Morphology and Function of the Aortic Valve after Transcatheter Closure of Ventricular Septal Defect with Aortic Valve Prolapse

Objective: This study aims to evaluate the morphology and function of the aortic valve after transcatheter closure of ventricular septal defect (VSD) with aortic valve prolapse (AVP) abased on clinical and radiological outcomes. Methods: From January 2013 to November 2014, 164 consecutive patients (97 males, 59.1%) with VSD and AVP were treated by transcatheter closure. The patients were divided into the mild AVP group (n = 63), moderate AVP group (n = 89) and severe AVP group (n = 12). The clinical and radiological outcomes of these patients were analyzed retrospectively. Results: In total, 146 (89.0%) patients were successfully treated with VSD occluders, including 59/63 (93.7%) with mild AVP, 80/89 (89.9%) with moderate AVP and 7/12 (58.3%) with severe AVP. The degree of AVP was ameliorated or disappeared in 39 (26.7%) patients, and remained unchanged in 103 (70.5%) patients after the intervention. In the 35 patients who initially had trivial-to-moderate aortic regurgitation (AR), the degree of AR was ameliorated or disappeared in 25 (71.4%) patients, aggravated from trivial to mild AR in 1 (2.9%) patient, and remained unchanged in 9 (25.7%) patients. In 111 patients without AR, 1 (0.9%) patient had mild AR and 24 (21.6%) patients had trivial AR after intervention. The depth and width of the prolapsed aortic valve decreased after transcatheter closure of VSD in all three groups. During the 70-month (range, 54–77) follow-up period, no patients with AVP and AR needed an aortic valve intervention. Conclusions: Transcatheter closure of VSD with AVP is feasible. The morphology and function of the prolapsed aortic valve improved and remained stable for a long period after intervention.     

Percutaneous transcatheter closure of patent ductus arteriosus: Initial experience of Sohag University

ObjectivesInitial experience with transcatheter closure of patent ductus arteriosus (PDA) using different types of devices is reported in Sohag University Hospital. We evaluated the outcome, complications, and also assessed the need of surgical backup for such interventional procedures.MethodsFrom March 2011 to September 2012, 51 patients who underwent transcatheter closure of PDA, were retrospectively identified and studied. Aortic angiogram was performed to evaluate the size, position, and shape of the duct for appropriately choosing the occluder device type and size. A second aortic angiogram was performed 10 min after device deployment. Echocardiography was repeated at intervals of 24 h, then at 1, 3, and 6 months after the procedure to assess complications. The PDA was closed by Amplatzer Duct Occluder (ADO) in 40 patients, Nit occlude PFM coil in five patients, Amplatzer muscular VSD in two patients and Detachable Cook coil in four patients .ResultsOf 51 cases, one patient had left pulmonary artery embolization of ADO that required surgical intervention. The PDA was successfully closed in 98.04% of the study population without any residual PDA shunting. All the patients were alive. Infants made up 29% of the total patients. 45 patients were children and six patients were adults.ConclusionOur initial results show that transcatheter occlusion of PDA using different types of devices is safe and effective with good midterm outcome alternative to surgery. Complications occurred in those with unfavorable duct anatomy and presence of pulmonary hypertension. Surgical backup was not important for such interventional procedures.     

Long-term results of percutaneous balloon valvuloplasty of congenital aortic stenosis in adolescents and young adults

