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Approaches and Challenges in Transcatheter Valve Treatment

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (10 August 2023) | Viewed by 6308

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Special Issue Editor

Dr. Marwan Saad

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Guest Editor

Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, RI, USA
Interests: interventional cardiology; complex high-risk indicated PCI (CHIP); congenital and structural heart disease

Special Issue Information

Dear Colleagues,

Transcatheter therapy has emerged as a safe and viable option for the treatment of various congenital and structural heart diseases, especially in patients who are deemed at high or prohibitive risk for surgical intervention. The steep uptake in transcatheter advances and innovations has led to a significant shift in structural heart intervention from predominantly surgical to a less-invasive catheter-based approach. Many transcatheter structural heart therapies are either commercially available or under investigation, including transcatheter aortic valve implantation (TAVI), transcatheter mitral and tricuspid valve edge-to-edge repair (M-TEER and T-TEER), transcatheter mitral and tricuspid replacement (TMVR and TTVR), transcatheter left atrial appendage occlusion (LAAO), transcatheter paravalvular leak (PVL) closure, and transcatheter closure of patent foramen ovale (PFO) and atrial septal defect (ASD), among others. Despite the safety and promising short-term outcomes of those transcatheter interventions, long-term outcomes remain under scrutiny, especially as relatively younger populations are being considered for those therapies. Further, with the expansion of those procedures to larger cohorts, physicians are facing many challenges as they deal with patients with difficult vascular and/or valve anatomy, as well as patients at increased risk of complications. In this Special Issue, we welcome authors to submit articles discussing the various approaches and current challenges in transcatheter structural heart disease interventions.

Dr. Marwan Saad
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

structural heart disease
transcatheter
valve intervention
left atrial appendage
patent foramen ovale
TAVR
TEER

Published Papers (5 papers)

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Research

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13 pages, 1336 KiB

Open AccessArticle

Favorable Prognosis in Patients with Recovered Pulmonary Hypertension after TAVI: An Analysis of the LAPLACE-TAVI Registry

by Takuma Koike, Hiroshi Iwata, Yuichi Chikata, Shinichiro Doi, Ryo Naito, Hidetoshi Yasuda, Takehiro Funamizu, Hirohisa Endo, Sakiko Miyazaki, Shinya Okazaki, Ryosuke Higuchi, Itaru Takamisawa, Kei Sato, Harutoshi Tamura, Hiroaki Yokoyama, Tetsuya Tobaru, Shuichiro Takanashi, Minoru Tabata and Tohru Minamino

J. Clin. Med. 2023, 12(2), 729; https://doi.org/10.3390/jcm12020729 - 16 Jan 2023

Cited by 1 | Viewed by 1409

Abstract

Pulmonary hypertension (PH) is a common complication of aortic stenosis (AS). Despite the established association between PH and poor outcomes in patients with AS, the prognostic implication of a change in PH after transcatheter aortic valve implantation (TAVI) has been rarely evaluated. This study analyzed a prospective multi-center TAVI registry database involving six Japanese centers and used the transtricuspid pressure gradient (TRPG) obtained by echocardiography to estimate pulmonary artery systolic pressure. The participants (n = 2056) were first divided into two groups by TRPG before TAVI, a PH (−) group (TRPG < 30 mmHg) (n = 1407, 61.9%) and a PH (+) group (TRPG ≥ 30 mmHg) (n = 649, 28.6%). Next, by TRPG after (4.1 ± 5.3 days) TAVI, the PH (+) group was further subdivided into two groups, Recovered PH (TRPG < 30 mmHg, n = 253) and Persistent PH (TRPG after TAVI ≥ 30 mmHg, n = 396). The median follow-up duration was 1.8 years. The primary and secondary endpoints were the composite and each of cardiovascular (CV) death and heart failure hospitalization, respectively. Unadjusted Kaplan-Meier estimates with log-rank comparisons showed significantly higher cumulative incidences of primary and secondary endpoints in the Persistent PH group compared to other groups. Moreover, adjusted multivariate Cox-proportional hazard analyses showed that a decreased (−10 mmHg) TRPG after TAVI was linearly associated with a reduced risk of the primary endpoint (hazard ratio (HR): 0.76, 95% confidence interval (CI): 0.64–0.90, p = 0.0020). The findings in the present study indicate that the recovery of PH may partly contributes to the prognostic benefit of TAVI procedure in patients with AS and elevated pulmonary artery systolic pressure. Full article

(This article belongs to the Special Issue Approaches and Challenges in Transcatheter Valve Treatment)

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Review

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12 pages, 284 KiB

Open AccessReview

Transcatheter Aortic Valve Replacement for Failed Surgical or Transcatheter Bioprosthetic Valves: A Comprehensive Review

by Taylor Groginski, Amr Mansour, Diaa Kamal and Marwan Saad

J. Clin. Med. 2024, 13(5), 1297; https://doi.org/10.3390/jcm13051297 - 25 Feb 2024

Viewed by 815

Abstract

Transcatheter aortic valve replacement (TAVR) has proven to be a safe, effective, and less invasive approach to aortic valve replacement in patients with aortic stenosis. In patients who underwent prior aortic valve replacement, transcatheter and surgical bioprosthetic valve dysfunction may occur as a result of structural deterioration or nonstructural causes such as prosthesis–patient mismatch (PPM) and paravalvular regurgitation. Valve-in-Valve (ViV) TAVR is a procedure that is being increasingly utilized for the replacement of failed transcatheter or surgical bioprosthetic aortic valves. Data regarding long-term outcomes are limited due to the recency of the procedure’s approval, but available data regarding the short- and long-term outcomes of ViV TAVR are promising. Studies have shown a reduction in perioperative and 30-day mortality with ViV TAVR procedures compared to redo surgical repair of failed bioprosthetic aortic valves, but 1-year and 5-year mortality rates are more controversial and lack sufficient data. Despite the reduction in 30-day mortality, PPM and rates of coronary obstruction are higher in ViV TAVR as compared to both redo surgical valve repair and native TAVR procedures. New transcatheter heart valve designs and new procedural techniques have been developed to reduce the risk of PPM and coronary obstruction. Newer generation valves, new procedural techniques, and increased operator experience with ViV TAVR may improve patient outcomes; however, further studies are needed to better understand the safety, efficacy, and durability of ViV TAVR. Full article

