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Clinical Advances in Surgical or Transcatheter Aortic Valve Replacement
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Clinical Advances in Surgical or Transcatheter Aortic Valve Replacement

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

Deadline for manuscript submissions: closed (15 July 2023) | Viewed by 9812

Special Issue Editor

Dr. Vuyisile T. Nkomo

E-Mail Website
Guest Editor
Department of Cardiovascular Medicine, Mayo Medical School, Rochester, MN 55905, USA
Interests: valvular heart disease; valvular heart disease epidemiology; echocardiography
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Transcatheter aortic valve replacement has transformed the management of aortic valve disease and emerged as an option for patients in all risk categories. Surgical aortic valve replacement remains the gold standard for many patients with aortic valve disease, and choosing between surgery and transcatheter aortic valve replacement can sometimes be challenging, as both have their unique advantages and disadvantages.

It is my pleasure to announce that I will be serving as the guest editor for a Special Issue of the Journal of Clinical Medicine dedicated to the clinical advances in surgical and transcatheter aortic valve replacement. As an expert in this field, I believe that you would make a significant and impactful contribution to this Special Issue.

The aim of this issue is to bring the reader up to date with the advances in surgical and transcatheter aortic valve replacement and to provide comprehensive yet clear practical information related to the evaluation and management of the patient with aortic valve disease. In addition, the reader should be appraised of the relevant latest technological developments that have the potential to impact surgery or transcatheter aortic valve replacement in the near future. This Special Issue will cover the following topics:

  1. When to intervene in an asymptomatic patient with aortic stenosis.
  2. When to intervene in asymptomatic patient with aortic valve regurgitation.
  3. Advances in minimally invasive surgical aortic valve replacement.
  4. Choice of mechanical versus tissue prosthesis.
  5. Advances in surgical aortic valve repair for aortic valve regurgitation.
  6. Advances in transcatheter aortic valve replacement for aortic valve regurgitation.
  7. Advances in transcatheter aortic valve replacement for bicuspid aortic valve stenosis.
  8. Incidence, management, and avoidance of high-grade atrioventricular block after transcatheter aortic valve replacement.
  9. Redo aortic valve replacement for a diseased aortic valve prosthesis: when to choose surgical versus transcatheter aortic valve replacement.
  10. Anticoagulation strategies following surgical or transcatheter aortic valve replacement.
  11. Bioprosthetic valve thrombosis: incidence, management, and long-term implications.
  12. Tissue-engineered heart valve for aortic valve replacement.

Dr. Vuyisile T. Nkomo
Guest Editor

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

  • valvular heart disease
  • aortic valve stenosis
  • aortic valve regurgitation
  • bicuspid aortic valve
  • minimally invasive surgery
  • surgical aortic valve replacement
  • transcatheter aortic valve replacement
  • aortic valve prosthesis
  • long-term outcomes

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Published Papers (4 papers)

