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Transcatheter Structural Heart Disease Interventions: Clinical Update
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Transcatheter Structural Heart Disease Interventions: Clinical Update

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

Deadline for manuscript submissions: closed (15 January 2022) | Viewed by 34198

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Dr. Maurizio Taramasso

E-Mail Website
Guest Editor
HerzZentrum Hirslanden Zurich, Witellikerstrasse 36, 8008 Zürich, Switzerland
Interests: cardiac surgery; structural heart interventions; transcatheter valve therapy; innovation; novel approaches to treat cardiovascular diseases; transcatheter aortic valve replacement; transcatheter mitral valve intervention; transcatheter tricuspid valve intervention
Special Issues, Collections and Topics in MDPI journals
Dr. Ana Paula Tagliari

E-Mail Website
Co-Guest Editor
Postgraduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
Interests: cardiac surgery; structural heart interventions; transcatheter valve therapy; cardiac implantable eletronic devices; transcatheter aortic valve replacement; transcatheter mitral valve intervention; transcatheter tricuspid valve intervention
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Transcatheter structural heart disease interventions represent a new branch of percutaneous treatments, covering a wide range of previously surgically treated or even not addressed cardiac diseases.

Gradually, we are experiencing a technological revolution in structural heart disease management, with several new or improved devices specially dedicated to this field. We now have the tools and the impulse to go beyond previous boundaries, treating conditions considered “forgotten” for decades. Additionally, we can offer a less invasive, less morbid, safer, but still effective treatment to some of the most frequent heart diseases, such as aortic stenosis, mitral regurgitation, tricuspid regurgitation, and atrial or ventricular septum defects. Once distant on the horizon, these procedures are now part of our daily routine in CAT labs and hybrid rooms. This revolution was only possible thanks to the innovative impetus and bravery of professionals from several specialties such as cardiology, cardiac surgery, interventional cardiology, electrophysiology, imaging, heart failure, and many others.

Despite all these advancements, however, many questions remain without answer. What is the best time to intervene in primary tricuspid regurgitation? What is the long-term durability of transcatheter valves? What is the impact of subclinical leaflet thrombosis? What is the role of cerebral embolic protection devices? Should transcatheter mitral valve repair be offered to patients who are not inoperable or high-risk? Transcatheter mitral valve replacement devices should replace repair devices? When should we close iatrogenic interatrial septum defects? What is the role of intracardiac echocardiography or fusion imaging? And so on.

With this Special Issue, we aim to present the up-to-date status of Transcatheter Structural Heart Disease Interventions. We would like to invite researchers from all transcatheter structural intervention associated areas to submit original articles or reviews, sharing their expertise and knowledge on this appealing subject. 

Dr. Maurizio Taramasso
Dr. Ana Paula Tagliari
Guest Editors

Manuscript Submission Information

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.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Structural heart interventions
  • Transcatheter valve therapy
  • Transcatheter aortic valve replacement
  • Transcatheter mitral valve intervention
  • Transcatheter tricuspid valve intervention
  • Imaging in structural heart interventions
  • Septal defect
  • Paravalvular leak
  • Left atrial appendage closure
  • Innovation

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Published Papers (14 papers)

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Editorial

Jump to: Research, Review

4 pages, 207 KiB  
Editorial
The Heart in the Transcatheter Intervention Era: Where Are We?
by Ana Paula Tagliari and Maurizio Taramasso
J. Clin. Med. 2022, 11(17), 5173; https://doi.org/10.3390/jcm11175173 - 01 Sep 2022
Viewed by 912
Abstract
It is so exciting to imagine that the heart, once considered an untouchable organ, is now routinely approached by so many different techniques and with a wide array of invasiveness [...] Full article
(This article belongs to the Special Issue Transcatheter Structural Heart Disease Interventions: Clinical Update)