Balloon aortic valvuloplasty (BAV) is a well accepted modality of treatment in congenital aortic stenosis in all age groups. Although in infants and children it is the modality of choice, in adolescents and young adults, it is of debatable efficacy.AimTo evaluate long-term results of aortic valvuloplasty particularly in adolescent and adults (>12 years) and compare the outcome in other age groups that are <1 year and between 1 are 11 years.SettingTertiary referral center.Patients165 consecutive patients treated at the median age of 9 years (1 day to 64 years). The follow-up was up to 14 years (median 3 years). The whole cohort was divided into 3 age-based subgroups: Group A (<1 year) n = 45, Group B (1 year–11 years) n = 52, and Group C (>12 years) n = 68. The characteristics of each subgroup were mutually compared.InterventionPercutaneous balloon valvuloplasty with mean (SD) balloon to annulus ratio of 0.93.Main outcome measures were repeat BAV, significant aortic regurgitation (AR), and aortic valve replacement/repair.ResultsThe incidence of significant AR from the whole cohort was 9.9% (8% moderate, 1.9% severe); n = 16. Group A = significant AR 9.5% (7.1% moderate, 2.4% severe), Group B = significant AR 11.3% (9.4% moderate, 1.9% severe), and Group C = significant AR 9% (7.5% moderate, 1.5% severe); p value = 0.99 (Group C vs Group A) and 0.92 (Group C vs Group B).Repeat BAV rate was 13.3% (n = 22 out of 165 patients). Group A – n = 5 (11.9%), Group B – n = 10 (18.2%), and Group C – n = 7 (10.3%). p Value = 0.78 (C vs A) and 0.19 (C vs B).Surgery in follow-up was needed in n = 4 (2.4%), none in Group A, 2 patients in Group B (3.6%), and 2 patients in group C (2.9%). Patients were followed up for a period of 14 years; Group A = up to 8 years, Group B = up to 13 years, and Group C = up to 14 years. Mean survival probability after the procedure was 8 years (Group A = 6.5 years, Group B = 8.1 years, and Group C = 9.9 years), and p value = 0.49 (A vs B), 0.23 (B vs C), and 0.4 (A vs C).ConclusionThere is no statistical difference in the long-term outcome in the adults and adolescents as compared to the children; thus BAV remains an obvious treatment of choice with good long-term outcome.     

Primary transcatheter closure of post-myocardial infarction ventricular septal rupture using amplatzer atrial septal occlusion device: A study from tertiary care in South India

ObjectiveThe study investigated effectiveness of transcatheter closure of post-myocardial infarction (MI) ventricular septal rupture (VSR) using atrial septal device (ASD) occluder in a cohort of patients admitted at our institute.MethodThis was a retrospective, observational and single center study, which included patients who were treated with transcatheter closure for post-MI VSR at our tertiary care center between May 2000 and August 2014 depending upon inclusion and exclusion criteria. Primary outcome was all-cause mortality at 30-days follow-up. The MELD-XI (Model for End Stage Liver Disease) score was used as a predictor for poor outcome in these patients.ResultsA total of 21 patients (mean age 66.4 ± 5.9 years) were included in the study. Study cohort predominantly included male patients (n = 15; 71.4%) and patients with single vessel disease (n = 15; 71.4%). Revascularization of the culprit lesion, before VSR closure, was attempted in 6 patients. Except one patient (treated with Cera^® occluder), all patients were treated with Amplatzer^® ASD occluders. Average diameter of VSR was 20.8 ± 6.9 mm. Diameter of the device used in the study ranged from 10 mm to 30 mm. Residual defect was detected in 13 patients (62%). All-cause mortality at 30-day follow-up was observed in 9 (42.9%) patients. Time to VSR closure, diameter of VSR, and serum creatinine levels were significantly related to the 30-day mortality. MELD-XI score was found to be strongly associated with increased risk of mortality.ConclusionPrimary transcatheter VSR closure using ASD occluders is a feasible approach which can provide reasonable survival outcomes along with equitable mortality rates.     

Transcatheter aortic valve implantation using the SAPIEN 3 valve to treat aortic regurgitation: The French multicentre S3AR study

BackgroundTranscatheter aortic valve implantation now has a major role in the treatment of patients with severe aortic stenosis. However, evidence is scarce on its feasibility and safety to treat patients with pure aortic regurgitation.AimsWe sought to evaluate the results of transcatheter aortic valve implantation using the balloon-expandable SAPIEN 3 transcatheter heart valve (Edwards Lifesciences, Irvine, CA, USA) in patients with pure aortic regurgitation on native non-calcified valves.MethodsWe conducted a retrospective and prospective French multicentre observational study. We included all patients with symptomatic severe pure aortic regurgitation on native non-calcified valves, contraindicated to or at high risk for surgical valve replacement, who underwent transcatheter aortic valve implantation using the SAPIEN 3 transcatheter heart valve.ResultsA total of 37 patients (male sex, 73%) with a median age of 81 years (interquartile range 69–85 years) were screened using transthoracic echocardiography and computed tomography and were included at eight French centres. At baseline, 83.8% of patients (n = 31) had dyspnoea New York Heart Association class ≥ III. The device success rate was 94.6% (n = 35). At 30 days, the all-cause mortality rate was 8.1% (n = 3) and valve migration occurred in 10.8% of cases (n = 4). Dyspnoea New York Heart Association class ≤ II was seen in 86.5% of patients (n = 32), and all survivors had aortic regurgitation grade ≤ 1. At 1-year follow-up, all-cause mortality was 16.2% (n = 6), 89.7% (n = 26/29) of survivors were in New York Heart Association class ≤ II and all had aortic regurgitation grade ≤ 2.ConclusionTranscatheter aortic valve implantation using the SAPIEN 3 transcatheter heart valve seems promising to treat selected high-risk patients with pure aortic regurgitation on non-calcified native valves, contraindicated to surgical aortic valve replacement.     

