormalities after the procedure is significant. We examine our experience with CoreValve TAVI focusing on electrocardiographic changes found pre‐, peri‐, and postintervention. Methods : During 2007–08 we undertook 33 cases utilizing the CoreValve revalving system (CoreValve, Paris, France). Assessment of ECGs, with particular reference to the PR and QRS duration, was made daily during each patient's hospital stay. Results : Patients were aged 81.7 ± 6.7 years and the majority were male (57%). Baseline cardiac rhythm was sinus (n = 28, 80%); atrial fibrillation (n = 6, 18%) or ventricular paced (n = 1, 3%). Following CoreValve implantation, prolongation of both the PR interval and QRS duration was seen. Preprocedural PR interval was 193.5 ± 38.7 ms and QRS interval preprocedure was 115.3 ± 24.8 ms. PR interval increased after the procedure by 23.5 ± 23.9 ms and peaked at day 4 with a mean increase of 66.1 ± 72.7 ms. QRS duration increased by a mean of 30.6 ± 26.1 ms postprocedure and remained stable thereafter during the remaining hospital stay. The need for PPM insertion was partially predicted by pre‐procedural QRS morphology: patients with pre‐existing right bundle branch block had an 83% chance of requiring a permanent pacemaker (P < 0.01 OR 28 95%CI 2.4–326.7); those with LBBB had a 33% chance of requiring a pacemaker (P = ns OR 2.3 95%CI 0.2–34.9). Patients undergoing the procedure later in our experience showed a decreased incidence of pacing (P = 0.046 OR 0.36 95% CI 0.07–1.82). Pre‐procedural annulus measurements also predicted the requirement for pacing with larger annulus sizes more likely to require a pacemaker (P = 0.044 OR 3.3 95% CI 0.63–17.6). The requirement for pacing was not predicted by age, baseline PR interval or gender. Requirement for pacing overall was 32% with an additional 13% having had a pacemaker inserted prior to the TAVI. Conclusion : CoreValve insertion was associated with an increase in PR interval and QRS duration. PR interval continued to rise during admission, peaking on Day 4 post procedure, making a prolonged period of monitoring highly desirable. There was a significant requirement for permanent pacing, which was predicted by pre‐procedural QRS morphology, annulus measurement, and the learning curve. © 2010 Wiley‐Liss, Inc. 相似文献
16.
Association of postprocedural aortic regurgitation with mitral regurgitation worsened after transcatheter aortic valve replacement
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Kentaro Shibayama MD Hirotsugu Mihara MD Javier Berdejo MD Kenji Harada MD Robert J. Siegel MD Raj R. Makkar MD Takahiro Shiota MD 《Echocardiography (Mount Kisco, N.Y.)》2018,35(3):346-352
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A 44-year-old woman with a history of chest radiotherapy developedostial coronary artery disease associated with aortic valvulardisease and a lesion of the right internal mammary artery. 相似文献
19.
Hector I. Michelena MD Oluseun Alli MD Allison K. Cabalka MD Charanjit S. Rihal MD 《Catheterization and cardiovascular interventions》2013,81(5):E219-E224
We report a case of transcatheter valve‐in‐valve therapy performed on an 85‐year‐old man with severe mitral bioprosthetic valve dysfunction. He was a high risk candidate for conventional surgery and he underwent placement of the Melody transcatheter heart valve into the mitral bioprosthesis via the right femoral vein.© 2012 Wiley Periodicals, Inc. 相似文献
20.
Nicolo Piazza MD Patrick W. Serruys MD PhD Peter de Jaegere MD PhD 《Catheterization and cardiovascular interventions》2009,73(2):161-166
Coronary atherosclerosis is a common finding in patients with severe aortic stenosis. Indeed, aortic stenosis is associated with risk factors similar those of coronary atherosclerosis such as older age, hypertension, diabetes, hypercholesterolemia and smoking. In light of the evolution of percutaneous aortic valve implantation (PAVI) and ongoing improvements in techniques of PCI, a combined approach using PCI and PAVI can be proposed for patients with complex coronary artery and aortic valve disease. This report describes the feasibility of the combination of percutaneous coronary intervention and percutaneous aortic valve implantation with peripheral left ventricular assist device (TandemHeart) support in 3 elderly patients with complex coronary altery disease and aortic stenosis considered too high risk for conventional surgical therapy. © 2009 Wiley‐Liss, Inc. 相似文献