Research

Jump to: Editorial, Review

10 pages, 241 KiB  
Article
Surgery after Failed Transcatheter Aortic Valve Implantation: Indications and Outcomes of a Concerning Condition
by Mohamed Salem, Christina Grothusen, Mostafa Salem, Derk Frank, Mohammed Saad, Markus Ernst, Thomas Puehler, Georg Lutter, Assad Haneya, Jochen Cremer and Jan Schoettler
J. Clin. Med. 2022, 11(1), 63; https://doi.org/10.3390/jcm11010063 - 23 Dec 2021
Cited by 1 | Viewed by 2340
Abstract
Objectives: The number of transcatheter aortic valve implantations (TAVI) has increased enormously in recent decades. Transcatheter valve prosthesis failure and the requirement of conventional surgical replacement are expected to attract more focus in the near future. Indeed, given the scarcity of research in [...] Read more.
Objectives: The number of transcatheter aortic valve implantations (TAVI) has increased enormously in recent decades. Transcatheter valve prosthesis failure and the requirement of conventional surgical replacement are expected to attract more focus in the near future. Indeed, given the scarcity of research in this field, the next decade will likely represent the beginning of a period of meaningful exploration of the degenerative changes that occur with transcatheter valves. The current study represents—through a series of consecutive cases—one of the first analyses of the underlying causes of TAVI failure, i.e., degenerative, functional and infective, followed by surgical aortic valve replacement (SAVR) and postoperative outcome. Methods: Between October 2008 and March 2021, 2098 TAVI procedures, including 1423 with transfemoral, 309 with transapical, and 366 with transaortic access, were performed in our institution. Among these, 0.5% (number(n) = 11) required acute SAVR (n = 6) within 7 days (n = 3) or later (n = 2), and were included in the study. Results: Valve stent dislocation was the most common cause of replacement (83%). Causes of replacement within 7 days after TAVI were multifactorial. In the later course, endocarditis was the sole indication for SAVR after TAVI. TAVI with transapical or transaortal approach had a higher EuroSCORE II (10.9 (7.2–35.3) vs. 3.5 (1.8–7.8)). Their 30-day mortality after surgical conversion was higher (67% vs. 20%), when compared to those who underwent a transfemoral procedure. The longest documented survival beyond 30 days was 58 months. Conclusions: The causes of SAVR after TAVI failure are multifactorial, and include biological, physical and infectious factors. An acceptable midterm prognosis may be expected in patients with physical causes when dislocation of the catheter prosthesis is observed; in such cases, emergency conversion is required. Conversion due to infection, as in cases of endocarditis, had the worst outcome. Prognosis after conversion due to degeneration is still problematic, due to a lack of autopsies and the recent history of prosthetic implantations. Full article
(This article belongs to the Special Issue Transcatheter Structural Heart Disease Interventions: Clinical Update)
13 pages, 268 KiB  
Article
Identifying Patients without a Survival Benefit following Transfemoral and Transapical Transcatheter Aortic Valve Replacement
by Daniela Geisler, Piotr Nikodem Rudziński, Waseem Hasan, Martin Andreas, Ena Hasimbegovic, Christopher Adlbrecht, Bernhard Winkler, Gabriel Weiss, Andreas Strouhal, Georg Delle-Karth, Martin Grabenwöger and Markus Mach
J. Clin. Med. 2021, 10(21), 4911; https://doi.org/10.3390/jcm10214911 - 24 Oct 2021
Cited by 7 | Viewed by 1575
Abstract
Transcatheter aortic valve replacement (TAVR) offers a novel treatment option for patients with severe symptomatic aortic valve stenosis, particularly for patients who are unsuitable candidates for surgical intervention. However, high therapeutical costs, socio-economic considerations, and numerous comorbidities make it necessary to target and [...] Read more.
Transcatheter aortic valve replacement (TAVR) offers a novel treatment option for patients with severe symptomatic aortic valve stenosis, particularly for patients who are unsuitable candidates for surgical intervention. However, high therapeutical costs, socio-economic considerations, and numerous comorbidities make it necessary to target and allocate available resources efficiently. In the present study, we aimed to identify risk factors associated with futile treatment following transfemoral (TF) and transapical (TA) TAVR. Five hundred and thirty-two consecutive patients (82 ± 9 years, female 63%) who underwent TAVR between June 2009 and December 2016 at the Vienna Heart Center Hietzing were retrospectively analyzed to identify predictors of futility, defined as all-cause mortality at one year following the procedure for the overall patient cohort, as well as the TF and TA cohort. Out of 532 patients, 91 (17%) did not survive the first year after TAVR. A multivariate logistic model identified cerebrovascular disease, home oxygen dependency, wheelchair dependency, periinterventional myocardial infarction, and postinterventional renal replacement therapy as the factors independently associated with an increased one-year mortality. Our findings underscore the significance of a precise preinterventional evaluation, as well as illustrating the subtle differences in baseline characteristics in the TF and TA cohort and their impact on one-year mortality. Full article