Comparison of immediate results and mid-term follow-up of surgical and percutaneous closure of ruptured sinus of Valsalva aneurysm

BackgroundThe past decade has witnessed considerable improvement in implantation techniques for percutaneous closure of ruptured sinus of Valsalva aneurysm. This study was undertaken to compare the immediate results and mid-term follow-up of traditional surgery and percutaneous closure of ruptured sinus of Valsalva aneurysm in China.MethodsBetween January 1993 and January 2013, a total of 35 patients with ruptured sinus of Valsalva aneurysm were enrolled for attempted closure in our institution. Twenty patients (57.1%) underwent surgical repair and the other 15 patients (42.9%) underwent percutaneous closure.ResultsNineteen patients (95.0%) in the surgical group had complete closure and 14 patients (93.3%) in the percutaneous closure group were treated successfully (p = 0.681). Twelve patients with ruptured sinus of Valsalva aneurysm combined with subarterial ventricular septal defect (VSD) underwent surgical repair concomitantly. Two patients in the percutaneous closure group were treated for ruptured sinus of Valsalva aneurysm and perimembranous VSD using occluders concomitantly. One case of severe hemolysis developed 8 h after the procedure in the percutaneous closure group. One death and one case of patch leak occurred in the surgical group during hospitalization. The time of hospital stay in the percutaneous closure group was shorter than that in the surgical group (p = 0.004). The total medical cost of isolated ruptured sinus of Valsalva aneurysm in the percutaneous closure group was lower compared with that in the surgical group (p = 0.046). During a median follow-up of 15 months (2–240 months), there were no deaths, infective endocarditis, device embolization, or malposition.ConclusionsPercutaneous closure is an attractive alternative to surgery in selected patients with ruptured sinus of Valsalva aneurysm for the better clinical advantages and economic benefits.     

Aortic velocity propagation: A novel echocardiographic method in predicting atherosclerotic coronary artery disease burden

BackgroundThe major burden of cardiovascular disease mortality around the globe is due to atherosclerosis and its complications. Hence its early detection and management with easily accessible and noninvasive methods are valuable. Aortic velocity propagation (AVP) through color M-mode of the proximal descending aorta determines aortic stiffness, reflecting atherosclerosis. The aim of this study was to find the utility of AVP in predicting coronary artery disease (CAD) burden assessed through SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score and compared with carotid intima-media thickness (CIMT), which is an established surrogate marker of atherosclerosis.MethodsIn this cross-sectional comparative study, we measured AVP by color M-mode and CIMT by using Philips QLAB-IMT software in 100 patients, who underwent conventional coronary angiogram (CAG) between May 2013 and November 2014. Coronary artery disease is considered significant if >50% diameter stenosis is present in any epicardial coronary artery and insignificant if otherwise.ResultsInitially, to know the normal range we measured AVP and CIMT in 50 patients without any major risk factors for CAD but CAG was not done. Aortic velocity propagation ranged from 46 cm/s to 76 cm/s (mean = 58.62 ± 6.46 cm/s), CIMT ranged from 0.50 mm to 0.64 mm (mean = 0.55 ± 0.03 mm). Among 100 patients who underwent CAG we found 69% had significant CAD, 13% had insignificant CAD, and 18% had normal coronaries. Those with significant CAD had significantly lower AVP (41.65 ± 4.94 cm/s) [F (2,97) = 44.05, p < 0.0001] and significantly higher CIMT (0.86 ± 0.11 mm) [F (2,97) =35.78, p < 0.0001]. AVP had significant strong negative correlation with CIMT (r = −0.836, p < 0.0001, n = 100) and SYNTAX score (r = –0.803, p < 0.0001, n = 69), while CIMT was positively correlated with SYNTAX score significantly (r = 0.828, p < 0.0001, n = 69).ConclusionsAVP and CIMT can predict CAD burden in a robust way. AVP may emerge as an exquisite bedside tool to predict atherosclerotic burden and guide in implementing preventive therapy for cardiovascular disease.     