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Research

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9 pages, 511 KiB  
Article
Comparison of Periprocedural and Intermediate-Term Outcomes of TAVI in Patients with Ejection Fraction ≤ 20% vs. Patients with 20% < EF ≤ 40%
by Arber Kodra, Michael Cinelli, Renita Alexander, Rahming Hamfreth, Denny Wang, Shankar Thampi, Craig Basman, Chad Kliger, Jacob Scheinerman and Luigi Pirelli
J. Clin. Med. 2023, 12(6), 2390; https://doi.org/10.3390/jcm12062390 - 20 Mar 2023
Cited by 2 | Viewed by 1912
Abstract
Treatment of congestive heart failure (CHF) with left ventricular (LV) systolic dysfunction and severe aortic stenosis (AS) is challenging, yet transcatheter aortic valve replacement (TAVR) has emerged as a suitable treatment option in such patients. We compared the periprocedural outcomes of TAVR in [...] Read more.
Treatment of congestive heart failure (CHF) with left ventricular (LV) systolic dysfunction and severe aortic stenosis (AS) is challenging, yet transcatheter aortic valve replacement (TAVR) has emerged as a suitable treatment option in such patients. We compared the periprocedural outcomes of TAVR in patients with an ejection fraction (EF) of ≤20% (VLEF group) to patients with an EF > 20% to ≤40% (LEF group). We included patients with severe AS and reduced LV ejection fraction (LVEF ≤ 40%) who underwent TAVR at four centers within Northwell Health between January 2016 and December 2020. Over 2000 consecutive patients were analyzed, of which 355 patients met the inclusion criteria. The primary composite endpoint was in-hospital mortality, moderate or greater paravalvular (PVL), stroke, conversion to open surgery, aortic valve re-intervention, and/or need for PPM. Secondary endpoints were length of stay, NYHA classification at 1 month and 1 year, mortality at 1 month and 1 year, mean valve gradient at 1 month, KCCQ score at 1 month, and ≥ moderate PVL at 1 month. There was no difference in the primary composite endpoint between the two groups (23.6% for VLEF vs. 25.3% for LEF, p = 0.29). During TAVR placement, 40% of patients in the VLEF group required ≥1 vasopressors for hypotension lasting ≥30 min vs. only 21% of patients in the LEF group (p < 0.01). Intra-aortic balloon pump (IABP) use during procedure was greater in the VLEF group (9% vs. 1%, p < 0.01)—all placed post TAVR. Emergency ECMO use was higher in the VLEF group as well (5% vs. 0%). Total length of stay was significantly different between the two groups as well (6 days vs. 3 days, p < 0.01). Both groups had a change in LVEF of ~10%. One-year outcomes were similar between the groups. All-cause mortality at 1 year was not significantly different at 1 year (13% for VLEF vs. 11% for LEF), and KCC scores were also similar (77.54 vs. 74.97). Mean aortic valve gradients were also similar (12 mmHg vs. 11 mmHg, p = 0.48). Our study suggests that patients with EF ≤ 20% can safely have TAVR with similar periprocedural outcomes compared to patients with EF > 20% to ≤40% despite higher rates of vasopressor and mechanical support. Full article
(This article belongs to the Special Issue Clinical Advances in Surgical or Transcatheter Aortic Valve Replacement)
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18 pages, 11712 KiB  
Article
Can Measuring the ‘Dual Anchors of Aorta’ Enhance the Success Rate of TAVR?—A Single-Center Experience
by Yang Chen, Md Misbahul Ferdous, Lakshme Kottu, Jie Zhao, Hong-Liang Zhang, Mo-Yang Wang, Guan-Nan Niu, Qing-Rong Liu, Zheng Zhou, Zhen-Yan Zhao, Qian Zhang, De-Jing Feng, Bin Zhang, Zi-Ang Li, Daphne Merkus, Bin Lv, Hai-Yan Xu, Guang-Yuan Song and Yong-Jian Wu
J. Clin. Med. 2023, 12(3), 1157; https://doi.org/10.3390/jcm12031157 - 1 Feb 2023
Cited by 4 | Viewed by 2939
Abstract
Introduction: Chronic severe aortic regurgitation (AR) has a poor long-term prognosis, especially among old-age patients. Considering their advancing age, the surgical approach of aortic valve replacement may not always be the best alternative modality of treatment in such patients. Therefore, this study’s primary [...] Read more.
Introduction: Chronic severe aortic regurgitation (AR) has a poor long-term prognosis, especially among old-age patients. Considering their advancing age, the surgical approach of aortic valve replacement may not always be the best alternative modality of treatment in such patients. Therefore, this study’s primary goal was to provide an initial summary of the medium- and short-term clinical effectiveness of transcatheter aortic valve replacement (TAVR) guided by accurate multi-detector computed tomography (MDCT) measurements in patients with severe and chronic AR, especially in elderly patients. Methods: The study enrolled retrospectively and prospectively patients diagnosed with severe AR who eventually underwent TAVR procedure from January 2019 to September 2022 at Fuwai cardiovascular Hospital, Beijing. Baseline information, MDCT measurements, anatomical classification, perioperative, and 1-year follow-up outcomes were collected and analyzed. Based on a novel anatomical categorization and dual anchoring theory, patients were divided into four categories according to the level of anchoring area. Type 1, 2, and 3 patients (with at least two anchoring regions) will receive TAVR with a transcatheter heart valve (THV), but Type 4 patients (with zero or one anchoring location) will be deemed unsuitable for TAVR and will instead receive medical care (retrospectively enrolled patients who already underwent TAVR are an exception). Results: The mean age of the 37 patients with severe chronic AR was 73.1 ± 8.7 years, and 23 patients (62.2%) were male. The American Association of Thoracic Surgeons’ score was 8.6 ± 2.1%. The MDCT anatomical classification included 17 cases of type 1 (45.9%), 3 cases of type 2 (8.1%), 13 cases of type 3 (35.1%), and 4 cases of Type 4 (10.8%). The VitaFlow valve (MicroPort, Shanghai, China) was implanted in 19 patients (51.3%), while the Venus A valve (Venus MedTech, Hangzhou, China) was implanted in 18 patients (48.6%). Immediate TAVR procedural and device success rates were 86.5% and 67.6%, respectively, while eight cases (21.6%) required THV-in-THV implantation, and nine cases (24.3%) required permanent pacemaker implantation. Univariate regression analysis revealed that the major factors affecting TAVR device failure were sinotubular junction diameter, THV type, and MDCT anatomical classification (p < 0.05). Compared with the baseline, the left ventricular ejection fraction gradually increased, while the left ventricular end-diastolic diameter remained small, and the N-terminal-pro hormone B-type natriuretic peptide level significantly decreased within one year. Conclusion: According to the results of our study, TAVR with a self-expanding THV is safe and feasible for patients with chronic severe AR, particularly for those who meet the criteria for the appropriate MDCT anatomical classification with intact dual aortic anchors, and it has a significant clinical effect for at least a year. Full article
(This article belongs to the Special Issue Clinical Advances in Surgical or Transcatheter Aortic Valve Replacement)
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Review