(This article belongs to the Special Issue Transcatheter Structural Heart Disease Interventions: Clinical Update)
10 pages, 1716 KiB  
Article
Safety and Efficacy of Four Different Diagnostic Catheter Curves Dedicated to One-Catheter Technique of Transradial Coronaro-Angiography—Prospective, Randomized Pilot Study. TRACT 1: Trans RAdial CoronaryAngiography Trial 1
by Michał Chyrchel, Stanisław Bartuś, Artur Dziewierz, Jacek Legutko, Paweł Kleczyński, Rafał Januszek, Tomasz Gallina, Bernadeta Chyrchel, Andrzej Surdacki and Łukasz Rzeszutko
J. Clin. Med. 2021, 10(20), 4722; https://doi.org/10.3390/jcm10204722 - 14 Oct 2021
Cited by 4 | Viewed by 1547
Abstract
Transradial coronaro-angiography (TRA) can be performed with one catheter. We investigate the efficacy of four different DxTerity catheter curves dedicated to the single-catheter technique and compare this method to the standard two-catheter approach. For this prospective, single-blinded, randomized pilot study, we enrolled 100 [...] Read more.
Transradial coronaro-angiography (TRA) can be performed with one catheter. We investigate the efficacy of four different DxTerity catheter curves dedicated to the single-catheter technique and compare this method to the standard two-catheter approach. For this prospective, single-blinded, randomized pilot study, we enrolled 100 patients. In groups 1, 2, 3, and 4, the DxTerity catheters Trapease, Ultra, Transformer and Tracker Curve, respectively, were used. In group 5 (control), standard Judkins catheters were used. The study endpoints were the percentage of optimal stability, proper ostial artery engagement and a good quality angiogram, the duration of each procedure stage, the amount of contrast, and the radiation dose. The highest rate of optimal stability was observed in groups 2 (90%) and 5 (95%). Suboptimal results with at least one episode of catheter fallout from the ostium were most frequent in group 1 (45%). The necessity of using another catheter was observed most frequently in group 4. The analysis of time frames directly depending on the catheter type revealed that the shortest time for catheter introduction and for searching coronary ostia was achieved in group 2 (Ultra). There were no differences in contrast volume and radiation dose between groups. DxTerity catheters are suitable tools to perform TRA coronary angiography. The Ultra Curve catheter demonstrated an advantage over other catheters in terms of its ostial stability rate and procedural time. Full article
(This article belongs to the Special Issue Transcatheter Structural Heart Disease Interventions: Clinical Update)
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11 pages, 411 KiB  
Article
Balloon Aortic Valvuloplasty for Severe Aortic Stenosis as Rescue or Bridge Therapy
by Pawel Kleczynski, Aleksandra Kulbat, Piotr Brzychczy, Artur Dziewierz, Jaroslaw Trebacz, Maciej Stapor, Danuta Sorysz, Lukasz Rzeszutko, Stanislaw Bartus, Dariusz Dudek and Jacek Legutko
J. Clin. Med. 2021, 10(20), 4657; https://doi.org/10.3390/jcm10204657 - 11 Oct 2021
Cited by 11 | Viewed by 2113
Abstract
The study aimed to assess procedural complications, patient flow and clinical outcomes after balloon aortic valvuloplasty (BAV) as rescue or bridge therapy, based on data from our registry. A total of 382 BAVs in 374 patients was performed. The main primary indication for [...] Read more.
The study aimed to assess procedural complications, patient flow and clinical outcomes after balloon aortic valvuloplasty (BAV) as rescue or bridge therapy, based on data from our registry. A total of 382 BAVs in 374 patients was performed. The main primary indication for BAV was a bridge for TAVI (n = 185, 49.4%). Other indications included a bridge for AVR (n = 26, 6.9%) and rescue procedure in hemodynamically unstable patients (n = 139, 37.2%). The mortality rate at 30 days, 6 and 12 months was 10.4%, 21.6%, 28.3%, respectively. In rescue patients, the death rate raised to 66.9% at 12 months. A significant improvement in symptoms was confirmed after BAV, after 30 days, 6 months, and in survivors after 1 year (p < 0.05 for all). Independent predictors of 12-month mortality were baseline STS score [HR (95% CI) 1.42 (1.34 to 2.88), p < 0.0001], baseline LVEF <20% [HR (95% CI) 1.89 (1.55–2.83), p < 0.0001] and LVEF <30% at 1 month [HR (95% CI) 1.97 (1.62–3.67), p < 0.0001] adjusted for age/gender. In everyday clinical practice in the TAVI era, there are still clinical indications to BAV a standalone procedure as a bridge to surgery, TAVI or for urgent high risk non-cardiac surgical procedures. Patients may improve clinically after BAV with LV function recovery, allowing to perform final therapy, within limited time window, for severe AS which ameliorates long-term outcomes. On the other hand, in patients for whom an isolated BAV becomes a destination therapy, prognosis is extremely poor. Full article