Registro español de cierre percutáneo de comunicación interventricular con dispositivo NitOcclud Lê VSD-Coil. Experiencia tras más de 100 implantes

Introduction and objectivesThe NitOcclud Lê VSD Coil was specifically designed for transcatheter occlusion of ventricular septal defects (VSD) and became available for this purpose in August 2010. Our objective was to describe the Spanish experience of this technique and analyze its reliability and short- to mid-term efficacy.MethodsNational multicenter observational study, which retrospectively recruited all patients (of any age) with VSD (of any location or type) who underwent percutaneous NitOcclud occlusion, using an intention-to-treat analysis, until January 2019.ResultsA total of 117 attempts were made to implant at least 1 NitOcclud in 116 patients in 13 institutions. The median [range] age and weight was 8.6 [0.4-69] years and 27 [5.8-97] kg, respectively. In 99 patients (85%), the VSD was an isolated congenital defect. The location was perimembranous in 95 (81%), and 74 (63%) of them were aneurysmatic. The mean fluoroscopy time was 34 [11.4-124] minutes. Of the 117 attempts, 104 were successful (89%) with a follow-up of 31.4 [0.6-59] months. At the last review, final complete occlusion of the defect without residual shunt or with only a minimal shunt was achieved in 92.3% (no shunt, n = 73; trivial shunt, n = 23). Four patients required a second procedure for residual shunt occlusion. Two devices had to be surgically explanted due to severe hemolysis. There were no deaths or other major complications.ConclusionsThe NitOcclud device can be used successfully for a wide anatomical spectrum of VSD. The main issue is residual shunt, but its incidence decreases over time. The incidence of hemolysis was very low and no permanent changes were detected in atrioventricular conduction.     

Paravalvular regurgitation after transcatheter aortic valve replacement: Diagnosis,clinical outcome,preventive and therapeutic strategies

Paravalvular regurgitation is a common, potentially life-threatening complication of transcatheter aortic valve replacement. Previous studies report a 65%–94% rate of paravalvular leakage after transcatheter implantation, mostly of mild degree. The rate of significant (≥ + 2) paravalvular regurgitation varies in large clinical trials, and is associated with worse clinical outcome. There is less agreement regarding the significance of mild regurgitation (grade 1 +). There are anatomical and procedural correlates for paravalvular leak—most importantly, severe valve calcification, patient prosthetic mismatch, and device malposition. The following review details the current knowledge on paravalvular regurgitation after transcatheter aortic valve replacement, including diagnosis, correlates, clinical outcome, preventive and therapeutic strategies related to this complication.     

Evolution of non-invasive myocardial work variables after transcatheter aortic valve implantation in patients with severe aortic stenosis

IntroductionGuidelines recommend aortic valve replacement in patients with severe aortic stenosis who present with symptoms or left ventricular ejection fraction < 50%, both conditions representing a late stage of the disease. Whereas global longitudinal strain is load dependent, but interesting for assessing prognosis, myocardial work has emerged.AimTo evaluate acute changes in myocardial work occurring in patients undergoing transcatheter aortic valve implantation (TAVI).MethodsPatients who underwent TAVI were evaluated before and after by echocardiography. Complete echocardiographies were considered. Myocardial work indices (global work index, global constructive work, global work efficiency, global wasted work) were calculated integrating mean transaortic pressure gradient and brachial cuff systolic pressure.ResultsOne hundred and twenty-five patients underwent successful TAVI, with a significant decrease in mean transaortic gradient (from 52.5 ± 16.1 to 12.2 ± 5.0; P < 0.0001). There was no significant change in left ventricular ejection fraction after TAVI. Myocardial work data after TAVI showed a significant reduction in global work index (1389 ± 537 vs. 2014 ± 714; P < 0.0001), global constructive work (1693 ± 543 vs. 2379 ± 761; P < 0.0001) and global work efficiency (85.0 ± 7.06 vs. 87.1 ± 5.98; P = 0.0034). The decrease in global work index and global constructive work after TAVI was homogeneous among different subgroups, based on global longitudinal strain, left ventricular ejection fraction and New York Heart Association status before TAVI. We observed a significant association between global work index and global constructive work before TAVI, and global longitudinal strain degradation after TAVI.ConclusionsMyocardial work variables show promising potential in best understanding the left ventricular myocardial consequences of aortic stenosis and its correction. Given their ability to discriminate between New York Heart Association status and global longitudinal strain evolution, we can hypothesize about their clinical value.     