(This article belongs to the Special Issue Approaches and Challenges in Transcatheter Valve Treatment)

22 pages, 2248 KiB

Open AccessReview

Transcatheter Aortic Valve Implantation to Treat Degenerated Aortic, Mitral and Tricuspid Bioprosthesis

by Arif A. Khokhar, Jonathan Curio, Alessandro Sticchi, Adam Hartley, Ozan M. Demir and Neil Ruparelia

J. Clin. Med. 2024, 13(2), 592; https://doi.org/10.3390/jcm13020592 - 19 Jan 2024

Viewed by 1308

Abstract

Transcatheter aortic valve implantation (TAVI) is now well established as the treatment of choice for patients with native aortic valve stenosis who are high or intermediate risk for surgical aortic valve replacement. Recent data has also supported the use of TAVI in patients at low surgical risk and also in anatomical subsets that were previously felt to be contra-indicated including bicuspid aortic valves and aortic regurgitation. With advancements and refinements in procedural techniques, the application of this technology has now been further expanded to include the management of degenerated bioprosthesis. After the demonstration of feasibility and safety in the management of degenerated aortic bioprosthetic valves, mitral and tricuspid bioprosthetic valve treatment is now also well-established and provides an attractive alternative to performing redo surgery. In this review, we appraise the latest clinical evidence and highlight procedural considerations when utilising TAVI technology in the management of degenerated aortic, mitral or tricuspid prosthesis. Full article

(This article belongs to the Special Issue Approaches and Challenges in Transcatheter Valve Treatment)

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9 pages, 556 KiB

Open AccessReview

Antithrombotic Management for Transcatheter Aortic Valve Implantation

by Lina Ya’Qoub, Jelena Arnautovic, Musa Sharkawi, Mirvat AlAasnag, Hani Jneid and Islam Y. Elgendy

J. Clin. Med. 2023, 12(24), 7632; https://doi.org/10.3390/jcm12247632 - 12 Dec 2023

Viewed by 1111

Abstract

Background: There have been significant changes in the optimal antithrombotic regimen post transcatheter aortic valve implantation (TAVI) after the results of major clinical trials in the past few years. Given the clinical importance of the optimal antithrombotic therapy post TAVI, we performed a narrative description of the major clinical trials behind the scientific evidence supporting these changes, as well the current guideline recommendations and knowledge gaps. Methods: We performed a narrative description of the major clinical trials behind the scientific evidence supporting these changes. We used PubMed as a major source to collect the major clinical trials including the following key words: “transcatheter aortic valve replacement”, “transcatheter aortic valve implantation”, “antithrombotic”, “antiplatelet” and “anticoagulation”. We selected the major clinical trials on this topic. This is not a systematic review or meta-analysis. Results: We describe the results of the major clinical trials on antithrombotic therapy post TAVI: POPULAR-TAVI A, POPULAR-TAVI B, ENVISAGE-TAVI AF, GALILEO, ATLANTIS and ADAPT-TAVR trials. Based on the results of these trials, single antiplatelet therapy is recommended post TAVI in patients without concomitant indication for oral anticoagulation or dual antiplatelet therapy, especially in elderly patients. In younger patients, it is advised to evaluate the patient’s bleeding and thrombotic risk, and dual antiplatelet therapy may be reasonable in patients with a high thrombotic risk and low bleeding risk. In patients with a concurrent indication for oral anticoagulation or dual antiplatelet therapy, it is recommended to continue oral anticoagulation or dual antiplatelet therapy post TAVI. Conclusion: In most patients without concomitant indication for oral anticoagulation, single antiplatelet therapy is recommended post TAVI. Full article

(This article belongs to the Special Issue Approaches and Challenges in Transcatheter Valve Treatment)

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14 pages, 1066 KiB

Open AccessReview

Endocarditis after Transcatheter Aortic Valve Replacement

by Lorenzo Braghieri, Simrat Kaur, Christopher K. Black, Paul C. Cremer, Shinya Unai, Samir R. Kapadia and Amgad Mentias

J. Clin. Med. 2023, 12(22), 7042; https://doi.org/10.3390/jcm12227042 - 11 Nov 2023

Viewed by 1213

Abstract

Transcatheter aortic valve replacement (TAVR) use is gaining momentum as the mainstay for the treatment of aortic stenosis compared to surgical aortic valve replacement (SAVR). Unfortunately, TAVR-related infective endocarditis (TAVR-IE) is expected to be detected more and more as a result of the ever-expanding indications in younger patients. Given the overall poor prognosis of TAVR-IE, it is imperative that clinicians familiarize themselves with common presentations, major risk factors, diagnostic pitfalls, therapeutic approaches, and the prevention of TAVR-IE. Herein, we review all of the above in detail with the most updated available literature. Full article

(This article belongs to the Special Issue Approaches and Challenges in Transcatheter Valve Treatment)

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