(This article belongs to the Special Issue Transcatheter Structural Heart Disease Interventions: Clinical Update)
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12 pages, 1350 KiB  
Article
Transcatheter versus Isolated Surgical Aortic Valve Replacement in Young High-Risk Patients: A Propensity Score-Matched Analysis
by Markus Mach, Thomas Poschner, Waseem Hasan, Tillmann Kerbel, Philipp Szalkiewicz, Ena Hasimbegovic, Martin Andreas, Christoph Gross, Andreas Strouhal, Georg Delle-Karth, Martin Grabenwöger, Christopher Adlbrecht and Andreas Schober
J. Clin. Med. 2021, 10(15), 3447; https://doi.org/10.3390/jcm10153447 - 03 Aug 2021
Cited by 2 | Viewed by 1939
Abstract
Background: Younger patients with severe symptomatic aortic stenosis are a particularly challenging collective with regard to the choice of intervention. High-risk patients younger than 75 years of age are often eligible for both the transcatheter aortic valve replacement (TAVR) and the isolated surgical [...] Read more.
Background: Younger patients with severe symptomatic aortic stenosis are a particularly challenging collective with regard to the choice of intervention. High-risk patients younger than 75 years of age are often eligible for both the transcatheter aortic valve replacement (TAVR) and the isolated surgical aortic valve replacement (iSAVR). Data on the outcomes of both interventions in this set of patients are scarce. Methods: One hundred and forty-four propensity score-matched patients aged 75 years or less who underwent TAVR or iSAVR at the Hietzing Heart Center in Vienna, Austria, were included in the study. The mean age was 68.9 years (TAVR 68.7 vs. SAVR 67.6 years; p = 0.190) and the average EuroSCORE II was 5.4% (TAVR 4.3 [3.2%] vs. iSAVR 6.4 (4.3%); p = 0.194). Results: Postprocedural adverse event data showed higher rates of newly acquired atrial fibrillation (6.9% vs. 19.4%; p = 0.049), prolonged ventilation (2.8% vs. 25.0%; p < 0.001) and multi-organ failure (0% vs. 6.9%) in the surgical cohort. The in-hospital and 30-day mortality was significantly higher for iSAVR (1.4% vs. 13.9%; p = 0.012; 12.5% vs. 2.8%; p = 0.009, respectively). The long-term survival (median follow-up 5.0 years (2.2–14.1 years)) of patients treated with the surgical approach was superior to that of patients undergoing TAVR (p < 0.001). Conclusion: Although the survival analysis revealed a higher in-hospital and 30-day survival rate for high-risk patients aged ≤75 years who underwent TAVR, iSAVR was associated with a significantly higher long-term survival rate. Full article
(This article belongs to the Special Issue Transcatheter Structural Heart Disease Interventions: Clinical Update)
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10 pages, 1020 KiB  
Article
Calculated Plasma Volume Status Is Associated with Adverse Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation
by Hatim Seoudy, Mohammed Saad, Mostafa Salem, Kassem Allouch, Johanne Frank, Thomas Puehler, Mohamed Salem, Georg Lutter, Christian Kuhn and Derk Frank
J. Clin. Med. 2021, 10(15), 3333; https://doi.org/10.3390/jcm10153333 - 28 Jul 2021
Cited by 3 | Viewed by 1729
Abstract
Background: Calculated plasma volume status (PVS) reflects volume overload based on the deviation of the estimated plasma volume (ePV) from the ideal plasma volume (iPV). Calculated PVS is associated with prognosis in the context of heart failure. This single-center study investigated the prognostic [...] Read more.
Background: Calculated plasma volume status (PVS) reflects volume overload based on the deviation of the estimated plasma volume (ePV) from the ideal plasma volume (iPV). Calculated PVS is associated with prognosis in the context of heart failure. This single-center study investigated the prognostic impact of PVS in patients undergoing transcatheter aortic valve implantation (TAVI). Methods: A total of 859 TAVI patients had been prospectively enrolled in an observational study and were included in the analysis. An optimal cutoff for PVS of −5.4% was determined by receiver operating characteristic curve analysis. The primary endpoint was a composite of all-cause mortality or heart failure hospitalization within 1 year after TAVI. Results: A total of 324 patients had a PVS < −5.4% (no congestion), while 535 patients showed a PVS ≥ −5.4% (congestion). The primary endpoint occurred more frequently in patients with a PVS ≥ −5.4% compared to patients with PVS < −5.4% (22.6% vs. 13.0%, p < 0.001). After multivariable adjustment, PVS was confirmed as a significant predictor of the primary endpoint (HR 1.53, 95% CI 1.05–2.22, p = 0.026). Conclusions: Elevated PVS, as a marker of subclinical congestion, is significantly associated with all-cause mortality and heart failure hospitalization within 1 year after TAVI. Full article
(This article belongs to the Special Issue Transcatheter Structural Heart Disease Interventions: Clinical Update)
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Graphical abstract