The impact of live case transmission on patient outcomes during transcatheter aortic valve replacement: Results from the VERITAS study

BackgroundLive case demonstration as an educational tool is widely used to rapidly and effectively disseminate information on surgical and interventional techniques. The risks and benefits of live case transmission for investigational devices, however, are in question.MethodsTranscatheter Aortic Valve Intervention-Live Transmission (VERITAS) is a case–control study of 60 patients from 5 centers who were treated with transcatheter aortic valve replacement (TAVR) during live- or recorded transmission; of which 42 have matched Control subjects from five sites. Case and Control subjects were matched by valve type, access strategy (Edwards SAPIEN transfemoral, Edwards SAPIEN transapical, CoreValve transfemoral), Society of Thoracic Surgeons (STS) score, date of TAVR procedure, and primary operator.ResultsThe Case and Control groups’ baseline characteristics were similar, with average ages of 84 and 82 years, and STS scores of 6.54 ± 3.22 and 6.46 ± 3.20, respectively. The number of operators, fluoroscopy time, contrast volume and length of hospital stay were also similar between groups. Overall, 91.7% of the cases had TAVR via a transfemoral approach; 72% of these patients received a closure device. The final valve position was adequate in 91.2% of the Case patients and in 97% of the Control patients, with no cases of valve migration or coronary obstruction. The Case patients had longer procedure times (130.2 ± 50.6 versus 100.6 ± 43.7 min; p = 0.006). The Valve Academic Research Consortium in-hospital complications were similar between groups. Four Case patients and 1 Control patient required additional valve implantation.ConclusionData support the notion that live transmission of TAVR procedures, when performed by experienced operators, can be done safely with similar outcomes when compared to non-transmitted cases.     

Contemporary outcomes of percutaneous closure of patent ductus arteriosus in adolescents and adults

BackgroundCatheter based treatment has gained wide acceptance for management of patent ductus arteriosus (PDA) ever since its introduction. Percutaneous closure in adults can be challenging because of anatomical factors including large sizes, associated pulmonary arterial hypertension (PAH) and co-morbidities. This study aimed to provide comprehensive contemporary data on the safety and efficacy of percutaneous device closure of PDA in adult and adolescent population at a large referral center.MethodsThis single-center retrospective analysis included 70 patients (33 adolescents and 37 adults) who underwent successful percutaneous device closure of PDA between January 2011 and February 2017.Baseline patient demographics, clinical characteristics, procedural and device related variables, and immediate outcomes during hospital stay were recorded. Patients were followed up for residual shunt and complications.ResultsOf 70 PDA device closure cases, 71.4% were females; the mean age was 23 years (range:10-58years). Devices used were 4-Cook’s detachable coils, 64-occluders (ADO-I and II, Lifetech, Cardi-O-Fix), 1-vascular plug and 1-ventricular septal occluder device. Device success was achieved in all including those with very large PDAs. At 24-h post-procedure, the success rate of transcatheter intervention was 95.7%. At 6-months follow up, complete closure was observed in all (mean follow up duration-531 days). In patients with severe PAH, significant immediate and sustained reduction of the mean pulmonary pressure was observed(77 mmHg to 33 mmHg;P = 0.014). No procedure-related complications including death, device embolization and stenosis of aorta or pulmonary artery occurred.ConclusionsIn contemporary practice, percutaneous device closure is an effective and safe treatment option for adolescent and adult PDA patients.     

