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Valve Disease
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
There has been a real revolution in treatment of aortic calcific stenosis. Surgical aortic valve replacement has been the standard treatment for patients with severe symptomatic aortic stenosis (AS). Transcatheter aortic-valve insertion (TAVI) has now been established as an alternative to surgery in patients with severe aortic stenosis who are at increased risk for death from surgery. These devices have an acceptable safety profile and provide excellent haemodynamic relief of aortic stenosis. In 2002, Dr. Alain Cribier performed the first successful percutaneous aortic valve replacement on an inoperable patient. The first approval of TAVI for severe risk patients came in 2011 with extension to moderate risk patients recently with more trials. In 2015, the indication was expanded to include ‘valve-in-valve’ procedure for failed surgical bioprosthetic valves in both children and adults.20
Transcatheter Aortic Valve Implantation (TAVI)
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Amalia Winters, Jessica Forcillo, Vinod H Thourani
Initial TAVR evaluation should include an assessment of the following patient variables: (i) severity of aortic stenosis, (ii) ileo-femoral vessel size, calcification and tortuosity, (iii) anatomic details of the aortic valve leaflets, (iv) annulus, sinotubular and sinus of Valsalva dimensions, (v) ventricular function and (vi) extent of coronary artery disease. Due to their accuracy and reproducibility, we utilize 3-D computed tomography (CT) of the chest, abdomen and pelvis, and echocardiography as the primary imaging modalities at our institution.
Cardiac conditions
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Aortic stenosis, as the name implies, is a narrowing of the aortic valve opening (see Figure 2.10). It can be caused by a congenital defect whereby the aortic valve has two cusps instead of three, or following damage to the valve from an episode of rheumatic fever.
Association between periprocedural myocardial injury and long-term all-cause mortality in patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis
Published in Scandinavian Cardiovascular Journal, 2022
Wentao Chen, Yilong Han, Chunlin Wang, Wenqiang Chen
Aortic stenosis (AS) is usually caused by the calcification of a congenitally bicuspid or trileaflet valve, and rheumatic diseases can also cause aortic stenosis. Its pathological process is mainly endothelial damage due to mechanical stress and lipid penetration leading to fibrosis, leaflet thickening, and calcification; the prevalence of AS increases with age [1]. Currently, there is a lack of effective drug treatments for this disease. Surgical aortic valve replacement is the gold standard treatment for this disease. However, with the development and progress of minimally invasive techniques, transcatheter aortic valve replacement (TAVR) has become an option for treating this disease [1]. The most recent European guidelines suggest that TAVR is a better option for older patients with multiple risk factors who can undergo surgery via the femoral artery approach [2]. However, that there will be various complications after TAVR, including periprocedural myocardial injury (PPMI), bleeding, and stroke, most of which will affect the prognosis of patients, should be considered [3]. PPMI may be caused by a variety of factors, such as compression of myocardial tissue caused by balloon valvuloplasty and deployment of the transcatheter valve itself, hypotension during rapid pacing, and mechanical trauma caused by anchoring of the transcatheter valve. If coronary artery occlusion or a rare coronary artery embolism occurs after TAVR, myocardial infarction may occur, which is highly life-threatening [4].
Less invasive aortic valve replacement using the trifecta bioprosthesis
Published in Scandinavian Cardiovascular Journal, 2022
Alfonso Agnino, Ascanio Graniero, Piersilvio Gerometta, Laura Giroletti, Giovanni Albano, Claudio Roscitano, Amedeo Anselmi
The treatment paradigms for severe aortic stenosis are evolving. The main features of such evolution include the expansion of the indications to TAVR (and the increasing standardization of both transfemoral and non-transfemoral access routes), as well as the growing adoption of less invasive techniques for surgical AVR. Rather than a reaction to the success of TAVR, this trend testifies the intention to provide patients with the benefits of an effective and reproductible treatment for aortic stenosis, and those of minimal surgical aggressiveness. Less invasive AVR has been associated with reduced ICU and overall hospital stay, shorter mechanical ventilation time, lower rate of transfusion and reduced postoperative pain vs. full sternotomy [7], despite longer average CPB and cross-clamp times. No previous investigations have specifically addressed the feasibility and safety of the Trifecta GT valve in various less invasive surgery settings. In fact, these settings entail peculiar technical conditions for valve implantation, including valve parachuting into position and knot tying. These aspects are significant to maintain the integrity and durability of this valve device. Trifecta GT is the second-generation Trifecta valve, it was introduced in 2016 and features several evolutions in design with respect to the first-generation device.
Valve-in-valve transcatheter aortic valve replacement versus redo aortic valve replacement: which procedure for which patient?
Published in Expert Review of Cardiovascular Therapy, 2022
Erika Hutt, Nandini Mehra, Milind Y. Desai
The development and utility of transcatheter valve technology has been game changing. Thought to be impossible a few years back, it has now become the standard of care for treatment of aortic stenosis in intermediate and high-surgical risk patients. We suspect that TAVR will soon be expanded to include the low-surgical risk population and become the standard of care for treatment of severe AS in all anatomically suitable patients. In addition, we hope that this rapid growth in transcatheter valve technology result in ongoing improvement in quality and durability of these valves by the manufacturing companies to decrease the incidence of bioprosthetic valve degeneration and need for reoperation. In the meantime, we know that this rapid expansion in TAVR use will lead to a large population of patients with bioprosthetic aortic valve degeneration requiring re-intervention. Thus, there is a major need for randomized control trials to understand which subgroup of patients are favored with ViV TAVR vs SAVR. Because comparative data between ViV TAVR and redo SAVR are limited to approximately 3–5 years, there remain uncertainties related to long-term outcomes and consequences of each approach. Until then, we are left with observational data to help guide shared decision making with these patients.