12 pages, 2356 KiB  
Article
Proper Selection Does Make the Difference: A Propensity-Matched Analysis of Percutaneous and Surgical Cut-Down Transfemoral TAVR
by Marco Gennari, Marta Rigoni, Giorgio Mastroiacovo, Piero Trabattoni, Maurizio Roberto, Antonio L. Bartorelli, Franco Fabbiocchi, Gloria Tamborini, Manuela Muratori, Laura Fusini, Mauro Pepi, Paola Muti, Gianluca Polvani and Marco Agrifoglio
J. Clin. Med. 2021, 10(5), 909; https://doi.org/10.3390/jcm10050909 - 25 Feb 2021
Cited by 4 | Viewed by 1840
Abstract
Background. Transcatheter aortic valve replacement (TAVR) is an established technique to treat severe symptomatic aortic stenosis patients with a wide range of surgical risk. Currently, the common femoral artery is the first choice as the main access route for the procedure. The objective [...] Read more.
Background. Transcatheter aortic valve replacement (TAVR) is an established technique to treat severe symptomatic aortic stenosis patients with a wide range of surgical risk. Currently, the common femoral artery is the first choice as the main access route for the procedure. The objective of this observational study is to report our experience on percutaneous and surgical cut-down transfemoral TAVRs comparing the two approaches. Methods. From January 2014 to January 2019, five hundred eleven consecutive patients underwent TAVR for severe symptomatic aortic stenosis. We analyzed only elective transfemoral procedures. After propensity score-matching based on age, sex, EuroSCORE II, mean aortic gradient, and left ventricular ejection fraction, we obtained two homogeneous populations: surgical cut-down (n = 119) and percutaneous (n = 225), which were labeled Group 1 and Group 2, respectively. Results. The main findings were that there were no significant procedural outcome differences between the two groups, but Group 2 patients had a shorter length of hospital stay and were more frequently discharged home. At follow-up, Group 1 patients had lower survival rates. Conclusions. An accurate preoperative assessment of the femoral access is mandatory to achieve satisfactory outcomes with transfemoral TAVRs. Nevertheless, the percutaneous approach allows shorter in-hospital stay and the need for rehabilitation, thus potentially decreasing the costs of the procedure. Full article
(This article belongs to the Special Issue Transcatheter Structural Heart Disease Interventions: Clinical Update)
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Graphical abstract