Short- and Long-Term Outcomes in Patients With New-Onset Persistent Left Bundle Branch Block After Transcatheter Aortic Valve Replacement

BackgroundThe impact of new-onset persistent left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) on all-cause mortality has been controversial.MethodsWe conducted a systematic review and meta-analysis of eleven studies (7398 patients) comparing the short- and long- outcomes in patients who had new-onset LBBB after TAVR vs. those who did not.ResultsDuring a mean follow-up of 20.5 ± 14 months, patients who had new-onset persistent LBBB after TAVR had a higher incidence of all-cause mortality (29.7% vs. 23.6%; OR 1.28 (1.04–1.58), p = 0.02), rehospitalization for heart failure (HF) (19.5% vs. 17.3%; OR 1.4 (1.13–1.73), p = 0.002), and permanent pacemaker implantation (PPMi) (19.7% vs. 7.1%; OR 2.4 (1.64–3.52), p < 0.001) compared with those who did not. Five studies (4180 patients) reported adjusted hazard ratios (HR) for all-cause mortality; new LBBB remained associated with a higher risk of mortality (adjusted HR 1.43 (1.08–1.9), p < 0.01, I² = 81%).ConclusionPost-TAVR persistent LBBB is associated with higher PPMi, HF hospitalizations, and all-cause mortality. While efforts to identify patients who need post-procedural PPMi are warranted, more studies are required to evaluate the best follow-up and treatment strategies, including the type of pacing device if required, to improve long-term outcomes in these patients.     

Sodium levels on admission are associated with mortality risk in hospitalized patients

AimsAbnormal sodium values are common among hospitalized patients. We aimed to investigate the association of admission sodium values and mortality.MethodsHistorical prospectively data of adult patients hospitalized to medical wards between January 2011 and December 2013. Admission sodium values were classified to five categories: severe hyponatremia (< 125 mEq/L), mild hyponatremia (125–135 mEq/L), normal sodium values (135–145 mEq/L), mild hypernatremia (145–150 mEq/L) and severe hypernatremia (> 150 mEq/L). Main outcomes were length of hospitalization, in-hospital mortality and mortality at the end-of-follow-up.ResultsThe cohort included 27,889 patients (mean age 67 ± 18 years, 52% males). The total follow-up was 1065 days. Most patients had normal sodium values (76%), 22% had hyponatremia, 3% had hypernatremia. Mean age increased with increase in severity of hyponatremia or hypernatremia. Median length of hospitalization was longer with mild and severe hypernatremia (7 and 5 days, respectively) or with mild and severe hyponatremia (4 and 4 days, respectively), compared to normal sodium levels (3 days). Compared to in-hospital mortality with normal sodium levels (5%), mortality was higher with mild and severe hyponatremia (9% and 14%, respectively) and was highest with mild (28%), and severe hypernatremia (52%). Mortality rate at the end of follow-up was 28% with normal sodium levels, 44% and 48% with mild and severe hyponatremia, 66% and 90% with mild and severe hypernatremia, respectively.ConclusionsAbnormal sodium values on admission were associated with longer hospitalization and increased short- and long-term mortality. Mortality risk was higher with hypernatremia, compared to hyponatremia.     

Transcatheter aortic valve implantation improves outcome compared to open-heart surgery in kidney transplant recipients requiring aortic valve replacement

BackgroundCardiovascular disease is the most frequent cause of mortality for kidney transplant recipients. Open heart surgery has particularly high mortality and morbidity. As an alternative to traditional aortic valve replacement (AVR) for patients with high-grade aortic stenosis, transcatheter aortic valve implantation (TAVI) was developed as an innovative therapy for patients considered at high surgical risk.MethodsWe considered all kidney transplant recipients as high-risk patients, which are candidates for TAVI. In 2010 and 2011, eight kidney transplant recipients with severe aortic stenosis underwent TAVI (6 transfemoral; 2 transapical; group I). The outcome of these patients was compared retrospectively to 18 kidney transplant recipients with aortic stenosis, who underwent conventional AVR (group II).ResultsBoth groups had similar baseline characteristics, including estimated perioperative risk (EuroSCORE group I vs. group II: 9.5 ± 5.9 vs. 10.4 ± 10.5; p = 0.829).All TAVI procedures were performed successfully with excellent functional results. In the TAVI group (group I), all patients were alive at the 12-month follow-up with one cardiovascular event (stroke). In contrast, the surgical group experienced a 30-day-mortality of 11.1% (n = 2) and a 1-year-mortality of 16.7% (n = 3).ConclusionsBased on our center's experience, TAVI appears to be an effective and safe alternative to conventional surgery for AVR in patients with prior renal transplantation. Renal transplantation is not currently identified as a risk factor in our traditional scoring system, and may need to be considered independently when weighing alternatives for AVR.     