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14 pages, 2018 KiB  
Review
The Evolving Role of Surgical Aortic Valve Replacement in the Era of Transcatheter Valvular Procedures
by Fernando M. Juarez-Casso and Juan A. Crestanello
J. Clin. Med. 2023, 12(16), 5299; https://doi.org/10.3390/jcm12165299 - 15 Aug 2023
Cited by 6 | Viewed by 2454
Abstract
Surgical aortic valve replacement (SAVR) has long been the standard treatment for severe symptomatic aortic stenosis (AS). However, transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive alternative; it was initially intended for high-risk patients and has now expanded its use [...] Read more.
Surgical aortic valve replacement (SAVR) has long been the standard treatment for severe symptomatic aortic stenosis (AS). However, transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive alternative; it was initially intended for high-risk patients and has now expanded its use to patients of all risk groups. While TAVR has demonstrated promising outcomes in diverse patient populations, uncertainties persist regarding its long-term durability and potential complications, raising the issue of the ideal lifetime management strategy for patients with AS. Therefore, SAVR continues to play an important role in clinical practice, particularly in younger patients with longer life expectancies, those with complex aortic anatomy who are unsuitable for TAVR, and those requiring concomitant surgical procedures. The choice between TAVR and SAVR warrants personalized decision-making, considering patient characteristics, comorbidities, anatomical considerations, and overall life expectancy. A multidisciplinary approach involving an experienced heart team is crucial in the preoperative evaluation process. In this review, we aimed to explore the current role of surgical management in addressing aortic valve stenosis amidst the expanding utilization of less invasive transcatheter procedures. Full article
(This article belongs to the Special Issue Clinical Advances in Surgical or Transcatheter Aortic Valve Replacement)
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11 pages, 1498 KiB  
Review
Risk Factors, Management, and Avoidance of Conduction System Disease after Transcatheter Aortic Valve Replacement
by Mohamad S. Alabdaljabar and Mackram F. Eleid
J. Clin. Med. 2023, 12(13), 4405; https://doi.org/10.3390/jcm12134405 - 30 Jun 2023
Cited by 3 | Viewed by 1952
Abstract
Transcatheter valve replacement (TAVR) is a rapidly developing modality to treat patients with aortic stenosis (AS). Conduction disease post TAVR is one of the most frequent and serious complications experienced by patients. Multiple factors contribute to the risk of conduction disease, including AS [...] Read more.
Transcatheter valve replacement (TAVR) is a rapidly developing modality to treat patients with aortic stenosis (AS). Conduction disease post TAVR is one of the most frequent and serious complications experienced by patients. Multiple factors contribute to the risk of conduction disease, including AS and the severity of valve calcification, patients’ pre-existing conditions (i.e., conduction disease, anatomical variations, and short septum) in addition to procedure-related factors (e.g., self-expanding valves, implantation depth, valve-to-annulus ratio, and procedure technique). Detailed evaluation of risk profiles could allow us to better prevent, recognize, and treat this entity. Available evidence on management of conduction disease post TAVR is based on expert opinion and varies widely. Currently, conduction disease in TAVR patients is managed depending on patient risk, with minimal-to-no inpatient/outpatient observation, inpatient monitoring (24–48 h) followed by ambulatory monitoring, or either prolonged inpatient and outpatient monitoring or permanent pacemaker implantation. Herein, we review the incidence and risk factors of TAVR-associated conduction disease and discuss its management. Full article
(This article belongs to the Special Issue Clinical Advances in Surgical or Transcatheter Aortic Valve Replacement)
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