10 pages, 1193 KiB  
Article
Feasibility and Safety of Cerebral Embolic Protection Device Insertion in Bovine Aortic Arch Anatomy
by Ana Paula Tagliari, Enrico Ferrari, Philipp K. Haager, Martin Oliver Schmiady, Luca Vicentini, Mara Gavazzoni, Marco Gennari, Lucas Jörg, Ahmed Aziz Khattab, Stefan Blöchlinger, Francesco Maisano and Maurizio Taramasso
J. Clin. Med. 2020, 9(12), 4118; https://doi.org/10.3390/jcm9124118 - 20 Dec 2020
Cited by 8 | Viewed by 2505
Abstract
Background: Cerebral embolic protection devices (CEPDs) have emerged as a mechanical barrier to prevent debris from reaching the cerebral vasculature, potentially reducing stroke incidence. Bovine aortic arch (BAA) is the most common arch variant and represents challenge anatomy for CEPD insertion during transcatheter [...] Read more.
Background: Cerebral embolic protection devices (CEPDs) have emerged as a mechanical barrier to prevent debris from reaching the cerebral vasculature, potentially reducing stroke incidence. Bovine aortic arch (BAA) is the most common arch variant and represents challenge anatomy for CEPD insertion during transcatheter aortic valve replacement (TAVR). Methods: Cohort study reporting the SentinelTM Cerebral Protection System insertion’s feasibility and safety in 165 adult patients submitted to a transfemoral TAVR procedure from April 2019 to April 2020. Patients were divided into 2 groups: (1) BAA; (2) non-BAA. Results: Median age, EuroScore II, and STS score were 79 years (74–84), 2.9% (1.7–6.2), and 2.2% (1.6–3.2), respectively. BAA was present in 12% of cases. Successful two-filter insertion was 86.6% (89% non-BAA vs. 65% BAA; p = 0.002), and debris was captured in 95% (94% non-BAA vs. 95% BAA; p = 0.594). No procedural or vascular complications associated with Sentinel insertion and no intraprocedural strokes were reported. There were two postprocedural non-disabling strokes, both in non-BAA. Conclusion: This study demonstrated Sentinel insertion feasibility and safety in BAA. No procedural and access complications related to Sentinel deployment were reported. Being aware of the bovine arch prevalence and having the techniques to navigate through it allows operators to successfully use CEPDs in this anatomy. Full article
(This article belongs to the Special Issue Transcatheter Structural Heart Disease Interventions: Clinical Update)
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Review