Non-invasive and invasive evaluation of aortic valve area in 100 patients with severe aortic valve stenosis: Comparison of cardiac computed tomography with ECHO (transesophageal/transthoracic) and catheter examination

BackgroundCurrent guidelines place emphasis on the determination of aortic valve area (AVA) for defining an appropriate treatment strategy. Invasive and non-invasive modalities are used to perform planimetric [transesophageal echocardiography (TEE) and cardiac multidetector computed tomography (MDCT)] and calculated [catheter examination (CE), transthoracic echocardiography (TTE)] AVA measurements.Purpose and methodsWe investigated 100 patients admitted to evaluate the AVA using cardiac MDCT (CT), TEE/TTE as well as invasive CE.ResultsIn all 100 patients we calculated a mean AVA of 0.79 ± 0.29 cm² (female 50/100, 0.70 ± 0.19 cm², male 0.9 ± 0.21 cm²) determined by all investigated examinations (mean ± SEM). AVA measurements determined by CT were significantly greater (0.86 ± 0.25 cm²) than those determined by CE: 0.75 ± 0.18 cm², p = 0.01. Echocardiographically determined AVA was comparable to CE (statistically not significant). Similar results were seen in all patients regardless of gender, presence of atrial fibrillation, and heart rate. We calculated a mean AVA for each patient and evaluated the variance of the AVA determined through investigated specific examinations as the bias. Overall, we found for CT 0.13 ± 0.1 cm², CE 0.13 ± 0.11 cm², TEE 0.16 ± 0.09 cm², and for TTE 0.16 ± 0.08 cm² a specific statistical non-significant variance. On subgroups: sinus rhythm, atrial fibrillation, females, males or combination, we found no further significant relevance for the specific variance.ConclusionOur data suggest the feasibility of cardiac MDCT to evaluate the correct AVA regardless of rhythm, heart rate, and sex. The planimetric concept to determine the AVA with CT displaces the “gold-standard” CE with respect to elucidating the potencies for complications, i.e. cerebral stroke. Regardless of CT's accessing of AVA measurement the TTE examination should remain the primary method of screening for aortic valve pathologies.     

Incidence of allergic rhinitis in a cohort of young adults from 13–15 years old to 23–25 years old in Castellon (Spain)

BackgroundThe objective of this study was to estimate the incidence of Allergic Rhinitis (AR) in young adults and its risk or protective factors.MethodsA population-based prospective cohort study was carried out in 2012. The cohort participated in the International Study of Asthma and Allergy in Childhood in Castellon in 1994 and 2002. A telephone survey was conducted using the same questionnaires. A new case of AR was defined as the participants free of the disease in 2002, who self-reported suffering from AR or taking medications for AR in the period 2002–2012.ResultsOf the 1805 schoolchildren in the cohort in 2002, 1435 young adults (23–25 years old) participated (follow-up 79.1%) in 2012; 743 were female and 692 male; their mean age was 24.9 ± 0.6 years. Two hundred new cases of AR occurred in 1259 participants free of the disease with an incidence of 17.3 per 1000 person–years, and the incidence increased from 2002 (RR = 1.42; 95% CI 1.15–1.75). The risk factors of AR adjusted by age and gender were sinusitis (RR = 1.77; 95% CI 1.16–2.68), atopic dermatitis (RR = 1.51; 95% CI 1.11–2.06) and constant exposure to truck traffic (RR = 1.88; 95% CI 1.12–3.17). For male participants, the risk factors were asthma, sinusitis and atopic dermatitis, and for females bronchitis was a risk factor and presence of older siblings a protective factor.ConclusionsAn increase in AR incidence was observed. Sinusitis, atopic dermatitis and constant exposure to truck traffic were the risk factors of the AR with some differences by gender.     

Evaluación multimodal de la degeneración estructural de válvulas percutáneas en el seguimiento a largo plazo

Introduction and objectivesWe assessed the long-term hemodynamic performance of transcatheter heart valve (THV) by paired transthoracic echocardiography (TTE), and the incidence, characteristics and factors associated with THV structural valve degeneration (SVD).MethodsA total of 212 patients who underwent transcatheter aortic valve replacement and had a potential follow-up > 5 years with at least 1 TTE ≥ 1-year postprocedure were included. All patients had a TTE at 1 to 5 years and 36 had another one at 6 to 10 years. SVD was defined as subclinical (increase > 10 mmHg in mean transvalvular gradient +  decrease > 0.3 cm² in valve area and/or new-onset mild or moderate aortic regurgitation) and clinically relevant (increase > 20 mmHg in mean transvalvular gradient + decrease > 0.6 cm² in valve area and/or new-onset moderate-to-severe aortic regurgitation). Fifteen patients had a transesophageal echocardiography at the time of SVD diagnosis, and 85 an opportunistic computed tomography examination at 1 (0.5-2) years.ResultsTransvalvular mean gradient increased and valve area decreased over time (P < .01). At 8 years of follow-up, SVD occurred in 30.2% of patients (clinically relevant: 9.3%). Transesophageal echocardiography revealed thickened and reduced-mobility leaflets in 80% and 73% of SVD cases, respectively. No baseline or procedural factors were associated with SVD. THV underexpansion (3.5%) or eccentricity (8.2%) had no impact on valve hemodynamics/SVD at follow-up.ConclusionsA gradual THV hemodynamic deterioration occurred throughout a 10-year period, leading to SVD in ～30% of patients (clinically relevant in < 10%). Leaflet morphology/mobility were frequently impaired in SVD cases, but THV geometry did not influence valve hemodynamics or SVD.     

Registro Español de Hemodinámica y Cardiología Intervencionista. XXIX Informe Oficial de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2019)

Introduction and objectivesThe Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) presents its annual report on the activity for 2019.MethodsAll Spanish centers with a catheterization laboratory were invited to participate. Data were introduced online and analyzed by an external company together with the Steering Committee of the ACI-SEC.ResultsA total of 119 centers participated (83 public, 36 private). In all, there were 165 124 diagnostic studies (4.7% more than in 2018). The use of pressure wire and intravascular ultrasound increased by 20% and that of optical coherence tomography by 8.4%. The number of percutaneous coronary interventions (PCI) rose by 4.5% (75 819 procedures). Of these, 22 529 were performed in the acute myocardial infarction setting, with 91.8% being primary PCI (6.3% increase). The mean number of primary PCIs per million inhabitants increased to 439. Among PCIs, access was radial in 88.3%. There were 4281 transcatheter aortic valve implantations (21.0% increase), with an average of 90.9 per million inhabitants. Mitral valve repair also rose by 17.4% (n = 385), left atrial appendage closure by 43.0% (n = 921) and patent foramen ovale closure by 38.1% (n = 710).ConclusionsIn 2019, the use of intracoronary diagnostic techniques increased, as did that of diagnostic and therapeutic coronary procedures, mainly in primary PCI. Of particular note was the marked increase in the number of transcatheter aortic valve implantations, as well as in the number of mitral valve repairs and left atrial appendage and patent foramen ovale closure procedures.     

Transcatheter aortic valve implantation in nonagenarians: Effective and safe

BackgroundThe number of nonagenarians is rising dramatically. These patients often develop severe aortic stenosis for which transcatheter aortic valve implantation (TAVI) is an attractive option. The aim of this study was to analyze the outcome of TAVI performed in a cohort of nonagenarian patients.MethodsBetween August 2008 and November 2012, 23 consecutive patients in their 90th year of age or older underwent TAVI in our institution after having been assessed by the local heart team. Data concerning baseline characteristics, procedural details and outcome were prospectively entered into a dedicated database. Transthoracic echocardiography and clinical follow-up were performed pre-procedure, at discharge, at 6 and 12 months and then annually post TAVI.ResultsPatients were male in 52% with a mean age of 90.3 ± 2.3 years. Mean logistic EuroSCORE and STS score were 26.6 ± 14.5% and 8.7 ± 2.9%, respectively. Transcatheter heart valve (THV) could be implanted in all but one patient. Mortality at 30 days was 8.7% overall and 4.8% for transfemoral approach. At 30 days the rate of stroke was 4.3%, paravalvular leak grade ≥ 2 was 8.7%, life-threatening bleeding was 13.0% and pacemaker implantation was 13%. Device success was 73.9%. The rate of all-cause mortality increased to 27.3% at one-year follow-up and 42.8% at a median follow-up of 417 days.ConclusionsTAVI is safe and effective even in a selected population of nonagenarians. Consequently, these patients should not be refused such a procedure based only on their age. Multi-disciplinary assessment is essential in order to properly select candidates.