Jump to: Editorial, Research

14 pages, 5825 KiB  
Review
Preoperative TAVR Planning: How to Do It
by Rodrigo Petersen Saadi, Ana Paula Tagliari, Eduardo Keller Saadi, Marcelo Haertel Miglioranza and Carisi Anne Polanczyck
J. Clin. Med. 2022, 11(9), 2582; https://doi.org/10.3390/jcm11092582 - 05 May 2022
Cited by 11 | Viewed by 2897
Abstract
Transcatheter aortic valve replacement (TAVR) is a well-established treatment option for patients with severe symptomatic aortic stenosis (AS) whose procedural efficacy and safety have been continuously improving. Appropriate preprocedural planning, including aortic valve annulus measurements, transcatheter heart valve choice, and possible procedural complication [...] Read more.
Transcatheter aortic valve replacement (TAVR) is a well-established treatment option for patients with severe symptomatic aortic stenosis (AS) whose procedural efficacy and safety have been continuously improving. Appropriate preprocedural planning, including aortic valve annulus measurements, transcatheter heart valve choice, and possible procedural complication anticipation is mandatory to a successful procedure. The gold standard for preoperative planning is still to perform a multi-detector computed angiotomography (MDCT), which provides all the information required. Nonetheless, 3D echocardiography and magnet resonance imaging (MRI) are great alternatives for some patients. In this article, we provide an updated comprehensive review, focusing on preoperative TAVR planning and the standard steps required to do it properly. Full article
(This article belongs to the Special Issue Transcatheter Structural Heart Disease Interventions: Clinical Update)
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13 pages, 8212 KiB  
Review
Atrial Functional Tricuspid Regurgitation as a Distinct Pathophysiological and Clinical Entity: No Idiopathic Tricuspid Regurgitation Anymore
by Diana R. Florescu, Denisa Muraru, Valentina Volpato, Mara Gavazzoni, Sergio Caravita, Michele Tomaselli, Pellegrino Ciampi, Cristina Florescu, Tudor A. Bălșeanu, Gianfranco Parati and Luigi P. Badano
J. Clin. Med. 2022, 11(2), 382; https://doi.org/10.3390/jcm11020382 - 13 Jan 2022
Cited by 19 | Viewed by 3021
Abstract
Functional tricuspid regurgitation (FTR) is a strong and independent predictor of patient morbidity and mortality if left untreated. The development of transcatheter procedures to either repair or replace the tricuspid valve (TV) has fueled the interest in the pathophysiology, severity assessment, and clinical [...] Read more.
Functional tricuspid regurgitation (FTR) is a strong and independent predictor of patient morbidity and mortality if left untreated. The development of transcatheter procedures to either repair or replace the tricuspid valve (TV) has fueled the interest in the pathophysiology, severity assessment, and clinical consequences of FTR. FTR has been considered to be secondary to tricuspid annulus (TA) dilation and leaflet tethering, associated to right ventricular (RV) dilation and/or dysfunction (the “classical”, ventricular form of FTR, V-FTR) for a long time. Atrial FTR (A-FTR) has recently emerged as a distinct pathophysiological entity. A-FTR typically occurs in patients with persistent/permanent atrial fibrillation, in whom an imbalance between the TA and leaflet areas results in leaflets malcoaptation, associated with the dilation and loss of the sphincter-like function of the TA, due to right atrium enlargement and dysfunction. According to its distinct pathophysiology, A-FTR poses different needs of clinical management, and the various interventional treatment options will likely have different outcomes than in V-FTR patients. This review aims to provide an insight into the anatomy of the TV, and the distinct pathophysiology of A-FTR, which are key concepts to understanding the objectives of therapy, the choice of transcatheter TV interventions, and to properly use pre-, intra-, and post-procedural imaging. Full article
(This article belongs to the Special Issue Transcatheter Structural Heart Disease Interventions: Clinical Update)
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14 pages, 2978 KiB  
Review
Imaging in Transcatheter Mitral Valve Replacement: State-of-Art Review
by Manuel Barreiro-Perez, Berenice Caneiro-Queija, Luis Puga, Rocío Gonzalez-Ferreiro, Robert Alarcon, Jose Antonio Parada, Andrés Iñiguez-Romo and Rodrigo Estevez-Loureiro
J. Clin. Med. 2021, 10(24), 5973; https://doi.org/10.3390/jcm10245973 - 20 Dec 2021
Cited by 11 | Viewed by 2736
Abstract
Mitral regurgitation is the second-most frequent valvular heart disease in Europe and it is associated with high morbidity and mortality. Recognition of MR should encourage the assessment of its etiology, severity, and mechanism in order to determine the best therapeutic approach. Mitral valve [...] Read more.
Mitral regurgitation is the second-most frequent valvular heart disease in Europe and it is associated with high morbidity and mortality. Recognition of MR should encourage the assessment of its etiology, severity, and mechanism in order to determine the best therapeutic approach. Mitral valve surgery constitutes the first-line therapy; however, transcatheter procedures have emerged as an alternative option to treat inoperable and high-risk surgical patients. In patients with suitable anatomy, the transcatheter edge-to-edge mitral leaflet repair is the most frequently applied procedure. In non-reparable patients, transcatheter mitral valve replacement (TMVR) has appeared as a promising intervention. Thus, currently TMVR represents a new treatment option for inoperable or high-risk patients with degenerated or failed bioprosthetic valves (valve-in-valve); failed repairs, (valve-in-ring); inoperable or high-risk patients with native mitral valve anatomy, or those with severe annular calcifications, or valve-in-mitral annular calcification. The patient selection requires multimodality imaging pre-procedural planning to select the best approach and device, study the anatomical landing zone and assess the risk of left ventricular outflow tract obstruction. In the present review, we aimed to highlight the main considerations for TMVR planning from an imaging perspective; before, during, and after TMVR. Full article
(This article belongs to the Special Issue Transcatheter Structural Heart Disease Interventions: Clinical Update)
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13 pages, 2225 KiB  
Review
The Use of BASILICA Technique to Prevent Coronary Obstruction in a TAVI-TAVI Procedure
by Ana Paula Tagliari, Rodrigo Petersen Saadi, Eduardo Ferreira Medronha and Eduardo Keller Saadi
J. Clin. Med. 2021, 10(23), 5534; https://doi.org/10.3390/jcm10235534 - 26 Nov 2021
Cited by 5 | Viewed by 2208
Abstract
Transcatheter aortic valve implantation (TAVI) to manage structural bioprosthetic valve deterioration has been successful in mitigating the risk of a redo cardiac surgery. However, TAVI-in-TAVI is a complex intervention, potentially associated with feared complications such as coronary artery obstruction. Coronary obstruction risk is [...] Read more.
Transcatheter aortic valve implantation (TAVI) to manage structural bioprosthetic valve deterioration has been successful in mitigating the risk of a redo cardiac surgery. However, TAVI-in-TAVI is a complex intervention, potentially associated with feared complications such as coronary artery obstruction. Coronary obstruction risk is especially high when the previously implanted prosthesis had supra-annular leaflets and/or the distance between the prosthesis and the coronary ostia is short. The BASILICA technique (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) was developed to prevent coronary obstruction during native or valve-in-valve interventions but has now also been considered for TAVI-in-TAVI interventions. Despite its utility, the technique requires a not so widely available toolbox. Herein, we discuss the TAVI-in-TAVI BASILICA technique and how to perform it using more widely available tools, which could spread its use. Full article
(This article belongs to the Special Issue Transcatheter Structural Heart Disease Interventions: Clinical Update)
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21 pages, 1860 KiB  
Review
Vascular Complications in TAVR: Incidence, Clinical Impact, and Management
by Markus Mach, Sercan Okutucu, Tillmann Kerbel, Aref Arjomand, Sefik Gorkem Fatihoglu, Paul Werner, Paul Simon and Martin Andreas
J. Clin. Med. 2021, 10(21), 5046; https://doi.org/10.3390/jcm10215046 - 28 Oct 2021
Cited by 26 | Viewed by 5222
Abstract
Transcatheter aortic valve replacement (TAVR) has replaced surgical aortic valve replacement as the new gold standard in elderly patients with severe aortic valve stenosis. However, alongside this novel approach, new complications emerged that require swift diagnosis and adequate management. Vascular access marks the [...] Read more.
Transcatheter aortic valve replacement (TAVR) has replaced surgical aortic valve replacement as the new gold standard in elderly patients with severe aortic valve stenosis. However, alongside this novel approach, new complications emerged that require swift diagnosis and adequate management. Vascular access marks the first step in a TAVR procedure. There are several possible access sites available for TAVR, including the transfemoral approach as well as transaxillary/subclavian, transcarotid, transapical, and transcaval. Most cases are primarily performed through a transfemoral approach, while other access routes are mainly conducted in patients not suitable for transfemoral TAVR. As vascular access is achieved primarily by large bore sheaths, vascular complications are one of the major concerns during TAVR. With rising numbers of TAVR being performed, the focus on prevention and successful management of vascular complications will be of paramount importance to lower morbidity and mortality of the procedures. Herein, we aimed to review the most common vascular complications associated with TAVR and summarize their diagnosis, management, and prevention of vascular complications in TAVR. Full article
(This article belongs to the Special Issue Transcatheter Structural Heart Disease Interventions: Clinical Update)
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